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Background: Increasingly, health insurance companies are asking for treatment results in mental health care to be expressed in actual numbers. They base their request on the data supplied by sbg (Stichting Benchmark ggz) and the procedures that sbg has followed. For the purpose of benchmarking, the sbg has accepted a limited number of questionnaires. These tools are not suitable for performing routine outcome monitoring (rom) in clinical practice. There is a urgent need for these questionnaires to be replaced by a widely-used depression questionnaire, namely the ids., Aim: To present arguments supporting the view that the ids is an excellent and useful instrument that the sbg should accept as a measuring tool., Method: We discuss the quality of the ids by reviewing the literature., Results: The ids is a high quality instrument well suited for measuring the severity of depressions and also is sufficiently sensitive for measuring mood improvements.
, Conclusion: The ids is an excellent tool for performing rom measurements and is available free of charge. The authors argue that the sbg should accept this questionnaire as a suitable instrument for benchmarking.

The first generation of genome-wide association studies (GWA studies) for psychiatric disorders has led to new insights regarding the genetic architecture of these disorders. We now start to realize that a larger number of genes, each with a small contribution, are likely to explain the heritability of psychiatric diseases. The contribution of a large number of genes to complex traits can be analyzed with genome-wide profiling. In a discovery sample, a genetic risk profile for depression was defined based on a GWA study of 1738 adult cases and 1802 controls. The genetic risk scores were tested in two population-based samples of elderly participants. The genetic risk profiles were evaluated for depression and anxiety in the Rotterdam Study cohort and the Erasmus Rucphen Family (ERF) study. The genetic risk scores were significantly associated with different measures of depression and explained up to ∼0.7% of the variance in depression in Rotterdam Study and up to ∼1% in ERF study. The genetic score for depression was also significantly associated with anxiety explaining up to 2.1% in Rotterdam study. These findings suggest the presence of many genetic loci of small effect that influence both depression and anxiety. Remarkably, the predictive value of these profiles was as large in the sample of elderly participants as in the middle-aged samples.

Background: Although antidepressants are effective in the treatment of depression, nonresponse is unfortunately a recurring problem. Treatment algorithms can help the health care professional to make consecutive step-by-step choices between the different available treatment options., Aim: To update the biological algorithm in the Dutch multidisciplinary guideline on the treatment of depression., Method: The literature was reviewed systematically., Results: There are five steps in the algorithm: 1. Treatment starts with an SSRI, a TCA, an SNRI, mirtazapine or buproprion. 2. If there is no response after 4-10 weeks, administer another antidepressant. 3. Augment medication with lithium. 4. Administer a monoamine oxidase inhibitor. 5. Apply electroconvulsive therapy., Conclusion: The algorithm is certainly worth using, but its efficacy needs to be fully investigated.s.

The use of placebos in an investigation into the efficacy of a new type of treatment for winter depression was not approved by a medical ethics committee because some test subjects receiving placebos might thereby be deprived of an effective treatment. According to the authors, the committee's decision constituted an impediment to research and prevented a thorough investigation of a possible new type of treatment. In this essay it is argued that the use of placebos in depression research is ethically acceptable.

Pharmacotherapy for mood disorders has existed for more that 50 years. Many kinds of drugs are registered for the treatment of depression or bipolar disorder; these include 20 antidepressants, lithium, various anticonvulsants and antipsychotics. Their effectiveness, however, is limited. Furthermore, the different opportunities are not used to the full. Over the years hopes of greater efficacy and of better targeting have been raised as a result of various developments (e.g. more selective compounds with a different working mechanism). Unfortunately, very few of these hopes have been fulfilled.

The main results of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study are discussed in order to find out whether the results should lead to changes in the way in which depression is treated in the Netherlands. The outcomes of the STAR*D study are not sufficient justification for altering the current recommendations about the successive steps to be taken according to the Dutch multidisciplinary guideline for the treatment of depression.

Background: Previous work suggests that subthreshold depression and subthreshold (hypo)mania are common, although little is known about the prognosis in terms of transition to clinical disorder. This paper presents data on the temporal relationship between subthreshold and clinical expression of mood phenotypes., Method: In a random general population sample of 7076 individuals, symptoms of depression and (hypo)mania were measured with the Composite International Diagnostic Interview (CIDI) at baseline, after 1 year, and 2 years later., Results: At baseline, the lifetime prevalences of depressive and (hypo)manic symptoms were 17.2% and 1.2% respectively. Predictive values of mood symptoms for a DSM-III-R mood disorder ranged from 14.3% to 50%. (Hypo)manic mood symptoms had much higher predictive values than unipolar manifestations, not only for bipolar disorder but also for major depression., Conclusions: The subthreshold expressions of depression and (hypo)mania are prevalent and continuous with more severe clinical states. The cross-prediction of mood symptoms may support a continuum from depressive to (hypo)manic symptoms. The high predictive value of (hypo)manic symptoms for mood disorders suggests that the experience of (hypo)manic symptoms is a stronger indicator of vulnerability for mood dysregulation than the experience of depressive symptoms.

