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

Social phobia is a prevalent anxiety disorder with potentially significant dysfunction and a high rate of comorbid depression. Treatment with an antidepressant is often indicated. Venlafaxine's dual activity at both serotonin and norepinephrine transporters suggests that it might be efficacious in treating social phobia, particularly in patients who do not respond to selective serotonin reuptake inhibitors (SSRIs). This report describes an open-label trial of venlafaxine in 9 patients with social phobia. Eight patients had previously been treated with an SSRI and had either been unable to tolerate the medication or failed to respond to it. Eight patients had a marked improvement on venlafaxine. The results from this chart review suggest that venlafaxine may be a valuable treatment for social phobia. Clearly, larger double-blind placebo-controlled studies are needed. Patients with social phobia may do better with a starting dose smaller than the one in the package insert.
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PMID:Venlafaxine in social phobia. 885 51

Comorbid conditions require attention in the planning of treatment strategies for panic disorder, as they affect the course and prognosis of the disorder as well as its response to treatment. The literature documents high rates of comorbidity for depression, bipolar disorders, generalized anxiety disorder, social phobia, other anxiety disorders, and personality disorders (especially dependent and avoidant personality disorders). The alcohol abuse research shows comorbidity rates that are lower than expected from clinical reports. Although agoraphobia is no longer considered a comorbid disorder, its presence with panic disorder represents more severe disturbance and involves a higher likelihood of one or more comorbid diagnoses. The disorders of depression and panic are usually more severe when they co-occur than when only one is present. Research on the role of specific comorbid conditions in the outcome of treatment for panic disorder is reviewed.
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PMID:Comorbidity and its effects on panic disorder. 885 26

A representative cohort of Swiss adults recruited at age 20 years and interviewed at ages 23, 28 and 30 years was studied regarding the symptomatology, prevalence and longitudinal course of functional gastrointestinal symptoms and their association with psychiatric syndromes. A functional gastrointestinal complaint was identified if a proband reported symptoms at least eight times in the past year or for a duration of at least 2 weeks without medical explanation and with a moderate degree of distress. Of the population, 9.4-17.7% was found to suffer from functional stomach complaints and 4.9-16% from functional intestinal complaints. Women reported functional gastrointestinal complaints two to three times more often than men, and increasingly so with age. The overlap of stomach and intestinal complaints was modest with 2.0-6.7%. Cross sectionally, functional stomach complaints were significantly associated with major depression (DSM-III-R), recurrent brief depression (RBD), subthreshold RBD and dysthymia, and with subthreshold panic disorder, agoraphobia, social phobia and recurrent brief anxiety. Functional intestinal complaints showed a consistently significant association with RBD, dysthymia, major depression, subthreshold RBD, panic disorder, subthreshold panic disorder, agoraphobia, simple and social phobia and generalized anxiety disorder. Individuals who at younger ages suffered from functional gastrointestinal complaints did not show an increased risk for a subsequent development of an anxiety or depressive disorder. Functional gastrointestinal complaints reflect an unspecific concomitant vegetative disturbance common to depression and anxiety; they do not reflect a risk factor for the development of a specific anxiety or depressive disorder.
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PMID:The Zurich Study: XXII. Epidemiology of gastrointestinal complaints and comorbidity with anxiety and depression. 886 5

From the Zurich cohort study (n = 591), the association of major depressive episodes and recurrent brief depression (RBD) with other psychiatric disorders is presented cross-sectionally at age 28 and 30 years, and over ten years (age 20 to 30 years). Longitudinally, the odds ratios of major depression are highest with dysthymia (4.4), generalised anxiety disorder (4.4), panic disorder (2.7), hypomania and agoraphobia (2.6), and social phobia (2.4). There is a significant association with cannabis consumption and smoking. Follow-up data over nine years are available for 41 patients with a major depressive disorder (MDD) and 62 with RBD: approximately 20% of MDD patients did not receive a diagnosis during follow-up. Major depression reoccurred in 32%, became bipolar in 24%, or developed into RBD in 24%. RBD remitted in 41%, reoccurred in 35%, turned into major depression in 22%, and became bipolar in only 7%. Longitudinally, MDD and RBD show a symmetrical diagnostic change in a quarter of the cases. There is no substantial development of MDD or RBD into minor depression or generalised anxiety disorder. Thirteen per cent of those with RBD later developed panic disorder.
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PMID:Comorbidity of mood disorders: a longitudinal prospective study. 886 46

Associations between affective disorders, anxiety disorders, and substance use disorders were examined in epidemiological studies conducted in Germany, Switzerland, Puerto Rico, and the mainland US. There was a remarkable degree of similarity across studies in the magnitude and type of specific disorders associated with the affective disorders. Comorbidity with affective disorders was greater for the anxiety disorders than for substance misuse. Panic disorder was the subtype of anxiety that was most highly comorbid with depression. Social phobia was the specific phobic type with the strongest association with the affective disorders. The magnitude of associations between substance misuse and affective disorders generally was quite low and less consistent across sites. No major differences were found in the patterns of comorbidity by gender or age group, affective subtype or prevalence period. The onset of anxiety disorders generally preceded that of depression, whereas alcohol misuse was equally likely to pre-or post-date the onset of affective disorders. Finally, comorbidity was associated with an elevation in treatment rates across all sites, confirming Berkson's paradox on an international level.
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PMID:Comorbidity and boundaries of affective disorders with anxiety disorders and substance misuse: results of an international task force. 886 50

