On Chemical Imbalances, Antidepressants, and the Diagnosis of Depression

2009 ◽  
Vol 11 (3) ◽  
pp. 199-214 ◽  
Author(s):  
Allan M. Leventhal ◽  
David O. Antonuccio
Keyword(s):  
Disease Model ◽  
Medical Model ◽  
Antidepressant Drugs ◽  
Standard Of Care ◽  
Economic Interests ◽  
Negative Results ◽  
Receptor Sites ◽  
Treatment Of Depression ◽  
Meta Analyses ◽  
Chemical Imbalance

Over the past 30 years psychiatry has made a paradigm shift within a medical model from a psychological to a biological explanation for mental disorder. Depression is attributed to an imbalance of monoamines in the brain caused by depletion of neurotransmitters at receptor sites. The standard of care for treating depression is prescription of antidepressant medications alleged to correct this chemical imbalance. Research results testing the chemical imbalance theories for depression have been contradictory to the theories. Analyses of data from studies and meta-analyses of the efficacy of antidepressants indicate selective publication fostering an inflated impression of effectiveness and that antidepressants offer little more than placebos. Several sources of error, particularly breaking of the blind, may have determined outcome in studies showing drug/placebo differences. Despite negative results regarding the theory and pharmacotherapy for depression, the frequency of diagnoses of depression and prescription of antidepressant drugs have increased enormously. Economic interests more than science appear to be determining the treatment of depression. Prescription of antidepressant drugs as the standard of care for depression warrants reconsideration. A biopsychosocial model may be more useful than a disease model for conceptualizing and treating depression.

scholarly journals What we know, what we do not know, and where are we heading? Efficacy and acceptability of psychological interventions for depression

2015 ◽  
Vol 25 (4) ◽  
pp. 301-308 ◽  
Author(s):  
N. Solomonov ◽  
J. P. Barber
Keyword(s):  
Randomized Clinical Trials ◽  
Behavioural Therapy ◽  
Drop Out ◽  
Interpersonal Therapy ◽  
Problem Solving Therapy ◽  
Cognitive Behavioural ◽  
Treatment Of Depression ◽  
Personalised Treatment ◽  
Meta Analyses ◽  
And Control

In the past several decades, increasing evidence supports the efficacy of psychotherapies for depression. The vast majority of findings from meta-analyses, randomized clinical trials (RCTs) and naturalistic studies have demonstrated that well-established psychotherapies (behavioural activation, problem-solving therapy, psychodynamic therapy, cognitive-behavioural therapy, interpersonal therapy and emotion-focused therapy) are superior to no-treatment and control conditions, and are in most cases equally effective in treating depression. However, despite this abundant support for psychotherapies, studies have also consistently shown high drop-out rates, high percentages of non-respondent patients who experience treatment failures, and mixed findings regarding the enduring effects of psychotherapy. Thus, there is a need to develop more personalised treatment models tailored to patients’ needs. A new integrative sequential stepwise approach to the treatment of depression is suggested.

scholarly journals Antidepressants and Circadian Rhythm: Exploring Their Bidirectional Interaction for the Treatment of Depression

Pharmaceutics ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 1975
Author(s):  
Soraia Silva ◽  
Joana Bicker ◽  
Amílcar Falcão ◽  
Ana Fortuna
Keyword(s):  
Circadian Rhythms ◽  
Intracellular Signaling ◽  
Scientific Evidence ◽  
Antidepressant Drugs ◽  
Positive Influence ◽  
Drug Dosing ◽  
Signaling Systems ◽  
Treatment Of Depression ◽  
Target Molecules ◽  
The Relationship

Scientific evidence that circadian rhythms affect pharmacokinetics and pharmacodynamics has highlighted the importance of drug dosing-time. Circadian oscillations alter drug absorption, distribution, metabolism, and excretion (ADME) as well as intracellular signaling systems, target molecules (e.g., receptors, transporters, and enzymes), and gene transcription. Although several antidepressant drugs are clinically available, less than 50% of depressed patients respond to first-line pharmacological treatments. Chronotherapeutic approaches to enhance the effectiveness of antidepressants are not completely known. Even so, experimental results found until this day suggest a positive influence of drug dosing-time on the efficacy of depression therapy. On the other hand, antidepressants have also demonstrated to modulate circadian rhythmicity and sleep–wake cycles. This review aims to evidence the potential of chronotherapy to improve the efficacy and/or safety of antidepressants. It includes pre-clinical and clinical studies that demonstrate the relevance of determining the most appropriate time of administration for antidepressant drugs. In parallel, their positive influence on the resynchronization of disrupted circadian rhythms is also herein discussed. It is expected that this review will promote the investigation of chronotherapy for the treatment of depression, contribute to a better understanding of the relationship between antidepressants and circadian rhythms, and consequently promote the development of new therapeutics.

