Commentary: Antidepressant Use During Acute Inpatient Care is Associated With an Increased Risk of Psychiatric Rehospitalisation Over a 12-Month Follow-Up after Discharge

Hengartner MP, Passalacqua S, Andreae A, Heinsius T, Hepp U, Rössler W and von Wyl A (2019) Antidepressant Use During Acute Inpatient Care Is Associated With an Increased Risk of Psychiatric Rehospitalisation Over a 12-Month Follow-Up After Discharge. Front. Psychiatry 10:79. doi: 10.3389/fpsyt.2019.0007

Emotional arousal modulates oscillatory correlates of targeted memory reactivation during NREM, but not REM sleep

Rapid eye movement (REM) sleep is considered to preferentially reprocess emotionally arousing memories. We tested this hypothesis by cueing emotional vs. neutral memories during REM and NREM sleep and wakefulness by presenting associated verbal memory cues after learning. Here we show that cueing during NREM sleep significantly improved memory for emotional pictures, while no cueing benefit was observed during REM sleep. On the oscillatory level, successful memory cueing during NREM sleep resulted in significant increases in theta and spindle oscillations with stronger responses for emotional than neutral memories. In contrast during REM sleep, solely cueing of neutral (but not emotional) memories was associated with increases in theta activity. Our results do not support a preferential role of REM sleep for emotional memories, but rather suggest that emotional arousal modulates memory replay and consolidation processes and their oscillatory correlates during NREM sleep

Stress management and the role of Rhodiola rosea: a review

Objective: Stress describes the physiological reaction to threat or pressure, which manifests as physical symptoms of exhaustion or energy loss and psychological symptoms, including irritability or tension. If untreated, chronic stress or burnout may develop, both are areas of unmet medical need. Evidence-based treatment and prevention measures are needed. Methods: Prevention strategies and existing treatment options for stress-related symptoms were evaluated to establish criteria for an adequate pharmacological approach to stress. The authors reviewed the literature to reach a clinically meaningful strategy for prevention and treatment of persistent stress symptoms and their consequences, including burnout and secondary diseases. Results: Current medication reveals a treatment gap. Most drugs target only psychological or physical stress symptoms. Furthermore, psychotropic medications sometimes prescribed for stress often have unacceptable side effects and bear a risk of overtreatment. Ideally pharmacological therapy should afford comprehensive treatment of all stress symptoms with a favourable safety profile. Conclusions: Rhodiola rosea extract (RRE) fulfils important requirements. It is the main adaptogen approved by the HMPC/EMA for the indication 'stress' and influences the release of stress hormones while boosting energy metabolism as revealed in animal literature. RRE offers comprehensive treatment of stress symptoms and can prevent chronic stress and stress-related complications

Neural correlates of experimental trauma memory retrieval

OBJECTIVES Traumatic memories such as intrusions and flashbacks play a major role in the development and maintenance of post-traumatic stress disorder (PTSD). A thorough understanding of the neural mechanisms underlying traumatic memories is indispensable for precise diagnosis, for personalized treatment and prevention. In particular, the identification of early neural predictor variables for intrusion development shortly after trauma exposure requires detailed investigation. EXPERIMENTAL DESIGN Here, we examined the neural correlates of early experimental trauma memory retrieval in a traumatic film paradigm in 42 young healthy females, using both implicit and explicit retrieval tasks. PRINCIPAL OBSERVATIONS We show that implicit experimental trauma retrieval specifically involved the retrosplenial cortex and the anterior cingulate cortex (ACC), while both retrieval tasks resulted in trauma-related activity in the posterior cingulate cortex (PCC) and the precuneus. Importantly, neural activity early after experimental trauma exposure predicted later intrusion development, with independent contributions from activity in the retrosplenial cortex (implicit retrieval) and the PCC (explicit retrieval). Additional analyses revealed a stronger connectivity between the bilateral amygdala and the supplementary motor area, precentral and paracentral lobule for the control group compared to the experimental trauma group. CONCLUSIONS Our study gives new insights in the neural correlates of experimental trauma memory retrieval and their predictive value for subsequent symptom development. Our results could provide the basis for personalized early treatment and prevention of PTSD. Hum Brain Mapp, 2017. © 2017 Wiley Periodicals, Inc. Hum Brain Mapp 38:3592-3602, 2017. © 2017 Wiley Periodicals, Inc

The NMDA antagonist ketamine and the 5-HT agonist psilocybin produce dissociable effects on structural encoding of emotional face expressions

Rationale: Both glutamate and serotonin (5-HT) play a key role in the pathophysiology of emotional biases. Recent studies indicate that the glutamate N-methyl-d-aspartate (NMDA) receptor antagonist ketamine and the 5-HT receptor agonist psilocybin are implicated in emotion processing. However, as yet, no study has systematically compared their contribution to emotional biases. Objectives: This study used event-related potentials (ERPs) and signal detection theory to compare the effects of the NMDA (via S-ketamine) and 5-HT (via psilocybin) receptor system on non-conscious or conscious emotional face processing biases. Methods: S-ketamine or psilocybin was administrated to two groups of healthy subjects in a double-blind within-subject placebo-controlled design. We behaviorally assessed objective thresholds for non-conscious discrimination in all drug conditions. Electrophysiological responses to fearful, happy, and neutral faces were subsequently recorded with the face-specific P100 and N170 ERP. Results: Both S-ketamine and psilocybin impaired the encoding of fearful faces as expressed by a reduced N170 over parieto-occipital brain regions. In contrast, while S-ketamine also impaired the encoding of happy facial expressions, psilocybin had no effect on the N170 in response to happy faces. Conclusion: This study demonstrates that the NMDA and 5-HT receptor systems differentially contribute to the structural encoding of emotional face expressions as expressed by the N170. These findings suggest that the assessment of early visual evoked responses might allow detecting pharmacologically induced changes in emotional processing biases and thus provides a framework to study the pathophysiology of dysfunctional emotional biase

