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Michael E. Thase - One of the best experts on this subject based on the ideXlab platform.
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The state of knowledge of Chronic Depression.
The Journal of clinical psychiatry, 2006Co-Authors: Alan J. Gelenberg, James H. Kocsis, James P. Mccullough, Philip T. Ninan, Michael E. ThaseAbstract:The Definition of Chronic Depression Dr. Gelenberg: Let’s begin with a discussion of the definition of Chronic Depression. What is the clinical relevance of the subtypes of Depression in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)? Dr. McCullough: My colleagues and I have reported on 1316 patients with Chronic Depression. We found no differences when a wide variety of demographic, psychosocial, and health measures were compared. For the DSM-V, we have argued that the existing subtypes do not represent qualitatively distinct entities. We have recommended a 2-by-2 table to accommodate a 4-fold classification of the unipolar disorders: mild versus moderate-to-severe severity and acute versus Chronic types of episodes (Table 1). We can greatly simplify the current subtypes of Chronic Depression by consolidating them into a single category termed Chronic Depression. Dr. Gelenberg: Will you define Chronic Depression? Dr. McCullough: Chronic Depression lasts a minimum of 2 years without at least a 2-month hiatus or a full remission. We are not suggesting the elimination of the DSM-IV categories for depressive disorders, but are recommending the deletion of distinct Chronic subtypes since these subtypes do not represent qualitatively different entities. Dr. Ninan: Perhaps we should review the current diagnostic criteria for depressive disorders. The criteria for dysthymia require depressed mood for the majority of time and 2 additional symptoms that persist for 2 years, while the criteria for a major depressive episode stipulate 5 or more symptoms, including depressed mood or anhedonia, persisting for at least 2 weeks. Dysthymia followed by a major depressive episode is frequently labeled double Depression. In the DSM-IV, Chronic Depression is defined as the persistence of the full criteria for a major depressive episode for at least 2 years. Major depressive disorder with incomplete recovery occurs when enough symptoms improve that the patient no longer meets the full criteria for major depressive disorder, but still has residual symptoms of Depression (i.e., subsyndromal Depression). If that patient later meets the full criteria for a major depressive episode without a period of remission in between, we consider it another episode of major Depression (i.e., 2 episodes with incomplete recovery in between). Dr. McCullough: On our 2-by-2 table, we recommend maintaining dysthymia on the Chronic row and in the mild severity column. Most of the disorders that Dr. Ninan just delineated would be in the moderateto-severe column. On the acute episode row, the mild disorder would be labeled minor depressive disorder and the moderate-to-severe episode would be termed episodic major Depression. Dan N. Klein, Ph.D., has LEADING EXPERTS IN THE TREATMENT
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The search for determinants of Chronic Depression: a review of six factors
Journal of affective disorders, 2002Co-Authors: Lawrence P. Riso, Ronald K. Miyatake, Michael E. ThaseAbstract:While strides have been made in the classification, assessment and identification of Chronic Depression, there remains a limited understanding of the factors underlying Chronicity. This review focuses on six putative determinants of Chronic Depression: developmental factors, personality and personality disorders, psychosocial stressors, comorbid disorders, biological factors and cognitive factors. The strongest support was found for the role of developmental factors in the Chronicity of Depression. Some support was found for the role of Chronic stressors and certain personality features such as stress reactivity. Few other factors found support. The determinants of Chronic Depression do not differ qualitatively from acute Depression. Rather, the development of Chronic Depression may involve increased levels of childhood adversity, protracted environmental stress and heightened stress reactivity. However, it is difficult to determine to what extent these putative determinants might reflect retrospective bias in data collection, or even parental reaction to children with subthreshold depressive traits. Detailed etiological models await further research attention to understudied areas and improved research designs. Suggestions for future research include greater specification of criteria for Chronicity, use of more appropriate comparison groups and longer term prospective follow-up studies.
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Sertraline versus imipramine to prevent relapse in Chronic Depression.
