The global arginine bioavailability ratio (GABR) is used to estimate arginine supply. Arginine is precursor to nitric oxide (NO) that has been suggested to play a role in major depressive disorder (MDD). NO also participates in neuronal, inflammatory and cardioprotective functions.

To compare GABR between:

– D patients and non-depressed controls;

– remitted and non-remitted MDD patients;

– baseline and follow-up within remitted and non-remitted MDD groups.

To investigate the role of NO production in MDD.

The sample comprised 99 MDD patients and 253 non-depressed controls (Beck Depression Inventory scores < 10) aged 20–71 years. Altogether, 78 patients returned for the follow-up; 33 were remitted and 45 non-remitted. GABR was calculated from serum levels of arginine, citrulline and ornithine, which were analysed using ultra-performance liquid chromatography. Differences between the study groups were examined using logistic regression adjusted for age, gender, smoking, alcohol use, physical exercise and glycated haemoglobin. The follow-up regression analyses were adjusted for age, gender and physical exercise.

Lowered GABR was associated with belonging to the MDD group (OR 0.13, 95% CI 0.03–0.50). Exclusion of participants using anti-depressants that were associated with measured metabolites did not change the results. Over the follow-up period, the remitted and non-remitted groups both showed an increase in GABR (Z = –.53, P < 0.001 and Z = –3.00, P = 0.003, respectively).

Decreased GABR may characterise MDD. This could affect neuronal, immunological and cardioprotective functions of NO.

The authors have not supplied their declaration of competing interest.

Depressive disorders (DD) are the second cause of disability worldwide. DD affect predominantly working age individuals, recurring in 75% of cases. DD pathophysiology is intricate and multi-factorial. Several inflammatory diseases have been linked to mood disorders. Amidst these conditions is multiple sclerosis (MS), a chronic inflammatory disease of the central nervous system, characterized by frequent exacerbations and progressive functional loss.

To review the current knowledge on DD and MS as comorbidities and the underlying pathophysiologic mechanisms.

We performed a bibliographic search in Pubmed–publications released in the last 5 years, written in English, Portuguese and Spanish, containing the keywords depression, inflammatory disorders, multiple sclerosis.

The inflammatory hypothesis of depression provides a strong foundation to explain its close link with multiple sclerosis. The incidence and prevalence of DD is significantly higher in MS, especially in men. Functional imaging studies have shown that depressive symptoms are closely linked to the extension of inflammatory lesions, especially on the frontal and parietal regions, with particular emphasis to those affecting the grey matter. On the one hand, the clinical course and response to treatment of MS may be hindered by DD; on the other hand, the evolution of MS lesions leads to fluctuations in mood, with significant improvement of DD with successful MS treatment, independently of physical improvement.

There appears to be a biological link between DD and MS, with a bidirectional interference in the clinical course, prognosis and treatment response. Thus, both conditions must be correctly identified and treated.

The authors have not supplied their declaration of competing interest.

The Beck Depression Inventory (BDI-II) has become one of the most widely used instruments for evaluating the severity of depressive symptoms in psychiatric patients and in normal populations. The Oxford Happiness Questionnaire (OHQ) has been derived from the Oxford Happiness Inventory (OHI). The OHI follows the design and format of BDI-II, which provided, when reversed, a set of 20 multiple-choice items relevant to subjective well being. Further items were added to cover aspects of happiness and 29 items were retained in the final scale. OHQ was translated into Arabic for the first time in the present study. The aim of the study is to examine the correlation between depression and happiness.

BDI-II (alpha .87) and the Arabic version of OHQ (alpha .92) were completed by a sample of (380) Kuwait university students (180) males and (200) females with mean age of 22.19 ± 2.8 years old. Pearson correlations were calculated.

Significant (P > 0.01) reverse correlation was found between depression and happiness (r = –54).

Although significant negative relationship existed between BDI-II and OHQ, the coefficient for determination of this correlation shows that nearly only half of depression changes are described and assessed with happiness score! It seems that the two psychometric tools do not completely stand against each other. However, further evaluation of this relationship is needed.

