Depression

Despite the clinician's goal of treating the depressed patient to the point of remission, this state is generally achieved in only 15% to 30% of patients. Another 10% to 30% of patients respond poorly to antidepressant treatment, while 30% to 40% have a remitting and relapsing course.1 Patients without a major depressive disorder are likely to be treated successfully by primary care physicians and/or other mental health professionals, which leaves psychiatrists to treat patients who have forms of depression that are less responsive to treatment.

Although suicidal ideation occurs in roughly 5% to 14% of pregnancies,1 suicide attempts are relatively rare (0.04%) and are associated with substance abuse and poor pregnancy outcome.2 After a suicide attempt, the clinician must first consider the possibility of recurrence of self-destructive behavior by assessing the woman's motivation, her attitude toward the pregnancy, and the severity of her depressive symptoms.

NEW YORK -- Low birth weight and child abuse combine synergistically to increase the later risks of depression by 10-fold and social dysfunction by nearly ninefold, researchers here said.

Depression and Diet in Elderly Community-Dwelling Mexican and European Americans

In recent months, it's been the rare week that doesn't come with a report about the dangers of antidepressants. These drugs do have their drawbacks, but the dangers they pose are not their main problem. Their biggest shortcoming is that they don't work very well; fewer than half of the patients treated with them get complete relief, and that relief takes an unacceptably long time 2 o 3 weeks t kick in.

Clinical depression is an increasingly well-recognized sequela of epilepsy (see "Optimizing Treatment of Seizures by Addressing Psychiatric Comorbidities," Applied Neurology, August 2006, pages 41-42). Questions are therefore surfacing as to whether patients with epilepsy are being adequately identified and treated.

Compared with other ethnic groups, Asian Americans underuse mental health services, resulting in delayed treatment and higher attrition rates. A report by the surgeon general states that the underutilization is because of the shortage of bilingual services, the low percentage of health care insurance coverage, and the Asian American tradition of using mental health treatment only as a last resort.

In July 2005, the FDA approved a new type of therapy for treatment-resistant depression: vagus nerve stimulation (VNS). However, the approval process incited controversy because the scientific team that was assigned to review the device rejected its approval unanimously 3 separate times. The reviewers were unimpressed with the efficacy research underlying the device, since the only reported placebo-controlled trial showed no significant difference between active and sham VNS.

Prevalence of depression in PD is estimated to range from 7% to 76%. The variation is largely attributed to the diversity of the populations under study, differences in the definition of depression, and the fact that some studies used point prevalence and other studies used monthly prevalence. Also, the prevalence of depression varies with fluctuations of cognitive status and other comorbidities that are an integral part of PD.

Nothing better reflects the difficulties of finding silver bullets for depression treatment than the results of the nearly completed Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, the largest clinical trial of its kind. With results imminent from the last of 4 trials in the study, psychiatrists are hoping for considerably more clinical guidance than what the first 3 levels of the trials produced.

The emotional and functional consequences of sensory impairment in older persons have not been well studied despite the increasing prevalence of vision loss, in particular, and its substantial adverse effects. This review examines the impact of vision loss on psychological health, discusses factors that may reduce its negative effects, and describes new in terventions to help older people cope with eye diseases such as age-related macular degeneration (AMD).

Alzheimer dementia (AD) represents a profound global health concern. By the year 2050, the prevalence of AD in the United States is expected to reach 15 million. At present, there are 4.5 million cases in the United States, which equals an estimated cost of $100 billion each year in medical and family expenses.

The treatment of unipolar major depression presents a substantial challenge for the clinician. Major depression is a common disorder with a high propensity for relapse and recurrence.

A small group of patients with treatment-resistant major depression achieved symptom relief within hours of receiving a single low-dose intravenous infusion of ketamine. The low-dose anesthetic apparently triumphed in these patients where other treatments including oral antidepressants, which can take 8 weeks or longer to "kick in" failed.

Despite the progressive increase in the number of available antidepressants, many patients with depression continue to be symptomatic.

Alcohol is the drug of choice for adolescents, with cigarettes and marijuana being second and third. Contrary to widespread belief, alcohol dependence is most common in 18- to 20-year-olds, with progressively decreasing rates of alcohol dependence in older age groups.

Depressive disorders and symptoms are common in cancer patients (up to 58% have depressive symptoms and up to 38% have major depression), worsen over the course of cancer treatment, persist long after cancer therapy, recur with the recurrence of cancer, and significantly impact quality of life.

It was just over a generation ago that the routine combination of psychotherapy and drug therapy seemed impossible. Then, one meta-analysis found that combined treatment with psychotherapy and medication was found to be notably superior to either treatment alone.

Depression has long been recognized as a primary concern for health care providers. Many approaches to treating depression have been developed, ranging from medications, to long-term psychotherapy, to shorter, more structured cognitive-behavioral treatments--all of which help some of the patients, some of the time, to some extent.

Despite advances in our understanding of depression therapy, many patients with depression remain unresponsive to treatment. As many as 50% of patients who begin treatment with an antidepressant do not respond.

In a study published in the April issue of Archives of Internal Medicine, researchers sought to determine whether young women who were hospitalized with acute MI also had higher rates of depression than other groups.

Is apathy in patients with Parkinson disease (PD) merely a symptom of depression or a core symptom of PD itself?

A young mother has just learned from her gynecologist that she is 2 months pregnant. She has had 7 major depressive episodes over the past 8 years, 3 of which were accompanied by serious suicide attempts. She is asking you if she should stop taking the antidepressant at this time. What do you advise?

A discussion of the pharmacologic management of bipolar depression, including emerging treatments and expert recommendations.

With an application to certify its use in depression before the FDA, transcranial magnetic stimulation (TMS) has become a hot topic in the expanding field of device-based treatment modalities.