According to certain researches, it is known that depressed patients are represented by a high percentage of psychiatric diseases. In these patients, there is a reduction of volitional dynamism, especially the drive to live as well as the social drive.

Failure to treat these patients can lead to serious consequences, suicides and social dysfunction (reluctance for any activity and social isolation).

That is why it is of great importance to apply adequate antidepressant therapy. On the other hand, according to data from the literature, it is known that depression abounds with a multitude of symptoms that cannot be overcome with the use of only one type of antidepressant, so a combination of them is needed.

The Aim of this study is to assess the effectiveness of combined antidepressant therapy in the treatment of depressed patients

This prospective present study included groups of 30 patients of either sex between 26-55 years with diagnosis F32, F33 evaluated in Private Psychiatric Institution Zora Mitic, Skopje. The study was conducted for 6 month. All the patients was written informed consent. Exclusion criteria was exist depressive disorders, patients with another psychiatric disorders and another organic disorders were not included in the study. The patients were examination before treatment and after treatment with Mirtazepine 15-30mg/day and Sertraline 50-100mg/day doses. The patients were assess using sociodemographic information by semi-structured questionnaire specially designed for the study. The sociodemographic data was:, marital status, education status and employment. Depression in patients was assessed by HAMD scale: 21 items graded ranging 0-4. The results obtained were compared using the t-test and Chi-square test. The quantitative data was expressed in number and percentage. The p value of statistical significance was set at p<0.05

Results The obtained results indicated that there is a statistical difference in depressive patients before treatment and after six months of treatment with antidepressant therapy the level of education (p=0,07), marital status (p=0,12); employment (p=0, 09) were without statistical significantly. But we got that the HAMD scale score were statistically significant when compare before treatment and after treatment with antidepressant therapy (p=0,03).

ConclusionThe results obtained in the study confirmed that the combined antidepressant therapy in patients with rich symptomatology reduced the depressive symptomatology and enabled an improvement in the functioning of the individuals.

None Declared

Electroconvulsive Therapy (ECT) is a proven treatment for treatment-resistant depression (TRD), especially in elderly patients. Managing depression in this population is challenging due to comorbidities and medication intolerance. Research suggests that factors like melancholic features and early symptom improvement predict a positive response to ECT. ECT offers rapid and sustained antidepressant effects.

To present the case of a 74-year-old woman with TRD who successfully underwent ECT after failing multiple medications.

A literature review was conducted on ECT for TRD in elderly patients. The clinical case is detailed, focusing on treatment, ECT application, and outcomes.

The patient had a history of severe depressive episodes. Previous hospitalizations were managed with tricyclic antidepressants, lithium, and olanzapine. However, lithium was discontinued after discharge due to subclinical hypothyroidism and renal function impairment. Although the patient remained stable for a time, her mood progressively worsened, leading to a marked decline in daily functioning and eventual admission to the psychiatric unit. Upon admission, the patient presented with severe depression, including loss of functionality, self-neglect, and passive suicidal ideation, hyporeactive state, significant vegetative symptoms, and moderate-to-severe anxiety. Given the lack of response to a comprehensive pharmacological regimen, ECT was initiated. The patient underwent six sessions of ECT, with initial improvements observed after the first session. By the third session, she showed marked improvements in mood, energy, and anxiety levels. By the end of the ECT course, she had regained full functionality and emotional stability.

This case underscores the effectiveness of ECT in managing psychotic depression in elderly patients when pharmacological treatments are ineffective or poorly tolerated. The patient’s rapid response aligns with previous findings suggesting that early symptom improvement predicts favorable ECT outcomes. Additionally, the presence of melancholic features may have contributed to the success of ECT, as described in the literature. Given the patient’s history of lithium intolerance and multiple pharmacological failures, ECT emerged as the most viable treatment option. ECT also demonstrated long-term benefits.

This case also highlights the importance of considering ECT earlier in the treatment process for elderly patients and demonstrates the crucial role of ECT in achieving rapid and sustained recovery in elderly patients with psychotic depression resistant to pharmacological treatments. Early intervention with ECT was essential for the patient’s full functional recovery, reinforcing its value as a therapeutic option in severe, treatment-resistant cases.

None Declared

Psychotic depression, a severe subtype of major depressive disorder with delusions or hallucinations, increases suicide risk due to distressing symptoms and hopelessness. Suicide attempts in psychotic depression can be severe and violent. Combining antidepressants and antipsychotics shows promise in reducing suicidal ideation and improving prognosis. This case presents a patient with a severe suicide attempt and self-harm in the context of psychotic depression, highlighting successful treatment with a combination of antidepressants and antipsychotics.

To present a case study of a patient with a depressive episode that progressed to psychotic features.

A comprehensive literature search was conducted to identify relevant studies on the treatment of depression with psychotic features. A case report was then developed, detailing the patient’s clinical presentation, diagnosis, and treatment regimen.