Journal of affective disorders, 2001Co-Authors: Lorrin M. Koran, Daniel N. Klein, Richard A. Friedman, James H. Kocsis, Susan G. Kornstein, Alan J. Gelenberg, Robert H Howland, Charles Debattista, Alan F. Schatzberg, Michael E. ThaseAbstract:Abstract Background: Chronic Depressions are common, disabling and under-treated, and long-term treatment is little studied. We report the continuation phase results from a long-term treatment study. Methods: After 12 weeks of acute phase treatment in a double-blind, randomized, parallel-group, multi-center trial of sertraline or imipramine, patients with Chronic Depression (≥2 years in major Depression, or major Depression superimposed on dysthymia) continued study drug for 16 weeks. Initially, 635 patients were randomized to sertraline or imipramine in a 2:1 ratio. Nonresponders after 12 weeks entered a 12-week double-blind crossover trial of the alternate medication. Entry into continuation treatment required at least a satisfactory response (partial remission) to initial or crossover treatment. Results: Of 239 acute or crossover responders to sertraline, 60% entered continuation in full remission and 40% with a partial remission. These proportions were identical for imipramine patients ( n =147). For both drug groups, over two-thirds of those entering in full remission retained it. For those entering in partial remission, over 40% achieved full remission. Patients requiring crossover treatment were less likely to maintain or improve their response during continuation treatment. The two drugs did not differ significantly in response distribution, drop out rates or discontinuation due to side effects during continuation treatment. Limitations: The absence of a placebo group constrains interpretation of our results, but Chronic Depressions have low placebo response rates. Conclusions: Most Chronic Depression patients who remit with 12 weeks of sertraline or imipramine treatment maintain remission during 16 weeks of continuation treatment. Most patients with a satisfactory therapeutic response (partial remission) after 12 weeks of treatment maintain it or further improve. Patients treated with imipramine experienced more side effects, but both drugs were well tolerated.
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gender differences in treatment response to sertraline versus imipramine in Chronic Depression
American Journal of Psychiatry, 2000Co-Authors: Susan G. Kornstein, Alan J. Gelenberg, James P. Mccullough, Michael E. Thase, Gabor I. Keitner, Alan F. Schatzberg, Kimberly A Yonkers, Sonia M Davis, Wilma Harrison, Martin B. KellerAbstract:Objective: The authors examined gender differences in treatment response to sertraline, a selective serotonin reuptake inhibitor (SSRI), and to imipramine, a tricyclic antidepressant, in Chronic Depression. Method: A total of 235 male and 400 female outpatients with DSM-III-R Chronic major Depression or double Depression (i.e., major Depression superimposed on dysthymia) were randomly assigned to 12 weeks of double-blind treatment with sertraline or with imipramine after placebo washout. Results: Women were significantly more likely to show a favorable response to sertraline than to imipramine, and men were significantly more likely to show a favorable response to imipramine than to sertraline. Gender and type of medication were also significantly related to dropout rates; women who were taking imipramine and men who were taking sertraline were more likely to withdraw from the study. Gender differences in time to response were seen with imipramine, with women responding significantly more slowly than men. Comparison of treatment response rates by menopausal status showed that premenopausal women responded significantly better to sertraline than to imipramine and that postmenopausal women had similar rates of response to the two medications. Conclusions: Men and women with Chronic Depression show differential responsivity to and tolerability of SSRIs and tricyclic antidepressants. The differing response rates between the drug classes in women was observed primarily in premenopausal women. Thus, female sex hormones may enhance response to SSRIs or inhibit response to tricyclics. Both gender and menopausal status should be considered when choosing an appropriate antidepressant for a depressed patient.
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Lost human capital from early-onset Chronic Depression.
The American journal of psychiatry, 2000Co-Authors: Ernst R. Berndt, Susan G. Kornstein, Alan J. Gelenberg, Michael E. Thase, Lorrin M. Koran, Stan N. Finkelstein, Ivan M. Miller, George A. Trapp, Martin B. KellerAbstract:OBJECTIVE: Chronic Depression starts at an early age for many individuals and could affect their accumulation of “human capital” (i.e., education, higher amounts of which can broaden occupational choice and increase earnings potential). The authors examined the impact, by gender, of early- (before age 22) versus late-onset major depressive disorder on educational attainment. They also determined whether the efficacy and sustainability of antidepressant treatments and psychosocial outcomes vary by age at onset and quantified the impact of early- versus late-onset, as well as never-occurring, major depressive disorder on expected lifetime earnings.METHOD: The authors used logistic and multivariate regression methods to analyze data from a three-phase, multicenter, double-blind, randomized trial that compared sertraline and imipramine treatment of 531 patients with Chronic Depression aged 30 years and older. These data were integrated with U.S. Census Bureau data on 1995 earnings by age, educational attainme...
