Treatment Resistant Depression

by John F. Greden

This unique book presents the treatment "roadmap" implemented by the University of Michigan Comprehensive Depression Center's Treatment Resistant Depression Program, step-by-step guidance that has long eluded clinicians, patients, and their ...

Treatment Resistant Depression

Author: John F. Greden

Publisher: American Psychiatric Pub

ISBN: 1585624098

Page: 338

View: 303

This unique book presents the treatment "roadmap" implemented by the University of Michigan Comprehensive Depression Center's Treatment Resistant Depression Program, step-by-step guidance that has long eluded clinicians, patients, and their families. Writing across discipline, modality, lifespan, and patient demographics, the authors have compiled the most current thinking on TRD and distilled it into a highly readable, imminently practical, and brilliantly organized source of hope. The authors believe that early intervention is critical, and they advocate strategies for renewed focus on identifying youths who are at risk or already symptomatic. Similarly, they devote chapters to special populations such as pregnant women, older people, and those with comorbidities. Perhaps most useful to patients and their families, the book has a strong self-care orientation, emphasizing the importance of exercise, nutrition, and healthy sleep guidelines. Patients who are actively engaged in managing their disease often have better outcomes. Treatment Resistant Depression is frequently a lifetime diagnosis. The book acknowledges that fact and offers a systematic course of treatment grounded in evidence-based research that is current and comprehensive. Treatment Resistant Depression: A Roadmap for Effective Care offers a new way of conceptualizing an old enemy, and should prove to be an indispensable weapon in the battle.

Pharmacotherapy for Depression and Treatment resistant Depression

by George I. Papakostas

1. Major depressive disorder and treatment-resistant depression. 1.1.

Pharmacotherapy for Depression and Treatment resistant Depression

Author: George I. Papakostas

Publisher: World Scientific

ISBN: 9814287598

Page: 699

View: 670

This unique ground-breaking work, authored by renowned Harvard-based researchers G I Papakostas and M Fava, represents, by far, the most comprehensive compilation to date of medical studies and reports involving the use of anti-depressants for the treatment of major depressive disorder, one of the most prevalent and devastating medical illnesses afflicting mankind today. Given the breadth of the scientific literature focusing on the use of anti-depressants for major depressive disorder, this work represents an invaluable tool for clinicians as well as scientists in search of a reference manual to help guide them through the field. The book is organized into four parts; each part focusing on a separate theme that will facilitate the reader to precisely access particular information of interest, whether be it clinical or scientific in nature. Each part is then sub-divided into several thematic chapters, which are enriched with tables and figures citing results from the most influential studies in the field. Finally, clinical and research pearls are listed throughout the book in bullet-point fashion to help summarize the available knowledge-base in a user-friendly format.

Treatment Resistant Depression

by Siegfried Kasper

This book clearly and succinctly summarizes the latest scientific research and its applications in clinical practice.

Treatment Resistant Depression

Author: Siegfried Kasper

Publisher: John Wiley & Sons

ISBN: 1118556739

Page: 232

View: 609

The first book devoted to a challenging disorder that affectsmillions of people around the world. Essential reading forall psychiatrists who manage these patients.

Ketamine for Treatment Resistant Depression

by Gustavo H. Vazquez

Ketamine for Treatment-Resistant Depression: Neurobiology and Applications provides a simple, evidence-based overview for neuropsychiatrists and translational researchers on this medication, its mechanisms of actions, eligibility of ...

Ketamine for Treatment Resistant Depression

Author: Gustavo H. Vazquez

Publisher: Academic Press

ISBN: 0128210338

Page: 150

View: 193

Ketamine for Treatment-Resistant Depression: Neurobiology and Applications provides a simple, evidence-based overview for neuropsychiatrists and translational researchers on this medication, its mechanisms of actions, eligibility of patients for treatment, and the preparation and implementation of ketamine clinics. Provides efficacy research on ketamine as a treatment for depression Identifies best practices for clinical use, both long-term and acute Discusses the molecular mechanisms and neurobiology of action

Treatment resistant Mood Disorders

by Andre Carvalho

Providing a concise view of the current definitions, assessment and evidence-based management of such disorders, this work reviews novel therapeutic targets, which may enhance the future therapeutic armamentarium of clinicians.

