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This is Shift to postnatal depression definition nhs discount geodon 20mg without prescription eating more vegetables mood disorder bipolar disorder cheap 40mg geodon with visa, Strategies to anxiety 7 question test buy cheap geodon 40mg on line achieve higher levels of intake especially important for nutrients that are fruits anxiety 78749 buy 40 mg geodon with amex, whole grains, and dairy of dietary vitamin D include consuming currently underconsumed. Although the to increase intake of nutrients seafood with higher amounts of vitamin D, majority of Americans consume suffcient of public health concern. Low intakes of potassium are due yogurt, orange juice, and breakfast Requirement or Adequate Intake levels. Low intakes of calcium are due to supplement may be appropriate, especially choline, magnesium, calcium, and vitamins low intakes of dairy. Low intakes for most of the best food sources of potassium, calcium, of calcium and dietary fber will meet these nutrients occur within the context vitamin D, and dietary fber are found in recommendations. Amounts of potassium of unhealthy overall eating patterns, Appendix 10, Appendix 11, Appendix 12, will increase but depending on food due to low intakes of the food groups— and Appendix 13, respectively. To increase potassium, Substantial numbers of women who are dairy—that contain these nutrients. Shifts focus on food choices with the most capable of becoming pregnant, including to increase the intake of these food groups potassium, listed in Appendix 10. For more information, see: Code of Federal Regulation Title 21, subchapter B, Part 182, Subpart B. Finally, some, like milk and can contribute excess calories while adolescent girls should consume foods fruit and vegetable juices, contain important providing few or no key nutrients. If they containing heme iron, such as lean meats, nutrients such as calcium, potassium, are consumed, amounts should be within poultry, and seafood, which is more readily and vitamin D, in addition to calories. The Beverages make a substantial contribution sources include legumes (beans and peas) use of high-intensity sweeteners, such to total water needs as well as to nutrient and dark-green vegetables, as well as as those used in “diet” beverages, as a and calorie intakes in most typical foods enriched or fortifed with iron, such replacement for added sugars is discussed eating patterns. Absorption of iron from non-heme sources Within beverages, the largest source For adults who choose to drink alcohol, limits is enhanced by consuming them along of calories is sweetened beverages, of only moderate intake (see Appendix 9) with vitamin C-rich foods. Other major sources and favored waters also can be selected, supplement when recommended by an of calories from beverages are milk and but calories from cream, added sugars, and obstetrician or other health care provider. Beverages Beverages are not always remembered or When choosing beverages, both the calories considered when individuals think about and nutrients they may provide are important considerations. In free—especially water—or that contribute for Shifts in addition to water, the beverages that are benefcial nutrients, such as fat-free and Food Choices most commonly consumed include sugar low-fat milk and 100% juice, should be the sweetened beverages, milk and favored primary beverages consumed. Milk and To support a healthy body weight, meet milk, alcoholic beverages, fruit and vegetable 100% fruit juice should be consumed within nutrient needs, and lessen the risk of juices, and coffee and tea. Beverages vary in recommended food group amounts and chronic disease, shifts are needed in their nutrient and calorie content. Folic acid fortifcation of enriched grain products in the United States has been successful in reducing the incidence of neural tube defects. Therefore, to prevent birth defects, all women capable of becoming pregnant are advised to consume 400 mcg of synthetic folic acid daily, from fortifed foods and/or supplements. This recommendation is for an intake of synthetic folic acid in addition to the amounts of food folate contained in a healthy eating pattern. Sources of food folate include beans and peas, oranges and orange juice, and dark-green leafy vegetables, such as spinach and mustard greens. Page 61 — 2015-2020 Dietary Guidelines for Americans Chapter 2• overall eating patterns—across and eggs subgroup. Although most Americans within food groups and from current urgently need to shift intakes to achieve typical choices to nutrient-dense options. As a recommendations than are adolescents result, individuals have many opportunities and young adults. In contrast, only half of adolescent females and young adult males consume three meals a day, but most also have two or more snacks per day. Also, among most age groups, 40 to 50 percent consume two to three snacks a day, and about one-third consume four or more snacks a day. However, Americans have increased the proportion of food they consume away from home from 18 percent in 1977-1978 to 33 percent in 2009-2010. These data suggest that multiple opportunities to improve food choices exist throughout the day and in varied settings where food is obtained and consumed. Small shifts made at each of these many eating occasions over time can add up to real improvements in eating patterns. Follow a healthy eating pattern across individuals align with the Dietary Guidelines. Choose a healthy eating In general, Americans are consuming pattern at an appropriate calorie level to Creating & Supporting too many