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PubMed2000

Is the clinical expression of late-life depression influenced by brain changes? MRI subcortical neuroanatomical correlates of depressive symptoms.

BACKGROUND: "Vascular depression" has recently been proposed. It is characterized by magnetic resonance imaging (MRI) T2-weighted subcortical lesions, a late onset of first episode of depression, and reduced heritability; a cerebrovascular etiology is suggested. The validity of "vascular depression" might be strengthened if an association was found between the subcortical lesions used to define it and particular depressive symptoms. METHODS: A blinded cross-sectional examination of DSM-III-R depressive symptoms (American Psychiatric Association, 1987) and MRI T2-weighted subcortical lesions in 44 patients with late-life depression. RESULTS: Many associations were found; however, because of multiple comparisons, their significance is viewed with caution. The most robust finding was that psychomotor retardation was independently related to total white-matter score. The odds of showing psychomotor retardation was increased 1.9 times for every point increase in severity of white-matter change. CONCLUSION: In late-life depression the clinical expression of the depression is influenced by the pattern of MRI T2-weighted subcortical lesions. This gives some validity to the concept of an MRI-defined "vascular" subtype of late-life depression and strengthens the argument for including neuroimaging in the classification of late-life depression.

Aged↗
PubMed2001

Depression in primary care. 2: general practitioners' recognition of major depression in elderly patients.

BACKGROUND: It is important that serious depressive illness be recognized and treated appropriately by primary care practitioners. This and the preceding article in this issue examine (a) factors responsible for older patients' decision to report depressive symptoms to their doctor and (b) general practitioners' (GPs') recognition of depression when it was present. METHODS: A survey was conducted of a stratified sample of 1,021 patients aged 70+ years of 30 GPs in Melbourne, Australia, using the Canberra Interview for the Elderly, which generates rigorous ICD-10 research diagnoses. RESULTS: GPs' ratings of depression were best predicted in descending order of importance by patients' past contact with a psychiatrist, the doctor's view that a patient did not have dementia, the number of current depressive symptoms, patients' disclosure of these symptoms, and current physical pain. Physicians' assessments of patients' mood concurred with research diagnoses in 23 of 35 (66%) cases of ICD-10 mild depressive episode and 23 of 26 (88%) cases of moderate or severe depressive episode. GPs were unaware, however, of many depressive symptoms and often rated patients as being depressed when they were not. CONCLUSION: The use of a simple checklist of depressive symptoms would lead to a dramatic improvement in doctors' knowledge of patients' current psychiatric status.

Aged↗
PubMed2002

Mother-child relationships of children with ADHD: the role of maternal depressive symptoms and depression-related distortions.

We investigated the Depression-->Distortion hypothesis by examining the effects of maternal depressive symptoms on cross-informant discrepancies in reports of child behavior problems and several measures of parent-child relationship. The sample included ninety-six 6 to 10-year-old children diagnosed with ADHD-Combined Type, and their mothers, who provided baseline data before participating in a randomized clinical trial. Measures incorporated child characteristics, self-reports of maternal depressive symptoms, parenting practices, and laboratory mother-child interactions. Elevations in maternal depressive symptoms were associated with maternal reports of negative parenting style but not with observed laboratory interactions. Mothers' levels of depressive symptoms predicted negative biases in their reports of their child's ADHD symptoms, general behavior problems, and their own negative parenting style. Whereas levels of depressive symptoms did not predict observed parenting behaviors, maternal distortions did predict problemaTic parent-child interactions. Exploratory analyses showed a marginally significant mediation effect of the relationship between maternal depressive symptomatology and reports of negative parenting by depressive distortions. We discuss implications of linkages between depressive symptoms in mothers, depression-related distortions, and mother-child relationships for research and intervention in developmental psychopathology.

Attention Deficit Disorder with Hyperactivity↗
PubMed2003

Gender and depression: a study of severity and symptomatology of depressive disorders (ICD-10) in general practice.

