Four cases are presented who debut with depressive episodes and after close follow-up, are diagnosed and treated for Alzheimer’s disease

The aim of this case series is to give a brief review of the depressive prodrome of dementia.

Four women, aged 67-77 years, treated on an outpatient basis, consulted for depressive symptoms. In addition to affective symptoms such as apathy, lack of interest, sadness, increased emotional lability and anhedonia, all three reported cognitive impairment. In their follow-up after two years, they became progressively more dependent on their partners, with more memory lapses, forgetfulness and progressive loss of higher cognitive functions. With the progression of cognitive impairment, anxious symptoms have become increasingly present.

The mean age of the patients is 70 years. Two of them had an insidious onset of depressive symptoms, while the other two had a psychotic onset of depression. None of the patients had no previous history of depression. All four were started on antidepressant treatment with little response. Following the diagnosis of cognitive impairment, treatment was started with rivastigmine, with an adequate response.

Dementia and depression are very common in the elderly. It appears that up to 40% of patients with dementia have depressive symptoms. It appears that depression in old age may actually be a prodromal symptom of dementia.

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There has been an exponential rise in SSRI prescribing, between 2021 and 2022 there was a 5% increase. The majority of SSRI prescription initiation takes place in primary care. This is a national trend and mirrored internationally.

The study was undertaken to understand barriers to deprescribing both prescribing clinicians and patients and the potential of dependence caused by continued prescribing of SSRI and SNRI. We wanted to understand deprescribing challenges and both clinical anxiety and difficulty experienced and see if there is a correlation with the Drug use screening tool (DUST) tool.

Those patients who were stable on SSRI were offered lowering of dose and deprescribing as part of routine medication reviews. During medication reviews patients were asked about willingness to embark on a deprescribing schedule. Patients were screened during medication reviews on the DUST to see if this can be used to predict difficulty with deprescribing. We designed a deprescribing difficult questionnaire to assess the difficulty experienced by clinicians during a deprescribing consultation. We were able to study the is a correlation with DUST scores and Clinician experience of difficulty and challenge in deprescribing of the SSRI and SNRI.

Current alcohol drinkers and smokers were less likely to deprescribe from their antidepressants. Clinicals should do a risk assessment using the DUST screening tool checking for risk of dependence. There is an R value of 0.1586 (P-value is 0.018848) between the correlation of patients increased length time and increased DUST score causing an increased risk of dependence. The average R-score across the three practices between patient’s length of time being on medications and their DUST score is R= 0.18705 (P value of 0.01)

Inability to access IAPT therapies, shortened length of CBT sessions and lack of post IAPT support caused poor patient experience and contributed to reluctance to re-engage with IAPT services. Both cascade and incremental prescribing following lower doses without documentation of the limitations of medication results in unrealistic expectations generated from the prescribing. There is positive correlation between length of SSRI and SNRI prescribed, DUST scores, and Clinical challenge scores with patients’ unwillingness to be deprescribed. Patients should have a DUST score review prior to having been put onto any antidepressant as there is a potential link between increased DUST score and lower chances of willingness to deprescribe. Clinicians need to counsel patient of risk of dependence. The likelihood is these are drugs of dependence and clinicians should counsel patients of these risks and given review dates and offered deprescribing.

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Hair loss is a common clinical complaint, resulting from a wide variety of causes, a variety of medications prescribed to treat mental diseases may contribute to hair loss.

As far as we know, no previously published reports of alopecia associated with quetiapine were identified in Morocco.

Through this work we will try to expose the first case having this undesirable effect in our context, next to the rare cases in the literature.

This article describes the experience of a 37-year-old male developing diffuse alopecia associated with use of quetiapin and recovering after cessation of the medicament is presented, besides presenting some rare cases that were found and described in other studies.

Among these psychotropic agents, this side effect is most often reported with the use of valproic acid and lithium It has been also reported with the atypical antipsychotic medicines olanzapine and risperidone, but only rare cases were reported in relation to quetiapine, In this paper, a 37-year-old male patient developing diffuse alopecia associated with use of quetiapine and recovering after cessation of the medicament is presented.

The results of this study are the first known in morocco, establishing a relationship between hair loss and the use of quetiapine will be taken in consideration while prescriping this medicine. These results confirm the relatively new idea of the impact of quetiapine on hair loss, unlike older studies which suggested good tolerance of this molecule.

