The Journal of clinical psychiatry
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Randomized Controlled Trial Comparative Study
A 9-week randomized trial comparing a chronotherapeutic intervention (wake and light therapy) to exercise in major depressive disorder patients treated with duloxetine.
The onset of action of antidepressants often takes 4 to 6 weeks. The antidepressant effect of wake therapy (sleep deprivation) comes within hours but carries a risk of relapse. The objective of this study was to investigate whether a new chronotherapeutic intervention combining wake therapy with bright light therapy and sleep time stabilization could induce a rapid and sustained augmentation of response and remission in major depressive disorder. ⋯ Patients treated with wake therapy in combination with bright light therapy and sleep time stabilization had an augmented and sustained antidepressant response and remission compared to patients treated with exercise, who also had a clinically relevant antidepressant response.
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The primary aim was to relate Toxoplasma gondii seropositivity and serointensity to scores on the self-rated Suicide Assessment Scale (SUAS-S). Another aim was to reevaluate the previously reported positive association between T gondii serointensity and a history of nonfatal suicidal self-directed violence. ⋯ These results are consistent with previous reports on the association between T gondii infection and nonfatal suicidal self-directed violence. Confirming these results in future large longitudinal studies and including suicide as an outcome may lead to novel individualized approaches in suicide prevention.
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Although depression is the strongest predictor for the full spectrum of suicidal ideation, several other mental disorders, eg, posttraumatic stress disorder (PTSD), are associated with suicidal ideation too. This study investigates whether suicidal ideation is specifically associated with PTSD or if this association is fully or partially mediated by comorbid depressive disorders. ⋯ The results of our study indicate that PTSD is associated with suicidal ideation, but this association was fully explained by comorbid depressive symptoms in the elderly general population. Thus, screening for depressive symptoms as well as administering an appropriate therapy seems the best way to prevent suicide attempts in the elderly, even in those patients with traumatic experiences and/or PTSD.
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Chronic pain is a common but undertreated health problem in the United States. Opioids are effective for moderate-to-severe chronic pain, but these drugs must be used with care due to the risks for overdose and addiction. ⋯ Patients should be monitored regularly for both improvement of function and for aberrant drug behaviors. With proper monitoring and risk management, patients with chronic pain can be treated effectively and safely with opioids.
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Randomized Controlled Trial Multicenter Study Comparative Study
The impact of chronic depression on acute and long-term outcomes in a randomized trial comparing selective serotonin reuptake inhibitor monotherapy versus each of 2 different antidepressant medication combinations.
To compare sociodemographic and clinical features, acute and continuation treatment outcomes, and adverse events/side effect burden between outpatients with chronic (current episode > 2 years) versus nonchronic major depressive disorder (MDD) who were treated with combination antidepressant therapy or selective serotonin reuptake inhibitor (SSRI) monotherapy. ⋯ Chronicity of illness does not appear to differentially impact acute or longer-term outcomes with SSRI monotherapy or combination antidepressant medication treatment in patients with moderate to severe nonpsychotic MDD.