Depression can lead to emotional and physical problems. Typically, people with depression find it hard to go about their day-to-day activities, and may also feel that life is not worth living.
What is Depression?
Feeling sad, or what we may call “depressed”, happens to all of us. The sensation usually passes after a while. However, people with a depressive disorder – clinical depression – find that their state interferes with daily life. Abraham Lincoln O-60 by Brady, 1862 Abraham Lincoln suffered from “melancholy”, known today as clinical depression.
For people with clinical depression, their normal functioning is undermined to such an extent that both they and those who care about them are affected by it.
Hippocrates, known as the father of Western medicine, described a syndrome of “melancholia”. He said melancholia was a distinct disease with specific physical and mental symptoms. Hippocrates characterized it as “(all) fears and despondencies if they last a long time” as being symptomatic of the illness.
According to the National Institutes of Health, a significant percentage of people with a depressive illness never seek medical help. This is unfortunate because the vast majority, even those with very severe symptoms, can improve with treatment.
A depressive disorder is a medical illness that causes a constant feeling of sadness and lack of interest.
The notion that depression is simply a “chemical imbalance” in the brain has given way to evidence that the disorder is associated with
- Disrupted neuroplasticity
- Glutamate as well as NE and 5HT receptors
- Cortical and subcortical changes
- Transition from pure pharmacology to neuromodulation (rTMS) that enhances hippocampal neurogenesis.
In short depression is truly a Brain Disease and its treatment should be multimodal to better allow those suffering from it to have their wellness restored, quality of life restored and functional capacity be fully realized. At The TMS Center of Southwest Florida we TMS as our primary treatment in treating the “Brain” illnesses our patients are suffering from.
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When you’re depressed, literally and figuratively stuck in a dark place, with no desire to get out and experience the world, it feels like time is inching by. Seconds feel like minutes, minutes feel like hours, and hours feel like days. Apparently, though, it’s not just a feeling. It’s a very real perception of time. New research from psychologists at the Johannes Gutenberg University of Mainz in Germany shows that depressed people actually experience time differently than healthy individuals. The scientists analyzed the results of 16 different studies examining 433 depressed subjects and 485 non-depressed control subjects. For the first part of the study, subjects were surveyed on their perception of time. “Psychiatrists and psychologists in hospitals and private practices repeatedly report that depressed patients feel that time only creeps forward slowly or is passing in slow motion,” reported study author Dr. Daniel Oberfeld-Twistel. The results of the meta-analysis confirmed that this is indeed the case. Then, for the second part of the study, they asked the subjects to subjectively estimate the length of a movie in minutes, press a button for five seconds, or identify the length of different sounds. In this case, the results obtained from the depressed […]
An interesting article on the wide range of symptoms used to diagnose depression: “the standard rating scales used by healthcare professionals and researchers to diagnose this disease often differ in the symptoms they list, perhaps explaining why a one-size-fits-all treatment has to date been so ineffective.” [Read Full Article Here]
When should you, the prescriber, conclude that your patient with depression is “treatment resistant,” and thereby eligible for alternative non-pharmacological interventions—such as vagus nerve stimulation (VNS), electroconvulsive therapy (ECT), or transcranial magnetic stimulation (TMS)? There are multiple ways that the failure to agree on a standardized definition of treatment-resistant depression (TRD) impacts the clinical care of patients who do not respond to multiple medication trials. In an article appearing in the January 2017 issue of JAMA Psychiatry, Charles Conway, M.D., Mark George, M.D., and Harold Sackheim, Ph.D., wrote that the lack of a consensus definition around what constitutes TRD “limits the ability to do comparative treatment research, to understand the biological underpinnings of TRD, and produces ambiguous medical insurance coverage issues.” Drawing on data from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial, they proposed a definition for TRD: failure to respond to two trials of an antidepressant prescribed at an adequate dose for an adequate duration of time. Conway, a professor of psychiatry and director of the Treatment Resistant Depression and Neurostimulation Clinic at Washington University, St. Louis, said that in the absence of a consensus definition of TRD, patients often receive multiple trials of medication. “Our experience has been that […]
Patrice Wendling August 03, 2017 MURRAY, UT — Depression and coronary artery disease are known to walk hand in hand, but a new study suggests that depression any time after a diagnosis of CAD is the strongest predictor of death. Among 24,137 patients identified with significant CAD, a new depression diagnosis was associated with a twofold higher risk of all-cause death after multivariable adjustment, the investigators reported in the European Heart Journal Quality of Care and Clinical Outcomes. “It was stronger than any follow-up events, stronger than diabetes, stronger than smoking, sex, prior diagnosis of high blood pressure or depression, and even whether they had a heart attack,” lead author Dr Heidi T May (Intermountain Heart Institute, Murray, UT) told theheart.org | Medscape Cardiology. “I thought it would be a significant predictor, but I didn’t anticipate it would be the strongest. “I would think most people would find that amazing.” She said the results emphasize the need for continual depression screening among all CAD patients, but an accompanying editorial notes that recommendations by the American Heart Association (AHA) for routine screening in patients with heart disease have been met with some opposition, in large part because of a lack of studies showing a survival benefit with depression treatment. “Given the […]
