Depression

Treatment-resistant unipolar major depression appears to be the rule rather than the exception. This view is supported by data from the STAR*D program, a multilevel treatment trial for major depression.

This May, the FDA called for a black box warning on antidepressants to indicate that patients aged 18 to 24 years are at heightened risk for treatment-emergent suicidality. But a member of the FDA advisory committee that recommended that warning has issued his own warning, saying that the "real killer in this story is untreated depression and the possible risk from antidepressant treatment is dwarfed by that from the disease."

Democratic control of Congress may result in the dislodging of a long-stuck bill authorizing an unspecified amount of additional federal funding for research into postpartum depression. But in hearings in a House subcommittee recently, Republicans voiced an intention to add postabortion depression to the bill's focus.

Response to SSRIs, the most frequently used first-line agents for major depression, tends to be slow, and full remission is obtained by fewer than half of treated patients.

In what was billed as the first randomized controlled study to simultaneously evaluate antidepressant therapy and short-term psychotherapy for depressed patients with coronary artery disease (CAD), treatment with an SSRI led to significant improvement, while addition of interpersonal psychotherapy provided no added benefit.

Asthma is one of the most impairing diseases of childhood, affecting more than 6% of children. Each year, it is responsible for 14 million lost school days and $3 billion in treatment costs.

Compared with schizophrenia, adherence behavior has been relatively overlooked in depression and other mood disorders. Major depression is increasingly thought of as a chronic illness. In most chronic illnesses, ideal concordance is the exception, not the rule.

Although treatment-resistant depression is defined in terms of a person's depression being resistant to medication, it usually also means that the patient has been unresponsive to whatever psychotherapy has been tried along the way. What might not be clear from the above but is known by all clinicians is that patients with TRD experience much internal suffering and misery.

Treatment interventions via telephone, Internet, and through other telemedical services are gaining popularity, especially in rural areas where licensed clinicians might not be available. Dr Per Carlbring and colleagues recently evaluated a 10-week, Internet-based, self-help program with weekly telephone calls for patients who had panic disorder with or without agoraphobia. The results were published in the December 2006 issue of the American Journal of Psychiatry.

I was disappointed to see the Figure titled Olanzapine and fluoxetine in the treatment of TRD in the article Treatment-Resistant Depression: Strategies for Management" ( Psychiatric Times, page 34) in the October 2006 special bonus edition.

The construct of bipolar spectrum disorder remains a work in progress. Its precise boundaries are still a matter of considerable debate. Some psychiatrists are convinced that it is widely overdiagnosed. It is possible that depending on the clinician and the clinical setting both views are correct.

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.