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INTRODUCTION: Recent guidelines on depressive disorders suggest a combination of antidepressants and psychotherapy in case of moderate to severe symptomatology. While cognitive behavioral therapy and interpersonal therapy are the most investigated interventions, psychodynamic psychotherapies have been less explored. OBJECTIVE: The aim of this paper is to systematically review literature data on the efficacy of shortterm psychodynamic psychotherapy (STPP) in combination with antidepressants in the treatment of depressive disorders, focusing both on short and on long-term results and on potential moderators that could influence its effectiveness. METHODS: The systematic review was conducted using the PRISMA guidelines. Databases searched were PubMed, Ovid, Scopus, and Cochrane Library, from inception to August 2023. RESULTS: Adding STPP to medications in the first six months of treatment didn't influence remission rates, but improved acceptability, work adjustment, interpersonal relationships, social role functioning, hospitalization rates and cost-effectiveness. After 12 months, a significant difference in remission rates arised, favouring combined therapy. In a long-term perspective, adding STPP to pharmacotherapy reduced the recurrence rate by almost 50%. STPP has proven to be more effective in longer depressive episodes, in more severe depressions and in patients with a childhood abuse history. Instead, STPP had no impact on major depressive disorder with comorbid Obsessive-Compulsive Disorder (OCD). CONCLUSIONS: Combining STPP with antidepressants appeared to be helpful both in a short-term and in a long-term perspective. Still, there are few rigorous studies with large samples and further research is needed to identify which subgroups of patients may benefit more from STPP.

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Background: The Behavioral Inhibition System (BIS) comprises limbic circuitry implicated in avoidance behaviors. Its increased activation has been identified as a risk factor for anxiety and depressive disorders. In addition, both Catechol-O-Methyltransferase (COMT) and Brain Derived Neurotrophic Factor (BDNF) have been postulated as candidate genes that constitute a vulnerability for the onset of anxiety and depressive disorders. The aim of this study was to evaluate the possible association between the rs4680 polymorphism of the COMT gene and the rs6265 polymorphism of the BDNF gene with the BIS and the Behavioral Activation System (BAS) in a population sample from Colombia. Methods: Genetic information was obtained by extracting DNA from blood samples of 80 participants and using Taqman probes designed for each polymorphism. In addition, participants completed a BIS/BAS scale in order to establish a neuropsychological classification. Results: The frequency of the Met allele of the BDNF gene was greater in the group with BIS sensitivity compared to the group with BAS sensitivity. On the contrary, the frequency of the Met allele of the COMT gen did not show a significant association with the BIS. Conclusions: The rs6265 polymorphism of BDNF gene is associated with the BIS which in turn constitutes a risk factor for anxiety and depression.

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The use of antidepressants during pregnancy benefits the mother's well-being, but the effects of such substances on neurodevelopment remain poorly understood. Moreover, the consequences of early exposure to antidepressants may not be immediately apparent at birth. In utero exposure to selective serotonin reuptake inhibitors (SSRIs) has been related to developmental abnormalities, including a reduced white matter volume. Several reports have observed an increased incidence of autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) after prenatal exposure to SSRIs such as sertraline, the most widely prescribed SSRI. The advent of human-induced pluripotent stem cell (hiPSC) methods and assays now offers appropriate tools to test the consequences of such compounds for neurodevelopment in vitro. In particular, hiPSCs can be used to generate cerebral organoids - self-organized structures that recapitulate the morphology and complex physiology of the developing human brain, overcoming the limitations found in 2D cell culture and experimental animal models for testing drug efficacy and side effects. For example, single-cell RNA sequencing (scRNA-seq) and electrophysiological measurements on organoids can be used to evaluate the impact of antidepressants on the transcriptome and neuronal activity signatures in developing neurons. While the analysis of large-scale transcriptomic data depends on dimensionality reduction methods, electrophysiological recordings rely on temporal data series to discriminate statistical characteristics of neuronal activity, allowing for the rigorous analysis of the effects of antidepressants and other molecules that affect the developing nervous system, especially when applied in combination with relevant human cellular models such as brain organoids.

