Research to date indicates that the number of coronary artery bypass graft （CABG） surgery patients affected by depression （i.e., major, minor, dysthymia） approximates between 30% and 40% of all cases. A longstandi...Research to date indicates that the number of coronary artery bypass graft （CABG） surgery patients affected by depression （i.e., major, minor, dysthymia） approximates between 30% and 40% of all cases. A longstanding empirical interest on psychosocial factors in CABG surgery patients highlights an association with increased risk of morbidity in the short and longer term. Recent evidence suggests that both depression and anxiety increase the risk for mortality and morbidity after CABG surgery independent of medical factors, although the behavioral and biological mechanisms are poorly understood. Though neither depression nor anxiety seem to markedly affect neuropsy- chological dysfunction, depression confers a risk for incident delirium. Following a comprehensive overview of recent literature, practical advice is described for clinicians taking into consideration possible screening aids to improve recognition of anxiety and depression among CABG surgery patients. An overview of contemporary interventions and randomized, controlled trials are described, along with suggestions for future CABG surgery research.展开更多
OBJECTIVE: To identify the antidepressant effect of Xingnao Jieyu (XNJY) decoction on a post-stroke depression (PSD) rat model and the underlying molecular mechanism. METHODS: We established a rat PSD model by middle ...OBJECTIVE: To identify the antidepressant effect of Xingnao Jieyu (XNJY) decoction on a post-stroke depression (PSD) rat model and the underlying molecular mechanism. METHODS: We established a rat PSD model by middle cerebral artery occlusion (MCAO) combined with chronic unpredictable mild stress (CUMS). Healthy SD rats were randomly divided into six groups: sham, PSD, fluoxetine (Flu), and XNJY groups at low, middle, and high doses. The sham group underwent sham operation, while the other groups underwent MCAO+CUMS. The Flu and XNJY decoction groups were intragastrically administered with Flu or different doses of XNJY for 21 consecutive days. Histopathological changes in the cortex and hippocampus were observed by staining with hematoxylin and eosin and Terminal-deoxynucleoitidyl Transferase Mediated Nick End Labeling. Iba1 positive cells were evaluated by immunofluorescence assay. The expressions of tumor necrosis factor-α(TNF-α), interleukin-6 (IL-6), interleukin-1β(IL-1β), 5-hydroxytryptamine (5-HT), and norepinephrine (NE) in the cortex and hippocampus were measured by enzyme linked immunosorbent assay. RESULTS: The PSD group rats had a significant decrease in body weight, consumption of sucrose water, and locomotor activity but an increase in immobility time during a forced swimming test (P < 0.01) compared with sham group. Flu and different doses of XNJY significantly recovered these indices (P < 0.01). XNJY also inhibited neuronal damage and apoptosis in the cortex induced by PSD (P < 0.01). Furthermore, XNJY reduced the number of Iba1 positive cells and the expressions of TNF-α, IL-6, and IL-1β, in addition to recovered the levels of 5-HT and NE in the cortex and hippocampus (P < 0.01). CONCLUSION: The alleviation of neuroinflammation might be an important mechanism of the XNJY decoction against PSD. Thus, XNJY might be a promising candidate for the treatment of PSD.展开更多
OBJECTIVE:To evaluate the clinical efficacy and safety of combined acupuncture and Western Medicine in the treatment of post-stroke depression using a meta-analysis.METHODS:The China National Knowledge Infrastructure ...OBJECTIVE:To evaluate the clinical efficacy and safety of combined acupuncture and Western Medicine in the treatment of post-stroke depression using a meta-analysis.METHODS:The China National Knowledge Infrastructure Database,Wanfang Database,China Science and Technology Journal Database,Chinese Biomedical Literature Database,Pub Med,Embase,and the Cochrane Library were searched from their establishment to August 2018 for randomized controlled trials(RCTs)of combined acupuncture and Western Medicine to treat post-stroke depression.Two researchers independently extracted and cross-checked data,and then applied the modified Jadad scale and the Cochrane-recommended assessment method to evaluate the risk of bias.Review Manager 5.3 was used to conduct the meta-analysis.RESULTS:A total of 1860 patients in 24 RCTs were analyzed.The results of the Meta-analysis showed that:(a)The effective rate of acupuncture+fluoxetine hydrochloride vs fluoxetine hydrochloride was significant[relative risk(RR)=1.16,95%confidence interval(CI)(1.08,1.26)],as was that of acupuncture+flupentixol/melitracen vs flupentixol/melitracen[RR=1.23,95%CI(1.10,1.37)].