Major depressive disorder MDD

Monoamine reuptake inhibitors elevate extracellular levels of serotonin (5-HT), norepinephrine (NE) and/or dopamine (DA) in the brain by binding to one or more of the transporters responsible for reuptake, namely the serotonin transporter (SERT), the norepinephrine transporter (NET) and the dopamine transporter (DAT), thereby blocking the reuptake of the neurotransmitter(s) from the synaptic cleft [1], Monoamine reuptake inhibitors are an established drug class that has proven utility for the treatment of a number of CNS disorders, especially major depressive disorder (MDD). 

Major Depressive Disorder (MDD). The distinction between MDD and BPAD is most problematic during the earliest episodes of illness and at younger ages of presentation. The first episode of bipolar illness is a depressive one in at least one-third of patients with BPAD. The younger the age of onset of an episode of depression, the greater the likelihood that the disease will progress to BPAD. 

Major Depressive Disorder (MDD) with Atypicai Features. The anhedonia of MDD is often manifested by social withdrawal. In contrast to social anxiety disorder, the social withdrawal of MDD is desired by the patient, at least during the major depressive episode, and does not persist when the episode remits. Atypical depression is characterized by another symptom reminiscent of social anxiety disorder—a longstanding pattern of sensitivity to interpersonal rejection. The interpersonal sensitivity associated with atypical depression is often characterized by stormy relationships and overly emotional responses to perceived slights. Such social lability is seldom observed in patients with social anxiety disorder. 

Appropriate management of AN also requires the early detection and treatment of any comorbid psychiatric disorders. The most common comorbid conditions associated with AN are major depressive disorder (MDD), obsessive-compulsive disorder (OCD), and substance use disorders. At the time of presentation, over 50% of AN patients also fulfill criteria for MDD however, accurate diagnosis of depression in these patients is complicated by the fact that prolonged starvation often produces a mood disturbance and neurovegetative symptoms identical to MDD. If MDD appears to be comorbid with AN at the time of presentation, there is debate as to whether it is more prudent to withhold treatment of the depression until weight restoration has been initiated. If the depression persists despite refeeding, then treatment of the depression is likely warranted. 

Suicidaiity in chiidren and adoiescents Antidepressants increased the risk of suicidal thinking and behavior (suicidaiity) in short-term studies in children and adolescents with major depressive disorder (MDD) and other psychiatric disorders. Anyone... 

Suicidality in children and adolescents Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of trazodone or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Trazodone not approved for use in pediatric patients (see Clinical worsening and suicide risk and Children sections in Warnings). 

The burden of mental illness has traditionally been underestimated worldwide. Despite treatment advances, major depressive disorder (MDD) is still a significant cause of morbidity and mortality. In fact, depression was the fourth leading cause of disease burden in the world in 1990, and is projected to be the second leading cause of disability by 2020. In the United States alone, it causes billions of dollars annually in direct and indirect medical costs and losses in productivity. It is now known that patients with MDD may experience both psychological and medical complaints, including pain, which underscores the severity of impact of MDD on the health-care system. 

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

Major depressive disorder (MDD) is a familial recurrent illness associated with poor psychosocial and academic outcome an increased risk for other psychiatric disorders, suicide, and suicide attempts and a high rate of depression and psychological difficulties in adult life (Birmaher et ah, 1996b Goodyer et ah, 1997 Lewin-sohn et ah, 1999 Pine et ah, 1998 Rao et ah, 1999 Weissman et ah, 1999a,b). The prevalence of MDD in children and adolescents is approximately 2% and 6%, respectively (Birmaher et ah, 1996b). Thus, early identification and prompt treatment of this disorder at its early stages is critical. 

High levels of aggression have been reported in adolescents with major depressive disorder (MDD) (Knox et al., 2000). Delinquent youth and youth with CD have high rates of affective illness (Puig-Antich 1987 Pliszka et al., 2000). Children and adolescents suffering from both MDD and antisocial behavior are at highest risk for suicidal acts (Brent et al., 1993). 

A major depressive episode consists of mood changes accompanied by neurovegetative symptoms on a daily basis for at least 2 weeks. Our nosology also lists inclusion and exclusion criteria for major depressive disorder (MDD) ( Table 6-1 Appendix G and Appendix H), but there are problems with these. 

