DepressionPub Date : 2019-10-01DOI: 10.1093/med/9780190929565.003.0021
E. Collins, Z. Segal
{"title":"Therapeutic Mindfulness and Depression","authors":"E. Collins, Z. Segal","doi":"10.1093/med/9780190929565.003.0021","DOIUrl":"https://doi.org/10.1093/med/9780190929565.003.0021","url":null,"abstract":"There is growing interest in mindfulness as a therapeutic intervention for a variety of physical and mental health conditions, including depression. A major contribution has been the growing evidence base of mindfulness-based cognitive therapy (MBCT) for prevention of depressive relapse in those with recurrent unipolar depression, as well as MBCT’s application to other mood disorders, special populations, and mental diagnoses. In addition, other mindfulness-based interventions, including mindfulness-based stress reduction (MBSR), dialectical behavioral therapy, acceptance and commitment therapy, and mindfully informed psychotherapies, are being used to target depression in both groups and individuals. This chapter explores the various applications of mindfulness for depression; its growing evidence base, with emphasis on systematic reviews, meta-analyses, and inclusion in treatment guidelines; its putative mechanisms of action and potential mediators and moderators; and future directions.","PeriodicalId":11179,"journal":{"name":"Depression","volume":"39 6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73202262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
DepressionPub Date : 2019-10-01DOI: 10.1093/med/9780190929565.003.0015
M. Fava
{"title":"Pharmacological Strategies for Targeting Residual Symptoms in Depression","authors":"M. Fava","doi":"10.1093/med/9780190929565.003.0015","DOIUrl":"https://doi.org/10.1093/med/9780190929565.003.0015","url":null,"abstract":"Achieving full symptom remission in major depressive disorder (MDD) should be the ultimate objective in the treatment of depressed patients. However, antidepressant monotherapies have shown to have limited efficacy in the treatment of MDD, as evidenced by the relatively high rate of residual symptoms even among responders to antidepressant treatments. These symptoms, which include anxiety, irritability, insomnia, somnolence/fatigue, apathy, and cognitive and executive dysfunction, are associated with an increased risk of relapse and poor psychosocial functioning. Comprehensive clinical data are not yet available to guide management of these symptoms—whether residual or drug-related—in patients treated pharmacologically for depressive disorders. Suggested approaches to the management of residual symptoms include addressing treatment-emergent side effects and comorbid conditions, optimizing antidepressant dosing, and using augmentation therapies. In this chapter, we will review how best to assess residual symptoms and some of the preferred pharmacological strategies to address them.","PeriodicalId":11179,"journal":{"name":"Depression","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88363452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
DepressionPub Date : 2019-10-01DOI: 10.1093/med/9780190929565.003.0018
D. Hellerstein, Alexander Kane
{"title":"Psychodynamic and Supportive Psychotherapy","authors":"D. Hellerstein, Alexander Kane","doi":"10.1093/med/9780190929565.003.0018","DOIUrl":"https://doi.org/10.1093/med/9780190929565.003.0018","url":null,"abstract":"Patients with mood disorders often can benefit from psychotherapy, whether as a primary treatment for depression or as an adjunct to medications or other biological treatments. Today, therapeutic approaches such as cognitive–behavioral therapy and interpersonal therapy are commonly thought of as first-line evidence-based treatments of depression, yet there is also evidence that psychodynamic psychotherapy (PDT) and supportive psychotherapy (SPT) can be effective treatments of depression. Both PDT and SPT are commonly used in clinical practice, by a wide range of clinicians and in many different settings. This chapter describes the theoretical background of each of these therapies, therapeutic techniques, how they can be adapted for treatment of depression, and patient populations for which they may be indicated.","PeriodicalId":11179,"journal":{"name":"Depression","volume":"30 3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76667975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
DepressionPub Date : 2019-10-01DOI: 10.1093/med/9780190929565.003.0014
R. Mago
