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Mixed Depression: A Mini-Review to Guide Clinical Practice and Future Research Developments.

ABSTRACT: The debate on mixed states (MS) has been intense for decades. However, several points remain controversial from a nosographic, diagnostic, and therapeutic point of view. The different perspectives that have emerged over the years have turned into a large, but heterogeneous, literature body. The present review aims to summarize the evidence on MS, with a particular focus on mixed depression (MxD), in order to provide a guide for clinicians and encourage the development of future research on the topic. First, we review the history of MS, focusing on their different interpretations and categorizations over the centuries. In this section, we also report alternative models to traditional nosography. Second, we describe the main clinical features of MxD and list the most reliable assessment tools. Finally, we summarize the recommendations provided by the main international guidelines for the treatment of MxD. Our review highlights that the different conceptualizations of MS and MxD, the variability of clinical pictures, and the heterogeneous response to pharmacological treatment make MxD a real challenge for clinicians. Further studies are needed to better characterize the phenotypes of patients with MxD to help clinicians in the management of this delicate condition.

SUBMITTER: Natale A

PROVIDER: S-EPMC8773514 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Depression is a major public health problem among youth, currently estimated to affect as many as 9% of US children and adolescents. The recognition that both genes (nature) and environments (nurture) are important for understanding the etiology of depression has led to a rapid growth in research exploring gene-environment interactions (GxE). However, there has been no systematic review of GxE in youth depression to date.The goal of this article was to systematically review evidence on the contribution of GxE to the risk of child and adolescent depression. Through a search of PubMed and PsycINFO databases to 1 April 2010, we identified 20 candidate gene-environment interaction studies focused on depression in youth (up to age 26) and compared each study in terms of the following characteristics: research design and sample studied; measure of depression and environment used; genes explored; and GxE findings in relation to these factors.In total, 80% of studies (n = 16) found at least one significant GxE association. However, there was wide variation in methods and analyses adopted across studies, especially with respect to environmental measures used and tests conducted to estimate GxE. This heterogeneity made it difficult to compare findings and evaluate the strength of the evidence for GxE.The existing body of GxE research on depression in youth contains studies that are conceptually and methodologically quite different, which contributes to mixed findings and makes it difficult to assess the current state of the evidence. To decrease this heterogeneity, we offer 20 recommendations that are focused on: (a) reporting GxE research; (b) testing and reporting GxE effects; (c) conceptualizing, measuring and analyzing depression; (d) conceptualizing, measuring and analyzing environment; (e) increasing power to test for GxE; and (f) improving the quality of genetic data used. Although targeted to GxE research on depression, these recommendations can be adopted by GxE researchers focusing on other mental health outcomes.

Project description:BackgroundThe tackle is the most common in-play event in rugby union and rugby league (the rugby codes). It is also associated with the greatest propensity for injury and thus accounts for the most injuries in the sport. It is therefore of critical importance to accurately quantify how tackle technique alters injury risk using gold-standard methodology of three-dimensional motion (3D) capture.ObjectiveTo examine the 3D motion capture methodology of rugby-style tackle techniques to provide recommendations to inform practice for future rugby code research and advance the knowledge of this field.Study designSystematic review.MethodsArticles published in English language, up to May 2020, were retrieved via nine online databases. All cross-sectional, correlational, observational, and cohort study designs using 3D motion capture of tackle techniques in rugby code players met inclusion criteria for this review. A qualitative synthesis using thematic analysis was pre-specified to identify five key themes.ResultsSeven articles met eligibility criteria. Participant demographic information (theme one) involved a total of 92 rugby union players, ranging in skill level and playing experience. Experimental task design information (theme two) included one-on-one, front-on (n=5) or side-on (n=1) contact between a tackler and a ball carrier, or a tackler impacting a tackle bag or bump pad (n=3). 3D data collection (theme three) reported differing sampling frequencies and marker sets. 3D data reduction and analysis (theme four) procedures could be mostly replicated, but the definitions of temporal events, joint modelling and filtering varied between studies. Findings of the studies (theme five) showed that the one-on-one tackle technique can be altered (n=5) when tackle height, leg drive and/or tackle speed is modified. A study reported tackle coaching intervention.ConclusionsThis is the first review to evaluate 3D motion capture of rugby-style tackle technique research. A research framework was identified: (i) participant demographic information, (ii) experimental task design information, (iii) 3D motion capture data specifications, and (iv) 3D data reduction and analysis. Adherence of future 3D tackling research to these framework principles will provide critical scientific evidence to better inform injury reduction and performance practices in the rugby codes.Trial registrationThe review was registered with PROSPERO (registration number CRD42018092312 ).

Project description:Depression affects over 300 million individuals worldwide and is responsible for most of the 800,000 annual suicides. Clinical practice guidelines (CPGs) for treatment of depression, founded on scientific evidence, are essential to improve patient care. However, economic and sociocultural factors may influence CPG elaboration, potentially leading to divergences in their recommendations. Consequently, we analyzed pharmacological recommendations for the treatment of depression from the most relevant CPGs. We included four CPGs with scores ? 80% for Domain 3 (rigor of development) on the Appraisal of Guidelines for Research and Evaluation and two other commonly used CPGs. The recommendations, their strengths, and the level of evidence were extracted from each CPG by two independent researchers and grouped as follows: (1) general recommendations for the pharmacological treatment for depression (suicide risk, acute treatment, continuation and maintenance phases, and treatment discontinuation); (2) treatment of non-responsive or partially responsive patients; and (3) treatment for subtypes of depression (chronic, psychotic, catatonic, melancholic, seasonal, somatic, mixed, and atypical). Only 50% of CPGs included recommendations for the risk of suicide associated with pharmacotherapy. All CPGs included serotonin selective reuptake inhibitors (SSRIs) as first-line treatment; however, one CPG also included agomelatine, milnacipran, and mianserin as first-line alternatives. Recommendations for depression subtypes (catatonic, atypical, melancholic) were included in three CPGs. The strength of recommendation and level of evidence clearly differed among CPGs, especially regarding treatment augmentation strategies. We conclude that, although CPGs converged in some recommendations (e.g., SSRIs as first-line treatment), they diverged in cardinal topics including the absence of recommendations regarding the risk of suicide associated with pharmacotherapy. Consequently, the recommendations listed in a specific CPG should be followed with caution.

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Mixed Depression: A Mini-Review to Guide Clinical Practice and Future Research Developments.

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