ITEMS IN AFP WITH MESH TERM:

Depressive Disorder

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Treatment-Resistant Depression - Article

ABSTRACT: Up to two thirds of patients with major unipolar depression will not respond to the first medication prescribed. Depression may be considered resistant to treatment when at least two trials with antidepressants from different pharmacologic classes (adequate in dose, duration, and compliance) fail to produce a significant clinical improvement. Evidence regarding the effectiveness of psychotherapy for treatment-resistant depression is limited. A recent high-quality trial found that patients who did not respond to citalopram and who received cognitive behavior therapy (with or without continued citalopram) had similar response and remission rates to those who received other medication regimens. Initial remission rates in that trial were 37 percent, and even after three additional trials of different drugs or cognitive behavior therapy, the cumulative remission rate was only 67 percent. In general, patients who require more treatment steps have higher relapse rates, and fewer than one half of patients achieve sustained remission. No treatment strategy appears to be better than another. Electroconvulsive therapy is effective as short-term therapy of treatment-resistant depression. There is no good-quality evidence that vagal nerve stimulation is an effective treatment for this condition.


Obsessive Compulsive Disorder: Diagnosis and Management - Article

ABSTRACT: Obsessive-compulsive disorder is an illness that can cause marked distress and disability. It often goes unrecognized and is undertreated. Primary care physicians should be familiar with the various ways obsessive-compulsive disorder can present and should be able to recognize clues to the presence of obsessions or compulsions. Proper diagnosis and education about the nature of the disorder are important first steps in recovery. Treatment is rarely curative, but patients can have significant improvement in symptoms. Recommended first-line therapy is cognitive behavior therapy with exposure and response prevention or a selective serotonin reuptake inhibitor. The medication doses required for treatment of obsessive-compulsive disorder are often higher than those for other indications, and the length of time to response is typically longer. There are a variety of options for treatment-resistant obsessive-compulsive disorder, including augmentation of a selective serotonin reuptake inhibitor with an atypical antipsychotic. Obsessive-compulsive disorder is a chronic condition with a high rate of relapse. Discontinuation of treatment should be undertaken with caution. Patients should be closely monitored for comorbid depression and suicidal ideation.


Depression in Post-MI Patients: An Opportunity for Primary Care - Editorials


Depressive Disorders - Clinical Evidence Handbook


Screening for Depression: Recommendations and Rationale - U.S. Preventive Services Task Force


Screening for Depression - Editorials


Depression in Children and Adolescents - Clinical Evidence Handbook


Depressive Disorders - Clinical Evidence Handbook


Antidepressants in Older Persons - Cochrane for Clinicians


Exercise, Yoga, and Meditation for Depressive and Anxiety Disorders - Article

ABSTRACT: Anxiety and depression are among the most common conditions cited by those seeking treatment with complementary and alternative therapies, such as exercise, meditation, tai chi, qigong, and yoga. The use of these therapies is increasing. Several studies of exercise and yoga have demonstrated therapeutic effectiveness superior to no-activity controls and comparable with established depression and anxiety treatments (e.g., cognitive behavior therapy, sertraline, imipramine). High-energy exercise (i.e., weekly expenditure of at least 17.5 kcal per kg) and frequent aerobic exercise (i.e., at least three to five times per week) reduce symptoms of depression more than less frequent or lower-energy exercise. Mindful meditation and exercise have positive effects as adjunctive treatments for depressive disorders, although some studies show multiple methodological weaknesses. For anxiety disorders, exercise and yoga have also shown positive effects, but there are far less data on the effects of exercise on anxiety than for exercise on depression. Tai chi, qigong, and meditation have not shown effectiveness as alternative treatments for depression and anxiety.


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