Treatment resistant Mood Disorders

Author: Andre Carvalho

Publisher: Oxford University Press, USA

ISBN: 0198707991

Page: 160

View: 582

Treatment-resistant major depression and bipolar disorder are highly prevalent and disabling conditions associated with substantial morbidity and mortality. The assessment and management of refractory patients with mood disorders is a major clinical challenge for mental health providers. Part of the Oxford Psychiatry Library (OPL) series, this pocketbook provides a concise view of the current definitions, assessment and evidence-based management of treatment-resistant mood disorders and reviews novel therapeutic targets for mood disorders, which may enhance the therapeutic armamentarium of clinicians in the near future. The pocketbook serves as a useful guide for mental health practitioners, including psychiatrists, clinical psychologists, trainees, and interested primary care physicians.

Ketamine for Treatment Resistant Depression

by Sanjay J. Mathew

This book brings together an international group of clinicians and researchers from a broad swath of inter-related disciplines to offer the most up-to-date information about clinical and preclinical research into ketamine and second ...

Ketamine for Treatment Resistant Depression

Author: Sanjay J. Mathew

Publisher: Springer

ISBN: 3319429256

Page: 155

View: 972

This book brings together an international group of clinicians and researchers from a broad swath of inter-related disciplines to offer the most up-to-date information about clinical and preclinical research into ketamine and second-generation “ketamine-like” fast-acting antidepressants. Currently available antidepressant medications act through monoaminergic systems, are ineffective for many individuals suffering from depression, and are associated with a delayed onset of peak efficacy of several months. The unexpected emergence of ketamine, an anesthetic N-methyl-D-aspartate (NMDA) receptor antagonist, as a rapid-acting antidepressant has reinvigorated CNS drug discovery research and catalyzed investigation in patient populations historically ignored in antidepressant drug development programs, particularly treatment-resistant patients and those with suicidality. Recent industry and academic research efforts have coalesced to explore NMDA receptor and glutamatergic molecular targets that lack ketamine’s psychotomimetic side effects and abuse liability but retain its rapid onset of efficacy. However, many fundamental questions remain regarding the neurobiological mechanisms underlying ketamine’s rapid antidepressant effects and the puzzling persistence of benefits observed in some patients following a single dose. This book examines how insights from these studies are forging new conceptual models of the neurobiology of stress-related affective, anxiety, and addictive disorders and the nature of treatment resistance. It also discusses how ketamine’s rapid antidepressant effects provide a scientific platform to facilitate innovation in clinical trial designs pertaining to patient selection, choice of control group, outcome measures, and dose-optimization. This book brings together data and insights from this rapidly expanding and extraordinarily promising field of study. Readers will be able to extract integrated themes and useful insights from the material contained in these diverse chapters and appreciate the paradigm-shifting contributions of ketamine to modern psychiatry and clinical neuroscience research.

Evidence Synthesis for Determining the Efficacy of Psychotherapy for Treatment Resistant Depression

by Ranak Trivedi

The current review will address the effectiveness of psychotherapeutic approaches as a second step treatment for MDD in patients who do not achieve remission after initial treatment with antidepressants.

Evidence Synthesis for Determining the Efficacy of Psychotherapy for Treatment Resistant Depression

Author: Ranak Trivedi

Publisher:

ISBN:

Page: 35

View: 800

BACKGROUND: Major depressive disorder (MDD) is a prevalent disorder impacting an estimated 13% of the general population, and a third of the veteran population. Of the patients who experience at least one depressive episode, approximately 20% will experience chronic depression and 60-85% will experience recurrence and relapse. Antidepressant medications are the most commonly prescribed treatment modality for MDD and are often the first line of treatment in primary care settings. However, fewer than 50% of patients fully remit after adequate dosage of antidepressant treatment. Treatment options for these "treatment resistant" patients vary but typically involve using other psychoactive medications as augmentation (i.e., addition of another medication) or substitution treatment (i.e., switching medications). Less attention has been paid to using psychotherapy as an augmentation or substitution treatment for treatment resistant patients, despite psychotherapy being associated with clinical improvements in MDD comparable to those achieved with antidepressants. The current review will address the effectiveness of psychotherapeutic approaches as a second step treatment for MDD in patients who do not achieve remission after initial treatment with antidepressants. Question: In primary care patients with major depressive disorder who do not achieve remission with acute phase antidepressant treatment, is empirically based psychotherapy used as an augmentation or substitution treatment more effective than control for achieving remission? SUMMARY: In summary, two good quality, moderate-sized trials showed equal benefit from augmenting antidepressant medication with CT and from active medication management, one fair quality small study showed lithium augmentation to be more beneficial than CT, and one fair quality trial showed short-term benefit from augmentation through 16 sessions of DBT. A moderate-sized, good quality study and a small, poor quality study found equal benefit from substituting CT for antidepressant treatment and from continuing management of depression with medication. There was significant heterogeneity in study designs, sample sizes, and comparator groups, and most studies were underpowered to detect moderate effect sizes. We conclude that current trials do not support favoring psychotherapy over antidepressant medication for mid-life adults with treatment resistant MDD; however, psychotherapy appears to be an equally effective treatment compared to antidepressant medication and is therefore a reasonable treatment option for this demographic. Whether these results are directly applicable to Veterans is uncertain because most study samples were mid-life adults, more than 50% female, and medical and psychiatric co-morbidity was incompletely described. The limited number of studies, mixed effects and uncertain applicability to Veterans suggest a need for additional trials to adequately evaluate the potential treatment benefit of psychotherapy for treatment resistant depression.

Nonpharmacologic Interventions for Treatment Resistant Depression in Adults

by U. S. Department of Health and Human Services

For these reasons, clinicians often look for alternative strategies for their TRD patients. This review is intended to help various decisionmakers come to informed choices about the use of nonpharmacologic interventions for TRD in adults.

Nonpharmacologic Interventions for Treatment Resistant Depression in Adults

Author: U. S. Department of Health and Human Services

Publisher: CreateSpace

ISBN: 9781484094525

Page: 828

View: 834

Major depressive disorder (MDD) is common and costly. Over the course of a year, between 13.1 million and 14.2 million people will experience MDD. Approximately half of these people seek help for this condition, and only 20% of those receive adequate treatment. For those who do initiate treatment for their depression, approximately 50% will not adequately respond following acute-phase treatment; this refractory group has considerable clinical and research interest. Patients with only one prior treatment failure are sometimes included in this group, but patients with two or more prior treatment failures are a particularly important and poorly understood group and are considered to have treatment-resistant depression (TRD). Patients with TRD incur the highest direct and indirect medical costs among those with MDD. These costs increase with the severity of TRD. Treatment-resistant patients are twice as likely to be hospitalized, and their cost of hospitalization is more than six times the mean total costs of depressed patients who are not treatment resistant. Given the burden of TRD generally, the uncertain prognosis of the disorder, and the high costs of therapy, clinicians and patients need clear evidence to guide their treatment decisions. The choices are wide ranging, include both pharmacologic and nonpharmacologic interventions, and are fraught with incomplete, potentially even conflicting, evidence. Somatic treatments, which may involve use of a pharmacologic intervention or a device, are commonly considered for patients with TRD. Antidepressant medications, which are the most commonly used intervention, have decreasing efficacy for producing remission after patients have experienced two failures. Such drugs also often have side effects, sometimes minor but sometimes quite serious. For these reasons, clinicians often look for alternative strategies for their TRD patients. This review is intended to help various decisionmakers come to informed choices about the use of nonpharmacologic interventions for TRD in adults. Our principal goal is to summarize comparative data on the efficacy, effectiveness, and harms of electroconvulsive therapy, repetitive transcranial magnetic stimulation, vagus nerve stimulation, and cognitive behavioral therapy or interpersonal psychotherapy in patients with TRD. The following Key Questions are addressed: KQ1a. For adults with TRD, do nonpharmacologic interventions such as electroconvulsive therapy, repetitive transcranial magnetic stimulation, vagus nerve stimulation, or demonstrated effective psychotherapy differ in efficacy or effectiveness in treating acute-phase depressive symptoms (e.g., response and remission), whether as a single treatment or part of a combination treatment? KQ1b. How do these nonpharmacologic treatments compare with pharmacological treatments in efficacy or effectiveness in treating acute-phase depressive symptoms after two or more failed adequate trials? KQ2. For adults with TRD, do nonpharmacologic interventions differ in their efficacy or effectiveness for maintaining response or remission, whether as a single treatment or part of a combination treatment? KQ3. Do nonpharmacologic interventions differ in their efficacy or effectiveness for treating TRD as a function of particular symptom subtypes (e.g., catatonic or psychotic symptoms)? KQ4. For adults with TRD, do nonpharmacologic interventions differ in safety, adverse events, or adherence? Adverse effects of interest include but are not limited to amnesia, memory loss, headaches, and postoperative complications. KQ5. How do the efficacy, effectiveness, or harms of treatment with nonpharmacologic treatments for TRD differ for the following subpopulations: Elderly or very elderly patients; other demographic groups (defined by age, ethnic or racial groups, and sex)? Patients with medical comorbidities? KQ6. For adults with TRD, do nonpharmacologic interventions differ in regard to other health-related outcomes?

