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Objectives: The paper identifies types of work-family trajectories of men and women and investigates their links with depression at older age. Method: We use data from the Heinz Nixdorf Recall study, with retrospective information on employment histories and parenthood between age 20 and 50 (1482 men and 1537 women, born between 1925 and 1955). We apply sequence analysis and group trajectories into six clusters for each gender. We test their association with two alternative measures of depression: self-reported depressive symptoms and intake of antidepressant medication. Multivariate models exclude participants with early life depression and adjust for age, marital status, education, and income. Results: We find clear differences of work-family trajectories between men and women, where women's trajectories are generally more diverse, and include family leaves and returns into full or part-time work. For men, work-family trajectories are neither related to depressive symptoms nor to medication intake. In contrast, women who returned into full-time work after family leave show more depression than those who return part-time, both in terms of depressive symptoms and intake of antidepressant medication. Conclusion: Our findings show gender differences in terms of work-family trajectories and their health-related consequences. In particular, findings suggest that mothers who return to full-time work are a vulnerable group for depression at older age and should be the focus of further research attention. [ABSTRACT FROM AUTHOR]

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In this article the author talks about Neurotoxicity and neuropathic pain which relative common side effects of antineoplastic chemotherapies. Topics discussed include the use of specific drugs to treat and, desirably, to prevent these effects is extremely important in order to offer an acceptable quality of life for the patients, and its application revealing hidden information useful for increase knowledge about patients' management and for personalized medicine.

Depressive disorders are a focus of growing social and economic concern. While antidepressant medications are widely accepted, they are ineffective for nearly 40% of users, and cause numerous adverse drug reactions. The pharmacogenomics of depression attempts to better understand the role of genetic variation in antidepressant metabolism in the hope of improving drug efficacy and tolerability. However, the development and delivery of genome-based antidepressants face many hurdles. In this paper we provide an overview of the potential impact of the pharmacogenomics of depression on public mental health care by focusing on the social and ethical issues at stake. These include questions about genetic testing, informed consent, drug access, and market fragmentation. We end the paper with a brief discussion of the wider context and how the pharmacogenomics of depression relates to broader trends in psychiatry and biomedicine. [ABSTRACT FROM AUTHOR]

The objective of this systematic review was to evaluate the impact of pharmacist delivered community-based services to optimise the use of medications for mental illness. Twenty-two controlled (randomised and non-randomised) studies of pharmacists' interventions in community and residential aged care settings identified in international scientific literature were included for review. Papers were assessed for study design, service recipient, country of origin, intervention type, number of participating pharmacists, methodological quality and outcome measurement. Three studies showed that pharmacists' medication counselling and treatment monitoring can improve adherence to antidepressant medications among those commencing treatment when calculated using an intention-to-treat analysis. Four trials demonstrated that pharmacist conducted medication reviews may reduce the number of potentially inappropriate medications prescribed to those at high risk of medication misadventure. The results of this review provide some evidence that pharmacists can contribute to optimising the use of medications for mental illness in the community setting. However, more well designed studies are needed to assess the impact of pharmacists as members of community mental health teams and as providers of comprehensive medicines information to people with schizophrenia and bipolar disorder [ABSTRACT FROM AUTHOR]

The paper presents major ethical, legal and methodological problems related to the use of placebo in mental disorders, especially in depression. It is pointed out that although authoritative groups of experts and numerous publications in the field of psychopharmacology indicate advisability of the double blind design with placebo in clinical trials of antidepressants, in recent years there have been more and more voices questioning legitimacy of this method. Objections of an ethical nature are raised, and reliability of this approach is put into doubt from the methodological viewpoint. These issues are discussed in more detail in the paper. Available alternative solutions should be implemented in psychotropic drug studies. The author shares these objections and doubts of an ethical nature, and believes that the placebo procedure is not a necessity in clinical trials of antidepressants. [ABSTRACT FROM AUTHOR]

In today's modern society, it seems to be more and more challenging to cope with life stresses. The effect of psychological stress on emotional and physical health can be devastating, and increased stress is associated with increased rates of heart attack, hypertension, obesity, addiction, anxiety and depression. This review focuses on the possibility of an influence of psychological stress on the metabolism of selected antidepressants (TCAs, SSRIs, SNRIs, SARIs, NDRIs a MMAs) and anxiolytics (benzodiazepines and azapirone), as patients treated with antidepressants and/or anxiolytics can still suffer from psychological stress. Emphasis is placed on the drug metabolism mediated by the enzymes of Phase I, typically cytochromes P450 (CYPs), which are the major enzymes involved in drug metabolism, as the majority of psychoactive substances are metabolized by numerous CYPs (such as CYP1A2, CYP2B6, CYP2C19, CYP2C9, CYP2A6, CYP2D6, CYP3A4). As the data on the effect of stress on human enzymes are extremely rare, modulation of the efficacy and even regulation of the biotransformation pathways of drugs by psychological stress can be expected to play a significant role, as there is increasing evidence that stress can alter drug metabolism, hence there is a risk of less effective drug metabolism and increased side effects.

This article discusses the use of antidepressants in the treatment of central serous chorioretinopathy (CSCR) associated with stress. The authors highlight the psychological associations in CSCR patients and emphasize the role of stress and anxiety in worsening the disease. They conducted a study in which CSCR patients were treated with a combination of escitalopram and clonazepam, resulting in rapid resolution of subretinal fluid and visual improvement. The authors also mention other ocular disorders that have an underlying stressor. The article concludes by emphasizing the importance of treating the underlying psychiatric illness and reducing stress through lifestyle modifications. [Extracted from the article]

Compared with placebo + antidepressants, esketamine + antidepressants significantly improved remission in patients with treatment-resistant depression (RR = 1.39, 95% CI 1.18 to 1.63, P < 0.0001) (Figure 5). All of them were conducted in the last 3 years, the treatment phase of the patients was a double-blind induction treatment period, and the patients were all treated with conventional antidepressants combined with esketamine or placebo. Efficacy and safety of fixed doses of intranasal esketamine as an add-on therapy to oral antidepressants in Japanese patients with treatment-resistant depression: a phase 2b randomized clinical study. Compared with the control group, esketamine + antidepressant significantly improved the response to antidepressants in patients with treatment-resistant depression (RR = 1.28, 95% CI 1.12 to 1.46, P = 0.0002) (Figure 4). [Extracted from the article]