Susan G. Kornstein - One of the best experts on this subject based on the ideXlab platform.
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Chronic Depression in women.
The Journal of clinical psychiatry, 2002Co-Authors: Susan G. KornsteinAbstract:Chronic Depression represents an important public health concern for women. It is under-recognized and undertreated and is associated with significant functional impairment and high rates of comorbidity. Moreover, recent research suggests that Chronic Depression may affect women more seriously than men; for example, women may experience illness onset at an earlier age and experience more severe psychosocial impairment compared with men. Recent studies have demonstrated the efficacy of both antidepressant medications and psychotherapy in treating Chronic Depression, with differential responsiveness to some treatments between women and men. Young women should be screened carefully and treated vigorously to prevent the serious consequences of this condition.
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Sertraline versus imipramine to prevent relapse in Chronic Depression.
Journal of affective disorders, 2001Co-Authors: Lorrin M. Koran, Daniel N. Klein, Richard A. Friedman, James H. Kocsis, Susan G. Kornstein, Alan J. Gelenberg, Robert H Howland, Charles Debattista, Alan F. Schatzberg, Michael E. ThaseAbstract:Abstract Background: Chronic Depressions are common, disabling and under-treated, and long-term treatment is little studied. We report the continuation phase results from a long-term treatment study. Methods: After 12 weeks of acute phase treatment in a double-blind, randomized, parallel-group, multi-center trial of sertraline or imipramine, patients with Chronic Depression (≥2 years in major Depression, or major Depression superimposed on dysthymia) continued study drug for 16 weeks. Initially, 635 patients were randomized to sertraline or imipramine in a 2:1 ratio. Nonresponders after 12 weeks entered a 12-week double-blind crossover trial of the alternate medication. Entry into continuation treatment required at least a satisfactory response (partial remission) to initial or crossover treatment. Results: Of 239 acute or crossover responders to sertraline, 60% entered continuation in full remission and 40% with a partial remission. These proportions were identical for imipramine patients ( n =147). For both drug groups, over two-thirds of those entering in full remission retained it. For those entering in partial remission, over 40% achieved full remission. Patients requiring crossover treatment were less likely to maintain or improve their response during continuation treatment. The two drugs did not differ significantly in response distribution, drop out rates or discontinuation due to side effects during continuation treatment. Limitations: The absence of a placebo group constrains interpretation of our results, but Chronic Depressions have low placebo response rates. Conclusions: Most Chronic Depression patients who remit with 12 weeks of sertraline or imipramine treatment maintain remission during 16 weeks of continuation treatment. Most patients with a satisfactory therapeutic response (partial remission) after 12 weeks of treatment maintain it or further improve. Patients treated with imipramine experienced more side effects, but both drugs were well tolerated.
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gender differences in treatment response to sertraline versus imipramine in Chronic Depression
American Journal of Psychiatry, 2000Co-Authors: Susan G. Kornstein, Alan J. Gelenberg, James P. Mccullough, Michael E. Thase, Gabor I. Keitner, Alan F. Schatzberg, Kimberly A Yonkers, Sonia M Davis, Wilma Harrison, Martin B. KellerAbstract:Objective: The authors examined gender differences in treatment response to sertraline, a selective serotonin reuptake inhibitor (SSRI), and to imipramine, a tricyclic antidepressant, in Chronic Depression. Method: A total of 235 male and 400 female outpatients with DSM-III-R Chronic major Depression or double Depression (i.e., major Depression superimposed on dysthymia) were randomly assigned to 12 weeks of double-blind treatment with sertraline or with imipramine after placebo washout. Results: Women were significantly more likely to show a favorable response to sertraline than to imipramine, and men were significantly more likely to show a favorable response to imipramine than to sertraline. Gender and type of medication were also significantly related to dropout rates; women who were taking imipramine and men who were taking sertraline were more likely to withdraw from the study. Gender differences in time to response were seen with imipramine, with women responding significantly more slowly than men. Comparison of treatment response rates by menopausal status showed that premenopausal women responded significantly better to sertraline than to imipramine and that postmenopausal women had similar rates of response to the two medications. Conclusions: Men and women with Chronic Depression show differential responsivity to and tolerability of SSRIs and tricyclic antidepressants. The differing response rates between the drug classes in women was observed primarily in premenopausal women. Thus, female sex hormones may enhance response to SSRIs or inhibit response to tricyclics. Both gender and menopausal status should be considered when choosing an appropriate antidepressant for a depressed patient.
