-
The International Journal of... Feb 2019Treatment-resistant depression refers to major depressive disorder, treatment of the disorder, and failure to obtain an "acceptable" outcome. Regarding the disorder, the... (Review)
Review
Treatment-resistant depression refers to major depressive disorder, treatment of the disorder, and failure to obtain an "acceptable" outcome. Regarding the disorder, the heterogeneous concept of major depressive disorder and the multiple definitions of treatment-resistant depression, hesitating between a categorical and a more dimensional approach, as well as the divergence between diagnostic criteria and the items in the assessment scales are a source of confusion. Classifications do not take into account the dramatic influence of patient characteristics strongly impacting outcome, although these can be the cause of so-called pseudo-resistance. Outcome is the result of spontaneous evolution, nonspecific factors (including placebo), and active treatment factors. These should be differentiated to have a reliable estimation of the impact of different treatment modalities before we can asses treatment-resistant depression or before we can ascertain the (non)efficacy of treatments for treatment-resistant depression.The impact and burden of major depressive disorder and treatment-resistant depression are immense and go far beyond their economic cost. It is often forgotten that both are not only associated with increased suicidality but also with nonsuicidal mortality and that both can even result in requests for assisted dying. The caregiver burden and associated stigma are also too often overlooked despite that it has been suggested that they do influence (treatment) outcome.
Topics: Cost of Illness; Depressive Disorder, Major; Depressive Disorder, Treatment-Resistant; Humans
PubMed: 29961822
DOI: 10.1093/ijnp/pyy052 -
Behavioural Brain Research Feb 2019Deep brain stimulation (DBS) is a new therapeutic approach for treatment-resistant depression (TRD). There is a preliminary evidence of the efficacy and safety of DBS... (Review)
Review
Deep brain stimulation (DBS) is a new therapeutic approach for treatment-resistant depression (TRD). There is a preliminary evidence of the efficacy and safety of DBS for TRD in the subgenual anterior cingulate cortex, the ventral capsule/ventral striatum, the nucleus accumbens, the lateral habenula, the inferior thalamic peduncle, the medial forebrain bundle, and the bed nucleus of the stria terminalis. Optimal stimulation targets, however, have not yet been determined. Here we provide updated knowledge substantiating the suitability of each of the current and potential future DBS targets for treating depression. In this review, we discuss the future outlook for DBS treatment of depression in light of the fact that antidepressant effects of DBS can be achieved using different targets.
Topics: Animals; Brain; Deep Brain Stimulation; Depressive Disorder; Humans
PubMed: 30414974
DOI: 10.1016/j.bbr.2018.11.004 -
Topics in Antiviral Medicine 2022Depressive disorders are the most common psychiatric disorders among people with HIV. Depressive disorders cause great suffering and disability and, among people with...
Depressive disorders are the most common psychiatric disorders among people with HIV. Depressive disorders cause great suffering and disability and, among people with HIV, are associated with numerous negative HIV outcomes, including nonadherence to antiretroviral medication and increased morbidity and mortality. This article is focused on the detection, differential diagnosis, and management of depressive disorders among adults in HIV primary care settings in the United States. Because of the siloed nature of HIV primary health care and behavioral health care in the United States, this paper is geared toward clinicians who are not behavioral health specialists and who are working in HIV care settings that have limited access to behavioral health services and still seek to treat depressive disorders. In clinical settings that are fortunate enough to have well-integrated behavioral health services, HIV primary care clinicians may be able to depend on this specialist workforce, but these settings tend to be the exception and not the rule.
Topics: Adult; Humans; United States; HIV Infections; Anti-Retroviral Agents; Depressive Disorder
PubMed: 36346702
DOI: No ID Found -
Physiological Research 2015Reduced levels of vitamin or its metabolites have been reported in various psychiatric disorders. Insufficient levels of vitamin D in depressive patients have been... (Review)
Review
Reduced levels of vitamin or its metabolites have been reported in various psychiatric disorders. Insufficient levels of vitamin D in depressive patients have been confirmed by many authors, but there have been conflicting results in subjects with anxiety disorders. In the present cross-sectional study, levels of calcidiol were determined in groups of depressive men and women and in men and women with anxiety disorders and compared with age matched controls. Significantly lower levels of calcidiol were found in men and women with depression as well as in age matched patients with anxiety disorders.
Topics: Animals; Anxiety; Cross-Sectional Studies; Depressive Disorder; Humans; Mood Disorders; Vitamin D
PubMed: 26680471
DOI: 10.33549/physiolres.933082 -
Behaviour Research and Therapy Nov 2014Major Depressive Disorder (MDD) is among the most prevalent of all psychiatric disorders and is the single most burdensome disease worldwide. In attempting to understand... (Review)
Review
Major Depressive Disorder (MDD) is among the most prevalent of all psychiatric disorders and is the single most burdensome disease worldwide. In attempting to understand the profound deficits that characterize MDD across multiple domains of functioning, researchers have identified aberrations in brain structure and function in individuals diagnosed with this disorder. In this review we synthesize recent data from human neuroimaging studies in presenting an integrated neural network framework for understanding the impairments experienced by individuals with MDD. We discuss the implications of these findings for assessment of and intervention for MDD. We conclude by offering directions for future research that we believe will advance our understanding of neural factors that contribute to the etiology and course of depression, and to recovery from this debilitating disorder.