Evidence Synthesis for Determining the Efficacy of Psychotherapy for Treatment Resistant Depression

by U. S. Department of Veterans Affairs

The current review will address the effectiveness of psychotherapeutic approaches as a second step treatment for MDD in patients who do not achieve remission after initial treatment with antidepressants.

Evidence Synthesis for Determining the Efficacy of Psychotherapy for Treatment Resistant Depression

Author: U. S. Department of Veterans Affairs

Publisher: Createspace Independent Pub

ISBN: 9781490304182

Page: 42

View: 133

Major depressive disorder (MDD) is one of the leading causes of disability worldwide. The lifetime prevalence of MDD in the general population is estimated at 13%2, of which approximately 20% will experience chronic depression and 60-85% will experience recurrence and relapse. This number is even higher in the VA medical system, where an estimated one third of veterans experience MDD. MDD is associated with greater health care utilization, greater functional impairment, and increased mortality. In addition, subclinical symptoms of depression can reduce quality of life, worsen disability, and adversely affect co-existing chronic medical conditions. Both antidepressant medications and depression-specific psychotherapies are effective as first-line treatments for MDD. In primary care settings, most patients with MDD are treated with antidepressant medications, but a substantial proportion of patients fail to recover with this initial treatment. This evidence synthesis was requested to evaluate the efficacy of psychological treatments as step-2 treatment for patients with MDD who do not achieve remission with an initial course of antidepressant medication. Major depressive disorder (MDD) is a prevalent disorder impacting an estimated 13% of the general population, and a third of the veteran population. Of the patients who experience at least one depressive episode, approximately 20% will experience chronic depression and 60-85% will experience recurrence and relapse. Antidepressant medications are the most commonly prescribed treatment modality for MDD and are often the first line of treatment in primary care settings. However, fewer than 50% of patients fully remit after adequate dosage of antidepressant treatment. Treatment options for these “treatment resistant” patients vary but typically involve using other psychoactive medications as augmentation (i.e., addition of another medication) or substitution treatment (i.e., switching medications). Less attention has been paid to using psychotherapy as an augmentation or substitution treatment for treatment resistant patients, despite psychotherapy being associated with clinical improvements in MDD comparable to those achieved with antidepressants. The current review will address the effectiveness of psychotherapeutic approaches as a second step treatment for MDD in patients who do not achieve remission after initial treatment with antidepressants. Question: In primary care patients with major depressive disorder who do not achieve remission with acute phase antidepressant treatment, is empirically based psychotherapy used as an augmentation or substitution treatment more effective than control for achieving remission?