OBJECTIVE: Gender differences in severity and symptomatology of depression in a large and representative sample of depressive patients from general practice were examined. METHOD: During a 2-year study period, 31 Danish general practitioners consecutively assessed patients, aged >18, for depression. A total of 1033 patients (692 female, 341 male) fulfilled ICD-10 criteria for depressive disorders. Gender differences were examined with regard to severity and symptomatology of depression. RESULTS: The severity of depression was similar for men and women with the following distribution: 22% mild, 56% moderate and 23% severe depressive episodes. The mean number of symptoms presented was 6.6 of 10 for both genders. There were no gender differences in prevalence of single depressive symptoms. CONCLUSION: No gender differences in the severity or symptomatology of depression were found in a highly representative sample of patients with depressive disorders.

Adolescent↗
PubMed1995

Evidence of latent depressive schemas in formerly depressed individuals.

Detecting the effects of latent depressive schemas constitutes an important step toward validating A. T. Beck's (1967) tenet of the depressive cognitive style as a causal factor in the onset and relapse of major depression. The authors examined whether a sample of formerly clinically depressed individuals continued to exhibit a negatively biased information-processing style in the absence of concurrent depressed mood. As predicted, the scores of formerly depressed individuals on 2 questionnaires tapping dysfunctional thinking did not differ from those of never depressed individuals, but responses of formerly depressed individuals were negatively biased on 2 of 3 information-processing measures administered following a self-focus manipulation. These results provide evidence for the persistence of a depressive schema in individuals who have recovered from major depression.

Adult↗
PubMed2004

Rapid screening for depression--validation of the Brief Case-Find for Depression (BCD) in medical oncology and palliative care patients.

Depression in oncology patients is under-recognised and associated with poor outcomes. Screening can increase case recognition. The Brief Case-Find for Depression (BCD) is a four-question, interviewer-administered instrument that has been previously validated in a general medical setting. The primary aim of this study was to validate the BCD in a medical oncology/palliative care setting, primarily by comparing its association with physical illness measures and with the Primary Care Evaluation of Mental Disorders (PRIME-MD), the Beck Depression Inventory (BDI) and the Hospital Anxiety and Depression Scale (HADS). Eligible adult oncology patients gave informed consent and completed the above measures and a pain scale. Agreement between the BCD and other instruments was assessed. Construct validity was determined by comparing depressed/nondepressed patients with respect to performance status, symptoms, pain score and functional impairment. A total of 100 patients had a median age of 58 (range 21-90) and ECOG performance status (PS) 2 (0-4). In all, 60% had metastatic disease. The therapeutic goal was curative/adjuvant in 39% and palliative in 61%. Prevalence of depression according to the various measures was: BCD 34%, PRIME-MD 12%, BDI 19% and HADS 14%. In total, 45% of patients responded positively to a single-item screening question. The BCD showed fair agreement with the PRIME-MD (kappa=0.21), moderate agreement with the BDI (kappa=0.43) and fair agreement with the HADS (kappa=0.27). Against the PRIME-MD diagnosis of depression, the BCD had greater sensitivity, but lesser specificity and overall agreement, compared with the BDI and depression scale of the HADS. Patients with probable depression (according to BCD) had inferior PS (P=0.0064), increased pain (P=0.045) and greater impairment of functioning (PRIME-MD: P=0.0003). There was no association with gender, age, disease status or therapeutic goal. Depression is common in oncology patients. The BCD is a quick, easy-to-administer screen for depression, which has reasonable psychometric properties in this population.

Adult↗
PubMed1999

The role of inflammatory mediators in the biology of major depression: central nervous system cytokines modulate the biological substrate of depressive symptoms, regulate stress-responsive systems, and contribute to neurotoxicity and neuroprotection.