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Background: The mild cognitive impairment (MCI) stage among elderly individuals is very complex, and the level of diagnostic accuracy is far from ideal. Some studies have tried to improve the 'MCI due to Alzheimer's disease (AD)' classification by further stratifying these patients into subgroups. Depression-related symptoms may play an important role in helping to better define the MCI stage in elderly individuals. Objective: In this work, we explored functional and structural differences in the brains of patients with nondepressed MCI (nDMCI) and patients with MCI with depressive symptoms (DMCI), and we examined how these groups relate to AD atrophy patterns and cognitive functioning. Methods: Sixty-five participants underwent MRI exams and were divided into four groups: cognitively normal, nDMCI, DMCI, and AD. We compared the regional brain volumes, cortical thickness, and white matter microstructure measures using diffusion tensor imaging among groups. Additionally, we evaluated changes in functional connectivity using fMRI data. Results: In comparison to the nDMCI group, the DMCI patients had more pronounced atrophy in the hippocampus and amygdala. Additionally, DMCI patients had asymmetric damage in the limbic-frontal white matter connection. Furthermore, two medial posterior regions, the isthmus of cingulate gyrus and especially the lingual gyrus, had high importance in the structural and functional differentiation between the two groups. Conclusion: It is possible to differentiate nDMCI from DMCI patients using MRI techniques, which may contribute to a better characterization of subtypes of the MCI stage.

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The high prevalence of mental health problems among university students poses a challenge when developing effective interventions, with digital technologies emerging as a potential resource to address this problem. The inclusion of student input in the design and development of such interventions is critical to improving their impact. This study contributed to the initial phase of a research project that aims to adapt and evaluate the feasibility and acceptability of an early intervention for anxiety and depression based on digital technologies for university students. Three participatory workshops were conducted with 13 university students in Chile to inquire about the features and content that a mental health mobile app should include to meet their needs and preferences. The workshop transcripts were analysed using inductive thematic analysis. The results of this study highlight the value of modifications such as the personalisation of some features of the app. The students recommended incorporating topics related to university life and the possibility of contacting a mental health professional, as well as the inclusion of peer interaction or other forms of support.

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Abstract Background Cognitive retraining or remediation approaches dispense high levels of stimulation and new learning tasks, leading to an increased neural connections, which facilitate rapid recovery in patients with neurological as well as psychiatric conditions. Objectives The current study aimed to investigate the effect of cognitive retraining (CR) in depressive disorders. We assigned 40 patients with mild to moderate depression to two sample groups, with 20 participants each: CR alone and CR with medicine. A 6-week CR module was delivered, and participants' scores on measures such as the Beck Depression Inventory-II, Metacognition Questionnaire 30, World Health Organization Quality of Life-Brief, and Global Assessment of Functioning were compared. Results Analysis using Stata/IC version 16 included descriptive statistics, paired and independent t-tests, analysis of covariance, and propensity score matching. Cohen's d was computed to determine the effect size. Within-group analysis revealed statistically significant differences in pre-post scores of the outcome measures (p < .05) and large effect size (d = 3.41; d = 3.60) in both groups. The difference in scores of outcome measures between the groups was not significant (p > .05) even when covariates were controlled, or nearest neighbor match analysis was carried out. CR is effective in alleviating symptoms and dysfunctional metacognitive beliefs in addition to enhancing functioning and quality of life. Conclusions CR-based interventions may be essential mental health services owing to growing research in psychotherapy via virtual modes such as tele- and video-conferencing. These interventions can substantiate both prevention and remedy.

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Introdução: A depressão é um transtorno incapacitante e causa prejuízos funcionais, além de altos custos para o sistema de saúde e previdência social. No Brasil, os Centros de Atenção Psicossocial são serviços de base comunitária, prioritários para o cuidado, a fim de possibilitar a reinserção social dos sujeitos adoecidos mentalmente. Objetivos: Investigar os custos diretos e indiretos da depressão no Brasil entre 2010 e 2018, e a oferta de cuidados em saúde dos CAPS a indivíduos com depressão, entre 2013-2019. Métodos: Estudo de custo da doença baseado na prevalência, com abordagem top-down, sob a perspectiva da sociedade, e estudo descritivo, ecológico, de série temporal, com dados secundários de bancos de dados nacionais, com adultos de 18 anos ou mais de idade, com diagnóstico de depressão. Foram incluídos custos diretos (hospitalares e ambulatoriais), provenientes dos Sistemas de Informação Hospitalar e Ambulatorial, e indiretos (absenteísmo), do Instituto Nacional de Seguro Social, além dos atendimentos efetuados nos CAPS, provenientes dos Registros das Ações Ambulatoriais de Saúde (RAAS psicossocial). Os custos foram calculados por ano, de 2010 a 2018. A cobertura presumida de CAPS foi calculada para 2013 e 2019, com base nos serviços cadastrados e ativos. Resultados: O custo da depressão foi de Int$ 2.288.511.607,39 no período analisado, com custo médio anual de Int$ 254.279.067,49. De 2014 a 2018, houve queda acentuada no custo da depressão (-44,24%), principalmente nos custos indiretos (-55,83%). No período investigado, os custos indiretos representaram 74,85% do custo total. Com o tempo, o ambulatório superou o custo hospitalar. Em 2017 e 2018, os custos ambulatoriais representaram, respectivamente, 43,22% e 39,57% dos custos totais. Em todos os anos analisados, predominaram os custos e atendimentos nos CAPS para o sexo feminino (77%). Houve um aumento de 107% no número de pacientes com depressão atendidos nos CAPS entre 2013 e 2019. Prevaleceram, entre os atendidos, aqueles de cor/raça branca (38%) e parda (34%), na faixa etária de 41-60 anos (49%). Foram mais frequentes o diagnóstico de episódios depressivos (65%) e o atendimento individual (75%). A cobertura presumida dos CAPS foi de 71% e 87% no país em 2013 e 2019, respectivamente, embora com disparidades acentuadas entre os estados. Conclusões: A depressão é uma doença com elevada carga econômica para o sistema de saúde. Foram identificados avanços na implementação dos CAPS no país, no período 2013-2019. No entanto, ainda são necessários investimentos, tal como maior cobertura dos serviços, pois ainda permanecem desigualdades entre as unidades federativas, além de serem reduzidos os atendimentos em grupos e familiares, sendo necessária a capacitação de equipes multiprofissionais e de profissionais de saúde aptos para a atenção psicossocial.

