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PubMed1996

Clinical and neuropsychological comparison of psychotic depression with nonpsychotic depression and schizophrenia.

OBJECTIVE: This study compared the clinical and neuropsychological characteristics of patients with psychotic depression to those of patients with nonpsychotic depression and patients with schizophrenia. METHOD: Two hundred eighteen patients over the age of 45, including 30 who met the DSM-III-R criteria for unipolar major depression with psychotic features, 28 with nonpsychotic unipolar major depression, and 160 with schizophrenia, were examined. Subjects were evaluated on several clinical measures as well as on neuropsychological tests of attention, learning, memory (retention), psychomotor speed, and motor skills. RESULTS: The three groups were comparable in age and education. The severity of depressive symptoms in the depressed patients with and without psychosis was similar. The patients with psychotic depression were comparable to those with schizophrenia on the neuropsychological measures; they were more impaired than the patients with nonpsychotic depression on the measures of psychomotor speed, motor skills, attention, and learning. The cognitive deficits seemed to be trait-related. CONCLUSIONS: The findings provide additional support for the validity of psychotic depression as a diagnostic category distinct from nonpsychotic depression.

Age of Onset↗
PubMed2003

'Real-life burden of depression' surveys--GP and patient perspectives on treatment and management of recurrent depression.

Depression is a chronic, recurrent illness carrying a heavy burden for the health service and the community. Current evidence suggests that the majority of patients with depression will experience recurrent episodes of illness, although there is extensive evidence that continuation therapy with antidepressant drugs will prevent relapse. Two surveys were designed and distributed in the UK in 2002 to compare the expectations of patients and GPs in the management of relapse in depression. For the patient survey, 1010 completed questionnaires of the 7000 distributed (through the charity Depression Alliance), were returned for analysis and feedback. For the GP survey (endorsed by the charity Primary care Mental Health Education (PriMHE), 200 responses were received from the 400 GPs contacted. A majority of patients in the survey (85%) who experience depression expressed concern about recurrent episodes and 88% of respondents had suffered at least one repeat episode. The survey found that 65% of respondents had stopped taking their medication at some stage: reasons cited include unacceptable side-effects and lack of efficacy. The findings suggest that discontinuation and non-compliance of therapies is associated with recurrent depression. Continuation therapy is now standard treatment to avoid recurrent depression; however, the majority of GPs questioned, continued therapy for less than the 6 months after acute treatment response as advised by the British Associated of Psychopharmacologists. Although depression is generally managed well at primary care level, this survey highlights the major worries of depression sufferers concerning further episodes of depression and the need to prevent relapse and recurrence through safe and effective therapies with which these patients are happy to comply.

Attitude of Health Personnel↗
PubMed1999

Post-stroke depression and functional outcome: a cohort study investigating the influence of depression on functional recovery from stroke.

OBJECTIVE: To investigate the influence of depression on functional recovery after stroke. DESIGN: Multicentre cohort study of 85 patients admitted for clinical rehabilitation. A two-stage case-finding procedure was used to identify patients with depression. For the control group, consecutive nondepressed stroke patients were enrolled. Patients were interviewed at 3-6 weeks and six months after stroke onset. SETTING: Three rehabilitation centres in the vicinity of Amsterdam. MAIN OUTCOME MEASURES: Functional outcome was determined by the Functional Independence Measure (FIM) and the Rehabilitation Activities Profile (RAP). RESULTS: The prevalence of depression (35%) was comparable with the findings of earlier studies in other settings. Patients classified as depressed according to DSM III R criteria (American Psychiatric Association Diagnostic and statistical manual of mental disorders) had a significantly lower functional score, both at onset and after follow-up (FIM and RAP). There was, however, no significant difference in functional improvement between the depressed and the nondepressed group. Mean functional improvement in the six patients treated with antidepressants was 30% better than in the untreated (depressed) patients; numbers were too small for the results to attain statistical significance. Subset analysis showed a significantly higher outcome for nondepressed patients for the FIM subitems personal care and transfers. However, functional improvement was not significantly different for any of the subitems in depressed versus nondepressed patients. CONCLUSION: Stroke patients with depression have significantly lower functional scores both at onset and after six months. Our results suggest under-recognition of post-stroke depression and a possible beneficial effect of antidepressant medication in depressed stroke patients. Further studies are required to determine the effect of antidepressants.