A 53-year-old male was hospitalized following a serious suicide attempt. The patient had a history of a recent work-related accident, leading to a depressive episode that progressed to psychotic features, including delusions of guilt and economic ruin, attempted suicide using a firearm, leading to significant self-inflicted injuries. Emergency surgical intervention was required for tendon and arterial damage. Psychiatrically, the patient exhibited profound hopelessness, delusional guilt, and active suicidal ideation. Following hospital admission, the patient was treated with a combination of sertraline, olanzapine, and mirtazapine, which resulted in significant improvement in mood, a reduction of delusions, and cessation of suicidal ideation over a three-weeks period. The patient returned to social activities and expressed interest in resuming his professional responsibilities, with no recurrence of psychotic symptoms or suicide attempts.

This case illustrates the severity of suicidal behavior in psychotic depression and the critical importance of combining antidepressants with antipsychotics for effective management. Research has consistently shown that psychotic depression carries a heightened risk of severe suicide attempts due to the intensity of delusions and hopelessness. Antidepressant-antipsychotic combinations, particularly those involving selective serotonin reuptake inhibitors (SSRIs) like sertraline, and atypical antipsychotics such as olanzapine, have demonstrated efficacy in reducing both depressive and psychotic symptoms, thereby mitigating suicide risk. In this case, the patient’s marked improvement and remission of psychotic features underscore the role of combined pharmacotherapy in stabilizing mood and preventing future suicidal behavior.

None Declared

Post-stroke depression (PSD) is the most common neuropsychiatric disorder after stroke, and also the main factor limiting recovery and rehabilitation in stroke patients, which leaded to poor quality of life. A prevalence of 30% is estimated between 1 to 5 years after stroke. More than half of all cases are neither diagnosed nor treated.

The aim of this paper is to review the latest updates regarding post-stroke depression and progress in its diagnosis and treatment.

A systematic review of the scientific and clinical literature on PSD was conducted. The review included databases such as PubMed and Cochrane, covering articles from the past 10 years. The scientific evidence obtained was analyzed and synthesized.

Currently, the diagnosis of PSD is mainly based on the DSM guidelines and combined with various depression scales. Symptoms usually occur within the first three months after stroke, the patient presents symptoms of a depressive episode such as low mood, anhedonia, loss of appetite, sleep disorders, vegetative symptoms or social withdrawal. Several mechanisms, including biological, behavioural, and social factors, are involved in its pathogenesis. The main predictors are personal history or cognitive impairment, as well as sequelae of the stroke. Left hemispheric strokes are those with the highest risk of early depression, as well as small subcortical vessel pathology. Treatment is mainly pharmacological, with SSRIs. The probability of recovery is between 15 and 57% in the first year, with a recurrence of 38% at two years, up to 100% at 15 years. In addition, there is an increase in mortality, especially in those under 65 years of age.

There are still many unanswered questions in the treatment of PSD, such as the best time to start treatment or the effects of antidepressants on cognition and motor function, among others. Although great advance has been made by researchers, the mechanism of PSD is not completely clear.

None Declared

Electroconvulsive therapy (ECT) has long been regarded as highly effective in the treatment of Treatment-Resistant Depression (TRD), with remission rates ranging from 50% to 70%. In recent years, esketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, has emerged as a novel treatment option for TRD due to its rapid and potent antidepressant effects (1).

This case aims to reflect on the comparative use of esketamine versus ECT in the management of TRD, considering clinical outcomes, side effects, and patient response.

A literature review was conducted using PubMed to gather evidence on the efficacy of esketamine and ECT for TRD. We also present a case study of a 53-year-old female patient with TRD to illustrate the clinical application and response to esketamine.

The patient, a 53-year-old divorced woman with a 31-year-old son, has a history of three psychiatric admissions in 2021 due to major depressive episodes. She was previously treated at a day hospital and continues follow-up care in outpatient settings. Her current psychopharmacological regimen includes Venlafaxine 300 mg and Mirtazapine 30 mg, with Aripiprazole recently discontinued.

The patient presented to the emergency department with a marked deterioration in mood, neglect of daily activities, and increased social isolation. Psychiatric evaluation revealed a depressed appearance, slowed speech, bradypsychia, and passive thoughts of death, though without suicidal ideation. Her biological rhythms were disrupted, and she experienced unquantified weight loss, despite good family support.

The patient received her first intranasal dose of esketamine (56 mg) without complications, followed by six additional doses twice weekly. Mild side effects included nausea and occasional depersonalization and derealization. Over time, the patient showed progressive improvement in both affective symptoms and daily functioning.

