Sections

Depression

Guidelines

Guidelines Summary

French Association for Biological Psychiatry and Neuropsychopharmacology and the Fondation FondaMental

Clinical guidelines on the management of depression in patients with psychiatric comorbidities were published in January 2019 by the French Association for Biological Psychiatry and Neuropsychopharmacology and the Fondation FondaMental.^[218]

Comorbid anxiety disorders

The following are recommended first-intention strategies during the first episode of major depressive disorder (MDD) with comorbid anxiety disorder:

Concurrent treatment of both disorders
Use of the same therapist, to the greatest extent possible, for disease management, with treatment including cognitive behavioral therapy, as well as a closer follow-up

First-intention medications and other treatment for MDD with comorbid obsessive-compulsive disorder, panic disorder, social anxiety, generalized anxiety disorder, or posttraumatic stress disorder include the following:

Selective serotonin reuptake inhibitor (SSRI)
Serotonin and norepinephrine reuptake inhibitor (SNRI)
Psychotherapy in combination

Comorbid substance use disorders

The following are recommended in first-intention treatment during the first episode of MDD with comorbid substance use disorder:

Full-time hospitalization or
Close monitoring in consultation (at least weekly)
Electrocardiographic evaluation prior to treatment
Substitution treatment initiated in response to opioid dependence

Also consider the following in first-intention treatment of patients with severe alcohol addiction:

Close biologic monitoring - Complete blood count, blood electrolytes, liver and renal function
Treatment of physical withdrawal syndrome
Antidepressant treatment - Prescribed after reassessment of mood and once appropriate care for physical withdrawal syndrome has ended

First-intention medications and other treatments for MDD with comorbid substance use disorders include the following:

Severe substance use disorders (except alcohol and nicotine) - SSRI; SNRI; α2 antagonist; disease management involving a team specialized in addictology, psychoeducational groups, or psychotherapy focusing on addictive relapse prevention; concurrent treatment of MDD and addiction
Severe comorbid alcohol addiction - SSRI, SNRI, α2 antagonist, structured psychotherapy
Active smoking - SSRI, SNRI, α2 antagonist, structured psychotherapy, concurrent treatment of MDD and smoking cessation

Comorbid personality disorders

The following are recommended during the first episode of MDD with comorbid personality disorder:

First-intention treatment with SSRI or SNRI (as monotherapy or in combination with psychotherapy)
Second-intention treatment with an imipraminic antidepressant or α2 antagonist

Geriatric depressive disorder

In adults over age 65 years, it is recommended, during an episode of MDD, that a physical examination and laboratory studies be performed to identify medical problems that could exacerbate or mimic depressive symptoms. Assessment includes the following:

Clinical examination
Biologic checkup - Ie, complete blood count, blood electrolytes, liver and renal function, and thyroid-stimulating hormone
Electrocardiographic evaluation
Mini-Mental State Examination
Evaluation of clinical severity using clinician- and self-rated scales

First-intention treatments for geriatric depression include the following:

Mild to moderate depression - SSRI, α2 antagonist
Moderate to severe depression - SSRI, SNRI, α2 antagonist
Severe cognitive impairment - SSRI, SNRI
Severe psychomotor agitation - SSRI, α2 antagonist
Severe psychomotor retardation - SSRI, SNRI
Severe sleep disorders - SSRI, α2 antagonist
Severe anhedonia - SSRI, SNRI
Psychotic symptoms - SNRI, potentiation with an atypical antipsychotic
High suicide risk - SSRI, SNRI

International Society for Nutritional Psychiatry Research

The International Society for Nutritional Psychiatry Research (ISNPR) recommends omega-3 polyunsaturated fatty acids (PUFAs) as adjunctive therapy for major depressive disorder.^[219]The recommended therapeutic dosage of pure eicosapentaenoic acid (EPA) is 1–2 g/day (either from pure EPA or a combination of EPA and docosahexaenoic acid [DHA]) for at least 8 weeks as adjunctive treatment. The guideline also endorses n-3 PUFAs as a potential prophylactic treatment for high-risk populations, and indicates that they can be used in overweight patients and those individuals with elevated levels of inflammatory markers.

