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Sao Paulo Medical Journal = Revista... Mar 2001Several investigations have postulated that the perimenopause may represent a period of increased psychiatric vulnerability, particularly for mood disorders. This review... (Review)
Review
CONTEXT
Several investigations have postulated that the perimenopause may represent a period of increased psychiatric vulnerability, particularly for mood disorders. This review characterizes the perimenopause, including biological changes, the influence of psychosocial factors and the most common clinical manifestations. Clinic-based studies and community-based surveys addressing the prevalence of depressive symptoms in perimenopausal women are critically reviewed. We also discuss the potential greater vulnerability to mood disturbance during the perimenopause in response to hormonal variability. A therapeutic algorithm for management of depressive symptoms in middle-aged perimenopausal women is also presented. The role of estrogen in the treatment of perimenopausal depressive symptoms is particularly discussed. In addition, we review the existing data regarding the potential efficacy of estrogen as an antidepressant agent (monotherapy, augmentation strategy or prophylaxis).
DESIGN
Narrative review.
Topics: Depressive Disorder; Estrogen Replacement Therapy; Female; Hormones; Humans; Menopause; Middle Aged; Prevalence; Socioeconomic Factors
PubMed: 11276171
DOI: 10.1590/s1516-31802001000200008 -
The Israel Medical Association Journal... Aug 2001Although a depressive state is known to occur following the resolution of an acute psychotic episode, little research has investigated its etiology, course, prognosis... (Review)
Review
Although a depressive state is known to occur following the resolution of an acute psychotic episode, little research has investigated its etiology, course, prognosis and treatment. Very often the depression is mistaken for an extrapyramidal-like syndrome--the secondary effect of antipsychotic medication--as a sense of inevitability assails both the patient and therapist. Post-psychotic depression, far from being an obscure and undefined clinical picture, has the characteristics of a clear-cut syndrome. Nevertheless, it was only recently referred to as a distinct entity in psychiatric classification systems. As a result, different researchers used varying criteria for the definition of the phenomenon, and the data collected in the different studies are therefore difficult to compare. We present a critical review of the data published to date, with emphasis on the importance of early recognition and treatment of post-psychotic depression.
Topics: Antipsychotic Agents; Depressive Disorder; Humans; Psychotic Disorders; Schizophrenia
PubMed: 11519384
DOI: No ID Found -
The American Journal of Psychiatry Jun 2011Interpersonal psychotherapy (IPT), a structured and time-limited therapy, has been studied in many controlled trials. Numerous practice guidelines have recommended IPT... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Interpersonal psychotherapy (IPT), a structured and time-limited therapy, has been studied in many controlled trials. Numerous practice guidelines have recommended IPT as a treatment of choice for unipolar depressive disorders. The authors conducted a meta-analysis to integrate research on the effects of IPT.
METHOD
The authors searched bibliographical databases for randomized controlled trials comparing IPT with no treatment, usual care, other psychological treatments, and pharmacotherapy as well as studies comparing combination treatment using pharmacotherapy and IPT. Maintenance studies were also included.
RESULTS
Thirty-eight studies including 4,356 patients met all inclusion criteria. The overall effect size (Cohen's d) of the 16 studies that compared IPT and a control group was 0.63 (95% confidence interval [CI]=0.36 to 0.90), corresponding to a number needed to treat of 2.91. Ten studies comparing IPT and other psychological treatments showed a nonsignificant differential effect size of 0.04 (95% CI=-0.14 to 0.21; number needed to treat=45.45) favoring IPT. Pharmacotherapy (after removal of one outlier) was more effective than IPT (d=-0.19, 95% CI=-0.38 to -0.01; number needed to treat=9.43), and combination treatment was not more effective than IPT alone, although the paucity of studies precluded drawing definite conclusions. Combination maintenance treatment with pharmacotherapy and IPT was more effective in preventing relapse than pharmacotherapy alone (odds ratio=0.37; 95% CI=0.19 to 0.73; number needed to treat=7.63).
CONCLUSIONS
There is no doubt that IPT efficaciously treats depression, both as an independent treatment and in combination with pharmacotherapy. IPT deserves its place in treatment guidelines as one of the most empirically validated treatments for depression.
Topics: Combined Modality Therapy; Depressive Disorder; Humans; Interpersonal Relations; Psychotherapy; Treatment Outcome
PubMed: 21362740
DOI: 10.1176/appi.ajp.2010.10101411 -
JAMA Psychiatry Sep 2013The brain processes sensory information in neuronal networks that are shaped by experience, particularly during early life, to optimally represent the internal and... (Review)
Review
The brain processes sensory information in neuronal networks that are shaped by experience, particularly during early life, to optimally represent the internal and external milieu. Recent surprising findings have revealed that antidepressant drugs reactivate a window of juvenile-like plasticity in the adult cortex. When antidepressant-induced plasticity was combined with appropriate rehabilitation, it brought about a functional recovery of abnormally wired neuronal networks. These observations suggest that antidepressants act permissively to facilitate environmental influence on neuronal network reorganization and so provide a plausible neurobiological explanation for the enhanced effect of combining antidepressant treatment with psychotherapy. The results emphasize that pharmacological and psychological treatments of mood disorders are closely entwined: the effect of antidepressant-induced plasticity is facilitated by rehabilitation, such as psychotherapy, that guides the plastic networks, and psychotherapy benefits from the enhanced plasticity provided by the drug treatment. Optimized combinations of pharmacological and psychological treatments might help make best use of existing antidepressant drugs and reduce the number of treatment-resistant patients. The network hypothesis of antidepressant action presented here proposes that recovery from depression and related mood disorders is a gradual process that develops slowly and is facilitated by structured guidance and rehabilitation.
