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PubMed1997

Psychiatric disorders in the relatives of depressed probands. II. Familial loading for comorbid non-depressive disorders based upon proband age of onset.

This study examined familial loading for non-depressive disorders in first-degree relatives (FDRs) of early-(< 20 years of age) and adult-onset (> or = 20 years of age) depressed probands. Our previous work, which demonstrated that FDRs of early-onset probands have higher rates of major depression as compared to FDRs of adult-onset probands, has not yet examined risk for non-depressive disorders in FDRs. In this paper, we focus on best-estimate diagnoses of anxiety disorders, alcoholism, and antisocial personality conducted on 639 first-degree relatives. The FDRs of early-onset probands had significantly higher rates of comorbid transmission of alcoholism and depression, and antisocial personality and depression, respectively. Significant co-transmission of anxiety disorders and depression was found in the FDRs of both early- and adult-onset probands. Future genetic studies of depression, especially early-onset depression, should hence broaden their definitions of phenotypes to include comorbid disorders when searching for the etiology of this complex disorder.

Adolescent↗
PubMed2000

Postnatal depression in Japanese women. Detecting the early onset of postnatal depression by closely monitoring the postpartum mood.

OBJECTIVES: The terminology and definition of mood disturbance during the early postpartum period has yet to be clearly elucidated among clinical practitioners. Criteria for maternity blues have not been well established, and it may overlap with the beginning of a postnatal depression. The aims of the present study, are firstly to survey the symptomatic features of mood disturbance in the very early postpartum period and secondary, to develop a guideline for detecting and predicting postnatal depression during the same period using a simple screening technique. SUBJECTS AND METHODS: Eighty-eight mothers recruited from a maternity ward for the prospective study completed the whole protocol. Two methods were used to survey the symptomatic features of mood disturbance; (1) interview and (2) self-report questionnaires. The interviews were carried out twice. At three weeks postpartum, the Schedule for Affective Disorder and Schizophrenia (SADS)/Research Diagnostic Criteria was administered, together with an interview of the symptoms of "maternity blues". The SADS interview was re-administered at three months postnatally. Two self-report questionnaires addressing mood disturbance were administered: (1) Maternity Blues Scale; (Stein, 1980). (2) Edinburgh Postnatal Depression Scale (EPDS; Cox et al., 1987). The Maternity Blues Scale was administered on the first five consecutive postnatal days. The EPDS was administered on the fifth day, one month and three months postnatally. In addition, the Life Event Scale (Burgha et al., 1985) was also administered at one month postnatally. Obstetric notes were also examined. RESULTS: At the first interview, 12 mothers were diagnosed with postnatal depression and 10 of these had their onset within one week. At the second interview three additional mothers were newly diagnosed with depression. In all mothers, depression was detected at one month using the EPDS, with a cut-off of 8/9. The EPDS scores on the fifth postnatal day were also higher in the depressed mothers and could detect early onset of postnatal depression. CONCLUSION: The use of the EPDS during the early postnatal days, can be a simple and useful screening instrument for the onset of early postnatal depression.

Depression, Postpartum↗
PubMed2000

Fluoxetine versus sertraline and paroxetine in major depression: tolerability and efficacy in anxious depression.

