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Search Results for "depression"
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Displaying 41 - 50 of 251 in Policy Library
Displaying 41 - 50 of 1535 in Annals of Internal Medicine
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Effectiveness of Psychological Therapies for Depression During the Perinatal Period: A Systematic Review and Meta-analysis: Annals of Internal Medicine: Vol 178, No 12
Background: Perinatal depression can have a deleterious impact on mothers and infants. Purpose: To evaluate psychological therapies for perinatal depression. Data Sources: 6 databases from January 2000 to March 2025. Study Selection: Randomized controlled trials (RCTs) of psychological therapies for people with depression during pregnancy and up to 1 year postpartum. Data Extraction: 6 researchers extracted study data and assessed the risk of bias and strength of evidence (SoE). Data Synthesis: Forty-four RCTs were included. Cognitive behavioral therapy (CBT; k = 25, n = 2962) was probably more effective than treatment as usual (TAU) in reducing depressive symptoms by an equivalent −1.7 points (95% CI, −2.0 to −1.3 points) on the Edinburgh Postnatal Depression Scale (EPDS; range, 0 to 30 points) (moderate SoE) and may have greater recovery rates from depressive symptoms (relative risk [RR], 1.7 [CI, 1.3 to 2.3]) (low SoE). Behavioral activation (k = 3, n = 508) may be more effective than TAU in reducing depressive symptoms by an equivalent −1.5 EPDS points (CI, −2.6 to −0.5 points) (low SoE). There may be no differences in depressive symptoms between CBT and counseling (k = 3, n = 226; EPDS, −0.5 [CI, −1.5 to 0.5]) or counseling and TAU (k = 3, n = 247; EPDS, −0.8 [CI, −2.6 to 1.0) (low SoE). Interpersonal therapy (IPT; k = 9, n = 1003) was probably more effective than TAU in reducing depressive symptoms by an equivalent −1.7 EPDS points (CI, −2.9 to −0.5 points) (moderate SoE) and may have greater recovery rates from depressive symptoms (RR, 1.2 [CI, 0.97 to 1.5]) (low SoE). Limitations: Participants were not blinded to treatment, study variation in country, interventions, populations, or reducing SoE. Differences may not be clinically important. Conclusion: For treatment of perinatal depression, CBT, behavioral activation, and IPT may be effective. Primary Funding Source: Agency for Healthcare Research and Quality (AHRQ).
Glucagon-Like Peptide-1 Receptor Agonists and Risk for Depression in Older Adults With Type 2 Diabetes: A Target Trial Emulation Study: Annals of Internal Medicine: Vol 178, No 3
Background: Although glucagon-like peptide-1 receptor agonists (GLP-1RAs) have shown potential antidepressant effects, population studies yield inconsistent results. Objective: To compare the risk for depression in older adults with type 2 diabetes (T2D) initiating treatment with GLP-1RAs versus sodium–glucose cotransporter-2 inhibitors (SGLT2is) or dipeptidyl peptidase-4 inhibitors (DPP4is). Design: Target trial emulation study. Setting: U.S. National Medicare administrative data from January 2014 to December 2020. Patients: Adults aged 66 years or older with T2D initiating treatment with a GLP-1RA were matched 1:1 on propensity score with those initiating treatment with either an SGLT2i or a DPP4i. Measurements: The primary end point was incident depression. Cox proportional hazards regression models were used to estimate the hazard ratio (HR) with 95% CI within matched groups. Results: A total of 14 665 matched pairs of older adults were included in the cohort for GLP-1RAs versus SGLT2is; the rate difference of depression between GLP-1RA users and SGLT2i users was 3.48 (95% CI, −0.81 to 7.78) per 1000 person-years, with an HR of 1.07 (CI, 0.98 to 1.18). In the cohort for GLP-1RAs versus DPP4is (13 711 matched pairs), the rate difference was −5.78 (CI, −10.49 to −1.07) per 1000 person-years, with an HR of 0.90 (CI, 0.82 to 0.98). Limitation: Unmeasured confounders (such as hemoglobin A1c levels and body mass index), outcome misclassification, and limited generalizability to all GLP-1RA users (for example, younger populations or those without T2D receiving the drug for obesity treatment). Conclusion: Among older adults with T2D, the incidence of depression was relatively low. Use of GLP-1RAs was associated with a modestly lower risk for depression compared with use of DPP4is, but not SGLT2is. Primary Funding Source: National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health.