calories, are not meeting food help achieve and maintain a healthy body Healthy Choices group and nutrient recommendations, weight, support nutrient adequacy, and and are not getting adequate physical reduce the risk of chronic disease. Focus on variety, nutrient density, and Dietary Guidelines (see Aligning With resources, and other factors affect the food amount. To meet nutrient needs within the Dietary Guidelines for Americans: and physical activity choices an individual calorie limits, choose a variety of nutrient What Does this Mean in Practice Limit calories from added sugars Social-Ecological Model and how they play is needed to create a new paradigm in and saturated fats and reduce sodium a role in infuencing the decisions individuals which healthy lifestyle choices at home, intake. Ideas for engaging these components in easy, accessible, affordable, and normative. Cut back on foods and beverages higher in collaborative ways to infuence individual Everyone has a role in helping individuals these components to amounts that ft decisions, and ultimately social and shift their everyday food,[1]beverage, and within healthy eating patterns. Choose nutrient-dense foods the Dietary Guidelines provides and beverages across and within all food recommendations that professionals, groups in place of less healthy choices. The Social especially policymakers, can translate into Consider cultural and personal preferences Ecological Model action to support individuals. This chapter to make these shifts easier to accomplish discusses a number of considerations and maintain. Consistent evidence shows that related to translating the Dietary Guidelines implementing multiple changes at various into action, including the signifcance 5. For example, strong eating and physical activity behaviors; the multiple settings nationwide, from home evidence from studies with varying development of educational resources to school to work to communities. The chapter For adults, moderate evidence indicates [1] If not specifed explicitly, references to “foods” refer to “foods and beverages. Approaches like these have Sectors dietary intake, and approaches targeting the potential to improve population health Sectors include systems. Among the components of the and advocacy), and businesses and and active engagement from various Social-Ecological Model, sectors and settings industries. A Social-Ecological Model for Food & Physical Activity Decisions the Social-Ecological Model can help health professionals understand how layers of infuence intersect to shape a person’s food and physical activity choices. The model below shows how various factors infuence food and beverage intake, physical activity patterns, and ultimately health outcomes. Page 65 — 2015-2020 Dietary Guidelines for Americans Chapter 3• these sectors all have an important role in behaviors, based on the values of a society, over time, thereby having the potential to helping individuals make healthy choices and are refected in everything from laws lead to meaningful shifts in dietary intake, because they either infuence the degree to to personal expectations. However, changes to sectors opportunities to identify and develop and settings—as previously discussed— the Dietary strategies that help individuals align can have a powerful effect on social and their choices with the Dietary Guidelines. Guidelines cultural norms and values over time and Strategies could include supporting can align with the Dietary Guidelines. During the past few decades, food policy and/or program changes, fostering products and menus have notably coalitions and networks, developing or evolved in response to consumer Individual Factors modifying products and menus, and/ demands and public health concerns. To ensure widespread adoption unique to the individual, such as age, sectors and settings have a unique sex, socioeconomic status, race/ethnicity, opportunity to continue to evolve and of these sectoral efforts, complementary the presence of a disability, as well as better align with the Dietary Guidelines. Education to improve individual offering more vegetables, fruits, whole Settings food and physical activity choices can be grains, low-fat and fat-free dairy, and Individuals make choices in a variety of a greater variety of protein foods that delivered by a wide variety of nutrition and settings, both at home and away from are nutrient dense, while also reducing physical activity professionals working alone home. Away-from-home settings include sodium and added sugars, reducing or in multidisciplinary teams. Portion sizes also can community centers, and food retail and Physical Activity Guidelines for Americans, be adapted to help individuals make food service establishments. These choices that align with the Dietary provide the foundation for nutrition and public organizational settings determine what Guidelines. Food manufacturers are health professionals to develop programs foods are offered and what opportunities for encouraged to consider the entire and materials that can help individuals physical activity are provided. Strategies to composition of the food, and not just enhance their knowledge, attitudes, and individual nutrients or ingredients align with the Dietary Guidelines that are motivation to make healthy choices. Similarly, when developing individual choices and have the potential All food and beverage choices are part of or modifying menus or retail settings, for broader population-level impact if they an individual’s eating pattern.