Managing Treatment Resistant Depression

by Joao Luciano de Quevedo

In addition, evidence supporting the use of psychotherapies and neuromodulation strategies are also reviewed. Written by top experts in the field, this book is the first of its kind to review all methods of treatment for TRD.

Managing Treatment Resistant Depression

Author: Joao Luciano de Quevedo

Publisher: Academic Press

ISBN: 0128240687

Page: 820

View: 866

Managing Treatment-Resistant Depression: Road to Novel Therapeutics defines TRD for readers, discussing the clinical and epidemiological predictors, economic burden and neurobiological factors. In addition, staging methods for treatment resistance are fully covered in this book, including serotonin specific reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, other classes of antidepressants, including tricyclic antidepressants and monoamine oxidase inhibitors, augmentation strategies, and newer antidepressant treatments like ketamine and esketamine. In addition, evidence supporting the use of psychotherapies and neuromodulation strategies are also reviewed. Written by top experts in the field, this book is the first of its kind to review all methods of treatment for TRD. Defines Treatment-Resistant Depression and Staging Treatment Intensity Includes Treatment-Resistant Depression options for children, adolescents, geriatrics, during pregnancy, and during post-partum and menopause transitions Discusses the use of Ketamine and Esketamine for treatment-resistant depression

Treatment resistant Depression Trd

by Deborah Diaz

This book provides new research on treatment options, challenges and the future directions for individuals with TRD.

Treatment resistant Depression Trd

Author: Deborah Diaz

Publisher:

ISBN: 9781536108255

Page: 100

View: 446

Major Depressive Disorder (MDD) is a common and debilitating neuropsychiatric disorder with high economic and societal impact. Approximately 30% of subjects with MDD achieve full remission after treatment with conventional antidepressants resulting in a relevant percentage of patients suffering from treatment resistant depression (TRD). Treating TRD is a difficult challenge for psychiatrists due to the complexity of this disabling condition. In fact, TRD is generally associated with a poorer outcome, higher suicidal risk, more severe psychosocial impairment and physical disability when compared to MDD. This book provides new research on treatment options, challenges and the future directions for individuals with TRD.

Management of Treatment Resistant Major Psychiatric Disorders

by Charles B. Nemeroff

This book summarizes the latest evidence from clinical studies concerning the treatment of patients with treatment-resistant psychiatric disorders.

Management of Treatment Resistant Major Psychiatric Disorders

Author: Charles B. Nemeroff

Publisher: OUP USA

ISBN: 0199739986

Page: 366

View: 228

A sizable percentage of patients with major psychiatric disorders do not respond to the first or second treatments they receive. This book summarizes the latest evidence from clinical studies concerning the treatment of patients with treatment-resistant psychiatric disorders. Both pharmacological and psychotherapeutic interventions are included, as well as somatic non-pharmacological treatments. The chapter authors represent the leaders in their respective fields.

Ketamine for Treatment Resistant Depression

by Gustavo H. Vazquez

Ketamine for Treatment-Resistant Depression: Neurobiology and Applications provides a simple, evidence-based overview for neuropsychiatrists and translational researchers on this medication, its mechanisms of actions, eligibility of ...

Ketamine for Treatment Resistant Depression

Author: Gustavo H. Vazquez

Publisher: Academic Press

ISBN: 0128210346

Page: 168

View: 779

Ketamine for Treatment-Resistant Depression: Neurobiology and Applications provides a simple, evidence-based overview for neuropsychiatrists and translational researchers on this medication, its mechanisms of actions, eligibility of patients for treatment, and the preparation and implementation of ketamine clinics. Provides efficacy research on ketamine as a treatment for depression Identifies best practices for clinical use, both long-term and acute Discusses the molecular mechanisms and neurobiology of action

Ready Set Action Potential Breakthrough Therapy for Treatment Resistant Depression

by Alvin Garlejo

Major depressive disorder is a psychiatric illness that is associated with a variety of debilitating symptoms such as persistent sadness, lack of interest and motivation, lassitude, pessimistic thoughts, and in severe cases, suicidal ...

