Economic Implications of Treatment-Resistant Depression Among Employees

Greenberg, Paul E.; Corey‐Lisle, Patricia K.; Birnbaum, Howard G.; Marynchenko, Maryna; Claxton, Ami J.

doi:10.2165/00019053-200422060-00003

Cited by 97 publications

(71 citation statements)

References 18 publications

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“…Previous research indicated that depression has a significant economic impact on medical care costs [19] and worker productivity [20], although such studies do not typically control for personality pathology. Given the significant increase in treatment utilization by patients in the BPD group over utilization by patients in the MAD group, the economic impact of a BPD diagnosis is likely considerable.…”

Section: Discussionmentioning

confidence: 99%

Psychosocial impairment and treatment utilization by patients with borderline personality disorder, other personality disorders, mood and anxiety disorders, and a healthy comparison group

Ansell

Sanislow

McGlashan

et al. 2007

Comprehensive Psychiatry

123

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This study compared psychosocial functioning and treatment utilization in 130 participants who were diagnosed with a borderline personality disorder (BPD), a non-BPD personality disorder (OPD), a mood and/or anxiety disorder (MAD), or had no current psychiatric diagnosis and served as a healthy comparison group. Diagnostic and Statistical Manual of Mental Disorders (4th Edition) diagnoses, psychosocial functioning, and treatment utilization were determined by using well-established semistructured research interviews conducted by trained doctoral-level clinicians. Analysis of variance revealed the most severe deficits in functioning characterized the BPD group across areas of global functioning with more moderate impairments in functioning occurring in OPD and MAD groups. The BPD group was characterized by significantly greater psychiatric and nonpsychiatric treatment utilization than the other groups. These findings indicate that BPD as well as other personality disorders are a source of considerable psychologic distress and functional impairment equivalent to, and at times exceeding, the distress found in mood and anxiety disorders. The public health impact of BPD diagnosis is highlighted by the high rates of psychiatric and nonpsychiatric treatment utilization. D

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Section: Discussionmentioning

confidence: 99%

Psychosocial impairment and treatment utilization by patients with borderline personality disorder, other personality disorders, mood and anxiety disorders, and a healthy comparison group

Ansell

Sanislow

McGlashan

et al. 2007

Comprehensive Psychiatry

123

View full text Add to dashboard Cite

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“…It is expected to become the second most common cause of disability worldwide by 2015 with obvious socio-economic implications (Strekalova et al, 2011). Traditional pharmacotherapy which focuses on increasing monoamines (norepinephrine or serotonin) neurotransmission has a relatively slow onset (Kupfer et al, 1989) of action and it has a limited effectiveness, between 10 and 20% of the treated patients do not respond to any antidepressant medication (Greenberg et al, 2004). Recent clinical studies have shown that a single subanesthetic dosage of the non-competitive N-methyl-Daspartate receptor (NMDARs) antagonist, ketamine, produces a rapid and lasting antidepressant effect in patients who were resistant to the current treatment (Maeng et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

Reduction in Ventral Midbrain NMDA Receptors Reveals Two Opposite Modulatory Roles for Glutamate on Reward

Hernández

Khodami-Pour

Lévesque

et al. 2015

Neuropsychopharmacol

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Glutamate is a major component of the reward circuitry and recent clinical studies suggest that new molecules that would target glutamate neurotransmission are most likely to constitute more effective medications for mood disorders. It is well known that activation of N-methyl-D-aspartate glutamate receptors (NMDARs) initiates dopamine burst firing, a mode associated with reward signaling; but NMDARs also contribute to the maintenance of an inhibitory drive to dopamine neurons. Such opposite modulatory functions imply that different subtypes of NMDARs are expressed on different ventral midbrain (VM) neurons and/or afferent inputs to dopamine neurons. By using the small interfering RNA (siRNA) technique, we studied the effects of VM downregulation of NMDAR subunits GluN1, GluN2A, and GluN2D on reward induced by dorsal raphe electrical stimulation. Reward thresholds were measured before and 24 h after each of three consecutive daily bilateral microinjections of siRNA for the targeted receptor subunit(s) or non-active RNA sequence. After the last measurement, reward thresholds were reassessed following a bilateral microinjection of the preferred GluN2A-NMDA antagonist, (2R,4S)-4-(3-Phosphopropyl)-2-piperidinecarboxylic acid (PPPA). Western-blot analysis showed that siRNAs reduced GluN1-and GluN2A-containing receptors whereas behavioral tests showed that only a reduction in GluN1 produced reward attenuation. Despite NMDAR reduction, reward-enhancing effect of PPPA remained unchanged. We conclude that VM glutamate relays the reward signal initiated by dorsal raphe electrical stimulation by acting on NMDARs devoid of GluN2A/2D subunits and exerts an inhibition on this reward signal by acting on GluN2A-containing NMDARs most likely located on afferent terminals.

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“…Although several therapeutic interventions have proven their effectiveness, some depressed patients (10 up to 20 %) receiving antidepressant medication are partially or totally resistant to treatment (Greenberg et al, 2004). For this group of drug-resistant patients alternative and effective therapeutic options are therefore required.…”

Section: Introductionmentioning

confidence: 99%

Effects of repetitive transcranial magnetic stimulation of the dorsolateral prefrontal cortex on the attentional processing of emotional information in major depression: A pilot study

Leyman

Raedt

Vanderhasselt

et al. 2011

Psychiatry Research

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Repetitive Transcranial Magnetic Stimulation (rTMS) is as a promising therapeutic tool for major depressive disorder. However, the degree of clinical improvement following rTMS treatment still remains questionable. This pilot study aimed at investigating potential working mechanisms of rTMS by examining the effects on attentional processing towards negative information, a proposed underlying cognitive vulnerability factor for depression. The antidepressant effect of high-frequency (10 Hz) rTMS over the left dorsolateral prefrontal cortex and possible effects on the inhibitory processing of emotional information was assessed in a sample of fourteen depressed patients immediately after the first stimulation session and at the end of a two week treatment period. One session of rTMS caused neither significant self-reported mood changes, nor improvements in inhibitory control towards negative information. After a 10-day treatment period, nine out of our fourteen patients demonstrated significant mood improvements, as indexed by a reduction of more than 50 % on the Hamilton depression rating scale. Responders also demonstrated significant improvements in the inhibitory processing of negative information. This study contributed to the existing evidence of the antidepressant effect of rTMS in the treatment of depression and additionally was able to demonstrate improvements in underlying deficiencies in inhibitory processes towards negative information.

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Economic Implications of Treatment-Resistant Depression Among Employees

Cited by 97 publications

References 18 publications

Psychosocial impairment and treatment utilization by patients with borderline personality disorder, other personality disorders, mood and anxiety disorders, and a healthy comparison group

Psychosocial impairment and treatment utilization by patients with borderline personality disorder, other personality disorders, mood and anxiety disorders, and a healthy comparison group

Reduction in Ventral Midbrain NMDA Receptors Reveals Two Opposite Modulatory Roles for Glutamate on Reward

Effects of repetitive transcranial magnetic stimulation of the dorsolateral prefrontal cortex on the attentional processing of emotional information in major depression: A pilot study

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