Severe Depression

Roger S. McIntyre; Jay Nathanson
Pub date
Feb 2010
Oxford Psychiatry Library
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Major depressive disorder is highly prevalent, recurrent, and associated with inter-episodic dysfunction. Individuals with severe depression exhibit profound morbidity, co-morbidity, disability, cost, and mortality. Severe depression is a heterogeneous phenotype with a lack of standardized definition. The chronic and heterogeneous nature of severe depression results in a lower probability of spontaneous remission and often a chronic course. The complicated course of illness in severe depression results in frequent clinical visits and longer courses of therapy. Pharmacological treatment strategies for severe depression are selective serotonin reuptake inhibitors, tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors, norepinephrine-serotonin reuptake inhibitors, and monoamine oxidase inhibitors. These agents, alone and in various combinations, as well as psychosocial treatments, electroconvulsive therapy, transcranial magnetic stimulation, vagal nerve stimulation, and deep brain stimulation, are under investigation. In addition, a variety of novel augmentation strategies are being tested. Hitherto relatively few reviews, texts or monographs have focused on the diagnosis and management of severe depression. Part of the Oxford Psychiatry Library, this concise pocketbook covers the clinical features and definition of severe major depressive disorder. It focuses on current treatment strategies as well as an algorithmic approach to selecting and sequencing therapies for individuals with severe depression. Novel systematic approaches as well as psychosocial strategies will also be reviewed. This book will serve as a valuable quick reference for practitioners in mental health (i.e. clinical psychiatrists, trainees, specialist nurses, as well as primary care providers). The book will also be of interest to private sectors and researchers.


1. Introduction
2. Defining severe depression
3. Epidemiology and burden of illness
4. Medical comorbidity
5. Suicidality
6. Neurobiology of depression
7. Pharmacotherapy of depression
8. Pharmacological augmentation strategies for depression
9. Psychotherapy
10. Neuromodulation
11. Self-help resources

About the author: 

Dr. Roger McIntyre is currently Associate Professor of Psychiatry and Pharmacology at the University of Toronto and Head of the Mood Disorders Psychopharmacology Unit at the University Health Network, Toronto, Canada. Dr. McIntyre is involved in multiple research endeavours which primarily aim to characterize the association between mood disorders and medical comorbidity. This research involves elucidating metabolic adverse events associated with the use of psychotropic medications, the impact of medical comorbidity on the course of mood disorders, and the effect of glucose homeostasis on neurocognition. He has received several teaching awards from the University of Toronto, Department of Psychiatry and was awarded the joint Canadian Psychiatric Association (CPA) / Council of Psychiatric Continuing Education 2000-2001 Award for the Most Outstanding Continuing Education Activity in Psychiatry in Canada.; Dr. Jay Nathanson joined the Mood Disorders Psychopharmacolgy Unit at the University Health Network, Toronto, Canada, in September 2008. He is a graduate of the University of Western Ontario Medical School and completed his residency in psychiatry and fellowship in psychosomatic medicine at Boston Medical Center in Boston, Massachusetts. He is board certified in both Psychiatry and Psychosomatic Medicine by the American Board of Psychiatry and Neurology. Dr. Nathanson received a Masters Degree in Public Health from the Boston University School of Public Health, where he concentrated in health law and medical ethics. Following his training, he completed a post-doctoral fellowship in the Department of Social Medicine at Harvard Medical School. Dr. Nathanson has worked as an attending psychiatrist on an in-patient mental health unit at the University of Massachusetts Medical Center. More recently, he worked as a general consultation-liaison psychiatrist.

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