This case highlights the rapid antidepressant effects of esketamine in TRD patients, aligning with current literature. Esketamine is noted for its quick action and efficacy compared to second-generation antipsychotics (2, 3). Despite these benefits, ECT remains a more cost-effective option with higher remission rates for TRD, even though it is slightly less expensive than esketamine (1). The patient experienced significant clinical improvement with esketamine, which was well-tolerated with minimal side effects. However, the long-term efficacy and cost-effectiveness of esketamine relative to ECT remain under discussion. Further research is needed to clarify esketamine’s role in TRD treatment and to establish the best approach for long-term management.

None Declared

Patient-reported outcomes are becoming increasingly important in the evaluation of antidepressant drug therapy. They capture the patient’s perspective on their symptoms, treatment experiences, and overall well-being, unlike traditional clinical measures that focus only on objective assessments (clinical scales measuring symptom reduction and psychological changes). These outcomes provide a more comprehensive understanding of the impact of antidepressants on daily living.

The main objective of the study was to determine patient-reported outcomes of antidepressant drug therapy.

300 patients from three study centers were included - a geriatric hospital (Germany), a Specialized psychiatric clinic (Germany), Outpatient psychiatric clinic (Croatia). Patients were assessed with the same questionnaire that consisted of two parts - the first one included questions about the patient’s current state (possible symptoms) and the second one included questions about possible antidepressant side effects. The main inclusion criterium was continuous antidepressant therapy, and the main exclusion criterium was the inability to communicate via a questionnaire.

Comparative analysis of patient perceptions in an acute psychiatric, outpatient psychiatric and geriatric patient cohort showed all patient cohorts were adherent to taking their medication but differed significantly in the level of awareness of any information regarding their medication taking (why are they taking it, when, what is the prescribed dose, etc.) with geriatric patients being the least aware. The results also show other differences between the three cohorts, especially between the Croatian and German cohorts. An interesting difference is shown in the open question about medication side effects - 99 Croatian patients didn’t report having side effects, while only 31 patients from one German center and 71 from another German center answered that they had no side effects when asked openly. When asked specifically, patients from all three cohorts gave similar answers.

Understanding patient-reported outcomes can be extremely beneficial, as antidepressant efficacy as well as side effect severity varies widely among individuals and affects adherence to treatment. Patient-reported outcomes are a great starting point for moving in the direction of patient-centered medicine and can help healthcare providers make more informed decisions regarding antidepressant drug therapy.

This study is a part of ArtiPro ERA PerMed (Multidisciplinary research projects on personalized medicine- development of clinical support tools for personalized medicine implementation) project. The main goal is to establish an artificial intelligence-based platform that integrates data from clinical research involving biomarkers as predictors of illness and treatment outcomes with a goal to identify robust multimodal biomarkers and outcomes for depression.

None Declared

Treatment-resistant depression (TRD) is a severe condition with substantial economic and social impacts, defined by a lack of response to two or more adequate antidepressant treatments. Esketamine, an NMDA receptor antagonist, acts as an antidepressant by modulating glutamatergic transmission. Some studies suggest that dopaminergic system activation is crucial for the antidepressant effect of (S)-Ketamine (Jelen LA et al. J Psychopharmacol. 2021 Feb;35(2):109-123). Recently, nasal spray esketamine (ESK-NS) has been approved for TRD by the EMA and FDA, showing high response rates in some studies (Martinotti ed al. 2022 J. Affect. Disord. 319, 646–654). However, while the efficacy of ESK-NS varies among patients, studies on predictive factors of response, especially clinical ones, are limited, and no research has yet examined personality traits as predictors of ESK-NS response.

In this multicenter study we aim to investigate correlations between personality traits and response to ESK-NS in a real-world sample of subjects with TRD.

Eighteen patients with TRD were enrolled in two different centers in Genoa. Sociodemographic and clinical data were collected through semi-structured interviews. The Temperament and Character Inventory (TCI) was administered before therapy (T0) to assess personality traits, while the Hamilton Depression Scale (HAM-D) was used at T0 and three months (T3) to evaluate depression severity and treatment response.

The mean age of patients was 56 years with SD 11,3 years. 66,6 % of patients (n=12) were female. The enrolled patients were divided into two groups (responders 55,6% and non-responders 44,4%) as determined by a reduction of at least 50% in the HAM-D score from T0 to T3. In a multivariate analysis with TCI as the dependent variable and HAM-D severity at T0 as a covariate, a statistically significant difference (p=0.018) was found between the responders and non-responders groups in the TCI Reward Dependence (RD) subscale with higher values in responders compared to non-responders.

Previous studies have examined the link between personality traits and antidepressant response, but this correlation with ESK-NS hasn’t been previously investigated. This study, for the first time, demonstrates the correlation between Esketamine responders and RD traits, even when accounting for depressive severity (HAM-D). This may be because individuals with high RD are more sensitive to positive reinforcement. If ESK-NS improves mood and rewarding experiences, these patients might benefit more quickly. Additionally, RD is linked to dopamine, and since ESK-NS influences dopaminergic pathways, those with high RD may respond better to the treatment. This finding supports earlier research that anhedonic features predict better responses in TRD patients (Pettorruso et al. Psychiatry Res. 2023 Sep;327:115378).

