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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Details of treatment remain imprecise in depression, as the trials of antidepressants have been more concerned with overall effectiveness than with specificity. The aetiology in depression does not provide sufficient guidance for treatment, even though drugs are preferred for endogenous depression and psychotherapy for neurotic depression. An unitary formulation of depression can be postulated on the basis of the concept of regression; endogenous and reactive depression would then stem from the nature of the depressed subject's personality. Such an approach can encompass the various possible aetiologies in depression: biochemical, psychological and social, without necessarily contrasting them. In this connection, depression is a psychobiological syndrome within which there may be different symptomatic pictures, depending notably upon the various monoamine hypotheses raised in numerous studies. In that event, possible correlations between biochemical abnormalities and certain clinical manifestations may better guide the selection of drugs.
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PMID:[Depressive symptomatology and type of treatment (author's transl)]. 4 68

This paper has focused on the sense of helplessness as an essential component of a depressive reaction. By inference, a sense of mastery and ability to achieve goals seems essential for a sense of well-being. Both patients presented here revealed infantile fantasies that hampered their exercising this mastery, and the path to well-being was the analysis of these fantasies. The treatment plans differed, though, in the locus of the fantasies. In an object-related depression such as Mr. Janson's, the fantasy involved the inhbition of functioning--that is, the inability to express aggression--and the treatment aimed at removing the inhibition. In a narcissistic depression such as Miss Gaynor's, the helplessness was not due to inhibited functioning per se. Rather, her goals were unrealistic, unattainable, and based on unconscious fantasies. Here the aim of treatment was the development of more reality-adapted and attainable objectives and the concommitant internalization of a more realistic sense of her own worth. Thus the common denominator in both depressive reactions was a sense of helplessness, and the path toward increased self-esteem was by way of the development of a sense of mastery and competence.
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PMID:Object-related vs. narcissistic depression: a theoretical and clinical study. 11 26

Fifty patients with moderate to severe primary depression were treated in equal groups of inpatients and outpatients with a constant dose of 60 mg. of mianserin daily for four weeks in a double blind placebo controlled trial with either a three times daily dosage regime or a single nightly dose. There was no difference in apparent compliance, side effects or therapeutic effect in either day-time or night-time dosage regimes. Patients developing high plasma levels of mianserin (greater than 70 microgram/l) were associated with a highly significantly poorer therapeutic outcome. Patients identified as endogenous depression demonstrated a significant negative correlation between plasma levels of mianserin and therapeutic response measured as an amelioration of either the Hamilton Rating Scale scores (r = --0.48) or on a new depression scale by Montgomery and Asberg (r = --0.51) with high levels associated with poor response. There was a significant correlation (r = 0.66) between mianserin plasma levels and age in endogenous depression. In those patients identified as suffering from reactive depression, no significant relationship could be seen between plasma levels and therapeutic response or with age. These findings support the view that the relationship between mianserin plasma levels and clinical response is more likely to be demonstrated in endogenous depression.
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PMID:Mianserin plasma levels and differential clinical response in endogenous and reactive depression. 37 84

SAdness and normal grief are distinguished from pathological grief and depression by intensity, duration, precipitating events, and the quality of psychopathological features. Depression is evaluated as a final common pathway of potential psychodynamic, genetic, psychosocial, physiological, and personality characteristics or events. The clinical entity of depression is diagnosed by describing some of each of the affective, behavioral, and cognitive changes concomitant with depression. The clinical entity of depression is further differentiated for purposes of treatment into the categories of bipolar depression (manic-depressive illness), unipolar depression (psychotic depressive reaction or involutional melancholia), neurotic depression, and secondary depression (secondary to somatic disease, drugs, or to other psychiatric disorders). The immediate treatment depends on the type of depression diagnosed. Unipolar and bipolar depressions respond to specific pharmacologic therapy and supportive care. Neurotic and characterologic depressions respond to supportive or insight psychotherapy with possible brief adjunctive anti-anxiety or hypnotic medication. All of the treatment modalities, with the possilbe exception of insight psychotherapy, can be effected very adequately by the primary care physician who is given clear diagnostic and assessment guidelines with specific treatment approaches.
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PMID:The depressed patient. 42 80

Depression reactive to severe early loss and current environmental pressure is a salient common characteristic of many adolescent girls in foster care. This paper describes work with developmentally-oriented mutual aid groups focused on depression and coping, which have been successful in promoting ego strengths and growth in this population.
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PMID:A group approach to the depressed adolescent girl in foster care. 67 84