Activities of Daily Living↗
PubMed1996

Relationships among negative, positive, and depressive symptoms in schizophrenia and psychotic depression.

BACKGROUND: We examined relationships among positive, negative, and depressive symptoms in schizophrenia and major depression with psychosis. METHOD: Patients with schizophrenia (n = 17) and major depression and psychotic features (n = 25), with no prior psychopharmacologic treatment were assessed on scales measuring positive psychotic, negative, and depressive symptoms. RESULTS: Analyses revealed the depressive symptoms positively correlated with anhedonia/asociality and avolition/apathy in both patient groups. Positive psychotic symptoms significantly correlated with depressive symptoms in the schizophrenic group. CONCLUSIONS: Several specific symptoms used in defining both depressive and negative syndrome constructs appear to be shared. The relationship between positive symptoms and depression in schizophrenia and not psychotic depression suggests the severity of depression may be involved in this relationship.

Adolescent↗
PubMed1995

Tianeptine. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in depression and coexisting anxiety and depression.

Tianeptine is a novel antidepressant agent, both structurally (modified tricyclic) and in terms of its pharmacodynamic profile. Unlike other antidepressant agents, tianeptine stimulates the uptake of serotonin (5-hydroxytryptamine; 5-HT) in rat brain synaptosomes and rat and human platelets, increases 5-hydroxyindoleacetic acid (5-HIAA) levels in cerebral tissue and plasma, and reduces serotonergic-induced behaviour. Tianeptine reduces the hypothalamic-pituitary-adrenal response to stress, antagonises stress-induced behavioural deficits and prevents changes in cerebral morphology. The antidepressant efficacy of tianeptine, as shown in 2 trials of patients with major depression or depressed bipolar disorder with or without melancholia, is greater than that of placebo. In patients with major depression without melancholia or psychotic features, depressed bipolar disorder or dysthymic disorder, the antidepressant efficacy of short term (4 weeks to 3 months) tianeptine therapy appears to be similar to that of amitriptyline, imipramine and fluoxetine and may be superior to that of maprotiline in patients with coexisting depression and anxiety. However, submaximal dosages of amitriptyline and maprotiline were used in these studies. Preliminary evidence suggests that tianeptine may also be effective in patients with endogenous depression. Progressive therapeutic improvements have been observed with up to 1 year of tianeptine treatment, and long term therapy may reduce the rate of relapse or recurrence. Tianeptine is effective in the treatment of depression in elderly and post-alcohol-withdrawal patient subgroups. Tianeptine was more effective in reducing psychic anxiety than placebo in patients with major depression or depressed bipolar disorder with or without melancholia. The overall anxiolytic properties of tianeptine in patients with coexisting depression and anxiety appear to be similar to those of amitriptyline, imipramine and fluoxetine and may be superior to those of maprotiline, although submaximal dosages of amitriptyline and maprotiline were used. Studies of tianeptine in patients with primary anxiety have not been conducted. Tianeptine is well tolerated in the short (3 months) and long (up to 1 year) term. The incidence of dry mouth (38 vs 20%), constipation (19 vs 15%), dizziness/syncope (23 vs 13%), drowsiness (17 vs 10%) and postural hypotension (8 vs 3%) are greater with amitriptyline than with tianeptine. Insomnia and nightmares occur in more tianeptine than amitriptyline recipients (20 vs 7%). The relative lack of sedative, anticholinergic and cardiovascular adverse effects with tianeptine makes it particularly suitable for use in the elderly and in patients following alcohol withdrawal; these patients are known to have increased sensitivity to the adverse effects associated with psychotropic drugs.(ABSTRACT TRUNCATED AT 400 WORDS)

Aging↗
PubMed2005

Overcoming Depression on the Internet (ODIN) (2): a randomized trial of a self-help depression skills program with reminders.

