Natural Solution for Depression Found

Destroy Depression

Destroy Depression is written by James Gordon, a former sufferer of depression from the United Kingdom who was unhappy with the treatment he was being given by medical personnell to fight his illness. Apparently, he stopped All of his medication one day and began to search for answers on how to cure himself of depression in a 100% natural way. He spent every waking hour researching all he could on the subject, making notes and changing things along the way until he had totally cured his depression. Three years later, he put all of his findings into an eBook and the Destroy Depression System was born. The Destroy Depression System is a comprehensive system that will guide you to overcome your depression and to prevent it from injuring you mentally and physically. Read more...

Destroy Depression Summary


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Geriatric Depressed Patients

Interpersonal therapy was initially used as an addition to a pharmacotherapy trial of geriatric patients with major depression to enhance compliance and to provide some treatment for the placebo control group (Rothblum et al., 1982 Sholomskas et al., 1983). Investigators noted that grief and role transition specific to life changes were the prime interpersonal treatment foci. These researchers suggested modifying IPT to include more flexible duration of sessions, more use of practical advice and support (for example, arranging transportation, calling physicians) and recognizing that major role changes (such as divorce at age 75) may be impractical and detrimental. The six-week trial compared standard IPT to nortriptyline in 30 geriatric depressed patients. Results showed some advantages for IPT, largely due to higher attrition from side effects in the medication group (Sloane, Stapes & Schneider, 1985). Reynolds et al. (1999) conducted a three-year maintenance study for geriatric...

Depressive illness and mania

Mood disorders (affective disorders) include depressive illness and mania. These are episodic conditions, occurring only once or twice in a lifetime for some patients but recurring at frequent intervals for others, usually with good recovery between episodes. Unipolar affective disorder single or recurrent depressive episode(s), without manic ones. This forms the vast majority of patients with affective disorders.

Conjoint IPT for Depressed Patients with Marital Disputes IPTCM

It is well established that marital conflict, separation and divorce can precipitate or complicate depressive episodes (Rounsaville et al., 1979). Some clinicians have feared that individual psychotherapy for depressed patients in marital disputes can lead to premature rupture of marriages (Gurman & Kniskern, 1978). To test and address these concerns, Klerman and Weissman developed an IPT manual for conjoint therapy of depressed patients with marital disputes (Klerman & Weissman, 1993). Both spouses participate in all sessions and treatment focuses on the current marital dispute. Eighteen patients with major depression linked to the onset or exacerbation of marital disputes were randomly assigned to 16 weeks of either individual IPT or IPT-CM. Patients in both treatments showed similar improvement in depressive symptoms but patients receiving IPT-CM reported significantly better marital adjustment, marital affection and sexual relations than did individual IPT patients (Foley et...

Classification of depressive illness in the ICD

Two or three of the above symptoms are usually present. The patient is usually distressed by these but will probably be able to continue with most activities. F32.1 Moderate depressive episode. Four or more of the above symptoms are usually present and the patient is likely to have great difficulty in continuing with ordinary activities. F32.2 Severe depressive episode without psychotic symptoms. An episode of depression in which several of the above symptoms are marked and distressing, typically loss of self-esteem and ideas of worthlessness or guilt. Suicidal thoughts and acts are common and a number of 'somatic' symptoms are usually present. There are obvious problems with the practical use of ICD in daily clinical psychiatry, however. For example, there is no minimum time period. If one takes the description literally, a person who has a brief episode of, say, 'decrease in activity . . . and . . . marked tiredness after even minimum effort', and who...

Diagnosis of depressive illness

Most episodes of depression are brief and mild, and are dealt with by the patient's own resources, or by talking with a relative or friend. Of those patients who do present for help, the vast majority are dealt with in primary care. The diagnosis of depressive illness in clinical settings will have some regard to the official classifications set out above. However, clinical training and experience also comes into play. Mild reactions to difficulties experienced in life may not in practice be diagnosed as clinical depression. The clinician should look for features such as biological symptoms of depression, anhedonia, and guilt before entertaining the diagnosis. Depressed mood which seems unduly severe or prolonged in relation to its apparent precipitant, the presence of somatic symptoms, and prominent guilt, pessimism, anhedonia, suicidal thinking, and low self-esteem, all suggest depressive illness.

Mood Disorders A Major Depressive Disorder

In some cultures, symptoms of depression are not generally recognized as a case for mental disorders. In addition, symptoms of depression might be presented in somatic terms rather than sadness or guilt (Castillo, 1997). For example, among Latin American and Mediterranean cultures depressive experiences might be manifested in terms of complaints of nerves and headaches Asians may show similar experiences in terms of weakness, tiredness, or imbalance, whereas among people from the Middle East and American Indian tribes these experiences might be shown in terms of difficulties with the heart or being Heartbroken, respectively (see DSM-IV, 1994, pp. 324-325). The severity of the depression might also be evaluated differently across cultures (e.g., sadness may lead to less concern than irritability in some cultures). Hallucinations and delusions, which are sometimes part of Major Depressive Disorder, should be differentiated from cultural hallucinations and delusions (e.g., fear of being...

Antidepressant medication

The initial choice of an antidepressant depends on the age and sex of the patient, prior response to medication, safety in overdosage and the sideeffect profile. All antidepressants are equally efficacious. The tricyclics and tetracyclics have been the first-line drugs but the newer drugs, the selective serotonin reuptake inhibitors and moclobemide (a reversible monoamine oxidase inhibitor (MAOI) antidepressant) are equally effective, are better tolerated, have a wider safety margin 6 and are now considered first-line drugs.

Depression and depressive disorders

Depression or depressive disorders (unipolar depression) are mental illnesses characterized by a profound and persistent feeling of sadness or despair and or a loss of interest in things that were once pleasurable. Disturbance in sleep, appetite, and mental processes are a common accompaniment. Everyone experiences feelings of unhappiness and sadness occasionally. But when these depressed feelings start to dominate everyday life and cause physical and mental deterioration, they become what are known as depressive disorders. Each year in the United States, depressive disorders affect an estimated 17 million people at an approximate annual direct and indirect cost of 53 billion. One in four women is likely to experience an episode of severe depression in her lifetime, with a 10-20 lifetime prevalence, compared to 5-10 for men. The average age a first depressive episode occurs is in the mid-20s, although the disorder strikes all age groups indiscriminately, from children to the elderly....

Pharmacologic Treatments Antidepressants

Many of the treatment studies of depression in dementia are difficult to compare given varying diagnostic categories (symptoms vs. depressive syndromes) and types of studies performed (case reports, case series, chart reviews, open trials). Results of the four placebo-controlled outcome trials of antidepressants in patients with AD who met criteria for major depression are shown in Table 10.3. concern that the tricyclic antidepressants (TCAs) increase vulnerability to anticholinergic effects, including cognitive decrements, by blocking brain muscarinic cholinergic receptors. TCAs have been noted to cause cognitive changes with even low doses (such as imipramine 25 mg day) in depressed AD patients (Teri, 1991). Although the SSRIs are not free of side effects, anticholinergic effects are considerably less problematic. As shown in Table 10.3, only one placebo-controlled trial has addressed the use of an SSRI in major depression in dementia this trial found significantly greater...

Antidepressants SSRI group

Their prescription to child patients however, has become very controversial, because of lack of evidence of effectiveness in this patient group, and also concern over increased suicide risk. Recent NICE guidance is that 'antidepressant medication should not be used for the initial treatment of children and young people with mild depression' even in moderate to severe depression the place of medication is given as 'brief psychological therapy + - fluoxetine' (http www.nice. On the face of it, there seems to be some discrepancy between this and the NICE guidance for adults 'When an antidepressant is to be prescribed in routine care, it should be a selective serotonin reuptake inhibitor (SSRI)' (http www. However, NICE is really preaching to the choir on this. SSRIs have been vigorously promoted, and have been commercially successful. Many GPs use them as first-line treatment for depressive illness, on the basis of claimed therapeutic advantages that have not always stood up to critical...

