In both the ICD-11 and the DSM-5, the core symptoms of depression are reported to be depressed mood (e.g., feeling sad, down or hopeless) and markedly diminished interest or pleasure in activities. However, in the ICD-10 diagnostic guidelines, a third core symptom was also identified: “fatigue or low energy”. In two regions of the world (Latin America and East Asia), “fatigue” is the most commonly

McIntyre et al1, in their excellent paper appearing in this issue of the journal, successfully tackle a critical issue in the field of depression: how should we define treatment-resistant depression (TRD) and how can we best manage it? They point out that a consensus definition of TRD with demonstrated predictive utility in terms of clinical decision-making and health outcomes does not currently exist

We provide here the first bottom-up review of the lived experience of depression, co-written by experts by experience and academics. First-person accounts within and outside the medical field were screened and discussed in collaborative workshops involving numerous individuals with lived experience of depression, family members and carers, representing a global network of organizations. The material

Populations with common physical diseases – such as cardiovascular diseases, cancer and neurodegenerative disorders – experience substantially higher rates of major depressive disorder (MDD) than the general population. On the other hand, people living with MDD have a greater risk for many physical diseases. This high level of comorbidity is associated with worse outcomes, reduced adherence to treatment

The later years of the 20th and the beginning of the 21st century – coinciding with deinstitutionalization and shift to managing mental health problems outside of hospitals – have been characterized by several socioeconomic trends which are of major importance for the strategies of community mental health care1, 2. The rampant urbanization is one of these trends. All the predictions are in agreement

When combined with pharmacotherapy, family psychoeducation and skills training are key strategies for preventing, delaying or minimizing the severity of illness episodes in major psychiatric disorders1-3. High levels of expressed emotion – as indicated by critical comments, hostility and/or emotional overinvolvement from caregivers – are associated with high rates of recurrence in patients with schizophrenia

Task-sharing – in which specialists train, supervise and support non-specialist health care providers – is proven to be acceptable, feasible and effective in scaling up mental health care for depressive and anxiety disorders1. In this perspective, we focus on reasons for and barriers to task-sharing of psychological interventions in primary health care. We also cover what the World Health Organization

The expression “mental health literacy” was introduced in 1997 by Jorm et al1, referring to “knowledge and beliefs about mental disorders which aid their recognition, management or prevention”. Compared to contemporaneous programmes aiming to reduce stigma and discrimination related to mental illness, this construct reflected a broader and positively framed public mental health goal. However, the concept

Treatment-resistant depression (TRD) is common and associated with multiple serious public health implications. A consensus definition of TRD with demonstrated predictive utility in terms of clinical decision-making and health outcomes does not currently exist. Instead, a plethora of definitions have been proposed, which vary significantly in their conceptual framework. The absence of a consensus definition

With the increasing recognition that major depressive disorder (MDD) is one of the world greatest public health problems1, 2, there have recently been concerted efforts to ensure that people suffering from this condition are promptly recognized, accurately diagnosed, and vigorously treated. Indeed, a relatively wide range of proven treatments are now available to help depressed people, and health care

As admirably detailed by McIntyre et al1, most definitions of treatment-resistant depression (TRD) weight failure to respond to a set of antidepressant medications and other physical treatment options. Is this the optimal paradigm when major depressive episodes may be caused not only by biological factors, but also by social and psychological ones? Wouldn't we expect, for example, that a woman depressed

I think we should be grateful to McIntyre et al1 for their extraordinarily thorough and balanced review of treatment-resistant depression (TRD). They note that this condition poses a plethora of clinical research challenges. Here I offer a few suggestions that might make research more cost-efficient and clinically generalizable. First, we should develop tools to systematically identify treatable causes

Congratulations are well deserved for this review by 27 psychiatric leaders, representing 14 countries, including 294 references1. This highly researched, well-written paper describes the characteristics of treatment-resistant depression (TRD), including prevalence, risks, clinical features, costs, public health burden, management and treatments. Despite the wealth of information provided, lingering

McIntyre et al1 provide an excellent overview of “treatment-resistant depression” (TRD) and of the ways future research can contribute to a better knowledge on how to handle the many patients with depression who do not respond to treatment. However, I argue here that the notion of TRD is based on a misconception of the effects of treatments in depression, and that it is much better to focus research

Depressive episodes can be of mild intensity and transient, but – especially in tertiary care settings – they are often chronic and/or relapsing. As clinicians we often see people towards the latter end of this spectrum, including “treatment-resistant depression” (TRD), and spend much of our efforts in treating them. McIntyre et al1 competently and comprehensively review the TRD definition, prevalence