BACKGROUND: Major depression with high levels of anxiety (anxious depression) is a common subtype of depression associated with greater psychosocial impairment and poorer response to antidepressant treatment. It is unclear whether in this population there are differences in efficacy or tolerability across selective serotonin reuptake inhibitors. For this reason, using head-to-head acute treatment comparison, we compared efficacy and tolerability of fluoxetine, sertraline, and paroxetine among depressed patients with high levels of anxiety. METHODS: Patients (N = 108) with DSM-IV major depression and high levels of anxiety (a HAM-D-Anxiety/Somatization Factor score > or =7) were randomized to fluoxetine, sertraline, or paroxetine treatment in a double-blind fashion. Changes in overall depression and anxiety were assessed. RESULTS: Patients demonstrated similar baseline-to-endpoint improvement in HAM-D-17 and HAM-D-Anxiety/Somatization Factor scores. Patients also demonstrated similar change-over-time improvement in HAM-D-17 and HAM-D-Anxiety/Somatization Factor scores, except at week one where fluoxetine- and sertraline-treated patients had statistically significantly greater improvement than paroxetine-treated patients in the HAM-D-Anxiety/Somatization Factor score. There were no significant differences across treatments in percentages of patients with substantial emergence, any worsening, or improvement at endpoint in individual HAM-D Items 9 (agitation), 10 (psychic anxiety), and 11 (somatic anxiety). Overall, all treatments were well tolerated. CONCLUSION: These data showed no significant differences in efficacy and tolerability of fluoxetine, sertraline, and paroxetine in patients with high levels of baseline anxiety symptoms during the acute treatment of major depression. Each treatment was similarly effective in improving depression in this subtype of patients with anxious depression.

Adult↗
PubMed2000

Moderate and severe depression. Gradations for the Montgomery-Asberg Depression Rating Scale.

BACKGROUND: Despite its importance, no distinction between moderate and severe depression using the Montgomery-Asberg Depression Rating Scale (MADRS) based on a direct comparison with the Hamilton Depression Rating Scale (HAMD-17) is available. METHODS: HAMD-17 and MADRS ratings from N=40 at least moderately depressed inpatients with major depression (DSM-III-R) were analyzed. Linear and non-parametric correlations were computed and a MADRS cut-off score for severe depression using an HAMD-17 score of at least 28 points as reference was estimated. RESULTS: HAMD-17 and MADRS mean scores were 24.6+/-4.3 and 32.6+/-5.0 points, respectively. Linear correlation of both scores was r=0.70 (P<0.0005). A MADRS cut-off score of at least 35 points was estimated to separate 'moderate' from 'severe' depression corresponding to a HAMD-17 cut-off of 28 points with sufficient sensitivity and specificity. LIMITATIONS: The sample size was limited and no observer ratings directly assessing the severity of depression were used. CONCLUSIONS: The preliminary findings are in line with previous findings and suggest a cut-off score of 35 points to separate moderate from severe depression with the MADRS accepting an HAMD-17 score of >/=28 point as reference. Further studies on this issue are warranted.

Adult↗
PubMed1999

Catecholamines in depression: a cumulative study of urinary norepinephrine and its major metabolites in unipolar and bipolar depressed patients versus healthy volunteers at the NIMH.

Studies comparing urinary norepinephrine (NE) and its metabolites in unipolar or bipolar depressed patients and healthy volunteers have not yielded consistent findings. However, in unipolar depressed patients, most studies in non-elderly populations consistently report elevated concentrations of plasma NE, at least following an orthostatic challenge. Expanding upon previous studies which showed elevated plasma NE in depression, we compared the urinary excretion of NE, normetanephrine (NMN), 3-methoxy-4-hydroxyphenylglycol (MHPG), and vanillylmandelic acid (VMA) in age- and sex-matched unipolar and bipolar depressed patients versus healthy volunteers hospitalized at an inpatient unit at the National Institute of Mental Health. Only depressed subjects with a minimum 4-week drug-free period were included. Total turnover (NE + NMN + MHPG + VMA) was reduced in this sample of unipolar and bipolar depressed patients. MHPG concentration did not distinguish unipolar from bipolar depressed patients and was not significantly different from that in healthy volunteers. A construct of the average fractional extraneuronal concentration of NE (NE + NMN/NE + NMN + MHPG + VMA) was significantly higher in unipolar and bipolar depressed patients than in healthy volunteers. This finding extends data suggesting that unmedicated unipolar and bipolar depressed patients have a 'hyperresponsive' noradrenergic system and provides a framework which ties together plasma and urinary findings.

Adult↗
PubMed1999

Psychosocial processes underlying the maintenance and persistence of depression: implications for understanding chronic depression.

