Major Depressive Disorder

Is there such a thing as a placebo effect? If so, at what point does the drug effect really occur? How do we distinguish between the two?

Health-related quality of life can provide a simultaneous and net assessment of the therapeutic and adverse affects of psychiatric treatments for depression. While the cognitive side effects of ECT might be thought of as a limiting factor in HRQOL gains, they have not been systematically studied until recently. Find out what quantitative assessment of HRQOL following ECT for major depressive disorder shows.

Seasonal affective disorder affects 1% to 3% of the North American population. Evidence exists for the efficacy of high-intensity bright, fluorescent light. Pharmacological management with SSRIs has shown equivalent efficacy to light therapy. How can these two therapies be combined? What other therapies are available?

Recent evidence suggests that reorganization of neuronal connectivity might play an important role in the pathophysiology of mood disorders and in both pharmacological and psychological treatments of depression. This evidence suggests a new framework for the etiology of mood disorders that focuses more on the problems in neuronal connectivity, plasticity and information processing in the brain than on abnormalities in chemical neurotransmission. Although this framework is still controversial and far from being complete, improved familiarity with the concepts of neuronal development and activity-dependent plasticity among mental health professionals would be useful.

Selective serotonin reuptake inhibitors have been shown effective in the treatment of depression with psychosis. This efficacy appears to correlate with the SSRIs’ level of affinity at the sigma-1 receptors in the brain. What role does the sigma-1 receptor play in psychotic depression? Based on this role, are there implications for other treatments?

By 2020, depression will be the second leading cause of death and disability worldwide. As the importance of depression as a public health problem has been reinforced, research efforts have followed different paths. Read about some of the latest developments.

When a family member is diagnosed with depression the whole family is affected. Additional family and marital stresses imposed on the patient with depression can add to the severity of depression and affect long-term remission rates. In order to ensure the best possible success in treatment, the therapist should integrate the family into the patient’s treatment.

New Clinical Drug Evaluation Unit presented new clinical data at their 45th annual meeting in Boca Raton, Fla. In the first of two articles, suicide studies, the effectiveness of antidepressants and the efficacy of drug combination therapy are explored.

The incidence of polypharmacy is on the rise, and with the increase comes a greater risk of drug-drug reactions. One survey estimated that patients seeing a psychiatrist may be six times more likely to receive multiple psychotropic medicines compared to patients seen by a primary care physician. This article provides an overview of the extent of polypharmacy, the factors driving the phenomenon and issues clinicians should consider when treating patients who are already taking medicines for other illnesses.

Comorbidity of Dysthymic Disorders in Children and Adolescents by Atilla Turgay, M.D. Many patients with dysthymic disorders also have associated comorbid disorders. A detailed history will provide insight into the comorbidity profile, cross-sectionally and developmentally. Dysthymic disorder should be addressed clinically, as it may cause long-term chronic unhappiness and poor quality of life for the patient.

Through the Times With Max Fink, M.D. by Arline Kaplan Long viewed as a pre-eminent researcher and advocate for electroconvulsive therapy, Max Fink, M.D., reflects on more than five decades of groundbreaking research.

Evidence-Based Therapies in Child and Adolescent Psychiatry by Jon McClellan, M.D. Given the lack of large, randomized controlled studies of psychiatric medications that involve children and adolescents, it can be difficult to establish evidence-based therapies that are effective for this population. However, there are studies that have shown the effectiveness of various medications, as well as for various psychotherapy techniques.

Updates Show Progress in TMS for Depression and Schizophrenia by Arline Kaplan In research presented at the 2005 APA annual meeting, transcranial magnetic stimulation is showing efficacy in treating depression and schizophrenia in the research setting. The question of how to translate those findings to a real-world setting still remains.

