A case of rapid stabilization using electroconvulsive therapy (ECT) for a major depressive disordered (MDD) patient with life-threatening low body mass index (BMI) is reported. This case report focuses on a 55-year-old Malay housewife with underlying hyperthyroidism in a euthyroid state who presented with MDD with mood congruent psychotic features, which were precipitated by the death of her husband. Her BMI was only 11 kg/m2 due to severe anorexia, and she was highly suicidal. Peripheral total parenteral nutrition was started and ECT was commenced for rapid stabilization on top of tablet escitalopram 15 mg nocte. Full remission was achieved after nine ECTs and steady healthy weight gain was achieved throughout admission. The patient was discharged at BMI of 13 kg/m2 with good appetite. ECT was safe for very low BMI MDD patient.
Electroconvulsive Therapy ; Depressive Disorder, Major

We aimed to compare the recommendations of the Korean Medication Algorithm Project for Depressive Disorder 2012 (KMAP-DD 2012) with other recently published treatment guidelines for depressive disorder. We reviewed a total of five recently published global treatment guidelines and compared each treatment recommendation of the KMAP-DD 2012 with those in other guidelines. For initial treatment recommendations, there were no significant major differences across guidelines. However, in the case of nonresponse or incomplete response to initial treatment, the second recommended treatment step varied across guidelines. For maintenance therapy, medication dose and duration differed among treatment guidelines. Further, there were several discrepancies in the recommendations for each subtype of depressive disorder across guidelines. For treatment in special populations, there were no significant differences in overall recommendations. This comparison identifies that, by and large, the treatment recommendations of the KMAP-DD 2012 are similar to those of other treatment guidelines and reflect current changes in prescription pattern for depression based on accumulated research data. Further studies will be needed to address several issues identified in our review.
Depression ; Depressive Disorder* ; Drug Therapy ; Prescriptions

OBJECTIVETo assess clinical therapeutic effect and safety of acupuncture combined with fuxiting on depression.

METHODSFifty-three cases of depression were divided into an observation group (n = 30) treated by acupuncture combined with fuxiting and a control group treated by fuxiting. Their clinical therapeutic effects were assessed by HAMD, HAMA and CGI, and adverse effects by TESS.

RESULTSAfter treatment of 6 weeks, the total effective rate was 80.0% in the observation group and 69.6% in the control group with no significant difference between the two groups (P > 0.05). There were significant differences in scores of HAMD and HAMA before and after treatment in the two groups (P < 0.01), with no significant difference between the two groups (P > 0.05). The adverse effect in the observation group was less and milder than that in the control group.

CONCLUSIONAcupuncture combined fuxiting has good therapeutic effect on depression with less and mild adverse effects.

OBJECTIVE: Pharmacogenomic-based antidepressant treatment (PGATx) may result in more precise pharmacotherapy of major depressive disorder (MDD) with better drug therapy guidance. METHODS: An 8-week, randomized, single-blind clinical trial was conducted to evaluate the effectiveness and tolerability of PGATx in 100 patients with MDD. All recruited patients were randomly allocated either to PGATx (n=52) or treatment as usual (TAU, n=48) groups. The primary endpoint was a change of total score of the Hamilton Depression Rating Scale-17 (HAMD-17) from baseline to end of treatment. Response rate (at least 50% reduction in HAMD-17 score from baseline), remission rate (HAMD-17 score ≥7 at the end of treatment) as well as the change of total score of Frequency, Intensity, and Burden of Side Effects Ratings (FIBSER) from baseline to end of treatment were also investigated. RESULTS: The mean change of HAMD-17 score was significantly different between two groups favoring PGATx by −4.1 point of difference (p=0.010) at the end of treatment. The mean change in the FIBSER score from baseline was significantly different between two treatment groups favoring PGATx by −2.5 point of difference (p=0.028). The response rate (71.7 % vs. 43.6%, p=0.014) were also significantly higher in PGATx than in TAU at the end of treatment, while the remission rate was numerically higher in PGATx than in TAU groups without statistical difference (45.5% vs. 25.6%, p=0.071). The reason for early drop-out associated with adverse events was also numerically higher in TAU (n=9, 50.0%) than in PGATx (n=4, 30.8%). CONCLUSION: The present study clearly demonstrate that PGATx may be a better treatment option in the treatment of MDD in terms of effectiveness and tolerability; however, study shortcomings may limit a generalization. Adequately-powered, well-designed, subsequent studies should be mandatory to prove its practicability and clinical utility for routine practice.
Antidepressive Agents ; Depression ; Depressive Disorder ; Depressive Disorder, Major* ; Drug Therapy ; Generalization (Psychology) ; Humans ; Precision Medicine

eatment alone. Most importantly, the addition of cognitive therapy to usual treatment appears to protect against future relapse in individuals known to be at high risk of repeated episodes of depression. In addition, subjects who received cognitive therapy showed significantly greater improvements in chronic depression than receiving antidepressant medication. Pooled data suggests that there is a significant relationship between the therapist's level of training or experience, the type of therapy used and patient outcome. Recent functional imaging studies examining brain changes following cognitive therapy report a variety of regional effects, but there is no consistent pattern across the few published studies. CONCLUSION: Cognitive therapy has proved beneficial in treating depressive patients. Despite empirical data supporting its efficacy, there are still problems in gaining access to cognitive therapy in clinical practice.
Brain ; Cognitive Therapy* ; Depression ; Depressive Disorder ; Depressive Disorder, Major* ; Humans ; Recurrence

OBJECTIVETo evaluate the clinical studies of acupuncture for treatment of depressive neurosis, collect the high quality evidence relative to clinical acupuncture practice for clinical decision-making reference.

