Indiana University-Purdue University Indianapolis (IUPUI) / Depression is a heterogeneous mental health condition, varying in presentation across individuals. A candidate etiology that may help account for this heterogeneity is the neurotrophin hypothesis of depression, which proposes that stress downregulates brain-derived neurotrophic factor (BDNF) expression, leading to aberrant neurogenesis and depression. This etiology may manifest in a distinct symptom profile that may be reflected in depressive symptoms or symptom clusters. The effect of psychological interventions on BDNF is not known. Additionally, it is not known if BDNF levels mediate intervention effects on depressive symptom clusters. Using data from the eIMPACT trial (NCT02458690, supported by R01 HL122245), I examined baseline associations of BDNF with depressive symptoms and depressive symptom clusters. Also, I examined if the modernized collaborative care intervention for depression (internet CBT, telephonic CBT, and select antidepressant medications) affected BDNF and if changes in BDNF mediated intervention effects on cognitive/affective and somatic depressive symptom clusters. 216 participants (primary care patients with depression and elevated cardiovascular disease risk ≥50 years from a safety net healthcare system) were randomized to 12 months of the eIMPACT intervention (n=107) or usual primary care for depression (primary care providers supported by embedded behavioral health clinicians and affiliated psychiatrists; n=109). Plasma BDNF was measured with commercial ELISA kits. Depressive symptoms were assessed by the PHQ-9 (M=15.1, SD=5.0) from which cognitive/affective and somatic subscale scores were computed. No significant baseline associations were observed between BDNF and individual depressive symptoms or depressive symptom clusters. The intervention did not improve BDNF over 12 months. Similarly, 12-month changes in BDNF were not associated with 12-month changes in PHQ-9 cognitive/affective or somatic subscale scores. However, the intervention significantly improved PHQ-9 cognitive/affective and somatic subscale scores over 12 months. 12-month changes in BDNF did not mediate the effect of the intervention on 12-month changes in the PHQ-9 subscale scores. These findings suggest that modernized collaborative care for depression does not improve BDNF. Modernized collaborative care does yield improvements in both cognitive/affective and somatic depressive symptom clusters, albeit not via changes in BDNF.

Introduction: The notion that depression is a disorder that moves along a continuum is well-established. Similarly, the belief in the continuity of mental illness is considered an important element in the stigma process. Against this background, it is the aim of this study to examine whether public continuum beliefs vary with the severity of depressive symptoms. Methods: Analyses were based on computer-assisted telephone interviews (CATIs) conducted in winter 2019/2020 in Germany (N = 1,009, response rate 46.8%). Using three vignettes representing mild, moderate, and severe depressive symptoms, beliefs regarding the continuity of symptoms, specifically a fundamental difference, were assessed with seven items. Sociodemographic characteristics and own experiences with depression (affliction and contact) were introduced as covariates. Results: Significant differences between the three groups of severity were found for the majority of the items measuring continuum beliefs or perceived fundamental difference. However, only few items showed a linear trend indicating a parallel between symptom severity and beliefs. Multivariate regression models showed that a moderate degree of depression was positively associated with stronger continuum beliefs but also with greater perceived difference compared to the mild degree, while no significant associations emerged for the severe vignette. Limitations: Although a comparison of our sample with official statistics supports the external validity, we cannot rule out a selection bias. It is arguable in how far short case vignettes convey a holistic picture of a person affected by depressive symptoms. Conclusion: Our results do not indicate a parallel between symptom severity and public continuum beliefs.

Ottosson, B. & Skog, S. Åtgärder för att symtomlindra depression eller nedstämdhet hos äldre - en litteraturstudie. Examensarbete i omvårdnad 15 högskolepoäng. Malmö universitet: Fakulteten för hälsa och samhälle, institutionen för vårdvetenskap, 2020.Bakgrund: Många äldre lider av nedstämdhet, vilket kan vara ett tecken på depression. Det anses ofta inte som något att söka vård för då det till stor del räknas som en naturlig del av åldrandet. De symtom på nedstämdhet som ignoreras då är: ökad oro, känsla av hopplöshet, sömnsvårigheter, minskad aptit och viktminskning.Metod: En litteraturstudie med 10 kvantitativa artiklar, artiklarna delades in i fyra kategorier som de sedan presenterades genom. Nivån av symtom mättes med Geriatric depression scale (GDS).Syfte: Målet med den här litteraturstudien var att undersöka och beskriva åtgärder som kan användas för att lindra depressionssymtom eller nedstämdhet hos äldre.Resultat: Alla studier hade inte signifikanta sänkningar av GDS i slutet av studien men alla hade det under tiden studien pågick. Den minsta sänkningen av GDS var 4,34 % med minnesterapi (Wang 2005) och den högsta sänkningen var efter interventionen med konst då GDS minskade med 66 % (Ching-Teng M.fl. 2019).Konklusion: Det sammanfattade resultatet visade att alla interventioner gav bra resultat under tiden studien varade. Enligt de procentuella beräkningarna så var det konst (66 %), mindfulness (50,7 %) och Qi-Gong (41,3 %) som gav bäst resultat enligt GDS skalan.Nyckelbegrepp: Depressionssymtom, geriatrik, nedstämdhet, sjuksköterska, symtomlindring. / Ottosson, B. & Skog, S. Strategies to ease depression symptoms or blues in the elderly - a literature review. Degree project in nursing 15 Credits. Malmö University: Faculty of Health and Society, Department of Care Science), 2020.En litteraturstudie med 10 kvantitativa artiklar, artiklarna delades in i fyra kategorier som de sedan presenterades genom.Background: Many elderly people suffer from the blues, which can be a sign of depression. It is not often considered something to seek care for as it is largely regarded as a natural part of aging. The symptoms of depression that are then ignored are: increased anxiety, feelings of hopelessness, insomnia, decreased appetite and weight loss.Method: A literature review of 10 quantitative articles, the articles were selected into 4 different categories and then presented through these. Symptoms were measured with the geriatric depression scale (GDS).Aim: The main purpose of this literature study was to investigate and describe what measures that can be used to prevent or alleviate depression symptoms or the blues in the elderly.Results: All the studies did not have significant reductions of GDS at the end of the study but they all had it during the study. The smallest reduction of GDS was 4.34 % with reminiscence therapy (Wang 2005) and the highest decrease was after the intervention with art when GDS decreased by 66 % (Ching-Teng M.fl. 2019).Conclusion: The summarized results showed that all interventions produced good results during the study. According to the percentage calculations, art (66 %), mindfulness (50.7 %) and Qi-Gong (41.3 %) gave the best results according to the GDS scale.Keywords: Blues, depression symptom, geriatric, nurse, symptom relief.