Past, Present, and Future Directions for Defining Optimal Treatment Outcome in Depression

Keller, Martin B.

doi:10.1001/jama.289.23.3152

Cited by 337 publications

(256 citation statements)

References 114 publications

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“…Even in those who respond, significant impairments including underemployment, disability, and disproportionate levels of medical illness persist (Kessler et al, 1997;Paradiso et al, 1997;Keller, 2003). An alternative strategy is to identify those at high risk for developing MDD with the goal of advancing prevention and early intervention.…”

Section: Introductionmentioning

confidence: 99%

Increased Default Mode Network Connectivity in Individuals at High Familial Risk for Depression

Posner

Cha

Wang

et al. 2015

Neuropsychopharmacol

113

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Research into the pathophysiology of major depressive disorder (MDD) has focused largely on individuals already affected by MDD. Studies have thus been limited in their ability to disentangle effects that arise as a result of MDD from precursors of the disorder. By studying individuals at high familial risk for MDD, we aimed to identify potential biomarkers indexing risk for developing MDD, a critical step toward advancing prevention and early intervention. Using resting-state functional connectivity MRI (rs-fcMRI) and diffusion MRI (tractography), we examined connectivity within the default mode network (DMN) and between the DMN and the central executive network (CEN) in 111 individuals, aged 11-60 years, at high and low familial risk for depression. Study participants were part of a threegeneration longitudinal, cohort study of familial depression. Based on rs-fcMRI, individuals at high vs low familial risk for depression showed increased DMN connectivity, as well as decreased DMN-CEN-negative connectivity. These findings remained significant after excluding individuals with a current or lifetime history of depression. Diffusion MRI measures based on tractography supported the findings of decreased DMN-CEN-negative connectivity. Path analyses indicated that decreased DMN-CEN-negative connectivity mediated a relationship between familial risk and a neuropsychological measure of impulsivity. Our findings suggest that DMN and DMN-CEN connectivity differ in those at high vs low risk for depression and thus suggest potential biomarkers for identifying individuals at risk for developing MDD.

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Section: Introductionmentioning

confidence: 99%

Increased Default Mode Network Connectivity in Individuals at High Familial Risk for Depression

Posner

Cha

Wang

et al. 2015

Neuropsychopharmacol

113

View full text Add to dashboard Cite

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“…1, [3][4] In a general hospital, the problem is even more serious since depressed patients with physical illness present lower adherence rates 5 and worse prognoses. [6][7][8] In such patients, depression often goes undiagnosed.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis and pharmacological treatment of depressive disorders in a general hospital

Cigognini

Furlanetto

2006

Rev. Bras. Psiquiatr.

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A b s t r a c t Objective: To determine the point prevalence of depressive disorders in medical inpatients, to identify related sociodemographic and medical factors and to evaluate the psychotropic treatment given. Method: A cross-sectional study identifying the prevalence of depressive disorders and related factors combined with a prospective longitudinal study evaluating the psychopharmacological treatment were conducted. Medical inpatients, aged 18 years or older, presenting suitability to be interviewed and giving written informed consent were selected. The sample was composed of 125 subjects. The following instruments were used: a sociodemographic questionnaire; the Mini International Neuropsychiatric Interview; and the Beck Depression Inventory. Data related to medical, personal and family histories of psychiatric disorders and psychotropic use were collected by interview and from patient charts. The study took place at the Hospital Santa Isabel, in Blumenau, located in the state of Santa Catarina, Brazil, from January to July of 2002. Results: The prevalence of depressive disorders was 26%. The factors that correlated with depressive disorders were being female, having an income lower than 3 times the minimum wage, having a personal history of depressive disorders, using psychotropic drugs, scoring higher than 13 on the Beck Depression Inventory and having been referred for a psychiatric consultation (p < 0.05). Only 43.8% of the individuals with depressive disorders received antidepressants. Most of the depressed patients were being treated with benzodiazepines (62.5%). The most frequently prescribed drugs were diazepam and fluoxetine. Conclusions: Approximately one-quarter of the medical inpatients had depressive disorders. However, antidepressants were prescribed for less than half of them. Women with a history of depression, using benzodiazepines and having a low income presented significantly higher rates of depressive disorders. Physicians should suspect depression in patients presenting such characteristics.Keywords: Depressive disorder; Hospitals, general; Length of stay; Prevalence; Psychotropic drugs Resumo Objetivo: Identificar a prevalência de transtornos depressivos em pacientes internados em enfermarias clínicas de um hospital geral, avaliar o tratamento psicofarmacológico recebido e detectar fatores sociodemográficos e clínicos associados. Método: Realizou-se um estudo observacional transversal identificando a prevalência de transtornos depressivos e fatores associados juntamente com estudo longitudinal prospectivo avaliando o tratamento psicofarmacológico recebido durante a internação. Foram selecionados pacientes com mais de 18 anos, que apresentavam condições para a entrevista e que consentiram. A amostra foi composta por 125 pessoas. Aplicaram-se os seguintes instrumentos: questionário com variáveis sociodemográficas; coleta de informações sobre história médica, psiquiátrica e familiar; questionário sobre uso de psicofármacos; Mini International Neuropsychiatric Interview; e Inventário ...

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“…85,93,[133][134][135][136][137] In adult studies, patients who do not reach remission are more likely to have recurrent or chronic depression, suicidal ideation or behavior, and continuing impairment in work, relationships, and overall quality of life. [138][139][140][141][142][143][144][145][146][147][148] Similar evidence on the impact of nonremission is not available for youth.…”

Section: Rationale and Evidencementioning

confidence: 99%

“…• Guideline 34,35,48,49 • Quasi/nonexperimental [138][139][140][141][142][143][144][145][146][147][148] • RCT …”

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Evidence for the Management of Adolescent Depression

et al. 2013

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Adolescent depression is a prevalent and disabling condition resulting in emotional suffering and social and educational dysfunction. Care for adolescent depression is suboptimal and could be improved through the development and use of quality indicators (QIs). This article reports on the development of a care pathway and QIs for the primary and specialty care management of adolescent depression from case identification through symptom remission. It presents evidence from a review of adolescent clinical practice guidelines and research literature to support QIs at critical nodes in the pathway, and describes implications for practice based on existing evidence. Barriers to measure development are identified, including gaps in empirical evidence, and a research agenda is suggested. Pediatrics 2013;132:e996-e1009

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Past, Present, and Future Directions for Defining Optimal Treatment Outcome in Depression

Cited by 337 publications

References 114 publications

Increased Default Mode Network Connectivity in Individuals at High Familial Risk for Depression

Increased Default Mode Network Connectivity in Individuals at High Familial Risk for Depression

Diagnosis and pharmacological treatment of depressive disorders in a general hospital

Evidence for the Management of Adolescent Depression

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