Medication

Villarroel M and Terlizzi E. Symptoms of Depression Among Adults: United States, 2019. CDC. Available at https://www.cdc.gov/nchs/products/databriefs/db379.htm. September 2020; Accessed: August 29, 2022.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision. Washington, DC: American Psychiatric Association; 2022.
Pampallona S, Bollini P, Tibaldi G, Kupelnick B, Munizza C. Combined pharmacotherapy and psychological treatment for depression: a systematic review. Arch Gen Psychiatry. 2004 Jul. 61(7):714-9. [QxMD MEDLINE Link].
Ishak WW, Ha K, Kapitanski N, Bagot K, Fathy H, Swanson B, et al. The impact of psychotherapy, pharmacotherapy, and their combination on quality of life in depression. Harv Rev Psychiatry. 2011 Dec. 19(6):277-89. [QxMD MEDLINE Link].
Hollon SD, Ponniah K. A review of empirically supported psychological therapies for mood disorders in adults. Depress Anxiety. 2010 Oct. 27(10):891-932. [QxMD MEDLINE Link]. [Full Text].
Depression. Society of Clinical Psychology, Division 12 of the APA. Available at https://www.div12.org/psychological-treatments/disorders/depression/. Accessed: 2/22/2018.
David-Ferdon C, Kaslow NJ. Evidence-based psychosocial treatments for child and adolescent depression. J Clin Child Adolesc Psychol. 2008 Jan. 37(1):62-104. [QxMD MEDLINE Link].
APA. Practice Guideline for the Treatment of Patients with Major Depressive Disorder (3rd edition). Accessed May 3, 2011. American Psychiatric Association. [Full Text].
Dunlop BW, Nemeroff CB. The role of dopamine in the pathophysiology of depression. Arch Gen Psychiatry. 2007 Mar. 64(3):327-37. [QxMD MEDLINE Link].
Alexopoulos GS. Depression in the elderly. Lancet. 2005 Jun 4-10. 365(9475):1961-70. [QxMD MEDLINE Link].
Mayberg HS, Liotti M, Brannan SK, McGinnis S, Mahurin RK, Jerabek PA, et al. Reciprocal limbic-cortical function and negative mood: converging PET findings in depression and normal sadness. Am J Psychiatry. 1999 May. 156(5):675-82. [QxMD MEDLINE Link].
Kempton MJ, Salvador Z, Munafò MR, Geddes JR, Simmons A, Frangou S, et al. Structural neuroimaging studies in major depressive disorder. Meta-analysis and comparison with bipolar disorder. Arch Gen Psychiatry. 2011 Jul. 68(7):675-90. [QxMD MEDLINE Link].
Sacher J, Neumann J, Fünfstück T, Soliman A, Villringer A, Schroeter ML. Mapping the depressed brain: A meta-analysis of structural and functional alterations in major depressive disorder. J Affect Disord. 2011 Sep 2. [QxMD MEDLINE Link].
Rice F. Genetics of childhood and adolescent depression: insights into etiological heterogeneity and challenges for future genomic research. Genome Med. 2010 Sep 20. 2(9):68. [QxMD MEDLINE Link]. [Full Text].
Tsuang MT, Faraone SV. The genetics of mood disorders. Baltimore, MD: Johns Hopkins University Press, 1990.
Abkevich V, Camp NJ, Hensel CH, Neff CD, Russell DL, et al. Predisposition locus for major depression at chromosome 12q22-12q23.2. Am J Hum Genet. 2003 Dec. 73(6):1271-81. [QxMD MEDLINE Link]. [Full Text].
Holmans P, Zubenko GS, Crowe RR, DePaulo JR Jr, Scheftner WA, Weissman MM, et al. Genomewide significant linkage to recurrent, early-onset major depressive disorder on chromosome 15q. Am J Hum Genet. 2004 Jun. 74(6):1154-67. [QxMD MEDLINE Link]. [Full Text].
Lohoff FW. Overview of the genetics of major depressive disorder. Curr Psychiatry Rep. 2010 Dec. 12(6):539-46. [QxMD MEDLINE Link]. [Full Text].
Caspi A, Sugden K, Moffitt TE, Taylor A, Craig IW, Harrington H, et al. Influence of life stress on depression: moderation by a polymorphism in the 5-HTT gene. Science. 2003 Jul 18. 301(5631):386-9. [QxMD MEDLINE Link].
Zhang X, Gainetdinov RR, Beaulieu JM, Sotnikova TD, Burch LH, Williams RB, et al. Loss-of-function mutation in tryptophan hydroxylase-2 identified in unipolar major depression. Neuron. 2005 Jan 6. 45(1):11-6. [QxMD MEDLINE Link].
Garriock HA, Allen JJ, Delgado P, Nahaz Z, Kling MA, Carpenter L, et al. Lack of association of TPH2 exon XI polymorphisms with major depression and treatment resistance. Mol Psychiatry. 2005 Nov. 10(11):976-7. [QxMD MEDLINE Link].
Yamada K, Hattori E, Iwayama Y, Ohnishi T, Ohba H, Toyota T, et al. Distinguishable haplotype blocks in the HTR3A and HTR3B region in the Japanese reveal evidence of association of HTR3B with female major depression. Biol Psychiatry. 2006 Jul 15. 60(2):192-201. [QxMD MEDLINE Link].
Binder EB, Salyakina D, Lichtner P, Wochnik GM, Ising M, Pütz B, et al. Polymorphisms in FKBP5 are associated with increased recurrence of depressive episodes and rapid response to antidepressant treatment. Nat Genet. 2004 Dec. 36(12):1319-25. [QxMD MEDLINE Link].
Akiskal HS, Weller ES. Mood disorders and suicide in children and adolescents. In: Kaplan HI, Saddock BJ, eds. Comprehensive Textbook of Psychiatry. 5th ed. Lippincott Williams & Wilkins; 1989. Vol 2:
Weissman MM, Leckman JF, Merikangas KR, Gammon GD, Prusoff BA. Depression and anxiety disorders in parents and children. Results from the Yale family study. Arch Gen Psychiatry. 1984 Sep. 41(9):845-52. [QxMD MEDLINE Link].
Nobile M, Begni B, Giorda R, Frigerio A, Marino C, Molteni M, et al. Effects of serotonin transporter promoter genotype on platelet serotonin transporter functionality in depressed children and adolescents. J Am Acad Child Adolesc Psychiatry. 1999 Nov. 38(11):1396-402. [QxMD MEDLINE Link].
Birmaher B, Kaufman J, Brent DA, Dahl RE, Perel JM, al-Shabbout M, et al. Neuroendocrine response to 5-hydroxy-L-tryptophan in prepubertal children at high risk of major depressive disorder. Arch Gen Psychiatry. 1997 Dec. 54(12):1113-9. [QxMD MEDLINE Link].
Blazer DG. Depression in late life: review and commentary. J Gerontol A Biol Sci Med Sci. 2003 Mar. 58(3):249-65. [QxMD MEDLINE Link].
Uhr M, Tontsch A, Namendorf C, Ripke S, Lucae S, Ising M, et al. Polymorphisms in the drug transporter gene ABCB1 predict antidepressant treatment response in depression. Neuron. 2008 Jan 24. 57(2):203-9. [QxMD MEDLINE Link].
Bishop JR, Moline J, Ellingrod VL, Schultz SK, Clayton AH. Serotonin 2A -1438 G/A and G-protein Beta3 subunit C825T polymorphisms in patients with depression and SSRI-associated sexual side-effects. Neuropsychopharmacology. 2006 Oct. 31(10):2281-8. [QxMD MEDLINE Link].
McMahon FJ, Buervenich S, Charney D, Lipsky R, Rush AJ, Wilson AF, et al. Variation in the gene encoding the serotonin 2A receptor is associated with outcome of antidepressant treatment. Am J Hum Genet. 2006 May. 78(5):804-14. [QxMD MEDLINE Link]. [Full Text].
Bruce ML. Psychosocial risk factors for depressive disorders in late life. Biol Psychiatry. 2002 Aug 1. 52(3):175-84. [QxMD MEDLINE Link].
O'Hara MW, Neunaber DJ, Zekoski EM. Prospective study of postpartum depression: prevalence, course, and predictive factors. J Abnorm Psychol. 1984 May. 93(2):158-71. [QxMD MEDLINE Link].
Abramson, Lyn Y.; Metalsky, Gerald I.; Alloy, Lauren B. Hopelessness Depression: A Theory-Based Subtype of Depression. Psychol Rev. Apr 1989. Vol 96(2):358-372.
Hyde JS, Mezulis AH, Abramson LY. The ABCs of depression: integrating affective, biological, and cognitive models to explain the emergence of the gender difference in depression. Psychol Rev. 2008 Apr. 115(2):291-313. [QxMD MEDLINE Link].
Lewinsohn, P. M. A behavioral approach to depression. Friedman R.J. and Katz M.M. The psychology of depression: Contemporary theory and research. Washington, DC.: Winston-Wiley; 1974. 157-178.
Ferster, C. B. A functional analysis of depression. Am Psychol. 1973. 28, 857-870.
Martell, C. R., Addis, M. E., & Jacobson, N. S. Depression in context: Strategies for guided action. New York: Norton; 2001.
Frodl T, Reinhold E, Koutsouleris N, Donohoe G, Bondy B, Reiser M, et al. Childhood stress, serotonin transporter gene and brain structures in major depression. Neuropsychopharmacology. 2010 May. 35(6):1383-90. [QxMD MEDLINE Link]. [Full Text].
Karg K, Burmeister M, Shedden K, Sen S. The Serotonin Transporter Promoter Variant (5-HTTLPR), Stress, and Depression Meta-analysis Revisited: Evidence of Genetic Moderation. Arch Gen Psychiatry. 2011 May. 68(5):444-54. [QxMD MEDLINE Link].
De Bellis MD, Dahl RE, Perel JM, Birmaher B, al-Shabbout M, Williamson DE, et al. Nocturnal ACTH, cortisol, growth hormone, and prolactin secretion in prepubertal depression. J Am Acad Child Adolesc Psychiatry. 1996 Sep. 35(9):1130-8. [QxMD MEDLINE Link].
Krishnan KR. Biological risk factors in late life depression. Biol Psychiatry. 2002 Aug 1. 52(3):185-92. [QxMD MEDLINE Link].
Anderson, P. Early-Life Depression Boosts Alzheimer's Risk. Medscape Medical News. Available at http://www.medscape.com/viewarticle/883327. July 24, 2017; Accessed: July 26, 2017.
Hammen C, Burge D, Adrian C. Timing of mother and child depression in a longitudinal study of children at risk. J Consult Clin Psychol. 1991 Apr. 59(2):341-5. [QxMD MEDLINE Link].
Wickramaratne P, Gameroff MJ, Pilowsky DJ, Hughes CW, Garber J, Malloy E, et al. Children of depressed mothers 1 year after remission of maternal depression: findings from the STAR*D-Child study. Am J Psychiatry. 2011 Jun. 168(6):593-602. [QxMD MEDLINE Link].
Thomas AJ, Kalaria RN, O'Brien JT. Depression and vascular disease: what is the relationship?. J Affect Disord. 2004 Apr. 79(1-3):81-95. [QxMD MEDLINE Link].
Helgason T. Epidemiology of mental disorders in Iceland. A psychiatric and demographic investigation of 5395 Icelanders. Acta Psychiatr Scand. 1964. 40:SUPPL 173:1+. [QxMD MEDLINE Link].
Jablensky A, Sartorius N, Gulbinat W, Ernberg G. Characteristics of depressive patients contacting psychiatric services in four cultures. A report from the who collaborative study on the assessment of depressive disorders. Acta Psychiatr Scand. 1981 Apr. 63(4):367-83. [QxMD MEDLINE Link].
Murphy JM, Laird NM, Monson RR, Sobol AM, Leighton AH. Incidence of depression in the Stirling County Study: historical and comparative perspectives. Psychol Med. 2000 May. 30(3):505-14. [QxMD MEDLINE Link].