Supplemental Digital Content is Available in the Text. Background: Studies suggest that manualized, measurement-guided, depression treatment is more efficacious than usual care but impact can wane. Our study among youth with HIV (YWH), aged 12–24 years at US clinical research sites in the International Maternal Pediatric Adolescent AIDS Clinical Trials Network, found a significant reduction in depressive symptoms among YWH who received a manualized, measurement-guided treatment. This paper reports outcomes up to 24 weeks after the intervention. Methods: Eligibility included diagnosis of ongoing nonpsychotic depression. Using restricted randomization, sites were assigned to either combination cognitive behavioral therapy and medication management algorithm tailored for YWH or to enhanced standard of care, which provided psychotherapy and medication management. Site-level mean Quick Inventory for Depression Symptomatology Self-Report (QIDS-SR) scores and proportion of youth with treatment response (>50% decrease from baseline) and remission (QIDS-SR ≤ 5) were compared across arms using t tests. Results: Thirteen sites enrolled 156 YWH, with baseline demographic factors, depression severity, and HIV disease status comparable across arms. At week 36, the site-level mean proportions of youth with a treatment response and remission were greater at combination cognitive behavioral therapy and medication management algorithm sites (52.0% vs. 18.8%, P = 0.02; 37.9% vs. 19.4%, P = 0.05), and the mean QIDS-SR was lower (7.45 vs. 9.75, P = 0.05). At week 48, the site-level mean proportion with a treatment response remained significantly greater (58.7% vs. 33.4%, P = 0.047). Conclusions: The impact of manualized, measurement-guided cognitive behavioral therapy and medication management algorithm tailored for YWH that was efficacious at week 24 continued to be evident at weeks 36 and 48. [ABSTRACT FROM AUTHOR]

In today's society, people with poor mental ability are prone to neuropsychiatric diseases such as anxiety, ADHD, and depression due to long-term negative emotions. Although conventional Western medicine has certain curative effect, these drugs have significant anticholinergic side effects central toxicity as well as cardiovascular and gastrointestinal side effects which limit their application in the elderly. At present, several antidepressants used in clinic have certain limitations. According to the symptoms of depression, this paper proposes a feedback emotion regulation method of brain-computer interface music therapy. This method uses special music stimulation to regulate the release of inhibiting sex hormones in the body, reduce the influence of negative emotions on the internal environment of the body, and maintain the steady state of the body. In this method, EEG is used as the emotional control signal of depressed patients, and this biological signal is transformed into music that depressed patients can understand, so as to clarify their physiological and psychological state and realize emotional self-regulation by feedback. [ABSTRACT FROM AUTHOR]

Purpose – The management of individuals with autism spectrum disorders (ASDs) requires a multimodal approach of behavioural, educational and pharmacological treatments. At present, there are no available drugs to treat the core symptoms of ASDs and therefore a wide range of psychotropic medications are used in the management of problems behaviours, co-occurring psychiatric disorders and other associated features. The purpose of this paper is to map the literature on pharmacological treatment in persons with ASD in order to identify those most commonly used, choice criteria, and safety. Design/methodology/approach – A systematic mapping of the recent literature was undertaken on the basis of the following questions: What are the most frequently used psychoactive compounds in ASD? What are the criteria guiding the choice of a specific compound? How effective and safe is every psychoactive drug used in ASD? The literature search was conducted through search engines available on Medline, Medmatrix, NHS Evidence, Web of Science and the Cochrane Library. Findings – Many psychotropic medications have been studied in ASDs, but few have strong evidence to support their use. Most commonly prescribed medications, in order of frequency, are antipsychotics, antidepressants, anticonvulsants and stimulants, many of them without definitive studies guiding their usage. Recent animal studies can be useful models for understanding the common pathogenic pathways leading to ASDs, and have the potential to offer new biologically focused treatment options. Originality/value – This is a practice review paper applying recent evidence from the literature. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to provide a comprehensive overview of the current knowledge regarding chronic hepatitis C (CHC) infection, antiviral therapy, depression, and gender. Design/methodology/approach – CHC and its treatment options were reviewed examining their relationship with depression and gender. Findings – CHC is a high prevalent chronic infection worldwide, being similar in men and women. However, the infection shows many gender differences in terms of innate response, genetic variability (i.e. IL-28B), route of transmission (i.e. intravenous drug use), disease progression (i.e. fibrosis), lifetime period (i.e. pregnancy), and risk factors (i.e. HIV). Both the hepatitis C infection and antiviral treatment (especially when using the pro-inflammatory cytokine interferon α), are highly associated with depression, where female gender constitutes a risk factor. It seems that the new direct-acting antiviral combinations produce fewer neuropsychiatric side effects. In fact, the presence of depression at baseline is no longer a limitation for the initiation of antiviral treatment. Antidepressant drugs have been recommended as current depression and prophylactic treatment in risk subgroups. However, caution should be exercised due to the risk of drug-drug interactions with some antiviral drugs. Women should be counselled prenatal, during and after pregnancy, taking into account the clinical situation, and the available evidence of the risks and benefits of antiviral and antidepressant treatments. Multidisciplinary approach shows cost-efficacy results. Originality/value – The paper clarifies the complex management of CHC therapy and the importance of individualizing treatment. The results also underline the need for an integrated multidisciplinary approach. [ABSTRACT FROM AUTHOR]

Depression and Parkinson's disease share pathogenetic characteristics, meaning that they can impact each other and exacerbate their respective progression. From a pathogenetic perspective, depression can develop into Parkinson's disease and is a precursor symptom of Parkinson's disease; Parkinson's disease is also often accompanied by depression. From a pharmacological perspective, the use of antidepressants increases the risk of developing Parkinson's disease, and therapeutic medications for Parkinson's disease can exacerbate symptoms of depression. Therefore, identifying how Parkinson's disease and depression impact each other in their development is key to formulating preventive measures and targeted treatment. One commonality in the pathogenesis of depression and Parkinson's disease are alterations in the gut microbiota, with mechanisms interacting in neural, immune inflammatory, and neuroendocrine pathways. This paper reviews the role of gut microbiota in the pathogenesis of depression and Parkinson's disease; conducts a study of the relationship between both conditions and medication; and suggests that dysregulated gut microbiota may be a key factor in explaining the relationship between Parkinson's disease and depression. Finally, on the basis of these findings, this article hopes to provide suggestions that new ideas for the prevention and treatment of depression and Parkinson's disease. • There is a pathogenetic of interaction between depression and Parkinson 's disease. • The interaction mechanism is related to similar changes in the gut microbiota. • Dysregulated gut microbiota play a role in neural, immune, and endocrine pathways. • Drugs cause the interaction between the two diseases by affecting the gut microbiota. [ABSTRACT FROM AUTHOR]

