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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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.

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...

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...

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

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...

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...

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...

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...

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....

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.

Antidepressants

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...

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.

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.

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.

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...

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).

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...

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.

Causes and symptoms

There is considerable evidence that OCD has a biological component. Some researchers have noted that OCD is more common in patients who have suffered head trauma or have been diagnosed with Tourette's syndrome. Recent studies using positron emission tomography (PET) scanning indicate that OCD patients have patterns of brain activity that differ from those of people without mental illness or with some other mental illness. Other studies using magnetic resonance imaging (MRI) found that patients diagnosed with OCD had significantly less white matter in their brains than did normal control subjects. This finding suggests that there is a widely distributed brain abnormality in OCD. Some researchers have reported abnormalities in the metabolism of serotonin, an important neurotransmitter, in patients diagnosed with OCD. Serotonin affects the efficiency of communication between the front part of the brain (the cortex) and structures that lie deeper in the brain known as the...

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.

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

Recommended dosage

Geriatric patients, children, and adolescents are more sensitive to the side effects and toxicities of tri-cyclic antidepressants than other people. For geriatric patients, the dose may range from 25 to 100 mg per day. For children six to 12 years old, the recommended dose ranges from 10 to 30 mg per day in divided doses. For adolescents, daily dosages range from 25 to 50 mg but may be increased up to 100 mg, if needed.

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,

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).

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.

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...

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).

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.

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.

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...

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.

The Question of Symptom Persistence

Some have suggested that many depressive symptoms are largely transient, mild, shallower, or self-limited in patients with dementia (Devanand et al., 1997 Katz, 1998). O'Connor, Pollitt, and Roth (1990) and Forsell, Jorm, and Winblad (1994) found remissions of depression in all of their subjects with depression in dementia at baseline. However, other studies have found evidence for the persistence of depressive symptoms syndromes. Janzing, Teunisse, and Bouwens (2000) reported that both syndromal and subsyn-dromal depression were highly persistent in nursing home residents with dementia, few of whom were treated with antidepressants. Another study demonstrated a recurrence rate of 85 for depressive symptoms in dementia (Levy et al., 1996). In terms of major depression, there is evidence for a chronic course of depression in dementia, with one study reporting that 58 of subjects with major depression in dementia still had depression at 16-month follow-up (Starkstein et al., 1997).

Pharmacokinetic And Pharmacodynamic Considerations

The use of antidepressants in older patients can be complicated by several factors. Older individuals use multiple medications (two or more prescription drugs) three times more frequently than younger persons, increasing the potential for interactions. Age-related alterations in physiology can result in variable plasma drug concentrations, which may increase the number of adverse events, and the elderly may be more sensitive to adverse events (McDonald et al., 2002). Aging is associated with a number of neuroendocrine changes, including alterations in monoamine oxidases, noradrenergic neurons, dopaminergic neurons and concentrations, cholinergic neurons and receptors, adrenocorticotropic hormone (ACTH) concentration and function, and serotonin receptors and concentrations (Rehman et al., Recommended initial doses are lower for the elderly for all antidepressants, and increases should be slow and individualized (De Vane et al., 1999). The pharmacoki-netics of some selective serotonin...

Augmentation And Novel Treatment Strategies

Lithium has demonstrated some benefits when used as augmentation to antidepressants in older patients, with a 50 response acute rate (Zullino et al., 2001). Lithium augmentation significantly reduced relapse rates compared to antidepressants alone over two years (Wilkinson et al., 2002). However, it is recommended that special care be taken when treating elderly patients with lithium, because of a higher risk of adverse effects. No benefit was seen when total sleep deprivation was added to paroxetine in fact, the two interventions seem to counteract each other (Reynolds et al., 2005). Light therapy significantly improved depressive symptoms in a study in older depressed patients (Tsai et al., 2004). A small randomized trial comparing repetitive transcra-nial magnetic stimulation (rTMS) and sham treatment in older patients with treatment-resistant MDD reported antidepressant effects in both groups, with no significant benefits associated with rTMS (Mosimann et al., 2004). St John's...

Assessing physical symptoms in psychiatric practice

The assessment depends in part upon the setting. In some cases, for example, the patient on antipsychotic medication who complains of a shakiness of the hands, the most likely diagnosis (extrapyramidal side-effects of medication) will be obvious. Another common instance of side-effects of medication is the patient on tricyclic antidepressants, who complains of a dry mouth. However, it is always important to remember that the emergence of a physical symptom could represent the first sign of an underlying physical disorder. This is particularly pertinent in new referrals, for example, to the outpatient clinic. Usually, it is the responsibility of the referring GP or other doctor to exclude physical disease. However, the psychiatrist must check that appropriate investigations have been done, and continue to remain on the alert and review the matter during the course of treatment. Otherwise, sooner or later, he will find himself in the unenviable position of having tried unsuccessfully to...

