Improved Alertness Is Associated with Early Increase in Serum Brain-Derived Neurotrophic Factor and Antidepressant Treatment Outcome in Major Depression.

Background/aims: In major depression cognitive impairment is common and may persist despite improvement in psychopathology. So far it is unclear how closely related improvement in cognitive functioning is to the clinical course of depression. Further, it is unclear whether recovery from cognitive impairment is linked to changes in serum brain-derived neurotrophic factor (sBDNF).

High baseline BDNF serum levels and early psychopathological improvement are predictive of treatment outcome in major depression.

Rationale: Major depressive disorder has been associated with low serum levels of brain-derived neurotrophic factor (sBDNF), which is functionally involved in neuroplasticity. Although sBDNF levels tend to normalize following psychopathological improvement with antidepressant treatment, it is unclear how closely sBDNF changes are associated with treatment outcome.

Objectives: To examine whether baseline sBDNF or early changes in sBDNF are predictive of response to therapy.

[Actual therapeutic options in the treatment of generalized anxiety disorders].

Among a variety of drugs used in the treatment of anxiety disorders, benzodiazepines and antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) are at present the most established and prescribed. In fact, recent guidelines recommend the antidepressants SSRI and SNRI as well as pregabaline, a newly developed drug, as the 1st choice treatment in generalized anxiety disorder (GAD). However, antidepressants have several disadvantages (latency of onset of action, adverse effects and drug interactions) that should not be neglected.

[Treatment strategies in anxiety disorders--an update].

Anxiety disorders are persistent impairing diseases, with often chronic course and suffering from symptoms throughout a life-span. The medication with the most evidence of efficacy is the benzodiazepines having a low incidence of side effects but may cause physical dependence, withdrawal and sedation. The use of these drugs should be limited to the acute treatments during the first several weeks in combination with an SSRI or and SNRI for the treatment of the acute phase.