Copeland JR, Beekman AT, Dewey ME, Hooijer C, Jordan A, Lawlor BA, et al. Depression in Europe. Geographical distribution among older people. Br J Psychiatry. 1999 Apr. 174:312-21. [QxMD MEDLINE Link].
Data and Statistics on Children’s Mental Health. Centers for Disease Control and Prevention. Available at https://www.cdc.gov/childrensmentalhealth/data.html. Accessed: August 29, 2022.
Kashani JH, Sherman DD. Childhood depression: Epidemiology, etiological models, and treatment implications. Integr Psychiatry. 1988. 6:1-8.
Lewinsohn PM, Hops H, Roberts RE, Seeley JR, Andrews JA. Adolescent psychopathology: I. Prevalence and incidence of depression and other DSM-III-R disorders in high school students. J Abnorm Psychol. 1993 Feb. 102(1):133-44. [QxMD MEDLINE Link].
Hankin BL, Abramson LY, Moffitt TE, Silva PA, McGee R, Angell KE. Development of depression from preadolescence to young adulthood: emerging gender differences in a 10-year longitudinal study. J Abnorm Psychol. 1998 Feb. 107(1):128-40. [QxMD MEDLINE Link].
Siegel JM, Aneshensel CS, Taub B. Adolescent depressed mood in a multiethnic sample. J Youth Adolesc. 1998. 27.
Tohen M, Khalsa HM, Salvatore P, et al. Two-year outcomes in first-episode psychotic depression The McLean-Harvard first-episode project. J Affect Disord. 2012 Jan. 136(1-2):1-8. [QxMD MEDLINE Link].
Practice parameters for the assessment and treatment of children and adolescents with depressive disorders. AACAP. J Am Acad Child Adolesc Psychiatry. 1998 Oct. 37(10 Suppl):63S-83S. [QxMD MEDLINE Link].
Pine DS, Cohen E, Cohen P, Brook J. Adolescent depressive symptoms as predictors of adult depression: moodiness or mood disorder?. Am J Psychiatry. 1999 Jan. 156(1):133-5. [QxMD MEDLINE Link].
Lespérance F, Frasure-Smith N. Depression and heart disease. Cleve Clin J Med. 2007 Feb. 74 Suppl 1:S63-6. [QxMD MEDLINE Link].
Millard PH. Depression in old age. Br Med J (Clin Res Ed). 1983 Aug 6. 287(6389):375-6. [QxMD MEDLINE Link]. [Full Text].
Alexopoulos GS, Chester JG. Outcomes of geriatric depression. Clin Geriatr Med. 1992 May. 8(2):363-76. [QxMD MEDLINE Link].
Geda YE, Knopman DS, Mrazek DA, Jicha GA, Smith GE, Negash S, et al. Depression, apolipoprotein E genotype, and the incidence of mild cognitive impairment: a prospective cohort study. Arch Neurol. 2006 Mar. 63(3):435-40. [QxMD MEDLINE Link].
Modrego PJ, Ferrández J. Depression in patients with mild cognitive impairment increases the risk of developing dementia of Alzheimer type: a prospective cohort study. Arch Neurol. 2004 Aug. 61(8):1290-3. [QxMD MEDLINE Link].
Katon W, Lyles CR, Parker MM, Karter AJ, Huang ES, Whitmer RA. Association of depression with increased risk of dementia in patients with type 2 diabetes: the diabetes and aging study. Arch Gen Psychiatry. 2012 Apr. 69(4):410-7. [QxMD MEDLINE Link].
Brooks M. Depression accelerates cognitive decline in type 2 diabetes. Medscape Medical News. Available at http://www.medscape.com/viewarticle/812762.. Accessed: October 22, 2013.
Sullivan MD, Katon WJ, Lovato LC, Miller ME, Murray AM, Horowitz KR, et al. Association of Depression With Accelerated Cognitive Decline Among Patients With Type 2 Diabetes in the ACCORD-MIND Trial. JAMA Psychiatry. 2013 Oct 1. 70(10):1041-7. [QxMD MEDLINE Link].
Li G, Wang LY, Shofer JB, et al. Temporal Relationship Between Depression and Dementia: Findings From a Large Community-Based 15-Year Follow-up Study. Arch Gen Psychiatry. 2011 Sep. 68(9):970-7. [QxMD MEDLINE Link].
Gotlib I, Hammen C. (2002). Handbook of Depression. New York: Guilford Press; 2002:
Centers for Disease Control and Prevention. Facts About Suicide. Centers for Disease Control and Prevention. Available at https://www.cdc.gov/suicide/facts/index.html. Accessed: August 29, 2022.
Friedman RA, Leon AC. Expanding the black box - depression, antidepressants, and the risk of suicide. N Engl J Med. 2007 Jun 7. 356(23):2343-6. [QxMD MEDLINE Link].
Tondo L, Albert MJ, Baldessarini RJ. Suicide rates in relation to health care access in the United States: an ecological study. J Clin Psychiatry. 2006 Apr. 67(4):517-23. [QxMD MEDLINE Link].
Suicide. World Health Organization. Available at https://www.who.int/news-room/fact-sheets/detail/suicide. June 17, 2021; Accessed: August 29, 2022.
Sheikh RM, Weller EB, Weller RA. Prepubertal depression: diagnostic and therapeutic dilemmas. Curr Psychiatry Rep. 2006 Apr. 8(2):121-6. [QxMD MEDLINE Link].
Spitz R. Anaclitic depression: An inquiry into the genesis of psychiatric conditions in early childhood. Psychoanalytic Study of the Child. 1946. Vol 2:313-342.
Kendell RE, Chalmers JC, Platz C. Epidemiology of puerperal psychoses. Br J Psychiatry. 1987 May. 150:662-73. [QxMD MEDLINE Link].
SIGN. Postnatal Depression and Puerperal Psychosis: A National Clinical Guideline. Scottish Intercollegiate Guidelines Network. 2002. 32.
USPSTF. Screening for depression in adults: U.S. preventive services task force recommendation statement. Ann Intern Med. 2009 Dec 1. 151(11):784-92. [QxMD MEDLINE Link].
ACOG Committee Opinion No. 343: psychosocial risk factors: perinatal screening and intervention. Obstet Gynecol. 2006 Aug. 108(2):469-77. [QxMD MEDLINE Link].
Peindl KS, Wisner KL, Hanusa BH. Identifying depression in the first postpartum year: guidelines for office-based screening and referral. J Affect Disord. 2004 May. 80(1):37-44. [QxMD MEDLINE Link].
Wisner KL, Parry BL, Piontek CM. Clinical practice. Postpartum depression. N Engl J Med. 2002 Jul 18. 347(3):194-9. [QxMD MEDLINE Link].
Beck CT. Postpartum depression: it isn't just the blues. Am J Nurs. 2006 May. 106(5):40-50; quiz 50-1. [QxMD MEDLINE Link].
Imsiragic AS, Begic D, Martic-Biocina S. Acute stress and depression 3 days after vaginal delivery--observational, comparative study. Coll Antropol. 2009 Jun. 33(2):521-7. [QxMD MEDLINE Link].
Scrandis DA, Sheikh TM, Niazi R, Tonelli LH, Postolache TT. Depression after delivery: risk factors, diagnostic and therapeutic considerations. ScientificWorldJournal. 2007 Oct 22. 7:1670-82. [QxMD MEDLINE Link].
Spinelli MG. Antepartum and postpartum depression. J Gend Specif Med. 1998 Oct-Nov. 1(2):33-6. [QxMD MEDLINE Link].
ACOG Practice Bulletin: Clinical management guidelines for obstetrician-gynecologists number 92, April 2008 (replaces practice bulletin number 87, November 2007). Use of psychiatric medications during pregnancy and lactation. Obstet Gynecol. 2008 Apr. 111(4):1001-20. [QxMD MEDLINE Link].
Earls, Marian, MD. Incorporating recognition and management of perinatal and postpartum depression into pediatric practice. Pediatrics. 2010 Nov. 126(5):1032-9. [QxMD MEDLINE Link].
Pignone MP, Gaynes BN, Rushton JL, Burchell CM, Orleans CT, Mulrow CD, et al. Screening for depression in adults: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2002 May 21. 136(10):765-76. [QxMD MEDLINE Link].
Vogelzangs N, Beekman AT, Boelhouwer IG, et al. Metabolic depression: a chronic depressive subtype? findings from the InCHIANTI study of older persons. J Clin Psychiatry. 2011 May. 72(5):598-604. [QxMD MEDLINE Link].
Siegmann E-M, Müller H, Luecke C, et al. Association of Depression and Anxiety Disorders With Autoimmune Thyroiditis: A Systematic Review and Meta-analysis. JAMA. May 2, 2018. [Full Text].
Ko DT, Hebert PR, Coffey CS, Sedrakyan A, Curtis JP, Krumholz HM. Beta-blocker therapy and symptoms of depression, fatigue, and sexual dysfunction. JAMA. 2002 Jul 17. 288(3):351-7. [QxMD MEDLINE Link].
Luijendijk HJ, van den Berg JF, Hofman A, Tiemeier H, Stricker BH. ß-blockers and the risk of incident depression in the elderly. J Clin Psychopharmacol. 2011 Feb. 31(1):45-50. [QxMD MEDLINE Link].
Portella MJ, de Diego-Adeliño J, Ballesteros J, Puigdemont D, Oller S, Santos B, et al. Can we really accelerate and enhance the selective serotonin reuptake inhibitor antidepressant effect? A randomized clinical trial and a meta-analysis of pindolol in nonresistant depression. J Clin Psychiatry. 2011 Jul. 72(7):962-9. [QxMD MEDLINE Link].
U.S. Preventive Services Task Force. Screening for Depression in Adults. U.S. Preventive Services Task Force. Available at http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/depression-in-adults-screening1. January 26, 2016; Accessed: January 27, 2016.
Mitchell AJ, Coyne JC. Do ultra-short screening instruments accurately detect depression in primary care? A pooled analysis and meta-analysis of 22 studies. Br J Gen Pract. 2007 Feb. 57(535):144-51. [QxMD MEDLINE Link]. [Full Text].
Arroll B, Khin N, Kerse N. Screening for depression in primary care with two verbally asked questions: cross sectional study. BMJ. 2003 Nov 15. 327(7424):1144-6. [QxMD MEDLINE Link]. [Full Text].
Tutus A, Kibar M, Sofuoglu S, Basturk M, Gönül AS. A technetium-99m hexamethylpropylene amine oxime brain single-photon emission tomography study in adolescent patients with major depressive disorder. Eur J Nucl Med. 1998 Jun. 25(6):601-6. [QxMD MEDLINE Link].
[Guideline] Qaseem A, Snow V, Denberg TD, Forciea MA, Owens DK. Using second-generation antidepressants to treat depressive disorders: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2008 Nov 18. 149(10):725-33. [QxMD MEDLINE Link]. [Full Text].
Chambless, D. L, Baker, M. J., Baucom, D. H., et al. Update on empirically validated therapies, II. Clin Psychol. 1998. 51, 3-16.
Task Force on Promotion and Dissemination of Psychological Procedures. Training in and dissemination of empirically validated psychological treatments. Clin Psychol. 1995. 48, 3-23.
Chambless, D. L., & Hollon, S. D. Defining empirically supported therapies. JCCP. 1998. 66, 7-18.
US Food and Drug Administration. Celexa (citalopram hydrobromide): Drug safety communication – abnormal heart rhythms associated with high doses. Accessed August 24, 2011. [Full Text].
