Journal ArticleDOI
Treatment and Prevention of Depression
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TLDR
Combined treatment with medication and CBT appears to be as efficacious as treatment with medications alone and to retain the enduring effects of CBT, and there are indications that the same strategies used to reduce risk in psychiatric patients following successful treatment can be used to prevent the initial onset of depression in persons at risk.Abstract:
Depression is one of the most common and debilitating psychiatric disorders and is a leading cause of suicide. Most people who become depressed will have multiple episodes, and some depressions are chronic. Persons with bipolar disorder will also have manic or hypomanic episodes. Given the recurrent nature of the disorder, it is important not just to treat the acute episode, but also to protect against its return and the onset of subsequent episodes. Several types of interventions have been shown to be efficacious in treating depression. The antidepressant medications are relatively safe and work for many patients, but there is no evidence that they reduce risk of recurrence once their use is terminated. The different medication classes are roughly comparable in efficacy, although some are easier to tolerate than are others. About half of all patients will respond to a given medication, and many of those who do not will respond to some other agent or to a combination of medications. Electro-convulsive therapy is particularly effective for the most severe and resistant depressions, but raises concerns about possible deleterious effects on memory and cognition. It is rarely used until a number of different medications have been tried. Although it is still unclear whether traditional psychodynamic approaches are effective in treating depression, interpersonal psychotherapy (IPT) has fared well in controlled comparisons with medications and other types of psychotherapies. It also appears to have a delayed effect that improves the quality of social relationships and interpersonal skills. It has been shown to reduce acute distress and to prevent relapse and recurrence so long as it is continued or maintained. Treatment combining IPT with medication retains the quick results of pharmacotherapy and the greater interpersonal breadth of IPT, as well as boosting response in patients who are otherwise more difficult to treat. The main problem is that IPT has only recently entered clinical practice and is not widely available to those in need. Cognitive behavior therapy (CBT) also appears to be efficacious in treating depression, and recent studies suggest that it can work for even severe depressions in the hands of experienced therapists. Not only can CBT relieve acute distress, but it also appears to reduce risk for the return of symptoms as long as it is continued or maintained. Moreover, it appears to have an enduring effect that reduces risk for relapse or recurrence long after treatment is over. Combined treatment with medication and CBT appears to be as efficacious as treatment with medication alone and to retain the enduring effects of CBT. There also are indications that the same strategies used to reduce risk in psychiatric patients following successful treatment can be used to prevent the initial onset of depression in persons at risk. More purely behavioral interventions have been studied less than the cognitive therapies, but have performed well in recent trials and exhibit many of the benefits of cognitive therapy. Mood stabilizers like lithium or the anticonvulsants form the core treatment for bipolar disorder, but there is a growing recognition that the outcomes produced by modern pharmacology are not sufficient. Both IPT and CBT show promise as adjuncts to medication with such patients. The same is true for family-focused therapy, which is designed to reduce interpersonal conflict in the family. Clearly, more needs to be done with respect to treatment of the bipolar disorders. Good medical management of depression can be hard to find, and the empirically supported psychotherapies are still not widely practiced. As a consequence, many patients do not have access to adequate treatment. Moreover, not everyone responds to the existing interventions, and not enough is known about what to do for people who are not helped by treatment. Although great strides have been made over the past few decades, much remains to be done with respect to the treatment of depression and the bipolar disorders.read more
Citations
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Journal ArticleDOI
The empirical status of cognitive-behavioral therapy: a review of meta-analyses.
TL;DR: The 16 meta-analyses reviewed support the efficacy of CBT for many disorders and are consistent with other review methodologies that also provide support for the efficacy CBT.
Journal ArticleDOI
Mental illness and/or mental health? Investigating axioms of the complete state model of health.
TL;DR: Confirmatory factor analyses supported the hypothesis that measures of mental health (i.e., emotional, psychological, and social well-being) and mental illness constitute separate correlated unipolar dimensions.
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Promoting and protecting mental health as flourishing: A complementary strategy for improving national mental health.
TL;DR: The conception and diagnosis of the mental health continuum, the findings supporting the two continua model of mental health and illness, and the benefits of flourishing to individuals and society are summarized.
Journal ArticleDOI
Antidepressant Drug Effects and Depression Severity: A Patient-Level Meta-analysis
Jay C. Fournier,Robert J. DeRubeis,Steven D. Hollon,Sona Dimidjian,Jay D. Amsterdam,Richard C. Shelton,Jan Fawcett +6 more
TL;DR: The magnitude of benefit of antidepressant medication compared with placebo increases with severity of depression symptoms and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms.
Journal ArticleDOI
Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression.
Sona Dimidjian,Steven D. Hollon,Keith S. Dobson,Karen B. Schmaling,Robert J. Kohlenberg,Michael E. Addis,Robert Gallop,Joseph B. McGlinchey,David K. Markley,Jackie K. Gollan,David C. Atkins,David L. Dunner,Neil S. Jacobson +12 more
TL;DR: Among more severely depressed patients, behavioral activation was comparable to antidepressant medication, and both significantly outperformed cognitive therapy, and the implications of current treatment guidelines and dissemination are discussed.
References
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Journal ArticleDOI
An inventory for measuring depression
TL;DR: The difficulties inherent in obtaining consistent and adequate diagnoses for the purposes of research and therapy have been pointed out and a wide variety of psychiatric rating scales have been developed.
Journal ArticleDOI
A rating scale for depression
TL;DR: The present scale has been devised for use only on patients already diagnosed as suffering from affective disorder of depressive type, used for quantifying the results of an interview, and its value depends entirely on the skill of the interviewer in eliciting the necessary information.
Journal ArticleDOI
Lifetime and 12-Month Prevalence of DSM-III-R Psychiatric Disorders in the United States: Results From the National Comorbidity Survey
Ronald C. Kessler,Katherine A. McGonagle,Shanyang Zhao,Christopher B. Nelson,Michael R. Hughes,Suzann Eshleman,Hans-Ulrich Wittchen,Kenneth S. Kendler +7 more
TL;DR: The prevalence of psychiatric disorders is greater than previously thought to be the case, and morbidity is more highly concentrated than previously recognized in roughly one sixth of the population who have a history of three or more comorbid disorders.
Journal ArticleDOI
The Department of Health and Human Services.
TL;DR: This letter is in response to your two Citizen Petitions, requesting that the Food and Drug Administration (FDA or the Agency) require a cancer warning on cosmetic talc products.
Journal ArticleDOI
Mourning and Melancholia
TL;DR: Freud, S. as discussed by the authors, The Complete Psychological Works of Sigmund Freud, Volume XIV (1914-1916): On the History of the Psycho-Analytic Movement, Papers on Metapsychology and Other Works, 237-258 Mourning and Melancholia, 237.