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PubMed2001

The clinical features of bipolar depression: a comparison with matched major depressive disorder patients.

BACKGROUND: Despite a resurgence of interest in the treatment of bipolar depression, there have been few controlled studies of the clinical characteristics of this condition. Identification of any distinctive clinical "signatures" of bipolar depression would be helpful in determining treatment options in the clinical setting. METHOD: From a cohort of 270 inpatients and outpatients assessed in detail during a DSM-IV major depressive episode, 39 bipolar I disorder patients were identified and closely matched with 39 major depressive disorder patients for gender, age, and the presence or absence of DSM-IV melancholic subtype. Patients were compared on a broad range of parameters including the Hamilton Rating Scale for Depression (depression severity), 54 depressive symptoms, the Newcastle Endogenous Depression Diagnostic Index, 3 family history items, 2 physical health items, the CORE scale (psychomotor disturbance), and 5 history items. RESULTS: Although the bipolar patients were no more severely depressed than the major depressive disorder controls, they were more likely to demonstrate psychomotor-retarded melancholic and atypical depressive features and to have had previous episodes of psychotic depression. These findings were largely duplicated even when the population was confined to those with DSM-IV melancholia. CONCLUSION: The clinical admixture of psychomotor-retarded melancholic signs and symptoms, "atypical" features, and (less frequently) psychosis may provide a "bipolar signature" in clinical scenarios when there is uncertainty concerning the polarity of a depressive presentation.

Adult↗
PubMedDate not supplied

[The Newcastle Index for the diagnosis of endogenous depression. Comparison with the Research Diagnostic Criteria for major depression].

The Newcastle index comprises 10 items (with a positive or negative score) the sum of which enables us to separate endogenous and neurotic depressive patients. We applied this index to a sample of 41 depressive inpatients who met Research Diagnostic Criteria (RDC) for major depression. According to Newcastle index, 20 patients were considered to be endogenous and 21 to be neurotic. There was no significant difference between the two groups with regard to sex distribution and mean age. The distribution of scores suggested a trend toward bimodality. Endogenous depressives exhibited higher severity level than neurotic depressives, as shown by the total score on the Hamilton depression scale as well as the scores on various items related to depressive mood, guilt, decreased activity, psychomotor disturbances, genital symptoms, helplessness, hopelessness, and worthlessness. This higher severity level was confirmed by the higher frequency of two symptomatic criteria of major depression among endogenous depressives as compared to neurotic depressives: psychomotor and memory disturbances. Moreover, endogenous depressives defined by Newcastle index were more frequently of primary, endogenous, agitated and simple RDC subtypes whereas neurotic depressives were more frequently of secondary and situational RDC subtypes. Therefore, the results of this preliminary study suggest that the Newcastle index may enable us to define two subtypes of depressive patients characterized by different symptomatic severity levels.

Adult↗
PubMed1996

[Quantitative EEG characteristics of the state of depressive phase and the state of remission in major depression].

We conducted a comparative study by using quantitative EEG analysis to clarify quantitative characteristics and possible markers of major depression. The subjects included 27 patients with major depression with melancholic features (DSM-III-R) (hereafter referred to as depressed group), 21 patients in the state of remission (hereafter referred to as remission group) and 17 subjects with no psychiatric disorder (hereafter referred to as control group). All participants were right-handed. All depressed group patients received medication treatment and all remission group patients had maintenance antidepressant medication. EEGs were recorded from the 16 electrode sites of the international 10-20 system while the subjects were at rest with their eyes closed. Artifacts rejected EEGs which were obtained from the bilateral frontal (F3, F4) and parietal (P3, P4) regions were analyzed on off-line with Fast Fourier Transform. The mean values of absolute amplitude power were calculated for 180 seconds (90 segments x 2 seconds), and derived for the following frequent bands: theta 1 (4.0-6.0 Hz), theta 2 (6.0-8.0 Hz), alpha 1 (8.0-10.5 Hz), alpha 2 (10.5-13.0 Hz), beta 1 (13.0-20.0 Hz) and beta 2 (20.0-40.0 Hz). Based on these values, the following parameters were calculated: F-Index "((F4-F3)/(F4+F3)) x 100" indicating relative predominance of the right side in the frontal region, P-Index "((P4-P3)/(P4+P3)) x 100" indicating relative predominance of the right side in the parietal region, and Left or Right PF-Index "((P-F)/(P+F) x 100" indicating relative predominance of parietal region to the frontal region on the left or right hemisphere. Compared with the control group, the remission group showed less theta 1 and alpha 2 power in the bilateral frontal regions and less right predominance in alpha 1 power in the parietal regions. Compared with the depressed group, the remission group showed less theta power in the bilateral frontal regions. Compared with the control group, both the depressed and remission groups showed higher beta 2 power in the bilateral frontal regions. These results may be considered as a trait dependent phenomena of major depression, although the effects of age and medications may affect these results. Both the depressed group and the remission group showed the parietal predominance in alpha 1 power in the left hemisphere. These results also may be considered as a trait dependent phenomena of major depression. For the next analysis, we calculated Left or Right PF-Index from the mean absolute amplitude power in the alpha 1 band. The indices were then plotted on a coordinates with Left PF-Index as the X axis and Right PF-Index as the Y axis. On the PF-Index coordinates, 93% of the depressed group patients and 86% of the remission group patients were plotted in the same areas. These areas which show their predominance of parietal to frontal are lower in the right hemisphere than in the left hemisphere, and the location of these areas on the coordinates were different from that of the control group. These results are consistent with our previous studies of depressed patients without receiving medication treatment. Our findings show the deviation of the inter and intra-hemispheric relationships is present not only in the state of depressed phase but also in the state of remission. Therefore, the inter- and intra-hemispheric relationships, depicted on the PF-Index coordinates, could be used as a trait marker of a major depressive disorder.

