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Editorial   |    
From the Guest Editor
Andrew A. Nierenberg, M.D.
FOCUS 2005;3:1-1.
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Copyright 2005 American Psychiatric Association

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Major depressive disorder is a widespread, serious, chronic, and recurrent condition that imposes the burden of depressive symptoms and associated dysfunction and can ultimately lead to suicide. Psychopharmacological and specific psychotherapeutic interventions lessen the burden of depression, yet in modern clinical trials high placebo rates make efficacy difficult to prove. The mixed proof of efficacy has contributed to reassessments of the benefit-risk ratio of antidepressants and a reemergence of concerns that antidepressants can induce suicidality. In 2004, the Food and Drug Administration issued black box warnings on package inserts of antidepressants that, in some ways, state the obvious: patients with depression, especially children and adolescents, should be tracked carefully for exacerbations and suicidal ideation during treatment. In other words, physicians should take depression and its treatment seriously.

In this issue of FOCUS, articles highlight the strengths and limitations of data on the pathophysiology and practical treatment of major depressive disorder. On balance, the data support the continued use of antidepressants and psychotherapy for depression. Recent data elucidating the genetics, neuroimaging, and pharmacogenetics of depression, in some cases pointing toward or supporting novel treatments, confirm that the exciting area of "depressionology" is alive and well.




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