Antidepressants

2012 ◽  
pp. 1185-1198
Author(s):  
Zubin Bhagwagar ◽  
George R. Heninger
Keyword(s):  
Burden Of Disease ◽  
Antidepressant Drugs ◽  
Public Health Problem ◽  
Premature Mortality ◽  
Primary Treatment ◽  
World Health ◽  
Years Of Life Lost ◽  
Major Public Health Problem ◽  
Treatment Of Depression ◽  
Health Organization

Major depressive disorder is a serious, recurrent illness which levies a crippling toll on individuals, families, and society in general. The importance of depression as a major public health problem is emphasized by findings from the World Health Organization Global Burden of Disease survey in showing that in 1990 it was the fourth largest cause of burden of disease (i.e. years of life lost due either to premature mortality or to years lived with a disability). It has been estimated that by the year 2020 it is expected to be the second largest cause of burden of disease. Depression is underdiagnosed and frequently under-treated, and depressed individuals have a much higher risk for suicide. The primary treatment for depression involves the use of antidepressant drugs, and it is therefore important that clinicians become familiar with and adept in utilizing this important group of compounds. Although primarily used for the treatment of depression, drugs within this category also have a number of other important uses. A thorough understanding of the pharmacology of antidepressants will aid the clinician in the selective use of these drugs for patients with depression as well as patients with a number of other disorders.

scholarly journals What does the latest meta-analysis really tell us about antidepressants?

2018 ◽  
Vol 27 (5) ◽  
pp. 430-432 ◽  
Author(s):  
J. Moncrieff
Keyword(s):  
Meta Analysis ◽  
Term Treatment ◽  
Significant Other ◽  
Brain Abnormality ◽  
Antidepressant Effects ◽  
Long Term Treatment ◽  
Clinically Significant ◽  
Meta Analyses ◽  
Chemical Imbalance

A recent meta-analysis of antidepressant trials is the largest conducted to date. Although it claims to prove antidepressant effectiveness beyond dispute, the main outcome is response rates, which are derived from continuous data in a process that can inflate differences between groups. The standardised mean difference of 0.3 is in line with other meta-analyses that show small differences between antidepressants and placebo that are unlikely to be clinically significant. Other factors likely to exaggerate the effects are discussed, and evidence on associations between antidepressant effects and severity and outcomes of long-term treatment is considered. Clinicians need to have open discussions with patients about the limitations of antidepressant research, the lack of evidence that antidepressants correct a chemical imbalance or other brain abnormality, and the range of adverse effects and mental and physical alterations they can produce.

Depression, demoralization, and suicidality

2015 ◽  
Author(s):  
David W. Kissane ◽  
Matthew Doolittle
Keyword(s):  
Symptom Control ◽  
Combined Treatment ◽  
Mental Condition ◽  
Medical Treatments ◽  
Cognitive Behavioural ◽  
Treatment Of Depression ◽  
Screening For Distress ◽  
Behavioural Therapies ◽  
Meta Analyses ◽  
Anxiety Depression

The development of clinical depression is common during palliative care, adversely affects quality of life and adherence to medical treatments, yet regrettably can pass unrecognized. Screening for distress as the sixth vital sign is therefore highly recommended. Demoralization is another form of distress where the apparent pointlessness of continued life may lead to suicidal thinking. As the mental condition deteriorates, co-morbid states of anxiety, depression, and demoralization become more likely. Rates of suicide are increased with advanced cancer and poor symptom control. Fortunately, combined treatment with medication and counselling is effective in ameliorating depression, demoralization, and suicidality. Meta-analyses of psychotherapy trials confirm clear benefits, with behavioural activation, supportive, interpersonal, and cognitive behavioural therapies all making contributions. Group, couple, and family therapies optimize support for all involved. All members of the multidisciplinary team contribute to the active treatment of depression, demoralization, and the prevention of suicide.

scholarly journals Glucocorticoids in Graves’ orbitopathy: mechanisms of action and clinical application

2020 ◽  
Vol 11 ◽  
pp. 204201882095833
Author(s):  
Jan Längericht ◽  
Irene Krämer ◽  
George J. Kahaly
Keyword(s):  
Low Cost ◽  
Standard Of Care ◽  
Daily Basis ◽  
Clinical Severity ◽  
Line Treatment ◽  
First Line ◽  
Graves Orbitopathy ◽  
Meta Analyses ◽  
First Line Treatment