Major depressive disorder (MDD) is a complex and devastating illness that affects people of all ages. Despite the large use of antidepressants in current medical practice, neither their mechanisms of action nor the aetiology of MDD are completely understood. Experimental evidence supports the involvement of Parvalbumin-positive GABAergic neurons (PV-neurons) in the pathogenesis of MDD. DLX5 and DLX6 (DLX5/6) encode two homeodomain transcription factors involved in cortical GABAergic differentiation and function. In the mouse, the level of expression of these genes is correlated with the cortical density of PV-neurons and with anxiety-like behaviours. The same genomic region generates the lncRNA DLX6-AS1, which, in humans, participates in the GABAergic regulatory module downregulated in schizophrenia and ASD. Here, we show that the expression levels of Dlx5/6 in the adult mouse brain are correlated with the immobility time in the forced swim test, which is used to measure depressive-like behaviours. We show that the administration of the antidepressant fluoxetine (Flx) to normal mice induces, within 24 h, a rapid and stable reduction in Dlx5, Dlx6 and Dlx6-AS1 expression in the cerebral cortex through the activation of the TrkB-CREB pathway. Experimental Dlx5 overexpression counteracts the antidepressant effects induced by Flx treatment. Our findings show that one of the short-term effects of Flx administration is the reduction in Dlx5/6 expression in GABAergic neurons, which, in turn, has direct consequences on PV expression and on behavioural profiles. Variants in the DLX5/6 regulatory network could be implicated in the predisposition to depression and in the variability of patients' response to antidepressant treatment. [ABSTRACT FROM AUTHOR]

Aim: To determine the efficacy and safety of pharmacogenomics (PGx)-guided antidepressant prescribing in patients with depression through an umbrella review and updated meta-analysis. Methods: A comprehensive systematic search was conducted on PsycINFO, PubMed, Embase and the Cochrane databases. The pooled effect sizes of randomized controlled trials (RCTs) were expressed as mean differences for continuous data and risk ratios for noncontinuous data. Results: Patients who received PGx-guided medications were 41% to 78% more likely to achieve remission and 20% to 49% more likely to respond to antidepressants than patients receiving treatment-as-usual (TAU). Conclusion: PGx-guided antidepressant prescribing improves the treatment of depression. However, the significance and magnitude of the benefit varies widely between studies and different PGx testing panels. [ABSTRACT FROM AUTHOR]

Alzheimer's Disease (AD) is the prevailing type of neurodegenerative illness, characterised by the accumulation of amyloid beta plaques. The symptoms associated with AD are memory loss, emotional variability, and a decline in cognitive functioning. To date, the pharmaceuticals currently accessible in the marketplace are limited to symptom management. According to several research, antidepressants have demonstrated potential efficacy in the management of AD. In this particular investigation, a total of 24 anti-depressant medications were selected as ligands, while the Microtubule Affinity Receptor Kinase 4 (MARK4) protein was chosen as the focal point of our study. The selection of MARK4 was based on its known involvement in the advancement of AD and other types of malignancies, rendering it a highly prospective target for therapeutic interventions. The initial step involved doing ADMET analysis, which was subsequently followed by molecular docking of 24 drugs. This was succeeded by molecular dynamics simulation and molecular mechanics generalised Born surface area (MMGBSA) calculations. Upon conducting molecular docking experiments, it has been determined that the binding affinities observed fall within the range of -5.5 kcal/mol to -9.0 kcal/mol. In this study, we selected six anti-depressant compounds (CID ID ‐ 4184, 2771, 4205, 5533, 4543, and 2160) based on their binding affinities, which were determined to be -9.0, -8.7, -8.4, -8.3, -8.2, and -8.2, respectively. Molecular dynamics simulations were conducted for all six drugs, with donepezil serving as the control drug. Various analyses were performed, including basic analysis and post-trajectory analysis such as free energy landscape (FEL), polarizable continuum model (PCM), and MMGBSA calculations. Based on the findings from molecular dynamics simulations and the MMGBSA analysis, it can be inferred that citalopram and mirtazapine exhibit considerable potential as anti-depressant agents. Consequently, these compounds warrant further investigation through in vitro and in vivo investigations in the context of treating AD. [ABSTRACT FROM AUTHOR]

Background: Adverse events (AEs) are commonly reported in clinical studies using the Medical Dictionary for Regulatory Activities (MedDRA), an international standard for drug safety monitoring. However, the technical language of MedDRA makes it challenging for patients and clinicians to share understanding and therefore to make shared decisions about medical interventions. In this project, people with lived experience of depression and antidepressant treatment worked with clinicians and researchers to co-design an online dictionary of AEs associated with antidepressants, taking into account its ease of use and applicability to real-world settings. Methods: Through a pre-defined literature search, we identified MedDRA-coded AEs from randomised controlled trials of antidepressants used in the treatment of depression. In collaboration with the McPin Foundation, four co-design workshops with a lived experience advisory panel (LEAP) and one independent focus group (FG) were conducted to produce user-friendly translations of AE terms. Guiding principles for translation were co-designed with McPin/LEAP members and defined before the finalisation of Clinical Codes (CCs, or non-technical terms to represent specific AE concepts). FG results were thematically analysed using the Framework Method. Results: Starting from 522 trials identified by the search, 736 MedDRA-coded AE terms were translated into 187 CCs, which balanced key factors identified as important to the LEAP and FG (namely, breadth, specificity, generalisability, patient-understandability and acceptability). Work with the LEAP showed that a user-friendly language of AEs should aim to mitigate stigma, acknowledge the multiple levels of comprehension in 'lay' language and balance the need for semantic accuracy with user-friendliness. Guided by these principles, an online dictionary of AEs was co-designed and made freely available (https://thesymptomglossary.com). The digital tool was perceived by the LEAP and FG as a resource which could feasibly improve antidepressant treatment by facilitating the accurate, meaningful expression of preferences about potential harms through a shared decision-making process. Conclusions: This dictionary was developed in English around AEs from antidepressants in depression but it can be adapted to different languages and cultural contexts, and can also become a model for other interventions and disorders (i.e., antipsychotics in schizophrenia). Co-designed digital resources may improve the patient experience by helping to deliver personalised information on potential benefits and harms in an evidence-based, preference-sensitive way. [ABSTRACT FROM AUTHOR]

