Mackenzie Alexander Astin (born May 12, 1973) is an American actor.
105-563: Astin was born on May 12, 1973, in Los Angeles, California, the son of actress Patty Duke and actor John Astin . His brother is actor Sean Astin . He attended Ralph Waldo Emerson Middle School and University High School in Los Angeles. He is married to Jennifer Abbott Astin (née Bautz). Astin made his acting debut at age 9 in the TV movie Lois Gibbs and the Love Canal , and is often remembered for
210-615: A mental disorder characterized by at least two weeks of pervasive low mood , low self-esteem , and loss of interest or pleasure in normally enjoyable activities. Introduced by a group of US clinicians in the mid-1970s, the term was adopted by the American Psychiatric Association for this symptom cluster under mood disorders in the 1980 version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), and has become widely used since. The disorder causes
315-532: A metabolic disturbance ; and a full blood count including ESR to rule out a systemic infection or chronic disease. Adverse affective reactions to medications or alcohol misuse may be ruled out, as well. Testosterone levels may be evaluated to diagnose hypogonadism , a cause of depression in men. Vitamin D levels might be evaluated, as low levels of vitamin D have been associated with greater risk for depression. Subjective cognitive complaints appear in older depressed people, but they can also be indicative of
420-442: A 2019 study found 102 variants in the genome linked to depression. However, it appears that major depression is less heritable compared to bipolar disorder and schizophrenia. Research focusing on specific candidate genes has been criticized for its tendency to generate false positive findings. There are also other efforts to examine interactions between life stress and polygenic risk for depression. Depression can also arise after
525-472: A Kiss . Duke received an Emmy nomination in 1999 for her appearances in three episodes of Touched by an Angel . In 1985, Duke became the second woman, after Kathleen Nolan , to be elected president of the Screen Actors Guild , a post she held until 1988. Her tenure as president was marked by factional in-fighting and controversy; however, she gained respect for managing to maintain solidarity among
630-791: A chronic or terminal medical condition, such as HIV/AIDS or asthma , and may be labeled "secondary depression". It is unknown whether the underlying diseases induce depression through effect on quality of life, or through shared etiologies (such as degeneration of the basal ganglia in Parkinson's disease or immune dysregulation in asthma). Depression may also be iatrogenic (the result of healthcare), such as drug-induced depression. Therapies associated with depression include interferons , beta-blockers , isotretinoin , contraceptives , cardiac agents, anticonvulsants , antimigraine drugs , antipsychotics , and hormonal agents such as gonadotropin-releasing hormone agonist (GnRH agonist). Celiac disease
735-506: A combination of medication and psychotherapy may be used. There is moderate-quality evidence that psychological therapies are a useful addition to standard antidepressant treatment of treatment-resistant depression in the short term. Psychotherapy has been shown to be effective in older people. Successful psychotherapy appears to reduce the recurrence of depression even after it has been stopped or replaced by occasional booster sessions. The most-studied form of psychotherapy for depression
840-511: A contestant on The $ 64,000 Question and won $ 32,000; her category of expertise, according to her autobiography Call Me Anna , was popular music. The game show was revealed to have been rigged , and she was called to testify before a panel of the United States Senate. Duke eventually testified before congressional investigators and broke into tears when she admitted she had been coached to speak falsely. Also in 1959, Duke appeared in
945-424: A depressed state mediated by increased serotonin. Further countering the monoamine hypothesis is the fact that rats with lesions of the dorsal raphe are not more depressive than controls, the finding of increased jugular 5-HIAA in people who are depressed that normalized with selective serotonin reuptake inhibitor (SSRI) treatment, and the preference for carbohydrates in people who are depressed. Already limited,
1050-459: A girl to add to their stable of child actors. The Rosses' methods of managing Duke's career were often unscrupulous and exploitative. They consistently billed Duke as being two years younger than she actually was and padded her resume with false credits. They gave her alcohol and prescription drugs, took unreasonably high fees from her earnings, and made sexual advances to her. She never saw her father and saw her mother only when she visited to do
1155-474: A higher chance of developing depression, which shows the two are connected. There is even evidence suggesting that altering the microbes in the gut can have regulatory effects on developing depression. Theories unifying neuroimaging findings have been proposed. The first model proposed is the limbic-cortical model, which involves hyperactivity of the ventral paralimbic regions and hypoactivity of frontal regulatory regions in emotional processing. Another model,
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#17330854118481260-411: A higher risk of developing clinical depression. There appears to be a link between air pollution and depression and suicide. There may be an association between long-term PM2.5 exposure and depression, and a possible association between short-term PM10 exposure and suicide. The pathophysiology of depression is not completely understood, but current theories center around monoaminergic systems,
1365-458: A hysterectomy. Duke also adopted Astin's other three sons; years later in 1998, they reversed the adoption with Duke's approval. The couple divorced in 1985. Duke married her fourth husband, drill sergeant Michael Pearce, in 1986, and remained married to him until her death 30 years later. Duke and Pearce had met during the production of A Time to Triumph , for which Pearce served as a consultant. The couple moved to Hayden, Idaho , and adopted
