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Harvard Review of Psychiatry 2018After participating in this activity, learners should be better able to:• Identify the relationships between depression, anxiety, and heart failure (HF).• Assess... (Review)
Review
LEARNING OBJECTIVES
After participating in this activity, learners should be better able to:• Identify the relationships between depression, anxiety, and heart failure (HF).• Assess methods for accurately diagnosing depression and anxiety disorders in patients with HF.• Evaluate current evidence for treatment of anxiety and depression in patients with HF.
BACKGROUND
In patients with heart failure (HF), depression and anxiety disorders are common and associated with adverse outcomes such as reduced adherence to treatment, poor function, increased hospitalizations, and elevated mortality. Despite the adverse impact of these disorders, anxiety and depression remain underdiagnosed and undertreated in HF patients.
METHODS
We performed a targeted literature review to (1) identify associations between depression, anxiety, and HF, (2) examine mechanisms mediating relationships between these conditions and medical outcomes, (3) identify methods for accurately diagnosing depression and anxiety disorders in HF, and (4) review current evidence for treatments of these conditions in this population.
RESULTS
Both depression and anxiety disorders are associated with the development and progression of HF, including increased rates of mortality, likely mediated through both physiologic and behavioral mechanisms. Given the overlap between cardiac and psychiatric symptoms, accurately diagnosing depression or anxiety disorders in HF patients can be challenging. Adherence to formal diagnostic criteria and utilization of a clinical interview are the best courses of action in the evaluation process. There is limited evidence for the efficacy of pharmacologic and psychotherapy in patients with HF. However, cognitive-behavioral therapy has been shown to improve mental health outcomes in patients with HF, and selective serotonin reuptake inhibitors appear safe in this cohort.
CONCLUSIONS
Depression and anxiety disorders in HF patients are common, underrecognized, and linked to adverse outcomes. Further research to improve detection and develop effective treatments for these disorders in HF patients is badly needed.
Topics: Anxiety Disorders; Comorbidity; Depressive Disorder; Heart Failure; Humans
PubMed: 29975336
DOI: 10.1097/HRP.0000000000000162 -
Anaesthesia Apr 2021Perinatal mental illness is common, affecting up to 20% of women, but remains under-recognised and under-diagnosed. It may have adverse effects on pregnancy and neonatal... (Review)
Review
Perinatal mental illness is common, affecting up to 20% of women, but remains under-recognised and under-diagnosed. It may have adverse effects on pregnancy and neonatal outcomes, and mental disorder remains one of the leading causes of maternal death in the UK. Women with mental ill health face difficult decisions in balancing risks and benefits of treatment. Stigma related to mental disorder may lead to non-engagement with maternity care. Some disorders bring specific challenges for anaesthetists working in maternity settings and it is vital that anaesthetists have knowledge of these disorders so they may offer care which is sensitive and appropriate.
Topics: Antidepressive Agents; Anxiety Disorders; Depressive Disorder; Electroconvulsive Therapy; Female; Humans; Mental Disorders; Postpartum Period; Pregnancy; Pregnancy Complications
PubMed: 33682099
DOI: 10.1111/anae.15424 -
Depression and Anxiety Apr 2021Treatment-resistant depression (TRD) is a debilitating chronic mental illness that confers increased morbidity and mortality, decreases the quality of life, impairs... (Review)
Review
BACKGROUND
Treatment-resistant depression (TRD) is a debilitating chronic mental illness that confers increased morbidity and mortality, decreases the quality of life, impairs occupational, social, and offspring development, and translates into increased costs on the healthcare system. The goal of this study is to reach an agreement on the concept, definition, staging model, and assessment of TRD.
METHODS
This study involved a review of the literature and a modified Delphi process for consensus agreement. The Appraisal of Guidelines for Research & Evaluation II guidelines were followed for the literature appraisal. Literature was assessed for quality and strength of evidence using the grading, assessment, development, and evaluations system. Canadian national experts in depression were invited for the modified Delphi process based on their prior clinical and research expertize. Survey items were considered to have reached a consensus if 80% or more of the experts supported the statement.
RESULTS
Fourteen Canadian experts were recruited for three rounds of surveys to reach a consensus on a total of 27 items. Experts agreed that a dimensional definition for treatment resistance was a useful concept to describe the heterogeneity of this illness. The use of staging models and clinical scales was recommended in evaluating depression. Risk factors and comorbidities were identified as potential predictors for treatment resistance.
CONCLUSIONS
TRD is a meaningful concept both for clinical practice and research. An operational definition for TRD will allow for opportunities to improve the validity of predictors and therapeutic options for these patients.
