Depression, anxiety, and cardiac morbidity outcomes after coronary artery bypass surgery： a contemporary and practical review

Research to date indicates that the number of coronary artery bypass graft （CABG） surgery patients affected by depression （i.e., major, minor, dysthymia） approximates between 30% and 40% of all cases. A longstanding empirical interest on psychosocial factors in CABG surgery patients highlights an association with increased risk of morbidity in the short and longer term. Recent evidence suggests that both depression and anxiety increase the risk for mortality and morbidity after CABG surgery independent of medical factors, although the behavioral and biological mechanisms are poorly understood. Though neither depression nor anxiety seem to markedly affect neuropsy- chological dysfunction, depression confers a risk for incident delirium. Following a comprehensive overview of recent literature, practical advice is described for clinicians taking into consideration possible screening aids to improve recognition of anxiety and depression among CABG surgery patients. An overview of contemporary interventions and randomized, controlled trials are described, along with suggestions for future CABG surgery research.

Levomilnacipran and vortioxetine:Review of new pharmacotherapies for major depressive disorder

Major depressive disorder(MDD) is a common psychiatric disorder with an estimated lifetime prevalence rate in the range of 13% to 16% in the United States population. Patients with MDD often have symptoms such as depressed mood, loss of interest or pleasure in usual activities, changes in eating or sleeping patterns, fatigue, difficulty concentrating and thoughts of suicide. Although many pharmacotherapy treatment options are available for MDD, antidepressants can oftencause adverse effects that could affect adherence to the medication. Additionally, it is estimated that MDD is unremitting in 15% of patients and 35% can have recurrent episodes. Given the high rate of recurrence and the adverse effects associated with existing medications, new treatment options for depression are needed. Both levomilnacipran and vortioxetine are new antidepressants that were approved by the food and drug administration in 2013 for the treatment of MDD in adults. Levomilnacipran is a serotonin norepinephrine reuptake inhibitor that was effective in several short term studies and sustained efficacy and tolerability was demonstrated in a 48-wk extension study. Vortioxetine is a multi-modal antidepressant and it is thought to work via inhibition of the serotonin(5-HT) transporter, 5-HT3 A, 5-HT7 and 5-HT1 D antagonist, a 5-HT1 B partial agonist, and a 5-HT1 A agonist. Vortioxetine was effective in the treatment of MDD in both short-term trials as well as in the prevention of relapse in a 24-36 wk trial. Sustained efficacy and tolerability was demonstrated in several long-term open-label trials. Further studies comparing levomilnacipran and vortioxetine to other currently available antidepressants are needed to establish its place in therapy.

Meta-analysis of the clinical effectiveness of combined acupuncture and Western Medicine to treat post-stroke depression

OBJECTIVE:To evaluate the clinical efficacy and safety of combined acupuncture and Western Medicine in the treatment of post-stroke depression using a meta-analysis.METHODS:The China National Knowledge Infrastructure Database,Wanfang Database,China Science and Technology Journal Database,Chinese Biomedical Literature Database,Pub Med,Embase,and the Cochrane Library were searched from their establishment to August 2018 for randomized controlled trials(RCTs)of combined acupuncture and Western Medicine to treat post-stroke depression.Two researchers independently extracted and cross-checked data,and then applied the modified Jadad scale and the Cochrane-recommended assessment method to evaluate the risk of bias.Review Manager 5.3 was used to conduct the meta-analysis.RESULTS:A total of 1860 patients in 24 RCTs were analyzed.The results of the Meta-analysis showed that:(a)The effective rate of acupuncture+fluoxetine hydrochloride vs fluoxetine hydrochloride was significant[relative risk(RR)=1.16,95%confidence interval(CI)(1.08,1.26)],as was that of acupuncture+flupentixol/melitracen vs flupentixol/melitracen[RR=1.23,95%CI(1.10,1.37)].(b)When analyzing Hamilton Depression Scale(HAMD)-17 scores,six trials showed that acupuncture combined with Western Medicine was superior to Western Medicine alone,and could relieve the depressive symptoms of patients.For HAMD-24 scores,five trials were included for acupuncture+fluoxetine hydrochloride vs fluoxetine hydrochloride,with significance at 2 weeks[WMD=-6.51,95%CI(-8.62,-4.40)],as well as at 4 weeks[WMD=-8.40,95%CI(-11.86,-4.94)]and 8 weeks.(c)For the activities of daily living scale,acupuncture+fluoxetine hydrochloride vs fluoxetine hydrochloride[WMD=22.65,95%CI(18.34,26.95)],acupuncture+flupentixol/melitracen vs flupentixol/melitracen[WMD=8.08,95%CI(2.57,13.59)],acupuncture+sertraline hydrochloride vs sertraline hydrochloride[WMD=6.94,95%CI(3.59,10.29)],and acupuncture+doxepin hydrochloride vs doxepin hydrochloride[WMD=18.80,95%CI(15.84,21.76)]had significance.(d)For Treatment Emergent Symptom Scale scores,there was significance in all four included studies.CONCLUSION:The therapeutic effects of acupuncture combined with Western Medicine on post-stroke depression are often better than those of Western Medicine alone,and fewer adverse reactions occur.However,more high-quality RCTs are needed to further confirm these findings.