Depression

The most common psychiatric sequelae following trauma include major depressive disorder, somatoform pain disorder, adjustment disorder and posttraumatic stress disorder (PTSD). In law, trauma that precipitates PTSD is viewed as a tort, which stems from the root word "torquere" (to twist), as does the word torture. In a sense, plaintiffs do allege torture in personal injury cases. A tort constitutes a civil or private wrong, as opposed to a criminal wrong, and rests on the general principle that every act of a person causing damage to a legally protected interest of another obliges that person, if at fault, to repair the damage (Slovenko, 1973).

It is now customary psychiatric practice to think of a patient's illness as primarily biological in origin-so much so that, for many illnesses, published practice guidelines almost exclusively describe medication strategies.

Daniel F. Kripke, M.D. has studied the relationship between biological rhythms and depression since the early 1970s. He states that seasonal responses in many mammals are controlled by the photoperiod. Therefore, it seemed that depression might be analogous to winter responses and that light might be an effective treatment.

Despite the development of better-tolerated antidepressants and more effective applications of nondrug modalities like cognitive-behavioral therapy, depressive disorders are often chronic or recurrent. The researchers point out that there has been relatively little evaluation of chronic depression, with most studies addressing short-term treatment of acute episodes.

In Western psychiatry, depression is considered a major cause of suicide. But research from China calls that assumption into question. More than 300,000 suicides occur annually in China, nearly 10 times the number of suicides in the United States.

An investigational compound that blocks the neurokinin "substance P" has demonstrated robust antidepressant effect in preliminary clinical testing against paroxetine (Paxil) and placebo. This finding has been described by as "a breakthrough discovery" in mental health care.

For reasons researchers are still trying to understand, clinical depression appears to be almost twice as common in women as in men. Why females are more prone to this debilitating disease than their male counterparts is still under investigation, although significant progress has been made.

While The Medical Letter relates several neuropsychiatric side effects with most drugs on the list, it emphasizes the association of depression with calcium channel blockers by indicating only this condition with this drug category. This, despite a single report of hallucinations with verapamil (Isoptin) as the only neuropsychiatric symptom of a calcium channel blocker included on the 1993 list.

Depression, subcortical dementia and normal aging: all three may have similar neurobehavioral manifestations. So how does a clinician make a differential diagnosis?

Lack of energy, recurrent thoughts of death and difficulty with concentration are viewed by more than half of medical decision-makers in families as natural components of aging rather than as symptoms of clinical depression, according to a Louis Harris and Associates survey. Additionally, 93% of all adults polled said they believe depression is a normal side effect for those suffering from a medical condition.

Venlafaxine (Effexor) is a novel antidepressant recently released to the American market. Its entry into the antidepressant market has been much heralded. The lay press has described the drug as "Prozac with a punch," and many patients were asking for it long before it was available. As the hoopla settles down, we are learning that venlafaxine is a potentially important drug with both advantages and disadvantages over other available antidepressants, including the selective serotonin reuptake inhibitors (SSRIs).