1470-486: A low mood, which pervades all aspects of life, and an inability to experience pleasure in previously enjoyable activities. Depressed people may be preoccupied with or ruminate over thoughts and feelings of worthlessness, inappropriate guilt or regret, helplessness or hopelessness. Other symptoms of depression include poor concentration and memory, withdrawal from social situations and activities, reduced sex drive , irritability, and thoughts of death or suicide. Insomnia
1575-426: A major role in the development of depression. Family and twin studies find that nearly 40% of individual differences in risk for major depressive disorder can be explained by genetic factors . Like most psychiatric disorders, major depressive disorder is likely influenced by many individual genetic changes. In 2018, a genome-wide association study discovered 44 genetic variants linked to risk for major depression;
1680-771: A monoamine—can cause depression in those in remission or relatives of people who are depressed, suggesting that decreased serotonergic neurotransmission is important in depression. Second, the correlation between depression risk and polymorphisms in the 5-HTTLPR gene, which codes for serotonin receptors, suggests a link. Third, decreased size of the locus coeruleus , decreased activity of tyrosine hydroxylase , increased density of alpha-2 adrenergic receptor , and evidence from rat models suggest decreased adrenergic neurotransmission in depression. Furthermore, decreased levels of homovanillic acid , altered response to dextroamphetamine , responses of depressive symptoms to dopamine receptor agonists, decreased dopamine receptor D1 binding in
1785-415: A more noticeable slowing of movements. Depressed children may often display an irritable rather than a depressed mood; most lose interest in school and show a steep decline in academic performance. Diagnosis may be delayed or missed when symptoms are interpreted as "normal moodiness". Elderly people may not present with classical depressive symptoms. Diagnosis and treatment is further complicated in that
1890-554: A number of times. The couple divorced in 1969. In early 1970, at age 23, Duke became involved with three men at the same time: 17-year-old Here's Lucy star Desi Arnaz Jr. , actor John Astin (who was 16 years her senior), and rock music promoter Michael Tell. The relationship with Arnaz was widely publicized, due in part to the vocal and public opposition of Arnaz's mother, actress and production company executive Lucille Ball . By late spring, Duke and Arnaz had broken off their relationship. In June 1970, Duke learned that she
1995-420: A nun in her youth. In her later life, she studied a number of different religions, commenting in 1995: "To suggest that one must spout Moses or Jesus or Buddha or chant like Tibetan monks in order to be religious, I believe, is not to walk in the path of Christ... I have been a Christian Scientist . If there's a religious definition of 'dabbler', I guess that would be me. I have studied Buddhism . There
2100-502: A pair of identical twins. Like many teen stars of the era, and bolstered somewhat by her appearance in the musical Billie , Duke had a successful singing career, including two top-40 hits in 1965, "Don't Just Stand There" (number eight) and "Say Something Funny" (number 22). She also performed on TV shows such as The Ed Sullivan Show . In 1987, Duke revealed in her autobiography that she had been diagnosed with manic depression (now called bipolar disorder ) in 1982, becoming one of
2205-482: A promising intervention in youth. Problem solving therapy , cognitive behavioral therapy, and interpersonal therapy are effective interventions in the elderly. Psychoanalysis is a school of thought, founded by Sigmund Freud , which emphasizes the resolution of unconscious mental conflicts. Psychoanalytic techniques are used by some practitioners to treat clients presenting with major depression. A more widely practiced therapy, called psychodynamic psychotherapy ,
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#17330854118482310-518: A range of related diagnoses, including dysthymia , which involves a chronic but milder mood disturbance; recurrent brief depression , consisting of briefer depressive episodes; minor depressive disorder , whereby only some symptoms of major depression are present; and adjustment disorder with depressed mood , which denotes low mood resulting from a psychological response to an identifiable event or stressor . The DSM-5 recognizes six further subtypes of MDD, called specifiers , in addition to noting
2415-451: A son, Kevin, who was born in 1988. From her marriage to Pearce until her death in 2016, Duke occasionally used the name "Anna Duke-Pearce" in her writings and other professional work. Duke had three granddaughters by her eldest son Sean, actresses Alexandra, Elizabeth, and Isabella. Duke died on the morning of March 29, 2016 in Coeur d'Alene, Idaho of sepsis from a ruptured intestine at
2520-524: A star on the Hollywood Walk of Fame . At age 15, Duke portrayed Helen Keller in the film The Miracle Worker (1962), a role she had originated on Broadway . She won an Academy Award for Best Supporting Actress for her performance. The following year, she played the dual role of "identical cousins" Cathy and Patty Lane on her own network television series The Patty Duke Show (1963–1966). She progressed to more mature roles, such as Neely O'Hara in
2625-513: A television adaptation of Meet Me in St. Louis as Tootie Smith, the role that had originated in the film version by Margaret O'Brien . Duke's first major starring role was Helen Keller (with Anne Bancroft as Anne Sullivan ), in the Broadway play The Miracle Worker , which ran from October 1959 to July 1961. Duke originated the role of Keller on Broadway, although Patty McCormack actually originated
2730-691: A treatment comparing favorably to other psychotherapies. The most common and effective treatments for depression are psychotherapy, medication, and electroconvulsive therapy (ECT); a combination of treatments is the most effective approach when depression is resistant to treatment. American Psychiatric Association treatment guidelines recommend that initial treatment should be individually tailored based on factors including severity of symptoms, co-existing disorders, prior treatment experience, and personal preference. Options may include pharmacotherapy, psychotherapy, exercise, ECT, transcranial magnetic stimulation (TMS) or light therapy . Antidepressant medication