Depression represents a major public health problem. It is estimated that 13-20% of the population has some depressive symptoms at any given time and about 5% of the population is assumed to suffer from major depression. Known pathological processes include ischemia, neoplasia, necrosis, apoptosis, infection, and inflammation. Of those, inflammation is the most compatible with the waxing and waning course of depression, and could explain the biology of this disorder that has a fluctuating course with severe episodes that can be followed by partial or complete remission. Over the years a body of evidence has been accumulated suggesting that major depression is associated with dysfunction of inflammatory mediators. Major depression commonly co-occurs with ischemic heart disease and decreased bone mineral density. Depressive symptoms are known to have a negative impact on cardiovascular prognosis, increasing the mortality rate of coronary artery disease. Several lines of evidence indicate that brain cytokines, principally interleukin-1beta (IL-1beta) and IL-1 receptor antagonist may have a role in the biology of major depression, and that they might additionally be involved in the pathophysiology and somatic consequences of depression as well as in the effects of antidepressant treatment. A particularly unique and novel aspect of the studies and views discussed here is their potential to lead to interventions which may reduce the morbidity and mortality risks for osteoporosis, cardiovascular disease, and behavioral symptoms in patients with major depression. We also discuss the emerging concept of peripheral and central cytokine compartments: their integration and differential regulation is a key element for the optimal functioning of the immune and nervous systems.

Animals↗
PubMed2003

Diagnosing depression in persons with brain injuries: a look at theories, the DSM-IV and depression measures.

There have been numerous articles published on the incidence of depression after brain injury.Unfortunately, the studies have shown the incidence of depression varies widely depending on multiple factors: definition of'depression', time of assessment post-injury and type of measure used. It is wellknown that traumatic brain injury (TBI) sequelae and depressive symptoms overlap, contributing further to measurement error and ultimately epidemiologic report of depression. This paper reviews different theories of depression, the DSM-IV depression diagnoses, the overlap in depression and TBI symptoms and depression measures and how they contribute to possible diagnostic error. This paper also discusses evaluation and treatment considerations when assessing depression in a person with a TBI.

Affect↗
PubMed2002

Parental identification of depression and mental health service use among depressed adolescents.

OBJECTIVE: To examine a proposed pathway to service use among depressed adolescents, this study assessed the effects of (1) parental perceptions of family burden due to adolescents'depression, (2) adolescent-parent communication, (3) parents' depressive symptomatology, and (4) comorbid substance use disorders on parental identification of adolescent depression and use of mental health services. METHOD: A two-stage screening process was used to recruit 44 depressed adolescents and their parents from pediatrics clinics between 1997 and 1999. Measures included structured diagnostic interviews with adolescents, the Child and Adolescent Services Assessment, the Child and Adolescent Functional Assessment Scale, the Beck Depression Inventory (for parents), and the Communication subscale of the Inventory of Parent and Peer Attachment. RESULTS: When history of service use was controlled, two predictors--parental perceptions of family burden and presence of a substance use disorder in the adolescent--were most strongly related to parental depression-identification. The data support the role of parental identification of depression as a mediator between the parent/adolescent characteristics and reports of mental health service use. CONCLUSION: Enhancing parents' abilities to identify and understand signs of depression may facilitate service use among depressed adolescents.

Adolescent↗
PubMed1975

Symptom patterns in depressed patients and depressed normals.

The availability of outpatient psychiatric treatment and community social support services has brought increasing numbers of persons with mild depressive symptoms to the attention of clinicians. However, little attention has been directed toward the study of these mild disturbances. A comparison of symptom patterns and clinical course is presented between clinically depressed psychiatric outpatients being treated with amitriptyline (depressed patients) and a group of unhappy and sad women not under psychiatric treatment but coming to a career guidance center (normal depressives). These data support the finding that normal depression is similar in degree to the mood disturbances of clinical depression but is not similar in symptom patterns. Normal depression is characterized by a relative absence of somatic complaints and somatic anxiety. The short term clinical course of drug-treated depressed patients and vocationally assisted unhappy women is quite similar in that both groups improve. This improvement is characterized by a reduction of most symptoms and of the central core of depressed mood. Further research is needed on the frequency, patterns, and course of these mild depressive states to determine their clinical importance and treatment indications.

Adolescent↗
PubMedDate not supplied

Depression, physical impairment, and treatment of depression in chronic heart failure.

