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The relationship between traumatic experiences and major depressive disorder provides relevant insight into the etiopathogenesis of major depression. The purpose of the current paper is to provide a narrative review on the role of both early-life trauma and recent stressful life events in the onset and maintenance of major depression. We searched for studies using PubMed, PsycLIT, PsycINFO and EBSCOhost electronic databases. The review of the studies suggests that most episodes of major depression are preceded by some stressful life events, mostly involving interpersonal loss. The central role of childhood adversity (parental death, divorce and marital discord, parental mental illness and substance abuse, exposure to family violence, neglect, and sexual and physical abuse) has also been extensively investigated. Evidence in current literature supports the notion that the impact of childhood traumatic experiences is more enduring and profound and leads to cumulative effects of stressful or traumatic events later in life. Furthermore, recent research has explored possible mediators of the trauma-depression relationship focusing on the identification of factors associated with resilient responses to traumatic stressors. Genetic influences, neurobiological pathways and psychosocial determinants have been found to be primarily involved in mediating resilient phenotypes.

OBJECTIVES: High, normal, or low plasma magnesium (Mg) levels have been observed in depressed patients. The aim of our study was to investigate the relationship of Mg levels with depression severity, specific psychopathological dimensions, and treatment outcome. METHODS: A total of 123 outpatients during a major depressive episode were recruited. All patients showed at least two major depressive episodes and did not achieve remission in the former treatment trial. A blood sample was collected to determine total plasma Mg levels. The psychopathological status was assessed using Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Depression Retardation Rating Scale for psychomotor retardation, and Snaith-Hamilton Pleasure Scale for anhedonia. Hamilton Depression Rating Scale was repeated at 3 months after treatment. RESULTS: All patients showed Mg levels mostly within the normal range. No association between Mg levels and psychopathological severity was reported. Patients who responded to antidepressant treatment showed higher Mg levels and higher retardation scores at basal evaluation in comparison with non-responders. DISCUSSION: 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.

Il ruolo delle risorse personali acquista sempre maggior rilievo grazie anche al loro potenziamento nella cooperazione, con un notevole impatto sulle possibilità di sopravvivere ed evolversi. Tali acquisizioni hanno condotto in questi ultimi anni al fiorire di un grosso numero di modalità terapeutiche che vanno sotto il nome di self-help Tali attività, in modo complementare agli specifici trattamenti, possono produrre effetti significativamente benefici sull’individuo ed appaiono in grado di alleviare il disagio psico-fisico consentendo lo sviluppo di un adattamento più efficace alla condizione di sofferenza. Nel capitolo vengono presentate le modalità attraverso cui si declina il self-help sia individualmente che in gruppo, nonché la valenza riabilitativa nell'ambito dei disturbi dell'umore.

La moderna visione dell’assistenza psichiatrica è centrata su un approccio alla cura ed alla riabilitazione del disturbo mentale in grado di confrontarsi “attivamente” con il problema della cronicità, grazie all’integrazione di livelli di intervento non rigidamente sequenziali ma complementari, e con molteplici possibilità di interazione. Le tecniche di riabilitazione psichiatrica vanno acquisendo un ruolo sempre più centrale nell’ambito dei trattamenti integrati di numerosi disturbi mentali, con l’obiettivo di promuovere ulteriormente l’integrazione del paziente nella comunità. D’altra parte la riabilitazione psichiatrica è stata a lungo considerata una pratica dai contorni non sempre ben delineati, con attività frequentemente guidate dal “buon senso”, dal coraggio e dalla “buona volontà” di figure più o meno professionali. Le moderne ricerche in tale ambito stanno sempre più contribuendo alla formulazione di interventi strutturati che si articolano in tappe progressive, ciascuna con obiettivi selettivi e mirati che vengono sottoposti costantemente a procedure di valutazione rigorose. Questo volume nasce dall’esigenza di fornire un quadro sufficientemente esaustivo ed approfondito sullo stato dell’arte della riabilitazione nell’ambito dei disturbi dell’umore. L’opera è diretta a tutti i professionisti della salute mentale, con particolare riferimento a coloro che vogliono acquisire gli strumenti necessari per promuovere tale attività nella loro pratica clinica. Il manuale si compone di due sezioni: ad una parte generale più strettamente teorica e finalizzata all’acquisizione di conoscenze, segue una parte speciale più specificatamente applicativa, in cui alcune delle competenze acquisite vengono declinate in paradigmi d’intervento che il lettore viene incoraggiato a sviluppare. Nella prima parte vengono pertanto presentati gli elementi essenziali alla definizione di un corretto percorso clinico per i pazienti affetti da disturbi dell’umore, con un amp

