-
Neuropsychopharmacologia Hungarica : a... Dec 2012Suicide is a ubiquitous phenomenon present in every country, and a function of the constellation of multiple risk and protective factors. The relatively low occurrence... (Review)
Review
Suicide is a ubiquitous phenomenon present in every country, and a function of the constellation of multiple risk and protective factors. The relatively low occurrence of attempted and completed suicide in the general community makes its research and consequentially prediction and prevention difficult, however, suicide events are common among psychiatric patients who contact their general practitioners some weeks or months before their suicidal act. Major depressive episode is the most common current psychiatric diagnosis among suicide victims and attempters (56-87%), and successful acute and long-term treatment of depression significantly reduces the risk of suicidal behaviour even in this high-risk population. The point prevalence of unipolar and bipolar major depressive episode encountered in general practice is more than 10% but unfortunately about half of these cases remain unrecognized, untreated or mistreated. As over half of all suicide victims contact their general practitioners within four weeks before their death, primary care physicians play a key role in suicide prediction and prevention. Several large-scale community studies show that education of general practitioners and other medical professionals on the recognition and appropriate pharmacotherapy of depression, particularly in combination with psycho-social interventions and public education significantly improves identification and treatment of depression and consequentially reduces the rate of completed and attempted suicide in the areas served by trained doctors.
Topics: Depressive Disorder; Depressive Disorder, Major; Education, Medical, Continuing; General Practice; General Practitioners; Humans; Hungary; Physician's Role; Psychotherapy; Social Support; Suicidal Ideation; Suicide; Suicide, Attempted; Suicide Prevention
PubMed: 23269211
DOI: No ID Found -
Neuropsychobiology 2020Electroconvulsive therapy (ECT) is still one of the most potent treatments in the acute phase of major depressive disorder (MDD) and particularly applied in patients... (Review)
Review
BACKGROUND/AIMS/METHODS
Electroconvulsive therapy (ECT) is still one of the most potent treatments in the acute phase of major depressive disorder (MDD) and particularly applied in patients considered treatment resistant. However, despite the frequent and widespread use of ECT for >70 years, the exact neurobiological mechanisms underlying its efficacy remain unclear. The present review aims to describe differential antidepressant and cognitive effects of ECT as well as effects on markers of neural activity and connectivity, neurochemistry, and inflammation that might underlie the treatment response and remission.
RESULTS
Region- specific changes in brain function and volume along with changes in concentrations of neurotransmitters and neuroinflammatory cytokines might serve as potential biomarkers for ECT outcomes.
CONCLUSIONS
However, as current data is not consistent, future longitudinal investigations should combine modalities such as MRI, MR spectroscopy, and peripheral physiological measures to gain a deeper insight into interconnected time- and modality-specific changes in response to ECT.
Topics: Depressive Disorder, Major; Electroconvulsive Therapy; Humans; Outcome Assessment, Health Care
PubMed: 32344410
DOI: 10.1159/000505553 -
Psychiatrike = Psychiatriki Dec 2021Major depressive disorder is a serious mental health disorder of high prevalence and the leading cause of disability worldwide. While there are several classes of... (Review)
Review
Major depressive disorder is a serious mental health disorder of high prevalence and the leading cause of disability worldwide. While there are several classes of therapeutic agents with proven antidepressant efficacy, only about 40-60% of patients respond to initial antidepressant monotherapy, and 30-40% of patients may even show resistance to treatment even under optimal antidepressant pharmacotherapy. Despite the existence of international guidelines, there are still no clear and widely accepted treatment algorithms, no established predictive biomarkers of response to treatment, while the management treatment- resistant depression is usually based on clinical experience. The present article offers a brief narrative review of studies published so far on the predictive quality of various blood-based peripheral biomarkers with respect to response to pharmacological, stimulation or behavioral treatment in patients with treatment-resistant depression. To summarize the results, there does not yet appear to be any specific biomarker that has sufficient discriminative predictive validity and can be used in the routine clinical practice of treating resistant depression. Many factors are likely to account for the above-mentioned research findings, including the wide variety of treatment protocols and the non-uniformly accepted definition of resistant depression used by the various studies, the small number of patients with treatment-resistant depression included, and the existence of different pathophysiological phenotypes of the disorder. The ineffective treatment of major depressive disorder requires an immediate improvement of our therapeutic approach by establishing clinically useful and easily accessible predictive biomarkers of response with high accuracy. The discovery of new and better clinical characterization of known biomarkers in the treatment of treatment-resistant depression could support a better staging and classification of the disorder, the development of personalized treatment algorithms for specific patient subgroups, the achievement of higher rates of stable remission, and the development of new precision drugs with minimal side effects.
Topics: Antidepressive Agents; Depression; Depressive Disorder, Major; Depressive Disorder, Treatment-Resistant; Humans; Prognosis
PubMed: 34990379
DOI: 10.22365/jpsych.2021.049 -
Journal of the American Academy of... Jul 2009Subthreshold depressive disorder is one of the best established risk factors for the onset of full-syndrome depressive disorders. However, many youths with subthreshold...
OBJECTIVES
Subthreshold depressive disorder is one of the best established risk factors for the onset of full-syndrome depressive disorders. However, many youths with subthreshold depressive disorder do not develop full-syndrome depression. We examined predictors of escalation to full-syndrome depressive disorders in a community sample of 225 adolescents with subthreshold depressive disorder.
METHOD
Criteria for subthreshold depressive disorder were an episode of depressed mood or loss of interest or pleasure lasting at least 1 week and at least two of the seven other DSM-IV-associated symptoms for major depression. Participants were assessed four times from mid-adolescence to age 30 years using semistructured diagnostic interviews.
RESULTS
The estimated risk for escalation to full-syndrome depressive disorders was 67%. Five variables accounted for unique variance in predicting escalation: severity of depressive symptoms, medical conditions/symptoms, history of suicidal ideation, history of anxiety disorder, and familial loading for depression. Adolescents with three or more risk factors had an estimated 90% chance of escalating to full-syndrome depressive disorder, compared with 47% of adolescents with fewer than three risk factors.
CONCLUSIONS
These data may be useful in identifying a subgroup of youths with subthreshold depressive disorder who are at especially high risk for escalating to full-syndrome depressive disorders.
Topics: Adolescent; Adult; Affect; Child; Comorbidity; Cross-Sectional Studies; Depressive Disorder; Depressive Disorder, Major; Diagnosis, Differential; Diagnostic and Statistical Manual of Mental Disorders; Disease Progression; Female; Genetic Predisposition to Disease; Health Surveys; Humans; Kaplan-Meier Estimate; Longitudinal Studies; Male; Mass Screening; Multivariate Analysis; Oregon; Personality Assessment; Proportional Hazards Models; Psychometrics; Risk; Young Adult
PubMed: 19465876
DOI: 10.1097/CHI.0b013e3181a56606 -
The American Psychologist 2012The 2009 Institute of Medicine report on prevention of mental, emotional, and behavioral disorders (National Research Council & Institute of Medicine, 2009b) presented... (Review)
Review
The 2009 Institute of Medicine report on prevention of mental, emotional, and behavioral disorders (National Research Council & Institute of Medicine, 2009b) presented evidence that major depression can be prevented. In this article, we highlight the implications of the report for public policy and research. Randomized controlled trials have shown that the incidence of major depressive episodes can be significantly reduced. Meta-analyses suggest that 22% to 38% of major depressive episodes could be prevented with currently available methods. We argue that if major depressive episodes can be prevented, the health care system should provide routine access to evidence-based depression prevention interventions, just as it provides inoculations for other common and debilitating health problems. At the same time, researchers should pursue the major directions advocated by the Institute of Medicine report to increase the enduring effectiveness of future prevention interventions. These directions include taking a developmental perspective, learning to identify groups at high risk, and testing evidence-based interventions that are likely to have the widest reach. Scientific evidence has shown that clinical depression can be averted. Our societies must take action to reduce clinical depression to the lowest possible level. This article is one of three in a special section (see also Biglan, Flay, Embry, & Sandler, 2012; Yoshikawa, Aber, & Beardslee, 2012) representing an elaboration on a theme for prevention science developed by the 2009 report of the National Research Council and Institute of Medicine.