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Caregiving negatively affects the psychological and physical health of the caregivers, especially in parents of children with neurological impairement (NI).Furthermore, the behavior and demands of the patient make the caregivers encounter increased stress levels and negative thoughtsabout the future that may lead to depression in caregivers.

To assess the relationship between caregiver burden and symptoms of depression in parents of children with NI.

A total of 33 caregivers of children with NI, participated in this cross-sectional, descriptive and analytical study, carried out in Child Neurology Department of the University Hospital in Sfax (Tunisia), between February and April 2021.

The Zarit-Caregiver-Burden-Scale (Zarit-CBS) and the Beck Depression Scale were administered.

The average age of the caregivers (27 mothers and 6 fathers) was 38,33 years ± 6,53 years. Among the parents, 81,81% didn’t exceed the secondary educational level and75,75% of them had an irregular occupation.

The average age of the children (21 boys and 12 girls) was 7,58±4,29 years.Near to the half of them (51,51%) had intellectual disability.Over 54.54% of the children had a functional independence, while 21.21% required help in walking and 24.24% were unable to walk.

The intervention was based on motor rehabilitation (57,57%), adequate equipment (24,24%), ergotherapy (45,45%) and speech therapy (60,6%).After the intervention, 63,63% of children had an improvement and 30,3% had a stationary state.

The mean score of Zarit-CBS was 52,45±14,26. The caregiver burden was noted in 96,96%.

The mean score of Beck was 9,33±5,48. The depression was noted in 78,78%.

The total Zarit-CBS score had positive correlation with Beck scores (p=0.038).

There is a positive relationship between the caregiver burden and depression symptoms. Thus, effort should be made to relieve caregiver burden in parents of children with NI.

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Depression whose onset in the peripartum period is commonly referred to as Postpartum Depression.Postpartum Depression affects 11.5% of women during pregnancy or postpartum.Brexanolone has been developed for the treatment of Postpartum Depression, it is a formulation of Allopregnanolone, which is administered parenterally. Several studies have found that a single Brexanolone infusion had rapid antidepressant effects for severe Postpartum Depression, with good safety.

The objective of this review is to evaluate the effectiveness of treatment with Brexanolone in Postpartum Depression.

A systematic search was performed through Pubmed, including randomized controlled trials (RCTs).

2 articles were selected that included three RCTs, in which participated 156 women diagnosed with Postpartum Depression who received an infusion of Brexanolone and 111 women with Postpartum Depression who received placebo .Compared to placebo, women who received Brexanolone had a significant clinical response, starting 24 hours after administration (RR: 1.34; 95% CI: 1.03–1.73). ), reaching its maximum action peak at 36 hours ( RR: 1.50; 95% CI 1.06–2.13; P = 0.02 ), and with a duration of effect up to the seventh day ( RR = 1.32, 95% CI: 1.01–1.73). Likewise, women with Postpartum Depression, treated with Brexanolone, had a significantly greater remission, starting at 24 hours of treatment (RR: 1.86; 95% CI: 1.03–3.34), reaching its peak maximum action at 60 hours ( RR: 2.20; 95% CI 1.31–3.70 ), and with a duration of effect up to 72 hours ( RR = 1.96; 95% CI: 1 .41–2.72).

The administration of a dose of Brexanolone seems to have an ultra-rapid antidepressant effect for the treatment of Postpartum Depression. The short-term and long-term therapeutic effect of brexanolone needs to be examined with large-scale randomized controlled studies.

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Catatonia is a clinical syndrome characterized by behavioral alterations, which may include motor immobility or excitation. As a symptom, catatonia may be present in several mental disorders, primarily schizophrenia and mood disorders. Symptoms can be severe and can lead to dangerous and lethal conditions if not diagnosed and treated properly.

To describe the complicated evolution of a case of major depression with psychotic symptoms, which developed catatonic status. We discuss the psychopharmacological approach and non-pharmacological therapies (ECT).

Case summary. We have conducted a systematic review of the descriptions published to date, regarding this case.

We present a case of extreme severity, in a 55-year-old male, with a broad differential diagnosis with organic pathology, which required multidisciplinary management in conjunction with other specialties and multiple complementary tests.

Eventually diagnosed with major depression with psychotic symptoms evolving into a catatonic state. During more than one year of follow-up, multiple drugs have been tested sequentially: SSRI antidepressants, dual action, low-dose antipsychotics (caripracin, lurasidone, aripiprazole, olanzapine).

Finally, a good response was obtained in the treatment with lorazepam 1mg /6h and 12 sessions of ECT administered concomitantly.

