People with severe mental illnesses, such as schizophrenia, depression or bipolar disorder, have worse physical health and reduced life expectancy compared to the general population. The excess cardiovascular mortality associated with schizophrenia and bipolar disorder is attributed in part to an increased risk of the modifiable coronary heart disease risk factors; obesity, smoking, diabetes, hypertension and dyslipidaemia. Antipsychotic medication and possibly other psychotropic medication like antidepressants can induce weight gain or worsen other metabolic cardiovascular risk factors. Patients may have limited access to general healthcare with less opportunity for cardiovascular risk screening and prevention than would be expected in a non-psychiatric population. The European Psychiatric Association (EPA), supported by the European Association for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC) published this statement with the aim of improving the care of patients suffering from severe mental illness. The intention is to initiate cooperation and shared care between the different healthcare professionals and to increase the awareness of psychiatrists and primary care physicians caring for patients with severe mental illness to screen and treat cardiovascular risk factors and diabetes.

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Exercise training given as adjunct to standard guideline based treatment appears to have additional effects on BDNF serum concentrations in people with MDD. Our results add further evidence to the beneficial effects of exercise in the treatment of MDD.

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Introduction: Many patients with major depressive disorder fail to achieve remission with standard antidepressant therapy. Current options for the management of treatment resistant depression (TRD) comprise dose optimization, switching within or between drug classes, augmenting with other drugs and combination strategies. However, the application of combination treatment may be limited by adverse side effects. Method: From February 2010 to February 2011, twelve inpatients with TRD were retrospectively identified as being treated with a combination of agomelatine and bupropion after discontinuation of former antidepressant treatment. Mean doses of agomelatine at the end of treatment were 47.9±7.2mg/d, and bupropion 325±86.6mg/d. Intensity of depressive symptoms was routinely assessed using Beck's Depression Inventory-2. Response was defined as decrease of BDI sum score by 50%, and remission as BDI sum score below 13. Metabolic parameters and adverse side effects were routinely measured. Statistical analysis was performed using paired t-test and repeated measurements ANOVA with degree of TRD as covariate, and unpaired t-test for gender comparisons. Results: Eight patients showed response, and seven reached remission after 6-8 weeks of inpatient treatment. This effect was independent of the degree of TRD. Discussion: How to continue antidepressive treatment after an initially unsuccessful trial is a vital question. However, guidance as to which option is to be favoured remains limited. In particular, the use of antidepressant combinations to address TRD is understudied. We have shown that combination treatment with agomelatine/ bupropion in TRD may lead to significant symptom relief. Future randomized controlled trials are needed to confirm our results.

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In this naturalistic observational study carried out in an inpatient treatment setting we as yet surveyed the parameters of the metabolic syndrome. A weekly monitoring procedure was implemented. The analysis included data of 350 patients over a time of 12 weeks. The last observation carried forward method was applied. Additionally we are evaluating the informative value of visceral body fat percentage as measured by a body composition analyzer. The patients showed a weight increase over the first 12 weeks (mean increase: 0.87 kg, p < .001) as well as an increase of the body mass index (mean increase: 0.45 kg/m2, p < .001). Accordingly, waist circumference (mean increase: 1.06 cm, p = .007) and visceral fat index (mean increase: 0.19, p = .007) increased. No worsening of fasting glucose and blood lipid concentrations was detected. Spearmens coefficient indicated correlations between visceral fat index and body mass index (ρ = .77; p < .001), waist circumference (ρ = .70; p < .001), and triglyceride concentrations (ρ = .39; p < .001). Correlations between visceral fat index and fasting glucose (ρ = .18; p = .019), and visceral fat index and total cholesterol (ρ = .16; p = .049) were weak but also significant. In contrast, the HDL cholesterol showed a negative relation with ρ < -.39 at each point in time (p < .001).We conclude that psychiatric patients are at increased risk for the development of metabolic alterations during inpatient treatment. The possible underlying mechanisms of this interaction are discussed.

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