The first to describe melancholia and mania as two aspects of the same disease was Areteo from Cappadocia in the I century B.C. The history of bipolar disorder started off in ancient Greece. This may reflect a paucity of primary studies upon which to base conclusions. Consistency and clarity in guidelines for second-line treatment of depression are therefore important for clinicians but lacking in most current guidelines. AGREE II ratings for stakeholder involvement in CPG development, editorial independence, and rigor of development are domains in which depression guidelines are often less robust.Ībout half of patients with depression require second-line treatment to achieve remission. There is variability between CPGs in recommending combination strategies. For adults with MDD, most CPGs do not define an "inadequate response" or provide specific suggestions regarding how to choose alternative medications when switching to an alternative antidepressant. None provides recommendations for those who do not respond to first-line SSRI treatment. Five CPGs consider patients with dysthymia or subthreshold or minor depression. From these 21 CPG were applicable to adults in primary care and outpatient settings. Two raters assessed quality using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument.įrom 46,908 citations, 3167 were screened at full text. Data extraction included definitions of adequate response and recommended treatment options. Two raters selected CPGs on depression with a national scope. Searches for CPGs (January 2004 to November 2014) in English included 7 bibliographic databases and grey literature sources using CPG and depression as the keywords. This systematic review critically evaluated clinical practice guidelines (CPGs) for treating adults with major depressive disorder, dysthymia, or subthreshold or minor depression for recommendations following inadequate response to first-line treatment with selective serotonin reuptake inhibitors (SSRIs). The combination of these biological biomarkers found in animals has led to the creation of behavioral models in rodents and zebrafish capable of better understanding depression and contributing to the discovery of new antidepressants.Key wordsDepressionBiomarkersInflammationBehavioral models In addition to the neurotransmitter and neuroendocrine markers that have been studied extensively for many decades, recent data points to the inflammatory response (and more generally the immune system) and metabolic and growth factors involved in depression. The vast literature on depression indicates a large number of biomarkers that may improve the treatment of people with depression. Providing ineffective therapies has significant consequences on individual and societal costs, including persistent distress and poor well-being, risk of suicide, loss of productivity, and waste of healthcare resources. The literature indicates that about two-thirds of patients with depression do not achieve remission on initial treatment and that the likelihood of non-response increases with the number of treatments tested.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |