Pathorpharmocologic Foundations

  1. Depression

Depression is a serious and common medical illness which negatively affects how a person feels, ways of thinking and acting. Depression causes loss of interest and feelings of sadness in activities which were once enjoyed. For instance, depression leads to physical and emotional problems and reduce a person’s ability in functioning at home and work. Depression has no one cause because it depends on the unique combination of individuals environmental conditions and genetic makeup. There are various factors associated with depression. First, is the brain chemistry or physical structure, family history, traumatic events, hormonal changes as well as other changes. Depression is divided into nine different types including dysthymia, psychotic, bipolar disorder, atypical, seasonal affective, postpartum despair, premenstrual dysphoric disorder, situation, and significant depression. Else, depression can be treated through combining various medical treatments and lifestyle therapies including medications, psychotherapy, alternative therapies, light therapy, exercise and avoiding alcoholic drugs.

A1. Pathophysiology of Depression

Depression, as World Health Organization describes it, refers to a mood disorder that is characterized by particular symptoms like loss of interest, lack of appetite, sadness, poor concentration, sleep disturbance, low esteem and feeling of guilt. Individuals who suffer from depression show varying degrees of hopelessness and helplessness, insomnia, inability to concentrate, loss of interest and feel of sadness which could be accompanied by thoughts of death.

The understanding of the pathophysiology of depression is very challenging because a single hypothesis cannot explain the disorder symptomatology. Pathophysiologic mechanisms include immunologic, neurogenesis, monoamine hypothesis, environmental, genetic and endocrine factors. On genetic factors, various studies and research have explored the likelihood of linking depression and genes. For instance, a British research group currently secluded a gene that seems to be prevailing in various family members having despair. The gene 3p25-26 was present in more than eight hundred relatives having recurring depression where scientist trust that forty percent of individuals having the disorder traces to a genetic link. Environmental and supplementary factors comprise the remaining sixty percent. Immunological changes during psychiatric and depression side effects caused by cytokines use in treating cancer and hepatitis provides evidence favoring the depression disorder. Additionally, an imbalance in hormones plays a significant role in despair. The probable mechanism is a defaulting in the hypothalamic-pituitary-adrenal (HPA) axis which is the system managing the body’s stress response. After receiving a scary situation, the hypothalamus produces substances like CRF which stimulates the pituitary gland to produce different hormones preparing someone for a response. Moreover, environmental factors which are linked to depression vulnerability are associated with changed cerebellar resting-state synchronization. When independently considered both the cerebellar resting -state depression liability and connectivity are caused by the convergence of several environmental and genetic factors. For instance, environmental factors that may lead to depression are synthetic chemicals like preservatives/food additives, genetically modified foods, hormones/drugs, industrial byproducts as well as pesticides which bombard our bodies. The other non-chemical environmental stress sources are natural disasters, electrical or noise pollution together with other catastrophic factors. Else, events such as lasting stress at home or work, childhood abuse, coping with losing a loved one or traumatic acts are considered environmental.

The combination and linkage of the listed factors have been implicated in the depression pathogenesis rather than a unitary product. Therefore, the environmental stressors as well as heritable genetic factors which act through endocrine and immunologic responses initiates functional and structural changes in various brain regions leading to dysfunctional neurotransmission and neurogenesis then manifesting as a constellation of symptoms presenting as depression (Duman, 2014).  For instance, the Hypothalamo-Pituitary-Adrenal axis is the main neurobiological link between such factors and depression development.

Depression is considered a possibly life-threatening ailment affecting millions of people around the globe. For instance, depression occurs at any stage from youthful to late life and is an incredible cost to society because it causes severe disruption or distress and if untreated it can be deadly. For instance, the psychopathological situation comprises of symptoms with depressed or low attitude, anhedonia, and low fatigue or energy. The other symptoms like the psychomotor and sleep instabilities, low self-esteem, feeling of guilt, suicidal propensities and autonomic as well as gastrointestinal disorders are always existing. Depression is not just a homogenous sickness but rather a multifaceted phenomenon with several sub-types and likely more than one etiology. The disease includes a disposition to intermittent and often liberal mood troubles, symptomatology variances range from minor to severe signs with or lacking psychotic features and relations with other somatic and psychiatric syndromes.

