Treatment‐resistant depression: definition, prevalence, detection, management, and investigational interventions

World Psychiatry, Год журнала: 2023, Номер 22(3), С. 394 - 412

Опубликована: Сен. 15, 2023

Treatment-resistant depression (TRD) is common and associated with multiple serious public health implications. A consensus definition of TRD demonstrated predictive utility in terms clinical decision-making outcomes does not currently exist. Instead, a plethora definitions have been proposed, which vary significantly their conceptual framework. The absence hampers precise estimates the prevalence TRD, also belies efforts to identify risk factors, prevention opportunities, effective interventions. In addition, it results heterogeneity practice decision-making, adversely affecting quality care. US Food Drug Administration (FDA) European Medicines Agency (EMA) adopted most used (i.e., inadequate response minimum two antidepressants despite adequacy treatment trial adherence treatment). It estimated that at least 30% persons meet this definition. significant percentage are actually pseudo-resistant (e.g., due inadequacy trials or non-adherence Although sociodemographic, clinical, contextual factors known negatively moderate depression, very few regarded as non-response across modalities treatment. Intravenous ketamine intranasal esketamine (co-administered an antidepressant) established efficacious management TRD. Some second-generation antipsychotics aripiprazole, brexpiprazole, cariprazine, quetiapine XR) proven adjunctive treatments partial responders, but only olanzapine-fluoxetine combination has studied FDA-defined Repetitive transcranial magnetic stimulation (TMS) FDA-approved for individuals accelerated theta-burst TMS recently showing efficacy. Electroconvulsive therapy acute maintenance intervention preliminary evidence suggesting non-inferiority intravenous ketamine. Evidence extending antidepressant trial, medication switching combining mixed. Manual-based psychotherapies on own offer symptomatic relief when added conventional antidepressants. Digital therapeutics under study represent potential future vista population.

Язык: Английский

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Suicide and self-harm

The Lancet, Год журнала: 2022, Номер 399(10338), С. 1903 - 1916

Опубликована: Май 1, 2022

Язык: Английский

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Risk factors for suicide in adults: systematic review and meta-analysis of psychological autopsy studies

Evidence-Based Mental Health, Год журнала: 2022, Номер 25(4), С. 148 - 155

Опубликована: Сен. 26, 2022

Question Effective prevention of suicide requires a comprehensive understanding risk factors. Study selection and analysis Five databases were systematically searched to identify psychological autopsy studies (published up February 2022) that reported on factors for mortality among adults in the general population. Effect sizes pooled as odds ratios (ORs) using random-effects models each factor examined at least three independent samples. Findings A total 37 case–control from 23 countries included, providing data 40 5633 cases 7101 controls. The magnitude effect varied substantially both between within domains. Clinical had strongest associations with suicide, including any mental disorder (OR=13.1, 95% CI 9.9 17.4) history self-harm (OR=10.1, 6.6 15.6). By comparison, smaller other domains relating sociodemographic status, family history, adverse life events (OR range 2–5). Conclusions wide predisposing precipitating are associated population, but clear differences their relative strength. PROSPERO registration number CRD42021232878.

Язык: Английский

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Temporal Trends in Suicidal Ideation and Attempts Among US Adolescents by Sex and Race/Ethnicity, 1991-2019

JAMA Network Open, Год журнала: 2021, Номер 4(6), С. e2113513 - e2113513

Опубликована: Июнь 14, 2021

Importance

Disparities by sex and racial/ethnic group in suicide death rates are present US adolescents. Whether disparities extend to groups targeted for prevention efforts, namely, those with suicidal ideation or nonfatal attempts, is unknown.

Objective

To examine differences temporal trends between attempts adolescents from 1991 through 2019 race/ethnicity subgroups.

Design, Setting, Participants

A cross-sectional analysis of the national Youth Risk Behavior Survey, weighted represent 2019, included 183 563 high-school students grades 9 12. Data were analyzed September 16, 2020, April 12, 2021.

