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depression there are at least two sides to every story.

Depression. It's not only a state of mind.. Reference: Adapted fromAmerican Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition,Text Revision. Washington, DC; American Psychiatric Association. 2000:345-356,489. . The symptoms of depression. Reference:Simon GE, et al. N Engl J Med. 1999;341(18):1329-1335. .

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depression there are at least two sides to every story.

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    1. Depression�There are at least two sides to every story.

    3. Depression � the physical presentation

    4. Aches/pain � a physical symptom of significance KEY POINTS These data show the prevalence of pain and body aches as well as anxiety disorders among depressed patients. Depending upon the survey, body aches and pain seem to be as prevalent among depressed patients as anxiety disorders. DATA Data computed using the two studies published in the Green journal. The two studies reported pain / body aches among pure vs depressed somatic patients (somatic defined as depression with sleep disturbances and appetite changes � pure is without these two).KEY POINTS These data show the prevalence of pain and body aches as well as anxiety disorders among depressed patients. Depending upon the survey, body aches and pain seem to be as prevalent among depressed patients as anxiety disorders. DATA Data computed using the two studies published in the Green journal. The two studies reported pain / body aches among pure vs depressed somatic patients (somatic defined as depression with sleep disturbances and appetite changes � pure is without these two).

    5. The importance of emotional and physical symptoms

    6. Serotonin5HT and NorepinephrineNE in the brain Serotonin and Norepinephrine in Depression1 Serotonin and norepinephrine are believed to be key neurotransmitters in the etiology of depression From the raphe nuclei and locus ceruleus, 5-HT and NE, respectively, send projections up to the prefrontal cortex and limbic system where emotional depressive symptoms are thought to be mediated. Additionally, there are also 5-HT and NE-rich tracts into the spinal cord, which are thought to modulate pain perception. 1. Adapted from Stahl SM. J Clin Psych. 2002; 63: 382-383.Serotonin and Norepinephrine in Depression1 Serotonin and norepinephrine are believed to be key neurotransmitters in the etiology of depression From the raphe nuclei and locus ceruleus, 5-HT and NE, respectively, send projections up to the prefrontal cortex and limbic system where emotional depressive symptoms are thought to be mediated. Additionally, there are also 5-HT and NE-rich tracts into the spinal cord, which are thought to modulate pain perception. 1. Adapted from Stahl SM. J Clin Psych. 2002; 63: 382-383.

    7. There are at least two sides to the neurotransmitter story Both serotonin and norepinephrine mediate a broad spectrum of depressive symptoms Some symptoms (e.g. appetite, attention) seem to be mediated more by one neurotransmitter than the other. Some other symptoms (e.g. anxiety) seem to be mediated by either. There are other symptoms (e.g. aches and pain) that seem to be mediated more consistently by a combination of both the neurotransmitters. Some symptoms (e.g. appetite, attention) seem to be mediated more by one neurotransmitter than the other. Some other symptoms (e.g. anxiety) seem to be mediated by either. There are other symptoms (e.g. aches and pain) that seem to be mediated more consistently by a combination of both the neurotransmitters.

    8. The neurotransmitter pathway story Dysregulation of Serotonin (5HT) and Norepinephrine (NE) in the brain are strongly associated with depression Dysregulation of 5HT and NE in the spinal cord may explain an increased pain perception among depressed patients1-3 Imbalances of 5HT and NE may explain the presence of both emotional and physical symptoms of depression.

    9. Depression: Current treatment outcomes1 Up to 70% of depressed patients respond (? 50% decrease in HAM-D score) to treatment but fail to achieve remission from their emotional and physical symptoms1* Approximately 30% of depressed patients achieve remission (? 7 score on the HAM-D) with treatment1*

    10. Response and Remission defined

    11. Remitted patients virtually equaled healthy controls on functioning levels at endpoint of 12-week treatment trial (Responders & non-responders did not)

    12. Many depressed patients are still depressed. Depressed patients present with emotional and physical symptoms. Approximately 30% of depressed patients achieve remission in clinical trials2* Up to 70% of patients who respond fail to remit2* Incomplete relief from symptoms may increase the risk of relapse2,3 Lingering emotional and physical symptoms may jeopardize achieving remission.

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