A2. Standard of Practice for Depression

The standards of practice for depression should be in line with the methods aimed at preventing and curing the disease among all the affected individuals. For instance, education and training are one of the best ways in which society can best deal with depression. Physicians should ensure that they maintain the best practices to guarantee that patients adhere to proper measures and guidelines. Physicians should create and keep a healing alliance which collaborates with the victim in making decisions as well as attendance to the preferences or concerns regarding treatment. Consequently, physicians should ensure that the psychiatric assessment is complete and evaluate patient safety. The other standard practices for physicians include evaluating the patient’s safety, the establishment of appropriate treatment setting, assess functional damage and life quality together with organizing the patients care with colleague clinicians. Furthermore, monitoring of the victim’s psychiatric standing, integrating measurement into management as well as education provision to the family and patient are among the standards of practices which should be adhered to by every physician.

High care standard for depression patients ensures that victim’s benefit from reduced antidepressants increased access to psychological interventions and support through active-follow-up and structured monitoring as well as reduced risks of chronic relapsing depression. For instance, individuals suffering from depression must receive an assessment identifying symptoms severity, the scope of associated functional impairment and the episode duration.

People suffering from depression require collaborative care which refers to an innovative way of treating anxiety and depression. The practice involves various health professional who works with a patient in helping overcome their challenges. Thus, collaborative care always involves a medical doctor, psychiatrist, and case manager. For instance, the methods used in allocating patients to routine or are not free from bias and many patients do not provide information or follow-up on their outcomes. Collaborative care appears better than routine care in anxiety improvement since it increases the patients’ number using the medication in line with recent guidance and improves mental health-related life quality. Hence, patients who are treated with collaborative are more satisfied.

A2a. Depression Evidence-Based Pharmacological Treatments in Florida

Depression is among the top favorite mental ailment in the United States. The latest research on despair indicates that the disease results from a combination of biotic, psychological, genetic as well as environmental factors. The risk aspects for the depression include family history, fundamental life changes like infection, strain, and trauma as well as other types of physical ailments and medications.

Depression among the Florida adolescents appears to nearly matching the national averages where 9.6% of the Floridians aged between 12-17 suffered from the disorder in 2013 (Hersen & Hasselt, 2013). A similar case is mostly correct in the Panama City Beach although less than thirty-one percent received specialized treatment for their ailment meaning that 69% of Florida adolescents lacked treatment. Therefore, such a condition probably results in abusing most of the elements in Florida because youngsters look towards self-medicating their misery. In Florida, a program referred to as JourneyPure is among those involved in the treatment of depression, especially in Panama City Beach. The program aims at treating and curing the disorder because even at most severe cases depression can be addressed. The disease can be handled by use of antidepressants because they assist in improving how the brain engages with a specific chemical for controlling stress or mood. JourneyPure Emerald Coast is addiction treatment benefactor in Panama City Beach which supports various people who are habituated to drugs in overcoming prescribed medical habits as well as any co-occurring disorder. The program takes a complete and general approach in the Depression Treatment Program which includes cognitive behavioral therapy, medical intervention together with holistic facilities like experimental treatments. The plan has positively helped in prescription medication users to living happily, prolific and with temperate lives.

The 2017-2018 Florida Best Practices Psychotherapeutic Medication Guidelines for Adults are established on the recent situation of scientific information publication time on appropriate or effective care and clinical consent judgments when research is missing. For instance, the unavoidable fluctuations in the state of technology and information dictate that the periodic review, appraising, and revisions shall be necessary. Bipolar depression remains to be the useful therapeutic target in bipolar disorder at Florida in most early and late phases of the disease. Moreover, depressive symptoms as part of bipolar disorder are always chronic and highly associated functional impairment, risk, suicidality, and comorbidity. The US Food and Drug Administration has authorized three psychotherapeutic agents of bipolar depression. For instance, the expert panel for the Florida Guidelines jointly agreed to list lamotrigine as being a possible first-line treatment strategy in the treatment of depression. The specialist panel recognized that lamotrigine did not receive regulatory approval for marketing in depression (Cuijpers et al., 2014). During the completion of 2017-2018 Florida Guidelines, outcomes from two pivotal registration trials in adults having depression show Cariprazine is useful in the acute treatment of depression. The 2017-2018 guidelines re-emphasize the hazards and ubiquity posed by bipolar disorder mixed features.

