More treatment but no less depression: The treatment-prevalence paradox

Ormel, Johan; Hollon, Steven D.; Kessler, Ronald C.; Cuijpers, Pim; Monroe, Scott M.

doi:10.1016/j.cpr.2021.102111

Cited by 109 publications

(65 citation statements)

References 150 publications

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“…There are several possible explanations for this “treatment‐prevalence paradox” 149 . First, it is possible that prevalence rates of depression have dropped, but that at the same time incidence has increased due to societal changes.…”

Section: Cbt and The Scale‐up Of Evidence‐based Psychotherapymentioning

confidence: 99%

“…The limited ability of current treatments to reduce the disease burden of mental disorders raises the socalled "treatment prevalence paradox" 149 . This refers to the fact that clinical treatment rates have in creased in the past decades, while popula tion prevalence rates of mental disorders have not decreased.…”

Section: Cbt and The Scale-up Of Evidence-based Psychotherapymentioning

confidence: 99%

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Psychiatric diagnosis and treatment in the 21st century: paradigm shifts versus incremental integration

et al. 2022

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Psychiatry has always been characterized by a range of different models of and approaches to mental disorder, which have sometimes brought progress in clinical practice, but have often also been accompanied by critique from within and without the field. Psychiatric nosology has been a particular focus of debate in recent decades; successive editions of the DSM and ICD have strongly influenced both psychiatric practice and research, but have also led to assertions that psychiatry is in crisis, and to advocacy for entirely new paradigms for diagnosis and assessment. When thinking about etiology, many researchers currently refer to a biopsychosocial model, but this approach has received significant critique, being considered by some observers overly eclectic and vague. Despite the development of a range of evidence-based pharmacotherapies and psychotherapies, current evidence points to both a treatment gap and a research-practice gap in mental health. In this paper, after considering current clinical practice, we discuss some proposed novel perspectives that have recently achieved particular prominence and may significantly impact psychiatric practice and research in the future: clinical neuroscience and personalized pharmacotherapy; novel statistical approaches to psychiatric nosology, assessment and research; deinstitutionalization and community mental health care; the scale-up of evidence-based psychotherapy; digital phenotyping and digital therapies; and global mental health and task-sharing approaches. We consider the extent to which proposed transitions from current practices to novel approaches reflect hype or hope. Our review indicates that each of the novel perspectives contributes important insights that allow hope for the future, but also that each provides only a partial view, and that any promise of a paradigm shift for the field is not well grounded. We conclude that there have been crucial advances in psychiatric diagnosis and treatment in recent decades; that, despite this important progress, there is considerable need for further improvements in assessment and intervention; and that such improvements will likely not be achieved by any specific paradigm shifts in psychiatric practice and research, but rather by incremental progress and iterative integration.

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Section: Cbt and The Scale‐up Of Evidence‐based Psychotherapymentioning

confidence: 99%

Section: Cbt and The Scale-up Of Evidence-based Psychotherapymentioning

confidence: 99%

Psychiatric diagnosis and treatment in the 21st century: paradigm shifts versus incremental integration

et al. 2022

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“…The underlying cause of this “treatment-prevalence paradox” is thought to be multifactorial. One such proposed reason is an initial overestimation of antidepressant medication efficacy combined with a lack of effect durability (a lessening of medication efficacy over time) [ 32 ]. Indeed, many medications aimed to treat mental illness have led to a diagnosis of a refractory disease that does not adequately respond to pharmacological treatment or becomes resistant to treatment at a previously effective dose of medication [ 33 ].…”

