Depression

Primary Care Psychiatry: Practical Skills for Internists: 2023 Video Recordings Package

Primary Care Psychiatry: Practical Skills for Internal Medicine Physicians: 2024 Video Recordings Package

Mental Health and Burnout, Part 1

Geriatrics and Palliative Medicine for Internal Medicine Physicians: 2024 Video Recordings Package

Bipolar Disorder

ACP Pain Management 2: Pain Assessment

Digital Health Equity: Bridging the Divide

Quality Indicators for Major Depressive Disorder in Adults: A Review of Performance Measures by the American College of Physicians

Physician Suicide Prevention and the Ethics and Role of a Healing Community: An American College of Physicians Policy Paper

ACP Response to Senate Finance Committee Inquiry Concerning Policies to Improve Behavioral Health Care

ACP Letter to the Senate Supporting Passage of Lorna Breen Healthcare Provider Protection Act of 2021

ACP Letter to the House Supporting Passage of Lorna Breen Healthcare Provider Protection Act of 2021

ACP Support Letter to the Senate HELP Committee for S. 3679, the Dr. Lorna Breen Health Care Provider Protection Reauthorization Act

ACP Letter for the Record on the Dr. Lorna Breen Health Care Provider Protection Act

Testosterone Treatment in Adult Men with Age-Related Low Testosterone: A Clinical Guideline from the American College of Physicians (2020)

Evidence-Based Interventions to Improve the Palliative Care of Pain, Dyspnea, and Depression at the End of Life

Nonpharmacologic versus Pharmacologic Treatment of Adult Patients with Major Depressive Disorder

Performance Measures Depression

Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan

Percentage of patients aged 12 years and older screened for depression on the date of the encounter or up to 14 days prior to the date of the encounter using an age-appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the eligible encounter.

Depression Utilization of the PHQ-9 Tool

The percentage of adolescent patients (12 to 17 years of age) and adult patients (18 years of age or older) with a diagnosis of major depression or dysthymia who have a completed PHQ-9 tool during a four month measurement period.

Depression Response at Twelve Months, Progress Towards Remission

The percentage of adolescent patients (12 to 17 years of age) and adult patients (18 years of age or older) with major depression or dysthymia who are progressing towards remission by achieving a response (PHQ-9 or PHQ-9M score reduced by 50% or greater) twelve months (+/- 60 days) after an index visit.

Depression Response at Six Months- Progress Towards Remission

The percentage of adolescent patients (12 to 17 years of age) and adult patients (18 years of age or older) with major depression or dysthymia who are progressing towards remission by achieving a response (PHQ-9 or PHQ-9M score reduced by 50% or greater) six months (+/- 60 days) after an index visit.

Depression Remission at Twelve Months

The percentage of adolescent patients 12 to 17 years of age and adult patients 18 years of age or older with major depression or dysthymia who reached remission 12 months (+/- 60 days) after an index event date.

Depression Remission at Six Months

The percentage of adolescent patients 12 to 17 years of age and adult patients 18 years of age or older with major depression or dysthymia who reached remission six months (+/- 60 days) after an index event date.

Bipolar Disorder and Major Depression: Appraisal for Alcohol or Chemical Substance Use

INACTIVE REVIEW: This measure review is older than five years. Percentage of patients with depression or bipolar disorder with evidence of an initial assessment that includes an appraisal for alcohol or chemical substance use.

Adult Major Depressive Disorder (MDD): Comprehensive Depression Evaluation: Diagnosis and Severity

INACTIVE REVIEW: This measure review is older than five years. Percentage of patients aged 18 years and older with a diagnosis or recurrent episode of major depressive disorder (MDD) with evidence that they met the DSM-IV criteria for MDD AND for whom there is an assessment of depression severity during the visit in which a new diagnosis or recurrent episode was identified.

Anti-Depressant Medication Management

"Percentage of patients 18 years of age and older who were treated with antidepressant medication, had a diagnosis of major depression, and who remained on an antidepressant medication treatment. Two rates are reported. a. Percentage of patients who remained on an antidepressant medication for at least 84 days (12 weeks). b. Percentage of patients who remained on an antidepressant medication for at least 180 days (6 months).

