Major Depressive Disorder

Four studies sprang from the TORDIA trial on treatment-resistant depression in children and adolescents and showed that several factors influence treatment efficacy following treatment resistance.

Ringing the Bell to Save the Bereavement Exclusion.

A team approach, continually balancing the views of the psychopharmacologist, psychologist, social worker, family practice resident, and patient is the clinical Promised Land.

Review on the roles of gender in connection with premenstrual dysphoric disorder, OCD, psychosis, and other mental disorders.

Anti-psychiatry proponents forget it is widely recognized that the DSM is a provisional diagnostic system pending progress in better understanding uniquely human disorders of our most complex organ.

The role of subtyping and bipolarity in TRD was discussed in Part 1 of this 2-part article. Here we review a number of the most common confounding factors of TRD but limit our scope to comorbidities that can be directly addressed and treated by psychiatrists.

It appears that the risk is greater with antidepressant use during late pregnancy but may be elevated with use during early pregnancy as well.

Ongoing advances in functional brain imaging will permit studies on postulated roles of magnetic fields, biophotons, and macroscopic highly coherent quantum field effects on normal brain functioning and mental illness.

Psychotherapy is a rubric--an umbrella under which a vast array of differing interventions exist. Its diverse forms are supported by different ideologies and vocabularies.

Two recent publications provide clinically relevant information about the risk to benefit ratio of antidepressants for the treatment of MDD in youths, adults, and the elderly.

Should we accept the analysis of a journalist who has not treated a patient or implemented a study and reaches conclusions that run counter to well-established practice guidelines?

This article provides a practical overview of the available evidence-based treatment and discusses circumstances in which certain interventions may be preferred over others.

The current system of payment for mental health care in the US can lead, or even incentivize, clinicians to focus on and code for Axis I disorders and their more readily reimbursed psychopharmacological treatment approaches.

A novel class of drugs directly targets the glutamatergic neurotransmitter system and produces rapid antidepressant effects in some patients.

Sleep-disordered breathing is common in patients with mood and anxiety disorders. This article explores the implication for practicing psychiatrists whose patients have sleep disorders.

Grief is the psychological, behavioral, social and physical reaction to a loss that is closely tied to a person’s commitment to heal.

New data show that patients with unipolar, non-psychotic major depressive disorder (MDD) receiving transcranial magnetic stimulation (TMS) achieved significant improvements in both depression symptoms and in quality of life measurements.

Despite its occurrence in up to 3.4% of adults, hair–pulling disorder or trichotillomania (TTM) is often under-diagnosed and inappropriately treated, according to a panel of experts presenting at the recent APA meeting.

The Suicide Risk Screening Alert is a clinical tool that assists the psychiatrist and nonpsychiatric physician in identifying patients at risk for suicide during brief medication management appointments.

BPD appears to be a neurodevelopmental disorder, influenced by the person’s genetics and brain development and shaped by early environment, including attachment and traumatic experiences.

ADHD has been significantly associated with a primary diagnosis of impulse control disorder and bipolar disorder and most commonly associated with social phobia and major depressive disorder. Details here. . .

For the first time in its history, DSM-5 has shown some flexibility and capacity to correct itself. Hopefully, this is just the beginning of what will turn out to be a number of other necessary DSM-5 retreats.

Staying empathic and keeping the conflict within the patient instead of between the patient and health care provider, is a key to successful management.

After seeing Death of a Salesman on Broadway, I knew I had seen something extraordinary-but it was only after a few days’ separation from the performance when my mind cleared and my emotions settled that I realized 2 of the reasons that made me very appreciative to see this play as a young psychiatrist.

The paradigm for modern psychiatry is evidence-based medicine (EBM)-it represents proven treatments for defined diagnoses. But there are major problems with this position, starting with the fact that while they are superior to placebo, evidence-based treatments too often are ineffective.

In a recent interview on 60 Minutes, Harvard psychologist Irving Kirsch, PhD, commented, “the difference between the effect of a placebo and the effect of an antidepressant is minimal for most people.”

Insight can be assessed in the course of a typical evaluation or follow-up interview with augmentation by questions borrowed from any of the validated insight rating scales.

We know that different people, cultures, and traditions all grieve differently. Yet it is ultimately our capacity for resilience that allows each of us to process the grief-inducing event in his or her own way.

When thinking about recent advances in psychopharmacology, we often point to new molecules with similar mechanisms of action but with better safety and tolerability profiles, or to molecules with novel mechanisms that effect positive change greater than that with existing treatments.

The diagnostic boundary between Major Depressive Disorder and Bipolar II Disorder is one of the most difficult and also one of the most important in psychiatry.