M. Marino: None Declared, E. Briasco: None Declared, R. Guglielmo: None Declared, E. Cavanna: None Declared, F. Schiavon: None Declared, G. Giacomini: None Declared, D. Malagamba: None Declared, G. Martinotti Grant / Research support from: Janssen-Cilag, Consultant of: Janssen-Cilag, Speakers bureau of: Janssen-Cilag, M. Amore: None Declared, G. Serafini: None Declared

Computational psychiatry uses computer models to improve the understanding, diagnosis, and treatment of mental health disorders. These models can integrate large datasets from various sources, including genetic, neurobiological, and environmental factors, to predict the likelihood of developing depression.

The aim of the study is to explore the potential of computational psychiatry methods in identifying risk factors for the development of depressive disorders.

A review of relevant studies was conducted using the PubMed database. The search focused on articles examining computational psychiatry approaches, particularly those assessing risk factors associated with the onset of depressive disorders.

The study highlights computational models that show potential in identifying risk factors for depressive disorders.

Computational psychiatry offers new insights into identifying risk factors for psychiatric disorders and has the potential to contribute to the prevention and treatment of depressive disorders. However, further research is needed to improve the generalizability and applicability of the models.

None Declared

This case study investigates the combined use of pharmacotherapy and music therapy in treating a 44-year-old male patient with recurrent depression and subthreshold autism traits. These traits contributed to emotional rigidity and reduced treatment outcomes, requiring an interdisciplinary approach to enhance treatment effects.

To explore the efficacy of pharmacotherapy and music therapy in treating recurrent depression complicated by subthreshold autism traits, focusing on emotional regulation and coping strategies in a neuroatypical patient.

The patient was treated in outpatient psychiatry with citalopram (10 mg/day) and nortriptyline (100 mg/day) while attending 18 months of individual music therapy at Aalborg University Hospital. The music therapy involved listening and improvisation aiming at addressing neuroatypical emotional rigidity and sensitivity.

While pharmacotherapy alleviated depressive symptoms, music therapy enabled expression and management of difficult emotions improving emotional flexibility and enhancing coping strategies. The patient was not diagnosed with Asperger’s syndrome, but exhibited traits of autism that influenced the treatment response.

The combination of pharmacotherapy and music therapy proved beneficial for the patient, offering a non-verbal approach to emotion regulation. This case highlights the value of interdisciplinary approaches for treating depression in patients with subthreshold autism, especially in complex, treatment-resistant cases.

None Declared

Parkinson’s Disease is associated with depigmentation of the substantia nigra and locus coeruleus, with specific pathophysiological alterations. It is characterized by tremor at rest, bradykinesia, postural instability and rigidity. But there are also other comorbid psychiatric disorders that accompany it, such as cognitive impairment, psychotic symptoms (hallucinations and delusions), mood disorders and sleep disorders, among others.

The main objective of this work is to review the current scientific evidence on the management of depression in Parkinson’s Disease.

The case of a 75-year-old man with a neurological history and a diagnosis of depression with a poor evolution is presented. A detailed search was performed on UpToDate using the search terms “Parkinson’s Disease” and “Depression”.

This is a 70-year-old man with a history of Parkinson’s disease and comorbid depression with a poor evolution. A multitude of therapeutic options have been tried, such as SSRIs, SNRIs, antipsychotics, tricyclic antidepressants and an intensive psychotherapeutic approach. Despite what has been described, the expected improvement is not obtained and, given the difficulties in the treatment of his Parkinson’s Disease, an update is necessary according to the scientific evidence collected.

According to the scientific evidence consulted, among the antidepressants most studied in Parkinson’s Disease are SSRIs, SNRIs and tricyclic antidepressants. The choice of antidepressant treatment will depend on the patient’s main symptoms and the risk-benefit assessment of starting treatment. The importance of cognitive-behavioral treatment is also highlighted.

Depression is one of the most common psychiatric disorders seen in PD. Depressive symptoms in PD are associated with increased motor disability and decreased quality of life. It is estimated that up to 50% of patients have depressive symptoms.

In conclusion, the approach to depression in Parkinson’s Disease must be multidisciplinary and comprehensive, with both psychopharmacological and psychotherapeutic treatment.

None Declared

Depressive disorders with psychotic symptoms in elderly individuals are serious conditions whose diagnosis may be complicated by confusion with neurocognitive disorders. Electroconvulsive therapy (ECT) is an effective intervention for these patients when pharmacological treatments are either ineffective or not feasible due to medical comorbidities.

To describe three clinical cases of women over 69 years of age with an initial diagnosis of depression with psychotic symptoms versus neurocognitive disorder.

To assess the clinical response to ECT during their hospitalization.

