Vol 8, No 2 - Depression in Medicine
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1 4 9 I n  t h i s  i s s u e . . . This issue of Dialogues in Clinical Neuroscience is devot- ed to the theme of “Depression in Medicine.” Depression has a high prevalence in the general popula- tion. The association of depression with somatic diseases is of increasing interest. Many patients seen in general practice, who consult their doctor for somatic symptoms, also present depressive symptoms. However, there are dif- ferences, on the one hand between the various forms of depression, and on the other hand between different medical conditions. This issue begins with an overview of the clinical variations in depression. In his State of the art article, (page 151), Franco Benazzi, who has great experience in clinical prac- tice, describes the different pictures of depression in rela- tion to its treatment. Rather than the categorical division of  bipolar  and  depressive  disorders,  a  dimensional approach is proposed. This approach describes the differ- ent types of depressive states as a continuum, such as that proposed by Angst, primarily by the grading of its severi- ty and associated features. This view will have a high impact on treatment strategies. The fascinating field of neuropsychoimmunology is sum- marized by Brian Leonard and Ayemu Myint (page 163) in their Basic research article. Based on immunological findings in depression, mainly altered proinflammatory cytokines, they develop an interesting theory associating depression with dementia. They postulate a continuum between depression and dementia, suggested by a cas- cade incorporating stress, hormones, and the role of the kynurenine pathways. Recent advances in depression research are presented in a Basic research article by Paul Holtzheimer and Charles Nemeroff  (page  175),  who  also  look  back  on  several decades of research in the area. Based on results in basic and clinical neuroscience, potential directions for the under- standing of the pathophysiology of depression are shown. These include the exploration of monoamine neuronal cir- cuits, and the role of neuroendocrine and neuropeptide systems. Integrative neuronal network theories are com- prehensively discussed, with a special focus on the devel- opment of new treatment avenues. The very wide repertoire of pharmacological treatments for depressive states is presented in a Pharmacological aspects article by Fabrice Duval, Barry Lebowitz, and Jean-Paul Macher (page 191). Despite the appearance of new, innovative drugs in recent decades, there are still fre- quently cases of insufficient treatment response. Ways to improve treatment success are examined with the evalu- ation of predictors for treatment response. Neuroen- docrinology, neurophysiology, and pharmacogenomics offer new tools for creating more individualized, tailored treatments. These new methodologies, together with new classes of drugs, may improve our effectiveness. How can we evaluate depressive symptomatology? In his Clinical research article, (page 207). Per Bech, a well- known expert in rating scales, illustrates the advantages and disadvantages of the different rating scales, focusing on the most useful and relevant items for judging outcome. Altough depression is frequently associated with sleep dis- turbances, relatively little research has been done on the subject. Michael Thase (page 217), in a Clinical research article, underlines the common pathophysiology of both disorders. The normal topography of sleep and the alter- ations in sleep neurophysiology are reviewed. Most anti- depressants interfere with sleep, particularly REM sleep. The effects of different antidepressants on the different stages of sleep are described. The management of depres- sive insomnia, a common residual syndrome of remitted depression, is discussed. The most recent developments in drug therapy targeting insomnia in depression are reported on. In another article discussing somatic symptoms of depres- sion, Hans-Peter Kapfhammer (page 227) who is experi- enced in liaison psychiatry, begins his Clinical research article with a historical progression taking us up to the Diagnostic and Statistical Manual of Mental Disorders, 4th ed (DSM IV) and the ICD-10 Classification of Mental and Behavioral Disorders. Clinical descriptions and diagnostic guidelines (ICD 10). He explains the background to the term “somatic” in somatic depression, and how and when this condition occurs, and discusses its pharmaco- logical implications. Due to the development of new methodology, somatic treatments, as described by Renana Eitan and Bernard Lerer in their Clinical research article (page 241), are cur- rently experiencing a renaissance. The long-established technique of electroconvusive therapy (ECT), still in use for