Treatment of Recurrent Depression Review of Psychiatry Series John M. Oldham, M.D. Michelle B. Riba, M.D., M.S. Series Editors Treatment of Recurrent Depression EDITED BY John F. Greden, M.D. No. 5 Washington, DC London, England Note: The authors have worked to ensure that all information in this book concerning drug dosages, schedules, and routes of administration is accurate as of the time of publication and consistent with standards set by the U.S. Food and Drug Administration and the general medical community. As medical research and practice advance, however, therapeutic standards may change. For this reason and because human and mechanical errors sometimes occur, we recommend that readers follow the advice of a physician who is directly involved in their care or the care of a member of their family. A product’s current package insert should be consulted for full prescribing and safety information. Books published by American Psychiatric Publishing, Inc., represent the views and opinions of the individual authors and do not necessarily represent the policies and opinions of APPI or the American Psychiatric Association. Copyright © 2001 American Psychiatric Publishing, Inc. 04 03 02 01 4 3 2 1 ALL RIGHTS RESERVED Manufactured in the United States of America on acid-free paper First Edition American Psychiatric Publishing, Inc. 1400 K Street, NW Washington, DC 20005 www.appi.org The correct citation for this book is Greden JF (editor): Treatment of Recurrent Depression (Review of Psychiatry Series, Volume 20, Number 5; Oldham JM and Riba MB, series editors). Washington, DC, American Psychiatric Publishing, 2001 Library of Congress Cataloging-in-Publication Data Treatment of recurrent depression / edited by John F. Greden. p. ; cm. — (Review of psychiatry ; v. 20, n. 5) Includes bibliographical references and index. ISBN 1-58562-025-4 (alk. paper) 1. Depression, Mental. 2. Depression, Mental—Treatment. I. Greden, John F., 1942– II. Review of psychiatry series v. 20, 5. [DNLM: 1. Depressive Disorder—therapy. 2. Depressive Disorder— prevention & control. 3. Recurrence—prevention and control. WM 171 T7844 2001] RC537 .T742 2001 616.85′2706—dc21 00-069520 British Library Cataloguing in Publication Data A CIP record is available from the British Library. Cover illustration: Copyright© 2001 Amy DeVoogd/Artville. Dedicated to those caring, magnanimous individuals who support the research necessary to conquer depression Contents Contributors xi Introduction to the Review of Psychiatry Series xv John M. Oldham, M.D., and Michelle B. Riba, M.D., M.S., Series Editors Chapter 1 Recurrent Depression: Its Overwhelming Burden 1 John F. Greden, M.D. Widespread Prevalence 3 Early Symptom Onset 4 Underdiagnosis and Undertreatment 5 Genetic Vulnerability 7 Frequent Recurrences 8 Inadequate Emphasis on RecurrencePrevention 10 Poor Maintenance Treatment Adherence and Stigma 11 Brain Tissue Degeneration 12 Strategies to Prevent Recurrences and Reduce the Burden of MDD 14 References 15 Chapter 2 Recurrent Depression in Women Throughout the Life Span 19 Sheila M. Marcus, M.D. Heather A. Flynn, Ph.D. Elizabeth A. Young, M.D. Neera Ghaziuddin, M.D. Sharon Mudd, M.S., R.N., C.S., N.P. Depression in Adolescence 19 Depression in Pregnancy and the Postpartum Period 27 Depression in Midlife 40 The Need for More Research 48 Conclusion 50 References 50 Chapter 3 Chronic and RecurrentDepression: Pharmacotherapy and Psychotherapy Combinations 59 Robert Boland, M.D. Martin B. Keller, M.D. Importance of Adequate Treatment 60 Medication Treatment 61 Combination Treatment 65 Current Issues, Unanswered Questions 74 Conclusion 77 References 78 Chapter 4 Prevention of Recurrences in Patients With Bipolar Disorder: The Best of the Old and the New 81 Charles L. Bowden, M.D. Cheryl L. Gonzales, M.D. Goals of Care for Patients WithBipolarDisorder 81 Pharmacotherapy 89 Combination Treatment 97 Summary 98 References 98 Chapter 5 New Depression TreatmentStrategies: What Does the Future Hold for Therapeutic Uses of Minimally InvasiveBrain Stimulation? 103 Mark S. George, M.D. Ziad Nahas, M.D. Xing-Bao Li, M.D. Jeong-Ho Chae, M.D. Nicholas Oliver, B.S. Arif Najib, B.S. Berry Anderson, R.N. Electroconvulsive Therapy 106 Transcranial Magnetic Stimulation 109 Vagus Nerve Stimulation 119 Deep Brain Stimulation 130 Conclusion 134 References 135 Chapter 6 Clinical Prevention of Recurrent Depression: The Need for Paradigm Shifts 143 John F. Greden, M.D. MDD Versus Other Diseases: WhatCanWeLearn? 143 Clinical Strategies for Preventing Recurrences of Major Depressive Disorder 146 Pressing Research Challenges 150 Treatment of Recurrent MDD: The Need for Paradigm Shifts 153 Conclusion 164 References 165 Index 171