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Mei Ieng Lam,1,2 Hong Cai,2,3 Pan Chen,2,3 Ka-In Lok,4 Ines Hang Iao Chow,2 Tong Leong Si,2 Zhaohui Su,5 Chee H Ng,6 Feng-Rong An,7 Yu-Tao Xiang2,3 1Education Department, Kiang Wu Nursing College of Macau, Macau SAR, People’s Republic of China; 2Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, University of Macau, Macao SAR, People’s Republic of China; 3Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, People’s Republic of China; 4Faculty of Health Sciences and Sports, Macao Polytechnic University, Macao, People’s Republic of China; 5School of Public Health, Southeast University, Nanjing, People’s Republic of China; 6Department of Psychiatry, The Melbourne Clinic and St Vincent’s Hospital, University of Melbourne, Richmond, Victoria, Australia; 7Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, People’s Republic of ChinaCorrespondence: Chee H Ng, Department of Psychiatry, The Melbourne Clinic and St Vincent’s Hospital, University of Melbourne, Richmond, Victoria, Australia, Email cng@unimelb.edu.au Yu-Tao Xiang, Faculty of Health Sciences, University of Macau, 1/F, Building E12, Macau, People’s Republic of China, Email xyutly@gmail.comBackground: Suicidality is a global public health problem which has increased considerably during the coronavirus disease 2019 (COVID-19) pandemic. This study examined the inter-relationships between depressive symptoms and suicidality using network analysis among Macau residents after the “relatively static management” COVID-19 strategy.Methods: An assessment of suicidal ideation (SI), suicide plan (SP), suicide attempt (SA) and depressive symptoms was conducted with the use of individual binary response items (ye

This international guideline proposes improving clozapine package inserts worldwide by using ancestry-based dosing and titration. Adverse drug reaction (ADR) databases suggest that clozapine is the third most toxic drug in the United States (US), and it produces four times higher worldwide pneumonia mortality than that by agranulocytosis or myocarditis. For trough steady-state clozapine serum concentrations, the therapeutic reference range is narrow, from 350 to 600 ng/mL with the potential for toxicity and ADRs as concentrations increase. Clozapine is mainly metabolized by CYP1A2 (female non-smokers, the lowest dose; male smokers, the highest dose). Poor metabolizer status through phenotypic conversion is associated with co-prescription of inhibitors (including oral contraceptives and valproate), obesity, or inflammation with C-reactive protein (CRP) elevations. The Asian population (Pakistan to Japan) or the Americas' original inhabitants have lower CYP1A2 activity and require lower clozapine doses to reach concentrations of 350 ng/mL. In the US, daily doses of 300-600 mg/day are recommended. Slow personalized titration may prevent early ADRs (including syncope, myocarditis, and pneumonia). This guideline defines six personalized titration schedules for inpatients: 1) ancestry from Asia or the original people from the Americas with lower metabolism (obesity or valproate) needing minimum therapeutic dosages of 75-150 mg/day, 2) ancestry from Asia or the original people from the Americas with average metabolism needing 175-300 mg/day, 3) European/Western Asian ancestry with lower metabolism (obesity or valproate) needing 100-200 mg/day, 4) European/Western Asian ancestry with average metabolism needing 250-400 mg/day, 5) in the US with ancestries other than from Asia or the original people from the Americas with lower clozapine metabolism (obesity or valproate) needing 150-300 mg/day, and 6) in the US with ancestries other than from Asia or the original people fr

Hong Cai,1– 3,* Yan-jie Zhao,1– 3,* Xiaomeng Xing,4,* Tengfei Tian,4,* Wang Qian,4 Sixiang Liang,4 Zhe Wang,4 Teris Cheung,5 Zhaohui Su,6 Yi-Lang Tang,7,8 Chee H Ng,9 Sha Sha,4 Yu-Tao Xiang1– 3 1Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao Special Administrative Region, People’s Republic of China; 2Centre for Cognitive and Brain Sciences, University of Macau, Macao Special Administrative Region, People’s Republic of China; 3Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao Special Administrative Region, People’s Republic of China; 4The National Clinical Research Center for Mental Disorder & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, People’s Republic of China; 5School of Nursing, Hong Kong Polytechnic University, Hong Kong Special Administrative Region, People’s Republic of China; 6School of Public Health, Southeast University, Nanjing, China, Nanjing, People’s Republic of China; 7Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA; 8Atlanta VA Medical Center, Decatur, GA, USA; 9Department of Psychiatry, The Melbourne Clinic and St Vincent’s Hospital, University of Melbourne, Richmond, Victoria, Australia*These authors contributed equally to this workCorrespondence: Sha Sha, The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, School of Mental Health, Beijing, People’s Republic of China, Email sarahbon@163.com Chee H Ng, Department of Psychiatry, The Melbourne Clinic and St Vincent’s Hospital, University

