Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 3 appraisals
Journal of affective disorders
Multiple peripheral inflammatory markers in adolescents with major depressive disorder treated with repeated esketamine infusions: results from a randomized controlled trial
OBJECTIVE: While inflammatory dysregulation is well-documented in major depressive disorder (MDD), its response to esketamine treatment in adolescents remains poorly understood. We aimed to examine the effects of esketamine on the inflammatory cytokines in adolescent MDD. METHODS: This randomized, double-blind trial assigned 49 adolescents with MDD to receive three infusions of esketamine or midazolam over five days between December 2020 and April 2022. Suicidal ideation (measured by Columbia Suicide Severity Rating Scale, C-SSRS), depressive symptoms (measured by Montgomery-Åsberg Depression Rating Scale, MADRS) and plasma levels of 10 inflammatory markers were assessed at baseline, Day 6, and Day 12. RESULTS: Linear mixed model revealed significant time effects for all markers, but no significant drug main effect was observed. In esketamine group, alterations in IL-8 were associated with the reduction of C-SSRS Intensity at Day 6 (r = 0.444, p = 0.026), and alterations in IFN-γ were correlated with the reduction of MADRS (r = 0.399, p = 0.048) and C-SSRS Intensity (r = 0.427, p = 0.033) at Day 12. Baseline C4 negatively related to the reductions of MADRS and C-SSRS Ideation at Day 6 and 12 (all p < 0.005). CONCLUSIONS: Our study found no significant drug main effects for inflammatory markers, with most changes representing time effects observed in both groups. Exploratory results indicate that IL-8, IFN-γ, and C4 may warrant further investigation as potential biomarkers of esketamine response in adolescent MDD.
15 June 2026
Read appraisal →The Journal of clinical psychiatry
Systematic Review and Meta-Analysis of Mood Stabilizers in the Treatment of Adolescent Patients With Nonsuicidal Self-Injury in China
Objective: Nonsuicidal self-injury (NSSI) refers to deliberate, repeated acts of damaging one's own body tissue without suicidal intent. The aim of this systematic review and meta-analysis was to explore the effectiveness of mood stabilizers in treating depressive adolescent patients with NSSI in China. Data Sources: Literature published before June 30, 2025, was included. Chinese databases searched included CBM (Chinese Biomedical Database), CNKI (China National Knowledge Infrastructure), WANFANG (Wanfang Database), and CSSCI (Chinese Social Sciences Citation Index); English databases included MEDLINE, Embase, and the Cochrane Library. Searches used the following keywords: [Bipolar disorder OR depression OR NSSI] AND [Mood stabilizer OR Lithium OR Valproate OR Carbamazepine OR Oxcarbazepine OR Lamotrigine OR Antipsychotic OR Antidepressant]. Study Selection: Chinese and English literature related to the treatment of NSSI with mood stabilizers in adolescent patients in China was searched. Editorials, comments, letters, reviews, and case reports were excluded. Randomized controlled trials conducted in China comparing mood stabilizer augmentation of basic therapy versus basic therapy alone for treating NSSI were included, and studies evaluating mood stabilizer treatment for NSSI using pre-post designs were also included. A total of 9 studies were included, 4 comparative studies by control group and 5 comparative studies of before and after treatment. Data Extraction and Synthesis: Indices of depression, anxiety, impulsivity, self-injury severity, and treatment response were synthesized and analyzed. Mean differences or standardized mean differences and 95% confidence intervals (CIs) were used for symptom change. Odds ratios and their 95% CIs were also used for binary outcomes. Results: Severity of anxiety, depression, impulsivity, and self-injury was significantly reduced following treatment with mood stabilizers. Compared to treatment without mood stabilizers, anxiety, depression, and self-injury were also significantly reduced, and the response rate was significantly improved in adolescents with depression and NSSI. The incidence of self-injury in these patients was significantly reduced by mood stabilizers. Conclusion: These results demonstrate the important role of mood stabilizers in treating NSSI and suggest that mood stabilization may be more critical than mere improvement of affective symptoms.
21 May 2026
Read appraisal →Journal of affective disorders
What retrospective and dynamic assessments tell us about youth depression: A network analysis perspective.
PURPOSE: Traditional assessments of depressive symptoms often rely on retrospective self-reports, which may be affected by cognitive and memory biases. Few studies have compared retrospective and dynamic (real-time) assessments to examine the consistency and structure of depressive symptom reporting. This study aimed to compare retrospective and dynamic assessments of depressive symptoms in youth using network analysis to explore symptom-level associations and clustering. METHODS: Ninety Brazilian adolescents and young adults (mean age = 18 years), with and without depression, completed the Short Mood and Feelings Questionnaire (SMFQ) every other day for 14 days via a smartphone-based chatbot (dynamic assessment). At the end of the 2-week period, they completed the same questionnaire retrospectively. Network analyses were conducted using Exploratory Graph Analysis (EGA) and Dynamic Exploratory Analysis (DEA) to identify symptom communities and compare network structures across both assessment methods. RESULTS: Both retrospective and dynamic assessments revealed three symptom communities; however, the composition and structure of these communities differed. Retrospective assessments showed stronger connections among cognitive symptoms, while dynamic assessments displayed a more balanced distribution, with stronger associations between somatic and affective symptoms. IMPLICATIONS: Findings highlight significant differences in depressive symptom networks between retrospective and dynamic assessments. Dynamic methods may offer less biased and more ecologically valid insights into youth depression, underscoring the importance of real-time data collection in clinical assessment and research.
16 Apr 2026
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