Novel Insights Into the Neurobiology of the Antidepressant Response From Ketamine Research: A Mini Review

The serendipitous discovery of ketamine's antidepressant effects represents one of the major landmarks in neuropsychopharmacological research of the last 50 years. Ketamine provides an exciting challenge to traditional concepts of antidepressant drug therapy, producing rapid antidepressant effects seemingly without targeting monoaminergic pathways in the conventional way. In consequence, the advent of ketamine has spawned a plethora of neurobiological research into its putative mechanisms. Here, we provide a brief overview of current theories of antidepressant drug action including monoaminergic signaling, disinhibition of glutamatergic neurotransmission, neurotrophic and neuroplastic effects, and how these might relate to ketamine. Given that research into ketamine has not yet yielded new therapies beyond ketamine itself, current knowledge gaps and limitations of available studies are also discussed

Side effects of adjunct light therapy in patients with major depression

Adjunct bright-light therapy has been suggested to augment antidepressant drug treatment in patients with non-seasonal major depression. Side effects of the combined therapy have not been investigated thus far. Therefore, somatic complaints and side effects of combined therapy were evaluated in 28 patients with major depression (DSM-III-R) randomly assigned to either trimipramine or trimipramine and serially applied adjunct bright-light therapy. Response rates were comparable in both treatment groups and rates of newly emergent side effects during treatment were generally low. The most prominent unfavourable side effects of adjunct bright-light therapy as compared with trimipramine monotherapy were aggravated sedation, persisting restlessness, emerging sleep disturbance and decreased appetite as well as the worsening of vertigo. Discriminant analysis revealed that the combination of trimipramine with bright light results in a different side effect profile compared with drug monotherap

Gender and Rapid Alterations of Hemispheric Dominance during Planning

Background: Mental planning and carrying out a plan provoke specific cerebral hemodynamic responses. Gender aspects of hemispheric laterality using rapid cerebral hemodynamics have not been reported. Method: Here, we applied functional transcranial Doppler sonography to examine lateralization of cerebral hemodynamics of the middle cerebral arteries of 28 subjects (14 women and 14 men) performing a standard planning task. There were easy and difficult problems, and mental planning without motor activity was separated from movement execution. Results: Difficult mental planning elicited lateralization to the right hemisphere after 2 or more seconds, a feature that was not observed during movement execution. In females, there was a dominance to the left hemisphere during movement execution. Optimized problem solving yielded an increased laterality change to the right during mental planning. Conclusions: Gender-related hemispheric dominance appears to be condition-dependent, and change of laterality to the right may play a role in optimized performance. Results are of relevance when considering laterality from a perspective of performance enhancement of higher cognitive functions, and also of psychiatric disorders with cognitive dysfunctions and abnormal lateralization patterns such as schizophrenia. Copyright (C) 2012 S. Karger AG, Base

Functional transcranial Doppler: Selection of methods for statistical analysis and representation of changes in flow velocity

INTRODUCTION Transcranial Doppler (TCD) is a method used to study cerebral hemodynamics. In the majority of TCD studies, regression analysis and analysis of variance are the most frequently applied statistical methods. However, due to the dynamic and interdependent nature of flow velocity, nonparametric tests may allow for better statistical analysis and representation of results. METHOD The sample comprised 30 healthy participants, aged 33.87 ± 7.48 years; with 33% (n = 10) females. During a visuo-motor task, the mean flow velocity (MFV) in the middle cerebral artery (MCA) was measured using TCD. The MFV was converted to values relative to the resting state. The results obtained were analyzed using the general linear model (GLM) and the general additional model (GAM). The fit indices of both analysis methods were compared with each other. RESULTS Both MCAs showed a steady increase in MFV during the visuo-motor task, smoothly returning to resting state values. During the first 20 seconds of the visuo-motor task, the MFV increased by a factor of 1.06 ± 0.07 in the right-MCA and by a factor of 1.08 ± 0.07 in the left-MCA. GLM and GAM showed a statistically significant change in MFV (GLM:F(2, 3598) = 16.76, P < .001; GAM:F(2, 3598) = 21.63, P < .001); together with effects of hemispheric side and gender (GLM:F(4, 3596) = 7.83, P < .005; GAM:F(4, 3596) = 2.13, P = .001). Comparing the models using the χ$^{2}$ test for goodness of fit yields a significant difference χ$^{2}$ (9.9556) = 0.6836, P < .001. CONCLUSIONS Both the GLM and GAM yielded valid statistical models of MFV in the MCA in healthy subjects. However, the model using the GAM resulted in improved fit indices. The GAM's advantage becomes even clearer when the MFV curves are visualized; yielding a more realistic approach to brain hemodynamics, thus allowing for an improvement in the interpretation of the mathematical and statistical results. Our results demonstrate the utility of the GAM for the analysis and representation of hemodynamic parameters