‘I have not found among my possessions anything which I hold more dear than, or value so much as, my knowledge of the actions of great people, acquired by long experience in contemporary affairs, and a continual study of antiquity.’ The Prince, Machiavelli

Simon Fifer,1 Andrea Puig,2 Vanessa Sequeira,3 Mustafa Acar,2 Chee H Ng,4 Michelle Blanchard,5 Ariana Cabrera,6 James Freemantle,7 Jennifer Grunfeld8 1Research and Innovation, Community and Patient Preference Research, Sydney, New South Wales, Australia; 2Real World Evidence, Janssen Australia, Macquarie Park, New South Wales, Australia; 3Medical Affairs, Janssen Australia, Macquarie Park, New South Wales, Australia; 4Professorial Unit, The Melbourne Clinic, Department of Psychiatry, University of Melbourne, Richmond, Victoria, Australia; 5Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Victoria, Australia; 6Data Analytics and Visualisation, Community and Patient Preference Research, Sydney, New South Wales, Australia; 7People Measures, South Melbourne, Victoria, Australia; 8Peninsula Therapeutic & Research Group, Frankston, Victoria, AustraliaCorrespondence: Andrea PuigReal World Evidence, Janssen Australia, 66 Waterloo Road, Macquarie Park, NSW, 2113, AustraliaTel +61-4-2912-8695Fax +61 2 9815 3200Email apuig@ITS.JNJ.comBackground: There is evidence of improved adherence and treatment outcomes when patients’ treatment preferences are considered, and shared decision making is utilized.Purpose: We aimed to better understand treatment preferences among Australians with treatment-resistant depression (TRD), focusing on the specific treatment attributes that people value (such as effectiveness, risk of side effects and cost) and their relative importance. The risk-benefit trade-offs that characterize treatment choices were also examined.Patients and Methods: An online survey of 75 patients with experience of TRD was conducted, consisting of two discrete choice experiment (DCE) components – a medication DCE and a treatment plan DCE. Participants were able to prioritize and trade off different features of medications and treatment plans. Additional questions aimed to better define this population group, which in

Wei Bai,1– 3,* Yanjie Zhao,1– 3,* Fengrong An,4,* Qinge Zhang,4,* Sha Sha,4,* Teris Cheung,5 Calvin Pak-Wing Cheng,6 Chee H Ng,7 Yu-Tao Xiang1– 3 1Unit of Psychiatry, Department of Public Health and Medicinal Administration, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, People’s Republic of China; 2Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, People’s Republic of China; 3Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, People’s Republic of China; 4The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, School of Mental Health, Beijing, People’s Republic of China; 5School of Nursing, Hong Kong Polytechnic University, Hong Kong SAR, People’s Republic of China; 6Department of Psychiatry, University of Hong Kong, Hong Kong SAR, People’s Republic of China; 7Department of Psychiatry, The Melbourne Clinic and St Vincent’s Hospital, University of Melbourne, Richmond, VIC, Australia*These authors contributed equally to this workCorrespondence: Yu-Tao XiangFaculty of Health Sciences, University of Macau, 1/F, Building E12, Avenida da Universidade, Taipa, Macao SAR, People’s Republic of ChinaTel +853 8822-4223Fax +853 2288-2314Email xyutly@gmail.comChee H NgDepartment of Psychiatry, The Melbourne Clinic and St Vincent’s Hospital, University of Melbourne, Richmond, VIC, AustraliaEmail cng@unimelb.edu.auPurpose: The coronavirus disease 2019 (COVID-19) pandemic is associated with increased risk of insomnia symptoms (insomnia hereafter) in health-care professionals. Network analysis is a novel approach in linking mechanisms at the symptom level. The aim of this study was to characterize the insomnia network structure in

