Diabetes mellitus and depression are the common comorbid disorders affecting humans worldwide. There is an unmet need to develop therapeutic strategies to treat both diabetes mellitus and comorbid depression. The present study evaluated the effectiveness of metformin and ascorbic acid against type 2 diabetes mellitus and comorbid depression in rats. Four groups of diabetic rats were orally administered with vehicle (1 mL/kg), metformin (25 mg/kg), ascorbic acid (25 mg/kg), or combination of metformin (25 mg/kg) and ascorbic acid (25 mg/kg) for 11 consecutive days. Diabetes was induced by single-dose administration of streptozotocin (65 mg/kg, i.p.) with nicotinamide (120 mg/kg, i.p.). Comorbid depression was induced by five inescapable foot-shocks (2 mA, 2 ms duration) at 10 s intervals on days 1, 5, 7, and 10. One group of healthy rats received only vehicles to serve as nondiabetic control group. On day 11, animals were sacrificed, and blood and brain samples were collected from each rat following forced swim test. Plasma glucose, insulin, and corticosterone levels were estimated in plasma. The levels of monoamines, proinflammatory cytokines, and oxidative stress were measured in prefrontal cortex. The combination therapy significantly reduced immobility period, glucose, and corticosterone levels relative to diabetes with comorbid depression group. Furthermore, the combination therapy increased the levels of insulin and monoamines, and caused a significant reductions in oxidative stress and proinflammatory cytokines. In conclusion, the present study revealed that metformin and ascorbic acid combination therapy could be a potential strategy to treat type 2 diabetes mellitus and comorbid depression.

Meditation is a popular form of stress management, argued to mediate stress reactivity. However, many studies in this field commonly fail to include an active control group. Given the frequency with which people are selecting meditation as a form of self-management, it is important to validate if the practice is effective in mediating stress-reactivity using well-controlled studies. Thus, we aimed to conduct a meta-analysis investigating the neurobiological effects of meditation, including focused attention, open monitoring and automatic self-transcending subtypes, compared to an active control, on markers of stress. In the current meta-analysis and systematic review, we included randomised controlled trials comparing meditation interventions compared to an active control on physiological markers of stress. Studied outcomes include cortisol, blood pressure, heart-rate, lipids and peripheral cytokine expression. Forty-five studies were included. All meditation subtypes reduced systolic blood pressure. Focused attention meditations also reduced cortisol and open monitoring meditations also reduced heart rate. When all meditation forms were analysed together, meditation reduced cortisol, C - reactive protein, blood pressure, heart rate, triglycerides and tumour necrosis factor-alpha. Overall, meditation practice leads to decreased physiological markers of stress in a range of populations.

Meditation is a popular form of stress management, argued to mediate stress reactivity. However, many studies in this field commonly fail to include an active control group. Given the frequency with which people are selecting meditation as a form of self-management, it is important to validate if the practice is effective in mediating stress-reactivity using well-controlled studies. Thus, we aimed to conduct a meta-analysis investigating the neurobiological effects of meditation, including focused attention, open monitoring and automatic self-transcending subtypes, compared to an active control, on markers of stress. In the current meta-analysis and systematic review, we included randomised controlled trials comparing meditation interventions compared to an active control on physiological markers of stress. Studied outcomes include cortisol, blood pressure, heart-rate, lipids and peripheral cytokine expression. Forty-five studies were included. All meditation subtypes reduced systolic blood pressure. Focused attention meditations also reduced cortisol and open monitoring meditations also reduced heart rate. When all meditation forms were analysed together, meditation reduced cortisol, C - reactive protein, blood pressure, heart rate, triglycerides and tumour necrosis factor-alpha. Overall, meditation practice leads to decreased physiological markers of stress in a range of populations.