Names of alternate identities such as “Devil” or “Satan” may reect patients’ concrete culture-bound stereotyp ing of their self-aspects using religious terminology rather than evidence of a demonic presence anxiety nightmares purchase geodon online now. Malevolently labeled self-states also may reect specic spiritual and/or religious abuse anxiety 8 months postpartum discount geodon master card, such as abuse by clergy and/or projection of blame by the abuser depression symptoms feeling worthless generic geodon 20mg otc. For example anxiety reduction 80mg geodon with visa, a child may be told that punishment is necessary because he or she “is lled with the devil. Work on the safety of the patient’s children should be an absolute priority in the adult patient’s treatment. Other family interventions, such as couples ther apy and family therapy sessions that include the patient’s children, may be indicated. Whenever possible, the patient (and his or her spouse or partner) should be advised of this possibility or necessity ahead of time. Guidelines regarding the possible conict between psychiatrists’ religious commitment and psychiatric practice. Statement on therapies focused on memories of childhood physical and sexual abuse. Clinical hypnosis and memory: Guidelines for clinicians and for forensic hypnosis. The psychological organization of multiple personality dis ordered patients as revealed in psychological testing. Deciphering the broken narrative of trauma: Signs of trau matic dissociation on the Rorschach. Clinical and spiritual effects of exorcism in fteen patients with multiple personality. Personality differences on the Rorschach of dissociative identity disorder, bor derline personality disorder and psychotic inpatients. Assessment of genuine and simulated dissociative identity disorder on the Structured Interview of Reported Symptoms. Recovered memories: the report of the working party of the British Psychological Society. Iatrogenic dissociative identity disorder: An evaluation of the scientic evidence. Rebuilding shattered lives: the responsible treatment of complex post-traumatic and dissociative disorders. An introduction to the Diagnostic Drawing Series: A standardized tool for diagnostic and clinical use. The differential diagnosis of multiple personality disorder: A comprehensive review. Iatrogenesis and malingering of multiple personality disorder in the forensic evaluation of homicide defendants. Recovered memory and the Daubert criteria: Recovered memory as professionally tested, peer reviewed, and accepted in the relevant scientic community. Treating the adult survivor of childhood sexual abuse: A psychoanalytic perspective. The long struggle to diagnose multiple personality disorder: Multiple personality disorder. The discovery of the unconscious: the history and evolution of dynamic psychology. Fraser’s “dissociative table technique” revisited, revised: A strat egy for working with ego states in dissociative disorders and ego-state therapy. Childhood trauma and risk for chronic fatigue syndrome: Association with neuroendocrine dysfunction. Trauma and recovery: the aftermath of violence from domestic abuse to political terror. Double depression and episodic major depression: Demographic, clinical, familial, personality, and socioenvironmental characteristics and short-term outcome. Expressive and functional therapies in the treatment of multiple personality disorder. On treating the older patient with multiple personality disorder: Race against time or make haste slowly Incest and subsequent revictimization: the case of therapist patient sexual exploitation, with a description of the sitting duck syn drome. The initial stages of psychotherapy in the treatment of multiple personality disorder patients. Objective documen tation of child abuse and dissociation in 12 murderers with dissociative identity disorder. Disorganization of attachment as a model for understanding dis sociative psychopathology. Demographic and seizure variables, but not hyp notizability or dissociation, differentiated psychogenic from organic seizures. An ofce mental status examination for complex chronic dissociative symptoms and multiple personality disorder. Posttraumatic and dissociative aspects of transference and countertransference in the treatment of multiple personality disorder. Diagnosis, epidemiology, clinical course, treatment, and cost effectiveness of treatment for dissociative disorders and multiple personal ity disorder: Report submitted to the Clinton administration task force on health care nancing reform. The high cost of dissociation and its impli cations for treatment of complex trauma. Assessment and management of somatoform symptoms in traumatized patients: Conceptual overview and pragmatic guide. Multiple personality and fantasy prone ness: Is there an association or dissociation The effects of hypnotic procedures on remembering: the experimental ndings and their implications for forensic hypnosis. Facilitating the identication of multiple personal ity disorder through art: the Diagnostic Drawing Series. Degree of somatoform and psychological dissociation in dissociative disorders is correlated with reported trauma. Somatoform dissociation discrimi nates between diagnostic categories over and above general psychopathology. Healing the divided self: Clinical and Ericksonian hypnotherapy for the treatment of post-traumatic and dissociative conditions. The clinical phenomenology of multiple personality disorder: A review of 100 cases. Divided minds and successive selfs: Ethical issues in disorders of identity and personality. Possession phenomena in North America: A case study with ethnographic, psychodynamic, religious and clinical