The Washington Needs Assessment Household Survey

The Washington Needs Assessment Household Survey (WANAHS) was conducted in the State of Washington by Washington State University for The Washington State Department of Social and Health Services. Although primarily a substance abuse survey, it included assessments for major depression, mania, anxiety, panic attacks, and psychosis using a CIDI-based screener developed by Kessler from the NCS. The WANAHS differs from the ECA and NCS in several significant ways first, it was a telephone survey second, it covered only one state and third, it provided significant oversamples of five major ethnic groups, including White, Black, Asian, Native, and Hispanic.

Interpersonal Behavioral Approaches

As noted in Table 10.3, significant placebo response has been found in three of the four placebo-controlled trials. Katz (1998) noted that the pronounced improvement of depressive symptoms in placebo groups in those trials suggests that interpersonal or behavioral approaches might be effective in the treatment of depression in dementia. Teri, Logsdon, Uomoto, and McCurry (1997) studied two types of behavioral interventions the use of pleasant events for patients living in the community and teaching problem solving for their caregivers compared to a control wait-list condition in depressed patients with AD. Both approaches were associated with significant improvement in depressive symptoms in both patients and caregivers, and the improvement was maintained for six months. These results suggest that

Clinical manifestation

Symptoms are occasionally noted by relatives earlier than by the patient himself. This is why a history given by these persons is of utmost importance. Typical complaints are slowing of reasoning, forgetfulness, difficulties concentrating, lack of energy drive, mild depressive symptoms and emotional blunting. For symptoms and signs see Tables 1 and 2. Emotional Loss of drive and initiative, withdrawal from social activities, failure to manage the financial and administrative aspects of one's life, depressive mood, emotional blunting.

Process Of Therapeutic Change

Jillian had been diagnosed with Bipolar Disorder (aggressiveness without mania) on two previous hospitalizations and presently met criteria for Major Depressive Disorder, severe. Despite the affective volatility and instability that was suggestive of Borderline Personality Disorder (BPD), Jillian was better described by the label Oppositional Disorder a DSM-IV category closely related to the description of Passive Aggressive Personality Disorder (PAG) from the DSM-III-R (APA, 1987). Her patterns that were independent of mood disorder and that supported this label included the following specific DSM-IV items (1) She often lost her temper, (3) she typically refused to comply with rules and requests, (5) she frequently blamed others for her mistakes or misbehavior, (6) she was touchy and easily annoyed by others, (7) she was often angry and resentful. The proper way to define the PAG category has been so controversial that in the DSM-IV, it was moved from Axis II in the DSM-III-R to a...

Ethnicity And Adolescent Depression A Prevalence

For example, Fleming and Offord (1990) identified nine epidemiologic studies of clinical depression and report that prevalence of current depression ranged from 0.4-5.7 in the five studies reporting such data. The mean prevalence of current major depression was 3.6 . Subsequent to that review, several other articles have appeared. Lewinsohn, Hops, Roberts, Seeley, and Andrews (1993) reported data from a large sample of high school students indicating a point prevalence for Diagnostic and Statistical Manual of Mental Disorders (3rd. rev. ed.) (DSM-III-R) (American Psychiatric Association, 1987) major depression of 2.6 . Garrison et al. (1992) reported 1 year prevalence rates of about 9 for DSM-III major depressive disorder in a large sample of middle-school students. Based on an epidemiologic survey of youths 6-17 years of age, Jensen et al. (1995) estimated prevalence of depression (Major Depressive Episode Dysthymia) to be 1.9 based on parent report and 2.8 based on child report....

Psychological and Nonpharmacological Aspects of Depression in Dementia

This chapter is divided into five sections. In the first section, we explore the evidence for and against the question of depression as risk factor or prodrome. In addition to providing the empirical evidence and interpreting whether it supports either or both concepts, we present information on the vascular depression hypothesis and how this framework may shed light on the mechanisms involved in the depression-dementia debate. In the second section, we explore the notion that depression causes excess disability in those with dementia. We interpret the empirical evidence in the context of the activity limitation framework of depression. In the third section, we review the evidence concerning the phenomenology of depression in dementia. Assessment of depression in dementia is discussed in the fourth section. In the final section, we explore nonpharmacological treatments that are available for practitioners in treating depression and its

Depression As Prodrome Or Risk Factor

Devanand and colleagues (1996) followed more than 1,000 individuals age 60 and older on a yearly basis. Baseline mood disorder in the absence of cognitive impairment was associated with a moderately increased risk for incident dementia at follow-up. Zubenko (2000) addressed the notion of depression as a prodrome to dementia in a slightly different fashion. He investigated the evidence for the neurobiology of major depression in AD. Forty-three percent of his sample of those who had depression along with a diagnosis of AD came from a family where major depression occurred. In contrast, only 9 of the nondepressed demented individuals came from a family with a history of major depression. Zubenko postulated that early The depression-as-a-risk-factor hypothesis suggests that the presence of depression somewhere along the life span puts individuals at higher risk for developing dementing disorders. The data from Speck et al. (1995) are intriguing in this regard. These authors took 294...