Published Thursday 26 October 2017 By Tim Newman Fact checked by Jasmin Collier According to a recent study, although treating major depressive disorder has benefits in the short-term, over a longer period of time, it may make the condition worse. Major depressive disorder is a serious, debilitating mental illness. In the United States, it affects more than 16.1 million people over the age of 18. Although its prevalence is high, it is still a difficult condition to treat. Treatments include medications such as selective serotonin re-uptake inhibitors and talking therapies, such as cognitive therapy. No case of depression is the same, and often, individuals receive a range of treatments across their lifetime. How well the treatment of depression works has come under scrutiny over recent years, and the debate is by no means over. The latest study, published in the journal Psychotherapy and Psychosomatics, adds another dimension to this ongoing conversation. Clinical Treatment Compared with Community Individuals with major depressive disorder who receive medication or cognitive therapy often see a reduction in their depressive symptoms and experience significantly longer times before relapse. But over the longer-term, the picture is less clear. This is primarily because studies generally only run for […]
Question: How do effects of genetics and rearing each contribute to the transmission of risk for major depression from parents to children? Findings: In this population register–based study of 2 269 552 offspring of intact, adoptive, not-lived-with father, stepfather, and triparental families from the general Swedish population, the effects of genes and rearing were approximately equal for parent-offspring resemblance for major depression. Genetic and rearing effects acted additively on offspring risk for major depression. Meaning: Genetic and rearing effects are important in the cross-generational transmission of major depression. Importance Twin studies have assessed sibling resemblance for major depression (MD) but cannot address sources of resemblance across generations. Objective To clarify the relative importance of genetic and rearing effects on the parent-offspring resemblance for MD. Design This Swedish population register–based study examined parents and children from the following 5 family types: intact (2 041 816 offspring), adoptive (14 104 offspring), not-lived-with (NLW) father (116 601 offspring), stepfather (67 826 offspring), and triparental (29 205 offspring). The 5 family types permitted quantification of parent-offspring resemblance for genes plus rearing, genes-only, and rearing-only associations. Treated MD was assessed from national primary care, specialist care, and inpatient registries. Data were collected from January 1, 1960, through […]
Significance Identifying biological targets in major depressive disorder (MDD) is a critical step for development of effective mechanism-based medications. The epigenetic agent acetyl-L-carnitine (LAC) has rapid and enduring antidepressant-like effects in LAC-deficient rodents. Here, we found that LAC levels were decreased in patients with MDD versus age- and sex-matched healthy controls in two independent study centers. In subsequent exploratory analyses, the degree of LAC deficiency reflected both the severity and age of onset of MDD. Furthermore, the lowest LAC levels were found in patients with treatment-resistant depression, whereby history of emotional neglect and being female predicted decreased LAC levels. These translational findings suggest that LAC may serve as a candidate biomarker to help the diagnosis of a clinical endophenotype of MDD. Abstract The lack of biomarkers to identify target populations greatly limits the promise of precision medicine for major depressive disorder (MDD), a primary cause of ill health and disability. The endogenously produced molecule acetyl-L-carnitine (LAC) is critical for hippocampal function and several behavioral domains. In rodents with depressive-like traits, LAC levels are markedly decreased and signal abnormal hippocampal glutamatergic function and dendritic plasticity. LAC supplementation induces rapid and lasting antidepressant-like effects via epigenetic mechanisms of histone acetylation. This mechanistic […]
WHY AREN’T SOME PATIENTS WITH MDD REACHING REMISSION? For more than 50 years, major depressive disorder (MDD) pharmacological treatment approaches have focused on increasing the level of monoamine neurotransmitters in the brain, with the hope of reducing symptoms.1 And while conventional antidepressants have helped most, the STAR*D trial* found that one-third of patients didn’t achieve remission after multiple treatment attempts.2 What’s missing? BEYOND NEUROTRANSMITTERS: SYNAPTIC CONNECTIONS One emerging theory suggests that MDD may be linked to impaired synaptic connections in areas of the brain that regulate mood.3,4 The hypothesis points to an intriguing possibility: If synaptic connections are disrupted in MDD, can this synaptic impairment be improved?5 SYNAPTIC CONNECTIVITY: THE GLUTAMATE HYPOTHESIS Scientists are honing in on the role of glutamate, a major excitatory neurotransmitter that helps regulate synaptic connectivity.6 A burst of glutamate may initiate pathways that are believed to be involved in the strengthening and formation of new synaptic connections.5 As research advances, a deeper understanding of MDD is within reach. Watch THIS video or visit Janssen Pharmaceuticals Inc. to learn more.
