Management Of Major Depression Research Articles

Trazodone in the Management of Major Depression Among Elderly Patients with Dementia: A Narrative Review and Clinical Insights.

Major depressive disorder (MDD) often co-occurs with dementia and other neurological disorders, and treatment with antidepressants can improve symptoms, quality of life, and survival in these patients. This narrative review provides an expert opinion about the role and effectiveness of trazodone in the treatment of older adults with MDD and cognitive impairment due to physical illnesses, such as dementia. Because of its mechanism of action, trazodone can treat several depression symptoms often seen in people with dementia, including insomnia, agitation, anxiety, cognitive impairment, and irritability. Trazodone may be beneficial for patients with dementia or other neurological disorders comorbid with MDD, especially when the clinical picture of depression includes or is comorbid to symptoms of insomnia, irritability, inner tension, anxiety, or psychomotor agitation.

Difficult decision-making in major depressive disorder: Practical guidance based on clinical research and experience.

To extend current published guidance regarding the management of major depression in clinical practice, by examining complex cases that reflect real-world patients, and to integrate evidence and experience into recommendations. The authors who contributed to recently published clinical practice guidelines were invited to identify important gaps in extant guidance. Drawing on clinical experience and shared knowledge, they then generated four fictional case studies to illustrate the real-world complexities of managing mood disorders. The cases focussed specifically on issues that are not usually addressed in clinical practice guidelines. The four cases are discussed in detail and each case is summarised using a life chart and accompanying information. The four cases reflect important real-world challenges that clinicians face when managing mood disorders in day-to-day clinical practice. To partly standardise the presentation of each case and for ease of reference we provide a Time Line, History Box and Management Chart, along with a synopsis where relevant. Discussion and formulation of the cases illustrate how to manage the complexities of each case and provide one possible pathway to achieving functional recovery. These cases draw on the combined clinical experience of the authors and illustrate how to approach diagnostic decision-making when treating major depressive disorder and having to contend with complex presentations. The cases are designed to stimulate discussion and provide a real-world context for the formulation of mood disorders.

(PO-174) Management of Major Depression Following Vasoconstrictive Stroke due to Serotonergic Medications

(PO-174) Management of Major Depression Following Vasoconstrictive Stroke due to Serotonergic Medications

Effectiveness of transcranial direct current stimulation alone or associated with antidepressants, psychotherapy or cognitive therapies for the management of major depression – a review on clinical trials

Considering the evidence that transcranial direct current stimulation (TDCS) is effective for major depression (MD) management, and the perspective of including this therapeutic modality among conventional treatments, our main objective was to evaluate the reported effectiveness of TDCS, combined with antidepressants, psychotherapy or cognitive therapies, on clinical and neuropsychological outcomes in MD patients. We performed an integrative review of clinical trials, guided by the PICO strategy, using PubMed and Ovid MEDLINE ® databases. Twelve scientific reports were selected according to inclusion and exclusion criteria, comparatively analyzed, discussed and theorized. According to these studies, anodic TDCS applied to the left dorsolateral prefrontal cortex exhibits significant antidepressant effects, comparable to low dose sertraline (50 mg/day). In addition, two main studies indicate that antidepressant effects can be enhanced by combined treatments, especially TDCS + sertraline. There is also evidence of a synergistic effect of TDCS and cognitive control training, although this finding is not unanimous under different methodological approaches, thus requiring further studies in order to support the correlation between neurocognitive and clinical improvement with this type of combined therapy. Finally, TCDS-induced positive cognitive effects, mainly on working memory, were also verified. In conclusion, the small number of reports employing TDCS associated with other therapies show very discrepant research methods, as well as short follow-up periods, which together with low sample number, leave many knowledge gaps to be answered by future studies.

Special Report: Management of Major Depression—Yesterday, Today, and Tomorrow

Special Report: Management of Major Depression—Yesterday, Today, and Tomorrow

Profiling rTMS: A critical response.

