Dear colleagues,
I am excited to present to you our fifth issue of 2013 covering updated guidelines and latest research results on the biological treatment of unipolar depression as well as on physiological and emotional features in post-traumatic stress disorder (PTSD).
At the outset of the issue, Bauer and colleagues present the latest update on the WFSBP guidelines for acute and continuation biological treatment of unipolar depressive disorders. Based on a systematic review and evaluation of up-to-date literature, this comprehensive manual provides not only an overview and evaluation of scientific evidence, but also clinically relevant practice recommendations. It is mainly concerned with biological treatment strategies, such as antidepressants, other psychopharmacological medications, electroconvulsive therapy, light therapy, adjunctive and novel therapeutic approaches, in adult patients suffering from unipolar depressive disorder. Physicians treating patients with unipolar depression are encouraged to adhere to these guidelines in order to further improve therapy progress, effectiveness and outcomes on a world-wide level. I wish to thank Michael Bauer, chair of the WFSBP Task Force on Unipolar Depressive Disorders, and the entire Task Force for their magnificent work.
In order to better evaluate the effectiveness of antidepressant drugs in the treatment of major depression in clinical practice, Severus and colleagues set out to illustrate the potential use of Marginal Structural Models (MSM) in the context of a depression maintenance study. Using inverse probability of treatment weighting (IPTW) approach with non-randomized data on 1000 depressed subjects, the authors found that MSM via IPTW substantially reduces the probability of wrongly rejecting the null hypothesis. The authors conclude that MSMs may allow for evaluating the causal effects associated with antidepressant treatment from the data observed in clinical practice.
Martini and colleagues introduce the second thematic focus of this issue by comparing the levels of total and activated cyclic adenosine monophosphate responsive element binding (CREB) protein in patients suffering from PTSD compared to healthy controls. This transcription factor previously was shown to be involved in different neural processes, such as learning, neuroplasticity and the modulation of stress response. Although PTSD patients had lower levels of total CREB protein in lympho-monocytes than healthy controls, no difference in activated CREB protein was detected. The authors conclude that the CREB system might play a role in the pathophysiology of PTSD.
Finally, Cacciaglia and colleagues investigated the effects of voluntary wheel running as model for intervention on the development of contextual fear and hyperarousal in a mouse model of PTSD. No significant effects of voluntary exercise on contextual fear conditioning, generalized fear response, acoustic startle response and emotionality was found, with the exception of enhanced anxiety levels in Dark-Light-Box and O-Maze tests. The authors conclude that running as a model for intervention has the potency to change emotional behaviours.
Yours sincerely,
Siegfried Kasper, MD
Chief Editor