Rhesus mother-infant pairs were housed in a playpen apparatus beginning just before the birth of four male infants. The infants were separated from their mothers four times beginning at a mean age of 218 days. In Type A separations (I and IV) the infants were removed and housed away from their familiar environment in a protected setting; in Type B separations (II and III) the infants remained in the familiar setting and mothers were removed. One pair was separated every 2 weeks for 6 days; for a particular infant, a mean of 8 weeks intervened between each of the separations. On the basis of infant behavior during separation. Type B separations appeared to have a more deleterious effect on the infant: infants did not show the typical behavioral signs of depression under Type A housing conditions, whereas, under Type B conditions, infants expressed the typical depressive reaction to separation. However, comparisons of pre- and postseparation behaviors in the mother-infant pairs indicated that Type A separations were more perturbing. Increases in ventral-ventral contact between mothers and infants were greater following Type A separations and increases in time at nipple occurred only after Type A separations; infant grooming by mother increased only after the first, a Type A, separation. Type B separations may have affected mothers more severely in that reciprocity between maternal cradling and infant clinging was greater following Type B separations than following Type A separations when infants clung significantly more often than mother cradled.
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PMID:Modification of the response to separation in the infant rhesus macaque through manipulation of the environment. 81 Dec 70

Measures of depression and undischarged drive were obtained for 292 psychiatric in-patients. In 200 of these cases inhibition of aggression was also assessed. All patients were classified as being endogenously depressed, reactively depressed, or as suffering from non-depressive primary disorders. The latter group was subdivided into secondarily depressed and non-depressed groups. The 3 depressed groups were then compared with the non-depressed subjects in respect of drive level and inhibition of aggressionmall 3 depressed groups showed significantly higher driver level than did the non-depressed subjects. The endogenous depressives also inhibited significantly more of their aggression than did the non-depressed subjects. The results are consistent with a drive inhibition theory of depression. However, while endogenous depression seems to be associated more specifically with the inhibition of aggression, reactive depression may be associated rather with the inhibition of drive generally.
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PMID:Depressive illness: the role of aggression further considered. 87 92

Undoubtedly the commonest psychiatric conditions seen in patients from the tropics are reactive depression and hysterical illness. These may both be seen as responses to stress, often over a prolonged period. Although typical depressive and hysterical syndromes are seen in all races, severe tiredness seems to be the principal hysterical symptom amongst Europeans as opposed to bizarre somatic symptoms in Negroes and Asians. Headaches are an important depressive sign in Negroes and Asians. Diarrhoea and abdominal pains may be linked directly to anxiety and depression or may emerge as an unconscious defence against insoluble problems.
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PMID:A study of the symptom patterns of psychiatric referrals in a tropical diseases unit. 100 61

Paroxetine is a selective serotonin reuptake inhibitor that is now licensed in various countries in Europe. It has comparable efficacy with the reference tricyclic antidepressants and is well tolerated with few adverse effects which are usually mild, transient and do not appear to compromise treatment. Paroxetine has a number of advantages as an antidepressant; of particular interest is its ability to improve sleep early in treatment without daytime sedation or interference with psychomotor function. Paroxetine appears effective compared with placebo in different subgroups of depression: it is effective in both endogenous and reactive depression, as well as being effective in moderate and severe depression. Paroxetine appears particularly effective in treating the anxiety associated with depression and has been shown to have greater efficacy than imipramine. There is some evidence that the onset of antidepressant action occurs slightly earlier with paroxetine than with imipramine. As well as being effective in the acute episode, placebo-controlled, long-term data are available indicating paroxetine to be of value in the prevention of depressive relapse.
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PMID:The advantages of paroxetine in different subgroups of depression. 143 Oct 17

Suicidal syndromes were analyzed in 339 patients older than 45 years. Psychiatric treatment was instituted because of endogenous, neurotic or reactive depression. Differences in the relationship between diagnosis, sex and two age groups are discussed. Violent suicide increases with age concomitantly in all forms of depression. The prevalence of suicide after the age of 45 points toward the significance of particular life events and social influences. Life events and psychodynamic leading to suicidal behaviour are discussed Characteristic arrays of symptoms correlating with suicidal behaviour in endogenous depression are outlined. Special problems in the management of suicidal behaviour in the elderly are discussed.
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PMID:[Suicidal risk in endogenous, neurotic and reactive depression in advanced age]. 169 25


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