BACKGROUND: Guided self-help programs for depression (with associated therapist contact) have been successfully delivered over the Internet. However, previous trials of pure self-help Internet programs for depression (without therapist contact), including an earlier trial conducted by us, have failed to yield positive results. We hypothesized that methods to increase participant usage of the intervention, such as postcard or telephone reminders, might result in significant effects on depression. OBJECTIVES: This paper presents a second randomized trial of a pure self-help Internet site, ODIN (Overcoming Depression on the InterNet), for adults with self-reported depression. We hypothesized that frequently reminded participants receiving the Internet program would report greater reduction in depression symptoms and greater improvements in mental and physical health functioning than a comparison group with usual treatment and no access to ODIN. METHODS: This was a three-arm randomized control trial with a usual treatment control group and two ODIN intervention groups receiving reminders through postcards or brief telephone calls. The setting was a nonprofit health maintenance organization (HMO). We mailed recruitment brochures by US post to two groups: adults (n = 6030) who received depression medication or psychotherapy in the previous 30 days, and an age- and gender-matched group of adults (n = 6021) who did not receive such services. At enrollment and at 5-, 10- and 16-weeks follow-up, participants were reminded by email (and telephone, if nonresponsive) to complete online versions of the Center for Epidemiological Studies Depression Scale (CES-D) and the Short Form 12 (SF-12). We also recorded participant HMO health care services utilization in the 12 months following study enrollment. RESULTS: Out of a recruitment pool of 12051 approached subjects, 255 persons accessed the Internet enrollment site, completed the online consent form, and were randomized to one of the three groups: (1) treatment as usual control group without access to the ODIN website (n = 100), (2) ODIN program group with postcard reminders (n = 75), and (3) ODIN program group with telephone reminders (n = 80). Across all groups, follow-up completion rates were 64% (n = 164) at 5 weeks, 68% (n = 173) at 10 weeks, and 66% (n = 169) at 16 weeks. In an intention-to-treat analysis, intervention participants reported greater reductions in depression compared to the control group (P = .03; effect size = 0.277 standard deviation units). A more pronounced effect was detected among participants who were more severely depressed at baseline (P = .02; effect size = 0.537 standard deviation units). By the end of the study, 20% more intervention participants moved from the disordered to normal range on the CES-D. We found no difference between the two intervention groups with different reminders in outcomes measures or in frequency of log-ons. We also found no significant intervention effects on the SF-12 or health care services. CONCLUSIONS: In contrast to our earlier trial, in which participants were not reminded to use ODIN, in this trial we found a positive effect of the ODIN intervention compared to the control group. Future studies should address limitations of this trial, including relatively low enrollment and follow-up completion rates, and a restricted number of outcome measures. However, the low incremental costs of delivering this Internet program makes it feasible to offer this type of program to large populations with widespread Internet access.

Adult↗
PubMed2003

Multimethod validation of the Beck Depression Inventory-II and Grossman-Cole Depression Inventory with an inpatient sample.

Psychometric examination of the Beck Depression Inventory-II has been adequate and varied for outpatient and nonclinical samples, but is still comparatively scant for inpatient psychiatric samples. In particular, important factor analytic questions have not been assessed on inpatient samples at all. Given that over time alone (regardless of symptom change) test scores on depression measures can spuriously drop, a convergent psychometric analysis of the Beck Depression Inventory-II was undertaken with a new measure of depression severity, the Grossman-Cole Depression Inventory. A sample of 101 psychiatric inpatients was administered both tests. Item and scale level psychometrics were reviewed for each measure. Results were highly consistent with previous findings, providing support for the use of the Beck Depression Inventory-II with inpatient samples. Moreover, the new inventory performed quite well, suggesting it has promise as another measure for self-reported depression symptom severity. The Beck Depression Inventory-II appears appropriately considered as a single-factor hierarchical measure of depression with the current inpatient sample. Moreover, the Grossman-Cole Depression Inventory is related enough to the Beck inventory to provide adequate similarity without being so similar the measures duplicate each other.

Adolescent↗
PubMed1993

Prevalence of post partum depression--or is it post-puerperium depression?

