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1.
BMC Psychol ; 9(1): 30, 2021 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-33597043

RESUMO

BACKGROUND: Studies in Western cultures have shown that perfectionism is conceptualized by two-factor higher-order model including perfectionistic strivings and perfectionistic concerns. However, little is known about the construct of perfectionism in Eastern societies. Thus, we examined the two-factor higher-order model of perfectionism in Iranian general and clinical samples. METHODS: We recruited a general population sample (n = 384) and patients with major depressive disorder, obsessive compulsive disorder, social anxiety disorder, and eating disorders (n = 152) from Tehran, Iran from September 2016 to December 2017. They completed the Clinical Perfectionism Questionnaire, Perfectionism Inventory, and Depression, Anxiety, Stress Scale-21. RESULTS: The two-factor higher-order model of perfectionism showed adequate fit with data for females from the general population and clinical sample. Data for males were only available from the general population, and the model showed adequate fit with the data first after removing the Rumination scale of the perfectionistic concerns. The perfectionistic strivings dimension showed no or negative association with depression, anxiety, and stress symptoms, but perfectionistic concerns dimension showed positive correlation with these indices in all samples for both males and females. CONCLUSIONS: The results support the two-factor higher-order model of perfectionism in samples of Iranian females from the general population and clinical sample. However, the results were different for males from the general population. In other words, the modified two-factor higher-order model showed acceptable fit with the data for males from the general population only after removing the Rumination scale from perfectionistic concerns. These differences among males and females were discussed.


Assuntos
Transtorno Depressivo Maior , Transtornos da Alimentação e da Ingestão de Alimentos , Perfeccionismo , Ansiedade/epidemiologia , Feminino , Humanos , Irã (Geográfico) , Masculino
2.
Artigo em Inglês | MEDLINE | ID: mdl-33557142

RESUMO

The COVID-19 pandemic disrupted food systems and the economy in the U.S. and abroad. This cross-sectional study examined the direct and indirect impacts of COVID-19 on food access among low-income and Black, Indigenous, and people of color (BIPOC) in New York State. New York residents were recruited to complete a web-based survey through Qualtrics. The survey took place in May and June 2020 and asked participants about COVID-19 health impacts, risk factors, and food access. Chi-square analysis examined issues with food access experienced by demographic characteristics, work disruptions, health impacts, and household risk for contracting the virus and experiencing severe illness, and significant results were analyzed in a series of logistic regression models. After accounting for covariates, Hispanic respondents, those with likely Major Depressive Disorder, and essential workers were more likely to experience worse food access during COVID-19. Improved policies and services to address impacts on vulnerable populations such as BIPOC, those suffering from mental health disorders, and workers in lower-paying essential jobs can reduce the risk of food access issues at this time. Future research can identify how food access issues during the pandemic influenced diet quality, chronic disease risk and infection, and persistence of food access issues.


Assuntos
Emprego , Pandemias , Estudos Transversais , Transtorno Depressivo Maior/epidemiologia , Grupos Étnicos , Hispano-Americanos/estatística & dados numéricos , Humanos , Modelos Logísticos , New York/epidemiologia , Ocupações/classificação , Pobreza , Fatores de Risco , Inquéritos e Questionários
3.
Epidemiol Psychiatr Sci ; 30: e10, 2021 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-33526166

