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Annual Review of Clinical Psychology May 2022Major depression is one of the most prevalent and debilitating personal and public health conditions worldwide. Less appreciated is that depression's tremendous burdens... (Review)
Review
Major depression is one of the most prevalent and debilitating personal and public health conditions worldwide. Less appreciated is that depression's tremendous burdens are not shared equally among all who become depressed. Some will suffer recurrences over the rest of their lives, whereas half or more will never have a recurrence. Based on these two distinctive life course prototypes, we propose a subtype distinction for research on the origins and lifetime course of major depression. A pressing goal is to determine at the time of depression's first onset who will follow which clinical trajectory. The lack of recognition of this distinction has resulted in many obstacles, including conceptual biases, methodological oversights, and definitional dead ends. Current theories are reviewed and compared. The implications for contemporary diagnostic controversies, reevaluating research on treatment and prevention, and enhancing the predictive strength of traditionally weak indicators of recurrences and recurrent depression are discussed.
Topics: Depression; Depressive Disorder, Major; Humans; Life Change Events; Recurrence
PubMed: 35216520
DOI: 10.1146/annurev-clinpsy-072220-021440 -
Neuron Jul 2020Depression represents the number one cause of disability worldwide and is often fatal. Inflammatory processes have been implicated in the pathophysiology of depression.... (Review)
Review
Depression represents the number one cause of disability worldwide and is often fatal. Inflammatory processes have been implicated in the pathophysiology of depression. It is now well established that dysregulation of both the innate and adaptive immune systems occur in depressed patients and hinder favorable prognosis, including antidepressant responses. In this review, we describe how the immune system regulates mood and the potential causes of the dysregulated inflammatory responses in depressed patients. However, the proportion of never-treated major depressive disorder (MDD) patients who exhibit inflammation remains to be clarified, as the heterogeneity in inflammation findings may stem in part from examining MDD patients with varied interventions. Inflammation is likely a critical disease modifier, promoting susceptibility to depression. Controlling inflammation might provide an overall therapeutic benefit, regardless of whether it is secondary to early life trauma, a more acute stress response, microbiome alterations, a genetic diathesis, or a combination of these and other factors.
Topics: Affect; Antidepressive Agents; Depression; Depressive Disorder, Major; Humans; Immune System; Inflammation
PubMed: 32553197
DOI: 10.1016/j.neuron.2020.06.002 -
Advances in Experimental Medicine and... 2021There is a growing body of evidence pointing to the co-occurrence of cannabis use and depression. There is also some evidence that the use of cannabis may lead to the... (Review)
Review
There is a growing body of evidence pointing to the co-occurrence of cannabis use and depression. There is also some evidence that the use of cannabis may lead to the onset of depression; however, strong evidence points to the inverse association; i.e. that depression may lead to the onset or increase in cannabis use frequency. Observational and epidemiological studies have not indicated a positive long-term effect of cannabis use on the course and outcome of depression. The association between cannabis use and depression may be stronger among men during adolescence and emerging adulthood and stronger in women during midlife. There is an indication for potential genetic correlation contributing to the comorbidity of cannabis dependence and major depression, namely that serotonin (5-HT) may mediate such association and there is also evidence for specific risk alleles for cannabis addiction. There is preclinical evidence that alteration in the endocannabinoid system could potentially benefit patients suffering from depression. However, the issue of using cannabis as an anti-depressant is at an early stage of examination and there is little evidence to support it. Finally, there has been little support to the notion that selective serotonin reuptake inhibitors (SSRIs) may be effective in decreasing depressive symptoms or rates of substance use in adolescents treated for depression and a co-occurring substance use disorder. In conclusion, despite methodological limitations, research in the past decades has broadened our knowledge on the association between cannabis use and depression from epidemiological, neurological, genetic, and pharmacological perspectives.
