Depression there are at least two sides to every story
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Depression—There are at least two sides to every story. Depression. It’s not only a state of mind. The symptoms of depression. Reference: Adapted from

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Depression there are at least two sides to every story

Depression—There are at least two sides to every story.


Depression it s not only a state of mind

Depression. It’s not only a state of mind.

The symptoms of depression

Reference: Adapted from

American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition,Text Revision. Washington, DC; American Psychiatric Association. 2000:345-356,489.


Depression the physical presentation

Depression – the physical presentation

In primary care, physical symptoms are often

the chief complaint in depressed patients

In a New England Journal of Medicine study, 69% of diagnosed depressed patients reported unexplained physical symptoms as their chief compliant1

N = 1146 Primary care patients with major depression

  • Reference:

  • Simon GE, et al.N Engl J Med. 1999;341(18):1329-1335.


Aches pain a physical symptom of significance

Aches/pain – a physical symptom of significance

Aches/Pain as common as anxiety among depressed patients

Adapted from

1.Silverstein B.Am J Psychiatry. 1999;156(3):480-482. 2.Silverstein B. Am J Psychiatry. 2002;159(6):1051-1052.


The importance of emotional and physical symptoms

The importance of emotional and physical symptoms

  • 76% of compliant depressed patients with lingering symptoms of depression relapsed within 10 months1*

94% of depressed patients who experienced lingering symptoms had mild to moderate physical symptoms1

*Psychiatric inpatients and outpatients.

  • Reference:

  • Adapted from: Paykel ES, et al.Psychol Med. 1995;25:1171-1180.


Serotonin 5ht and norepinephrine ne in the brain

Serotonin5HT and NorepinephrineNE in the brain

Limbic System

Prefrontal Cortex

Locus Ceruleus (NE Source)

Raphe Nuclei (5-HT source)

Cooper JR, Bloom FE. The Biochemical Basis of Neuropharmacology. 1996.


There are at least two sides to the neurotransmitter story

Concentration

Interest

Motivation

Sex

Appetite

Aggression

There are at least two sides to the neurotransmitter story

Functional domains of Serotonin and Norepinephrine1-4

  • Both serotonin and norepinephrine mediate a broad spectrum of depressive symptoms

Serotonin (5-HT)

Norepinephrine (NE)

Depressed Mood

Anxiety

Irritability

Thought process

Vague Aches and pain

  • References:

  • Adapted from: Stahl SM. In: Essential Psychopharmacology: Neuroscientific Basis and Practical Applications: 2nd ed. Cambridge University Press 2000.

  • Blier P, et al.J Psychiatry Neurosci. 2001;26(1):37-43.

  • Doraiswamy PM.J Clin Psychiatry. 2001;62(suppl 12):30-35.

  • Verma S, et al.Int Rev Psychiatry. 2000;12:103-114.


The neurotransmitter pathway story

The neurotransmitter pathway story

It’s not all in your head

  • 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.

Descending Pathway

Descending

Pathway

Ascending

Pathway

Ascending Pathway

  • Adapted from References:

  • Stahl SM.J. Clin Psych. 2002;63:203-220.

  • Verma S, et al.Int Rev Psychiatry. 2000;12:103-114.

  • Blier P, et al.J Psychiatry Neurosci. 2001;26(1):37-43.


Depression current treatment outcomes 1

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*

* Antidepressant clinical drug trials.

References:

1. O’Reardon JR, et al.PsychiatrAnn. 1998;28:633-640.


Response and remission defined

Response and Remission defined

Hamilton Depression Rating Scale (HAM-D): 17 Items, Total Score 0 - 52

HAM-D17 Scores

Depression

(Major Depressive Disorder)

15

  • Response

  •  50% reduction from baseline HAM-D score

  • Remission: HAM-D Score  7

7

References:

1. Frank E. Conceptualization and rationale for consensus definition terms in MDD, Arch Gen Psych. 1991; 48:851-855.


Depression there are at least two sides to every story

5

*

3

Social Adjustment Scale-SR (Mean ± SD)

*

**

2

1

Normal

(n=482)

Remission (n=202)

Response

(n=122)

Nonresponse

(n=299)

Treatment outcome:Effect on work & social functioning

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

Higher Score indicates greater impairment

Study in chronic depressed patients

*p.05 vs nonresponse. **p.05 vs response.

Miller IW, et al. J Clin Psychiatry. 1998;59(11):608-619.


Many depressed patients are still depressed

Many depressed patients are still depressed.

Depressed patients continue to have needs that are not being fully addressed1

  • 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.

  • References:

  • Nierenberg AA, et al.J Clin Psychiatry. 1999:60(suppl 22):7-11.

  • O’Reardon JR, et al.PsychiatrAnn. 1998;28:633-640.

  • Lynch ME.J Psychiatry Neurosci. 2001;26(1):30-36.

*In antidepressant clinical drug trials.


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