DepressionPub Date : 2019-10-01DOI: 10.1093/med/9780190929565.003.0008
Jennifer L. Hughes
{"title":"Primer on Depression","authors":"Jennifer L. Hughes","doi":"10.1093/med/9780190929565.003.0008","DOIUrl":"https://doi.org/10.1093/med/9780190929565.003.0008","url":null,"abstract":"Suicide is a public health problem worldwide and one of the leading causes of death in the United States. Suicidal behavior is also a major public health concern, with more than 1 million people per year attempting suicide in the United States. Suicide is a complex phenomenon, occurring because of a convergence of genetic, environmental, psychological, social, cultural, and systemic risk and protective factors. As such, suicide prevention efforts must include interventions across the spectrum of society, from healthcare to school to public health and community efforts. This chapter reviews the risk and protective factors related to suicide; research findings about the mechanisms and functions of suicidal behavior; principles of crisis intervention; treatments to address suicidal behavior; an overview of suicide risk and treatment in special populations, including youth, geriatric, and sexual and gender minority populations; and an overview of postvention efforts.","PeriodicalId":11179,"journal":{"name":"Depression","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85445032","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/9780190929565.003.0013
B. Kadriu, Subha Subramanian, Z. Deng, I. Henter, Lawrence T. Park, C. Zarate
{"title":"Rapid-Acting Antidepressants","authors":"B. Kadriu, Subha Subramanian, Z. Deng, I. Henter, Lawrence T. Park, C. Zarate","doi":"10.1093/med/9780190929565.003.0013","DOIUrl":"https://doi.org/10.1093/med/9780190929565.003.0013","url":null,"abstract":"Major depressive disorder (MDD) is a highly prevalent and debilitating illness and closely linked to suicide risk. Currently available antidepressants take weeks to work and have low remission rates; indeed, about a third of individuals with MDD fail to fully remit in response to these agents. Novel therapies that target the glutamatergic system, such as ketamine, offer rapid antidepressant effects as well as high remission rates, making them attractive therapeutic options. This chapter reviews the evidence for the antidepressant efficacy of several novel therapeutics (ketamine, esketamine, nitrous oxide, scopolamine, GLYX-13, and buprenorphine) as well as interventional techniques such as sleep deprivation. Notably, ketamine and esketamine also rapidly reduce suicidal thoughts, making them attractive solutions in an emergency setting. Because studying the rapid onset of antidepressant effects associated with these agents has also improved our understanding of the neurocircuitry and neural signaling systems underlying MDD, some pivotal drug trials using rodents, neuroimaging, and electrophysiological studies are also reviewed.","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":"83401338","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/9780190929565.003.0025
H. Oughli, J. Karp, E. Lenze
{"title":"Depression in Older Adults","authors":"H. Oughli, J. Karp, E. Lenze","doi":"10.1093/med/9780190929565.003.0025","DOIUrl":"https://doi.org/10.1093/med/9780190929565.003.0025","url":null,"abstract":"Late-life depression (LLD) is relatively common in older adults. It is associated with deleterious health outcomes, exacerbates frailty and functional decline, and contributes to all-cause mortality. LLD tends to have a chronic course, with frequent recurrences and relapses. This chapter reviews the clinical presentation, assessment, and etiologies of LLD. The chapter also focuses on therapeutic targets of LLD, which include pharmacotherapy, neurostimulation, and psychosocial treatment. An antidepressant treatment algorithm based on a summary of current data, clinical evidence and expert opinion is included to help guide physicians. Additionally, psychotropic medications with novel mechanisms of action are discussed with some directions for further research.","PeriodicalId":11179,"journal":{"name":"Depression","volume":"87 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79418258","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/9780190929565.003.0016
S. Hollon
{"title":"Cognitive Behavior Therapy","authors":"S. Hollon","doi":"10.1093/med/9780190929565.003.0016","DOIUrl":"https://doi.org/10.1093/med/9780190929565.003.0016","url":null,"abstract":"Cognitive behavior therapy can be as efficacious as antidepressant medications when adequately implemented, and it has an enduring effect that lasts beyond the end of treatment. Adding medications to cognitive behavior therapy makes it more efficacious still in terms of acute response but may interfere with its enduring effects. Some patients respond better to one modality or the other, and selection algorithms are being developed based on machine learning that can find the best treatment for a given patient (precision medicine). Treatment with uncomplicated patients who are just depressed is relatively straightforward and brief, but the approach can be expanded to deal with patients with more chronic and characterological depressions, although it can take considerably longer.","PeriodicalId":11179,"journal":{"name":"Depression","volume":"84 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90421133","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/9780190929565.003.0007
S. D. da Costa, M. Sanches, J. Soares
