EFFECT OF CONCURRENT SUBSTANCE USE DISORDER ON THE EFFECTIVENESS OF SINGLE AND COMBINATION ANTIDEPRESSANT MEDICATIONS FOR THE TREATMENT OF MAJOR DEPRESSION: AN EXPLORATORY ANALYSIS OF A SINGLE-BLIND RANDOMIZED TRIAL: Effect of Concurrent Substance Use Disorder

The co-occurrence of substance use disorder (SUD) and major depressive disorder (MDD) is common and is often thought to impair response to antidepressant therapy. These patients are often excluded from clinical trials, resulting in a significant knowledge gap regarding optimal pharmacotherapy for the treatment of MDD with concurrent SUD

Suicide risk in schizophrenia: learning from the past to change the future

Suicide is a major cause of death among patients with schizophrenia. Research indicates that at least 5–13% of schizophrenic patients die by suicide, and it is likely that the higher end of range is the most accurate estimate. There is almost total agreement that the schizophrenic patient who is more likely to commit suicide is young, male, white and never married, with good premorbid function, post-psychotic depression and a history of substance abuse and suicide attempts. Hopelessness, social isolation, hospitalization, deteriorating health after a high level of premorbid functioning, recent loss or rejection, limited external support, and family stress or instability are risk factors for suicide in patients with schizophrenia. Suicidal schizophrenics usually fear further mental deterioration, and they experience either excessive treatment dependence or loss of faith in treatment. Awareness of illness has been reported as a major issue among suicidal schizophrenic patients, yet some researchers argue that insight into the illness does not increase suicide risk. Protective factors play also an important role in assessing suicide risk and should also be carefully evaluated. The neurobiological perspective offers a new approach for understanding self-destructive behavior among patients with schizophrenia and may improve the accuracy of screening schizophrenics for suicide. Although, there is general consensus on the risk factors, accurate knowledge as well as early recognition of patients at risk is still lacking in everyday clinical practice. Better knowledge may help clinicians and caretakers to implement preventive measures. This review paper is the results of a joint effort between researchers in the field of suicide in schizophrenia. Each expert provided a brief essay on one specific aspect of the problem. This is the first attempt to present a consensus report as well as the development of a set of guidelines for reducing suicide risk among schizophenia patients

Is bereavement-related depression different than non-bereavement-related depression?

Background. This review tackles the question: 'Is bereavement related depression (BRD) the same or different from standard (non-bereavement-related) major depression (SMD)?' To answer this question, we examined published data on key characteristics that define and characterize SMD to assess whether they also characterize BRD.Method. We searched all English-language reports in Medline up to November 2006 to identify relevant studies. Bibliographies of located articles were searched for additional studies.Results. Consistent with the position that BRD is distinct from SMD, some, but not all, studies report that men are as likely as women to have BRD and that past or family histories of SMD do not predict BRD. With greater consistency, studies suggest that, like SMD, BRD is: more common in younger than in older adults, predicated by poor health or low social support, followed by recurrent episodes of major depressive episode (MDE), and associated with impaired immunological responses, altered sleep architecture, and responsivity to antidepressant treatment.Conclusions. Overall, the prevailing evidence more strongly supports similarities than differences between BRD and SMD. Because so few studies focus on BRD occurring within the first 2 months of bereavement, the period identified by the DSM to exclude the diagnosis of MDE, more research is needed specifically on this group to help us evaluate the validity of this important diagnostic convention