Acute Treatment of Major Depression

The first acute study of IPT was a four-cell, 16-week randomized trial comparing IPT, amitriptyline (AMI), combined IPT and AMI, and a non-scheduled control treatment for 81 outpatients with major depression (DiMascio etal., 1979 Weissman etal., 1979). Amitripty-line more rapidly alleviated symptoms, but at treatment completion there was no significant difference between IPT and AMI in symptom reduction. Each reduced symptoms more efficaciously than the control condition, and combined AMI-IPT was more efficacious than either active monotherapy. One-year follow-up found that many patients remained improved after the brief IPT intervention. Moreover, IPT patients had developed significantly better psychosocial functioning at one year, whether or not they received medication. This effect on social function was not found for AMI alone, nor was it evident for IPT immediately after the 16-week trial (Weissman et al., 1981). The ambitious, multi-site National Institute of Mental Health...

Schizophrenia bipolar disorder and major depressive disorder

All three major psychiatric disorders, schizophrenia, bipolar disorder (BP) and major depressive disorder (MDD) affect brain cytoarchitecture. Along with numerous histopathological signals of neuronal malfunction (e.g. reduction in neuronal size, dendritic length and dendritic spines density), these diseases also affect glial cells. There are some indications for loss of astrocytes and GFAP expression in schizophrenia, BP and MDD. In BP and MDD, significant decreases in the numbers and volume of astroglial cells were detected in prefrontal and


The reported frequency of depression in DLB varies between 30 and 50 . Rates may be slightly less frequent when Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV American Psychiatric Association, 1994) criteria for major depression are used and slightly higher if only depressive symptoms are assessed. The literature is also conflicting as to whether depression is more or less common in DLB when compared to AD or PD. Randomized, placebo-controlled trials comparing the various classes of antidepressants in DLB are limited. While depression is a well-recognized feature of DLB, appropriate treatment is not well studied. The severity of the cholinergic deficit in DLB should make the family of tricyclic antide-pressants (TCAs) a less than optimal choice because of their anticholinergic side effects. The selective serotonin reuptake inhibitors (SSRIs) and the multireceptor antidepressants venlafaxine, mirtazapine, and trazodone may be a better choice when efficacy...

Principle 3 Treatment Interventions Should Be Based on Conceptual Frameworks and Tested Empirically to Determine

Behavioral and psychosocial interventions with persons with dementia and with family and professional caregivers are based on the conviction that persons with dementia, similar to those with any chronic disease, can have an improved quality of life. Because dementia attacks both cognitive and noncognitive aspects of functioning, interventions are geared to both. Learning theory and cognitive-behavioral theory are the underpinnings of many successful interventions with persons with dementia. Learning theory has been applied to cases of dementia, demonstrating how best to maximize cognitive abilities, use whatever cognitive strengths remain, and integrate all of this into daily life. Behavioral theory has been applied to the understanding of mood and depressive disorders in those with dementia demonstrating clinical effectiveness in reducing depressive symptoms. Each of these interventions has as its aim to affect the patient's behavior and to improve the psychosocial and physical...

Adjustment disorder

People with chronic physical illnesses appear to have an increased risk of developing adjustment disorders, particularly one with depressed mood. This connection has been demonstrated among cancer patients. The relationship between chronic pain (as is commonly experienced by cancer patients) and depressive symptoms is still being studied.

Alcohol and related disorders

Alcoholism is defined as alcohol seeking and consumption behavior that is harmful. Long-term and uncontrollable harmful consumption can cause alcohol-related disorders that include antisocial personality disorder, mood disorders (bipolar and major depression) and anxiety disorders.

Mental Illness and Substance Abuse

The prevalence of serious mental illness and substance abuse is high among homeless persons. In a nationwide U.S. survey of homeless people, 39 had mental health problems, 50 had an alcohol and or drug problem, and 23 had concurrent mental health and substance use problems (Burt, 2001). Common psychiatric diagnoses among homeless people include major depression, bipolar disorder, schizophrenia, and personality disorders. A systematic review of the prevalence of schizophrenia in homeless persons found rates ranging from 4 to 16 and a weighted average of 11 in the ten methodologically strongest studies (Folsom and Jeste, 2002). Characteristics associated with a higher prevalence of schizophrenia were younger age, female sex, and chronic homelessness. Marked cross-national variation is seen in the prevalence of schizophrenia, with prevalence rates of 23-46 reported among homeless people in Sydney, Australia (Teesson, et al., 2004).

Historical background

Psychiatry goes through phases in which one or other of these various physical, social, or psychological models is regarded as most influential in psychiatric causation generally. In the early and mid-twentieth century, the psychological theories stemming from psychoanalysis (Freud) were dominant, especially in the USA. Later, 'biological' psychiatry was dominant, following the discovery - all in the 1950s - of effective mood stabilizers, antidepressants, and antipsychotic drugs.

Examples Of The Evidence Base

One of the most famous and most expensive therapy outcome studies was the National Institute of Mental Health (NIMH) Treatment of Depression Collaborative Research Program, which will be considered in order to illustrate the problems that have arisen from the general failure to find differential effectiveness of therapy outcome (see Elkin et al., 1989 Elkin, 1994) but also to illustrate other issues about the evidence base. This trial was the largest of its kind ever carried out. There were 28 therapists working at three sites eight therapists were cognitive-behavioural, 10 were interpersonal therapists, and a further 10 psychiatrists managed two pharmacotherapy conditions, one being imipramine plus 'clinical management', the second being placebo plus 'clinical management'. Two-hundred-and-fifty patients meeting the criteria for major depressive disorder were randomly allocated between the four conditions. The therapies were manualised and considerable training and supervision...

Prevention of psychiatric disorder

The value of early detection of relapse in existing patients is not in dispute. Education of patients and carers is vital. When education extends to organized campaigns directed at other health professionals and the general public, however (as in the Royal College of Psychiatrists' recent 'Defeat Depression' campaign), it becomes more controversial. It is clearly in the interests of the drug companies who tend to pay for such campaigns that diagnosis of depression should be increased. Increased prescription of antidepressant medication will then follow. However, there is a danger of medicalizing normal states of distress.

Combination Therapy A Brief Relevant History

During the 1970s, psychiatrists and psychoanalysts argued, with analysts insisting that psycho-pharmaceuticals interfered with analysis. Today, mainstream psychiatry is characterized by a CT of psychotherapy and psychopharmacology. In the 1990s, psychiatrists finally integrated SSRIs synergistically with cognitive-behavior therapy to treat depression. Indeed such a model, frequently practiced in modified form by PCPs, probably dominates the treatment of depression today. There is an emerging literature demonstrating the benefit of combining both pharmacological and psychological treatments for a number of psychiatric conditions (24-26).

Acculturation And Clinical Manifestations Of Illness

Depression serves as an excellent example of an illness that is influenced by external factors such as contextual environment, culture, acculturation processes, and social psychological situations. Depression is also an illness definable by clinical DSM-IV criteria. As noted elsewhere in this handbook (see Panigua, chapter 8), culture shapes the manifestations of many illnesses, including those of depressive illness. It also determines the patient's explanatory model of their illness. As Seligman, (1998) points out, some explanatory models of illness have distinct prognostic values. For example, patients who tend to blame others may have a poorer prognosis than those who assume some responsibility for their condition and are willing to invest in their recovery in some meaningful way.

Uncertainty and the effects of knowledge

In a review of adult-onset disorders, Meiser et al. (2000) commented that there is limited data on the impact of testing for the hereditary cancers. One study of hereditary breast-ovarian cancer showed a reduction in depressive symptoms in non-carriers compared to carriers and those who declined testing, but carriers showed no increase in depressive symptoms (Lerman et al., 1996). Croyle et al. (1997) found that women experience significantly different levels of psychological distress following BRCA1 mutation testing as a function of their test results. Those who had never experienced cancer or surgery, and were found to carry the mutation, showed the highest distress following testing. In a study of 200 patients undergoing testing for hereditary non-polyposis colon cancer, 24 were found to have symptoms of depression. The finding was linked to being female, having less formal education and fewer social contacts. High anxiety was linked to a younger age, less formal education,...

Statistical Prediction

Scores that are not based on information that is normally used by mental health professionals. Thus, if a statistical rule makes a diagnosis of major depression, but longitudinal data reveal that the client later developed a manic episode, then we could say that this diagnosis was incorrect.