The author has not supplied his/her declaration of competing interest.

Treatment resistant depression (TRD) affecting approximately 10–30% of all depressed patients often remains misdiagnosed and undertreated, leading to a higher risk of relapse and suicide. Electroconvulsive therapy (ECT) and sub-anesthetic ketamine have repeatedly shown to be effective in the TRD population. Administering ketamine as an anesthetic component to augment antidepressant efficacy of ECT has been proven inconclusive, while a combination of alternating ECT and ketamine has not been investigated yet.

We present a severely depressed and chronically suicidal female inpatient who failed multiple antidepressant treatment attempts, requiring frequent psychiatric admissions. Since available conventional as well as non-conventional antidepressant treatment strategies were nearly exhausted, we employed a combination of ECT (bilateral stimulation up to 150%) 2–3 times/week, while intravenous racemic ketamine (up to 75 mg per infusion) was administered on ECT free days 2–3 times/week. Consequently, robust anti-suicidal and antidepressant effects could be observed already during the first treatment week. The temporarily occurring subjective forgetfulness disappeared after the last ECT. Summarizing, we employed 9 ECT treatments and 7 ketamine infusions leading to a stable psychopathological state even after discharge from psychiatric inpatient care. In order to prevent relapse a maintenance-therapy comprising ECT once monthly and 2 ketamine infusions (up to 100 mg per infusion) administered on the day before and after ECT was established.

In our patient alternating ECT and intravenous racemic ketamine were proven safe and long-term effective after numerous failed antidepressant trials including ECT and ketamine alone. We may hence encourage clinicians to widen their therapeutic armamentarium in severe TRD.

The authors have not supplied their declaration of competing interest.

Studies have shown that somatic pain influences the severity of major depressive disorder (MDD), and could be moderated through pain coping strategies and not catastrophizing to pain.

The aim of the study was to ascertain the correlation between pain coping strategies, catastrophizing to pain and severity of depression.

The study sample consisted of 82 patients diagnosed with MDD, aged between 18 and 65 years old (M = 46.21). Assessment instruments included The Beck Depression Inventory-II (BDI-II), The Brief Pain Inventory-Short Form-BPISF (consisting of two subscales: BPI1-intensity of pain, and BPI2-interference with daily functioning), The Vanderbilt Pain Management Inventory-VPMI (consisting of active-VPMIAC and passive pain coping mechanism subscales-VPMIPC) and The Pain Catastrophizing Scale-PCS (consisting of subscales of rumination, exaggeration and helplessness).

The average BDI-II score was 27.21 (SD = 11.53); the average score at BPI1 was 2.99 (SD = 2.83) and 3.35 (SD = 3.26) at BPI2; the average scores on the active coping mechanism subscale was 20.72 (SD = 4.87), and on the passive coping mechanism subscale 34.05 (SD = 7.86); the average catastrophizing scale score was 28.78 (SD = 10.72). Active mechanism of pain coping has shown significant negative correlation with depression (r = –0.227, P > 0.05) while passive mechanism of pain coping has shown significant positive correlation with depression (r = 0.269, P > 0.05). Intensity of depression was significantly positively correlated with intensity of catastrophizing to pain (r = 0.358, P > 0.01) and its derivatives: rumination, exaggeration and helplessness.

Interventions focusing on targeting catastrophizing to pain and pain coping mechanisms should be considered in the treatment of patients with MDD with somatic pain.

The authors have not supplied their declaration of competing interest.

The PHQ-9 has been recommended as the best available screening and case-finding instrument for primary care based on its brevity, and ability to inform the clinicians on both depression severity and diagnostic criteria.

Our study evaluated the reliability and the validity of the Tunisian version of the PHQ-9 in detecting major depression in general population.

We undertook a cross-sectional and analytical study. A total of 134 participants, representative of the Tunisian general population, were enrolled. The PHQ-9 was validated against the HAD reference standard. The types of validity determined for the PHQ-9 in this study were: translation validity, internal reliability and criterion validity.