(b)When analyzing Hamilton Depression Scale(HAMD)-17 scores,six trials showed that acupuncture combined with Western Medicine was superior to Western Medicine alone,and could relieve the depressive symptoms of patients.For HAMD-24 scores,five trials were included for acupuncture+fluoxetine hydrochloride vs fluoxetine hydrochloride,with significance at 2 weeks[WMD=-6.51,95%CI(-8.62,-4.40)],as well as at 4 weeks[WMD=-8.40,95%CI(-11.86,-4.94)]and 8 weeks.(c)For the activities of daily living scale,acupuncture+fluoxetine hydrochloride vs fluoxetine hydrochloride[WMD=22.65,95%CI(18.34,26.95)],acupuncture+flupentixol/melitracen vs flupentixol/melitracen[WMD=8.08,95%CI(2.57,13.59)],acupuncture+sertraline hydrochloride vs sertraline hydrochloride[WMD=6.94,95%CI(3.59,10.29)],and acupuncture+doxepin hydrochloride vs doxepin hydrochloride[WMD=18.80,95%CI(15.84,21.76)]had significance.(d)For Treatme展开更多
Major depressive disorder(MDD) is a common psychiatric disorder with an estimated lifetime prevalence rate in the range of 13% to 16% in the United States population. Patients with MDD often have symptoms such as depr...Major depressive disorder(MDD) is a common psychiatric disorder with an estimated lifetime prevalence rate in the range of 13% to 16% in the United States population. Patients with MDD often have symptoms such as depressed mood, loss of interest or pleasure in usual activities, changes in eating or sleeping patterns, fatigue, difficulty concentrating and thoughts of suicide. Although many pharmacotherapy treatment options are available for MDD, antidepressants can oftencause adverse effects that could affect adherence to the medication. Additionally, it is estimated that MDD is unremitting in 15% of patients and 35% can have recurrent episodes. Given the high rate of recurrence and the adverse effects associated with existing medications, new treatment options for depression are needed. Both levomilnacipran and vortioxetine are new antidepressants that were approved by the food and drug administration in 2013 for the treatment of MDD in adults. Levomilnacipran is a serotonin norepinephrine reuptake inhibitor that was effective in several short term studies and sustained efficacy and tolerability was demonstrated in a 48-wk extension study. Vortioxetine is a multi-modal antidepressant and it is thought to work via inhibition of the serotonin(5-HT) transporter, 5-HT3 A, 5-HT7 and 5-HT1 D antagonist, a 5-HT1 B partial agonist, and a 5-HT1 A agonist. Vortioxetine was effective in the treatment of MDD in both short-term trials as well as in the prevention of relapse in a 24-36 wk trial. Sustained efficacy and tolerability was demonstrated in several long-term open-label trials. Further studies comparing levomilnacipran and vortioxetine to other currently available antidepressants are needed to establish its place in therapy.展开更多
Study of depression and antidepressant drugs mainly depends on animal models. Twelve animal models of depression related to some sets of validating criteria are reviewed. Of the 12 models, some traditional models (res...Study of depression and antidepressant drugs mainly depends on animal models. Twelve animal models of depression related to some sets of validating criteria are reviewed. Of the 12 models, some traditional models (reserpine reversal, amphetamine potentiation) are rejected as they are devoid of selectivity, insufficient to predict antidepressant activity in the compounds tested. The models with the highest overall validity are the intracranial self-stimulation, chronic stress and learned helplessness models in rats, and the primate separation model. A combination of several models may be the best way to study depression and to screen antidepressant drugs. This combination can be used to detect compounds comparable to those antidepressants possessing clinically established antidepressant activity.展开更多
文摘Research to date indicates that the number of coronary artery bypass graft （CABG） surgery patients affected by depression （i.e., major, minor, dysthymia） approximates between 30% and 40% of all cases. A longstanding empirical interest on psychosocial factors in CABG surgery patients highlights an association with increased risk of morbidity in the short and longer term. Recent evidence suggests that both depression and anxiety increase the risk for mortality and morbidity after CABG surgery independent of medical factors, although the behavioral and biological mechanisms are poorly understood. Though neither depression nor anxiety seem to markedly affect neuropsy- chological dysfunction, depression confers a risk for incident delirium. Following a comprehensive overview of recent literature, practical advice is described for clinicians taking into consideration possible screening aids to improve recognition of anxiety and depression among CABG surgery patients. An overview of contemporary interventions and randomized, controlled trials are described, along with suggestions for future CABG surgery research.