RESUMO

AIMS: Late-life depression has substantial impacts on individuals, families and society. Knowledge gaps remain in estimating the economic impacts associated with late-life depression by symptom severity, which has implications for resource prioritisation and research design (such as in modelling). This study examined the incremental health and social care expenditure of depressive symptoms by severity. METHODS: We analysed data collected from 2707 older adults aged 60 years and over in Hong Kong. The Patient Health Questionnaire-9 (PHQ-9) and the Client Service Receipt Inventory were used, respectively, to measure depressive symptoms and service utilisation as a basis for calculating care expenditure. Two-part models were used to estimate the incremental expenditure associated with symptom severity over 1 year. RESULTS: The average PHQ-9 score was 6.3 (standard deviation, s.d. = 4.0). The percentages of respondents with mild, moderate and moderately severe symptoms and non-depressed were 51.8%, 13.5%, 3.7% and 31.0%, respectively. Overall, the moderately severe group generated the largest average incremental expenditure (US$5886; 95% CI 1126-10 647 or a 272% increase), followed by the mild group (US$3849; 95% CI 2520-5177 or a 176% increase) and the moderate group (US$1843; 95% CI 854-2831, or 85% increase). Non-psychiatric healthcare was the main cost component in a mild symptom group, after controlling for other chronic conditions and covariates. The average incremental association between PHQ-9 score and overall care expenditure peaked at PHQ-9 score of 4 (US$691; 95% CI 444-939), then gradually fell to negative between scores of 12 (US$ - 35; 95% CI - 530 to 460) and 19 (US$ -171; 95% CI - 417 to 76) and soared to positive and rebounded at the score of 23 (US$601; 95% CI -1652 to 2854). CONCLUSIONS: The association between depressive symptoms and care expenditure is stronger among older adults with mild and moderately severe symptoms. Older adults with the same symptom severity have different care utilisation and expenditure patterns. Non-psychiatric healthcare is the major cost element. These findings inform ways to optimise policy efforts to improve the financial sustainability of health and long-term care systems, including the involvement of primary care physicians and other geriatric healthcare providers in preventing and treating depression among older adults and related budgeting and accounting issues across services.


Assuntos
Serviços de Saúde Comunitária/estatística & dados numéricos , Depressão/terapia , Gastos em Saúde/estatística & dados numéricos , Qualidade de Vida/psicologia , Idoso , Idoso de 80 Anos ou mais , Serviços de Saúde Comunitária/economia , Análise Custo-Benefício , Estudos Transversais , Transtorno Depressivo Maior/terapia , Feminino , Geriatria , Pesquisa sobre Serviços de Saúde , Hong Kong , Humanos , Vida Independente , Masculino , Pessoa de Meia-Idade , Questionário de Saúde do Paciente , Apoio Social
4.
Medicine (Baltimore) ; 100(6): e24568, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578553

RESUMO

RATIONALE: Piribedil is an orally active dopamine agonist that has been widely used for Parkinson disease (PD), with its partial D2/D3 agonistic functions and alpha2-adrenoreceptor antagonistic effects, piribedil has been proved to be efficacious in the relief of motor symptoms in PD, while it can also lead to impulse control disorders such as pathological gambling due to its dopamine agonistic effects. PATIENT CONCERNS: A 28-year-old Chinese female patient with Parkinson disease and a history of taking piribedil finally developed pathological gambling and depressive episode. DIAGNOSES: After a careful clinical observation and evaluation, the patient met the criteria of severe depressive episode and pathological gambling due to antiparkinson therapy. INTERVENTIONS: We discontinued piribedil and picked bupropion, a dopamine reuptake inhibitor, to alleviate the depressive symptom. Benzhexol and selegiline were also added for the control of motor fluctuations. OUTCOMES: After 3 weeks' treatment, the patient's depressive mood was significantly alleviated and her recurring PD symptoms were also relieved. She was no more addicted to network gambling, and there was no recurrence during the 1-year follow-up. LESSONS: Piribedil-induced problem gambling and impulse control disorders are side effects needed to be evaluated when commencing a patient on piribedil. This case further emphasizes the importance of monitoring and controlling Parkinson symptoms after drug reduction or withdrawal. Anticipation of this risk strengthens the significance of detailed medical history-taking and targeted clinical management.


Assuntos
Antiparkinsonianos/efeitos adversos , Transtorno Depressivo Maior/induzido quimicamente , Jogo de Azar/induzido quimicamente , Piribedil/efeitos adversos , Adulto , Feminino , Humanos
5.
PLoS One ; 16(2): e0246602, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33544761

