The serotonin (5-HT) hypothesis of depression has played an important role in the history of psychiatry, yet it has also been criticized for the delayed onset and inadequate efficacy of selective serotonin reuptake inhibitors (SSRIs). With evolvement of neuroscience, the neuroplasticity hypothesis of major depressive disorder (MDD) has been proposed and may provide a better framework for clarification the pathogenesis of MDD and antidepressant efficacy. In this article, we first summarized the evidence challenging the monoamine hypothesis and proposed that the antidepressant efficacy of SSRIs is not derived from elevated monoamine (5-HT, noradrenaline (NE), or dopamine (DA)) concentration or monoamine neurotransmission. Second, we reviewed the role of stress in the pathogenesis of MDD and gave a brief introduction to the neuroplasticity hypothesis of MDD. Third, we explored the possible mechanisms underlying the antidepressant efficacy of typical antidepressants in the context of neuroplasticity theory. Fourth, we tried to provide an explanatory framework for the significant difference in onset of efficacy between typical antidepressants and ketamine. Finally, we provided a brief summarization about this review article and some perspectives for future studies.

BackgroundThe evidence for effectiveness of Cognitive Behaviour Therapy (CBT) is robust and the national organizations in the United Kingdom and the United States recommend its use. It is not utilized to its full potential in low and middle-income countries. Adaptation of CBT treatment to the target culture may facilitate its uptake.This study explored views of patients with schizophrenia, their caregivers, and mental health professionals for the purpose of cultural adaptation of CBT.MethodThe project was conducted in a teaching hospital in China. Systematic content and question analysis were the techniques we used to analyse the data generated in a series of qualitative interviews (N 45) in China. After identification of emerging themes and categories we compared and contrasted the themes across different interviews recursively. Triangulation of themes and concepts was undertaken to compare further and contrast the data from the different participating groups.ResultsThis work highlighted the barriers in therapy as well as opportunities for use of CBT in that environment. Patients and their carers in China use a bio-psycho-spiritual-social model of illness. CBT is not commonly used to help those with schizophrenia in China.ConclusionsThis study will facilitate the therapists using CBT for people with psychosis in China. These results require to be tested in clinical trials.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-017-1290-6) contains supplementary material, which is available to authorized users.

ParticipantsA total of 1,558 participants, including 782 patients with major depressive disorder (MDD) and 776 healthy controls (HCs), were recruited from 5 research centers in China (The Second Xiangya Hospital, ). The detailed inclusion and exclusion criteria for each center are listed below. CMU dataset:Four hundred thirty-one participants were recruited for participation in this study, including 155 patients with MDD and 276 HCs. All patients with MDD were recruited from the outpatient clinic at the Department of Psychiatry, First Affiliated Hospital of China Medical University and the Mental Health Center of Shenyang. Patients with MDD were diagnosed by two trained psychiatrists using the Structured Clinical Interview for DSM-IV Disorders. Participants with MDD met the DSM-IV diagnostic criteria for MDD but not for any other Axis I disorders. The severity of depression was rated using the 17-item HDRS (Williams, 1988) and the Clinical Global Impression of Severity Scale (Guy, 1976). The control group was recruited from the local community. HC participants did not have a current or lifetime history of Axis I disorders or a history of psychotic, mood, or other Axis I disorders in first-degree relatives as determined from the detailed family history. The participants were excluded for the following reasons: 1) a lifetime history of substance/alcohol abuse or dependence, 2) a concomitant major medical disorder, 3) any MRI contraindications, 4) a history of head trauma with loss of consciousness ≥5 minutes or any neurological disorder, and 5) suboptimal imaging data quality. The study was approved by the Institutional Review Board of China Medical University. Among these participants, 1 patient and 5 HCs were excluded because of duplicate data in the data transfer, 1 HC was excluded due to errors in raw DICOM data, 6 patients were excluded due to the use of different scanning parameters, 3 HCs were excluded due to abnormalities in anatomical brain images, 6 patients and 6 HCs were excluded for large head motion during the R-fMRI scan (exceeding 3 mm of translational movements or 3° of rotational movements), 13 patients and 8 HCs were excluded because the MRI scan did not cover the entire brain, 4 patients and 2 HCs were excluded due to a change in the diagnosis in follow-up interviews, 1 HC was excluded due to a lack of demographic information, and 1 HC was excluded because of his young age. Finally, data from the remaining 125 patients with MDD and 249 HCs were used in the present study. CSU dataset:Patients with MDD were recruited from inpatient or outpatient departments of the Psychiatry Hospital of Zhumadian, Henan Province, China. The diagnosis of MDD was confirmed by

Background: Stigma against those who suffer from mental illness is a major issue in many nations. Stigma, which is comprised of prejudice, ignorance, and discrimination, serves as a barrier to seeking help and staying in contact with mental health services.It is thus imperative that concerted efforts are taken against stigma.Methods: Eight young psychiatrists from eight Asian nations offer a narrative review of the state of stigma in their respective nations, the sociocultural reasons behind this stigma, recent anti-stigma efforts and the effects, if any, of such efforts.

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BackgroundDozens of randomized controlled trials (RCTs) and meta-analyses have demonstrated the efficacy of repetitive transcranial magnetic stimulation (rTMS) for major depressive disorder (MDD) treatment, but there has not been a meta-analysis report which evaluates the efficacy and tolerability of rTMS used as an augmentative strategy for antidepressants in treatment-resistant depression (TRD) treatment. We thus conducted this meta-analysis, aimed at clarifying whether rTMS enhances the efficacy of TRD.MethodsWe searched MEDLINE and Cochrane Central Register of Controlled Trials for RCTs for studying the efficacy of rTMS versus (vs) sham condition when combined with antidepressants in TRD treatment, and screened the references of the previous meta-analysis about the rTMS for MDD treatment. Response rates and NNT were chose as the primary outcomes, and remission rates, change from baseline of HAMD scores, dropouts were used as secondary outcomes. For dichotomous data, an intention-to-treat analysis principle was applied; for continuous data, we calculated the standard mean difference between groups with a random-effect model. Sensitivity analysis was done to explore the source of heterogeneity and the factors which potentially impact the efficacy.ResultsSeven RCTs were finally included in the meta-analysis. The total sample size was 279, with 171 in the rTMS group and 108 in the sham group. The pooled response and remission rate for the rTMS and sham group was 46.6% and 22.1%, respectively; the pooled odds ratio (OR) was 5.12 [95% confidence interval (CI) 2.11-12.45, z = 3.60, p = 0.0003, and the associated number needed to treat (NNT) was 3.4. rTMS group achieved a significant reduction of HAMD score than the sham group, the pooled SMD of change from baseline was 0.86 [95% confidence interval (CI) 0.57-1.15, z = 5.75, p < 0.00001]. Because of the small number of included RCTs, the preplanned sensitivity and subgroup analyses were finally abandoned. The dropouts in both groups were relatively low, indicating the high acceptability of rTMS.ConclusionsFor TRD patients, augmentative rTMS after the failure of medications significantly increases the effect of antidepressants, and rTMS was a safe strategy with relatively low adverse events and low dropout rate, suggesting that augmentative rTMS is an effective intervention for TRD.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-014-0342-4) contains supplementary material, which is available to authorized users.

The evidence for the efficacy of probiotics in alleviating anxiety, as presented in currently published RCTs, is insufficient. More reliable evidence from clinical trials is needed before a case can be made for promoting the use of probiotics for alleviating anxiety.