Wednesday, November 3rd, 2010
As seen in Editor’s note From Current Psychiatry
Philip G Janicak, MD, Professor of Psychiatry at Rush University Medical Center in Chicago, IL reports that approximately 30% of patients with major depression (MD) do not benefit from existing therapies or experience relapse or recurrence within months of acute benefit. In this context, the updated American Psychiatric Association Clinical Practice Guideline includes helpful resources on the use of measurement-based care, newer approaches to manage treatment resistance (eg, transcranial magnetic stimulation), and an expanded discussion of maintenance strategies for psychiatrists. In addition, Klinkma et al reported significantly greater improvement in chronically depressed adults who received “low intensity,” primary care-based education on self-management skills by phone or email compared with treatment as usual. Increasing attention properly focuses on depression in younger populations. For example, Warren et al found that an induced abortion in pregnant adolescents did not elevate the risk of depression or low self-esteem for up to 5 years after termination. By contrast, Chronis-Tuscano et al observed a 4-fold or greater increase in depression and suicide attempts in young children (age 4 to 6) with attention-deficit/hyperactivity disorder followed prospectively up to age 18. Further, Lam et al reported a 2.5-times greater relative risk for depression in Chinese students (age 13 to 18) who pathologically used the Internet compared with non-pathological users. Additionally the APA has released new depression treatment guidelines for treating patients with major depressive disorders. These guidelines include new evidence-based recommendations on antidepressants, psychotherapies, and several forms of therapeutic neuromodulation (TMS Therapy). Key changes address the use of rating scales, strategies for treatment-resistant depression, physical exercise, and more aggressive recommendations for maintenance treatment.