Managing of depression in Florida is mostly through the use of antidepressants. The method and utilization of antidepressants are still an understudied and controversial matter in depression. No single antidepressant or group is authorized for bipolar disorder. For instance, the Florida Expert Panel recognizes that antidepressants remain to be utilized at a very high rate in adults having bipolar disorder. The guiding principle for antidepressants utilization in depression is that they should not be prioritized than the established and approved FDA treatment and should be utilized as adjunctive treatment strategies. In the treatment of depression electroconvulsive therapy (ECT) is the recommended therapeutic option with evidence supporting alternative neurostimulators approaches.

Accessing to depression medications in Florida is a challenge to various individuals. For instance, there is an acute shortage of psychiatrists in the state. Besides, parents might not see mental health problem symptoms or even be aware of how severe the problem is due to lacking knowledge of depression in patients. The above factors are depression treatment barriers which are unfortunate. Nevertheless, one of the obstacles hardly addressed is if parents ignore visible depression signs or they want to assist.

Not all depression requires treating with medications. Nevertheless, therapies which have been approved depression treatment by the US FDA helps in improving symptoms in some people. During diagnosis of depression doctors typically consider one’s history and reviews mental status and behavior. After that, the doctor evaluates symptoms, rules out depression physical causes and decides whether the disorder is an appropriate diagnosis. Besides, screening of a brain disorder causing strange mood, energy and activity level shifting is recommended. On treatment of depression with medication, antidepressants work by changing the brain chemical referred to as neurotransmitters. The major classifications of antidepressants are SSRIs, SNRIs, TCAs and MAOIs and others include Remeron and Wellbutrin.

A2b. Clinical Guidelines for Assessment, Diagnosis and Patient Education for Depression

Management of depression includes full assessment together with appropriate diagnosis formation. For instance, the estimate is always based on a thorough history, mental state, and physical scrutiny. History should be attained from each source specifically the family. Thus, the analysis should be noted as per the recent diagnostic standards.

Detailed assessment and proper diagnosis for depression should be established. The evaluation for the disorder should be based on detailed history, mental and physical state examinations. History should be obtained from all sources and especially the family. For assessment instruments, scales and interviews having a different scope of degrees are used as instruments for measurement of depression severity and response to treating depressive disorders. The assessment instruments help in evaluating patient symptoms within a given timeframe through grading every item and providing a final score. For instance, the assessment instruments cannot be used in forming diagnosis which is established from psychopathological information that is obtained in the clinical interview. The guidelines for treatment of depression as released by the American Psychiatric Association (APA) have been updated to summarise recommendations on using antidepressants and therapies including cognitive behavior therapy and electroconvulsive therapy (ECT). Depression should be treated per the guidelines about the primary diagnosis which include the following phases acute, continuation and maintenance stages. Treatment in acute phase aims at incorporating the decrease of the depressing episode together with reaching a whole return to the functioning baseline level. The second stage is the continuous phase which aims at preventing relapse. Systematic symptoms assessment and checking for opposing medications effects, therapy adherence and efficient status are relevant. The maintenance phase is the third stage which should be considered for patients with other recurrence risk factors. Other considerations are the patient preference, treatment type received, comorbid conditions, the persistence of depressive symptoms and adverse effects.

Depression always presents with combined symptoms such as loss of interest, depressed mood, reduced attention and attention, decreased energy and fatigue. Some of the symptoms are more marked and develop characteristic features depending on depression severity which are regarded to have special clinical significance. Else, some patients with despair might present prime complains fatigue, pain and may not show sad mood on their own (Duman, 2014). The important aspect of depression diagnosis is the ruling out of bipolar disorder. For instance, several patients having a disorder avail themselves to the physician during depressive illness stage and instinctively do not account the previous manic or hypomanic occurrences. Vigilant history from a victim as well as other sources always provides necessary clues for depression.

