Restoring functioning in depression: achieving therapeutic efficiency by S. Kennedy and A. Cyriac, Canada Major depressive disorder MDD is a disabling disorder with significant global, societal, perte de poids bowie md economic impact.
The Sheehan Disability Scale SDS is increasingly included as an outcome measure in clinical trials designed to differentiate symptom and functional outcomes in depressed patients during antidepressant treatment. Diverse clinical profiles of MDD and functional status Through public awareness and treatment advances, there has been a sizable shift in managing MDD from an inpatient model of care to a community-based outpatient approach,12 where more depressed patients are dealing with work-related issues.
This coincides with an increased focus on depression in the workplace and functional outcomes.
At the same time, the recurrent nature of depressive episodes draws comparisons to other chronic diseases such as rheumatoid arthritis or renal failure. The extent of impairment in functioning and well-being in MDD compared with other chronic conditions was first reported in the Medical Outcomes Study, in which greater social and physical impairment, poorer quality of life, more days in bed with perte de poids bowie md pain-free days, higher treatment costs, and a lower perception of health status was observed in depressed patients compared with those with diabetes, hypertension, coronary artery disease, arthritis, and back, lung, and gastrointestinal disorders.
Importantly, there appears to be a bidirectional relationship between depression and comorbidity, where one can exacerbate or trigger the other.
Strategies to enhance function Impairment in neurocognition is increasingly recognized as a determinant of functional outcome in depression. For instance, some antidepressant treatments may be preferred over others in order to specifically treat neurocognitive impairments and functional deficits.
Adjunctive treatments with psychostimulants may also be beneficial. The aim of cognitive remediation therapy is to improve specific skills processing speed, attention, memory, executive functions through weekly training sessions using computerized drills, strategy monitoring, and application of skills to real-life settings.
Bowie and colleagues29 evaluated a form of cognitive remediation, which involved 15 hours of group treatment plus supplemental online computerized exercises in a small group of treatment-resistant depressed patients.
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This represents a promising new approach which perte de poids bowie md be explored in larger patient samples of depressed patients. The need for diagnostic refinement While these interventions represent an incremental advance in dealing with functional impairment, a more fundamental issue relates to the diversity of clinical profiles in major depressive episodes MDEs.
Restoring functioning in depression: achieving therapeutic efficiency
It is hard to imagine that two patients, one with depressed mood, insomnia, weight loss, psychomotor agitation, and inappropriate guilt and the other with diminished pleasure, hypersomnia, weight gain, psychomotor retardation, and loss of energy, have similar abnormalities in underlying neural circuitry. This contrast illustrates the enormous number of clinical phenotypes that encompass a MDE diagnosis. Based on current DSM symptom criteria, there are almost potential combinations of symptoms that would satisfy diagnostic criteria for a MDE.
Using these techniques, anhedonia has emerged as a potential endophenotype that may reflect differences in behavior and neural circuitry in a subgroup of individuals with MDD. There is evidence that low reward perte de poids bowie md is specific to depression compared with anxiety disorders or schizophrenia,34,35 and subsequent studies have also demonstrated that anhedonia is a unique predictor of antidepressant nonresponse36,37 which correlates with ventral striatal, and anterior cingulate activity.
For example, agomelatine differentially enhances interest and pleasure compared with venlafaxine, despite similar effects of both drugs on standard depressive symptoms.
In this trial, there was a bimodal separation of responders and nonresponders with clinical and fMRI profiles at baseline showing clear distinctions between the two groups. Reference 1.
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Diverse clinical profiles of MDD and functional status
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Neuropsychological and socio- occupational functioning in young psychiatric outpatients: a longitudinal investigation. PLoS One. Lisdexamfetamine dimesylate augmentation in adults with persistent executive dysfunction after partial or full remission of major depressive disorder. Epub ahead of print.
Modafinil augmentation of selective serotonin reuptake inhibitor therapy in MDD partial responders with persistent fatigue and sleepiness. Cognitive remediation as a treatment for major depression: A rationale, review of evidence and recommendations for future research. Aust N Z J Psychiatry. A meta-analysis of cognitive remediation in schizophrenia.
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Psychol Sci. Testing a tripartite model: I. Evaluating the convergent and discriminant validity of anxiety and depression symptom scales. J Abnorm Psychol. Anhedonia predicts poorer recovery among youth with selective serotonin reuptake inhibitor treatment-resistant depression. Differential efficacy of escitalopram and nortriptyline on dimensional measures of depression. Br J Psychiatry.
Reduced caudate and nucleus accumbens response to rewards in unmedicated individuals with major depressive disorder. Agomelatine versus venlafaxine XR in the treatment of perte de poids bowie md in major depressive disorder: a pilot study. J Clin Psychopharmacol. Anhedonia and reward-circuit connectivity distinguish nonresponders from responders to dorsomedial prefrontal repetitive transcranial magnetic stimulation in major depression. Anhedonia as predictor of clinical events after acute coronary syndromes: a 3-year prospective study.
Compr Psychiatry. Social Anhedonia and affiliation: Examining behaviour and subjective reactions within perte de poids pauvre social interaction. Kennedy et A. Cela suggère que la charge globale de la dépression peut être en grande partie perte de poids bowie md à une perte de fonctionnement, et non aux symptômes dépressifs.
Des traitements complémentaires par des psychostimulants peuvent également être bénéfiques25, Bowie et al Cette nouvelle approche prometteuse doit être explorée dans des échantillons plus importants de patients déprimés.
Mots clés : anhédonie ; dépression ; épisode dépressif majeur ; efficience thérapeutique ; fonctionnement ; trouble dépressif majeur.