A JAMA THEME ISSUEEdited by Richard M. Glass, MD
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
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.
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.
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.
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
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.
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
Keller reviews evidence demonstrating that remission is the optimal
outcome of treatment for depression and discusses future directions in defining
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.
Insel and Charney summarize priority areas for depression research identified
by the National Institute of Mental Health.
For your patients: Information about depression.
This Week in JAMA. JAMA. 2003;289(23):3047. doi:10.1001/jama.289.23.3047