RESUMO

BACKGROUND: Healthcare workers are at increased risk of adverse mental health outcomes during the COVID-19 pandemic. Studies are warranted that examine socio-ecological factors associated with these outcomes to inform interventions that support healthcare workers during future disease outbreaks. METHODS: We conducted an online cross-sectional study of healthcare workers during May 2020 to assess the socio-ecological predictors of mental health outcomes during the COVID-19 pandemic. We assessed factors at four socio-ecological levels: individual (e.g., gender), interpersonal (e.g., social support), institutional (e.g., personal protective equipment availability), and community (e.g., healthcare worker stigma). The Personal Health Questionnaire-9, Generalized Anxiety Disorder-7, Primary Care Post-Traumatic Stress Disorder, and Alcohol Use Disorders Identification Test-Concise scales assessed probable major depression (MD), generalized anxiety disorder (GAD), posttraumatic stress disorder (PTSD), and alcohol use disorder (AUD), respectively. Multivariable logistic regression models were used to assess unadjusted and adjusted associations between socio-ecological factors and mental health outcomes. RESULTS: Of the 1,092 participants, 72.0% were female, 51.9% were frontline workers, and the mean age was 40.4 years (standard deviation = 11.5). Based on cut-off scores, 13.9%, 15.6%, 22.8%, and 42.8% had probable MD, GAD, PTSD, and AUD, respectively. In the multivariable adjusted models, needing more social support was associated with significantly higher odds of probable MD, GAD, PTSD, and AUD. The significance of other factors varied across the outcomes. For example, at the individual level, female gender was associated with probable PTSD. At the institutional level, lower team cohesion was associated with probable PTSD, and difficulty following hospital policies with probable MD. At the community level, higher healthcare worker stigma was associated with probable PTSD and AUD, decreased satisfaction with the national government response with probable GAD, and higher media exposure with probable GAD and PTSD. CONCLUSIONS: These findings can inform targeted interventions that promote healthcare workers' psychological resilience during disease outbreaks.


Assuntos
Alcoolismo/epidemiologia , Transtornos de Ansiedade/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Pessoal de Saúde , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Adulto , Alcoolismo/psicologia , Transtornos de Ansiedade/psicologia , Estudos Transversais , Transtorno Depressivo Maior/psicologia , Feminino , Pessoal de Saúde/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Pandemias , Resiliência Psicológica , Fatores Socioeconômicos , Transtornos de Estresse Pós-Traumáticos/psicologia , Estados Unidos/epidemiologia
7.
J Urban Health ; 98(1): 13-26, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33420551

RESUMO

It is suggested that the nationwide social distancing due to coronavirus disease 2019 (COVID-19) has adverse mental health consequences despite its necessity. We investigated the associations of social distancing measures with mental health problems. Using national representative sample of 509,062 adults in the USA, we examined the associations of small business closure and reduced urban mobility with generalized anxiety disorder (GAD) and major depression disorder (MDD). Multilevel regression models were fitted with individual, household, and state-level covariates, in addition to state and census-region-level random effects. Living in state with the highest quartile of small business closures was associated with increased prevalence of GAD (OR: 1.06; CI: 1.03-1.11) compared to lowest quartile, but had no association with MDD. Living in the highest quartile of urban mobility was associated with lower prevalence of both GAD (OR: 0.88; CI: 0.85-0.93) and MDD (OR: 0.90; CI: 0.86-0.95) relative to the lowest quartile. Our findings suggest that small business closures and reduced mobility during COVID-19 pandemic were negatively associated with the two mental health outcomes in the USA, despite their important roles in preventing the infection.


Assuntos
Transtornos de Ansiedade/etiologia , Transtorno Depressivo Maior/etiologia , Saúde Mental/estatística & dados numéricos , Empresa de Pequeno Porte/estatística & dados numéricos , Estresse Psicológico/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos de Ansiedade/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , Prevalência , Estados Unidos/epidemiologia , Adulto Jovem
8.
Adv Exp Med Biol ; 1281: 17-31, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33433866

RESUMO

Behavioral variant frontotemporal dementia (bvFTD) is a syndrome defined by a set of core clinical criteria, which include disinhibition; apathy or inertia; loss of sympathy or empathy; perseverative, stereotyped, or compulsive/ritualistic behavior; and hyperorality. The clinical features of bvFTD overlap substantially with those of psychiatric disease, particularly major depressive disorder and bipolar affective disorder. The similarities between bvFTD and primary psychiatric disease results in a significant diagnostic challenge for clinicians. Understanding the neuropsychiatric aspects of bvFTD may assist in differentiating bvFTD from a primary psychiatric disorder.