Changsu Han,1 Gang Wang,2 Sandra Chan,3 Tadafumi Kato,4,5 Chee H Ng,6 Wilson Tan,7 Lili Zhang,8 Yu Feng,8 Chia-Yih Liu9 1Department of Psychiatry, Korea University College of Medicine, Seoul, South Korea; 2The National Clinical Research Center for Mental Disorder & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital & The Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, People’s Republic of China; 3Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, People’s Republic of China; 4RIKEN Center for Brain Science, Wako, Saitama, Japan; 5Department of Psychiatry and Behavioral Science, Juntendo University Graduate School of Medicine, Tokyo, Japan; 6Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia; 7Regional Medical Affairs, Janssen Pharmaceutical Companies of Johnson and Johnson, Singapore, Singapore; 8Medical Affairs, Xian Janssen Pharmaceutical Ltd, Beijing, People’s Republic of China; 9Department of Psychiatry, Chang Gung Medical Center and Chang Gung University School of Medicine, Taoyuan City, TaiwanCorrespondence: Chia-Yih LiuDepartment of Psychiatry, Chang Gung Medical Center and Chang Gung University School of Medicine, No. 5, Fuching Street, Guishan District, Taoyuan City, TaiwanTel +886-3-3281200 Ext 2439Email liucy752@cgmh.org.twWilson TanRegional Medical Affairs, Janssen Pharmaceutical Companies of Johnson and Johnson, 2 Science Park Drive, #07– 13, Ascent, Singapore Science Park 1, Singapore 118222, SingaporeTel +65-69187930Email wtan27@its.jnj.comPurpose: An Asia-Pacific expert consensus defined treatment-resistant depression (TRD) as failure of ≥ 2 antidepressants given at adequate doses for 6– 8 weeks during a major depressive episode. A survey examined how TRD was being diagnosed in real-world practices across Asia. An expert panel then interpreted the results and prov

Gang Wang,1,2 Changsu Han,3 Chia-Yih Liu,4 Sandra Chan,5 Tadafumi Kato,6,7 Wilson Tan,8 Lili Zhang,9 Yu Feng,9 Chee H Ng10 1The National Clinical Research Center for Mental Disorder & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, People’s Republic of China; 3Department of Psychiatry, Korea University College of Medicine, Seoul, South Korea; 4Department of Psychiatry, Chang Gung Medical Center, and Chang Gung University School of Medicine, Taoyuan City, Taiwan; 5Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, People’s Republic of China; 6RIKEN Center for Brain Science, Wako, Saitama, Japan; 7Department of Psychiatry and Behavioral Science, Juntendo University Graduate School of Medicine, Tokyo, Japan; 8Regional Medical Affairs, Janssen Pharmaceutical Companies of Johnson and Johnson, Singapore, Singapore; 9Medical Affairs, Xian Janssen Pharmaceutical Ltd, Beijing, People’s Republic of China; 10Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, AustraliaCorrespondence: Chee H NgThe Melbourne Clinic, 130 Church Street, Richmond, Victoria 3121, AustraliaTel +61 3 9420 9350Fax +61 3 9421 0704Email cng@unimelb.edu.auWilson Tan Regional Medical AffairsJanssen Pharmaceutical Companies of Johnson and Johnson, 2 Science Park Drive, #07-13, Ascent, Singapore Science Park 1, 118222, SingaporeTel +65-69187930Email wtan27@its.jnj.comPurpose: Consensus is lacking on the management of treatment-resistant depression (TRD), resulting in significant variations on how TRD patients are being managed in real-world practice. A survey explored how clinicians managed TRD across Asia, followed by an expert panel that interpreted the survey results and provided recommendations on how TRD could be managed in real-world

Weihua Zhang,1,2,* Na Zhu,3,* Jianbo Lai,1,4 Jingjing Liu,1,5 Chee H Ng,6 Jun Chen,3 Chao Qian,1,7 Yanli Du,1 Chanchan Hu,1,4 Jingkai Chen,1,4 Jianbo Hu,1,4 Zhong Wang,1,4 Hetong Zhou,1,4 Yi Xu,1,4 Yiru Fang,3 Chuan Shi,8– 11 Shaohua Hu1,4 1Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, People’s Republic of China; 2Department of Psychiatry, Taizhou Second People’s Hospital, Taizhou 317200, People’s Republic of China; 3Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai 200030, People’s Republic of China; 4The Key Laboratory of Mental Disorder Management of Zhejiang Province, Hangzhou 310003, People’s Republic of China; 5Department of Psychiatry, Wenzhou Kangning Hospital, Wenzhou 325000, People’s Republic of China; 6The Melbourne Clinic Department of Psychiatry, University of Melbourne, Melbourne, Victoria 3052, Australia; 7Department of Psychiatry, The Seventh Shaoxing People’s Hospital, Shaoxing 312000, People’s Republic of China; 8Department of Psychological Assesssment, Peking University Sixth Hospital, Beijing 100191, People’s Republic of China; 9Peking University Institute of Mental Health, Beijing 100191, People’s Republic of China; 10NHC Key Laboratory of Mental Health, Beijing 100191, People’s Republic of China; 11National Clinical Research Center for Mental Disorders, Beijing 100191, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yiru FangShanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai 200030, People’s Republic of ChinaEmail yirufang@aliyun.comShaohua HuDepartment of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, The Key Laboratory of Mental Disorder Management of Zhejiang Province, 79 Qing Chun Road, Hangzh

