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PubMed2002

Group cognitive-behavioral treatment for depressed adolescent offspring of depressed parents in a health maintenance organization.

OBJECTIVE: A randomized, controlled effectiveness trial of group cognitive-behavioral therapy (CBT) for depressed adolescent offspring of depressed parents in a health maintenance organization (HMO) was conducted. METHOD: Potential adult cases were found by reviewing antidepressant medication prescriptions, mental health appointments, and medical charts. Introductory study letters signed by each parent's treating physician were mailed to the appropriate adults. Eligible offspring aged 13 to 18 who met current DSM-III-R criteria for major depression and/or dysthymia were randomly assigned to either usual HMO care (n = 47) or usual care plus a 16-session group CBT program (n = 41). Assessments were conducted at baseline, after treatment, and at 12- and 24-month follow-up. RESULTS: Using intent-to-treat analyses, the authors were unable to detect any significant advantage of the CBT program over usual care, either for depression diagnoses, continuous depression measures, nonaffective measures, or functioning outcomes. CONCLUSIONS: Group CBT does not appear to be incrementally beneficial for depressed offspring of depressed parents who are receiving other mental health care. However, given that many other studies have found positive effects of CBT for youth depression, this single study should not be viewed as evidence that CBT is ineffective overall.

Adolescent↗
PubMed1990

Clinical effects of the 5-HT1A partial agonists in depression: a composite analysis of buspirone in the treatment of depression.

The azapirone class of anxiolytic drugs is being evaluated for clinical use in the treatment of depression. Buspirone, a serotonin (5-hydroxytryptamine, 5-HT) partial agonist active at the 5-HT1A receptor subtype, was evaluated in the treatment of depression in a series of five placebo-controlled, parallel group studies involving 382 patients with DSM-III major depression and significant associated anxiety symptoms (both Hamilton depression [HAM-D] and Hamilton anxiety [HAM-A] scales greater than or equal to 18). Buspirone therapy was initiated at 15 mg/day with individual dose titration to a maximum of 90 mg/day and resulted in marked improvement in both depressive and anxiety symptoms. Analyses of the composite data base from the five studies show significant (p less than 0.05) improvement in mean HAM-D, HAM-A, and Clinical Global Impression-Global Improvement scale ratings for buspirone-treated compared with placebo-treated patients. Of particular interest was significant improvement in cardinal depression symptoms, e.g., depressed mood, guilt, work and interest, anergia, and diurnal variation of mood. Subset analyses revealed that patients with melancholic-type major depression and patients with more severe symptoms (judged by higher initial HAM-D or HAM-A total scores) responded better to buspirone than did patients who were less ill. The buspirone dose most frequently associated with clinically significant improvement was 40 mg/day. Gepirone, an analogue of buspirone with highly selective binding affinity for the 5-HT1A receptor subtype, also shows promise of antidepressant efficacy in preliminary controlled clinical trials. These data suggest that azapirones, which as partial agonists modulate 5-HT1A receptor function, have clinically important antidepressant properties.

Adolescent↗
PubMed1998

The use of venlafaxine in the treatment of major depression and major depression associated with anxiety: a dose-response study. Venlafaxine Investigator Study Group.

This 12-week, double-blind, placebo-controlled study evaluated the efficacy and safety of venlafaxine as first-line therapy for the treatment of major depression and major depression associated with anxiety in 384 adult outpatients. Fixed total daily dosages of 75, 150, and 200 mg of venlafaxine were administered in a twice-a-day regimen. Primary efficacy parameters were the Hamilton Rating Scale for Depression (HAM-D) total score, the HAM-D Depressed Mood Item, the Montgomery-Asberg Depression Rating Scale total score, and the Clinical Global Impressions Scale. Overall, a higher percentage of patients responded to venlafaxine than to placebo. Efficacy data indicated a dose-related response, most evident in the onset of clinical improvement; statistically significant improvements in some primary parameters were seen as early as 1 to 2 weeks after initiation of treatment, especially in the 150-and 200-mg/day groups. These dose-related clinical improvements continued through week 12. Venlafaxine-treated patients who had depression associated with anxiety showed significant dose-related improvements compared with placebo-treated patients; improvement was noted by scores on the HAM-D Anxiety-Psychic Item and Anxiety-Somatization Factor. Few clinically significant changes were observed in laboratory values, vital signs, or electrocardiogram tracings. Venlafaxine was generally well tolerated at all dosages. The most common study events included nausea, dizziness, somnolence, insomnia, dry mouth, and asthenia, which are consistent with findings of previous studies. The current study demonstrated that 75 to 200 mg/day of venlafaxine twice daily produced a dose-related improvement in the primary efficacy parameters and in the onset of significant antidepressant effects, which was noted at weeks 1 to 2 with the highest dosage tested (200 mg/day). The study also demonstrated that these dosages of venlafaxine were safe and effective as first-line therapy for major depression and depression associated with anxiety.