Diabetes mellitus is a lifelong metabolic disorder that impacts people's well-being and biopsychosocial status. Psychiatric problems and diabetes mellitus have a complex, reciprocal interaction in which one condition affects the other. In this narrative review, we provide an overview of the literature on the psychological effects of diabetes, expound on the evaluation of emotional disorders in the setting of diabetes, and suggest interventions aimed at enhancing both mental and physical health. Diabetes can make daily life complicated and stressful. Frequent blood glucose testing, taking medications on a regular basis, adhering to a tight diet plan, and exercising are some examples of the suggested daily routine of subjects with diabetes. Furthermore, comorbid diseases and typical diabetic complications can have a detrimental impact on quality of life. When mental health conditions coexist with diabetes mellitus, there is a greater likelihood of medication noncompliance, a decreased commitment to diabetes-related self-care, increased functional impairment, inadequate glycemic control, a higher risk of complications, and overall higher healthcare expenses. Thus, evaluation of the mental health status of patients with diabetes is crucial. When treating psychological issues and psychiatric disorders, a comprehensive biopsychosocial approach should be taken, and where appropriate, psychopharmacological therapies or psychotherapy should be applied. The goal of continuous education and assistance for self-care is to give individuals with the disease the information and abilities they need to control their condition over time. [ABSTRACT FROM AUTHOR]

Background: The Clinical Dementia Rating Scale Sum of Boxes (CDRSOB) score is known to be highly indicative of cognitive-functional status and is regularly employed for clinical and research purposes. Objective: Our aim is to determine whether CDRSOB is consistent with clinical diagnosis in evaluating drug class associations with risk of progression to mild cognitive impairment (MCI) and dementia. Methods: We employed weighted Cox regression analysis on longitudinal NACC data, to identify drug classes associated with disease progression risk, using clinical diagnosis and CDRSOB as the outcome. Results: Aspirin (antiplatelet/NSAID), angiotensin II inhibitors (antihypertensive), and Parkinson's disease medications were significantly associated with reduced risk of progression to MCI/dementia and Alzheimer's disease medications were associated with increased MCI-to-Dementia progression risk with both clinical diagnosis and CDRSOB as the outcome. However, certain drug classes/subcategories, like anxiolytics, antiadrenergics, calcium (Ca2+) channel blockers, and diuretics (antihypertensives) were associated with reduced risk of disease progression, and SSRIs (antidepressant) were associated with increased progression risk only with CDRSOB. Additionally, metformin (antidiabetic medication) was associated with reduced MCI-to-Dementia progression risk only with clinical diagnosis as the outcome. Conclusions: Although the magnitude and direction of the effect were primarily similar for both diagnostic outcomes, we demonstrate that choice of diagnostic measure can influence the significance of risk/protection attributed to drug classes and consequently the conclusion of findings. A consensus must be reached within the research community with respect to the most accurate diagnostic outcome to identify risk and improve reproducibility. [ABSTRACT FROM AUTHOR]

Objectives: Individuals who die by suicide often consult their general practitioners (GPs) in their final weeks of life. The aim of this study was to gain a deeper knowledge of the clinical characteristics and GP assessments and treatments among individuals who consulted their GPs during the month preceding suicide. Further, we compared these features in those with and without contact with psychiatric services (PC and NPC, respectively) during the two years that preceded the suicide. Design: A nationwide retrospective explorative study investigating medical records. Setting: Primary care in Sweden. Participants: Individuals who died by suicide in Sweden in 2015 with a GP visit within 30 days of death. Results: The study cohort corresponds to one fifth (n = 238) of all suicides that occurred in Sweden in 2015 (n = 1179), representing all those with available primary care records showing contact with a GP during the final 30 days of life (NPC: n = 125; PC: n = 113). The mean age was 58 years ± 19. Patients in the NPC group were older (NPC: 63 years ± 19 vs. PC: 53 years ± 18, p < 0.0001) and presented psychiatric symptoms less often (NPC: 50% vs. PC: 67%, p < 0.006). Somatic symptoms were as common as psychiatric symptoms for the whole sample, being present in more than half of individuals. Suicide risk was noted in only 6% of all individuals. Referral to psychiatric services occurred in 14%, less commonly for the NPC group (NPC: 6% vs. PC: 22%, p < 0.001). Cardiovascular or respiratory symptoms were noted in 19%, more often in the NPC group (NPC: 30% vs. PC: 6%, p < 0.001), as were diagnoses involving the circulatory system (all 10%, NPC:14% vs. PC: 5%, p < 0.020). Conclusion: A high level of somatic symptoms was observed in primary care patients both with and without psychiatric contact, and this might have influenced GPs' management decisions. Psychiatric symptoms were noted in two thirds of those with psychiatric contact but only half of those without. While GPs noted psychiatric symptoms in over half of all individuals included in the study, they seldom noted suicide risk. These findings highlight the need for increased attention to psychiatric symptoms and suicide risk assessment, particularly among middle-aged and older individuals presenting with somatic symptoms. Strengths and limitations of this study: The National Cause of Death Register has excellent coverage of suicide deaths and access to medical records was very good. The medical record review provided detailed information regarding primary care utilization before death by suicide. Because of the lack of statistical power, due to the limited number of persons with GP contact during the last month of life, we chose not to correct for multiple comparisons. Our study approach did not capture the reasons behind GPs' documentation of elevated suicide risk. No systematic inter-rater reliability (IRR) testing was made, however, reviewers received training and continuous support from the research group. [ABSTRACT FROM AUTHOR]

Importance: Approximately 9% of US adults experience major depression each year, with a lifetime prevalence of approximately 17% for men and 30% for women. Observations: Major depression is defined by depressed mood, loss of interest in activities, and associated psychological and somatic symptoms lasting at least 2 weeks. Evaluation should include structured assessment of severity as well as risk of self-harm, suspected bipolar disorder, psychotic symptoms, substance use, and co-occurring anxiety disorder. First-line treatments include specific psychotherapies and antidepressant medications. A network meta-analysis of randomized clinical trials reported cognitive therapy, behavioral activation, problem-solving therapy, interpersonal therapy, brief psychodynamic therapy, and mindfulness-based psychotherapy all had at least medium-sized effects in symptom improvement over usual care without psychotherapy (standardized mean difference [SMD] ranging from 0.50 [95% CI, 0.20-0.81] to 0.73 [95% CI, 0.52-0.95]). A network meta-analysis of randomized clinical trials reported 21 antidepressant medications all had small- to medium-sized effects in symptom improvement over placebo (SMD ranging from 0.23 [95% CI, 0.19-0.28] for fluoxetine to 0.48 [95% CI, 0.41-0.55] for amitriptyline). Psychotherapy combined with antidepressant medication may be preferred, especially for more severe or chronic depression. A network meta-analysis of randomized clinical trials reported greater symptom improvement with combined treatment than with psychotherapy alone (SMD, 0.30 [95% CI, 0.14-0.45]) or medication alone (SMD, 0.33 [95% CI, 0.20-0.47]). When initial antidepressant medication is not effective, second-line medication treatment includes changing antidepressant medication, adding a second antidepressant, or augmenting with a nonantidepressant medication, which have approximately equal likelihood of success based on a network meta-analysis. Collaborative care programs, including systematic follow-up and outcome assessment, improve treatment effectiveness, with 1 meta-analysis reporting significantly greater symptom improvement compared with usual care (SMD, 0.42 [95% CI, 0.23-0.61]). Conclusions and Relevance: Effective first-line depression treatments include specific forms of psychotherapy and more than 20 antidepressant medications. Close monitoring significantly improves the likelihood of treatment success. This narrative review uses data from network meta-analyses and systematic reviews to explore the prevalence, diagnosis, and treatment of major depression in US adults, including specific forms of psychotherapy and more than 20 antidepressant medications. [ABSTRACT FROM AUTHOR]

