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PubMed1995

Total serum protein and serum protein fractions in depression: relationships to depressive symptoms and glucocorticoid activity.

Recently, it has been reported that major depression is accompanied by changes in plasma protein concentrations indicative of an acute-phase protein (APP) response. The purpose of the present study was to examine total serum protein (TSP) and the electrophoretically separated major fractions of serum proteins (SP), i.e., albumin (Alb), alpha 1, alpha 2, beta and gamma globulin, in depression. Highly significant differences were found in TSP and the separated SP fractions between major depressed patients and normal controls and between melancholic and minor depressed patients. Major depressed subjects showed significantly lower TSP and Alb concentrations and a higher percentage of the alpha 1 globulin fraction than normal controls and minor depressed subjects. Major depressed subjects had significantly higher and lower percentages, respectively, of alpha 2 and gamma globulin fractions than normal controls. In depressed subjects, there were significant negative correlations between TSP or Alb concentrations and severity of illness. Psychomotor retardation and anorexia were psychopathological correlates of lower TSP and Alb concentrations while middle insomnia and psychomotor retardation were related to changes in the alpha 2 globulin fractions. Basal plasma cortisol values were significantly and positively related to serum alpha 2 globulin. The results support the view that major depression is accompanied by an APP response.

Acute-Phase Proteins↗
PubMed1986

Chronic pain and depression. III. Family history study of depression and alcoholism in chronic low back pain patients.

In an attempt to unravel the relationship between chronic pain and depression, the authors studied the incidence of depression, alcoholism, and chronic pain in first degree relatives of 100 chronic pain patients with and without depression. A higher incidence of major depression was found in first degree relatives of those patients with depression than those without depression. Familial incidence of alcohol dependence was similar in both groups of patients. These findings confirm an earlier report and raise questions about the notion of considering chronic pain simply as a variant of depression and suggest the possibility that the occurrence of major depression in chronic back pain might be related to genetic vulnerability to depression in these patients.

Adult↗
PubMed2006

Disturbances in morning cortisol secretion in association with maternal postnatal depression predict subsequent depressive symptomatology in adolescents.

BACKGROUND: We have previously reported higher and more variable salivary morning cortisol in 13-year-old adolescents whose mothers were depressed in the postnatal period, compared with control group adolescents whose mothers did not develop postnatal depression (PND). This observation suggested a biological mechanism by which intrafamilial risk for depressive disorder may be transmitted. In the current article, we examined whether the cortisol disturbances observed at 13 years could predict depressive symptomatology in adolescents at 16 years of age. METHODS: We measured self-reported depressive symptoms in 16-year-old adolescents who had (n = 48) or had not (n = 39) been exposed to postnatal maternal depression and examined their prediction by morning and evening cortisol indices obtained via 10 days of salivary collections at 13 years. RESULTS: Elevated morning cortisol secretion at 13 years, and particularly the maximum level recorded over 10 days of collection, predicted elevated depressive symptoms at 16 years over and above 13-year depressive symptom levels and other possible confounding factors. Morning cortisol secretion mediated an association between maternal PND and symptomatology in 16-year-old offspring. CONCLUSIONS: Alterations in steroid secretion observed in association with maternal PND may provide a mechanism by which risk for depression is transmitted from mother to offspring.

Adolescent↗
PubMed2003

Severity of stressful life events in first and subsequent episodes of depression: the relevance of depressive subtype.