METHODSAround crucial common questions of acupuncture clinical practice, the documents of clinical study were comprehensively retrieved. According to 5-grade criterion of evidence-based medicine, the evidence from high to low level were selected to answer corresponding clincal questions and RevMan 5.0.20 was used to analyze the final indicator.

RESULTSNineteen documents of clinical study accord with the inclusive criterion were retrieved. Level-A evidence showed effectiveness of acupuncture. Acupuncture might be superior or equal to fluoxetine, with little adverse effect and high safety. Level-C evidence showed acupuncture might be superior or equal to Amitriptyline, with little adverse effect and high safety. And no relative clinicial evidence compared effect of acupuncture with that of psychotherapy or behavior therapy. Only one level-C evidence showed there was no effect difference between acupuncture combined with bloodletting therapy and bloodletting alone. Two level-C evidence showed the effect of acupuncture combined with western medicine was superior to that of medicine alone, eg. catgut embedding therapy combined with Fluoxetine, electroacupuncture combined with Seroxat.

CONCLUSIONAcupuncture for depressive nerosis has a positive effect. Acupuncture has an equal effect compared with western medicine, while strictly designed equivalent and non-inferior studies are demanded. The effect of acupuncture combined with medicine has some advantage, but need high quality studies to verify.

OBJECTIVETo probe into an effective method for treatment of poststroke depression.

METHODSTwo hundred and fifty-six cases of poststroke depression were randomly divided into a control group (n = 76) treated by oral administration of amitilin and an acupuncture group (n = 180) treated by activating brain and regaining consciousness needling method. Their clinical therapeutic effects and changes of relative factors of poststroke depression and plasma contents of monoamine neurotransmitters were observed.

RESULTSIn the acupuncture group, the clinical symptoms and the relative indexes in the depression scales improved and plasma contents of the monoamine neurotransmitters increased significanty as compared with the control group (P < 0.05).

CONCLUSIONThe needling method for activating brain and regaining consciousness can improve relative factors to cure poststroke depression.

Electroconvulsive therapy (ECT) is an interventional technique capable of highly effective neuromodulation in major depressive disorder (MDD), but its antidepressant mechanism remains unclear. By recording the resting-state electroencephalogram (RS-EEG) of 19 MDD patients before and after ECT, we analyzed the modulation effect of ECT on the resting-state brain functional network of MDD patients from multiple perspectives: estimating spontaneous EEG activity power spectral density (PSD) using Welch algorithm; constructing brain functional network based on imaginary part coherence (iCoh) and calculate functional connectivity; using minimum spanning tree theory to explore the topological characteristics of brain functional network. The results show that PSD, functional connectivity, and topology in multiple frequency bands were significantly changed after ECT in MDD patients. The results of this study reveal that ECT changes the brain activity of MDD patients, which provides an important reference in the clinical treatment and mechanism analysis of MDD.
Humans ; Depressive Disorder, Major/therapy* ; Electroconvulsive Therapy ; Brain ; Algorithms ; Electroencephalography

Major depressive disorder(MDD) is one of the most common diseases with serious health consequences such as increased morbidity, disability, and mortality. Electroconvulsive therapy(ECT) has been used as a treatment for mental disorder since the 1930s. A growing number of recent publications support the conclusions that ECT is an effective and safe treatment for depressed patients. Dosing strategies, frequency, safety, side effects and efficacy of ECT in MDD will be considered. ECT may be an alternative to treatment with antidepressants.
Antidepressive Agents ; Depressive Disorder, Major ; Electroconvulsive Therapy ; Humans ; Mental Disorders

OBJECTIVES: The efficacy and safety of paroxetine in the treatment of depressive disorders are well known, however its efficacy and safety for the treatment of depression in patients with cancer has been poorly studied. This study therefore aimed to evaluate the efficacy and safety of paroxetine in treatment of depressed patients with hematological malignancy (HM). METHODS: Fifty-two patients with major depressive disorder (MDD) based on DSM-IV criteria along with comorbid HM were allotted to 8 weeks trial with a flexible-dose regime of paroxetine in combination with their chemotherapy or supportive pharmacotherapy. Treatment response was assessed at baseline, week 2, week 4, and week 8 with 17-item Hamilton Rating Scale for Depression (HAM-D17), Montgomery sberg Depression Rating Scale (MADRS), and Clinical Global Impression-severity (CGI-S). Side effects were collected with the reported adverse events and laboratory test throughout the study period. RESULTS: 44.2% of 52 patients completed the eight weeks trial. Scores on the HAM-D17, MADRS, and CGI-s (last observation carried forward, LOCF) at baseline were significantly reduced with mean reduction of 30.5%, 32.8%, and 39.1%, respectively, after 8 weeks treatment with paroxetine. Forty-six patients (88.5%) reported at least one adverse event. The most common adverse event observed in this study was nausea and no serious adverse event was found. CONCLUSION: In this preliminary study, overall results showed paroxetine could be used for the treatment of depressed patients with HM, but more controlled study is needed to confirm the efficacy and safety of paroxetine in this area.
Depression* ; Depressive Disorder ; Depressive Disorder, Major ; Diagnostic and Statistical Manual of Mental Disorders ; Drug Therapy ; Hematologic Neoplasms* ; Humans ; Nausea ; Paroxetine*