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Where Research Paths Converge: Improving Treatments for Depression

(PSYCHIATRIC TIMES) - 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.

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