In this case, the patient presented a refusal to eat and weight loss with a BMI of malnutrition. We had to be coordinated with the endocrinology service for a nutritional restitution strategy through dietary supplements. Once nutritional restitution was achieved, we started treatment with clomipramine, with good results on affective symptoms.

Nowadays, the origin and treatment of catatonia are still unclear.

We present the case of a man with melancholic depression with psychotic symptoms, who evolved into a catatonic syndrome. A good response was achieved with the combination of ECT and benzodiazepines.

We want to highlight nutritional recovery as an important point to achieve good absorption of antidepressant drugs. Once achieved, we started treatment with clomipramine with good results.

During the treatment, he has presented multiple difficulties and finally, he was able to leave after five months of hospitalization in the acute mental health unit.

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In contrast to women, men do no experience a sudden cessation of gonadal function comparable to menopause. However, there is a progressive decline in hypothalamic-pituitary-gonadal function in aging men: testosterone level decline, and there is a loss of circadian rhythm of testosterone secretion.

By age 75 years, mean plasma testosterone levels have decreased 35% compared with young adults, and more than 25% of men of this age are clinically hypogonadal. Age related hypogonadism, which has been termed»andropause«, is thought to be responsible for variety of symptoms experienced by elderly men, including reduced muscle and bone mass, sexual dysfunction, depression, fatigue and irritability.

However, it has been difficult to establish correlations between these symptoms and plasma testosterone levels. Clinical trials of testosterone replacement have documented some symptoms relief (improved muscle strength and bone mineral density), yet studies to date on the specific relation between depression and testosterone level have been methodologically flawed.

Data are presented from systematic clinical and epidemiological studies with bearing on this relation:

1. 1. population-based assessments of the relation between testosterone level, genetic factors and depression in elderly men,

2. 2. placebo-controlled clinical trials of testosterone replacement in men with major depressive disorder.

Results suggest that age-related hypothalamo-pituitary-gonadal hypofunction may have particular etiologic importance in late-onset male dysthimia.

However, there is still the dilemma whether late-onset depression in older men is predominantly biological (in which testosterone decline certainly plays an important role), psychosocial, or stress-diathesis origin.

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The association between Atopic Dermatitis (AD) and Major Depressive Disorder (MDD) has long been reported by some population-based observational studies. However, observational studies are susceptible to potential confounders and inverse causation, rendering it difficult to conclude about the causality of such association. Mendelian randomization (MR) analysis is a novel epidemiological method to assess the causation between an exposure and an outcome, with less susceptibility to potential confounders and reverse causation by using genetic variants as instrumental variables.

To report a clinical case of depression in association with atopic dermatitis and to review what contributions MR studies have been bringing to the matter of causality between AD and MDD.

Case report and literature review based on PubMed using the terms “atopic dermatitis”, “eczema”, “depression", “depressive”, “mood” and “Mendelian randomization”, which were searched in the title and abstract fields.

Case-report: A 26-year-old man was admitted for inpatient treatment with a clinical picture of sadness, irritability, social isolation and insomnia, with 4 months of evolution, aggravated by suicidal ideation in the preceding days. On examination of the mental status, the patient had a frankly depressed mood, with congruent affects. He was contemplating suicide methods, pointing to sodium nitrite intoxication as an option. The patient related these symptoms to the worsening of his atopic dermatitis. In fact, he had a history of other depressive episodes contemporaries with periods of dermatological worsening.

Literature review: The PubMed research identified 7 articles, 4 of which assessed the causal effect of AD on MDD. Three studies did support a causal effect of AD genetic risk on MDD. One study supported a small causal effect of AD on MDD, with the significance disappearing when a stricter threshold for selection of single-nucleotide polymorphisms was applied.

The MR studies included in this poster favour the absence of a causal effect of AD on MDD, suggesting that the comorbidity observed clinically is unlikely to be causal. We must be aware that these studies are few and are not free of limitations (e.g. subgroup analysis for age and severity was not carried out, AD and MDD diagnosis were self-reported in some cases). Further research may help clarify the existence of causality and/or uncover the factors responsible for the observed association of AD with MDD in observational studies.

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Depression is a common illness worldwide, with an estimated 3.8% of the population affected, including 5.0% among adults and 5.7% among adults older than 60 years. Lactose intolerance affects 70% of the world population. With both conditions being common there are a lot of people having both lactose intolerance and depression. People with lactose intolerance are unable to fully digest lactose. As a result, they have diarrhea, bloating and gas after eating or drinking dairy products. Lactose is one of the most used excipients in drug formulations and is ofteny overlooked when prescribed.