Interest in the use of serotonergic agonists such as psilocybin in treatment-resistant depression (TRD) has grown more quickly than the evidence on which to base a final opinion, as emphasized by McIntyre et al1 in their review. Psilocybin, once metabolized to psilocin, activates 5-HT2A receptors, enhancing GABA function in local circuits in the cortex and increasing connectivity between functional

McIntyre et al's paper1 is not just another literature review on the topic of treatment-resistant depression (TRD). It puts everyone in agreement and offers a concrete basis for a constructive reflection on the subject. More than that, it invites us to approach TRD in all its facets, the most complex but also those still unsuspected. Since the 1970s, the scientific literature on TRD has abounded with

This study aimed to identify the 20-year trajectories of positive and negative symptoms after the first psychotic episode in a sample of patients with an ICD-10 diagnosis of schizophrenia spectrum disorder, and to investigate the baseline characteristics and long-term outcomes associated with these trajectories. A total of 373 participants in the OPUS trial were included in the study. Symptoms were

The offspring of parents with mental disorders are at increased risk for developing mental disorders themselves. The risk to offspring may extend transdiagnostically to disorders other than those present in the parents. The literature on this topic is vast but mixed. To inform targeted prevention and genetic counseling, we performed a comprehensive, PRISMA 2020-compliant meta-analysis. We systematically

Many societies have been recently exposed to humanitarian and health emergencies, which have resulted in a large number of people experiencing significant distress and being at risk to develop mental disorders such as depression, anxiety and post-traumatic stress disorder. The World Health Organization has released a series of scalable psychosocial interventions for people impaired by distress in communities

Exposure to adverse childhood experiences (ACEs), including maltreatment and family dysfunction, is a major contributor to the global burden of disease and disability. With a large body of international literature on ACEs having emerged over the past 25 years, it is timely to now synthetize the available evidence to estimate the global prevalence of ACEs and, through a series of moderator analyses

The behavioral repertoires of patients with obsessive-compulsive disorder (OCD) often appear puzzling and irrational. For example, an OCD patient who just locked a door might repeatedly return and check that it is locked. Similarly, a patient might continue washing and rewashing his hands, waiting for a vague “just-right” feeling before deciding to stop. Numerous models have been proposed to explain

Cognitive models of anxiety and depression postulate that these conditions are marked by negative attentional biases, i.e. increased or exaggerated attention to disorder-relevant negative information. These biases are not regarded as mere correlates of these disorders, but are thought to play a major role in their development and maintenance. Temperamental factors such as neuroticism are thought to

It is over a decade since the new diagnosis of Somatic Symptom Disorder (SSD) was introduced in the DSM-5, and Bodily Distress Disorder was proposed for inclusion in the ICD-11. These new diagnoses were introduced to move away from the terms “somatoform” and “somatization”, which were thought to be unhelpful to patients and doctors. It was also thought necessary to define these disorders in a positive

Catatonia is being increasingly recognized in both clinical practice and ongoing research. Although originally described as a unique syndrome by Kahlbaum in 1874, it was associated with schizophrenia by Kraepelin and Bleuler in the early 1900s, and this nosological oversight was reflected in the first three editions of the DSM1. Fink and Taylor supported its separate categorization as a syndrome in

Our social ties underpin the substance of our daily lives and exert a strong influence on our individual mental health and collective well-being. While these connections often imbue our lives with meaning and positive feelings, they can for some people go terribly awry. One of the more striking manifestations of this is called hikikomori. Hikikomori has been an emerging topic of study in psychiatry

ChatGPT (Chat Generative Pretrained Performer), an artificial intelligence (AI) chatbot, was launched in 2022. It is trained on a large language model (LLM) consisting of text derived from websites, Internet forums, digital books, and subtitles of videos. After registration on openai.com, users can prompt ChatGPT on chat.openai.com to give answers to any questions. Research and clinical communities

Population prevalence rates indicate that depression is twice as common in women as in men1. But, is this estimate an accurate reflection of men's mental health, or rather an artifact of diagnostic criteria favouring female-typical manifestations of depression2? We and others would argue that the latter is, in fact, the case2-6. Indeed, results from decades of epidemiological and clinical studies point

Early intervention for youth mental disorders has received increasing attention in recent decades. For psychosis, this is exemplified by the clinical high-risk (CHR) paradigm, which has been highly successful in defining a subpopulation at enhanced risk. However, the subpopulation captured by CHR services represents a small proportion of all psychosis cases1, highlighting the need for additional approaches

Stable employment is consistently and strongly linked to key indicators of life quality and longevity, including physical and mental health, social integration, self-conception and self-fulfilment1. Involuntary exclusion, destabilization, or marginalization from the workforce has negative impacts across these same personal, social and economic domains. These effects may be further compounded by individual