The three major theoretical perspectives on the maintenance and persistence of depression in the psychological literature are reviewed. Cognitive theorists, such as Teasdale and Nolen-Hoeksema, focus on how a reciprocal relationship between depressed mood and the individual's processing of, and response to, their symptoms maintains and prolongs the duration of depressive episodes. Interpersonal theorists, such as Lewinsohn and Coyne, hypothesize that the depressed person's interpersonal behavior elicits negative reactions from the social environment, leading to a downward spiral of persistent depression. Finally, recent studies have indicated that individuals who experienced childhood adversity are more susceptible to a chronic course of depression. Although these three perspectives vary somewhat in the degree of support they have accumulated, each exhibits some promise for helping to elucidate the maintenance and persistence of depression. However, much of the available empirical literature suffers from a number of critical limitations, including the lack of clinical samples, longitudinal studies, and adequate attention to confounding variables, such as the severity and duration of depression at baseline and comorbid psychopathology. We conclude by suggesting a number of ways in which cognitive and interpersonal factors and early adversity may interact to maintain and prolong depressive episodes.

Adaptation, Psychological↗
PubMed2000

Oncology staff recognition of depressive symptoms on videotaped interviews of depressed cancer patients: implications for designing a training program.

We examined oncologists' and nurses' ability to recognize depressive symptoms in two cancer patients who were interviewed on videotape. The study was conducted in a rural community, hospital-based outreach network. Staff were given a one-hour in-service on the use of the Mini International Neuropsychiatric Interview (MINI)-a brief diagnostic interview-to provide a differential diagnosis (no psychiatric diagnosis, major depressive disorder, or adjustment disorder with depressed mood). Next, the staff viewed a videotape of an investigator (S.P.) utilizing the MINI to interview two depressed breast cancer patients. Staff subsequently rated depressive symptoms on the MINI and made a diagnosis. Findings indicated a high concordance among staff regarding symptom ratings on a straightforward example of major depressive disorder. Concordance on diagnosis, severity level, and specific symptoms declined slightly on a more difficult case involving primarily cognitive symptoms and a diagnosis of adjustment disorder. Following brief didactic training on depressive disorders, oncologists and nurses were able to identify depressive symptoms in cancer patients on videotape. Learning to use a semistructured interview can increase oncologists' awareness of depressive symptoms and may be a good training model.

Adult↗
PubMed2003

Sleep disorders and depressive feelings: a global survey with the Beck depression scale.

OBJECTIVES: Patients with (chronic) sleep disorders are prone to depression. Until now studies on the prevalence of depression in the various sleep disorders focused mainly on obstructive sleep apnea patients and narcolepsy. Studies in other common sleep disorders are scarce. The aim of our study was to estimate the prevalence of depressive feelings in the various sleep disorders diagnosed in a Center for Sleep and Wake Disorders. METHODS: We included 917 consecutive patients (age between 14 and 84 years, median age: 49, 396 male and 521 female), seen in our center for sleep and wake disorders during 2001 and first half of 2002. The diagnosis was based on the history taken at the outpatient-clinic and two consecutive 24-h polysomnographic recordings at home (APSG). The final decisions on the diagnosis were made according to the ASDA international classification of sleep disorders. The severity of depressive feelings was based on the Beck depression scale. RESULTS: Overall, the prevalence of depressive feelings was high. There were no significant differences in age and gender. In psychophysiological insomnia, inadequate sleep- and wake hygiene, sleep state misperception and periodic limb movement disorder/restless legs syndrome some form of depression occurred in more than half of the patients. Moderate to severe depression was found in 3.5% of the patients. CONCLUSION: The study suggests that the use of a depression scale in the daily routine of diagnosing and treating sleep disorders should be encouraged in order to optimise diagnosis and therapy in these patients.