Depression

Most psychiatric care is delivered in primary care settings, where depression is the most common presenting psychiatric symptom. Given the high prevalence of depression worldwide and the well-established consequences of untreated depression, the ability of primary care clinicians to effectively diagnose and treat it is critically important. This article offers up-to-date guidance for the diagnosis and treatment of major depressive disorder, including practical considerations for delivering optimal and efficient care for these patients.

Depression

This issue provides a clinical overview of depression, focusing on screening, diagnosis, treatment, and practice improvement. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of additional science writers and physician writers.

Comparing the Effectiveness of Depression Treatments for Patients Undergoing Maintenance Hemodialysis

Medicine and Nonmedicine Options for the Treatment of Adults With Major Depressive Disorder

Screening for Depression in Children and Adolescents: U.S. Preventive Services Task Force Recommendation Statement

Quality Indicators for Major Depressive Disorder in Adults: A Review of Performance Measures by the American College of Physicians

Major depressive disorder (MDD) is a severe mood disorder that affects at least 8.4% of the adult population in the United States. Characteristics of MDD include persistent sadness, diminished interest in daily activities, and a state of hopelessness. The illness may progress quickly and have devastating consequences if left untreated. Eight performance measures are available to evaluate screening, diagnosis, and successful management of MDD. However, many performance measures do not meet the criteria for validity, reliability, evidence, and meaningfulness. The American College of Physicians (ACP) embraces performance measurement as a means to externally validate the quality of care of practices, medical groups, and health plans and to drive reimbursement processes. However, a plethora of performance measures that provide low or no value to patient care have inundated physicians, practices, and systems and burdened them with collecting and reporting of data. The ACP’s Performance Measurement Committee (PMC) reviews performance measures using a validated process to inform regulatory and accreditation bodies in an effort to recognize high-quality performance measures, address gaps and areas for improvement in performance measures, and help reduce reporting burden. Out of 8 performance measures, the PMC found only 1 measure (suicide risk assessment) that was valid at all levels of attribution. This paper presents a review of MDD performance measures and highlights opportunities to improve performance measures addressing MDD management.

The American College of Physicians Living Guideline on Depression: A Step Forward, but Gaps Remain

Nonpharmacologic and Pharmacologic Treatments of Adults in the Acute Phase of Major Depressive Disorder: A Living Clinical Guideline From the American College of Physicians

An update is available for this article. Description: The purpose of this guideline from the American College of Physicians (ACP) is to present updated clinical recommendations on nonpharmacologic and pharmacologic interventions as initial and second-line treatments during the acute phase of a major depressive disorder (MDD) episode, based on the best available evidence on the comparative benefits and harms, consideration of patient values and preferences, and cost. Methods: The ACP Clinical Guidelines Committee based these recommendations on an updated systematic review of the evidence. Audience and Patient Population: The audience for this guideline includes clinicians caring for adult patients in the acute phase of MDD in ambulatory care. The patient population includes adults in the acute phase of MDD. Recommendation 1a: ACP recommends monotherapy with either cognitive behavioral therapy or a second-generation antidepressant as initial treatment in patients in the acute phase of moderate to severe major depressive disorder (strong recommendation; moderate-certainty evidence). Recommendation 1b: ACP suggests combination therapy with cognitive behavioral therapy and a second-generation antidepressant as initial treatment in patients in the acute phase of moderate to severe major depressive disorder (conditional recommendation; low-certainty evidence). The informed decision on the options of monotherapy with cognitive behavioral therapy versus second-generation antidepressants or combination therapy should be personalized and based on discussion of potential treatment benefits, harms, adverse effect profiles, cost, feasibility, patients' specific symptoms (such as insomnia, hypersomnia, or fluctuation in appetite), comorbidities, concomitant medication use, and patient preferences. Recommendation 2: ACP suggests monotherapy with cognitive behavioral therapy as initial treatment in patients in the acute phase of mild major depressive disorder (conditional recommendation; low-certainty evidence). Recommendation 3: ACP suggests one of the following options for patients in the acute phase of moderate to severe major depressive disorder who did not respond to initial treatment with an adequate dose of a second-generation antidepressant: • Switching to or augmenting with cognitive behavioral therapy (conditional recommendation; low-certainty evidence) • Switching to a different second-generation antidepressant or augmenting with a second pharmacologic treatment (see Clinical Considerations) (conditional recommendation; low-certainty evidence) The informed decision on the options should be personalized and based on discussion of potential treatment benefits, harms, adverse effect profiles, cost, feasibility, patients' specific symptoms (such as insomnia, hypersomnia, or fluctuation in appetite), comorbidities, concomitant medication use, and patient preferences.