Topics: Adult; Animals; Antidepressive Agents; Depressive Disorder; Humans; Nerve Net; Neuronal Plasticity; Recovery of Function
PubMed: 23842648
DOI: 10.1001/jamapsychiatry.2013.1 -
Psychotherapy and Psychosomatics 2003
Topics: Depressive Disorder; Folic Acid Deficiency; Humans; Methylenetetrahydrofolate Reductase (NADPH2); Oxidoreductases Acting on CH-NH Group Donors; Polymorphism, Genetic
PubMed: 12601222
DOI: 10.1159/000068693 -
Annals of Medicine Apr 1995
Topics: Depressive Disorder; Humans; Risk Factors; Suicide; Survival Rate; Suicide Prevention
PubMed: 7632406
DOI: 10.3109/07853899509031951 -
Drug Research Nov 2017
Topics: Antidepressive Agents; Cost of Illness; Depressive Disorder; Humans; Neurotransmitter Agents
PubMed: 29069687
DOI: 10.1055/s-0043-118159 -
Clinical Psychology Review May 2005This is a review of the studies comparing unipolar and bipolar depression, with focus on the course, symptomatology, neurobiology, and psychosocial literatures. These... (Review)
Review
This is a review of the studies comparing unipolar and bipolar depression, with focus on the course, symptomatology, neurobiology, and psychosocial literatures. These are reviewed with one question in mind: does the evidence support diagnosing bipolar and unipolar depressions as the same disorder or different? The current nomenclature of bipolar and unipolar disorders has resulted in research that compares these disorders as a whole, without considering depression separately from mania within bipolar disorder. Future research should investigate two broad categories of depression and mania as separate disease processes that are highly comorbid.
Topics: Bipolar Disorder; Comorbidity; Depressive Disorder; Diagnosis, Differential; Genetic Predisposition to Disease; Humans; Neurotransmitter Agents; Research Design; Terminology as Topic
PubMed: 15792852
DOI: 10.1016/j.cpr.2004.12.002 -
Clinical Interventions in Aging 2006Anxiety symptoms are frequently present in patients with late-life depression. The designation "anxious depression" has been used to describe major depressive disorder... (Review)
Review
Anxiety symptoms are frequently present in patients with late-life depression. The designation "anxious depression" has been used to describe major depressive disorder (MDD) accompanied by clinically significant but subsyndromal anxiety symptoms. MDD may also present comorbid with diagnosable anxiety disorders, although this presentation is less common in late life. Diagnosis of anxious depression in the elderly is complicated by several factors (eg, their tendency to experience and report psychiatric symptoms as somatic illness) and is associated with a more severe clinical presentation, increased risk for suicidal ideation, increased disability, and poorer prognosis. Standard pharmacotherapy for depression may be sufficient but for many patients must be modified or augmented. Psychosocial interventions may also be an important component in the treatment of these patients, although no specific psychosocial treatments have been developed for late-life anxious depression.
Topics: Age Factors; Aged; Aging; Anxiety Disorders; Depressive Disorder; Diagnosis, Differential; Humans; Quality of Life; Risk Factors
PubMed: 18047256
DOI: 10.2147/ciia.2006.1.1.41 -
Aging & Mental Health Jul 2005Although depressive symptomatology has been well studied in caregivers of patients with dementia, depressive disorders have been examined much less. We conducted a... (Review)
Review
Although depressive symptomatology has been well studied in caregivers of patients with dementia, depressive disorders have been examined much less. We conducted a systematic literature search in major bibliographical databases (Medline, Psychinfo, Dissertation Abstracts), and included studies examining caregivers of dementia patients that reported the prevalence of major depressive disorder, according to diagnostic criteria as assessed with a standardized psychiatric diagnostic interview. Ten studies with a total of 790 caregivers were identified (sample sizes: 22-147). In only one of the studies, a representative community sample was used. A total of 176 subjects (22.3%) had a depressive disorder (prevalence range from 0.15-0.32). In the three studies reporting differential prevalence rates for men and women somewhat smaller prevalence rates were found for men than for women. In six studies caregivers were compared to a (mostly matched) control group. The relative risks of having a depressive disorder in caregivers ranged from 2.80-38.68 (all RR's were significant). In the three prospective studies relatively high incidence rates were found (0.48). This study made it clear that prevalence and incidence of depressive disorders are increased in caregivers of dementia patients. More research is clearly needed in this population.
Topics: Aged; Caregivers; Case-Control Studies; Dementia; Depressive Disorder; Epidemiologic Studies; Female; Humans; Incidence; Male; Prevalence; Sex Factors
PubMed: 16019288
DOI: 10.1080/13607860500090078