2835-446: Is CBT, which teaches clients to challenge self-defeating, but enduring ways of thinking (cognitions) and change counter-productive behaviors. CBT can perform as well as antidepressants in people with major depression. CBT has the most research evidence for the treatment of depression in children and adolescents, and CBT and interpersonal psychotherapy (IPT) are preferred therapies for adolescent depression. In people under 18, according to
2940-558: Is a history of prior episodes, with no history of mania). ICD-11 symptoms, present nearly every day for at least two weeks, are a depressed mood or anhedonia , accompanied by other symptoms such as "difficulty concentrating, feelings of worthlessness or excessive or inappropriate guilt, hopelessness, recurrent thoughts of death or suicide, changes in appetite or sleep, psychomotor agitation or retardation, and reduced energy or fatigue." These symptoms must affect work, social, or domestic activities. The ICD-11 system allows further specifiers for
3045-446: Is a mood disturbance appearing as a psychological response to an identifiable event or stressor, in which the resulting emotional or behavioral symptoms are significant but do not meet the criteria for a major depressive episode. Other disorders need to be ruled out before diagnosing major depressive disorder. They include depressions due to physical illness, medications , and substance use disorders . Depression due to physical illness
3150-454: Is activated by stressful life events. The preexisting vulnerability can be either genetic , implying an interaction between nature and nurture , or schematic , resulting from views of the world learned in childhood. American psychiatrist Aaron Beck suggested that a triad of automatic and spontaneous negative thoughts about the self , the world or environment , and the future may lead to other depressive signs and symptoms. Genes play
3255-675: Is also a connection between the gut microbiome and the central nervous system, otherwise known as the Gut-Brain axis , which is a two-way communication system between the brain and the gut. Experiments have shown that microbiota in the gut can play an important role in depression as people with MDD often have gut-brain dysfunction. One analysis showed that those with MDD have different bacteria living in their guts. Bacteria Bacteroidetes and Firmicutes were most affected in people with MDD, and they are also impacted in people with irritable bowel syndrome . Another study showed that people with IBS have
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3360-490: Is an assessment of the person's current mood and thought content, in particular the presence of themes of hopelessness or pessimism , self-harm or suicide, and an absence of positive thoughts or plans. Specialist mental health services are rare in rural areas, and thus diagnosis and management is left largely to primary-care clinicians. This issue is even more marked in developing countries. Rating scales are not used to diagnose depression, but they provide an indication of
3465-399: Is another possible contributing factor. Substance use in early age is associated with increased risk of developing depression later in life. Depression occurring after giving birth is called postpartum depression and is thought to be the result of hormonal changes associated with pregnancy . Seasonal affective disorder , a type of depression associated with seasonal changes in sunlight,
3570-705: Is common; in the typical pattern, a person wakes very early and cannot get back to sleep. Hypersomnia , or oversleeping, can also happen, as well as day-night rhythm disturbances, such as diurnal mood variation . Some antidepressants may also cause insomnia due to their stimulating effect. In severe cases, depressed people may have psychotic symptoms. These symptoms include delusions or, less commonly, hallucinations , usually unpleasant. People who have had previous episodes with psychotic symptoms are more likely to have them with future episodes. A depressed person may report multiple physical symptoms such as fatigue , headaches, or digestive problems; physical complaints are
3675-444: Is diagnosed as a mood disorder due to a general medical condition . This condition is determined based on history, laboratory findings, or physical examination . When the depression is caused by a medication, non-medical use of a psychoactive substance, or exposure to a toxin , it is then diagnosed as a specific mood disorder (previously called substance-induced mood disorder ). Preventive efforts may result in decreases in rates of
3780-444: Is either depressed mood or loss of interest or pleasure. Depressed mood occurs nearly every day as subjective feelings like sadness, emptiness, and hopelessness or observations made by others (e.g. appears tearful). Loss of interest or pleasure occurs in all, or almost all activities of the day, nearly every day. These symptoms, as well as five out of the nine more specific symptoms listed, must frequently occur for more than two weeks (to
3885-784: Is equivalent to the use of medications or psychological therapies in most people. In older people it does appear to decrease depression. Sleep and diet may also play a role in depression, and interventions in these areas may be an effective add-on to conventional methods. In observational studies, smoking cessation has benefits in depression as large as or larger than those of medications. Talking therapy (psychotherapy) can be delivered to individuals, groups, or families by mental health professionals, including psychotherapists, psychiatrists, psychologists, clinical social workers , counselors, and psychiatric nurses. A 2012 review found psychotherapy to be better than no treatment but not other treatments. With more complex and chronic forms of depression,
3990-412: Is in a person's 20s, with females affected about twice as often as males. The course of the disorder varies widely, from one episode lasting months to a lifelong disorder with recurrent major depressive episodes . Those with major depressive disorder are typically treated with psychotherapy and antidepressant medication . Medication appears to be effective, but the effect may be significant only in
