Medication
[…] Treatment outcomes for major depressive disorder (MDD) need to be improved. Presently, no clinically relevant tools have been established for stratifying subgroups or predicting outcomes. This literature review sought to investigate factors closely linked to outcome and summarize existing and novel strategies for improvement.
Therapy
New York: Oxford University Press; 2012. pp. 1304–12. [Google Scholar] 3. American Psychiatric Association. Practice Guideline for the Treatment of Patients with Major Depressive Disorder.
Self-care
Management of depression involves comprehensive assessment and proper establishment of diagnosis. The assessment must be based on detailed history, physical examination and mental state examinations. History must be obtained from all sources, especially the family.
How can we improve treatment outcomes for major depressive disorder?
These medications include beta-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers.(73) Assessing the severity of major depression
What is the Oxford University Press book on major depression?
What is the management of depression?
What medications are used to treat major depression?
What is one effective treatment for major depressive disorder?
Psychotherapy, or traditional talk therapy, is an effective treatment for major depressive disorder.
What are the 2 types of treatment for major depressive disorder?
There are several treatment methods for major depression disorder. These approaches include psychotherapy, antidepressant medications, electroconvulsive treatment (ECT), and other somatic therapies. However, ECT is generally avoided, except in extreme circumstances, in favor of both psychotherapy and antidepressants.
What is major depressive disorder Google Scholar?
Introduction. Major depressive disorder (MDD) is a complex and multidimensional condition (1), which is associated with significant impairment of psychosocial functioning and health-related quality of life (2–4).
What is the first-line treatment for MDD?
SSRIs, which include fluoxetine, sertraline, paroxetine, citalopram, escitalopram, and fluvoxamine, have become the first-line treatment for major depression.
Which form of therapy is most effective for major depression?
Studies have shown that cognitive therapy is an effective treatment for depression and is comparable in effectiveness to antidepressants and interpersonal or psychodynamic therapy. The combination of cognitive therapy and antidepressants has been shown to effectively manage severe or chronic depression.
What are the 3 basic approaches to treating depression?
There are many types of therapy available. Three of the more common methods used in depression treatment include cognitive behavioral therapy, interpersonal therapy, and psychodynamic therapy.
How is MDD diagnosed?
Major depressive disorder is a clinical diagnosis; it is mainly diagnosed by the clinical history given by the patient and mental status examination. The clinical interview must include medical history, family history, social history, and substance use history along with the symptomatology.
What are 4 characteristics associated with major depression?
Feelings of sadness, tearfulness, emptiness or hopelessness. Angry outbursts, irritability or frustration, even over small matters. Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports. Sleep disturbances, including insomnia or sleeping too much.
What causes MDD?
The exact cause of MDD isn't known. However, several factors can increase your risk of developing the condition. A combination of genes and stress can affect brain chemistry and reduce the ability to maintain mood stability. Changes in the balance of hormones might also contribute to the development of MDD.
What medication is best for severe depression?
The types of medications used to treat depression include: Selective serotonin reuptake inhibitors (SSRIs) such as escitalopram (Lexapro), fluoxetine (Prozac), and sertraline (Zoloft). These are usually the first-choice medications for depression.
What is the best treatment protocol for major depressive disorder and schizophrenia?
For most patients, optimal treatments include a selective serotonin reuptake inhibitor, a serotonin-norepinephrine reuptake inhibitor, mirtazapine (Remeron), or bupropion (Wellbutrin). The use of nonselective monoamine oxidase inhibitors should be restricted to patients who do not respond to other treatments.
Which antidepressant is best for major depression?
Paxil is a type of antidepressant known as an SSRI (selective serotonin reuptake inhibitor), which is thought to boost mood by making more of the neurotransmitter serotonin available in the brain. Other popular SSRIS include citalopram (Celexa), fluoxetine (Prozac), and sertraline (Zoloft).
What is the DSM-5?
The DSM-5 provides a set of criteria that should be fulfilled in order to diagnose major depression (Box 2).(1) The patient is said to have major depression if low mood or anhedonia (defined as loss of interest or pleasure) is present nearly every day for two or more weeks, together with other symptoms.
