Reconsidering Dietary Polyunsaturated Fatty Acids in Bipolar Disorder: A Translational Picture.

Inflammation is an important mediator of pathophysiology in bipolar disorder. The omega-3 (n-3) and omega-6 (n-6) polyunsaturated fatty acid (PUFA) metabolic pathways participate in several inflammatory processes and have been linked through epidemiologic and clinical studies to bipolar disorder and its response to treatment. We review the proposed role of PUFA metabolism in neuroinflammation, modulation of brain PUFA metabolism by antimanic medications in rodent models, and anti-inflammatory pharmacotherapy in bipolar disorder and in major depressive disorder (MDD).

Low unesterified:esterified eicosapentaenoic acid (EPA) plasma concentration ratio is associated with bipolar disorder episodes, and omega-3 plasma concentrations are altered by treatment.

Objectives: Omega (n)-3 and n-6 polyunsaturated fatty acids (PUFAs) are molecular modulators of neurotransmission and inflammation. We hypothesized that plasma concentrations of n-3 PUFAs would be lower and those of n-6 PUFAs higher in subjects with bipolar disorder (BD) compared to healthy controls (HCs), and would correlate with symptom severity in subjects with BD, and that effective treatment would correlate with increased n-3 but lower n-6 PUFA levels. Additionally, we explored clinical correlations and group differences in plasma levels of saturated and monounsaturated fatty acids.

Effects of mental health benefits legislation: a community guide systematic review.

Context: Health insurance benefits for mental health services typically have paid less than benefits for physical health services, resulting in potential underutilization or financial burden for people with mental health conditions. Mental health benefits legislation was introduced to improve financial protection (i.e.

Mediators of sexual functioning and marital quality in chronically depressed adults with and without a history of childhood sexual abuse.

Introduction: Sexual dysfunction is common among depressed adults. Childhood sexual abuse (CSA) and depressive symptomology are among the risk factors for sexual dysfunction, and these factors may interact to predict adult relationship functioning. Several models have been developed postulating interactions between these variables.

Gender differences, clinical correlates, and longitudinal outcome of bipolar disorder with comorbid migraine.

Objective: Migraine is a common comorbidity of bipolar disorder and is more prevalent in women than men. We hypothesized comorbid migraine would be associated with features of illness and psychosocial risk factors that would differ by gender and impact outcome.

Method: A retrospective analysis was conducted to assess association between self-reported, physician-diagnosed migraine, clinical variables of interest, and mood outcome in subjects with DSM-IV bipolar disorder (N = 412) and healthy controls (N = 157) from the Prechter Longitudinal Study of Bipolar Disorder, 2005-2010.

Sexual functioning in patients with recurrent major depressive disorder enrolled in the PREVENT study.

The incidence of treatment-emergent sexual dysfunction in the acute and continuation phases of the prevention of recurrent episodes of depression with venlafaxine ER for two years (PREVENT) study was assessed. Adult outpatients with recurrent major depressive disorder were randomly assigned to receive venlafaxine extended release (ER; 75-300 mg/day) or fluoxetine (20-60 mg/day). Sexual dysfunction was assessed using items from the 17-item Hamilton Rating Scale for Depression (HAM-D(17)) and the Inventory of Depressive Symptomatology-Self-Report (IDS-SR).

Sleep quality during euthymia in bipolar disorder: the role of clinical features, personality traits, and stressful life events.

Background: Poor sleep quality is known to precede the onset of mood episodes and to be associated with poor treatment outcomes in bipolar disorder (BD). We sought to identify modifiable factors that correlate with poor sleep quality in BD independent of residual mood symptoms.

Methods: A retrospective analysis was conducted to assess the association between the Pittsburgh Sleep Quality Index and clinical variables of interest in euthymic patients with DSM-IV BD (n = 119) and healthy controls (HC; n = 136) participating in the Prechter Longitudinal Study of Bipolar Disorder.