implications. Dissociative identity disorder: Diagnosis, clinical features, and treatment of multiple personality. The Axis-I dissociative disorder comorbidity of borderline personality disorder among psychiatric outpatients. Eye movement desensitization procedure: A new treatement of post-traumatic stress disorder. Phase-oriented treatment of structural dissociation in complex traumatization: Overcoming trauma-related phobias. Factitious and malingered dissociative identity disorder: Clinical features observed in 18 cases. Bearing witness to uncorrob orated trauma: the clinician’s development of reective belief. International classication of diseases and related health problems, 9th revision. International classication of diseases and related health problems, 10th revision (2nd ed. As a result, past versions of the billing guide, such as this one, have broken hyperlinks. Washington Apple Health means the public health insurance programs for eligible Washington residents. Copyright disclosure Current Procedural Terminology copyright 2014 American Medical Association. The page numbers in this table of contents are now “clickable”—simply hover over on a page number and click to go directly to the page.
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There are no indicators of societal risks mood disorder nos dsm iv code effective geodon 80 mg, but it may be feasible and impactful to bipolar depression vs depression purchase geodon 20mg amex analyze such risks at the sub-national and community levels depression symptoms chronic order discount geodon online. The monitoring framework will track any emergence of such approaches and report on them anxiety test purchase 20mg geodon mastercard. The indicators for Category 3A in the table above are designed to track assessments of vulnerabilities and their use in policymaking, rather than particular outcomes of such analyses in specific countries. To date, no global risk assessments have been regularly prepared, despite the high and potentially catastrophic risk from a pandemic of influenza or similarly contagious disease. Intrinsic risk: dissemination and Analyses, dissemination and use of risk maps/indices. Preparedness mapping: maps Existence and quality of preparedness maps/indices: how and indices many exist Several experts recommended that analyses of risks from outbreaks and pandemics should be adequately incorporated into these broader exercises. For instance, global disaster risk reduction work should examine how health emergencies and biological hazards are integrated into national disaster risk prevention and mitigation plans. Global disaster risk analyses may be useful for allocation of assistance by large donors and international organizations and in devising new mechanisms to promote prevention or improve the efficiency of responses. Animal disease surveillance barely exists in most developing countries because of the weakness of veterinary public health systems. However, ProMed, a non-governmental initiative, and the largest provider of outbreak information, is an important data source for analyses of disease risk; one commenter cautioned, however, that some ProMed information is edited and geographic coverage is far from universal. Another data source, the Emerging Infectious Disease Repository, mines data from a number of sources, including ProMed, and verifies data accuracy. This data source 58 Chapter 3 includes follow-up reports and submissions of periodic information on 116 diseases. The research team included these references and related analytical work in the monitoring framework. Rating agencies charge countries for conducting a risk rating; as a result, more than 65 low-income countries have no financial ratings from prominent rating services. For pandemic risk, the situation will be similar, especially if leading international development organizations and governments continue to neglect pandemic risk. Even though the World Bank has shown that it is better for a country to be rated than unrated, when countries receive external financial support to pay for such ratings, many are still reluctant to have their financial sectors analyzed. One option, to overcome such obstacles, could be a centralized global mechanism, which would be owned by countries and supported by relevant multilateral organizations. Official multilateral institutions have already incorporated other unconventional risk indicators in their assessments although these risks did not impose excessive fiscal imbalances or lead to incorrect monetary policies. What enabled inclusion of these risk measures were political will and accountable leadership. Most low-income countries may have unsustainable fiscal imbalances, but most of the harm is borne by their own economies. The rest of the world is not affected because these countries’ economies are not systemically important to the global economy. But they can be a source of pandemic risk if their public health capacities cannot stop the outbreak. When the outbreak spreads, it will impose costs in high-income countries that will be measured in trillions of dollars. Official vetting of the assessments by a competent intergovernmental agency is needed. This would then guide work by the World Bank as it advises its country clients on analyses of risks and undertakes construction of risk indices. Three dimensions typically determine overall vulnerability to the health, community, and economic toll of infectious disease outbreaks. First is intrinsic risk, the risk that comes from the underlying probability that an outbreak will occur in any given country or context. Second, public