4095-456: Is in the tradition of psychoanalysis but less intensive, meeting once or twice a week. It also tends to focus more on the person's immediate problems, and has an additional social and interpersonal focus. In a meta-analysis of three controlled trials of Short Psychodynamic Supportive Psychotherapy, this modification was found to be as effective as medication for mild to moderate depression. Conflicting results have arisen from studies that look at
4200-484: Is not adequate as a diagnosis tool, because its sensitivity is only 44%. These stress-related abnormalities are thought to be the cause of hippocampal volume reductions seen in people who are depressed. Furthermore, a meta-analysis yielded decreased dexamethasone suppression, and increased response to psychological stressors. Further abnormal results have been obscured with the cortisol awakening response , with increased response being associated with depression. There
4305-562: Is often difficult. Development of mental health services is minimal in many countries; depression is viewed as a phenomenon of the developed world despite evidence to the contrary, and not as an inherently life-threatening condition. There is insufficient evidence to determine the effectiveness of psychological versus medical therapy in children. Physical exercise has been found to be effective for major depression, and may be recommended to people who are willing, motivated, and healthy enough to participate in an exercise program as treatment. It
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4410-564: Is particularly beneficial in preventing relapse. Cognitive behavioral therapy and occupational programs (including modification of work activities and assistance) have been shown to be effective in reducing sick days taken by workers with depression. Several variants of cognitive behavior therapy have been used in those with depression, the most notable being rational emotive behavior therapy , and mindfulness-based cognitive therapy . Mindfulness-based stress reduction programs may reduce depression symptoms. Mindfulness programs also appear to be
4515-663: Is recommended as an initial treatment choice in people with mild, moderate, or severe major depression, and should be given to all people with severe depression unless ECT is planned. There is evidence that collaborative care by a team of health care practitioners produces better results than routine single-practitioner care. Psychotherapy is the treatment of choice (over medication) for people under 18, and cognitive behavioral therapy (CBT), third wave CBT and interpersonal therapy may help prevent depression. The UK National Institute for Health and Care Excellence (NICE) 2004 guidelines indicate that antidepressants should not be used for
4620-430: Is recommended. People with chronic depression may need to take medication indefinitely to avoid relapse. SSRIs are the primary medications prescribed, owing to their relatively mild side-effects, and because they are less toxic in overdose than other antidepressants. People who do not respond to one SSRI can be switched to another antidepressant , and this results in improvement in almost 50% of cases. Another option
4725-434: Is some evidence for a similar effect in mild depression. Similarly, a Cochrane systematic review of clinical trials of the generic tricyclic antidepressant amitriptyline concluded that there is strong evidence that its efficacy is superior to placebo. Antidepressants work less well for the elderly than for younger individuals with depression. To find the most effective antidepressant medication with minimal side-effects,
4830-634: Is thought to be triggered by decreased sunlight. Vitamin B 2 , B 6 and B 12 deficiency may cause depression in females. Adverse childhood experiences (incorporating childhood abuse , neglect and family dysfunction ) markedly increase the risk of major depression, especially if more than one type. Childhood trauma also correlates with severity of depression, poor responsiveness to treatment and length of illness. Some are more susceptible than others to developing mental illness such as depression after trauma, and various genes have been suggested to control susceptibility. Couples in unhappy marriages have
4935-521: Is to augment the atypical antidepressant bupropion to the SSRI as an adjunctive treatment. Venlafaxine , an antidepressant with a different mechanism of action, may be modestly more effective than SSRIs. However, venlafaxine is not recommended in the UK as a first-line treatment because of evidence suggesting its risks may outweigh benefits, and it is specifically discouraged in children and adolescents as it increases
5040-593: The American Psychiatric Association 's Diagnostic and Statistical Manual of Mental Disorders (DSM) and the World Health Organization 's International Statistical Classification of Diseases and Related Health Problems (ICD). The latter system is typically used in European countries, while the former is used in the US and many other non-European nations, and the authors of both have worked towards conforming one with
5145-504: The Elmhurst neighborhood of Queens , where her brother Raymond, her sister Carol, and she experienced a difficult childhood. Their father was an alcoholic, and their mother suffered from clinical depression and was prone to violence. When Duke was six, her mother forced her father to leave the family home. When Duke was eight, her care was turned over to talent managers John and Ethel Ross who, after promoting Patty's brother, were looking for
5250-503: The Internet . The Netherlands mental health care system provides preventive interventions, such as the "Coping with Depression" course (CWD) for people with sub-threshold depression. The course is claimed to be the most successful of psychoeducational interventions for the treatment and prevention of depression (both for its adaptability to various populations and its results), with a risk reduction of 38% in major depression and an efficacy as
5355-462: The National Institute for Health and Clinical Excellence , medication should be offered only in conjunction with a psychological therapy, such as CBT , interpersonal therapy , or family therapy . Several variables predict success for cognitive behavioral therapy in adolescents: higher levels of rational thoughts, less hopelessness, fewer negative thoughts, and fewer cognitive distortions. CBT