A retrospective observational case series was conducted. Three female patients over 69 years old, admitted with a diagnosis of major depression with psychotic symptoms and signs of cognitive impairment, and who received ECT as part of their treatment, were included. The patients’ medical records were reviewed to gather information on their diagnosis, evolution, and response to treatment.

Case 1: Patient A (80 years old): psychomotor slowing, delayed response latency, nihilistic delusions with major affective symptoms. She received 10 sessions of ECT, with significant improvement in psychotic, depressive, and cognitive symptoms. She was discharged for outpatient follow-up.

Case 2: Patient B (70 years old): delusions of guilt, impersonation, and persecution, with concomitant major affective symptoms. She received 11 sessions of ECT, with significant improvement in affective, psychotic, and cognitive symptoms. Upon discharge, she continued follow-up with her Mental Health team.

Case 3: Patient C (72 years old): perplexed gaze, hypomimic facies, psychomotor slowing, thought blocking, no delusional symptoms, and major affective symptoms. She received 10 sessions of ECT, with little response in the affective and cognitive spheres. Care continued in the Convalescence Unit (subacute), and she was later institutionalized in a senior residence.

ECT was effective in two of the three patients in terms of psychotic, affective, and cognitive symptom response. In the third patient, where symptoms were more indicative of a neurocognitive disorder, ECT was ineffective, requiring long-term follow-up coordinated between Psychiatry and Neurology.

ECT is effective in treating major depression with psychotic symptoms in elderly patients, although it may have limited response in cases of cognitive impairment. Therefore, a comprehensive approach and multidisciplinary follow-up are required to manage these cases.

None Declared

This research investigates gender differences in psychosomatic responses among individuals of various ages, who had been diagnosed with depressive or anxiety disorders, or were in remission. It evaluates symptoms using the Beck Depression Inventory–Second Edition (BDI) and DASS-42 scales in a cohort of 30 adults in an outpatient clinic environment.

The aim of the study was to demonstrate the relationship between the degree of development of nicotine and the severity of symptoms related to emotions and mood with patients suffering from schizophrenia.

A total of 30 adult participants (ages 21-69) were assessed using the BDI and DASS-42 scales. The study is focused on somatic symptoms (as measured by specific DASS-42 items) and their relationship to gender, age, and the severity of depression. The severity of depression was classified into mild, moderate, and severe categories based on BDI scores.

The study revealed that depression significantly affects both daily functioning and emotional responses to stress, with individuals suffering from severe depression showing psychosomatic symptoms most often, regardless of gender. The findings revealed that women diagnosed with depression reported higher rates of psychosomatic symptoms, such as dry mouth, breathing difficulties, and increased heart palpitations, compared to men. Men, on the other hand, exhibited difficulties in emotional regulation in response to stress, which can potentially indicate a general sense of insecurity and anxiety. Younger female individuals, under the age of 40, diagnosed with depression according to the BDI, exhibited more intense psychosomatic symptoms compared to older female patients. Furthermore, within the same cohort of women under 40, the intensity of psychosomatic symptoms was significantly higher in comparison to men in the same age group.

The study uncovered the strong and interconnected relationship between stress and depression. Moreover, it indicated that the severity of psychosomatic symptoms associated with depression and stress is influenced by gender and age. As a result, it is crucial to adopt a comprehensive and personalized approach when treating patients, considering the severity of their conditions. The BDI and DASS-42 scales are effective in capturing these differences, highlighting their usefulness in both clinical and research contexts.

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Adropin is a unique hormone or biomarker that is produced in the liver, brain, and peripheral tissues such as the heart and gastrointestinal tract. It was discovered in 2008 by Kumar and others. It is encoded by a gene associated with energy homeostasis. Adropin plays a key role in the development of various CNS disorders such as stroke, schizophrenia, bipolar disorder, Alzheimer’s disease, and Parkinson’s disease.

Depressive disorder affects a large number of people worldwide, with symptoms such as loss of energy and motivation, sadness, fatigue, and weakness significantly impacting quality of life and functionality. Numerous studies have shown that depression has various neurobiological mechanisms. Deregulation of energy metabolism in the brain is one of the mechanisms associated with the onset of depressive disorder. Adropin can activate BDNF, and since BDNF plays a crucial role in neurogenesis, synapse formation, plasticity, learning, memory, and has a neuroprotective function, adropin may play an important role in the development of depression.

We conducted a study in which we examined adropin concentrations in depressive disorder in individuals who were diagnosed with depression for the first time and compared adropin levels with healthy controls. We followed up with depressive patients after six months of introducing SSRIs (Selective Serotonin Reuptake Inhibitors) antidepressants.

The adropin values after the introduction of antidepressants and improvement of depressive symptoms were significantly higher after six months compared to the initial blood draw.