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Lost human capital from early-onset Chronic Depression.
The American journal of psychiatry, 2000Co-Authors: Ernst R. Berndt, Susan G. Kornstein, Alan J. Gelenberg, Michael E. Thase, Lorrin M. Koran, Stan N. Finkelstein, Ivan M. Miller, George A. Trapp, Martin B. KellerAbstract:OBJECTIVE: Chronic Depression starts at an early age for many individuals and could affect their accumulation of “human capital” (i.e., education, higher amounts of which can broaden occupational choice and increase earnings potential). The authors examined the impact, by gender, of early- (before age 22) versus late-onset major depressive disorder on educational attainment. They also determined whether the efficacy and sustainability of antidepressant treatments and psychosocial outcomes vary by age at onset and quantified the impact of early- versus late-onset, as well as never-occurring, major depressive disorder on expected lifetime earnings.METHOD: The authors used logistic and multivariate regression methods to analyze data from a three-phase, multicenter, double-blind, randomized trial that compared sertraline and imipramine treatment of 531 patients with Chronic Depression aged 30 years and older. These data were integrated with U.S. Census Bureau data on 1995 earnings by age, educational attainme...
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the treatment of Chronic Depression part 3 psychosocial functioning before and after treatment with sertraline or imipramine
The Journal of Clinical Psychiatry, 1998Co-Authors: Ivan W. Miller, Daniel N. Klein, Susan G. Kornstein, Michael E. Thase, John C Markowitz, Gabor I. Keitner, Alan F. Schatzberg, A J Rush, D Schlager, Sonia M DavisAbstract:Background Previous research has suggested that depressed patients, and particularly Chronically depressed patients, have significant impairments in many areas of their lives. While previous studies suggested that these "psychosocial" impairments improve following pharmacologic treatment, no large scale definitive study using multiple measures of psychosocial functioning has been reported. Method We assessed multiple domains of psychosocial functioning using interviewer-rated and self-report measures within the context of a 12-week acute treatment trial of sertraline and imipramine for patients with Chronic Depression (double Depression and Chronic major Depression). We also compared the psychosocial functioning data of this sample before and after treatment with normative data available from published community samples. Results Chronically depressed patients manifested severe impairments in psychosocial functioning at baseline. After treatment with sertraline or imipramine, psychosocial functioning improved significantly. Significant improvements appeared relatively early in treatment (week 4). Despite these highly significant improvements in functioning during acute treatment, the study sample as a whole did not achieve levels of psychosocial functioning comparable to a comparator nondepressed community sample. However, patients who reached full symptomatic response (remission) during acute treatment did have levels of psychosocial functioning in most areas at endpoint that approached or equaled those of community samples. Conclusion These results indicate that successful antidepressant treatment with sertraline or imipramine can alleviate the severe psychosocial impairments found in Chronic Depression.
Daniel N. Klein - One of the best experts on this subject based on the ideXlab platform.
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Chronic Depression Diagnosis and Classification
Current Directions in Psychological Science, 2010Co-Authors: Daniel N. KleinAbstract:Traditionally, non-bipolar Depression has been viewed as an episodic, remitting condition. However, with the recognition that Depressions can persist for many years, the current diagnostic classification system includes various forms of Chronic Depression. The distinction between Chronic and nonChronic Depressions is useful for reducing the heterogeneity of the disorder. Individuals with Chronic Depression differ from those with nonChronic Depression on a variety of clinically and etiologically significant variables, including comorbidity, impairment, suicidality, history of childhood maltreatment, familial psychopathology, and long-term course. In contrast, there is little support for current distinctions between different forms of Chronic Depression. This suggests that it may be simpler to collapse the existing forms of Chronic Depression in the current classification system into a single category. However, there is growing evidence that other characteristics, such as age of onset and a childhood histor...