Vascular Depression Hypothesis

A conceptual framework for understanding the mechanisms at work with depression as a prodrome or risk factor for dementia may be the vascular depression hypothesis (Alexopoulos, Meyers, Young, Campbell, et al., 1997 Alexopoulos, Meyers, Young, Kakuma, et al., 1997). This hypothesis states that vascular risk factors and or disease can predispose, precipitate, or perpetuate depressive disorders in older age. The authors speculate that specific disruption of the frontal-subcortical brain circuitry is responsible for the mood disorder. O'Brien et al. (1996) investigated white matter changes in a group of normal adults age 55 years and older (n 40), depressives age 55 years and older (n 61), and a group of nondepressed Alzheimer's patients (n 68). The authors confirmed Coffey's finding that white matter changes were common in 59 of normal elders. White matter changes were extremely common in depressives, with 85 having these changes and 30 showing severe changes. Overall, deep white matter...

Acute Versus Chronic Pathology

For example, endogenous depression, in which a historically long-standing depressive mood exists without an obvious external precipitant, can suggest a poor prognosis. In contrast, the diagnosis of reactive depression incorporated in DSM-IV as dysthymic disorder indicates a depressive mood of relatively recent onset in which the symptom is directly tied to a specific traumatic event such as loss or injury. In such cases of recent onset, the depression is a reaction within the personality that is designed to allay panic and anxiety and allow the individual to gain time to cope with the problem. Under these circumstances of acute onset, prognosis is generally positive. When the traumatic event is not dealt with adap-tively, however, the acute reaction can potentially develop into a more protracted depressive state.

Phenomenology Of Depression In Dementia

Chemerinski, Petracca, Sabe, Kremer, and Starkstein (2001) evaluated how well mood as rated by both caregiver and dementia patient accounted for depressive syndromes in 253 persons with AD, 47 persons with depression but no dementia, and 20 healthy controls. Depressed mood as rated by both caregivers and patients was a powerful predictor of a host of other depressive symptoms including apathy, anxiety, insomnia, loss of interest, agitation, and psychomotor retardation. These data further supported the importance of assessing mood in persons with dementia. 14 of those with dementia only and 0 in the control group. Forsell, Jorm, Fratiglioni, Grut, and Winbald (1993) used a population-based sample to examine how depression phenomenology changed over time. Investigating 213 persons with possible dementia, 11 met the criteria of the Diagnostic and Statistical Manual of Mental Disorders, third edition, revised (DSM-III-R American Psychiatric Association APA , 1987) for major depressive...

Behavioral Management Techniques

Literature that compares drug treatment to behavior management therapy (BMT) indicates that, in some instances, BMT can be as effective in managing symptoms as pharmaceutical interventions. Teri et al. (2000) compared pharmacological and nonpharmacological treatments in managing agitation and depressive symptoms for AD patients. Behavioral therapy has demonstrated efficacy in managing difficult behaviors, agitation, and aggression, and mood can be elevated through identification and involvement in pleasant activities, while matching activities to the individual's cognitive status (Holmberg, 1997 Teri, 1994). In a comparison of behavioral management strategies, Teri, Logsdon, Uomoto, and McCurry (1997) examined behavioral treatments for depressive symptoms of AD patients. Two behavioral treatments, one emphasizing maximizing pleasant events and the other emphasizing caregiver problem solving, were compared to two control conditions, standard care and wait-list. Two active treatment...

How long should treatment be continued

Benzodiazepines for anxiety and insomnia should be given for only a few weeks at a time, because of the risk of tolerance and dependence but antidepressants, if effective, should be continued for several months to prevent relapse. Lithium for prophylaxis of affective disorder, and antipsychotics for maintenance treatment of schizophrenia, are usually continued for several years and sometimes are needed for life.