Creatine is a naturally occurring compound found in muscles that plays a vital role in energy metabolism. It has been shown to have beneficial effects on skeletal muscle function and exercise performance, but recent studies have investigated its potential role in various fields of medicine. The study aimed to analyze accessible literature and illustrate the current state of knowledge on the use of creatine in these settings, as well as make predictions for further research. A link between low creatine concentrations and poorer mental well-being has been proven in the central nervous system. After many studies and insightful conclusions about the molecular mechanisms of action of creatine in the brain and the finding that it acts as a neurotransmitter, creatine began to be successfully studied as an antidepressant - both in monotherapy and as an adjunct to treatment with SSRI drugs. Years of research have shown creatine to act in various, not fully understood mechanisms on the course and recovery of stroke. The use of creatine as an additional treatment in stroke prevention for at-risk groups and rehabilitation of stroke patients seems possible shortly. One of the most important aspects of chronic heart failure is metabolic dysfunction that occurs in cardiomyocytes, including impairment of CR/PCR/ATP shuttle. Multiple studies undertaking the role of creatine supplementation in patients with cardiovascular diseases present various findings. Therefore, creatine appears as a promising substance with supportive effects in the above-mentioned conditions; however, further research is needed to confirm that the benefit outweighs the risks. [ABSTRACT FROM AUTHOR]

Obesity is a significant clinical problem worldwide, posing an increasing challenge for both physicians and patients each year. Its complications affect physical and mental health, as well as social and economic consequences. The disease exhibits remarkable heterogeneity, leading to diverse pathogenesis among individuals. Despite a growing selection of weight -reducing medications and increased awareness of the importance of a healthy lifestyle, the effectiveness of obesity therapy often remains insufficient. This raises the question of whether tailoring obesity pharmacotherapy to specific phenotypes and individual patient characteristics results in improved treatment outcomes. Objective: To review literature on the effectiveness of obesity treatment based on the personalization of pharmacotherapy according to its underlying causes. Current Knowledge: Currently, the early outcome of weight loss is closely linked to the long-term effectiveness of obesity pharmacotherapy. However, due to the diversity of obesity pathogenesis, it is not helpful in selecting therapy at the initiation of treatment. Specific characteristics are sought to indicate the appropriate drug during therapy planning. In a U.S. study (Acosta et al., 2021), four obesity phenotypes were identified through relevant tests: "brain hunger," "intestinal hunger," "emotional hunger," and "slow burning." Subsequently, treatments were matched accordingly: phentermine with topiramate or lorcaserin, liraglutide, bupropion with naltrexone, and monotherapy with phentermine. The analysis results showed that phenotype-guided obesity pharmacotherapy resulted in clinically significant absolute weight loss of >10%, >15%, and >20% in 79%, 43%, and 30% of patients, respectively, after one year, compared to 35%, 17%, and 8% in the non-phenotyped group. Other studies demonstrated that for very rare types of obesity dependent on specific genetic mutations, targeted treatment addressing these defects yielded the best therapeutic outcomes (recombinant human leptin therapy for patients with leptin gene mutation - Farooqi et al., 2002; setmelanotide therapy for individuals with proopiomelanocortin deficiency - Clément et al., 2020). The impact of specific gene variants on therapeutic response should also be considered, leading to variability in treatment effects for different patients using the same drug. Conclusion: The concept of basing therapy on obesity phenotypes may currently serve as a guide for treatment selection, although it still requires confirmation in randomized clinical trials. Individualizing the choice of pharmacotherapy must primarily be based on the comprehensive patient picture: their preferences, contraindications, or coexisting conditions, with consideration of depression and the influence of antidepressant medications on body weight. [ABSTRACT FROM AUTHOR]

Objective: In this review, the authors update the 2018 position statement of the American Psychiatric Association Council of Research Workgroup on Biomarkers and Novel Treatments on pharmacogenomic (PGx) tools for treatment selection in depression. Methods: The literature was reviewed for new clinical trials and meta-analyses, published from 2017 to 2022, of studies using PGx tools for treatment selection in depression. The blinding and control conditions, as well as primary and secondary outcomes and post hoc analyses, were summarized. Results: Eleven new clinical trials and five meta-analyses were identified; all studies had primary outcome measures related to speed or efficacy of treatment response. Three trials (27%) demonstrated efficacy on the primary outcome measure with statistical significance; the three studies used different PGx tools; one study was open-label and the other two were small single-blind trials. Five trials (45%) did not detect efficacy with statistical significance on either primary or secondary outcome measures. Only one trial (9%) used adverse events as a primary outcome measure. All studies had significant limitations; for example, none adopted a fully blinded study design, only two studies attempted to blind the treating clinician, and none incorporated measures to estimate the effectiveness of the blinds or the influence of lack of blinding on the study results. Conclusions: The addition of these new data do not alter the recommendations of the 2018 report, or the advice of the U.S. Food and Drug Administration, that the evidence does not support the use of currently available combinatorial PGx tools for treatment selection in major depressive disorder. Priority efforts for future studies and the development and testing of effective tools include fully blinded study designs, inclusion of promising genetic variants not currently included in any commercially available tests, and investigation of other uses of pharmacogenomics, such as estimating the likelihood of rare adverse drug effects, rather than increasing the speed or magnitude of drug response. [ABSTRACT FROM AUTHOR]