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Chronic Depression: update on classification and treatment.
Current psychiatry reports, 2008Co-Authors: Dana C. Torpey, Daniel N. KleinAbstract:A significant proportion of patients with depressive disorders suffer from Chronic conditions. The DSM-IV recognizes several forms of Chronic Depression. Chronic Depressions differ from nonChronic major depressive disorder (MDD) on many clinical, psychosocial, and familial variables. However, less support exists for current distinctions between the various forms of Chronic Depression. Antidepressant medications and at least some forms of psychotherapy are efficacious in treating Chronic Depression, and the combination of pharmacotherapy and psychotherapy appears to be superior to either monotherapy alone. Still, Chronic Depression is often inadequately treated, and many patients fail to respond or continue to experience residual symptoms after treatment. An important direction for future research is to elucidate the multiple pathways to Chronic Depression and to tailor treatments to specific etiopathogenetic subgroups.
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Dysthymia and Chronic Depression: introduction, classification, risk factors, and course.
Journal of clinical psychology, 2003Co-Authors: Daniel N. Klein, Neil J. SantiagoAbstract:Chronic forms of Depression are more common and impairing than is generally recognized. This article introduces an In Session issue devoted to dysthymic disorder and Chronic Depression, and it reviews current knowledge about these disorders. First, we discuss nosological issues, followed by a summary of potential risk factors. Finally, the naturalistic course of Chronic Depression is described and implications for clinical practice are discussed.
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Group comparisons of DSM-IV subtypes of Chronic Depression: validity of the distinctions, part 2.
Journal of abnormal psychology, 2003Co-Authors: James P. Mccullough, Daniel N. Klein, Lawrence P. Riso, Martin B. Keller, Frances E. Borian, Robert H Howland, Phillip L. C. BanksAbstract:The nosology of Chronic Depression in Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV, American Psychiatric Association, 1994) is highly complex and requires clinicians to differentiate among several Chronic course subtypes. This study replicates an earlier investigation (J. McCullough et al., 2000; see record 2000-05424-007) that found few differences among Diagnostic and Statistical Manual of Mental Disorders (3rd ed. rev.; DSM-III-R; American Psychiatric Association, 1987) categories of Chronic Depression. In the present study, 681 outpatients with Chronic major Depression, double Depression, recurrent major Depression without full interepisode recovery, and Chronic major Depression superimposed on antecedent dysthymia were compared. Few differences were observed on a broad range of demographic, clinical, psychosocial, family history, and treatment response variables. The authors suggest that Chronic Depression should be viewed as a single, broad condition that can assume a variety of clinical course configurations.
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Sertraline versus imipramine to prevent relapse in Chronic Depression.
Journal of affective disorders, 2001Co-Authors: Lorrin M. Koran, Daniel N. Klein, Richard A. Friedman, James H. Kocsis, Susan G. Kornstein, Alan J. Gelenberg, Robert H Howland, Charles Debattista, Alan F. Schatzberg, Michael E. ThaseAbstract:Abstract Background: Chronic Depressions are common, disabling and under-treated, and long-term treatment is little studied. We report the continuation phase results from a long-term treatment study. Methods: After 12 weeks of acute phase treatment in a double-blind, randomized, parallel-group, multi-center trial of sertraline or imipramine, patients with Chronic Depression (≥2 years in major Depression, or major Depression superimposed on dysthymia) continued study drug for 16 weeks. Initially, 635 patients were randomized to sertraline or imipramine in a 2:1 ratio. Nonresponders after 12 weeks entered a 12-week double-blind crossover trial of the alternate medication. Entry into continuation treatment required at least a satisfactory response (partial remission) to initial or crossover treatment. Results: Of 239 acute or crossover responders to sertraline, 60% entered continuation in full remission and 40% with a partial remission. These proportions were identical for imipramine patients ( n =147). For both drug groups, over two-thirds of those entering in full remission retained it. For those entering in partial remission, over 40% achieved full remission. Patients requiring crossover treatment were less likely to maintain or improve their response during continuation treatment. The two drugs did not differ significantly in response distribution, drop out rates or discontinuation due to side effects during continuation treatment. Limitations: The absence of a placebo group constrains interpretation of our results, but Chronic Depressions have low placebo response rates. Conclusions: Most Chronic Depression patients who remit with 12 weeks of sertraline or imipramine treatment maintain remission during 16 weeks of continuation treatment. Most patients with a satisfactory therapeutic response (partial remission) after 12 weeks of treatment maintain it or further improve. Patients treated with imipramine experienced more side effects, but both drugs were well tolerated.