health and health system core capacity risk is the probability that an outbreak will not be detected and controlled effectively. The third source of global risk is the economic vulnerability associated with an infectious disease outbreak of international concern. This risk arises from the interaction of the intrinsic risk and preparedness components with the specific mix of industrial and household economic activities that make up a country’s economy. Where these vulnerable sectors are major elements of the economy, the risks of significant economic disruption and loss are heightened. Experts noted that approaches to measure intrinsic risk and preparedness have been developed, although use of these approaches is uneven. In response, the monitoring framework provides for tracking of any assessments of economic vulnerabilities that would be developed and carried out by leading global agencies. The indicators in Domain 3 aim to follow and encourage the conduct of analyses and assessments in two categories: (1) country-level risk analysis and incentives for action and (2) global risk assessment and incentives for action. While there is conceptual overlap between the two, they serve different purposes and clients. Raising and sustaining risk-awareness are fundamentally important objectives in all countries, and risk awareness benefits each country. Global risk analyses can help policy-makers steer scarce resources to areas of highest impact, such as support for core public health capacities in regions where outbreaks are most likely to occur and where capacity to control the outbreaks is low. They can also raise pandemic risk on the global policy agenda and thus prioritize global health security among global public organizations. Since public authorities and organizations have not been held accountable for past episodes of neglect, risk assessment is all the more important as an incentive for prevention and preparedness, both in countries and globally. Pandemic risk reduction is a quintessential global public good, and the place of universal health security on the global policy agenda should no longer be optional. Historically, infectious disease threats have been communicated principally as health and mortality risks. Although such outcomes clearly matter, they have been small compared to the ongoing health toll of other preventable diseases. But disease outbreaks have had adverse economic and social impacts that have imposed high costs on communities and businesses. In some cases, they have disrupted healthcare systems and reduced healthcare services for patients with conditions unrelated to the outbreak. The magnitude of the social and economic impacts of future outbreaks could be very large. The costs of future outbreaks will tend to grow in tandem with the increasing interconnectedness of national economies. The scale of economic impacts has been seldom consistently tallied, recorded, and communicated. This is a major shortcoming, 60 Chapter 3 considering that for severe flu pandemic simulations, more than two thirds of the impacts are due to changed behaviors by the healthy, or so-called avoidance behaviors (Brahmbhatt and Jonas 2015; Brahmbhatt and Dutta 2008). Most recent estimates suggest that under conservative assumptions, the world’s annualized losses from pandemics are already $570 billion (see Annex 1), which is comparable to estimates of expected annual costs of climate change. Communicating these substantial economic risks is imperative, given their significance in analyses of macroeconomic risks and policy decision-making (Sands et al. A simple and robust measure of the economic threat can facilitate effective communication to decision makers. Pandemic risk is the annual expected economic losses that arise from a pandemic with low probability of occurrence but large, potentially catastrophic economic impacts. This risk is more than the estimated probability that a pandemic will occur; it also includes the economic damage. For instance, a pandemic of severe influenza (or another readily transmissible disease) could cost the global economy $6 trillion during its relatively brief spell of one to two years, with a rapid recovery in the post-pandemic period. The probability of onset of such a pandemic in any one year is, however, very small. If this annual probability is just 1%, such a pandemic is called a once-in-a-hundred-years event and the risk is $60 billion per year. So far, severe pandemics have been infrequent, with intervals longer than a human lifetime. The world underestimates the risks of infectious disease outbreaks, and devotes far too little to their prevention (Jonas 2013, Hoelscher & Blitzer 2007).
Further for those with mild to depression symptoms digestive problems buy geodon overnight moderate major depressive disorder who decline or are unable to depression and bipolar support alliance geodon 40 mg without prescription access first line recommended psychotherapies or pharmacotherapies depression symptoms length buy genuine geodon line, the guideline suggests offering short-term psychodynamic psychotherapy or nondirective supportive psychotherapy angle of depression definition english buy generic geodon 40mg on line. It was published in 2005, and currently another update is in progress with information on antidepressant medication and psychotherapies. If the child is unresponsive to fluoxetine, then sertraline or citalopram may be used. Challenges in Developing the Guideline and Recommendations for Future Efforts In developing this guideline, the panel consistently identified and documented challenges and limitations for the