Depression Treatment: Clinical Review of Treatment Options for Major Depressive Disorder in Patients With Coronary Heart Disease.

Clinical review of treatment options for major depressive disorder in patients with coronary heart disease.

Filed under: Depression Treatment

Saudi Med J. 2012 Nov; 33(11): 1159-68
Alosaimi FD, Baker B

It is established that the prevalence of major depressive disorder (MDD) in coronary heart disease (CHD) populations is high and is associated with increased mortality. In this systematic review, we examined the evidence for the effective treatment of MDD in CHD patients by reviewing randomized control trials (RCTs) between 1980 and 2011 and then assessing whether these treatments were clinically meaningful. A total of 8 RCTs were retrieved. Sertraline, citalopram, and mirtazapine were safe from a cardiac perspective, but only sertraline and citalopram were clearly more effective than placebo in CHD patients with moderate-to-severe type, recurrent MDD, or MDD episode onset before the CHD event. Augmenting sertraline with omega-3 fatty acids did not result in superior depression outcomes. Cognitive-behavioral therapy was equivocally superior to usual care. Interpersonal psychotherapy was only superior to clinical management in patients with high baseline functional status. Exercise is a potential treatment for those with mild depression.
HubMed – depression

Deep Brain Stimulation of the Lateral Habenular Complex in Treatment-resistant Depression: Traps and Pitfalls of Trajectory Choice.

Filed under: Depression Treatment

Neurosurgery. 2012 Nov 9;
Schneider TM, Beynon C, Sartorius A, Unterberg AW, Kiening KL

BACKGROUND:: Deep brain stimulation (DBS) has recently been discussed as a promising treatment option for severe cases of major depression. Experimental data have suggested that the lateral habenular complex (LHb-c) is a central region of depression-related neuronal circuits. Due to its location close to the midline, stereotactic targeting of the LHb-c confronts surgeons with distinct challenges. OBJECTIVE:: To define the obstacles of DBS surgery for stimulation of the LHb-c and thus establish safe trajectories. METHODS:: Stereotactic MRI datasets of 54 hemispheres originating from 27 DBS patients were taken for analysis on a stereotactic planning workstation. After alignment of images according to the ACPC-definition, analyses focused on vessels and enlarged ventricles interfering with trajectories. RESULTS:: As major trajectory obstacles, (1) enlarged ventricles and (2) an interfering superior thalamic vein were found. A standard frontal trajectory (angle >40° relative to the ACPC in sagittal images) for bilateral stimulation was safely applicable in 48% of patients, whereas a steeper frontal-trajectory (angle <40° relative to ACPC in sagittal images) for bilateral stimulation was possible in 96%. Taken together, safe bilateral targeting of the LHb-c was possible in 98% of all patients. CONCLUSION:: Targeting LHb-c is a feasible and safe technique in the majority of patients undergoing surgery for DBS. However, meticulous individual planning to avoid interference with ventricles and thalamus-related veins is mandatory, as an alternative steep frontal entry point has to be considered in about half of the patients. HubMed – depression

Fecundity of Patients With Schizophrenia, Autism, Bipolar Disorder, Depression, Anorexia Nervosa, or Substance Abuse vs Their Unaffected Siblings.

Filed under: Depression Treatment

Arch Gen Psychiatry. 2012 Nov 12; 1-8
Power RA, Kyaga S, Uher R, Maccabe JH, Långström N, Landen M, McGuffin P, Lewis CM, Lichtenstein P, Svensson AC

CONTEXT It is unknown how genetic variants conferring liability to psychiatric disorders survive in the population despite strong negative selection. However, this is key to understanding their etiology and designing studies to identify risk variants. OBJECTIVES To examine the reproductive fitness of patients with schizophrenia and other psychiatric disorders vs their unaffected siblings and to evaluate the level of selection on causal genetic variants. DESIGN We measured the fecundity of patients with schizophrenia, autism, bipolar disorder, depression, anorexia nervosa, or substance abuse and their unaffected siblings compared with the general population. SETTING Population databases in Sweden, including the Multi-Generation Register and the Swedish Hospital Discharge Register. PARTICIPANTS In total, 2.3 million individuals among the 1950 to 1970 birth cohort in Sweden. MAIN OUTCOME MEASURES Fertility ratio (FR), reflecting the mean number of children compared with that of the general population, accounting for age, sex, family size, and affected status. RESULTS Except for women with depression, affected patients had significantly fewer children (FR range for those with psychiatric disorder, 0.23-0.93; P < 10-10). This reduction was consistently greater among men than women, suggesting that male fitness was particularly sensitive. Although sisters of patients with schizophrenia and bipolar disorder had increased fecundity (FR range, 1.02-1.03; P < .01), this was too small on its own to counterbalance the reduced fitness of affected patients. Brothers of patients with schizophrenia and autism showed reduced fecundity (FR range, 0.94-0.97; P < .001). Siblings of patients with depression and substance abuse had significantly increased fecundity (FR range, 1.01-1.05; P < 10-10). In the case of depression, this more than compensated for the lower fecundity of affected individuals. CONCLUSIONS Our results suggest that strong selection exists against schizophrenia, autism, and anorexia nervosa and that these variants may be maintained by new mutations or an as-yet unknown mechanism. Bipolar disorder did not seem to be under strong negative selection. Vulnerability to depression, and perhaps substance abuse, may be preserved by balancing selection, suggesting the involvement of common genetic variants in ways that depend on other genes and on environment.
HubMed – depression

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