Adult↗
PubMed1998

Depression in the family physician's office: what the psychiatrist needs to know: the Michigan Depression Project.

A rapidly growing body of research suggests that depression in primary care may differ from that in psychiatry in its nature, severity, comorbidity, and responsiveness to treatment. The Michigan Depression Project is a long-term series of studies designed to explore the twin assumptions that depressed primary care patients are similar to depressed psychiatric patients and that identical treatment will benefit both groups. Major findings are (1) criterion-based diagnosis of major depressive disorder in primary care includes many patients with mild depression and little to no impairment; (2) the onset of depression among family practice patients-but not psychiatric patients-is usually preceded by a severe life event; (3) in primary care, outcome for patients with undetected depression appears to be comparable to that for those with detected depression; and (4) family physicians appear to employ historical cues in assigning the diagnosis of depression to distressed and impaired patients. The results of the Michigan Depression Project and the recent work of other researchers suggest that the challenges facing primary care physicians in the diagnosis and treatment of depressed patients are daunting. These challenges lead to a set of consultative skills and behaviors on the part of psychiatrists that may be different than generally expected. One-time, stand-alone psychiatric consultations are often needed, because neither the primary care physician nor the patient desires the psychiatric care to be "carved out" from the continuing care of a set of chronic problems. Future intervention studies should compare subgroups of patients who appear most in need of treatment (on the basis of functional impact) with those who are mildly depressed and barely meet diagnostic criteria. These studies will help primary care physicians focus their energies and therapies where they will have the most benefit in treating what is clearly a common and important, but still poorly understood, problem in primary care medical practice.

Adolescent↗
PubMed2006

Second-generation antidepressant discontinuation and depressive relapse in adult patients with bipolar depression: results of a retrospective database analysis.

BACKGROUND: To date, few postmarketing studies have addressed whether long-term prophylactic treatment with second-generation antidepressants (ADs) delays depressive episodes in patients with bipolar disorder. OBJECTIVE: The aim of this study was to compare the risk of depressive relapse between patients with bipolar disorder who took second-generation ADs>-6 months after depressive remission with those who discontinued AD use early. METHODS: Using a large US managed-care claims database, continuously enrolled bipolar subjects who took second-generation ADs after a depressive remission were identified between January 1, 1998, and December 31, 2002. Duration of AD and concurrent mood stabilizer use were based on coded diagnoses and pharmacy records. A Cox proportional hazards model was developed to predict time from depressive remission to next depressive relapse with continuous AD use, categorized as either >or=6 months or <6 months. Propensity scoring with greedy matching was used to help balance the observed background covariates and baseline disease severity between groups. RESULTS: Five hundred eighty-nine subjects met the inclusion criteria. A Kaplan-Meer estimate found that the median depressive relapse times for the continuous (ie, >or=6 months) and early discontinuation (ie, <6 months) AD treatment groups were 16.5 and 6.8 months, respectively (P<0.05). The Cox proportional hazards model with propensity score matching identified a significantly lower risk of depressive relapse over a 2-year period among those who continued AD treatment>or=6 months after remission, compared with those who discontinued treatment within 6 months (hazard ratio, 0.61 [95% CI, 0.42-0.88]; continuous vs early discontinuation, P<0.01). CONCLUSIONS: Continuous second-generation AD therapy for >or=6 months after depressive remission was associated with a lower risk of depressive relapse over a 2-year period in patients with bipolar depression. Given concerns regarding the risk of AD users with bipolar disorder switching to mania, an optimal prophylactic treatment after depressive remission should balance the risks between manic switching and depressive relapse.