Despite over 1,000 randomised controlled trials (RCTs) evaluating the efficacy of antidepressants, their effectiveness in important subgroups of depression is almost unknown. Around 40% of patients with depression do not respond to treatment with selective serotonin-reuptake inhibitors, the most frequently used type of antidepressant in The Netherlands. Only 3 RCTs have studied whether another type of antidepressant is effective in these patients. Two other examples are psychotic depression and bipolar depression. While these conditions account for 15% and 20% of all depressed patients, respectively, their treatment has been studied in only 10 and 12 RCTs, respectively. The main reason for this lack of research is lack of funding. Therefore, it is argued that a special Dutch research programme for comparative drug studies is warranted. Funds for such a programme should become available from The Netherlands Organisation for Health Research and Development (ZonMw), the pharmaceutical industry and health-insurance companies.

Efficacious forms of treatment for depression are available, but too many people suffering from depression are either treated inadequately or not at all. This undertreatment may play a role in the failure to reduce in the prevalence of depression. Possible causes of undertreatment include delayed help-seeking, delayed treatment, non-compliance, mediocre self-care and inappropriate treatment. Furthermore, the treatment culture is insufficiently population-based and proactive, and the chronic-recurrent nature of many depressions is too often neglected. Both the content and organisation of mental health care, in primary care and speciality services alike, should explicitly target reduction of the prevalence of depression in the population, in particular by trying to narrow the gap between the 'efficacy' and 'effectiveness' of treatment modalities. Important elements in this approach include 'individualized stepped care' models, implementation of optimal care by means of care programs, redefinition of the roles of care-provider and patient (greater emphasis on partnership) and abolition of the distinction between somatic health care and mental health care.

The biological treatment of depression includes administration of psychoactive drugs (cyclic antidepressants, MAO-inhibitors, neuroleptics and lithium), use of certain substances which in small amounts are normally present in food such as, L-tryptophan (L-TP) and L-5-hydroxytryptophan (L-5HTP), electroconvulsive therapy (ECT) and various manipulations of the sleep-wake rhythms. This paper reviews the literature on the efficacy of these treatments in patients resistant to earlier adequate treatment(s) with cyclic antidepressants. Subsequently the following strategy for the biological treatment of (non-psychotic) major depression is suggested: (1) administration of a cyclic antidepressant; (2) if after a period of 4 to 6 weeks a patient has not responded to an adequate dose, another cyclic antidepressant should be tried, adding lithium if the patient still does not respond; (3) MAO-inhibitors and (4) ECT. In psychotic depression the suggestions for the first, third and fourth steps are the same. In the second step, the cyclic antidepressant should be combined with a neuroleptic.

Rhebergen D, Batelaan NM, de Graaf R, Nolen WA, Spijker J, Beekman ATF, Penninx BWJH. The 7-year course of depression and anxiety in the general population. Insight into the long-term course of depression and anxiety. Data were derived from Netherlands Mental Health Survey and Incidence Study/Netherlands Study of Depression and Anxiety, epidemiologic surveys in the adult population in the Netherlands. Three hundred and three respondents with depressive and/or anxiety Composite International Diagnostic Interview (CIDI) disorder were interviewed, examining the 7-year course of depression ( n = 141), anxiety ( n = 102) and the comorbid state ( n = 60) and possible prognostic factors. Outcomes were CIDI diagnostic status after 7 years and percentage of time during 7 years with depressive and/or anxiety symptoms, retrospectively assessed by the Life Chart Interview (LCI). After 7 years, 60.7% of the subjects were free from a 12-month CIDI depression or anxiety diagnosis. The odds were higher for subjects with anxiety and comorbidity compared to subjects with depression. Low physical functioning and high neuroticism predicted the presence of a diagnosis after 7 years. During 7-year follow-up, 37.3% of the subjects were free from depressive and anxiety symptoms according to the LCI, 51.8% had symptoms <50% of the time, and 10.9%≥50% of the time. (Comorbid) anxiety resulted in a poorer course. High neuroticism and childhood adversity predicted more follow-up time with symptoms. Course trajectories were more favorable than expected, although comorbidity resulted in poorer course. Neuroticism, physical functioning, and childhood adversity predicted an unfavorable course. [ABSTRACT FROM AUTHOR]

Objective: To construct a score that allows prediction of major depressive episode (MDE) persistence in individuals with MDE using determinants of persistence identified in previous research. Method: Data were derived from 250 subjects from the general population with new MDE according to DSM-III-R. These subjects were recruited from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), using the Composite International Diagnostic Interview. Determinants for persistence were transformed into a practical risk score using proportional hazards models and bootstrapping techniques. Results: The risk of MDE persistence after 12 months was 23%. The score comprised measures of physical illness, social support, depression severity and recurrency, and duration of previous episodes. With increasing categories of these measures, the predicted risks increased from 7 to 40%. Conclusion: We constructed the Persistence of Depression Score (PDS) showing reasonable performance. The PDS could be of importance in clinical practice to support treatment decisions. [ABSTRACT FROM AUTHOR]