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Lakartidningen Jan 2019
Topics: Antidepressive Agents; Cognitive Behavioral Therapy; Combined Modality Therapy; Depressive Disorder; Humans; Secondary Prevention
PubMed: 30644995
DOI: No ID Found -
Psychopathology 2020Since the introduction of DSM-III anhedonia has become a core depressive criterion and is defined as the loss of interest or pleasure. Although the origin of the word... (Review)
Review
Since the introduction of DSM-III anhedonia has become a core depressive criterion and is defined as the loss of interest or pleasure. Although the origin of the word goes back to the end of the 19th century and numerous anhedonic symptoms are described in classic texts on depression, this centrality in the diagnosis of depression is only recent. Anhedonia is best described as a symptom complex with unclear boundaries cutting across the tripartite model of the mind (affect, volition, and cognition). Popular concepts of anhedonia pertain to the pleasure cycle and positive affectivity. These concepts partially overlap and are often mixed up, but clearly stem from different theoretical backgrounds: the affective science of reward processing versus more general, dimensional modelling of affect. The former concept seems more suitable to understand anhedonic emotions, the latter more suitable to understand anhedonic mood or trait. This narrative review covers the history of "anhedonia," the different anhedonic phenomena, and psychopathological concepts. An attempt is made to go beyond a merely descriptive psychopathology. Neurobiological and psychological insights shed a light on how symptoms are made and interconnected; these insights possibly call for a new psychopathological language.
Topics: Adult; Anhedonia; Depressive Disorder; Female; Humans; Male
PubMed: 32668436
DOI: 10.1159/000508773 -
Acta Medica Portuguesa 2001The Portuguese Medical Association, through its Colleges of Specialistes, has decided to establish working groups to establish Therapeutic Guidelines in pathologies of... (Review)
Review
The Portuguese Medical Association, through its Colleges of Specialistes, has decided to establish working groups to establish Therapeutic Guidelines in pathologies of great interest and current relevance in order to improve and rationalize health care. The group in charge of establishing the Therapeutic Recommendations in Depression, whose work I had the responsability and pleasure of coordinating during part of 1998 and 1999, is comprised of colleagues selected by the Portuguese Medical Association (Ordem dos Médicos). In the last few years, there has been rapidly increasing clinical and scientific interest in the study and treatment of depression throughout the life cycle, in different contexts and levels of medical practice. The rapid progress made in the neurosciences and psychopharmacology, new research in the field of psychotherapies and improved knowledge of relevant psychosocial aspects has not only broadened our knowledge of the aetiology and pathogenesis of depression, but also improved our criteria of diagnosis and classification. This has allowed the development of new therapeutic approaches and new drugs of proven efficacy. These Recommendations are aimed at systematizing and disseminating a consensus on interventions in depression, supported by evidence and the most recent scientific developments, in a way that will optimise therapeutic treatment. Due to some delay in the publication of these Recommendations (through no fault of the working group), and the rapid evolution of knowledge in this area, some of the contents may shortly need to be revised and updated. The writers and publishers of this document are fully aware of this and in accordance.
Topics: Clinical Protocols; Depressive Disorder; Humans
PubMed: 11475987
DOI: No ID Found -
Current Psychiatry Reports Dec 2012Alcohol use disorders (AUDs) and depressive illnesses are highly prevalent, frequently co-occur, and are associated with worse outcomes when paired. The assessment and... (Review)
Review
Alcohol use disorders (AUDs) and depressive illnesses are highly prevalent, frequently co-occur, and are associated with worse outcomes when paired. The assessment and treatment of patients with co-occurring alcohol use disorders and depressive illnesses is wrought with many significant challenges. When it comes to advocating treatment guidelines for this dually-diagnosed population, the data are limited, but, nonetheless, do suggest that an integrated approach to patients presenting with co-occurring AUD and depressive symptoms can be efficacious. In this approach, ongoing evaluation and treatment are provided under one roof according to the evolving needs of each patient. Utilizing antidepressant medications in conjunction with psychosocial therapies may augment overall treatment efficacy; data also suggest that combining and tailoring psychosocial therapies, such as motivational enhancement therapies, cognitive therapies, and twelve-step facilitation may further improve treatment outcomes for patients with co-occurring depressive and alcohol use disorders.
Topics: Alcoholism; Antidepressive Agents; Depressive Disorder; Depressive Disorder, Major; Diagnosis, Dual (Psychiatry); Humans; Psychotherapy
PubMed: 22907336
DOI: 10.1007/s11920-012-0314-7 -
BMC Surgery Feb 2016The interaction of depression and anesthesia and surgery may result in significant increases in morbidity and mortality of patients. Major depressive disorder is a... (Review)
Review
BACKGROUND
The interaction of depression and anesthesia and surgery may result in significant increases in morbidity and mortality of patients. Major depressive disorder is a frequent complication of surgery, which may lead to further morbidity and mortality.
LITERATURE SEARCH
Several electronic data bases, including PubMed, were searched pairing "depression" with surgery, postoperative complications, postoperative cognitive impairment, cognition disorder, intensive care unit, mild cognitive impairment and Alzheimer's disease.