Martin B. Keller - One of the best experts on this subject based on the ideXlab platform.
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Group comparisons of DSM-IV subtypes of Chronic Depression: validity of the distinctions, part 2.
Journal of abnormal psychology, 2003Co-Authors: James P. Mccullough, Daniel N. Klein, Lawrence P. Riso, Martin B. Keller, Frances E. Borian, Robert H Howland, Phillip L. C. BanksAbstract:The nosology of Chronic Depression in Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV, American Psychiatric Association, 1994) is highly complex and requires clinicians to differentiate among several Chronic course subtypes. This study replicates an earlier investigation (J. McCullough et al., 2000; see record 2000-05424-007) that found few differences among Diagnostic and Statistical Manual of Mental Disorders (3rd ed. rev.; DSM-III-R; American Psychiatric Association, 1987) categories of Chronic Depression. In the present study, 681 outpatients with Chronic major Depression, double Depression, recurrent major Depression without full interepisode recovery, and Chronic major Depression superimposed on antecedent dysthymia were compared. Few differences were observed on a broad range of demographic, clinical, psychosocial, family history, and treatment response variables. The authors suggest that Chronic Depression should be viewed as a single, broad condition that can assume a variety of clinical course configurations.
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Long-term treatment of recurrent and Chronic Depression.
The Journal of Clinical Psychiatry, 2001Co-Authors: Martin B. KellerAbstract:Depression is associated with high rates of impairment and comorbidity with other disorders and has a devastaling effect on those who suffer from it. Treatment options are avadable and can greatly improve functioning: however, undertreatment still persists. Undertreatment may result from incor rect or incomplete diagnoses or inadequate treatment duration. In addition, when treating Depression, clinicians must identify underlying conditions, life-span issues, and proper treatment duration to maximize outcome. This article provides an overview of the underlying implications of Depression, reviews issues in treating Chronic Depression that are still unresolved, and recommends standards for maintenance therapy.
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gender differences in treatment response to sertraline versus imipramine in Chronic Depression
American Journal of Psychiatry, 2000Co-Authors: Susan G. Kornstein, Alan J. Gelenberg, James P. Mccullough, Michael E. Thase, Gabor I. Keitner, Alan F. Schatzberg, Kimberly A Yonkers, Sonia M Davis, Wilma Harrison, Martin B. KellerAbstract:Objective: The authors examined gender differences in treatment response to sertraline, a selective serotonin reuptake inhibitor (SSRI), and to imipramine, a tricyclic antidepressant, in Chronic Depression. Method: A total of 235 male and 400 female outpatients with DSM-III-R Chronic major Depression or double Depression (i.e., major Depression superimposed on dysthymia) were randomly assigned to 12 weeks of double-blind treatment with sertraline or with imipramine after placebo washout. Results: Women were significantly more likely to show a favorable response to sertraline than to imipramine, and men were significantly more likely to show a favorable response to imipramine than to sertraline. Gender and type of medication were also significantly related to dropout rates; women who were taking imipramine and men who were taking sertraline were more likely to withdraw from the study. Gender differences in time to response were seen with imipramine, with women responding significantly more slowly than men. Comparison of treatment response rates by menopausal status showed that premenopausal women responded significantly better to sertraline than to imipramine and that postmenopausal women had similar rates of response to the two medications. Conclusions: Men and women with Chronic Depression show differential responsivity to and tolerability of SSRIs and tricyclic antidepressants. The differing response rates between the drug classes in women was observed primarily in premenopausal women. Thus, female sex hormones may enhance response to SSRIs or inhibit response to tricyclics. Both gender and menopausal status should be considered when choosing an appropriate antidepressant for a depressed patient.
