Abstract:
BACKGROUND:Several small studies suggest that the adjunctive use of anti-inflammatory agents might improve depressive symptoms in bipolar disorder. However, there are few well designed, appropriately powered clinical trials assessing the efficacy of these novel treatment strategies. We aimed to assess the efficacy of adjunctive minocycline or celecoxib in this setting. METHODS:This double-blind, 12-week, randomised, placebo-controlled trial was done in four outpatient psychiatric clinics in Pakistan. Eligible participants were adults (aged 18-65 years) with DSM-5 bipolar disorder (type I or II) and a major depressive episode. In a 2 × 2 factorial design, participants were randomly assigned (1:1:1:1) to receive either active minocycline plus active celecoxib, active minocycline plus placebo celecoxib, placebo minocycline plus active celecoxib, or placebo minocycline plus placebo celecoxib. The primary outcome was the mean change from baseline to week 12 in score on the 17-item Hamilton Depression Rating Scale (HAMD-17), assessed in all randomised participants (missing data were imputed and assumed to be missing at random). The trial was registered with ClinicalTrials.gov, NCT02703363. FINDINGS:266 (17%) of 1542 patients assessed between May 1, 2016, and March 31, 2019, were randomly assigned to receive minocycline plus celecoxib (n=68), minocycline plus placebo (n=66), celecoxib plus placebo (n=66), or placebo plus placebo (n=66). From baseline to week 12, depressive symptoms as per HAMD-17 reduced in all four groups (from 24·5-25·2 to 11·3-12·8), but these reductions did not differ significantly between the groups. In terms of main effects, reductions in HAMD-17 did not differ for patients treated with minocycline (mean adjusted difference vs non-minocycline 1·48 [95% CI -0·41 to 3·36]; p=0·123) or for celecoxib (mean adjusted difference vs non-celecoxib -0·74 [-2·61 to 1·14]; p=0·443). Rates of serious adverse effects did not differ between groups (31 participants had a manic switch, two self-harmed, and one died in a motor vehicle accident). INTERPRETATION:We found no evidence that minocycline or celecoxib was superior to placebo for the treatment of bipolar depression. This large trial casts doubt on the potential therapeutic benefits of adjunctive anti-inflammatory drugs for the acute management of bipolar depression. FUNDING:Stanley Medical Research Institute.
journal_name
Lancet Psychiatryjournal_title
The lancet. Psychiatryauthors
Husain MI,Chaudhry IB,Khoso AB,Husain MO,Hodsoll J,Ansari MA,Naqvi HA,Minhas FA,Carvalho AF,Meyer JH,Deakin B,Mulsant BH,Husain N,Young AHdoi
10.1016/S2215-0366(20)30138-3subject
Has Abstractpub_date
2020-06-01 00:00:00pages
515-527issue
6eissn
2215-0366issn
2215-0374pii
S2215-0366(20)30138-3journal_volume
7pub_type
临床试验,杂志文章,多中心研究,随机对照试验abstract:BACKGROUND:The definition of post-traumatic stress disorder (PTSD) underwent substantial changes in the 2013 edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). How this will affect estimates of prevalence, whether clinical utility has been improved, and how many individuals who meet symptom c...
journal_title:The lancet. Psychiatry
pub_type: 杂志文章
doi:10.1016/S2215-0366(14)70235-4
更新日期:2014-09-01 00:00:00
abstract:BACKGROUND:Self-harm in adolescents is common and repetition occurs in a high proportion of these cases. Scarce evidence exists for effectiveness of interventions to reduce self-harm. METHODS:This pragmatic, multicentre, randomised, controlled trial of family therapy versus treatment as usual was done at 40 UK Child a...
journal_title:The lancet. Psychiatry
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/S2215-0366(18)30058-0
更新日期:2018-03-01 00:00:00
abstract::Mental health has been included in the UN Sustainable Development Goals. However, uncertainty exists about the extent to which the major social determinants of mental disorders are addressed by these goals. The aim of this study was to develop a conceptual framework for the social determinants of mental disorders that...
journal_title:The lancet. Psychiatry
pub_type: 杂志文章
doi:10.1016/S2215-0366(18)30060-9
更新日期:2018-04-01 00:00:00
abstract:BACKGROUND:Substantial evidence suggests that cognitive deficits might persist after remission of a major depressive episode. However, results are inconsistent relative to the importance, pattern, severity, and moderating factors of this impairment. We aimed to determine how cognitive function following a major depress...
journal_title:The lancet. Psychiatry
pub_type: 杂志文章,meta分析
doi:10.1016/S2215-0366(19)30291-3
更新日期:2019-10-01 00:00:00
abstract:BACKGROUND:Statins have shown both protective and adverse associations with neuropsychiatric outcomes. We aimed to examine the possible associations between statins and suicidality, depression, anxiety, and seizures. METHODS:Using Swedish national registers, we linked data on dispensed statin prescriptions with data o...