Test-Retest reliability was determined by intraclass correlation. This scale is stable over 2 weeks (ICC = 0.97). The Tunisian version of the PHQ-9 was found to have good internal reliability (Cronbach's alpha = 0.84). As for criterion validity of the PHQ-9, the Pearson's correlation coefficient between the PHQ-9 and HAD was 0.94 and the Spearman's correlation coefficient was 0.81. This indicated a positive association of good strength between the two instruments. A cut-off score of 10 or higher on the PHQ-9 had a sensitivity of 86.2 and a specificity of 83.8. The VPP was 0.6 and the VPN was 0.9.

The Tunisan version of the PHQ-9 has several potential advantages. It was found to be a valid and reliable casefinding instrument for detecting depression in general population.

The authors have not supplied their declaration of competing interest.

Depression is a major burden for the health-care system worldwide.

To identify prevalence and severity of depression in Tunisian general population and define socoiodemographic characteristics of screened positive to depression participants.

We undertook a cross-sectional and descriptive study. A total of 134 participants, representative of the Tunisian general population, were enrolled. Age, gender, and educational level were the major criteria for representativeness. Depression was assessed with the Patient Health Questionnaire (PHQ-9).

The cut-off score was 10. The prevalence of depression was 13.4%. There were no statistical difference in gender, education and age for the prevalence of depression.

The World Health Organization ranks depression as the fourth leading cause of disability worldwide. Thus, the detection of depression and the dissemination of treatment in the general population are very important to reduce the burden of the disease.

The authors have not supplied their declaration of competing interest.

The course of medical studies is a long route asking for a lot of breath. It is enclosed by the national examination for specialisation, which allows to access professional training. This examination requires a diligent preparation over several months in difficult conditions for the most part of the candidates who are in practical training.

and aims We suggest estimating the degree of anxiety and depression at the candidates in the week following the national examination for specialization of 2016.

We have put online on the pages of the various Tunisian Faculties of Medicine an anonymous questionnaire intended for the candidates who took the national examination for specialization of 2016. We used the scale HAD (Hospital Anxiety and depression scale).

We recruited 220 participants. More or less half of the participants declare to be rather often in a good mood, that they take little only of the pleasure in the same things as before, that they laugh and see the highly-rated voucher of things really less than before, that they are made of the concern very often and that they sometimes experience sensations of fear. A third of the participants feel tense or irritated most of the time feel sudden sensations of panic rather often and have the impression to work in slow motion rather often.

Taking the national examination of specialization rhymes with stress and anxiety. It leads us to question: is it necessary to assure a psychological coverage during the preparation and upstream of the competition?

The authors have not supplied their declaration of competing interest.

The objectıve was to determine correlation between depression, anxiety and stress in menopausal and post-menopausal women and shedding more light on a complex relationship.

A cross-sectional based on Arabian women at the Primary Health Care (PHC) Centers in Qatar during July 2012 and May 2014 and 1101 women agreed to participate and responded to the study. Depression, anxiety and stress were measured using the Depression Anxiety Stress Scales (DASS-21). Data on body mass index (BMI), clinical and other parameters were used.

The mean age and SD of the menopausal age was 49.55 ± 3.12, and postmenopausal age was 58.08 ± 3.26 (P < 0.001). There were statistically significant differences between menopausal stages with regards to age, ethnicity, educational status, occupation status, and place of living. Also, there were statistically significant differences between menopausal stages with regards to BMI, systolic and diastolic blood pressure, vitamin D deficiency, and diseases. Depression and anxiety were more common among postmenopause women. The multivariate regression analyses revealed that age in years, diastolic BP, consanguinity, regular exercise were predictor for depression. Meanwhile, diastolic BP, occupation and physical activity considered the main risk factors for anxiety. Furthermore, age in years, occupation and sheesha smoking habits were considered as the main risk factors associated with stress.

