Neurooncology and Neurosurgery

Depression affects approximately 4.4% of the world’s population (over 300 million people) and is the leading cause of disability worldwide. Being a heterogenous disease, its pathophysiology has been linked with a number of distinct factors including metabolic factors. For instance, research has shown an association between depression and insulin resistance (IR). Its comorbidity with IR is known to increase disease severity, while also predisposing to antidepressant ineffectiveness. Some insulin sensitivity-enhancing lifestyle and dietary-related adjuncts have been found to improve antidepressant effectiveness. These include exercise, vitamin D supplementation, zinc supplementation and hygienic-dietary recommendations. The aim of this systematic review was to synthesize available clinical evidence from the literature (by searching CENTRAL, MEDLINE PubMed, Embase, PsychINFO, ClinicalTrials.gov and EU clinical trials register), with a view to establishing a link between the insulin sensitivity- enhancing potential of these adjuncts and their antidepressant treatment response-improving potential. Sixteen randomized controlled trials with 827 depressed patients were included in this meta-analysis. Adjunctive therapy with any of the above stated lifestyle/dietary adjuncts was compared with conventional antidepressant treatment with or without placebo. Random-effects meta-analysis was used to separately combine the effects estimates of studies that reported binary outcomes (% remission) and those that reported continuous outcomes- mean change in standard depression rating scale (HAM-D, BDI and MADRS) scores, from baseline to follow-up. The results of this analysis will be discussed during this presentation as this will add to the body of evidence on the utility of insulin sensitivity-enhancing non-pharmacological therapies in enhancing conventional antidepressant treatment response.