Our study measured serum adropin levels in patients who had not previously been treated for depressive disorder. After introducing SSRIs (Selective Serotonin Reuptake Inhibitors) and six months after the initiation of therapy, we repeated the adropin measurements. The results showed a statistically significant difference between the first and second measurements. In the second measurement, adropin levels were higher than in the first. We can conclude that with the improvement of depressive symptoms, the serum adropin levels, as a neuroprotective biomarker, also increased.

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Major depressive disorder (MDD) presents as episodes lasting at least two weeks, affecting mood, cognitive, and neurovegetative functions, leading to significant distress [1]. Remission is challenging, with rates of only 30-50% after 6-8 weeks of antidepressant treatment [2]. The STAR*D study shows that 30-40% of patients achieve remission with first-line treatment, and a third fail even after four trials [3]. Recurrence risk is high, reaching 90% after three or more episodes [4][5].

The study aims to identify predictive factors for recurrence in major depressive disorder patients at Arrazi Psychiatric Hospital in Salé and to assess the impact of sociodemographic, biological, psychological, socio-environmental, and treatment-related factors on recurrence risk.

This retrospective, descriptive, and analytical study will collect data from medical records of major depressive disorder patients at Arrazi Psychiatric Hospital in Salé, including sociodemographic, clinical, and therapeutic details. Standardized data extraction ensures anonymity, and factors will be analyzed through univariate, bivariate, and multivariate statistical methods (logistic regressions), with adjusted odds ratios calculated for significant factors and a p-value threshold of < 0.05 applied.

The study shows that women represent approximately 60-70% of patients, with an average age of 30-40 at the first episode and often limited social support in 50-60% of cases. About 40% present psychiatric comorbidities, and 20-30% have physical comorbidities. Nearly 50% of patients have recently experienced stressful events, and 30-40% live in precarious conditions. Therapeutic adherence is insufficient for 30-40% of cases, and 25-35% discontinued treatment prematurely. Meanwhile, those who benefited from combined therapy represent 50-60%, showing a lower recurrence risk.

The recurrence of major depressive disorder poses a major clinical challenge, impacting long-term patient management. Identifying risk factors can enhance preventive interventions and therapeutic follow-up, while an integrative approach considering sociodemographic and psychological factors may help reduce relapse rates. These findings underscore the need for further research into the mechanisms of recurrence in major depressive disorder.

None Declared

Prenatal unipolar depression is a significant mental health challenge affecting a considerable number of pregnant women worldwide, with higher prevalence rates in developing regions. Due to the potential risks of antidepressant medications on fetal health, there is an increasing need for safe, non-pharmacological treatments. Repetitive transcranial magnetic stimulation (rTMS) has emerged as a promising neuromodulation therapy, offering a non-invasive approach to treating depression. This systematic review explores the efficacy and safety of rTMS in addressing prenatal depression, aiming to provide evidence for its potential as an alternative therapy for this vulnerable population.

The primary objective of this review was to assess the therapeutic effectiveness and safety profile of rTMS in treating unipolar depression among pregnant women. The secondary aim was to identify gaps in the current literature and provide recommendations for future research to strengthen clinical guidelines for rTMS use during pregnancy.

A comprehensive search was conducted using the PubMed database without a time restriction, focusing on case reports, case series, uncontrolled studies, and randomized controlled trials that examined rTMS for prenatal depression. Inclusion criteria required studies to involve adult pregnant women diagnosed with major depressive disorder undergoing rTMS treatment. Data on depressive symptom improvements and any adverse effects on both mother and fetus were extracted for analysis.

Analysis of ten studies, including six case reports/series, three uncontrolled studies, and one randomized controlled trial, indicated that rTMS was well-tolerated by pregnant women and showed effectiveness in reducing depressive symptoms. Notably, no adverse effects were observed in fetal outcomes across these studies. Symptom improvement was significant, with high patient satisfaction reported, yet the limited sample sizes and variations in methodology underscore the need for more robust trials.

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The findings from this review suggest that rTMS is a promising, non-invasive alternative for managing prenatal depression with minimal fetal risk. However, due to the limited number of high-quality studies, further research is necessary to confirm these preliminary findings and establish standardized protocols for rTMS use in prenatal depression treatment. Expanding the evidence base will support the development of safe, effective treatment options tailored to the unique needs of expectant mothers facing depression.

None Declared

One of the directions of scientific research in modern psychiatry is the search for predictors of the developing of a manifest psychotic attack in patients with non-psychotic disorders, that is, predictors of an ultra-high risk of psychosis. Such predictors may include various biomarkers, for example, the quantitative EEG parameters, which subtly reflect the features of the brain functional state.

The aim of the study was to search for EEG correlates of the brain functional state in depressive patients of the group of an ultra-high risk of developing psychosis in comparison with EEG parameters of patients without symptoms of a risk of psychosis.

