Integrated Management of Depression in Schizophrenia: Emerging Paradigms and Future Directions

Advances in the Treatment of Cognitive Impairment in Major Depressive Disorder: Innovations and Research Challenges

A critical appraisal of integrating family constellation therapy with pharmacological treatment for depression

Depression remains a leading cause of disability worldwide, driven by a complex interplay of biological, psychological, and social factors. While pharmacotherapy, particularly selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors, provides essential symptom control, its limitations—including delayed onset, variable response, and side effects—underscore the need for complementary approaches that address systemic and relational roots of the disorder. This narrative review synthesizes evidence on the integration of antidepressant medication with family constellation therapy (FCT), a systemic, experiential group intervention targeting transgenerational family dynamics. We first outline the core mechanisms and clinical challenges of pharmacotherapy, then examine how adverse family environments, dysfunctional communication patterns, and unresolved familial trauma contribute to depression risk. Next, we present the theoretical foundations and preliminary evidence base for FCT, noting moderate effect sizes for general psychopathology but a critical lack of depression-specific randomized trials. The central argument is that combining pharmacotherapy and FCT aligns with the biopsychosocial model by concurrently stabilizing acute biological symptoms and addressing the family-systemic factors that sustain vulnerability. However, direct comparative evidence is absent, and current support for integration is drawn largely from indirect data on combined psychotherapy and medication. We discuss sequential and parallel implementation models, highlight the urgent need for rigorous randomized controlled trials, and identify practical barriers including limited therapist training and the absence of standardized treatment protocols. In conclusion, the integration of pharmacotherapy with FCT represents a theoretically promising but empirically unvalidated strategy; its clinical utility will depend on the development of testable, manualized protocols and

Treatment-resistant depression: Current therapeutic strategies

It is concluded that the management of ESRD should be individualized, based on up-to-date scientific evidence, and integrated with multidisciplinary approaches, aiming at symptom remission, functional recovery, and improvement of patients' quality of life.

Integrated approaches to geriatric mental disorders: pathophysiology, interventions, and precision medicine horizons

The global aging demographic has precipitated a surge in late-life mental disorders (LMDs)—including late-life depression (LLD), anxiety, and behavioral and psychological symptoms of dementia (BPSD)—posing critical public health challenges. This review synthesizes current evidence on the unique pathophysiology, clinical management, and emerging frontiers of geriatric mental health, emphasizing the interplay of neurobiological aging, multimorbidity, and psychosocial stressors. Key pathophysiological mechanisms include “inflammaging” (microglial overactivation), cerebral small vessel disease (CSVD), and senescence of monoaminergic systems, which collectively reduce neural resilience and complicate diagnosis. Clinical challenges—such as atypical symptom presentation (e.g., somatic masking of depression), polypharmacy risks, and diagnostic ambiguity between LLD and pseudodementia—necessitate tailored interventions. Notably, caregiver burden represents an independent predictor of patient institutionalization. Multiple systematic reviews and meta-analyses have consistently identified caregiver burden and distress as significant predictors of nursing home admission, with carer stress sometimes serving as the single determining factor for this transition. This underscores the critical need to integrate caregiver well-being into routine clinical assessment. Pharmacological strategies prioritize SSRIs/SNRIs but require cautious dosing due to age-related pharmacokinetic alterations (e.g., reduced renal clearance) and cardiovascular/metabolic risks. Emerging targets (e.g., ketamine for treatment-resistant LLD, anti-inflammatory agents guided by biomarker profiling) highlight a shift toward precision. Psychotherapeutic adaptations—including modified cognitive behavioral therapy (CBT), problem-solving therapy (PST), and life review therapy—address cognitive and psychosocial needs, while integrated care models (e.g., Collaborative Care Model [CoCM]) demonstrate superior outcomes over fragmented care. Lifestyle interventions (exercise) and neuromodulation (rTMS) further expand treatment options. Critical gaps remain, including underrepresentation of older adults in clinical trials and pervasive polypharmacy. Future directions emphasize pharmacogenomics, AI-driven early detection, and culturally equitable care to advance precision psychiatry for LMDs. This synthesis provides clinicians and researchers with a roadmap to navigate the complexities of geriatric mental health, advocating for multidisciplinary, patient-centered approaches to improve outcomes in aging populations.

Bridging the Gap Between Depression and Epilepsy: A Call for Integrated Neuropsychiatric Care

Abstract “Brain health” encompasses key functions such as cognition, emotion, and behaviour, and is increasingly relevant given its role across neurological and psychiatric conditions. One of these, depression is the most common psychiatric comorbidity in people with epilepsy (PWE). When unrecognized and untreated, depression is associated with increased seizure severity and poorer treatment response, significantly impacting patients’ prognosis and quality of life; conversely, the rate of epilepsy is 2-fold higher in individuals with incident depression compared to those without depression. Several studies have confirmed a strong bidirectional relationship between epilepsy and depression; an advisory panel of psychiatrists and neurologists with expertise in epilepsy and mood disorders convened for a virtual meeting held in 2024 to assess the impact of the interplay between these two conditions. A comprehensive, interdisciplinary approach to discussion was adopted to address challenges in diagnosing and managing depression in PWE, focusing on early intervention, patient education, and tailored treatments strategies; additionally, the meeting emphasized the importance of integrated care between neurologists and psychiatrists to address this unmet medical need. The authors identified depression in PWE as being underdiagnosed due to overlapping symptoms, stigma, and limited psychiatric care integration. Management is challenging as some antiseizure medication worsen depression and certain antidepressants may lower the seizure threshold, requiring careful selection and monitoring to balance efficacy and safety. Potential interactions between these medicines underscore the importance of carefully selecting therapeutic combinations to minimize adverse effects. Effective management involves an interdisciplinary approach, integrating neurologists and psychiatrists. Key strategies include early screening, psychoeducation, a personalized approach to pharmacological and nonpharmacological treatment, and increased awareness among healthcare providers, patients, and caregivers regarding the overlap of neurological and psychiatric disorders. Furthermore, educational resources, as well as digital tools, can help inform and educate patients and caregivers on holistic brain health management.

Towards precision psychiatry: initial foundations and future directions.

This Perspective discusses mechanistic approaches that focus on excitation-inhibition balance, reward and aversion circuits, hippocampal-prefrontal neuroplasticity, and processing of social cues, highlighting how these frameworks can elucidate drug mechanisms and predict treatment responses.