Suicide in children and adolescents

The suicide rate among children and adolescents in the U.S. has risen faster than that of the world population as a whole. The suicide rate for Caucasian males aged 15 to 24 years has tripled since 1950 and it has more than doubled for Caucasian females in the same age bracket. In 1999, a survey of high school students found that 20 had seriously considered suicide or attempted it in the previous year. Of adolescents who do commit suicide, 90 have at least one diagnosable psychiatric disorder at the time of their death. Most frequently it is major depression, substance abuse disorder, or conduct disorder. Adolescents are particularly susceptible to dramatic or glamorized portrayals of suicide in the mass media.

Deficiency Signs And Symptoms

Secondary deficiencies can develop in chronic diarrhoea, liver disease, chronic alcoholism, adrenal or thyroid hormone insufficiency and postoperative situations in which TPN solutions lack riboflavin. In most cases, riboflavin deficiency is accompanied by other vitamin deficiencies such as vitamin B6, niacin and folic acid. Drugs that impair riboflavin absorption or utilisation by inhibiting the conversion of the vitamin to the active coenzymes include tricyclic, antidepressants, chemotherapy drugs and psychotropic agents. There is also evidence suggesting an apparent increase in riboflavin requirements with increased physical exercise.

Self Report Measures Geriatric Depression Scale GDS

Chemerinski et al. (2001) investigated how well Alzheimer's patients themselves could report their own mood. Patients with dementia ( both with and without depression) had a mean MMSE score of 19, although the standard deviation was large (6). The depressed patients (as diagnosed by psychiatrists) themselves rated their own mood as significantly worse than those persons with dementia but without depression (t 6, p < .00001). This finding is consistent with Mast's (2002) and Espiritu et al.'s (2001) finding that self-report depression information offers unique and valuable clinical information.

Nonpsychotic Mood Disorders

Another kind of bipolar disorder included in DSM-IV is the cyclothymic type. Essentially, this diagnosis involves a mood disorder with periods of elation and depression that are considered less severe than in the bipolar disorder. In the dysthymic disorder, depression is the unipolar dimension to be considered and this diagnosis of the dysthymic disorder roughly corresponds to the reactive depression of DSM-II where the depression was designed in the personality to allay anxiety stimulated by a specific precipitating event. In addition, the reactive depression of DSM-II could be diagnosed in connection with a reaction to any recent event and did not require the two-year framework, in which the depression was sustained, that corresponds to the dysthymic disorder introduced in DSM-III and continued in DSM-IV. Using DSM-IV, any depression less severe than that enduring two years and meeting the other severity requirements of dysthymia requires the...

Other antidepressant drugs

When the last edition of this book was coming out, antidepressants new to the market included Venlafaxine (see below) and Nefazadone. However, Nefazodone had to be withdrawn after a few years, because of liver toxicity. This should stand as a further warning, as if any were needed, against hasty prescription of new medications. (The wise psychiatrist will wait a few years while other doctors try out new drugs on their patients.) Nevertheless, the field of antidepressant prescribing seems to continue to be a 'dedicated follower of fashion' the latest SSRI or other compound being likely to be widely adopted if it is innocuous and skillfully marketed. Flupenthixol, which has somewhat confusingly been renamed flupentixol, is mainly used as an antipsychotic drug - most frequently as the long-acting depot injection Modecate. However, low doses (1-3 mg daily) are given by mouth as an antidepressant medication. It can be a useful adjunct when there has been a partial response to other forms...

Clinical Aspects

However, there are intermediate situations in which depressed patients also produce normal levels of melatonin, and there are apparently cases of depression, such as the winter blues that are more dependent on biorhythm phasing, of which melatonin production can be a marker. Although complex, it is likely that melatonin production will have significance for certain types of depression and for the chronicity of sleep-wake cycles and may play a role in others melatonin may also be important in this latter type where environmental bright light is a factor. There also seems to be the possibility that, in some cases of depression, high levels of melatonin are produced, but for some reason may not be utilized appropriately (in the hypo-

The Ejaculation Distribution Theory of Premature Ejaculation

Evidence for the role of the 5-HT2C receptor has been found in four stopwatch studies in men with premature ejaculation (31,42-44). It was demonstrated that the 5-HT2C receptor stimulating and the 5-HT2C blocking antidepressants exerted an ejaculation delay and absence of ejaculation delay, respectively. In a double-blind placebo-controlled study with the 5-HT2C 5-HT2A receptor antagonist and 5-HT noradrenaline reuptake inhibitor nefazo-done, 400 mg nefazodone daily did not exert any ejaculation delay in contrast

Psychiatric Diseases And Symptoms

Depressive symptoms are common in patients with AD, and in elderly persons with depression it is often difficult to distinguish this from AD. The sleep pattern Sleep problems are common in elderly persons with depressive disorders, and in the Diagnostic Statistical Manual (DSM-IV) of Mental Disorders, sleep deterioration is included as one of the nine criteria for the diagnosis of major depression (American Psychiatric Association 2000). Depression is a fairly common condition. In a recent questionnaire survey in northern Sweden among men and women of ages 18 years and older, the prevalence of major depression was found to be 4.8 in men and 6.3 in women with only minor difference with respect to age (Asplund et al., 2004). In persons with depression, sleep problems occur most frequently during acute depressive episodes, but the disturbed sleep often persists during remission. The sleep symptoms consist mainly of an increase in sleep latency, a reduced total sleep time, and a decrease...

