Depression. Problems and solution

When making a diagnosis of depressive spectrum disorder, it is necessary to exclude: hypothyroidism ; alcohol abuse; schizophrenia, post-traumatic mental disorder, dementia, bipolar disorder.

Between 20 and 50% of cases of depression are in the spectrum of bipolar disorder.

Major depressive disorder (MDD) is manifested by a chronic course, emotional, psychological, and behavioral signs. In the presence of anxiety, there is a worse prognosis of curability. Unipolar depression is the first cause of disability worldwide. 17% of US residents have experienced at least one episode of unipolar depression. 6.7% of adults – 16 million and 12.8% of adolescents – 3.1 million had signs of major depressive disorder in 2016. More than half of people with depressive disorder have professional and family impairments. Moreover, depression increases mortality by 60-80%. Depression is often untreated, even in wealthy countries like the United States, only 25% of people with unipolar depression receive adequate treatment. General practitioners do not consider the mood of patients, so the period between the onset of symptoms of depression and the start of treatment is four years.

The existing Hamilton and Montgomery- Osberg depression scales are not suitable for use in everyday clinical practice, as they are time-consuming. The PHQ-9, QIDS-SR, CUDOS reagents are more suitable for diagnosing symptoms of depression. With major depressive disorder, 50% improvement is seen after 4-8 weeks, but there may be residual symptoms of depression. If after 6-8 weeks of treatment there is no remission, then a change of drugs or treatment strategy is necessary. After the onset of remission, treatment for depression continues for 4 to 9 months, with the patient taking the drug in one dose to prevent relapse. Sometimes the course of preventive therapy lasts months or years.

More than twenty drugs are now used to treat major depressive disorder, but many patients develop treatment-resistant depression. This occurs in 40% -50% of cases. Treatment-resistant depression costs $ 201 billion annually. This is a great burden on the country’s economy.

Creation of more and more new generations of antidepressants is not a way out. And the study of the neurobiological causes of depression and the creation of therapeutic complexes on their basis will help to eliminate the causes of depression. Neuronal plasticity, neuroinflammation , neurotransmitters may be targets in the treatment of depression.

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