journal_title:The lancet. Psychiatry
pub_type: 杂志文章
doi:10.1016/S2215-0366(20)30311-4
更新日期:2020-11-01 00:00:00
abstract:BACKGROUND:In high-income countries, maternal postnatal depression is associated with adverse outcomes in the child. However, few studies have investigated this relation in countries of low and middle income. Furthermore, to our knowledge, no studies have followed up cohorts into later childhood. We aimed to investigat...
journal_title:The lancet. Psychiatry
pub_type: 杂志文章
doi:10.1016/S2215-0366(14)70361-X
更新日期:2014-11-01 00:00:00
abstract::The aim of this Review is to identify effective interventions and treatment guidelines to manage common types of psychiatric emergencies in non-specialist settings in low-income and middle-income countries. Mental health specialist services in low-income and middle-income countries are scarce. We did a systematic revi...
journal_title:The lancet. Psychiatry
pub_type: 杂志文章,评审
doi:10.1016/S2215-0366(15)00094-2
更新日期:2015-06-01 00:00:00
abstract:BACKGROUND:Adults with intellectual disabilities have substantial health inequalities and poor access to health care. We assessed whether practice nurse-delivered health checks could improve the health of adults with intellectual disabilities compared with standard care. METHODS:In this cluster-design, single-blind, r...
journal_title:The lancet. Psychiatry
pub_type: 杂志文章
doi:10.1016/S2215-0366(14)00078-9
更新日期:2014-12-01 00:00:00
abstract:BACKGROUND:The conceptualisation of transgender identity as a mental disorder has contributed to precarious legal status, human rights violations, and barriers to appropriate health care among transgender people. The proposed reconceptualisation of categories related to transgender identity in WHO's forthcoming Interna...
journal_title:The lancet. Psychiatry
pub_type: 杂志文章
doi:10.1016/S2215-0366(16)30165-1
更新日期:2016-09-01 00:00:00
abstract:BACKGROUND:Long-standing concerns exist about reverse causation and residual confounding in the prospective association between job strain and risk of future common mental disorders. We aimed to address these concerns through analysis of data collected in the UK National Child Development Study, a large British cohort ...
journal_title:The lancet. Psychiatry
pub_type: 杂志文章
doi:10.1016/S2215-0366(18)30137-8
更新日期:2018-06-01 00:00:00
abstract:BACKGROUND:Cognitive behaviour therapy (CBT) added to specialist medical care (SMC), or graded exercise therapy (GET) added to SMC, are more effective in reducing fatigue and improving physical function than both adaptive pacing therapy (APT) plus SMC and SMC alone for chronic fatigue syndrome. We investigate putative ...
journal_title:The lancet. Psychiatry
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/S2215-0366(14)00069-8
更新日期:2015-02-01 00:00:00
abstract::The ubiquitin-proteasome system is a master regulator of neural development and the maintenance of brain structure and function. It influences neurogenesis, synaptogenesis, and neurotransmission by determining the localisation, interaction, and turnover of scaffolding, presynaptic, and postsynaptic proteins. Moreover,...
journal_title:The lancet. Psychiatry
pub_type: 杂志文章,评审
doi:10.1016/S2215-0366(19)30520-6
更新日期:2020-06-01 00:00:00
abstract::The unpredictability and uncertainty of the COVID-19 pandemic; the associated lockdowns, physical distancing, and other containment strategies; and the resulting economic breakdown could increase the risk of mental health problems and exacerbate health inequalities. Preliminary findings suggest adverse mental health e...
journal_title:The lancet. Psychiatry
pub_type: 杂志文章,评审
doi:10.1016/S2215-0366(20)30307-2
更新日期:2020-09-01 00:00:00
abstract::Over the past decade, concussion has become the most widely discussed injury in contact sports. However, concussions also occur in several other settings, such as non-contact sports, elderly individuals, young children, military personnel, and victims of domestic violence. Concussion is frequently undiagnosed as a cau...
journal_title:The lancet. Psychiatry
pub_type: 杂志文章,评审
doi:10.1016/S2215-0366(16)30266-8
更新日期:2016-12-01 00:00:00
abstract:BACKGROUND:Suicidal ideation due to abortion has been used to justify restrictive US abortion policies. Much research examining abortion and mental health has relied on self-report, has had low participation rates, and did not consider confounding factors. In the present study, we used data that do not rely on self-rep...
journal_title:The lancet. Psychiatry
pub_type: 杂志文章
doi:10.1016/S2215-0366(19)30400-6
更新日期:2019-12-01 00:00:00
abstract::We argue that the global burden of mental illness is underestimated and examine the reasons for under-estimation to identify five main causes: overlap between psychiatric and neurological disorders; the grouping of suicide and self-harm as a separate category; conflation of all chronic pain syndromes with musculoskele...