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#17330854118485460-522: The United States Congress and joined forces with the National Institute of Mental Health and the National Alliance on Mental Illness to increase awareness, funding, and research for people with mental illness. In 2007, Duke appeared on The Oprah Winfrey Show , talking about her bipolar disorder. Duke wrote three books. Her autobiography, Call Me Anna ( ISBN 0-553-27205-5 )
5565-484: The circadian rhythm , immunological dysfunction, HPA-axis dysfunction and structural or functional abnormalities of emotional circuits. Derived from the effectiveness of monoaminergic drugs in treating depression, the monoamine theory posits that insufficient activity of monoamine neurotransmitters is the primary cause of depression. Evidence for the monoamine theory comes from multiple areas. First, acute depletion of tryptophan —a necessary precursor of serotonin and
5670-462: The striatum , and polymorphism of dopamine receptor genes implicate dopamine , another monoamine, in depression. Lastly, increased activity of monoamine oxidase , which degrades monoamines, has been associated with depression. However, the monoamine theory is inconsistent with observations that serotonin depletion does not cause depression in healthy persons, that antidepressants instantly increase levels of monoamines but take weeks to work, and
5775-449: The Rosses' laundry. In addition, the Rosses made Duke change her name. "Anna Marie is dead," they said. "You're Patty now." They hoped that Patty Duke would duplicate the success of Patty McCormack . One of Duke's early acting roles was in the late 1950s on the soap opera The Brighter Day . She also appeared in print ads and in television commercials. In 1959, at the age of 12, Duke was
5880-536: The TV miniseries Captains and the Kings and her third in 1980 for a TV version of her 1979 stage revival of The Miracle Worker , this time playing Anne Sullivan to Melissa Gilbert 's Helen Keller. Her turns in the made-for-TV movies The Women's Room (1980) and George Washington (1984) both garnered her Emmy nominations. In the 1980s, Duke was cast in a number of short-lived TV series. The ABC sitcom It Takes Two , from Soap and Benson creator Susan Harris ,
5985-711: The actress and activist Helen Keller briefly met. At 16, Duke was the youngest person at that time to have received an Academy Award in a competitive category. Duke returned to television, this time starring with Laurence Olivier and George C. Scott in a television production of The Power and the Glory (1961). Duke's own series, The Patty Duke Show , created by Sidney Sheldon especially for her, began airing in September 1963. At that time, Duke had not been diagnosed as having bipolar disorder , but Sheldon did notice that she had two distinct sides to her personality, so he developed
6090-632: The adolescent television role of Andy Moffett over four seasons from 1985 to 1988 on the sitcom The Facts of Life . He has had recurring roles on Scandal , The Magicians , and Homeland , and has made guest appearances on LOST , House , Psych , Grey's Anatomy , and NCIS . Astin has appeared in motion pictures including Iron Will with Kevin Spacey , Wyatt Earp with Kevin Costner , The Evening Star with Shirley MacLaine , and Whit Stillman's The Last Days of Disco . He starred in
6195-527: The age of 69. Her son Sean Astin invited the public to contribute to a mental-health foundation in his mother's name, the Patty Duke Mental Health Initiative. She was cremated and her ashes were interred at Forest Cemetery in Coeur d'Alene. (Unreleased) (Unreleased) Major depressive disorder Major depressive disorder ( MDD ), also known as clinical depression , is
6300-417: The concentration of quinolinic acid correlates to the severity of depressive symptoms. A diagnostic assessment may be conducted by a suitably trained general practitioner , or by a psychiatrist or psychologist , who records the person's current circumstances, biographical history, current symptoms, family history, and alcohol and drug use. The assessment also includes a mental state examination , which
6405-448: The concept of identical cousins with contrasting personalities. Duke portrayed both main characters: Patricia "Patty" Lane, a fun-loving American teenager who occasionally got into trouble at school and home, and her prim and proper "identical cousin" from Scotland, Catherine "Cathy" Lane. William Schallert portrayed Patty's father, Martin, and his twin brother, Kenneth, Cathy's father; Jean Byron played her mother, Natalie; Paul O'Keefe
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#17330854118486510-846: The condition of between 22 and 38%. Since 2016, the United States Preventive Services Task Force (USPSTF) has recommended screening for depression among those over the age 12; though a 2005 Cochrane review found that the routine use of screening questionnaires has little effect on detection or treatment. Screening the general population is not recommended by authorities in the UK or Canada. Behavioral interventions, such as interpersonal therapy and cognitive-behavioral therapy , are effective at preventing new onset depression. Because such interventions appear to be most effective when delivered to individuals or small groups, it has been suggested that they may be able to reach their large target audience most efficiently through
6615-445: The cortico-striatal model, suggests that abnormalities of the prefrontal cortex in regulating striatal and subcortical structures result in depression. Another model proposes hyperactivity of salience structures in identifying negative stimuli, and hypoactivity of cortical regulatory structures resulting in a negative emotional bias and depression, consistent with emotional bias studies. The newer field of psychoneuroimmunology ,
6720-413: The course of her career, Duke received an Academy Award for Best Supporting Actress , three Emmy Awards in 10 nominations, and two Golden Globe Awards amongst four nominations. In 1963, when she won her Academy Award, Duke became the youngest person to ever win an Academy Award in a competitive category. On August 17, 2004, Duke received a star on the Hollywood Walk of Fame for her contribution to