Augmentation with TMS in partially responsive, depressed patients has also been investigated. In one study of 24 major depressive disorder (MDD) patients, Conca et al. (212) compared an antidepressant plus LF-rTMS (<0.17 Hz, 1.9 T, 10 sessions) with an antidepressant only. Using the Hamilton Depression Rating Scale (HDRS) as the primary outcome measure, the authors reported that the combined treatment was superior to antidepressant monotherapy. 

Major depressive disorder (MDD) can occur in children as young as 6 years of age. The diagnosis is based on the same criteria as in adults. These patients typically have a high familial loading for psychiatric disorders (110), with more than 70% of mothers having MDD, either pure or complicated by the presence of other psychiatric syndromes. Fathers, however, are more likely to have alcohol abuse or dependence, as opposed to MDD. Given this familial pattern, it is not surprising that many children and adolescents with MDD frequently also meet criteria for other psychiatric syndromes, particularly conduct and oppositional disorder ( 110). 

Depression as an emotion is common and usually short-lived. As a symptom it can occur in most psychiatric disorders as well as other medical conditions, e.g. hypothyroidism, Parkinson s disease. As an illness, major depressive disorder (MDD), it is less common but, nevertheless, moderate to severe forms affect 5-10% of people in their lifetime and milder forms 20-30%. After a first episode, prophylaxis is required for at least 6 months and ideally 12 months to prevent relapse. This should usually be with the dose of antidepressant to which the patient initially responded. Those with recurrent episodes require prophylaxis over many years. 

The diagnosis of depression still rests primarily on the clinical interview. Major depressive disorder (MDD) is characterized by depressed mood most of the time for at least 2 weeks and/or loss of interest or pleasure in most activities. In addition, depression is characterized by disturbances in sleep and appetite as well as deficits in cognition and energy. Thoughts of guilt, worthlessness, and suicide are common. Coronary artery disease, diabetes, and stroke appear to be more common in depressed patients, and depression may considerably worsen the prognosis for patients with a variety of comorbid medical conditions. 

There are two major types of depression major depressive disorder (MDD) and bipolar or manic-depressive illness. Both disorders are characterized by changes in mood as the primary clinical manifestation. Major depression is characterized by feelings of intense sadness and despair with little drive for socialization or communication. Physical changes such as insomnia, anorexia and sexual dysfunction can also occur. Mania is characterized by excessive elation, irritability, insomnia, hyperactivity and impaired judgment. It may effect as much as 1% of the U.S. population."... 

Extensive studies on bupropion, including animal models of depression, have demonstrated that the desired inhibition of dopamine and norepinephrine reuptake resides mainly with radafaxine (that is the (S,S)-enantiomer, 2a). Furthermore, these studies confirmed that the (R,R) -enantiomer, 2b, is associated with a number of the known related undesirable side effects. Hence, development of radafaxine hydrochloride was undertaken for the treatment of Major Depressive Disorder (MDD) as a stand-alone New Chemical Entity (NCE). Furthermore, owing to the undesirable side effects associated with the (R,R)-enantiomer 2b, levels of this compound were to be controlled to <0.5% to minimize these effects. 

FIGURE 8-1. Anxiety and depression can be combined in a wide variety of syndromes. Generalized anxiety disorder (GAD) can overlap with major depressive disorder (MDD) to form mixed anxiety depression (MAD). Subsyndromal anxiety overlapping with subsyndromal depression to form subsyn-dromal mixed anxiety depression, sometimes also called anxious dysthymia. Major depressive disorder can also overlap with subsyndromal symptoms of anxiety to create anxious depression GAD can also overlap with symptoms of depression such as dysthymia to create GAD with depressive features. Thus, a spectrum of symptoms and disorders is possible, ranging from pure anxiety without depression, to various mixtures of each in varying intensities, to pure depression without anxiety. 

FIGURE 8—6. Subsyndromal mixed anxiety depression (MAD) may be an unstable psychological state, characterized by vulnerability under stress to decompensation to more severe psychiatric disorders, such as generalized anxiety disorder (GAD), full-syndrome MAD, or major depressive disorder (MDD). 

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