There are some clear differences between the treatments used by Canadian doctors and patients: first-line treatments were more commonly used by Canadian patients. More effective treatments are more used by Canadian doctors. In the case of antidepressants, one third of patients were prescribed more efficacious agents, and one third were prescribed antidepressants that had not been proven for their efficacy. Although psychiatrists do report receiving and providing a variety of treatments, and patients do report feeling better after receiving treatments, the data also shows that not all patients are properly treated and that there are no standardized protocols for how they receive the treatment. Patients should start with the least efficacious treatments they can afford.
The lifetime prevalence of major depressive episode within the U.S. population exceeds 2% (2.0%). This rate is similar to estimates of lifetime prevalence of major depression among all cultures, and is higher than many previous estimates.
Depression should not be oversimplified to be explained by a simple chemical imbalance in the brain. Instead, depression is likely to be more complicated with a multiplicity of contributing factors.
The first cause of depression is the death of a loved one, most commonly a parent, or a romantic partner, with a rate of around 50%. The second cause is the loss of a loved friend. About 15% of the population gets depression every year, and this varies over time and from place to place. The third major cause is financial problems, such as unemployment, insufficient income, or an unfavourable relationship with a spouse or partner. Around 5% of people suffer from depression or a recurrence of depression once a year or more often, and about 6% suffer from moderate or serious depression every year, or more often. The fourth cause of depression is a loss of a job, with a rate of around 3%.
Patient advocacy groups and patients' organizations often report that trials' investigators focus on inclusion criteria based on symptom profiles of the patients they enroll. The evidence obtained from these trials is most likely to benefit the most patients in clinics where patients are very ill with severe depression, but also benefit the most patients in practices where the majority of patients are not severely ill but are nonetheless depressed. There is therefore important potential for improving access to clinical trials in psychiatry by increasing participation by disadvantaged patients whose symptoms are more representative of patients the investigators wish to study in clinical trials.
It is possible that interpersonal psychotherapy can improve psychological outcomes in depressed adolescents with interpersonal problems compared to control groups. It is also possible that group skills training may help alleviate some of the interpersonal and emotional difficulties faced by adolescents.
A recent review of antidepressant agents concluded that 5-HT antagonists and serotonin-norepinephrine reuptake inhibitors have greater efficacy and fewer side effects than SSRIs and SNRIs in the treatment of depression. At this time, the evidence supports the use of 5-HT antagonists and SNRIs in the treatment of depression in the elderly. Evidence from trials with serotonin and norepinephrine reuptake inhibitors (SNRIs) suggests that the efficacy of antidepressant agents may vary with age and gender. Evidence from trials with SSRIs and SNRIs suggests that the efficacy of antidepressant agents may vary with baseline depression severity, with the strongest antidepressant efficacy occurring in patients with moderate or severe depression.
Interpersonal psychotherapy is feasible for adults and adolescents with similar needs and characteristics. Given their strong commitment and personal integrity, individuals of this generation may lend themselves most to the development of personal contact sessions using a psychodynamic model of care.
This is a pilot research study that will determine whether enhancing the core interpersonal skills learned in a group setting with adolescent skills training has an impact on the degree to which participants experience improvements in quality of life. Preliminary data suggest that increased interpersonal skills in group treatment may lead to improvements in social and interpersonal functioning.