Topics: Canada; Consensus; Depressive Disorder, Major; Depressive Disorder, Treatment-Resistant; Humans; Quality of Life
PubMed: 33528865
DOI: 10.1002/da.23135 -
Psychiatry Research Mar 2019Repetitive transcranial magnetic stimulation (TMS) is now widely available for the clinical treatment of depression, but the associated financial and time burdens are... (Meta-Analysis)
Meta-Analysis
Repetitive transcranial magnetic stimulation (TMS) is now widely available for the clinical treatment of depression, but the associated financial and time burdens are problematic for patients. Accelerated TMS (aTMS) protocols address these burdens and attempt to increase the efficiency of standard TMS. This systematic review and meta-analysis aimed to examine accelerated TMS studies for depressive disorders in accordance with PRISMA guidelines. Inclusion criteria consisted of studies with full text publications available in English describing more than one session of TMS (repetitive or theta burst stimulation) per day. Studies describing accelerated TMS protocols for conditions other than depression or alternative neuromodulation methods, preclinical studies, and neurophysiology studies regarding transcranial stimulation were excluded. Eighteen articles describing eleven distinct studies (seven publications described overlapping samples) met eligibility criteria. A Hedges' g effect size and confidence intervals were calculated. The summary analysis of three suitable randomized control trials revealed a cumulative effect size of 0.39 (95% CI 0.005-0.779). A separate analysis including open-label trials and active arms of suitable RCTs revealed a g of 1.27 (95% CI 0.902-1.637). Overall, the meta-analysis suggested that aTMS improves depressive symptom severity. In general, study methodologies were acceptable, but future efforts could enhance sham techniques and blinding.
Topics: Depressive Disorder; Humans; Randomized Controlled Trials as Topic; Time Factors; Transcranial Magnetic Stimulation; Treatment Outcome
PubMed: 31207865
DOI: 10.1016/j.psychres.2018.12.041 -
The Journal of Clinical Psychiatry Mar 2021Estimates of prevalence and burden of treatment-resistant depression (TRD) vary widely in the literature. This study evaluated the prevalence and burden of TRD and the...
OBJECTIVE
Estimates of prevalence and burden of treatment-resistant depression (TRD) vary widely in the literature. This study evaluated the prevalence and burden of TRD and the share of TRD in the burden of medication-treated major depressive disorder (MDD) using the most commonly accepted definition of TRD and a novel bottom-up approach.
METHODS
Prevalence and health care burden of TRD were estimated by synthetizing inputs across 4 similarly designed claims studies in adults covered by Medicare, Medicaid, commercial plans, and the US Veterans Health Administration (VHA). Productivity (absenteeism and presenteeism) and unemployment burden were estimated based on inputs from a study conducted with data from the Kantar National Health and Wellness Survey (NHWS; 2017). A targeted literature search for additional inputs was performed. A cost model was developed to estimate the burden of TRD and medication-treated DSM-5-defined MDD in the United States. Study outcomes were the 12-month prevalence of TRD and the annual health care, productivity, and unemployment burden of TRD and medication-treated MDD in the United States.
RESULTS
The estimated 12-month prevalence of medication-treated MDD in the United States was 8.9 million adults, and 2.8 million (30.9%) had TRD. The total annual burden of medication-treated MDD among the US population was $92.7 billion, with $43.8 billion (47.2%) attributable to TRD. The share of TRD was 56.6% ($25.8 billion) of the health care burden, 47.7% ($8.7 billion) of the unemployment burden, and 32.2% ($9.3 billion) of the productivity burden of medication-treated MDD.
CONCLUSIONS
TRD is associated with disproportionate health care costs and unemployment, suggesting potentially large economic and societal gains with effective management.
Topics: Absenteeism; Adult; Antidepressive Agents; Cost of Illness; Depressive Disorder, Major; Depressive Disorder, Treatment-Resistant; Health Care Costs; Humans; Prevalence; United States
PubMed: 33989464
DOI: 10.4088/JCP.20m13699 -
Current Neuropharmacology 2021Multiple studies on the pathomechanisms of depressive disorder and antidepressants have been reported. However, literature involving scientometric analysis of depressive...
