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

Up to 80% of women of reproductive age experience physical and behavioral changes premenstrually. However, these changes are predominantly normal and most often do not result in disabling distress or functional impairment. Still, 20% to 40% of women do experience premenstrual disorders. For 2% to 10% of women, the symptoms are severe enough to impair work and interpersonal relationships. Only in recent years has there been significant recognition and research of the problem. Diagnostic criteria are now evolving, and well-designed studies of treatment efficacy are providing greatly improved treatment information. No single treatment is effective for all women with premenstrual syndrome (PMS), although most women can be helped with careful diagnosis and a systematic approach to potential therapies. The overlap between PMS and atypical depression--in which emotional hypersensitivity, increased anxiety, irritability, and food cravings predominate--is particularly notable. Both disorders are believed to involve the serotonin system, which accumulating evidence shows to have a role in modulating mood and behavior. Results of various preliminary studies that examined markers and activity of the serotonin system are consistent with the hypothesis that abnormalities in central serotonergic activity may be involved in PMS. Clinical studies suggest that approximately 60% to 70% of women who have undergone a careful diagnostic evaluation of severe PMS report significant symptom reduction with the serotonergic antidepressants, although as yet there are no drugs with FDA approval for the indication of PMS. Continued research is essential to confirm and expand the pharmacologic treatments for PMS and to increase understanding of this complex disorder.
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PMID:Can Antidepressants be Used to Tame Psychological Symptoms of PMS? 974 52

It is difficult to treat a family, particularly when clinicians only have the opportunity to see one or two members in the medical setting. Still, one can accomplish a great deal by viewing the patient within a family system. Advantages of this systemic approach are similar to those accrued when one views the individual patient's problems as being inter-connected. For example, we know that pain stemming from MS can exacerbate depression that, in turn, increases pain ... and so on. By the same token, if the clinician treats either pain or depression, it will likely reduce the other one. One doesn't need to treat all aspects of the family to show a fundamental improvement in the system. If the well partner attends a support group, his or her ability to care for the patient may increase, which could reduce his or her own depression. If children learn to explain the patient's MS to their friends, then they feel more comfortable with closeness to the parent. Treating the family helps it stay healthy, and it is the family who ultimately cares for the patient. To treat the family is to provide the patient with essential care.
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PMID:Treating the family with multiple sclerosis. 989 17

Ever since Freud created psychoanalysis over 100 years ago, it has been popular, especially in the USA. However, biological psychiatry is now at the forefront and the emphasis is on neurosciences and pharmacotherapy. Still, the question remains, what place is there for psychotherapy in psychiatric practice? We need to be aware of the need for psychotherapy for some patients. This has been scientifically demonstrated in the study of patients with moderate and severe major depression. It has been convincingly shown that there is a place for interpersonal therapy and for cognitive behavioral therapy. Moderately depressed patients may benefit from a regimen of psychotherapy. In contrast, those with severe depression also need antidepressant medication. Because people in the Pacific Rim countries are heterogeneous, their requirements may be diverse. Asian populations need emphasis on the family as a part of the treatment team. Biological and cultural issues also enter the picture. Using the example of the flushing response, 25% of Koreans versus 50% of the Han Chinese and Japanese have the flushing response. Confucius' teachings have influenced Chinese, Koreans and Japanese for over 2000 years. The need for therapy and education is great. One solution is in primary and secondary prevention with cognitive behavioral classes such as the depression prevention course.
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PMID:Psychotherapy in the Pacific Rim countries. 989 55

The arginine deiminase system in oral streptococci is highly regulated. It requires induction and is repressed by catabolites such as glucose or by aeration. A comparative study of regulation of the system in Streptococcus gordonii ATCC 10558, Streptococcus rattus FA-1, and Streptococcus sanguis NCTC 10904 showed an increase in activity of the system in S. sanguis of some 1467-fold associated with induction-depression of cells previously uninduced-repressed. The activity of the system was assayed in terms of levels of arginine deiminase, the signature enzyme of the system, in permeabilized cells. Increases in enzyme levels associated with induction-depression were less for the other two organisms, mainly because of less severe repression, especially for S. rattus FA-1, which was the least sensitive to catabolite repression or aeration. Regulation of the arginine deiminase system involving induction and catabolite repression was demonstrated also with monoorganism biofilms composed of cells of S. sanguis adherent to glass slides. Fully uninduced-repressed cells from suspension cultures or biofilms were compromised in their abilities to catabolize arginine to protect themselves against acid damage. However, it was found that the system can be rapidly turned on or turned off, although induction-depression did appear to require cell growth. Still, the system could respond rapidly to the availability of arginine to reestablish high capacity for alkali production.
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PMID:Turning on and turning off the arginine deiminase system in oral streptococci. 1003 2

Cognitive behavioral therapies have strong empirical support as the treatments of choice for PTSD. Still, a significant proportion of the patients retain distressing PTSD symptoms after treatment. A treatment named Exposure Counterconditioning (EC), based on Wolpe's (1995, Theories of behaviour therapy (pp. 23-57). Washington, DC: American Psychological Association) reciprocal inhibition theory and Pavlovian conditioning mechanisms (Baldwin & Baldwin, 1986, Behavior principles in everyday life (pp. 41-42). New Jersey: Prentice-Hall) is presented. The EC treatment is proposed as an addition to the established treatments for PTSD. A case study from which the EC treatment was first developed is illustrated. The patient suffered from severe PTSD and depression. The EC treatment was effective in eliminating the patient's PTSD and depression. Also, the patient's severe anger, guilt and dissociation were eliminated. The results and important clinical observations are discussed within an counterconditioning framework.
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PMID:Exposure counterconditioning (EC) as a treatment for severe PTSD and depression with an illustrative case. 1048 87