Values and Preferences of Patients With Depressive Disorders Regarding Pharmacologic and Nonpharmacologic Treatments: A Rapid Review: Annals of Internal Medicine: Vol 176, No 2

Background: Developers of clinical practice guidelines need to take patient values and preferences into consideration when weighing benefits and harms of treatment options for depressive disorder. Purpose: To assess patient values and preferences regarding pharmacologic and nonpharmacologic treatments of depressive disorder. Data Sources: MEDLINE (Ovid) and PsycINFO (EBSCO) were searched for eligible studies published from 1 January 2014 to 30 November 2022. Study Selection: Pairs of reviewers independently screened 30% of search results. The remaining 70% of the abstracts were screened by single reviewers; excluded abstracts were checked by a second reviewer. Pairs of reviewers independently screened full texts. Data Extraction: One reviewer extracted data and assessed the certainty of evidence, and a second reviewer checked for completeness and accuracy. Two reviewers independently assessed risk of bias. Data Synthesis: The review included 11 studies: 4 randomized controlled trials, 5 cross-sectional studies, and 2 qualitative studies. In 1 randomized controlled trial, participants reported at the start of therapy that they expected supportive-expressive psychotherapy and antidepressants to yield similar improvements. A cross-sectional study reported that non-Hispanic White participants and men generally preferred antidepressants over talk therapy, whereas Hispanic and non-Hispanic Black participants and women generally did not have a preference. Another cross-sectional study reported that the most important nonserious adverse events for patients treated with antidepressants were insomnia, anxiety, fatigue, weight gain, agitation, and sexual dysfunction. For other comparisons and outcomes, no conclusions could be drawn because of the insufficient certainty of evidence. Limitations: The main limitation of this review is the low or insufficient certainty of evidence for most outcomes. No evidence was available on second-step depression treatment or differences in values and preferences based on gender, race/ethnicity, age, and depression severity. Conclusion: Low-certainty evidence suggests that there may be some differences in preferences for talk therapy or pharmacologic treatment of depressive disorders based on gender or race/ethnicity. In addition, low-certainty evidence suggests that insomnia, anxiety, fatigue, weight gain, agitation, and sexual dysfunction may be the most important nonserious adverse events for patients treated with antidepressants. Evidence is lacking or insufficient to draw any further conclusions about patients' weighing or valuation of the benefits and harms of depression treatments. Primary Funding Source: American College of Physicians. (PROSPERO: CRD42020212442)

Cost-Effectiveness of First- and Second-Step Treatment Strategies for Major Depressive Disorder: A Rapid Review: Annals of Internal Medicine: Vol 176, No 2

Background: Major depressive disorder (MDD) is the most prevalent, disabling form of depression, with a high economic effect. Purpose: To assess evidence on cost-effectiveness of pharmacologic and nonpharmacologic interventions as first- and second-step treatments in patients with MDD. Data Sources: Multiple electronic databases limited to English language were searched (1 January 2015 to 29 November 2022). Study Selection: Two investigators independently screened the literature. Seven economic modeling studies fulfilled the eligibility criteria. Data Extraction: Data abstraction by a single investigator was confirmed by a second; 2 investigators independently rated risk of bias. One investigator determined certainty of evidence, and another checked for plausibility. Data Synthesis: Seven modeling studies met the eligibility criteria. In a U.S. setting over a 5-year time horizon, cognitive behavioral therapy (CBT) was cost-effective compared with second-generation antidepressants (SGAs) as a first-step treatment from the societal and health care sector perspectives. However, the certainty of evidence is low, and the findings should be interpreted cautiously. For second-step treatment, only switch strategies between SGAs were assessed. The evidence is insufficient to draw any conclusions. Limitations: Methodologically heterogeneous studies, which compared only CBT and some SGAs, were included. No evidence on other psychotherapies or complementary and alternative treatments as first-step treatment or augmentation strategies as second-step treatment was available. Conclusion: Although CBT may be cost-effective compared with SGAs as a first-step treatment at a 5-year time horizon from the societal and health care sector perspectives, the certainty of evidence is low, and the findings need to be interpreted cautiously. For other comparisons, the evidence was entirely missing or insufficient to draw conclusions. Primary Funding Source: American College of Physicians.

