American Psychiatric Association Depression

Major depressive disorder is a disorder of mood in which the individual experiences one or more major depressive episodes without a history of manic, mixed, or hypomanic episodes. A major depressive episode is defined by the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders, 4th ed.. Text Revision (DSM-IV-TR), published by the American Psychiatric Association. Depression is associated with significant functional disability, morbidity, and mortality. 

In a study promoted by the National Institute of Mental Health (NIMH) the Hutterites showed high rates of psychosis (Eaton 8c Weil, 1955). Nevertheless, a later re-analysis of the data using DSM-III-R diagnostic criteria (American Psychiatric Association [APA], 1980) showed that the rate of major depression was four times higher than that of schizophrenia (Torrey, 1995). 

The American Psychiatric Association diagnostic criteria are listed in Table 19.1. Table 19.2 describes the clinical features and Table 19.3 lists medical illnesses and drugs that can cause depressive symptoms. 

Data from American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4thi erf, text revision. Washington, DC American Psychiatric Association, 2000 429-484 Schneier FR. Social anxiety disorder. N Engl J Med 2006 355 1029-1056 arid Ballenger JQ Davidson JRT, Lecrubier V, et al. Consensus statement on social anxiety disorder from the International Consensus Croup on Depression and Anxiety. J Clin Psychiatry 998 59(Suppl 17)54-690. 

Data from Torrey EF, Knable MB. Surviving Manic Depression A Manual on Bipolar Disorder for Patients, Families and Providers. New York Basic Book, 2002 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed.. Text Revision. Washington, DC American Psychiatric Association, 2000 382-401 and American Psychiatric Association, Practice guideline for the treatment of patients with bipolar disorder (revision). Am J Psychiatry2002 159 1-50. 

Major depression is one of the most common mental disorders. It has a lifetime prevalence of 17% in the general population, and a current prevalence of 4.9%, constituting a significant public health problem (Blazer et al. 1994). It is characterized by intense sadness and cognitive impairments most notable in concentration, worry, pessimism, and lowered self-esteem (American Psychiatric Association 1994). Interpersonal relationships may suffer and social withdrawal occurs. Physio-... 

The term "bipolar disorder" originally referred to manic-depressive illnesses characterized by both manic and depressive episodes. In recent years, the concept of bipolar disorder has been broadened to include subtypes with similar clinical courses, phenomenology, family histories and treatment responses. These subtypes are thought to form a continuum of disorders that, while differing in severity, are related. Readers are referred to the Diagnostic and Statisticial Manual of Mental Disorders of the American Psychiatric Association (DSM-IV) for details of this classification. 

The authors measure of quality of care was based on the Depression Guideline Panel (1993) recommendations and American Psychiatric Association (2003) guidelines. These state that if antidepressant medication is... 

American Psychiatric Association. 2003. Practice Guidelines for the Treatment of Patients with Major Depression. Available at www.psych.org/psych pract/treatg/pg/ Depression2e.book.cfm. Last accessed luly 18, 2004. 

American Psychiatric Association. Practice guidelines for major depressive disorder (MDD) in adults. Am J Psychiat 2000 157(Suppl 4) 1 5. 

American Psychiatric Association (APA) (2000) Practice for the treatment of patients with major depressive disorder [revision] Am J Psychiatry 157 (Suppl) 1—45. 

Birmaher, B., McCafferty, J.P., Bellow, K.M., and Beebe, K.L. (2000b) Comorbid ADHD and disruptive behavior disorders as predictors of response in adolescents treated for major depression. Presented at the American Psychiatric Association Annual Meeting, Chicago, IL. 

Alderman, J., Wolkow, R., Chung, M., and Johnston, H.R (1998). Sertraline treatment of children and adolescents with obsessive-compulsive disorder or depression pharmacokinetics, tolerability, and efficacy./ Am Acad Child Adolesc Psychiatry 37 386—394. American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders, 3rd ed. Washington, DC American Psychiatric Association Press. 