Within the bipolar world, there is a chronic gnashing of teeth among experts, decrying clinicians' poor ability to diagnose bipolar disorder early in the course of the disorder. The feared consequence of this delayed diagnosis is risking a greater number of episodes early in adult life and increasing the likelihood of prescriptions of antide-pressants without mood stabilizers with their attendant risks when taken by those diagnosed as having unipolar depression but who are latently bipolar. These papers typically point to the long time frame from initial depressive symptoms to the proper bipolar diagnosis, usually measured in many years if not a decade or more. Clinicians are then usually urged to be more vigilant in ferreting out subtle hypomanic symptoms and looking for predictors of bipolar outcome. The treatment implication of making this earlier, accurate diagnosis of bipolar disorder would be to institute mood stabilizers and (presumably) to avoid antidepressants. Of course, in order to follow these recommendations, predictors of bipolar outcome among depressed patients must be established and validated across studies. [ABSTRACT FROM AUTHOR]

Reboxetine is a selective noradrenaline (norepinephrine) reuptake inhibitor, the first drug of a new antidepressant class. Most clinical studies of reboxetine were of 4 to 8 weeks’ duration and are published in summary papers; only a few trials have been published in full. This prevents accurate determination of the efficacy and tolerability of reboxetine because data are limited for some studies. Nevertheless, reboxetine (usually 4 to 10 mg/day) generally has significantly greater efficacy than placebo, similar efficacy to the selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitor (SSRI) fluoxetine and appears at least as effective as the tricyclic antidepressants desipramine and imipramine. Some evidence suggests that, compared with fluoxetine, reboxetine may be more effective in severely depressed patients and at improving social behaviour. This requires confirmation, as do limited long term data suggesting that reboxetine may prevent relapse in patients who respond to short term therapy. Reboxetine recipients generally have a lower incidence of dry mouth and blurred vision than desipramine recipients and are less likely to experience dry mouth, somnolence, hypotension-related symptoms and tremor than patients treated with imipramine, according to short term tolerability data. Compared with fluoxetine, reboxetine causes fewer events typical of SSRIs (nausea and related symptoms and diarrhoea) and less somnolence but is associated with more anticholinergic-type events, paraesthesia, flushing and hypotension. Constipation, urinary hesitancy or retention, hypertension and rash are reported more frequently with long term reboxetine therapy than with placebo. Urinary retention or hesitancy in males is the only event that is more common with long term than with short term reboxetine therapy in placebo-controlled trials. Conclusions: In summary, reboxetine is the first of a new class of antidepressants, the selective noradrenaline reuptake inhibitors. As reported predominantly in summary papers, reboxetine appears to be at least as effective as the tricyclic antidepressants desipramine and imipramine and similar in efficacy to the SSRI fluoxetine after short term therapy. Reboxetine may also improve social functioning, an important corollary of depression. However, clarification of this point, and of its comparative efficacy and tolerability and ability to prevent relapse is required in fully reported and well designed trials before its role can be established definitively. Nevertheless, with its selective mechanism of action and acceptable tolerability profile, reboxetine can be considered a promising new agent for the treatment of depression. [ABSTRACT FROM AUTHOR]

This paper documents the meanings attached to taking anti-depressant medications. In depth interview materials from a sample of persons diagnosed and treated for depression suggest that taking doctor-prescribed drugs involves an extensive interpretive process about the meanings of having an emotional "illness." The data and analysis extend previous studies on the meanings of taking psychotropic drugs by showing how those meanings change over the course of the depression "career." An individual's changing responses to psychiatric medications can be described as a socialization process having radical implications for self definition. The four stages constituting this socialization process and central to the analysis in the paper are: resistance, trial commitment, conversion, and disenchantment. Each of these stages is discussed in terms of its impact on personal identity. The implications of the presented data for challenges to the medical model are discussed. [ABSTRACT FROM AUTHOR]

Deborah Robertson provides an overview of recently published articles that may be of interest to non-medical prescribers. Should you wish to look at any of the papers in more detail, a full reference is provided [ABSTRACT FROM AUTHOR]

A simple, eco‐friendly, accurate and inexpensive pencil graphite electrode (PGE) was utilized for the quantitative determination of Vilazodone hydrochloride (VLZ) by Square wave voltammetric (SWV) method. Optimum electrochemical performance of the electrode was achieved by optimizing the pH of the measuring solution, the rate of potential scan and the time of accumulation onto the electrode surface. The SWV showed linearity over the concentration range of 9.99×10−9 to 9.78×10−7 M, with LOD of 6.4×10−9 M. This method was applied to evaluate VLZ in pharmaceutical preparation and spiked plasma with %recovery± RSD of 99.99±0.41 and 99.40±1.36, respectively. [ABSTRACT FROM AUTHOR]

Tics are one of the most common neuropsychiatric disturbances in children and adolescents. This paper reviews tic disorder definition, epidemiology, differential diagnosis, and co-morbidity. The major emphasis is on current principles of psychopharmacologic management of tic disorders in children and adolescents. Chronic motor tic disorder and Tourette's syndrome typically require the use of psychopharmacologic agents that traditionally have included haloperidol, pimozide, and clonidine. Risperidone and aripiprazole are now preferred by many to haloperidol. A variety of other medications have been used to ameliorate tics, but with less anecdotal and research support. The safe and effective treatment of Tourette's disorder, and other tic disorders, is based on a logical hierarchy of interventions, from cognitive and behavioral therapies to pharmacologic agents. Thus, it is important for clinicians caring for pediatric patients to have knowledge of the various medications used to ameliorate tics. [ABSTRACT FROM AUTHOR]

Depression is one of the most commonly diagnosed and debilitating illness in the United States (US) (AADD, 2018; NIH, 2018) and it afflicts over 300 million people around the world (WHO, 2018). Though genetics, biological make-up, environment, and psychological factors play a role in the predisposition of depression, it crosses all ages, racial/ethnic groups, and socioeconomical status (NIH, 2018). Depression incidence has cost the U.S over 67 billion in direct cost of Medicare resulting in occupational injury and morbidity (Asfaw & Souza, 2012). Although patients experience many recurrent episodes, Major Depressive Disorder (MDD) is the "most common mood disorder having at least one single major depressive episode" (Stahl, p. 239). the purpose of this paper is to discuss and review current drugs and treatment for MDD. [ABSTRACT FROM AUTHOR]

