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07.01.2014

Major depressive disorder treatment options, what causes lack of hearing - Try Out

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The most prominent symptom of major depression is a severe and persistent low mood, profound sadness, or a sense of despair. Some people who have episodes of major depression also have episodes of relatively high energy or irritability.
If a woman has a major depressive episode within the first two to three months after giving birth to a baby, it is called postpartum depression. A primary care physician or a mental health professional usually can diagnose depression by asking questions about medical history and symptoms.
Many people with depression do not seek evaluation or treatment because of society's attitudes about depression. There is no way to prevent major depression, but detecting it early can diminish symptoms and help to prevent the illness from returning. Regarding side effects, SSRIs are known to cause problems with sexual functioning, some nausea, and an increase in anxiety in the early stages of treatment. Although experts continue to debate the research, clinicians agree that it is important to have your treatment monitored closely and for you to report any troubling symptoms or worsening mood to your doctor immediately.
A number of psychotherapy techniques have been demonstrated to be helpful, depending on the causes of the depression, the availability of family and other social support, and personal style and preference. In some situations, a treatment called electroconvulsive therapy (ECT) can be a life-saving option. Depression is a painful and potentially dangerous illness, so you should contact a health care professional if you have any suspicion that you or a loved one is depressed. When treatment is successful, it is important to stay in close touch with your doctor or therapist, because maintenance treatment is often required to prevent depression from returning. The long-term course of unipolar major depressive disorder (MDD) is characterized by high rates of recurrence and prolonged symptomatic chronicity.
Keeping these facts in mind, it is apparent that the primary goals of long-term, maintenance (prophylactic) treatment are to prevent a new episode of depression (a recurrence) and development of chronicity. Pharmacotherapy is the most studied treatment modality in the long-term treatment of recurrent MDD. A meta-analysis of discontinuation randomized controlled trials (RCTs) in patients with MDD reported that 60% of patients on placebo relapsed in the year after randomization and 29% relapsed in months 12 to 36.24 For clinical decision making it is also useful to express the relative benefit of an active treatment over placebo using the “number needed to treat” (NNT).
The efficacy of antidepressant medication in the acute treatment of MDD in adults is well proven by a large number of RCTs.13,14 This has been investigated in many RCTs comparing active antidepressants with placebo treatment and with active comparators. Side effects and tolerability of medications are key considerations in maximizing adherence to treatment, and they should be as minimal as possible. There is growing recognition that prophylactic treatment of depressive disorders may be inadequate in a substantial proportion of patients. The mood changes that occur in major depression are defined as lasting at least two weeks but usually they go on much longer — months or even years.
Some people who have many episodes of major depression also have a background pattern of a milder depressed mood called dysthymia.
Depression that occurs mainly during the winter months is called seasonal affective disorder, or SAD. The vast majority of people who suffer severe depression do not attempt or commit suicide, but they are more likely to do so than people who are not depressed.
By definition, major depression is diagnosed when a person has many of the symptoms listed above for at least two weeks.
The person may feel the depression is his or her fault or may worry about what others will think. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment.