OBJECTIVE: Depressive symptoms are common among patients with fibromyalgia, and behavioral intervention has been recommended as a major treatment component for this illness. The objective of this study was to test the effects of the Mindfulness-Based Stress Reduction (MBSR) intervention on depressive symptoms in patients with fibromyalgia. METHODS: This randomized controlled trial examined effects of the 8-week MBSR intervention on depressive symptoms in 91 women with fibromyalgia who were randomly assigned to treatment (n = 51) or a waiting-list control group (n = 40). Eligible patients were at least 18 years old, willing to participate in a weekly group, and able to provide physician verification of a fibromyalgia diagnosis. Of 166 eligible participants who responded to local television news publicizing, 49 did not appear for a scheduled intake, 24 enrolled but did not provide baseline data, and 2 were excluded due to severe mental illness, leaving 91 participants. The sample averaged 48 years of age and had 14.7 years of education. The typical participant was white, married, and employed. Patients randomly assigned to treatment received MBSR. Eight weekly 2.5-hour sessions were led by a licensed clinical psychologist with mindfulness training. Somatic and cognitive symptoms of depression were assessed using the Beck Depression Inventory administered at baseline, immediately postprogram, and at followup 2 months after the conclusion of the intervention. RESULTS: Change in depressive symptoms was assessed using slopes analyses of intervention effects over time. Depressive symptoms improved significantly in treatment versus control participants over the 3 assessments. CONCLUSION: This meditation-based intervention alleviated depressive symptoms among patients with fibromyalgia.

OBJECTIVE: Depressive symptoms are common among patients with fibromyalgia, and behavioral intervention has been recommended as a major treatment component for this illness. The objective of this study was to test the effects of the Mindfulness-Based Stress Reduction (MBSR) intervention on depressive symptoms in patients with fibromyalgia. METHODS: This randomized controlled trial examined effects of the 8-week MBSR intervention on depressive symptoms in 91 women with fibromyalgia who were randomly assigned to treatment (n = 51) or a waiting-list control group (n = 40). Eligible patients were at least 18 years old, willing to participate in a weekly group, and able to provide physician verification of a fibromyalgia diagnosis. Of 166 eligible participants who responded to local television news publicizing, 49 did not appear for a scheduled intake, 24 enrolled but did not provide baseline data, and 2 were excluded due to severe mental illness, leaving 91 participants. The sample averaged 48 years of age and had 14.7 years of education. The typical participant was white, married, and employed. Patients randomly assigned to treatment received MBSR. Eight weekly 2.5-hour sessions were led by a licensed clinical psychologist with mindfulness training. Somatic and cognitive symptoms of depression were assessed using the Beck Depression Inventory administered at baseline, immediately postprogram, and at followup 2 months after the conclusion of the intervention. RESULTS: Change in depressive symptoms was assessed using slopes analyses of intervention effects over time. Depressive symptoms improved significantly in treatment versus control participants over the 3 assessments. CONCLUSION: This meditation-based intervention alleviated depressive symptoms among patients with fibromyalgia.

BACKGROUND:Depression among nursing students is an ongoing problem. Several psychotherapies have been suggested as alternatives to antidepressants in the management of depression. The aim of this randomized controlled study was to compare the effectiveness of mindfulness meditation versus physical exercise in the management of depression among nursing students.

METHOD:A sample of 181 soon-to-graduate nursing students participated in the study and were assigned at random to one of two therapies: physical exercise (n = 90) or mindfulness meditation (n = 91). The Center for Epidemiologic Studies Depression Scale was completed by the participants in both groups prior to the therapies and after completion.

RESULTS:The findings indicated that both therapies were effective in the management of depression. However, mindfulness meditation is more effective than physical exercise.

CONCLUSION:Mindfulness meditation is recommended over physical exercise in the management of depression among undergraduate nursing students. [J Nurs Educ. 2017;56(10):599-604.].

BACKGROUND:Approximately two thirds of patients with irritable bowel syndrome (IBS) respond well to hypnotherapy. However, it is time consuming as well as expensive to provide and therefore a way of predicting outcome would be extremely useful. The use of imagery and color form an integral part of the hypnotherapeutic process and we have hypothesised that investigating color and how it relates to mood might help to predict response to treatment. In order to undertake this study we have previously developed and validated a method of presenting colors to individuals for research purposes called the Manchester Color Wheel (MCW). Using this instrument we have been able to classify colors into positive, neutral and negative shades and this study aimed to assess their predictive role in hypnotherapy.

