Context Existing therapies for major depression have a lag of onset of action of several weeks, resulting in considerable morbidity. Exploring pharmacological strategies that have rapid onset of antidepressant effects within a few days and that are sustained would have an enormous impact on patient care. Converging lines of evidence suggest the role of the glutamatergic system in the pathophysiology and treatment of mood disorders. Objective To determine whether a rapid antidepressant effect can be achieved with an antagonist at theN-methyl-D-aspartate receptor in subjects with major depression. Design A randomized, placebo-controlled, double-blind crossover study from November 2004 to September 2005. Setting Mood Disorders Research Unit at the National Institute of Mental Health. Patients Eighteen subjects withDSM-IVmajor depression (treatment resistant). Interventions After a 2-week drug-free period, subjects were given an intravenous infusion of either ketamine hydrochloride (0.5 mg/kg) or placebo on 2 test days, a week apart. Subjects were rated at baseline and at 40, 80, 110, and 230 minutes and 1, 2, 3, and 7 days postinfusion. Main Outcome Measure Changes in scores on the primary efficacy measure, the 21-item Hamilton Depression Rating Scale. Results Subjects receiving ketamine showed significant improvement in depression compared with subjects receiving placebo within 110 minutes after injection, which remained significant throughout the following week. The effect size for the drug difference was very large (d = 1.46 [95% confidence interval, 0.91-2.01]) after 24 hours and moderate to large (d = 0.68 [95% confidence interval, 0.13-1.23]) after 1 week. Of the 17 subjects treated with ketamine, 71% met response and 29% met remission criteria the day following ketamine infusion. Thirty-five percent of subjects maintained response for at least 1 week. Conclusions Robust and rapid antidepressant effects resulted from a single intravenous dose of anN-methyl-D-aspartate antagonist; onset occurred within 2 hours postinfusion and continued to remain significant for 1 week. Trial Registration clinicaltrials.gov Identifier:NCT00088699.

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A Randomized Trial of an N-methyl-D-aspartate Antagonist in Treatment-Resistant Major Depression

https://onlinelibrary.wiley.com/doi/epdf/10.1002/acr.20543

Measures of Adult Pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP)

Visual analogue scales (VAS) have been used in the social and behavioral sciences to measure a variety of subjective phenomena. The VAS method has potential utility for the measurement of a variety of clinical phenomena of interest to nurse investigators. In this review a description of the various forms of the VAS and an historical overview of their development are presented. In addition, conceptual, psychometric, and statistical aspects of the VAS are considered. Finally, strengths and limitations of the VAS method are addressed.

A critical review of visual analogue scales in the measurement of clinical phenomena

ATS/ACCP statement on cardiopulmonary exercise testing.

Five studies on the relation between positive and negative affect are reported. In Studies 1 and 2 we found that positive feelings were remembered as being nearly independent of negative feelings in the past year, but the two types of affect were moderately negatively correlated for the past month. In Studies 3 and 5, subjects completed daily mood reports for 70 and 30 days, respectively. In Study 4, subjects completed three-week, daily, and moment mood reports and also filled out reports when they experienced strong emotions. The principal finding was that the relation between positive and negative affect differed greatly depending on the time frame. The strongest negative correlation between the two affects occurred during emotional times. The correlation decreased in a linear fashion as the time span covered increased logarithmically. It appears that positive and negative affect are independent in terms of how much people feel in their lives over longer time periods. Researchers need to focus on the processes that underlie both positive and negative affect and that are responsible for producing their relative independence.

R C B Aitken

Papers

Measurement of feelings using visual analogue scales.

Measurement of mood.