Exposures

Calendar year, sex, race/ethnicity, interactions race/ethnicity.

Main Outcomes Measures

Survey-weighted prevalence estimates, annual percentage changes (APCs) average APC survey-weighted constructed self-reported ideation, plan, each survey (non-Hispanic White, non-Hispanic Black, Hispanic, Asian Pacific Islander Native Hawaiian, American Indian/Alaska Native), their (sex × race/ethnicity).

Results

In (unweighted) (mean [SD] age, 16.07 [1.23] years; 94 282 females [weighted percentage, 49.4%; 95% CI, 48.8%-50.1%]), decreased (from 19.4% 15.8%; 0.7%-0.9%), whereas increased 7.3% 8.9%; 1.0%-1.4%). Joinpoint regression indicated a −3.1% (95% −3.7% −2.6%) decrease 2009, followed 3.4% increase 1.9% -4.8%) 2009 2019. Decreasing increasing showed modestly different turning points female (1991-2009, 2009-2019), White Hispanic (1991-2007, 2007-2019), Black (1991-2005, 2005-2019) Although no significant observed male (68.4% increase; 0.2% -1.2%) (79.7% 0.1%-1.5%) had greater increases attempts. Interaction revealed (APC, 4.3%; 1.5%-7.1%), 2005 3.4%; 1.4%-5.4%), 3.3%; 1.0%-5.6%) 3.1%; 0.3%-6.0%).

Conclusions Relevance

The findings this study show apparent Increases since individuals; represented largest Evidence-based programs need be tailored calling diversification health care system, school, community approaches.

Язык: Английский

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Structural Racism and Suicide Prevention for Ethnoracially Minoritized Youth: A Conceptual Framework and Illustration Across Systems

American Journal of Psychiatry, Год журнала: 2022, Номер 179(6), С. 422 - 433

Опубликована: Май 23, 2022

Suicide rates among ethnoracially minoritized youth (i.e., of color) peak before the age 30, and striking disparities in access to mental health services have been identified this group. However, suicide prevention strategies yet fully address structural racism as a mechanism producing risk, protective factors, quality effective intervention for color. Such an approach is critical provide more culturally responsive care. Through adapted socio-ecological model, authors propose Structural Racism Prevention Systems Framework illustrate pathways through which impacts color United States. The contextualize impact three key settings where occurs: services, schools, interface between crisis care law enforcement. posit that attention must be paid intersection mutually reinforcing, interdependent systems rather than isolation. then recommendations prevention, including macro-level interventions improve societal conditions, research inform solutions, training approaches institutional racism, clinical racial trauma on youths families.

Язык: Английский

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Diagnosis and management of bipolar disorders

BMJ, Год журнала: 2023, Номер unknown, С. e073591 - e073591

Опубликована: Апрель 12, 2023

Abstract Bipolar disorders (BDs) are recurrent and sometimes chronic of mood that affect around 2% the world’s population encompass a spectrum between severe elevated excitable states (mania) to dysphoria, low energy, despondency depressive episodes. The illness commonly starts in young adults is leading cause disability premature mortality. clinical manifestations bipolar disorder can be markedly varied within individuals across their lifespan. Early diagnosis challenging misdiagnoses frequent, potentially resulting missed early intervention increasing risk iatrogenic harm. Over 15 approved treatments exist for various phases disorder, but outcomes often suboptimal owing insufficient efficacy, side effects, or lack availability. Lithium, first treatment continues most effective drug overall, although full remission only seen subset patients. Newer atypical antipsychotics increasingly being found depression; however, long term tolerability safety uncertain. For many with combination therapy adjunctive psychotherapy might necessary treat symptoms different illness. Several classes medications treating predicting which medication likely tolerable not yet possible. As pathophysiological insights into causes revealed, new era targeted aimed at causal mechanisms, they pharmacological psychosocial, will hopefully developed. time being, judgment, shared decision making, empirical follow-up remain essential elements care. This review provides an overview features, diagnostic subtypes, major modalities available people highlighting recent advances ongoing therapeutic challenges.

