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This Week in JAMA
June 18, 2003

This Week in JAMA

JAMA. 2003;289(23):3047. doi:10.1001/jama.289.23.3047

Edited by Richard M. Glass, MD

Epidemiology of Major Depressive Disorder

The National Comorbidity Survey Replication on major depressive disorder (MDD), a nationally representative face-to-face household survey of adults aged 18 years or older, was conducted in the 48 contiguous United States from February 2001 through December 2002. The survey was based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnostic criteria for MDD. Kessler and colleagues report that in this survey, lifetime prevalence for MDD was 16.2% and prevalence in the preceding year, 6.6%. Only 21.7% of respondents with MDD in the preceding year reported receiving adequate treatment.

Treatment of Depression After Myocardial Infarction

Evidence suggests that depression and low perceived social support after myocardial infarction are associated with increased morbidity and mortality. In the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) trial,Article patients with an acute myocardial infarction and depression, low perceived social support, or both were randomly assigned to receive either cognitive behavioral therapy plus a selective serotonin reuptake inhibitor when indicated or usual care. After an average follow-up of 29 months, the event rate of the composite end point of death or nonfatal recurrent myocardial infarction was not significantly different in the 2 study groups. In an editorial, Frasure-Smith and LespéranceArticle consider why treatment of depression and low perceived social support failed to improve event-free survival in this trial and suggest directions for future trials of treatment of depression after myocardial infarction.

Interpersonal Psychotherapy for Depression in Uganda

Bolton and colleagues conducted a randomized trial in 30 villages in an impoverished region of southwest Uganda to assess the efficacy of group interpersonal psychotherapy for treatment of depression and to evaluate the feasibility of conducting a trial of a psychological intervention in sub-Saharan Africa. After completion of the intervention, the proportion of persons who met diagnostic criteria for major depression was significantly lower in the intervention groups than in the control groups. Decreases in depression and dysfunction severity scores were significantly greater in the intervention groups than in the control groups.

Regional Brain Metabolism and Depression Symptoms

Both noradrenergic and serotonergic systems appear to be involved in the mediation of symptoms of depression. In this trial among patients with depression who achieved remission while receiving norepinephrine reuptake inhibitors, Bremner and colleagues measured regional brain metabolism rates with positron emission tomography after catecholamine depletion induced by α-methylparatyrosine (AMPT) and after placebo challenge. In patients who experienced AMPT-induced return of depression symptoms, brain metabolism rates were decreased in several cortical regions following AMPT administration compared with placebo challenge, with the greatest effects in orbitofrontal cortex, dorsolateral prefrontal cortex, and thalamus. Resting metabolic rates in prefrontal and limbic regions were increased in patients who had AMPT-induced return of depression symptoms.

Lost Productive Work Time Associated With Depression

To estimate lost productive work time and associated labor costs among US workers with depression, Stewart and colleagues conducted supplemental extended interviews in a sample of employed participants in the American Productivity Audit. Workers with depression reported significantly more total health-related lost productive time than those without depression. Extrapolation of the survey results to the population of US workers suggests that US workers with depression cost employers an excess of $31 billion per year compared with workers without depression.

Medical News & Perspectives

Connections between art and mental health is a recurrent theme in the work and life of Kay Redfield Jamison, PhD, an expert on bipolar disorder and author of an eloquent memoir of her own struggles with the illness.

Clinician's corner

A systematic review of studies on interventions to improve management of depression in primary care indicates that complex interventions involving case management and collaborative care with mental health specialists are more likely to be effective than simple guideline implementation and educational strategies.

Outcomes of Depression Treatment

Keller reviews evidence demonstrating that remission is the optimal outcome of treatment for depression and discusses future directions in defining remission.

Depression in Physicians

A consensus statement developed in a workshop convened by the American Foundation For Suicide Prevention calls for a shift in professional attitudes and institutional policies to encourage physicians with depression and suicidality to seek help.

Depression Research

Insel and Charney summarize priority areas for depression research identified by the National Institute of Mental Health.

JAMA Patient Page

For your patients: Information about depression.