Health Issues Affecting Lgbt Populations

Sexual orientation is not intrinsically linked to mental health problems however, stigma, homophobia, and prejudice may negatively impact the mental health of LGBT individuals (Meyer, 2003). Furthermore, estrangement from family members, adjusting to a LGBT identity, lack of support for relationships and families may be additional stressors. Unfortunately, population-based estimates of prevalence of mental disorders among LGBT people are lacking (Dean, et al., 2000). The few probability based studies that have been done found higher rates of depression, panic attacks syndrome, and psychological distress among MSM (Cochran and Mays, 2000 Cochran, et al., 2003 Mills, et al., 2004), especially among those who had experienced anti-gay harassment (Mills, et al., 2004). Lesbian and bisexual women appear to have higher prevalence of general anxiety disorder compared to heterosexual women (Cochran, et al., 2003). HIV (Bing, et al., 2001 Dickey, et al., 1999) as well as the stress of caring...

Depressed HIVPositive Patients IPTHIV

Recognizing that medical illness is the kind of serious life event that might lend itself to IPT treatment, Markowitz etal. (1992) modified IPT for depressed HIV patients (IPT-HIV), emphasizing common issues among this population including concerns about illness and death, grief and role transitions. A pilot open trial found that 21 of the 24 depressed patients responded. In a 16-week controlled study, 101 subjects were randomized to IPT-HIV, CBT, supportive psychotherapy (SP), or IMI plus SP (Markowitz et al., 1998). All treatments were associated with symptom reduction but IPT and IMI-SP produced symptomatic and functional improvement significantly greater than CBT or SP. These results recall those of more severely depressed subjects in the NIMH TDCRP study (Elkin et al., 1989). Many HIV-positive patients responding to treatment reported improvement of neurovegetative physical symptoms that they had mistakenly attributed to HIV infection.

Depressed Primary Care Patients

Patients with current major depression (n 276) were randomly assigned to IPT, nortriptyline, or primary care physicians' usual care. They received 16 weekly sessions followed by four monthly sessions of IPT (Schulberg et al., 1996). Depressive symptoms improved more rapidly with IPT or nortriptyline than in usual care. About 70 of treatment completers receiving nortriptyline or IPT recovered after eight months, compared to 20 in usual care. This study had an odd design for treatment in the United States in bringing mental health treatment into medical clinics, but might inform treatment in the United Kingdom, where a greater proportion of antidepressant treatments are delivered in primary care settings.

ATPBinding Cassette or Multidrug Resistance Genes

Various therapies in vitro 47,180 , and a number of them are in clinical trials in a variety of tumor systems 167 . In addition to modulation by inhibitors, polymorphisms in this gene have recently been identified that may affect the efficacy of some drugs such as cardiac glycosides, tricyclic antidepressants, and others, but to date there is little in the literature to suggest that these polymorphisms have a major effect on therapy resistance in cancer 181 . These studies are still somewhat limited and more work is needed to definitively determine the effects, if any, of polymorphisms in these genes 167 .

Psychologic problems

Depressive disorders contribute to more than half of all cases of CPP. Frequently, the pain becomes part of a cycle of pain, disability, and mood disturbance. The diagnostic criteria for depression include depressed mood, diminished interest in daily activities, weight loss or gain, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue, feelings of worthlessness, loss of concentration, and recurrent thoughts of death.

Antepartum Postpartum Depression

Pregnancy and the postpartum period are times of heightened depressive risk for patients who may wish to avoid pharmacotherapy. Spinelli & Endicott (2003) compared 16 weeks of IPT to a weekly parenting education control programme in a group of 38 antepartum women with major depression. Pregnancy is deemed a role transition that involves the depressed pregnant woman's self-evaluation as a parent, physiological changes of pregnancy, and altered relationships with the spouse or significant other and with other children. 'Complicated pregnancy' has been added as a fifth potential interpersonal problem area. Session timing and duration are adjusted for bed rest, delivery, obstetrical complications, and child care, and postpartum mothers may bring children to sessions. As with depressed HIV-positive patients, therapists use telephone sessions and hospital visits as necessary (Spinelli, 1997). The IPT group showed significantly greater improvement of depression than the parent education...

Socioeconomic factors

As well as long-term social difficulties, there is a well-established body of evidence indicating that patients with depression have experienced more adverse 'life events' than people without depression. These events, particularly so-called 'loss events', appear to be the precipitant of the majority of episodes of diagnosed depression. Such 'events, dear boy, events', seem to combine with the above-mentioned long-term difficulties, which include not only material poverty, but also absence of confiding relationships and family social support, to produce the depressive episode.

From Philosophy To Theory

While the concept of prototype and subtype allows the natural heterogeneity of persons to be accommodated within a classification system, there are as many ways to fulfill a given diagnosis as there are subsets of the number of diagnostic criteria required at the diagnostic threshold. For example, there are many ways to score five of a total of nine diagnostic criteria, whatever the actual syndrome. In the context of an idealized medical disease model, which Axis I approximates, the fact that two different individuals, both of whom are depressed, might possess substantially different sets of depressive symptoms is not really problematic. The symptoms may be expressed somewhat differently, but the underlying pathology process is the same and can be treated in the same way. For example, while one person gains weight and wakes early in the morning, and the other loses weight and sleeps long into the day, both may be treated with an antidepressant and cognitive therapy. Personality,...

Mental features of depression

The cardinal symptom of a depressive illness is of course a pervasive depression of mood. This must go beyond the everyday experience of, for example, 'I'm really depressed about the gas bill.' The mood must be low, flat, and empty, and not able to be cheered up by things that the patient formerly enjoyed. There are those in psychiatry who feel that depression can be diagnosed without depression of mood being obvious to the patient or readily apparent to the psychiatrist. It is just conceivable that this may apply to prodromal or very mild cases of depression, or to patients with a mixture of anxiety and depression symptoms. However, generally speaking, it is necessary to do violence to the idea of clinical depression to consider that any significant case of depressive illness can exist without depression of mood. In a true depressive illness, the patient has a negative view of himself, so that he feels guilty, and that he is a failure or a bad person. This will tend to be coupled...

Differential Therapeutics

As a clinician, when might you think of using IPT As a psychiatrist decides which antide-pressant medication to prescribe based on a patient's symptom constellation and research findings, so too should clinicians consider when to use IPT. The research to date supports that IPT works best for depressed patients who face distressing life events ranging from medical illness to job and relationship changes and conflicts. Patients with interpersonal deficits who report no recent life events or changes will probably fare better in CBT. Interpersonal therapy may also work well for patients with anxiety and personality disorders who report recent life events, but research is in these areas, although promising, is still in the early stages. Interpersonal therapy may be a good option for patients who want to augment their medication treatment with psychotherapy given that IPT and pharmacotherapy share the medical model of depressive illness, IPT seems like a good fit, although further research...

Clinical classification of depression

The authors of the above classifications emphasize that they have to be interpreted by the experienced clinician. Their inherent problems in respect of depression have been alluded to briefly above. I therefore now proceed to give a clinical guide to depressive illness. The GP, noting a positive family history of bipolar affective disorder in the father, made a diagnosis of depressive illness. He prescribed lofepra-mine, and, with the patient's consent, involved the girlfriend in discussing the nature and prognosis of the illness. The patient had visited the GP to discuss this and had been tearful, upon which depression had been diagnosed and antidepressant medication prescribed. She was no better a month later and was referred by fax. A 44-year-old married man came to the attention of a junior hospital psychiatrist after taking an overdose in the context of marital breakdown. He described depressed mood, anhedonia, and continuing suicidal ideation. Although he made a fairly rapid...

Selective Serotonin Reuptake Inhibitors

Results from uncontrolled studies suggest that SSRIs are effective for anxiety in PD (42-44). In an open-label study (n 10), Menza et al. (42) reported that citalopram (mean dose 19mg d) improved anxiety in depressed PD patients. In a study of 30 patients, paroxetine (20 mg twice daily) reduced psychic and somatic anxiety symptoms, as well as depressive symptoms after six weeks (43). Sertraline was also found to have anxiolytic effects in PD patients (44). Although these data are derived from uncontrolled studies, many specialists prefer to use SSRIs for managing anxiety and depression in PD (49).

Clinical evaluation of premenstrual syndrome

Affective symptoms of PMS strongly resemble major depression, except that PDD differs from major depression in that PDD occurs in the premenstrual phase alone. Selective serotonin reuptake inhibitors have been shown to be effective in the treatment of premenstrual dysphoria.