Adult↗
PubMed1987

The course of depressive symptoms in suicidal vs. nonsuicidal depressed inpatients.

The present study attempts to delineate the course of depressive illness in suicidal, depressed inpatients as compared with a matched group of nonsuicidal, depressed inpatients. Thirty adult nonpsychotic psychiatric inpatients presenting with symptoms of a major depressive episode participated in the present study. Two subject groups were identified, one suicidal and the other nonsuicidal according to their responses on the Modified Scale for Suicidal Ideation. Subjects were assessed on a variety of self-report measures and several clinical interviews during hospitalization and follow-ups at 4, 10 and 16 months after discharge. Results supported the hypothesis that, although displaying similar levels of depression during hospitalization as well as at long-term follow-up, the two groups differed in the speed of their recovery. Approximately 4 months after discharge virtually all of the nonsuicidal patients had recovered, whereas a majority of the suicidal group remained quite depressed. These results suggest that more time is needed for the recovery process to occur in suicidal patients. Future research in the area of depression and suicide should take into account the different courses seen in these two groups of subjects. Furthermore, those who treat suicidally depressed patients should be cautions of the slow recovery of these patients.

Adult↗
PubMed1992

Depression in Korean immigrants in Canada. I. Method of the study and prevalence of depression.

This study reports the prevalence and risk factors of depression in a large representative community sample of adult Korean immigrants in Toronto, Canada. The Center for Epidemiologic Studies-Depression scale was used to measure depression by applying DSM-III criteria. Results in general suggest few differences between the immigrant community and the larger communities in Canada and the United States. Depressive syndrome was present in 4.5% of the sample, a prevalence similar to rates reported by the Epidemiologic Catchment Area studies. The risk factors associated with depression in larger populations were also found to be related to depression in this sample. Gender, marital status, intention to re-migrate, and social support were the most powerful correlates of depressive syndrome. In summary, Korean immigrants in Toronto are not exceptionally vulnerable to depression, and the social support from informal ethnic networks at the time of arrival has long-lasting effects on their mental health. Future research should focus on how the informal social supports available at the time of arrival are maintained by immigrants and the precise ways in which they exert long-term protective effects.

Adult↗
PubMed1998

Major depression: behavioral parameters of depression and recovery.

This paper reports on an ethological study of 11 depressed hospitalized subjects. Major depression and recovery are described in terms of general behavioral traits, i.e., behavior parameters. The hypothesis, that the primary behavioral feature of major depression is a reduction of social interaction and that secondary features are reduced self occupation and body mobility (posture flexibility) is tested. The behavioral patterns of depression and recovery are described and elucidated by 12 defined behavioral parameters, eight of which show significant changes between the first and the last hospital week. Findings from six of the parameters are consistent with the hypothesis and demonstrate social inhibition during depression; interactions between depression and nonverbal behavior are particularly striking. Findings also confirm that, during depression, self occupation and body mobility are reduced to a less significant degree than social inhibition. Possible relationships between findings and agitated forms of major depression are discussed. A final section examines findings in an evolutionary context and emphasizes their clinical implications.

Adult↗
PubMedDate not supplied

Perimenstrual depression: its relationship to pain, bleeding, and previous history of depression.

Daily ratings of depression, pain, and menstrual blood loss, as well as past history of treated depression, were analyzed in 210 women attending a Premenstrual Syndrome Clinic. Severity and duration of perimenstrual depression was strongly associated with the severity of premenstrual and menstrual pain, raising the possibility of a causal relationship. It is not yet clear whether the occurrence of depression alters a woman's perception of pain, pain aggravates a tendency to perimenstrual depression, or some common factor aggravates both. A relationship between depression and subjective ratings of blood loss was also observed but was less marked than the relationship with pain. Both relationships had been reported in an earlier study using retrospective ratings. A relationship between past history of treated depression and severity and timing of current perimenstrual depression, observed previously, was not found in this study. This discrepancy was not due to differences between retrospective and prospective methods of assessment, but may have partly resulted from differences in the reporting of premenstrual pain in the two studies. Further studies of this association should control for the confounding effect of pain.

Adult↗
PubMed2003

Circadian blood pressure regulation in hospitalized depressed patients and non-depressed comparison subjects.

BACKGROUND: Neuroendocrine dysregulation and disturbed sleep, frequently seen in major depression, may interfere with circadian blood pressure regulation. DESIGN AND METHODS: Using a portable device, 24 h blood pressure profiles were registered in 69 depressed in-patients and 26 hospitalized, non-depressed comparison subjects. The use of antihypertensive medication was considered to be indicative of known arterial hypertension. Mean systolic and diastolic blood pressure levels were compared between the group of depressed patients not taking antihypertensive medication and the healthy comparison subjects, both for the entire 24 h of measurement, and for the daytime and night-time periods. In a subgroup of patients, circadian blood pressure follow-up data were obtained after 5 weeks of antidepressant therapy. RESULTS: Depressed patients not receiving antihypertensive medication (n=52) had higher mean 24 h systolic blood pressure levels than non-depressed comparison subjects (125.5+/-14.7 versus 119.6+/-13.3 mmHg, P<0.05). Subgroup analysis revealed that this difference could be almost exclusively attributed to patients on hypnotic medication; this subgroup also had a high day/night blood pressure change ('dip'). In depressed patients using antihypertensive agents (n=17), circadian blood pressure levels pointed to a suboptimal control of hypertension. In the subgroup with follow-up measurements, circadian blood pressure levels had not changed after 5 weeks of antidepressant therapy. CONCLUSION: Circadian blood pressure monitoring identified a subgroup of depressed patients characterized by higher mean systolic blood pressure levels, the use of hypnotics and a high day/night blood pressure change.

Adult↗
PubMed2002

Maternal anxiety and depression, poverty and marital relationship factors during early childhood as predictors of anxiety and depressive symptoms in adolescence.

BACKGROUND: This paper examines the degree to which symptoms of anxiety and depression at age 14 years are associated with early childhood experience of maternal anxiety and depression, poverty, and mother's marital relationship distress and break-up. METHODS: In a longitudinal study, 4434 families were followed-up from infancy to adolescence. RESULTS: Maternal anxiety and depression during early childhood were found to have small, but significant, influences upon the development of high anxiety-depression symptoms at age 14, after controlling for the effects of poverty and marital relationship factors. This effect was greater with repeated exposure to high maternal anxiety and depression. Poverty, distressed marital relationship and marital break-up during the child's first five years also produced small, but significant, increases in risk of high anxiety and depression symptoms in adolescence. Stable, single-parent status was not found to be a risk factor. There was no evidence of marked gender differences in risk factors, other than poverty, which had a stronger impact for girls than boys. CONCLUSIONS: Overall, the results suggest that maternal anxiety and depression, poverty, parent relationship conflict and marital break-up during early childhood are associated with small, but significant, increased risk of anxiety-depression symptoms in adolescence.

Adolescent↗
PubMed2003

The pitch of maternal voice: a comparison of mothers suffering from depressed mood and non-depressed mothers reading books to their infants.

BACKGROUND: Research suggests that storybook reading promotes language development and that there is a relationship between maternal affective responses in relation to infant affect and language development. The purpose of this study is to relate maternal paralinguistic and verbal behaviour during storybook reading to maternal mood state. METHOD: Mothers (n = 32) reporting depressed mood (as measured by the Edinburgh Postnatal Depression Scale) were matched on age of baby (mean age = 6 months, mean age = 10 months), sex of baby, educational status of mother and parity with 32 non-depressed mothers. They were video- and audio-taped in their homes while reading a picture-book to their infants. Maternal textual and extra-textual utterances were transcribed and analysed in terms of mean length utterance (MLU), fundamental frequency and pitch modulation. RESULTS: There was an interaction between psychological well being and age group with regard to MLU for text read. Non-depressed mothers had a smaller MLU for younger babies in comparison with older babies, while depressed mothers showed no difference in their MLU. There was a main effect of psychological well being with depressed mothers speaking with a higher mean pitch and more modulations in their pitch, in comparison with non-depressed mothers. Furthermore, there was a significant interaction of the psychological well being of the mother and the mean fundamental frequency used when reading the text and when speaking to their child during the picture-book session. CONCLUSIONS: These differences in maternal speech indicate that mothers who are depressed are less attuned to their infants which might force the infant into self-regulatory patterns that eventually compromise the child's development.

Adult↗
PubMed2006

The meaning of depression: Swedish nurses' perceptions of depressed inpatients.

People suffering from depressive disorder are affected by one of the western world's largest medical groups of disorders in both psychiatric and general medicine. Drug treatment is usually the first-line intervention and has been shown to be an effective treatment. Other therapies, including nursing interventions that could be implemented in care, are infrequently used. It is therefore important to understand whether nurses' perceptions of depressed people could be explained from the medical model by defining the nurses' view of psychiatric inpatients. Therefore, the aim of this study was, with the clinical picture as the starting point, to investigate the nurses' view of hospitalized patients with a diagnosis of depression. In this prospective study, 155 nurses' opinion of depression among depressive inpatients was assessed using a questionnaire based on the Montgomery-Asberg Depression Rating Scale. To elucidate the relationship between the variables in the questionnaire, factor analysis rotated by the Varimax method with Kaiser's normalization was used. The factor analysis identified five factors. The number of variables was reduced from 61 to 34. Based on the factor interpretation, an initial factor structure for the depressive inpatient was defined. The identified factors were interpreted and labelled to create the nurses' fused "picture" or meaning of the depressed inpatient as an individual who experienced feelings of annihilation, alienation, fatigue, emptiness and affliction, an individual who is disconnected from the whole of temporality.

Acute Disease↗
PubMed1988

Self-rated depression scales and screening for major depression in the older hospitalized patient with medical illness.

Until now, no self-rated depression scale had been validated as a screening measure for major depression in the older patient hospitalized with medical illness. The present report establishes the validity of two brief, easily administered depression screening tests, the Geriatric Depression Scale (GDS) and the Brief Carroll Depression Rating Scale (BCDRS), in this population. Structured psychiatric interviews were performed and self-rated depression measures administered to 128 men, aged 70 and over, consecutively admitted to medical and neurological services of a VA hospital. The GDS and BCDRS were both shown to have high sensitivity and specificity for detecting major depression in this setting. Optimal cut-off scores determined by the receiver operating curve characteristics of these tests were 11 for the GDS and 6 for the BCDRS. At a cutoff score of 11, the GDS had a sensitivity of 92%, a specificity of 89%, and a negative predictive value of 99%; lowering the break point to 8 did not increase sensitivity. At a cutoff score of 6, the BCDRS achieved a 100% sensitivity, 93% specificity, and 100% negative predictive value. Whether clinicians decide to implement either of these depression screens in their practice will depend to a large degree on the importance ascribed to the detection of these disorders and on attitudes toward the benefits of treatment.

Aged↗
PubMed2002

Postpartum depressed women's explanation of depression.

PURPOSE: To gain empirically derived knowledge of postpartum depression upon which to base detection and intervention strategies. DESIGN: From 1997 through 2000, a sample of 30 nonhospitalized women, self-identified as postpartum depressed was recruited by network and "snowball sampling" to discuss their beliefs about postpartum depression. With reference to the Kleinman explanatory model of illness, their beliefs about postpartum depression and its treatment were contrasted to the biomedical model of postpartum depression. METHODS: Content analysis was done to classify data into cause, effect, severity, expectations, fears, and suggestions for treatment. Results were compared with DSM-IV diagnostic criteria. RESULTS: Postpartum depressed mothers' explanatory model of depression differed from the DSM-IV criteria for depression in that mothers' depiction was generally milder in form and consisted of sleep deprivation instead of sleep disorders. Also, mothers were confused, overwhelmed, and guilty about thoughts of hurting their babies. The mothers did not exhibit suicidal ideation. Mothers described the illness as severe and long lasting, causing multiple problems including marital discord. IMPLICATIONS: Mothers suggested more public education and support for new mothers to prevent and treat the disorder.