The primary goals of continuation andmaintenance treatment are to prevent a fast relapse into depression or new episode of depression (recurrence). 50% to 85% of the patients who suffer a depressive episode will have another episode of major depression.1 The likelihood of a recurrence increases with the number of previous depressive episodes and the severity of the current episode. A recurrence is an episode that appears after a completely asymptomatic period (remission) has been achieved for a 6-month period.4,5 The consideration of the patient’s course of illness and treatment history is essential for the implementation ofmaintenance phase therapy.
Among the therapeutic options available, antidepressant medications, and lithium have received the most study. Most publications are reporting responder and remitter rates together with end-point differences in depression rating scales such as different versions of the HAM-D or the MADRS scale using the “last observation carried forward” (LOCF) method, which follows all included patients. Even mild-to-moderate side effects during maintenance treatment may lead to noncompliance with the consequence of symptom worsening and increased risk of recurrence.
Current evidence suggests that maintenance treatment should be continued as long as the risk of recurrence persists. Or the person suffering major depression may not be able to take pleasure in activities that usually are enjoyable. People who have a family member with major depression are more likely to develop depression or drinking problems. They are as effective as the newer ones and can be very useful when someone has not responded well to other treatments. According to the British National Institute for Clinical Excellence (NICE) it is defined “as the extent to which a specific treatment or intervention, under ideally controlled conditions (eg, in a laboratory), has a beneficial effect on the course or outcome of disease compared with no treatment or other routine care.27 The mean differences of scores on any applied depression rating scale (typically the Hamilton Rating Scale for Depression [HAM-D] or the Montgomery Asberg Depression Rating Scale [MADRS]) between active antidepressant drugs and placebo shown in pivotal RCTs are used for decision making by the regulatory authorities to determine whether new antidepressants may receive approval or not. Usual responder rates vary between 32% and 70%,28 HAM-D17 differences between active and placebo treatment after 6 to 8 weeks of treatment often reach only 3 to 4 absolute points, but represent mean reductions in comparison to the scores before treatment of about 50% to 60%. The standard exclusion criteria of most trials, which have become much more stringent over the past decade, do exclude a significant number of patients suffering from suicidality, comorbid axis I disorders, and medical illnesses. Using medications with a more favorable side effect profile than the TCAs may facilitate patient compliance with pharmacotherapy, as long as these agents are effective in the maintenance treatment of depression. However, little data from formal studies are available to guide physicians in the maintenance treatment of patients suffering from recurrences during standard prophylactic treatment.12 Combination therapy administering two or even three antidepressants, maybe combined with lithium (or in case of refractoriness or intolerance lamotrigine or valproate), are treatment options for the clinician although there are little controlled data to support such polypharmacy. Recurrence after recovery from major depressive disorder during 15 years of observational follow-up.
Conceptualization and rationale for consensus definitions of terms in major depressive disorder. Practice guideline for the treatment of patients with major depressive disorder (revision). World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Unipolar Depressive Disorders, Part 2: Maintenance treatment of major depressive disorder and treatment of chronic depressive disorders and subthreshold depressions. World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Unipolar Depressive Disorders in Primary Care.
Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 2000 British Association for Psychopharmacology guidelines. World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for biological treatment of unipolar depressive disorders, Part 1: Acute and continuation treatment of major depressive disorder. Prophylactic effect of citalopram in unipolar, recurrent depression: placebo-controlled study of maintenance therapy. A randomized, placebo-controlled trial of sertraline for prophylactic treatment of highly recurrent major depressive disorder. Escitalopram maintenance treatment for prevention of recurrent depression: a randomized, placebo-controlled trial. Prevention of recurrent episodes of depression with venlafaxine ER in a 1-year maintenance phase from the PREVENT Study.


Duloxetine in the prevention of depressive recurrences: a randomized, double-blind, placebo-controlled trial. Continuation phase treatment with bupropion SR effectively decreases the risk for relapse of depression. Agomelatine prevents relapse in patients with major depressive disorder without evidence of a discontinuation syndrome: a 24-week randomized, double-blind, placebo-controlled trial. Relapse prevention with antidepressant drug treatment in depressive disorders: a systematic review.
The clinical significance of antidepressant treatment effects cannot be derived from placebo-verum response differences. Comparative efficacy of lithium and amitriptyline in the maintenance treatment of recurrent unipolar depression: a randomised study.
Comparison of full-dose versus half-dose pharmacotherapy in the maintenance treatment of recurrent depression. Dose-response efficacy of paroxetine in preventing depressive recurrences: a randomized, double-blind study. Mirtazapine versus amitriptyline in the long-term treatment of depression: a double-blind placebo-controlled study.
Long-term safety and clinical acceptability of venlafaxine and imipramine in outpatients with major depression.
Therefore family members or friends may need to encourage the depression suffer to seek help. Education does not only reduce treatment attrition, but also leads to a better outcome.8 Strategies to prepare patients and their families for maintenance treatment include education on the typical course of the illness, treatment options, medication effects and side effects, use of (daily) selfreport instruments to track mood and early warning signs of relapse or recurrence, long-term perspectives, and projected end of treatment. The final choice of prophylactic agent does depend on how individual patients respond to and tolerate treatment with antidepressants and lithium.
In the case of trials investigating the efficacy of antidepressants, patients with a history of treatment failures and long depressive index episodes are generally also excluded from participation. It appears that the likelihood of a recurrence increases with the number of previous depressive episodes. Extending treatment for an additional 6 months (continuation therapy) can reduce the likelihood of relapse by about 70%, and extending treatment for another 12 months or longer (maintenance therapy) can reduce the risk of recurrence. Patients’ preference and their own or their family member’s experience with maintenance treatment are also helpful in the choice of the medication. Most patients receive antidepressants during the acute and continuation phase, and the best treatment recommendation to prevent relapse and recurrence of depression is to continue the antidepressant medication at the same dose during these treatment phases as well.
ECT is the quickest and most effective treatment for the most severe forms of depression, and in most people, it is not more risky than other antidepressant treatments.
Randomized placebo-controlled efficacy studies (RCTs, usually conducted 1 or 2 years after remission) indicate that all major classes of antidepressants are effective in preventing recurrence of depression with about a twofold higher relapse rate with placebo treatment. Only with long-term antidepressant treatment can the risk of development of serious depressive illness with a high relapse and suicide rate be stopped or at least reduced. Nevertheless, according to NICE and regulatory authorities such as the EMA, RCTs remain the most important method for establishing treatment efficacy and estimating the clinical effectiveness of antidepressants.



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