REVIEW OF THE LITERATURE
The suppression of the immune system in depressive disorders may expose the patients to increased rates of postoperative infections and increased mortality from cancer. Depression is commonly associated with cognitive impairment, which may be exacerbated postoperatively. There is evidence that acute postoperative pain causes depression and depression lowers the threshold for pain. Depression is also a strong predictor and correlate of chronic post-surgical pain. Many studies have identified depression as an independent risk factor for development of postoperative delirium, which may be a cause for a long and incomplete recovery after surgery. Depression is also frequent in intensive care unit patients and is associated with a lower health-related quality of life and increased mortality. Depression and anxiety have been widely reported soon after coronary artery bypass surgery and remain evident one year after surgery. They may increase the likelihood for new coronary artery events, further hospitalizations and increased mortality. Morbidly obese patients who undergo bariatric surgery have an increased risk of depression. Postoperative depression may also be associated with less weight loss at one year and longer. The extent of preoperative depression in patients scheduled for lumbar discectomy is a predictor of functional outcome and patient's dissatisfaction, especially after revision surgery. General postoperative mortality is increased.
CONCLUSIONS
Depression is a frequent cause of morbidity in surgery patients suffering from a wide range of conditions. Depression may be identified through the use of Patient Health Questionnaire-9 or similar instruments. Counseling interventions may be useful in ameliorating depression, but should be subject to clinical trials.
Topics: Critical Care; Delirium; Depressive Disorder; Humans; Pain, Postoperative; Risk Factors
PubMed: 26830195
DOI: 10.1186/s12893-016-0120-y -
Actas Espanolas de Psiquiatria Sep 2015Cognitive impairments are core symptoms of depressive disorders. We assess the systematic reviews and meta-analysis studies published over the last 10 years (2004-2014)... (Review)
Review
Cognitive impairments are core symptoms of depressive disorders. We assess the systematic reviews and meta-analysis studies published over the last 10 years (2004-2014) that address cognitive performance of depressed patients and taking into account age; clinical and demographic features; symptom severity; number of previous episodes; clinical remission; depressive subtypes and pharmacological treatment. Twelve (12) papers were included after search in international databases. In first episode depression the cognitive domains affected were psychomotor speed, attention, visual learning and memory as well as executive functions. Depressive patients in remission phase improved their performance in attention tasks although they did not achieve similar performance levels as healthy controls. Melancholic patients seem to have a different pattern of cognitive impairment compared with non-melancholic depressive patients. Patients treated with the current antidepressants perform worse in inhibition tasks, verbal fluency, and working memory scores as well as on composite scores of visual and verbal working memory. Future research should study longitudinal outcome and clinical relevance of cognitive symptoms, determine their underlying etiopathogenesis and how they impact on clinical functioning. Specifically, it would be important to analyze the ability of the new antidepressant drugs to improve affective symptoms as well as cognitive dysfunctions.
Topics: Cognitive Dysfunction; Depressive Disorder; Humans; Meta-Analysis as Topic; Review Literature as Topic
PubMed: 26320897
DOI: No ID Found -
American Family Physician Jul 2009Up to two thirds of patients with major unipolar depression will not respond to the first medication prescribed. Depression may be considered resistant to treatment when... (Review)
Review
Up to two thirds of patients with major unipolar depression will not respond to the first medication prescribed. Depression may be considered resistant to treatment when at least two trials with antidepressants from different pharmacologic classes (adequate in dose, duration, and compliance) fail to produce a significant clinical improvement. Evidence regarding the effectiveness of psychotherapy for treatment-resistant depression is limited. A recent high-quality trial found that patients who did not respond to citalopram and who received cognitive behavior therapy (with or without continued citalopram) had similar response and remission rates to those who received other medication regimens. Initial remission rates in that trial were 37 percent, and even after three additional trials of different drugs or cognitive behavior therapy, the cumulative remission rate was only 67 percent. In general, patients who require more treatment steps have higher relapse rates, and fewer than one half of patients achieve sustained remission. No treatment strategy appears to be better than another. Electroconvulsive therapy is effective as short-term therapy of treatment-resistant depression. There is no good-quality evidence that vagal nerve stimulation is an effective treatment for this condition.
Topics: Antidepressive Agents; Antidepressive Agents, Tricyclic; Cognitive Behavioral Therapy; Combined Modality Therapy; Comorbidity; Depressive Disorder; Depressive Disorder, Major; Electroconvulsive Therapy; Humans; Recurrence; Remission Induction; Treatment Failure
PubMed: 19621857
DOI: No ID Found -
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 -
BMJ (Clinical Research Ed.) Aug 2002
Topics: Antidepressive Agents; Child; Cognitive Behavioral Therapy; Depressive Disorder; Humans
PubMed: 12153903
DOI: 10.1136/bmj.325.7358.229 -
Nephron. Clinical Practice 2008Depression is the most common psychopathological condition among patients with end-stage renal disease (ESRD), yet it is still under-recognized and misdiagnosed.... (Review)
Review
Depression is the most common psychopathological condition among patients with end-stage renal disease (ESRD), yet it is still under-recognized and misdiagnosed. Depression reduces quality of life and has a negative clinical impact upon sufferers with chronic illness, including ESRD. This article discusses the negative effects of depression among the ESRD population treated with dialysis, the prevalence of the condition, the methodological issues involved with screening and treatment, and the possible psychological and somatic causes. There is a need to identify the prevalence of the disorder by effective methods, overcome the current issues surrounding depression assessment and to undertake trials of suitable treatments.
Topics: Depressive Disorder; Humans; Kidney Failure, Chronic; Prevalence; Psychiatric Status Rating Scales; Quality of Life; Renal Dialysis
PubMed: 18401193
DOI: 10.1159/000124749