Adolescent↗
PubMed2002

[Depressive disorder and depression within schizophrenia spectrum disorders: are they the same?].

Depressive states are a prevalent condition in mental disorders other than depressive disorders, which raises the question of whether or not depression in non-depressive disorders and depressive disorders has the same clinical and biological meaning. The aim of this study was to test the hypothesis that depression in schizophrenia spectrum disorders and depressive disorders does have the same characteristics regarding gender distribution and family history of mood disorders in first-degree relatives. The study sample was made up of 660 psychotic patients who were assessed for alternative definitions of depressive states. The pattern of gender distribution and family antecedents of mood disorders in those patients having depressive symptoms or syndromes was very similar to that reported in depressive disorders, and more specifically to depression in patients with schizophrenia spectrum disorders. These data support the hypothesis that depressions in schizophrenia spectrum disorders do have the same biological meaning as in depressive disorders.

English Abstract↗
PubMed2006

Associations of hormones and menopausal status with depressed mood in women with no history of depression.

CONTEXT: Whether depressed mood reported in the transition to menopause by women with no history of depression is associated with menopausal status and changes in reproductive hormones is controversial and lacks scientific information. OBJECTIVES: To identify new onset of depressive symptoms and diagnosed depressive disorders in the menopausal transition and to determine the associations of menopausal status, reproductive hormones, and other risk factors with these cases. DESIGN: A within-woman, longitudinal (8-year) study to identify risk factors of depressed mood. SETTING: A subset of a randomly identified, population-based cohort. PARTICIPANTS: Premenopausal women with no history of depression at cohort enrollment. MAIN OUTCOME MEASURES: The Center for Epidemiological Studies of Depression scale (CES-D) was used to assess depressive symptoms, and the Primary Care Evaluation of Mental Disorders (PRIME-MD) was used to identify clinical diagnoses of depressive disorders. RESULTS: High CES-D scores (> or=16) were more than 4 times more likely to occur during a woman's menopausal transition compared with when she was premenopausal (odds ratio, 4.29; 95% confidence interval, 2.39-7.72; P<.001). Within-woman change in menopausal status, increased levels of follicle-stimulating hormone and luteinizing hormone, and increased variability of estradiol, follicle-stimulating hormone, and luteinizing hormone around the woman's own mean levels were each significantly associated with high CES-D scores after adjusting for smoking, body mass index, premenstrual syndrome, hot flashes, poor sleep, health status, employment, and marital status. A diagnosis of depressive disorder was 2(1/2) times more likely to occur in the menopausal transition compared with when the woman was premenopausal (odds ratio, 2.50; 95% confidence interval, 1.25-5.02; P=.01); the hormone measures were also significantly associated with this outcome. CONCLUSION: Transition to menopause and its changing hormonal milieu are strongly associated with new onset of depressed mood among women with no history of depression.

Adult↗
PubMed2000

Caregiver support for postpartum depression.

BACKGROUND: Supportive relationships during the perinatal period may enhance a mother's feeling of wellbeing and control. Support to women during labour and after birth has shown benefits and this may also be the case for mothers with postpartum depression. OBJECTIVES: The objective of this review was to assess the effect of professional and/or social support interventions for the treatment of postpartum depression. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register. SELECTION CRITERIA: Randomised and quasi-randomised trials comparing additional support from caregivers with usual forms of care in the postpartum period, in women who were clinically depressed in the six months after giving birth. DATA COLLECTION AND ANALYSIS: Trial quality was assessed and data were extracted by both reviewers. Study authors were contacted for additional information. MAIN RESULTS: Two studies involving 137 women were included. There is potential for bias in at least one study, due to large numbers of women refusing to take part in the trial as well as significant losses to follow-up during the trial. Treatment of postpartum depression with support was associated with a reduction in depression at 25 weeks after giving birth (odds ratio 0.34, 95% confidence intervals 0.17 to 0.69). REVIEWER'S CONCLUSIONS: There is some indication that professional and/or social support may help in the treatment of postpartum depression. The types of support should be investigated to assess which models are most effective.

Caregivers↗
PubMed2000

Postnatal depression-myth and reality: maternal depression before and after the birth of a child.

