Background Psychomotor retardation is a prominent and disabling feature of melancholic depression. Accelerated intermittent theta-burst stimulation (aiTBS) may hasten antidepressant effects, but neural substrates of early symptom improvement remain unclear. Given the central role of frontostriatal circuitry in motivation and behavioral activation, structural alterations in the striatum may represent a possible neural substrate of early therapeutic change. Methods Structural MRI was acquired from 61 patients with melancholic TRD and 77 healthy controls, and voxel-based morphometry was used to assess baseline striatal gray matter volume differences. Patients then underwent a randomized, double-blind, sham-controlled trial of left dorsolateral prefrontal aiTBS, comprising 20 sessions over four days. In 50 patients with complete pre- and post-treatment data, we tested whether GMV change in the baseline-identified striatal region was associated with clinical change in the active and sham groups (n = 25 each). Results Patients showed greater right putamen GMV than controls at baseline. After active aiTBS, greater right putamen GMV increase was associated with greater psychomotor retardation improvement. This association was absent after sham stimulation and was not observed for overall depression severity. Conclusion The right putamen appears structurally altered in melancholic TRD. After active aiTBS, short-term putamen GMV increase was associated with psychomotor rather than broader depressive improvement. This pattern should not be interpreted as structural normalization but may reflect a relationship between putaminal change and early psychomotor recovery.
Background Suicide is a global public health concern, with the highest rates among older males in most countries. Access to mental healthcare is central to suicide prevention. This study examined mental healthcare contact among older adults who died by suicide compared with controls from the general population. Methods Using Norwegian national health and administrative registries, we conducted a nested case-control study of individuals aged 60 and older who died by suicide between 2009 and 2021. Cases were matched on age and sex to controls from the general population. Mental healthcare contact and sociodemographic characteristics were described for cases and controls, and mental health diagnosis of cases in contact with mental healthcare services. Results A substantial proportion of older adults who died by suicide (N = 2002) had prior mental healthcare contact. Specialized mental healthcare contact decreased with age and was more common among females than males (60–69: 50% vs. 38%; 70–79: 42% vs. 22%; 80+: 33% vs. 13%). Primary mental healthcare contact showed small sex differences and remained relatively stable (24–30%) across age. Depression or depressive symptoms were common among cases in both specialized (35%) and primary care (36%). Among those without mental health contact, cases more often were males, not married, and living alone than controls. Conclusion Older adults who died by suicide received care across multiple healthcare levels and were often diagnosed with depressive symptoms, highlighting the need for prevention and treatment across mental healthcare settings. Improving prevention strategies, particularly among older males, may strengthen suicide prevention in later life.
Objectives To analyze factors associated with postmortem cannabis detection among suicide decedents in the Federal District, Brazil. Methods Population-based cross-sectional study of 1164 suicide deaths (2009–2019) with toxicological data, drawing on death certificates, police reports, and Legal Medicine Institute (IML) forensic postmortem examinations. Poisson regression with robust variance yielded crude and adjusted prevalence ratios (PR) with 95% confidence intervals. Results Cannabis was detected in 7.8% of cases. Independent correlates included age 12–17 years (aPR = 4.61; 95%CI: 1.31–16.17), prior criminal offense record (aPR = 1.71; 95%CI: 1.11–2.63), the period 2016–2019 (aPR = 2.83; 95%CI: 1.20–6.67), and concurrent cocaine detection (aPR = 2.57; 95%CI: 1.67–3.96). Conclusion Cannabis detection clustered in high-vulnerability subgroups marked by younger age, criminal history, and polysubstance use, a profile that may inform postvention surveillance and targeted substance-use screening among suicide decedents.