Celexa (citalopram hydrobromide) [package insert]. St. Louis, Missouri: Forest Pharmaceuticals, Inc. August, 2011. Available at [Full Text].
Henigsberg N, Mahableshwarkar AR, Jacobsen P, Chen Y, Thase ME. A randomized, double-blind, placebo-controlled 8-week trial of the efficacy and tolerability of multiple doses of Lu AA21004 in adults with major depressive disorder. J Clin Psychiatry. 2012 Jul. 73(7):953-9. [QxMD MEDLINE Link].
Alvarez E, Perez V, Dragheim M, Loft H, Artigas F. A double-blind, randomized, placebo-controlled, active reference study of Lu AA21004 in patients with major depressive disorder. Int J Neuropsychopharmacol. 2012 Jun. 15(5):589-600. [QxMD MEDLINE Link]. [Full Text].
Mahableshwarkar AR, Jacobsen PL, Serenko M, Chen Y, Trivedi M. A randomized, double-blind, parallel group study comparing the efficacy and safety of 2 doses of vortioxetine in adults with major depressive disorder. Program and abstracts of the 166th Annual American Psychiatric Association Meeting; May 18-22, 2013; San Francisco, California. Poster NR9-02.
Jacobsen PL, Mahableshwarkar AR, Serenko M, Chen Y, Trivedi M. A randomized, double-blind, placebo-controlled study of the efficacy and safety of vortioxetine 10 mg and 20 mg in adults with major depressive disorder. Program and abstracts of the 166th Annual American Psychiatric Association Meeting; May 18-22, 2013; San Francisco, California. Poster NR9-06.
Katona C, Hansen T, Olsen CK. A randomized, double-blind, placebo-controlled, duloxetine-referenced, fixed-dose study comparing the efficacy and safety of Lu AA21004 in elderly patients with major depressive disorder. Int Clin Psychopharmacol. 2012 Jul. 27(4):215-23. [QxMD MEDLINE Link].
Boulenger JP, Loft H, Florea I. A randomized clinical study of Lu AA21004 in the prevention of relapse in patients with major depressive disorder. J Psychopharmacol. 2012 Nov. 26(11):1408-16. [QxMD MEDLINE Link].
Baldwin DS, Hansen T, Florea I. Vortioxetine (Lu AA21004) in the long-term open-label treatment of major depressive disorder. Curr Med Res Opin. 2012 Oct. 28(10):1717-24. [QxMD MEDLINE Link].
Mahableshwarkar AR, Jacobsen PL, Chen Y. A randomized, double-blind trial of 2.5?mg and 5?mg vortioxetine (Lu AA21004) versus placebo for 8 weeks in adults with major depressive disorder. Curr Med Res Opin. 2013 Mar. 29(3):217-26. [QxMD MEDLINE Link].
Jain R, Mahableshwarkar AR, Jacobsen PL, Chen Y, Thase ME. A randomized, double-blind, placebo-controlled 6-wk trial of the efficacy and tolerability of 5 mg vortioxetine in adults with major depressive disorder. Int J Neuropsychopharmacol. 2013 Mar. 16(2):313-21. [QxMD MEDLINE Link].
Rush AJ, Trivedi MH, Stewart JW, et al. Combining Medications to Enhance Depression Outcomes (CO-MED): Acute and Long-Term Outcomes of a Single-Blind Randomized Study. Am J Psychiatry. 2011 Jul. 168(7):689-701. [QxMD MEDLINE Link].
Rexulti (brexpiprazole) [package insert]. Rockville, MD: Otsuka America Pharmaceutical, Inc. July 2015. Available at [Full Text].
Canuso CM, Singh JB, Fedgchin M, Alphs L, Lane R, Lim P, et al. Efficacy and Safety of Intranasal Esketamine for the Rapid Reduction of Symptoms of Depression and Suicidality in Patients at Imminent Risk for Suicide: Results of a Double-Blind, Randomized, Placebo-Controlled Study. Am J Psychiatry. 2018 Jul 1. 175 (7):620-630. [QxMD MEDLINE Link].
Daly EJ, Singh JB, Fedgchin M, Cooper K, Lim P, Shelton RC, et al. Efficacy and Safety of Intranasal Esketamine Adjunctive to Oral Antidepressant Therapy in Treatment-Resistant Depression: A Randomized Clinical Trial. JAMA Psychiatry. 2018 Feb 1. 75 (2):139-148. [QxMD MEDLINE Link]. [Full Text].
Fu DJ, Ionescu DF, Li X, Lane R, Lim P, Sanacora G, et al. Esketamine Nasal Spray for Rapid Reduction of Major Depressive Disorder Symptoms in Patients Who Have Active Suicidal Ideation With Intent: Double-Blind, Randomized Study (ASPIRE I). J Clin Psychiatry. 2020 May 12. 81 (3):9-15. [QxMD MEDLINE Link]. [Full Text].
Davenport L. Esketamine Nasal Spray May Rapidly Reduce Suicidal Thoughts. Medscape Medical News. 2019 Sep 09. Available at https://www.medscape.com/viewarticle/917955.
Carhart-Harris RL, Roseman L, Bolstridge M, Demetriou L, Pannekoek JN, Wall MB, et al. Psilocybin for treatment-resistant depression: fMRI-measured brain mechanisms. Sci Rep. 2017 Oct 13. 7 (1):13187. [QxMD MEDLINE Link].
Agency for Healthcare Research and Quality. Comparative Effectiveness of Second-Generation Antidepressants in the Pharmacologic Treatment of Adult Depression. Accessed March 22, 2010. AHRQ: Agency for Healthcare Research and Quality. [Full Text].
Zisook S, Lesser IM, Lebowitz B, Rush AJ, Kallenberg G, Wisniewski SR, et al. Effect of antidepressant medication treatment on suicidal ideation and behavior in a randomized trial: an exploratory report from the Combining Medications to Enhance Depression Outcomes Study. J Clin Psychiatry. 2011 Oct. 72(10):1322-32. [QxMD MEDLINE Link].
Fournier JC, DeRubeis RJ, Hollon ST, et al. Antidepressant drug effects and depression severity: a patient-level meta-analysis. JAMA. [Full Text].
Cipriani A, Furukawa TA, Salanti G, Chaimani A, Atkinson LZ, Ogawa Y, et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Lancet. 2018 Feb 20. [QxMD MEDLINE Link].
Hopko DR, Lejuez CW, Ruggiero KJ, Eifert GH. Contemporary behavioral activation treatments for depression: procedures, principles, and progress. Clin Psychol Rev. 2003 Oct. 23(5):699-717. [QxMD MEDLINE Link].
Jacobson NS, Dobson KS, Truax PA, Addis ME, Koerner K, Gollan JK, et al. A component analysis of cognitive-behavioral treatment for depression. J Consult Clin Psychol. 1996 Apr. 64(2):295-304. [QxMD MEDLINE Link].
Kanter JW, Manos RC, Bowe WM, Baruch DE, Busch AM, Rusch LC. What is behavioral activation? A review of the empirical literature. Clin Psychol Rev. 2010 Aug. 30(6):608-20. [QxMD MEDLINE Link].
Lejuez CW, Hopko DR, Hopko SD. A brief behavioral activation treatment for depression. Treatment manual. Behav Modif. 2001 Apr. 25(2):255-86. [QxMD MEDLINE Link].
Dimidjian S, Hollon SD, Dobson KS, Schmaling KB, Kohlenberg RJ, Addis ME, et al. Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. J Consult Clin Psychol. 2006 Aug. 74(4):658-70. [QxMD MEDLINE Link].
McCauley, E., Schloredt, K., Gudmundsen, G., et al. Expanding behavioral activation to depressed adolescents: Lessons learned in treatment development. Cogn and Behav Pract. 2011. 18, 371-383.
Meeks S, Looney SW, Van Haitsma K, Teri L. BE-ACTIV: a staff-assisted behavioral intervention for depression in nursing homes. Gerontologist. 2008 Feb. 48(1):105-14. [QxMD MEDLINE Link].
Sood, J. R., Cisek, E., Zimmerman, J., et al. Treatment of depressive symptoms during short-term rehabilitation: an attempted replication of the DOUR project. Rehabil Psychol. 2003. 48, 44-49.
Quijano, L. M., Stanley, M. A., Peterson, N. J., et al. Healthy Ideas: a depression intervention delivered by community-based case managers serving older adults. J Appl Gerontol. 2007. 26:139-156.
Young JE, Weinberger AD, Beck, AT. Cognitive therapy for depression. Barlow D.H. Clinical handbook of psychological disorders: A step-by-step treatment manual. Third Edition. New York: Guilford Press; 2001. 264-308.
Beck AT, Rush AJ, Shaw BF, Emery G. Cognitive therapy of depression. New York: Guilford Press; 1979.
Areán PA, Cook BL. Psychotherapy and combined psychotherapy/pharmacotherapy for late life depression. Biol Psychiatry. 2002 Aug 1. 52(3):293-303. [QxMD MEDLINE Link].
Pinquart M, Duberstein PR, Lyness JM. Treatments for later-life depressive conditions: a meta-analytic comparison of pharmacotherapy and psychotherapy. Am J Psychiatry. 2006 Sep. 163(9):1493-501. [QxMD MEDLINE Link].
Klerman, G. L., Weissman, M. M., Rounsaville, B. J., et al. Interpersonal Psychotherapy of Depression. New York: Basic Books; 1984.
Gillies, L. A. Interpersonal psychotherapy for depression and other disorders. Barlow D.H. Clinical Handbook of Psychological Disoders: A Step-by-Step Treatment Manual. 3rd ed. New York: The Guilford Press; 2001.
Mufson L, Fairbanks J. Interpersonal psychotherapy for depressed adolescents: a one-year naturalistic follow-up study. J Am Acad Child Adolesc Psychiatry. 1996 Sep. 35(9):1145-55. [QxMD MEDLINE Link].
Reynolds CF 3rd, Frank E, Perel JM, Imber SD, Cornes C, Miller MD, et al. Nortriptyline and interpersonal psychotherapy as maintenance therapies for recurrent major depression: a randomized controlled trial in patients older than 59 years. JAMA. 1999 Jan 6. 281(1):39-45. [QxMD MEDLINE Link].
Kabat-Zinn, J. Full Catastrophe Living: The program of the Stress Reduction Clinic at the University of Massachusetts Medical Center. New York: Delta; 1990.
Segal, Z. V., Teasdale, J. D., & Williams, J. M. G. Mindfulness-based cognitive therapy: Theoretical rationale and empirical status. Hayes, S.C., Follette, V.M. and Linehan, M.M. Mindfulness and Acceptance: Expanding the Cognitive-Behavioral Tradition. New York: Guilford Press; 2011.
Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. Mindfulness based cognitive therapy for depression: A new approach to preventing relapse. New York: Guilford Press; 2002.
Teasdale JD, Segal ZV, Williams JM, Ridgeway VA, Soulsby JM, Lau MA. Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. J Consult Clin Psychol. 2000 Aug. 68(4):615-23. [QxMD MEDLINE Link].
Ma SH, Teasdale JD. Mindfulness-based cognitive therapy for depression: replication and exploration of differential relapse prevention effects. J Consult Clin Psychol. 2004 Feb. 72(1):31-40. [QxMD MEDLINE Link].
Kuyken W, Warren FC, Taylor RS, Whalley B, Crane C, Bondolfi G, et al. Efficacy of Mindfulness-Based Cognitive Therapy in Prevention of Depressive Relapse: An Individual Patient Data Meta-analysis From Randomized Trials. JAMA Psychiatry. 2016 Apr 27. [QxMD MEDLINE Link].