For 50 years, pharmacological treatment approaches in MDD have focused on targeting monoamine receptors in the hopes of reducing symptoms. While conventional therapies have helped many, the STAR*D trial* revealed that as many as a third of patients may not achieve remission despite treatment with traditional antidepressants.¹,² Dr Rakesh Jain, clinical professor of psychiatry at Texas Tech University School of Medicine, discusses the estimated 5 million patients who aren’t reaching remission despite multiple treatment attempts in a video available on ConnectingMDD.com. THE LIKELIHOOD OF REMISSION DROPS TO 14% AFTER A SECOND TREATMENT FAILURE* In the STAR*D trial, 37% of patients reached remission after the first-line treatment step with an oral antidepressant.1 The chances for remission dropped substantially after 2 treatment attempts, even with augmentation strategies.1 WITHOUT REMISSION, THE BURDEN OF MDD GROWS REFERENCES Rush AJ, et al. Am J Psychiatry. 2006;163:1905-1917. The National Institute of Mental Health. Major depression among adults. https://www.nimh.nih.gov/health/statistics/major-depression.shtml. Updated November 2017. Accessed April 6, 2018. Uher R, et al. Depress Anxiety. 2014;(31):459-471. Feldman RL, et al. J Med Econ. 2013;16(1):62-74.
With well over two dozen traditional antidepressants available in the US, and an ever-growing list of other psychotropic compounds with apparent antidepressant properties, pharmacological options for treating clinical depression today are broad and vast. However, recent findings suggest that the magnitude of efficacy for most antidepressants compared with placebo may be more modest than previously thought.1Most depressed patients do not respond fully to a first antidepressant trial, and with each consequent trial, there is less chance of symptom remission.2 About one-third of patients receiving long-term treatment report persistent moderate-to-severe depression.3 Hence, there remains more than a little room for improvement. Since the late 1950s, the traditional view of treating depression has focused on the role of monoamines (serotonin, norepinephrine, and dopamine) as the main targets for medications. Newer treatments are looking beyond effects on monoamines as potential strategies to leverage depressive symptoms. A major challenge for progress in novel pharmacotherapies has been our lack of a full understanding about the causes of depression. Advances in functional neuroimaging and genetic markers have begun to shed new light on brain regions and pathways associated with aberrant neural functioning in depression, but not in ways that have led to treatments aimed at remedying its pathogenesis. […]
Heart attack, conceptual computer illustration. Mild depression was a long-term independent predictor of death in patients after acute myocardial infarction (AMI), per cohort study data published in Heart, Lung and Circulation. Investigators conducted a 25-year follow-up of men who were recruited after AMI to participate in a randomized controlled trial in the 1980s. The initial trial investigated the impact of high intensity exercise on physical and psychological health; depression was assessed at baseline using the Beck Depression Inventory. Sociodemographic information, cardiovascular risk factors, and severity of AMI were also captured at baseline. During the 25-year follow-up period, investigators used the Australian National Death Index to determine mortality status of patients after their index AMI. Cox proportional-hazards modeling was used to assess the relationship between depression severity and all-cause mortality at 5, 10, 15, 20, and 25 years post-AMI. Related Articles Pharmacotherapy May Reduce Depressive Symptoms After Traumatic Brain InjuryDepression Associated With Polygenic Risk for Major Depression, Bipolar Disorder, and SchizophreniaPostnatal Paternal Depression Associated With Depression in Girls The final analysis cohort comprised 185 men, mean age 54.15 (8.54). Per the Beck Depression Inventory, 114 patients (60.4%) had low to no depression, 47 (25.2%) had mild depression, and 27 (14.3%) had moderate to severe […]
