Depression recurrence

The TCAs, SSRIs, and lithium have been found to be efficacious for the prevention of depressive recurrences in adults (APA, 2000). However, given the noted advantages of the SSRIs and their efficacy in the acute treatment of MDD and dysthymia, this group is considered the first-choice medication for Intervention. 

Depression is a common, serious, sometimes fatal illness that is chronic and recurrent in nature, impairs family life, reduces social adjustment, and is a burden on the community (Klerman and Weissman, 1992). This disease chronicity magnifies hoth its societal impact and its economic burden. It has been estimated that more than 17% of the disability associated with mental disorders is the result of depressive disorders (Rosenbaum and Hylan, 1999), and that the global burden of depression, measured in terms of disability-adjusted life years, will rank second only to ischaemic heart disease by the year 2020 (Murray and Lopez, 1996). 

Cost-utility of maintenance treatment of recurrent depression with sertraline versus episodic treatment with dothiepin. Pharmacoeconomics 5,249—64. 

Risk-stratification of the patient with NSTE ACS is more complex, as in-hospital outcomes for this group of patients varies with reported rates of death of 0% to 12%, reinfarction rates of 0% to 3%, and recurrent severe ischemia rates of 5% to 20%.12 Not all patients presenting with suspected NSTE ACS will even have CAD. Some will eventually be diagnosed with non-ischemic chest discomfort. In general, among NSTE patients, those with ST-segment depression (Fig. 5-1) and/or elevated troponin and/or CK-MB are at higher risk of death or recurrent infarction. 

In patients with NSTE ACS scheduled for early PCI, administration of either abciximab or eptifibatide (double bolus) is recommended. The use of tirofiban in these patients is not recommended, because it has been shown to be inferior to abciximab.2 Medical therapy with glycoprotein Ilb/IIIa receptor inhibitors in patients not undergoing PCI is reserved for higher-risk patients, such as those with positive troponin or ST-segment depression, and patients who have continued or recurrent ischemia despite other antithrombotic therapy.2... 

Diazepam Being extremely lipophilic, diazepam penetrates quickly into the CNS, but can rapidly redistribute into body fat and muscle. This results in a faster decline in CNS levels and early recurrence of seizures. It is dosed at 5 to 10 mg (or 0.15 mg/kg) and infused no faster than 5 mg/minute. Repeated doses can be given every 5 minutes until seizure activity stops or toxicities are seen (e.g., respiratory depression). Diazepam can also be administered as a rectal suppository, making it possible for non-medical personnel to provide rapid therapy for seizures that develop at home or in public areas.11 The adult dose is 10 mg given rectally and this dose may be repeated once if necessary. Diazepam is erratically absorbed via the intramuscular route therefore, IM administration is not recommended. 

Depression can occur despite the absence of major life stressors, and conversely, major life stressors do not invariably cause depression. Nevertheless, there is an undeniable association between life stressors and depression, and there appears to be a significant interaction between life stressors and genetic liability in causing depression.6 Although acute stressors may precipitate depression, chronic stressors have a longer risk period, cause longer episodes, and are more likely to lead to relapse and recurrence.6... 

The obvious goal of therapy for the depressed patient is the resolution of depressive symptoms and a return to euthymia. Once symptoms have resolved, then the purpose of ongoing therapy is to prevent relapse and recurrence of depressive symptoms. One extremely important outcome in the treatment of MDD is the prevention of suicidal attempts. Other essential outcomes include improvement of the patient s quality of life, normalization of functioning in areas such as work and relationships, avoidance or minimization of adverse effects, and reduction of health care costs.15... 

Interpersonal therapy and cognitive behavioral therapy are types of psychotherapy that have well-documented efficacy for the treatment of MDD. Psychotherapy alone is an initial treatment option for mild to moderate cases of depression, and it may be useful when combined with pharmacotherapy in the treatment of more severe cases of depression. In fact, the combination of psychotherapy and pharmacotherapy can be more effective than either treatment modality alone in cases of severe or recurrent MDD. Psychotherapy can be especially helpful for patients with significant psychosocial stressors, interpersonal difficulties, or comorbid personality disorders.16... 

Antidepressant medications appear to be useful for certain children and adolescents, particularly those who have severe or psychotic depression, fail psychotherapeutic measures, or experience chronic or recurrent depression. SSRIs generally are considered the initial antidepressants of choice, although comorbid conditions may favor alternative agents. Clinicians should be aware of the possibility of behavioral activation with the SSRIs, including such symptoms as impulsivity, silliness, daring conduct, and agitation.44 Desipramine should be used with caution in this population because of several reports of sudden death, and a baseline and follow-up electrocardiogram (ECG) may be warranted when this medication is used to treat pediatric patients.9... 

Mauri, M., Sarno, N., Rossi, V. M., Armani, A., et al., Personality disorders associated with generalized anxiety, panic, and recurrent depressive disorders. Journal of Personality Disorders 6(2), 162-167, 1992. 

Silvana Grandi, Six-Year Outcome of Cognitive Behavior Therapy for Prevention of Recurrent Depression , AmericanJournal ofPsychiatry 161 (2004) 1872-76... 

In the past several decades there has been increased incidence of depression, which motivated Gerald Klerman to describe this era as the age of melancholia [5], The lifetime prevalence of depression in the U.S. is higher in women (21.3%) than in men (12.7%). Although the rates of major depression vary across the world, data from fifty countries support the notion that this disease is the fourth leading cause of disability worldwide (second in developed countries) [3]. Longitudinal studies verify that the typical course of the disease is recurrent, with periods of recovery and periods of depression symptoms however, approximately 17% of patients have a chronic unremitting disease [6], Depression is the major cause of suicidal behavior and the rate of suicidal attempts has been estimated to be around 56% in depressed patients [7]. 

Versiani M, Mehilane L, Gaszner P, Arnaud-Castiglioni R. Reboxetine, a unique selective NRI, prevents relapse and recurrence in long-term treatment of major depressive disorder. J Clin Psychiatry 1999 60 400-406. 

The clinical value of lithium has been recognized since 1949. Lithium carbonate is used in manic depressive psychoses for the treatment of recurrent mood changes.261,262 Mood stability may only occur after months rather than weeks. The drug is administered orally in doses up to 2 g day-1 (30 mmol day-1). The serum Li concentration should be in the range of 0.4-0.8 mmol 1. ... 

The reason most likely lies in genetic and developmental effects having created a neurobiological diathesis for recurrent episodes of major depression or mania. It is of note that the clinical picture of major depression varies greatly... 

Oruc, L., Verheyen, G. R., Furac, I. et al. Positive association between the GABRA5 gene and unipolar recurrent major depression. Neuropsychobiol. 36 62-64,1997. 

Sheline, Y. I., Sanghavi, M., Min tun, M. A. and Gado, M. H. Depression duration but not age predicts hippocampal volume loss in medically healthy women with recurrent major depression. /. Neurosci. 19 5034-5043,1999. 

Bipolar disorder, previously known as manic-depressive illness, is a cyclical, lifelong disorder with recurrent extreme fluctuations in mood, energy, and behavior. Diagnosis requires the occurrence, during the course of the illness, of a manic, hypomanic, or mixed episode (not caused by any other medical condition, substance, or psychiatric disorder). 

Major depressive disorder, recurrent Bipolar disorder, type I ... 

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