Depression natural history

Kantor SJ, Glassman AH Delusional depression natural history and response to treatment. Br J Psychiatry 131 351-360, 1977 Kao KR, Ehnson RP Dorsalization of mesoderm induction by lithium. Dev Biol 132 81-90, 1989... 

Kantor S, Glassman A. Delusional depressions natural history and response to treatment. Br J Psychiatry 1977 131 351-360. 

Clinical descriptions and criteria for diagnosis of disorders of mood will only be mentioned in passing. The reader should consult standard reference sources for this material. Here we will discuss how discoveries of various antidepressants have impacted the diagnostic criteria for depression and how they may have modified the natural history and course of this illness. The goal of this chapter is to acquaint the reader with current ideas about the clinical and biological aspects of mood disorders in order to be prepared to understand how the various antidepressants and mood stabilizers work. 

In the 1990s, diagnostic criteria for depression began to be applied increasingly to describing the epidemiology and natural history of mood disorders so that the effects... 

In summary, the natural history of depression indicates that this is a life-long illness, which is likely to relapse within several months of an index episode, especially if untreated or under-treated or if antidepressants are discontinued, and is prone to multiple recurrences that are possibly preventable by long-term antide-... 

To learn the epidemiology and natural history as well as longitudinal course of depression. 

The time spent reviewing the natural history and longitudinal course of depression was just right. ... 

Contents Introduction, history and brain basics—Older antidepressants tricyclics and monoamine oxidase inhibitors—Selective serotonin reuptake inhibitors—Second generation antidepressants—Lithium, a medication for bipolar depression—Natural depressants—Teens and antidepressants trends and attitudes—Case study one girl s experience with antidepressants. 

The natural history of major depression (either as unipolar depression or depressive phases of bipolar disorder) is that individual episodes tend to remit spontaneously over 6—12 months however, there is a high risk of relapse of depression for at least several months after discontinuation of antidepressant treatment. This risk is estimated at 50% within 6 months and 65—70% at 1 year, rising to 85% by 3 years. To minimize this risk, it is best to continue antidepressant medication for at least 6 months following apparent clinical recovery. Continued use of initially therapeutic doses is recommended, although tolerability and acceptance by patients may require flexibility. 

Obtain a thorough history of prescription, nonprescription, natural, and illicit drug product use. Rule out medications or medical disorders that may cause or mimic depressive symptoms. 

It is still debated whether patients with two previous episodes should receive maintenance treatment. Overall, maintenance treatment has been recommended for adult depressed patients with two episodes who have one or more of the following criteria (Depression Guideline Panel, 1993) (1) a family history of bipolar disorder or recurrent depression, (2) early onset of the first depressive episode (before age 20), and (3) both episodes were severe or life threatening and occurred during the past 3 years. Given that depression in youth has similar clinical presentation, sequelae, and natural course as in adults, these guidelines should probably be applied for youth with two previous major depressive episodes. 

Until recently very little was really known about what happens to depression if it is not treated. It is now thought that most untreated episodes of depression last 6 to 24 months (Fig. 5—1). Perhaps only 5 to 10% of untreated sufferers have their episodes continue for more than 2 years. However, the very nature of this illness includes recurrent episodes. Many individuals who present for the first time for treatment will have a history of one or more prior unrecognized and untreated episodes of this illness, dating back to adolescence. 

Typical side effects are constitutional in nature, including a flu-like syndrome within 6 hours after dosing in more than 30% of patients that tends to resolve upon continued administration. Other potential adverse effects include thrombocytopenia, granulocytopenia, elevation in serum aminotransferase levels, induction of autoantibodies, nausea, fatigue, headache, arthralgias, rash, alopecia, anorexia, hypotension, and edema. Severe neuropsychiatric side effects may occur. Absolute contraindications to therapy are psychosis, severe depression, neutropenia, thrombocytopenia, symptomatic heart disease, decompensated cirrhosis, uncontrolled seizures, and a history of organ transplantation (other than liver). Alfa interferons are abortifacient in primates and should not be administered in pregnancy. 

In a prospective study, 50 patients with chronic hepatitis B or C who received 18-30 MU/week of natural or recombinant interferon alfa were followed for 12 months (144). The SCID before starting interferon alfa identified 16 patients with a current psychiatric diagnosis and eight with a previous psychiatric disorder 26 patients free of any psychiatric history constituted the control group. Psychiatric manifestations during treatment occurred in 11 patients (five from the control group), major depression in five, depressive disorders in three, severe dysphoria in two, and generalized... 

The treatment of anxiety throughout human history has involved a variety of natural agents which were administered to relieve tension and induce a state of altered consciousness, with ethanol in its various forms the most widely used [4]. Within the last century, general CNS depressants such as barbiturates, bromide salts, and ethanol surrogates such as chloral hydrate and paraldehyde have been employed to treat anxiety. Because of side-effects of the other drugs, barbiturates were used predominantly in the first half of this century as anxiolytics, but their clinical utility was limited by tolerance and dependence liability. Propanediolcarbamates such as meprobamate were also used to treat anxiety but displayed many of the barbiturate side-effects. 

---