BackgroundSerum BDNF levels are decreased in major depressive disorder (MDD) and tend to normalize under antidepressant treatment, serving as a treatment outcome predictor. BDNF is initially synthetized as precursor protein proBDNF and is cleaved to mature BDNF (mBDNF) while only the latter exerts neurotrophic activity.AimThe aim was to explore if a specific enzyme-linked immunosorbent assay (ELISA) kit for mBDNF in serum would be superior to the unspecific assessment of total serum BDNF in predicting treatment response in MDD.MethodsTwenty-five patients with MDD underwent standardized treatment with duloxetine. Severity of depression was measured by Hamilton Depression Rating Scale (HDRS) at baseline (BL), after one (W1), two (W2) and six weeks (W6) of treatment. Treatment response was defined as a HDRS ≥ 50% reduction of BL score at W6. mBDNF and total BDNF serum levels were determined at BL, W1 and W2.ResultsA high and stable correlation was found between mBDNF and total BDNF serum levels over all measurements. The predictive value of mBDNF BL levels and mBDNFΔW1 to response was similar to that of total BDNF BL and total BDNFΔW1. The assessment of serum mBDNF was not superior to total BDNF in prediction of treatment outcome.ConclusionsNot only baseline total BDNF but also mBDNF is predictive to treatment outcome. The later might represent the main player in this respect, which supports the idea of a functional link between neuroplasticity and MDD.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Background/Aims: Serum BDNF levels are commonly decreased in major depression, and low baseline BDNF serum levels are predictive to poor treatment outcome [1]. In most previous clinical studies, total (tot)BDNF was assessed with enzyme-linked immunosorbent assay (ELISA) kits that did not distinguish between precursor protein proBDNF and mature (m)BDNF. Therefore, our aim was to explore if assessment of mBDNF in serum would be superior to assessment of totBDNF in predicting treatment response in major depression. Methods: In a sample of twenty-five patients with major depressive disorder who underwent a standardized treatment with duloxetine over six weeks, severity of depression (Hamilton Depression Rating Scale (HDRS)), mBDNF and totBDNF were assessed at baseline and after one and six weeks of treatment. Treatment response was defined as a HDRS ≥ 50% reduction of baseline score at week 6. Results: Serum levels of mBDNF and totBDNF were strongly and positively correlated. In responders (N = 18), baseline serum levels of both, mBDNF and totBDNF, were significantly higher than in non-responders (N = 7). Moreover, a steep early rise between baseline and week 1 of both, mBDNF and totBDNF, was associated with poor treatment outcome. Conclusion: Due to the high correlation between mBDNF and totBDNF serum levels, assessment of mBDNF was not superior to totBDNF in prediction of treatment response.

Background/Aims: In major depression cognitive impairment is common and may persist despite improvement in psychopathology. So far it is unclear how closely related improvement in cognitive functioning is to the clinical course of depression. Further, it is unclear whether recovery from cognitive impairment is linked to changes in serum brain-derived neurotrophic factor (sBDNF). The objectives of this study were (1) to explore the predictive value of cognitive impairment for therapeutic outcome, and (2) to assess the association between cognitive performance and sBDNF levels over a 6-week course of antidepressant treatment. Methods: Twenty-five adult patients suffering from major depression underwent standardized treatment with duloxetine. Both severity of depression as assessed by the Hamilton Depression Rating Scale and sBDNF levels were measured at baseline, and after 1, 2 and 6 weeks of treatment. Cognitive performance, i.e. alertness, working memory, and divided attention, was assessed at baseline, after 1 week, and at the end of treatment after 6 weeks. Results: Higher performance in alertness and divided attention at baseline correlated with less severe depression at week 6. During the first week of treatment, a greater increase in sBDNF was associated with a greater improvement in alertness at week 6. Conclusion: Greater alertness at baseline was a predictor of favorable antidepressive treatment outcome. Moreover, the early increase in sBDNF correlated with improvement in attention functioning. Thus, recovery from cognitive impairment and an early increase in sBDNF seem to be associated.

Brain-derived neurotrophic factor (BDNF) is involved in neuroplasticity and pathophysiology of major depression (Hashimoto, 2010). SerumBDNF levels are decreased inmajor depression and tend to normalize under antidepressant treatment (Bocchio-Chiavetto et al. 2010). Moreover, baseline serum BDNF levels as well as its early rise have been found predictive to antidepressant treatment outcome (Mikoteit et al. 2014; Giese et al. 2014). BDNF is initially synthesized as precursor protein proBDNF, and mature BDNF (mBDNF) is derived by proteolytic cleavage. Only mBDNF exerts neurotrophic activity, while proBDNF has opposing functions. Remarkably, in most clinical studies, the unspecific BDNF enzyme-linked immunosorbent assay (ELISA) kits applied did not distinguish between proand mBDNF (BocchioChiavetto et al. 2010). Therefore, our aim was to explore if a specific ELISA kit for mBDNF (Human BDNF ELISA SK00752-1, Aviscera Bioscience, Santa Clara, CA, USA) in serum would be superior to the assessment of total serum BDNF, by using an unspecific antibody recognizing both proand mBDNF (BDNF Emax ImmunoAssay Systems, Promega, Switzerland), in predicting treatment response in major depression.

Major depressive disorder has been associated with low serum levels of brain-derived neurotrophic factor (sBDNF), which is functionally involved in neuroplasticity. Although sBDNF levels tend to normalize following psychopathological improvement with antidepressant treatment, it is unclear how closely sBDNF changes are associated with treatment outcome.