{"title":"Bipolar Disorder","authors":"S. D. da Costa, M. Sanches, J. Soares","doi":"10.1093/med/9780190929565.003.0007","DOIUrl":"https://doi.org/10.1093/med/9780190929565.003.0007","url":null,"abstract":"Bipolar disorder (BD) is a complex and severe mental illness, associated with substantial morbidity and increased mortality. Depressive symptoms frequently prevail in the course of illness, and significant morbidity arises from acute affective episodes and subacute states. Phenotypically, unipolar and bipolar depression seem to share several clinical features, which leads to an average delay of 10 years between initial symptoms and the diagnosis of BD. Multidimensional approaches have been proposed to better predict BD in at-risk populations; however, the differential diagnosis between these two entities remains a clinical challenge. Similarly to other chronic conditions, it has been proposed that BD is also a progressive disorder, where multiple affective episodes may result in structural, functional, and neurobiological brain abnormalities that accelerate illness progression, with subsequent treatment resistance and reduction in interepisode interval. Therefore, strategies to improve diagnosis accuracy are pivotal to improve clinical outcomes and long-term prognosis in the course of BD. In this chapter, we aim to provide a critical overview of psychopathological, sociodemographic, and neurobiological features to help clinicians properly distinguish unipolar and bipolar depression. Pathological and therapeutic implications of misdiagnosing BD are briefly discussed.","PeriodicalId":11179,"journal":{"name":"Depression","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88926269","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/9780190929565.003.0012
Naji C Salloum, G. Papakostas
{"title":"Primer on Depression","authors":"Naji C Salloum, G. Papakostas","doi":"10.1093/med/9780190929565.003.0012","DOIUrl":"https://doi.org/10.1093/med/9780190929565.003.0012","url":null,"abstract":"Several first-line antidepressant therapies are currently available for the treatment of major depressive disorder (MDD), but in most patients depression fail to remits after an initial medication trial. In this chapter, we explore the evidence for different augmentation strategies used to enhance the response from an initial antidepressant monotherapy. Atypical antipsychotics, several of which are now approved by the US Food and Drug Administration as adjunctive agents for the treatment of MDD, and lithium are among the most evidence-based augmentation pharmacotherapies. Other therapies, such as bupropion, mirtazapine, triiodothyronine, nutraceuticals, and psychotherapy, are also commonly used. Additionally, several investigational drugs, including ketamine, esketamine, and ALKS 5461, with novel mechanisms of action, show promise.","PeriodicalId":11179,"journal":{"name":"Depression","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81586336","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/9780190929565.003.0017
Brett J Davis, S. Dufour, Jessica A. Janos, L. Sylvia
{"title":"Behavioral Activation for Depression","authors":"Brett J Davis, S. Dufour, Jessica A. Janos, L. Sylvia","doi":"10.1093/med/9780190929565.003.0017","DOIUrl":"https://doi.org/10.1093/med/9780190929565.003.0017","url":null,"abstract":"Behavioral activation (BA) is an empirically based psychotherapy for depression that improves symptoms by increasing a client’s contact with sources of positive reinforcement by making behavioral changes. Core aspects of BA approaches include performance and monitoring of scheduled activities that are selected based on a client’s values or specific depressive behaviors. To address individual and environmental barriers to activation, many BA treatment manuals also include additional components such as mindfulness techniques, social skills training, and contingency management strategies. Evidence supports the effectiveness of BA for treating depression, and researchers have found it to be as effective as many standard treatments for depression, including pharmacotherapy, cognitive therapy, and cognitive–behavioral therapy. Future directions are discussed, such as the application of BA to special populations and settings, including for groups, remote delivery, and specific subpopulations.","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":"89739908","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 : 2019-09-23DOI: 10.2307/j.ctt9qgqhf.9
Emma Wisniewski
{"title":"Going Down","authors":"Emma Wisniewski","doi":"10.2307/j.ctt9qgqhf.9","DOIUrl":"https://doi.org/10.2307/j.ctt9qgqhf.9","url":null,"abstract":"In “The Dogma of Gender,” Patricia Berry explores the pleasures and restrictions of gender categories, and the comparatively confused “polymorphous” state of the “pre-gender” realm—the eroticism that exists in early childhood before we have learned our gender roles (39). Berry posits that primal sexual feeling comes with an attendant sense of inferiority. Gender is constructed to protect us from this feeling, and the pre-gender realm, from which the feeling arises, is labeled dark, chaotic, and dangerous. And yet, Berry finds that this realm is constantly seeking to “work on” itself, “defining, refining and recombining its pleasures” (51). She concludes that “the polymorphous underrealm has form and logos within it”—that it is not dark and chaotic as we fear but in fact has its own structure, and even its own light (50). She suggests that we cannot remain like Pentheus of The Bacchae, “superior to it all, looking down”: if we don’t dive deep sometimes, we may end up trapped within the “dogma” she speaks of (51). Indeed, diving deep may create the power to set us free.","PeriodicalId":11179,"journal":{"name":"Depression","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82290307","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 : 1996-01-01DOI: 10.1002/(SICI)1522-7162(1996)4:2<81::AID-DEPR8>3.0.CO;2-I
Michael C. Gemar Ph.D., Shitij Kapur M.D., F.R.C.P.(C), Zindel V. Segal Ph.D., Gregory M. Brown M.D., Ph.D., F.R.C.P.(C), Sylvain Houle M.D., Ph.D., F.R.C.P.(C)
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