Target Audience: Pharmacists
Activity Type: Application
Release Date: November 16, 2018
Expiration Date: November 16, 2019
Estimated Time to Complete Activity: 3.0 hours
Understanding the Prevalence, Burden, and Impact of Major Depressive Disorder
Major depressive disorder (MDD) is a mental health condition that is commonly encountered at the primary care office. Often, a chief “physical symptom” complaint may be a manifestation of this psychiatric condition, and, if the primary care provider is aware of the sometimes subtle physiologic symptoms of depression, routine screening for depression at medical office visits can often identify this potentially disabling condition. Beyond the hallmark symptoms of depressed mood or loss of interest or pleasure, changes in weight, sleep patterns, and increased complaints of pain can all be associated with MDD and may continue residually in patients treated for depression who experience only a partial response to therapy.
The incidence of MDD fluctuates over a lifetime. The highest incidence of depression is reported in adults aged 18 to 25 years, with roughly 10.9% of the individuals in the United States within this age bracket having experienced 1 or more major depressive episodes within the past year. This is compared with roughly 4.8% of adults older than 50 years. Evaluating data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III, Hasin et al estimated that the 12-month and lifetime prevalence of MDD is 10.4% and 20.6%, respectively. Despite efforts to increase awareness and decrease the stigma associated with mental illness, MDD continues to be underreported, underdiagnosed, and, often, undertreated.
New Epidemiologic Data and Trends
MDD is now understood to be a disease of the brain caused by both environmental and genetic factors that determine the course of the disease. Genomic research has identified 44 genetic variants linked to depression, some of which are associated with other serious mental illnesses, such as schizophrenia. The genetic similarities in the comorbid mental illnesses, coupled with new information about specific genetic targets, foster hope that the genome-wide association research will result in more individualized treatments for those with a diagnosis of MDD. Pharmacogenomic testing is now more widely available; however, because large-scale, randomized controlled trials to explore the absolute clinical value are lacking, the routine use of such testing is not yet recommended. Other studies explore the use of a more algorithmic approach, investigating demographic and clinical factors to establish pretreatment characteristics that will identify individuals who may be more likely to benefit preferentially from selective serotonin reuptake inhibitor (SSRI) treatment, which will further promote the goal of personalizing treatment selection for patients with MDD.
Despite the advances in pharmacotherapy, there are patients who will not respond to standard treatment interventions. Symptom profiles are highly heterogeneous, and severity of illness can range significantly. The complexity of treatment challenges providers to address the unmet needs of symptom relief and restoration of quality of life to those who experience MDD. Treatment resistance is generally recognized as a failure of treatment to produce a response or remission after 2 or more attempts using different antidepressant agents of an adequate dose and duration.
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