Collaborative care to improve the management of depressive disorders: a community guide systematic review and meta-analysis.

Context: To improve the quality of depression management, collaborative care models have been developed from the Chronic Care Model over the past 20 years. Collaborative care is a multicomponent, healthcare system-level intervention that uses case managers to link primary care providers, patients, and mental health specialists. In addition to case management support, primary care providers receive consultation and decision support from mental health specialists (i.

Boosting serotonin in the brain: is it time to revamp the treatment of depression?

Abnormalities in serotonin systems are presumably linked to various psychiatric disorders including schizophrenia and depression. Medications intended for these disorders aim to either block the reuptake or the degradation of this neurotransmitter. In an alternative approach, efforts have been made to enhance serotonin levels through dietary manipulation of precursor levels with modest clinical success.

Optimizing depression treatment to increase the likelihood of remission.

Depression is one of the highest ranking causes of disease burden worldwide but remains underrecognized and undertreated in clinical settings. Measurement-based care is the standard of care strived for by leading psychiatric researchers and is considered treatment as usual in other areas of medicine. However, routine measurement has yet to be implemented in all clinical practices for the detection and treatment of mental disorders such as depression.

Performance improvement CME: improving outcomes in depression.

Performance Improvement CME (PI CME) is an educational activity in which clinicians retrospectively assess their current clinical practice, choose areas for improvement and implement interventions based on treatment guidelines and health care standards, and then re-evaluate their clinical practice to assess the improvements made. This PI CME focuses on improving the detection and initial treatment of depression, enhancing patients' treatment response, and preventing relapse and recurrence.

A review of the current guidelines for depression treatment.

A variety of American and European guidelines are available for clinicians treating major depressive disorder and depressive subtypes. Major Western guidelines published since 2000 make similar recommendations for all stages of treatment for depression, including a reliance on measurement-based care. First-line treatment is usually a serotonin reuptake inhibitor, psychotherapy, or a combination of pharmacotherapy and psychotherapy.

International consensus statement on major depressive disorder.

Because considerable variability exists between countries in the management of major depressive disorder, experts in psychiatry gathered for the International Consensus Group on Depression to outline a universal treatment algorithm for this illness. The experts decided to adapt the existing treatment algorithm developed in Japan and discuss strategies for clinical issues that have been problematic in some countries. Specific recommendations were made by the consensus group for screening for, diagnosing, and treating depression, which include periodically screening all patients for depression, completing a differential diagnosis of depression, referring to a psychiatric specialist if needed, establishing a therapeutic alliance with patients and their families, choosing and optimizing the dose of appropriate antidepressants based on individual patient's needs, and incorporating nonpharmacologic treatment strategies as necessary.

Using assessment tools to screen for, diagnose, and treat major depressive disorder in clinical practice.

Depression remains underrecognized and undertreated worldwide, although it is a leading cause of disease burden. Many instruments are available to enhance the assessment of major depressive disorder (MDD) at 3 levels: screening, diagnosing, and monitoring treatment. This article reviews a variety of tools that can be used at each level of assessment as part of a measurement-based care approach to MDD.

The prevalence and impact of depression.

Depression affects up to 25% of women and 12% of men and is a highly chronic disorder. Further, the more episodes patients have, the more likely they are to have additional episodes, subsequently worsening the course of the disorder with each occurrence. Even after patients recover from an index episode of depression, their chances of maintaining that recovery are drastically diminished over time.

Depression symptomatology and neurobiology.

The DSM-IV-TR distinguishes major depressive disorder (MDD) from normal sadness and grief by requiring a certain duration and number of symptoms that cause impairment and dysfunction. Depression is considered a heterogeneous condition in which different biologic abnormalities may be responsible for problems with sleeping, eating, energy, and emotional reactions. Neuroimaging, pharmacology, and genomics are among the sources of information that have contributed to theories about the pathophysiology of MDD and may lead to truly personalized medicine in the future.