Education regarding depression and treatments should be provided to all the patients as well as the involved family members. For instance, certain instructive elements might be supportive in various situations like despair being a real disease and that active treatments are essential or accessible may be critical for individuals attributing own disorder to witchcraft or moral flaw. Education concerning the current treatments possibilities helps victims to make conversant decisions where they anticipate side consequences and adheres to behaviors. The other vital aspect of teaching provision is notifying the patient or family about the delay period of antidepressants action inception.

A2c. Comparing Standard of Practice for Depression Management

In the whole of united states around eleven percent of the adult, people are projected to have had a depressive illness for over 12 months. For instance, lifetime frequency is around 19% and gets to 24% among females. Depressive symptoms also make a significant contribution to the morbidity in the population (Corona, Rastrelli & Maggi, 2013). Else, the frequency in the community of depressing signs and ailments can be expensive fitness status procedures with which the desire for any healing or preventive intrusions impact measures can be monitored. Obtaining a detailed frequency data on a community-wide base requires society survey having valid and reliable screening questions. There is a probability of accessing depression in population subgroups through periodic screening in settings like worksites, faith groups, human service agencies, and health plans. Testing in schools which may be suitable for adolescent populations requires instruments which are validated for use within that age group.

Communities may try the determination of the residents’ proportion having depressing symptoms or disorder does not receive action meaning that it is at high risk for well-being and damage. Examination of the socioeconomic or demographic characteristics in Florida for those not being cured can assist communities in assessing additional services needed if certain provider groups offer much attention to misery among their patients and whether steps may be vital for improvement of access or accepting of suitable amenities. In Florida managed care organizations (MCOs), as well as other serving distinct populations, may access the degree of untreated despair in such communities.

A3. Characteristics of And Resources for Patients Who Manages Depression Well

Patients who manage depression well show improved access to care, treatment options, and better outcomes when it comes to dealing with the disorder. The first characteristic of well-managed depression is showing improved and regular access to care which is necessary for managing depression. Besides, patients who manage depression well have various treatment options meaning that they will have a high life expectancy and healthy living. Therefore, the outcome will be characterized by better performance in all their activities and engagements.

A3a. Disparities Between Management of The Selected Disease on National and International Level

There is a sign of differences in treating despair by aspects including ethnicity or race, age, and insurance category. The federal and state government have complementary roles in regulation and funding of mental health and substance use treatment. For instance, most of the despair disparities care might be due to variances in the rates of finding depression handling. On initiating depression treatment disparities, inadequate care is significant where African Americans have a high probability of receiving adequate treatment course than Caucasians for those receiving counseling or psychotherapy.

Despite being among the most violent mental disorder in the globe, accessing depression handling is still deficient particularly in low- and middle-income nations. According to the data from Global Burden of Disease Study in the year 2010, it indicated that depression is the leading contributor of Disability Adjusted Life Years (DALYs) accounting for 2.5% and the second leading cause of disability accounting for 8.2% of Years Lived with Disability (Leontjevas et al., 2013). Consequently, depression was recognized as the leading source of sixteen million perversities DALYs and around four million ischemic heart ailment DALYs.

Primary care doctors in various states diagnose the precise similar depression symptoms differently depending on the gender of the person. For instance, there are substantial variations between nations in managing patients with signs indicative of depression. International alterations in depression frequency rates and maybe another disease might partly result from changes among the healthcare systems in various nations. Else, international differences in diagnosing and managing depression are becoming a high interest in health service researchers or epidemiologists. Reported country modifications in frequency rates for depression are presumed to be actual where the subsequent search for fundamental reasons focuses on the family background as well as genetics and culture differences in risk behaviors or lifestyle.

Nevertheless, it is equally likely that the similar signs and symptoms of depression are managed and diagnosed differently in various countries resulting in international differences in disorder prevalence rates. Variability in provider behavior is highly invoked as an explanation for within-country health disparities although the reason is rarely extended to an understanding of international medical and health care variations. For instance, international comparative health services, as well as policy research, is still due to reliance on current medical records.

A4. Factors Contributing to Ability of a Patient to Manage Depression

Some of the factors that contribute to the patient’s ability in managing diabetes include financial resources, Medicare/Medicaid, access to care as well as insured/uninsured victims. The listed factors have great contribution when it comes to patient’s wellbeing. For instance, financial resources are vital because victims will be able to access medical care at any time and anywhere around the world. For the patients who are insured they cannot struggle due to lack of funds but can access care at any time since the resources and required capital is available. Else, Medicaid/Medicare plays a more significant role for depression patients because there is guaranteed care for those who are enrolled in the program.

