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Adults: The Latest Assessment and Treatment Strategies
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Only one-third of adult patients newly diagnosed with major
depression achieve complete relief of symptoms after taking one
antidepressant. These remission rates apply even when patients take
"newer" antidepressants such as selective serotonin reuptake
inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors
When a first drug fails, three next-step options exist: switching
to a new medication, augmenting the first drug with one that acts
in a different way, or augmenting drug treatment with
Augmentation is generally considered the best option when a first
drug provides partial relief but does not completely alleviate
symptoms. Disadvantages of this strategy include cost of additional
treatment and (if drug augmentation is used) increased likelihood
of side effects and drug interactions.
One of the most relevant studies for real-world clinical practice,
the Sequenced Treatment Alternatives to Relieve Depression (STAR*D)
trial, found that both psychotherapy and drugs are about equally
effective as augmentation strategies. More recent clinical trials
have tested dietary supplements as possible augmentation agents,
adding to the options.
In scientific studies, the term placebo usually refers to an inert
pill or procedure that serves as a comparison to an active
intervention (typically a drug or psychotherapy). Now a handful of
acupuncture studies not only provides additional evidence that a
placebo itself can have dramatic impact on illness, but also
suggest that the context in which an intervention takes place can
bolster the placebo response.
The nature of the placebo response — and whether it even exists —
has been the subject of scientific discussion for decades. In a
1955 paper, pioneering anesthesiologist Dr. Henry K. Beecher
famously described the placebo response as powerful. Nearly a
half-century later, a review published by the prestigious Cochrane
Collaboration concluded instead that the placebo might be
powerless. More recently, the Cochrane reviewers conducted another
analysis and reached a middle ground, concluding that for some
clinical conditions — particularly pain and nausea — placebos may
confer symptom alleviation, while in other situations they do not.
This raises the obvious question: why would placebos work in some
cases but not in others? The latest research has been aimed at
better understanding the placebo response by studying it on its own
rather than just as a comparison to a drug or psychotherapy.
Parents and clinicians report that sleep problems affect 25% to
50% of children and adolescents with attention deficit
hyperactivity disorder (ADHD). The most typical problems include
bedtime resistance and difficulty falling asleep.
Studies using objective measures of sleep quality have produced
inconsistent results, however. For example, studies using an
actigraph, a lightweight monitor that people can use at home, have
found that sleep in youths with ADHD is similar to that of other
youths when it comes to parameters such as sleep onset, duration,
and quality. At the same time, actigraph studies suggest that
youths with ADHD are more active during the night (assessed by
frequency and duration of movements), and they show greater
variability in sleep patterns from one night to the next —
suggesting unstable regulation of sleep and arousal.
The symptoms of ADHD and sleeping problems often overlap, making it
difficult to differentiate the two. For this reason, it's important
to rule out sleep problems before confirming a diagnosis of ADHD.
At the same time, sleep disorders can exacerbate symptoms of ADHD —
and vice versa — presenting a challenge to both parents and
Researchers studying the effects of chemotherapy on thinking and
cognitive ability believe there are several possible sources for
Recently I've been staying up until 3 or 4 in the morning to work on my oil paintings. I know I should feel tired, but I don't. One of my friends said that I might be hypomanic. What is that?