59,60 Reduction in hippocampal volume has been consistently reported in MDD63 and linked to duration of untreated depression,64 as well as deficits in neurocognition.50 There are also preliminary reports on potential selleck markers for treatment resistance. Lower serotonin transporter binding in the midbrain, medulla, and anterior cingulate cortex was associated with nonremission,65

while hypermetabolism Inhibitors,research,lifescience,medical in the ventral anterior cingulate area brain region was a predictor of nonresponse to both cognitive therapy and venlafaxine.66 Though provocative, these interesting findings are unlikely to influence diagnostic or treatment, selection practices in the near future. In the meantime, a re-examination Inhibitors,research,lifescience,medical of core symptoms in depressed patients

and careful clinical attention to their response to disparate antidepressant, strategies will remain the cornerstone of good clinical practice. Selected abbreviations and acronyms MDD Major Depressive Disorder HAM-D Hamilton Rating Scale for Depression MDE Major Depressive Episode DSM Diagnostic and Statistical Manual of Mental Disorders ICD International Classification of Diseases
Prior to the late 19th century, although detailed systems of classification abounded, the main problem for psychiatric nosology was the establishment of the broad major disorders. Melancholia was recognized as early as the time of Hippocrates, and continued through Galenic medicine Inhibitors,research,lifescience,medical and medieval times. The earlier connotation of the term was very wide, and included all forms of quiet Inhibitors,research,lifescience,medical insanity. It was linked with the humoral theory

of causation, specifically, as the term indicates, with black bile. Most psychiatric terms have changed meaning over their history, and they are always partly dependent on Inhibitors,research,lifescience,medical language. Melancholia later became more clearly associated with the more modern idea of melancholy or despair, for instance, in the classic work of the English Renaissance author, Richard Burton, The Anatomy of Melancholy,1 first published in 1621. The alternation of melancholia and mania in what is now termed bipolar disorder or manic-depressive disorder, although in some respects suggested in the writings nearly of Arateus of Cappadocia, and those of later authors, was not clearly described until 1854, independently by the French psychiatrists, Falret and Baillarger.The term depression also began to appear in the 19th century, to indicate a state of sadness. Detailed accounts of these aspects and later history can be found in Jackson’ and Berrios.3 When Kraepelin, in the late nineteenth century, built on the work of his predecessors and simplified it to delineate the foundations of the modem classification of psychiatric disorders, one of his major categories was that of manicdepressive insanity. Kraepelin’s classic textbook went through successive editions, which included some changes in his views.