Disruption of biological rhythms as a core problem and therapeutic target in mood disorders: the emerging concept of 'rhythm regulators'

Biological rhythms have always been considered to be disrupted in depression, with the predominant theory being that of hyperarousal. However, recent data suggest that it might be more appropriate to suggest that depressed patients are incapable of achieving and maintaining the particular level of internal homeostasis which permits them to function smoothly, to lower the level of arousal during sleep sufficiently so that quality of sleep is good, and to increase this level enough during the day so the person can function properly. Therefore, the transition from one state to another is somewhat problematic, delayed, incomplete and desynchronised. Thus, agents with a 'rhythm stabilising' effect could be beneficial in the treatment of mood disorders. Such an agent should have a beneficial effect on restoring and stabilising the rhythm of a physiological function while not pushing it towards a specific pole, or inducing the opposite pole; it should also allow response to internal and environmental stimuli and zeitgebers, and restore synchronisation of the various body rhythms while not inducing or worsening desynchronisation. Agomelatine could represent the first of a new class of 'rhythm stabilising antidepressants', but further research is necessary to support this theory

Pharmaceutical treatment of acute bipolar depression

The treatment of bipolar depression is one of the most challenging fields in contemporary psychiatry. The best data concern the antipsychotics quetiapine and the olanzapine-fluoxetine combination. However, the usefulness of antidepressants in bipolar depression remains controversial; positive data are available for fluoxetine but negative results have been published for paroxetine. Accumulated knowledge so far suggests that bipolar patients need continuous administration of an antimanic agent even during the acute depressive phase. Although our knowledge is indeed limited, the development of guidelines for polypharmacy is necessary and should be done as soon as possible

Antidepressant drugs and the response in the placebo group: the real problem lies in our understanding of the issue

In a recent paper, Horder and colleagues (Horder et al., 2010, J Psychopharmacol 25: 1277–1288) have suggested that the mainproblem in the Kirsch analysis is methodological. We argue that the results are similar irrespective of the method used. In our opinion the data suggest that placebo and drug effects are non-additive: antidepressants act independently of depression severity, while the placebo effect is present only in milder cases. While the response in the placebo group is due to unstable ‘noise’ and ‘artefacts’, the medication effect is reliable, valid and stable

EFFECT OF THE COVID-19 EMERGENCY STATE IN THE LATVIAN GENERAL POPULATION WITH DEPRESSION AND DISTRESS ON CHANGES OF PATTERNS OF SMOKING AND PSYCHOACTIVE SUBSTANCE USE

Publisher Copyright: © 2024 Sciendo. All rights reserved.The World Health Organisation warned that the COVID-19 pandemic could have psychiatric consequences, such as elevated levels of depression and increased alcohol and psychoactive substance use. On 12 March 2020, Latvia declared a state of emergency, which was repealed on 10 June 2020. A nationwide representative online study in the general population of Latvia was conducted from 7 to 27 July 2020. The Centre for Epidemiologic Studies Depression Scale was used to determine the presence of distress/depression. A structured questionnaire was used to determine psychoactive substance use. The study sample included 2608 respondents. In the study population, prevalence of depression and distress was estimated to be 5.7% (95% CI 4.92-6.71) and 7.82% (95% CI 6.85-8.91), respectively. Patients with depression and distress smoked more tobacco than respondents without distress/depression. During the state of emergency, there were changes in smoking habits in patients with depression, in contrast with respondents without reported depressive symptoms, with a tendency to smoke either more (28% vs. 7.4%) or less (22% vs. 9.7%). Patients with distress smoked more than healthy patients (30.9% vs. 7.4%). Patients with depression and distress were significantly more likely to consume more alcohol during an emergency (14.0% and 17.7%). Patients with depression were more likely to use less alcohol during an emergency than healthy respondents (18.0% vs. 10.6%). There was no statistically significant difference in the use of other psychoactive substances among those who were depressed or in distress. Participants with depression were more likely to change their smoking habits during the state of emergency and to consume smaller alcohol amounts compared to participants without symptoms. Participants with distress smoked more and consumed larger alcohol amounts compared to healthy participants.Peer reviewe

Is there a dysfunction in the visual system of depressed patients?

BACKGROUND: The aim of the current study was to identify a possible locus of dysfunction in the visual system of depressed patients. MATERIALS AND METHODS: Fifty Major Depressive patients aged 21–60 years and 15 age-matched controls took part in the study The diagnosis was obtained with the SCAN v 2.0. The psychometric assessment included the HDRS, the HAS, the Newcastle Scales, the Diagnostic Melancholia Scale and the GAF scale. Flash Electroretinogram and Electrooculogram were performed in all subjects. The statistical analysis included ANCOVA, Student's t-test and Pearson Product Moment Correlation Coefficient were used. RESULTS: The Electro-oculographic findings suggested that all subtypes of depressed patients had lower dark trough and light peak values in comparison to controls (p < 0.001), while Arden ratios were within normal range. Electroretinographic recordings did not reveal any differences between patients and controls or between subtypes of depression. DISCUSSION: The findings of the current study provide empirical data in order to assist in the understanding of the international literature and to explain the mechanism of action of therapies like sleep deprivation and light therapy

Report of three cases that received maintenance treatment with risperidone as a mood stabilizer

INTRODUCTION: The current study is a short report of 3 cases of bipolar patients. MATERIAL AND METHODS: Three bipolar patients were prospectively followed up. All were partial responders to lithium therapy alone, and unresponsive to other therapies (anticonvulsants, antidepressants, typical antipsychotics, various combinations). RESULTS: All manifested complete remission of symptoms after combination therapy with lithium (plasma levels above 0.8 mEq/lt) plus 1–3 mg of risperidone daily. The two of them are still free of symptomatology during the maintenance period for 28 and 38 months respectively. The third patient, after several months during which she was free of symptomatology discontinued lithium against the psychiatrist's advise and received only 3 mg of risperidone daily. For the next 15 months the patient was under risperidone monotherapy and free of symptomatology. She discontinued therapy to become pregnant, the illness recurred several times during pregnancy and after the delivery the patient restarted risperidone therapy. She was free of symptoms for the following 9 months until her last follow-up. DISCUSSION: The current study provides preliminary evidence concerning the long term efficacy of risperidone in the treatment of bipolar patient