Copyright of Anatolian Journal of Psychiatry / Anadolu Psikiyatri Dergisi is the property of Anatolian Journal of Psychiatry and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Studies of clinical populations that combine MRI data generated at multiple sites are increasingly common. The Canadian Biomarker Integration Network in Depression (CAN-BIND; www.canbind.ca) is a national depression research program that includes multimodal neuroimaging collected at several sites across Canada. The purpose of the current paper is to provide detailed information on the imaging protocols used in a number of CAN-BIND studies. The CAN-BIND program implemented a series of platform-specific MRI protocols, including a suite of prescribed structural and functional MRI sequences supported by real-time monitoring for adherence and quality control. The imaging data are retained in an established informatics and databasing platform. Approximately 1300 participants are being recruited, including almost 1000 with depression. These include participants treated with antidepressant medications, transcranial magnetic stimulation, cognitive behavioural therapy and cognitive remediation therapy. Our ability to analyze the large number of imaging variables available may be limited by the sample size of the substudies. The CAN-BIND program includes a multimodal imaging database supported by extensive clinical, demographic, neuropsychological and biological data from people with major depression. It is a resource for Canadian investigators who are interested in understanding whether aspects of neuroimaging — alone or in combination with other variables — can predict the outcomes of various treatment modalities. [ABSTRACT FROM AUTHOR]

Precision medicine, in the sense of tailoring the choice of medical treatment to patients' pretreatment characteristics, is nowadays gaining a lot of attention. Preferably, this tailoring should be realized in an evidence-based way, with key evidence in this regard pertaining to subgroups of patients that respond differentially to treatment (i.e., to subgroups involved in treatment–subgroup interactions). Often a-priori hypotheses on subgroups involved in treatment–subgroup interactions are lacking or are incomplete at best. Therefore, methods are needed that can induce such subgroups from empirical data on treatment effectiveness in a post hoc manner. Recently, quite a few such methods have been developed. So far, however, there is little empirical experience in their usage. This may be problematic for medical statisticians and statistically minded medical researchers, as many (nontrivial) choices have to be made during the data-analytic process. The main purpose of this paper is to discuss the major concepts and considerations when using these methods. This discussion will be based on a systematic, conceptual, and technical analysis of the type of research questions at play, and of the type of data that the methods can handle along with the available software, and a review of available empirical evidence. We will illustrate all this with the analysis of a dataset comparing several anti-depressant treatments. [ABSTRACT FROM AUTHOR]

Copyright of Psihiatru.ro is the property of MEDICHUB MEDIA, S.R.L. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BACKGROUND: Millions of people are treated with antidepressants like selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs). This clinical practice is based on short-term trials that have exaggerated the benefits and underestimated the harms. We also know too little about long-term harms. AIM: To assess harms of SSRIs and SNRIs that persist after end of drug intake. METHODS: Systematic review of placebo-controlled randomised trials of any length in patients with a psychiatric diagnosis and a follow-up of at least six months. Our primary outcomes were mortality, functional outcomes, quality of life and core psychiatric events. We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials and checked the references for eligible articles. One researcher extracted data and another checked the data extraction. RESULTS: Our searches returned 9,153 unique records. We included 22 papers for 12 trials on SSRIs. Median intervention and follow-up periods were 15 and 52 weeks, respectively. Median number of randomised participants was 51; only two trials had a drop-out rate below 20%. Outcome reporting was less thorough during follow-up than for the intervention period and only two trials maintained the blind during follow-up. All authors concluded that the drugs were not beneficial in the long term. All trials reported harms outcomes selectively or did not report any. Only two trials reported on any of our primary outcomes (school attendance and number of heavy drinking days). CONCLUSION: The randomised trials currently available cannot be used to investigate persistent harms of antidepressants. [ABSTRACT FROM AUTHOR]

When developmental psychopathology emerged as a discipline in the late 1970s and early 1980s, its proponents were as careful to explain what it was not, as they were to define what it was (e.g. Sroufe & Rutter, 1984). In particular, they differentiated developmental psychopathology from child psychiatry, which is primarily concerned with the differential diagnosis, prognosis, and treatment of childhood disorders. In contrast, developmental psychopathology was defined as 'the study of the origins and course of individual patterns of behavioral maladaptation, whatever the age of onset, whatever the causes, whatever the transformations in behavioral manifestation, and however complex the course of the developmental pattern may be' (Sroufe & Rutter, 1984, p. 18). [ABSTRACT FROM AUTHOR]

Copyright of Journal of Psychiatry & Clinical Psychology / Psychiatria i Psychologia Kliniczna is the property of Medical Communications Sp. z o.o. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: Selective serotonin (5-HT) reuptake inhibitors (SSRIs) are amongst the most prescribed drugs worldwide not only for psychiatric conditions, but also for medical purposes. Converging data gathered throughout the decades following their development would indicate that SSRIs have a broader side effect profile than previously assumed. Therefore, the aim of the present paper was to to review available literature highlighting less common side effects emerging with their long-term use. Method: This systematic review, carried out according to PRISMA guidelines, was performed through searching electronic databases of PubMed, Google Scholar, Cochrane Library, Embase, MEDLINE, PsycINFO and Scopus. The keyword used was "SSRIs" combined with the following: "Side effects", or "Emotional blunting or flattening", or "Cognition", or "Neuroimaging", or "Bone", "or "Platelet aggregation", or "Bleeding". Results: The most common side effects, besides the classical ones described in the literature are represented by decreased emotional response to both adversive and pleasurable events, some cognitive impairments, bone fractures and prolonged overall bleeding time. Conclusions: After analyzing critically the available findings, it should be noted that only the so-called "emotional blunting" is supported by converging data, while results on cognitive impairment are extremely controversial, given some evidence showing that SSRIs may improve cognition. Similarly, no agreement exists on the detrimental effects of SSRIs on bone metabolism and coagulation. Large, prospective and long-term studies are needed to clarify the possible impact of SSRIs on emotions, cognitive functions, bone fractures and coagulation, as well to detect other possible still neglected side effects. [ABSTRACT FROM AUTHOR]

Purpose: Currently only one‐third of patients treated for depression enjoy complete remission of their negative symptoms. This paper explores ketamine research as it applies to understanding and treating mood illnesses. Conclusions: Ketamine's rapid antidepressant effect implicates downstream signal transduction involving the spontaneous transmissions associated with ketamine's action at the NMDA receptor. Practice Implications: Better understanding of brain neuropathophysiology offers hope for symptom relief to those living with affective illness refractory to currently available medical management. [ABSTRACT FROM AUTHOR]