A4a. How Lack of Factors Leads to Unmanaged Depression

The first factor leading to unmanaged depression is financial resources. For instance, people having mental illnesses are most likely to face financial problems or be in debt. First, depression and anxiety may interfere with money and employment management. Debt and unexpected unemployment exacerbate depression or triggers episodes for those prone to them. Regardless of mental illness or financial problem coming first any of the issues may fuel the other causing a spiral of shame and paralysis where every choice appears to be the wrong one. Tax time can be a stressful time because it is a time of cold, hard financial reckoning. Therefore, people have to gather statements and bills which might be a stressful process. In so doing there is a confrontation in the state of our finances which might not be certainly right meaning that when depressed there is the likelihood of ignoring our entire investments.

The other factor leading to unmanaged depression is Medicare/Medicaid. First, individuals who are covered by Medicare programs are likely to receive better care and become well when they get sick. Medicare beneficiaries having depressive symptoms reported poorer experiences with care compared to recipients lacking depressive symptoms. Since there are credible reasons for expecting patient behaviors linked with depression to affect care process analysis adversely is that study supports an interpretation of such differences as reflective to real care differences (Corona et al., 2013). Therefore, Medicare beneficiaries having depressive symptoms have less confidence in the capability to manage their care compared to recipients lacking deceptive signs and that less confidence shall be associated with poorer care experiences.

Lastly, accessing quality care is one of the factors that contribute to managing of depression where the mechanism appears to be improved continuity. For instance, individuals planning the implementation of advanced access to care needs to do so in a way that enhances the practice rather than being harmed by the change. Else, lacking health insurance or even restricted coverage for depression and mental health amenities might form fiscal constraints. Employers are likely to be affected by despair through lost productivity, health care, and incapacity claims. Consequently, employers impact treatment access by covering mental services like insurance plans. Furthermore, communities might wish to assess the proportion of the population with health benefits through employment-based insurance or determining if the gains can be compared to handling for other medical care systems.

A4i. Characteristics of A Patient with Unmanaged Depression

Unmanaged depression is a severe problem because it increases the chances of risky behaviors like drug addiction. Therefore, individuals with unmanaged depression portray various characteristics. First, patients with unmanaged depression experience loss and sadness when issues like job loss, divorce or death of loved ones occur. Nevertheless, according to the University of California, Berkeley acute sadness lasting for more than two weeks should be brought to physicians’ attention. The most common signs of severe depression are acute sadness, changes in appetite, sleep troubles and losing interest in things which once brought pleasure.

Furthermore, patients with unmanaged depression show some side which is not universal. Such characteristics include stomach and headache problems, difficulties in concentration, frequent falls as well as increased muscle or body pain. Consequently, experiencing suicidal thoughts, harming oneself or even killing are some characteristics associated with patients having unmanaged depression.

  1. How Depression Affects Patients, Families, and Populations

Depression has various effects on the victims, families and the population in general. First despair is linked with vital damage across several functioning areas. Persons reporting mild impairment due to depression experiences high medical care need perceptions, always utilize healthiness services and are most commonly hospitalized. Consequently, depression patients are twice likely to be unemployed compared to ones lacking despair symptoms. Besides, depression has substantial social or economic impacts. The disease is linked with increased use of health services inclusive of primary and specialty care utilization visits (Hersen et al., 2013). People who suffer from depression are downcast with less energy and capacity for enjoyment and activities. For instance, things which appeared to be necessary for the individual no longer has special significance, self-esteem together with confidence plummet. Close family members of the patient always feel powerless since they struggle with mixed emotions like fear and anxiety as well as anger or irritation. Thus, the ensuing guilt and living with hard feelings can be ordeal over time.