What is the most common mental disorder in Singapore?
Major depression is the most prevalent mental disorder in Singapore. Patients often present with somatic nonspecific complaints apart from the usual symptoms. Major depression is also common among patients with chronic conditions; there is a bidirectional relationship between the two factors.
How long does a person have to be asymptomatic for a PDD?
Persistent depressive disorder (PDD) is characterised by milder depressive symptoms that persist for at least two years, or at least one year in children or adolescents.(1) Patients should not be asymptomatic for more than two months.
How long does bipolar disorder last?
A large proportion may remain misdiagnosed for up to ten years.(49,50) There are various reasons for this.
Can a primary care physician exclude organic disease?
In a person who presents predominantly with somatic symptoms, the primary care physician needs to first exclude any organic disease.(21 ,31) Depending on the symptomatology, the scope of organic conditions to consider can be wide, especially with elderly patients.
Is depression a chronic illness?
Major depression is the most common mental disorder in the community and patients often present with somatic symptoms. Major depression is potentially a chronic illness that has considerable morbidity, and high relapse and recurrence rates. There is a bidirectional relationship between major depression and chronic diseases.
Is depression considered mild?
Major depression is classified as mild if (a) the patient has very few, if any, symptoms in excess of the five required to fulfil the criteria for diagnosis; (b) the symptoms are manageable; and (c) functional impairment is minor (e.g. the patient is still able to work).
What is the management of depression?
Management of depression involves comprehensive assessment and proper establishment of diagnosis. The assessment must be based on detailed history, physical examination and mental state examinations. History must be obtained from all sources, especially the family.
What is depression in health?
INTRODUCTION. Depression is a common disorder, which often leads to poor quality of life and impaired role functioning. It is known to be a major contributor to the global burden of diseases and according to World Health Organization (WHO), depression is the fourth leading cause of disability worldwide and it is projected that by 2020, ...
What to do after discontinuing treatment?
After the discontinuation of active treatment, patients shouldbe reminded of the potential for a depressive relapse. Patient may be again informed about the early signs of depression, and a plan for seeking treatment in the event of recurrence of symptoms may be formulated.
What are the determinants of psychotherapy?
The major determinants of type of psychotherapy are patient preference and the availability of clinicians with appropriate training and expertise in specific psychotherapeutic approaches. Other clinical factors which will influence the type of psychotherapy include the severity of the depression.
What is the first line of antidepressants?
In general, because of the side effect and safety profile, selective serotonin reuptake inhibitors (SSRIs) are considered to be the first line antidepressants. Other preferred options include tricyclic antidepressants, mirtazapine, bupropion, and venlafaxine.
What happens if a patient relapses after discontinuing medication?
If a patient suffers a relapse upon discontinuation of medication, treatments need to be promptly reinitiated. In general, the previous treatment regimen to which the patient responded in the acute and continuation phase are to be considered. MANAGEMENT OF TREATMENT RESISTANCE DEPRESSION.
What is the goal of acute phase treatment?
The goal of acute phase treatment is to achieve remission, as presence of residual symptoms increase the risk of chronic depression, poor quality of life and also impairs recovery from physical illness. Treatment generally results in improvement in quality of life and better functional capacity.
What is the construct of major depressive disorder?
The construct of major depressive disorder makes no etiological assumptions about populations with diverse symptom clusters. “Depressed mood” and “loss of interest or pleasure in nearly all activities” are core features of a major depressive episode, though a strong case can be made to pay increasing attention to symptoms of fatigue, ...
What are melancholic features?
For example, “with melancholic features” requires at least three of the following symptoms: complete loss of pleasure, lack of reactivity, psychomotor retardation, significant weight loss, excessive guilt, or distinct quality of depressed mood.
Is SSRI a melancholic medication?
These distinctions have been less apparent with the current, generation of selective serotonin reuptake inhibitor (SSRI) and serotonin-norepinephrine reuptake inhibitors (SNRI) antidepressants, and no currently available antidepressant carries a specific indication for either melancholic or atypical symptoms.
