1.Trazodone Add-on in COVID-19-related Selective Serotonin Reuptake Inhibitor-resistant Post-traumatic Stress Disorder in Healthcare Workers: Two Case Reports
Domenico De BERARDIS ; Michele FORNARO ; Antonio VENTRIGLIO ; Alessandro VALCHERA ; Federica VELLANTE ; Mauro PETTORRUSO ; Giovanni MARTINOTTI ; Silvia FRATICELLI ; Massimo Di GIANNANTONIO
Clinical Psychopharmacology and Neuroscience 2021;19(4):780-785
COVID-19 represents a significant stress factor for all people worldwide due to several factors, including quarantine, lockdowns, fear of contagion, deaths, and other traumatic events. However, the healthcare workers (HCWs) have paid the higher price of this pandemic in terms of fatalities, contagions, and psychological well-being. Studies suggest that this particular population is at increased risk of developing a severe post-traumatic stress disorder (PTSD). The early diagnosis and timely treatment of PTSD in HCWs may restore well-being and significantly impact health services functioning, reducing burnout, days spent far from work, disrupted personal and team empowerment, and worse job performances. In the present article, we reported on two cases of HCWs directly involved in the treatment of COVID-19patients who showed selective serotonin reuptake inhibitor-resistant PTSD, which was successfully treated with extended-release trazodone TRZ ContramidⓇ add-on.
2.Alexithymia, Suicide Ideation and Homocysteine Levels in Drug Naïve Patients with Major Depression: A Study in the “Real World” Clinical Practice
Domenico DE BERARDIS ; Luigi OLIVIERI ; Gabriella RAPINI ; Serena DI NATALE ; Nicola SERRONI ; Michele FORNARO ; Laura ORSOLINI ; Alessandro VALCHERA ; Alessandro CARANO ; Federica VELLANTE ; Paola Annunziata VARASANO ; Gabriella Lucidi PRESSANTI ; Gianluca SERAFINI ; Maurizio POMPILI ; Giovanni MARTINOTTI ; Massimo DI GIANNANTONIO
Clinical Psychopharmacology and Neuroscience 2019;17(2):318-322
OBJECTIVE: This study was performed to elucidate relationships between alexithymia, suicide ideation and homocysteine levels in drug-naïve outpatients with major depressive disorder (MDD). METHODS: Sixty seven outpatients with MDD with melancholic features were evaluated by the means of the Hamilton Depression Rating Scale, the Toronto Alexithymia Scale (TAS–20), the Scale of Suicide Ideation, and homocysteine levels. RESULTS: Alexithymic subjects showed higher scores on all scales and higher homocysteine levels. Regression analysis shown higher homocysteine levels and TAS-20’ “Difficulty in Describing Feelings” dimension, in turn being associated with higher suicide ideation. CONCLUSION: In conclusion, alexithymic MDD outpatients may characterize for homocysteine dysregulation that may be linked to suicide ideation, regardless depression’ severity. However, study limitations are discussed and must be considered.
Affective Symptoms
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Depression
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Depressive Disorder, Major
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Homocysteine
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Humans
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Outpatients
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Suicidal Ideation
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Suicide
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Weights and Measures
3.Understanding the Complex of Suicide in Depression: from Research to Clinics
Laura ORSOLINI ; Roberto LATINI ; Maurizio POMPILI ; Gianluca SERAFINI ; Umberto VOLPE ; Federica VELLANTE ; Michele FORNARO ; Alessandro VALCHERA ; Carmine TOMASETTI ; Silvia FRATICELLI ; Marco ALESSANDRINI ; Raffaella LA ROVERE ; Sabatino TROTTA ; Giovanni MARTINOTTI ; Massimo DI GIANNANTONIO ; Domenico DE BERARDIS
Psychiatry Investigation 2020;17(3):207-221
Objective:
Amongst psychiatric disorders, major depressive disorder (MDD) is the most prevalent, by affecting approximately 15–17% of the population and showing a high suicide risk rate equivalent to around 15%. The present comprehensive overview aims at evaluating main research studies in the field of MDD at suicide risk, by proposing as well as a schematic suicide risk stratification and useful flow-chart for planning suicide preventive and therapeutic interventions for clinicians.
Methods:
A broad and comprehensive overview has been here conducted by using PubMed/Medline, combining the search strategy of free text terms and exploded MESH headings for the topics of ‘Major Depressive Disorder’ and ‘Suicide’ as following: ((suicide [Title/Abstract]) AND (major depressive disorder [Title/Abstract])). All articles published in English through May 31, 2019 were summarized in a comprehensive way.
Results:
Despite possible pathophysiological factors which may explain the complexity of suicide in MDD, scientific evidence supposed the synergic role of genetics, exogenous and endogenous stressors (i.e., interpersonal, professional, financial, as well as psychiatric disorders), epigenetic, the hypothalamic-pituitary-adrenal stress-response system, the involvement of the monoaminergic neurotransmitter systems, particularly the serotonergic ones, the lipid profile, neuro-immunological biomarkers, the Brain-derived neurotrophic factor and other neuromodulators.
Conclusion
The present overview reported that suicide is a highly complex and multifaceted phenomenon in which a large plethora of mechanisms could be variable implicated, particularly amongst MDD subjects. Beyond these consideration, modern psychiatry needs a better interpretation of suicide risk with a more careful assessment of suicide risk stratification and planning of clinical and treatment interventions.