B1. Financial Costs Associated with Depression

The financial costs of depression to the patients, families, and populations are significant. For instance, the economic ripples for depression are disproportionate and extensive to the price which is used depression. For any dollar used on depression treatment an extra $4.70 is utilized on direct and indirect charges of associated illnesses and $1.90 used on a combined workplace efficiency as well as budgetary losses linked to direct associated depression suicide. In America, despair expenses the society $210 billion annually where forty percent of the total amount is associated with depression (Leontjevas et al., 2013). The cost of depression is related to mental illness like anxiety or post-traumatic stress disorder and physical illnesses including sleep and back disorders as well as migraines.  Besides, financial costs for the individual having depression are a problem especially to patients who are financially challenged. An example of a patient cost is that of Susan Hyatt of Denver pays to manage own grief, as well as a seasonal affective disorder (SAD), links to care productive. When Susan’s plans of staying prolific are not valid, she loses some income where she cannot pay for things helping her staying better and feeling free. In addition to Susan’s medicine around $70 monthly out-of-pocket for bupropion and trazodone. For instance, Hyatt uses around $100 to $150 on complements and herbs each month as well as $300 for exercise and other lifestyle actions that keep inspired in working. Generally, the overall societal costs have slightly risen although the treatment rate has substantially grown. However, with the appropriate managed care, despair patients are not spending a lot of time at the hospital or being attended by psychological or psychiatric experts.

  1. How to Promote Depression Best Practices?

The best practices for managing depression can be promoted through the development and implementation of programs for preventing and treating depression. First, the states should target interventions or actions aimed at supporting vulnerable, high-risk groups with proper plans or tools for building resilience. Therefore, countries should encourage depression recognition across all care levels as well as among various types of health and medical professionals.  Also, the best practices should be promoted through collaboration between education, health and labor sectors for awareness raising and enabling better access to support (Yamaguchi et al., 2013). Moreover, there should be the implementation of evidence-based e-mental health tools which help with prevention of depression or mitigating the onset of the disease through self-help or even self-management approaches.

C1. Strategies for Implementing Best Practices for Depression Management

There are various strategies which can be sued for implementing the best depression management practices. The first strategy of implementation is at individual consumer level which is centered on health problems linked to increased depression rates or murder and the want of improving enactment on individual consumer and healthcare system level for ensuring care satisfaction. For successful treatment practice, consumer health curing technologies have to address health practitioners concerns in the design phase, account for types of health practitioners, clinical practices and treatment methods. Consequently, an individual should seamlessly strive towards integrating traditional or nontraditional despair indicators within several health practitioners’ clinical practices. Thus, an individual consumer level a person should develop a goal therapy, learn to improve any situation meta-awareness and determine the treatment dose which works for them as well as not seeing depression as a personal flaw.  The other implementation strategy is a healthcare structure and plan levels. At the healthcare structure level, there are two possible implementation outcomes including low threshold and safe quality care (Duman, 2014). At the policy phase there emerges two likely outcome implementation areas which include the desire for a strategy of stigma reduction through ensuring mental health complications are visible in social inclusion and society. The next approach is collaborative and stepped care. The results for effectiveness and cost-effectiveness depression collaborative care are promising although less conclusive. Active collective responsibility follows stepped care principles where treatment is steadily changed, strengthened or even climbed up when patients do not improve as projected.

C2. Appropriate Method for Evaluation of Each of The Strategies

The most appropriate method for evaluating depression management is the linear growth curve models with sociodemographic and clinical covariates. The plan is suitable in determining the trajectory of symptom reduction throughout psychiatric hospitalization together with identifying patient characteristics associated with recovery and quantifying the magnitude of the expected change through using recognized clinical benchmarks.

The evaluation of individual consumer level should be evaluated using the randomized methods. Non-randomized methods are divided into two including cohort and case-control studies. Cohort studies involve allocating an intervention non-randomly and can be prospective and retrospective although adjustments can be found for confounders. On the other hand, case-control studies include investigation of rare outcomes where individuals are defined as the basis of result instead of healthcare.

The best method in evaluating healthcare structure and plan levels is the health technology assessment. The technique examines the best technology which can deliver to a particular patient or population group. For instance, the method assesses the cost-effectiveness of treatments against the next or current best healings.

In evaluating collaborative and stepped care the appropriate method involves conducting a qualitative study. The technique consists of the use of a purposive sample strategy where  semi-structured interviews gather data.



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