6825-484: The criteria for a major depressive episode. A major depressive episode is characterized by the presence of a severely depressed mood that persists for at least two weeks. Episodes may be isolated or recurrent and are categorized as mild (few symptoms in excess of minimum criteria), moderate, or severe (marked impact on social or occupational functioning). An episode with psychotic features—commonly referred to as psychotic depression —is automatically rated as severe. If
6930-411: The current depressive episode: the severity (mild, moderate, severe, unspecified); the presence of psychotic symptoms (with or without psychotic symptoms); and the degree of remission if relevant (currently in partial remission, currently in full remission). These two disorders are classified as "Depressive disorders", in the category of "Mood disorders". According to DSM-5, at least one of the symptoms
7035-454: The dosages can be adjusted, and if necessary, combinations of different classes of antidepressants can be tried. Response rates to the first antidepressant administered range from 50 to 75%, and it can take at least six to eight weeks from the start of medication to improvement. Antidepressant medication treatment is usually continued for 16 to 20 weeks after remission, to minimize the chance of recurrence, and even up to one year of continuation
7140-427: The effectiveness of antidepressants in people with acute, mild to moderate depression. A review commissioned by the National Institute for Health and Care Excellence (UK) concluded that there is strong evidence that SSRIs , such as escitalopram , paroxetine , and sertraline , have greater efficacy than placebo on achieving a 50% reduction in depression scores in moderate and severe major depression, and that there
7245-421: The elderly are often simultaneously treated with a number of other drugs, and often have other concurrent diseases. The etiology of depression is not yet fully understood. The biopsychosocial model proposes that biological, psychological, and social factors all play a role in causing depression. The diathesis–stress model specifies that depression results when a preexisting vulnerability, or diathesis ,
7350-479: The existence of atypical antidepressants which can be effective despite not targeting this pathway. One proposed explanation for the therapeutic lag, and further support for the deficiency of monoamines, is a desensitization of self-inhibition in raphe nuclei by the increased serotonin mediated by antidepressants. However, disinhibition of the dorsal raphe has been proposed to occur as a result of decreased serotonergic activity in tryptophan depletion, resulting in
7455-656: The experimental treatment of ketamine with treatment-resistant depression. With this, in MDD, people will more likely have a Th-1 dominant immune profile, which is a pro-inflammatory profile. This suggests that there are components of the immune system affecting the pathology of MDD. Another way cytokines can affect depression is in the kynurenine pathway , and when this is overactivated, it can cause depression. This can be due to too much microglial activation and too little astrocytic activity. When microglia get activated, they release pro-inflammatory cytokines that cause an increase in
7560-489: The extent in which it impairs functioning) for the diagnosis. Major depressive disorder is classified as a mood disorder in the DSM-5. The diagnosis hinges on the presence of single or recurrent major depressive episodes . Further qualifiers are used to classify both the episode itself and the course of the disorder. The category Unspecified Depressive Disorder is diagnosed if the depressive episode's manifestation does not meet
7665-453: The film Valley of the Dolls (1967) and Natalie Miller in the film Me, Natalie (1969). The latter earned her a Golden Globe Award for Best Actress – Motion Picture Comedy or Musical . From 1985 to 1988, she served as president of the Screen Actors Guild . Duke was diagnosed with bipolar disorder in 1982. Following her diagnosis, she devoted much of her time to advocating for and educating
7770-564: The film has since become a camp classic —thanks in large part to Duke's over-the-top performance —at the time it almost ruined her career. In 1969, Duke starred in Me, Natalie , in which she played an "ugly duckling" Brooklyn teenager struggling to make a life for herself in the Bohemian world of Greenwich Village . Duke won the Golden Globe Award for Best Actress (Musical or Comedy) for
7875-531: The first public figures to speak out about her personal experience of mental illness. She also suffered from anorexia nervosa and during her teenaged years, weighed as little as 76 pounds. She attempted suicide in 1967 and was again hospitalized for mental health problems in 1969, eventually being diagnosed as manic depressive in 1982. Her treatment, which included the use of lithium as medication and therapy, successfully stabilized her moods. She subsequently became an activist for mental health causes. She lobbied
7980-409: The guild's members. During her term, she led industrial actions and contract negotiations and oversaw the relocation of the guild's headquarters. Duke gradually reduced her work schedule in the 2000s but took occasional TV roles, including guest appearances on shows such as Glee and the reboot of Hawaii Five-0 . In 2011, she joined the cast of the drama The Protector . She also returned to
8085-553: The initial treatment of mild depression because the risk-benefit ratio is poor. The guidelines recommend that antidepressants treatment in combination with psychosocial interventions should be considered for: The guidelines further note that antidepressant treatment should be continued for at least six months to reduce the risk of relapse , and that SSRIs are better tolerated than tricyclic antidepressants . Treatment options are more limited in developing countries, where access to mental health staff, medication, and psychotherapy
8190-637: The length, severity and presence of psychotic features: To confirm major depressive disorder as the most likely diagnosis, other potential diagnoses must be considered, including dysthymia , adjustment disorder with depressed mood, or bipolar disorder . Dysthymia is a chronic, milder mood disturbance in which a person reports a low mood almost daily over a span of at least two years. The symptoms are not as severe as those for major depression, although people with dysthymia are vulnerable to secondary episodes of major depression (sometimes referred to as double depression ). Adjustment disorder with depressed mood