Introduction: Depression is a disabling disorder and it causes functional damages, in addition to high costs to the health system and social previdence. In Brazil, the Psychosocial Atention Centers are services of communitarian base intented to care and enable the social reinsertion of mentally diseased individuals. Objectives: To investigate depression's direct and indirect costs in Brazil between 2010 and 2018, and CAPS' offer of medical care to individuals with depression, between 2013-2019. Methods: Study of cost based on prevalence, with top-down approach, under the perspective of society, and descriptive, ecological study of temporal series, with secondary data from national data banks, with adults over 18 years old or more, diagnosed with depression. Direct costs (hospital and outpatient) that came from Hospital and Outpatient Information Systems and indirect ones (absenteeism) that came from the National Institute of Social Security were included, in addition to the performed medical cares in CAPS, which can be found on the Records of Outpatient Health Actions (psychosocial RAAS). The costs were calculated by year, from 2010 to 2018. CAPS' presumed coverage was calculated for 2013 and 2019, based on registered and active services. The cost of depression was from Int$ 2.288.211.607,39 in the analyzed period, with an average annual cost of Int$ 254.279.067,49. From 2014 to 2018, there was an elevated decrease in the cost of depression (-44,24%), mainly in indirect costs (-55,83%). In the investigated period, the indirect costs represented 74,85% of the total cost. With time, the outcare overcame the hospital cost. In 2017 and 2018, outcare costs represented, respectively, 43,22% and 39,57% of total costs. During all the analyzed years, the costs and medical cares in CAPS were mostly for the feminine sex (77%). There was an increase of 107% in the number of patients with depression that received medical care in CAPS between 2013 and 2019. Those that received medical cares the most were of white color-race (38%) and brown (34 %), between the ages of 41 and 60 years old (49%). The diagnose of depressive episodes (65%) and the individual medical care (75%) were most frequent. The presumed CAPS' coverage was of 71% and 87% in the country, respectively, although with accentuated disparities between the states. Conclusion: Depression is a disease with elevated economical charge to the health system. Advancements were identified in the implementation of CAPS in the country, during 2013-2019. However, investments are still necessary, just as a bigger coverage of the services, because there are still inequalities bwtween the federative unities, in addition to reduced medical cares for groups and families, making the training of multi-professional and professional health teams that are able to pychosocial attention, necessary.

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SUMMARY OBJECTIVE: This study aimed to analyze the epidemiological profile and psychological disorder of the suicide attempt cases in Francisco Beltrão, Paraná. METHODS: This is an epidemiological descriptive/qualitative study of suicide attempts conducted between 2017 and 2020. This study used data from the Brazilian Information system for notifications involving suicide attempts (Sistema de Informação de Agravos de Notificação, SINAN) and 447 notifications were obtained. An analysis of the electronic medical record of these patients was performed in order to investigate the mental disorders, using a questionnaire. RESULTS: Of the 447 notifications, 382 were eligible for the study. Using the 95% confidence interval, there was a higher frequency of females with 71.7% aged between 18 and 35 years representing 48.4%, with 77.2% white race/color, the singles appeared in the majority with 47.6% with a history of previous suicide attempts, using exogenous intoxication as a method in the attempt with 67.5%. Regarding mental health, 66.5% of the patients had some mental disorders, with the highest prevalence of recurrent depressive disorder found in 40.6%. CONCLUSION: It was observed that there is a need for training of health professionals and implementation of programs and preventive measures aimed primarily at females aged between 18 and 35 years with mental disorders, especially with recurrent depressive disorder and with a history of previous suicide attempt.