基金Supported by the Natural Science Foundation of China:Study on the mechanism of eliminating phlegm and dissolving blood stasis interfering cAMP-response element binding protein signal pathway in post-stroke depression treatment(No.81373840)
文摘OBJECTIVE: To identify the antidepressant effect of Xingnao Jieyu (XNJY) decoction on a post-stroke depression (PSD) rat model and the underlying molecular mechanism. METHODS: We established a rat PSD model by middle cerebral artery occlusion (MCAO) combined with chronic unpredictable mild stress (CUMS). Healthy SD rats were randomly divided into six groups: sham, PSD, fluoxetine (Flu), and XNJY groups at low, middle, and high doses. The sham group underwent sham operation, while the other groups underwent MCAO+CUMS. The Flu and XNJY decoction groups were intragastrically administered with Flu or different doses of XNJY for 21 consecutive days. Histopathological changes in the cortex and hippocampus were observed by staining with hematoxylin and eosin and Terminal-deoxynucleoitidyl Transferase Mediated Nick End Labeling. Iba1 positive cells were evaluated by immunofluorescence assay. The expressions of tumor necrosis factor-α(TNF-α), interleukin-6 (IL-6), interleukin-1β(IL-1β), 5-hydroxytryptamine (5-HT), and norepinephrine (NE) in the cortex and hippocampus were measured by enzyme linked immunosorbent assay. RESULTS: The PSD group rats had a significant decrease in body weight, consumption of sucrose water, and locomotor activity but an increase in immobility time during a forced swimming test (P < 0.01) compared with sham group. Flu and different doses of XNJY significantly recovered these indices (P < 0.01). XNJY also inhibited neuronal damage and apoptosis in the cortex induced by PSD (P < 0.01). Furthermore, XNJY reduced the number of Iba1 positive cells and the expressions of TNF-α, IL-6, and IL-1β, in addition to recovered the levels of 5-HT and NE in the cortex and hippocampus (P < 0.01). CONCLUSION: The alleviation of neuroinflammation might be an important mechanism of the XNJY decoction against PSD. Thus, XNJY might be a promising candidate for the treatment of PSD.