Topics: Cannabis; Comorbidity; Depression; Depressive Disorder, Major; Humans; Marijuana Abuse
PubMed: 33332004
DOI: 10.1007/978-3-030-57369-0_5 -
Neuroscience May 2016Major depressive disorder (MDD) will affect one out of every five people in their lifetime and is the leading cause of disability worldwide. Nevertheless, mechanisms... (Review)
Review
Major depressive disorder (MDD) will affect one out of every five people in their lifetime and is the leading cause of disability worldwide. Nevertheless, mechanisms associated with the pathogenesis of MDD have yet to be completely understood and current treatments remain ineffective in a large subset of patients. In this review, we summarize the most recent discoveries and insights for which parallel findings have been obtained in human depressed subjects and rodent models of mood disorders in order to examine the potential etiology of depression. These mechanisms range from synaptic plasticity mechanisms to epigenetics and the immune system where there is strong evidence to support a functional role in the development of specific depression symptomology. Ultimately we conclude by discussing how novel therapeutic strategies targeting central and peripheral processes might ultimately aid in the development of effective new treatments for MDD and related stress disorders.
Topics: Animals; Behavior, Animal; Brain; Depression; Depressive Disorder, Major; Disease Models, Animal; Humans; Mice; Microglia; Neuronal Plasticity; Neurons; Rats; Synapses
PubMed: 26037806
DOI: 10.1016/j.neuroscience.2015.05.053 -
Journal of Clinical Neuroscience :... Jan 2018Geriatric depression is a major public health problem and has an especially large effect on health when comorbid with a chronic medical condition. Hypertension, coronary... (Review)
Review
Geriatric depression is a major public health problem and has an especially large effect on health when comorbid with a chronic medical condition. Hypertension, coronary heart disease, and diabetes are accompanied by a high incidence of depression and can affect the treatment and prognosis. Depression is a highly prevalent risk factor for incident of and is associated with morbidity and mortality of cardiovascular disease. In addition to the proactive and effective control of primary diseases, efforts should also be made to improve patients' psychological and social function. Current evidence on antidepressive therapy in patients with coronary diseases is limited. A better understanding of pathophysiological mechanisms underpinning depression and cardiovascular disease as well as the complex biological crosstalk of cardiovascular disease complicated with depression is particularly important for future therapeutic strategies. The following review is on current understanding of geriatric depression and cardiovascular disease.
Topics: Aged; Aging; Cardiovascular Diseases; Comorbidity; Depression; Depressive Disorder; Humans
PubMed: 29066229
DOI: 10.1016/j.jocn.2017.09.022 -
Maturitas Oct 2014Depression is a common disorder in later life that is associated with increased disability and costs, and negative health outcomes over time. Antidepressant treatments... (Review)
Review
Depression is a common disorder in later life that is associated with increased disability and costs, and negative health outcomes over time. Antidepressant treatments in the form of medications or psychotherapy are available, but a large proportion of those treated fail to respond fully, and relapse or recurrence of symptoms is frequent among those who recover. Hence, successful prevention would avoid these negative outcomes. This paper selectively reviews currently available observational and trial data on the prevention of depression. It initially reviews risk factors associated with depression, and then discusses strategies for primary (including universal, selective and indicated), secondary and tertiary prevention. Currently available evidence suggests that selective and indicated preventive interventions are feasible and initial results look promising. Existing trial data indicate that ongoing antidepressant treatments reduce the risk of relapse and recurrence of symptoms, but benefits may not extend beyond two or three years. At this point in time, no interventions have been shown to reduce the long term complications associated with depression. Mental health professionals will need to work collaboratively to develop primary, secondary and tertiary preventive interventions that are effective at targeting relevant risk factors systematically and that can be easily adopted into clinical practice.