Is sexual dysfunction a depression?
Sexual dysfunction is also a complex issue among patients with depression. Common complaints include reduction in desire or libido, diminished arousal, a decline in the frequency of intercourse, or an undesirable delay in achieving orgasm.
Is apathy a core symptom?
Similarly, apathy may overlap with diminished interest, loss of energy, and even indecisiveness, but this construct is too nonspecific to be considered a core symptom. In fact, apathy has been reported more frequently as a side effect, in up to 20% of patients who receive SSRI antidepressants.42. Cognitive dysfunction.
What is the most common psychiatric disease?
Major depressive disorder (MDD) is the most common psychiatric disease and a worldwide leading cause of years lived with disability 1, 2. In addition, the bulk of suicides are linked to a diagnosis of MDD.
What is the risk of MDD?
Heritable risk for MDD is between 30 and 40%, with higher rates in women. A large, collaborative genome-wide association study (GWAS) detected 44 significant loci associated with MDD 94. Specific analyses identified neuronal genes (but not microglia or astrocytes), gene-expression regulating genes (such as RBFOX1 ), genes involved in gene-splicing, as well as genes that are the targets of antidepressant treatment. The authors suggested that alternative splicing could lead to shifts in the proportion of isoforms and altered biological functions of these proteins 94.
Does stress affect MDD?
High stress levels significantly influence outcomes in MDD patients who are prone to vulnerable states, such as those with high levels of neuroticism 33, 34. A meta-analysis found that history of childhood maltreatment was associated with elevated risk of developing recurrent and persistent depressive episodes, as well as with lack of response or remission during treatment 35. Another meta-analysis confirmed the detrimental impact of childhood maltreatment (emotional physical or sexual maltreatment or neglect) as a predisposing risk factor for severe, early-onset, and treatment-resistant depression 36, 37. Studies also found gender-specific effects; in particular, at lower stress levels females were at higher risk of MDD than males 34. Moreover, twin studies have suggested a differential reactivity of gender in response to type of SLE 38. For instance, a treatment study using escitalopram and nortriptyline investigated the association between number of SLEs (e.g., job loss, psychological trauma, loss of a loved one) and antidepressant treatment. Subjects with more SLEs exhibited greater cognitive symptoms at baseline but not significantly more mood or neurovegetative symptoms. These patients also had greater cognitive symptom reduction in response to escitalopram but not nortriptyline 39. This suggests that SLEs may have a cognitive domain-specific impact in MDD, but more data are needed to elucidate this issue.
Does MDD have bidirectional effects?
MDD and several physical diseases—including cardiovascular disease and diabetes—appear to have bidirectional effects on disease trajectory 47, 48, yet pathophysiologic links are most likely complex and have to be elucidated. In addition, depression appears to be linked to hormonal diseases, including hypothyroidism 49.
Is ketamine a rapid acting antidepressant?
Based on the success of ketamine, other rapid-acting or novel antidepressant substances within the glutamatergic/GABA neurotransmitter systems are being developed, several of which are in Phase III clinical trials. A prototype novel substance is AV-101 (L-4-cholorkynurenine). This is a potent selective antagonist at the glycine-binding site of the NMDAR NR1 subunit and has demonstrated antidepressant-like effects in animal models, while human Phase II studies are currently ongoing 164. Brexanolone is a formulation of the endogenous neurosteroid allopregnanolone, which modulates neuronal activation of GABA A receptors and has met positive endpoints in Phase III, leading to FDA approval for postpartum depression. A comparable substance is under development for MDD 165. In addition, serotonergic agonists have been studied as our understanding of their mechanism of action (e.g., their effects on glutamate release or plasticity) has increased 166. Encouraging results have been seen for the serotonin 2A receptor agonist psilocybin 167, but these findings need to be replicated in larger systematic clinical trials. Initial positive trials of add-on agents—such as buprenorphine 168, 169, rapastinel 170, or scopolamine 145 —have also been conducted. However, it is beyond the scope of this manuscript to review all of these findings, and we refer the interested reader to recent comprehensive reviews of this subject 144, 145, 165, 171.