BACKGROUND: Recent studies have reignited debate concerning the relationship between stressful life events and depressive subtypes, particularly in relation to first versus subsequent episodes. AIMS: To investigate the relationship between stressful life events and variably defined melancholic/non-melancholic depressive subtypes, and the import of such life events to first compared with subsequent episodes across those subtypes. METHOD: Acute and chronic stressful life events were rated in 270 patients with DSM-IV Major Depressive episodes who were allocated to melancholic and non-melancholic groups separately as defined by DSM-III-R, DSM-IV, the Newcastle criteria and the CORE system. RESULTS: Severe stressful life events (both acute and chronic)-as defined by DSM-III-R axis IV-were more likely to occur prior to first rather than subsequent episodes, particularly for those with non-melancholic depression. LIMITATIONS: Dependence or independence of life events was not assessed. Genetic vulnerability to depression was not determined. Life events in first and subsequent depressive episodes were compared cross-sectionally between groups, not prospectively in the same cohort of patients. There were no differences in the number of severe life events-as defined by clinician consensus-between the first and subsequent episodes. CONCLUSIONS: These findings are consistent with other studies in suggesting an enhanced sensitisation of depressed patients to subsequent episodes of depression, but suggest that any such phenomenon is specific to non-melancholic depression, in comparison to one key previous study.

Acute Disease↗
PubMed1997

Double depression: a distinctive subtype of unipolar depression.

Whether depression is a single disease that varies from mild to severe, with varying episode durations and difficult course patterns, or whether it is an umbrella diagnosis representing depressive subtypes with different psychological and biological characteristics has been debated by clinicians and researchers for many years. However, most scientists now agree that understanding the heterogeneous subtypes of depression allows for greater accuracy in describing and differentiating patients suffering from depression and, therefore, greater precision in describing the most efficacious treatment plan. This article will focus on the distinctions between unipolar major depression, double depression and dysthymia, and will review the history of the DSM classifications for these "subtypes" of major depressive disorder, clinicians and researchers continue to subclassify major depression and, particularly, for the purpose of testing the efficacy of new psychopharmocologic and psychosocial treatments. There continues to be a need for future research to more clearly establish the predictive value in terms of course, recovery, rates of relapse and treatment in regard to distinguishing type of depression as well as to validate the current nosology.

Age of Onset↗
PubMed1998

Depressive symptom differences in hospitalized, medically ill, depressed psychiatric inpatients and nonmedical controls.

This study compared depressive and anxious symptoms in chronic medically ill individuals and depressed psychiatric inpatients using conceptually based standardized measures of cognitions and symptoms. Seventy-five hospitalized medical patients, 52 depressed psychiatric inpatients, and 25 normal controls were assessed with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1987), the Mood and Anxiety Symptom Questionnaire, Hamilton Rating Scales of Anxiety and Depression, Hospital Anxiety and Depression Scales, Beck Depression Inventory, Cognitions Checklist, and Hopelessness Scale. Analysis revealed that depression in medical patients was best distinguished by symptoms of anhedonia, low positive affect, and physiological hyperarousal, whereas syndromal depression in psychiatric inpatients was specifically characterized by negative cognition symptoms. Implications are discussed for assessing depression in medically ill populations.

Adolescent↗
PubMedDate not supplied

Major depressive episodes with hypomanic symptoms are common among depressed outpatients.

Depressive mixed states (major depressive episodes [MDE] with some hypomanic symptoms) are not classified in DSM-IV. The aim of the present study was to determine the prevalence of depressive mixed states in depressed outpatients, and to compare bipolar II with unipolar depressive mixed states. Seventy consecutive bipolar II and unipolar depressed outpatients were interviewed using the DSM-IV Structured Clinical Interview (SCID). At least one hypomanic symptom was present in 90% of patients, and three or more in 28.5%. Symptoms of depressive mixed states included irritable mood, distractibility, racing thoughts, and increased talking. Bipolar II subjects had more concurrent hypomanic symptoms (three or more in 48.7% v 3.2%, P = 0.000). Depressive mixed states with three or more hypomanic symptoms correctly classified 70.0% of bipolar II subjects. These findings have important treatment implications, as antidepressants may worsen the symptoms of depressive mixed states, and mood stabilizers can be useful.

Adult↗
PubMed1992

Maternal depression, assessment methods, and physical symptoms affect estimates of depressive symptomatology among children with cancer.

