scholarly journals Maintenance Pharmacotherapy for Recurrent Major Depressive Disorder in Primary Care: A 5-year Follow-up Study

2017 ◽  
Vol 41 (1) ◽  
pp. 111-114 ◽  
Author(s):  
K. Riihimäki ◽  
M. Vuorilehto ◽  
E. Isometsä
Keyword(s):  
Primary Care ◽  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Maintenance Treatment ◽  
Antidepressant Treatment ◽  
Major Depressive ◽  
Recurrent Major Depressive Disorder ◽  
Major Depressive Episodes ◽  
Depressive Episodes

AbstractBackgroundMost practice guidelines recommend maintenance antidepressant treatment for recurrent major depressive disorder. However, the degree to which such guidance is actually followed in primary health care has remained obscure. We investigated the provision of maintenance antidepressant treatment within a representative primary care five-year cohort study.MethodsIn the Vantaa Primary Care Depression Study, a stratified random sample of 1119 adult patients was screened for depression using the Prime-MD. Depressive and comorbid psychiatric disorders were diagnosed using SCID-I/P and SCID-II interviews. Of the 137 patients with depressive disorders, 82% completed the prospective five-year follow-up. A graphic life chart enabling evaluation of the longitudinal course of episodes plus duration of pharmacotherapies was used. In accordance with national guidelines, an indication for maintenance treatment was defined to exist after three or more lifetime major depressive episodes (MDEs); maintenance treatment was to commence four months after onset of full remission.ResultsOf the cohort patients, 34% (46/137) had three or more lifetime MDEs, thus indicating the requirement for maintenance pharmacotherapy. Of these, half (54%, 25/46) received maintenance treatment, for only 29% (489/1670) of the months indicated.ConclusionsIn this cohort of depressed primary care patients, half of patients with indications for maintenance treatment actually received it, and only for a fraction of the time indicated. Antidepressant maintenance treatment for the prevention of recurrences is unlikely to be subject to large-scale actualization as recommended, which may significantly undermine the potential public health benefits of treatment.

scholarly journals Maintenance pharmacotherapy for recurrent major depressive disorder: 5-year follow-up study

2008 ◽  
Vol 193 (2) ◽  
pp. 163-164 ◽  
Author(s):  
Irina A. K. Holma ◽  
K. Mikael Holma ◽  
Tarja K. Melartin ◽  
Erkki T. Isometsä
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Maintenance Treatment ◽  
Antidepressant Treatment ◽  
Psychiatric Patients ◽  
Major Depressive ◽  
Good Adherence ◽  
Follow Up Study ◽  
Recurrent Major Depressive Disorder

SummaryPractice guidelines endorse maintenance antidepressant treatment for recurrent major depressive disorder. In the Vantaa Depression Study, we followed 218 psychiatric patients with major depressive disorder for up to 5 years with a life-chart. Of these patients, 86 (39.4%) had more than three lifetime episodes and an indication for maintenance pharmacotherapy. However, of these, only 57% received treatment and only for 16% of the time indicated. Good adherence to pharmacotherapy in the acute phase independently predicted maintenance treatment. The tertiary preventive impact of maintenance treatment may remain limited, as many patients with major depressive disorder either do not receive it, or receive it for too short a period.

scholarly journals Psychotherapy for subclinical depression: meta-analysis

2014 ◽  
Vol 205 (4) ◽  
pp. 268-274 ◽  
Author(s):  
Pim Cuijpers ◽  
Sander L. Koole ◽  
Annemiek van Dijke ◽  
Miquel Roca ◽  
Juan Li ◽  
...  
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Symptoms ◽  
Major Depression ◽  
Depressive Disorder ◽  
Psychological Treatment ◽  
Meta Analysis ◽  
Major Depressive ◽  
Major Depressive Episodes ◽  
Depressive Episodes ◽  
Subclinical Depression

BackgroundThere is controversy about whether psychotherapies are effective in the treatment of subclinical depression, defined by clinically relevant depressive symptoms in the absence of a major depressive disorder.AimsTo examine whether psychotherapies are effective in reducing depressive symptoms, reduce the risk of developing major depressive disorder and have comparable effects to psychological treatment of major depression.MethodWe conducted a meta-analysis of 18 studies comparing a psychological treatment of subclinical depression with a control group.ResultsThe target groups, therapies and characteristics of the included studies differed considerably from each other, and the quality of many studies was not optimal. Psychotherapies did have a small to moderate effect on depressive symptoms against care as usual at the post-test assessment (g = 0.35, 95% CI 0.23–0.47; NNT = 5, 95% CI 4–8) and significantly reduced the incidence of major depressive episodes at 6 months (RR = 0.61) and possibly at 12 months (RR = 0.74). The effects were significantly smaller than those of psychotherapy for major depressive disorder and could be accounted for by non-specific effects of treatment.ConclusionsPsychotherapy may be effective in the treatment of subclinical depression and reduce the incidence of major depression, but more high-quality research is needed.