Chronic Eosinophilic Pneumonia With Multiple Drug-Related Risk Factors: Diagnosis and Management | Annals of Internal Medicine: Clinical Cases

Chronic eosinophilic pneumonia is a rare illness characterized by pneumonic infiltrates with peripheral eosinophilia. The underlying cause is unknown, but it is associated with multiple medications. The present article reports a woman in her 60s with a history of chronic sinusitis and asthma who presented with subacute cough and hemoptysis and significant peripheral and bronchioalveolar eosinophilia. This patient also had anxiety and depression treated chronically with trazodone and venlafaxine, which are associated with eosinophilic pneumonia. Symptoms promptly resolved within 24 hours following steroid treatment. This article highlights the diagnostic challenge eosinophilic pneumonia presents.

Apathetic Thyrotoxicosis Presenting With New-Onset Pulmonary Hypertension | Annals of Internal Medicine: Clinical Cases

Apathetic thyrotoxicosis is a distinct clinical entity of hyperthyroidism that occurs in elderly patients. Manifestations include depression, weight loss, mild tachycardia, and symptoms of heart failure. Noteworthy is the absence of typical hyperkinetic motor symptoms. Pulmonary hypertension is an often-overlooked manifestation of thyrotoxicosis. Here, we present a case of a 67-year-old woman who presented to the clinic with complaints of dyspnea on exertion, orthopnea, leg edema, and 20-lb weight loss. Further work-up revealed pulmonary hypertension with thyrotoxicosis, without the typical sympathetic symptoms. After achieving a euthyroid state with methimazole therapy, she experienced resolution of her symptoms, and her pulmonary artery pressures normalized.

Multifocal Intestinal Extranodal Marginal Zone Lymphoma Presenting With Autoimmune Hemolytic Anemia: A Case Report | Annals of Internal Medicine: Clinical Cases

Extranodal marginal zone lymphoma of the intestine is a rare, indolent non-Hodgkin lymphoma that often presents with nonspecific symptoms, making diagnosis challenging. We report a 74-year-old woman who presented with severe anemia attributable to autoimmune hemolytic anemia. Imaging revealed splenomegaly and intestinal wall thickening, whereas subsequent endoscopy showed ulcerated lesions in the ileocecal valve, transverse colon, and descending colon. Biopsy results confirmed extranodal marginal zone lymphoma. Treatment with the R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) regimen led to partial remission of the lymphoma and complete resolution of autoimmune hemolytic anemia.

A Rare Case of Severe Vitamin D Deficiency Presenting as Diffuse Osteosclerosis | Annals of Internal Medicine: Clinical Cases

Maintaining calcium homeostasis is essential for various physiologic processes, with vitamin D playing a key role. Hyperparathyroidism typically causes fragility fractures and osteolytic lesions but rare cases can present with osteosclerosis. We report a 64-year-old woman with a history of gastric bypass presenting with back pain who was found to have diffuse osteosclerosis and hyperparathyroidism due to severe vitamin D deficiency. Nutritional supplementation led to symptom resolution. This case underscores the importance of considering bone-mineral pathology in patients with unexplained pain and highlights the need for close follow-up in postoperative care after bariatric surgery.

A Case of Semaglutide-Induced Skin Burning | Annals of Internal Medicine: Clinical Cases

We discuss a case of semaglutide-induced skin burning in an 86-year-old patient. The skin burning stopped with withdrawal of semaglutide and reoccurred when semaglutide was rechallenged a few months later. The patient received multiple other glucagon-like peptide 1 receptor agonists and did not experience this reaction. As the use of GLP-1 therapies increase, it will be important to recognize and manage unique adverse events that may arise.