Review: In major depressive disorder, antidepressant drugs improve short-term response compared with placebo
Source Citation Cipriani A, Furukawa TA, Salanti G, et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Lancet. 2018. [Epub ahead of print]. 29477251
In older men, 5α-reductase inhibitors were linked to increased risk for self-harm and depression but not suicide
Source Citation Welk B, McArthur E, Ordon M, et al. Association of suicidality and depression with 5α-reductase inhibitors. JAMA Intern Med. 2017;177:683-91. 28319231
Displaying 41 - 50 of 75 in Annals of Internal Medicine: Clinical Cases
Autopsy Case of Colonic Plasmablastic Lymphoma Exhibiting Unique Endoscopic Phenotypic Changes During Ulcerative Colitis Therapy | Annals of Internal Medicine: Clinical Cases
Plasmablastic lymphoma (PBL), a rare and aggressive CD20-negative B-cell lymphoma, has been increasingly recognized in individuals who are HIV-negative and who are also immunosuppressed. To our knowledge, we report the first autopsy case of a 74-year-old woman with ulcerative colitis (UC) who developed colonic PBL under immunosuppressive therapy. Serial colonoscopies demonstrated a morphologic transformation from serpiginous ulcers to elevated lesions. The patient ultimately died because of carcinomatous lymphangitis. Autopsy showed widespread metastases and numerous flat elevated lesions with lobulations throughout the colon. This case demonstrates a unique endoscopic phenotypic transition in colonic PBL, suggesting the importance of careful monitoring for timely diagnosis in immunosuppressed UC patients.
Familial Iliac Aneurysms Associated With Compound Mutations in the COL1A2 Gene | Annals of Internal Medicine: Clinical Cases
Iliac artery aneurysms are uncommon and usually asymptomatic but may undergo spontaneous dissection, rupture, and thrombosis. Aneurysmal ruptures carry a high mortality rate. Mutations in collagen-encoding genes such as COL3A1 are associated with vascular Ehlers–Danlos syndrome, including reports of familial iliac aneurysms. To our knowledge, this is the first reported case of COL1A2 mutations associated with iliac artery aneurysms. In this report, we describe a patient with iliac aneurysms associated with 2 novel missense mutations in the COL1A2 gene. Family history then revealed 3 first-degree male relatives with iliac and/or aortic aneurysms suggestive of an autosomal-dominant inheritance with high penetrance. This case adds a new gene in the collagen pathway in which mutations contribute to aneurysm formation and underscores the importance of targeted genetic testing in families with iliac aneurysms.
Complete Response to Pembrolizumab in Prostate Cancer With Microsatellite Instability–High, Deficient Mismatch Repair, Tumor Mutational Burden–High, and Programmed Death–Ligand 1 Positivity | Annals of Internal Medicine: Clinical Cases
A 72-year-old man initially presented with prostate cancer and a metastatic right rib lesion. He developed rapid progression on androgen deprivation therapy in 7 months and subsequent treatment with enzalutamide in 3 months. Biomarker studies after progression to castration-resistant prostate cancer revealed deficient mismatch repair, microsatellite instability–high, tumor mutational burden of 21 mut/Mb, and programmed death–ligand 1–positive disease. Based on the results of the KEYNOTE 158 study, immunotherapy with pembrolizumab was initiated. The patient had a complete clinical, radiologic, and biochemical response with an undetectable prostate-specific antigen level within 3 months and continued pembrolizumab 8 years after diagnosis.
When Sarcoidosis Looks Like Myeloma: A Diagnostic Pitfall | Annals of Internal Medicine: Clinical Cases
Multiple myeloma (MM) is a plasma cell malignant disorder with variable clinical presentations. Because MM is the most prevalent hematologic malignancy among Black patients, a high index of suspicion is often applied in this population. However, premature diagnostic closure may occur when initial findings appear consistent with MM, while conflicting information is overlooked. This case describes a 46-year-old Black man initially diagnosed with active MM but ultimately found to have active sarcoidosis and smoldering myeloma. This case illustrates the importance of recognizing cognitive bias and considering granulomatous disease in the differential diagnosis of hypercalcemia, lytic lesions, and systemic abnormalities.
From a Papule to Friable Papillary Projections: A Case of Old World Cutaneous Leishmaniasis | Annals of Internal Medicine: Clinical Cases
This case aims to characterize an unusual cutaneous manifestation in a patient with confirmed cutaneous leishmaniasis, highlighting clinical features that are often underrecognized and may contribute to diagnostic uncertainty. By exploring this atypical presentation, it underscores the potential for misdiagnosis and its implications for patient management. Additionally, it emphasizes the broad spectrum of cutaneous lesions that can mimic Old World cutaneous leishmaniasis, further increasing the risk of diagnostic error.