Neurotransmitters mental disorders and medications

In depression, which afflicts about 3.5 of the population, there appears to be abnormal excess or inhibition of signals that control mood, thoughts, pain, and other sensations. Depression is treated with antidepressants that affect norepinephrine and serotonin in the brain. The antidepressants help correct the abnormal neurotransmit-ter activity. A newer drug, fluoxetine (Prozac), is a selective serotonin reuptake inhibitor (SSRI) that appears to establish the level of serotonin required to function at a normal level. As the name implies, the drug inhibits the re-uptake of serotonin neurotransmitter from synaptic gaps, thus increasing neurotransmitter action. In the brain, then, the increased serotonin activity alleviates depressive symptoms.

Detection and Assessment

There are no reliable and empirically derived criteria for recognition of depression in PD. Therefore, it is not surprising that depression remains under-detected and under-treated in the PD population (15,71). In a clinic-based study, nearly two-thirds of patients with clinically significant depressive symptomatology were not receiving antidepressant therapy (11). Older individuals often underreport depressive symptoms and are likely to focus on somatic or vegetative complaints (e.g., fatigue or loss of energy, reduced sexual desire or functioning, pain, sleep changes, or appetite changes), which are the prominent features of mood disorders as well as PD (102). Patients may simply attribute any mood symptoms to their PD, even when their PD has been relatively stable and the mood changes are relatively acute. In one study, over half the patients who had clinically significant depressive symptoms did not consider themselves depressed (11). The DSM-IV diagnostic criteria for major...

Assessment of Efficacy

Overall, based on clinical experience and the available scientific data, SSRIs and TCAs may be considered useful for the treatment of depression in PD, and the agent that provides the best overall clinical benefit-to-risk profile should be selected (168). Amoxapine and lithium should be avoided, given the propensity of these agents to worsen motor symptoms and the availability of safer agents (169,170). Additionally, the nonselective MAO inhibitors (e.g., isocarboxazid, phenelzine, and tranylcypromine) should be avoided in levodopa-treated patients due to the risk of hypertensive crisis. Several antidepressants, such as bupropion, fluoxetine, fluvoxamine, nefa-zodone, and paroxetine, are potent in vivo inhibitors of various cytochrome P450 (CYP450) drug-metabolizing isoenzymes (171,172). These antidepressants may increase the risk for drug interactions. The first step in treating a patient who fails to respond to treatment is to increase the dosage of the antidepressant. If a patient...

Causes and symptoms

Nightmares can be a side effect of some medications or drugs of abuse, including drugs given for high blood pressure levodopa and other drugs given to treat Parkinson's disease amphetamines, cocaine, and other stimulants and some antidepressants. Withdrawal from alcohol and other medications can also sometimes cause nightmares.

Problemsolving Skills Training

This training is a highly useful component in a number of behaviour therapeutic methods across a variety of problem areas. To illustrate, many depressed patients are characterized by deficient problem-solving skills (Nezu, 1987) and there is evidence that problem-solving training contributes to mood improvement among depressives. Problem-solving training is also an important part of communication training among couples with relationship distress (Emmelkamp et al., 1988). Favourable results were also reported when problem-solving training was added to exposure in vivo in the treatment of agoraphobic patients (Kleiner et al., 1987). Likewise, among schizophrenic patients, problem-solving training was shown to be an important supplement to social skills training (Hansen, 1985).

Recommended dosage

The therapeutic effects of nortriptyline, like other tri-cyclic antidepressants, appear slowly. Maximum benefit is often not evident for two to three weeks after starting the drug. People taking nortriptyline should be aware of this and continue taking the drug as directed even if they do not see immediate improvement.

Communication Training

Relationship distress between partners can give rise to a dramatic increase in the risk of clinical depression. About half of the women who are in treatment for depression report marital difficulties. In some cases individual therapy for the depressed patient is inadequate and needs to be supplemented with treatment efforts focused on the relationship issues. Three controlled studies examined the effect of couple's therapy (communication training) on depression (Beach & O'Leary, 1992 Emanuels-Zuurveen & Emmelkamp 1996 Jacobson et al., 1991). There was no overall difference in mood improvement between patients in the individual cognitive behavioural therapy versus those in couple's therapy but relationship improvement was significantly higher among patients in couple's therapy. These findings suggest that depressed patients with marital difficulties are better served by couple's therapy than by individual cognitive behavioural therapy. Moreover, the additional benefit in terms of...

General Treatment of Psychosis

The management of the psychotic PD patient begins by searching for correctable causes, including infection, metabolic derangements, social stress, and drug toxicity. Infections may not always cause fevers in the geriatric population, so a search for urinary tract infections or pneumonias is warranted. Some PD patients who did not manifest psychotic symptoms at home may decompensate upon moving into the hospital environment. In many of these cases, moving the patient into a secure familiar environment or treating the underlying medical illness may ameliorate psychotic symptoms (19). Finally, medications with CNS effects may cause or exacerbate psychosis in PD and are often overlooked. These medications include pain or sleeping medications such as narcotics, anxiolytics, hypnotics, and antidepressants.

Generalized anxiety disorder anxiety state

The prevalence of pure generalized anxiety disorder is about 3 per cent of the population, and a further 8 per cent have mixed anxiety and depressive disorder. Physical and or mental symptoms of anxiety, as listed above, are present most of the time in the absence of real danger, and are 'free-floating' rather than focused on any particular stimulus.

Incidence Prevalence and Risk Factors

Incidence rates for PD dementia range from 4 to 11 per year, with a relative risk for the development of dementia in PD of 2 to 6 (12,129,131-133). Age and severity of extrapyramidal symptoms were associated with an overall risk of developing dementia. One study demonstrated that age and severity of disease by themselves were not associated with a greater risk of dementia, but the combination of these two features resulted in an almost 10-fold greater risk (134), suggesting a combined effect. Later age of onset of PD, longer duration of PD symptoms, the presence of hallucinations, depressive symptoms, and a family history of dementia have also been reported to be risk factors for dementia, although less consistently.

The importance of early attachment pattern and the effect of an early disruption being exposed in genetic counselling

She improved with antidepressant medication and supportive counselling. In that counselling, the focus of her distress was on the unfairness of her test result and the story of her early relationship life. The family history took on a new relevance as she expanded her story in the counselling sessions. The facts had already been established in the early interviews before testing but, perhaps, the personal significance had not been expressed or realised. The woman tearfully explained that her mother had left the family without saying goodbye and from the age of 10 years, she and her sister had been brought up by their father who, as he became more affected by Huntington's disease, treated them both violently and unpredictably. She had been told about her mother's departure by her older sister, who had received letters from her mother. The woman repeatedly cried that she would never understand how her mother could leave in such a way and why had she never contacted her.

General Treatment of Dementia

And medications with CNS effects (sedatives, narcotics, antidepressants, anxiolytics, and antihistamines) should be discontinued, or used sparingly. The clinician should also be aware that other commonly prescribed medications, including antiemetics, antispasmodics for the bladder, H2 receptor antagonists, antiarrhythmic agents, antihypertensive agents, and nonsteroidal anti-inflammatory agents, may also cause cognitive impairment.

Management of Depressed Mood

Although Dianne's sleeping and eating improved to some extent, her worrying lessened and her panic attack disappeared, Dianne kept on feeling sad and low on energy. Thus, the probable diagnosis of general anxiety disorder was not confirmed however, the diagnosis of depressive disorder was reaffirmed. Therefore after seven sessions of alcohol treatment, the manual Spouse-aided Therapy with Depressive Disorders (Emanuels-Zuurveen & Emmelkamp, 1997) was incorporated into Dianne and Mick's treatment programme. Inactivity being one of Dianne's most salient high-risk situations, we introduced activity training as an intervention to tackle negative mood as well as her drinking problem. Activation training is a fairly common behavioural technique in treating depression, derived from Lewinson's theory of depression. We encouraged Mick to help his wife in organizing her week combining basic daily activities (like getting dressed in the morning), taking care of neglected activities (such as...