Investigated the incidence of depressive symptoms and their covariates in a sample of 99 children undergoing treatment for cancer and their mothers. Although the prevalence of depressive symptoms falling within the clinical range was low (7 to 8%), classification of these children was highly dependent upon the informant and instrument used. Interrater reliabilities did not differ from chance levels. Separate multiple regression analyses of the mother's and nurse's ratings of the child's level of depression, the child's self-report on the Child Depression Inventory, and the mother's responses to the Child Behavior Checklist depression scales revealed different statistical models for each method of assessment. However, increased severity of the mother's self-report of depressive symptoms on the Beck Depression Inventory, which was predicted by low perceived social support and hospitalization of her child, was associated with higher levels of child depression on all child- and parent-report measures. Parental adjustment, sociodemographic, and medical factors as well as methods of assessment must be addressed by models explaining the etiology of depressive symptoms among pediatric oncology patients.

Adult↗
PubMed2003

Depressive personality and its relationship to depressed mood, interpersonal loss, negative parental perceptions, and perfectionism.

Eighty veteran psychiatric outpatients were evaluated for depressive personality disorder on the Depressive Personality Disorder Inventory (DPDI). It was predicted that those classified with depressive personality would report higher levels of interpersonal loss, negative perceptions of their parents, and higher levels of perfectionism than psychiatric control subjects. Nine of the 12 measures of these variables were significantly greater in those with depressive personality compared with psychiatric control subjects. When statelike depression was controlled for, seven of the nine variables still significantly differed between the two groups. Hierarchical regression analysis and discriminant function analysis found that these variables predicted 9% of the variance in the DPDI above and beyond statelike depression, and that a combination of these variables correctly classified 91% of the depressive personalities and 88% of the psychiatric control subjects. It is concluded that, as hypothesized, depressive personality disorder is associated with loss, negative parental perceptions, and perfectionism, and that these relationships are not accounted for exclusively by a depressed mood.

Ambulatory Care↗
PubMed1992

Can mildly depressed outpatients with atypical depression benefit from antidepressants?

OBJECTIVE: The authors' goal was to explore the efficacy of antidepressant medications in outpatients with mild depression. METHOD: Four hundred one outpatients were diagnosed as depressed by DSM-III criteria. Atypical Depression Diagnostic Scale criteria were also applied to these patients; these criteria require reactivity of mood plus two of four associated features, including hypersomnia, hyperphagia, leaden paralysis, and pathological sensitivity to rejection. All patients were then randomly treated for 6 weeks with up to 300 mg/day of imipramine, up to 90 mg/day of phenelzine, or placebo. Outcome at 6 weeks was determined by clinical global improvement ratings. The outcomes of patients with entry Hamilton Rating Scale for Depression scores in the low (scores of 12 or lower), medium (scores of 13-15), and high (scores above 16) range were compared. RESULTS: The majority (N = 332, 83%) of the 401 depressed patients had definite or probable atypical depression. Among the 140 patients who had low pretreatment Hamilton scale scores, 19 (33%) of 57 given placebo, 25 (60%) of 42 given imipramine, and 34 (83%) of 41 given phenelzine responded. Each of the antidepressants was superior to placebo. Similar findings applied to the patients with medium and high Hamilton scale scores, except that the rates of placebo response were lower (29% and 10%, respectively). CONCLUSIONS: These data support the use of antidepressant medication for some mildly depressed patients, at least if they have atypical depression. Too few patients were included who did not have atypical depression to draw conclusions about such patients.

Adolescent↗
PubMedDate not supplied

Cerebrovascular disease and late-life depression: a latent-variable analysis of depressive symptoms after stroke.

