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Depression
Published in Henry J. Woodford, Essential Geriatrics, 2022
A period of six to eight weeks on treatment is usually required to achieve maximal improvement,20 but beneficial effects are seen in many people within two weeks.38 Current guidance suggests continuing pharmacotherapy for at least six months after remission has been achieved.14 This should lower the risk of relapse. If no improvement is detected after three to four weeks then check adherence, consider increasing the dose or switching to an alternative drug.14 When switching between agents it is preferable to have a period of around two days off all antidepressant medications. This time period should be increased when switching to or from monoamine oxidase inhibitors (MAOIs) or fluoxetine due to the prolonged half-lives of these drugs or their metabolites. If there is still no improvement, specialist input is necessary to consider alternative strategies such as combinations of antidepressant agents or ECT (see following sections).
“Are All My Patients Depressed?”
Published in Paul Ian Steinberg, Psychoanalysis in Medicine, 2020
Conditions such as persistent depressive disorder (PDD) (formerly dysthymic disorder) and adjustment disorder with depressed mood (ADDM), which present very frequently to family physicians, are less responsive to antidepressants. Nevertheless, antidepressant medication often is prescribed for patients complaining of depressive mood, regardless of whether they have symptoms suggesting that their “depression” would be responsive to antidepressants.
Examples from Actual Clinical Trials in Choosing and Specifying Estimands
Published in Craig Mallinckrodt, Geert Molenberghs, Ilya Lipkovich, Bohdana Ratitch, Estimands, Estimators and Sensitivity Analysis in Clinical Trials, 2019
Craig Mallinckrodt, Geert Molenberghs, Ilya Lipkovich, Bohdana Ratitch
MDD is a common psychiatric condition with a lifetime incidence of approximately 15% (Kessler et al., 2005). The disorder ranges from mild to severe and is associated with significant potential morbidity and mortality, contributing to suicide and adverse impact on concomitant medical illnesses, interpersonal relationships, and work. The objectives of treatment are to reduce or resolve signs and symptoms of the disease, restore psychosocial and occupational function, and reduce the likelihood of relapse or recurrence (Primary Care Clinical Practice Guideline, 2010). Guidelines support pharmacological therapy for the treatment of depression in addition to psychotherapy. Antidepressant medications include selective serotonin reuptake inhibitors (SSRIs), serotonin/norepinephrine reuptake inhibitors (SNRIs), atypical antidepressants, serotonin-dopamine activity modulators (SDAMs), tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs) (Practice Guideline for The Treatment of Patients With Major Depressive Disorder, 2010).
Clinical guidelines for the use of lifestyle-based mental health care in major depressive disorder: World Federation of Societies for Biological Psychiatry (WFSBP) and Australasian Society of Lifestyle Medicine (ASLM) taskforce
Published in The World Journal of Biological Psychiatry, 2023
Wolfgang Marx, Sam H. Manger, Mark Blencowe, Greg Murray, Fiona Yan-Yee Ho, Sharon Lawn, James A. Blumenthal, Felipe Schuch, Brendon Stubbs, Anu Ruusunen, Hanna Demelash Desyibelew, Timothy G. Dinan, Felice Jacka, Arun Ravindran, Michael Berk, Adrienne O’Neil
Major Depressive Disorder (MDD) is a leading cause of global disability and is one of the leading causes of disease burden worldwide (GBD Mental Disorders Collaborators 2022). MDD is common, with approximately 4.7% of the world’s population experiencing depression in any 12-month period (Ferrari et al. 2013). The prevalence of MDD is also consistent across high, middle, and low income countries, emphasising the global burden of this disease (World Health Organization 2017). Pharmacological and psychological approaches are effective for MDD management (Leichsenring et al. 2022). However, meta-analyses suggest that both of these forms of therapy may have only modest benefits and are not effective for everyone for reducing depressive symptoms (Leichsenring et al. 2022). Moreover, antidepressant medications may be accompanied by undesirable side-effects including sexual dysfunction, sedation, cardiac dysfunction, osteoporosis, and weight gain, which may reduce treatment efficacy and diminish long-term adherence (Carvalho et al. 2016). Furthermore, financial and resourcing barriers to accessing mental health services are notable especially in low- and middle-income countries where there is a high prevalence of stigma to mental health care (Herrman et al. 2022).
Assessment of clinical outcomes of medicinal cannabis therapy for depression: analysis from the UK Medical Cannabis Registry
Published in Expert Review of Neurotherapeutics, 2022
Sajed Mangoo, Simon Erridge, Carl Holvey, Ross Coomber, Daniela A Riano Barros, Urmila Bhoskar, Gracia Mwimba, Kavita Praveen, Chris Symeon, Simmi Sachdeva-Mohan, James J Rucker, Mikael H Sodergren
Antidepressant medications are a key component of depression treatment [2]. Despite their widespread use, there is debate surrounding the efficacy of antidepressants [3]. A recent meta-analysis demonstrated that although second-generation antidepressants were more effective than placebo, the summary effect sizes were mostly modest, with response rates around 50% [3]. According to another meta-analysis, antidepressants have no or minimal effects in mild-to-moderate depression, whereas the effects were more substantial in very severe depression [4]. Despite second-generation antidepressants displacing tricyclic antidepressants due to improved tolerability, adverse effects remain an issue an dropout rates are significantly higher among patients administered second-generation antidepressants in randomized controlled trials (RCTs) compared to placebo [5].
A study protocol for an ongoing multi-arm, randomized, double-blind, sham-controlled clinical trial with digital features, using portable transcranial electrical stimulation and internet-based behavioral therapy for major depression disorders: The PSYLECT study
Published in Expert Review of Neurotherapeutics, 2022
Lucas Borrione, Patricia C Cirillo, Luana VM Aparicio, Beatriz A Cavendish, Leandro Valiengo, Darin O Moura, Juliana P de Souza, Matthias S Luethi, Izio Klein, Bruna Bariani, José Gallucci-Neto, Paulo Suen, Frank Padberg, Stephan Goerigk, Marie-Anne Vanderhasselt, Zhi De Deng, Jacinta O’Shea, Paulo A Lotufo, Isabela M Bensenor, Andre R Brunoni
The exclusion criteria are: (1) other psychiatric diagnoses (i.e. schizophrenia, schizoaffective disorder, bipolar disorder, obsessive-compulsive disorder, attention-deficit and hyperactivity disorder, eating disorders, personality disorders, substance use disorders), although anxiety disorders, as comorbidities, are accepted; (2) suicidal ideation or a suicide attempt within 4 weeks or less, prior to baseline; (3) previous or current psychotic symptoms, not otherwise specified; (4) depressive symptoms better explained by other clinical conditions (i.e. hypothyroidism, anemia, congestive heart failure, among others) or other psychiatric disorders; (5) severe clinical conditions, including Post-Acute Sequelae of COVID-19 [35]; (6) epilepsy and/or other neurological disorders; (7) suspected or confirmed pregnancy; (8) lactation; and (9) use of diazepam > 10 mg per day (or equivalent doses of other benzodiazepines). Regarding other medications, no antidepressant washout is being performed, and antidepressant medications currently in use should be in stable doses for at least 6 weeks prior to baseline.