This article is a detailed response to the criticisms levelled by the authors of an accompanying viewpoint, which claims that the positioning of repetitive transcranial magnetic stimulation (rTMS) in the 2020 Royal Australian and New Zealand College of Psychiatrists (RANZCP) clinical practice guidelines for the management mood disorders (MDcpg2020) is incorrect. We, the authors of the MDcpg2020, strongly refute these assertions and argue that first we have determined the positioning of rTMS using the same criteria as those applied to other treatments for depression. Second, in accordance with National Health and Medical Research Council (NHMRC) guidelines, the processes by which we have developed the MDcpg2020 have been guided by best practice and have been overseen throughout by the RANZCP. Third, our objective and detailed examination of the relevant research has shown that the evidence needed to support the positioning of rTMS alongside standard therapies for depression is severely deficient. And therefore, as a consequence, we set out clearly both our logic and reasoning with respect to interpreting rTMS data and outline our evidence-informed position in which rTMS remains a potential alternative therapy that can be considered in certain clinical circumstances once both suitable psychological and pharmacological treatments have been trialled. We also discuss why, until further research is conducted, rTMS is perhaps best regarded as an experimental therapy and an investigational tool, and to assist in this regard, we propose a framework for consideration by those conducting rTMS studies in the future. Thus, based on current knowledge, we conclude that rTMS does not have a sufficient evidence base to warrant recognition as a standard therapy for depression alongside established treatments such as psychological interventions, pharmacotherapy, and electroconvulsive therapy. Furthermore, there is no clinical profile for depressed patients that might benefit from rTMS and therefore tolerability alone is not good enough reason to promote rTMS in the management of major depression.

Understanding the genetic aspects of resistance to antidepressants treatment.

Major depression disorder (MDD) is an extremely prevalent disorder and is expected to be the second leading cause of disease burden by 2020 according to the World Health Organisation (WHO). Moreover, this disease burden is predicted to rise in the next 20 years. Antidepressant medications are vital in the therapy of major depression. However, approximately 30-60% of patients treated with current antidepressant drugs fail to attain remission of depressive symptoms leading to drug resistance. Such patients account for a disproportionately great burden of disease, as supported by cost, augmented disability, and suicidal incidents. Antidepressants resistance remains to challenge mental health care professionals, and more relevant research relating newer medications is necessitated to enhance the quality of life of patients with depression. Enhancement in response rates continues the major challenge in antidepressant research, thus a wealth of potentials still exists concerning the antidepressant resistance for the management of major depression. However, the mechanisms causing resistance to antidepressant treatment remain unknown. Hence, clinical and basic research in understanding the fundamental mechanism of antidepressant resistance should remain a key priority. One potential source accounting for these differences in treatment outcome is genetic variations. The pharmacological mechanisms behind antidepressant response are only partly known but genetic factors play a significant role. Future research of risk factors should assist to advance the understanding of the mechanisms underlying drug resistance in mood disorders and contribute to progress their therapeutic management. Thus, psychiatrists could rely on more effective approaches to treat depressive episodes, reducing the incidence of further drug resistance. This review critically summarises the author's view on many aspects of treatment resistance, specific genetic biomarkers, potential strategies and clinical relevance from both clinical and preclinical studies in drug resistance to antidepressant therapies. Finally, this will allow us to suggest possible recommendations and innovative treatment strategies to improve therapeutic outcomes in managing antidepressant resistance.

Assessment of current clinical practices for major depression in Japan using a web-based questionnaire.

PurposeTo investigate the current clinical practice of Japanese physicians in the diagnosis and management of major depression (major depressive disorder [MDD]).Patients and methodsJapanese physicians specializing in psychiatry or psychosomatic medicine in the medical database of Nihon Ultmarc Inc. (Chuo-Ku, Tokyo, Japan), who had treated ≥30 patients with MDD in the past month were invited to complete a web-based questionnaire from January 15 to 29, 2018. The questionnaire was comprised of 28 questions pertaining to the physician’s background, the criteria and tools used to diagnose MDD during physician–patient consultation, and actual and preferred duration of physician–patient consultation. Responses were given as single answer numerical values or as multiple-choice answers.ResultsFrom the 518 physicians invited to participate, 340 completed questionnaires were analyzed. Respondents were predominantly male (90%), hospital based (73%), affiliated with the Department of Psychiatry (95%), and members of the Japanese Society of Psychiatry and Neurology (87%). The majority of physicians (84%) agreed that “improvement of cognitive dysfunction caused by major depression is an important factor for patients to return to work” was the most challenging aspect of MDD diagnosis and management. Moreover, 83% of physicians conducted psychological assessments using a cognition evaluation test with most of their patients at the time of MDD diagnosis; the most commonly used tool was the Hasegawa Dementia Scale-Revised. Both hospital-based physicians and general practitioners would prefer to have longer consultations with their patients.ConclusionPhysicians acknowledge the importance of the assessment and management of cognitive dysfunction in patients with MDD. However, most physicians would prefer to have longer consultation times with their patients for the diagnosis of MDD. In the future, it may be useful to introduce digital tools (eg, THINC-it®) for the initial screening of cognitive dysfunction.

