Towards Personalizing Treatment for Depression : Developing Treatment Values Markers.

Towards Personalizing Treatment for Depression : Developing Treatment Values Markers.

Filed under: Depression Treatment

Patient. 2013 Feb 19;
Wittink MN, Morales KH, Cary M, Gallo JJ, Bartels SJ

BACKGROUND: While ‘personalized medicine’ commonly refers to genetic markers or profiles associated with pharmacological treatment response, tailoring treatments to patient preferences and values is equally important. OBJECTIVE: To describe and demonstrate a method to develop ‘values markers,’ or profiles based on the relative importance of attributes of depression treatment. STUDY DESIGN: Discrete choice analysis was used to assess individuals’ relative preferences for features of depression treatment. Preference profiles were developed using latent profile analysis. PATIENTS OR OTHER PARTICIPANTS: Eighty-six adults participating in an internet-based discrete choice questionnaire. MAIN OUTCOME MEASURE: Participants were presented with two depression scenarios representing mild and severe depression. For each scenario, they were asked to compare 18 choice sets based on the type of medication side effect (nausea, dizziness, and sexual dysfunction) and severity (mild, moderate, and severe); and for counseling frequency (once per week or every other week) and provider setting (the office of a mental health professional, primary care doctor, or spiritual counselor). RESULTS: Three profiles were identified: profile 1 was associated with a preference for counseling and an avoidance of medication side effects; profile 2 with an avoidance of strong medication side effects and for receiving counseling in medical settings; and profile 3 with a preference for medication over counseling. When presented with a severe depression scenario, there was a higher prevalence for profile 1 and patients were more likely to prefer mental health over primary care and spiritual settings. CONCLUSIONS: Values markers may provide a foundation for personalized medicine, and reflect current initiatives emphasizing patient-centered care. Next steps should assess whether values markers are predictive of treatment initiation and adherence.
HubMed – depression

Dietary Composition in the Treatment of Polycystic Ovary Syndrome: A Systematic Review to Inform Evidence-Based Guidelines.

Filed under: Depression Treatment

J Acad Nutr Diet. 2013 Feb 15;
Moran LJ, Ko H, Misso M, Marsh K, Noakes M, Talbot M, Frearson M, Thondan M, Stepto N, Teede HJ

While lifestyle management is recommended as first-line treatment of polycystic ovary syndrome (PCOS), the optimal dietary composition is unclear. The aim of this study was to compare the effect of different diet compositions on anthropometric, reproductive, metabolic, and psychological outcomes in PCOS. A literature search was conducted (Australasian Medical Index, CINAHL, EMBASE, Medline, PsycInfo, and EBM reviews; most recent search was performed January 19, 2012). Inclusion criteria were women with PCOS not taking anti-obesity medications and all weight-loss or maintenance diets comparing different dietary compositions. Studies were assessed for risk of bias. A total of 4,154 articles were retrieved and six articles from five studies met the a priori selection criteria, with 137 women included. A meta-analysis was not performed due to clinical heterogeneity for factors including participants, dietary intervention composition, duration, and outcomes. There were subtle differences between diets, with greater weight loss for a monounsaturated fat-enriched diet; improved menstrual regularity for a low-glycemic index diet; increased free androgen index for a high-carbohydrate diet; greater reductions in insulin resistance, fibrinogen, total, and high-density lipoprotein cholesterol for a low-carbohydrate or low-glycemic index diet; improved quality of life for a low-glycemic index diet; and improved depression and self-esteem for a high-protein diet. Weight loss improved the presentation of PCOS regardless of dietary composition in the majority of studies. Weight loss should be targeted in all overweight women with PCOS through reducing caloric intake in the setting of adequate nutritional intake and healthy food choices irrespective of diet composition.
HubMed – depression

Physical activity and psychological well-being in obese pregnant and postpartum women attending a weight-gain restriction programme.

Filed under: Depression Treatment

Midwifery. 2013 Feb 15;
Claesson IM, Klein S, Sydsjö G, Josefsson A

OBJECTIVE: the objective of the study was to compare the differences in psychological well-being and quality of life during pregnancy and post partum of obese physically active women and obese physically inactive women enroled in a weight gain restriction programme. We also wanted to explore whether physical activity influences weight change or health status during pregnancy. DESIGN: a prospective intervention study. SETTING: antenatal care clinic. PARTICIPANTS: a total of 74 obese pregnant women in a physically active group and 79 obese women in a physically inactive group. MEASUREMENTS: the women kept diaries of their physical activity during pregnancy and answered the Beck Anxiety Inventory, the Edinburgh Postnatal Depression Scale and Medical Study Short-Form Health Survey in gestational weeks 15 and 35 and 11 weeks post partum. Physical activity was measured in metabolic equivalents. FINDINGS: the physically active women experienced fewer depressive symptoms and estimated an improved quality of life during their pregnancies as measured by physical functioning, bodily pain, social functioning, role limitations due to emotional problems and general mental health as compared with the physically inactive women. There were no differences between the groups in gestational weight gain or weight change from early pregnancy to post partum or in prevalence of complications. KEY CONCLUSIONS: physical activity among obese pregnant women provides better psychological well-being and improved quality of life, but does not prevent weight change. IMPLICATIONS FOR PRACTICE: staff at Antenatal Care Clinics that face obese pregnant women, should encourage and emphasise the benefits of being physically active throughout pregnancy.
HubMed – depression

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