Research and treatment approaches to depression

IN 6 PAGES of my book published in French. Starting out as a specialist in alcoholism and after 30 years of analysing depression, the present text details the conclusions which I have made in the subject. As a matter of fact, in the 1970's I was never satisfied by the passive attitude of my masters in hepatology, when faced with the multiple recurrences of our alcoholic patients. They used to state that recurrences were due to the stupidity of the patients. I preferred to search how to treat the possible causes of their problem, to lower the frequency and severity of its consequences. As an internist, it became quickly obvious to me, when consulting alcoholics, that depression played a central role in their problem. I consequently progressively identified a collection of indicators-mainly somatic-starting by a pain perceived when performing rectal digital examination. I also quickly realized that publishing personal studies was very difficult for an isolated private practice physician. In addition, the fast rate of discovery of new indicators discouraged me to fight for papers dealing with outdated concepts in the field so I decided to publish a book in 2005 in order to summarize my understanding to-date of depression and its treatment. 20 years ago I established a list of indicators and succeeded only recently in obtaining a statistical analysis which showed that each one had its own diagnostic value. One consequence was that the classical conception of indicators linked one to the other as in a chain was to be reconsidered. The second was that depression was a neurological-biochemical illness inducing plurisystemic dysfunction. It is, in any case, an obvious deduction of the efficiency of medication and of neurological studies. It is astonishing to see the discrepancy between scientific evidence of a unity of brain and body and day-today vision of medical and non-medical people functioning still with Plato's concept of soul acting independently of the body. It is evident that the case of patients being depressed when they had every thing to be happy about should have marked Hippocrates. However, it is time to evolve and to have a larger conception. It could be compared to tuberculosis which is not merely a pulmonary disease but rather an infectious one, with frequent, but not exclusive, pulmonary manifestations. My experience showed me that unrecognized features of depression are very frequent and various – and which must be taken into consideration when resorting to existing efficacious treatment, clearing not only the troubles leading to the visit but also all the other troubles which are part of the same cause. Psychiatrists have described this illness and this fact explains why its bodily manifestations are usually unrecognized. In fact, its mechanism is a deregulation of the chemical aspects of the nervous system, which leads frequently to various psychic effects, but also-and without parallel – to the functioning of the body. Psychiatrists have described diagnostic criteria based mainly on psychic signs. Their diagnostic methods are tailored, of course, to be specific but nobody had taken into account the sensitivity and the limitations of " non-depressiveness " which has never been described or even studied. This illness is very frequent but is not in line with normality – no more so than slight tuberculosis is an extreme of normality.

Pilar Montesó-Curto2 (Universidad Rovira i Virgili, España), Carme Ferré-Grau (Universidad Rovira i Virgili, España), Mar Lleixà-Fortuño (Universidad Rovira i Virgili, España), Núria Albacar Riobóo (Universidad Rovira I Virgili, España), Antonio Sánchez-Herrero (Hospital Virgen de la Cinta, España), Carina Aguilar-Martín (Atención Primaria Terres de l’Ebre, España), Marilene Lejeune (Area de Biología Molecular, España)

BMJ, 2002

Depressive illness is usually treatable. It is common and results in marked disability, diminished survival, and increased healthcare costs. As a result, it is essential that all doctors have a basic understanding of its diagnosis and management. In patients with physical illness depression may x Be a coincidental association x Be a complication of physical illness x Cause or exacerbate somatic symptoms (such as fatigue, malaise, or pain). Clinical features and classification The term depression describes a spectrum of mood disturbance ranging from mild to severe and from transient to persistent. Depressive symptoms are continuously distributed in any population but are judged to be of clinical significance when they interfere with normal activities and persist for at least two weeks, in which case a diagnosis of a depressive illness or disorder may be made. The diagnosis depends on the presence of two cardinal symptoms of persistent and pervasive low mood and loss of interest or pleasure in usual activities. Adjustment disorders are milder or more short lived episodes of depression and are thought to result from stressful experiences. Major depressive disorder refers to a syndrome that requires the presence of five or more symptoms of depression in the same two week period. Dysthymia covers persistent symptoms of depression that may not be severe enough to meet the criteria for major depression, in which depressed mood is present for two or more years. Such chronic forms of depression are associated with an increased risk of subsequent major depression, considerable social disability, and unhealthy lifestyle choices such as poor diet or cigarette smoking. Manic depressive (bipolar) disorder relates to the occurrence of episodes of both major depression and mania.