Vortioxétine : Quelle place dans la prise en charge de la dépression majeure ?

Vortioxétine : Quelle place dans la prise en charge de la dépression majeure ?

Challenges in management of Major Depression in patients with co-morbid medical conditions

Depression is a heterogeneous illness and depression with co-morbid physical illness may represent a phenotype of depression. Concurrent medical illness in depression is associated with greater functional and social impairment and significantly higher health care costs. A variety of mechanisms including lifestyle factors, immune-inflammatory pathways, medications and psychological factors have been proposed to explain the association between depression and physical illness. However, each of these pathways engenders unique challenges in managing such patients. Of utmost importance is to establish the nature of the underlying medical or psychological cause(s) which will inform customized management plans. This article initially reviews the prevalence of depression in medical conditions and vice versa. Subsequently, we move on to discuss specific approaches to diagnosis of depression in the context of medical co-morbidity. Finally, we describe evidence based pharmacological and psychosocial intervention strategies with some recommendations for common clinical scenarios. Evidence based care models to manage depression with physical illness are described which may be adapted for use in low resource settings.

Challenges in management of Major Depression in patients with co-morbid medical conditions

Depression is a heterogeneous illness and depression with co-morbid physical illness may represent a phenotype of depression. Concurrent medical illness in depression is associated with greater functional and social impairment and significantly higher health care costs. A variety of mechanisms including lifestyle factors, immune-inflammatory pathways, medications and psychological factors have been proposed to explain the association between depression and physical illness. However, each of these pathways engenders unique challenges in managing such patients. Of utmost importance is to establish the nature of the underlying medical or psychological cause(s) which will inform customized management plans. This article initially reviews the prevalence of depression in medical conditions and vice versa. Subsequently, we move on to discuss specific approaches to diagnosis of depression in the context of medical co-morbidity. Finally, we describe evidence based pharmacological and psychosocial intervention strategies with some recommendations for common clinical scenarios. Evidence based care models to manage depression with physical illness are described which may be adapted for use in low resource settings.

Opinions of general practitioners about psychotherapy and their relationships with mental health professionals in the management of major depression: A qualitative survey.

BackgroundFrench general practitioners (GPs) refer their patients with major depression to psychiatrists or for psychotherapy at particularly low rates.ObjectivesThis qualitative study aims to explore general practitioners' (GP) opinions about psychotherapy, their relationships with mental health professionals, their perceptions of their role and that of psychiatrists in treating depression, and the relations between these factors and the GPs' strategies for managing depression.MethodsIn 2011, in-depth interviews based on a semi-structured interview guide were conducted with 32 GPs practicing in southeastern France. Verbatim transcripts were examined by analyzing their thematic content.ResultsWe identified three profiles of physicians according to their opinions and practices about treatment strategies for depression: pro-pharmacological treatment, pro-psychotherapy and those with mixed practices. Most participants considered their relationships with psychiatrists unsatisfactory, would like more and better collaboration with them and shared the same concept of management in general practice. This concept was based both on the values and principles of practice shared by GPs and on their strong differentiation of their management practices from those of psychiatrists,ConclusionSeveral attitudes and values common to GPs might contribute to their low rate of referrals for psychotherapy in France: strong occupational identity, substantial variations in GPs' attitudes and practices regarding depression treatment strategies, representations sometimes unfavorable toward psychiatrists. Actions to develop a common culture and improve cooperation between GPs and psychiatrists are essential. They include systems of collaborative care and the development of interdisciplinary training common to GPs and psychiatrists practicing in the same area.

