Prevalence 1) Is depression more prevalent now? Prevalence since world war II: Increased by a)25% b)50% c)100%
Types of Depression 2) How many types of Depressions are known to clinicians? a) 2 types b) 8 types c) Infinite number of types
History of Antidepressants 3) Safe antidepressants have been available for more than: a) 100 years b) 75 years c) 50 years
Major Depression –What is it? 4) Major depression is mainly: a) a functional "mental illness” b) a physical disease c) A body-mind illness
Failure to Achieve Remission: Consequences brain changes chronicity suicide attempts higher relapse rates Failure to Achieve Remission • inter-episode • duration medical comorbidity mortality # of chronic depressive episodes use of medical services and disability benefits impairment in work and relationships McIntyre. J Clin Psych 2010;71:16-20; Trivedi. J Clin Psychiatry 2009;70:26-31; Gradin, Pomi. J Biol Phys 2008;34:107-20.
Physiological Consequences Failure to Achieve Remission: Brain Structural Changes Cognitive impairment and maintenance of depressed mood in MDD may be related to atrophy and altered function of these brain structures • Hippocampal atrophy • Frontal cortex atrophy • Glial cell loss prefrontal cortex • Amygdala hyperactivity Campbell & MacQueen. J Psychiatry Neurosci 2004; 29: 417-26. McKinnon et al. J Psychiatry Neurosci 2009; 34: 41-54.