To quantify and identify the amount of lactose in medications used for the treatment of depression and to identify ‘lactose-free’ medication registered in Croatia.

Medications used for the treatment of depression were identified from the Agency for medicinal products and medical products of Croatia (HALMED). Their formulation including excipients was obtained from the Agency.

Wide range of antidepressants contains lactose. We have quantified the lactose amount using information on medicinal products with marketing authorisation granted by HALMED.

With this research, we have pointed out a high proportion of the most commonly prescribed antidepressants that contain lactose. Considering the high proportion of the general population with lactose intolerance, we have pointed out the importance of knowing the data that antidepressants do not contain lactose in order to choose an adequate therapy for our patients, while not causing them discomfort that will further reduce the effectiveness of the therapy, as well as increase the percentage of those who due to the side effects of the drug, they stop taking the therapy. This research will help clinicians in their daily work to choose the most optimal therapy for their patients. With this study, we will give doctors a list of medications for depression treatment without lactose. With this study, we will give doctors a list of medications for depression treatment without lactose.

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Around 1% of the general population have schizophrenia. It dramatically affects not only the patients who suffer from it, but also their family members. It represents a difficult task for family caregivers, especially at the time of deinstitutionalization of the patients, when they have to assume some of the functions and care previously provided by psychiatric institutions. This day-to-day care can influence the lives of the caregivers and cause anxiety or depression, which might affect the care that the patients receive.

The objectives of our study were to assess anxiety and depression in family caregivers of patients with schizophrenia and to identify associated risk factors.

We conducted a cross-sectional study including family caregivers of patients with schizophrenia. Anxiety and depression were assessed using the 14-item Anxiety and Depression Scale in its validated version in Tunisian dialect (HAD scale).Statistical analysis was performed by SPSS 26.0.

We included 30 family caregivers of patients with schizophrenia.

The prevalence of depression in family caregivers was 40 % while 56% of them were anxious. Six caregivers had both depression and anxiety, 63.3% of them were unemployed and 52.2% stopped working to take care of their relative.

In our study, the schizophrenic patient’s history of aggression towards the caregiver was statistically associated with depression (p=0.025 ). The worse the compliance of the patient to the treatment, the more likely the caregiver is to develop anxiety (p= 0.027).The parents (mother or father) were the most exposed to depression, anxiety or both (p=0.016). Family caregivers who lived with the patient under the same roof developed more anxious symptoms than the ones who didn’t (p=0.005). The time spent taking care of the patient was higher for the caregivers with depression, anxiety or both (p = 0.046).

Schizophrenia may cause a significant psychological distress for family members such as depression or anxiety .Several factors seem to be involved, inherent to the disease, to the patient and to the caregiver.

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The Persistent Depression and Self-Management Study is a mixed-methods pragmatic randomized controlled trial that evaluated the “Patient and Partner Education Program for All Chronic Illnesses” (PPEP4All) in patients with persistent depressive disorder (PDD) compared to care as usual (CAU). PPEP4All is a brief, structured self-management program that focuses on functional recovery and involves the partner/caregiver in the program. The latter may improve patient outcomes and reduce caregiver psychosocial burden related to PDD.

In addition to evaluating the cost- and clinical-effectiveness of PPEP4All, we conducted a nested qualitative study to deepen our understanding of how patients with PDD and their caregivers cope with chronic depression. Additionally we identify areas in which they require care and learn how they could benefit from a self-management program like PPEP4All.

In the nested qualitative study, 28 patients (16 from PPEP4All, 12 from CAU) and 9 partners/caregivers agreed to participate. The in-depth semi-structured interviews took place at participant’s home, the main research location, or over telephone. For each interview, we used a topic list, which was initially evaluated in a pilot study of patients with PDD. All interviews were audio recorded, with consent from the participant, and transcribed verbatim. Data were analyzed using Grounded Theory, with a constant comparative analysis method, using Atlas.ti version 9 software.

Qualitative data are currently being analyzed. We expect to identify important themes relevant to the patient’s and caregiver’s personal experience and learn how they use and implement self-management in their lives.

PPEP4All may help patients with PDD and caregivers learn important self-management techniques to effectively cope with chronic depression and its consequences, and thus, it may help them meet their needs for care.