Topics: Brain; Depressive Disorder; Humans; Nerve Net; Neuroimaging; Neurosciences; Psychiatric Status Rating Scales
PubMed: 25239242
DOI: 10.1016/j.brat.2014.08.008 -
BMC Psychiatry Apr 2016Abortion is associated with moderate to high risk of psychological problems such as depression, use of alcohol or marijuana, anxiety, depression and suicidal behaviours....
BACKGROUND
Abortion is associated with moderate to high risk of psychological problems such as depression, use of alcohol or marijuana, anxiety, depression and suicidal behaviours. The increased risk of depression after spontaneous abortion in Asian populations has not been clearly established. Only a few studies have explored the relationship between grief and depression after abortion.
METHODS
A study was conducted to assess the prevalence and risk factors of depressive disorder and complicated grief among women 6-10 weeks after spontaneous abortion and compare the risk of depression with pregnant women attending an antenatal clinic. Spontaneous abortion group consisted of women diagnosed with spontaneous abortion by a Consultant Obstetrician. Women with confirmed or suspected induced abortion were excluded. The comparison group consisted of randomly selected pregnant, females attending the antenatal clinics of the two hospitals. Diagnosis of depressive disorder was made according to ICD-10 clinical criteria based on a structured clinical interview. This assessment was conducted in both groups. The severity of depressive symptoms were assessed using the Patients Health Questionnaire (PHQ-9). Grief was assessed using the Perinatal Grief Scale which was administered to the women who had experienced spontaneous abortion.
RESULTS
The sample consisted of 137 women in each group. The spontaneous abortion group (mean age 30.39 years (SD = 6.38) were significantly older than the comparison group (mean age 28.79 years (SD = 6.26)). There were more females with ≥10 years of education in the spontaneous abortion group (n = 54; SD = 39.4) compared to the comparison group (n = 37; SD = 27.0). The prevalence of depression in the spontaneous abortion group was 18.6 % (95 CI, 11.51-25.77). The prevalence of depression in the comparison group was 9.5 % (95 CI, 4.52-14.46). Of the 64 women fulfilling criteria for grief, 17 (26.6 %) also fulfilled criteria for a depressive episode. The relative risk of developing a depressive episode after spontaneous abortion was significantly higher than in females with a viable pregnancy (RR = 2.19, 95 % CI, 1.05 to 4.56). After adjustment for age and period of amenorrhoea, the difference was not significant. Prevalence of complicated grief was 54.74 % (95 % CI, 46.3-63.18).
CONCLUSION
The relative risk of developing a depressive episode after spontaneous abortion was not significantly higher compared to pregnant women after taking into account age and period of amenorrhoea (POA). Almost half the women developed complicated grief after spontaneous abortion. Of these, a significant proportion also had features of depressive disorder.
Topics: Abortion, Spontaneous; Adult; Depressive Disorder; Female; Grief; Humans; Pregnancy; Risk Factors; Sri Lanka
PubMed: 27071969
DOI: 10.1186/s12888-016-0812-y -
European Archives of Psychiatry and... Dec 2016According to ICD-10 criteria, mixed anxiety and depressive disorder (MADD) is characterized by co-occurring, subsyndromal symptoms of anxiety and depression, severe... (Review)
Review
According to ICD-10 criteria, mixed anxiety and depressive disorder (MADD) is characterized by co-occurring, subsyndromal symptoms of anxiety and depression, severe enough to justify a psychiatric diagnosis, but neither of which are clearly predominant. MADD appears to be very common, particularly in primary care, although prevalence estimates vary, often depending on the diagnostic criteria applied. It has been associated with similarly pronounced distress, impairment of daily living skills, and reduced health-related quality of life as fully syndromal depression and anxiety. Although about half of the patients affected remit within a year, non-remitting patients are at a high risk of transition to a fully syndromal psychiatric disorder. The validity and clinical usefulness of MADD as a diagnostic category are under debate. It has not been included in the recently released DSM-5 since the proposed diagnostic criteria turned out to be not sufficiently reliable. Moreover, reviewers have disputed the justification of MADD based on divergent results regarding its prevalence and course, diagnostic stability over time, and nosological inconsistencies between subthreshold and threshold presentations of anxiety and depressive disorders. We review the evidence in favor and against MADD and argue that it should be included into classification systems as a diagnostic category because it may enable patients to gain access to appropriate treatment early. This may help to reduce patients' distress, prevent exacerbation to a more serious psychiatric disorder, and ultimately reduce the societal costs of this very common condition.