In a longitudinal study, the prevalence of post partum depression was investigated in 293 women. They were assessed during gestation at 32 weeks, and consecutively after parturition with an interval of six weeks from four weeks until 34 weeks' post partum. The prevalence of post partum depression (RDC) varied between seven and 14%, with a peak at ten weeks' post partum. It was found that women were depressed significantly more often at ten weeks' post partum compared with pregnancy, the first post partum weeks and the later post partum period. This finding suggests that it is not directly after parturition that women are more prone to depression. The relationship between variables such as blues, parity, PMS and depression showed that at different assessments in the post partum period different women are depressed, women who do not necessarily share the same characteristics. This finding may explain why in some studies a relationship was found between certain kinds of variables and post partum depression while in others not. PMS was found to be significantly related to post partum depression only at the time of the women resumed menstruation. It is suggested that screening on post partum depression partly involves screening on depressive symptoms related to PMS.

Adult↗
PubMed1999

Depression duration but not age predicts hippocampal volume loss in medically healthy women with recurrent major depression.

This study takes advantage of continuing advances in the precision of magnetic resonance imaging (MRI) to quantify hippocampal volumes in a series of human subjects with a history of depression compared with controls. We sought to test the hypothesis that both age and duration of past depression would be inversely and independently correlated with hippocampal volume. A sample of 24 women ranging in age from 23 to 86 years with a history of recurrent major depression, but no medical comorbidity, and 24 case-matched controls underwent MRI scanning. Subjects with a history of depression (post-depressed) had smaller hippocampal volumes bilaterally than controls. Post-depressives also had smaller amygdala core nuclei volumes, and these volumes correlated with hippocampal volumes. In addition, post-depressives scored lower in verbal memory, a neuropsychological measure of hippocampal function, suggesting that the volume loss was related to an aspect of cognitive functioning. In contrast, there was no difference in overall brain size or general intellectual performance. Contrary to our initial hypothesis, there was no significant correlation between hippocampal volume and age in either post-depressive or control subjects, whereas there was a significant correlation with total lifetime duration of depression. This suggests that repeated stress during recurrent depressive episodes may result in cumulative hippocampal injury as reflected in volume loss.

Adult↗
PubMed2000

The Temple-Wisconsin Cognitive Vulnerability to Depression Project: lifetime history of axis I psychopathology in individuals at high and low cognitive risk for depression.

The authors tested the cognitive vulnerability hypotheses of depression with a retrospective behavioral high-risk design. Individuals without current Axis I diagnoses who exhibited either negative or positive cognitive styles were compared on lifetime prevalence of depressive and other disorders and the clinical parameters of depressive episodes. Consistent with predictions, cognitively high-risk participants had higher lifetime prevalence than low-risk participants of major and hopelessness depression and marginally higher prevalence of minor depression. These group differences were specific to depressive disorders. The high-risk group also had more severe depressions than the low-risk group, but not longer duration or earlier onset depressions. The risk group differences in prevalence of depressive disorders were not mediated by current depressive symptoms.

Adolescent↗
PubMed2001

Sequential interactions in the parent-child communications of depressed fathers and depressed mothers.

Parental depression predicts adjustment problems and depression in offspring, yet little is known about the factors that explain this intergenerational transmission. In the present study, the authors examined one model suggesting that families with a depressed member may respond differently to positive and negative communications than families without a depressed member, differences that have been theorized to adversely impact offspring development. The authors compared the sequential patterns of parent-child interaction among families with depressed mothers, depressed fathers, and nondepressed parents. Positivity suppression, defined as decreased rates of positivity following a positive communication from other family members, characterized the interactions of families with a depressed father, but not those with a depressed mother or no depressed parent. Father-child positivity suppression and low base rates of positivity were associated with child behavior problems, but not after accounting for paternal depression.

Adolescent↗
PubMed2000

[Depression in the aged: preliminary evaluation of the effectiveness, as an screening instrument, of the 5-item version of the Geriatric Depression Scale].