Nezu, A. M., Nezu, C. M., & D’Zurilla, T. J. Solving life’s problems: A 5-step guide to enhanced well-being. New York: Springer; 2007.
Nezu AM, Ronan GF. Life stress, current problems, problem solving, and depressive symptoms: an integrative model. J Consult Clin Psychol. 1985 Oct. 53(5):693-7. [QxMD MEDLINE Link].
Nezu, A. M., Nezu, C. M., Saraydarian, L., et al. Social problem solving as a moderator variable between negative life stress and depressive symptoms. Cognitive Ther Res. 1986. 10:489-498.
Nezu, A. M. Problem solving and behavior therapy revisited. Behav Ther. 2004. 35:1-33.
D’Zurilla, T. J. & Nezu, A. M. Problem-solving therapy: A positive approach to clinical intervention. 3rd ed. New York: Springer; 2007.
D’Zurilla, T. J., Nezu, A. M., & Maydeu-Olivares, A. Social problem solving: Theory and assessment. Chang, E.C., D’Zurilla, T.J., & Sanna, L.J. Social problem solving: Theory, research, and training. Washington, DC: American Psychological Association; 2004. 11-27.
Nezu, A. M., Nezu, C. M., & Lombardo, E. Problem-solving therapy. O’Donohue, W., Fisher, J. E. & Hayes, S. C.,. Cognitive behavior therapy: Applying empirically supported techniques in your practice. Hoboken, NJ: John Wiley & Sons; 2003. 301-307.
Nezu AM. Efficacy of a social problem-solving therapy approach for unipolar depression. J Consult Clin Psychol. 1986 Apr. 54(2):196-202. [QxMD MEDLINE Link].
Nezu AM, Perri MG. Social problem-solving therapy for unipolar depression: an initial dismantling investigation. J Consult Clin Psychol. 1989 Jun. 57(3):408-13. [QxMD MEDLINE Link].
Arean PA, Perri MG, Nezu AM, Schein RL, Christopher F, Joseph TX. Comparative effectiveness of social problem-solving therapy and reminiscence therapy as treatments for depression in older adults. J Consult Clin Psychol. 1993 Dec. 61(6):1003-10. [QxMD MEDLINE Link].
Mynors-Wallis LM, Gath DH, Lloyd-Thomas AR, Tomlinson D. Randomised controlled trial comparing problem solving treatment with amitriptyline and placebo for major depression in primary care. BMJ. 1995 Feb 18. 310(6977):441-5. [QxMD MEDLINE Link]. [Full Text].
Dowrick C, Dunn G, Ayuso-Mateos JL, Dalgard OS, Page H, Lehtinen V, et al. Problem solving treatment and group psychoeducation for depression: multicentre randomised controlled trial. Outcomes of Depression International Network (ODIN) Group. BMJ. 2000 Dec 9. 321(7274):1450-4. [QxMD MEDLINE Link]. [Full Text].
Lam RW, Levitt AJ, Levitan RD, Michalak EE, Morehouse R, Ramasubbu R, et al. Efficacy of Bright Light Treatment, Fluoxetine, and the Combination in Patients With Nonseasonal Major Depressive Disorder: A Randomized Clinical Trial. JAMA Psychiatry. 2015 Nov 18. 1-9. [QxMD MEDLINE Link].
Lieverse R, Van Someren EJ, Nielen MM, Uitdehaag BM, Smit JH, Hoogendijk WJ. Bright light treatment in elderly patients with nonseasonal major depressive disorder: a randomized placebo-controlled trial. Arch Gen Psychiatry. 2011 Jan. 68(1):61-70. [QxMD MEDLINE Link].
Wirz-Justice A, Bader A, Frisch U, Stieglitz RD, Alder J, Bitzer J, et al. A randomized, double-blind, placebo-controlled study of light therapy for antepartum depression. J Clin Psychiatry. 2011 Jul. 72(7):986-93. [QxMD MEDLINE Link].
Cassels C. FDA Clears TMS Device for Resistant Depression. Medscape Medical News. Jan 9 2013. [Full Text].
Brooks, M. FDA Okays TMS Device for Rapid Treatment of Major Depression. Mescape Medical News. Available at http://www.medscape.com/viewarticle/878770. April 18, 2017; Accessed: April 24, 2017.
Brooks M. FDA Clears New Brain Stimulation System for Depression. Medscape Medical News. Available at https://www.medscape.com/viewarticle/850332. August 31, 2015;
Brooks M. FDA Clears 3-Minute Brain Stimulation Protocol for Depression. Medscape Medical News. Available at https://www.medscape.com/viewarticle/901052. August 22, 2018; Accessed: August 29, 2018.
Krogh J, Nordentoft M, Sterne JA, Lawlor DA. The effect of exercise in clinically depressed adults: systematic review and meta-analysis of randomized controlled trials. J Clin Psychiatry. 2011 Apr. 72(4):529-38. [QxMD MEDLINE Link].
Kennedy SH, Giacobbe P, Rizvi SJ, et al. Deep brain stimulation for treatment-resistant depression: follow-up after 3 to 6 years. Am J Psychiatry. 2011 May. 168(5):502-10. [QxMD MEDLINE Link].
Brunoni AR, Valiengo L, Baccaro A, Zanão TA, de Oliveira JF, Goulart A, et al. The Sertraline vs Electrical Current Therapy for Treating Depression Clinical Study: Results From a Factorial, Randomized, Controlled Trial. JAMA Psychiatry. 2013 Feb 6. 1-9. [QxMD MEDLINE Link].
Klawansky S, Yeung A, Berkey C, Shah N, Phan H, Chalmers TC. Meta-analysis of randomized controlled trials of cranial electrostimulation. Efficacy in treating selected psychological and physiological conditions. J Nerv Ment Dis. 1995 Jul. 183 (7):478-84. [QxMD MEDLINE Link].
Brooks M. FDA OKs Brain Stimulator for Insomnia, Anxiety, Depression. Medscape Medical News. Available at https://www.medscape.com/viewarticle/910999. March 27, 2019; Accessed: March 28, 2019.
Rush AJ, Trivedi MH, Wisniewski SR, Nierenberg AA, Stewart JW, Warden D, et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry. 2006 Nov. 163(11):1905-17. [QxMD MEDLINE Link].
Rush AJ. Star-D: lessons learned and future implications. Depress Anxiety. 2011 Jul. 28(7):521-4. [QxMD MEDLINE Link].
Berman RM, Marcus RN, Swanink R, McQuade RD, Carson WH, Corey-Lisle PK, et al. The efficacy and safety of aripiprazole as adjunctive therapy in major depressive disorder: a multicenter, randomized, double-blind, placebo-controlled study. J Clin Psychiatry. 2007 Jun. 68(6):843-53. [QxMD MEDLINE Link].
Marcus RN, McQuade RD, Carson WH, Hennicken D, Fava M, Simon JS, et al. The efficacy and safety of aripiprazole as adjunctive therapy in major depressive disorder: a second multicenter, randomized, double-blind, placebo-controlled study. J Clin Psychopharmacol. 2008 Apr. 28(2):156-65. [QxMD MEDLINE Link].
Berman RM, Fava M, Thase ME, Trivedi MH, Swanink R, McQuade RD, et al. Aripiprazole augmentation in major depressive disorder: a double-blind, placebo-controlled study in patients with inadequate response to antidepressants. CNS Spectr. 2009 Apr. 14(4):197-206. [QxMD MEDLINE Link].
Lowry F. Vagus nerve stimulation effective in resistant depression. Medscape Medical News. May 16, 2013. [Full Text].
Conway CR, Chibnall JT, Gebara MA, Price JL, Snyder AZ, Mintun MA, et al. Association of cerebral metabolic activity changes with vagus nerve stimulation antidepressant response in treatment-resistant depression. Brain Stimul. 2013 Feb 13. [QxMD MEDLINE Link].
Cassels C. TMS for resistant depression: long-term results are in. Medscape Medical News. May 24, 2013. [Full Text].
March JS, Silva S, Petrycki S, Curry J, Wells K, Fairbank J, et al. The Treatment for Adolescents With Depression Study (TADS): long-term effectiveness and safety outcomes. Arch Gen Psychiatry. 2007 Oct. 64(10):1132-43. [QxMD MEDLINE Link].
Hughes CW, Emslie GJ, Crismon ML, Posner K, Birmaher B, Ryan N, et al. Texas Children's Medication Algorithm Project: update from Texas Consensus Conference Panel on Medication Treatment of Childhood Major Depressive Disorder. J Am Acad Child Adolesc Psychiatry. 2007 Jun. 46(6):667-86. [QxMD MEDLINE Link].
Brent DA. The treatment of SSRI-resistant depression in adolescents (TORDIA): in search of the best next step. Depress Anxiety. 2009. 26(10):871-4. [QxMD MEDLINE Link].
Leonard HL, March J, Rickler KC, Allen AJ. Pharmacology of the selective serotonin reuptake inhibitors in children and adolescents. J Am Acad Child Adolesc Psychiatry. 1997 Jun. 36(6):725-36. [QxMD MEDLINE Link].
Rey-Sánchez F, Gutiérrez-Casares JR. Paroxetine in children with major depressive disorder: an open trial. J Am Acad Child Adolesc Psychiatry. 1997 Oct. 36(10):1443-7. [QxMD MEDLINE Link].
Tsapakis EM, Soldani F, Tondo L, Baldessarini RJ. Efficacy of antidepressants in juvenile depression: meta-analysis. Br J Psychiatry. 2008 Jul. 193(1):10-7. [QxMD MEDLINE Link].
Emslie GJ, Rush AJ, Weinberg WA, Kowatch RA, Hughes CW, Carmody T, et al. A double-blind, randomized, placebo-controlled trial of fluoxetine in children and adolescents with depression. Arch Gen Psychiatry. 1997 Nov. 54(11):1031-7. [QxMD MEDLINE Link].
March JS, Silva S, Petrycki S, Curry J, Wells K, Fairbank J, et al. The Treatment for Adolescents With Depression Study (TADS): long-term effectiveness and safety outcomes. Arch Gen Psychiatry. 2007 Oct. 64(10):1132-43. [QxMD MEDLINE Link].
Cassels C. FDA Suicide Warnings Change Antidepressant Prescribing Patterns, but Physicians Ignore Monitoring Recommendations. Medscape Today. Available at http://www.medscape.com/viewarticle/715952. Accessed: March 22, 2010.
Cassels C. FDA Suicide Warnings About Antidepressants Cut Rates of Depression Diagnosis and Treatment. Medscape Today. Available at http://www.medscape.com/viewarticle/704235. Accessed: March 22, 2010.
Leon AC, Solomon DA, Li C, et al. Antidepressants and risks of suicide and suicide attempts: a 27-year observational study. J Clin Psychiatry. 2011 May. 72(5):580-6. [QxMD MEDLINE Link].
Carlsten A, Waern M, Ekedahl A, Ranstam J. Antidepressant medication and suicide in Sweden. Pharmacoepidemiol Drug Saf. 2001 Oct-Nov. 10(6):525-30. [QxMD MEDLINE Link].
Hall WD, Mant A, Mitchell PB, Rendle VA, Hickie IB, McManus P. Association between antidepressant prescribing and suicide in Australia, 1991-2000: trend analysis. BMJ. 2003 May 10. 326(7397):1008. [QxMD MEDLINE Link]. [Full Text].
Olfson M, Marcus SC, Druss B, Pincus HA. National trends in the use of outpatient psychotherapy. Am J Psychiatry. 2002 Nov. 159(11):1914-20. [QxMD MEDLINE Link].
March J, Silva S, Petrycki S, Curry J, Wells K, Fairbank J, et al. Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents With Depression Study (TADS) randomized controlled trial. JAMA. 2004 Aug 18. 292(7):807-20. [QxMD MEDLINE Link].