Efficacy and prediction of response

About 80 per cent of severe depressive episodes respond well to ECT in the short term. Features predicting a good response - which are essentially markers of a severe depressive illness in a previously healthy person - include retardation, guilt, delusions, early morning waking, symptoms worse in the mornings, short duration of illness, and stable premorbid personality.

Timing and number of treatments

ECT is usually given twice a week for depressive illness, and more frequent administration has no advantage. The number of treatments required in a course of ECT varies considerably, although typically it is 6-10. There is usually a transient improvement for a few hours after each application, which gradually becomes sustained. Most depressive illnesses are episodes of a recurrent condition, often requiring prophylactic treatment. This is usually with medication, but there are very occasional patients whom only 'maintenance' ECT administered every few weeks can keep from relapse.

Internalizing Disorders Anxiety Disorders

Unhappiness or wide swings in mood from sadness to elation. The two most common mood disorders in childhood are major depressive disorder (MDD) and dysthymic disorder (DD APA, 2000). MDD and DD are related many children with DD eventually develop MDD, and some children may experience both disorders (Lewinsohn, Rohde, Seeley, & Hops, 1991). A third mood disorder, bipolar disorder, is rare in children, although there is growing interest in this problem in young people (Carlson, Bromet, & Sievers, 2000 Geller & Luby, 1997). In the sections to follow, we limit our discussion to anxiety disorders, highlighting many of the same features that we covered for ADHD. Once again, issues that we raise in discussing anxiety disorders have relevance for other childhood disorders as well. SAD is the most common anxiety disorder in youths, occurring in about 10 of all children. It seems to be equally common in boys and girls, although when gender differences are found they tend to favor girls...

Genetic epidemiology Affective disorders

There is no doubt that affective disorders tend to run in families. Among the first to remark on this was Kraepelin (1921), the founder of modern psychiatric classification, who noted that ''hereditary taint'' was apparent in 80 of his patients suffering from manic-depressive illness. The first studies to distinguish between UPD and BPD were comparatively recent. They were carried out by Angst (1966), a Swiss psychiatrist, and independently, in the same year, by Perris (1966) in Sweden. Perris found that there was a striking degree of homotypia, that is, a tendency for relatives of UP and BP probands to ''breed true'' and exhibit the same type of disorder. However, the findings of Angst were more complex. Among the relatives of probands with UPD there was an increase only of UPD, but among the relatives of BPD probands there was an excess of both UPD and BPD. Most subsequent studies have conformed to the pattern found by Angst (McGuffin and Katz, 1986). Focusing initially on women,...

Cardiac Disease Introduction

The important contribution of psychological factors to mortality and morbidity associated with ischaemic heart disease (IHD) is now well recognised. In a review of evidence-based cardiology, Hemingway & Marmot (1999) concluded that 'prospective cohort studies provide strong evidence that psychosocial factors, particularly depression and social support, are independent aetiological and prognostic factors for coronary heart disease.' The prevalence rates of major depressive illness in patients with IHD are three times that in the normal population. Cardiac mortality rates are increased by between three and four times for patients who are depressed post myocardial infarction (MI) compared with patients who have had a MI but are not depressed. Indeed the prognostic impact of depressive illness is comparable to that of degrees of ventricular dysfunction or coronary atherosclerosis in patients who have had a heart attack. Half of all cases of depression post-MI will remit spontaneously,...

Case Study I Neurological Perspectives

Regal is a 67-year-old woman who was initially treated by a geriatric psychiatrist three years ago for major depression complicated by generalized anxiety. Her depression improved with treatment, but she continued to have persistent anxiety symptoms. However, she did not return to see her psychiatrist. Mrs. Regal was functionally independent until she was hospitalized for a routine hysterectomy because of uterine bleeding caused by large fibroids. The second postoperative day, Mrs. Regal developed visual hallucinations (i.e., seeing a man in her room) and paranoid delusions (i.e., thought the nurses were plotting to kill her). The patient was given haloperidol orally for these symptoms in addition to the prochlorperazine that she was receiving for nausea. Within an hour of receiving haloperidol, she became very lethargic and immobile. She continued to have difficulty standing, dressing, and feeding herself for several days. After 10 days, she was discharged from the hospital...

