Siegfried Kasper, Raffaele Antonelli Incalzi, Marco Bozzali, Pedro Morgado, Marcin Siwek
{"title":"Managing depression in the elderly: real-world clinical considerations and perspectives.","authors":"Siegfried Kasper, Raffaele Antonelli Incalzi, Marco Bozzali, Pedro Morgado, Marcin Siwek","doi":"10.1097/YIC.0000000000000577","DOIUrl":"https://doi.org/10.1097/YIC.0000000000000577","url":null,"abstract":"<p><p>This study aims to elucidate current trends in clinical practice for managing depression in elderly patients, focusing on the utilization of pharmacotherapeutics and integrated care models to improve patient outcomes. A comprehensive survey was conducted among physicians from various European countries to gather insights into prescribing habits, treatment patterns, and the impact of comorbidities on therapeutic choices, with a focus on trazodone. The participants included psychiatrists, general practitioners, and neurologists actively involved in elderly depression care. The findings reveal a preference among physicians for using antidepressants like trazodone, due to efficacy and tolerability. Selective serotonin reuptake inhibitors and serotonin-noradrenaline reuptake inhibitors were also commonly prescribed, while tricyclic antidepressants and monoamine oxidase inhibitors were less favored. Psychiatric conditions and sleep disturbances significantly influenced treatment decisions. The survey underscored the importance of multidisciplinary management and the crucial role of caregivers in the treatment process. Effective management of depression in the elderly demands a precision approach that incorporates a thorough understanding of pharmacology, comorbidities, and a collaborative approach to maximize the effects of treatment while trying to minimize polypharmacy and the co-occurring side effects. The study highlights the need for tailored treatment strategies that address the complex needs of the elderly to enhance their quality of life and treatment outcomes.</p>","PeriodicalId":13698,"journal":{"name":"International Clinical Psychopharmacology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142970559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Age matters when improving symptoms of anxiety, depression, and sleepiness in patients with obstructive sleep apnea treated with continuous positive airway pressure.","authors":"Amitoj Singh, Sanket Meghpara, Rijesh Niraula, Lynn Keenan, Lourdes M DelRosso","doi":"10.1097/YIC.0000000000000579","DOIUrl":"https://doi.org/10.1097/YIC.0000000000000579","url":null,"abstract":"<p><p>Obstructive sleep apnea (OSA) is a prevalent sleep disorder linked to significant daytime sleepiness and mood disturbances. Continuous positive airway pressure (CPAP) therapy is the standard treatment for OSA, but its effects on mental health outcomes, are not well understood. This study aimed to evaluate the impact of CPAP on daytime sleepiness, depressive symptoms, and anxiety symptoms while assessing how improvements vary with age. A total of 98 participants diagnosed with OSA were included in this study. Pretreatment and posttreatment scores for daytime sleepiness [Epworth Sleepiness Scale (ESS)], depression [Patient Health Questionnaire (PHQ)], and anxiety [Generalized Anxiety Disorder (GAD)] were collected. Improvements were calculated as the difference between pretreatment and posttreatment scores. Age, sex, ethnicity, apnea-hypopnea index, and CPAP compliance, were analyzed. Significant improvements were observed across all age groups after CPAP treatment: ESS scores improved by a mean of 5.6 points (P < 0.001), PHQ scores improved by 6.3 points (P < 0.001), and GAD scores improved by 1.1 points (P = 0.002). CPAP therapy effectively reduced daytime sleepiness, depression, and anxiety in patients with OSA, with significant age-related differences in outcomes. Younger individuals benefited most from treatment.</p>","PeriodicalId":13698,"journal":{"name":"International Clinical Psychopharmacology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142948370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gianluca Borgiani, Chiara Possidente, Chiara Fabbri, Vincenzo Oliva, Mirjam Bloemendaal, Alejandro Arias Vasquez, Ted G Dinan, Eduard Vieta, Marco Menchetti, Diana De Ronchi, Alessandro Serretti, Giuseppe Fanelli
{"title":"The bidirectional interaction between antidepressants and the gut microbiota: are there implications for treatment response?","authors":"Gianluca Borgiani, Chiara Possidente, Chiara Fabbri, Vincenzo Oliva, Mirjam Bloemendaal, Alejandro Arias Vasquez, Ted G Dinan, Eduard Vieta, Marco Menchetti, Diana De Ronchi, Alessandro Serretti, Giuseppe Fanelli","doi":"10.1097/YIC.0000000000000533","DOIUrl":"10.1097/YIC.0000000000000533","url":null,"abstract":"<p><p>This review synthesizes the evidence on associations between antidepressant use and gut microbiota composition and function, exploring the microbiota's possible role in modulating antidepressant treatment outcomes. Antidepressants exert an influence on measures of gut microbial diversity. The most consistently reported differences were in β-diversity between those exposed to antidepressants and those not exposed, with longitudinal studies supporting a potential causal association. Compositional alterations in antidepressant users include an increase in the