Practical Neurology

Psychoanalytic Psychotherapy, 2009

This paper reviews some of the essential facts about depression in adults. The term can refer to a symptom, a syndrome or a diagnosis. As a symptom, it occurs in many mental disorders and physical diseases. The boundaries of depression are reviewed: depression is biologically distinct from bipolar affective disorder, but it overlaps with the other common neurotic conditions; the spectrum of depressive disorders, melancholia, depressive adjustment reactions and dysthymia is described. Categorical classifications of depression have many problems, but are currently necessary. The epidemiology of depression in adulthood is presented with reference to old age, after childbirth, its prognosis and long-term disability and the limitations of short-term treatments. The immediate causes of depression include complex interactions between life events and their personal meaning influenced by personality factors and neuroticism. Ethological perspectives indicate that depression may have both adaptive and maladaptive aspects.

Journal of Affective Disorders, 1999

The Journal of Clinical Psychiatry, 2006

The Definition of Chronic Depression Dr. Gelenberg: Let's begin with a discussion of the definition of chronic depression. What is the clinical relevance of the subtypes of depression in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)? 1 Dr. McCullough: My colleagues and I have reported on 1316 patients with chronic depression. 2,3 We found no differences when a wide variety of demographic, psychosocial, and health measures were compared. For the DSM-V, we have argued that the existing subtypes do not represent qualitatively distinct entities. We have recommended a 2-by-2 table to accommodate a 4-fold classification of the unipolar disorders: mild versus moderate-to-severe severity and acute versus chronic types of episodes (Table 1). We can greatly simplify the current subtypes of chronic depression by consolidating them into a single category termed chronic depression. Dr. Gelenberg: Will you define chronic depression? Dr. McCullough: Chronic depression lasts a minimum of 2 years without at least a 2-month hiatus or a full remission. We are not suggesting the elimination of the DSM-IV categories for depressive disorders, but are recommending the deletion of distinct chronic subtypes since these subtypes do not represent qualitatively different entities. Dr. Ninan: Perhaps we should review the current diagnostic criteria for depressive disorders. The criteria for dysthymia require depressed mood for the majority of time and 2 additional symptoms that persist for 2 years, while the criteria for a major depressive episode stipulate 5 or more symptoms, including depressed mood or anhedonia, persisting for at least 2 weeks. Dysthymia followed by a major depressive episode is frequently labeled double depression. In the DSM-IV, chronic depression is defined as the persistence of the full criteria for a major depressive episode for at least 2 years. Major depressive disorder with incomplete recovery occurs when enough symptoms improve that the patient no longer meets the full criteria for major depressive disorder, but still has residual symptoms of depression (i.e., subsyndromal depression). If that patient later meets the full criteria for a major depressive episode without a period of remission in between, we consider it another episode of major depression (i.e., 2 episodes with incomplete recovery in between). Dr. McCullough: On our 2-by-2 table, we recommend maintaining dysthymia on the chronic row and in the mild severity column. Most of the disorders that Dr. Ninan just delineated would be in the moderateto-severe column. On the acute episode row, the mild disorder would be labeled minor depressive disorder and the moderate-to-severe episode would be termed episodic major depression. Dan N. Klein, Ph.D., has

Journal of Pharmaceutical Research International

Central nervous system (CNS) disorder is the world’s leading cause of disability and account of more hospitalizations. Central nervous system disorders are a group of neurological disorder that affect the structure or function of the brain or spinal cord. Depression (major depressive disorder or clinical depression) is a common but serious mood disorder. It causes severe symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working. The aim of treatment is release of neurotrophic proteins in the brain that can help to rebuild the hippocampus that has been reduced due to depression and to optimize patients’ physical, psychological and social functioning. This review presents a brief summary on psychological implications of living with depression, pathogenesis, diagnosis, causes, sign and symptoms and treatments associated with depression.

2015