journal_title:The lancet. Psychiatry
pub_type: 杂志文章,评审
doi:10.1016/S2215-0366(15)00505-2
更新日期:2016-02-01 00:00:00
abstract:BACKGROUND:Many older adults with major depression, particularly veterans, do not have access to evidence-based psychotherapy. Telemedicine could increase access to best-practice care for older adults facing barriers of mobility, stigma, and geographical isolation. We aimed to establish non-inferiority of behavioural a...
journal_title:The lancet. Psychiatry
pub_type: 杂志文章,随机对照试验
doi:10.1016/S2215-0366(15)00122-4
更新日期:2015-08-01 00:00:00
abstract:BACKGROUND:Use of involuntary psychiatric hospitalisation varies widely within and between countries. The factors that place individuals and populations at increased risk of involuntary hospitalisation are unclear, and evidence is needed to understand these disparities and inform development of interventions to reduce ...
journal_title:The lancet. Psychiatry
pub_type: 杂志文章,meta分析
doi:10.1016/S2215-0366(19)30406-7
更新日期:2019-12-01 00:00:00
abstract::Cannabis use and related problems are on the rise globally alongside an increase in the potency of cannabis sold on both black and legal markets. Additionally, there has been a shift towards abandoning prohibition for a less punitive and more permissive legal stance on cannabis, such as decriminalisation and legalisat...
journal_title:The lancet. Psychiatry
pub_type: 杂志文章,评审
doi:10.1016/S2215-0366(17)30075-5
更新日期:2017-08-01 00:00:00
abstract::This Review reports on a scoping review followed by a systematic review to consider interventions designed to address or manage depression or anxiety in children and young people up to the age of 25 years without the need to involve mental health professionals. The scoping review identified 132 approaches, 103 of whic...
journal_title:The lancet. Psychiatry
pub_type: 杂志文章
doi:10.1016/S2215-0366(18)30465-6
更新日期:2019-01-01 00:00:00
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journal_title:The lancet. Psychiatry
pub_type: 杂志文章,评审
doi:10.1016/S2215-0366(15)00508-8
更新日期:2016-03-01 00:00:00
abstract::Contemporary psychiatry faces major challenges. Its syndrome-based disease classification is not based on mechanisms and does not guide treatment, which largely depends on trial and error. The development of therapies is hindered by ignorance of potential beneficiary patient subgroups. Neuroscientific and genetics res...
journal_title:The lancet. Psychiatry
pub_type: 杂志文章,评审
doi:10.1016/S2215-0366(15)00361-2
更新日期:2016-01-01 00:00:00
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journal_title:The lancet. Psychiatry
pub_type: 杂志文章,随机对照试验
doi:10.1016/S2215-0366(15)00536-2
更新日期:2016-04-01 00:00:00
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journal_title:The lancet. Psychiatry
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/S2215-0366(19)30045-8
更新日期:2019-04-01 00:00:00
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journal_title:The lancet. Psychiatry
pub_type: 杂志文章,随机对照试验
doi:10.1016/S2215-0366(17)30476-5
更新日期:2018-01-01 00:00:00
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journal_title:The lancet. Psychiatry
pub_type: 杂志文章,评审
doi:10.1016/S2215-0366(16)30142-0
更新日期:2016-09-01 00:00:00
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journal_title:The lancet. Psychiatry
pub_type: 杂志文章,评审
doi:10.1016/S2215-0366(19)30293-7
更新日期:2020-02-01 00:00:00
abstract:BACKGROUND:Social anxiety disorder-a chronic and naturally unremitting disease that causes substantial impairment-can be treated with pharmacological, psychological, and self-help interventions. We aimed to compare these interventions and to identify which are most effective for the acute treatment of social anxiety di...
journal_title:The lancet. Psychiatry
pub_type: 杂志文章
doi:10.1016/S2215-0366(14)70329-3
更新日期:2014-10-01 00:00:00
abstract:BACKGROUND:The PACE trial found that, when added to specialist medical care (SMC), cognitive behavioural therapy (CBT), or graded exercise therapy (GET) were superior to adaptive pacing therapy (APT) or SMC alone in improving fatigue and physical functioning in people with chronic fatigue syndrome 1 year after randomis...
journal_title:The lancet. Psychiatry
pub_type: 杂志文章,随机对照试验
doi:10.1016/S2215-0366(15)00317-X
更新日期:2015-12-01 00:00:00
abstract:BACKGROUND:Exercise is known to be associated with reduced risk of all-cause mortality, cardiovascular disease, stroke, and diabetes, but its association with mental health remains unclear. We aimed to examine the association between exercise and mental health burden in a large sample, and to better understand the infl...
journal_title:The lancet. Psychiatry
pub_type: 杂志文章
doi:10.1016/S2215-0366(18)30227-X
更新日期:2018-09-01 00:00:00