Depression research and treatment

Editor's Notes

• #16 The indications for the use of ECT include the following: Need for a rapid antidepressant response Failure of drug therapies History of good response to ECT Patient preference High risk of suicide High risk of medical morbidity and mortality Transcranial magnetic stimulation (TMS) has been approved by the FDA for the treatment of major depressive disorder when one class of antidepressant has failed.  Vagus nerve stimulation (VNS) has been approved by the FDA for use in adult patients who have failed to respond to at least 4 adequate medication and/or ECT treatment regimens. The device requires surgical implantation.
• #17 Low-sodium Dietary Approaches to Stop Hypertension (DASH) diet A study found that participants who most closely adhered to the diet were 11% less likely to become depressed over time than those least adherent to the diet The Mediterranean diet, which emphasizes fish, fruits, and vegetables, with olive oil as the main source of fat, protects cognition and can improve mental health in individuals with depression Physical activity and exercise contribute to recovery from major depressive disorder. Patients should be counseled regarding stress reduction.
• #18 St John’s wort St John’s wort (SJW) is an extract of Hypericum perforatum, a yellow-flowering perennial herb found in temperate zones worldwide. while long-term controlled studies are needed, short-term use of SJW is as effective as antidepressant drugs, with fewer side effects. St John’s wort should not be combined with SSRIs, TCAs, or monoamine oxidase inhibitors, as this might lead to symptoms of serotonin syndrome. Folate Folate is required for the synthesis of dopamine, norepinephrine, and serotonin. Folate has been evaluated as adjunctive therapy in depression in 3 small RCTs. There is insufficient evidence to recommend folate for the treatment of depression. Because folate deficiency is associated with poorer outcomes in depression, as well as mild cognitive impairment, megaloblastic anemia, and neural tube defects, it might be reasonable to screen and treat depressed patients for folate deficiency. Acupuncture Acupuncture is a part of traditional Chinese medicine that involves inserting fine needles into specific points to restore proper flow of energy in the body. There is moderate evidence that acupuncture is not effective for treatment of depression, with most trials reporting no better outcomes than experienced by wait-list controls. Interestingly, 3 of 3 trials reported it to be as effective as antidepressant drugs, raising further questions about the efficacy of the latter. Exercise Exercise is known to make people feel good, but precisely how this occurs is not clear. Large systematic reviews suggest that exercise improves depression. Omega-3 fatty acids Docosahexaenoic acid (DHA) and eicosapentenoic acid (EPA) are long-chain polyunsaturated fatty acids, the primary dietary source of which is oily seafood. Omega-3 fatty acids show promise for the treatment of depression, but further research is needed to better understand sources of heterogeneity.
• #19 St John’s wort St John’s wort (SJW) is an extract of Hypericum perforatum, a yellow-flowering perennial herb found in temperate zones worldwide. while long-term controlled studies are needed, short-term use of SJW is as effective as antidepressant drugs, with fewer side effects. St John’s wort should not be combined with SSRIs, TCAs, or monoamine oxidase inhibitors, as this might lead to symptoms of serotonin syndrome. Folate Folate is required for the synthesis of dopamine, norepinephrine, and serotonin. Folate has been evaluated as adjunctive therapy in depression in 3 small RCTs. There is insufficient evidence to recommend folate for the treatment of depression. Because folate deficiency is associated with poorer outcomes in depression, as well as mild cognitive impairment, megaloblastic anemia, and neural tube defects, it might be reasonable to screen and treat depressed patients for folate deficiency. Acupuncture Acupuncture is a part of traditional Chinese medicine that involves inserting fine needles into specific points to restore proper flow of energy in the body. There is moderate evidence that acupuncture is not effective for treatment of depression, with most trials reporting no better outcomes than experienced by wait-list controls. Interestingly, 3 of 3 trials reported it to be as effective as antidepressant drugs, raising further questions about the efficacy of the latter. Exercise Exercise is known to make people feel good, but precisely how this occurs is not clear. Large systematic reviews suggest that exercise improves depression. Omega-3 fatty acids Docosahexaenoic acid (DHA) and eicosapentenoic acid (EPA) are long-chain polyunsaturated fatty acids, the primary dietary source of which is oily seafood. Omega-3 fatty acids show promise for the treatment of depression, but further research is needed to better understand sources of heterogeneity.
• #20 St John’s wort St John’s wort (SJW) is an extract of Hypericum perforatum, a yellow-flowering perennial herb found in temperate zones worldwide. while long-term controlled studies are needed, short-term use of SJW is as effective as antidepressant drugs, with fewer side effects. St John’s wort should not be combined with SSRIs, TCAs, or monoamine oxidase inhibitors, as this might lead to symptoms of serotonin syndrome. Folate Folate is required for the synthesis of dopamine, norepinephrine, and serotonin. Folate has been evaluated as adjunctive therapy in depression in 3 small RCTs. There is insufficient evidence to recommend folate for the treatment of depression. Because folate deficiency is associated with poorer outcomes in depression, as well as mild cognitive impairment, megaloblastic anemia, and neural tube defects, it might be reasonable to screen and treat depressed patients for folate deficiency. Acupuncture Acupuncture is a part of traditional Chinese medicine that involves inserting fine needles into specific points to restore proper flow of energy in the body. There is moderate evidence that acupuncture is not effective for treatment of depression, with most trials reporting no better outcomes than experienced by wait-list controls. Interestingly, 3 of 3 trials reported it to be as effective as antidepressant drugs, raising further questions about the efficacy of the latter. Exercise Exercise is known to make people feel good, but precisely how this occurs is not clear. Large systematic reviews suggest that exercise improves depression. Omega-3 fatty acids Docosahexaenoic acid (DHA) and eicosapentenoic acid (EPA) are long-chain polyunsaturated fatty acids, the primary dietary source of which is oily seafood. Omega-3 fatty acids show promise for the treatment of depression, but further research is needed to better understand sources of heterogeneity.