基金Supported by the Project of the National Natural Science Foundation of China:Research and Formulation of Heat Sensitive Moxibustion Sensation Scale Based on Modern And Classical Measurement Theory(No.81573835)Science and Technology Planning Project of Jiangxi Health and Family Planning Commission,China:a Network Meta-analysis of Evidence-based Decision-making of Acupuncture Combined With Western Medicine for Post-stroke Depression(No.20151092)+2 种基金Jiangxi Outstanding Young Talents Funding Scheme,China(No.20171BCB23093)Jiangxi Young Jinggang Scholars Award Program,China(Ganjiao Dengzi[2018]No.82)the Top-Level Young Talents of the"1050 Young Talent Project"of Jiangxi University of Traditional Chinese Medicine(No.5141900101)。
文摘OBJECTIVE:To evaluate the clinical efficacy and safety of combined acupuncture and Western Medicine in the treatment of post-stroke depression using a meta-analysis.METHODS:The China National Knowledge Infrastructure Database,Wanfang Database,China Science and Technology Journal Database,Chinese Biomedical Literature Database,Pub Med,Embase,and the Cochrane Library were searched from their establishment to August 2018 for randomized controlled trials(RCTs)of combined acupuncture and Western Medicine to treat post-stroke depression.Two researchers independently extracted and cross-checked data,and then applied the modified Jadad scale and the Cochrane-recommended assessment method to evaluate the risk of bias.Review Manager 5.3 was used to conduct the meta-analysis.RESULTS:A total of 1860 patients in 24 RCTs were analyzed.The results of the Meta-analysis showed that:(a)The effective rate of acupuncture+fluoxetine hydrochloride vs fluoxetine hydrochloride was significant[relative risk(RR)=1.16,95%confidence interval(CI)(1.08,1.26)],as was that of acupuncture+flupentixol/melitracen vs flupentixol/melitracen[RR=1.23,95%CI(1.10,1.37)].(b)When analyzing Hamilton Depression Scale(HAMD)-17 scores,six trials showed that acupuncture combined with Western Medicine was superior to Western Medicine alone,and could relieve the depressive symptoms of patients.For HAMD-24 scores,five trials were included for acupuncture+fluoxetine hydrochloride vs fluoxetine hydrochloride,with significance at 2 weeks[WMD=-6.51,95%CI(-8.62,-4.40)],as well as at 4 weeks[WMD=-8.40,95%CI(-11.86,-4.94)]and 8 weeks.(c)For the activities of daily living scale,acupuncture+fluoxetine hydrochloride vs fluoxetine hydrochloride[WMD=22.65,95%CI(18.34,26.95)],acupuncture+flupentixol/melitracen vs flupentixol/melitracen[WMD=8.08,95%CI(2.57,13.59)],acupuncture+sertraline hydrochloride vs sertraline hydrochloride[WMD=6.94,95%CI(3.59,10.29)],and acupuncture+doxepin hydrochloride vs doxepin hydrochloride[WMD=18.80,95%CI(15.84,21.76)]had significance.(d)For Treatme
文摘Major depressive disorder(MDD) is a common psychiatric disorder with an estimated lifetime prevalence rate in the range of 13% to 16% in the United States population. Patients with MDD often have symptoms such as depressed mood, loss of interest or pleasure in usual activities, changes in eating or sleeping patterns, fatigue, difficulty concentrating and thoughts of suicide. Although many pharmacotherapy treatment options are available for MDD, antidepressants can oftencause adverse effects that could affect adherence to the medication. Additionally, it is estimated that MDD is unremitting in 15% of patients and 35% can have recurrent episodes. Given the high rate of recurrence and the adverse effects associated with existing medications, new treatment options for depression are needed. Both levomilnacipran and vortioxetine are new antidepressants that were approved by the food and drug administration in 2013 for the treatment of MDD in adults. Levomilnacipran is a serotonin norepinephrine reuptake inhibitor that was effective in several short term studies and sustained efficacy and tolerability was demonstrated in a 48-wk extension study. Vortioxetine is a multi-modal antidepressant and it is thought to work via inhibition of the serotonin(5-HT) transporter, 5-HT3 A, 5-HT7 and 5-HT1 D antagonist, a 5-HT1 B partial agonist, and a 5-HT1 A agonist. Vortioxetine was effective in the treatment of MDD in both short-term trials as well as in the prevention of relapse in a 24-36 wk trial. Sustained efficacy and tolerability was demonstrated in several long-term open-label trials. Further studies comparing levomilnacipran and vortioxetine to other currently available antidepressants are needed to establish its place in therapy.
文摘Study of depression and antidepressant drugs mainly depends on animal models. Twelve animal models of depression related to some sets of validating criteria are reviewed. Of the 12 models, some traditional models (reserpine reversal, amphetamine potentiation) are rejected as they are devoid of selectivity, insufficient to predict antidepressant activity in the compounds tested. The models with the highest overall validity are the intracranial self-stimulation, chronic stress and learned helplessness models in rats, and the primate separation model. A combination of several models may be the best way to study depression and to screen antidepressant drugs. This combination can be used to detect compounds comparable to those antidepressants possessing clinically established antidepressant activity.