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Due to the often long-standing and extensive doctor-patient relationship, family doctors have special access to the mental state of their patients. They are often the first point of contact, and consequently the treatment of depression often begins in the GP’s practice or even takes place entirely there. This requires dedicated knowledge on the part of the general practitioner, especially with regard to diagnostic criteria and treatment.

The aim of this article is to describe the basic diagnostic process for the general practitioner’s practice, to give advice on the indication and implementation of psychopharmacological interventions, and to present the results. This overview summarises the most relevant connections to the diagnosis, assessment of the severity and psychopharmacotherapy of depression in general practice.

The following therapy algorithms and remarks are essentially based on the treatment recommendations of the Swiss Society for Psychiatry and Psychotherapy (SGPP) and the Swiss Society for Anxiety and Depression (SGAD) as well as the German S3 guideline of the German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN).

Family doctors play a central role in the treatment of depressive disorders. They are often the first point of contact for patients with depression and in about 40 percent of cases even the only contact point. The likelihood of developing a depressive episode in the course of a lifetime is 10 to 15 percent globally. Evaluations by the World Health Organisation WHO show that 9 to 23 percent of people with chronic illnesses have depression as a concomitant illness. A cross-sectional epidemiological study in Germany showed that 60 percent of patients in general medical care were not treated with antidepressants and/or psychotherapy in accordance with guidelines. In Switzerland, about half of the antidepressants are currently prescribed by general practitioners. Image 1 shows a detailled overview (in German) of the current medication.

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Specialists in general internal medicine have a central role in recognition and treatment of depressive syndromes. Somatic causes can be ruled out by means of physical examination, laboratory and ECG/EEG/imaging. Mild and moderate depressive episodes can be treated by psychoeducation, counselling and medication. If the symptoms are mild, psychosocial support or psychotherapy alone can be considered. If acute suicidal tendencies or psychotic symptoms are identified, emergency symptoms, emergency admission to a psychiatric hospital should be considered.

The presence of other psychiatric comorbidities, resistance to therapy or complex psychiatric medication necessitate referral to outpatient specialists. Metabolic and cardiovascular side effects and interactions between psychopharmacological and internal medicine must be considered.

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Major depression is a common condition. Despite significant advances in psychopharmacology since the 1950s, the onset of action and drug resistance remain therapeutic challenges for traditional antidepressant agents, such as serotonin reuptake blockers. The recent discovery of the rapid antidepressant effect of ketamine, receptor antagonist, has revolutionized research in this field.

demonstration of the antidepressant properties of ketamine

For this purpose, major search engines such as Pubmed, medline, Science Direct, and journals specializing in sociology were contacted, with the introduction of keywords (ketamine-Esketamine-resistant depression) and the selection of literature reviews but also articles deemed relevant for this review.

The initial demonstration of ketamine’s antidepressant effects was gradual, rather unusually in a treatment-resistant patient population. First administered in single doses in studies, ketamine showed a rapid and robust antidepressant effect, but not sustained over time. However, studies of repeated doses, spread over a period of a few weeks, then revealed that it was possible to prolong and even improve the clinical response. It is important to mention that the use of ketamine to treat depression still remains.

In 2000, the first randomized-controlled, double-blind clinical study used a crossover design, in which each participant received two infusions over 40 minutes, alternating between one week and one infusion of ketamine (0. 5 mg/kg) and a placebo infusion. A statistically significant antidepressant effect of ketamine compared to placebo was observed as early as 240 minutes after treatment and reached a maximum after 3 days; of the 8 patients treated with ketamine, 7 had an improvement in their symptoms of at least 30% and 4 of at least 50%

In 2006, Zarate et al. carried out the first replication study of the results obtained by the group from Yale University . In this study, 71% and 29% of the 17 patients who received ketamine achieved a response and remission, respectively ,the significant effect of ketamine was revealed after 110 minutes of treatment and until the end of the 7-day post-infusion follow-up.However, one week later, only 35% of patients had reached the clinical response threshold.

In 2010, Diazgranados et al. published the first study of ketamine treatment for bipolar depression. While the first two studies required patients to take no other psychotropic drugs, patients in this study had to show unresponsiveness to a therapeutic dose of lithium or valproic acid, two agents used in the treatment of bipolar disorder. Again here, 71% of patients who received ketamine achieved a clinical response

Finally, note that the discovery of the antidepressant action of ketamine has opened the door to the search for other molecules targeting the glutamatergic system, which will possibly provide an even greater

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Both in consultations with the general practitioner and with the psychiatrist, antidepressants are one of the most used drugs (1). These have multiple indications, and there are different groups according to their mechanism of action. In relation to this case, we are going to talk about Venlafaxine, a dual-type antidepressant, that is, it inhibits the reuptake of serotonin and norepinephrine. One of the most common side effects is digestive discomfort, which usually resolves after a few weeks (2). However, we should not ignore these symptoms, since they can hide something more serious.

