Major Depressive Disorder

Since its introduction in DSM-III in 1980, attention-deficit/ hyperactivity disorder (ADHD) has proved to be a developmental disorder with many causes and complex behavioral, cognitive, and emotional manifestations that can impair academic functioning, occupational achievement, social relationships, and self-esteem.

Bone mineral density (BMD) was reduced at a greater rate in older women when they had symptoms of depression, according to one recent report from the Study of Osteoporotic Fractures Research Group, while another report implicated treatment with SSRI antidepressants.

Suicide is the third leading cause of death in younger (10- to 14-year-old) adolescents in the United States and the leading cause of death in this age group in other countries, including China, Sweden, Ireland, Australia, and New Zealand.

In 20 years of dealing with severe schizophrenia in her sister and daughter, it occurred to psychologist Joyce Burland, PhD, that she "had never been given any instruction on how to be helpful to them," so in 1991, she wrote up a highly structured course with a standardized curriculum and training guide.

The American Academy of Child and Adolescent Psychiatry recently published a practice parameter with evidence-based guidelines for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Recommendations for the best treatment practices were made based on empirical evidence and clinical consensus, and the strength of these recommendations was based on the extent and degree of these variables. This column will provide a summary of the parameter.

Attachment may be defined as a composite of behaviors in an infant, toddler, or young child that is designed to achieve physical and emotional closeness to a mother or preferred caregiver when the child seeks comfort, support, nurturance, or protection.

Major depression is at once simple and complex. At one level, the treatment of this disorder is straightforward. Yet, at a multitude of other levels, it is a complex condition for which available treatments remain suboptimal.

If clinical trials data are any indication, the potential impact of placebo treatment on depression outcomes may be potent. Placebo response rates in clinical trials for depression average approximately 30%, with a top range beyond 50%-and the trend is upward.

Mood disorders are among the most prevalent forms of mental illness. Serious depression is especially common; based on a face-to-face survey conducted from December 2001 to December 2002, the past-year prevalence rate of clinically significant major depressive disorder (MDD) was estimated to be 6.6%, affecting at least 13.1 to 14.2 million Americans.

Mood disorders are common in women and typically emerge during the childbearing years. While pregnancy has traditionally been considered a time of emotional well- being, recent data indicate that about 10% to 15% of women experience clinically significant depressive symptoms during pregnancy.

In this article, we use the example of major depressive disorder (MDD) to review research efforts to identify predictors of treatment response, both to antidepressant medications and to psychotherapy. We describe the promises and limitations of this research, with some emphasis on brain imaging studies, and then discuss how this work may be integrated into clinical practice in the future.

In lecturing to medical students, residents, and psychiatrists during the past several years, we have encountered widespread hesitancy in the use of MAOIs and even TCAs, mainly because of concerns about their safety but also because of doubts about their effectiveness compared with newer alternatives. Thus, it is timely to review the literature on the efficacy and safety of TCAs and MAOIs, with a view to maintaining an appropriate place for these 2 drug classes in the pharmacotherapy of depression.

Adherence, in a medical context, refers to the degree to which a patient follows the treatment plan that has been agreed on between the prescriber (usually, but not always, a physician) and the patient.

Although cognitive therapy (CT) is the best-studied form of psychotherapy, its effectivenes compared with antidepressant medication remains controversial. Over the years, there has been some variability in the results of randomized controlled trials and other types of clinical trials, as well as meta-analyses.

Given the burdens of living with schizophrenia, and the increasing focus on patients' quality of life, it’s no wonder clinicians are seeking other treatment options for the disorder. Here, a discussion of the most promising nonconventional therapies and how to use them.

Major depressive disorder (MDD) affects a large proportion of the world's population, but much still needs to be done to categorically improve the lives of people with this condition.

Obsessive-compulsive disorder (OCD) is a heterogeneous disorder with a variety of phenotypic expressions. Delineation of clinically distinct subtypes of the disorder may be valuable in predicting treatment response and resistance.

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.

Like medicine in general, psychiatry and psychotherapy have long focused on relieving illness and pain. Traditional psychotherapeutic approaches have often emphasized examination and understanding of painful experiences as a route toward obtaining relief from suffering.

Sexual dysfunctions as distinct syndromes were first identified in DSM-III in 1980. At that time, sets of criteria were specified for inhibited sexual desire, inhibited sexual excitement, inhibited female orgasm, inhibited male orgasm, premature ejaculation, dyspareunia, and functional vaginismus.

Premenstrual dysphoric disorder (PMDD) is a distinct cyclical disorder in which women experience distressed mood and behavioral symptoms in the late luteal or premenstrual phase of their menstrual cycle. PMDD is the most extreme or severe form of premenstrual syndrome (PMS).

Among 25 to 30 million Americans in whom depression is diagnosed annually, 18 to 25 million are treated with antidepressants, of which 90% are SSRI or non-selective serotonin reuptake inhibitor (SRI) antidepressants, the most frequently prescribed medications for all outpatients aged 18 to 65 years.

Ejaculatio praecox, or premature (rapid, early) ejaculation (PE), is a prevalent male sexual complaint. It may be part of the normal ejaculation variability in men, but it may also be the symptom of an ejaculatory dysfunction.

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.

Homelessness rates in both Canada and the United States have increased dramatically over the past 10 years. Among the homeless, there is a high prevalence of mental illness and substance use disorders.

Figures from the US Department of Justice indicate that more than half of prison and jail inmates have a mental health problem. Mental health courts (MHCs) were designed to divert mentally ill persons convicted of nonviolent crimes to supervised treatment instead of incarceration, but while the number of MHCs has grown substantially over the past decade, limited information has been available about outcomes and costs.

A recently published study examined the impact of publicity regarding the pediatric suicidality data on the prescribing practices of physicians in the United States. The researchers focused on the period from June 2000 to March 2005.

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.