Multiple studies on the pathomechanisms of depressive disorder and antidepressants have been reported. However, literature involving scientometric analysis of depressive disorder is sparse. Here, we use scientometric analysis and a historical review to highlight recent research on depression. We use the former to examine research on depressive disorders from 1998 to 2018. The latter is used to identify the most frequent keywords in keyword analysis, as well as explore hotspots and depression trends. Scientometric analysis uncovered field distribution, knowledge structure, research topic evolution, and topics emergence as main explorations in depressive disorder. Induction factor, comorbidity, pathogenesis, therapy and animal models of depression help illustrate occurrence, development and treatment of depressive disorder. Scientometric analysis found 231,270 research papers on depression, a 4-fold increase over the last 20 years. These findings offer a vigorous roadmap for further studies in this field.
Topics: Animals; Antidepressive Agents; Bibliometrics; Depressive Disorder; Publications
PubMed: 32888272
DOI: 10.2174/1570159X18666200905151333 -
Psychiatry and Clinical Neurosciences Apr 2018Major depressive disorder is one of the most common mental illnesses as it affects more than 350 million people globally. Major depressive disorder is etiologically... (Review)
Review
Major depressive disorder is one of the most common mental illnesses as it affects more than 350 million people globally. Major depressive disorder is etiologically complex and disabling. Genetic factors play a role in the etiology of major depression. However, identical twin studies have shown high rates of discordance, indicating non-genetic mechanisms as well. For instance, stressful life events increase the risk of depression. Environmental stressors also induce stable changes in gene expression within the brain that may lead to maladaptive neuronal plasticity in regions implicated in disease pathogenesis. Epigenetic events alter the chromatin structure and thus modulate expression of genes that play a role in neuronal plasticity, behavioral response to stress, depressive behaviors, and response to antidepressants. Here, we review new information regarding current understanding of epigenetic events that may impact depression. In particular, we discuss the roles of histone acetylation, DNA methylation, and non-coding RNA. These novel mechanisms of action may lead to new therapeutic strategies for treating major depression.
Topics: Depressive Disorder, Major; Epigenesis, Genetic; Humans; Neuronal Plasticity
PubMed: 29154458
DOI: 10.1111/pcn.12621 -
Maturitas Dec 2016Depression is one of the leading causes of disease-related disability in women, and they are nearly twice as likely as men to suffer from an episode of depression. The... (Review)
Review
Depression is one of the leading causes of disease-related disability in women, and they are nearly twice as likely as men to suffer from an episode of depression. The difference begins in early life and persists through to mid-life, and as such, these reproductive years have been labelled by some as a 'window of vulnerability'. The prevalence has been reported to be particularly high during the menopausal transition, but there is no consensus supporting a direct association with reproductive status. This may be partly due to methodological limitations and inconsistencies in the available studies, resulting from a large number of confounding factors. In addition, relationships between sex hormones and the neurotransmitters purported to be responsible for depression are complex. What appears to be universally accepted is that treatment, with oestrogen, for low mood in women during midlife years may be beneficial, and should be considered.
Topics: Adult; Depression; Depressive Disorder; Estrogens; Female; Humans; Menopause; Middle Aged; Prevalence
PubMed: 27823736
DOI: 10.1016/j.maturitas.2016.09.004 -
International Journal of Molecular... Mar 2020The acute treatment duration for major depressive disorder (MDD) is 8 weeks or more. Treatment of patients with MDD without predictors of treatment response and future... (Review)
Review
The acute treatment duration for major depressive disorder (MDD) is 8 weeks or more. Treatment of patients with MDD without predictors of treatment response and future recurrence presents challenges and clinical problems to patients and physicians. Recently, many neuroimaging studies have been published on biomarkers for treatment response and recurrence of MDD using various methods such as brain volumetric magnetic resonance imaging (MRI), functional MRI (resting-state and affective tasks), diffusion tensor imaging, magnetic resonance spectroscopy, near-infrared spectroscopy, and molecular imaging (i.e., positron emission tomography and single photon emission computed tomography). The results have been inconsistent, and we hypothesize that this could be due to small sample size; different study design, including eligibility criteria; and differences in the imaging and analysis techniques. In the future, we suggest a more sophisticated research design, larger sample size, and a more comprehensive integration including genetics to establish biomarkers for the prediction of treatment response and recurrence of MDD.
Topics: Biomarkers; Depressive Disorder, Major; Humans; Machine Learning; Neuroimaging; Recurrence
PubMed: 32245086
DOI: 10.3390/ijms21062148 -
Canadian Journal of Psychiatry. Revue... May 2018
Topics: Anhedonia; Biomarkers; Cognitive Dysfunction; Depressive Disorder, Major; Humans; Precision Medicine; Sleep Wake Disorders
PubMed: 29278937
DOI: 10.1177/0706743717748883