Simon GE, Savarino J, Operskalski B, Wang PS. Suicide risk during antidepressant treatment. Am J Psychiatry. 2006 Jan. 163(1):41-7. [QxMD MEDLINE Link].
Grote NK, Bridge JA, Gavin AR, Melville JL, Iyengar S, Katon WJ. A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Arch Gen Psychiatry. 2010 Oct. 67(10):1012-24. [QxMD MEDLINE Link].
Chambers CD, Hernandez-Diaz S, Van Marter LJ, Werler MM, Louik C, Jones KL, et al. Selective serotonin-reuptake inhibitors and risk of persistent pulmonary hypertension of the newborn. N Engl J Med. 2006 Feb 9. 354(6):579-87. [QxMD MEDLINE Link]. [Full Text].
Occhiogrosso M, Omran SS, Altemus M. Persistent pulmonary hypertension of the newborn and selective serotonin reuptake inhibitors: lessons from clinical and translational studies. Am J Psychiatry. 2012 Feb. 169(2):134-40. [QxMD MEDLINE Link].
FDA drug safety communication: Selective serotonin reuptake inhibitor (SSRI) antidepressant use during pregnancy and reports of a rare heart and lung condition in newborn babies. US Food and Drug Administration. Available at http://www.fda.gov/Drugs/DrugSafety/ucm283375.htm. Accessed: December 14, 2011.
Levinson-Castiel R, Merlob P, Linder N, Sirota L, Klinger G. Neonatal abstinence syndrome after in utero exposure to selective serotonin reuptake inhibitors in term infants. Arch Pediatr Adolesc Med. 2006 Feb. 160(2):173-6. [QxMD MEDLINE Link].
di Scalea TL, Wisner KL. Pharmacotherapy of postpartum depression. Expert Opin Pharmacother. 2009 Nov. 10(16):2593-607. [QxMD MEDLINE Link]. [Full Text].
Yonkers KA, Wisner KL, Stewart DE, Oberlander TF, Dell DL, Stotland N, et al. The management of depression during pregnancy: a report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists. Obstet Gynecol. 2009 Sep. 114(3):703-13. [QxMD MEDLINE Link].
Wisner KL, Perel JM, Peindl KS, Hanusa BH, Piontek CM, Findling RL. Prevention of postpartum depression: a pilot randomized clinical trial. Am J Psychiatry. 2004 Jul. 161(7):1290-2. [QxMD MEDLINE Link].
Weissman AM, Levy BT, Hartz AJ, Bentler S, Donohue M, Ellingrod VL, et al. Pooled analysis of antidepressant levels in lactating mothers, breast milk, and nursing infants. Am J Psychiatry. 2004 Jun. 161(6):1066-78. [QxMD MEDLINE Link].
Andreescu C, Lenze EJ, Mulsant BH, Wetherell JL, Begley AE, Mazumdar S, et al. High worry severity is associated with poorer acute and maintenance efficacy of antidepressants in late-life depression. Depress Anxiety. 2009. 26(3):266-72. [QxMD MEDLINE Link]. [Full Text].
Cooper C, Katona C, Lyketsos K, et al. A systematic review of treatments for refractory depression in older people. Am J Psychiatry. 2011 Jul. 168(7):681-8. [QxMD MEDLINE Link].
Anderson P. DASH Diet Linked to Lower Risk for Depression. Medscape Medical News. Available at https://www.medscape.com/viewarticle/893222. February 28, 2018; Accessed: March 21, 2018.
Bogomolova S, Zarnowiecki D, Wilson A, Fielder A, Procter N, Itsiopoulos C, et al. Dietary intervention for people with mental illness in South Australia. Health Promot Int. 2018 Feb 1. 33 (1):71-83. [QxMD MEDLINE Link].
Jacka FN, O'Neil A, Opie R, Itsiopoulos C, Cotton S, Mohebbi M, et al. A randomised controlled trial of dietary improvement for adults with major depression (the 'SMILES' trial). BMC Med. 2017 Jan 30. 15 (1):23. [QxMD MEDLINE Link].
McEvoy CT, Guyer H, Langa KM, Yaffe K. Neuroprotective Diets Are Associated with Better Cognitive Function: The Health and Retirement Study. J Am Geriatr Soc. 2017 Aug. 65 (8):1857-1862. [QxMD MEDLINE Link].
Fabian TJ, Amico JA, Kroboth PD, Mulsant BH, Corey SE, Begley AE, et al. Paroxetine-induced hyponatremia in older adults: a 12-week prospective study. Arch Intern Med. 2004 Feb 9. 164(3):327-32. [QxMD MEDLINE Link].
King RA, Segman RH, Anderson GM. Serotonin and suicidality: the impact of acute fluoxetine administration. I: Serotonin and suicide. Isr J Psychiatry Relat Sci. 1994. 31(4):271-9. [QxMD MEDLINE Link].
Teicher MH, Glod CA, Cole JO. Antidepressant drugs and the emergence of suicidal tendencies. Drug Saf. 1993 Mar. 8(3):186-212. [QxMD MEDLINE Link].
Pan A, Okereke OI, Sun Q, Logroscino G, Manson JE, Willett WC, et al. Depression and incident stroke in women. Stroke. 2011 Oct. 42(10):2770-5. [QxMD MEDLINE Link]. [Full Text].
Pan A, Sun Q, Okereke OI, Rexrode KM, Hu FB. Depression and risk of stroke morbidity and mortality: a meta-analysis and systematic review. JAMA. 2011 Sep 21. 306(11):1241-9. [QxMD MEDLINE Link]. [Full Text].
Baldessarini RJ, Tondo L, Ghiani C, Lepri B. Illness risk following rapid versus gradual discontinuation of antidepressants. Am J Psychiatry. 2010 Aug. 167(8):934-41. [QxMD MEDLINE Link].
Nelson JC, Papakostas GI. Atypical antipsychotic augmentation in major depressive disorder: a meta-analysis of placebo-controlled randomized trials. Am J Psychiatry. 2009 Sep. 166(9):980-91. [QxMD MEDLINE Link].
Gilbody S, Bower P, Fletcher J, Richards D, Sutton AJ. Collaborative care for depression: a cumulative meta-analysis and review of longer-term outcomes. Arch Intern Med. 2006 Nov 27. 166(21):2314-21. [QxMD MEDLINE Link].
Kroll L, Harrington R, Jayson D, Fraser J, Gowers S. Pilot study of continuation cognitive-behavioral therapy for major depression in adolescent psychiatric patients. J Am Acad Child Adolesc Psychiatry. 1996 Sep. 35(9):1156-61. [QxMD MEDLINE Link].
Bennabi D, Yrondi A, Charpeaud T, Genty JB, Destouches S, et al. Clinical guidelines for the management of depression with specific comorbid psychiatric conditions French recommendations from experts (the French Association for Biological Psychiatry and Neuropsychopharmacology and the fondation FondaMental). BMC Psychiatry. 2019 Jan 30. 19 (1):50. [QxMD MEDLINE Link].
[Guideline] Guu TW, Mischoulon D, Sarris J, Hibbeln J, McNamara RK, Hamazaki K, et al. International Society for Nutritional Psychiatry Research Practice Guidelines for Omega-3 Fatty Acids in the Treatment of Major Depressive Disorder. Psychother Psychosom. 2019. 88 (5):263-273. [QxMD MEDLINE Link]. [Full Text].
National Institute of Mental Health. Major Depression Among Adults. National Institutes of Health. Available at https://www.nimh.nih.gov/health/statistics/prevalence/major-depression-among-adults.shtml. 2015; Accessed: July 26, 2017.
Conwell Y, Duberstein PR, Caine ED. Risk factors for suicide in later life. Biol Psychiatry. 2002 Aug 1. 52(3):193-204. [QxMD MEDLINE Link].
Elovainio M, Shipley MJ, Ferrie JE, Gimeno D, Vahtera J, Marmot MG, et al. Obesity, unexplained weight loss and suicide: the original Whitehall study. J Affect Disord. 2009 Aug. 116(3):218-21. [QxMD MEDLINE Link].
A Message From APA President Dilip Jeste, M.D., on DSM-5. Available at http://www.psychnews.org/files/DSM-message.pdf. Accessed: December 1, 2012.
Anderson P. Stimulation device shows 'immediate' impact on depression. Medscape Medical News. July 31, 2014. [Full Text].
Asnis GM, Bose A, Gommoll CP, Chen C, Greenberg WM. Efficacy and safety of levomilnacipran sustained release 40 mg, 80 mg, or 120 mg in major depressive disorder: a phase 3, randomized, double-blind, placebo-controlled study. J Clin Psychiatry. 2013 Mar. 74(3):242-8. [QxMD MEDLINE Link].
Bender K. Cognitive therapy, meds equal in curbing depression relapse. Medscape Medical News. November 20, 2013. [Full Text].
Brauser D. Depression Causally Linked to Heart Disease. Medscape Medical News. Available at http://www.medscape.com/viewarticle/820313. Accessed: February 12, 2014.
Brunner EJ, Shipley MJ, Britton AR, Stansfeld SA, Heuschmann PU, Rudd AG, et al. Depressive disorder, coronary heart disease, and stroke: dose-response and reverse causation effects in the Whitehall II cohort study. Eur J Prev Cardiol. 2014 Feb 3. [QxMD MEDLINE Link].
Cassels C. FDA Approves New SNRI for Major Depression. Medscape Medical News. Available at http://www.medscape.com/viewarticle/808481.. Accessed: August 6, 2013.
Cassels C. FDA Approves Vortioxetine for Major Depression. Medscape Medical News. Available at http://www.medscape.com/viewarticle/811892. Accessed: October 8, 2013.
Dennis CL, Dowswell T. Psychosocial and psychological interventions for preventing postpartum depression. Cochrane Database Syst Rev. 2013 Feb 28. 2:CD001134. [QxMD MEDLINE Link].
Harris EC, Barraclough B. Suicide as an outcome for mental disorders. A meta-analysis. Br J Psychiatry. 1997 Mar. 170:205-28. [QxMD MEDLINE Link].
Hollon SD, Ponniah K. A review of empirically supported psychological therapies for mood disorders in adults. Depress Anxiety. 2010 Oct. 27(10):891-932. [QxMD MEDLINE Link]. [Full Text].
Irwin MR, Levin MJ, Laudenslager ML, Olmstead R, Lucko A, Lang N, et al. Varicella Zoster Virus-Specific Immune Responses to a Herpes Zoster Vaccine in Elderly Recipients With Major Depression and the Impact of Antidepressant Medications. Clin Infect Dis. 2013 Feb 13. [QxMD MEDLINE Link].
Jarrett RB, Minhajuddin A, Gershenfeld H, Friedman ES, Thase ME. Preventing depressive relapse and recurrence in higher-risk cognitive therapy responders: a randomized trial of continuation phase cognitive therapy, fluoxetine, or matched pill placebo. JAMA Psychiatry. 2013 Nov 1. 70(11):1152-60. [QxMD MEDLINE Link].
Rohan ML, Yamamoto RT, Ravichandran CT, et al. Rapid mood-elevating effects of low field magnetic stimulation in depression. Biol Psychiatry. 2014 Aug 1. 76(3):186-93. [QxMD MEDLINE Link].
Steingard RJ, Renshaw PF, Yurgelun-Todd D, Appelmans KE, Lyoo IK, Shorrock KL, et al. Structural abnormalities in brain magnetic resonance images of depressed children. J Am Acad Child Adolesc Psychiatry. 1996 Mar. 35(3):307-11. [QxMD MEDLINE Link].
Ali-Sisto T, Tolmunen T, Viinamäki H, Mäntyselkä P, Valkonen-Korhonen M, Koivumaa-Honkanen H, et al. Global arginine bioavailability ratio is decreased in patients with major depressive disorder. J Affect Disord. 2018 Mar 15. 229:145-151. [QxMD MEDLINE Link].