Summary And Conclusions

Exposure therapies are the treatment of choice in adult specific phobia, social phobia, agoraphobia, and obsessive-compulsive disorder (Emmelkamp, 2004) and have also been found quite effective in phobic children (Nauta et al., 2003). Studies of the behavioural treatment of depression have come to a standstill due to the rise of cognitive therapy in this area but the lack of further research into the behavioural treatment of depression is not justified by the data. There are still a number of important issues that need to be addressed. For example, we have no idea why cognitive therapy, behavioural interventions, IPT and pharmacotherapy work equally well with depressed patients, although various researchers provide various theoretical explanations. Unfortunately, to date there is no evidence that

Current theories about the origin of mental disorders

Genetics is at this time an important area of research for psychiatric disorders. For example, a specific gene has been associated with bipolar disorder (also known as manic-depressive disorder), but unfortunately, the switch that controls the expression of the disorder is still unknown. It is presently thought that many genes go into the expression or nonexpression of any human characteristic, such as a facial feature or a certain aspect of mental health. Research done on identical twins has provided strong support for a genetic component in the development of schizophrenia. For instance, the average person in the United States has a 1 chance of developing schizophrenia, while the identical twin of a person diagnosed with schizophrenia has a 50 chance, even if he or she has been reared by adoptive parents. Other researchers who are studying schizophrenia have found that during embryonic development, there are nerve cells that do not migrate to their proper position in the...

Current theory and future directions

Integrate some of the electromagnetic aspects of nature into the mind-brain puzzle. In addition, the National Institute of Mental Health (NIMH) is researching alternative healing modalities. Prominent among them is acupuncture, which has been used to treat depression, anxiety and panic disorder. Other alternative treatments being studied include the effects of prayer, meditation, creative writing, and yoga.

Glucocorticoids and Behavioral States Reciprocal Determinism

A subset of depressed patients (50 -60 ) show elevated Cortisol levels, an attenuated circadian rhythm, and a blunted response to dexamethasone (see Parker, Schatzberg, & Lyons, 2003). This may reflect conditions within brain feedback circuits or changes in glucocorticoid receptor sensitivity. We will return to these possibilities later, in the context of stress effects.


Depressive illness, which is probably the greatest masquerade of general practice, is one of the commonest illnesses in medicine and is often confused with other illnesses. It is a very real illness that affects the entire mind and body. Unfortunately, there is a social stigma associated with depression and many patients tend to deny that they are depressed. Many episodes of depression are transient and should be regarded as normal but 10 of the population have significant depressive illness. The lifetime risk of being treated for depression is approximately 12 for men and 25 for women. 1

Depression in children

Major depression in children and adolescents may be diagnosed using the same criteria as for adults, namely loss of interest in usual activities and the presence of a sad or irritable mood, persisting for 2 weeks or more. 6 The other constellation of depressive symptoms including somatic complaints may be present. Examples include difficulty in getting to sleep, not enjoying meals, poor concentration and low self-esteem. It can present as antisocial behaviour or as a separation anxiety, e.g. school refusal. Although suicidal thoughts are common, suicide is rare before adolescence. Depressed adolescents are a serious suicide risk. Referral of these patients to an experienced child psychiatrist is advisable.

The diagnostic approach

Depression can be associated with many illnesses but it is important to realise that the somatic symptoms may be the presentation of depressive illness and thus 'undifferentiated illness' is a feature. The patient tends to complain of aches and pains, gastrointestinal symptoms and other similar symptoms rather than emotional problems. There is a relationship between anxiety and depression so that many depressed patients are agitated and anxious a feature that may mask the underlying depression. 7

Newer Target Of Lithium Direct And Indirect Inhibition Of Glycogen Synthase Kinase

In 1996 it was discovered that lithium inhibited the enzyme glycogen synthase kinase-3 (GSK-3) 39,40 , a highly conserved protein serine threonine kinase first characterized for its role in glycogen synthesis. These findings raised the possibility that GSK-3 inhibition might play a role in the treatment of bipolar disorder and depression. However, the past two years has seen the emergence of exciting new biochemical, pharmacological, genetic, and rodent behavioral studies, all of which support the hypothesis that inhibition of GSK-3 represents a therapeutically relevant target for lithium's mood stabilizing properties. Furthermore, as we discuss, more recent preclinical evidence implicates the modulation of GSK-3 in either the direct or downstream mechanism of action of many other mood stabilizer and antidepressant medications currently in use (Table 7.1). Antidepressants

Explanatory supportive notes for patients and relatives

The basis of treatment is to replace the missing chemicals with antidepressant medication. Antidepressants are not drugs of addiction and are very effective but take about two weeks before an improvement is noticed. Alcohol can interact with the tablets so it is important not to drink and drive. If the person is very seriously depressed and there is a risk of suicide, admission to hospital will most likely be advised. Other more effective treatments can be used if needed. The depressed person needs a lot of understanding, support and therapy. Once treatment is started, the outlook is very good (an 80 cure rate).

Differential diagnosis

Depression is the main condition liable to be confused with dementia, especially in the elderly. Depressivepseudodementia, as the name implies, refers to states of depressive illness where the presentation mimics dementia. It can usually be distinguished from dementia by the history of comparatively recent and quick onset, almost always in a patient with a history of previous episodes of depressive illness. Mental state examination may show pronounced features of low mood, and psychological testing may produce better results than in true dementia. In doubtful cases, a therapeutic trial of antidepressant drugs or ECT should be undertaken. In some patients, the two disorders co-exist, indeed depression is thought to be a risk factor for the development of dementia.

Cardiovascular Complications

Chemotherapy, particularly alkylating agents like cyclophosphamide, can induce infertility and, in women, premature menopause, with its attendant problems of hot flashes, mood swings, vaginal dryness, and urinary incontinence. Cyclophosphamide is commonly used in breast cancer, but management of the menopausal symptoms is complicated by the fact that hormone replacement therapy is considered contraindi-cated in patients with a history of breast cancer. Consequently, other treatments must be used for hot flashes, such as antidepressants.52 This example illustrates the importance of both recognizing the symptoms related to ovarian failure in a cancer patient in which it would be otherwise unexpected, and having knowledge of the oncologic considerations of the therapies being chosen.

Mood and Behavioral Disturbances

The clinical presentations of depression and anxiety are not often distinguishable between dementias, further clouding the picture among AD, VaD, and MD. In addition, mood disturbances can range from major depressive disorder to mild depression symptoms. However, studies suggest that the presence of ischemic disease seems to be positively correlated with the presence of depressed mood and psychomotor slowing (e.g., Corey-Bloom et al., 1993 Hargrave, Geck, Reed, & Mungas, 2000). In a study of 256 individuals with AD and 36 with ischemic vascular disease or MD, not only was depression more frequent in the latter group, but also it was more severe (Hargrave, Geck, et al., 2000). In another study of three large groups of patients (possible AD, probable AD, and MD), a trend toward a greater frequency of depressed mood was found in the MD group (Corey-Bloom et al., 1993). Therefore, it appears to be critical for the clinician to assess for mood disturbance in individuals presenting with...

Evaluation Of Newer Cytotoxic Agents For Hepatic Arterial Infusion Therapy

Single-agent activity of HAI oxaliplatin has been demonstrated in two clinical trials. Mancuso et al. evaluated HAI oxaliplatin given at 20 mg m2 day for five days every three weeks (79). A 46 response rate was noted in 15 patients. In a phase I II study of single-agent HAI oxaliplatin given as a 30-minute infusion every three weeks, Fiorentini et al. reported an MTD of 150 mg m2. A PR rate of 33 was noted in four out of 12 patients (33 ) (80). These response rates are impressive given the low single-agent activity of IV oxaliplatin in advanced colorectal cancer (71). The overall toxicities of HAI oxaliplatin were very similar to those observed following systemic administration of the drug with the exception of abdominal pain. Severe right upper quadrant epigastric pain (in the absence of chemical hepatitis or sclerosing cholangitis) was noted by Mancuso et al. to be dose-limiting in 41 of the patients (80). Interestingly, the abdominal pain was unrelieved by nonsteriodal...

Assessing Multimethod Association With Categorical Variables

Nominal variables are variables whose values only serve to identify categories without any quantitative meaning. Clinical disorders, for example, are often assessed using nominal variables. The assignment of 1 to paranoid schizophrenia disorder and 2 to major depressive disorder is equally admissible as the reverse. The assignment of numbers to the categories has no impact on the further analysis of the data, because nominal variables are not ordered in a specific manner. Nominal variables can be obtained using a wide array of measurement methods such as self-ratings, peer ratings, and medical and psychological diagnoses (see Neyer, chap. 4, this volume Bakeman & Gnisci, chap. 10, this volume). It is important to note that every subject has to be categorized and that he or she can only be classified into one category. In other words, the categories must be exhaustive and mutually exclusive. In most cases,

Evidence For Drug Treatments

There is evidence that serotonin reuptake inhibitors (SRIs) are more effective than placebo (Abramowitz, 1997 Goodman et al., 1990 Kobak et al., 1998 Piccinelli et al., 1995) and more effective than other kinds of antidepressants (Hoehn-Saric et al., 2000 Picinelli et al., 1995) in reducing OCD symptoms in clinical trials. The evidence suggests that different serotonin reuptake inhibitors have similar efficacy (Kobak et al., 1998 Picinelli et al., 1995) but clomipramine has a higher rate of adverse effects than selective serotonin reuptake inhibitors (Jenike, 1998). Unfortunately most drug studies assess response only over a short period. One prospective study showed that sertraline produced further significant improvement in a 40-week open label extension of a RCT (Rasmussen et al., 1997). Over 50 of patients respond to serotonin reuptake inhibitors (Erzegovesi et al., 2001 Ravizza et al., 1995) but there is evidence of a rapid return of symptoms in most treatment responders...

