Major Depressive Disorder

I just received a very important email from Dr Dayle Jones who chairs the DSM-5 Task Force of the American Counseling Association (ACA). The ACA has provided a much needed wake-up call for the American Psychiatric Association.

In a decade-long study of antipsychotic prescribing for hospitalized children and adolescents, researchers found that antipsychotics were used in 44.3% of patients and were often prescribed for behavioral disorders, PTSD, and other anxiety disorders as well as psychotic disorders.

A large-scale, systematic depression screening of adults with cardiovascular disease (CVD) conducted by Kaiser Permanente in Southern California produced some unexpected result. Even those with negative depression screens benefitted.

If ketamine is able to turn off a patient’s depression, even for one day, you have accomplished something important, whether or not you can maintain it. This is because you have at least given the patient hope . . . that in itself is very significant from a therapeutic perspective.

Deliberate self-harm (DSH) is a behavior in which a person commits an act with the purpose of physically harming himself or herself with or without a real intent of suicide.

The evidence-based approach to bipolar depression symptoms includes treatment with lithium, conventional unimodal antidepressants, lamotrigine, or divalproex.

Whenever a suicide happens in the New Asylums, a palpable, muted dread descends over the institution. It stays there in full force for weeks and months afterwards, sometimes longer. After that, it is added as another sedimentary layer to the strata and culture of the particular institution. Before things get too deeply buried, it is important to excavate.

Digital technology is a valuable tool, but if it dazzles us with its speed and control, there is the risk that we may forget the old way of connecting.

Mixed depression is defined as a major depressive episode (MDE) with concurrent manic or hypomanic symptoms that are insufficient in number for a patient to meet the criteria for mixed hypomania.

Mixed states constitute a wondrously variegated universe of psychopathology. These states are characterized by the intrusion of features characteristic of depression into states of hypomania or mania and the converse. Mixed states assume a myriad of forms that as a family may be among the most commonly encountered states of affective illness.

The title of Gardiner Harris’s front-page story in the March 6 New York Times was blunt: “Talk Doesn’t Pay, So Psychiatry Turns Instead to Drug Therapy.” For those of us who see our profession as a humanistic calling, this piece is likely to provoke a mixture of sadness and anger.

Dr McIntyre discusses bipolar disorder and several studies in medical comorbidity in general and more specifically neurological comorbidity.

The efficacy of psychodynamic psychotherapy is supported by empirical evidence. Patients have reported residual therapeutic gains following treatment.

Charles Moser, PhD, MD, has forwarded an interesting suggestion to solve the problem of weak diagnoses that have received a free ride through previous revisions of DSM. His is a middle way intended to steer between the contrasting risks of continuing questionable diagnoses and the risks of eliminating them.

Major mood disorders have been associated with increased suicidal behavior. This is especially true in patients with a mixed, manic-depressive, or dysphoric-agitated state.

Expansion of age-appropriate developmental psycho-therapeutic services must become a top public health priority to make these treatments more widely available to young children and to capture the potential greater benefit of the earliest possible intervention for mental disorders.

. . . her fixed state is one of intent though fruitless searching. She is inactive not because she is too lazy to work but because work has become meaningless to her; her energy is paralyzed not by sleep but by thought.”

ECT, like abortion, is surrounded by controversy and strong opinions on both sides. Fortunately, for those of us who practice ECT, the discussion is not quite as heated nor the risks as high as for our colleagues in ob-gyn.

I would like to start off this blog with two stories that happened many years ago.

Dr Fogelson discusses how science has refined research designs to measure the efficacy of psychotropic drugs.

In my previous blog, The Missing Person in the DSM, I questioned whether the DSM diagnostic manual classifies psychiatric disorders or the individuals suffering from diagnostic disorders-Ms Smith’s bipolar disorder, or Ms Smith, a person with bipolar disorder.

FDA regulators are deciding whether to downgrade the risk classification of ECT from high to medium risk. In 1990, FDA regulators proposed declaring ECT devices safe for major depression but because of an uproar by ECT opponents, a final decision was never made.

Erroneous conclusions, and medical harm, can come from accepting any hypothesis uncritically, and growing evidence indicates that treatments based on disorder hypotheses for depression do cause harm.

Many psychiatrists, residents, and other mental health professionals believe that psychodynamic therapy lacks empirical support or that other psychotherapies are more effective.

Psychiatrists helping nonpsychiatrists refer their patients has a long but not always illustrious history.