The study included 74 female depressive patients (F31.3-4, F32.1-2, by ICD-10) aged 16-26 years (mean age 20,8±3,5 years) at the stage of remission establishing after treatment course, clinically divided into two groups. First group consisted of 32 patients with depressive conditions and attenuated prodromal psychotic symptoms assessed by SANS and SAPS scales and by COGDIS and COPER criteria, but without a history of manifest psychotic attack. The second group included 42 depressive patients without symptoms of ultra-high risk of developing psychosis. In all patients, multichannel background EEG was recorded with spectral power analysis in narrow frequency sub-bands. Intergroup EEG differences were statistically analized using Mann-Whitney test.

According to EEG data, the functional state of the cerebral cortex in patients of group 2 at the stage of remission establishing was approaching normal. The EEG of the 1st group of patients differed from the EEG of the 2nd group by significantly lower values of EEG spectral power in the alpha3 sub-band (11-13 Hz) in the occipital leads and by significantly increased spectral power of theta1 (4-6 Hz) activity in the central-parietal areas. Such EEG frequency structure of patients in group 1 reflects a reduced functional state of associative areas, and may also indicate dysfunction of the frontal parts of the cerebral cortex. These EEG features of patients in group 1 are consistent with a significantly greater severity of their positive and negative symptoms scores by the SAPS and SANS scales compared to group 2.

In depressive patients at the stage of remission establishing who have symptoms of an ultra-high risk of developing psychosis a reduced functional state of the associative and frontal areas of the cerebral cortex is noted, which may underlie the characteristics of their clinical conditions.

None Declared

Reduced ability to make adequate decisions significantly affects the daily functioning and social adaptation in depressive patients. Neurophysiological bases of reduced efficiency of decision-making based on both logical reasoning and emotional processes are not sufficiently studied.

The aim of the study was to search for possible links between signs of decision-making efficiency and EEG parameters in depressive patients.

The study involved 48 depressive female in-patients (F31.3-4, F34.0, by ICD-10), aged 16-25 years (mean age 18.4 ± 2.6). To assess the decision-making process, computer versions of the Wisconsin Card Sorting Test (WCST) and the Iowa Game Task (IGT) were used. Multichannel resting EEG recordings with spectral power analysis were performed at the same visit before the start of treatment. The rank correlation analysis (Spearman) was used for statistical data processing.

In WCST test, negative correlations (p<0.05) were found between the “percentage of conceptual level responses”, and the spectral power values of beta1 (13-20 Hz), beta2 (20-30 Hz) in the central and posterior areas, and theta1 (4-6 Hz) in anterior areas of the cerebral cortex. Delta (2-4 Hz) activity values in the left frontal areas positively correlated with the WCST parameters “number of moves spent on completing the first category”, “number of perseverations on the previous move”, “number of moves” and “test completion time”. Thus, patients complete the task longer and less effectively with frontal hypoactivity and increased activation of the posterior areas of the cortex that reflects a violation of the brain’s inhibitory mechanisms. In the IGT test, positive correlations (p<0.01) were revealed between the number of choices of the “bad” deck (A) and both “bad” decks (A and B), as well as negative correlations between the preference for “good” (C and D) over “bad” (A and B) decks in the second half of testing and the values of the alpha2 (9-11 Hz) spectral power in the anterior areas of the left hemisphere. The preference for “good” over “bad” decks on moves 40–60 negatively correlated with the values of alpha3 (11-13 Hz) and beta2 (20-30 Hz) in the right frontal and central areas. Thus, decision-making deficit in the IGT was associated with a relative decrease in the activation of the anterior regions of the left hemisphere and hyperactivation of the right hemisphere.

In depressive patients, impairments in the logical reasoning task (WCST) are associated with hypofrontality while impairments in the emotional learning task (IGT) − with disbalance of hemispheric activation, namely with hypoactivation of the frontal regions of the left hemisphere and increased activation of the right hemisphere.

None Declared

The need to study and clarify the neurobiological basis of depression is due to the widespread prevalence and heavy socioeconomic burden of this disease. In order to prevent relapses, it is recommended to continue treatment for depression for a long time after the relief of the main depressive symptoms. However, delayed EEG changes have been almost completely unstudied.

The aim of the study was to analyze the dynamics of spectral-coherent EEG parameters during long-term treatment for endogenous depression in young female patients.

The study included 20 female patients aged 16-25 years who underwent quantitative clinical (using the HDRS-17 and GAF scales) and neurophysiological (multichannel resting EEG recordings with subsequent analysis of absolute spectral power and EEG coherence) examination three times: upon admission to hospital before the start of the course of treatment (at visit 1), upon discharge from the hospital at the stage of remission establishing (at visit 2) and one year after discharge from the hospital on maintenance therapy (at visit 3). The clinical and EEG changes were statistically assessed using the Wilcoxon test.