Bacteroidetes phylum, Christensenellaceae family, and Bacteroides and Clostridium genera, while a decrease was found in the Firmicutes phylum, Ruminococcaceae family, and Ruminococcus genus. In addition, antidepressants attenuate gut microbial differences between depressed and healthy individuals, modulate microbial serotonin transport, and influence microbiota's metabolic functions. These include lyxose degradation, peptidoglycan maturation, membrane transport, and methylerythritol phosphate pathways, alongside gamma-aminobutyric acid metabolism. Importantly, baseline increased α-diversity and abundance of the Roseburia and Faecalibacterium genera, in the Firmicutes phylum, are associated with antidepressant response, emerging as promising biomarkers. This review highlights the potential for gut microbiota as a predictor of treatment response and emphasizes the need for further research to elucidate the mechanisms underlying antidepressant-microbiota interactions. More homogeneous studies and standardized techniques are required to confirm these initial findings.</p>","PeriodicalId":13698,"journal":{"name":"International Clinical Psychopharmacology","volume":"40 1","pages":"3-26"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11594561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Paula Jhoana Escobedo-Aedo, Irene Pans, Enrique Baca-García, Jose de Leon, María-Luisa Barrigón, Santiago Ovejero
{"title":"Dropped-Head syndrome: a possible new variant of clozapine-induced inflammation during titration.","authors":"Paula Jhoana Escobedo-Aedo, Irene Pans, Enrique Baca-García, Jose de Leon, María-Luisa Barrigón, Santiago Ovejero","doi":"10.1097/YIC.0000000000000507","DOIUrl":"10.1097/YIC.0000000000000507","url":null,"abstract":"","PeriodicalId":13698,"journal":{"name":"International Clinical Psychopharmacology","volume":"40 1","pages":"41-45"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Louis Chevalier, Samuel Bulteau, Louis Cheval, Jalal Charron, Anne Sauvaget, Andrew Laurin
{"title":"Differed spontaneous dissociative symptoms following the use of esketamine intranasal spray in a patient suffering from treatment-resistant depression: a case report.","authors":"Louis Chevalier, Samuel Bulteau, Louis Cheval, Jalal Charron, Anne Sauvaget, Andrew Laurin","doi":"10.1097/YIC.0000000000000527","DOIUrl":"10.1097/YIC.0000000000000527","url":null,"abstract":"<p><p>Intranasal esketamine is used in France for treatment-resistant depression. Dissociative symptoms are common side effects during treatment sessions. We report a case of delayed spontaneous dissociative symptoms following esketamine administration. A 20-year-old female with treatment-resistant depression received esketamine treatment. Dissociative symptoms occurred during sessions and persisted at a distance, often accompanied by anxiety. Delayed dissociative phenomena disappeared within the fourth week of treatment by esketamine. The literature mainly discusses dissociation during esketamine treatment sessions, with limited data on differed spontaneous episodes. Three hypotheses are discussed concerning the mechanism of occurrence of these dissociative phenomena, including esketamine's direct effect, central nervous system sensitization, and anxiety-induced dissociation. We present the first case of differed spontaneous dissociative effects after intranasal esketamine administration for treatment-resistant depression. Our main hypothesis suggests that esketamine may act as a 'pattern' for dissociative experiences, heightening the patient's ability to discern these phenomena during other instances of dissociation, such as acute anxiety attacks. Further research is needed to validate this hypothesis.</p>","PeriodicalId":13698,"journal":{"name":"International Clinical Psychopharmacology","volume":" ","pages":"37-40"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139566334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michael E Thase, Paul P Yeung, Ludmyla Rekeda, Meng Liu, Shane Varughese
{"title":"Safety and tolerability of cariprazine for the adjunctive treatment of major depressive disorder: a pooled analysis of phase 2b/phase 3 clinical trials.","authors":"Michael E Thase, Paul P Yeung, Ludmyla Rekeda, Meng Liu, Shane Varughese","doi":"10.1097/YIC.0000000000000528","DOIUrl":"10.1097/YIC.0000000000000528","url":null,"abstract":"<p><p>To characterize the safety and tolerability of adjunctive cariprazine in patients with major depressive disorder (MDD) and inadequate response to monotherapy antidepressant treatment (ADT). Post hoc analyses evaluated pooled data from 2 fixed-dose phase 3 cariprazine studies (1.5 and 3 mg/d [approved doses for MDD]). In a separate safety analysis, cariprazine 0.1-4.5 mg/d was evaluated using data from the 2 fixed-dose trials plus 3 flexible-dose studies grouped by modal-daily dose. In the pooled phase 3 studies (placebo = 503, 1.5 mg/d = 502, 3 mg/d = 503), overall cariprazine-treated patients had high rates of study completion (90%). Patients had mostly mild/moderate treatment-emergent adverse events that caused premature discontinuation of 4.3%. Only akathisia, nausea, and insomnia occurred in ≥5% of cariprazine patients (any group) and at twice the rate of placebo; potential dose-dependent responses were observed for akathisia and insomnia. Cariprazine had a neutral metabolic profile, with mean weight increase of <1 kg. Modal-dose results were similar, and both analyses were consistent with the known safety profile of cariprazine across its approved indications. Adjunctive cariprazine therapy was safe and generally well tolerated in patients with MDD who had not obtained an adequate response to ADT monotherapy; no new safety signals were identified.