The introduction of complex post-traumatic stress disorder (CPTSD) and the revised descriptions of personality disorders in the ICD-111 is being accompanied by some uncertainty in clinical practice regarding the differentiation between the diagnostic profiles of CPTSD and borderline personality disorder (BPD). The CPTSD diagnosis requires “exposure to an event or series of events of an extremely threatening

The European Group for Research in Schizophrenia (EGRIS) was founded in the late 1990s to develop strategies for the promotion and coordination of schizophrenia research in Europe. The founding members were W. Fleischhacker (Austria), J. Peuskens (Belgium), D. Naber (Germany), I. Bitter (Hungary), J. Gerlach (Denmark), J.-J. Lopez-Ibor (Spain), S. Galderisi (Italy), J. Libiger (Czech Republic), M.

The life-course approach to health shows how early exposure to physical, environmental and psychosocial factors shapes future health and mental health. In particular, when this exposure occurs during critical life phases such as adolescence, it may cause shifts in health trajectories that become difficult to restore1, 2. Future health and mental health patterns are established during youth. More than

In 2019, the WPA set up an Expert International Advisory Panel for Early Intervention in Psychosis (EIP) in Low- and Middle-Income Countries (LMICs), as part of a presidential initiative1 linked to the WPA Action Plan 2020-20232-4. Here we present an update on recent activities related to that initiative. The WPA has promoted several symposia and keynote/plenary lectures at international conferences

Global development seems to have openness to the world as a prerequisite. In psychiatry, this intercultural dialogue is particularly relevant, considering the diversity in illness manifestations and classifications1 and the growing number of diasporas around the world2. Although early career psychiatrists have been calling for overseas training to acquire global health competencies, accessing such

As the COVID-19 pandemic persists and millions are impacted by war and economic unrest, it is critical that mental health services receive support1-4. Despite the pressing need, there remains a significant gap in access to services and an ongoing shortage of mental health workforce, especially in low- and middle-income countries5. In the WPA Action Plan 2020-2023, capacity building and promotion of

Clinician-scientists are members of the health care workforce who devote at least half of their time to research1. There is a concern throughout medicine that the number of clinician-scientists is woefully insufficient to meet the needs of the population. For example, the number of clinician-scientists in the US declined by 22% from 1983 to 20031. According to a 2012 report by the US National Institutes

The treatment gap for persons with mental disorders averages 50% in all countries of the world and rises to 90% in least-resourced countries1. The mental health care sector is increasingly adopting newer digital health options that may help to significantly reduce this gap. Although telemental health care has a long-standing history and compelling empirical evidence base, its implementation in routine

In 2016, the WPA President and Executive Committee appointed seven sites as WPA Collaborating Centres, with the aims to: a) collect and disseminate information on mental health; b) provide training and links to clinical and research centres; c) support capacity building at country or regional level; d) conduct and coordinate educational and research activities with the support of the WPA1. The Centres

In this issue of the journal1, R.M. Nesse – one of evolutionary psychiatry's most intellectually fertile theorists – provides a primer of the field's accomplishments and makes a compelling argument for evolutionary psychiatry as a foundational science for psychiatry. He portrays a rapidly maturing field bursting with fresh insights and provocative hypotheses. Using innovative methodologies – ranging

Arguably, there is not a more important theme in psychiatry today than biomarkers. We don’t have many; some would say, none. The panel of authors of Abi-Dargham et al's paper1 is eminent and broad, and they have been capable to summarize our current needs and advise on developing and using biomarkers in our field. The authors note a gap in the biomarker validation process, i.e., in demonstrating that

It seems now an appropriate time to reflect on all that the WPA has achieved regarding scientific meetings during the triennium 2020-2023. Although the COVID-19 pandemic has disrupted the organization of medical conferences across the entire world1, the WPA has strived together and advanced in terms of holding high-quality meetings. We are pride of these accomplishments, and we could have not achieved

Four main axes have been addressed during this triennium concerning WPA scientific publications. The first axis has been the project of publishing WPA co-sponsored thematic issues in regional journals. After the very successful experience of the thematic issue on disasters and trauma in the British Journal of Psychiatry 1, we published in 2022 a WPA co-sponsored supplement of the English-language Brazilian

As most countries have lifted their travel restrictions imposed for the prevention of the spread of the COVID-19 pandemic, the WPA has resumed organizing and co-organizing face-to-face academic conferences. While this is a welcome move to many mental health professionals who have longed for meeting up with their long-time research collaborators and friends from different areas of the world, not all

When the 145 WPA Member Societies will meet in Vienna, Austria in September/October 2023 for the 23rd World Congress of Psychiatry, they will also convene for the WPA General Assembly, taking place every three years. This Assembly, the Association's highest decision-making body, will vote on a multitude of motions brought to the floor and meant to govern the Association for the next triennium. Reflecting