Chris Dowrick,1,2 Ryuki Kassai,2,3 Cindy LK Lam,2,4 Raymond W Lam,5,6 Garth Manning,2 Jill Murphy,5,6 Chee H Ng,7,8 Chandramani Thuraisingham2,9 1Department of Primary Care and Public Health, University of Liverpool, Liverpool, UK; 2World Organization of Family Doctors (WONCA), Bangkok, Thailand; 3Department of Community and Family Medicine, Fukushima Medical University, Fukushima, Japan; 4Department of Family Medicine & Primary Care, The University of Hong Kong, Hong Kong; 5Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; 6Asia-Pacific Economic Cooperation (APEC) Digital Hub for Mental Health, Vancouver, BC, Canada; 7Department of Psychiatry, University of Melbourne, Melbourne, Australia; 8Asia-Pacific Economic Cooperation(APEC) Digital Hub for Mental Health, Melbourne, Australia; 9Department of Family Medicine, International Medical University, Kuala Lumpur, MalaysiaCorrespondence: Cindy LK Lam; Chee H Ng Email clklam@hku.hk; cng@unimelb.edu.auAbstract: Mental ill health affects individual well-being and national economic prosperity and makes up a substantial portion of the burden of disease globally, especially in the Asia-Pacific region. Integrating mental health into primary care is widely considered a key strategy to improve access to mental health care. Integration, however, is a complex process that needs to be addressed at multiple levels. A collaboration between the Asia-Pacific Economic Cooperation (APEC) Digital Hub for Mental Health and the World Organization of Family Doctors (WONCA) is described in this paper, which outlines a framework and next steps to improve the mental health of communities in APEC economies. This paper notes gaps related to the integration of mental health into primary care across the region and identifies enablers and current best practices from several APEC economies. The potential of digital technology to benefit primary mental health care for populations in the APEC region, including de

Nina T Castillo-Carandang,1 Robert D Buenaventura,2 Yook-Chin Chia,3 Dung Do Van,4 Cheng Lee,5 Ngoc Long Duong,6 Chee H Ng,7 Yolanda R Robles,8 Anwar Santoso,9 Helen S Sigua,10 Apichard Sukonthasarn,11 Roger Tan,12 Eka Viora,13 Hazli Zakaria,14 Grace E Brizuela,15 Priyan Ratnasingham,16 Mathew Thomas,17 Anurita Majumdar16 1Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Philippines; and Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines Manila, Manila, Philippines; 2Department of Psychiatry, Manila Theological College - College of Medicine, Manila, Philippines; 3Department of Medical Sciences, School of Healthcare and Medical Sciences, Sunway University, Bandar Sunway, Selangor, Malaysia; 4The University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam; 5National Addictions Management Service, Institute of Mental Health, Singapore; 6Department of Research, Education and Technology, Vietnam National Heart Institute, Hanoi, Vietnam; 7Department of Psychiatry, The Melbourne Clinic and St Vincent’s Hospital, University of Melbourne, Richmond, VIC, Australia; 8College of Pharmacy, University of the Philippines Manila, Manila, Philippines; 9Department of Cardiology, Vascular Medicine, National Cardiovascular Centre - Harapan Kita Hospital, Universitas Indonesia, Jakarta, Indonesia; 10University of the Philippines Open University, Laguna, Philippines; 11Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 12Roger Kidney Clinic, Gleneagles Hospital, Singapore; 13Indonesia Psychiatrist Association, Jakarta, Indonesia; 14Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia; 15Research, Development and Medical, Pfizer Upjohn, Manila, Philippines; 16Research, Development and Medical, Pfizer Upjohn, Singapore; 17Corporate Affairs, Pfizer

The original article [1] contained two minor errors.

The original article [1] contained two minor errors.

