Article

Major Depressive Disorder Treatment Guidelines in America and Europe

Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA.
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 03/2010; 71 Suppl E1(suppl E1):e04. DOI: 10.4088/JCP.9058se1c.04gry
Source: PubMed

ABSTRACT

The various major American and European guidelines for the treatment of depression provide similar basic principles of treatment, which include individualizing the treatment plan, preparing the patient for potential long-term treatment, providing measurement-based care, and treating to remission. While the guidelines are all evidence-based, certain factors can influence differences in specific recommendations, such as the consensus group's composition, underlying mandates, and cultural attitudes. The similarities and differences among 6 sets of guidelines from Europe and the Americas published in the past decade are reviewed here (American Psychiatric Association, British Association for Psychopharmacology, Canadian Network for Mood and Anxiety Treatments, National Institute for Health and Clinical Excellence, Texas Medication Algorithm Project, and World Federation of Societies of Biological Psychiatry). In the guidelines, mild depression has the most variance in treatment recommendations; some, but not all, guidelines suggest that it may resolve with exercise or watchful waiting, but psychotherapy or antidepressants could be used if initial efforts fail. Moderate and severe major depression carry broadly similar recommendations among the guidelines. First-line treatment recommendations for moderate major depressive disorder include antidepressant monotherapy, psychotherapy, and the combination of both. Severe depression may require the combination of an antidepressant and an antipsychotic, electroconvulsive therapy, or the combination of an antidepressant and psychotherapy. Benzodiazepines play a very limited role in the treatment of depression; if the patient has catatonic depression, acutely suicidal depression, or depression with symptoms of anxiety, agitation, or insomnia, benzodiazepines are recommended by some guidelines for short-term treatment only.

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    • "Indeed, agents such as selective 5-hydroxytryptamine (5-HT) reuptake inhibitors are widely prescribed to improve the quality of life of depressed patients (Davidson, 2010; Gelenberg, 2010). Nevertheless , the slow onset of action and side-effects of these antidepressants are relevant clinical limitations. "
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    ABSTRACT: Major depressive disorder (MDD) is one of the leading causes of morbidity worldwide. Several antidepressants have been widely prescribed to treat patients with MDD. However, neuronal changes in brain function remain poorly understood. Based on the standard chronic mild stress (CMS) model of depression in mice, we investigated the neuronal mechanisms of the classic antidepressant, fluoxetine, and a new compound (termed YY-23 in this study) derived from furostanol saponin. The results showed that both fluoxetine and YY-23 normalized CMS-induced depressive-like behaviors. YY-23 caused antidepressant-like behaviors with a faster action than fluoxetine. In terms of in vivo neuronal activities, a CMS-induced decrease in spontaneous firing in burst of medial prefrontal cortex pyramidal neurons rather than ventral tegmental area (VTA) was reversed by the chronic administration of fluoxetine and YY-23. We also found that CMS-induced deficits in the expression of prefrontal brain-derived neurotrophic factor (BDNF) were also restored by chronically administering YY-23 and fluoxetine. In addition, chronic administration of fluoxetine rather than YY-23 resulted in an improvement of antidepressive-like behavior and a change of burst firing of VTA in control-housed animals, indicating that the pharmacological effects of YY-23 were specific to CMS-treated animals. Together, these data suggest that the burst-firing patterns of pyramidal cells may be a neural biomarker of depressive-like mice and antidepressant action. Furthermore, synaptic transmission and BDNF may contribute to the rapid antidepressant-like effects on depression.
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    • "Depression is one of the most common mental disorders in current Western societies. At present, it continues to grow in numbers and is one of the main causes of disability around the world, particularly in high-income regions (e.g.,Davidson, 2010;McKenna, Michaud, Murray, & Marks, 2005; World Health Organization[WHO], 2005). To deal with this relevant health and social problem, there are several efficient interventions such as use of antidepressant drugs (ADs;Geddes et al., 2003;Perestelo-Pérez et al., 2010) and psychological treatments, particularly those derived from a cognitive-behavioural approach (Aguilera, Garza, & Muñoz, 2010;Kaltenthaler et al., 2006;Merry, McDowell, Hetrick, Bir, & Muller, 2004). "

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    • "Depression is one of the most common mental disorders in current Western societies. At present, it continues to grow in numbers and is one of the main causes of disability around the world, particularly in high-income regions (e.g., Davidson, 2010; McKenna, Michaud, Murray, & Marks, 2005; World Health Organization [WHO], 2005). To deal with this relevant health and social problem, there are several efficient interventions such as use of antidepressant drugs (ADs; Geddes et al., 2003; Perestelo-Pérez et al., 2010) and psychological treatments, particularly those derived from a cognitive-behavioural approach (Aguilera, Garza, & Muñoz, 2010; Kaltenthaler et al., 2006; Merry, McDowell, Hetrick, Bir, & Muller, 2004). "
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    ABSTRACT: The objective of this research study was to assess pharmacological, somatic and/or psychological treatments in adults with a diagnosis of major depressive disorder who have not responded to at least one course of antidepressant medication. We conducted a systematic review to identify systematic scientific reviews and meta-analyses on treatment-resistant depression (TRD) published until February 2012. Of the sixty studies selected, sixteen met the inclusion criteria and were therefore included in the review. We considered eight main themes, including the definition of TRD, long-term results, and different treatment strategies, including so-called somatic therapies. Based on the review, the definition of TRD should be standardized in order to achieve a shared conceptualization of this disorder. This would allow a better understanding among clinicians and researchers in the field, promoting a homogeneous research methodology and thus leading to more reliable and comparable results. This essential conceptual clarification would also have a positive impact on patients with TRD, their families, and social and health systems.
    Full-text · Article · May 2014 · International Journal of Clinical and Health Psychology
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