Unipolar depression in adults and initial treatment: Investigational approaches
- Michael Gitlin, MD
Michael Gitlin, MD
- Professor of Clinical Psychiatry
- Geffen School of Medicine at UCLA
- Paul Ciechanowski, MD
Paul Ciechanowski, MD
- Clinical Associate Professor of Psychiatry
- University of Washington School of Medicine
Unipolar depression is highly prevalent, disabling, and recurrent. Community surveys in 14 countries have estimated that the lifetime prevalence of unipolar depressive disorders is 12 percent , and the World Health Organization ranks unipolar major depression as the 11th greatest cause of disability and mortality in the world, among 291 diseases and causes of injury . Following recovery from one major depressive episode, the estimated rate of recurrence over two years is greater than 40 percent; after two episodes, the risk of recurrence within five years is approximately 75 percent .
In addition, initial treatment of unipolar major depression is often unsuccessful. The prospective, observational Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study initially treated 2876 outpatients with full doses of citalopram for up to 14 weeks, and found that remission occurred in only 33 percent .
As a result, many therapies (primarily medications) have been investigated for the initial treatment of depression, but have not been widely adopted due to limited evidence of their efficacy, safety, and tolerability. This topic reviews the evidence for these nonstandard treatments.
The general principles and prognosis for the initial treatment of depression are discussed separately, as are the choice of therapy for the initial treatment of depression and the general evidence of efficacy of standard therapies, and the evidence for standard therapies that are used for initially treating depression in primary care patients and in patients with general medical illnesses. Continuation and maintenance treatment of major depression, the treatment of resistant depression and refractory depression, and the clinical manifestations and diagnosis of depression are also discussed separately.
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- INVESTIGATED THERAPIES
- - Antiglucocorticoids
- - Botulinum toxin
- - Creatine
- - Lamotrigine
- - Lithium
- - Modafinil
- - Omega-3 fatty acids
- - Pindolol
- - Quetiapine
- - St. John’s wort
- - Sarcosine
- - Scopolamine
- - Statins
- - Stimulants
- - Testosterone
- - Triiodothyronine
- - Vitamins
- Bright light therapy