Three New Studies in Major Depression

Oct 23, 2018

Results from these studies yield important clinical implications to improve treatment and prognosis for patients with major depression.

DEPRESSION RESEARCH UPDATE

Findings from three new studies in major depression indicate that

1 Vagus nerve stimulation improves the quality of life of patients with treatment-resistant depression;

2 Higher blood levels of omega-3 fatty acids have been linked to improved depression symptoms in patients with both depression and heart failure;

3 Treating depression in teens may benefit parents’ mental health.

Vagus nerve stimulation improves quality of life in patients with depression

Adding vagus nerve stimulation (VNS) to antidepressant therapy significantly improved the quality of life of patients with treatment-resistant depression.1 Self-reported quality of life assessments were used in a multicenter, longitudinal registry to compare the antidepressant efficacy of VNS plus antidepressant treatment (328 patients) with antidepressant treatment alone (271 patients). The patients had either unipolar or bipolar depression and experienced treatment failure in at least 4 antidepressant trials.

On about 10 of the 14 measures, patients in the VNS group had a clinically meaningful quality of life improvement of 34% to 40%, which was below the classically defined antidepressant response of 50%. Patients in this group also had significant gains in quality-of-life measures, such as mood, ability to work, social relationships, family relationships, and leisure activities compared with those who received only treatment as usual.

Clinical implications. “When evaluating patients with treatment-resistant depression, we need to focus more on their overall well-being. A lot of patients are on as many as three, four, or five antidepressant medications, and they are just barely getting by. But when you add a vagus nerve stimulator, it really can make a big difference in people’s everyday lives,” said principal investigator Charles R. Conway, MD, professor of psychiatry at Washington University.

Omega-3 supplementation eases depression in heart failure

Supplementation with omega-3 fatty acids can improve cognitive depressive symptoms and social functioning in patients with comorbid heart failure and depression.2 A randomized, double-blind, placebo-controlled pilot clinical trial included 108 patients with chronic heart failure and MDD.

The patients received a combination of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) fish oil, an almost pure EPA, or a matched placebo daily for 12 weeks. Higher omega-3 blood levels were related to lower cognitive depression scores on the Beck Depression Inventory. The social functioning sub-score of the SF-36 was significantly improved on the EPA/DHA supplement and tended to improve with the high EPA supplement.

Clinical implications. “Generally, we think of the function of omega-3s as preventative rather than as treatment. If used as treatment, the dose must be fairly high (4 grams is a typical drug dose) and blood levels must be measured. Linking higher blood levels of omega-3s to improved depression symptoms in people with both depression and heart failure hopefully leads to better treatment for their conditions,” said co-author William Harris, MD, of the Sanford School of Medicine in Sioux Falls, South Dakota.

Symptoms of depression linked in teens and parents

A long-term study included 325 teens who had a diagnosis of depression and 325 of their parents or caregivers.3 The teens were randomly assigned to receive cognitive behavioral therapy, an antidepressant, or a combination of both. The first treatment period ran for nearly one year, with an additional year of follow-up visits. One-quarter of the parents who participated also reported moderate to severe levels of depression before the treatment period.

The results showed that depressive symptoms improved in parents during treatment for adolescent depression in their children. In addition, improvement in adolescent depressive symptoms was associated with improvement in parental depressive symptoms. This supports the link between parent and youth mood and suggests that treatment for youth depression may benefit parents.

Clinical implications. “Depression is a massive public health concern that will take a variety of approaches to better manage. We believe our study is among the first to evaluate how the emotional health of a child can impact that of the parent,” said co-author Mark A. Reinecke, PhD, Professor of Psychiatry and Behavioral Sciences at the Northwestern University Feinberg School of Medicine. Lead author Kelsey R. Howard, MS, of Northwestern University, added: “The concept of emotions being ‘contagious’ and spreading from person to person is well-known by psychologists. This work opens up a range of possibilities for future research on the family wide effects of treatment for adolescent depression.”

References:

1. Conway CR, Kumar A, Xiong W, et al. Chronic vagus nerve stimulation significantly improves quality of life in treatment-resistant major depression. J Clin Psychiatry. 2018;79:18m12178.

2. Jiang W, Whellan DJ, Adams KF, et al. Long-chain omega-3 fatty acid supplements in depressed heart failure patients: results of the OCEAN trial. JACC Heart Fail. 2018;S2213-S1799:30226-30229.

3. Howard KR. Parental depressive symptoms over the course of treatment for adolescent depression. Presented at the American Psychological Association Annual Convention. San Francisco; August 9-12, 2018. ❒

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