BACKGROUND: Much has been written about postnatal depression as a clinical condition. There is some evidence to suggest that a substantial proportion of women who give birth experience a depression in the postnatal period. This paper reports the results of a longitudinal study of the mental health of a large sample of women who were in the early stages of pregnancy at entry to the study. METHODS: Each participant was assessed for symptoms of depression at the first clinic visit (entry to the study), and reassessed at various intervals--at 3-5 days, at 6 months, and again at 5 years after the birth of the child--using the DSSI-D (Delusions-Symptoms-States Inventory). RESULTS: Retrospective recall questions indicate that shortly after the birth the majority of women experienced some depressed mood. Of those who experienced depressed mood, the data suggest that the symptoms were not severe, nor did these symptoms generally continue beyond a few weeks. The longitudinal data indicate that levels of depression in our sample are highest either at the first clinic visit or at the 5-year follow-up. Rates of depression at the 6-month follow-up are relatively low by comparison. CONCLUSION: While most mothers experience periods of depressed mood after the birth of their baby, these periods are generally of short duration and of lesser intensity than a major depression. Mothers appear to experience increasing levels of symptoms of depression as their child grows up. Many of the "cases" of depression experienced at the 5-year follow-up represent a recurrence of a previous experience of depression.

Adolescent↗
PubMed2006

Severe melancholic depression is more vulnerable than non-melancholic depression to minor precipitating life events.

BACKGROUND: The present study examines the moderating role of global depression severity on the relation of melancholic versus non-melancholic depression to severe and non-severe levels of stress. METHOD: A community sample of 50 women with unipolar major depressive disorder, of which 54% met Research Diagnostic Criteria for melancholic depression, were interviewed regarding stressful life events experienced prior to onset. Events were coded as severe or non-severe based on the rigorous Bedford College contextual rating system. RESULTS: Greater severity of depression was related to a higher likelihood of a severely stressful event prior to onset only for women with non-melancholic major depression. By contrast, greater severity of depression was related to a higher likelihood of a non-severe, more minor, stressful event prior to onset only for women with melancholic major depression. LIMITATIONS: The present study was limited by its use of a female volunteer sample, which might not be entirely representative of the population of individuals with major depression. In addition, the study employed a cross-sectional design, which limits conclusions relating to the causal relation of stress to melancholic versus non-melancholic depression. CONCLUSIONS: Far from being autonomous of stress, individuals with severe melancholic depression may be especially sensitive to stress, such that their episodes are influenced by more minor stressors than those of individuals with non-melancholic depression.

Adolescent↗
PubMed2006

Recognition of depressive symptoms by Chinese subjects: the influence of acculturation and depressive experience.

BACKGROUND: We have previously found that the level of acculturation in Chinese subjects influences reporting of depression. It is not clear to what extent such differences in reporting are a consequence of differences in the recognition of depressive symptoms. This study examined the influence of acculturation and personal depressive experience on recognition of depressive symptoms in a sample of Chinese subjects and controls in a western region. METHOD: A 35-item Depressive Symptom Questionnaire was given to 385 Chinese subjects, grouped according to their language preference, and 143 non-Chinese Controls all recruited from general practices. Subjects rated recognition of symptoms on a 3-point scale according to the likelihood of someone who had depression experiencing each of the 35 symptoms. Three symptom dimensions were extracted using factor analysis: core, cognitive and somatic symptoms. The influence of acculturation and previous experience of depression on these symptom dimensions was examined. RESULTS: The level of acculturation in the Chinese influenced the recognition of 'somatic' and 'cognitive' symptoms, but the Chinese groups did not differ from Controls in recognition of 'core' symptoms. Previous experience of depression led to greater recognition of all three dimensions of symptoms, regardless of level of acculturation. CONCLUSIONS: Westernized Chinese, despite varying levels of acculturation, appeared capable of recognizing depressive symptoms as well as Control subjects. This suggests that the influence of acculturation on reporting on depressive symptoms may be due to factors other than the recognition of depression. This study has implications for the early detection of depression among the Chinese in differing geographical regions.

Acculturation↗
PubMed2006

Depression and immunity: inflammation and depressive symptoms in multiple sclerosis.

