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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 -
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 -
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 -
JAMA Feb 2017
Topics: Depression; Depressive Disorder; Depressive Disorder, Major; Humans
PubMed: 28241337
DOI: 10.1001/jama.2017.0233 -
Psychogeriatrics : the Official Journal... Sep 2013Dopaminergic dysfunction is implicated in the pathophysiology of treatment-resistant depression. In this review, we describe the putative role of dopamine in depression,... (Review)
Review
Dopaminergic dysfunction is implicated in the pathophysiology of treatment-resistant depression. In this review, we describe the putative role of dopamine in depression, summarize the evidence for the efficacy of dopamine receptor agonists in the treatment of treatment-resistant depression, and discuss the underlying mechanisms by which these medications work. Both preclinical and clinical data suggest that adjunctive dopamine agonists could be a promising option for the treatment of such a condition, indicating that there is a dopamine agonist-responsive subgroup of depression. Future clinical studies are warranted to clarify unresolved issues regarding dopamine agonists such as long-term efficacy, efficacy as a monotherapy, and efficacy for juvenile and senile depression. Further basic research is also necessary to fully understand how dopamine acts in the brain of depressed patients.
Topics: Depressive Disorder; Dopamine; Dopamine Agonists; Humans
PubMed: 25913769
DOI: 10.1111/psyg.12014 -
Neural Plasticity 2015Major depressive disorder (MDD) is a chronic, recurrent, and severe psychiatric disorder with high mortality and medical comorbidities. Stress-related pathways have been... (Review)
Review
Major depressive disorder (MDD) is a chronic, recurrent, and severe psychiatric disorder with high mortality and medical comorbidities. Stress-related pathways have been directly involved in the pathophysiology and treatment of MDD. The present paper provides an overview on the stress system as a model to understand key pathophysiological paradigms in MDD. These mechanisms involve behavioral, cognitive, and systemic manifestations and are also associated with the mechanisms of action of effective antidepressants. Aspects such as depression subtypes, inflammation, insulin resistance, oxidative stress, and prothrombotic states in critical brain circuits and periphery are critically appraised. Finally, new strategies for approaching treatment-resistant major depression and potential adverse effects associated with this complex and intricate network are highlighted. The authors used PubMed as the database for this review. Each author extracted relevant data and assessed the methodological quality of each study.
Topics: Animals; Brain; Depressive Disorder; Homeostasis; Humans; Inflammation; Neurogenesis; Neuronal Plasticity; Oxidative Stress; Stress, Physiological; Stress, Psychological
PubMed: 25878903
DOI: 10.1155/2015/581976 -
Psychiatria Danubina Sep 2009The rate of comorbid depression and medical illness varies from 10 to 40%. Patients with depressive disorder compared to general population more often have... (Review)
Review
BACKGROUND
The rate of comorbid depression and medical illness varies from 10 to 40%. Patients with depressive disorder compared to general population more often have cardiovascular and cerebrovascular disorders, diabetes, irritable bowel syndrome, and some types of tumor. Side effects of mental health medications may appear in a form that is very similar to clinical presentation of somatic illness. Side effects that appear during treatment of depressive disorder, e. g. cardiovascular, gastrointestinal, movement disorders, etc., may provoke certain diagnostic issues regarding origin of such symptoms (somatic illness vs. side effect). The aim of this article is to review literature regarding comorbidity of depressive disorder and somatic illness and to point at possible diagnostic problems in differentiating comorbid somatic illness and side effects of antidepressants.
CONTENT ANALYSIS OF LITERATURE
Literature research included structured searches of Medline and other publications on the subject of comorbidity of depressive disorder and somatic disorders and possible diagnostic problems in differentiating comorbid somatic illnesses from side effects of antidepressants.
CONCLUSION
Comorbidity between depressive disorder and various somatic disorders appears often. Investigations suggest that depressive disorder is underdiagnosed in such cases. Side effects of antidepressants are sometimes very hard to differentiate from symptoms of somatic illness, which may lead to diagnostic issues. Bearing in mind frequent comorbidity between of depressive and somatic disorders, early recognition of such comorbidity is important, as well as the selection of antidepressant. It is important to recognize depressive disorder in patients with somatic illnesses, as well as somatic illness in patients primarily treated because of depressive disorder.
Topics: Antidepressive Agents; Comorbidity; Depressive Disorder; Diagnosis, Differential; Diagnosis, Dual (Psychiatry); Humans; Risk Factors
PubMed: 19794363
DOI: No ID Found -
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 -
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 -
Current Psychiatry Reports Jun 2017Depressive spectrum disorders, including major depression, persistent depression, minor and sub-syndromal depression, and other forms of depressive conditions, such as... (Review)
Review
Depressive spectrum disorders, including major depression, persistent depression, minor and sub-syndromal depression, and other forms of depressive conditions, such as demoralization, are among the most common psychiatric consequences of cancer patients, affecting up to 60% of patients. In spite of the negative effects and the burden for cancer patients and their families, these disorders often remain under-recognized and undertreated. The present review aims at summarizing the relevant data concerning the diagnostic challenges within the depressive spectrum disorders among cancer patients. Also, the most relevant data relative to integrated intervention, including psychopharmacological and psychosocial treatment, for depression in cancer patients are critically evaluated. It is mandatory that health care professionals working in oncology (e.g., oncologists, surgeons, radiation oncologists, primary care physicians, nurses, social workers, psychologists) receive training in the diagnosis and integrated management of the different types of disorder within the spectrum of clinical depression.
Topics: Depressive Disorder; Diagnostic Errors; Disease Management; Humans; Neoplasms; Psychotherapy; Psychotropic Drugs
PubMed: 28488207
DOI: 10.1007/s11920-017-0785-7