In Search Of Depressogenic Thought Processes

There has been a rather extensive search for a latent (as opposed to state-dependent) processing bias that might underlie depression (Segal, 1988 Segal & Ingram, 1994). What we can say from this research is that there may not be one. Rather, depres-sogenic thought is only revealed when the person is self-focused or in a sad mood at the time of testing (Segal & Ingram, 1994). From the perspective of an implicit science of personality, we believe that these results are important. They suggest that depression is nothing like a trait. Rather, it is a phenomenon that co-occurs with negative mood states and certain dispositional vulnerabilities. Thus, it may come as little surprise that self-reported traits play a relatively minimal role in understanding clinical depression (Segal & Ingram, 1994).

History And Clinical Examination The History

Start with general information about the man's life and work. Employment related stress and relationship difficulties are often involved in the etiology. Ask about the problem, its duration, frequency, and specifics such as whether the erection can be elicited but not maintained (suggestive of a veno-occlusive disorder). Ask about his past medical history and current treatments. As we have already seen, an elderly diabetic is in the highest risk group for ED. What is the patient's motivation for seeking help, and why now There is sometimes a mismatch of expectation between the patient and his sexual partner. ED is often situational, occurring only in the presence of a partner, but the man may enjoy satisfactory masturbation and have spontaneous nocturnal erections. Note that loss of nocturnal erections is a strong indicator of a physical problem, but can also be as a result of a major depressive disorder. Ask specific questions about other cardiovascular, neurological, and...

The Effect Of Comorbid Depression On Response To Bt Cbt And Sri Treatment

Abramowitz et al. (2000) found that patients with severe depression showed significantly less improvement with CBT, yet even highly depressed patients showed moderate treatment gains. Cox et al. (1993) found that exposure was not significantly effective for depressed mood. Hoehn-Saric (2000) found an SRI (sertraline) was better for co-morbid OCD and major depressive disorder than a non-SRI (desipramine). Hohagen et al. (1998) showed that BT plus fluvoxamine had a significantly better reduction in YBOCS than BT plus placebo in severely depressed patients with OCD.

Distribution of Prominent GPCR Families with Known Endogenous Ligands in the Central Nervous System

FIGURE 7.1 History of psychiatric drug development. Timeline shows emergence of selected drug mechanisms (solid arrows) and therapeutic agents (plain text) with relevance to schizophrenia (above the line) and depression anxiety (below the line). S2 D2 serotonin 5HT2A + dopamine D2 receptor antagonists. TCA tricyclic antidepressants. MAOI monoamine oxidase inhibitor. SSRI selective serotonin reuptake inhibitor. SNRI selective serotonin and norepinephrine reuptake inhibitor.

Commonly Occurring Disorders

It is important to mention the high rates of traumatic stress experienced by Indian Natives as abuse victims and witnesses of the abuse of others, for they are related to the development of psychiatric symptomatology. As an example, Piasecki et al. (1989) found significantly higher rates of development disorders, conduct disorders, drug use disorders, depressive disorders, and anxiety disorders in abused Indian and Native youth than those without similar histories.

Use of Standardized Methods

Given that norms are typically nonexistent and that such culturally appropriate instruments are also lacking, clinicians using standardized measures should approach results with caution. As a general rule, clinicians should interpret and report data consistent across measures in an assessment battery. For example, it is probably reasonable to conclude an American Indian male is depressed if he indicates depressed affect and other depressive symptoms such as insomnia during a clinical interview and testing further reveals an elevated D scale on the MMPI, a positive Depression Index on the Rorschach, and a very slow processing speed within the Performance subtests of the Weschler Adult Intelligence Scale (WAIS). As described below, however, clinicians should routinely utilize other sources of information beyond standardized measures and incorporate this data into any diagnostic formulation.

The aftermath of suicide effects on those involved

Some suicides, such as those resulting from an acute severe depressive illness which could almost certainly have been cured, are major tragedies. In other cases, such as those associated with chronic intractable mental or physical illness, the argument that it might have been preventable may be less strong.

Specific Treatment Suggestions

From the American Indian literature more specifically, both Trimble (1992) and Manson and Brenneman (1995) present descriptions of how conventional cognitive-behavioral treatment programs were adapted for use with American Indian youth and elders. Manson and Brenneman (1995), for instance, adapted the Coping with Depression course created by Lewinsohn, Munoz, Youngren, and Zeiss (1986) with the aim of preventing the psychological sequelae associated with chronic disease in American Indian elders. Culturally salient examples of symptom expression and mood descriptors were incorporated into each component, and the program was expanded from 12 to 16 sessions to compensate for language and cultural barriers. The utility of this treatment and its adaptations were evident in the diminishment of depressive symptoms between pre- and posttest for those elders participating in this project. Trimble (1992) likewise modified a cognitive-behavioral skills enhancement program to prevent drug use...

Electroconvulsive therapy

Electroconvulsive therapy (ECT) is a medical procedure in which a small, carefully controlled amount of electric current is passed through the brain to treat symptoms associated with certain mental disorders. The electric current produces a convulsion for the relief of symptoms associated with such mental illnesses as major depressive disorder, bipolar disorder, acute psychosis, and catatonia. The American Psychiatric Association's Practice Guidelines for the Treatment of Psychiatric Disorders discusses the use of ECT in the treatment of major depressive disorder, bipolar disorder and schizophrenia. Electroconvulsive therapy is administered to provide relief from the signs and symptoms of these and occasionally other mental illnesses. ECT is used routinely to treat patients with major depression, delusional depression, mania, and depression associated with bipolar dis ECT may become the treatment of first choice for depression if a patient with severe depression or psychotic symptoms...

Special Situations Requiring Interventions for Men with ED

Sexual dysfunction associated with the use of serotonin reuptake inhibitors has been reported in 30-70 of treated patients and is a significant contributor to discontinuation of these medications. A review of selective phosphodiesterase type-5 inhibitors for antidepressant-associated sexual dysfunction suggests treatmet of this side effect of antidepressant medication could improve depression disease management outcomes (105).

Summary And Additional Thoughts

Finally, regardless of the client's race and or ethnicity status, the clinical management of clients with HIV AIDS in mental health services require not only a clear understanding of medical, psychosocial, and multicultural variables, but it is also important to assess and treat the most significant emotional or psychological problems resulting from (a) thinking that one is HIV positive (or that one has AIDS) because of engagement in behaviors considered at risk for HIV infection (e.g., multiple sexual partners, sex without using condoms, anal intercourse, injecting drug use, etc.) (b) being told that one is HIV positive (c) experiencing symptoms suggesting progression toward AIDS, and (d) a recognition that one is about to die because of AIDS (Flaskerud & Miller, 1999 Kalichman, 1995). For example, in the first case Anxiety and Panic Disorders would be expected in many clients seeking mental health services because they think that they has been infected with the virus. In the...

Difficulties In Assessing Outcome Research

In clinical practice it is rare to meet an individual who only meets ICD-10 DSM-IV criteria for a single personality disorder. As noted above, many individuals meet criteria for more than one personality disorder and others meet criteria for both Axis I and Axis II disorders (Oldham et al., 1995). This makes it difficult to decipher improvements observed clinically or reported in the literature. For example, a person with BPD and major depression may become more impulsive and destructive as the depression lifts (appearing to become more 'borderline') or this behaviour may diminish with the anergia of depression, creating the impression of improved impulse control. Despite the confounding effect of comorbidity when measuring outcome, published studies have generally failed to report this clearly.