{"title":"Management of Side Effects of Antidepressant Medications","authors":"R. Mago","doi":"10.1093/med/9780190929565.003.0014","DOIUrl":"https://doi.org/10.1093/med/9780190929565.003.0014","url":null,"abstract":"Side effects of antidepressants are common, distressing, and impairing. They have a substantial effect on nonadherence to antidepressants, which is very common. Greater attention to learning about various strategies for preventing, reducing, and managing side effects may have a significant effect in improving the outcomes of treatment with antidepressants. Attention needs to be paid to both common, “nuisance” side effects and the uncommon or rare “medically serious” side effects. This chapter provides examples of both categories. While nuisance side effects may seem unimportant, in fact, they have a considerable impact on nonadherence. On the other hand, while medically serious side effects may be seen as uncommon or even rare, they can lead to serious consequences. In particular, clinicians who often treat patients who are at high risk of such medically serious side effects need to be thoroughly familiar with them. Clinicians who prescribe antidepressant medications are urged to have a menu of options for the management of side effects, ranging from simple, benign interventions to more active interventions that may carry risks of their own. The latter are often needed in situations where continuing that particular antidepressant, or type of antidepressant, is essential and stopping or changing it is not a reasonable option. In such situations, risk/benefit considerations require that the side effect be actively treated to allow the patient to stay on the medication. This chapter provides many examples of both simple and more active interventions for a variety of potential side effects of antidepressants.","PeriodicalId":11179,"journal":{"name":"Depression","volume":"58 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76061133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
DepressionPub Date : 2019-10-01DOI: 10.1093/med/9780190929565.003.0005
Bharathi S. Gadad, M. Jha, M. Trivedi
{"title":"Biomarkers Predicting Antidepressant Treatment Response","authors":"Bharathi S. Gadad, M. Jha, M. Trivedi","doi":"10.1093/med/9780190929565.003.0005","DOIUrl":"https://doi.org/10.1093/med/9780190929565.003.0005","url":null,"abstract":"In clinical practice, patients do not always experience symptomatic remission or treatment response, even after trying various types of antidepressant medications. To improve outcomes and reduce attrition and nonadherence, there is a great need for personalized treatment of major depression. Hence, recent research efforts have focused on the identification of biological markers (or biomarkers) that can predict whether an individual patient will respond to the commonly used antidepressants. In this chapter, we review the biomarkers associated with antidepressant treatment response with particular attention to genetic, proteomic, metabolomic, transcriptomic, epigenetic biological, and biochemical markers. Although the “omics” approach holds great promise for the future, challenges and roadblocks for future research will need to be addressed.","PeriodicalId":11179,"journal":{"name":"Depression","volume":"54 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76306321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
DepressionPub Date : 2019-10-01DOI: 10.1093/med/9780190929565.003.0019
John P Coetzee, N. Williams
{"title":"Neuromodulation for Depression","authors":"John P Coetzee, N. Williams","doi":"10.1093/med/9780190929565.003.0019","DOIUrl":"https://doi.org/10.1093/med/9780190929565.003.0019","url":null,"abstract":"Neuromodulation (also known as neurostimulation) is a growing and important category of treatments for depression. First-line treatments such as pharmacotherapy and counseling often fail to achieve remission, and neuromodulation can help many such patients. Neuromodulatory techniques can be broadly divided into invasive approaches, which include deep brain stimulation, epidural cortical stimulation, and vagal nerve stimulation, and noninvasive approaches, which include electroconvulsive therapy, transcranial magnetic stimulation, theta burst stimulation, and transcranial direct-current stimulation, among others. While efficacy varies among techniques, those with the most efficacy tend to be those that target nodes of a proposed tripartate functional connected circuit that includes left dorsolateral prefrontal cortex, subgenual anterior cingulate cortex, and vagus nerve. Treatments currently being developed that hold promise include accelerated intermittent theta burst stimulation and low-intensity focused ultrasound pulsation.","PeriodicalId":11179,"journal":{"name":"Depression","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73439302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
DepressionPub Date : 2019-10-01DOI: 10.1093/med/9780190929565.003.0024
Andrew Diederich, Jessica M. Jones, G. Emslie
{"title":"Child and Adolescent Depression","authors":"Andrew Diederich, Jessica M. Jones, G. Emslie","doi":"10.1093/med/9780190929565.003.0024","DOIUrl":"https://doi.org/10.1093/med/9780190929565.003.0024","url":null,"abstract":"Early onset depression is prevalent and causes significant morbidity, mortality, and psychosocial impairment. Evidence-based psychosocial and psychopharmacological treatments are available for depressed youth, but many children and adolescents do not receive sufficient treatment. Pediatric and adult depressive disorders involve essentially the same symptoms, with the exception of irritability, as depressed youth may present with irritable mood in the absence of explicit sadness. This chapter examines aspects of depression that are unique to children and adolescents. It focuses on diagnosis and symptomatology, epidemiology, and pharmacological, psychotherapeutic, and other treatments. The chapter also addresses barriers to treatment of early onset depression and future research directions.","PeriodicalId":11179,"journal":{"name":"Depression","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77355366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