Topics: Depressive Disorder; Depressive Disorder, Major; Evidence-Based Medicine; Health Policy; Health Promotion; Humans; Resilience, Psychological
PubMed: 22583342
DOI: 10.1037/a0027666 -
American Family Physician Apr 2002
Review
Topics: Antidepressive Agents; Bibliotherapy; Cognitive Behavioral Therapy; Depressive Disorder; Electroconvulsive Therapy; Evidence-Based Medicine; Exercise Therapy; Humans; Prognosis; Risk Factors
PubMed: 11996424
DOI: No ID Found -
The Indian Journal of Medical Research Apr 2017
Topics: Depressive Disorder; History, Ancient; Humans; India
PubMed: 28862171
DOI: 10.4103/ijmr.IJMR_295_17 -
Child and Adolescent Psychiatric... Jul 2017This article reviews recent empirical literature on the prevalence, correlates, assessment, and treatment of preschool-onset internalizing disorders. Major advances in... (Review)
Review
This article reviews recent empirical literature on the prevalence, correlates, assessment, and treatment of preschool-onset internalizing disorders. Major advances in the acceptance and recognition of both preschool-onset depression and anxiety have occurred over the past decade. This work has been greatly enhanced by the discovery of genetic, neural, and physiologic indicators, which further validate these constellations of symptoms in young children. Despite this growth in research, much work still needs to be done to further elucidate the cause, risk, treatment, and protective factors for preschool-onset internalizing disorders.
Topics: Anxiety Disorders; Child, Preschool; Depressive Disorder; Humans
PubMed: 28577606
DOI: 10.1016/j.chc.2017.02.006 -
Neuropsychopharmacology : Official... Nov 2011Major depressive disorder (MDD) is a heterogeneous illness for which there are currently no effective methods to objectively assess severity, endophenotypes, or response... (Review)
Review
Major depressive disorder (MDD) is a heterogeneous illness for which there are currently no effective methods to objectively assess severity, endophenotypes, or response to treatment. Increasing evidence suggests that circulating levels of peripheral/serum growth factors and cytokines are altered in patients with MDD, and that antidepressant treatments reverse or normalize these effects. Furthermore, there is a large body of literature demonstrating that MDD is associated with changes in endocrine and metabolic factors. Here we provide a brief overview of the evidence that peripheral growth factors, pro-inflammatory cytokines, endocrine factors, and metabolic markers contribute to the pathophysiology of MDD and antidepressant response. Recent preclinical studies demonstrating that peripheral growth factors and cytokines influence brain function and behavior are also discussed along with their implications for diagnosing and treating patients with MDD. Together, these studies highlight the need to develop a biomarker panel for depression that aims to profile diverse peripheral factors that together provide a biological signature of MDD subtypes as well as treatment response.
Topics: Animals; Antidepressive Agents; Biomarkers; Brain; Cytokines; Depressive Disorder; Depressive Disorder, Major; Humans; Treatment Outcome
PubMed: 21814182
DOI: 10.1038/npp.2011.151 -
Ugeskrift For Laeger Aug 2014The prevalence of depression is not clearly established, but estimated to 3-4% in a Danish questionnaire study. Lifetime's prevalences of 12-17% are reported in other... (Review)
Review
The prevalence of depression is not clearly established, but estimated to 3-4% in a Danish questionnaire study. Lifetime's prevalences of 12-17% are reported in other community samples. In the current diagnostic system depression is defined categorically and operationally. It has been argued, that these diagnostic criteria represent an oversimplification, which has blurred the concept of depression. We suggest a greater emphasis on the depressed mood as the core symptom of depression, which may increase the specificity of the diagnosis. Furthermore, basic principles for the treatment of depression are presented.
Topics: Denmark; Depressive Disorder; Humans; International Classification of Diseases
PubMed: 25292467
DOI: No ID Found