The WPA has been severely affected in the past three years by the impact of the COVID-19 pandemic and its after-effects, the war in Ukraine, and several other adversities in many regions of the world. However, all of its components have adapted their activities, learnt to work in new ways and sought innovative ways to support mental health professionals worldwide. We have focused in particular on selected

The burden of mental health is high, affecting people from all walks of life1. Good mental health is an essential aspect of overall well-being and significantly impacts an individual's daily and lifelong quality of life. Despite this, there is often a lack of actions taken to address the growing mental health problems2. The issue of the global mental health situation is especially critical due to the

The links between mental and physical illness are an emerging topic, with the potential to transform research and practice in medicine and psychology1. Symptoms of mental illness have been found to be underpinned by one single factor explaining the propensity to develop any mental health condition, which has been termed the “p” (for psychopathology) factor2. The “p” factor has been demonstrated not

The Russian invasion of Ukraine – starting on February 24, 2022 – is a global catastrophe. It is a moral and a public health crisis posing challenges for individuals, families and nations. Leaders of international and national psychiatric associations gathered in Warsaw, Poland on February 24, 2023, aiming to work together to address the horrific consequences of an immoral war, and the traumatic damage

There has been considerable optimism in the care of early course psychotic disorders in recent years, as reflected by the rapid implementation of coordinated specialty care (CSC) services around the world in the background of steadily progressing standards of care. While benefits are seen early with CSC interventions, these results may not be sustained. In a large 10-year follow-up study (N=347), it

To assess the current status of psychodynamic therapy (PDT) as an empirically supported treatment (EST), we carried out a pre-registered systematic umbrella review addressing the evidence for PDT in common mental disorders in adults, based on an updated model for ESTs. Following this model, we focused on meta-analyses of randomized controlled trials (RCTs) published in the past two years to assess

Evolutionary biology provides a crucial foundation for medicine and behavioral science that has been missing from psychiatry. Its absence helps to explain slow progress; its advent promises major advances. Instead of offering a new kind of treatment, evolutionary psychiatry provides a scientific foundation useful for all kinds of treatment. It expands the search for causes from mechanistic explanations

Substance use disorders (SUDs) are highly prevalent and exact a large toll on individuals’ health, well-being, and social functioning. Long-lasting changes in brain networks involved in reward, executive function, stress reactivity, mood, and self-awareness underlie the intense drive to consume substances and the inability to control this urge in a person who suffers from addiction (moderate or severe

Despite explosive progress over recent decades in understanding the molecular basis of circadian rhythms and their pervasive role throughout the brain and body, our understanding of a related construct – chronotype – remains incomplete. Historical wisdom going back to Aristotle espouses the benefits of an early sleep-wake schedule for health, financial success, and intellectual prowess. Accumulating

The Internet has become the main source of health information, which is usually obtained via online health search using relevant engines – a behavioral pattern also known as “Dr. Google”. Online health search has had an empowering effect, allowing an easy access to hitherto difficult-to-find health information. However, it can also become problematic and lead to cyberchondria. Cyberchondria is an excessive

The laws legalizing recreational cannabis use, the increasing strength of cannabis and cannabis derivatives, and the growing availability and commercialization of cannabis call attention to the possible implications for mental health, and specifically for the incidence of psychosis. Several lines of evidence suggest that exposure to cannabis and synthetic cannabinoids may contribute to the risk for

The increased awareness by mental health professionals of the effects of the COVID-19 pandemic and of post-COVID-19 conditions, and of the consequent need for augmenting and increasing access to mental health services, requires an update of the WPA Position Paper on this topic published in this journal in 20201. Most international evidence suggests that the COVID-19 pandemic has generated an increased

Over the years, it appears that the profession of psychiatry has become increasingly wedded to diagnostic systems such as the ICD and DSM, and to biological interventions. The major professional mental health organizations have recognized manualized “evidence-based” forms of intervention as the standard for treatment of traumatic syndromes such as post-traumatic stress disorder (PTSD). But there have

The ultimate goal of both diagnosis and biomarkers in psychiatry – as in all areas of medicine – is to lead to better outcomes through improved management, tailored as necessary to the individual patient. As Abi-Dargham et al show in their magisterial overview of the field1, despite a massive research effort spanning half a century, no biomarkers have been identified that have proven useful and valid

Providing therapist-guided cognitive behaviour therapy via the Internet (ICBT) has advantages, but a central research question is to what extent similar clinical effects can be obtained as with gold-standard face-to-face cognitive behaviour therapy (CBT). In a previous meta-analysis published in this journal, which was updated in 2018, we found evidence that the pooled effects for the two formats were