Adolescent↗
PubMed1993

The prevalence of depressive disorders and the distribution of depressive symptoms in later life: a survey using Draft ICD-10 and DSM-III-R.

The point prevalence of depressive disorders was estimated in a sample of persons aged 70 years and over, which included both those living in the community and those in institutional settings. Lay interviewers administered the Canberra Interview for the Elderly to the subjects and their informants. The point prevalence of depressive episodes as defined by the Draft ICD-10 diagnostic criteria was 3.3%. The rate for DSM-III-R major depressive disorder was 1.0%. The latter prevalence rate is similar to those reported elsewhere for the elderly. Evidence is accumulating that older persons may indeed have low rates for depressive disorders at the formal case level. Possible reasons for this finding are offered. A scale for depressive symptoms, based exclusively on those specified in Draft ICD-10 and DSM-III-R, showed that the elderly do experience many depressive symptoms. Contrary to expectation, these did not increase with age. The number of depressive symptoms was correlated with neuroticism, poor physical health, disability and a history of previous depression. Attention now needs to be directed to the clinical significance of depressive symptoms below the case level in elderly persons.

Age of Onset↗
PubMed1995

Sub-typing depression, II. Clinical distinction of psychotic depression and non-psychotic melancholia.

We have attempted to clarify clinical differentiating features of psychotic depression. Forty-six depressed subjects meeting DSM-III-R criteria for major depression with psychotic features were compared with (i) DSM-defined melancholic, (ii) Newcastle-defined endogenous, and (iii) a residual DSM-defined major depressive episode group. Additionally, a 'bottom up' latent class analysis (LCA) suggested a larger sample of 82 'psychotic depressive' subjects, and multivariate analyses contrasted these subjects with both LCA-identified melancholic and all residual depressed subjects. Analyses suggested that, in addition to two features with absolute specificity (delusions and hallucinations), both the DSM-defined and LCA-defined 'psychotic depressive' subjects were significantly more likely to demonstrate marked psychomotor disturbance, to report two morbid cognitions (feeling sinful and guilty; feeling deserving of punishment), as well as be more likely to report constipation, terminal insomnia, appetite/weight loss and (variable across the defined 'psychotic depressive' groups) loss of interest and pleasure. The study identifies a wider set of potentially discriminating clinical variables than previous studies, as well as both indicating the existence and assisting identification of 'true' psychotic depression in the absence of formal psychotic features being acknowledged or elicited.

Adult↗
PubMed2001

The Cardiff Depression Study: a sib-pair study of dysfunctional attitudes in depressed probands and healthy control subjects.

BACKGROUND: Current cognitive theories propose that depression develops as a result of the interaction between dysfunctional cognitive schemata and environmental stressors. There is also consistent evidence of a substantial genetic contribution to depression. This study examines the familiality and stability of dysfunctional attitudes and attempts to distinguish whether they reflect trait vulnerability to depression or the state of being depressed. METHOD: The 24-item Dysfunctional Attitude Scale (DAS-24) was completed by 108 depressed probands and their nearest-aged siblings and 105 healthy control probands and their nearest-age siblings, at the time of a semi-structured clinical interview and 10-12 months later. Subjects also completed self-report measures of depressed mood on both occasions. RESULTS: Measures of clinical depression were significantly correlated with DAS scores. At retest, DAS scores remained elevated despite improvement in mood, giving support for earlier findings, that dysfunctional attitudes remain active following recovery. The dependency subscale (DAS-D) of the DAS showed modest familiality, although there were no significant differences for DAS-D scores between the two groups of siblings. In a multiple regression analysis, current mood-state was the overwhelming predictor of DAS scores. However for DAS-D, gender as well as current mood influenced scores on this subscale. CONCLUSION: Although there was modest evidence for temporal stability and familiality for some DAS-24 subscale scores, dysfunctional attitudes were predominantly influenced by current low mood, and therefore reflect the state of being depressed rather than a familial vulnerability trait underpinning depression.

