Major Depressive Disorder . A clinical review Barry J. Fenton, M.D. Depression—an Overview. Prevalence Comorbidity Impact on society Diagnosis Treatment options Treatment guidelines Treatment compliance. 17.1%. Major depressive disorder. Alcohol dependence. 14.1%. 13.3%.
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A clinical review
Barry J. Fenton, M.D.
Major depressive disorder
Social anxiety disorder
Premenstrual dysphoricdisorder (PMDD)
Lifetime prevalence (%)Lifetime Prevalence of Common Psychiatric Disorders
*In menstruating women.
Kessler 1994; Kessler 1995; DSM-IV-TR™2000.
Kessler 1994; US Bureau of the Census 2000; Depression in Primary Care, 1 (AHCPR) 1993; DSM-IV-TR 2000.
Kessler 1999; Carney 1987; Frasure-Smith 1993; AHCPR Guidelines 1993; Anderson 2001; Bing 2001; Reifler 1986; Rovner 1989; Breslau 1991; Minden 1987; Joffe 1987.
Katon 1990; Gregor 1997.
Up to 65% of patients with panic disorder*
42% of patients with generalized anxiety disorder
Social anxiety disorder
34% to 70% of patients with social anxiety disorder
67% of patients with obsessive-compulsive disorderDepression—Anxiety Comorbidities
Many patients with anxiety disorders have depression at some time during their lives
*Figures for panic disorder and depression not specified as lifetime in DSM-IV-TR™.
Kessler 1995; DSM-IV-TR™ 2000; Brawman-Mintzer 1993; Rasmussen 1992; Stein 2000; Van Ameringen 1991; Wittchen 1999.
In patients with comorbid panic disorder and depression,
Brown 1996; Coryell 1988; Roy-Byrne 2000.
Indirect Costs = $31.3 billion per year
(inpatient, outpatient, and partial care)
Cost of depression in the US estimated at $43.7 billion (1990 dollars)
Prevalence-based analysis of direct and indirect costs of depression, including direct costs of medical, psychiatric, and pharmacologic care; mortality costs from depression-related suicides; and morbidity costs (reduced productivity and absenteeism) associated with depression in the workplace.
Simon 1995; Luber 2000; Verbosky 1993; Wells 1989.
Five or more of the following symptoms are present most of the day, nearly every day, during a period of at least 2 consecutive weeks
At least 1
of these2 symptoms
Hirschfeld 1997; US Dept of Health and Human Services 1999; Simon 1999; Simon and VonKorff 1995; Callahan 1996.
Simon 1999; Depression in Primary Care 1 (AHCPR), 1993.
IMS America February 2003; Sadock and Sadock 2003; Depression in Primary Care 2 (AHCPR), 1993.
Acute Phase of Treatment
Continuation Phase of Treatment
Maintenance Phase of Treatment
Progression to Disorder
(1 or more years)Depression—AHCPR* Treatment Guidelines
*Agency for Health Care Policy and Research currently known as the Agency for Healthcare Research and Quality (AHRQ), an agency within the US Department of Health and Human Services.
Kupfer 1991; Depression in Primary Care, 2 (AHCPR) 1993.
Inappropriate or no treatmentDepression—Undertreatment
In a 12-month period, one study showed,
A majority of patients with depressive disorder did not receive adequate treatment
Treatment monthDepression—Adherence to Treatment
In a study examining adherence,
28% of patients discontinued antidepressant treatment within the first month
Lin 1995; Depression in Primary Care, 2 (AHCPR) 1993.
Kessler 1994; Bureau of the Census 2000; Depression in Primary Care, 1 (AHCPR), 1993; Kessler 1999; Carney 1987; Frasure-Smith 1993; Anderson 2001; Bing 2001; Reifler 1986; Rovner 1989; Breslau 1991; Minden 1987; Joffe 1987; Kessler 1995; Brawman-Mintzer 1993; Rasmussen 1992; Stein 2000; Van Ameringen 1991; Hirschfeld 1997; US Department of Health and Human Services 1999; Simon 1999; Simon and VonKorff 1995; Callahan 1996; Greenberg 1993; Simon 1995; Luber 2000; Verbosky 1993; Wells 1989; Hirschfeld 2000; Kroenke 2001; Kupfer 1991. Depression in Primary Care, 2 (AHCPR) 1993.