BACKGROUND AND RESEARCH OBJECTIVE: This study examines the contribution of attitudes about impairment to the relation between depression and physical impairment in patients with heart failure. It also describes the current status of antidepressant treatment in a sample of outpatients with heart failure. SUBJECTS AND METHODS: A total of 32 depressed and 51 nondepressed patients with heart failure were recruited while seeking heart failure treatment in an outpatient heart failure or family practice clinic. Medical, functional, cognitive, and psychological measures were administered at baseline. Depression measures were readministered to the 32 depressed patients at 8, 16, and 24 weeks after the baseline interview. RESULTS AND CONCLUSIONS: Attitudes about impairment and perceived social support were the strongest cross-sectional correlates of depression. The strong association between physical impairment and depression was no longer significant after controlling for attitudes about impairment. In addition, attitudes about impairment predicted chronicity of depressive symptoms longitudinally after controlling for baseline depressive symptom severity. The relation between physical impairment and depression in heart failure is strongly related to how patients cope with impairment. These results call for the development of additional interventions to treat depression that focus on the emotional adjustment to physical impairment.

Aged↗
PubMedDate not supplied

Reduction of natural killer cytotoxic activity in major depression: interaction between depression and cigarette smoking.

OBJECTIVE: Epidemiological data suggest that the presence of a depressed mood combined with cigarette smoking increases the risk of cancer at sites associated with smoking and at sites not associated with smoking. This study tested the hypothesis that major depression and smoking together contribute to a decline of natural killer cell (NK) activity, an immune parameter thought to be important in immune surveillance. METHODS: A sample of 245 men were stratified into four groups: control subjects who were not smokers, control subjects who were smokers, subjects with major depression who were not smokers, and subjects with major depression who were smokers. Blood samples were obtained for measurement of total white blood cell (WBC) counts, differential cell counts, and assay of NK activity. RESULTS: Major depression and cigarette smoking interact and were together associated with changes in WBC counts and NK activity. Depressed subjects who were smokers had higher WBC counts (p < .001) and lower NK activity (p < .01) than depressed nonsmoking subjects. However, WBC counts and NK activity were similar in control smokers and nonsmokers. Backward elimination regression analyses showed that the interaction of depression and smoking significantly (p < .001) predicted WBC counts and NK activity. CONCLUSIONS: This study extends previous findings of immune alterations in patients with major depression. Major depression and smoking interact and together contribute to an elevation of total WBC count and a decline of NK activity.

Adult↗
PubMed2001

Cognitive vulnerability to depression in 5-year-old children of depressed mothers.

Studies of cognitive vulnerability to depression in young children have, in the main, relied on self-report questionnaires (e.g. of self-esteem, attributional style). They have failed to produce convincing evidence of a cognitive vulnerability to depression in children under 8 years. In the current study latent depressive cognitions were investigated in the 5-year-old children (N = 94) of depressed and well mothers in a situation of mild stress, that is, the threat of losing a card deal in a modified version of the competitive children's card game "Snap"'. In the context of "losing", but not "winning", deals, children who had been exposed to maternal depression, either in the previous 12 months or at any other time during their lifetime, were more likely than nonexposed children to express depressive cognitions (hopelessness, pessimism, and low self-worth). The association between depressive cognitions and recent exposure to maternal depression was in part accounted for by current maternal hostility to the child. The results of this study stand in contrast to those of studies which have used questionnaire methods to assess vulnerability to depressive cognitions in this age group. They suggest that it might be important to employ ecologically realistic situations to access latent self-cognitions in young children; and they underscore the importance. increasingly evident in research with adults and older children, of employing methods that involve the induction of low mood in order to elicit cognitions relevant to depression.

Adaptation, Psychological↗
PubMed1995

Assessment of depression: comparison between Beck Depression Inventory and subscales of Comprehensive Psychopathological Rating Scale.

