Major depressive disorder: Difference between revisions
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Community studies generally show a high prevalence of depression in different countries. Estimations of the so called point prevalence (the number of people meeting criteria of the disorder at a certain moment in time) vary between 5 and 7.5%. The one-year prevalence of major depressive disorder in the [[United States]] varies from 3% in the Epidemiological Catchment Area Study<ref>Regier DA et al.(1993). The defacto US mental and addictive disorders service system. Epidemiologic Catchment Area prospective 1-year prevalence rates of disorders and services. Arch Gen Psych 50:85-94.</ref> to 10% in the National Co-morbity Study.<ref>Kessler RC et al. (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psych 51:8-19.</ref> | Community studies generally show a high prevalence of depression in different countries. Estimations of the so called point prevalence (the number of people meeting criteria of the disorder at a certain moment in time) vary between 5 and 7.5%. The one-year prevalence of major depressive disorder in the [[United States]] varies from 3% in the Epidemiological Catchment Area Study<ref>Regier DA et al.(1993). The defacto US mental and addictive disorders service system. Epidemiologic Catchment Area prospective 1-year prevalence rates of disorders and services. Arch Gen Psych 50:85-94.</ref> to 10% in the National Co-morbity Study.<ref>Kessler RC et al. (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psych 51:8-19.</ref> | ||
==Diagnostic criteria== | |||
{{DSMCR}} | {{DSMCR}} | ||
The core symptoms of depression are depressed mood and a lack of interest or pleasure from daily activities (anhedonia). Several additional features may be present, like lack of concentration, inappropriate guilt feelings, suicidal thoughts, psychomotor retardation or agitation and loss of libido. A diurnal variation, e.g. the symptoms are worse in the morning, may be present. | The core symptoms of depression are depressed mood and a lack of interest or pleasure from daily activities (anhedonia). Several additional features may be present, like lack of concentration, inappropriate guilt feelings, suicidal thoughts, psychomotor retardation or agitation and loss of libido. A diurnal variation, e.g. the symptoms are worse in the morning, may be present. | ||
==Treatment== | |||
Approximately 30% of patients have remission of depression with medications.<ref name="pmid16390886">{{cite journal |author=Trivedi MH, Rush AJ, Wisniewski SR, ''et al'' |title=Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice |journal=The American journal of psychiatry |volume=163 |issue=1 |pages=28–40 |year=2006 |pmid=16390886 |doi=10.1176/appi.ajp.163.1.28}}</ref> For patients with inadequate response, either adding sustained-release [[bupropion]] (initially 200 mg per day then increase by 100 mg up to total of 400 mg per day) or [[buspirone]] (up to 60 mg per day) for augmentation as a second drug can cause remission in approximately 30% of patients<ref name="pmid16554526">{{cite journal |author=Trivedi MH, Fava M, Wisniewski SR, ''et al'' |title=Medication augmentation after the failure of SSRIs for depression |journal=N. Engl. J. Med. |volume=354 |issue=12 |pages=1243–52 |year=2006 |pmid=16554526 |doi=10.1056/NEJMoa052964}}</ref>, while switching medications can achieve remission in about 25% of patients<ref name="pmid16554525">{{cite journal |author=Rush AJ, Trivedi MH, Wisniewski SR, ''et al'' |title=Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression |journal=N. Engl. J. Med. |volume=354 |issue=12 |pages=1231–42 |year=2006 |pmid=16554525 |doi=10.1056/NEJMoa052963}}</ref>. | Approximately 30% of patients have remission of depression with medications.<ref name="pmid16390886">{{cite journal |author=Trivedi MH, Rush AJ, Wisniewski SR, ''et al'' |title=Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice |journal=The American journal of psychiatry |volume=163 |issue=1 |pages=28–40 |year=2006 |pmid=16390886 |doi=10.1176/appi.ajp.163.1.28}}</ref> For patients with inadequate response, either adding sustained-release [[bupropion]] (initially 200 mg per day then increase by 100 mg up to total of 400 mg per day) or [[buspirone]] (up to 60 mg per day) for augmentation as a second drug can cause remission in approximately 30% of patients<ref name="pmid16554526">{{cite journal |author=Trivedi MH, Fava M, Wisniewski SR, ''et al'' |title=Medication augmentation after the failure of SSRIs for depression |journal=N. Engl. J. Med. |volume=354 |issue=12 |pages=1243–52 |year=2006 |pmid=16554526 |doi=10.1056/NEJMoa052964}}</ref>, while switching medications can achieve remission in about 25% of patients<ref name="pmid16554525">{{cite journal |author=Rush AJ, Trivedi MH, Wisniewski SR, ''et al'' |title=Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression |journal=N. Engl. J. Med. |volume=354 |issue=12 |pages=1231–42 |year=2006 |pmid=16554525 |doi=10.1056/NEJMoa052963}}</ref>. | ||
==References== | ==References== | ||
<references/> | <references/> | ||
Revision as of 14:04, 5 December 2007
Community studies generally show a high prevalence of depression in different countries. Estimations of the so called point prevalence (the number of people meeting criteria of the disorder at a certain moment in time) vary between 5 and 7.5%. The one-year prevalence of major depressive disorder in the United States varies from 3% in the Epidemiological Catchment Area Study[1] to 10% in the National Co-morbity Study.[2]
Diagnostic criteria
Note: The American Psychiatric Association, which publishes the Diagnostic and Statistical Manual of Mental Disorders, forbids the unauthorized reproduction of their diagnostic criteria. A narrative of the DSM-IV-TR criteria follows. The core symptoms of depression are depressed mood and a lack of interest or pleasure from daily activities (anhedonia). Several additional features may be present, like lack of concentration, inappropriate guilt feelings, suicidal thoughts, psychomotor retardation or agitation and loss of libido. A diurnal variation, e.g. the symptoms are worse in the morning, may be present.
Treatment
Approximately 30% of patients have remission of depression with medications.[3] For patients with inadequate response, either adding sustained-release bupropion (initially 200 mg per day then increase by 100 mg up to total of 400 mg per day) or buspirone (up to 60 mg per day) for augmentation as a second drug can cause remission in approximately 30% of patients[4], while switching medications can achieve remission in about 25% of patients[5].
References
- ↑ Regier DA et al.(1993). The defacto US mental and addictive disorders service system. Epidemiologic Catchment Area prospective 1-year prevalence rates of disorders and services. Arch Gen Psych 50:85-94.
- ↑ Kessler RC et al. (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psych 51:8-19.
- ↑ Trivedi MH, Rush AJ, Wisniewski SR, et al (2006). "Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice". The American journal of psychiatry 163 (1): 28–40. DOI:10.1176/appi.ajp.163.1.28. PMID 16390886. Research Blogging.
- ↑ Trivedi MH, Fava M, Wisniewski SR, et al (2006). "Medication augmentation after the failure of SSRIs for depression". N. Engl. J. Med. 354 (12): 1243–52. DOI:10.1056/NEJMoa052964. PMID 16554526. Research Blogging.
- ↑ Rush AJ, Trivedi MH, Wisniewski SR, et al (2006). "Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression". N. Engl. J. Med. 354 (12): 1231–42. DOI:10.1056/NEJMoa052963. PMID 16554525. Research Blogging.