Presentation of a clinical case on a patient who presented an increase in pancreatic amylase after starting treatment with Venlafaxine.

Bibliographic review including the latest articles in Pubmed on side effects of antidepressant treatment, and more specifically at the gastrointestinal level (in this case we will talk about pancreatitis).

We present the case of a 49-year-old woman, who was hospitalized 2 years ago, due to a first depressive episode. During this admission, psychopharmacological treatment was started for the first time, on that occasion with a selective serotonin reuptake inhibitor (SSRI), treatment of first choice (3). The patient had no side effects at that time, but the response was very modest, so it was decided to replace that antidepressant with Venlafaxine (with dual action), up to 150mg. The depressive symptoms improved markedly, however the patient began to feel digestive discomfort (which at first did not seem to be of great importance). A general analysis was performed, in which an increase in lipase (978 U/L) and amylase (528 U/L) was detected. An echoendoscopy, an abdominal scan, and a magnetic resonance cholangiography were performed; Pancreatitis secondary to drugs was suspected (a severe condition). Luckily, no significant lesions were found in the tests, and the levels of amylase and lipase decreased when Venlafaxine treatment was withdrawn (without reaching the normal range). The patient was discharged and continued to attend consultations. In the last control, amylase had dropped to 225 U/L. His abdominal pain disappeared. Treatment with Vortioxetine (a multimodal antidepressant) was started, however the amylase levels continue to be monitored, and the patient continues to see the gastroenterologist.

Gastrointestinal side effects are very common when taking antidepressant treatment, and in most cases they do not usually represent a serious problem.

However, it is described in the scientific literature that in some cases, acute pancreatitis secondary to some drugs, including Venlafaxine, can occur (4). In order to detect it, it is necessary to perform a blood test and sometimes also other complementary tests.

For its treatment, the fundamental thing is to withdraw the causing drug, trying to find other alternatives, and carry out a control to monitor possible complications

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Maintenance electroconvulsive therapy (mECT) is an option in the treatment of affective disorders which progress is not satisfactory. It is certainly neglected and underused during the clinical practice.

To evaluate the efficacy of mECT in reducing recurrence and relapse in recurrent depression within a sample of three patients.

We followed up these patients among two years since they received the first set of electroconvulsive sessions. We applied the Beck Depression Inventory (BDI) in the succesives consultations for evaluating the progress.

The three patients were diagnosed with Recurrent Depressive Disorder (RDD). One of them is a 60 year old man that received initially a cycle of 12 sessions; since then he received 10 maintenance sessions. Other one is a 70 year old woman that received initially a cycle of 10 sessions; since then she received 6 maintenance sessions. The last one is a 55 year old woman that received initially a cycle of 14 sessions; since then she received 20 maintenance sessions.

All of them showed a significant reduction in depressive symptoms evaluated through BDI and clinical examination. In the first case, we found a reduction in the BDI from the first consultation to the last that goes from 60 to 12 points; in the second case, from 58 to 8 points; and in the last case, from 55 to 10 points. The main sections that improved were emotional, physical and delusional.

As side-effects of the treatment, we found anterograde amnesia, lack of concentration and loss of focus at all of them.

We find mECT as a very useful treatment for resistant cases of affective disorders like RDD.

It should be considered as a real therapeutic option when the first option drugs have been proved without success.

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Depression is second only to cardiovascular disease as a cause of disability and affects 3 to 5% of the general population. The therapist always tries to guarantee a total remission of the symptoms of depression, but partial remission remains frequent.

Evaluating the quality of remission in a group of patients followed for major depressive disorder at the Arrazi Hospital in Salé.

Cross-sectional study in adult patients followed up in consultation for major depressive disorder according to DSM-V criteria and having been under treatment for at least 2 months. Information was collected using a hetero questionnaire containing information on sociodemographic data and the depressive episode.

The quality of remission is assessed using the Hamilton Rating Scale for Depression.

We recruited 70 patients followed for major depressive disorder at 2 months of evolution. The Hamilton scale revealed that 40% of patients were in partial remission.

Residual symptoms can be the cause of relapse in major depressive disorder, hence the interest in seeking both a symptomatic remission and a complete functional remission, and this by the evaluation and the continuous management of the patients.