The purpose of this study was to investigate the relationship between self-rating and therapist rating in nonpsychotic patients with unipolar depressive disorders. We also wanted to find out whether the presence of personality disorders would influence the results. At admission and discharge 117 patients filled in the Beck Depression Inventory (BDI) and were rated by a therapist on the Comprehensive Psychopathological Rating Scale (CPRS). Based on the CPRS-scores, two indices of depression were calculated: CPRS-dep and Montgomery Asberg Depression Rating Scale (MADRS). Sixty-three patients had DSM-III-R major depression, 30 had dysthymic disorder, while 24 had no depressive disorder. Eighty suffered from one or more personality disorders, mostly within cluster C. The self rating (BDI) and therapist ratings (CPRS-dep and MADRS) were strongly intercorrelated, with a nonsignificant tendency for weaker correlations in patients with personality disorders. All scales were useful to separate depressed from non-depressed, and to discriminate between major depression and dysthymic disorder, with a tendency in favour of BDI. As cut-off scores for major depression we recommend the sum score of 23 on the BDI, and mean scores of 1 on CPRS-dep and 1.1 on MADRS on a 0-3 scale. When these values are used, 70-79% of patients are correctly classified.

Adult↗
PubMed1997

Lower serum high-density lipoprotein cholesterol (HDL-C) in major depression and in depressed men with serious suicidal attempts: relationship with immune-inflammatory markers.

Recently, there have been some reports that changes in serum lipid composition may be related to suicide, major depression and immune-inflammatory responses. Findings from our laboratory suggest that major depression is accompanied by reduced formation of cholesteryl esters and perhaps by impairment of reverse cholesterol transport. The latter is reportedly accompanied by lower serum high-density lipoprotein cholesterol (HDL-C). The aim of this study was to examine whether (i) major depression is accompanied by lower serum HDL-C or by abnormal levels of serum total cholesterol, triglycerides, low-density lipoprotein-C (LDL-C) or vitamin E, (ii) suicidal attempts are related to lower serum HDL-C and (iii) there are significant associations between serum HDL-C and immune/inflammatory markers. A total of 36 subjects with major depression, of whom 28 patients showed treatment resistance, as well as 28 normal control subjects, had blood sampled for the assay of the above lipids, serum zinc (Zn), albumin (Alb) and flow cytometric determination of the T-helper/T-suppressor (CD4+/CD8+) T-cell ratio. In total, 28 depressed subjects had repeated measures of these variables both before and after treatment with antidepressants. Serum HDL-C and total cholesterol, as well as the HDL-C/cholesterol ratio, were significantly lower in subjects with major depression than in normal controls. Serum HDL-C levels were significantly lower in depressed men who had at some time made serious suicidal attempts than in those without such suicidal behaviour. Treatment with antidepressants for 5 weeks did not significantly alter either serum HDL-C or other lipid variables. Serum HDL-C levels were significantly and negatively correlated with the (CD4+/CD8+) T-cell ratio, and positively correlated with serum Alb and Zn. These results suggest that (i) lower serum HDL-C levels are a marker for major depression and suicidal behaviour in depressed men, (ii) lower serum HDL-C levels are probably induced by the immune/inflammatory response in depression and (iii) there is impairment of reverse cholesterol transport from the body tissues to the liver.

Adult↗
PubMed1978

The effects of reducing frequency of negative thoughts on the mood of depressed patients-tests of a cognitive model of depression.

Cognitive theories of depression propose that depressed mood is caused by depressing cognitions (negative thoughts). In two studies of depressed patients, presentation of external information at a high rate was used to reduce the frequency of negative thoughts, and the subsequent effect on depressed mood examined. Single-case designs were employed in both studies. In the first study, significant reduction in negative thoughts and depressed mood was achieved in each of two selected patients. In the second study, the same procedure produced reduction in negative thoughts which was individually significant for seven of 13 unselected depressed patients, and also significant for the 13 patients as a group. However, this led to little improvement in depressed mood. This appeared to be due to the small extent of thought reduction achieved. Reduction in negative thought frequency correlated significantly with score on the Newcastle diagnosis scale, being greater for neurotic compared to endogenous depression. Mean depressed mood and mean negative thought frequency were significantly positively correlated across subjects.

