Antidepressant effects of light therapy and "natural" treatments for winter depression

Although bright light treatment may alleviate the symptoms of winter depression, it still remains to be clarified whether chronobiological mechanisms are involved in this antidepressant response. We studied the therapeutic action of bright light in 61 women with and 36 women without winter depression at the medical academic hospital near Novosibirsk (55 degrees North). Bright light was administered with cool-white incandescent lamp for seven days, two hours daily. The treatment started from either 8:00 (n = 29 patients and 16 controls) or 16:00 (n = 24 and 14, respectively) or 18:00 (n = 8 and 6, respectively). The subsets of bright light-treated subjects were then restudied in wintertime before and after one-week vacation in Firuza resort (south of Turkmeniya, 38 degrees North) (n = 19 and 0, respectively), in summertime (n = 42 and 18, respectively) and in the next winter before and after a week 30-min exposure in the morning hours to dim red light emitting “Light Cap” (n = 9 and 0, respectively). The results suggest that, in controls, mood slightly but statistically significantly improved after light treatment and in summer. In patients, the improvement of mood after one week of bright light was comparable with the effects of such “natural” treatments as trips south and transition from winter to summer seasons. Although next winter response to 0.5-h dim light was clinically significant, it was significantly worse compared to the previous response to 2-h bright light. Our therapeutic results indicate that, despite the different potential phase-shifting effect of bright light administered in the morning and in the second half of the day, the responses to all treatments are equally beneficial. This finding provides evidence against the view that circadian phase shifts are the key to the pathogenesis of winter depression and efficacy of light therapy. Although several different physiological effects of light therapy might be involved in the antidepressant response, none of them seems to be of more importance compared to psychological components of this response. Ours and earlier published reports on the independence of beneficial action of bright light from treatment timing support the suggestion that, in the open investigational trials, the placebo effect accounts for a large portion of the antidepressant response. We also reviewed several facts pointing to the close dependence of antidepressant effects of non-drug therapy upon patients' expectations and researchers' enthusiasm. In sum, unlike patients' chronobiology, their psychology seems to be most powerful mediator of the clinical response to bright light.     

Effect of electroconvulsive therapy on serum myelin basic protein immunoreactivity.

A sensitive radioimmunoassay that can detect brain damage in cases of head injury and stroke was applied to blood samples from 13 patients before and after they received multiple treatments with electroconvulsive therapy for psychiatric disorder. None of the patients showed a significant increase in serum myelin basic protein immunoreactivity. As increased serum myelin basic protein immunoreactivity may reflect myelin damage it is apparent that in these patients electroconvulsive therapy did not cause measureable breakdown of myelin.     

Effect of aquariums on electroconvulsive therapy patients

Abstract

This study investigates the effect of an aquarium on pre-treatment anxiety, fear. frustration, and depression in electroconvulsive therapy (ECT) patients. Forty-two patients consecutively referred for ECT were rotated between rooms with and without aquariums. Self report measures of depression, anxiety, fear, and frustration were obtained, along with heart rate and blood pressure measurements. Preliminary mixed-model, repeated measures analysis of variance (ANOVA) revealed no significant differences between the aquarium and control conditions on any of the dependent measures. A trend toward significance was found for self reported anxiety (p=0.08) and further data were collected. Subsequent mixed model, repeated measures ANOVA confirmed the trend toward differences (p=0.08) in anxiety between the aquarium and control conditions. Factoring out demographic factors, the average patient experienced 12% less anxiety in the presence of an aquarium.     

Effect of electroconvulsive therapy without anticonvulsive premedication on serum growth hormone in man.

Serum concentrations of human growth hormone (HGH) were measured in psychiatric patients during the first, third and sixth electroconvulsive therapy (ECT) without anticonvulsive premedication. Serum HGH increased 30 min after the application of current and no differences were found between responses to 1st, 3rd, or 6th ECT. Maximal increase of serum glucose was seen after the first ECT and gradual decreases after the 3rd and 6th ECT were observed     

Pulseless electrical activity during electroconvulsive therapy: a case report

Background

Arrhythmias resulting in cardiac arrest during electroconvulsive therapy have been reported. Most reported cases of cardiac arrest had asystole as the initial rhythm. Pulseless electrical activity as an initial rhythm of cardiac arrest during electroconvulsive therapy has never been reported. Also, thromboembolism after inflation of pneumatic tourniquet during lower limb surgery has been reported but never following tourniquet inflation during an electroconvulsive therapy.

Case presentation

We report a case involving an 81- year- old female who presented to us for an electroconvulsive therapy for severe depression and developed pulseless electrical activity immediately after electroconvulsive therapy. She was successfully resuscitated and was later found to have bilateral pulmonary emboli with a complete occlusion of the right lower lobe pulmonary artery. The source of embolus was from her left lower extremity deep venous thrombus, which we believe, got dislodged intraoperatively after inflation of pneumatic tourniquet. Our patient not only survived the massive pulmonary embolus, but also showed significant improvement in her mental status compared to her pre-admission level at the time of discharge to a sub-acute rehabilitation centre.

Conclusion

We recommend that patients who are elderly and at high risk of thromboembolism should selectively undergo a preoperative doppler ultrasound for deep venous thrombosis. Also, selective application of tourniquet in the upper limb, to monitor for seizure activity, would reduce the incidence of pulmonary thrombo-embolism as embolic events are significantly less from deep venous thromboses of upper extremities when compared to lower extremities.     

木豆素对慢性不可预见温和应激小鼠的抗抑郁作用

目的观察木豆素于抗抑郁方面的作用,并初步探讨其可能的作用机制。方法采用小鼠慢性不可预见温和应激模型(chronic unpredictable mild stress,CUMS),进行糖水偏好实验评价经木豆素处理的小鼠的快感缺失情况,采用酶联免疫吸附测定法测定小鼠血清皮质酮的含量,采用LC-MS/MS法检测小鼠皮层和海马中多种神经递质的含量。结果木豆素可以逆转CUMS引起的糖水偏爱指数降低和血清皮质酮水平升高。并且与正常组相比,模型组小鼠皮层和海马中相关神经递质的含量发生了显著的改变,而木豆素给药对于CUMS小鼠体内相关神经递质具有明显的调节作用。结论木豆素可能通过降低血清皮质酮水平和调节脑内神经递质来实现抗抑郁作用。