Topics: Aged; Antidepressive Agents; Depression; Depressive Disorder; Humans; Psychotherapy; Recurrence; Risk Factors
PubMed: 24713453
DOI: 10.1016/j.maturitas.2014.03.005 -
International Journal of Molecular... Sep 2019Depression has become one of the most severe psychiatric disorders and endangers the health of living beings all over the world. In order to explore the molecular... (Review)
Review
Depression has become one of the most severe psychiatric disorders and endangers the health of living beings all over the world. In order to explore the molecular mechanism that underlies depression, different kinds of animal models of depression are used in laboratory experiments. However, a credible and reasonable animal model that is capable of imitating the pathologic mechanism of depression in mankind has yet to be found, resulting in a barrier to further investigation of depression. Nevertheless, it is possible to explain the pathologic mechanism of depression to a great extent by a rational modeling method and behavioral testing. This review aims to provide a reference for researchers by comparing the advantages and disadvantages of some common animal depression models.
Topics: Animals; Behavior, Animal; Depression; Depressive Disorder; Disease Models, Animal; Humans
PubMed: 31569393
DOI: 10.3390/ijms20194827 -
Advances in Experimental Medicine and... 2020Although anxiety and depression have been considered as two distinct entities according to the diagnostic criteria, anxious depression (comorbid anxiety and depression)... (Review)
Review
Although anxiety and depression have been considered as two distinct entities according to the diagnostic criteria, anxious depression (comorbid anxiety and depression) is relatively a common syndrome. According to the DSM-5 criteria, it uses "with anxious distress specifier" to define anxious depression in its MDD section. Anxious depression is known to have different neurobiological profiles compared to non-anxious depression. Several studies have revealed significant differences between anxious depression and non-anxious depression regarding the hypothalamic-pituitary-adrenal (HPA) axis function, structural and functional brain imaging findings, inflammation markers, etc. Patients with anxious depression were significantly more likely to be found in primary care setting and more likely to be associated with female gender, non-single, unemployed, less educated, and more severe depression. Previous reports also showed that patients with anxious depression had more frequent episodes of major depression and a higher risk of suicidal ideation and previous suicide attempts than those with non-anxious depression. Although anxious depression is known to be associated with poor treatment outcomes in several studies, recent researches have sought to find better treatment strategy to improve patients with anxious depression.
Topics: Anxiety; Anxiety Disorders; Comorbidity; Depression; Depressive Disorder, Major; Humans
PubMed: 32002932
DOI: 10.1007/978-981-32-9705-0_14 -
AMA Journal of Ethics Jul 2021Too many men who suffer from depression remain undiagnosed. While men are diagnosed with depression at half the rate of women, they die by suicide 3 to 4 times as...
Too many men who suffer from depression remain undiagnosed. While men are diagnosed with depression at half the rate of women, they die by suicide 3 to 4 times as frequently. Gendered processes of socialization affect how some boys and men express depression. Notably, gender disparities in diagnosis disappear when "male-typical" symptoms of depression are incorporated. Historically and to this day, masculinities have created barriers to care. Addressing disparities in depression diagnoses and treatment requires making psychological services affordable, adopting collaborative care models, revisiting sex as a risk factor for depression, and reexamining major depressive disorder's diagnostic criteria.
Topics: Anxiety; Depression; Depressive Disorder, Major; Female; Humans; Male; Suicide
PubMed: 34351273
DOI: 10.1001/amajethics.2021.586 -
The New England Journal of Medicine Feb 2019A 45-year-old woman with hypothyroidism that has been treated with a stable dose of levothyroxine presents to her primary care provider with depressed mood, negative... (Review)
Review
A 45-year-old woman with hypothyroidism that has been treated with a stable dose of levothyroxine presents to her primary care provider with depressed mood, negative feelings about herself, poor sleep, low appetite, poor concentration, and lack of energy. These symptoms began several months ago during a conflict with her partner. Although she has been able to continue with work and life responsibilities, she feels sadness most days and occasionally thinks that she would be better off dead. How would you evaluate and treat this patient?
Topics: Antidepressive Agents; Combined Modality Therapy; Depression; Depressive Disorder; Depressive Disorder, Major; Diagnostic and Statistical Manual of Mental Disorders; Female; Humans; Middle Aged; Practice Guidelines as Topic; Primary Health Care; Psychotherapy
PubMed: 30726688
DOI: 10.1056/NEJMcp1712493