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The recent global pandemic has led, for many, to a period of enforced isolation. Anecdotally we are now seeing a “fourth wave” of morbidity. This is not a further wave of Covid infections but a surge of people presenting with depression. Given the potential importance of loneliness and isolation as risk factors for depressive symptoms, we sought to review the literature on this topic.

What is the impact of loneliness and isolation on the development and perpetuation of depression?

A search of the literature was carried out using Medline via OvidSP and Web of Knowledge core collection. Search terms used on Web of Science were ‘lonel*’ AND ‘depress*’, ‘isolat*’ AND ‘depress*’. OvidSP utilised search terms ‘lonel*’ AND ‘depression’, ‘isolation’ AND ‘depression’. MeSH terms were incorporated into the OvidSP search: these included ‘loneliness’, ‘social isolation’, ‘depression’, ‘depression, postpartum’. Papers were filtered first by publication year and article type, then manually through the review of titles and objectives. Full texts of relevant papers were obtained, reviewed and appraised to see if they could help to answer the study question.

Several key themes emerged across the papers reviewed.

Loneliness may be a risk factor for the development of depression and vice versa (Van As et al. International Psychogeriatrics 2022; 34(7) 657–69).

Equally, they may have a common aetiology for example shared genetic factors (Achterbergh et al. BMC Psychiatry 2020; 20(1) 1-23).

The experience of loneliness was shown to create a cyclical pattern in which feelings of loneliness worsen the deterioration of depression, which in turn worsens the proceeding loneliness. (Wahid et al. Child and Adolescent Psychiatry and Mental Health 2022; 16(1), 1-17). Loneliness has also been shown to increase the likelihood of reoccurrence of depression, as well as negatively predicting for recovery from depression (Gabarrell-Pascuet et al. Depression and anxiety 2022; 39(2) 147-155, Van As et al. International Psychogeriatrics 2022; 34(7) 657–69).

Fear of disclosing depressive symptoms to friends, due to fear of rejection and subsequent social isolation resulting in loneliness, was shown to lead individuals to withdraw from their relationships. This brought about social isolation: consequences of this isolation, such as loss of meaningful relationships, are in themselves risk factors for depression (Caputi et al. The Journal of Genetic Psychology 2017; 178(4) 207-216).

To prevent and improve recovery from depression, it is important to consider the importance of loneliness and isolation as risk factors. Consideration should be given to treating both using a biopsychosocial approach.

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It is known that after gastric bypass surgery, Vitamin B12 and folate (B9) are common micronutrient deficiencies affecting this population. It may cause several neuropsychiatric symptoms which, if left untreated, leads to severe consequences.

To describe a clinical case of the patient with recurrent depressive disorder (RDD), Vitamin B12 and B9 deficiency after gastric bypass surgery, and to review the literature.

Clinical case presentation through the review of the patient’s clinical file and non-systematic literature review on PubMed and ResearchGate.

34-year-old female patient presented in psychiatric outpatient clinic with low mood, lack of appetite, disgust against food, vomiting, dizziness and syncopal episodes. She noted anxiety, fear of death, fatigue and decrease in activity. She was apathetic, lacked motivation and had sleep disturbance. PHQ-9 - 18 points. Patient had hand tremor and ataxic gait. Weight 78kg, height 1.79m, BMI 24.34kg/m2.

Patient was diagnosed with morbid obesity in teenage years (130kg, 1.79m, BMI 40.57kg/m2). At the age of 23, gastric bypass surgery was done. After the operation patient was satisfied, lost weight. A few years later she felt depressed, apathetic and dropped out of university. Patient was reluctant to visit her GP. In 2021 patient’s vision worsened, gait became ataxic, appeared disgust against food, dizziness, several syncopal episodes. Patient was hospitalized in Neurological clinic due to suspected demyelinating central nervous system (CNS) disease. Patient was diagnosed with alimentary B12 and B9 deficiency, gastroesophageal reflux. She received treatment with Vitamins B12, B9. Demyelinating CNS disease was not confirmed. Patient became more depressed and anxious. She was diagnosed with depression and received treatment with escitalopram, later switched to venlafaxine, mirtazapine and phenibut. Little temporary improvement was observed, but patient had side-effects and still had vomiting and syncopal episodes.