purposes of improving future efforts at both research and guideline development and implementation. For example, there is emerging research regarding promising Internet based interventions in general and particularly for children and adolescents (Reyes-Portillo et al. However, the available reviews often included both children and adolescents together. The panel incorporated children into the guideline, but because the original search focused solely on adolescents, the sampling of the child literature is likely incomplete. The panel has supplemented the guideline mechanisms in some sections with information related to some of these domains when appropriate, but the panel is supportive of future efforts to incorporate these domains formally into guidelines, where there is literature available. Implications of Alignment with the Institute of Medicine Standards It is noted throughout this document that the current clinical practice guideline development panel adopted the Institute of Medicine’s (2011a) standards for guideline development. Following such guidance restricted our ability to incorporate those reviews that did not meet such standards, regardless of the quality of the review in all other aspects. In the absence of any other “gold standard,” the answer is “yes” given that the ultimate goal is to produce a scientifically sound clinical practice guideline. The panel determined it could not create an adequately meaningful guideline without broadening the inclusion parameters and determined to consider reviews that did not utilize a dual review process for selecting articles for inclusion. In another example, studies of newer therapies such as schema-focused therapy, emotion focused therapy, and acceptance and commitment therapy, although used in the community for treating depression, were not reviewed. Use of smartphone-based treatment was not reviewed due to inadequate comparison conditions in the general adult population. Medication as a comparator across the age populations varied greatly in terms of quality of treatment and conformity to standards of practice, with the physician members of the panel noting that in some cases the standard doses were below recommended doses, or the medication was not used in current practice. These limitations restricted the nature of the recommendations the panel could make. In domains where there are limited randomized controlled trials available, it may be reasonable to develop preliminary recommendations based on well-designed correlational studies, particularly if there is longitudinal data available. Depression is one of the disorders most widely studied in psychotherapy research, with over 400 randomized clinical trials for depression across the last 3 decades (Cuijpers, van Straten, Warmerdam, & Andersson, 2008). It is imperative that the field generate more evidence to support different psychotherapies (with preliminary efficacy as this is crucial for the advancement of the scientific field, diversification of education, and training opportunities for and adherence to scientific calls for personalized approaches to treatment). There is still lack of sufficient evidence on the enduring long-term effects of treatments for depression. While some evidence suggests that effects of some psychotherapies persist longer than the effects of medication. In that respect, understanding long-term change trajectories could also help researchers develop interventions that are focused on relapse prevention. Therefore, future research should examine some of the more commonly co-occurring physical ailments of depression like stroke, diabetes, and cancer, as well as subsyndromal depression and substance use disorders. Also, further research is needed to examine culturally relevant outcomes of standardized interventions as well as interventions targeted specifically to the needs of these diverse groups, such as school-based mental health services for minority youth (Atkins, Frazier, Adil, & Talbott, 2003; Bear, Finer, Guo, & Lau, 2014; Langley, Nadeem, Kataoka, Stein, & Jaycox, 2010). Given preliminary evidence suggesting that ethnicity moderates treatment effects. These issues include training in multicultural competency to properly conduct research with such individuals, using culturally relevant and appropriate assessment tools for a given group or subgroup, and including individuals of a particular minority population of research focus within a larger stakeholder framework. Also, more studies with children and with adolescents comparing active interventions are needed. However, the target outcome for indicated prevention studies is prevention of increasing symptom severity and acquisition of a depression diagnosis rather than recovery or remission from diagnosed depression. Combining prevention and intervention studies within meta-analyses may have obscured differences in outcomes of similar treatments with different targets, reducing the confidence in strength of effectiveness for a given treatment approach. Despite establishing that some psychotherapies are beneficial to older adults, the research literature is at best limited. This underscores the importance of engaging family members in the process of care, both as sources of reliable information about how a loved one with depression is doing, and also to foster engagement in and adherence to treatment for a sufficient period of time to realize and to sustain meaningful benefit. Similar to the general adult population, there is also a great need for comparative effectiveness research because, as suggested by the Nelson et al. Further, as noted above, there is limited