8295-450: The monoamine hypothesis has been further oversimplified when presented to the general public. A 2022 review found no consistent evidence supporting the serotonin hypothesis, linking serotonin levels and depression. HPA-axis abnormalities have been suggested in depression given the association of CRHR1 with depression and the increased frequency of dexamethasone test non-suppression in people who are depressed. However, this abnormality
8400-566: The most common presenting problem in developing countries, according to the World Health Organization 's criteria for depression. Appetite often decreases, resulting in weight loss, although increased appetite and weight gain occasionally occur. Major depression significantly affects a person's family and personal relationships , work or school life, sleeping and eating habits, and general health. Family and friends may notice agitation or lethargy . Older depressed people may have cognitive symptoms of recent onset, such as forgetfulness, and
8505-416: The most severely depressed. Hospitalization (which may be involuntary ) may be necessary in cases with associated self-neglect or a significant risk of harm to self or others. Electroconvulsive therapy (ECT) may be considered if other measures are not effective. Major depressive disorder is believed to be caused by a combination of genetic , environmental, and psychological factors, with about 40% of
8610-512: The motion-picture industry. On December 14, 2007, her 61st birthday, Duke was awarded an honorary doctorate in humane letters degree from the University of North Florida for her work in advancing awareness of mental health issues. On March 6, 2010, she was awarded an honorary doctorate in humane letters degree from the University of Maryland Eastern Shore . Duke was married four times and had three children. A Catholic, Duke had dreams of becoming
8715-528: The movie Hell and Mr. Fudge in 2012. In November 2020, Astin was cast in a recurring role on the third season of the Netflix psychological thriller series You . CAMIE Awards Young Artist Awards Patty Duke Anna Marie " Patty " Duke (December 14, 1946 – March 29, 2016) was an American actress. Over the course of her acting career, she was the recipient of an Academy Award , two Golden Globe Awards , three Primetime Emmy Awards , and
8820-502: The onset of a dementing disorder , such as Alzheimer's disease . Cognitive testing and brain imaging can help distinguish depression from dementia. A CT scan can exclude brain pathology in those with psychotic, rapid-onset or otherwise unusual symptoms. No biological tests confirm major depression. In general, investigations are not repeated for a subsequent episode unless there is a medical indication . The most widely used criteria for diagnosing depressive conditions are found in
8925-668: The other. Both DSM and ICD mark out typical (main) depressive symptoms. The most recent edition of the DSM is the Fifth Edition, Text Revision (DSM-5-TR), and the most recent edition of the ICD is the Eleventh Edition (ICD-11). Under mood disorders, ICD-11 classifies major depressive disorder as either single episode depressive disorder (where there is no history of depressive episodes, or of mania ) or recurrent depressive disorder (where there
9030-406: The person has had an episode of mania or markedly elevated mood , a diagnosis of bipolar disorder is made instead. Depression without mania is sometimes referred to as unipolar because the mood remains at one emotional state or "pole". Bereavement is not an exclusion criterion in the DSM-5, and it is up to the clinician to distinguish between normal reactions to a loss and MDD. Excluded are
9135-475: The person, provider, and/or the medical system. Non-psychiatrist physicians have been shown to miss about two-thirds of cases, although there is some evidence of improvement in the number of missed cases. A doctor generally performs a medical examination and selected investigations to rule out other causes of depressive symptoms. These include blood tests measuring TSH and thyroxine to exclude hypothyroidism ; basic electrolytes and serum calcium to rule out
9240-531: The production of COX 2 . This, in turn, causes the production of PGE 2 , which is a prostaglandin , and this catalyzes the production of indolamine , IDO. IDO causes tryptophan to get converted into kynurenine and kynurenine becomes quinolinic acid . Quinolinic acid is an agonist for NMDA receptors, so it activates the pathway. Studies have shown that the post-mortem brains of patients with MDD have higher levels of quinolinic acid than people who did not have MDD. With this, researchers have also seen that
9345-469: The public on mental health. She was also an occasional singer and author. Patty Duke was born Anna Marie Duke on December 14, 1946 at Bellevue Hospital in Manhattan to Frances Margaret ( née McMahon) (1913–1993), a cashier, and John Patrick Duke (1913–1964), a handyman and cab driver of Irish descent. She was the youngest of three children. She was raised Roman Catholic . Duke spent her early life in
9450-430: The risk being genetic. Risk factors include a family history of the condition, major life changes, childhood traumas, certain medications, chronic health problems , and substance use disorders . It can negatively affect a person's personal life, work life, or education, and cause issues with a person's sleeping habits, eating habits, and general health. A person having a major depressive episode usually exhibits
9555-472: The role in its earlier original presentation as a live television drama on Playhouse 90 . During the run, Duke's name was elevated above the play's title on the theater's billboard, believed to be the first time this had been done for such a young star. The play was subsequently made into a 1962 film for which Duke received the Academy Award for Best Supporting Actress . Before the film started shooting,
9660-469: The role. Duke returned to television in 1970, starring in a made-for-TV movie, My Sweet Charlie . Her portrayal of a pregnant teenager on the run won Duke her first Emmy Award. Her acceptance speech was rambling and disjointed, leading many in the industry to believe she was drunk or using drugs at the time. In fact, Duke was experiencing a manic phase of her bipolar disorder, which remained undiagnosed until 1982. She received her second Emmy in 1977 for