A large number of factors were associated with experiencing menopausal and psychosocial problems and which had negative effects on the quality of life among Arabian women. Depression, anxiety and stress should be considered as an important risk factors for osteoporosis.

The author ha not supplied his/her declaration of competing interest.

The work is supported by the project of Russian Foundation of Basic Research No 14-04-01157a.

Major depressive disorders (MDD) are among the most prevalent psychiatric disorders worldwide. While there is abundant literature showing that an increased cortisol secretion, understood as a proxy of the deteriorated hypothalamus-pituitary-adrenocortical axis activity (HPA AA), and poor cognitive performance are tightly related, less is known as regards to the HPA AA and higher cognitive information processes such as problem solving.

Investigating the association between cortisol secretion and problem solving performance among patients with MDD.

Fifteen inpatients with MDD (HDRS > 24; mean age: 59 years; 80% females) underwent a pharmacologic HPA AA challenge both at baseline and six weeks later to assess the cortisol secretion. They were treated with standard antidepressants at therapeutic dosages. Further, they learned how to solve the Tower-of-Hanoi problem-solving task (ToH-PS-T) and how to apply the problem solving strategy to other tasks (transfer). Testing occurred both at baseline and six weeks later. Outcome variables were symptoms of depression, cortisol secretion and the performance to transfer the acquired ToH-PS-T.

Both symptoms of depression and cortisol secretion decreased over time, and transfer performance increased over time. Neither at baseline nor six weeks later, symptoms of depression, transfer performance and cortisol secretion were statistically related.

The pattern of results suggests that cortisol secretion as a proxy of physiological stress regulation, symptoms of depression, and higher order cognitive performances seem unrelated. Given that cognitive information processing performance substantively increased regardless from depression and cortisol secretion, problem-solving skills need to be focused separately.

The authors have not supplied their declaration of competing interest.

To review epidemiology, pathogenesis, risk factors, consequences and current recommendations for therapeutic intervention.

Medline/Pubmed database search using the terms poststroke depression, depression and stroke, depression and cerebral vascular accident, stroke patients, published in the last 16 years.

The treatment of PSD has been shown effective in improving the evolution and prognosis of these patients, therefore it is very important early diagnosis.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The efficacy of electroconvulsive therapy (ECT) in the treatment of depressive episodes is well established, and so is reflected in the major guides.

Description of a clinical case of a patient diagnosed with major depressive episode with psychotic symptoms and obsessive compulsive disorder prevalence of compulsive acts that do not respond to drug treatment but to electroconvulsive therapy.

Presentation and review of a case.

A 55-year-old woman diagnosed with recurrent depressive disorder with worsening in the last 4 years.

Clinical depressive Sadness, spontaneous crying in the form of access, apathy, isolation and clinofilia desires, complaints mnemonic deficits and complete anhedonia. Obsessional symptoms compulsive as more repetitive behaviors of obsessive ideas, which repeats incessantly despite checking, that does not prepare or calm. The patient has not responded to any pharmacological strategy, despite using full doses and combinations of antidepressant, but euthymics more antipsychotics (sertraline, fluoxetine, reboxetine, venlafaxine, bupropion, lithium, valproic acid, lamotrigine, risperidone, quetiapine, trifluoperazine, clotiapine). For this reason, it was decided to start treatment with ECT, progressively responds in each session, after 8 sessions the patient is euthymic, it has resumed normal activities, no obsessive or psychotic symptoms.

It is important to know that it is a safe technique that would save not only an economic cost, if not a personal emotional cost. It is noteworthy that more than 50% of depressed patients who respond to a course of ECT, fall between 6 and 12 months despite receiving adequate pharmacological treatment then so we will have to closely monitor the patient.

The authors have not supplied their declaration of competing interest.

The non-competitive N-methyl-d-aspartate glutamate receptor antagonist ketamine has been shown to have rapid antidepressant effects in treatment-resistant depression (TRD). However, only a few studies have investigated which clinical characteristics predict a response to ketamine.

To assess sociodemographic variables and clinical markers that predict response to ketamine in unipolar TRD patients.