An Uncommon Case of Siblings With Homozygous Prothrombin G20210A Pathological Variant Expressing as Unique Manifestations | Annals of Internal Medicine: Clinical Cases

Heterozygous carriers of the prothrombin gene G20210A pathogenic variant (PV), with a 1.7% to 3% prevalence, experience a 3-fold increase in risk for thrombosis. Homozygosity for the prothrombin G20210A PV is much less common, with a prevalence of 0.014%, and further increases the risk for thrombosis, although data is insufficient to predict the increased likelihood. While venous thrombi and pulmonary emboli (PE) are common manifestations of this PV, portal vein thrombosis (PVT) and neuropsychiatric disorders are uncommon manifestations. We present a pair of siblings who are homozygous for this prothrombin G20210A PV.

Pheochromocytoma in a Postpartum Patient With Cardiogenic Shock From Epicardial Vasospasm Necessitating Mechanical Circulatory Support | Annals of Internal Medicine: Clinical Cases

A 25-year-old woman presented with pheochromocytoma crisis and cardiogenic shock. Her ejection fraction was severely reduced at 10%, and she needed venoarterial extracorporeal membrane oxygenation (VA-ECMO) for hemodynamic support. Coronary angiography demonstrated diffuse coronary vasospasm as the underlying mechanism for her cardiogenic shock. Her ejection fraction improved with nondihydropyridine calcium channel blockers for treatment of epicardial coronary vasospasm. Her adrenal crisis was treated with sequential use of alpha-blockers followed by beta-blockers after resolution of cardiogenic shock; a right adrenalectomy was then performed before discharge. This case highlights the importance of prompt diagnosis and treatment of a pheochromocytoma complicated by cardiogenic shock when mechanical circulatory support is essential.

Recurrent Pain and Heat Retention as Indications of Acquired Idiopathic Generalized Anhidrosis | Annals of Internal Medicine: Clinical Cases

Acquired idiopathic generalized anhidrosis is a rare disease worldwide. It is typically seen in young men. The patient in this case has generalized anhidrosis. Cholinergic urticaria is often associated with this disease, causing recurrent pain, itching, decreased sweating, and hyperthermia. In this case, a 52-year-old man had recurrent generalized pain, itching, and fever for 10 years, especially after exposure to excessive heat from exercise or environmental factors. Increased regular temperature measurements due to the COVID-19 pandemic and recognition of high body temperature as well as the pain becoming more pronounced, led to the diagnosis of acquired idiopathic generalized anhidrosis.

An Unusual Case of Neurogenic Orthostatic Hypotension Without Parkinsonian Features | Annals of Internal Medicine: Clinical Cases

Orthostatic hypotension is a common cause of syncope, especially in the older adult population. While it is a commonly encountered issue as a cause of syncope, neurogenic orthostatic hypotension (nOH) is less common. Accurate diagnosis and management of neurogenic orthostatic hypotension is important especially when conservative measures fail. The condition of nOH is often seen in Parkinson disease or Parkinson plus syndromes. We present an unusual presentation of a patient with nOH who had no parkinsonian features but once started on norepinephrine agonism improved dramatically.

Stress Cardiomyopathy in Chronic Obstructive Pulmonary Disease and Asthma Exacerbations: A Narrative Literature Review | Annals of Internal Medicine: Clinical Cases

In patients with asthma or chronic obstructive pulmonary disease exacerbations, the association between use of β-adrenergic agonists and stress cardiomyopathy is becoming increasingly recognized. Considering the emergence of this association, we sought to consolidate information from the existing body of literature to derive observational trends. One case series and 8 case reports were reviewed. Sex, age, ethnicity, comorbid conditions, presenting symptoms, electrocardiogram findings, troponin values, amount and type of β-agonist used, and time to resolution of cardiomyopathy were examined.

Depression risk lower with GLP-1 receptor agonists than DPP-4 inhibitors, target trial finds

Older patients with type 2 diabetes taking glucagon-like peptide-1 (GLP-1) receptor agonists had a modestly decreased risk for incident depression compared with those on dipeptidyl peptidase-4 (DPP-4) inhibitors, but no difference was found compared to sodium-glucose cotransporter-2 inhibitors, according to the target trial emulation study.

Measuring high-quality depression care

ACP's Performance Measurement Committee looked at eight quality measures for major depressive disorder (MDD) and voted to support one on suicide risk assessment.