Adolescent↗
PubMed1997

Qualitative magnetic resonance imaging findings in geriatric depression. Possible link between later-onset depression and Alzheimer's disease?

BACKGROUND: Several clinical and neuroimaging investigations support the notion that underlying brain changes may relate to depression in older patients, especially those with a later-age initial episode. However uncertainty still exists about diagnostic and pathogenic significance of structural brain abnormalities in aged depressives, in part because many studies lack all-elderly and age-similar normal comparison populations. METHODS: Brain morphology of elderly depressives (N = 30) and normal controls (N = 36) was compared by assessing magnetic resonance imaging (MRI) brain scans with qualitative criteria-based scales. Ratings included lateral and third ventricle enlargement, and cortical, medial temporal, and caudate atrophy. RESULTS: Significant differences between depressed and control groups were not demonstrated. Later-onset depressives had significantly more left medial temporal and left caudate atrophy than early-onset counterparts of similar age. Medial temporal atrophy significantly correlated with cognitive impairment and was not related to physical illness. Depressives with medial temporal atrophy (N = 7) were older and had later age at onset of depression than those without such changes. Cerebrovascular disease risk factors did not predict MRI abnormalities. CONCLUSIONS: Results indicate non-specificity and lack of homogeneity of qualitatively measured structural brain changes in geriatric depression, but suggest that pathology of specific, lateralized brain regions may be implicated in some later-onset patients. The relationship between medial temporal atrophy and late-onset depression raises the possibility that such patients may suffer from as-yet undeclared Alzheimer's disease. Lack of association between cerebrovascular disease risk factors and brain changes suggests other pathophysiological contributions.

Aged↗
PubMed1999

Onset of disability in depressed and non-depressed primary care patients.

BACKGROUND: While cross-sectional and longitudinal studies have consistently found depressive illness and disability to be related, understanding whether depression leads to subsequent onset of disability is limited. METHODS: In the context of the multi-centre international WHO Collaborative Study on Psychological Problems in General Health Care, we followed prospectively consulting non-elderly primary care patients who were essentially disability free at baseline but who differed in baseline depression status, comprising 1051 patients free of physical disability at baseline including 14% depression; 914 free of social disability including 9% depression. Depression status was assessed with the CIDI; patient-reported physical disability with the MOS physical functioning scale and social disability with the BDQ role functioning and number of disability days measures; investigator-rated social disability with the Occupational section of Groningen Social Disability schedule; and the treating physicians rated the severity of physical illness. RESULTS: In patients essentially disability free at baseline, depressive illness resulted in a 1.5-fold (at 3 months) and a 1.8-fold (at 12 months) increase in risk of onset of physical disability, after controlling for physical disease severity. Depressive illness also resulted in a 2.2-fold (at 3 months) and a 23-fold (at 12 months) increase in risk of onset of social disability, after controlling for physical disease severity, physical disability and onset of physical disability. CONCLUSIONS: Among non-elderly primary care patients, depressive illness is associated with onset of physical disability and shows an even stronger association with onset of social disability.

Adolescent↗
PubMed2002

Melatonin response to atenolol administration in depression: indication of beta-adrenoceptor dysfunction in a subtype of depression.

OBJECTIVE: To investigate peripheral beta-adrenoceptor sensitivity in depression by assessing urinary melatonin pre- and post-administration of atenolol. METHOD: Overnight urinary melatonin pre- and post-administration of 100 mg oral atenolol was assessed in 36 depressed subjects and 47 controls. RESULTS: Baseline melatonin was significantly lower in depressed patients than controls (P=0.004). Melatonin following atenolol administration was strongly reduced in both groups (P < 0.0001). This reduction depends on whether the subject is a high or low (cutoff: 0.25 nmol/l) baseline melatonin excretor (P=0.025) and on whether he is depressed being a low excretor (P=0.048). A negative correlation (P=0.007) was found between melatonin decrease after atenolol and the Montgomery-Asberg Depression Rating Scale score. CONCLUSION: Atenolol strongly reduces melatonin in depressed and control subjects; this decrease relates inversely to the severity of depressive symptoms. Furthermore, responsiveness to atenolol differs between low melatonin depressed patients and low excretor controls, alluding to beta-adrenoceptor up-regulation in a subtype of depression.