Prevalence Of Latelife Depression And Anxiety

The Epidemiological Catchment Area Study (ECA) (Regier et al., 1988) was a major study investigating rates of depression and anxiety in the community carried out across five sites in the US. The ECA prevalence rates of major depressive disorder amongst older adults were lower than for younger adults (for review see Powers et al., 2002). In the UK, Lindesay, Brigs & Murphy (1989) reported prevalence rates of 4.3 for severe depression and 13.5 for mild moderate depression in a community dwelling urban sample. Beekman, Copeland & Prince (1999) carried out a systematic review of community-based studies examining prevalence of depression in older adults. Overall, Beekman, Copeland & Prince (1999) calculated prevalence rates of 13.5 for clinically relevant depression but concluded that major depression is relatively rare in later life (1.8 ) whereas minor depression is relatively more common (9.8 ). Similar figures reported by Copeland et al. (1987) and Livingston et al. (1990)...

Kathryn L Bleiberg and John C Markowitz

Interpersonal psychotherapy (IPT) is a time-limited (12-16 sessions), diagnosis-targeted, empirically tested treatment. Relative to most psychotherapies, it has been carefully studied but, until recently, used primarily in research settings and not widely used in clinical practice. The success of IPT in the treatment of outpatients with major depression has led to its testing for an expanded range of diagnostic indications. Furthermore, it has grown from being a treatment used by research therapists into an increasingly popular treatment approach for clinicians in private practice.

Depression in Older Patients

Major depressive disorder is frequently undiagnosed and untreated in older patients, and can be associated with high morbidity and mortality in this patient group, who are particularly prone to completed suicide or self-neglect. Grief, pain, sleep issues, concurrent medications, altered physiology, and the presence of comorbid medical and psychiatric conditions can complicate the management of depression in older patients. Comorbid medical conditions, including cardiovascular events, stroke, vascular dementia, and Alzheimer's disease, which are common among older patients, can have a significant impact on depression, and vice versa. Depression is not a natural part of the aging process, and it should be diagnosed and actively treated in the elderly, just as it is in younger patients. Pharmacother-apy can be safe and effective in this population, as long as pharmacokinetic and pharmacodynamic properties, as well as the inherent biological differences in the elderly population are...

Theoretical Formulations

A meta-analytic review by Gould and colleagues (Gould et al., 1997) addressed treatment efficacy for 13 studies comparing psychological therapy with no treatment, wait-list or psychological placebo and 22 studies comparing pharmacotherapy with pill placebo. Both within- and between-group effect sizes were calculated for anxiety and depression measures at post-treatment and, where available, for follow-up. Length of treatment was fairly short (three to nine weeks for pharmacotherapy and six to 15 weeks for psychological therapy) and follow-up data limited to six months in six of the psychological treatment studies. The majority of studies allowed comorbid anxiety disorders as long as GAD was the primary disorder. The results indicated that, for severity of anxiety symptoms at post-treatment, both CBT and pharmacotherapy were superior to control conditions and of broadly similar efficacy with moderately large effect sizes (ES 0.70 for CBT, ES 0.61 for pharmacotherapy). For severity of...

Dean Filandrinos Thomas R Yentsch and Katie L Meyers

John's wort has demonstrated clinical efficacy for mild to moderate depression and compares favorably to other more potent or toxic antidepressants. Low side effects and potential benefits warrant its use as a first-line agent for select patients with mild to moderate depression or anxiety-related conditions. Benefits related to other reported uses such as an antimicrobial, agent to treat neuropathic pain, antiinflammatory, treatment alternative for atopic dermatitis, and antioxidant are either not well documented or evidence is encouraging but not conclusive and further study is needed. St. John's wort has an inherently wide margin of safety when taken by itself, with most reported adverse drug reactions (ADRs) being related to skin reactions. Isolated, but more significant ADRs have been reported in relation to neurological effects, impact on thyroid function, and increased prothrombin time. Of greatest concern is the potential for interactions between St. John's wort and...

Seven masquerades checklist

Depressive illness has to be considered in any patient with a chronic pain complaint. This common psychiatric disorder can continue to aggravate or maintain the pain even though the provoking problem has disappeared. This is more likely to occur in people who have become anxious about their problem or who are under excessive stress. Many doctors treat such patients with a therapeutic trial of antidepressant medication, for example, amitriptyline or doxepin.

