35 It is unclear whether this is secondary to the trauma or pre-existent. Treatment Obviously the treatment of this entity has to be directed towards prevention. However, it also has implications for medication treatment. In one study, 681 patients with chronic forms of major depression were treated with an antidepressant (nefazodone),

Cognitive Behavioral Analysis System of Psychotherapy (CBASP), or the combination. Selleck LBH589 Overall, the effects of the antidepressant alone and psychotherapy alone were equal, and significantly less effective than combination treatment. However, among those with a history of early childhood Inhibitors,research,lifescience,medical trauma (loss of parents at an early age, physical or sexual abuse, or neglect), psychotherapy alone was superior to antidepressant monotherapy.36 Moreover, the combination of psychotherapy and pharmacotherapy was only marginally superior to psychotherapy alone among the childhood abuse cohort. TTiis clearly has implications for managing depression in the context of maltreatment. In fact, this Inhibitors,research,lifescience,medical is one of the strongest arguments for defining early life stress disorder as a distinct entity. Without definitions and codification, the implications of research findings will not be well translated, either for Inhibitors,research,lifescience,medical research or for clinical purposes. We do not have knowledge of many aspects of this entity. That is, we do not know what the early

features are, or what the gene /environment interaction is. For example, catechol-O-methyl trasfera.se (COMT) variation has been implicated in predilection to violence in the context of trauma and serotonin transporter genetic variation to depression with the same context, ie, depending Inhibitors,research,lifescience,medical on the genetic background, stress produces a different expression.37 It is likely that clinical features of this entity will not be just syndromal depression or symptoms of PTSD but likely will include anxiety, aggression, and other features not typically considered in the current DSM Inhibitors,research,lifescience,medical context or labeled as comorbidity. Why the need to define early life stress disorder as an entity? The

reason for calling a particular feature an entity brings focus and attention. Thus, instead of evaluating patients with depression and stating that a high proportion suffered from trauma, and then stating that they have high comorbidity etc, it reverses the focus and the thinking pattern to first a potential cause and the varied manifestations of that cause. By implication, this can lead to a focused search for understanding biology, better assessment of risk prognosis, genetic and social factors, and thereby better treatment and prevention. Given the high estimated rates of this condition, such a focus is imperative at both the research and clinical ends. Vascular depression The concept of vascular depression and its potential labeling gives us cause to reflect on the state of labeling psychiatric disorders and the challenges that lie ahead.