</p>","PeriodicalId":13698,"journal":{"name":"International Clinical Psychopharmacology","volume":" ","pages":"27-36"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11594553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139563327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Siamand Mazhar, Ahmad Shamabadi, Kimia Kazemzadeh, Mohammad Aidin Farahvash, Atiye Heidari Dalfard, Bita Fallahpour, Mohammad-Reza Khodaei Ardakani, Shahin Akhondzadeh
{"title":"Crocus sativus (saffron) adjunct to risperidone for negative symptoms of schizophrenia: a randomized, double-blind, placebo-controlled trial.","authors":"Siamand Mazhar, Ahmad Shamabadi, Kimia Kazemzadeh, Mohammad Aidin Farahvash, Atiye Heidari Dalfard, Bita Fallahpour, Mohammad-Reza Khodaei Ardakani, Shahin Akhondzadeh","doi":"10.1097/YIC.0000000000000575","DOIUrl":"https://doi.org/10.1097/YIC.0000000000000575","url":null,"abstract":"<p><p>Current treatments for schizophrenia encounter resistance, limited efficacy, and limiting complications, necessitating novel approaches. The effects of saffron on negative symptoms were investigated as it has shown neuroprotective and antipsychotic properties. Fifty-six clinically stable chronic schizophrenic outpatients were equally assigned to saffron 15 mg q12hr or placebo groups while continuing risperidone. The Positive and Negative Syndrome Scale (PANSS) was used to assess schizophrenia-related symptoms in weeks 4 and 8. Also, the patients were assessed for the Hamilton depression rating scale (HDRS) and adverse effects. The baseline characteristics of the groups were comparable (Ps > 0.05). There were significant time-treatment interaction effects on negative ( = 0.137), general psychopathology ( = 0.193), and total ( = 0.113) PANSS scores. Affirmatively, their reductions were significantly greater in the saffron group until weeks 4 (Cohen's ds = 0.922, 0.898, and 0.759, respectively) and 8 (Cohen's ds = 0.850, 1.047, and 0.705, respectively). Regarding the negative symptoms, a better 25% response rate was obtained in the saffron group until the endpoint (P = 0.003). The HDRS scores, extrapyramidal symptom rating scale scores, and side effect frequencies were comparable between the groups (Ps > 0.05). Saffron was beneficial for primary negative symptoms of chronic schizophrenia in a safe and tolerable manner. It also outperformed placebo in improving general psychopathology and total symptoms.</p>","PeriodicalId":13698,"journal":{"name":"International Clinical Psychopharmacology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mauro Scala, Daniel Sánchez-Reolid, Roberto Sánchez-Reolid, Patricia Fernández-Sotos, Verónica Romero-Ferreiro, Miguel Ángel Alvarez-Mon, Guillermo Lahera, Giuseppe Fanelli, Alessandro Serretti, Chiara Fabbri, Antonio Fernández-Caballero, Roberto Rodriguez-Jimenez
{"title":"Differences in emotion recognition between nonimmersive versus immersive virtual reality: preliminary findings in schizophrenia and bipolar disorder.","authors":"Mauro Scala, Daniel Sánchez-Reolid, Roberto Sánchez-Reolid, Patricia Fernández-Sotos, Verónica Romero-Ferreiro, Miguel Ángel Alvarez-Mon, Guillermo Lahera, Giuseppe Fanelli, Alessandro Serretti, Chiara Fabbri, Antonio Fernández-Caballero, Roberto Rodriguez-Jimenez","doi":"10.1097/YIC.0000000000000576","DOIUrl":"https://doi.org/10.1097/YIC.0000000000000576","url":null,"abstract":"<p><p>Deficits in social cognition may impair emotional processing and facial emotional recognition (FER) in patients with bipolar disorder (BD) and schizophrenia. FER is generally explored using photographs or images of static faces that do not fully capture the complexity of real-life facial stimuli. To overcome this limitation, we developed a set of dynamic virtual faces depicting six basic emotions (i.e. happiness, sadness, anger, fear, disgust, and surprise) and a neutral expression suitable for presentation in immersive and nonimmersive virtual realities. This study presents preliminary findings on the differences in FER accuracy from a frontal view between immersive and nonimmersive virtual realities among patients experiencing a relapse of schizophrenia (n = 10), a manic phase of BD (n = 10), and a group of healthy controls (HCs) (n = 10). As a secondary objective, we compare the FER accuracy across these three groups. Patients with schizophrenia and BD showed similar accuracy in recognizing emotions in immersive and nonimmersive virtual reality settings. However, patients with schizophrenia exhibited lower FER accuracy than HCs in both settings. Individuals with BD showed intermediate accuracy between those with schizophrenia and HCs, although these differences were not statistically significant. Notably, recognition of negative emotions was significantly impaired in both groups of patients.</p>","PeriodicalId":13698,"journal":{"name":"International Clinical Psychopharmacology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}