Diffuse Lewy Body Dementia DLBD

Prevalence rates for depression in DLBD are less studied. Depression may be more common in DLBD than in AD (Ballard et al., 2002). Rates of depressive symptoms have been reported to be up to 50 of DLBD patients (Klatka, Louis, & Schiffer, 1996) with the proportion of major depression estimated at 14 to 33 (Ballard et al., 1995 McKeith, Perry, Fairbairn, Jabeen, & Perry, 1992). A study comparing clinical and neuropathological cohorts using Diagnostic and Statistical Manual of Mental Disorders, third edition, revised (DSM-III-R American Psychiatric Association, 1987) criteria for major depression found that depression was more common in DLBD than in AD (clinical cohort DLBD 19 vs. 8 AD neuropathological cohort 32 DLBD and 12.5 AD Ballard et al., 1999).

Lifelong Delayed Ejaculation

Unfortunately there is no drug treatment available for delayed ejaculation in men. In animals, the 5-HT1A receptor agonist, 8-OH-DPAT, fastens the ejaculation latency, but such selective 5-HT1A agonists are not yet available for safe human use. Another possibility is a selective blockade of the 5-HT2C receptor. However, in a stopwatch controlled study in men with premature ejaculation, the 5-HT2C receptor blocking antidepressants, nefazodone and mirtazapine, did not lead to either delayed ejaculation or a faster ejaculation time.

Legal Remedies as a Result of Being Involved in a Single Life Threatening Situation

That said there appears to be two important aspects to determine whether liability should be imposed. First, the injury alleged must be a recognised psychiatric disorder that is more than a claim purely for a temporary upset such as grief or distress or fright from which we all suffer at times (Hinz v. Berry, 1970 cf. Tredget v. Bexley Health Authority, 1994). Examples of psychiatric illness would include clinical depression, personality changes, PTSD. Second, the person claiming the psychiatric harm must fall within a category accepted by the courts as being entitled to claim. This latter restriction may present difficulties for the 'professional' rescuer, such as a police officer, as we shall see shortly.

Chronic fatigue syndrome ICD neurasthenia F480

Many patients have depressive symptoms, but it is not clear whether these are part of the syndrome itself, or a secondary reaction to it. Whatever the aetiology, psychosocial factors appear to be of prime importance in maintaining persistent symptoms and disability. Some patients, convinced that they are suffering from continuing viral illness, insist on continuing to rest, and this causes loss of fitness and eventually makes fatigue worse. Others are willing to engage in a programme of gradually increasing activity, although they are often reluctant to consider that their problems may have a psychological dimension.

Pharmacological Toxicological Effects

There have been many clinical trials studying the effectiveness of St. John's wort in the treatment of depression. By the spring of 2002, there were 34 controlled trials including more than 3000 patients. Most of these trials included patients with mild to moderate depression and used the Hamilton Rating Scale of Depression (HAMD) to measure efficacy (6). Schulz compared the results of all of the trials since 1990. Nine of the 11 placebo-controlled trials showed a significant difference in the HAMD scores favoring hypericum, and a trend favoring hypericum was demonstrated in the other two. Linde also compared clinical trials with hypericum, and came to the conclusion that hypericum was superior to placebo in mild to moderate depression (7). When compared with the synthetic antidepressants, there was one trial with amitriptyline, four with imiprimine, two with fluoxetine, two with sertraline, one with bromazepam, and one with maprotiline. Of these trials, hypericum was equal to or...

Physical somatic biological vegetative symptoms

Physical symptoms are just as common as psychological ones and often form the presenting complaint when depressed patients consult in general practice. Core symptoms of depression include pain and tiredness. These have been recognized since the early days of psychiatry. (Indeed, a more insightful way of looking at the problem would be to retreat from the somewhat arbitrary mind body split in which, at any rate in Western societies, we view the experience of distress.) Pain and fatigue and depressed mood can in fact be thought of as an army - or at any rate a platoon - that marches together often, the depressed mood is the most prominent feature and the correct clinical diagnosis of a depressive illness is easily made.

Cognitive Behavioural Therapy Rationale

Such findings do not argue against CBT as a treatment for depression. On the contrary they demonstrate its consistently robust performance in the face of many comparative evaluations. However they highlight the relative absence of studies with depressed patients in which CBT was found to be superior to an alternative psychological treatment, a superiority tacit in the predominance of this model of practice. Cognitive behavioural therapy has demonstrated equivalence in good quality pharmacology studies (De Rubeis et al., 1999 Hollon et al., 1992 McKnight, Nelson-Gray & Barnhill, 1992). Hollon et al. (1992) also found no difference in CBT outcome with more severely depressed patients, in contrast to the findings of the TDCRP (Elkin et al. 1995). De Rubeis et al. (1999) also conducted a meta-analysis of four studies comparing CBT and medication for patients with severe depression. Direct comparisons between the two lines of intervention showed no significant differences but overall...