Anxiety, depression treatment linked with improved outcomes in cardiovascular disease

Patients who had been hospitalized and had both cardiovascular disease and a mental health condition were 75% less likely to be readmitted if they received psychotherapy and medication for their anxiety or depression.

Walking, jogging, yoga, and strength training help treat depression, analysis finds

More vigorous exercise had a greater effect on depression, according to a meta-analysis of 218 randomized controlled trials that examined the effect of exercise on major depressive disorder compared with psychotherapy, antidepressants, and control conditions.

Mobile apps can help treat moderate to severe depression

A meta-analysis found that the apps were effective regardless of whether patients were currently receiving depression treatment. Interventions that lasted less than eight weeks were more effective than longer ones.

Oral drug for postpartum depression approved

This column reviews recent recalls, alerts, and approvals.

A living guideline for depression treatment

ACP recommends choosing between a second-generation antidepressant or cognitive behavioral therapy for adults in the acute phase of moderate to severe major depressive disorder.

ACP's updated depression guideline recommends CBT, second-generation antidepressants

ACP stressed the importance of informing patients and taking their preferences into account when deciding between the recommended first-line therapies of cognitive behavioral therapy (CBT) or an antidepressant.

Portal-based population health screening appears effective for depression

Patients who received emails inviting them to complete an online screener via a patient portal were more likely to be screened for depression and had a higher rate of positive screens than those who received usual care, a single-center study found.

Detecting depression just as important in the elderly

Raising the issue of mental health is key in the elderly, by asking patients how often they talk to other people, if they're getting help with daily activities, or if they are feeling isolated.

Depression

Depression should be classified by episode, severity, and state of remission.

Persistent depressive symptoms linked to death, readmission after HF hospitalization

Heart failure (HF) patients with persistent depressive symptoms at one month after discharge had more than double the risk of cardiovascular death within a year as those without depression, a Chinese study found.

Internship's depression-inducing effects improved from 2007 to 2019

Medical interns reported increases in sleep hours, quality of faculty feedback, and use of mental health services, as well as a decrease in work hours, all of which might be mitigating internship's adverse effects on mental health.

ACP advises on physician suicide prevention; study examines depression in med students

New ethical guidance from the College offers advice on how to respond to physician suicide, while a recent study found that depressive symptoms became more common as medical students progressed through school.

Digging up and dealing with inpatient depression

Accurately diagnosing depression in a medically ill person can be tricky, but hospitalists can take steps to improve inpatient and postdischarge mental health care.

Patients discharged with depression more likely to die or be readmitted in 30 days, review finds

Hospitalized patients with depressive symptoms have a 2-fold risk of death and a 73% increased risk of readmission within 30 days of discharge compared to those without depression, according to a recent systematic review.

Study finds one-third of medical residents screen positive for depression or its symptoms

Depression among residents may also affect patients, given established associations between physician depression and lower-quality care, the study authors noted.

Depression a risk factor to consider in ACS patients

Depression should be considered as a risk factor for adverse outcomes in patients with acute coronary syndrome (ACS), according to a new scientific statement from the American Heart Association (AHA).

Approvals of drugs to treat seizures, chronic hepatitis C virus infection, depression

Details on the latest drug and device approvals.

Inpatient data can predict post-stroke depression risk

A new clinical prediction model could help predict stroke patients' risk of developing depression using data collected within a week after stroke, according to a recent study.

Depression risk lower with GLP-1 receptor agonists than DPP-4 inhibitors, target trial finds

Older patients with type 2 diabetes taking glucagon-like peptide-1 (GLP-1) receptor agonists had a modestly decreased risk for incident depression compared with those on dipeptidyl peptidase-4 (DPP-4) inhibitors, but no difference was found compared to sodium-glucose cotransporter-2 inhibitors, according to the target trial emulation study.

Depression associated with death in older patients with type 2 diabetes

A study that screened patients with type 2 diabetes in Spain for depression found that depression was associated with higher all-cause mortality in patients older than age 65 years, but not in younger patients.

Exercise and CBT are cost-effective for diabetes patients with depression

A study used simulation modeling to project the long-term effects of a three-month exercise and cognitive behavioral therapy (CBT) intervention for patients with type 2 diabetes and major depressive disorder. It found clear cost-effectiveness with the interventions alone or combined.