A Case of Dacrystic Seizure in a 72-Year-Old Man | Annals of Internal Medicine: Clinical Cases
Dacrystic seizures are rare, stereotyped episodes of ictal crying. We describe a 72-year-old man with recurrent crying spells, initially attributed to orthostatic hypotension with psychogenic episodes. Electroencephalography monitoring captured interictal left frontal spikes and diffuse background slowing. Magnetic resonance imaging demonstrated a prominent left mesial temporal lesion, though no episodes were identified in the 24-hour monitoring period. The patient was treated with levetiracetam and reported significantly fewer events at home. Clinical response confirms the diagnosis. This case highlights the diagnostic challenge of emotional seizure semiologies and the critical role of multidisciplinary evaluation, particularly for hospitalists encountering atypical neurologic presentations.
Diffuse Large B-Cell Lymphoma Presenting as Aortic Aneurysm Rupture: A Case Report | Annals of Internal Medicine: Clinical Cases
We present a rare case of diffuse large B-cell lymphoma (DLBCL) mimicking an abdominal aortic aneurysm rupture. A 78-year-old male with prior endovascular aneurysm repair presented with abdominal pain, hypotension, and renal failure. Imaging revealed a periaortic mass concerning for aneurysm leak; however, PET/CT and biopsy confirmed DLBCL. This case underscores the diagnostic challenge posed by periaortic lymphoma masquerading as vascular emergencies. Clinicians should maintain a broad differential, as early recognition may avoid unnecessary surgery and enable appropriate oncologic management.
De Novo Esophageal Small-Cell Neuroendocrine Carcinoma in a Patient With Achalasia: A Case Report | Annals of Internal Medicine: Clinical Cases
Esophageal neuroendocrine carcinoma (NEC) is rare and aggressive, representing 0.4% to 2% of esophageal cancers, with small-cell NEC comprising 95% of cases. Achalasia is known to increase the risk for esophageal malignancy, particularly squamous cell carcinoma. We describe an 81-year-old woman with longstanding achalasia who developed dysphagia. Endoscopy showed a fungating mass, and biopsy confirmed small-cell NEC. She was treated with platinum–etoposide chemotherapy, resulting in complete resolution. This case demonstrates remission with chemotherapy alone, challenging traditional surgical approaches. To our knowledge, this is the first reported case of esophageal small-cell NEC arising in conjunction with achalasia. Further research is warranted to establish optimal management strategies for such rare presentations.
Targetable Immune Dysregulation in a Patient With Heart Failure: Cardiovascular Manifestations of CTLA-4 Deficiency Improve With Evolocumab | Annals of Internal Medicine: Clinical Cases
We report the case of a 76-year-old man with germline CTLA-4 deficiency manifesting as multivessel coronary artery disease, heart failure with mid-range ejection fraction, and an aortic root aneurysm. New York Heart Association (NYHA) class 3 functional limitation was disproportionate to ischemic burden despite guideline-directed medical therapy. Statin intolerance prompted initiation of evolocumab, a PCSK9 inhibitor. Within 3 weeks, the patient's symptoms improved to NYHA class 1, suggesting a rapid immunomodulatory effect. This case illustrates targetable cardiomyopathy mediated by CTLA-4 deficiency, supports exploring PCSK9 inhibition for the management of immune-driven heart failure, and emphasizes genetic evaluation in unexplained cardiomyopathy.
Resolution of Hypokalemia and Hypotension With Tacrolimus and Extrarenal Transplantation in Gitelman Syndrome | Annals of Internal Medicine: Clinical Cases
Gitelman syndrome (GS) is characterized by genetic mutations in the sodium chloride cotransporter (NCC), leading to renal potassium, sodium, and magnesium wasting. Calcineurin inhibitors recapitulate familial hyperkalemic hypertension, with gain of function of the NCC. Whether calcineurin inhibition can overcome fluid/electrolyte dyscrasias in GS is unknown. We describe a patient with GS initiated on tacrolimus, a calcineurin phosphatase inhibitor, after orthotopic heart transplantation. Potassium supplementation and potassium-sparing diuretics were discontinued with no consequential hypokalemia, and hypotension and hypomagnesemia also improved. This case provides proof of concept that calcineurin inhibitors may help overcome clinical sequelae of loss of function of NCC in GS.