treatment of recurrent depression

Treatment of Recurrent Depression Review of Psychiatry Series John M. Oldham, M.D. Michelle B. Riba, M.D., M.S. Series Editors No. 5 Washington, DC London, England Treatment of Recurrent Depression EDITED BY John F. Greden, M.D. Note: The authors have worked to ensure that all information in this book concerning drug dosages, schedules, and routes of administration is accurate as of the time of publication and consistent with standards set by the U.S. Food and Drug Administration and the general medical community. As medical research and practice advance, however, therapeutic standards may change. For this reason and because human and mechanical errors sometimes occur, we recommend that readers follow the advice of a physician who is directly involved in their care or the care of a member of their family. A product’s current package insert should be consulted for full prescribing and safety information. Books published by American Psychiatric Publishing, Inc., represent the views and opinions of the individual authors and do not necessarily represent the policies and opinions of APPI or the American Psychiatric Association. Copyright © 2001 American Psychiatric Publishing, Inc. 04 03 02 01 4 3 2 1 ALL RIGHTS RESERVED Manufactured in the United States of America on acid-free paper First Edition American Psychiatric Publishing, Inc. 1400 K Street, NW Washington, DC 20005 www.appi.org The correct citation for this book is Greden JF (editor): Treatment of Recurrent Depression (Review of Psychiatry Series, Volume 20, Number 5; Oldham JM and Riba MB, series editors). Washington, DC, American Psychiatric Publishing, 2001 Library of Congress Cataloging-in-Publication Data Treatment of recurrent depression / edited by John F. Greden. p. ; cm. — (Review of psychiatry ; v. 20, n. 5) Includes bibliographical references and index. ISBN 1-58562-025-4 (alk. paper) 1. Depression, Mental. 2. Depression, Mental—Treatment. I. Greden, John F., 1942– II. Review of psychiatry series v. 20, 5. [DNLM: 1. Depressive Disorder—therapy. 2. Depressive Disorder— prevention & control. 3. Recurrence—prevention and control. WM 171 T7844 2001] RC537 .T742 2001 616.85′2706—dc21 00-069520 British Library Cataloguing in Publication Data A CIP record is available from the British Library. Cover illustration: Copyright© 2001 Amy DeVoogd/Artville. Dedicated to those caring, magnanimous individuals who support the research necessary to conquer depression Contents Contributors xi Introduction to the Review of Psychiatry Series xv John M. Oldham, M.D., and Michelle B. Riba, M.D., M.S., Series Editors Chapter 1 Recurrent Depression: Its Overwhelming Burden 1 John F. Greden, M.D. Widespread Prevalence 3 Early Symptom Onset 4 Underdiagnosis and Undertreatment 5 Genetic Vulnerability 7 Frequent Recurrences 8 Inadequate Emphasis on Recurrence Prevention 10 Poor Maintenance Treatment Adherence and Stigma 11 Brain Tissue Degeneration 12 Strategies to Prevent Recurrences and Reduce the Burden of MDD 14 References 15 Chapter 2 Recurrent Depression in Women Throughout the Life Span 19 Sheila M. Marcus, M.D. Heather A. Flynn, Ph.D. Elizabeth A. Young, M.D. Neera Ghaziuddin, M.D. Sharon Mudd, M.S., R.N., C.S., N.P. Depression in Adolescence 19 Depression in Pregnancy and the Postpartum Period 27 Depression in Midlife 40 The Need for More Research 48 Conclusion 50 References 50 Chapter 3 Chronic and Recurrent Depression: Pharmacotherapy and Psychotherapy Combinations 59 Robert Boland, M.D. Martin B. Keller, M.D. Importance of Adequate Treatment 60 Medication Treatment 61 Combination Treatment 65 Current Issues, Unanswered Questions 74 Conclusion 77 References 78 Chapter 4 Prevention of Recurrences in Patients With Bipolar Disorder: The Best of the Old and the New 81 Charles L. Bowden, M.D. Cheryl L. Gonzales, M.D. Goals of Care for Patients With Bipolar Disorder 81 Pharmacotherapy 89 Combination Treatment 97 Summary 98 References 98 Chapter 5 New Depression Treatment Strategies: What Does the Future Hold for Therapeutic Uses of Minimally Invasive Brain Stimulation? 103 Mark S. George, M.D. Ziad Nahas, M.D. Xing-Bao Li, M.D. Jeong-Ho Chae, M.D. Nicholas Oliver, B.S. Arif Najib, B.S. Berry Anderson, R.N. Electroconvulsive Therapy 106 Transcranial Magnetic Stimulation 109 Vagus Nerve Stimulation 119 Deep Brain Stimulation 130 Conclusion 134 References 135 Chapter 6 Clinical Prevention of Recurrent Depression: The Need for Paradigm Shifts 143 John F. Greden, M.D. MDD Versus Other Diseases: What Can We Learn? 143 Clinical Strategies for Preventing Recurrences of Major Depressive Disorder 146 Pressing Research Challenges 150 Treatment of Recurrent MDD: The Need for Paradigm Shifts 153 Conclusion 164 References 165 Index 171 [...]... stubbornly persistent in spite of the best efforts of our experts John Greden takes up one such area in Treatment of Recurrent DepresIntroduction to the Review of Psychiatry Series xvii sion, referring to recurrent depression as one of the most disabling disorders of all, so that, in his opinion, “a call to arms” is needed Experienced clinicians and researchers review optimal treatment approaches for this... stimulation (rTMS) may join our treatment armamentarium (see Chapter 5) 5 An update of recommendations to help us make progress in preventing recurrences of depression, emphasizing that noth2 TREATMENT OF RECURRENT DEPRESSION ing short of paradigm shifts will suffice, nothing short of a “call to arms” (see Chapter 6) Figure 1–1 presents contributors to the overwhelming burden of MDD These will be reviewed... for this approach, a recommended fundamental of treatment planning Psychotherapy alone, of course, may be the best treatment for some patients, just as pharmacotherapy may be the mainstay of treatment for others, but in all cases there should be thoughtful consideration of a combination of these approaches Finally, despite tremendous progress in the treatment of most psychiatric disorders, there are some... Poor Maintenance Treatment Adherence and Stigma In addition to clinicians’ lack of awareness and lack of prescription of extended maintenance medication, poor adherence to treatment among patients is a major problem (Crisp et al 2000) Poor adherence is often driven by prevailing stigma about depression Various estimates suggest the following: Recurrent Depression 11 • Fewer than 10% of individuals with... Medical University of South Carolina, Charleston, South Carolina John M Oldham, M.D Dollard Professor and Acting Chairman, Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York xii TREATMENT OF RECURRENT DEPRESSION Nicholas Oliver, B.S Research Associate, Brain Stimulation Laboratory and Center for Advanced Imaging Research, Departments of Psychiatry, Radiology,... 1–2 Course of illness for patients with and without residual symptoms following treatment for first episode of major depressive disorder (MDD) * P . best efforts of our experts. John Greden takes up one such area in Treatment of Recurrent Depres- xviii TREATMENT OF RECURRENT DEPRESSION sion, referring to recurrent depression as one of the most. Department of Psychiatry, University of Michigan, Ann Arbor, Michigan xii TREATMENT OF RECURRENT DEPRESSION Cheryl L. Gonzales, M.D. Assistant Professor, Department of Psychiatry, University of Texas. Treatment of Recurrent Depression Review of Psychiatry Series John M. Oldham, M.D. Michelle B. Riba, M.D., M.S. Series Editors No. 5 Washington, DC London, England Treatment of Recurrent Depression EDITED