Affective Disorders

Affective disorders are common among patients with eating disorders, leading some researchers to postulate that eating disorders are a variant of affective disorders. Comorbid major depression is frequent among patients with eating disorders (42,43), occurring in over half of all patients in some series. In addition, family history of affective disorders is often more frequent among patients than controls. The response of symptoms to antidepressant treatment, in both bulimia nervosa and binge eating disorder, has been proposed as further evidence of this link. However, it is unknown if the depression seen in bulimia nervosa and binge eating disorder is primary, secondary to the eating disorder, or due to an underlying common pathogenesis. Dysfunction of the serotonergic pathways, which could affect both appetite and mood, has been postulated as one such possible mechanism (44). While depression is common in patients with anorexia nervosa, at least some of these symptoms may be...

Depressed Adolescents IPTA

Mufson, Moreau & Weissman (1993) modified IPT to address developmental issues of adolescence. In adapting IPT to this population, they added a fifth problem area and potential focus the single parent family. This interpersonal situation appeared frequently in their adolescent treatment population and actually reflected multiple wider social problems in an economically deprived, high crime and drug-filled neighbourhood. Other adaptations included family and school contacts. The researchers completed a controlled 12-week clinical trial comparing IPT-A to clinical monitoring in 48 clinic-referred, 12- to 18-year-old patients who met DSM-III-R criteria for major depressive disorder. Thirty-two patients completed the protocol (21 IPT-A, 11 controls). Patients who received IPT-A reported significantly greater improvement in depressive symptoms and social functioning, including interpersonal functioning and problem-solving skills (Mufson, Weissman & Moreau, 1999). Mufson is completing...

Subsyndromally Depressed Hospitalized Elderly Patients

Recognizing that subthreshold symptoms for major depression impeded recovery of hospitalized elderly patients, Mossey et al. (1996) conducted a trial using a modification of IPT called interpersonal counselling (IPC) (Klerman et al., 1987). Seventy-six hospitalized patients over age 60 with subsyndromal depression were randomly assigned to either 10 sessions of IPC or usual care (UC). A euthymic, untreated control group was also followed. Three-month assessment showed non-significantly greater improvement in depressive symptoms and on all outcome variables for IPC relative to UC, whereas controls showed mild symptomatic worsening. In the IPC and euthymic control groups, rates of rehospitalization were similar and significantly less than the subsyndromally depressed group receiving usual care. After 6 months the IPC group showed statistically significant improvement in depressive symptoms and self-rated health as compared to the UC group. The investigators felt 10 sessions were not...

Serotonin 5Hydroxytryptamine Neurotransmission and 5HT Receptors

However, serotonergic neurotransmission becomes seriously disturbed by the action of serotonergic antidepressants. Selective serotonin reuptake inhibitors (SSRIs) block the 5-HT transporters, both in the presynaptic membrane and around the cell-body. As a consequence, serotonin concentration increases outside the cell-body and in the synapses. Owing to the increased serotonin levels, 5-HT1A autoreceptors at the surface of the cell-body and 5-HT1B auto-receptors in the presynaptic membrane become activated. The activation of both the somatodendritic 5-HT1A autoreceptors and the presynaptic 5-HT1B auto-receptors results in an inhibition of 5-HT release into the synaptic cleft. Consequently, serotonin concentration in the synaps diminishes but remains slightly increased due to blockage of the 5-HT transporters leading to some stimulation of all postsynaptic 5-HT receptors. After some days, the 5-HT1A and 5-HT1B autoreceptors become desensitized resulting in a diminished inhibitory action...

Lost In Darknes Depression Diabetes And Heart Disease

Although depression causes severe dysfunction, many people can be successfully treated by a combination of medication and by tested forms of behavioral therapy such as cognitive behavioral therapy, which is a form of coaching. Regular physical exercise has been shown to reduce depressive symptoms exercise also improves blood glucose control and cardiovascular function.

Affective disorders Depression

Depressive symptoms, often reactive to a loss or other life stress, are common in young children but the full-blown picture of depressive illness is rare before puberty. Somatic symptoms like anorexia, abdominal pain, or headaches are a frequent presentation. The treatment of depression in this age group has become controversial cases have been widely reported in which links were claimed between suicide and the prescription of antidepressant medication. The question has recently been reviewed by NICE (2005), and a 'stepped care' approach was recommended. Professionals in primary care are advised against the prescription of antidepres-sant medication it is considered that they should concentrate on support and risk assessment. Only in moderate to severe depression is antidepressant medication (fluoxetine) recommended, and then only in specialist hands.

Binge Eating Disorder

Antidepressant medication is frequently used in the treatment of binge eating disorder, although few studies of its efficacy have been published (107). Agras et al. (127) found that adding desipramine to a combination of CBT and behavioral weight loss treatment did not provide any additional benefit in reduction of binge eating. However, those on medication did maintain a significantly larger weight loss at 3-month post-treatment follow-up, as well as favorable reductions in disinhibition.

Upper Airway Colonization

Colonization of the upper respiratory tract by both Gram-negative (GNB Enterobacteriaceae, P. aeruginosa) and Gram-positive bacteria (S. aureus) is more prevalent in the elderly and is related more to the severity of systemic illness and level of care than to age per se (Johanson et al., 1969 Valenti et al., 1978). Factors leading to colonization of the lower and upper respiratory tract include antibiotic therapy, endotracheal intubation, smoking, malnutrition, surgery, and any serious medical illness. Decreased salivation such as that induced by antidepressants, antiparkinsonian medications, diuretics, antihypertensives, and antihistamines also contributes to oropharyngeal GNB colonization.

Psychiatric Assessment and Treatment of Depression in Dementia

The interface of depression and dementia is a challenging but critical area in the assessment and treatment of dementia. The traditional focus of this interface has been an emphasis on avoiding the misdiagnosis of dementia in elderly patients having depression with associated cognitive impairment, so-calledpseudodementia. However, it is increasingly recognized that a more common and often more difficult clinical quandary is accurately diagnosing depression in existing dementia (Draper, 1999). Depressive symptoms and syndromes are frequent in already-established cases of dementia, complicating clinical management, exacerbating functional difficulties, and creating other negative outcomes. Recent studies have also investigated whether depression may be a prodromal symptom of or an independent risk factor for the development of dementia. This chapter focuses on depression occurring in the three most common types of dementia Alzheimer's dementia (AD), vascular dementia (VaD), and diffuse...

The Issue Of Pseudodementia

These findings have led some to suggest that pseudodementia may in fact be predementia (Reifler, 2000), although a small study of subjects who died during a major depressive episode did not confirm that cognitive impairment during a depressive episode was related to AD- or VaD-type neu-ropathological change on autopsy (O'Brien et al., 2001). In a recent small single photon emission computed tomography (SPECT) study of depressive pseudodementia subjects compared to healthy controls, depressed subjects and AD subjects found decreased cerebral blood flow in the pseudodementia group in the temporoparietal region, similar to that of the AD group and different from that of the depression group (Cho et al., 2002). Taking into account the studies to date suggests that, in a subset of elderly patients (perhaps up to half ), depression heralds a dementia syndrome. These lines of evidence have led investigators to study the question of whether depression is a prodromal symptom of dementia or...

Seasonal affective disorder

Seasonal affective disorder, often abbreviated as SAD, is a type of mood disorder that follows an annual pattern consistent with the seasons. The most common course for SAD includes an onset of depressive symptoms late in the fall, continuation of symptoms throughout winter, and remission of symptoms in the spring. < u own. Instead, SAD is considered a pattern specifier, or H subtype, of another mood disorder diagnosis. For exam ple, an individual may be diagnosed as having a major depressive episode with a seasonal pattern. Some studies have shown that up to 6 of people experience some depressive symptoms in winter. SAD is a more common phenomenon in women than men. According to the DSM-IV-TR, women make up 60-90 of people with the seasonal pattern of depression. SAD primarily affects adults, although it is possible for children and adolescents to suffer from it. Research indicates that SAD is much more common in countries and regions where there are distinct seasonal changes. In...

Evidencebased Psychotherapy With Older People

Scogin & McElreath (1994) produced the first meta-analysis of the efficacy for psychosocial treatments in late-life depression. Scogin & McElreath (1994) included 17 studies published from 1975 to 1990. In their analyses they reported mean effect sizes for treatment versus no treatment or placebo of 0.78, similar to effect sizes of 0.73 reported by Robinson et al. (1990) in their review of psychotherapy for depression across all age ranges. Scogin & McElreath (1994) also carried out separate analyses using a subset of studies satisfying diagnostic criteria for major depressive disorder and reported an effect size of 0.76. They also calculated a mean effect size of 0.3 when comparing cognitive and behavioural therapies with other psychosocial treatments. They investigated treatment delivery methods and reported a mean effect size of 0.74 for group treatments and a mean effect size of 0.77 for individual treatments. Despite the clear superiority of psychological treatments...