Ready Set Action Potential Breakthrough Therapy for Treatment Resistant Depression

Author: Alvin Garlejo

Publisher:

ISBN:

Page:

View: 314

Major depressive disorder is a psychiatric illness that is associated with a variety of debilitating symptoms such as persistent sadness, lack of interest and motivation, lassitude, pessimistic thoughts, and in severe cases, suicidal ideation and behavior. Current psychological and pharmacological treatments have been demonstrated efficacious; however, an ever-growing number of individuals frequently report minimal to no improvement with these treatments; and in some cases, a worsening of symptoms. This inadequacy to treatment is commonly known as treatment-resistant depression. At Kadima Neuropsychiatry Institute, Dr. Feifel treats individuals with treatment-resistant depression with advanced treatments such as TMS and ketamine. During my fieldwork internship at Kadima Neuropsychiatry Institute, my project focused on evaluating the efficacy of ketamine administered intramuscular to patients with treatment-resistant depression and determining which characteristics of a patient0́9s psychedelic experience or 0́−trip0́+ is associated with the decrease in their depressive symptoms. The results of this project demonstrated that an initial low dose of ketamine was significantly quick and efficacious in decreasing depressive symptoms in patients with treatment resistant depressive. In addition, a first of its kind exploratory analysis suggested that the intensity, positive content, and dissociative characteristics of a ketamine induced psychedelic trip were strongly associated with the decrease in depressive symptoms. Despite the significance in these results, more research needs to include a larger sample and explore the specific subjective characteristics within a psychedelic 0́−trip0́+ to further understand its association with a decrease in depressive symptoms. The quick and efficacious antidepressant effects of ketamine demonstrated in this project provide much potential for a program involving a mobile ketamine clinic to address severe depression and suicidality. Such therapeutic and intervention potentials can be explored further given an expansion of current policy limiting ketamine as a schedule III substance.

05 KETAMINE ANTIDEPRESSANT ACTIONS IN ELECTROCONVULSIVE THERAPY OF TREATMENT RESISTANT DEPRESSION

by Bruno Josu00e9 Prates

Background and aims: Major depressive disorder affects approximately 5% of the population with nearly 1-third of patients failing to achieve remission, despite adequate pharmacological treatment [1].

05 KETAMINE ANTIDEPRESSANT ACTIONS IN ELECTROCONVULSIVE THERAPY OF TREATMENT RESISTANT DEPRESSION

Author: Bruno Josu00e9 Prates

Publisher:

ISBN:

Page:

View: 624

Background and aims: Major depressive disorder affects approximately 5% of the population with nearly 1-third of patients failing to achieve remission, despite adequate pharmacological treatment [1]. Although electroconvulsive therapy (ECT) is the gold standard approach for treatment resistant depression (TRD), a considerable fraction of patients also show a delayed improvement or appear to be resistant to ECT. One of the most promising rapid-acting antidepressants is ketamine, a noncompetitive N-methyl-D-Aspartate receptor antagonist that can be used as an anesthetic during ECT to augment antidepressant efficacy [2].Data on ECTs using ketamine are both scarce and conflicting which lead the American Psychiatric Association to call for further studies [3]. We aim to clarify the potential synergism of ketamine and ECT for the treatment of TRD.Materials and methods: An experimental, non-randomized clinical trial with consecutive sampling of TRD patients with a HAM-D and PDAS scores u2265 23 was conducted. Patients that were initially assigned to 6 ECT sessions using thiopental anesthesia (ECT Std) but showed a very limited symptomatic relief were included in the study. Patients in Group 1 were then treated with further 6 ECT sessions using ketamine anesthesia (ECT Ket) whereas Group 2 maintained treatment with ECT Std (Fig. 1).Results: Clinical assessment showed no significant reduction in the mean HAM-D and PDAS scores for Group 1 but a significant reduction of the HAMD score of 38,8u00b12,4 to 13.4u00b110.55 (p

Understanding Treatment resistant Depression

by Maya Gupta

Background: Treatment-resistant depression (TRD) encompasses a segment of individuals with major depressive disorder who are severely ill in terms of chronicity, comorbidity, and prognosis.

