Where Research Paths Converge: Improving Treatments for Depression

Psychiatric Times

October 2005

Vol. XXII

Issue 11

During the past three decades, more research has been conducted on depression than on any other psychiatric disorder. The clinical and public health significance of depression was heightened by the results of the Medical Outcomes Study, which demonstrated that depression was more impairing than other chronic medical disorders such as arthritis and diabetes, and as impairing as cardiovascular disease (Wells et al., 1989). Recently, the replication of the National Comorbidity Survey confirmed previous findings regarding the high prevalence of major depressive disorder in the United States (Kessler et al., 2005).

Efforts to improve the treatment of patients with depression and understand the mechanisms underlying successful treatment have followed different paths. The current Special Report illustrates several different lines of investigation. Eero Castrén, M.D., Ph.D., reviews recent suggestions that neural plasticity and neurogenesis are central to effective treatment in his article "Neuronal Plasticity and Mood Disorders." Challenging the "chemical balance" theory of etiology and treatment, Castrén suggests that structural changes in neural networks underlie symptom amelioration.

Michael A. Posternak, M.D., likewise challenges traditional teaching--with regards to the onset of action of antidepressant medication in his article "How Quickly Do Antidepressants Begin to Work?" Traditional teaching says that medications generally take at least two to four weeks to work. Posternak summarizes a meta-analysis he recently conducted, which found that the greatest difference between active drug and placebo was in the first two weeks of treatment.

In their article "Impact of ECT on Health-Related Quality of Life and Function in Patients With Depression," W. Vaughn McCall, M.D., M.S., and Peter B. Rosenquist, M.D., highlight the importance of considering more than symptoms when evaluating treatment outcome.

Gabor I. Keitner, M.D., reinforces the notion that depression, like other illnesses, is a biopsychosocial disorder that has a reciprocal relationship with the interpersonal environment in which it occurs. In "Family Therapy in the Treatment of Depression," Keitner reviews studies demonstrating the beneficial effect of family therapy in treating depression and offers some general principles to consider when meeting with the families of patients with depression.

Depression may be a significant psychosocial risk factor in the development of coronary heart disease. In her article, "Depression, Stress and the Risk of Heart Disease," Chiara Rafanelli, M.D., Ph.D, reviews data from a recent study assessing the impact of depression, demoralization and stressful life events in predicting myocardial infarction and/or first-episode instable angina. The final two reports "Understanding the Role of Sigma-1 Receptors in Psychotic Depression" by Teruo Hayashi, M.D., Ph.D., and Tsung-Ping Su, Ph.D., and "The Light-er Side of Treating Seasonal Affective Disorder" by Daniel M. Blumberger, M.D., and Anthony J. Levitt, M.D., MBBS, FRCP, touch on issues related to the heterogeneity of depression. The DSM-IV offers three options to reduce heterogeneity: division into separate disorders, subtyping within disorders and specifiers within disorders. Each of these approaches represents an attempt to identify more homogeneous groups of patients with presumptively different pathophysiologies, course and treatment response. Hayashi and Su discuss the role of the s receptor and subtyping depression based on the presence of psychotic features and the potential importance this has on selecting an antidepressant in treating psychotic depression. Blumberger and Levitt discuss the use of light therapy and pharmacotherapy in the treatment of seasonal depression.

Acknowledgement

Psychiatric Times extends a warm thank you to Dr. Zimmerman for his assistance with this Special Report.

Dr. Zimmerman is director of outpatient psychiatry at Rhode Island Hospital and associate professor of psychiatry and human behavior at Brown University Medical School.

References

Kessler RC, Chiu WT, Demler O et al. (2005), Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. [Published erratum Arch Gen Psychiatry 62(7):709.] Arch Gen Psychiatry 62(6):617-627 [see comment].

Wells KB, Stewart A, Hayes RD et al. (1989), The functioning and well-being of depressed patients. Results from the Medical Outcomes Study. JAMA 262(7):914-919 [see comment].