Evidence Based Medicine

In contrast to authority-based medicine, evidence-based medicine (26) has been accepted today as the hallmark for clinical research and medical practice. Particularly in last decade, randomized clinical trials with clomipramine (27,28) and some SSRIs (29-33) have repeatedly demonstrated the efficacy of serotonergic antidepressants to delay ejaculation. In spite of these studies, the belief persists among those involved in sexology that premature ejaculation is a psychological disorder. In order to unravel this dichotomy, it is important to apply principles of evidence-based medicine to both the psychological and neurobiological approaches to premature ejaculation and its treatments. In contrast with the easily accepted behavioral treatment by sexologists, drug treatment had to prove itself far more explicitly to avoid rejection by professionals in the field. Only a few physicians have tried to develop drug strategies to treat premature ejaculation. Currently, in spite of some residual...

Geriatric Depression Scale

The Geriatric Depression Scale (GDS) is a 30-item self-report assessment designed specifically to identify depression in the elderly. The items may be answered yes or no, which is thought to be simpler than scales that use a five-category response set. It is generally recommended as a routine part of a comprehensive geriatric assessment. One point is assigned to each answer and corresponds to a scoring grid. A score of 10 or 11 or lower is the usual threshold to separate depressed from nonde-pressed patients. However, a diagnosis of clinical depression should not be made on the GDS results alone. Although the test has well-established reliability and validity, responses should be considered in conjunction with other results from a comprehensive diagnostic work-up. A short version of the GDS containing 15 questions has been developed. The GDS is also available in a number of languages other than English. Depression is widespread among elderly persons, affecting one in six patients...

Conclusions And Summary

Psychological treatments constitute a much-needed effective treatment alternative to physical treatments for late-life anxiety and depression because many older adults are unable to tolerate antidepressants or there may contra-indications to their use with older people with cardiac problems (Orrell et al., 1995) and in the case of anxiety disorders there may be a number of concerns about the prescription of benzodiazepines (Gerson et al., 1999). Future research is required into the effectiveness of psychological treatment for depression and anxiety in common medical conditions such as dementia, post-stroke depression and Parkinson's disease. A number of studies are currently at early stages of evaluation of efficacy in terms of psychological and physical treatments for depression and anxiety. At present a lot remains unknown about the potential for psychological therapies in a range of settings such as in nursing homes.

Ejaculation Threshold Hypothesis

According to this threshold hypothesis, it appears to be the level of 5-HT2C and 5-HT1A receptor activation that determines the setpoint and associated ejaculation latency time of an individual man. In case of men with premature ejaculation or any man using serotonergic antidepressants, the SSRIs and clomipramine activate the 5-HT2C receptor and therefore switch the setpoint to a higher level leading to a delay in ejaculation. The effects of SSRIs on the setpoint appear to be individually determined some men respond with extreme delay whereas others only experience a small delay at the same dose of the drug. Moreover, cessation of treatment results in a uniform reset of the setpoint within 3-5 days to

Factors Unique To Older Minorities

Research has also identified certain factors unique to older minorities that influence the development of mental disorders among the elderly. Many groups of minority elderly are largely composed of immigrants almost 50 of older Hispanic Americans and 66 of older Asian Americans, for example, are immigrants (Hobbs & Damon, 1996). Studies on immigration have demonstrated both positive and negative effects regarding health and mental health. Overall, immigrants tend to be healthier than nonimmigrants, referred to as the healthy immigrant effect or migration selection (Moscicki, Locke, Rae, & Boyd, 1989). Immigration is also, however, a stressful event with lasting consequences such as reduced resources and social support. A recent study of older Mexican Americans (Black, Markides, & Miller, 1998) demonstrated that older male immigrants reflect the healthy immigrant effect in that they experience lower rates of depressive symptoms than males born in the United States. Among older...

Neuroendocrine Theories

Orcadian rhythm disturbance has been hypothesized to contribute to mental decline and depressive mood in AD (Moe, Vitello, Larsen, Larsen, & Prinz, 1995). Liu et al. (2000) investigated the expression of neuropep-tide vasopressin (AVP) mRNA in the human suprachiasmatic nucleus of AD patients with and without depression as well as age-matched controls. No significant differences were found in amount of AVP mRNA between AD patients with and without depression.

Neurobehavioral Changes

In addition to cognitive changes in diabetes, affective disorders, notably the incidence of depression, is increased in diabetes (Gavard et al., 1993 Lustman et al., 1986). Major depression has a higher recurrence rate, and depressive episodes may last longer in individuals with type 1 or type 2 diabetes (Lustman et al., 1986 Ryan, 1988). A significant relationship between poor glycemic control and major depression has been reported, although this relationship was not supported by other studies. Insulin resistance has been postulated as the missing link between the affective disorders and AD. However there is no conclusive empirical data to support this hypothesis at this time (Rasgon and Jarvik, 2004). It is not clear whether the high prevalence of depression in diabetes is the result of neurobiochemical changes associated with diabetes, or is secondary to psychological factors related to chronic disease state or its treatment.

Cerebral Imaging and Blood Flow Correlates

The increase in depressive symptoms in VaD with subcortical impairment may relate to pathology of frontostriatal circuits (Austin & Mitchell, 1995). Starkstein et al. (1996) found evidence for more severe frontal lobe dysfunction using SPECT scanning in VaD than AD patients. Using positron emission tomography (PET) scanning techniques, investigators also found that depression in AD was significantly associated with frontal hypometabolism, supporting frontal involvement (especially left-sided) in depression, regardless of disease etiology (Hirono et al., 1998). Another cerebral blood flow study found that over time, elderly AD subjects with dementia and depression exhibited fewer affective reactive symptoms and greater agitation motor slowing, which paralleled significant reductions in left temporal regional cerebral blood flow compared to nondepressed AD subjects (Ritchie, Gilham, Ledesert, Touchon, & Kotzki, 1999). A magnetic resonance imaging (MRI ) study found no relationship...

Adverse Reactions

It has been estimated that approximately 1 In 30,000 people using SJW will experience an adverse reaction, including those attributed to drug interactions (Schulz 2006). The incidence of side-effects to SJW is approximately 10-fold lower than for conventional antidepressants (SSRIs). According to an overview of 16 postmarketing surveillance studies, gastrointestinal symptoms, sensitivity to light and other skin conditions and agitation were the most commonly reported side-effects and were generally described as mild (Linde & Knuppel 2005). PHOTOSENSITIVITY (UNLIKELYAT THERAPEUTIC DOSES) The most common adverse event among spontaneous reports is photosensitivity, which is estimated to occur in 1 in 300,000 treated cases. This can occur with a dose of 5-10 mg day hypericin, which is 2-4-fold higher than the recommended dose. Commission E has noted the possibility of photosensitivity reactions, particularly in fair-skinned people.

Relationship to Behavioural and Neural Functioning

As for FA, MTR is a non-specific marker of neural damage, such as demyelina-tion. Many of the published MT studies have focused on patients with multiple sclerosis, who show decreased MT in both ROI and whole-brain histogram analyses. In other diseases, results are similar, indicating MTR is a viable marker for affected white and gray matter. MTR has been shown to increase with brain development during the first several years of life (Rademacher et al. 1999 van Buchem et al. 2001) and regional decreases with aging have been found (Armstrong et al. 2004). Differences in MTR were sufficiently large to distinguish patients with mild cognitive impairment from patients with Alzheimer's disease and controls (Kabani et al. 2002a Kabani et al. 2002b). A number of published studies have also used magnetization transfer methods to compare the brains in patients with schizophrenia against healthy control subjects (Foong et al. 2001 Bagary et al. 2003 Kiefer et al. 2004 Kubicki et al. 2005)....

Organization of services

Many of the problems identified in a comprehensive assessment are social rather than psychiatric, and require practical interventions accordingly. For example, a depressed patient living alone in poor accommodation will be unlikely to make a good recovery with antidepressant medication alone. Attending a day centre might combat loneliness and improve nutrition, and a social worker would advise about housing and social security benefits.

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