Pharmacological Treatment of the Paraphilias

There is no data to suggest that pharmacological intervention cans specifically target or ameliorate underlying paraphilic mechanisms. Rather, pharmacological interventions are either symptom focused or directed toward ameliorating or managing comorbid conditions. For example, where hypersexuality is a factor, pharmacological treatments are commonly implemented to lower libidinal drive where concurrent mania fosters hypersexuality, mood stabilizing agents are indicated where comorbid depression or anxiety exacerbates paraphilic urges and behaviors, pharmacological intervention to lower affective distress may be a crucial early treatment where paraphilic behavior is driven by underlying psychotic or delusional processes, the obvious first line treatment is pharmacological management of the psychotic state. As exemplified in these scenarios, pharmacological interventions for the paraphilias fall into three primary categories antidepressants, antiandrogens, and neuroleptics and other...

Vulvar Vestibulitis Syndrome

Activity in a group of vestibulitis sufferers (92). Follow-up data and a randomized clinical trial are needed in order to fully assess the effects of this kind of treatment, as local and systemic medications, such as creams, antibiotics, and injectable medical treatments may cause more harm than benefit (5). In addition, there is no empirical evidence for the success of any medication, such as antidepressants, for the pain of vestibulitis.

Child Depression Inventory

In 2002 the National Institute of Mental Health (NIMH) estimated that as many as 2.5 of children and 8.3 of adolescents under the age of 18 in the United States suffer from depression. A study sponsored by the NIMH of 9- to 17-year-olds found that 6 developed depression in a six-month period, with 4.9 diagnosed as having major depression. Research also indicates that children and adolescents experience the onset of depression at earlier ages than previous generations, are more likely to experience recurrences, and are more likely to experience severe depression as adults.

Humanistic Therapies Theoretical Basis

Although an early meta-analysis suggested less favourable outcomes for humanistic therapies (Smith, Glass & Miller, 1980), more recent meta-analyses have indicated large effect sizes for pre- to post-treatment change in these therapies, particularly with relationship problems, anxiety and depressive disorders and trauma, with treatment gains generally being maintained at follow-up (Elliott, 1996, 2001, 2002 Elliott, Greenberg & Lietaer, 2004 Greenberg, Elliott & Lietaer, 1994). There is also evidence of such therapies being 'possibly efficacious' for people diagnosed with anger-related problems, schizophrenia, severe personality disorders and physical health problems. In comparative outcome studies, these effect sizes are generally equivalent to those in the other therapies studied, but considerably greater than those in untreated controls. There are also indications of greater effect sizes for Gestalt and process-experiential than for non-directive humanistic therapies.

Zyprexa see Olanzapine

Alzheimer's disease major depressive disorder substance use, abuse, or dependence Agoraphobia childhood Internet addiction major depressive disorder may occur with Wernicke-Korsakoff major depressive disorder postpartum depression seasonal affective disorder substance dependence undifferentiated somatoform disorder Arousal, sexual disorder major depressive disorder nightmare disorder post-traumatic stress disorder Attention-seeking behavior brief psychotic disorder major depressive disorder schizophrenia schizophreniform disorder Cold hands and feet anorexia nervosa Communication. See language Daily activities difficulties Alzheimer's disease childhood disintegrative disorder Decision-making difficulties dependent personality disorder major depressive disorder Defiance Alzheimer's disease bipolar disorder borderline personality disorder cyclothymic disorder dysthymic disorder major depressive disorder may occur with pyromania may occur with sexual dysfunctions pain disorder postpartum...

The Effects Of Drugs On Womens Orgasmic Ability

A number of psychotherapeutic drugs have been noted to affect the ability of women to attain orgasm. The selective serotonin reuptake inhibitors (SSRIs) frequently affect orgasmic functioning, leading to delayed orgasm or anorg-asmia. There is variability, however, in that some antidepressants have been associated with anorgasmia less frequently than others. For example, the anti-depressant, nefazodone, has been reported to produce fewer sexual side effects In summary, drugs that increase serotonergic activity (e.g., antidepressants), or decrease dopaminergic activity (e.g., antipsychotics) adversely impact female orgasm. The degree to which the former of these influences orgasm appears to be dependent upon which serotonin receptor subtype they activate inhibit.

Anxiety and Depression 101

Anxiety and Depression 101

Everything you ever wanted to know about. We have been discussing depression and anxiety and how different information that is out on the market only seems to target one particular cure for these two common conditions that seem to walk hand in hand.

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