Methylphenidate is an effective treatment for reducing intravenous drug use in patients with severe amphetamine dependence.

Adverse life events and/or poor perceived social support influence the medium-term outcome of all psychiatric patients with MDD. These factors appear to have the strongest predictive value in the subgroup of patients currently in full remission.

The descriptive validity of the DSM-IV melancholic features specifier may be questionable in MDD. There appear to be no major differences in current co-morbidity, or course of depression between melancholic and non-melancholic patients. The consistency of DSM-IV melancholic features across episodes appears weak.

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Which MDD patient is classified as having suicidal ideation depends strongly on the method of assessment, with the greatest variation likely in primary care. Differences in assessments may cause inconsistency in risk factors. Predicting suicide attempts is difficult, but not futile.

The impact of persistent depression on social support (SS) is not well known. In the Vantaa Depression Study (VDS), 193 patients with DSM-IV MDD were interviewed at baseline, at 6 and 18 months. Objective SS was measured with the Interview Measure of Social Relationships (IMSR), and subjective SS with the Perceived Social Support Scale-Revised (PSSS-R); the influence of time spent in major depressive episodes (MDEs) on SS at 18 months was investigated. Low objective SS was independently predicted by low baseline objective SS, male gender, and longer time spent in MDEs; low subjective SS by longer time spent in MDEs and lower baseline subjective SS. Along with clinical improvement, subjective SS improved but objective SS did not. The persistence of MDD seems to weaken both objective and subjective SS. Whether this results in progressively weakening objective and subjective SS, and thereby lowers the threshold for future depressive episodes, should be further investigated.

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