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Academician of the American Medical College Professor Ellen Frank: New Progress in the Diagnosis and Treatment of Depressive Disorders

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Academician of the American Medical College Professor Ellen Frank: New Progress in the Diagnosis and Treatment of Depressive Disorders

Author:
FONCOO
2019/09/04
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Recently, Professor Ellen Frank, an academician at the American Medical College, visited China and gave a wonderful report on “Depressive Disorder Studies” in the Peking University Sixth Hospital, Beijing Anding Hospital, Shandong Mental Health Center and Nanjing Brain Hospital. She made her visit in the company of Foncoo Shenzhen. Now let’s have a look at the wonderful content from the following six aspects: “diagnosis, epidemiology, disease course, treatment, comorbidity and challenge”.
 
 
I. Diagnosis (DSM-5):
Diagnostic criteria for depression: more than five of the following symptoms occur each day within 2 weeks. One symptom must be (1) black mood or (2) loss of interest or happiness.
1. Black mood
2. Significant decrease in interest or happiness
3. Obvious change in body weight or appetite
4. Slow thinking or psychomotor retardation
5. Fatigue or energy loss
6. Unworthiness or feeling of guilt
7. Unable to think or scatterbrained, and indecisive
8. Frequent intention to commit suicide or plan to commit suicide
Major depressive disorder (MDD) in DSM-5:
•No change in the basic standards
•Potentially useful annotation notes are added
•Notes: MDD is part of bipolar affective disorders
Explanation to “mixed outbreak”
•DSM-5 demands to expand the concept with only a few symptoms with “opposite” polarity
•Suitable for manic and severe depressive episode
•Exclude overlapping opposite symptoms
•Suitable for manic or hypomanic episode: more than 3 depressive symptoms in most of the time
•Suitable for severe depressive episode: more than 3 manic symptoms in most of the time
•If these two criteria are met, it implies manic and hypomanic episode with mixed characteristics
 
Explanation to the seasonal pattern
•DSM-IV: Only suitable for severe depressive episode
•DSM-5: Suitable for seasonal mania, hypomanic or depressive seasonal pattern; the opposite episode may not follow this pattern.
Explanation to anxiety disorders
The pain of anxiety is defined as having at least 2 of the following symptoms: feeling nervous; feeling very restless; unable to focus attention because of fear; feeling worried that something terrible may happen; likely to get out of control.
 
II. Epidemiology
The Prevalence of Unipolar Depression in China, Professor Ellen Frank referred to Professor Huang Yueqin’s research article published in The Lancet Psychiatry (IF: 15.233) in 2019.
Unweighted/weighted lifetime prevalence and 12-month prevalence of mental disorders:
 
III. Course of Unipolar Severe Depression
 
 
IV. Treatment
Common definition
•Response: ≥50% improved, but lower than the remission threshold
•Remission: MADRS score ≤ the normal-range specific critical value in the definition, such as HRSD or MARS≤7 or PHQ-9≤5.  
•Key problem: How long does each item take?
Main antidepressants: selective serotonin reuptake inhibitors (SSRIs), serotonin noradrenalin reuptake inhibitor (SNRI), atypical antidepressants, tricyclic antidepressants (TCAs), monoamine oxidase inhibitor (MAOIs)
Physiotherapy: electroshock therapy (ECT), deep brain stimulation (DBS), repetitive transcranial magnetic stimulation (rTMS), vagus nerve stimulation (VMS), acupuncture and moxibustion.
Psychotherapy: cognitive behavioral therapy (CBT), interpersonal psycho-therapy (IPT). As an independent therapy, psychotherapy is effective, especially to moderately severe depression. A combination of these therapies with medications can usually improve the effect.
 
V. Comorbidities
Common comorbidities of unipolar depression:
•Psychiatric comorbidities—anxiety, alcohol use disorders, substance use disorders, personality disorders (avoidance, dependence, obsessive-compulsive disorders). When depression is treated, anxiety, alcohol use disorders and substance use disorders can be improved with specific treatment. Personality disorders may require special treatment or be cured with an effective antidepressive therapy.
•Physical comorbidities—caner, stroke, acute cardiocerebrovascular syndromes, diabetes, chronic cardiovascular diseases, obesity.
 
VI. Challenges
•Treatment compliance: Acute treatment: a balance between therapeutic effects and drug side-effects. Long-term treatment: talk patients into maintaining treatment in the absence of symptoms.
•Identification and treatment of depression in children and adolescents: Distinguish between depression and normal emotional regulation; convince the necessity of receiving treatment; get help from a specialist in childhood depression; involve parents/caregivers in the treatment process; balance adolescents’ need for safety.
•Perinatal depression: It may be difficult to make a differential diagnosis of “postpartum depression” and pure exhaustion after childbirth; the antenatal period may be mistaken for a protection period; complex physical and mental social state.

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