Assuntos
Transtorno Depressivo Maior , Demência Frontotemporal , Demência Frontotemporal/diagnóstico , Humanos , Testes Neuropsicológicos
9.
Curr Probl Cardiol ; 46(4): 100737, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33412349

RESUMO

BACKGROUND: The COVID-19 pandemic's mental health consequences remain unknown. AIM: To assess the mental health status of ambulatory cardiometabolic patients during COVID-19 pandemic lockdown in Spanish speaking Latin American countries. METHODS: Cardiometabolic patients without COVID-19 evidence in 13 Latin American countries answered a survey between June 15th and July 15th, 2020. The Diagnosis Manual of Mental Disorders fifth edition was used to identify the presence of major depressive symptoms. RESULTS: The sample included 4216 patients, 1590 (37.71%; IC95% 36.24-39.19) were considered suffering major depression. Female gender, consuming ≥5 medications day, physical activity <100 minutes weekly, low fruits and vegetables intake, poor treatment adherence, reduced food consumption were independently associated to the presence of major depressive symptoms. CONCLUSIONS: The CorCOVID Latam Psy study showed that one-third of the Latin American Spanish speaking population is suffering from major depressive symptoms during the COVID-19 outbreak.


Assuntos
Doenças Cardiovasculares/epidemiologia , Depressão/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Diabetes Mellitus/epidemiologia , Síndrome Metabólica/epidemiologia , Adulto , Idoso , Doenças Cardiovasculares/psicologia , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/psicologia , Depressão/psicologia , Transtorno Depressivo Maior/psicologia , Diabetes Mellitus/psicologia , Dieta/estatística & dados numéricos , Dislipidemias/epidemiologia , Dislipidemias/psicologia , Ingestão de Alimentos , Exercício Físico/psicologia , Feminino , Frutas , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/psicologia , Humanos , Hipertensão/epidemiologia , Hipertensão/psicologia , América Latina/epidemiologia , Masculino , Saúde Mental , Síndrome Metabólica/psicologia , Pessoa de Meia-Idade , Fatores Sexuais , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/psicologia , Inquéritos e Questionários , Cooperação e Adesão ao Tratamento/psicologia , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Verduras
10.
BMJ Case Rep ; 14(1)2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33462045

RESUMO

Inherited pseudocholinesterase deficiency refers to an uncommon defect in the butyrylcholinesterase enzyme which can result in prolonged muscle paralysis due to delayed breakdown of choline ester paralytic anaesthetic agents. We describe a 25-year-old woman receiving electroconvulsive therapy (ECT) for treatment of depression in whom motor function did not recover adequately after administration of succinylcholine. Investigated post-ECT, she was found to have severe pseudocholinesterase deficiency. Implications of pseudocholinesterase deficiency for ECT treatment and anaesthetic strategies are discussed.


Assuntos
Apneia/diagnóstico , Butirilcolinesterase/deficiência , Transtorno Depressivo Maior/terapia , Eletroconvulsoterapia , Erros Inatos do Metabolismo/diagnóstico , Adulto , Feminino , Humanos
11.
BMC Psychol ; 9(1): 11, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33482927

RESUMO

BACKGROUND: Major depressive disorder (MDD) is a prevalent psychiatric condition associated with significant disability, mortality and economic burden. Cognitive behavioral therapy (CBT) and psychodynamic psychotherapy (PDT) are found to be equally effective for patients with depression. However, many patients do not respond sufficiently to either treatment. To offer individualized treatment, we need to know if some patients benefit more from one of the two therapies. At present little is known about what patient characteristics (moderators) may be associated with differential outcomes of CBT and PDT, and through what therapeutic processes and mechanisms (mediators) improvements occur in each therapy mode. Presently only theoretical assumptions, sparsely supported by research findings, describe what potentially moderates and mediates the treatment effects of CBT and PDT. The overall aim of this study is to examine theoretically derived putative moderators and mediators in CBT and PDT and strengthen the evidence base about for whom and how these treatments works in a representative sample of patients with MDD. METHODS: One hundred patients with a diagnosis of MDD will be randomized to either CBT or PDT. Patients will be treated over 28 weeks with either CBT (one weekly session over 16 weeks and three monthly booster sessions) or PDT (one weekly session over 28 weeks). The patients will be evaluated at baseline, during the course of therapy, at the end of therapy, and at follow-up investigations 1 and 3 years post treatment. A large range of patient and observer rated questionnaires (specific preselected putative moderators and mediators) are included. DISCUSSION: The clinical outcome of this study may better guide clinicians when deciding what kind of treatment any individual patient should be offered. Moreover, the study aims to further our knowledge of what mechanisms lead to symptom improvement and increased psychosocial functioning. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03022071.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Transtorno Depressivo Maior/terapia , Psicoterapia Psicodinâmica/métodos , Humanos , Resultado do Tratamento
14.
Adv Exp Med Biol ; 1264: 67-80, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33332004

