Treatment outcomes for depression: challenges and opportunities Depressive disorders are common, costly, have a strong effect on quality of life, and are associated with considerable morbidity and mortality. Effective treatments are available: antidepressant medication and talking therapies are included in most guidelines as first-line treatments.
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What do we know about depression treatment goals and preferences?
Treatment goals and preferences of depressed patients are important, but they are rarely empirically studied. Although clinicians are likely to discuss goals with individual patients, research that clarifies overall patterns in the treatment goals of depressed patients could be useful in informing new interventions for depression.
How do depressed outpatients set treatment goals?
The finding that depressed outpatients are likely to set treatment goals directly related to their day-to-day functioning is not surprising, given that distress due to functional impairments, such as relationship or employment problems, may often prompt entry into care.
What are the need factors influencing help-seeking behaviour in depressed patients?
Studies on the need factors influencing help-seeking behaviour often focused on the severity of depression (14 datasets), psychiatric comorbidity (11 datasets), duration of episode (9 datasets), subjective disability (5 datasets), number of depressive episodes (6 datasets), somatic comorbidity (6 datasets), and presence of certain depressive sym...
What happens to patients who do not achieve remission from depression?
Patients who do not achieve remission, including those cycling on ineffective therapies, are at greater risk for relapse and recurrence, more long-term depressive episodes, and a shorter duration between depressive episodes.
Why is it important to seek treatment for major depression?
A depression treatment plan helps you to feel motivated to be happy again. At the most basic level, treatment can stabilize someone who has suicidal thoughts and provides them with the support and tools they need. Treating severe depression is just as critical as treating any other health concern.
What is the most effective intervention for depression?
Cognitive Behavior Therapy (CBT) This form of therapy is considered by many to be the gold standard in depression treatment.
What are three treatment strategies options for someone who has been diagnosed with depression?
Three of the more common methods used in depression treatment include cognitive behavioral therapy, interpersonal therapy, and psychodynamic therapy. Often, a blended approach is used.
What are some possible treatment options for someone who is suffering from depression?
Education, lifestyle changes, social support and psychological therapy are important treatments for depression. People may also require antidepressant medication. Medications may take up to six weeks to be effective, so be patient.
Why is it important to identify and treat clinical depression in mental health?
NOT treating depression may lead to dire consequences. “Untreated depression increases the chance of risky behaviors such as drug or alcohol addiction,” according to an article on WebMD. “It also can ruin relationships, cause problems at work, and make it difficult to overcome serious illnesses.”
What are the most effective ways to treat depression research paper?
Psychotherapy, or talk therapy, is another effective and common choice. 1 It is especially efficacious when combined with antidepressant therapy.
How do you approach a patient with depression?
be patient and understanding.offer encouragement and acknowledge gains, no matter how small.ask if there is anything you can do to help, instead of asking what's wrong.acknowledge that the mental health condition isn't their fault.speak clearly and at a pace that they understand.More items...
Which of the following is the treatment of choice for patients with depressive personality?
According to the results of a study published in 2012 by Lund University, depressive people respond relatively well to treatment with forms of psychotherapy called cognitive behavioral therapy and psychodynamic therapy.
What efforts are underway to improve treatment of depression?
Efforts to improve the management of depression and other common mental disorders in primary care have focused on screening, education of primary care providers, development of treatment guidelines, and referral to mental health specialty care.
What type of therapy is used for depression?
Cognitive Behavioral Therapy (CBT) Cognitive behavioral therapy, or CBT, helps an individual identify and change negative thoughts and associated behaviors. People who suffer from depression often struggle with negative thought patterns. These thought patterns can influence our behavior.
What is the first-line treatment for depression?
Main Points. Consider sertraline and escitalopram as first-line agents for initial treatment of major depression in adults. The least tolerated antidepressants in this study were bupropion, fluoxetine, paroxetine, and duloxetine.
Is depression a treatable condition?
Depression is among the most treatable of mental disorders. Between 80% and 90% percent of people with depression eventually respond well to treatment. Almost all patients gain some relief from their symptoms.
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 atypical depression affect waist circumference?
Interestingly, one study found that individuals with atypical depression had significantly higher body-mass index, waist circumference, levels of inflammatory markers, and triglyceride levels, and lower levels of high-density lipid cholesterol than those with melancholic depression or controls 126.
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 factors predict good outcomes?
Factors predicting good outcome included early response and a low level of schizoid personality disorder symptoms, and variables predicting poor outcome included a high score for harm avoidance and the absence of an early response. Conclusions: Depression is a recurring and chronic disorder. Personality factors such as a high harm avoidance score ...