Topics: Anxiety Disorders; Depressive Disorder; Humans; International Classification of Diseases; Psychiatric Status Rating Scales
PubMed: 27002521
DOI: 10.1007/s00406-016-0684-7 -
Ugeskrift For Laeger Apr 2022This narrative review addresses the challenges of how to identify and treat bipolar depression. Bipolar depression, i.e. depressive episode(s) as part of bipolar... (Review)
Review
This narrative review addresses the challenges of how to identify and treat bipolar depression. Bipolar depression, i.e. depressive episode(s) as part of bipolar disorder, can be differentiated from unipolar depression only through the previous course of illness. A correct diagnosis therefore may be delayed. The pharmacotherapy of bipolar depression differs from that of unipolar depression due to a high risk of recurrence of either hypomanic/manic or depressive episodes or mood instability. Therefore, long periods of specialized treatment will often be required. Both bipolar and unipolar depression will often benefit from adjunctive social and psychological interventions.
Topics: Bipolar Disorder; Depressive Disorder; Diagnostic and Statistical Manual of Mental Disorders; Humans
PubMed: 35410656
DOI: No ID Found -
The Australian and New Zealand Journal... Aug 2017Research has suggested that sexual minority young people are more likely to have depressive symptoms or depressive disorder, but to date most studies in the field have... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Research has suggested that sexual minority young people are more likely to have depressive symptoms or depressive disorder, but to date most studies in the field have relied on convenience-based samples. This study overcomes this limitation by systematically reviewing the literature from population-based studies and conducting a meta-analysis to identify whether depressive disorder and depressive symptoms are elevated in sexual minority youth.
METHOD
A systematic review and meta-analysis were conducted and informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement to determine if rates of depressive symptoms or depressive disorder differ for sexual minority youth, relative to heterosexual adolescents. MEDLINE, PsycINFO, EMBASE and ERIC databases were searched. Studies reporting depressive symptom data or the prevalence of depressive disorder in population-based samples of adolescents, which included sexual minority youth and heterosexual young people, were included in the review. A meta-analysis was conducted to examine differences between groups.
RESULTS
Twenty-three articles met the inclusion criteria. The proportion of sexual minority youth in the studies ranged from 2.3% to 12%. Sexual minority youth reported higher rates of depressive symptoms and depressive disorder (odds ratio = 2.94, p < 0.001 and standardized mean difference, d = 0.39, p < 0.001) in comparison to heterosexual young people. Female sexual minority youth were more likely to report depressive symptoms when compared to male sexual minority youth (standardized mean difference, d = 0.34, p < 0.001). Limitations included variations in how sexuality was operationalized and how depressive symptoms or depressive disorder was measured.
CONCLUSIONS
There is robust evidence that rates of depressive disorder and depressive symptoms are elevated in sexual minority youth in comparison to heterosexual young people. Despite the elevated risk of depressive symptoms or depressive disorder for sexual minority youth, the treatment for this group of young people has received little attention.
Topics: Adolescent; Depression; Depressive Disorder; Humans; Sexual and Gender Minorities; Sexuality
PubMed: 28565925
DOI: 10.1177/0004867417713664 -
Psychiatria Polska Apr 2019In recent years increased interest in the connection of intestinal microflora and the state of human health resulted in a great deal of research on the influence of... (Review)
Review
In recent years increased interest in the connection of intestinal microflora and the state of human health resulted in a great deal of research on the influence of intestinal microflora in particular on mental health, including works on affective functions of the central nervous system (CNS). Previous studies on animals have revealed the existence of a bi-directional communication system between the gastrointestinal microbiota and the central nervous system, the so-called .gut-brain axis' which modulates functioning of CNS through immunological, endocrine and neuronal mechanisms. Clinical studies have shown a connection between supplementation of probiotics containing specific species and strains of bacteria and the regulation of the body's response to stress and with the exacerbation of depressive and anxiety symptoms in humans. Studies have also demonstrated differences in the composition of the intestinal microflora of patients with a diagnosis of major depressive disorder in comparison with the healthy population. The aim of this article is to present the current state of knowledge on the relationship between composition of intestinal microflora and affective functions of CNS and on effects of supplementation of probiotics on depressive and anxiety symptoms in humans. Previous studies on the use of probiotics in the prophylaxis and treatment of depressive and anxiety disorders included too small groups of persons, especially in groups of patients diagnosed with depression, to be able to clearly determine the effectiveness of probiotics in prevention and, in particular, treatment of these disorders in humans.
Topics: Anxiety Disorders; Depressive Disorder; Dietary Supplements; Gastrointestinal Microbiome; Humans; Mental Health; Microbiota; Probiotics
PubMed: 31317970
DOI: 10.12740/PP/92392