RESUMO

There is a growing body of evidence pointing to the co-occurrence of cannabis use and depression. There is also some evidence that the use of cannabis may lead to the onset of depression; however, strong evidence points to the inverse association; i.e. that depression may lead to the onset or increase in cannabis use frequency. Observational and epidemiological studies have not indicated a positive long-term effect of cannabis use on the course and outcome of depression. The association between cannabis use and depression may be stronger among men during adolescence and emerging adulthood and stronger in women during midlife. There is an indication for potential genetic correlation contributing to the comorbidity of cannabis dependence and major depression, namely that serotonin (5-HT) may mediate such association and there is also evidence for specific risk alleles for cannabis addiction. There is preclinical evidence that alteration in the endocannabinoid system could potentially benefit patients suffering from depression. However, the issue of using cannabis as an anti-depressant is at an early stage of examination and there is little evidence to support it. Finally, there has been little support to the notion that selective serotonin reuptake inhibitors (SSRIs) may be effective in decreasing depressive symptoms or rates of substance use in adolescents treated for depression and a co-occurring substance use disorder. In conclusion, despite methodological limitations, research in the past decades has broadened our knowledge on the association between cannabis use and depression from epidemiological, neurological, genetic, and pharmacological perspectives.


Assuntos
Cannabis/efeitos adversos , Depressão/induzido quimicamente , Depressão/tratamento farmacológico , Transtorno Depressivo Maior/induzido quimicamente , Transtorno Depressivo Maior/tratamento farmacológico , Comorbidade , Depressão/epidemiologia , Depressão/genética , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/genética , Humanos , Abuso de Maconha/epidemiologia
15.
Vnitr Lek ; 66(7): 46-54, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33380135

RESUMO

Long lasting, low intensity depressive episodes have been diversely integrated according to the classifications types or the psychodynamic points of view. The concept of anxious persistent lasting depression, neurotic depressive states, neurotic depression have been unified into the dysthymic disorder category of the DSM classification. This concept unification have been a topic of dispute considering that dysthymic disorder was a restrictive, heterogeneous an extensively comorbid diagnosis. Nevertheless the definition of this category offers the opportunity to place the notions of temperament, personality, adjustment disorder. Including dysthymic disorders as a category inside of the mood disorders classification suggests the interest of using an antidepressive medication in presence of chronic depressive states not included in the major depressive disorder category. But the most important treatment is psychotherapy, because dysthymie is connected with pathologic cognition and interpretation of reality. This paper describes that dysthymia induced similar problems in the family members of dysthymic persons, and even induced somatic disorders in sensitive persons, as described in this paper.


Assuntos
Transtorno Depressivo Maior , Transtorno Distímico , Depressão , Humanos , Masculino , Transtornos da Personalidade , Cônjuges
16.
Psychiatr Danub ; 32(3-4): 325-333, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33370729

RESUMO

Major depressive disorder is the greatest burden of developed countries in the context of morbidity caused by mental disorders. Until recent, ketamine has been mostly used for anesthesia, analgesia, sedation and treatment of chronic pain syndromes. However, unique pharmacodynamic properties of ketamine have increased interests in it's use for treatment of depression. It is assumed that ketamine reverses synaptic chronic stress pathology within one day of administration by postsynaptic glutamate activation, providing synaptic connectivity restoration that last for days or weeks. Potential glutamatergic agents, in context of treatment of major depressive disorder are not entirely novel phenomenon. Considering the aforementioned, current neurobiological view of depression as a solely monoaminergic phenomenon should be reassessed in order to prompt discovery of putative antidepressant drugs of novel generation. Acute side effects, such as increased salivation, increase in heart rate, systemic arterial pressure and intracranial pressure necessitate careful monitoring during intravenous administration of ketamine, even in subanesthetic doses. However, major burden of ketamine administration lies in it's ability to produce psychotomimetic side effects and emergence delirium. Esketamine nasal spray has now been widely approved and is considered safe in terms of acute side effects, tolerability and consistent therapeutic benefit.


