New paradigm for treating recurrent depression: from symptom control to managing enduring vulnerabilities

Italian patients with more recent onset of Major Depressive Disorder have a shorter duration of untreated illness

BACKGROUND

Previous investigation on the duration of untreated illness (DUI) in patients with Major Depressive Disorder (MDD) revealed a different latency to first antidepressant treatment, with adverse consequences in terms of outcome for individuals with a longer DUI. Recent reports, moreover, documented a reduced DUI, as observed with the passage of time, in patients with different psychiatric disorders. Hence, the present study was aimed to assess DUI and related variables in a sample of Italian patients with MDD as well as to investigate potential differences in subjects with onset before and after 2000.

METHODS

An overall sample of 188 patients with MDD was assessed through a specific questionnaire investigating DUI and other variables related to the psychopathological onset and latency to first antidepressant treatment, after dividing them in two different subgroups on the basis of their epoch of onset.

RESULTS

The whole sample showed a mean DUI of approximately 4.5 years, with patients with more recent onset showing a significantly shorter latency to treatment compared with the other group (27.1±42.6 vs 75.8±105.2 months, P<.05). Other significant differences emerged between the two subgroups, in terms of rates of onset-related stressful events and benzodiazepine prescription, respectively, higher and lower in patients with more recent onset.

CONCLUSIONS

Our findings indicate a significant DUI reduction in MDD patients whose onset occurred after vs before 2000, along with other relevant differences in terms of onset-related correlates and first pharmacotherapy. Further studies with larger samples are warranted to confirm the present findings in Italy and other countries.

Spiritually integrated treatment of depression: a conceptual framework

Many studies have found an inverse correlation between religious/spiritual involvement and depression. Yet several obstacles impede spiritually integrated treatment of depressed individuals. These include specialization and fragmentation of care, inexperience of clinicians and spiritual care providers, ideological bias, boundary and ethical concerns, and the lack of an accepted conceptual framework for integrated treatment. Here I suggest a framework for approaching these obstacles, constructed from a unified view of human experience (having emotional, existential, and spiritual dimensions); spirituality seen as a response to existential concerns (in domains such as identity, hope, meaning/purpose, morality, and autonomy in relation to authority, which are frequently distorted and amplified in depression); a rationale for locating spiritually oriented approaches within a clinician's assessment, formulation, and treatment plan; and recognition of the challenges and potential pitfalls of integrated treatment.

Grey matter volume reductions in the emotion network of patients with depression and coronary artery disease

Coronary Artery Disease (CAD) and Major Depressive Disorder (MDD) commonly co-occur and may be linked by a network of brain regions involved in emotion regulation, including the orbitofrontal cortex, amygdala/parahippocamal region and insula. We hypothesized structural differences in this emotion network more prominently in CAD+MDD versus CAD and healthy control (CTRL) groups that do not involve depression-related emotion circuitry. In contrast, we hypothesized structural similarities between CAD+MDD and MDD groups, both involving depression-related circuitry. We obtained structural magnetic resonance imaging scans from age-matched consenting subjects (CAD+MDD, n = 12; CAD, n = 12; MDD, n = 19; CTRL, n = 17) and performed a region of interest analysis. We found decreased grey matter volumes in the bilateral orbitofrontal cortex, bilateral amygdala/parahippocampal gyrus and right insula in CAD+MDD versus CTRL subjects and decreased grey matter volumes in the bilateral amygdala/parahippocampal regions in CAD+MDD versus CAD subjects. We found grey matter reductions in the right orbitofrontal cortex of CAD+MDD versus MDD subjects, and reductions in right insula of CAD versus CRTL subjects. Our results support that the network of brain regions involved in emotion regulation may be relevant to the relationship between CAD and MDD.