The diagnosis and management of unipolar depression remain challenging. This highly prevalent and disabling illness continues to be underdiagnosed and undertreated. Delay in treatment may lead to disease progression at a gross structural level and to a crystallization of a negative self-concept.
Public misconceptions about the illness and cultural factors may be barriers to treatment seeking and adherence. We are limited clinically by the lack of useful disease markers and the paucity of predictors of treatment response. Changes in endocrine physiology across the life cycle may interact with the neurobiology of depression and contribute to treatment resistance.
No single antidepressant will bring a majority of patients to achieve symptom remission. A trial of medications in combination with psychotherapy and close collaboration with primary care physicians is often needed.
The articles in this Special Report discuss some of the challenges faced by clinicians in the diagnosis and treatment of depression across the life cycle and provide sensible tools and solutions. The article by Georg Northoff, MD, PhD, offers an intriguing hypothesis regarding the psychopathology and pathophysiology of depression, which places increased self-focus and body focus and decreased environment focus at the heart of the pathogenetic process.
Bernadette Mazurek Melnyk, PhD, and Pamela Lusk, DNP, write about depression in adolescents and college-age adults. They make a case for early identification and treatment of depression, which may check the illness before it progresses. The dynamic brain changes during this key developmental phase may facilitate treatment and promote lasting gains. They describe an easily adopted form of cognitive-behavioral therapy–based psychotherapy that they have developed.
The article by Barbara L. Parry, MD, moves us forward in the life cycle and reviews the literature on the relationship between the depression and the perimenopause/menopause stages. A close collaboration between psychiatrists and primary care physicians/gynecologists is encouraged in order to bring the possible therapeutic benefits of hormone replacement therapy to patients.
Jessica Warner, MD, and Noah S. Philip, MD, present the evidence base for the various augmentation strategies currently available for MDD. A systematic approach that seeks to exploit pharmacodynamic interactions is encouraged.
The article by María P. Aranda, PhD, is particularly germane, given the expected continued growth in the Hispanic population in the United States. It calls for and promotes a personalized and culturally sensitive approach to the care of older, low-acculturated US Latinos.
Collectively, the articles remind us of the wide knowledge base that is needed in the management of the depressed patient and of the multiple conceptual levels that must be integrated in the care of our patients.