Treatment-resistant depression can be a frustrating challenge for doctor and patient alike. The trial-and-error process of trying different medications and treatments to see what alleviates patients’ depression symptoms can feel like a “shot in the dark” approach. According to Ann McDonald, former editor of the Harvard Mental Health Letter, in her blog post on the Harvard Health Blog, only about a third of patients who are diagnosed with major depressive disorder (MDD) find a medication that works for them on the first try. “When the first medication doesn’t adequately relieve symptoms, next step options include taking a new drug along with the first, or switching to another drug. With time and persistence, nearly seven in 10 adults with major depression eventually find a treatment that works. Of course, that also means that the remaining one-third of people with major depression cannot achieve remission even after trying multiple options.” The Mayo Clinic says: “If you’ve already tried an antidepressant and it didn’t work, don’t lose hope. You and your doctor simply may not have found the right dose, medication or combination of medications that works for you.” One way to find out this information is through pharmacogenomic testing, which analyzes your genes and tells your doctor what might […]
A study published this week in Depression & Anxiety suggests that among patients with cancer who are prescribed antidepressants, those who take the medication may live longer than those who are non-adherent. Patients with cancer are known to have higher rates of depression than the general public—a factor that may reduce adherence to cancer treatment and increase their risk of death. The findings “add to the pressing need to encourage adherence to [antidepressants] among cancer patients,” wrote Gal Shoval, M.D., of the Geha Mental Health Center in Tel Aviv, Israel, and colleagues. To examine the relationship between antidepressant adherence and mortality in people with cancer, Shoval and colleagues analyzed the medical records of patients with cancer who had at least one prescription for an antidepressant between January 2008 and January 2012. Patients were followed from the time of initial antidepressant prescription until death or the end of the four-year study. Patients were categorized into one of four adherence groups: Nonadherent if adherence was below 20%, poor adherence for those with 20% to 50% adherence, moderate adherence for those with 50% to 80% adherence, and good adherence for those with adherence above 80%. Of the 42,075 patients included in the analysis, 28.9% were nonadherent, […]
Handan Gunduz-Bruce, M.D., Christopher Silber, M.D., Inder Kaul, M.D., Anthony J. Rothschild, M.D., Robert Riesenberg, M.D., Abdul J. Sankoh, Ph.D., Haihong Li, Ph.D., Robert Lasser, M.D., Charles F. Zorumski, M.D., David R. Rubinow, M.D., Steven M. Paul, M.D., Jeffrey Jonas, M.D., et al. Abstract BACKGROUND Altered neurotransmission of γ-aminobutyric acid (GABA) has been implicated in the pathogenesis of depression. Whether SAGE-217, an oral, positive allosteric modulator of GABA type A receptors, is effective and safe for the treatment of major depressive disorder is unknown. METHODS In this double-blind, phase 2 trial, we enrolled patients with major depression and randomly assigned them in a 1:1 ratio to receive 30 mg of SAGE-217 or placebo once daily. The primary end point was the change from baseline to day 15 in the score on the 17-item Hamilton Depression Rating Scale (HAM-D; scores range from 0 to 52, with higher scores indicating more severe depression). Secondary efficacy end points, which were assessed on days 2 through 8 and on days 15, 21, 28, 35, and 42, included changes from baseline in scores on additional depression and anxiety scales, a reduction from baseline of more than 50% in the HAM-D score, a HAM-D score of 7 or lower, and a Clinical Global Impression of Improvement score of […]
Every day last week, approximately 122 people in the United States took their lives by suicide. This week, as we recognize World Suicide Prevention Day, it’s more important than ever to help spread awareness that can save lives. The tragedy of suicide is stealing loved ones-leaving behind family and friends to navigate the tragedy of loss, emptiness, and despair. Untreated mental illnesses are often the cause of suicide. Unfortunately, the stigma surrounding mental health leaves many feeling in the dark with nowhere to turn. This is why we need to do more as a society to help end the stigma and move forward in compassion and understanding. Because depression is more than just having a bad day and it’s not just something people can shake off. Depression can be debilitating. It can interfere with every aspect of your life…making it hard to function each day. In fact, depression is currently the leading cause of disability and poor health worldwide. And, with an estimated 1 in 6 Americans affected by the darkness of depression, it’s time to put the spotlight on treatments that help people get better. The darkness of depression is something that affects an estimated 1 in 6 Americans. […]