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Introducción: la enfermedad renal crónica avanzada se define como la presencia de daño renal y se caracteriza por alteraciones estructurales y funcionales que disminuyen la tasa de filtración glomerular. Esta enfermedad constituye un punto de cambio en la vida de las personas que la padecen, pues los obliga a diseñar estrategias mediante las cuales puedan reestructurar sus sueños, aspiraciones y proyectos de vida debido a que esta es una condición que cambia los estilos de vida y ocasiona otras entidades que afectan los niveles físico, psicológico y social. Objetivo: determinar los factores asociados a la depresión en personas con enfermedad renal crónica avanzada en población del departamento de Boyacá, Colombia. Materiales y métodos: se realizó un estudio transversal en 201 pacientes con enfermedad renal crónica en fases avanzadas y que estuvieran en manejo con terapia dialítica. Para la obtención de los datos se aplicó el cuestionario de depresión de Beck, además se incluyeron variables demográficas, sociales y clínicas. Resultados: la edad promedio de los participantes fue 58,5 años, el 76,11 % eran varones y la prevalencia de depresión fue de 40,29 %. Las personas con pareja estable y que cuentan con apoyo familiar y buena atención por parte del personal de salud tienen menos probabilidad de presentar depresión, mientras que los mayores de 50 años de edad, quienes llevan más dos años en terapia dialítica y aquellos que presentan otras enfermedades como diabetes mellitus y enfermedad pulmonar obstructiva crónica tienen probabilidades más altas de desarrollar depresión. Conclusiones: se considera prudente crear grupos de apoyo en las unidades de diálisis, donde se incluya a los pacientes y sus familiares, con el fin de detectar tempranamente problemas de salud mental y darles un manejo temprano, buscando de esta forma una adecuada adherencia al tratamiento de las patologías de base.

Introduction: Renal insufficiency is defined as the presence of renal damage and is characterized by structural and functional alterations with decreased glomerular filtration rate. This disease constitutes a turning point in the lives of people who suffer from it, since it requires elaborate forms or methods by which they can structure their dreams, aspirations and life projects additionally changing lifestyles, and generates other entities that affect the physical, psychological and social level. With this project they were determined the factors associated with depression in people with advanced chronic kidney disease in population of the department of Boyacá. Materials and methods: A cross-sectional study was conducted, which included patients with chronic kidney disease in advanced stages who were managed with dialysis therapy. Demographic, social and clinical variables were included. Where the Beck depression questionnaire was applied. Results: A total of 201 people participated. The average age was 58.5 years and 76.11 % were male. The prevalence of depression was 40.29 %. People with a stable partner, who have family support and good care from health personnel are less likely to have depression, while people over 50 years of age, with more than two years in dialysis therapy and the presence of Diseases such as diabetes mellitus and chronic obstructive pulmonary disease are more likely to develop depression. Conclusions: It is considered prudent to create support groups in dialysis units, where patients and their families are included, this in order to detect mental health problems early and give early management, thus seeking an adequate to the adherence of the underlying pathologies.

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Abstract Objective To assess the most common psychological disturbances in women with deep endometriosis and bowel involvement who are waiting surgical treatment and to evaluate what forms of coping are used to solve the problem. Methods This was a cross-sectional observational study of 40 women diagnosed with deep endometriosis and intestinal symptoms. They completed two questionnaires: one for anxiety and depression (Hospital Anxiety and Depression Scale [ HADS]) and the Scale of Mode of Confronting Problems (EMEP, in the Portuguese acronym). Results We found that 77.1% of the patients had anxiety and depression, with anxiety being the most prevalent (87.5% of the patients); 90% of the patients used problem focused and religious introspection as their main modes of confronting problems. Conclusion In the use of the HADS questionary, two psychological aspects were the most present in women with deep endometriosis awaiting surgical treatment: anxiety and depression. The most used forms of coping to solve the problem were problem coping and religious practices.

Resumo Objetivo Avaliar os distúrbios psicológicos mais comuns em mulheres com endometriose profunda e acometimento intestinal que aguardam tratamento cirúrgico e avaliar as formas de enfrentamento que são usadas para resolver o problema. Métodos Estudo observacional transversal com 40 mulheres com diagnóstico de endometriose profunda e acometimento intestinal. As pacientes responderam dois questionários: para ansiedade e depressão (Hospital Anxiety and Depression Scale [HADS, na sigla em inglês) e outro para enfrentamento dos problemas (EMEP). Resultados Constatamos que 77% das pacientess apresentaram ansiedade e depressão, sendo a ansiedade a mais prevalente (87,5%); 90% das pacientes usaram a forma religiosa e focada no problema como sua principal estratégia de enfrentamento. Conclusão Os aspectos psicológicos mais encontrados em mulheres com endometriose profunda e intestinal que aguardam tratamento cirúrgico são ansiedade e depressão. As formas mais usadas de enfrentamento para resolver o problema foram práticas religiosas e focada no problema.

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