Unlike older monoamine oxidase inhibitors, which irreversibly and nonselectively bind monoamine oxidase (MAO), moclobemide is a reversible and selective inhibitor of the MAO-A isozyme. Moclobemide only weakly potentiates the pressor response induced by tyramine or other indirectly acting sympathomimetics; therefore, there is no need to avoid dietary tyramine or over-the-counter decongestants with moclobemide as there is with older MAO inhibitors. Recent clinical trials and meta-analyses have confirmed the efficacy of moclobemide in the treatment of depressive disorders. Moclobemide has been shown to have similar efficacy to tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs) and nonselective, irreversible MAO inhibitors. Long term follow-up studies of 6 to 12 months' duration have demonstrated that the antidepressant efficacy of moclobemide is maintained. Moclobemide, given alone or in combination with another antidepressant, has shown some efficacy in patients with refractory depression; however, comparative trials are required to confirm these findings. Data are also available to show clinical efficacy of moclobemide in the management of social phobia. Comparative studies have established that moclobemide is better tolerated at therapeutic dosages and has less toxicity in overdose than TCAs and nonselective, irreversible MAO inhibitors. Moclobemide lacks the anticholinergic, sedative and cardiovascular effects associated with many of the older antidepressants. Compared with SSRIs, moclobemide has a similar overall tolerability, although it tends to cause fewer gastrointestinal effects than the SSRIs and has not been reported to interfere with sexual function. In summary, recent data which confirm and extend its comparative therapeutic efficacy and low potential for adverse effects have established moclobemide as an effective treatment in depressive disorders. The drug is also effective in patients with a primary diagnosis of social phobia. Its lack of adverse anticholinergic, cardiovascular, cognitive and psychomotor effects makes moclobemide a particularly useful option in the elderly or patients with cardiac disease.
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PMID:Moclobemide. An update of its pharmacological properties and therapeutic use. 887 33

A study was conducted in Paris among primary care physicians as part of a World Health Organization study entitled Psychological Problems in General Health Care. Though social phobia is associated with significant impairment and drug use, the level of problem recognition by general practitioners was low. Social phobia (n = 38) was identified as a psychological case in 53% of the patients in whom social phobia was not comorbid with depression, and in 66% when comorbid with depression. This low level of recognition was comparable to that observed for depression where only 66% of the depressed patients (n = 121) were recognized as psychological cases. Psychotropic drug use was high: 61% of patients with social phobia had taken at least one psychotropic drug in the last month, compared to only 32% of those without social phobia. This difference was explained by a significant difference in the use of anxiolytics (45.4 versus 12.1%). The use of psychotropic drugs was twice as frequent in patients with social phobia who were depressed than in those not depressed. The results of this study emphasize the crucial need for primary care physician training in the recognition and treatment of mental disorders.
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PMID:Social phobia in primary care: level of recognition and drug use. 892 6

Social phobia is a common disorder which is associated with considerable suffering and impairment. Effective treatments have now been developed and they represent an important advance in the management of the disorder. Moclobemide is a reversible inhibitor of monoamine oxidase A (RIMA) which has an established place in the treatment of depression. The efficacy of moclobemide in social phobia has been demonstrated in short-term treatment for up to 12 weeks in three placebo-controlled studies. It has also proved to be effective in long-term treatment in a placebo-controlled study and in open treatment studies. This paper reviews the efficacy of moclobemide in social phobia.
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PMID:Moclobemide in the treatment of social phobia. 892 14

Patients meeting the social phobia criteria of the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) on the DSM-III-R Structured Clinical Interview (n = 101) entered a long-term moclobemide treatment study. These patients were treated for 2 years with moclobemide (phase I) followed by drug withdrawal, in most cases abruptly (phase II). Those who relapsed entered phase III for a further period of 2 years of treatment. During phase I 40 patients (39.6%) withdrew due to inefficacy or relapse. Two patients were removed from the study because of other diagnoses (borderline or schizophreniform). At the end of phase I the remaining patients (58.4%) were rated as not ill (45.5%) or minimally ill (11.9%). Effort was taken to achieve the maximum dose of moclobemide (750 mg/day) and the mean (+/-SD) dose was 723.3 +/- 67.7 mg/day (month 21). A marked decrease in symptoms in the patients who responded was recorded on the Liebowitz Scale for Social Phobia, Clinical Global Impressions. Hamilton Anxiety Scale and Hamilton Depression Scale. Non-response was mainly associated with co-morbidity, especially alcohol abuse, axis II disorders, and a history of major depression or secondary dysthymia. The drug was well tolerated; the more frequent side effects were mild and occurred mainly in the first 2 months of phase I, including nausea, headaches or insomnia. In phase II there was a relapse rate of 88% and 51 patients entered phase III; these patients are still being treated.
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PMID:The long-term treatment of social phobia with moclobemide. 892 15

The separation of social phobia from normal social anxiety (shyness) and from other psychiatric disorders (e.g. agoraphobia, atypical depression with rejection sensitivity) is as important for research and for treatment decisions as is the definition of subtypes. While empirical evidence supports the distinction of a generalized and a specific subtype of social phobia, the other boundary issues, the separation of social phobia from shyness and its distinction from the comorbidity with other psychiatric disorders, still require research.
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PMID:The boundaries of social phobia and its subtypes: workshop report 1. 892 18


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