Язык: Английский

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Gone Too Soon: priorities for action to prevent premature mortality associated with mental illness and mental distress

The Lancet Psychiatry, Год журнала: 2023, Номер 10(6), С. 452 - 464

Опубликована: Май 11, 2023

Язык: Английский

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Individual-level risk factors for suicide mortality in the general population: an umbrella review

The Lancet Public Health, Год журнала: 2023, Номер 8(11), С. e868 - e877

Опубликована: Окт. 26, 2023

Deaths by suicide remain a major public health challenge worldwide. Identifying and targeting risk factors for mortality is potential approach to prevention. We aimed summarise current knowledge on the range magnitude of individual-level in general population evaluate quality evidence.

Язык: Английский

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National Incidence of Physician Suicide and Associated Features

JAMA Psychiatry, Год журнала: 2025, Номер unknown

Опубликована: Фев. 26, 2025

Importance Previous reports regarding comparative suicide incidence among US physicians vs nonphysicians have been inconclusive. Objective To estimate the national of male and female physician analyze associated factors, comparing findings to general population. Design, Setting, Participants This retrospective cohort study investigated suicides aged 25 years older in from January 2017 December 2021. The analysis took place November 2023 September 2024. National Violent Death Reporting System data 30 states Washington, DC, were used. Decedents with missing age or sex excluded for incidence, race, ethnicity, marital status further analyses. Exposure Physician occupation. Main Outcome Measures Suicide rate ratios (IRRs) odds (aORs) adjusted by age, sex, used compare preceding circumstances, primary method, substances. Results A total 448 (354 [79%] 94 [21%] female; mean [SD] 60 [16] years) 97 467 population (76 697 20 770 51 [17] identified. Female had higher rates than (IRR, 1.88; 95% CI, 1.19-2.83) 2019 1.75; 1.09-2.65), overall 2021 risk 1.53; 1.23-1.87). Male lower 0.84; 0.75-0.93). Compared including all available jurisdiction data, depressed mood (aOR, 1.35; 1.14-1.61; P < .001) as well mental health 1.66; 1.39-1.97; .001), job 2.66; 2.11-3.35; legal 1.40, 1.06-1.84; = .02) problems use poisoning 1.85; 1.50-2.30; sharp instruments 4.58; 3.47-6.06; .001). Physicians also positive toxicology caffeine; poison; cardiovascular agents; benzodiazepines; anxiolytics, nonbenzodiazepines, hypnotics; drugs not prescribed home use. Conclusion Relevance These show a compared nonphysicians. Comprehensive multimodal prevention strategies remain warranted.

Язык: Английский

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Arketamine, a new rapid-acting antidepressant: A historical review and future directions

Neuropharmacology, Год журнала: 2022, Номер 218, С. 109219 - 109219

Опубликована: Авг. 14, 2022

The N-methyl-d-aspartate receptor (NMDAR) antagonist (R,S)-ketamine causes rapid onset and sustained antidepressant actions in treatment-resistant patients with major depressive disorder (MDD) other psychiatric disorders, such as bipolar post-traumatic stress disorder. is a racemic mixture consisting of (R)-ketamine (or arketamine) (S)-ketamine esketamine), (S)-enantiomer having greater affinity for the NMDAR. In 2019, an esketamine nasal spray by Johnson & was approved USA Europe depression. contrast, increasing number preclinical studies show that arketamine has potency longer-lasting antidepressant-like effects than rodents, despite lower binding Importantly, side effects, i.e., psychotomimetic dissociative abuse liability, are less those animals humans. An open-label study demonstrated MDD. A phase 2 clinical trial MDD underway. This designed to review brief history novel arketamine, molecular mechanisms underlying its actions, future directions. article part Special Issue on 'Ketamine Metabolites'.

Язык: Английский

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