Approximately 65%–75% of patients with major depression will respond to drug therapy. However, conventional antidepressants may be costly and have side effects and drug interactions that may inconvenience the patient, limit the use of the particular drug, or require the discontinuation of a particular therapy. In this past decade, there has been a renewed interest in alternative medicines, especially for depression, that are available without a prescription. The ability of patients to self-medicate depression presents a risk of inappropriate treatment, thereby increasing the morbidity and mortality rates associated with this sometimes fatal disease. In addition, herbal products are not regulated by the government, leading to problems with batch-to-batch consistency and adulteration, even for products that have evidence of efficacy in depression. The potential for herbal-pharmaceutical grade drug interactions increases the need for input and follow-up from health care practitioners. There is limited quality evidence describing the efficacy and optimal dosing for these products. Clinicians must acknowledge that patients are using herbal products and educate on their use to avoid negative outcomes in patients with depressive disorders.
Several depressive disorders are unique to women, affecting them at various points in their life cycle. These disorders include premenstrual dysphoric disorder (PMDD), pregnancy-associated depressive disorders, and perimenopausal affective disorders. Recently, the importance of the relationship between depression and the reproductive cycle has been highlighted due to the approval of medications to treat (PMDD). The role of gender difference in the prevalence of depressive disorders has long been recognized. This article will examine whether there are differences between men and women in the clinical presentation of depression, including differences in symptom manifestation, course of illness, comorbidities, and treatment. Systematic evaluation of the role of hormonal and neuroendocrine factors may lead to more appropriate treatment of depressive disorders in women.
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