information about moderators of treatment response (which treatment for which patient). There is yet, however, no strong evidence-based consensus about which patients need maintenance pharmacotherapy, apart from those with three or more episodes of major depression. The modest efficacy of antidepressant pharmacotherapy needs to be weighed against side-effect burden and adverse effects, especially in frail older adults with medical poly morbidity. Potential safety concerns in older adults treated with antidepressants include drug– drug interactions, hyponatremia, falls and fractures, gastrointestinal bleeding, cardiovascular effects, and bone metabolism/osteoporosis. It has further demonstrated reduction in long-term rates of mortality from co-occurring medical conditions (Gallo et al. Thus, both the short and long-term risks and benefits of antidepressant pharmacotherapy in older adults, together with patient preferences, need to be carefully weighed in shared decision-making with patients and families. Similarly, a well-defined model of psychotherapy, emotion-focused therapy, was grouped in reviews under “non-specific and supportive models” (Cuijpers, Driessen, et al. Experts indicate that this is a mis-categorization, but the categorization resulted in masking potential evidence regarding efficacy of this intervention. Other times, the same or similar labels were used to describe approaches that are actually quite different from each other. For instance, although conceptually similar, psychoanalysis, psychoanalytic psychotherapy, brief psychodynamic psychotherapy, and interpersonal psychotherapy are also different regarding emphasis, focus, strategies, length of treatment, and hypothesized mechanisms of action. The problem is compounded by the fact that it is often hard to know how the actual treatments were delivered, how adherent the therapists were, and how much “borrowing” from other treatment modalities was done. Need for Rigorous Comparisons of Treatments and Treatment Modality Despite the increasing number of studies and meta-analyses comparing different treatments, the differences, process, and outcome data on different treatments remains elusive (Cuijpers, 2015; Cuijpers et al. One of the most challenging and yet pressing needs is developing methods to evaluate the contribution of specific aspects of psychotherapy models compared with the shared or nonspecific aspects. Fewer studies have compared the efficacy of individual modalities of treatment versus group modalities. The panel found that some reviews lumped different settings or technologies together, limiting the panel’s ability to make comparisons. In addition, the panel supports articles including links to archives and appendices to facilitate transparency and replicability, especially when journals allow very limited number of words. This can be particularly helpful with publication of treatment manuals associated with specific interventions. The panel also supports incorporating a section on harms and burdens in reports on psychotherapy trials, consistent with the standard practice in pharmacotherapy research. Yet the outcomes of recovery, relapse, and recurrence are critical for understanding the endurance of treatment effects (Frank et al. Testing Moderators and Mediators of Treatment Outcome Some psychotherapy research demonstrated that, after treatment completion, more than half of patients remained depressed (Thase et al. More specifically, if a given treatment protocol has been found to be efficacious, for example, in comparison to no treatment, a large portion of the sample may still have not responded fully (or at all). Last, studies should examine the efficacy of a step-wise approach like switching patients from medication to types of psychotherapies (or vice versa) in cases of treatment failure (see Rush et al. Funding Needs Given the complexity and large amount of resources required to conduct scientifically valid randomized clinical trials (Barber, 2009; Nezu & Nezu, 2008), it is understandable that available high-quality research is limited. Further the field is encouraged to generate additional research and reviews on humanistic therapies, emotion-focused therapy, and different treatment modalities. Altogether, the current guideline makes an important contribution to the field and complements existing knowledge by addressing treatment of depression from childhood through older adulthood, including an examination of psychotherapeutic interventions. All panel members and staff affiliated with development of the depression clinical practice guideline updated their conflicts of interest form on an annual basis and were asked to provide more timely updates if changes in their disclosures were perceived to be relevant to the development of the guideline. Emphasis was placed on disclosing all potential conflicts and allowing the staff and chair (or other appropriate entity in the case of the chair) to review the disclosures and determine whether or not such information could reasonably be construed as to be a source of possible influence on the guideline development process. They were also required to disclose interests of family members, defined as “a spouse, domestic partner, parent, child, or other relative with whom [they] have a comparably close tie. None of the reported potential conflicts of interest precluded a nominated candidate from serving on the guideline development panel. Excluding all guideline development panel candidates with any potential conflicts of interest risks excluding the level and type of expertise needed to fully evaluate treatment benefits and risks.