Ketamine, Similar Compounds Emerging as Mood Disorder Treatments Sanjay J. Mathew, MD, vice chair for research at Baylor College of Medicine and staff physician at the Michael E. Debakey VA Medical Center in Houston, Texas, has long been interested in the brain’s glutamate system and how it could be manipulated with substances such as ketamine to treat conditions including depression and suicidal ideation. At this year’s Psych Congress, Dr. Mathew, who is also director of Baylor’s mood and anxiety disorders program, will share the top 5 things that mental health clinicians should know about therapy with ketamine and the esketamine nasal spray newly approved by the US Food and Drug Administration (FDA). Below, he discusses his research into ketamine, how it works in the body, ongoing research into the compound, and similar agents that are in development. Q: How did you first become involved with research into glutamatergic agents such as ketamine? A: I‘ve been involved ever since my faculty position at Mount Sinai [School of Medicine], where we were interested in the glutamate system broadly for its potential impact in neuroplasticity and we were studying agents such as riluzole, which is approved in amyotrophic lateral sclerosis (ALS), and repurposing it for depression and generalized […]
Let’s face it: we’re all stressed these days. In fact, recent polls show just how stressed out Americans are over things like politics, work, finances … the list goes on and on. It seems like we’ve adopted a new work culture where the 8-hour workday is a thing of the past. People are working 9 or 10-hour days, skipping vacation time, and slowly losing sight of priorities outside of work. With jam-packed schedules and 24/7 connection through technology, it’s easy to understand why Americans are so stressed. The problem is that chronic stress can affect your mental and physical health. So, how can you manage stress in today’s world where people wear stress like a badge of honor? Understanding Stress To start, it’s important to realize there are different types of stress in life. In many ways, stress can be a normal part of life. You might feel stressed about an upcoming deadline or major life event and that’s OK. Sometimes, this type of stress stems from excitement and anticipation and can even work as a motivator. However, chronic stress is the type of stress that lingers even after the event or deadline passes. You might feel anxious and overwhelmed […]
In January of 2011 Dr. Bob Pollack opened his office at 6804 Porto Fino Circle, Suite 1 in Fort Myers Florida. He, along with Julie Kuhns, LCSW, began serving the people of Fort Myers. Dr. Pollack had a long career in Psychiatry with a multitude of accomplishments. His intent was to have a small, quiet practice and enjoy his relocation to the area. He was wrong. Beginning in 2011 he introduced the following advanced psychiatric services which have grown in popularity tremendously: • Genomic Testing• Transcranial Magnetic Stimulation• Ketamine Infusions• Theta Burst Stimulation• QEEG All of these innovations make use of more scientific knowledge and techniques to enhance the quality of the treatments that are offered to patients. With the addition of each new treatment, PASWFL has also had to make space for new equipment, new staff to operate the equipment and new patients who are interested in advanced psychiatric treatments. Since 2011 all of this has been conducted in the same 2000 square foot office space consisting of 4 offices and a waiting room. All of these treatments were administered in the office and all on an outpatient basis. Evidently, PASWFL has grown significantly since 2011 and as this […]
Our world is plagued by an epidemic. By a disease that shows no mercy. The demons known as addiction and depression are very real. And they have claimed far too many of those we love, far soonerthan they should have left us. Those still with us are fighting a battle they wage every day oftheir lives keeping those demons at bay. It’s up to us to show them that they aren’t alone. That they have nothing to be ashamed of. That we understand and we will fight with them and for them. NATIONAL ADDICTION HOTLINE: 1-800-662-4357 NATIONAL SUICIDE PREVENTION LIFELINE: 1-800-273-8255 INTERNATIONAL HELP RESOURCES [Read the Original Publication Here]
What does being sick with COVID-19 look like compared with a cold or the flu? Check what types of symptoms show up for each illness and how often in the chart below. NOTE: If you have not been to a country or area with an outbreak of COVID-19 or have not had contact with someone who has, the Centers for Disease Control and Prevention says the risk of getting the disease is low.