Patients with chronic mental illness are frequently hospitalized and discharged from psychiatry wards. This situation is referred to as the "revolving door phenomenon" (RDP). In addition to factors related to the patient and the disease, limited number of beds leading to shortened hospital stay are among the reasons associated with frequent hospitalization. This study aims to compare patients with RDP and patients with single hospitalization in terms of clinical, sociodemographic, and treatment-oriented characteristics in order to evaluate the risk factors causing frequent hospitalization. In this study, patients who were admitted and hospitalized between May 1, 2011 - May 1, 2016 were retrospectively evaluated from patient records. The RDP group consisted of 74 patients and the single-hospitalization group consisted of 59 patients who met inclusion criteria. The RDP group had significantly higher rates of male gender, ECT history, past suicide attempts, multiple drug treatment, clozapine use, legal incidents, and noncompliance to follow up following discharge compared to the single-hospitalization group (p<0.05). This study demonstrates that Turkey also has RDP patients with characteristics and hospitalization patterns similar to patients in countries with different cultural, social, and economic conditions. It is important to identify and correct factors that cause frequent hospitalization as it will reduce the burden of the health system as well as provide benefit to the patient.

Objective: To narratively review currently available antidepressants and future potential antidepressants as monotherapy for the treatment of depressive disorders. Methods: Selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), dopamine reuptake inhibitor (bupropion), tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs) were reviewed according to the results from Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Study and systematic reviews. For the rest of the antidepressants, a PubMed/Medline search was conducted with priority for systematic reviews. For drugs in development for depressive disorders, PubMed, Google, and Clinicaltrials.gov databases were used. Results: The STAR*D Study demonstrated that sertraline, venlafaxine, and bupropion monotherapy had similar efficacy in patients with major depressive disorder (MDD) who failed citalopram. A network meta-analyses of randomized, placebo-controlled trials found that SSRIs, SNRIs, bupropion, TCAs, mirtazapine, and agomelatine had similar relative efficacy compared to placebo, but had different acceptability. Gepirone had more failed/negative studies and smaller effect size relative to placebo compared to other antidepressants. The combination of dextromethorphan and bupropion, ketamine infusion, and intranasal esketamine had faster onset of action but similar effect size compared to monoamine-based antidepressants as monotherapy. Brexanolone and zuranolone are effective in postpartum depression (PPD), but the effect size of zuranolone in MDD as monotherapy or adjunctive therapy was very small. Psychedelics, glutamate receptor-related agents, kappa opioid receptor antagonists, orexin receptor antagonists, new anti-inflammatory agents, and biomarker-based antidepressant therapy have been under investigation for depressive disorders. Psychedelics showed faster onset of action, large effect size, and long durability. Conclusions: Monoamine-based antidepressants likely continue to be the mainstream antidepressants for depressive disorder. NMDA receptor antagonists and neurosteroid antidepressants will play a bigger role with the improvement of accessibility. Psychedelics may become a game changer if phase III studies validate their efficacy and safety in depressive disorders.

Repetitive transcranial magnetic stimulation (rTMS) has emerged as a noninvasive therapy for treatment resistant depression (TRD). The results of studies on the mechanism of rTMS and the predictive parameters for determining which patients will respond to rTMS are inconclusive. This study aims to investigate the relationship between pre-treatment systemic inflammatory markers and the response to rTMS in TRD patients. We retrospectively reviewed 86 patients with TRD who received 10 Hz rTMS to the left dorsolateral prefrontal cortex (DLPFC) at Gazi University between June 2017 and June 2023. Inflammatory markers, including neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and systemic immune-inflammatory index (SII), were evaluated. Treatment response was assessed using the Montgomery-Åsberg Depression Rating Scale (MADRS), with a ≥50% reduction in MADRS score and a score ≤8 at the end of treatment considered as a positive response. Patients divided in to two groups accoording to rTMS response. 53 patients were responders and 33 patients were non-responders. Significant differences in inflammatory parameters were observed, with non-responders showing higher NLR ( p =0.001), PLR ( p =0.008), and SII ( p =0.002) values. Logistic regression analysis revealed that higher NLR was significantly associated with a poorer response to rTMS (OR=0.373, p =0.022). Additionally, early improvement in MADRS score in the first week predicted overall treatment outcome (OR=1.070, p <0.001). Our findings suggest that systemic inflammation plays a role in TRD and that higher pre-treatment NLR is associated with a poorer response to rTMS. Largerscale studies are needed to further understand the mechanisms and improve treatment strategies for TRD patients.