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From 1991-2006, the suicide rate was consistently higher among males. Suicide rates declined among both sexes from 1991-2000; the rate among males decreased from 24.64 to 20.67 suicides per 100,000 and 5.48 to 4.62 suicides per 100,000 among females. From 2000-2006, however, the suicide rates gradually increased among females. Note: All rates are age-adjusted to the standard 2000 population. Rates based on less than 20 deaths are statistically unreliable. Source: Centers for Disease Control and Prevention. National suicide statistics at a glance: Trends in suicide rates among persons ages 10 years and older, by sex, United States, 1991-2006. Available at: http://www.cdc.gov/violenceprevention/suicide/statistics/trends01.html. Accessed: May 5, 2010.
Geriatric Depression Scale.
Geriatric Depression Scale-Short.
Hamilton Depression Scale.
Center for Epidemiologic Studies Depression Scale.
Cornell Scale for Depression in Dementia.
Suicide rate by age and gender. 2004 data compiled from CDC. The mean suicide rate for the entire population was 12.8/100,000/year.
Depression in the US Household Population, 2009–2012. Courtesy of National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC).
12-month Prevalence of Major Depressive Episode Among US Adults, 2015. Courtesy of National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC).

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Table.

level of support	Therapy
Efficacious and specific	Interpersonal psychotherapy (IPT)
	Cognitive behavior therapy (CBT)
	Problem-solving therapy (PST)
	Behavioral activation (BA)/contingency management
Possibly efficacious	Dynamic psychotherapy
	Cognitive behavioral analysis system for psychotherapy (CBASP)
	Emotion-focused therapy (EFT)