METHODS:156 consecutive IBS patients (aged 14-74, mean 42.0 years, 127 (81%) females, 29 (19%) males) were studied. Before treatment, each patient was asked to relate their mood to a color on the MCW as well as completing the IBS Symptom Severity Score, the Hospital Anxiety and Depression (HAD) Scale, the Non-colonic Symptom Scale, the Quality of Life Scale and the Tellegen Absorption Scale (TAS) which is a measure of hypnotisability. Following hypnotherapy all these measures were repeated with the exception of the TAS.

RESULTS:For patients with a positive mood color the odds of responding to hypnotherapy were nine times higher than that of those choosing either a neutral or negative color or no color at all (odds ratio: 8.889; p = 0.042). Furthermore, a high TAS score and the presence of HAD anxiety also had good predictive value (odds ratio: 4.024; p = 0.092, 3.917; p<0.001 respectively) with these markers and a positive mood color being independent of each other. In addition, these factors could be combined to give an even stronger prediction of outcome. Twice as many responders (63, 77.8%) had a positive mood color or were anxious or had a high TAS score compared with 32 (42.7%) without these factors (p<0.001).

CONCLUSION:A positive mood color, especially when combined with HAD anxiety and a high TAS score, predict a good response to hypnotherapy.

Microbiota is a set of microorganisms resident in gut ecosystem that reacts to psychological stressful stimuli, and is involved in depressed or anxious status in both animals and human being. Interestingly, a series of studies have shown the effects of physical exercise on gut microbiota dynamics, suggesting that gut microbiota regulation might act as one mediator for the effects of exercise on the brain. Recent studies found that gut microbiota dynamics are also regulated by metabolism changes, such as through physical exercise or diet change. Interestingly, physical exercise modulates different population of gut bacteria in compared to food restriction or rich diet, and alleviates gut syndromes to toxin intake. Gut microbiota could as well contribute to the beneficial effects of exercise on cognition and emotion, either directly through serotonin signaling or indirectly by modulating metabolism and exercise performance.

PURPOSE:Chronic stress is a precipitating factor for depression, whereas exercise is beneficial for both the mood and cognitive process. The current study demonstrates the anti-depressive effects of regular exercise and the mechanisms linked to hippocampal neurogenesis.

METHODS:Mice were subjected to 14 consecutive days of restraint, followed by 3 weeks of treadmill running, and were then subjected to behavioral tests that included the forced swimming and Y-maze tests. Protein levels were assessed using western blot analysis and newborn cells were detected using 5-bromo-2'-deoxyuridine (BrdU).

RESULTS:Three weeks of treadmill running ameliorated the behavioral depression caused by 14 days of continuous restraint stress. The exercise regimen enhanced BrdU-labeled cells and class IIIβ-tubulin levels in the hippocampal dentate gyrus, as well as those of thioredoxin-1 (TRX-1) and synaptosomal β2-adrenergic receptors (β2-AR) under stress. In vitro experiments involving treatment with recombinant human TRX-1 (rhTRX-1) augmented the levels of phospho-extracellular signal-regulated kinases 1 and 2 (ERK1/2), nuclear β-catenin, and proliferating cell nuclear antigens, which were previously inhibited by U0216 and FH535 (inhibitors of ERK1/2 and β-catenin/T cell factor-mediated transcription, respectively). The hippocampal neurogenesis elicited by a 7-day exercise regimen wasabolished by a selective inhibitor of β2-AR, butoxamine.

CONCLUSION:These results suggest that TRX-1-mediated hippocampal neurogenesis byβ2-AR function is a potential mechanism underlying the psychotropic effect of exercise.