This study examined whether personality disorders (PDs) are associated with alexithymic features at varying levels of comorbid psychopathology distress. 167 psychiatric outpatients completed the Toronto Alexithymia Scale (TAS) and the General Severity Index (GSI) of the SCL90-revised. Bootstrapping analyses were performed to test whether the PD/alexithymia relationship was moderated by psychopathology distress (GSI). The overall number of PD criteria was associated with cognitive aspects of alexithymia (i.e., Externally Oriented Thinking, EOT) only at low/moderate levels of distress. Borderline criteria predicted EOT only when distress was low, while avoidant and dependent criteria were independently related with EOT. No association was found between other PDs and alexithymia facets. Thus, within clinical samples the alexithymia/PD association is mainly explained by comorbid psychopathology; however, individuals with avoidant, dependent and borderline features might have a specific difficulty with focusing on internal reality, even when their current symptom distress is low.

Introduction:We showed previously that 31% of Swiss population (N=1002)suffers from insomnia(DSM-IV criteria) (Delini-Stula et al. 2007). We report here the results of the analysis of the causes, day-time consequences and treatments.Method:An 80 items questionnaire was addressed (telephone interview)to a random sample of subjects of both sexes. The recorded responses were either transformed into numerical and categorical values or expressed in percentages of observations. The results were descriptively analyzed.Results:The main causes of insomnia were classified into 6 categories: personal-, professional and financial problems, diseases, alcoholism and environmental factors. The most frequent were personal (32%) and professional (34%) problems. Only 1% of subjects reported financial worries as cause of insomnia. The most prominent day-time consequences were: fatigue (72%, p<0.003) reduced vitality (46%, p<0.002), irritability (54%, p<0.001) depressed mood (44%, p<002)and impaired cognition (44-51 %, p<0.001). 70% of insomnia subjects reported never to use any treatment. Only 40% of severe insomniacs used prescribed drugs. Also, of the whole population only 44% believed in the efficacy of the hypnotics, but 56% though that herbal products are effective.Conclusion:In view of marked day-time consequences and obviously under-treatment, insomnia (defined by DSM-IV criteria) in Switzerland is a problem that needs more attention.

The aim of the survey studywas to assess sleep behavior of theSwiss population in order to providean estimate of the prevalenceof insomnia and the need for specificprograms to improve itsdiagnostics and treatment.

Objective. The purpose of the present study was to document the experience with the use of a new, fast-dissolving oral tablet (FDT, RemeronSolTab®) of mirtazapine, a NaSSA antidepressant, in the treatment of depressed patients in daily practice in Switzerland. Methods. It was an open, prospective collection of observations in a total of 1121 depressive patients (>18 years old, both sexes). The treatment duration was 8 weeks with assessments after the second and eighth week. Efficacy measures were CGI (seven points) and specific check-lists for the ratings of severity of anxiety and sleep disturbances. At the end of the trial the acceptance (eight-item questionnaire) of the new formulation was recorded too. Results. The results showed that there was highly significant (P<0.001) and rapid improvement of severity of depression, anxiety and sleep disturbances in the whole population. Subgroup analyses showed that the antidepressant efficacy was independent of gender, initial severity of depression or of the type of depression (first episode, recurrent, chronic depression). The majority of patients (80%) liked at least one of the properties of FDT and, out of 75% of patients having experience with conventional tablet, 50% stated to be better compliant with this new formulation. Conclusion. This report documents the antidepressant efficacy of mirtazapine FDT. The new formulation found good acceptance by the patients. The results also suggest a likelihood of improved compliance with the mirtazapine FDT.

A major goal of antidepressant development is to improve on preceding drug classes with agents with greater specificity (and therefore fewer unwanted side-effects) and with more rapid onset of antidepressant action. To this end, four antidepressants with significantly distinct pharmacological characteristics have been recently introduced: venlafaxine, nefazodone, mirtazapine, and reboxetine. Venlafaxine is the first antidepressant in a new drug class referred to as the serotonin noradrenergic reuptake inhibitors (SNaRIs). Nefazodone is a weaker serotonin and norepinephrine reuptake inhibitor, but a potent serotonin 5-HT2 receptor antagonist. Mirtazapine is a potent antagonist of central 2α-adrenergic autoreceptors, and heteroreceptors and is an antagonist of serotonin 5-HT2 and 5-HT3 receptors. The result of these actions is to increase both noradrenergic and specific (5-HT1) serotonergic transmission, and mirtazapine has therefore been termed a noradrenergic and specific serotonergic antidepressant (NaSSA). Reboxetine is the first selective noradrenaline reuptake inhibitor (NaRI) to be introduced since the tricyclics, and lacks immediate serotonergic effects.

Even though many scales for the assessment of sexual dysfunction have been recently developed, most of them are suitable rather for the research purpose in clinical trials than to routine interviews in a daily, private practice. We report here the first experience with a simple, semi-quantitative scale for parallel assessment of sexual dysfunction and lifesatisfaction (considered to globally reflect the quality of life), which was tested in depressed patients treated in the psychiatric, private practice setting. A combined Sexual Dysfunction(SD-S) and Life-Satisfaction Scale (LS-S), was constructed based on previous interviews with patients. Both consisted of 4-items, assumed to represent core elements of sexual function and individual well-being. The scales were applied to depressed patients treated with any of the SSRIs or with moclobemide, a reversible and selective MAO-A inhibitor. These two treatments were selected for testing the scales because it is known that SSRIs can induce or exacerbate them and moclobemide does not seem to affect them. The selection of treatment modality in this study was, however, entirely at the discretion of the physician. The assessments were done during 3 visits (at baseline, after 2 months and after 4 months). The results of this exploratory trial, testing the applicability, acceptance and utility of a combined mini- SD-S- and LS-S- scale, in 62 depressed patients, showed that the scale: a) was simple to use and well accepted by physicians and patients, b) was a suitable instrument for the practicing physician to control the success of the treatment and c) was sensitively assessing the presence and severity of sexual dysfunction.