OBJECTIVE: The author used a structural-equation modeling approach to examine depression symptom endorsement between geriatric stroke patients and general-medical geriatric patients. From the literature related to cerebrovascular disease and depression, he predicted that geriatric stroke patients would be more likely to endorse symptoms of withdrawal and affective flattening, and less agitation. METHODS: Data from 576 geriatric rehabilitation patients were utilized (N=176 with stroke). Confirmatory factor analysis of the Geriatric Depression Scale was conducted to determine the optimal factor structure for examining symptom endorsement differences between the two groups. MIMIC (Multiple Indicators, Multiple Causes) model analyses were incorporated to examine group differences in depression severity and symptom-cluster endorsement. RESULTS: Results indicate that stroke patients did not demonstrate greater depression severity. There were no differences in endorsement of depressive mood. However, stroke patients were more likely to endorse social withdrawal and less likely to endorse agitation symptoms. CONCLUSIONS: The current results suggest that geriatric stroke patients were more likely, after controlling for depression severity, to endorse greater social withdrawal and less agitation, but not depressed mood. These findings have implications for the types of symptoms evaluated in the context of geriatric stroke and depression.

Aged↗
PubMed1991

[Masked depression: medical face of psychic depression].

The internist is frequently faced with patients affected by depression. The incorporation of psychiatry to general hospitals allowed physicians to become aware of many forms of depression, among them masked depression. The term is usually applied to patients whose depression is hidden behind somatic symptoms. Outstanding among them are common symptoms such as diarrhea, headache, palpitation, abdominal pain, etc; acute or chronic systemic diseases which are accompanied or followed by depression; depressive symptoms appearing for the first time in older patients or depression secondary to the use of drugs including alcohol. An active search for depressive symptoms is required from the physician if masked depression is not to go unnoticed.

Depression↗
PubMed1994

Major depression, dysthymia and depressive personality disorder.

The separation of persistent depression into meaningful and useful subcategories, including major depression, dysthymia, recurrent brief depression, and depressive personality disorder, is the subject of much debate. Depressions can be grouped on the basis of their type and severity of symptoms, aetiology, clinical course, or their association with other psychiatric illnesses. Several investigators have conducted epidemiologic and family studies to evaluate the prevalence of depressive disorders, their diagnostic stability over time, and the amount of overlap among the disorders. Although progress has been made toward a better understanding of the different disorders, insufficient evidence exists to support the hypothesis that these disorders are separate and distinct from one another. However, preliminary data suggest that depressive personality disorder is separate from the other disorders. Additionally, several questions have been raised, particularly the extent to which differentiation between the depressive disorders, specifically major depression and dysthymia, has an impact on treatment decisions.

Adolescent↗
PubMed1984

Appetite disturbance and excessive guilt in major depression. Use of family study data to define depressive subtypes.

A post hoc analysis of the relationship between depression in first-degree family members (N = 810) and specific patterns of "endogenous" symptoms in 133 probands with nonbipolar major depression revealed that concomitant appetite disturbance and excessive guilt in the depressed probands was associated with increased rates of major depression among family members. The depressed, interviewed relatives of depressed probands with appetite disturbance and excessive guilt were found to be at a 2.5 greater risk for this same subtype compared with the depressed, interviewed relatives of the remaining depressed probands. These findings suggest that this subtype of depression may "breed true" within these families.

Adult↗
PubMed2002

Parental major depression and the risk of depression and other mental disorders in offspring: a prospective-longitudinal community study.

