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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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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.
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
Aches/Pain as common as anxiety among depressed patients
1.Silverstein B.Am J Psychiatry. 1999;156(3):480-482. 2.Silverstein B. Am J Psychiatry. 2002;159(6):1051-1052.
94% of depressed patients who experienced lingering symptoms had mild to moderate physical symptoms1
*Psychiatric inpatients and outpatients.
Locus Ceruleus (NE Source)
Raphe Nuclei (5-HT source)
Cooper JR, Bloom FE. The Biochemical Basis of Neuropharmacology. 1996.
AggressionThere are at least two sides to the neurotransmitter story
Functional domains of Serotonin and Norepinephrine1-4
Vague Aches and pain
It’s not all in your head
* Antidepressant clinical drug trials.
1. O’Reardon JR, et al.PsychiatrAnn. 1998;28:633-640.
Hamilton Depression Rating Scale (HAM-D): 17 Items, Total Score 0 - 52
(Major Depressive Disorder)
1. Frank E. Conceptualization and rationale for consensus definition terms in MDD, Arch Gen Psych. 1991; 48:851-855.
Social Adjustment Scale-SR (Mean ± SD)
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.
Depressed patients continue to have needs that are not being fully addressed1
*In antidepressant clinical drug trials.