There is strong evidence that depression involves alterations in multiple aspects of immunity that may contribute to the development or exacerbation of a number of medical disorders and also may play a role in the pathophysiology of depressive symptoms. Accordingly, aggressive management of depressive disorders in medically ill populations or individuals at risk for disease may improve disease outcome or prevent disease development. On the other hand, in light of data suggesting that immune processes may interact with the pathophysiologic pathways known to contribute to depression, novel approaches to the treatment of depression may target relevant aspects of the immune response. Taken together, the data provide compelling evidence that a psychoimmunologic frame of reference may have profound implications regarding the consequences and treatment of depression. In addition, this approach may be used to investigate the possibility that peripheral and central production of cytokines may account for neuropsychiatric symptoms in inflammatory diseases. This article summarizes evidence for a cytokine-mediated pathogenesis of depression and fatigue in MS. The effects of central inflammatory processes may account for some of the behavioral symptoms seen in patients who have MS that cannot be explained by psychosocial factors or CNS damage. This immune-mediated hypothesis is supported by indirect evidence from experimental and clinical studies of the effect of cytokines on behavior, which have found that both peripheral and central cytokines may cause depressive symptoms. Emerging clinical data from patients who have MS support an association of central inflammation (as measured by MRI) and inflammatory markers with depressive symptoms and fatigue. Based on the literature reviewed in this article, subtypes of MS fatigue and depression may exist that are caused by different pathogenetic mechanisms, including inflammation and CNS damage as well as psychosocial factors or predisposition. The existence of these subtypes could have important clinical implications. For example, an inflammatory depression may require different therapeutic approaches than a reactive depression in MS. Future research should aim to characterize these subtypes better with the goal of optimizing treatment.

Animals↗
PubMed1994

Prevalence of depressive symptoms and depressive disorder in primary care patients over 65 years of age.

The aim of this study was to estimate the prevalence of depressive symptoms and depressive disorder (ICHPPC-2-defined) in patients over 65 years of age. A cross-sectional, partly two-phased, study was performed in general practices in The Netherlands. A total of 384 consecutive patients aged 65 and above, 116 men and 268 women were included, both during practice visits and home visits. Depressive symptoms were recorded with the Zung Self-rating Depression Scale, the Geriatric Depression Scale, and with physician ratings. Assessments of depressive disorder were based on an adaptation of interview ratings with the Montgomery Asberg Depression Rating Scale. The proportion of patients considered to have depressive symptoms ranged from 11 to 29% of patients, depending on the self-report instrument and the cut-off point. According to interviews a depressive disorder was estimated to be present in 17%. The high prevalence of depressive symptoms and depressive disorder suggest a higher index of suspicion of depression in elderly general practice patients.

Aged↗
PubMed1999

Adolescent depressive symptoms as predictors of adult depression: moodiness or mood disorder?

OBJECTIVE: The authors' goal was to examine the relationship between subclinical depressive symptoms in adolescence and major depressive episodes in adulthood. METHOD: An epidemiologic sample of 776 young people received psychiatric assessments in 1983, 1985, and 1992. Among adolescents not meeting criteria for major depression, the authors estimated the magnitude of the association between subclinical adolescent depressive symptoms and adult major depression. RESULTS: Symptoms of major depression in adolescence strongly predicted an adult episode of major depression: having depressive symptoms more than two-standard-deviations above the mean in number predicted a two-fold to three-fold greater risk for an adult major depressive episode. CONCLUSIONS: Symptoms of depression in adolescence strongly predict an episode of major depression in adulthood, even among adolescents without major depression.

Adolescent↗
PubMed2004

Characteristics of depressed preschoolers with and without anhedonia: evidence for a melancholic depressive subtype in young children.

OBJECTIVE: This study investigated whether a melancholic subtype similar to that established in depressed adults can be identified in depressed preschool children. METHOD: A final group total of 156 preschool children between the ages of 3.0 and 5.6 years and their caregivers underwent a comprehensive psychiatric assessment that included a structured psychiatric interview modified for young children. The clinical characteristics of four study groups (N=156) were compared: depressed preschoolers with anhedonia, depressed preschoolers without anhedonia ("hedonic"), a psychiatric comparison group with DSM-IV attention deficit hyperactivity disorder and/or oppositional defiant disorder, and a healthy comparison group. RESULTS: Fifty-four depressed preschoolers were identified, and 57% of this depressed group was anhedonic, a symptom deemed to be highly developmentally and clinically significant when arising in the preschool period. The anhedonic depressed subgroup identified was characterized by greater depression severity, alterations in stress cortisol reactivity, increased family history of major depressive disorder, and increased frequency of psychomotor retardation as well as other melancholic symptoms, such as a lack of brightening in response to joyful events. CONCLUSIONS: The clinical characteristics of this depressed subgroup are consistent with those described in melancholic depressed adults and suggest that a melancholic depressed subtype can be manifest in children as young as age 3.

Affective Symptoms↗