Is depression a chronic disorder?
Conclusions: Depression is a recurring and chronic disorder. Personality factors such as a high harm avoidance score and schizoid traits were associated with a worse outcome, but demographic features, depression characteristics, depression subtypes, and comorbidity were not.
Why is it important to understand the process of help seeking?
A better understanding of the process of help-seeking by individuals suffering from major depression and improved knowledge of the factors that influence this process are important for identifying groups at risk of failing to seek adequate professional help and for improving their access to depression care.
How does feedback affect health outcomes?
The model includes feedback loops to demonstrate that outcomes can affect health behaviours, predisposing, enabling and need factors and health behaviours can influence predisposing, enabling and need factors.
What is the goal of an inpatient treatment program?
The goal of the inpatient program is to decrease the intensity of depression, reduce the risk for suicide, improve coping skills, adjust medication, or incorporate other treatments.
Why is depression not a result of laziness?
Or poor parenting, if your child needs inpatient care. Suicidal thinking doesn’t happen because you're selfish. Or aren't smart enough to know how to fix things in life.
What kind of therapists are on the inpatient floor?
Your therapist will tell you that a team of professionals on the inpatient floor will likely include psychiatrists, psychologists, social workers, nurses, nutritionists, recreational therapists, music and art therapists —and if you're a child or teenager, school teachers and pediatricians too.
How often can you visit a unit?
Another thing to know is that visiting hours occur every day in most units—sometimes twice a day.
Is it necessary to be inpatient for depression?
But if you do, inpatient psychiatric hospitalization can be a meaningful treatment. Yes, you read that correctly. Meaningful.
Is depression a serious illness?
Depression is a serious illness that can sometimes require immediate, intensive, and consistent care. Accepting hospitalization takes grit and courage, and don’t ever let anyone tell you otherwise. It will feel scary at first, but it will likely lead to significant change and meaningful experiences. SHARE.
Is psychiatric hospitalization meaningful?
But if you do, inpatient psychiatric hospitalization can be a meaningful treatment. Yes, you read that correctly. Meaningful. Inpatient hospitalization for psychiatric illness has come a long way from straight-jackets, rubber rooms, and metal beds. A long way from wicked nurses or frightening procedures.
How long does depression last?
The maintenance phase of treatment may continue indefinitely, depending on an individual's risk of recurrence, but for the first episode of depression, it is usually recommended to continue for 12 months.
What is the likelihood of recurrence after a second episode of depression?
After a second episode of depression, the likelihood of recurrence increases to roughly 70%. The risk of recurrence is greater than 90% after a patient has a third episode of depression. 22-24 Unfortunately, less than one third of adults with depression obtain appropriate professional treatment, 12 and a majority are not treated sufficiently ...
How to achieve remission?
Effective strategies to achieve remission include an increase in dose, augmentation of medication, combination of psychotherapy and antidepressant treatments, or using medications with more than 1 mechanism of action. These strategies may be most easily applied through the use of a treatment algorithm.
Why is there an inadequate response to antidepressants?
This inadequate response often results because of insufficient dosing for an inadequate duration and/or drug intolerance. The positive dose-response relationship observed with antidepressant therapy dictates that the dose should be pushed to the highest tolerable levels to achieve remission and prevent relapse.
What is the goal of relapse treatment?
At this point in the treatment process, the main goal is to prevent relapse, defined as a regression of the patient's condition to less than optimal physical and psychological status, or, more simply, a return of depressive symptoms.
What is the burden of depression?
Burden of Depression. Usual care for depression typically consists of a prescribed antidepressant, psychotherapy, or both. However, mental health specialists encourage earlier and more aggressive therapy to help increase the likelihood of achieving remission and therefore lead to a lower overall cost of care.
What is the first line of medication for depression?
First-line medications typically used in the treatment of depression include the selective serotonin reuptake inhibitors (SSRIs), which have reasonable efficacy and a relatively low rate of adverse events. There are a number of agents in this class available as generics.
How long after antidepressant treatment is a binary outcome?
Binary treatment outcome in terms of remission from depression. [ Time Frame: Baseline to clinical follow-up at 8 weeks after antidepressant treatment. ]#N#Treatment outcome defined as changes in HAMD-6 score after antidepressant treatment (remitters and non-responders as previously defined).
Do antidepressants work on serotonin?
However, at the same time the etiological understanding is limited. Most antidepressants act on the serotonin (5- HT) system, yet between 30-50 % of patients with MDD does not respond successfully to 5-HT acting drugs.