Understanding Treatment resistant Depression

Author: Maya Gupta

Publisher:

ISBN:

Page: 120

View: 415

Background: Treatment-resistant depression (TRD) encompasses a segment of individuals with major depressive disorder who are severely ill in terms of chronicity, comorbidity, and prognosis. Although functional impairment is a prominent and costly feature of treatment-resistance, very little is known about the factors that contribute to and maintain functional impairment in TRD. Purpose: This study examined the relationships among neurocognition, symptoms, and functional impairment in TRD. Specifically, I examined the neurocognitive impairments that relate to different symptom domains and to level of symptom severity, as well as the predictors of functional outcomes and real-world behaviour in TRD. Method: Patients (N = 29) with a diagnosis of major depressive disorder were recruited from the Mood Disorders Treatment and Research Service at Providence Care Mental Health Services in Kingston, Ontario. Data were collected during a baseline assessment for a neurocognitive enhancement therapy program. Results: Individuals with TRD show mild to moderate impairments across all neurocognitive domains, with a superimposed severe impairment in verbal working memory. Verbal working memory significantly correlated with depressive symptoms and anxiety, such that increased verbal working memory capacity was related to more severe clinical symptoms. Greater response inhibition significantly correlated with less anxiety. Interpersonal competence was predicted by sustained attention and severity of depressive symptoms. Adaptive competence was significantly predicted by age at baseline and set shifting. Real-world work behaviour, interpersonal relations, and general satisfaction were predicted by the severity of depressive symptoms, whereas observed mood and anxiety predicted real-world recreational activity. Conclusions: The current study pioneered some of the first data regarding the relationships among neurocognition, symptoms, and functional outcomes in treatment-resistant depression. Verbal working memory appears to play an important role in the symptomatology of TRD. Neurocognitive variables and depressive symptoms are important in predicting functional competence (what one can do) but only depressive symptoms predict functional performance (what one actually does in the real world). There may be additional intrinsic or extrinsic factors that mediate the relationships among neurocognition, symptoms, and functioning in TRD.

Still Down

by Dean F. MacKinnon

In Still Down, Dr. MacKinnon uses case studies of such individuals to reassess treatment-resistant depression (TRD) and explore what's going on with people who don't feel better, even with treatment.

Still Down

Author: Dean F. MacKinnon

Publisher: JHU Press

ISBN: 1421421062

Page: 152

View: 854

"Many people have depression symptoms that resist treatment. Despite medications, psychotherapy, and sometimes electroconvulsive therapy, these people don't feel well. What can they do to feel better? Dr. Dean MacKinnon, a psychiatrist at Johns Hopkins Hospital in Baltimore, specializes in finding out why treatment hasn't been helpful for a patient, and in helping that patient feel better. In Still Down, Dr. MacKinnon uses case studies of such individuals to reassess treatment-resistant depression (TRD) and explore what's going on with people who don't feel better, even with treatment. As some of the cases illustrate, some people who have been diagnosed with treatment-resistant depression have depression that actually will respond to appropriate treatment--but they have not yet received appropriate treatment. Other cases illustrate what happens when someone is incorrectly diagnosed with depression; that person needs treatment for a different disorder, not for depression. Finally, some cases illustrate people who have depression that does not respond to treatment for depression, regardless of how finely tuned the treatment is. These people, who have true TRD, can benefit from a variety of treatments alone or in combination, and even though they may not feel entirely well, they can feel better. Writing for people who have treatment-resistant depression and their families, as well as medical professionals and mental health care providers, MacKinnon hopes to help people with depression get appropriate diagnoses and treatment. He also hopes to improve care providers' understanding of treatment-resistant depression, by identifying aspects of the individual's qualities, behaviors, and experiences that may account for poor response to treatment"--