9765-410: The second-most years lived with disability , after lower back pain . The diagnosis of major depressive disorder is based on the person's reported experiences, behavior reported by relatives or friends, and a mental status examination . There is no laboratory test for the disorder, but testing may be done to rule out physical conditions that can cause similar symptoms. The most common time of onset
9870-865: The severity of symptoms for a time period, so a person who scores above a given cut-off point can be more thoroughly evaluated for a depressive disorder diagnosis. Several rating scales are used for this purpose; these include the Hamilton Rating Scale for Depression , the Beck Depression Inventory or the Suicide Behaviors Questionnaire-Revised . Primary-care physicians have more difficulty with underrecognition and undertreatment of depression compared to psychiatrists. These cases may be missed because for some people with depression, physical symptoms often accompany depression. In addition, there may also be barriers related to
9975-526: The stage on occasion—in 2002 as Aunt Eller in a revival of Oklahoma! on Broadway and in 2009 as Madame Morrible in the San Francisco production of the musical Wicked . In May 2011, Duke directed the stage version of The Miracle Worker at the now defunct Interplayers Theater in Spokane, Washington . In 2010, she hosted a PBS TV special When Irish Eyes Are Smiling: An Irish Parade Of Stars . The special
10080-597: The study between the immune system and the nervous system and emotional state, suggests that cytokines may impact depression. Immune system abnormalities have been observed, including increased levels of cytokines -cells produced by immune cells that affect inflammation- involved in generating sickness behavior , creating a pro-inflammatory profile in MDD. Some people with depression have increased levels of pro-inflammatory cytokines and some have decreased levels of anti-inflammatory cytokines. Research suggests that treatments can reduce pro-inflammatory cell production, like
10185-402: The true story of Concetta Hassan, a woman who struggles to support her family after her husband is injured, but who eventually becomes a United States Army helicopter pilot. In 1990, Duke's autobiography, Call Me Anna, was adapted for television; she played herself from her mid-30s onward. In 1992, Duke portrayed the mother of Meg Ryan 's character in the film adaptation of the play Prelude to
10290-459: The villain role of Sue Ellen Turner when Kitty Sullivan was unable to reprise her role. After the cancellation of The Patty Duke Show in 1966, Duke began her adult acting career by playing Neely O'Hara in Valley of the Dolls (1967). The film was a box-office success, but audiences and critics had a difficult time accepting all-American-teenager Duke as an alcoholic, drug-addicted singing star. While
10395-537: Was Sean's biological father, emphasizing those two assertions in several parts of the book. Both of her statements on these matters appear to have been incorrect: in 1994, biological tests determined that Tell was Sean's biological father. Duke married John Astin on August 5, 1972. Astin adopted Sean, and the couple had a son together, actor Mackenzie Astin . Duke and Astin worked together extensively during their marriage, and she took his name professionally, becoming "Patty Duke Astin". During this period, Duke underwent
10500-502: Was a time when I very seriously considered Judaism . And, yes, I do go to church now. I go to a Unity Church . I also go to Catholic church occasionally because the child in me desperately needs the bells and smells." In 1965, at age 18, Duke married director Harry Falk , who was 13 years her senior. It led to the end of Duke's relationship with her childhood guardians, the Rosses. During their marriage, she had repeated mood swings, drank heavily, became anorexic , and overdosed on pills
10605-569: Was cancelled after one season; Hail to the Chief , in which she appeared as the first female President of the United States; and a comedy, Karen's Song , which aired on the fledgling Fox network. Duke's film roles in the 1980s included the Canadian film By Design (1981), which garnered her a Genie Award nomination for Best Foreign Actress, and the made-for-TV movie A Time to Triumph (1986),
10710-641: Was her younger brother, Ross; and Eddie Applegate portrayed her boyfriend, Richard Harrison (though the actor was more than a decade older than Duke). The show also featured such high-profile guest stars as Sammy Davis Jr. , Peter Lawford , Paul Lynde , and Sal Mineo . The series lasted three seasons and earned Duke an Emmy Award nomination. In 1999, the program's characters were revisited and updated in The Patty Duke Show: Still Rockin' in Brooklyn Heights , with Cindy Williams taking on
10815-617: Was part of the My Music series and featured Irish and Irish-American folk music and sentimental standards. In 2011, Duke appeared in public service announcements for the U.S. government, promoting the Social Security website. In several, she appeared as Patty and Cathy using split-screen effects. In others, she appeared with George Takei wearing a Star Trek -like costume. In 2015, Duke made her final TV appearance, guest-starring on Liv and Maddie as Grandma Janice and Great-aunt Hilary,
10920-414: Was pregnant; she then married Michael Tell on June 26, 1970, during a manic phase, to "give (her child) a name." Their marriage lasted 13 days before ending in an annulment on July 9, 1970. Her son, actor Sean Astin , was born on February 25, 1971; she later told him that Arnaz was his biological father. Duke wrote in her 1987 autobiography that the marriage to Tell was never consummated, and that Astin
11025-463: Was published in 1987 and Brilliant Madness: Living with Manic Depressive Illness ( ISBN 0-553-56072-7 ) was published in 1992. The third, In The Presence of Greatness—My Sixty Year Journey as an Actress ( ISBN 9781629332352 ) (with William J. Jankowski), published posthumously in February 2018, is a collection of essays about her experiences with other artists and celebrities. Over
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