At the time of Psychiatric outpatient visit, additional blood tests were done, revealing severe Vitamin D3 deficiency (3.96ng/ml). During treatment with fluvoxamine (50mg per day) in combination with olanzapine (5mg per day), vitamin B12, B9, D3 supplementation, patient‘s mood gradually improved, disgust against food disappeared, appetite improved, patient became more active, syncopal episodes disappeared and sleep improved. PHQ-9 after two months was 5 points.

Patient with RDD and Vitamin B12, folate and D3 deficiency, disgust against food, vomiting, fainting, benefited from combination of fluvoxamine, olanzapine and vitamin supplementation. Dynamic monitoring of patients after gastric bypass surgeries and education on this topic is vital to ensure patient health. Further research is necessary on treatment combination strategies for RDD in case of vitamin deficiencies.

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Multiple sclerosis(MS)is a chronic immune-mediated, inflammatory disease of the central nervous system. Depression is one of the most common psychiatric conditions associated with MS. Lifetime prevalence of major depression has been estimated to be around 50%.

Although the prevalence of depression in MS patients has been shown by many studies, there has not been a case in the literature demonstrating the onset of MS disease with depressive symptoms. In this article, a case of multiple sclerosis (undiagnosed before) presenting as depression in a young woman is presented and discussed.

An eighteen years-old female patient visited the emergency room of Erenkoy Mental and Neurological Diseases Hospital with complaints of unhappiness,malaise,anhedonia,introversion,sleepiness,lack of appetite and nausea. She was admitted to another hospital one and a half years ago with similar complaints and duloxetine 30 mg/day treatment was started. The patient, who did not benefit from this treatment, stopped using the drug by herself and did not consult a doctor again. Her complaints regressed over time without treatment.Her current symptoms started four days prior to her visit. She had no other medically diagnosed condition. No pathology was detected in the emergency blood test parameters of the patient.Her brain tomography was normal. The patient, who had periventricular ovoid hyperintense lesions on cranial MRI, was diagnosed with multiple sclerosis and was admitted to the neurology unit of our hospital. The lumbar puncture was performed during the hospitalization, oligoclonal band positivity was detected. The IgG index was found to be increased at CSF (cerebrospinal fluid). She underwent pulse steroid therapy for seven days. The patient was discharged since her symptoms regressed after treatment.

Here we present a case of MS presenting as depression in a young woman. Depression is a very common, and very important comorbidity in multiple sclerosis. The etiology of depression in MS is likely to be multifactorial, and to include biological, psychological, and social determinants. Although the relationship between depression and MS has been clearly demonstrated in all of these studies, there is no case of MS presenting as depression in the literature.

We know that depression may occur as a prodromal symptom in some organic diseases that affect brain such as dementia and Parkinson. In this case, we wanted to emphasize that organic etiological research is necessary for patients who present with psychiatric complaints for the first time, and that psychiatric complaints may be a symptom of organic diseases that may affect the brain.

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Ankylosing spondylitis (AS) is an inflammatory rheumatic disease characterized by spinal and/or peripheral involvement, enthesitis, dactylitis, and several extra-articular manifestations. Chronic inflammation often leads to reduced spinal mobility and functional disability. The frequency of psychological problems has increased in AS patients.

The objective of this study was to determine the prevalence of symptoms of anxiety and depression among AS patients and explore the underlying associated factors.

The Bath Ankylosing Spondylitis Functional Index (BASFI), the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and other clinical measures were collected during the clinical trial. We evaluated also the hospital anxiety and depression scale (HADs). P values < 0.05 were considered statistically significant.

Sixty-two patients with AS were included in the study. The average age was 41 years [18-65]. The diagnostic delay varied from one year to 26 years with an average of 4 years. Twenty-nine years is the average age of onset of symptoms with a standard deviation of 10 years. The mean duration of the disease was 10 ± 8 years. At baseline, the mean BASFI score was 53.9 ± 2 and BASDAI was 4.5± 2.

Clinically significant symptoms of anxiety and depression were present in 48.4% and 54.8% of patients, respectively. Depression was noted with a mean HADS depression of 10,5 ± 5,2. Anxiety was noted with a mean HADS anxiety of 11,3 ± 4,6.

In univariate analysis, anxiety was associated with the low educational level of patients (p = 0.038) and with CRP level (p= 0.041). There was a significant association between depression and anxiety (p=0.000). There was no relationship between these psychiatric disorders and disease activity, treatment modalities or functional status (p>0.05)

In patients with Ankylosing spondylitis, the prevalence of risk of mental disorders is high.

Anxiety and depression are common in AS and even alter the quality of life.

Patients should be regularly screened for these disorders.

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