Background: Graves’ orbitopathy (GO) is the most frequent extrathyroidal manifestation of the autoimmune Graves’ disease. GO significantly impacts quality of life and has a psycho-social morbidity. Inflammation and swelling of the orbital tissue often leads to proptosis, diplopia, and decrease of visual acuity. Due to the inflammatory background of the disease, glucocorticoids (GC) have been used as a first-line treatment for decades. Methods: PubMed and MeSH database were searched for original articles, clinical trials, reviews, and meta-analyses published between 1 January 2000 and 31 March 2020 and pertaining to both the mechanism of action and immunological effects of GC as well as to the treatment of GO by GC. The publications were evaluated according to their setting and study design. Results: GC act through genomic (trans-activation and trans-repression) and rapid non-genomic mechanisms. GC in general, and the intravenous (IV) administration of GC in particular, markedly decrease the activity and number of the most potent antigen-presenting dendritic cells. According to the internationally acknowledged European Thyroid Association Guidelines for the management of GO, weekly IVGC application over 12 weeks is recommended as first-line treatment for patients with active and severe GO. The daily and cumulative dose should be tailored according to clinical severity, for example, 4.5 g of IV methylprednisolone for the inflammatory component versus 7.5 g in the presence of diplopia and severe proptosis. Fast and significant improvements in orbital symptoms and signs are noted in 65–70% of patients. Long-term experience over decades, and worldwide availability at low cost, underline the clinical and therapeutic relevance of GC. Adverse events are rarely severe, dose-dependent, and usually reversible, hence easy to handle by medical investigators. Oral GC application on a daily basis is characterized by high bioavailability but reduced efficacy and increased toxicity. Conclusion: IVGC still represents the standard of care in active/severe GO. Innovative biologicals, like monoclonal antibodies targeting the thyrotropin/Insulin-like growth factor-1 receptors or pro-inflammatory cytokines (e.g., Interleukin-6) should be compared with standard GC treatment with respect to short- and long-term efficacy, safety, costs, and global availability.

scholarly journals A critical review of the possible benefits associated with homeopathic medicine

2003 ◽  
Vol 58 (6) ◽  
pp. 324-331 ◽  
Author(s):  
Renan Moritz V. Rodrigues Almeida
Keyword(s):  
Critical Review ◽  
Scientific Research ◽  
Research Progress ◽  
Reference Source ◽  
Ample Evidence ◽  
Negative Results ◽  
Plausible Mechanism ◽  
Meta Analyses ◽  
Positive Results

OBJECTIVE: To evaluate the recent scientific research progress on homeopathy. METHODOLOGY: Homeopathy was evaluated in terms of its clinical research; in vitro research, and physical foundations. The Medline database was the main reference source for the present research, concerning data of approximately the last 10 years. Secondary references (not available in this database) were obtained by means of direct requests to authors listed in the primary references. RESULTS: Clinical studies and in vitro research indicate the inefficacy of homeopathy. Some few studies with positive results are questionable because of problems with the quality and lack of appropriate experimental controls in these studies. The most recent meta-analyses on the topic yielded negative results. One of the few previous meta-analyses with positive results had serious publication bias problems, and its results were later substantially reconsidered by the main authors. The sparse in vitro homeopathic research with positive results has not been replicated by independent researchers, had serious methodological flaws, or when replicated, did not confirm the initial positive results. A plausible mechanism for homeopathic action is still nonexistent, and its formulation, by now, seems highly unlikely. CONCLUSIONS: As a result of the recent scientific research on homeopathy, it can be concluded that ample evidence exists to show that the homeopathic therapy is not scientifically justifiable.

Random error in cardiovascular meta-analyses: How common are false positive and false negative results?

2013 ◽  
Vol 168 (2) ◽  
pp. 1102-1107 ◽  
Author(s):  
Zaina AlBalawi ◽  
Finlay A. McAlister ◽  
Kristian Thorlund ◽  
Michelle Wong ◽  
Jørn Wetterslev
Keyword(s):  
Random Error ◽  
False Positive ◽  
False Negative ◽  
Negative Results ◽  
False Negative Results ◽  
Meta Analyses

The Risks Associated With Stimulant Medication Use in Child and Adolescent Populations Diagnosed With Attention-Deficit/Hyperactivity Disorder

2012 ◽  
Vol 14 (1) ◽  
pp. 5-14
Author(s):  
Jeanne M. Stolzer
Keyword(s):  
United States ◽  
Attention Deficit Hyperactivity Disorder ◽  
Attention Deficit ◽  
Developmental Stages ◽  
Stimulant Medication ◽  
Medical Model ◽  
Child And Adolescent ◽  
The United States ◽  
Hyperactivity Disorder ◽  
Chemical Imbalance

Throughout human history, psychiatric dysfunction in child and adolescent populations has been rare. However, over the last 2 decades, psychiatric diagnoses have reached epidemic proportions—particularly in the United States. Currently, attention-deficit/hyperactivity disorder (ADHD) is the most commonly diagnosed psychiatric illness in child and adolescent populations with an estimated 10–12 million children diagnosed in the United States. Over the last 2 decades, behavior patterns that were once perceived as typical, normative developmental stages have been systematically redefined by those promoting the mass labeling and drugging of children as a “chemical imbalance of the brain.” Grounded in bioevolutionary theory, this article will challenge the existing medical model and will explore in-depth the risks associated with the ADHD label and the use of stimulant medication in pediatric populations. In addition, this article will examine the cultural, physical, neurological, psychological, and social correlates as they relate to the diagnosis of ADHD in America.

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