Depression Treatment: Evaluating Depression Care Management in a Community Setting: Main Outcomes for a Medicaid HMO Population With Multiple Medical and Psychiatric Comorbidities.

Evaluating Depression Care Management in a Community Setting: Main Outcomes for a Medicaid HMO Population with Multiple Medical and Psychiatric Comorbidities.

Filed under: Depression Treatment

Depress Res Treat. 2012; 2012: 769298
Waxmonsky JA, Thomas M, Giese A, Zyzanski S, Dickinson LM, McGinnis GF, Nutting P

The authors describe the implementation of a depression care management (DCM) program at Colorado Access, a public sector health plan, and describe the program’s clinical and system outcomes for members with chronic medical conditions. High medical risk, high cost Medicaid health plan members were identified and systematically screened for depression. A total of 370 members enrolled in the DCM program. Longitudinal analyses revealed significantly reduced depression severity scores at 3, 6, and 12 months after intervention as compared to baseline depression scores. At 12 months, 56% of enrollees in the DCM program had either a 50% reduction in PHQ-9 scores or a PHQ-9 score < 10. Longitudinal economic analyses comparing 12 months before and after intervention revealed a significant but modest increase in ER visits, outpatient office visits, and overall medical and pharmacy costs when adjusted for months enrolled in DCM. Limitations and recommendations for the integrated depression care management are discussed. HubMed – depression

Regional Homogeneity within the Default Mode Network in Bipolar Depression: A Resting-State Functional Magnetic Resonance Imaging Study.

Filed under: Depression Treatment

PLoS One. 2012; 7(11): e48181
Liu CH, Ma X, Li F, Wang YJ, Tie CL, Li SF, Chen TL, Fan TT, Zhang Y, Dong J, Yao L, Wu X, Wang CY

We sought to use a regional homogeneity (ReHo) approach as an index in resting-state functional magnetic resonance imaging (fMRI) to investigate the features of spontaneous brain activity within the default mode network (DMN) in patients suffering from bipolar depression (BD).Twenty-six patients with BD and 26 gender-, age-, and education-matched healthy subjects participated in the resting-state fMRI scans. We compared the differences in ReHo between the two groups within the DMN and investigated the relationships between sex, age, years of education, disease duration, the Hamilton Rating Scale for Depression (HAMD) total score, and ReHo in regions with significant group differences.Our results revealed that bipolar depressed patients had increased ReHo in the left medial frontal gyrus and left inferior parietal lobe compared to healthy controls. No correlations were found between regional ReHo values and sex, age, and clinical features within the BD group.Our findings indicate that abnormal brain activity is mainly distributed within prefrontal-limbic circuits, which are believed to be involved in the pathophysiological mechanisms underlying bipolar depression.
HubMed – depression

Serum BDNF concentrations show strong seasonal variation and correlations with the amount of ambient sunlight.

Filed under: Depression Treatment

PLoS One. 2012; 7(11): e48046
Molendijk ML, Haffmans JP, Bus BA, Spinhoven P, Penninx BW, Prickaerts J, Voshaar RC, Elzinga BM

Earlier findings show seasonality in processes and behaviors such as brain plasticity and depression that in part are regulated by Brain-Derived Neurotrophic Factor (BDNF). Based on this we investigated seasonal variation in serum BDNF concentrations in 2,851 persons who took part in the Netherlands Study of Depression and Anxiety (NESDA). Analyses by month of sampling (monthly n’s >196) showed pronounced seasonal variation in serum BDNF concentrations (P<.0001) with increasing concentrations in the spring-summer period (standardized regression weight (ß)?=?0.19, P<.0001) and decreasing concentrations in the autumn-winter period (ß?=?-0.17, P<.0001). Effect sizes [Cohen's d] ranged from 0.27 to 0.66 for monthly significant differences. We found similar seasonal variation for both sexes and for persons with a DSM-IV depression diagnosis and healthy control subjects. In explorative analyses we found that the number of sunshine hours (a major trigger to entrain seasonality) in the week of blood withdrawal and the 10 weeks prior to this event positively correlated with serum BDNF concentrations (Pearson's correlation coefficients ranged: 0.05 - 0.18) and this could partly explain the observed monthly variation. These results provide strong evidence that serum BDNF concentrations systematically vary over the year. This finding is important for our understanding of those factors that regulate BDNF expression and may provide novel avenues to understand seasonal dependent changes in behavior and illness such as depression. Finally, the findings reported here should be taken into account when designing and interpreting studies on BDNF. HubMed – depression

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