Stroke is the fifth leading cause of death and the number one cause of long-term disability. Seventy-five percent of annual stroke victims are older than 65. Post-stroke depression (PSD) is a common consequence of stroke, with the estimated prevalence ranging from 25% to 79%. Although several studies have investigated the impact of pharmacological interventions on PSD, there is a significant gap in knowledge regarding the efficacy of nonpharmacological measures for treatment of PSD. The purpose of the current integrative literature review was to synthesize the state of knowledge on selected nonpharmacological treatments for PSD and present findings regarding the efficacy of investigated treatments. Twenty-one studies published from 1992-2016 were identified and synthesized. Results indicated that studies demonstrating improvement in depressive symptoms included ecosystem-focused therapy, life review therapy, problem solving therapy, meridian acupressure, repetitive transcranial magnetic stimulation, music therapy, exercise, light therapy, motivational interviewing, and robotic-assisted neurorehabilitation. [Res Gerontol Nurs. 2017; x(x):xx-xx.].

Physical activity (PA) is linked to reduced risk of depression, but research on the objectively measured PA in clinically diagnosed adult outpatients with major depressive disorder (MDD) is scarce. This study aimed to examine relationships of objectively measured PA with depression and mood. A total of 19 outpatients (6 males) with MDD, a mean age of 47.79± 11.67 years and mild-moderate depression participated in the study. To record PA, participants wore a triaxial accelerometer device on the right hip during waking hours for seven consecutive days. Depression and mood were assessed with self-reports immediately after day seven. Participants wore the accelerometers for a high number of days (M = 6.26 ± 1.24 days) and hours per day (13.40 ± 2.61 h), recording light (266.01 ± 100.74 min/day) or moderate (31.19 ± 24.90 min/day) PA, and sedentary time (515.33 ± 155.71 min/day). Stepwise regression analysis yield a significant prediction (p < .05) with only moderate PA contributing to the prediction of depression (Beta = -0.47, p < .05). The model explained 22% of the variance of depression. Our findings provide valuable preliminary evidence regarding the relationship between objectively measured PA and lower depression in clinically diagnosed outpatients with MDD, suggesting moderate PA may help alleviating depressive symptoms.

OBJECTIVE: To search for an effective therapy for depression. METHODS: One hundred and twenty cases were randomly divided into two groups. The acupuncture group (60 cases) was treated with acupuncture at Zhong wan (CV 12) and Si-guan points [Taichong (LR 3) and Hegu (LI 4)] selected as main acupoints, combined with Baihui (GV 20), Sishencong (EX-HN 1), etc. , meanwhile, the reinforcing-reducing manipulation of respiration was adopted. The western medicine group (60 cases) was treated with oral administration of Fluoxetine Hydrochloride at the dosage of 20 mg every day. These treatments lasted for 8 weeks in both groups. The depression severities were assessed with Hamilton Depression Scale (HAMD) before treatment and at the 8th week of the treatment and adverse reactions were appraised respectively with Treatment Emergent Symptom Scale (TESS). RESULTS: The total effective rate was 95.0% in the acupuncture group and 91.7% in the western medicine group with no significant difference between the two groups (P > 0.05). After treatment, the HAMD score had very significant changes in the two groups as compared with those before treatment (both P < 0.01), but there was no significant difference between the two groups (P > 0.05). After treatment, there was a significant difference between two groups in TESS score (P < 0.01). There was almost no adverse reaction in the acupuncture group, while the main clinical manifestations in the western medicine group were nausea, anorexia, diarrhea, etc. CONCLUSION: Acupuncture at Zhongwan (CV 12) and Si-guan points combined with reinforcing-reducing manipulation of respiration can significantly improve symptoms of depression patients with a similar therapeutic effect to oral administration of Fluoxetine Hydrochloride and it is a safe method for depression without adverse reactions.