There is an utmost necessity of developing novel biomarkers of depression that result in a more efficacious use of current antidepressant drugs. The present report reviews and discusses a recent series of experiments that focused on analysis of membrane protein clustering in peripheral lymphocytes as putative biomarkers of therapeutic efficacy for major depressive disorder. This review recapitulates how the ideas were originated, and the main findings demonstrated that analysis of serotonin transporter and serotonin 2 A receptor clustering in peripheral lymphocytes of naïve depression patients resulted in a discrimination of two subpopulations of depressed patients that showed a differential response upon 8 weeks of antidepressant treatment. The paper also reviews the usefulness of animal models of depression for an initial evaluation of membrane protein clustering in lymphocytes, which provides a screening tool to determine additional proteins to be further evaluated in depression patients. Finally, the present review provides a brief discussion of the general field of biomarkers of depression in relation to therapeutic outcomes and suggests additional ideas to provide extra value to the reviewed studies. [ABSTRACT FROM AUTHOR]

Medicinal chemistry is a science applied to the search and discovery of new therapeutic agents for the treatment of various diseases. Therefore, promising structures have been identified; one of these structures is the piperazine moiety, a cyclic molecule containing two nitrogen atoms in positions 1 and 4 as well as four carbon atoms. Many piperazine derivatives have central pharmacological activity that mainly involves the activation of the monoamine pathway. Thus, piperazine derivatives have been the subject of research for many central therapeutic applications, including antipsychotic, antidepressant and anxiolytic applications. Benzylpiperazine is the prototype of piperazine derivatives; this substance is the main component of recreational drugs, partly due to its stimulant and euphoric effects. This paper describes some piperazine derivatives used therapeutically as antipsychotic (clozapine), antidepressant (vortioxetine) and anxiolytic (buspirone) drugs. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this meta-analysis was to investigate the antidepressant effects of repetitive transcranial magnetic stimulation (rTMS) over the prefrontal cortex (PFC) of patients with Parkinson's disease (PD) and to determine the optimal rTMS parameters, such as the intensity, frequency and the delivered pattern of rTMS stimulation. Methods: EMBASE, PubMed, Web of Science, MEDLINE, and Cochrane data bases were researched for papers published before March 12, 2018. Studies investigating the anti-depression effects of rTMS over PFC in patients with PD were considered. The main outcomes of pre- and post-rTMS treatment as well as score changes were all extracted. The mean effect size was estimated by calculating the standardized mean difference (SMD) with 95% confidence interval (CI) by using fixed or random effect models as appropriate. Results: Nine studies containing 137 PD patients with depression were included. The pooled results showed significant pre-post anti-depressive effects of rTMS over PFC in PD patients with depression (SMD = −0.80, P < 0.00001). The subgroup analyses of stimulation intensity, frequencies, and models also revealed significant effects (Intensities: 90% RMT: SMD = −1.16, P = 0.0006; >100% RMT: SMD = −0.82, P < 0.0001. Frequencies: < 1.0 Hz: SMD = −0.83, P = 0.03; 5.0 Hz: SMD = −1.10, P < 0.0001; ≥10.0 Hz: SMD = −0.55, P = 0.02. Models: Continuous: SMD = −0.79, P < 0.0001; Discontinuous: SMD = −0.84, P = 0.02). But the results of the studies with place-controlled designs were not significant (Overall: SMD = −0.27, P = 0.54. Intensities: 90% RMT: SMD = 0.27, P = 0.68; 100% RMT: SMD = −0.32, P = 0.33. Frequencies: 5.0 Hz: SMD = −0.87, P = 0.10; ≥10.0 Hz: SMD = 0.27, P = 0.66. Models: Continuous: SMD = −0.28, P = 0.68; Discontinuous: SMD = −0.32, P = 0.33). The greater effect sizes of rTMS with 90% RMT, 5.0 Hz in discontinuous days can be observed rather than the other parameters in both kinds of analyses across study design. Conclusions: rTMS may have a significant positive pre-post anti-depressive effect over PFC on patients with depression, especially by using 5.0 Hz frequency with 90% RMT intensity in discontinuous days, which may produce better effects than other parameters. The real effect, though, was not different from that of the placebo. Future studies with larger sample sizes and high-quality studies are needed to further corroborate our results and to identify the optimal rTMS protocols. [ABSTRACT FROM AUTHOR]

Background: Patients with cancer are vulnerable to depression or other depressive conditions. The aim of this paper was to evaluate the efficacy and safety of Chinese herbal medicine (CHM) for the treatment of depression or depressive symptoms in cancer patients. Methods: CENTRAL, MEDLINE, EMBASE, PsycINFO, CNKI, VIP, SinoMed, and online clinical trial registry websites were searched for relevant RCTs until May 2017. The methodological quality of each included study was assessed with the "risk of bias" tool. Review Manager 5.3.5 was used to analyze the data. Results: We identified 18 RCTs that included data from 1441 participants. Twelve different types of Chinese herbal preparations were investigated by these studies, and they showed a better therapeutic effect in most comparisons when measured in terms of depression rating scale scores, with SMDs (95% CI) of − 2.30 (− 3.54, − 1.05) (CHM versus no treatment), − 0.61 (− 1.03, − 0.18) (CHM versus antidepressants), and − 0.55 (− 1.07, − 0.02) (CHM plus psychological treatments versus psychological treatments), or when measured in terms of treatment response rate, with RRs (95% CI) of 1.65 (1.19, 2.29) (CHM versus no treatment), 1.15 (1.03, 1.28) (CHM versus psychological treatments), 1.32 (1.07, 1.63) (CHM plus antidepressants versus antidepressants), and 1.70 (1.02, 2.85) (CHM plus psychological treatments versus psychological treatments). Compared with antidepressants, these CHMs showed borderline superiority for improving the response rate, with an RR (95% CI) of 1.08 (0.93, 1.26). Subgroup analysis based on psychiatric diagnosis (depression versus depressive symptoms) did not modify the direction of these estimates and neither could it explain the high level of heterogeneity. Patients in the CHM group experienced fewer adverse events of cardiac toxicity (P = 0.02), functional gastrointestinal disorders (P = 0.008), sleep disturbances (P = 0.02), blurred vision (P = 0.02) and fatigue (P = 0.03) than the patients in the no treatment group or the antidepressants group. Conclusions: According to the investigation of the twelve herbal preparations, the CHM intervention appears to alleviate depressive symptoms in cancer patients, either alone or combined with antidepressants or psychological treatments. However, a high risk of bias and high heterogeneity made the mean estimates uncertain. Well-designed trials with comprehensive and transparent reporting are warranted in the future. [ABSTRACT FROM AUTHOR]