Section: Introductionmentioning

confidence: 99%

Unraveling the Mysteries of Mental Illness With Psilocybin

Sotille¹,

Singh²,

Weisman³

et al. 2022

Cureus

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Current medications have not been effective in reducing the prevalence of mental illness worldwide. The prevalence of illnesses such as treatment-resistant depression has increased despite the widespread use of a broad set of psychopharmaceuticals. Transcranial magnetic stimulation and ketamine therapy are making great strides in improving treatment-resistant depression outcomes but they have limitations. New psychotherapeutics are required that specifically target the underlying cellular pathologies leading to neuronal atrophy. This neuronal atrophy model is supplanting the long-held neurotransmitter deficit hypothesis to explain mental illness. Interest in psychedelics as therapeutic molecules to treat mental illness is experiencing a 21st-century reawakening that is on the cusp of a transformation. Psilocybin is a pro-drug, found in various naturally occurring mushrooms, that is dephosphorylated to produce psilocin, a classic tryptamine psychedelic functional as a 5-hydroxytryptamine 2A receptor agonist. We have focused this review to include studies in the last two years that suggest psilocybin promotes neuronal plasticity, which may lead to changes in brain network connectivity. Recent advancements in clinical trials using pure psilocybin in therapy suggest that it may effectively relieve the symptoms of depression in patients diagnosed with major depressive disorder and treatment-resistant depression. Sophisticated cellular and molecular experiments at the systems level have produced evidence that demonstrates psilocybin promotes neuritogenesis in the mouse brain - a mechanism that may address the root cause of depression at the cellular level. Finally, studies with psilocybin therapy for major depressive disorder suggest that this ancient molecule can promote functionally connected intrinsic networks in the human brain, resulting in durable improvements in the severity of depressive symptoms. Although further research is necessary, the prospect of using psilocybin for the treatment of mental illness is an enticing possibility.

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“…[ 13 ] Therefore, the use of Chinese medicines with obvious curative effects and fewer side effects has become a hot topic in current research. [ 14 , 15 ] Duhuo Jisheng decoction (DHJSD), a classical prescription for the treatment of knee OA created by Sun Simiao, a physician of the Tang Dynasty, has been widely used in China for more than 1400 years in China. It was recorded in “Bei Ji Qian Ji Yao Fang” (备急千金要方), which had the effects of dispelling cold and removing dampness, relieving joint pain and tonifying liver and kidney.…”

Section: Introductionmentioning

confidence: 99%

Discussion on the molecular mechanism of Duhuo Jisheng decoction in treating osteoarthritis based on network pharmacology and molecular docking

et al. 2022

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In this study, network pharmacology and molecular docking technology were used to explore the molecular mechanisms of the Duhuo Jisheng decoction in the treatment of osteoarthritis (OA). The chemical composition of the prescriptions was obtained from the traditional Chinese medicine systems pharmacology database and analysis platform (TCMSP) database and the retrieved literature. Targets for the active ingredients were obtained using TCMSP and the Swiss Target Prediction Database. Disease targets were obtained from GeneCards and DisGeNET databases. The online tool, Venny, was used to obtain common targets for drugs and diseases. Protein-protein interactions (PPI) between common targets were analyzed using the search tool for the retrieval of interacting genes/proteins (STRING) database. Common targets were analyzed for gene ontology (GO) and Kyoto encyclopedia of genes and genomes (KEGG) pathway enrichment using the database for annotation, visualization and integrated discovery (DAVID) database. Molecular docking of the first 10 targets and first 10 components was verified using AutoDock Tools software, and the docking diagram was visualized using PyMOL software. After screening, 210 chemical components of the Duhuo Jisheng decoction (DHJSD) were identified. The 253 common targets of drugs and diseases were combined by eliminating repeat values. Based on PPI network analysis, the top ten targets were SRC, STAT3, MAPK3, MAPK1, RELA, PIK3R1, HSP90AA1, TP53, EP300, and AKT1. KEGG analysis showed that DHJSD could regulate the HIF-1, PI3K-Akt, and JAK-STAT signaling pathways. The biological processes involved include inflammatory reactions, the negative regulation of apoptosis, and the positive regulation of cell proliferation. Molecular docking results showed that all targets, except the RELA protein, showed good binding to the compounds, indicating that the 10 components might exert therapeutic effects by binding to the above targets. DHJSD can treat OA by regulating the HIF-1, PI3K-Akt, and JAK-STAT signaling pathways. The proteins involved were SRC, STAT3, MAPK3, MAPK1, and PIK3R1. In this study, network pharmacology was used to predict the mechanism of DHJSD in OA treatment, which was verified by molecular docking to provide experimental research ideas and scientific basis for OA treatment.

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More treatment but no less depression: The treatment-prevalence paradox

Cited by 109 publications

References 150 publications

Psychiatric diagnosis and treatment in the 21st century: paradigm shifts versus incremental integration

Psychiatric diagnosis and treatment in the 21st century: paradigm shifts versus incremental integration

Unraveling the Mysteries of Mental Illness With Psilocybin

Discussion on the molecular mechanism of Duhuo Jisheng decoction in treating osteoarthritis based on network pharmacology and molecular docking

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