Aim: High-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. Methods: 123 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. Results: hs-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). Conclusions: In 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.

Aim: High-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. Methods: 123 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. Results: hs-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). Conclusions: In 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.

Background and Aim: High, normal or low plasma magnesium (Mg) levels have been observed in depressed patients. The aim of our study was to investigate the relationship of plasma Mg levels with depression severity, specific psychopathological dimensions and treatment outcome. Materials and Methods: 123 outpatients (M/F 60/63; mean age=48±15) during a Major Depressive Episode (MDE) were recruited. Most of them were affected by “difficult to treat” depression, that includes patients with history of at least two MDE, risk of chronicization and who did not achieve remission in previous treatments. The psychopathological status was assessed using HAM-D, HAM-A, DRRS for psychomotor retardation and SHAPS for anhedonia. HAM-D was repeated at 3 months. A blood sample was collected to determine total plasma Mg levels. Results: we observed an association between Mg levels and psychomotor retardation scores (p = 0.045). Moreover, subjects with residual symptoms after treatment (HAM-D at 3 months > 15) have lower starting Mg values compared to treatment-responsive individuals (2.14±0.2 vs. 2.25±0.21, p=0,039). Conclusions: Conflicting data on plasma Mg levels in depression could be due to the isolation of brain Mg compartments from blood Mg compartments. As in a previous study, the association between high Mg levels and psychomotor retardation found in this larger sample strengthens the notion that high Mg levels play a part in the hypoactivity so often observed in depressed patients. Also, low Mg values in patients with poor treatment outcome suggest Mg could have a therapeutic potential in “difficult-to-treat” patients.

Introduction: There is growing evidence of a link between chronic low-grade inflammation and both depression and several aging associated diseases. Moreover, major depression appears to be associated with increased plasma concentrations of cytokines and C-reactive protein, a marker used to emphasize low-grade inflammation and to predict cardiovascular events in patients with coronary heart disease. Recently, a relationship between C-Reactive Protein and mood disorders has been proposed by some researchers. The aim of our study was to investigate the correlation between plasma concentrations of C-Reactive Protein and both severity of symptoms and psychopathological dimensions (anhedonia, psychomotor retardation and aggression), in patients with major depression during an acute phase of illness. Methods: 67 drug-free patients (M/F = 30/37; mean age 47,41±12,68) with a Major Depressive Disorder (MDD) during a Major Depressive Episode (MDE) have been recruited at the Day Clinic of Psychiatry of the Catholic University of Sacred Heart in Rome. A blood sample for the determination of plasma C-Reactive Protein levels was collected before starting treatment. Severity of depressive and anxiety symptoms was measured with 21-HDRS (21 Item - Hamilton Depression Rating Scale) and HARS (Hamilton Anxiety Rating Scale). Social functioning was evaluated by SASS (Social Adaptation Self-Evaluation Scale). Anhedonia, psychomotor retardation and aggression were evaluated by SHAPS (Snaith Hamilton Pleasure Scale), DRRS (Depression Retardation Rating Scale) and AQ (Aggression Questionnaire). The levels of C-reactive protein were measured using a nefelometric system. Results: No significant correlation between C-Reactive Protein values and severity of depressive and anxious symptoms (HDRS and HARS scores) has been observed in our sample. After controlling for age, C-Reactive Protein levels were significantly correlated to SASS scores (r = -0,64 t = 0,001). When we considered the psychopath