DepressionPub Date : 2019-10-01DOI: 10.1093/med/9780190929565.003.0010
S. Perry, Ma-Li Wong, J. Licinio
{"title":"General Medical Conditions","authors":"S. Perry, Ma-Li Wong, J. Licinio","doi":"10.1093/med/9780190929565.003.0010","DOIUrl":"https://doi.org/10.1093/med/9780190929565.003.0010","url":null,"abstract":"Our appreciation and understanding of the interrelationships between disrupted metabolic function and psychiatric disease, depression in particular, have increased significantly over the last few decades. Several broad-scale pathophysiologic mechanisms implicated in both disease areas include inflammation, cytokine and hypothalamic–pituitary–adrenal (HPA) axis dysregulation, oxidative stress, neurotransmitter disruptions, neurogenesis and neuroplasticity, and the microbiome. This chapter will explore these mechanistic overlaps of depression with metabolic disorders, defined broadly to include obesity, diabetes, and cardiovascular disease. The different components of metabolic syndrome will be discussed within this framework. We will touch briefly on relationships between the numerous yet rare inherited metabolic disorders and depression. We will conclude with a discussion of integrated therapeutic strategies for treating depression comorbid with metabolic disease.","PeriodicalId":11179,"journal":{"name":"Depression","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90383752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
DepressionPub Date : 2019-10-01DOI: 10.1093/med/9780190929565.003.0022
B. Mason, A. Czysz
{"title":"Probiotics and Nutraceuticals","authors":"B. Mason, A. Czysz","doi":"10.1093/med/9780190929565.003.0022","DOIUrl":"https://doi.org/10.1093/med/9780190929565.003.0022","url":null,"abstract":"The field of nutritional psychiatry seeks to expand our understanding of how diet and nutrition influences the risk for psychiatric disorders, including depression. Improved knowledge about these relationships will provide new insights to guide the prevention and treatment of depression. A number of different methodologies trying to quantify how diet, nutrition, and dietary elements may affect mood and the risk for developing depression are detailed in this chapter, including naturalistic studies of diet, specific analysis of dietary elements, and clinical trials using dietary elements as treatments. Dietary elements that are commonly taken used as supplements but are suggested to function in some ways like medication are referred to as nutraceuticals. Those with reasonable support for their use in depression are detailed here, including omega-3 fatty acids. Continued examination of the role of the gut microbiota provides new avenues for treatment development and a deeper understanding of the physiology that underlies depression. Importantly, the gut microbiota is responsive to diet, taking what we eat and turning it into other products, and these byproducts are thought to have an important role in mood regulation. Thus, cultivation or supplementation of important bacterial groups by dietary modulation or probiotics may be new tools for improving depressive symptoms. This chapter will provide a broad perspective on the knowledge of how nutrition influences depression and some emerging probiotic and nutraceutical treatment strategies.","PeriodicalId":11179,"journal":{"name":"Depression","volume":"122 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78446506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
DepressionPub Date : 2019-10-01DOI: 10.1093/med/9780190929565.003.0009
Patricia D Pilkinton, L. Davis
{"title":"General Medical Conditions","authors":"Patricia D Pilkinton, L. Davis","doi":"10.1093/med/9780190929565.003.0009","DOIUrl":"https://doi.org/10.1093/med/9780190929565.003.0009","url":null,"abstract":"The differential diagnosis of major depressive disorder should include a comprehensive evaluation of past and current medical disorders. Comorbid medical conditions and/or their treatments can be a root cause or a contributor to the depressive episode. Conversely, symptoms of depression can exacerbate or mimic a medical condition. This chapter reviews cardiovascular, pulmonary, endocrine, gastrointestinal, hepatic, immunologic, dermatologic, and neurologic medical conditions that can mimic or exacerbate depression, as well as cancer and pain. Suggestions for treatment and management of depression are provided for each major organ system, as well as medications that have possible depression as a side effect. Untreated depression in patients with general medical conditions is a modifiable risk factor for poor medical outcomes.","PeriodicalId":11179,"journal":{"name":"Depression","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75569508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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