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When Depression Comes Back: What To Do Is Not What "Big PHRMA" Wants You To Do.
January 13, 2003Relapse is a major problem for depressed patients. With this review, Psychotherapy and Psychosomatics launches a new section (case Management), which addresses management of cases in clinical practice. Investigators with conflict of interest are excluded from contributing. The Authors are from the Department of Psychology of the University of Bologna (Drs Fava and Ruini) and the Department of Mental Health of Padova (Dr Sonino). They discuss the case of a 37-year-old woman with a major depressive episode of recent onset. She had 2 previous episodes 1 and 3 years earlier, which had been treated by her primary care physician with fluoxetine for 6 months each time. There is no evidence of bipolar illness. She wants to know which treatment is right for her at this point.
The chronic and recurrent nature of major depressive disorder is getting increasing attention. Approximately 8 of 10 people experiencing a major depressive episode will have one or more episode during their lifetime, a recurrent major depressive disorder.
In the nineties, prolongation or lifelong pharmacotherapy has emerged as the main therapeutic tools for preventing relapse in depression. Such therapeutic choice is based on the effectiveness of antidepressant drugs compared to placebo in decreasing relapse risk and on the better tolerability of the newer components in terms of side effects profiles. However, outcome after discontinuation of antidepressants does not seem to be affected by the duration of their administration. Loss of clinical effects, despite adequate compliance, has also emerged as a vexing clinical problem. Use of intermittent pharmacotherapy with follow-up visits is another therapeutic option that would leave patients with periods free of drugs and side effects and would consider that a high proportion of patients would discontinue the antidepressant anyway. However, the problems of resistance (the fact that a drug treatment may be associated with a diminished chance of response in those patients who successfully responded to it, but discontinued it) and of discontinuation syndromes are a substantial disadvantage of this therapeutic option.
In recent years, several controlled trials have suggested that a sequential use of pharmacotherapy in the treatment of the acute episode and psychotherapy in its residual phase may improve long-term outcome. Patients, however, should be motivated for psychotherapy and skilled therapists should be available.
Despite an impressive amount of research in depression treatment, there is still paucity of studies addressing the specific problems that prevention of recurrent depression entails. It is important to discuss with the patient the various therapeutic options and to adapt strategies to the specific needs of patients.
Psychotherapy and Psychosomatics, Journal of
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Interferon as long-term treatment for hepatitis C not effective, report HALT-C researchers
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Mix of taiji, cognitive therapy and support groups benefits those with dementia
Those diagnosed with early stage dementia can slow their physical, mental and psychological decline by taking part in therapeutic programs that combine counseling, support groups, Taiji and qigong, researchers report. Some of the benefits of this approach are comparable to those achieved with anti-dementia medications.
Nearly 5 percent of the US population suffers from persistent depression or anxiety
Though effective treatments are available for individuals suffering from chronic depression and anxiety, very little is known about how often these treatments are used or how prevalent these conditions are among the nation's general population.
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Stress-related disorders affect brain's processing of memory
Researchers using functional MRI (fMRI) have determined that the circuitry in the area of the brain responsible for suppressing memory is dysfunctional in patients suffering from stress-related psychiatric disorders. Results of the study will be presented today at the annual meeting of the Radiological Society of North America (RSNA).
Gay men's risky sexual behavior linked to feeling undesirable
Gay men who are not considered sexually desirable are more likely to engage in risky sexual behavior according to new research out of the University of Toronto. They may also develop psychological problems as a consequence of feeling undesirable.
Lower childhood IQ associated with higher risk of adult mental disorders
Researchers have hypothesized that people with lower IQs may have a higher risk of adult mental disorders, but few studies have looked at the relationship between low childhood IQ and psychiatric disorders later in life.
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