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Lost human capital from early-onset Chronic Depression.
The American journal of psychiatry, 2000Co-Authors: Ernst R. Berndt, Susan G. Kornstein, Alan J. Gelenberg, Michael E. Thase, Lorrin M. Koran, Stan N. Finkelstein, Ivan M. Miller, George A. Trapp, Martin B. KellerAbstract:OBJECTIVE: Chronic Depression starts at an early age for many individuals and could affect their accumulation of “human capital” (i.e., education, higher amounts of which can broaden occupational choice and increase earnings potential). The authors examined the impact, by gender, of early- (before age 22) versus late-onset major depressive disorder on educational attainment. They also determined whether the efficacy and sustainability of antidepressant treatments and psychosocial outcomes vary by age at onset and quantified the impact of early- versus late-onset, as well as never-occurring, major depressive disorder on expected lifetime earnings.METHOD: The authors used logistic and multivariate regression methods to analyze data from a three-phase, multicenter, double-blind, randomized trial that compared sertraline and imipramine treatment of 531 patients with Chronic Depression aged 30 years and older. These data were integrated with U.S. Census Bureau data on 1995 earnings by age, educational attainme...
James P. Mccullough - One of the best experts on this subject based on the ideXlab platform.
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The state of knowledge of Chronic Depression.
The Journal of clinical psychiatry, 2006Co-Authors: Alan J. Gelenberg, James H. Kocsis, James P. Mccullough, Philip T. Ninan, Michael E. ThaseAbstract:The Definition of Chronic Depression Dr. Gelenberg: Let’s begin with a discussion of the definition of Chronic Depression. What is the clinical relevance of the subtypes of Depression in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)? Dr. McCullough: My colleagues and I have reported on 1316 patients with Chronic Depression. We found no differences when a wide variety of demographic, psychosocial, and health measures were compared. For the DSM-V, we have argued that the existing subtypes do not represent qualitatively distinct entities. We have recommended a 2-by-2 table to accommodate a 4-fold classification of the unipolar disorders: mild versus moderate-to-severe severity and acute versus Chronic types of episodes (Table 1). We can greatly simplify the current subtypes of Chronic Depression by consolidating them into a single category termed Chronic Depression. Dr. Gelenberg: Will you define Chronic Depression? Dr. McCullough: Chronic Depression lasts a minimum of 2 years without at least a 2-month hiatus or a full remission. We are not suggesting the elimination of the DSM-IV categories for depressive disorders, but are recommending the deletion of distinct Chronic subtypes since these subtypes do not represent qualitatively different entities. Dr. Ninan: Perhaps we should review the current diagnostic criteria for depressive disorders. The criteria for dysthymia require depressed mood for the majority of time and 2 additional symptoms that persist for 2 years, while the criteria for a major depressive episode stipulate 5 or more symptoms, including depressed mood or anhedonia, persisting for at least 2 weeks. Dysthymia followed by a major depressive episode is frequently labeled double Depression. In the DSM-IV, Chronic Depression is defined as the persistence of the full criteria for a major depressive episode for at least 2 years. Major depressive disorder with incomplete recovery occurs when enough symptoms improve that the patient no longer meets the full criteria for major depressive disorder, but still has residual symptoms of Depression (i.e., subsyndromal Depression). If that patient later meets the full criteria for a major depressive episode without a period of remission in between, we consider it another episode of major Depression (i.e., 2 episodes with incomplete recovery in between). Dr. McCullough: On our 2-by-2 table, we recommend maintaining dysthymia on the Chronic row and in the mild severity column. Most of the disorders that Dr. Ninan just delineated would be in the moderateto-severe column. On the acute episode row, the mild disorder would be labeled minor depressive disorder and the moderate-to-severe episode would be termed episodic major Depression. Dan N. Klein, Ph.D., has LEADING EXPERTS IN THE TREATMENT
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Cognitive Behavioral Analysis System of Psychotherapy (CBASP) for Chronic Depression
Handbook of Psychotherapy Integration, 2005Co-Authors: James P. McculloughAbstract:Chapter 13 discusses the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) for Chronic Depression, and covers the integrative approach, the diagnosis of Chronic Depression, assessment, its applicability and structure, processes (including Structural-Perceptual psychopathology, inability to generate empathy, and gross interpersonal skill deficits), methods used (Situational Analysis (SA), the Interpersonal Discrimination Exercise (IDE), and Social Skill/Role Rehearsal Training (SS/RRT)), the therapy relationship, a case example, empirical research, and future directions.
