Challenges of residual symptoms and functioning in management of MDD

Abstract

Major depression is the leading cause of ill health and disability worldwide. 2017 marked the year when the World Health Organization led a one‐year global campaign with the goal that more people with depression both seek and get help.1,2 In England, Hospital Episode Statistics and Mental Health and Learning Disabilities data sets show that one in three patients with depression are unrecognised. Those who are recognised are often then under‐treated, fail to achieve remission and have difficulty returning to full functioning.

A Systematic Review and Individual Patient Data Network Analysis of the Residual Symptom Structure Following Cognitive-Behavioral Therapy and Escitalopram, Mirtazapine and Venlafaxine for Depression

“…Importantly, an ADM network could not be estimated for BDI-II samples, making cross-treatment comparisons of this measure not possible. Nevertheless, the HRSD-related result expands on previous psychometric network models, observing fatigue-related symptoms as consistently central post-treatment (1,26,28). The centrality of general somatic symptoms post-CBT and not ADM's may result from the superior ADM's effect on inflammatory cytokines.…”

“…All data-sets not obtained following two attempts of contact were then excluded from the analysis under "data not available." From each of the studies meeting the systematic review inclusion criteria, both those "providing IPD, " and "data not available, " the following variables were independently coded: (1) participants characteristics, including: number of participants at each assessment time point, mean (M) age and percentage of males; (2) intervention characteristics, including type of intervention administered; and (3) symptom characteristics, including: symptom measures used.…”

“…Depression is the leading cause of disability worldwide, reaching this status two decades earlier than originally projected (1). Much of depression's disease burden is attributed to its high relapse and recurrence rates (2).…”

“…Furthermore, symptoms associated with depression do co-vary independently from depression as a latent variable (e.g., sleep problems leading to fatigue), violating assumptions of local-independence (21). A continued focus on sum-scores slows down progress in depression relapse/recurrence research as they obfuscate complex relationships amongst symptoms that can remain posttreatment (1).…”

Emotion networks across self-reported depression levels during the COVID-19 pandemic

“…Unfortunately, this has been due to the virus arriving against the backdrop of existing mental health problems among populations worldwide (Holmes et al, 2020). For example, prior to COVID-19, depression was already the leading cause of disability worldwide (Rasmussen & Young, 2018). Furthermore, pandemic-related stressors such as changes in routine personal freedoms and unfamiliar public health measures may also greatly contribute to further distress and emotional disturbance (Pfefferbaum & North, 2020).…”