Antidepressants associated with decreased mortality rates in patients with diabetes and depression

A retrospective cohort study in Taiwan found that antidepressant use was associated with a significantly reduced risk for death, and after adjustment, total mortality decreased as total cumulative antidepressant dose increased.

Spotlight on depression in diabetes

Recent studies analyzed depression in diabetes, including associated causes of death, the potential benefits of peer support and a plant-based diet, and strategies for screening and treatment.

In uncontrolled type 2 diabetes, CBT improved glycemic control and reduced depression

Patients with diabetes and depression who received cognitive behavioral therapy (CBT) had improvements in medication adherence, self-monitoring of glucose, depressive symptoms, and HbA1c compared to those who received usual care.

MKSAP quiz: Screening recommendations

This month's quiz asks readers to choose a screening test for a 46-year-old man with hypertension, hyperlipidemia, obesity, and depression.

Comprehensive telehealth approach improved HbA1c in type 2 diabetes

Compared with a simpler approach of telemonitoring and care coordination, an intervention that added self-management and diet/activity support, medication management, and depression care improved outcomes in veterans with poorly controlled type 2 diabetes, a trial found.

Adults with diabetes more likely to report mental stress during the COVID-19 pandemic

An online survey of U.S. adults in mid-2020, most of whom were White women, found that those with diabetes were less likely to report resilience and more likely to experience depression than adults without diabetes.

Antidepressant adherence linked to lower risk of advanced complications of diabetes

In patients with diabetes and depression in Taiwan, regular use of an antidepressant was associated with a 0.92-fold decreased risk of macrovascular complications and a 0.86-fold decreased risk of all-cause mortality compared with poor adherence.

Antidepressants may mitigate link between inflammatory bowel disease and depression

Patients with depression had more than double the risk of developing Crohn's disease or ulcerative colitis over a median follow-up of more than six years.

Depression may be associated with higher risk for aggressive IBD

A prospective observational cohort study assessed the effects of baseline depression on inflammatory bowel disease (IBD) in patients from seven U.S. academic centers.

Spotlight on psychological factors and GERD

Studies published in the past month found a relationship between psychological factors, including anxiety and depression, and gastroesophageal reflux disease (GERD).

MKSAP Quiz: Confusion and a history of cirrhosis

This month's quiz asks readers to determine the most appropriate next step in evaluation in the ED for a 56-year-old patient with symptoms of progressive confusion and a history of cirrhosis due to alcohol use, as well as depression and anxiety.

Spotlight on mental health and gastrointestinal symptoms

One recent study found a link between depression and diarrhea and constipation, while another found that cognitive behavioral therapy may be an effective treatment for patients with refractory irritable bowel syndrome.

Clinical practice update advises on management of cyclic vomiting syndrome

A basic workup for episodic vomiting should include bloodwork and urinalysis, and management of cyclic vomiting syndrome often entails multiple abortive medications, the American Gastroenterological Association said.

In primary care, second-line IBS therapy with amitriptyline vs. placebo reduced symptoms at 6 mo

An ACP Journal Club commentary said the high-quality randomized trial provides pragmatic guidance on amitriptyline dosing in patients with irritable bowel syndrome (IBS), as well as additional support for the drug as an option in primary care after first-line therapies fail.

Cyclic vomiting syndrome affects 42 per 100,000 Medicaid beneficiaries, study finds

Within 30 days of diagnosis of cyclic vomiting syndrome, only 32% to 35% of adult patients had prescriptions for prophylactic treatment and 47% to 55% for acute treatment, according to an industry-funded study of U.S. claims databases.

Low-dose amitriptyline appears effective as second-line treatment for IBS

Patients with irritable bowel syndrome (IBS) who were randomized to titrated doses of a tricyclic antidepressant had significant improvements in their IBS symptom scores at six months compared to those receiving a placebo, a trial in primary care found.

PPIs, H2 blockers not linked to cognitive problems in older patients, study finds

Data from a post hoc analysis of a randomized trial should provide reassurance about the safety of long-term use of proton-pump inhibitors (PPIs) among adults ages 65 years and older, according to the authors.