Is depression a hormonal disorder?
In addition, depression appears to be linked to hormonal diseases, including hypothyroidism 49. A number of physical disabilities and medical comorbidities have been shown to significantly impact outcome measures in MDD 50, particularly in elderly subjects 51.
Is depression a watch and wait disease?
The research reviewed above indicates that early recognition and early adequate treatment at illness onset are preferable to watch-and-wait strategies. The studies reviewed above also underscore the manner in which SLEs, as well as physical and psychiatric comorbidities, contribute to impaired outcomes. Together, these factors contribute toward treatment resistance, which has gained a substantial amount of importance as a patient-stratifying variable.
What is the most evidence based treatment for depression?
EVIDENCE BASE FOR COGNITIVE BEHAVIORAL THERAPY IN DEPRESSION. Cognitive behavioral therapy ( CBT) is one of the most evidence-based psychological interventions for the treatment of several psychiatric disorders such as depression, anxiety disorders, somatoform disorder, and substance use disorder.
What is the most common psychiatric disorder?
Depressive disorders are one of the most common psychiatric disorders that occur in people of all ages across all world regions. Although it may present at any age however adolescence to early adults is the most common age of onset, and females are affected two times more in comparison to the males.
What is the cognitive behavioral model of depression?
Cognitive behavioral therapy model of depression. Schema - stable internal structure of information usually formed during early life, also include core belief about self. information processing and intermediate belief are usually interpreted as rules of living and usually expressed in terms of “if and then” sentences.
What are some behavioral activities that help people stay grounded in the present?
Other important behavioral activities are:-. Mindfulness meditation: Helps people stay grounded in the present by keeping away from ruminations.
How does intellectual level affect treatment?
Intellectual level of the patient might also affect the overall effectiveness of the treatment. Willingness and motivation on the part of patients: Although it is not prerequisite, patients who are motivated to analyze their feelings and ready to undergo various homework show a better response to treatment.
Is CBT effective for depression?
A meta-analysis of 115 studies has shown that CBT is an effective treatment strategy for depression and combined treatment with pharmacotherapy is significantly more effective than pharmacotherapy alone.[2] .
How to help depression?
But in addition to professional treatment, these self-care steps can help: Stick to your treatment plan. Don't skip psychotherapy sessions or appointments. Even if you're feeling well, don't skip your medications.
How to deal with depression and change behaviors?
Identify negative beliefs and behaviors and replace them with healthy, positive ones. Explore relationships and experiences, and develop positive interactions with others. Find better ways to cope and solve problems. Identify issues that contribute to your depression and change behaviors that make it worse.
What is the term for depression that begins a week before your period?
Premenstrual dysphoric disorder. This involves depression symptoms associated with hormone changes that begin a week before and improve within a few days after the onset of your period, and are minimal or gone after completion of your period. Other depression disorders.
What is the term for a disorder that develops during the teenage years?
This disorder typically develops into depressive disorder or anxiety disorder during the teen years or adulthood. Persistent depressive disorder. Sometimes called dysthymia (dis-THIE-me-uh), this is a less severe but more chronic form of depression.
What are the characteristics of a melancholic personality?
Melancholic features — severe depression with lack of response to something that used to bring pleasure and associated with early morning awakening, worsened mood in the morning, major changes in appetite, and feelings of guilt, agitation or sluggishness. Atypical features — depression that includes the ability to temporarily be cheered by happy ...
What is a specifier in psychology?
A specifier means that you have depression with specific features, such as: Anxious distress — depression with unusual restlessness or worry about possible events or loss of control. Mixed features — simultaneous depression and mania, which includes elevated self-esteem, talking too much and increased energy.
What tests can a doctor do for depression?
Your doctor may do a physical exam and ask questions about your health. In some cases, depression may be linked to an underlying physical health problem. Lab tests. For example, your doctor may do a blood test called a complete blood count or test your thyroid to make sure it's functioning properly. Psychiatric evaluation.