Adolescent↗
PubMed2004

Depressive mixed state: a feature of the natural course of bipolar II (and major depressive) disorder?

BACKGROUND: Depressive mixed state (DMX), i.e., a combination of hypomanic and depressive symptoms during the same episode, has recently seen a rebirth of studies after Kraepelin's description. Kraepelin observed, in an inpatient sample, that DMX was related to the number of episodes and to duration of manic-depressive insanity (illness). STUDY AIM: The aim was to test Kraepelin's observations in a very different sample. METHODS: 563 consecutive outpatients with major depressive episode (MDE)--320 with bipolar II disorder and 243 with major depressive disorder--were interviewed, in a private practice, by the Structured Clinical Interview for DSM-IV as modified by Benazzi and Akiskal (2003). Hypomanic symptoms during MDE were systematically assessed in patients while off psychoactive drugs. DMX was dimensionally defined, following Akiskal and Benazzi (2003), as an MDE plus 3 or more combined hypomanic symptoms. Kraepelin's examples of DMX, i.e., agitated depression (MDE plus psychomotor agitation) and depression with flight of ideas (MDE plus racing thoughts) were also tested. Univariate and multivariate logistic regression was used to study associations. RESULTS: DMX was present in 49.5% of the patients. Multiple logistic regression of DMX versus MDE recurrences and duration of illness, controlled for age, found a strong and significant association only between DMX and duration of illness. The same association was found between agitated depression and duration of illness (but not in depression with racing thoughts). LIMITATION: There was only a single interviewer. DISCUSSION: The findings support Kraepelin's observation of a link between DMX and durations of illness, but not that between DMX and recurrences. Onset of DMX could be more related to the natural course of manic-depressive illness than to a kindling process.

Adult↗
PubMed2005

Psychopathologic correlates of suicidal ideation in major depressive outpatients: is it all due to unrecognized (bipolar) depressive mixed states?

BACKGROUND: Recent transatlantic concern about suicidality in patients receiving antidepressants prompted us to examine the psychopathologic correlates of suicidal ideation occurring in clinically depressed patients. METHODS: The study sample, which consisted of 644 consecutive major depressive outpatients, of which 58.0% had bipolar II disorder (BP-II), was systematically interviewed with the SCID, in order to delineate the diagnostic and psychopathologic correlates of suicidal ideation. RESULTS: Such ideation, which was present in 49.5% [and favoring BP-II vs. major depressive disorder (MDD)] at an odds ratio (OR) of 1.3 (95% confidence interval = 0.98-1.8), was clinically significantly associated with depressive mixed state (racing/crowded thoughts and psychomotor agitation/activation during index depression), mood lability, decreased self-esteem, anorexia, as well as melancholic and psychotic features. Multiple logistic regression of suicidal ideation versus depressive symptoms and intradepressive excitatory symptoms revealed that decreased self-esteem (OR = 3.3), racing/crowded thoughts (OR = 1.5), and psychomotor agitation/activation (OR = 1.4) were independent and clinically significant correlates of suicidal ideation, irrespective of depression severity. DISCUSSION: From a psychopathologic standpoint, suicidality might be conferred by a combination of both the excited (mixed) depressive and agitated (melancholic) clusters. Trait mood lability appears to favor the genesis of these affective clusters. Within the framework of Kraepelinian psychiatry, both clusters represent depressive mixed states. Given that such states are more prevalent in BP-II, our data provide a possible explanation for the greater suicidality in BP-II patients reported in the literature. In light of the higher odds of suicidal ideation in BP-II versus MDD patients, we hypothesize that the higher prevalence of mental and psychomotor activation in BP-II might be one factor among others that favors the greater likelihood of the transition from suicidal ideation to suicidal action in BP-II. Our analyses delineate a mixed depressive substrate at risk for suicidality. To what extent, if any, antidepressant monotherapy might contribute to the genesis of such states and/or suicidality cannot be answered with the methodology of the present study.

Adult↗