Depression Treatment: Pediatricians’ Self-Reported Role in Treating Children and Adolescents With Major Depressive Disorder: A National Random Survey.

Pediatricians’ Self-Reported Role in Treating Children and Adolescents With Major Depressive Disorder: A National Random Survey.

Filed under: Depression Treatment

Prim Care Companion CNS Disord. 2012; 14(4):
Pfalzgraf AR, Scott V, Makela EH, Hartsock SL, Kavookjian J, Miller LA

Objective:Major depressive disorder (MDD) is a serious US public health problem for children and adolescents. This study explored pediatricians’ self-reported role in treating children and adolescents with DSM-IV-TR MDD after the 2004 US Food and Drug Administration black-box warning.Method:A national random sample of pediatricians (N = 2,000) was surveyed from the beginning of November 2007 through the end of January 2008, with a usable response rate of 22.7% (408 of 1,800 deliverable surveys). Descriptive statistics and ?(2) tests were used to analyze the data on treatment versus referral of children and adolescents with MDD and on the proportion of pediatricians in 4 geographic regions who treat children and adolescents with MDD.Results:The majority of the pediatricians (60.0%, 245 of 408) do not treat either children or adolescents with MDD. Fewer than one-third of the pediatricians (28.2%, 115) reported treating both children and adolescents. The majority of the pediatricians (83.6%, 341) reported referring both children and adolescents to psychiatrists for treatment. The ?(2) tests indicate that the proportion of pediatricians who treat children (P = .088) and adolescents (P = .259) does not vary significantly according to the 4 geographic regions analyzed (Northeast, South, Midwest, and West).Conclusions:On the basis of self-report, the majority of US pediatricians do not treat children and adolescents with MDD but instead refer these patients to psychiatrists. In light of the current shortage of child and adolescent psychiatrists in the United States, referral to these specialists may be problematic.
HubMed – depression

Eszopiclone Treatment for Insomnia: Effect Size Comparisons in Patients With Primary Insomnia and Insomnia With Medical and Psychiatric Comorbidity.

Filed under: Depression Treatment

Prim Care Companion CNS Disord. 2012; 14(4):
Krystal AD, McCall WV, Fava M, Joffe H, Soares CN, Huang H, Grinell T, Zummo J, Spalding W, Marshall R

Objective: The purpose of this post hoc analysis was to compare the treatment effect size of eszopiclone 3 mg for insomnia in patients with a diagnosis of primary insomnia and in several of the psychiatric and medical conditions that are most commonly comorbid with insomnia.Method: Data were analyzed from 5 large, multicenter, randomized, double-blind, placebo-controlled studies of adult outpatients of at least 1 month duration published between 2006 and 2009. Diary-derived indices of sleep and daytime functioning and the Insomnia Severity Index were compared for patients with primary insomnia (DSM-IV-TR criteria, n = 828) and for those with insomnia comorbid with major depressive disorder (MDD, DSM-IV-TR criteria, n = 545), generalized anxiety disorder (GAD, DSM-IV-TR criteria, n = 595), perimenopause/postmenopause (Stages of Reproductive Aging Workshop criteria, n = 410), and rheumatoid arthritis (American College of Rheumatology criteria, n = 153). Cohen d effect sizes were calculated for each individual study as the between-treatment difference score divided by the pooled standard deviation.Results: Effect sizes ranged from 0.40 to 0.69 (small-medium) as early as week 1 and were maintained at 0.26-0.63 at week 4 for sleep latency, wake time after sleep onset, and total sleep time. Sleep latency and total sleep time effect sizes increased from week 1 to week 4 in the primary insomnia group. At week 4, effect sizes on all 3 parameters and the Insomnia Severity Index tended to be highest for the primary insomnia patients and tended to be lowest for patients with comorbid GAD and MDD. The effect sizes for daytime functioning were small for all insomnia patient groups.Conclusions: Eszopiclone 3 mg is an effective treatment for insomnia across 5 clinically diverse patient populations; however, magnitude of effect is mediated by underlying comorbidity and their treatments, with largest measures of effect seen in primary insomnia and lowest in MDD and GAD. These consistent results, and the fact that clinical trials were conducted in patients being treated as appropriate for their comorbid clinical conditions, support the results’ real-world generalizability and utility to clinical practice.
HubMed – depression

Depression in the elderly: clinical features and risk factors.

Filed under: Depression Treatment

Aging Dis. 2012 Dec; 3(6): 465-71
Sözeri-Varma G

Depression in elderlies is not known quite well and thus cannot be treated adequately. The fact that elderliness is accepted as a property of depressive symptoms both by the relatives of the patients and doctors is one of the factors which make it difficult to recognize depression. Existence of multiple physical diseases in elderlies, use of multiple medicines, occurrence of pharmacokinetic and pharmacodynamics changes depending on the age necessitate to take several factors into account while diagnosing and using medicines. In this study, clinical properties and risk factors of depression in old age period was reviewed and the properties of such depressions were summarized.
HubMed – depression

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