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The Emerging Role of GABAergic Mechanisms in Mood Disorders by Po W. Wang, M.D., and Terence A. Ketter, M.D. Gamma-aminobutyric acid is a major inhibitory neurotransmitter widely distributed in the mammalian central nervous system. Animal models of depression have pointed toward the importance of the GABA system in the pathophysiology of mood disorders. Thus, elucidating the GABAergic effects of benzodiazepines, mood stabilizers, antidepressants, and new anticonvulsants and antipsychotics may expand our understanding of mood disorder pathophysiology and potentially generate new targets for treatment.

This article will provide an overview of treatment modalities, with emphasis on the future direction of interventions targeting aggression in children with autism.

Treating bipolar disorder in young patients can often result in aggravation, irritability or even reactivation depending on the type of medication used. What are typical examples of medication-induced rebound and what are the implications of these types of responses in children?

A discussion about new depression treatments with the chairperson of Stanford University’s department of psychiatry, Alan Schatzberg, M.D.

Individuals with schizophrenia are at greater risk for weight gain than the general population. From recent research, it appears that some of the second-generation antipsychotics may be more likely to cause weight gain than others. Recommendations for treatment strategies are provided.

Posttraumatic stress disorder is one of the most devastating psychiatric disorders. Research has shown that a combination of multiple genes can lead to conditions for PTSD. Environmental factors, as well as comorbidities, must also be considered when looking for genetic conditions of PTSD.

Suicidal behavior is a complex and multi-factorial phenomenon for which epidemiological genetics suggests a genetic basis that may be specific and independent from those implicated in the vulnerability to the psychiatric disorders associated with SB. Recently, new molecular biology tools have been designed to identify predisposition factors to complex disorders. One of the main goals of current studies is to specify the suicidal phenotype, as well as the intermediate phenotypes associated with these genes.

"Chemobrain," a term coined by patients in breast cancer support groups to describe cognitive impairment associated with chemotherapy, is becoming a subject of research.

Sensitivity and specificity of a new bipolar spectrum diagnostic scale.

Can a common cough medicine contribute to effective treatment of symptoms in persons with neurologic disorders? The evidence is mounting in its favor. At the recent American Academy of Neurology annual meeting, research results were presented from a phase 3, double-blind, placebo-controlled, multicenter study into the safety and efficacy of a dextromethorphan/quinidine capsule in

Diagnosis of the two main major eating disorders, anorexia nervosa and bulimia nervosa, can be difficult because of denial of symptomatology by the patients and problems with some of the diagnostic criteria. Although CBT has been the most effective, there are no treatments available that can guarantee a cure for either disorder. Medication is only a helpful adjunct to the treatment of anorexia, while many controlled studies that show antidepressant medications are effective in reducing binge/purge behavior in bulimia.

The FDA has issued a "black box" warning about the use of all antidepressants in the pediatric population due to a 1.8-fold increase in suicidality on drug compared to placebo. Yet these medications can be an effective tool in treating depression. How should parents and patients be educated, considering this information?

Sildenafil (Viagra, Pfizer) may help patients recover from stroke by aiding regeneration of brain cells. After successfully proving that the drug stimulates cortical neurogenesis in experimental models of stroke, researchers from the Henry Ford Hospital in Detroit have now embarked on a clinical trial of sildenafil and plan to recruit 84 patients who have suffered a moderate stroke within 72 hours of entering the study.

With one in six Iraqi War veterans exhibiting mental health problems, psychiatrists are faced with the challenge of reducing or averting the psychological wounds of war and preventing long-term, service-connected disabilities. At the 13th Annual Medicine Meets Virtual Reality Conference, new therapies using virtual reality were put to the test.

The dozens of journalists killed while covering the current war in Iraq gives currency to the dangers encountered by those who bring us the news from the world's conflict zones. Despite the risks inherent in their profession, it is only recently that the psychological health of war reporters has been captured in a systematic and empirical manner.

Traumatic events affect individuals as well as entire communities. In this Special Report on trauma and violence, a number of often forgotten traumatic experiences are described. The individuals exposed to these events are at increased risk of several psychiatric disorders, as well as behavioral changes such as increased alcohol use or cigarette smoking.