The symptoms of depression can be improved by agents that act by various mechanisms to increase synaptic concentrations of monoamines. This finding led to the adoption of the monoamine hypothesis of depression, first put forward over 30 years ago, which proposes that the underlying biological or neuroanatomical basis for depression is a deficiency of central noradrenergic and/or serotonergic systems and that targeting this neuronal lesion with an antidepressant would tend to restore normal function in depressed patients. The hypothesis has enjoyed considerable support, since it attempts to provide a pathophysiologic explanation of the actions of antidepressants. However, in its original form it is clearly inadequate, as it does not provide a complete explanation for the actions of antidepressants, and the pathophysiology of depression itself remains unknown. The hypothesis has evolved over the years to include, for example, adaptive changes in receptors to explain why there should be only a gradual clinical response to antidepressant treatment when the increase in availability of monoamines is rapid. Still, the monoamine hypothesis does not address key issues such as why antidepressants are also effective in other disorders such as panic disorder, obsessive-compulsive disorder, and bulimia, or why all drugs that enhance serotonergic or noradrenergic transmission are not necessarily effective in depression. Despite these limitations, however, it is clear that the development of the monoamine hypothesis has been of great importance in understanding depression and in the development of safe and effective pharmacologic agents for its treatment.
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PMID:History and evolution of the monoamine hypothesis of depression. 1077 17

This large, long-term study of families served by hospice found that nearly 95 percent said hospice had been helpful. Still, about 30 percent of family members said there was something they wish hospice had done differently. Those who had some complaint were more likely than those who had no complaints to be women, to report the patient had needed a great deal of care, to have a history of depression and greater levels of distress before and after the patient's death, and to be dissatisfied with the support they received from family members and friends.
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PMID:Predictors of family members' satisfaction with hospice. 1127 Nov 58

We discuss two types of age-associated diseases; aging-dependent such as Alzheimer's disease and congestive heart failure which increase logarithmically with age, versus age-dependent such as multiple sclerosis and amyotrophic lateral sclerosis which occur at proscribed ages, and then occurrence of new cases ceases or diminishes with further aging. Prevention strategies with both types emphasize postponement or delay of onset. The non-fatal aging-dependent diseases and conditions are an accumulating burden as we age, and increase overall morbidity in late years. These include Alzheimer's disease and other dementias, Parkinson's disease, loss of vision and hearing, incontinence, osteoporosis and hip fracture, osteoarthritis and depression. With mortality postponed, we will be living for many years at old and vulnerable ages. Life's quality will be reasonable for most. Still, increasing the chance that all will experience this desirable outcome requires pursuing the means to delay the onset of the physical and social events which we categorize as the non-fatal aging-dependent diseases and conditions. We must recognize that each added year occurs at the tip of an exponential curve where risk is maximal.
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PMID:Age-associated diseases and conditions: implications for decreasing late life morbidity. 1140 87

Diurnal, nocturnal or seasonal modes of behavior are not passive responses to changes in the environment; rather, they are generated by an endogenous circadian pacemaker, entrained by a few environmental cues like lightdark cycles. Circadian clock mechanisms involve periodic gene expression, synchronized by a hierarchically superior structure located in mammals in the hypothalamic suprachiasmatic nuclei. Cycles of sleep and wakefulness are the most conspicuous circadian rhythm. Since modern humans use artificial light to extend their period of wakefulness and activity into the evening hours, they adhere to a shortnight sleep schedule with a highly consolidated and efficient sleep. As shown by studies in artificial long nights, modern humans may be sleepdeprived. Humans have also increasingly insulated themselves from the natural cycles of light and darkness. Still, the human circadian pacemaker has conserved a capacity to detect seasonal changes in day length. A mood disorder involving a recurring autumn or winter depression (seasonal affective disorder, SAD) is related to latitude, with the number of cases increasing with distance from the equator. SAD is ameliorated by using brilliant light. In nonseasonal depression, mood typically fluctuates daily, with improvement over the course of the day, and various physiological functions exhibit an altered circadian pattern, suggesting a link with circadian disruption. Treatment of circadian rhythm disorders, whether precipitated by intrinsic factors (e.g., sleep disorders, blindness, mental disorders, aging) or by extrinsic factors (e.g., jet lag, shift work) has led to the development of a new type of agents called "chronobiotics," among which melatonin is the prototype.
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PMID:The human body circadian: How the biologic clock influences sleep and emotion. 1145 28

Few medical professionals would dispute the obvious health benefits afforded by regular exercise if pursued judiciously and in moderation. Cardiovascular disease, hypertension, osteoporosis, diabetes, depression, and fibromyalgia are a few of the many disorders in which exercise plays a key role in management. Less well-appreciated until recently is the beneficial effect exercise may have in the treatment of osteoarthritis (OA). Previously, rest and inactivity seemed to be the prevailing treatment strategy until it was recognized that this approach was ineffective and contributed further to the patient's disability and loss of function. New trial data support the value of physical exercise whether it involves aerobic or resistance-type training. The studies are not without statistical and methodologic imperfections. Still, the evidence favoring an exercise intervention as part of the OA treatment plan is impressive. It remains for the clinician to select an appropriate exercise routine that meets the strength, balance, flexibility, and aerobic needs of the patient. The clinician then monitors and evaluates the patient's response to this activity with the same exactness used in following pharmacologic therapy.
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PMID:Exercise in the treatment of osteoarthritis. 1170 15


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