INTRODUCTION: The best approach to improve under-recognition of depression is routine screening, ideally using an instrument that is highly effective and easy to administer. OBJECTIVE: To test the effectiveness of the 5-item version of the Geriatric Depression Scale (5-GDS) for depression screening in a community-dwelling Chilean elderly population. PARTICIPANTS AND METHODS: 110 subjects were evaluated at the geriatric outpatient clinic of a university teaching hospital. Patients answered a questionnaire that included the Geriatric Depression Scale (GDS), and demographic information. Using the 15-item GDS score as reference standard to classify subjects as depressed, test characteristics of the 5-GDS were evaluated. RESULTS: Subjects had a mean 15-item GDS score of 5.4; 47% classified as depressed. Depressed and not depressed subjects were similar with regard to demographics, educational level and comorbid conditions. The mean score was 1.9 for the 5-item GDS. Pearson correlation for 15-item and 5-item GDS scores was 0.92, p < 0.001. Using 15-item GDS score as reference standard, the 5-item GDS had a sensitivity of 0.88, specificity 0.90, positive predictive value 0.88 and negative predictive value 0.90. CONCLUSIONS: The 5-item GDS seems to be a promising screening tool for depression. If revalidated against clinical evaluation, it might be the preferred screening tool for depression in the Chilean community-dwelling elderly.

Aged↗
PubMed2003

An epidemiological study of depressive symptomatology among Israeli adults: prevalence of depressive symptoms and demographic risk factors.

BACKGROUND: Depression is a common, under-recognized disorder that causes a great burden on the individual, the family and the community. Depressive symptomatology has serious effects on the psychological and medical condition of patients, and also disrupts their well-being and daily activities. The aim of the present study was to investigate the prevalence of depressive symptomatology in the Israeli population, and its relation to demographic variables and perceived health. METHODS: A random sample of 937 Israeli adults filled out the Beck Depression Inventory (BDI) together with a demographic questionnaire. RESULTS: 21.5% scored positively for depressive symptomatology (BDI > 9). 3.8% reached a BDI score in the range of severe depression. Female gender, old age, lower education, immigrant status, manual work and lower income were associated with increased rates of depressive symptomatology. Poor perceived health was also associated with depressive symptomatology. CONCLUSIONS: The rates of depressive symptomatology in this study are similar to those found in other studies, performed mostly in Western countries. Despite several methodological limitations, we conclude that the rate and the demographic risk factors of depression in Israel are similar to that of other developed and Western countries.

Adolescent↗
PubMed2006

Moderate or severe depression is uncommon in women seeking infertility therapy according to the beck depression inventory.

PURPOSE: To determine what percentage of infertility patients have depression. METHODS: The Beck Depression Inventory test was given to new infertility patients on a voluntary basis. RESULTS: There were no women with moderate or severe depression. In fact only 10% (3/30) scored mild depression. For those women without or with minimal depression 37% (10/27) conceived on their first cycle vs none (0/3) of those with mild depression. CONCLUSIONS: The numbers with mild depression were too small to make valid conclusions. However, this group had a significantly longer length of infertility. Thus even if a more extensive study shows similar data it may well be that the length of infertility causes only mild depression rather than that depression leads to infertility. However the possibility still exists that even mild depression may to some degree impair success with infertility therapy.

Adult↗
PubMed1993

[The personality of unipolar depressive and bipolar manic-depressive patients].

Starting from central hypotheses on the relationship between personality and affective disorders, the profiles in the Freiburg Personality Inventory (FPI-A) of 23 unipolar depressives, 26 bipolar manic-depressives and 30 healthy controls of the standardization sample were analysed. Assessment by the Freiburg Personality Inventory was carried out at the time of discharge under the instruction to refer the answers to the time before the beginning of the illness. Parallel to the personality assessment the degree of remission was documented by the scales "Depressive Syndrome", "Apathetic Syndrome" and "Manic Syndrome" of the AMDP system and the d2 concentration test. In intraclass covariance analyses the following scales showed significant differences between unipolar depressives, bipolar manic-depressives and normal controls: FPI3 "Depressiveness", FPI8 "Inhibition" and FPIE "Extraversion". The differences cannot be explained by age or sex. In contrast to manic-depressives, unipolar depressives characterize themselves as more depressive, inhibited and introverted. The bipolar manic-depressives do not differ from the norms in any scale of the FPI. These findings are compared both with the starting hypotheses and with results reported in the literature.