Distinguishing Depressive Symptoms From Similar Cancer-Related Somatic Symptoms: Implications for Assessment and Management of Major Depression after Breast Cancer

Prevalence rates of major depressive disorder (MDD) following breast cancer diagnosis are estimated to be ~5% to >20%, and these rates range from slightly below to somewhat above the expected prevalence rate for MDD in the general population of women in the United States. Women with a history of MDD are at increased risk for recurrence of MDD after breast cancer and need to be monitored closely. To properly diagnose and treat MDD, healthcare providers must be able to recognize depressive symptoms and distinguish them from similar somatic symptoms that are associated with breast cancer and breast cancer treatment. The National Comprehensive Cancer Network and the American Society of Clinical Oncology have published guidelines for the screening, assessment, and care of adult cancer patients with depressive symptoms. Use of a standardized and validated screening measure may help healthcare providers identify patients in need of further assessment or treatment. Evidence-based nonpharmacological interventions such as cognitive behavioral therapy and antidepressant medications are recommended treatment options.

Screening for Depression in African-American Churches.

Substantial racial/ethnic disparities exist in the identification and management of major depression. Faith-Based Health Promotion interventions reduce disparities in health screenings for numerous medical conditions. However, the feasibility of systematically screening for depression in faith-based settings has not been investigated. The purpose of this study was to assess the feasibility of using a validated instrument to screen for depression in African-American churches. Participants were recruited between October and November 2012 at three predominantly African-American churches in New York City. A participatory research approach was used to determine screening days. The Patient Health Questionnaire-9 (PHQ-9) was administered to 122 participants. Positive depression screen was defined as a PHQ-9 score ≥10. Descriptive statistics were used to report sample characteristics, prevalence of participants who screened positive, and history of help seeking. Logistic regression analyses were conducted to determine the association of positive depression screen and sociodemographic characteristics. Initial analyses were conducted in 2013, with additional analyses in 2014. The prevalence estimate for positive depression screen was 19.7%. More men (22.5%) screened positive than women (17.7%). Total household income was inversely related to positive depression screen. A similar percentage of respondents had previously sought help from primary care providers as from clergy. It was feasible to screen for depression with the PHQ-9 in African-American churches. The prevalence of positive depression screen was high, especially among black men. Churches may be an important setting in which to identify depressive symptoms in this underserved population.

Validity of four screening scales for major depression in MS

Background: There is a role for brief assessment instruments in detection and management of major depression in MS. However, candidate scales have rarely been validated against a validated diagnostic interview. In this study, we evaluated the performance of several candidate scales: Patient Health Questionnaire (PHQ)-9, PHQ-2, Center for Epidemiologic Studies Depression rating scale (CES-D), and Hospital Anxiety and Depression Scale (HADS-D) in relation to the Structured Clinical Interview for DSM-IV (SCID). Methods: The sample was an unselected series of 152 patients attending a multiple sclerosis (MS) clinic. Participants completed the scales during a clinic visit or returned them by mail. The SCID was administered by telephone within two weeks. The diagnosis of major depressive episode, according to the SCID, was used as a reference standard. Receiver-operator curves (ROC) were fitted and indices of measurement accuracy were calculated. Results: All of the scales performed well, each having an area under the ROC > 90%. For example, the PHQ-9 had 95% sensitivity and 88.3% specificity when scored with a cut-point of 11. This cut-point achieved a 56% positive predictive value for major depression. Conclusions: While all of the scales performed well in terms of their sensitivity and specificity, the availability of the PHQ-9 in the public domain and its brevity may enhance the feasibility of its use.