Assuntos
Antidepressivos/farmacologia , Antidepressivos/uso terapêutico , Transtorno Depressivo Maior/tratamento farmacológico , Ketamina/farmacologia , Ketamina/uso terapêutico , Transtorno Depressivo Maior/genética , Transtorno Depressivo Maior/metabolismo , Interações Medicamentosas , Epigênese Genética/efeitos dos fármacos , Ácido Glutâmico/metabolismo , Humanos , Ketamina/efeitos adversos , Ketamina/química
19.
Artigo em Russo | MEDLINE | ID: mdl-33340295

RESUMO

OBJECTIVE: To comparare socio-demographic and clinical characteristics of patients with the first depressive episode and recurrent depression. MATERIAL AND METHODS: Three hundred and twenty one patients with unipolar depression, including 96 patients with first depressive episode and 225 patients with recurrent depression, were examined using clinical and psychometric methods. RESULTS AND CONCLUSION: There were differences in clinical characteristics between groups but such factors as gender, marital status, level of education, family history of mental disorders and personality were similar. With each new episode of recurrent depression, the next episode tends to be more severe with more intense pessimistic and suicidal thoughts but fewer anxiety and complaints of depressive mood that affects the differences and requires further research, especially considering the effect of therapy.


Assuntos
Transtorno Bipolar , Transtorno Depressivo Maior , Afeto , Depressão/diagnóstico , Depressão/epidemiologia , Humanos , Psicometria
20.
Bipolar Disord ; 22(8): 788-804, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33320412

RESUMO

OBJECTIVES: To provide a succinct, clinically useful summary of the management of major depression, based on the 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders (MDcpg2020 ). METHODS: To develop the MDcpg2020 , the mood disorders committee conducted an extensive review of the available literature to develop evidence-based recommendations (EBR) based on National Health and Medical Research Council (NHMRC) guidelines. In the MDcpg2020 , these recommendations sit alongside consensus-based recommendations (CBR) that were derived from extensive deliberations of the mood disorders committee, drawing on their expertise and clinical experience. This guideline summary is an abridged version that focuses on major depression. In collaboration with international experts in the field, it synthesises the key recommendations made in relation to the diagnosis and management of major depression. RESULTS: The depression summary provides a systematic approach to diagnosis, and a logical clinical framework for management. The latter begins with Actions, which include important strategies that should be implemented from the outset. These include lifestyle changes, psychoeducation and psychological interventions. The summary advocates the use of antidepressants in the management of depression as Choices and nominates seven medications that can be trialled as clinically indicated before moving to Alternatives for managing depression. Subsequent strategies regarding Medication include Increasing Dose, Augmenting and Switching (MIDAS). The summary also recommends the use of electroconvulsive therapy (ECT), and discusses how to approach non-response. CONCLUSIONS: The major depression summary provides up to date guidance regarding the management of major depressive disorder, as set out in the MDcpg2020 . The recommendations are informed by research evidence in conjunction with clinical expertise and experience. The summary is intended for use by psychiatrists, psychologists and primary care physicians, but will be of interest to all clinicians and carers involved in the management of patients with depressive disorders.


Assuntos
Antidepressivos/uso terapêutico , Transtorno Depressivo Maior/terapia , Eletroconvulsoterapia/métodos , Transtornos do Humor/terapia , Guias de Prática Clínica como Assunto , Psiquiatria , Austrália , Consenso , Transtorno Depressivo Maior/diagnóstico , Humanos , Transtornos do Humor/diagnóstico , Nova Zelândia , Sociedades Médicas
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