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Treatment for Chronic Depression using Cognitive Behavioral Analysis System of Psychotherapy (CBASP).
Journal of clinical psychology, 2003Co-Authors: James P. McculloughAbstract:The article presents an overview of the Chronic Depression construct in the Diagnostic and Statistical Manual of Mental Disorders (DSMs) since 1980, including developmental etiology and psychopathological patterns of the Chronically depressed adult. Then the Cognitive Behavioral Analysis System of Psychotherapy (CBASP), an empirically supported psychotherapy and the only therapy developed specifically to treat Chronic Depression, is described. CBASP addresses the idiosyncratic problems of the Chronically depressed adult using Situational Analysis, the Interpersonal Discrimination Exercise, and Behavioral Skill Training/Rehearsal techniques. The first two techniques are illustrated using a verbatim case example.
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Group comparisons of DSM-IV subtypes of Chronic Depression: validity of the distinctions, part 2.
Journal of abnormal psychology, 2003Co-Authors: James P. Mccullough, Daniel N. Klein, Lawrence P. Riso, Martin B. Keller, Frances E. Borian, Robert H Howland, Phillip L. C. BanksAbstract:The nosology of Chronic Depression in Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV, American Psychiatric Association, 1994) is highly complex and requires clinicians to differentiate among several Chronic course subtypes. This study replicates an earlier investigation (J. McCullough et al., 2000; see record 2000-05424-007) that found few differences among Diagnostic and Statistical Manual of Mental Disorders (3rd ed. rev.; DSM-III-R; American Psychiatric Association, 1987) categories of Chronic Depression. In the present study, 681 outpatients with Chronic major Depression, double Depression, recurrent major Depression without full interepisode recovery, and Chronic major Depression superimposed on antecedent dysthymia were compared. Few differences were observed on a broad range of demographic, clinical, psychosocial, family history, and treatment response variables. The authors suggest that Chronic Depression should be viewed as a single, broad condition that can assume a variety of clinical course configurations.
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gender differences in treatment response to sertraline versus imipramine in Chronic Depression
American Journal of Psychiatry, 2000Co-Authors: Susan G. Kornstein, Alan J. Gelenberg, James P. Mccullough, Michael E. Thase, Gabor I. Keitner, Alan F. Schatzberg, Kimberly A Yonkers, Sonia M Davis, Wilma Harrison, Martin B. KellerAbstract:Objective: The authors examined gender differences in treatment response to sertraline, a selective serotonin reuptake inhibitor (SSRI), and to imipramine, a tricyclic antidepressant, in Chronic Depression. Method: A total of 235 male and 400 female outpatients with DSM-III-R Chronic major Depression or double Depression (i.e., major Depression superimposed on dysthymia) were randomly assigned to 12 weeks of double-blind treatment with sertraline or with imipramine after placebo washout. Results: Women were significantly more likely to show a favorable response to sertraline than to imipramine, and men were significantly more likely to show a favorable response to imipramine than to sertraline. Gender and type of medication were also significantly related to dropout rates; women who were taking imipramine and men who were taking sertraline were more likely to withdraw from the study. Gender differences in time to response were seen with imipramine, with women responding significantly more slowly than men. Comparison of treatment response rates by menopausal status showed that premenopausal women responded significantly better to sertraline than to imipramine and that postmenopausal women had similar rates of response to the two medications. Conclusions: Men and women with Chronic Depression show differential responsivity to and tolerability of SSRIs and tricyclic antidepressants. The differing response rates between the drug classes in women was observed primarily in premenopausal women. Thus, female sex hormones may enhance response to SSRIs or inhibit response to tricyclics. Both gender and menopausal status should be considered when choosing an appropriate antidepressant for a depressed patient.