Background: Metabolic syndrome and co-morbid physical health conditions are highly prevalent in people with a mental illness. Modifiable lifestyle factors have been targeted to improve health outcomes. Healthy Body Healthy Mind (HBHM) program was developed to provide an integrated evidence-based program incorporating practical diet and exercise instruction; alongside meditation and mindfulness strategies, and comprehensive psychoeducation, to improve the physical and mental health of those with a mental illness. Methods: We report on two data points: (1) Qualitative data derived from the first HBHM program (version 1) exploring its utility and acceptance according to patient feedback; (2) Biometric and mental health data collected on the modified and enhanced 12-week HBHM program (version 2) involving a pilot of 10 participants. Mental and physical health outcomes, weight, abdominal circumference, fasting glucose, cholesterol, and triglycerides were measured at program entry and completion. Results: Qualitative data from HBHM version 1 provided valuable feedback to redevelop and enhance the program. At the end of the HBHM (version 2) 12-week program, a significant mean weight loss of 2 kg was achieved, p = 0.023. There was also a significant reduction in abdominal circumference (mean = 2.55 cm) and a decrease in BMI of almost one point (mean = 0.96 kg/m2), p = 0.046 and p = 0.019, respectively. There were no significant changes in mental health measures or on any other biometrics. Conclusion: Pilot data from the HBHM program found significant reductions in weight and abdominal obesity. The HBHM program could benefit from further modifications, and study replication is required using a controlled design in a larger sample.

INTRODUCTION: First line pharmacological treatments for bipolar disorder (BD) can leave shortfalls in recovery leading to patients seeking alternative and adjunctive treatments such as nutraceuticals. This protocol for a systematic review and proposed meta-analysis aims to answer the research question: in patients with BD, how does use of nutraceutical treatments compare with placebo in reducing depressive and mania symptoms? METHODS AND ANALYSIS: Clinical trials will be identified through database searches using PubMed via PubMed, EMBASE via embase.com, Cochrane Central Register of Controlled Clinical Trials (CENTRAL) via cochranelibrary.com and CINAHL Complete via EBSCO. Search terms for BD and specific nutraceuticals (75 total search terms) will be used. Double-blind, randomised, controlled, clinical trials of adults with BD will be included in the review. Risk of bias will be assessed using the Cochrane Collaboration's tool for assessing risk of bias in randomised trials. ETHICS AND DISSEMINATION: This review will only look at published data (already reviewed for ethical compliance); therefore, ethical approval is not required. We aim to publish the systematic review in a peer-reviewed journal and present at conferences. PROSPERO REGISTRATION NUMBER: CRD42019100745.

New treatments are urgently needed for serious mental illnesses including bipolar disorder and schizophrenia. This review proposes that Garcinia mangostana Linn. (mangosteen) pericarp is a possible adjunctive therapeutic agent for these disorders. Research to date demonstrates that neurobiological properties of the mangosteen pericarp are well aligned with the current understanding of the pathophysiology of bipolar disorder and schizophrenia. Mangosteen pericarp has antioxidant, putative neuroprotective, anti-inflammatory, and putative mitochondrial enhancing properties, with animal studies demonstrating favorable pharmacotherapeutic benefits with respect to these disorders. This review summarizes evidence of its properties and supports the case for future studies to assess the utility of mangosteen pericarp as an adjunctive treatment option for mood and psychotic disorders.

BACKGROUND: A phasic dysregulation of mitochondrial bioenergetics may operate in bipolar disorder, increased in mania and decreased in depression. We aimed to examine efficacy of two add-on treatments in bipolar depression: N-acetylcysteine (NAC) and NAC with a combination of nutraceutical agents that may increase mitochondrial biogenesis. METHODS: A three-arm 16-week, double-blind, randomised, placebo-controlled trial, adjunctive to usual treatment, was conducted. Participants (n = 181) with bipolar disorder and current depressive symptoms were randomised to 2000 mg/day NAC (n = 59), 2000 mg/day NAC with the combination nutraceutical treatment (CT, n = 61), or placebo (n = 61). The primary outcome was change in Montgomery-Åsberg Depression Rating Scale (MADRS) total score from baseline to week 16. Young Mania Rating Scale, Clinical Global Impression (CGI)-Improvement and CGI-Severity scales, Patient Global Impression scale, Social and Occupational Functioning Assessment Scale (SOFAS), Longitudinal Interval Follow-Up Evaluation - Range of Impaired Functioning Tool (LIFE-RIFT), and Quality of Life Enjoyment, and Satisfaction Questionnaire Short Form (Q-LES-Q-SF) were secondary outcomes. RESULTS: One hundred forty-eight participants had post-randomisation data and were analysed (NAC = 52, CT = 47, Placebo = 49). No between-group differences were found for the rate of change between baseline and 16 weeks on any of the clinical and functioning variables. Improvements in MADRS, BDRS, SOFAS, and LIFE-RIFT scores from baseline to the week 20 post-discontinuation visit were significantly greater in the CT group compared to those in the placebo. At week 20, the CGI-I was significantly lower in the CT group versus placebo. Gastrointestinal symptoms were significantly greater in the NAC than in the placebo group. CONCLUSIONS: These overall negative resul

The original article [1] contained two minor errors.