BACKGROUND: This article examines associations between DSM-IV depressive disorders, their natural course, other psychopathology, and parental major depression in a community sample of adolescents and young adults. METHODS: Baseline and 4-year follow-up data were used from the Early Developmental Stages of Psychopathology Study, a prospective-longitudinal community study of adolescents and young adults. Results are based on 2427 subjects who completed the follow-up and for whom diagnostic information for both parents was available. DSM-IV mental disorders in respondents were assessed using the Munich-Composite International Diagnostic Interview. Information on depression in parents was collected as family history information from the respondents and from diagnostic interviews with parents of the younger cohort. RESULTS: Offspring with 1 (odds ratio [OR], 2.7; 95% confidence interval [CI], 2.1-3.5) or 2 affected parents (OR, 3.0; 95% CI, 2.2-4.1) had an increased risk for depression. They also had a higher risk for substance use (1 parent affected: OR, 1.4; 95% CI, 1.1-1.7; both parents affected: OR, 1.4; 95% CI, 1.0-1.8) and anxiety disorders (1 parent affected: OR, 1.6; 95% CI, 1.3-1.9; both parents affected: OR, 2.1; 95% CI, 1.6-2.8). There were no differences whether mother or father was affected. Parental depression was associated with an earlier onset and a more malignant course (severity, impairment, recurrence) of depressive disorders in offspring. CONCLUSIONS: Major depression in parents increases the overall risk in offspring for onset of depressive and other mental disorders and influences patterns of the natural course of depression in the early stages of manifestation.

Adolescent↗
PubMed2001

Bereitschaftspotential in depressed and non-depressed patients with Parkinson's disease.

Impaired initiation and slowed execution of movements are two of the principal characteristics of Parkinson's disease (PD). A similar pattern of movement impairments (psychomotor retardation) can be seen frequently in patients with idiopathic depression. In addition, affective disorders have been frequently reported in patients with different basal ganglia disorders. The aim of this study was to determine whether there are some particularities in the cerebral electrical activity during the preparation and execution of voluntary internally paced movements (i.e., Bereitschaftspotential, BP) in depressed PD patients, which can distinguish them from non-depressed PD patients, as well as from healthy controls. The BPs were recorded in 16 patients with idiopathic PD, eight of whom were depressed (PD-D), and eight of whom were not (PD-ND). Additional recordings were taken from a group of eight age- and sex-matched healthy subjects. Depression was classified using the Research Diagnostic Criteria and the two PD groups were matched for age, disease severity, and disease duration. The amplitudes and slopes of the BPs from PD patients were generally smaller than in controls, but there was no specific pattern of BP changes that distinguished depressed from non-depressed PD patients. In addition, there was no particular association between measures of depression severity and BP parameters. The data suggest that presence of depression in PD might not have any additional deteriorating influence on already impaired preparation for self-paced spontaneous movements.

Adult↗
PubMed1985

The Zurich Study--a prospective epidemiological study of depressive, neurotic and psychosomatic syndromes. IV. Recurrent and nonrecurrent brief depression.

How common and how significant are brief depressive episodes (BDE) lasting less than 2 weeks? The authors propose splitting the BDE into two groups: one occurring monthly over 1 year of observation, termed 'recurrent brief depression' (RBD), and those occurring less frequently, labeled 'nonrecurrent brief depression' (NRBD). From a medical point of view, the RBD are a relevant group. Different thresholds of definition are tested, the narrowest of which (including occupational impairment and predetermined minimum number of symptoms) is accepted for 'case'-definition. The such defined RBD (SYM) group differs from major depression only by length and frequency of episodes. In a young cohort, its 1-year prevalence rate was found to be 4.4% (males 3.9%, females 4.9%). One-third of these cases needed treatment, a fourth suffered from pronounced subjective and social impairment as well as from persistent suicidal ideation. The self-reporting of subjective impairment, assessed with the SCL-90 symptom inventory and an analog-rating, yields high scores which are in no way inferior to major depression diagnosed with RDC, DSM-III or EDE (SYM) criteria. The RBD (SYM) demonstrate less hypomania than the major depressive disorders. On the other hand, a family history of depression is equally frequent across all groups. The validity of the RBD (SYM) group has yet to be confirmed by a follow-up study, and further research is needed to delineate it from secondary depression. The findings largely support the hypothesis of a continuum from mild and short to more severe, longer lasting depressive syndromes, but they do not exclude heterogeneity of RBD (Angst and Dobler-Mikola 1984b).(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Psychological↗