OBJECTIVE: To search for an effective therapy for depression. METHODS: One hundred and twenty cases were randomly divided into two groups. The acupuncture group (60 cases) was treated with acupuncture at Zhong wan (CV 12) and Si-guan points [Taichong (LR 3) and Hegu (LI 4)] selected as main acupoints, combined with Baihui (GV 20), Sishencong (EX-HN 1), etc. , meanwhile, the reinforcing-reducing manipulation of respiration was adopted. The western medicine group (60 cases) was treated with oral administration of Fluoxetine Hydrochloride at the dosage of 20 mg every day. These treatments lasted for 8 weeks in both groups. The depression severities were assessed with Hamilton Depression Scale (HAMD) before treatment and at the 8th week of the treatment and adverse reactions were appraised respectively with Treatment Emergent Symptom Scale (TESS). RESULTS: The total effective rate was 95.0% in the acupuncture group and 91.7% in the western medicine group with no significant difference between the two groups (P > 0.05). After treatment, the HAMD score had very significant changes in the two groups as compared with those before treatment (both P < 0.01), but there was no significant difference between the two groups (P > 0.05). After treatment, there was a significant difference between two groups in TESS score (P < 0.01). There was almost no adverse reaction in the acupuncture group, while the main clinical manifestations in the western medicine group were nausea, anorexia, diarrhea, etc. CONCLUSION: Acupuncture at Zhongwan (CV 12) and Si-guan points combined with reinforcing-reducing manipulation of respiration can significantly improve symptoms of depression patients with a similar therapeutic effect to oral administration of Fluoxetine Hydrochloride and it is a safe method for depression without adverse reactions.

[n/a]

Psychological dissociation is commonly perceived by mental health professionals as the pathological splitting of consciences or as an impairment in adaptive integration. In hypnotherapy dissociation is considered one of the most significant features of hypnosis, constituting a major therapeutic resource. In the present article, we use hypnotically induced dissociation (HID) to treat patients with obstinate mental disorders (OMD). These disorders are characterized by persistent, problematic behaviors, thoughts, and feelings that become organizing principals of identity and form enduring psychopathologies. To promote psychological change in patients with OMD, we use HID to enhance dissociative processes that enable the differentiation of health from pathology and allow the emergence of experiences previously overshadowed by pathological personality patterns. Three clinical cases of OMD (chronic depression, obsessive-compulsive disorder, and a personality disorder) illustrate the effects of HID as an effective therapeutic tool that facilitates emotional processing, consolidates therapeutic achievements, and secures therapeutic results.

Physical limitations, depression and anxiety are prevalent among older adults. Mild to moderate exercise can promote physical and psychological health and reduce the risk of chronic diseases. Qigong, a type of Chinese traditional medicine exercise, has demonstrated beneficial effects on physical ability and mental health in adults with chronic conditions. The purpose of this review was to systematically assess the effects of Qigong exercise on physical and psychological health outcomes in older adults. A total of 1282 older adults aged 62 to 83 years with depressive symptoms, frailty or chronic medical illnesses were included in this review. The meta-analysis showed that Qigong exercise resulted in significantly improved physical ability compared with active control or usual care (standardized mean difference [SMD]  1.00 and 1.20, respectively). The pooled effects of studies with thrice weekly Qigong sessions had the greatest effect () on physical ability in older adults. Lower quality studies demonstrated larger effect sizes than those of higher quality. Although Qigong exercise showed favorable effects on depression, balance and functioning, the overall effects did not reach statistical significance. No significant adverse events were reported. The findings suggest that the Qigong exercise may be an option for older adults to improve physical ability, functional ability, balance and to lessen depression and anxiety. However, the number of RCTs that enroll older adults is limited. More methodologically sound RCTs are needed to confirm the efficacy of Qigong exercise on physical and psychological health in older adults with chronic illnesses.