Adrenergic beta-Antagonists↗
PubMed1991

Responses to depression and their effects on the duration of depressive episodes.

I propose that the ways people respond to their own symptoms of depression influence the duration of these symptoms. People who engage in ruminative responses to depression, focusing on their symptoms and the possible causes and consequences of their symptoms, will show longer depressions than people who take action to distract themselves from their symptoms. Ruminative responses prolong depression because they allow the depressed mood to negatively bias thinking and interfere with instrumental behavior and problem-solving. Laboratory and field studies directly testing this theory have supported its predictions. I discuss how response styles can explain the greater likelihood of depression in women than men. Then I intergrate this response styles theory with studies of coping with discrete events. The response styles theory is compared to other theories of the duration of depression. Finally, I suggest what may help a depressed person to stop engaging in ruminative responses and how response styles for depression may develop.

Adaptation, Psychological↗
PubMed1997

Depression-related psychosocial variables: are they specific to depression in adolescents?

Although the psychosocial difficulties associated with adolescent depression are relatively well known, the extent to which these problems are specific to depression has received little attention. The authors examined the specificity to depression of a wide range of psychosocial variables in the following 3 groups of adolescents: depressed cases (n = 48), nonaffective disorder cases (n = 92), and never mentally ill participants (n = 1,079). The authors found 3 of the 44 variables assessed in this study to be strongly specific to depression, and only the depressed participants exhibited more problematic functioning than did the never mentally ill controls. Three variables are as follows: self-consciousness, self-esteem, and a reduction in activities because of physical illness or injury. Eight variables were more strongly associated with depression than with nonaffective disorder, and 8 variables characterized both depressed and nonaffective disorder adolescents. Implications of these findings for psychosocial theories of depression are discussed.

Adaptation, Psychological↗
PubMed1990

Effects of responses to depression on the remediation of depressive affect.

The effects of different types of responses to a depressed mood on the duration and severity of the mood were examined. On the basis of Nolen-Hoeksema's (1987) response styles theory of depression, it was hypothesized that distracting, active responses would be more effective in alleviating a depressed mood than would ruminative, passive responses. A depressed mood was induced in 35 male and 34 female Ss, and subjects were randomly assigned to engage in 1 of 4 types of responses: an active task that distracted them from their mood; a passive, distracting task; an active task designed to lead to ruminations about their mood; or a passive, ruminative task. As predicted, the greatest remediation of depressed mood was found in Ss in the distracting-active response condition, followed in order by the distracting-passive, ruminative-active, and ruminative-passive response conditions. Degree of rumination had a greater impact on remediation of depressive affect than level of activity, with greater rumination leading to lesser remediation of depressive affect. In addition, the effects of the response tasks were limited to depressed mood. The implications of these results for interventions with depressed persons are discussed.

Adaptation, Psychological↗
PubMed1994

Contagious depression: existence, specificity to depressed symptoms, and the role of reassurance seeking.

This study prospectively examined the phenomenon of contagious depression in 96 pairs of college roommates during 2 assessment sessions separated by 3 weeks. Depression, anxiety, negative and positive affect, negative life stress, and reassurance seeking were assessed. Consistent with prediction, roommates of depressed target students became more depressed themselves over the course of the 3-week study. The effect persisted when baseline levels of roommate depression and roommate negative life events were controlled. Furthermore, these findings were specific to depressed symptoms. Finally, as predicted, reassurance seeking served as a vulnerability factor for the contagion effect: High-but not low-reassurance-seeking roommates of depressed target students became more depressed themselves. However, the moderating effects of reassurance seeking were not specific to depressed symptoms.

Adult↗