TITLE

Severe depression: is there a best approach?

AUTHOR(S)
Sonawalla, S.B.; Fava, M.
PUB. DATE
October 2001
SOURCE
CNS Drugs;2001, Vol. 15 Issue 10, p765
SOURCE TYPE
Academic Journal
DOC. TYPE
journal article
ABSTRACT
A major depressive episode can be categorised as severe based on depressive symptoms, scores on depression rating scales, the need for hospitalisation, depressive subtypes, functional capacity, level of suicidality and the impact that the depression has on the patient. Several biological, psychological and social factors, and the presence of comorbid psychiatric or medical illnesses, impact on depression severity. A number of factors are reported to influence outcome in severe depression, including duration of illness before treatment, severity of the index episode, treatment modality used, and dosage and duration of and compliance with treatment. Potential complications of untreated severe depression include suicide, self-mutilation and refusal to eat, and treatment resistance. Several antidepressants have been studied in the treatment of severe depression. These include tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), serotonin-noradrenaline (norepinephrine) reuptake inhibitors, noradrenergic and specific serotonergic antidepressants, serotonin 5-HT(2) receptor antagonists, monoamine oxidase inhibitors, and amfebutamone (bupropion). More recently, atypical antipsychotics have shown some utility in the management of severe and resistant depression. Data on the differential efficacy of TCAs versus SSRIs and the newer antidepressants in severe depression are mixed. Some studies have reported that TCAs are more efficacious than SSRIs; however, more recent studies have shown that TCAs and SSRIs have equivalent efficacy. There are reports that some of the newer antidepressants may be more effective than SSRIs in the treatment of severe depression, although the sample sizes in some of these studies were small. Combination therapy has been reported to be effective. The use of an SSRI-TCA combination, while somewhat controversial, may rapidly reduce depressive symptoms in some patients with severe depression. The combination of an antidepressant and an antipsychotic drug is promising and may be considered for severe depression with psychotic features. Although the role of cognitive behaviour therapy (CBT) in severe depression has not been adequately studied, a trial of CBT may be considered in severely depressed patients whose symptoms respond poorly to an adequate antidepressant trial, who are intolerant of antidepressants, have contraindications to pharmacotherapy, and who refuse medication or other somatic therapy. A combination of CBT and antidepressants may also be beneficial in some patients. Electroconvulsive therapy (ECT) may be indicated in severe psychotic depression, severe melancholic depression, resistant depression, and in patients intolerant of antidepressant medications and those with medical illnesses which contraindicate the use of antidepressants (e.g. renal, cardiac or hepatic disease).
ACCESSION #
5381115

 

Related Articles

  • Breaking the myths: new treatment approaches for chronic depression. Michalak, Erin E; Lam, Raymond W // Canadian Journal of Psychiatry;Sep2002, Vol. 47 Issue 7, p635 

    Background: Chronic depressive disorders are common, accounting for approximately one-third of all cases of depression and posing a major public health problem. In the past, chronic depression has been thought to be treatment-resistant, and evidence suggests that it is currently...

  • Major depressive disorder in adolescence: a brief review of the recent treatment literature. Milin, Robert; Walker, Selena; Chow, Joy // Canadian Journal of Psychiatry;Oct2003, Vol. 48 Issue 9, p600 

    Objective: Treating adolescents with depression remains a major clinical and public health challenge. Because of the serious morbidity and mortality associated with adolescent major depressive disorder (MDD), there is a need to review the published literature on treatment efficacy...

  • Prevalence of depression and prescriptions for antidepressants, Bella Coola Valley, 2001. Thommasen, Harvey v.; Baggaley, Earle; Thommasen, Carol; Zhang, William // Canadian Journal of Psychiatry;May2005, Vol. 50 Issue 6, p346 

    Objective: To determine the prevalence of depression-anxiety disorders and the degree to which physicians prescribed antidepressants for Aboriginal and non-Aboriginal populations living in a remote rural community in British Columbia in 2001.Methods: To obtain data for...

  • Hard times and good friends: negative life events and social support in patients with seasonal and nonseasonal depression. Michalak, Erin E.; Tam, Edwin M.; Manjunath, Chinnapalli V.; Yatham, Lakshmi N.; Levitt, Anthony J.; Levitan, Robert D.; Lam, Raymond W. // Canadian Journal of Psychiatry;Jun2004, Vol. 49 Issue 6, p408 

    Objective: Although a relatively large body of research has now accumulated concerning the relation between negative life events, social support, and major depressive disorder (MDD), little is known about the relation between seasonal affective disorder and these psychosocial...

  • The course of depressive illness in general practice. Limosin, Frédéric; Loze, Jean-Yves; Zylberman-Bouhassira, Myriam; Schmidt, Mark E.; Perrin, Eléna; Rouillon, Frédéric; Limosin, Frédéric; Perrin, Eléna; Rouillon, Frédéric // Canadian Journal of Psychiatry;Feb2004, Vol. 49 Issue 2, p119 

    Objective: Depression is reported to be common in primary care settings and to have a high likelihood of relapse during the 4- to 6-month period following initial symptomatic improvement. However, most prospective studies of long-term treatment of depression have been conducted with...

  • Differentiating DSM-IV anxiety and depressive disorders in the general population: comorbidity and treatment consequences. Ohayon, Maurice M; Shapiro, Colin M; Psych, MRC; Kennedy, Sidney H; Ohayon, M M; Shapiro, C M; Kennedy, S H // Canadian Journal of Psychiatry;Mar2000, Vol. 45 Issue 2, p166 

    Objective: To attempt, for the first time, to apply a positive and differential diagnosis process in the general population during interviews using DSM-IV classification to ascertain the profile and occurrence of concomitant mental disorders.Method: A representative...

  • Are St John's wort and SSRI antidepressants really ineffective in depression? Sarris, Jerome; Schweitzer, Isaac; Mischoulon, David // Australian Journal of Herbal Medicine;2012, Vol. 24 Issue 4, p118 

    This paper provides a reply to the Wong (AJHM 24:3;97-9) critique of the Rapaport et al (2011) study which found no significant difference between St John's wort, citalopram and placebo in treating minor depression. Additionally we address the reasons why St John's wort and antidepressant...

  • Antidepressants may not improve all symptoms of depression.  // Healthcare Counselling & Psychotherapy Journal;Jul2011, Vol. 11 Issue 3, p2 

    The article reports on research on depression which was conducted at the University of Texas Southwestern Medical Center and found that even people who have shown a positive treatment response to antidepressants continue to experience symptoms like insomnia, sadness and decreased concentration.

  • Drug vs class-specific black box warnings: does one bad drug spoil the bunch? Dusetzina, Stacie B.; Caleb Alexander, G. // JGIM: Journal of General Internal Medicine;Jun2011, Vol. 26 Issue 6, p570 

    The article focuses on the importance of considering clinical contexts in applying black box warning across drugs within the same chemical classes. It states that only quetiapine, not 5HT2-D2 antagonists, had an approved clinical indication for use as an adjunctive treatment to antidepressants...

  • Treatment-resistant depression: A systematic review of systematic reviews. Pérez-Wehbe, Alia Inés; Perestelo-Pérez, Lilisbeth; Bethencourt-Pérez, Juan Manuel; Cuéllar-Pompa, Leticia; Peñate-Castro, Wenceslao // International Journal of Clinical Health & Psychology;may2014, Vol. 14 Issue 2, p145 

    The objective of this research study was to assess pharmacological, somatic and/or psychological treatments in adults with a diagnosis of major depressive disorder who have not responded to at least one course of antidepressant medication. We conducted a systematic review to identify systematic...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics