Efficacy of transcranial magnetic stimulation in treatment-resistant depression

Background/aim: The use of Transcranial Magnetic Stimulation (TMS) in the add-on treatment of patients with treatment-resistant depression (TRD) is becoming more common. This study aims to investigate the efficacy of TMS on depression and accompanying anxiety symptoms among patients with TRD. Materials and methods: The current study was conducted with 38 patients diagnosed with TRD. The patients were randomly divided into two groups and received 20 sessions of high-frequency (10Hz) TMS and 20 sessions of sham TMS to the left dorsolateral prefrontal cortex in a double-blind and cross-over fashion without a change in their pharmacotherapy. In the clinical evaluation, Hamilton Depression Rating Scale (HAM-D) and Hamilton Anxiety Rating Scale (HAM-A) were carried out three times in total: before, crossover phase, and at the end of the treatment. Results: A statistically significant decrease was found in the HAM-D and HAM-A in the group who were actively stimulated in the cross-over phase of the study. While there was a significant decrease in the HAM-A in the group who received sham stimulation, the decrease in the HAM-D was not statistically significant. Group comparisons revealed a statistically significant decrease in HAM-D in the group who were actively stimulated compared to the group receiving sham stimulation. At the end of the study, 63% of 38 patients responded to treatment, 15% partially responded, and 42% reached remission. Conclusion: This randomized, double-blind, sham-controlled, cross-over study revealed that TMS is superior to sham-TMS, provides clinically significant improvement when implemented besides pharmacotherapy among patients with treatment-resistant depression, and is beneficial for accompanying anxiety symptoms

Psychopharmacology of Addiction

Addiction is a primary, chronic, neurobiological disease, with genetic, psychosocial, and environmental factors influencing its development. Developments in the psychopharmacology of addiction is much slower than the other disciplines of psychiatry. For a long time, social and behavioral therapeutic approaches are the only choices for the treatment of addictive disorders. Disulfiram was the only pharmacological agent approved for addiction treatment until the end of 20th century. Pharmacological treatment options available for treatment have grown along with our understanding of the neurobiological mechanisms underlying the development and persistence of addiction. Several new medications like naltrexone, acamprosate, methadone and buprenoprhine have been approved for the treatment of alcohol and opioid use disorders ever since. Based on ever-increasing information about neurotransmitter and receptors, many studies have been performed concerning craving and relapse prevention in recent years. Besides many other pharmacological agents have been focus of new researches for treatment of different types of addiction. The aim of this article is to briefly review the literature on psychopharmacology of addictive disorders and recent developments in this area

Theory of Mind in Somatization and Depression Is It Cause or Phenomenon?

Although mentalization is important in somatic symptom disorder (SSD) and major depressive disorder (MDD), it is not fully understood. In this study, we aimed to investigate the relation between somatic and depressive symptoms with mentalization. A total of 48 patients diagnosed with SSD, 50 patients diagnosed with MDD, and 50 healthy individuals, participated the study. The Montgomery-Asperg Depression Scale, Symptom Checklist-90 Revised, and Reading the Mind in the Eyes Test (RMET) were applied to the participants. The patients with SSD showed significantly the lowest performance of theory of mind. There was no significant difference between MDD and healthy controls. High somatization score was found to be a predictor for low RMET scores (95% confidence interval, -0.339; p = 0.014). Mentalization deficit seems to be associated with somatization rather than depression.Pamukkale University Scientific Research Projects Commission [2017TIPF009]Funding was provided by the Pamukkale University Scientific Research Projects Commission (project number: 2017TIPF009)

The Relationship Between Methylation of the Glucocorticoid Receptor Gene (NR3C1) and Childhood Trauma and Alexithymia

Background: Childhood traumas affect the hypothalamo-pituitary-adrenal (HPA) axis functions, and therefore emotional regulation response to stress. Glucocorticoid receptor (GR) gene NR3C1 plays a key role in HPA axis. The aim of the study was to investigate the relationship between methylation of NR3C1 gene with childhood trauma and alexithymia in somatic symptom disorder (SSD) and major depressive disorder (MDD). Methods: A total of 48 patients with SSD, 50 patients with MDD and 50 healthy controls were included in the study. Mongomery-Asberg Depression Rating Scale (MADRS), Toronto Alexithymia Scale (TAS-20), and the Childhood Trauma Questionnaire (CTQ) were applied to the participants. Methylation levels of the NR3C1 gene were determined quantitatively in DNA blood samples. Results: TAS-20 and CTQ total scores were found to be the highest in patients with SSD. CTQ scores were observed to be higher in SSD and MDD compared with the control group. NR3C1 gene methylation levels were found to be lowest in SSD and highest in MDD. There was no correlation between scores of TAS-20 and NR3C1 methylation. High alexithymia level was predictive for SSD (OR:1.237, 95% CI:1.018-1504). High methylation levels increase the risk of MDD (OP:7.449, 95% CI: 3.702-14.986), decrease the risk of SSD (OR: 0.00006 95% CI: 0.000-0.038). Conclusion: Our results show that emotion processing processes and GR methylation are different in both disorders. Childhood trauma may be related to epigenetic changes in the GR gene. The type of epigenetic changes may result in vulnerability to different psychiatric disorders.Pamukkale University Scientific Research Projects Commission [2017TIPF009]The research project received ethics council approval from the Pamukkale University Faculty of Medicine Ethics Council dated July 21, 2016, number 60116787-020/44577. Funding was provided by the Pamukkale University Scientific Research Projects Commission for the commercial kits that were used in determining the methylation states of the N3CR1 gene (Project number: 2017TIPF009)