Although further studies investigating the relationship between hypomagnesaemia, depression, and treatment outcome are certainly necessary, we have hypothesized that hypomagnesaemia could be an epiphenomenic biochemical trait in less drug-responsive depressed patients. It is also plausible that lower Mg levels and hyperactive traits identify a biological subtype of patients with increased catecholaminergic functioning and a poorer response to aminergic drugs. Moreover, Mg depletion could partly account for the correlation between low Mg levels and poor outcome and this raises the question of Mg's possible therapeutic role in depression.

The present study describes a new mixed program of psychoeducational and psychological interventions for bipolar patients, applicable during everyday practice. Thirty-two bipolar patients recruited at a psychiatric day-hospital service have been admitted to a program consisting of 30 meetings and 2 follow-ups at 6 and 12 months. The psychoeducational support determined a general improvement of all included patients. At baseline, patients with residual depression had higher Hamilton Depression Rating Scale (HDRS) scores than euthymic patients (mean score ± SD: 21.25 ± 3.92 vs. 7.00 ± 2.95, respectively). After psychoeducation sessions, the HDRS scores of euthymic patients remained stable (mean ± SD: 7.00 ± 3.74), whereas the HDRS scores of depressed patients demonstrated a statistically significant improvement (mean ± SD: 14.00 ± 6.72, t = 2.721, p = 0.03). Results of the Connor-Davidson Resilience scale and specifically constructed questionnaire Questionario per la Valutazione della Conoscenza e dell'Apprendimento per il Disturbo Bipolare showed a statistically significant improvement in resilience and insight in all recruited patients. Psychoeducational intervention as adjunctive treatment to pharmacotherapy seems to be very effective in bipolar patients, not only for those in the euthymic phase, but this model could also be extended to patients with an ongoing mild or moderate depressive episode.

ObjectivesWe investigated the clinical benefits of bright light therapy (BLT) as an adjunct treatment to ongoing psychopharmacotherapy, both in unipolar and bipolar difficult-to-treat depressed (DTD) outpatients.MethodsIn an open-label study, 31 depressed outpatients (16 unipolar and 15 bipolar) were included to undergo 3 weeks of BLT. Twenty-five completed the treatment and 5-week follow-up.Main outcome measuresClinical outcomes were evaluated by the Hamilton Depression Rating Scale (HDRS). The Snaith–Hamilton Pleasure Scale and the Depression Retardation Rating Scale were used to assess changes in anhedonia and psychomotor retardation, respectively.ResultsThe adjunctive BLT seemed to influence the course of the depressive episode, and a statistically significant reduction in HDRS scores was reported since the first week of therapy. The treatment was well-tolerated, and no patients presented clinical signs of (hypo)manic switch during the overall treatment period. At the end of the study (after 5 weeks from BLT discontinuation), nine patients (36%, eight unipolar and one bipolar) still showed a treatment response. BLT augmentation also led to a significant improvement of psychomotor retardation.ConclusionBLT combined with the ongoing pharmacological treatment offers a simple approach, and it might be effective in rapidly ameliorating depressive core symptoms of vulnerable DTD outpatients. These preliminary results need to be confirmed in placebo-controlled, randomized, double-blind clinical trial on larger samples.

Our intervention proved to be effective in the treatment of complex and severe forms of depression. Our results on the role of family support require further investigation to better define suitable targets for tailored therapeutic approaches.

AimHigh-sensitive C-reactive protein (hs-CRP) has been used to assess low-grade immune system activation. In a population-based cohort hs-CRP was associated with functional somatic symptoms (SS), particularly with general and musculoskeletal functional SS clusters.Immune system dysregulation has also been reported in depression that is frequently associated to a high burden of SS.We investigated the correlation between hs-PCR and SS in depressed patients.Methods123 outpatients (M/F = 58/65; mean age 48,6 ± 14,8) during a Major Depressive Episode were recruited at the Institute of Psychiatry of the Catholic University in Rome. Severity of depression was assessed with the HAM-D scale. The somatization factor of the HAM-D (somatic anxiety, gastrointestinal symptoms, general somatic symptoms, hypochondria, weight loss) measured SS burden. A blood sample was collected to determine hs-CRP.ResultsHs-CRP and depression severity were not correlated, while hs-CRP and SS were (r = -0,27; p = 0,001). Patients with higher (> 3) somatizazion factor had significantly lower hs-PCR values compared to patients with lower (≤3) somatization factor (2,47 mg/L ± 4.77 vs. 3.20 mg/L ± 4.44; p = 0,026).ConclusionsIn contrast with the hypothesized cytokine involvement in somatic features of sickness behavior, higher somatic burden correlates with lower immune activation.The role of sickness behavior in experiencing SS and hs-CRP's use as valid indicator of cytokine production remain uncertain. Further studies are necessary, also to explore the relationship between HPA axis dysregulation and immune activation, possibly relevant to the interpretation of our results.