After the course of stopping treatment (at visit 2), there was a significant (p<0.01) reduction in depressive symptoms. This was associated with an EEG slowdown in the form of a generalized increase in the spectral power of theta-delta activity (2-4 Hz and 4-8 Hz), which was significant (p<0.05) in the frontal-central leads, and a significant (p<0.05) decrease in the alpha2 (9-11 Hz) and alpha3 (11-13 Hz) components of the alpha rhythm in the occipital zones. Further improvement in the clinical condition (according to the HDRS-17 scale) and social functioning (according to the GAF scale) was noted a year later (at visit 3), and was associated with the same EEG pattern, including a significant (p<0.05) increase of theta2 sub-band (6-8 Hz) spectral power in the central-parietal-occipital leads.

The observed EEG slowdown is considered to be a reflection of a complex restructuring of brain activity into a mode more adequate for these patients, ensuring the suppression of depressive symptoms and restoration of the social functioning of patients, rather than traditionally considered general decrease of the brain functional state.

None Declared

Early marriage is a widespread practice among the Roma population, an ethnic minority spread across Europe and other regions, including Albania. Despite efforts to address social disparities and promote human rights, early marriage persists and poses a significant challenge to the mental health and well-being of the individuals involved.

The study aims to evaluate the relationship between depressive symptoms and various determining factors that affect mental health within the Roma minority in Tirana as a result of early marriages. Specifically, it seeks to identify factors related to early marriage that impact individuals’ well-being, assess levels of depressive symptoms based on the total scores of the Beck Inventory, and examine depressive symptoms by gender. Additionally, the study will explore the relationship between socio-demographic data and depressive symptoms, as well as the connection between factors related to early marriage and depressive symptomatology, all measured through the total scores of the Beck Inventory.

Our study is cross-sectional and examined 220 members of the Roma minority, residents of Tirana, both in urban and peripheral areas. This study explores the determining factors of mental health and their impact on depressive symptoms within the Roma community. The administered questionnaire consists of three parts, respectively covering the socio-demographic characteristics of the population, the Beck Inventory, and factors contributing to depressive symptoms.

The study included 220 Roma minority members, with 58.6% being female and 41.4% male. The average age of the subjects was 35.66 years, and 67.7% were married. Most participants lived in urban areas (65%), with the majority earning less than the minimum wage (40,000 ALL). Educationally, most had completed only primary education, and the average age at first marriage was 15.92 years, driven by love, tradition, and family pressure.

Depressive symptoms were reported by 60.5% of the subjects. Regression analysis identified statistically significant factors contributing to depressive symptoms, including age difference with the first partner, gender (with higher prevalence among females), education level, income level, and number of children. Other significant factors included satisfaction with education, loneliness, financial stress, and conflict frequency with partners.

The analysis concluded statistically significant relationships (p≤0.05) between the sample and several determining factors in depressive symptoms.

This study can serve as a basis for more in-depth research aimed at developing more effective interventions and support strategies for this marginalized group.

None Declared

Treatment-Resistant Depression (TRD) is commonly defined as an inadequate response to two or more antidepressant trials. The severity of TRD can be evaluated by means of the Maudsley Staging Method (MSM). The MSM consists of five domains including duration of the depression, symptom severity, number of treatment failures, augmentation therapy, and electroconvulsive therapy use. The Danish Medicines Council has suggested that the MSM could guide treatment decisions. However, the use of MSM in clinical practice is lagging and the evaluation of TRD in clinical practice has remained subjective and unstandardized.

To evaluate the use of MSM in clinical practice, we investigate the association between MSM scores and response to repetitive transcranial magnetic stimulation (rTMS) treatment, as measured by the 17-item Hamilton Depression Rating Scale (HAM-D17).

Patients with unipolar depression referred to six weeks of treatment with rTMS were consecutively invited to participate in the study. The study was a multi-center study with inclusion sites in Randers, Viborg, and Skejby, Denmark. Demographic information and clinical data were retrieved from the patient’s Electronic Health Record (EHR). The patients were assessed on the MSM within the first two weeks of the treatment. Ratings on the HAM-D17 and self-administered questionnaires including the depressive symptoms, side effects, and quality of life were completed on a weekly basis. Additionally, three side-effect interview assessments were conducted during the six weeks rTMS treatment. A power calculation estimated the inclusion of 65 patients.

Response is to be evaluated by means of the Spearman’s rank correlation coefficient (rho) between MSM score and HAM-D17. An adequate response is defined as a 50% decrease in the Hamilton score or below the threshold for remission.

Data collection is ongoing. As of September 2024, a total of 59 out of 65 participants have been recruited. Preliminary results will be presented at the EPA 2025 Congress.

A systematic assessment of TRD according to the MSM in clinical practice, holds promise for predicting treatment outcomes and guiding treatment decisions. Integrating MSM, for instance, during the recording of patient medical history, could enhance its practical utility in everyday clinical settings.

None Declared