Table.

level of support	Therapy
Efficacious and specific	Prior CBT to prevent relapse
Efficacious	Mindfulness-based cognitive therapy (MBCT) to prevent relapse/recurrence
Possibly efficacious	Prior dynamic psychotherapy to prevent recurrence
	Maintenance IPT to prevent recurrence
	Continuation cognitive therapy (CT) to prevent relapse/recurrence
	Maintenance CBASP to prevent recurrence
	EFT to prevent relapse

Table 1. Treatment Response Over Time in the Treatment of Adolescents with Depression Study

Treatment	Response Rate (%)
	Week 12	Week 18	Week 36
Fluoxetine	62	69	81
Cognitive-behavioral therapy (CBT)	48	65	81
Fluoxetine plus CBT	73	85	86

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Author

Jerry L Halverson, MD Medical Director of Rogers Memorial Hospital at Oconomowoc; Voluntary Clinical Assistant Professor, Department of Psychiatry, University of Wisconsin School of Medicine and Public Health; Clinical Assistant Professor of Psychiatry, Department of Psychiatry and Behavioral Sciences, Medical College of Wisconsin

Jerry L Halverson, MD is a member of the following medical societies: American College of Psychiatrists, American Medical Association, American Psychiatric Association

Disclosure: Nothing to disclose.

Coauthor(s)

Ravinder N Bhalla, MD Assistant Clinical Professor of Child Psychiatry, Rutgers New Jersey Medical School; Medical Director, Mental Health Clinic of Passaic; Consulting Staff, Christian Health Care Center

Ravinder N Bhalla, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry

Disclosure: Received income in an amount equal to or greater than $250 from: Allergen.

Pascale Moraille-Bhalla, MD Medical Director, Outpatient Clinic of Hoboken University Medical Center; Staff Psychiatrist, Mental Health Clinic of Passaic

Pascale Moraille-Bhalla, MD is a member of the following medical societies: American Psychiatric Association

Disclosure: Nothing to disclose.

Louise B Andrew, MD, JD Medical-Legal, Risk Management and Trial Consultant, Litigation Stress Counselor

Louise B Andrew, MD, JD is a member of the following medical societies: American Association of Women Emergency Physicians, American College of Emergency Physicians, American Medical Association

Disclosure: Nothing to disclose.

Rachel C Leonard, PhD Clinical Director, Rogers Behavioral Health

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

David Bienenfeld, MD Professor, Departments of Psychiatry and Geriatric Medicine, Wright State University, Boonshoft School of Medicine

David Bienenfeld, MD is a member of the following medical societies: American Medical Association, American Psychiatric Association, Association for Academic Psychiatry

Disclosure: Nothing to disclose.

Acknowledgements

Iqbal Ahmed, MBBS, FRCPsych (UK) Faculty, Department of Psychiatry, Tripler Army Medical Center; Clinical Professor of Psychiatry, Clinical Professor of Geriatric Medicine, University of Hawaii, John A Burns School of Medicine

Iqbal Ahmed, MBBS, FRCPsych (UK) is a member of the following medical societies: Academy of Psychosomatic Medicine, American Association for Geriatric Psychiatry, American Neuropsychiatric Association, American Psychiatric Association, American Society of Clinical Psychopharmacology, and Royal College of Psychiatrists

Disclosure: Nothing to disclose.

Sarah C Aronson, MD Associate Professor, Departments of Psychiatry and Medicine, Case Western Reserve School of Medicine/University Hospitals of Cleveland

Disclosure: Nothing to disclose.

Barry I Liskow, MD Professor of Psychiatry, Vice Chairman, Psychiatry Department, Director, Psychiatric Residency Program, University of Kansas School of Medicine; Director, Psychiatric Outpatient Clinic, The University of Kansas Medical Center

Disclosure: Nothing to disclose.

Mohammed A Memon, MD Chairman and Attending Geriatric Psychiatrist, Department of Psychiatry, Spartanburg Regional Medical Center

Mohammed A Memon, MD is a member of the following medical societies: American Association for Geriatric Psychiatry, American Medical Association, and American Psychiatric Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Art Walaszek, MD Associate Professor of Psychiatry, Residency Training Director, Department of Psychiatry, University of Wisconsin School of Medicine and Public Health; Consulting Staff, University of Wisconsin Hospital and Clinics, Meriter Hospital

Art Walaszek, MD is a member of the following medical societies: American Association for Geriatric Psychiatry, American Medical Association, American Psychiatric Association, and Association for Academic Psychiatry

Disclosure: Terra Nova Learning Systems, Inc. Consulting fee Consulting; Wisconsin Psychiatric Association Honoraria Speaking and teaching; Care Wisconsin, Inc. Honoraria Speaking and teaching