Searches of Pubmed, NCBI and Google Scholar were conducted for clinical trials and systematic reviews, through October 2016, using the keywords:

ketamine, N-methyl-d-aspartate receptor antagonist, rapid-acting antidepressant, depression, treatment-resistant depression, clinical predictors.

Findings support the following clinical predictors:

– sociodemographic variables: positive family history of alcohol abuse disorder in first-degree relative (increased antidepressant response and fewer depressive symptoms for up to 4 weeks post-infusions), higher BMI (improvement in depression severity at 230 minutes and one day post-infusion), negative history of suicide attempt (greater improvement at day 7);

– infusion-associated events: greater dissociation during infusion (better antidepressant response at 230 minutes and one week post-infusion); rapid response to first infusion (sustained response to subsequent infusions in one-third responders for up to 83 days);

– symptomatology: anxious depression (fewer depression symptoms at day one up to 25 associated with longer time to relapse); neurocognitive performance (lower attention) predicts change in severity of depressive symptoms over six infusions.

Findings suggest that specific clinical characteristics are predictors of ketamine response in TRD. Future studies confirming reliable predictors will assist clinicians to implement efficacious and individualized treatment for TRD patients.

The authors have not supplied their declaration of competing interest.

Despite the frequency and the severity of depressive episodes, the major depressive disorder (MDD) is today inadequately diagnosed and treated, and the risk factors for its recurrence are not well elaborated. The objectives of this study were to describe the sociodemographic, clinical evolutionary and therapeutic features of this disorder and to identify the factors involved in the risk of its recurrence.

This is a retrospective, descriptive and analytical study, involving 150 patients with MDD, isolated episode or recurrent major depressive disorder (RMDD) with a follow-up for at least two years. Data collection was performed using two pre-established questionnaires for the MDD isolated episode and for the RMDD respectively with 51 and 92 items. A study of the recurrence period was performed by Kaplan–Meier method. The Cox-test was used to determine the survival curves and to look for the risk factors significantly associated with MDD recurrence.

A total of 150 patients was gathered, predominantly female, married and from urban origin. The average age at the beginning of the disorder was 35 years. The recurrence period was 109 months and the factors associated with recurrence were the early age of onset of the disorder, family history of mood disorders, the severity of MDE index, residual symptoms and discontinuation of treatment.

The study of factors involved in MDD recurrence is of a particular importance since it allows not only to know the group of patients at risk but also to improve their therapeutic care.

The authors have not supplied their declaration of competing interest.

The birth of a preterm infant evokes considerable psychological distress in mothers and is associated with an increased risk for postpartum depression.

The aim of this study was to assess the prevalence of postnatal depression among preterm infant mothers and to identify highlighting associated factors.

We conducted a cross-sectional, descriptive and analytical study, including 97 mothers of premature infants who presented to the outpatient unit of neonatology at the UH Hedi Chaker of Sfax in Tunisia. For each mother, we collected sociodemographic and obstetric data. We used the Edinburgh Postnatal Depression Scale (EPDS) for screening postpartum depression.

Average age of mothers was 30.2 years. Average gestational age was 32.82 weeks. Almost all the mothers were married (99%), had a satisfactory couple relationship (93.7%), almost two thirds were multiparous (64.9%), and 77.3% gave birth by caesarean section. Prematurity was unexpected by 56.7% of women. Regarding newborns, digestive problems were noted in 25.8% of cases and sleep disturbances in 20.6% of them. Prevalence of depression in the population studied was 39.2%. It was significantly associated with unexpected prematurity (P < 0.001), impaired couple relationship (P = 0.001), digestive problems (P = 0.013) and sleep disturbances (P = 0.002).

Mothers of preterm infants seem to be particularly vulnerable to postpartum depression. Systematic screening for depressive symptoms in this obstetric population can help to have an optimal psychological outcomes for mothers and infants during a crucial period of development of mother–infant coregulation.

The authors have not supplied their declaration of competing interest.

The author has not supplied his/her declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.