Diagnosing depression is not a simple matter. Everyone experiences sadness once in a while, and in certain situations, such as the loss of a loved one, it is expected. The American Psychiatric Association, a group of professional psychiatrists, publishes the Diagnostic and Statistic Manual of Mental Disorders, a manual that outlines the criteria for diagnosing psychiatric disorders. This widely followed manual is periodically updated, and it is currently in its fourth edition. DSM-IV, as it is often abbreviated, defines a major depressive episode to be when the patient shows a depressed mood or the absence of pleasure for a certain period of time, as well as exhibiting some other symptoms such as loss of sleep, appetite, or recurrent thoughts of suicide. Depression is one of the most common disorders, with millions of cases diagnosed every year in the United States alone. 

Electroconvulsive therapy (ECT) is an established and effective treatment of depression and some forms of schizophrenia. ECT is the treatment of choice in several types of depression (W. Z. Potter and Rudorfer 1993), especially severe depression (American Psychiatric Association Task Force on Electroconvulsive Therapy 1990 W. Z. Potter et al. 1991). The mechanism by which ECT exerts its antidepressant effect is still unknown. Studies of pharmacologically as well as of electrically induced convulsions suggest that the convulsion is a necessary condition for ECT s therapeutic effects (Cerletti and Bird 1938 Lerer 1987 Lerer et al. 1984). However, there is no satisfactory explanation for the clinical efficacy of convulsions. 

To date, only one study has been completed with an antidepressant other than a TCA combined with an antipsychotic in the treatment of PMD. Rothschild and colleagues (1993) investigated the efficacy of fluoxetine and perphenazine in the treatment of PMD and found that approximately 73% of 30 patients who met DSM-III-R (American Psychiatric Association 1987) criteria for major depression with psychotic features had at least a 50% reduction on their Hamilton Rating Scale for Depression scores over 5 weeks. Furthermore, the combination of fluoxetine and perphenazine appeared to be better tolerated than the combination of TCAs with antipsychotics. Although there is no evidence that monotherapy with an antidepressant other than amoxapine is efficacious, the combination therapy with many antidepressants other than the TCAs may prove useful. 

DSM-111, DSM-III-R, and DSM-IV [American Psychiatric Association 1980, 1987, 1994] specified arbitrary time criteria (e.g., 2 weeks duration] before a person qualified for a diagnosis of MDD. Such arbitrariness meant that brief recurrences [e.g., 7-10 days] sometimes were not officially diagnosed as depression, and the relapsing pattern went undetected. 

Gold MS, Miller NS, Floffman NG Depression in drug dependency. Paper presented at the annual meeting of the American Psychiatric Association, Philadelphia, PA, May 25, 1994... 

Goodwin FK, Roy-Byrne P Treatment of bipolar disorders, in Psychiatry Update The American Psychiatric Association Annual Review, Vol 6. Edited by fJales RE, Francis AJ. Washington, DC, American Psychiatric Press, 1987, p 89 Goodwin FK, Murphy DL, Bunney WE lithium-carbonate treatment in depression and mania a longitudinal double-blind study. Arch Gen Psychiatry 21 486-496, 1969... 

American Psychiatric Association Practice Guideline for the Treatment of Patients With Major Depressive Disorder, 2nd Edition. Washington, DC, American Psychiatric Association, 2000... 

Lithium has been proven effective for acute and prophylactic treatment of both manic and depressive episodes in patients with bipolar illness (American Psychiatric Association 2002). However, patients with rapid-cycling bipolar disorder (i.e., patients who experience four or more mood disorder episodes per year) have been reported to respond less well to lithium treatment (Dunner and Fieve 1974 Prien et al. 1984 Wehr et al. 1988). Lithium is also effective in preventing future depressive episodes in patients with recurrent unipolar depressive disorder (American Psychiatric Association 2002) and as an adjunct to antidepressant therapy in depressed patients whose illness is partially refractory to treatment with antidepressants alone (discussed in Chapter 2). Furthermore, hthium may be useful in maintaining remission of depressive disorders after electroconvulsive therapy (Coppen et al. 1981 Sackeim et al. 2001). Lithium also has been used effectively in some cases of aggression and behavioral dyscontrol. 

Figure 8.1 Design of the study by Klerman et al. Treatment of depression by drugs and psychotherapy 131 186-191 (1974). 1974 the American Psychiatric Association http // AJP.psychiatryonline.org. Reprinted by permission...

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