Integrated management of major depression for people with cancer

Major depression is an important complication of cancer. However, it is frequently inadequately treated. There are challenges both in identifying which cancer patients are depressed, and in ensuring that these patients receive effective treatment for their depression. Integration of depression management into cancer care has been advocated as a way to address these challenges. Such integrated approaches must include both the systematic identification of cases and the delivery of treatment. We describe here a system of depression care that includes both a screening programme to identify patients with depression and a linked treatment programme, based on the collaborative care model, called ‘Depression Care for People with Cancer’ (DCPC). The system of care was designed to be fully integrated with specialist cancer services and has been robustly evaluated in randomized trials. We describe how the system operates and explain why it is designed as it is. We also summarize the evidence for its effectiveness and cost-effectiveness and discuss its implementation in routine clinical practice.

Probable association between duloxetine, acute angle-closure glaucoma

Duloxetine is a serotonin-norepinephrine reuptake inhibitor (SNRI) approved for the management of major depression as well as diabetic peripheral neuropathic pain. Although SNRIs and selective serotonin reuptake inhibitors (SSRIs) have good safety profiles, there have been reports of acute angle-closure glaucoma associated with their use. The following report describes an elderly female who developed ocular side effects two days after receiving duloxetine for management of low back pain and polyneuropathy.1

Current Status of Lithium in the Treatment of Mood Disorders

Arguably, lithium is the only true mood stabilizer and the only medication developed specifically for the treatment of bipolar disorder. Providing effective long-term prophylaxis, in addition to efficacy in acute treatment of mania and bipolar depression, lithium remains a valuable first-line therapeutic choice. Up to a third of patients on lithium treatment achieve complete remission for up to a decade, markedly countering the burden exacted by the illness. Its clinical use also extends to adjunctive therapy as an augmentation strategy in the management of major depression, dysthymia and cyclothymia; contexts within which its uniquely anti-suicidal properties are apposite. Despite these advantages and a burgeoning body of both empirical and scientific research establishing its efficacy, the clinical use of lithium has diminished in recent years because of displacement by newer agents and erroneous concerns regarding long-term side effects and potential for toxicity. Currently, lithium is experiencing a resurgence of interest as researchers attempt to understand its mechanisms of action and better define its clinical efficacy. This paper briefly reviews its current status with respect to the treatment of mood disorders, and argues that its prominent positioning in clinical practice guidelines worldwide is absolutely justified.

Psychology of Craving

Craving is a complex psychological condition characterized by impaired dietary intake, sleep disturbance, sexual dysfunction, and drug abuse. Craving may be associated with risk-taking reckless behavior to seek pleasure including cigarette smoking, binge alcohol drinking, and illicit drug abuse (e.g. cocaine, methamphetamine, methylene deoxy meth-amphetamine (MDMA), ecstasy, morphine and heroine). Craving for food, sex and drugs involves the limbic system and prefrontal cortex. Thus, basic understanding of craving is exceedingly important for the better clinical management of major depression, hopelessness, and poor quality of life among young adolescents, as well as morbidity and early mortality among adults. Physical, psychological, nutritional, and medical rehabilitation may be helpful in the effective clinical management of patients with craving of any age, sex and race. Further studies on the psychology of craving will curb the number of hospital admissions as several victims of drug craving develop schizophrenia later in their life, if they remain untreated.

Evaluation of efficacy of fluoxetine in the management of major depression and arthritis in patients of Rheumatoid Arthritis

BackgroundPatients with chronic pain suffer significant reduction in physical, psychological, and social well-being. Anxiety and depressive disorders occur in 20%–25% of patients with Rheumatoid Arthritis (RA). Antidepressants are useful in the treatment of major depression, however the analgesic properties of this class of drugs is not clear. ObjectiveTo study the association between RA and depression along with independent effect of fluoxetine on depression and arthritis. MethodOne hundred women attending a rheumatology clinic with RA were included in the study along with controls. Hospital Anxiety Depression Rating Scale (HADS), Montgomery–Asberg Depression Rating Scale (MADRS) and Clinical Global Impression – Change Scale (CGI) were applied. Both the groups were treated with DMARD. RA with depression group also received fluoxetine. ResultsDepression is significantly associated with RA; however severity of RA has no relationship with severity of depression. Treatment outcome was better and earlier with add on fluoxetine in the RA with depression group as compared to RA without depression. ConclusionTreatment of associated depression may expedite the recovery of physical symptoms thus improving the quality of life of an individual with chronic painful conditions.