Psychotic Depression: Diagnosis, Differential Diagnosis, and Treatment

Dubovsky, Steven; Ghosh, Biswarup M; Serotte, Jordan C; Cranwell, Victoria

doi:10.1159/000511348

Cited by 96 publications

(64 citation statements)

References 131 publications

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“…Depression is considered to be a serious and chronic mental illness characterized by low mood, loss of interest and desire, sleep disorders, fatigue, suicidal behavior, the ability to compromise social and occupational functions, and affecting individuals regardless of their social or economic status [1][2][3][4][5]. The World Health Organization predicted that this disorder would affect individuals of both sexes and of all ages, being considered the second-leading cause of global disease by 2020, and leading consequently to early deaths due to physical health problems and difficulty accessing health services [1,6].…”

Section: Introductionmentioning

confidence: 99%

New Method for the Monitoring of Antidepressants in Oral Fluid Using Dried Spot Sampling

et al. 2021

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The increase in the consumption of antidepressants is a public health problem worldwide, as these are a class of compounds widely used in the treatment of several illnesses, such as depression and anxiety. This work aimed to develop and optimize a method for the quantification of a number of antidepressants and their metabolites (fluoxetine, venlafaxine, O-desmethylvenlafaxine, citalopram, sertraline, and paroxetine) in 100 µL of oral fluid using the dried saliva spots (DSS) sampling approach and gas chromatography coupled with tandem mass spectrometry (GC–MS/MS). The method was validated, presenting linearity within the studied range, with detection and quantification limits ranging between 10 and 100 ng/mL, and coefficients of determination (R2) of at least 0.99 for all analytes. Recoveries were between approximately 13 and 46%. The analysis of precision and accuracy presented acceptable coefficients of variation and relative errors, considering the criteria usually accepted in the validation of bioanalytical procedures. The method herein described is the first to be reported using DSS for the extraction of antidepressants, proving to be a sensitive, simple, and fast alternative to conventional techniques, and capable of being routinely applied in clinical and forensic toxicology scenarios.

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Section: Introductionmentioning

confidence: 99%

New Method for the Monitoring of Antidepressants in Oral Fluid Using Dried Spot Sampling

et al. 2021

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“…A clinimetric approach that includes repeated assessments, macroanalysis, staging, broadening of clinical information, and consideration of iatrogenic comorbidity [20, 27, 43] appears to be necessary when anxiety and depression coexist. Similar considerations may be extended to depression with psychotic features [71] or in the setting of psychotic disorders [72].…”

Section: Discussionmentioning

confidence: 99%

When Anxiety and Depression Coexist: The Role of Differential Diagnosis Using Clinimetric Criteria

Cosci

Fava

2021

Psychother Psychosom

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Depressive and anxiety disorders are frequently associated. Depression may be a complication of anxiety and anxiety can complicate depression. The nature of their relationship has been a source of controversy. Reviews generally base their conclusions on randomized controlled trials and meta-analyses that refer to the average patient and often clash with the variety of clinical presentations that may occur when anxiety and depression coexist. The aim of this review was to examine the literature according to profiling of subgroups of patients based on clinimetric criteria, in line with the recently developed concept of medicine-based evidence. We critically reviewed the literature pertaining to the specific presentations of anxiety and depression, outlining the advantages and disadvantages of each treatment approach. The following prototypic cases were presented: depression secondary to an active anxiety disorder, depression in patients with anxiety disorders under treatment, anxious depression, anxiety as a residual component of depression, and demoralization secondary to anxiety disorder. We argue that the selection of treatment when anxiety and depression coexist should take into account the modalities of presentation and be filtered by clinical judgment. Very different indications may ensue when the literature is examined according to this perspective.

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“…Manic-depressive illness, also known as bipolar disorder, is a multifaceted psychiatric illness of significant prevalence, morbidity and mortality associated with markedly reduced quality of life and functionality, suicidality and premature death and high socioeconomic burden [1]. Bipolar depression also conveys a larger risk of psychotic symptoms than unipolar depression [2].…”

Section: Introductionmentioning

confidence: 99%

“…The management of the disorder has traditionally included pharmacological agents as well as psychological therapies [3,4] with psychotic symptoms usually requiring pharmacotherapy or electroconvulsive therapy (ECT) [2]. However, some patients do show little to no response to such treatment options or do not comply due to side effects [4] which in turn has led to an increased interest in alternative treatments such as neurostimulation.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Repetitive Transcranial Magnetic Stimulation in the Treatment of Bipolar Disorder in Comparison to the Treatment of Unipolar Depression in a Naturalistic Setting

et al. 2022

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Repetitive transcranial magnetic stimulation (rTMS) is effective in the treatment of depression. However, for the subset of patients with bipolar disorder, less data is available and overall strength of evidence is weaker than for its use in unipolar depression. A cohort of 505 patients (of which 46 had a diagnosis of bipolar disorder) with depression who were treated with rTMS were analyzed retrospectively with regards to their response to several weeks of treatment. Hamilton Depression Rating Scale (HDRS) was assessed as main outcome. Unipolar and bipolar patients with depression did not differ significantly in baseline demographic variables or severity of depression. Both groups did not differ significantly in their response to treatment as indicated by absolute and relative changes in the HDRS and response and remission rates. On HDRS subitem-analysis, bipolar patients showed superior amelioration of the symptom “paranoid symptoms” in a statistically significant manner. In conclusion, depressed patients with a diagnosis of bipolar disorder benefit from rTMS in a similar fashion as patients with unipolar depression in a naturalistic setting. rTMS might be more effective in reducing paranoia in bipolar than in unipolar patients.

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Psychotic Depression: Diagnosis, Differential Diagnosis, and Treatment

Cited by 96 publications

References 131 publications

New Method for the Monitoring of Antidepressants in Oral Fluid Using Dried Spot Sampling

New Method for the Monitoring of Antidepressants in Oral Fluid Using Dried Spot Sampling

When Anxiety and Depression Coexist: The Role of Differential Diagnosis Using Clinimetric Criteria

Effectiveness of Repetitive Transcranial Magnetic Stimulation in the Treatment of Bipolar Disorder in Comparison to the Treatment of Unipolar Depression in a Naturalistic Setting

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