The original article [1] contained two minor errors.

The original article [1] contained two minor errors.

The original article [1] contained two minor errors.

The original article [1] contained two minor errors.

OBJECTIVE: There is burgeoning interest in augmentation strategies for improving inadequate response to antidepressants. The adjunctive use of standardized pharmaceutical-grade nutrients, known as nutraceuticals, has the potential to modulate several neurochemical pathways implicated in depression. While many studies have been conducted in this area, to date no specialized systematic review (or meta-analysis) has been conducted. METHOD: A systematic search of PubMed, CINAHL, Cochrane Library, and Web of Science was conducted up to December 2015 for clinical trials using adjunctive nutrients for depression. Where sufficient data were available, a random-effects model analyzed the standard mean difference between treatment and placebo in the change from baseline to endpoint, combining the effect size data. Funnel plot and heterogeneity analyses were also performed. RESULTS: Primarily positive results were found for replicated studies testing S-adenosylmethionine (SAMe), methylfolate, omega-3 (primarily EPA or ethyl-EPA), and vitamin D, with positive isolated studies for creatine, folinic acid, and an amino acid combination. Mixed results were found for zinc, folic acid, vitamin C, and tryptophan, with nonsignificant results for inositol. No major adverse effects were noted in the studies (aside from minor digestive disturbance). A meta-analysis of adjunctive omega-3 versus placebo revealed a significant and moderate to strong effect in favor of omega-3. Conversely, a meta-analysis of folic acid revealed a nonsignificant difference from placebo. Marked study heterogeneity was found in a Higgins test for both omega-3 and folic acid studies; funnel plots also revealed asymmetry (reflecting potential study bias). CONCLUSIONS: Current evidence supports adjunctive use of SAMe, methylfolate, omega-3, and vitamin D with antidepressants to reduce depressive symptoms.

OBJECTIVE: There is burgeoning interest in augmentation strategies for improving inadequate response to antidepressants. The adjunctive use of standardized pharmaceutical-grade nutrients, known as nutraceuticals, has the potential to modulate several neurochemical pathways implicated in depression. While many studies have been conducted in this area, to date no specialized systematic review (or meta-analysis) has been conducted. METHOD: A systematic search of PubMed, CINAHL, Cochrane Library, and Web of Science was conducted up to December 2015 for clinical trials using adjunctive nutrients for depression. Where sufficient data were available, a random-effects model analyzed the standard mean difference between treatment and placebo in the change from baseline to endpoint, combining the effect size data. Funnel plot and heterogeneity analyses were also performed. RESULTS: Primarily positive results were found for replicated studies testing S-adenosylmethionine (SAMe), methylfolate, omega-3 (primarily EPA or ethyl-EPA), and vitamin D, with positive isolated studies for creatine, folinic acid, and an amino acid combination. Mixed results were found for zinc, folic acid, vitamin C, and tryptophan, with nonsignificant results for inositol. No major adverse effects were noted in the studies (aside from minor digestive disturbance). A meta-analysis of adjunctive omega-3 versus placebo revealed a significant and moderate to strong effect in favor of omega-3. Conversely, a meta-analysis of folic acid revealed a nonsignificant difference from placebo. Marked study heterogeneity was found in a Higgins test for both omega-3 and folic acid studies; funnel plots also revealed asymmetry (reflecting potential study bias). CONCLUSIONS: Current evidence supports adjunctive use of SAMe, methylfolate, omega-3, and vitamin D with antidepressants to reduce depressive symptoms.

Li, H., Sun, D., Wang, A., Pan, H., Feng, W., Ng, C. H., ... & Xiang, Y. T. (2019). Serum 25-Hydroxyvitamin D levels and depression in older adults: A dose-response meta-analysis of prospective cohort studies. The American Journal of Geriatric Psychiatry, 27(11), 1192-1202. Available here.