Depression Treatment: Neuromodulation Therapies and Treatment-Resistant Depression.

Neuromodulation therapies and treatment-resistant depression.

Filed under: Depression Treatment

Med Devices (Auckl). 2012; 5: 53-65
Al-Harbi KS, Qureshi NA

BACKGROUND: Patients with treatment-resistant depression (TRD) who showed partial response to pharmacological and psychotherapeutic interventions need a trial of neuromodulation therapies (NTs). OBJECTIVE: This paper aims to review evidence-based data on the use of NTs in TRD. METHOD: Using keywords and combined-word strategy, multiple computer searches of PubMed, Google Scholar, Quertle(R), and Medline were conducted for retrieving relevant articles published in English-language peer-reviewed journals (2000-2012). Those papers that addressed NTs in TRD were retained for extensive review. RESULTS: Despite methodological challenges, a range of 30%-93% of TRD patients showed substantial improvement to one of the NTs. One hundred-percent improvement was reported in two single-case studies on deep brain stimulation. Some studies reported no benefits from transcranial direct current stimulation. NTs were reported to have good clinical efficacy, better safety margin, and benign side-effect profile. Data are limited regarding randomized clinical trials, long-term efficacy, and cost-effectiveness of these approaches. Both modified electroconvulsive therapy and magnetic seizure therapy were associated with reversible but disturbing neurocognitive adverse effects. Besides clinical utility, NTs including approaches on the horizon may unlock the biological basis underlying mood disorders including TRD. CONCLUSION: NTs are promising in patients with TRD, as the majority of them show good clinical response measured by standardized depression scales. NTs need further technological refinements and optimization together with continuing well-designed studies that recruit larger numbers of participants with TRD.
HubMed – depression

Comparing common reasons for inpatient and outpatient visits between commercially-insured duloxetine or pregabalin initiators with fibromyalgia.

Filed under: Depression Treatment

J Pain Res. 2012; 5: 443-451
Zhao Y, Sun P, Bernauer M

BACKGROUND: The purpose of this study was to examine the main reasons for inpatient or outpatient visits after initiating duloxetine or pregabalin. METHODS: Commercially insured patients with fibromyalgia and aged 18-64 years who initiated duloxetine or pregabalin in 2006 with 12-month continuous enrollment before and after initiation were identified. Duloxetine and pregabalin cohorts with similar demographics, pre-index clinical and economic characteristics, and pre-index treatment patterns were constructed via propensity scoring stratification. Reasons for inpatient admissions, physician office visits, outpatient hospital visits, emergency room visits, and primary or specialty care visits over the 12 months post-index period were examined and compared. Logistic regression was used to assess the contribution of duloxetine versus pregabalin initiation to the most common reasons for visits, controlling for cross-cohort differences. RESULTS: Per the study design, the duloxetine (n = 3711) and pregabalin (n = 4111) cohorts had similar demographics (mean age 51 years, 83% female) and health care costs over the 12-month pre-index period. Total health care costs during the 12-month post-index period were significantly lower for duloxetine patients than for pregabalin patients ($ 19,378 versus $ 27,045, P < 0.05). Eight of the 10 most common reasons for inpatient admissions and outpatient hospital (physician office, emergency room, primary or specialty care) visits were the same for both groups. Controlling for cross-cohort differences, duloxetine patients were less likely to be hospitalized due to an intervertebral disc disorder or major depressive disorder, to have a physician office visit due to nonspecific backache/other back/neck pain (NB/OB/NP) disorder, or to go to specialty care due to a soft tissue, NB/OP/NP, or intervertebral disc disorder. However, duloxetine patients were more likely to have a primary care visit due to a soft tissue disorder, essential hypertension, or other general symptoms. CONCLUSION: Among similar commercially insured patients with fibromyalgia who initiated duloxetine or pregabalin, duloxetine patients had significantly lower health care costs over the 12-month post-index period. The leading reasons for inpatient or outpatient visits were also somewhat different. HubMed – depression

Emotional benefit of cosmetic camouflage in the treatment of facial skin conditions: personal experience and review.

Filed under: Depression Treatment

Clin Cosmet Investig Dermatol. 2012; 5: 173-182
Levy LL, Emer JJ

BACKGROUND: Recent studies highlighting the psychological benefits of medical treatment for dermatological skin conditions have demonstrated a clear role for medical therapy in psychological health. Skin conditions, particularly those that are overtly visible, such as those located on the face, neck, and hands, often have a profound effect on the daily functioning of those affected. The literature documents significant emotional benefits using medical therapy in conditions such as acne, psoriasis, vitiligo, and rosacea, but there is little evidence documenting similar results with the use of cosmetic camouflage. Here we present a review highlighting the practical use of cosmetic camouflage makeup in patients with facial skin conditions and review its implications for psychological health. METHODS: A search of the Medline and Scopus databases was performed to identify articles documenting the emotional benefit of cosmetic camouflage. RESULTS: Cosmetic camouflage provides a significant emotional benefit for patients with facial skin conditions, and this is substantiated by a literature review and personal experience. More clinical studies are needed to assess and validate the findings reported here. CONCLUSION: Patients with visible skin conditions have increased rates of depression, anxiety, and decreased self-esteem. It is prudent for us to consider therapies that can offer rapid and dramatic results, such as cosmetic camouflage.
HubMed – depression

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