Adult↗
PubMedDate not supplied

[Anhedonia in major depression. Comparison of 55 depressed patients with 54 healthy probands].

A study on 55 subjects who meet Spitzer's research Diagnosis Criteria of primary major depressive disorder and 54 healthy subjects has been conducted to explore anhedonia. The two groups were matched concerning the socio-demographic variables (sex, age, education level). Anhedonia was rated using the Physical Anhedonia Scale (PAS) and a physical sub-scale (FCPCS-PP) extracted from the Fawcett Clark pleasure scale. The severity of depression was rated using the Bech HDRS (Hamilton Depression Rating Scale) subscale for global severity. The results have shown that the major depressives are significantly more anhedonic than controls. The PAS mean score of depressives (m = 24.45, sd = 9.22) was significantly higher than the meaning score of normals (m = 16.9, sd = 7.13) (t = 4.7, df = 107, p = 0.0001). The FCPCS-PP mean score of depressives (m = 81, sd = 15) was significantly lower than the mean score of normals (m = 90.6, sd = 7.3) (t = 4.2, df = 107, p = 0.0001). The Pearson correlation coefficients between the anhedonia scales (PAS and FCPCS-PP) and the Bech HDRS were not statistically significant. Anhedonia in major depression seems to be independent of the depression intensity. The distribution of the PAS and the FCPCS-PP scores have been studied in the major depressive group using a test of normality (chi 2 analysis). The results have shown for each scale a normal distribution. Our results do not support the hypothesis of the existence of a severely anhedonic sub-group of major depressives.

Adult↗
PubMed1998

McLean Hospital depression research facility: early-onset phobic disorders and adult-onset major depression.

BACKGROUND: This study explores the temporal relationship between anxiety and major depressive disorders in a cohort of patients with current major depression. METHOD: Current prevalence and lifetime history of specific anxiety disorders were assessed using the Structured Clinical Interview for DSM-III-R Diagnosis (SCID-P) in 85 patients with DSM-III-R major depression. Consensus DSM-III-R diagnoses were assigned by at least two psychiatrists or psychologists. RESULTS: Twenty-nine per cent met criteria for at least one current anxiety disorder and 34% had at least one anxiety disorder at some point in their lives. The mean (s.d.) age of onset of anxiety disorder in the depressed patients with comorbid social or simple phobia (15 (9) years) was significantly younger than was that of their major depression (25 (9) years). In contrast, the mean (s.d.) age of onset of anxiety in patients with comorbid panic or OCD (20 (8) years) was similar to that seen for their major depression (21 (9) years). In patients with major depression with comorbid anxiety disorders, both the social phobia (10 of 13) and simple phobia (4 of 4) were more commonly reported to start at least two years prior to their major depression in contrast to depressives with comorbid panic (3 of 10 subjects)-Fisher's exact test, P = 0.01. CONCLUSIONS: Early-onset social and simple phobias appear to be risk factors for later onset of major depression.

Adolescent↗
PubMed2006

Predicting the onset of major depressive disorder and dysthymia in older adults with subthreshold depression: a community based study.

BACKGROUND: It is well-established that the incidence of major depressive disorder is increased in subjects with subthreshold depression. A new research area focuses on the possibilities of preventing the onset of major depressive disorders in subjects with subthreshold depression. An important research question for this research area is which subjects with subthreshold depression will develop a full-blown depressive disorder and which will not. METHODS: We selected 154 older subjects with subthreshold depression (CES-D>16) but no DSM mood disorder from a longitudinal study among a large population based cohort aged between 55 and 85 years in The Netherlands. Of these subjects, 31 (20.1%) developed a mood disorder (major depression and/or dysthymia) at three-year or six-year follow-up. We examined risk factors and individual symptoms of mood disorder as predictors of onset of mood disorder. RESULTS: Two variables were found to be significant predictors in both bivariate and multivariate analyses: eating problems and sleep problems. The incidence of mood disorders differed strongly for different subpopulations, varying from 9% (for those not having any of the two risk factors) to 57% (for those having both risk factors). CONCLUSIONS: It appears to be possible to predict to a certain degree whether a subject with subthreshold depression will develop a mood disorder during the following years.

Aged↗