PMC:3660126 / 4975-8773 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/3660126","sourcedb":"PMC","sourceid":"3660126","source_url":"http://www.ncbi.nlm.nih.gov/pmc/3660126","text":"Mood disorders\nMood disorders are common mental health problems, afflicting 154 million people around the world.2 Major depression is currently the third leading cause of disability worldwide. Major depression is preferentially associated with female gender, with manic disorders distributed equally between males and females. Major depression is more common among people of low socioeconomic status, those with low education, those who are unmarried, separated, or divorced, those from a rural background, and those without intact families.3 Major depression has adverse consequences, including increased absenteeism from work, reduced productivity, disruption of family life, and increased health care utilization and costs. Smoking, drug abuse, sexual dysfunction, crime, violence, and suicidal behavior are further consequences for many sufferers.4–6 In addition, mood disorders are the most common cause of premature mortality, acceleration of aging, and reduced life expectancy.7\nMood disorders exist in many forms, including unipolar depression, bipolar depression, mania, mixed syndromes, and subsyndromes, and these conditions can co-occur with other psychiatric and physical disorders.8–10 Comorbid conditions complicate not only the diagnosis but also the management, prognosis, and outcome of major depression.11\nPsychopharmacological and nondrug therapies are effective in many patients with mood disorders. However, 30%–40% of patients with major depression become resistant to these treatments as a result of medical comorbidity, unavailability of appropriate services, and poor adherence with available therapies. These difficult-to-treat patients need specialized treatment strategies.12,13 The two major classifications of mental disorders provide a comprehensive view of mood disorders, but these have now been divided into more than 30 diagnostic categories.14,15 Major depression has a definite onset, is strongly influenced by biological and psychosocial factors,3,16,17 and is also related to personality disorders.18 Preclinical studies in animals and basic neurobiological research in human subjects have provided biological insights into the pathogenesis of major depression, and have helped in the development of drugs now used in major depression and other mood disorders.19,20\nNondrug interventions have also been developed to treat major depression, in view of the influence of psychosocial factors.21 Dacher described four healing systems, ie, homeostatic, conventional, mind-body, and spiritual.21 Sarris has also described an antidepressant-lifestyle-psychological-social model for treating depression that integrates conventional drug treatments with CAM, lifestyle changes, and psychosocial techniques.22 A combination of biological and psychosocial treatment produces better outcomes and reduces the rates of relapse and suicide.23 From a psychopharmacological perspective, there have been many controlled trials in mood disorders consistently reporting that 30% of patients achieve full remission, 30% are partial responders, and the rest are nonresponders.24,25 However, application of these results in the real-world setting is problematic because of the criteria used to select patients for entry into these trials. In a naturalistic study of 4000 patients with chronic depression and comorbid psychiatric or medical conditions treated with citalopram up to 60 mg/day, the remission rate was 27% and the response rate was 47%. When nonresponders were augmented or switched to another antidepressant, 30% remitted.26 According to Bambauer et al, patients with treatment-resistant depression attributable to nonadherence with medication27 need augmentation strategies.12,13 Patients with treatment-resistant depression are also at higher risk for 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