Major depressive disorder (MDD) is a prevalent psychiatric disorder associated with varied prognosis, chronic course, and duration of illness with reduced quality of life. One factor that significantly contributes to the relevant disease burden of MDD is the heterogeneous treatment response patients experience with current treatment options. A variety of experimental protocols in humans and animals have highlighted that inflammation and neuroinflammation are relevant biological factors that interact with external stimuli and neurophysiological mechanisms, and can trigger MDD. It is well established that exercise is efficacious in treating mild to moderate depression with response rates comparable to mainstream therapies such as antidepressant medication and cognitive behavioral therapy. Several studies have shown that physical exercise is beneficial for a range of chronic diseases. Indeed, physical exercise can promote molecular changes that swerve a chronic pro-inflammatory state to an anti-inflammatory state in both periphery and central nervous system. The changes caused by physical exercise include an increase in PGC1α gene expression, a transcriptional co-activator involved in reducing the synthesis and releasing of pro-inflammatory cytokines, and an increase in anti-inflammatory cytokines. PGC1α changes the metabolism of kynurenine towards, and, in turn, it reduces glutamatergic neurotoxicity. Moreover, somestudies have shown that physical exercise promotes alterations in the circuitry of monoaminergic neurotransmission, at least in some aspects, through the effects on the release of proinflammatory cytokines. This review will highlight the effects of physical exercise as therapy and its relation withthe biological mechanisms involved in the pathophysiology of MDD, with particular emphasis in the interactions among physical exercise, hypothalamic-pituitary-adrenal (HPA) axis, neuroinflammation, and with the neurotransmitters underlying the main brain circuits involved in the MDD.

BACKGROUND:Physical exercise is increasingly recognized as a treatment for major depression, even among older patients. However, it is still unknown which depressive symptoms exercise affects most, (e.g. somatic vs. affective) and the timing of its effects. Thus, the aim of this study was to examine the changes of depressive symptoms after treatment with exercise.

METHODS:We analyzed data from the SEEDS study, a trial comparing the antidepressant effectiveness of sertraline (S) and sertraline plus exercise (S+EX). Exercise was delivered thrice weekly in small groups and monitored by heart rate meters. Patients with late life depression (n=121) were assessed at baseline, 4, 8, 12 and 24 weeks with the Hamilton Depression Scale. Scores of affective, vegetative, anxiety and agitation/insight factors were analyzed using Multilevel Growth Curve Models and sensitivity analyses (multiple imputation).

RESULTS:Compared with the S group, patients in the S+EX group displayed significantly greater improvements of the affective symptom dimension (total effect size = 0.79) with largest changes in the first 4 weeks and last 12 weeks. Improvements were mainly driven by depressed mood and psychomotor retardation.

LIMITATIONS:Sample size; lack of an exercise only treatment arm

CONCLUSIONS: Adding exercise to antidepressant drug treatment may offer significant advantages over affective symptoms of depression, rather than somatic symptoms or other dimensions of depression. Compared with standard antidepressant treatment, clinical advantages should be expected both at an early (first 4 weeks) and later stage (after 12 weeks).

BACKGROUND:Depression is very common in the elderly population. Physical exercise is one of the non-pharmacological procedures that promise to be a solution to improve the severity of depression. Brain-Derived Neurotrophic Factor (BDNF) plays a role in maintaining the survival of neuronal cells and in the regulation of synapse plasticity, affecting serotonin production in the hippocampus and thus the depressive symptoms.

AIM:This study aimed to assess the role of physical exercise in affecting BDNF levels in elderly with depression.

METHODS:Thirty-five elderly women (age≥ 50 years) with depressive episodes based on Diagnostic and Statistical Manual of Mental Disorders (DSM)-V criteria were enrolled as treatment group, and 35 elderly women without depressive episodes were enrolled as control group, and underwent physical exercise in the form of treadmill with a speed of 6 km/h for 15 minutes. Physical exercise was carried out once a day for 28 days. As much as 1 ml of blood from the study, subjects were obtained from the cubital vein before the exercise commenced. Brain-Derived Neurotrophic Factor (BDNF) serum level was assessed by Enzyme-Linked Immunosorbent Assay (ELISA). Data were presented in the form of mean ± SD. An independent T-test was used to test levels after exercise in the depression group compared to the non-depression group.

RESULTS:Pre-exercise BDNF levels in the depression group were lower than the group of elderly without depression. Physical exercise increased BDNF production in both elderly groups with and without depression. In the depression group, the increasing percentage of BDNF level was higher compared to non-depressive elderly.

CONCLUSION:The increasing percentage of BDNF level was found to be higher in depressive elderly performing physical exercise. Physical exercise may be beneficial in supporting the therapy of elderly with depression.