Psychosocial Treatments for Major Depressive Disorder

2015 ◽  
Author(s):  
W. Edward Craighead ◽  
Benjamin N. Johnson ◽  
Sean Carey ◽  
Boadie W. Dunlop
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Rating Scales ◽  
Behavioral Therapy ◽  
Psychosocial Interventions ◽  
Pharmacological Interventions ◽  
Major Depressive ◽  
Psychosocial Treatments ◽  
Major Depressive Episodes ◽  
Depressive Episodes

Behavior therapy, cognitive-behavioral therapy, and interpersonal psychotherapy have each been shown by at least two randomized controlled trials, as well as by numerous meta-analytic reports, to be effective psychosocial interventions for patients meeting criteria for major depressive disorder. All three psychosocial treatments have yielded substantial reductions in scores on the two major depression rating scales, significant decreases in percentage of patients meeting depression criteria at posttreatment, and substantial maintenance of effects well after treatment has ended. The data for outcomes of psychosocial and pharmacological interventions for major depressive episodes suggest that the two treatment modes are equally efficacious.

May duration of untreated illness influence the long-term course of major depressive disorder?

2008 ◽  
Vol 23 (2) ◽  
pp. 92-96 ◽  
Author(s):  
A. Carlo Altamura ◽  
Bernardo Dell'Osso ◽  
Serena Vismara ◽  
Emanuela Mundo
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Antidepressant Treatment ◽  
Age At Onset ◽  
Major Depressive ◽  
Chi Square ◽  
Duration Of Untreated Illness ◽  
Course Variables ◽  
Depressive Episodes

AbstractThe aim of this naturalistic study was to investigate the possible influence of the duration of untreated illness (DUI) on the long-term course of Major Depressive Disorder (MDD). One hundred and thirteen patients with recurrent MDD, according to DSM-IV-TR criteria, followed up for 5 years, were selected, interviewed and their clinical charts were reviewed. The DUI was defined as the interval between the onset of the first depressive episode and the first adequate antidepressant treatment. The sample was divided into two groups according to the DUI: one group with a DUI ≤ 12 months (n = 75), and the other with a DUI > 12 months (n = 38). The main demographic and clinical course variables were compared between the two groups using Student's t-tests or chi-square tests. Patients with a longer DUI showed an earlier age at onset (t = 2.82, p = 0.006) and a longer duration of illness (t = 3.20, p = 0.002) compared to patients with a shorter DUI. In addition, the total number of depressive episodes occurring before the first antidepressant treatment was higher in the group with a longer DUI (t = −2.223, p < 0.03). Even though limited by the retrospective nature of the study, these preliminary findings would suggest that a longer DUI may negatively influence the course of MDD. Larger prospective studies are warranted to further investigate the role of the DUI within MDD.

Intrinsic functional connectivity of cortico-basal ganglia-thalamo-cortical circuitry underlying psychomotor retardation in major depressive disorder

2017 ◽  
Vol 41 (S1) ◽  
pp. S328-S328
Author(s):  
Y. Yin ◽  
Y. Yuan ◽  
L. Fan ◽  
C. Xie ◽  
Z. Zhang
Keyword(s):  
Major Depressive Disorder ◽  
Basal Ganglia ◽  
Functional Connectivity ◽  
Depressive Disorder ◽  
Antidepressant Treatment ◽  
Psychomotor Retardation ◽  
Indirect Pathway ◽  
Major Depressive ◽  
Competing Interest

IntroductionPsychomotor retardation (PMR) in depression is analogous to the hypokinesia in Parkinson's disease, which is associated with the unbalanced direct and indirect pathways of cortico-basal ganglia-thalamo-cortical (CBTC) circuitry. This study hypothesized PMR in major depressive disorder (MDD) should be associated with the hyperactivity of CBTC indirect pathways.ObjectivesTo substantiate the hypothesis that the PMR symptom of MDD might attribute to the hyperactivity of the ortico-basal ganglia-thalamo-cortical indirect pathway which could inhibit psychomotor performance.MethodsWe investigated the intrinsic stiato-subthalamic nucleus (STN)-thalamic functional connectivity (FC), three pivotal hubs of the indirect pathway, in 30 MDD patients with PMR (PMR group) and well matched 30 patients without PMR (NPMR group) at baseline, and 11 patients of each group at follow-up who remitted after antidepressant treatment.ResultsThe results showed increased STN-striatum FC of PMR group at baseline and no more discrepancy at follow-up, and significant correlation between PMR severity and thalamo-STN FC.ConclusionsOur findings suggested the increased STN- striatum FC should be considered as a state biomarker to distinguish MDD patients with PMR from patients without PMR at acute period, and thalamo-STN FC could be identified as the predictor of the PMR severity for MDD patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Recent advances in predicting responses to antidepressant treatment

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 619 ◽  
Author(s):  
Thomas Frodl
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Targeted Therapies ◽  
Antidepressant Treatment ◽  
Inflammation Markers ◽  
Major Depressive ◽  
The Past ◽  
Recent Advances ◽  
The World ◽  
Depressive Episodes

Major depressive disorder is one of the leading causes of disability in the world since depression is highly frequent and causes a strong burden. In order to reduce the duration of depressive episodes, clinicians would need to choose the most effective therapy for each individual right away. A prerequisite for this would be to have biomarkers at hand that would predict which individual would benefit from which kind of therapy (for example, pharmacotherapy or psychotherapy) or even from which kind of antidepressant class. In the past, neuroimaging, electroencephalogram, genetic, proteomic, and inflammation markers have been under investigation for their utility to predict targeted therapies. The present overview demonstrates recent advances in all of these different methodological areas and concludes that these approaches are promising but also that the aim to have such a marker available has not yet been reached. For example, the integration of markers from different systems needs to be achieved. With ongoing advances in the accuracy of sensing techniques and improvement of modelling approaches, this challenge might be achievable.

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