Adult↗
PubMed1980

A comparison of inpatients with primary unipolar depression and depression secondary to anxiety.

Retrospective comparisons between primary unipolar depression and depression secondary to anxiety in 65 inpatients revealed a number of differences. Secondary depression was associated with a significantly higher incidence of neurotic traits in childhood, chronic unhappiness, and unsupportive family. Tricyclic antidepressants and ECT were both more effective in primary depression, and some secondary depressives became worse on ECt. When primary depression was sub-divided into familial, nonfamilial and spectrum types, the greatest differences were noted between familial and secondary depressions. In the former group a more stable life style was noted. Secondary and spectrum types differed on only two variables and several similarities were noted. Platelet monoamine oxidase activity was significantly higher in secondary depression.

Adult↗
PubMed1994

Lower degree of esterification of serum cholesterol in depression: relevance for depression and suicide research.

Previous studies have suggested that depression and suicide are related to alterations in total cholesterol serum concentrations, and that an altered distribution of haptoglobin (Hp) phenotypes in major depression indicates that variation on chromosome 16 may be associated with that illness. Lecithin:cholesterol acyl transferase (LCAT, EC 2.3.1.43), the enzyme that catalyzes the esterifying reaction of cholesterol in serum, is located close to the Hp gene. This study examined the serum concentrations of total and free cholesterol and the esterified cholesterol ratio in 26 healthy controls, 47 unipolar depressed subjects (16 minor, 14 simple major and 17 melancholic depressed subjects) and 12 relatives of melancholic subjects. Depressed subjects (regardless of subtype) and relatives of depressed subjects had a significantly lower esterified cholesterol ratio than normal controls. No significant differences in total or free cholesterol concentrations were found between the above study groups. In depressed subjects, there were no significant relationships between the esterified cholesterol ratio, total or free cholesterol and postdexamethasone adrenocorticotropic or cortisol values, Hp phenotypes, severity of illness or suicidal symptoms. It is hypothesized that lower esterification in serum cholesterol may constitute a vulnerability factor for depression through alterations in cell membrane microviscosity.

Adult↗
PubMed1996

Atypical depressive symptoms and clusters in unipolar and bipolar depression.

In order to examine differences in the atypical symptoms of depression between unipolar and bipolar patients, we studied 109 depressed patients (79 unipolar and 30 bipolar subjects) diagnosed with DSM-IV criteria. Patients were assessed using the Atypical Depression Diagnostic Scale (ADDS), a semi-structured interview that rates mood reactivity and other atypical depressive symptoms. Although atypical depression was common in this sample (28% of cases with definite atypical depression), no differences were found between the unipolar and bipolar patients in either the atypical symptom profile or the prevalence of an atypical depression diagnosis. The interrelationships between the atypical symptoms were also examined using a hierarchical cluster analysis. A five-cluster solution maximized differences between groups, with results suggesting that atypical depression may be a heterogeneous diagnosis.

Adult↗
PubMed1998

Reality negotiation in non-depressed and depressed persons.

OBJECTIVES: Non-depressed and depressed persons were hypothesized to input and recall self-referential information that was consistent with their self theories. DESIGN: Non-depressed and depressed persons were compared. METHODS: Non-depressed (14) and depressed (14) students chose between positive or negative audio statements, and then recalled the statements. RESULTS: Non-depressed relative to depressed participants: (i) listened more to the positive than the negative tapes; and (ii) fabricated (i.e. incorrectly recalled) less negative messages. CONCLUSION: Partial support is given to reality negotiation processes.

Adolescent↗
PubMed2006

The validity of the hospital anxiety and depression scale and the geriatric depression scale in Parkinson's disease.

We assessed the concurrent validity of the Hospital Anxiety and Depression Scale (HADS) and the Geriatric Depression Scale (GDS) against the Hamilton Rating Scale for Depression (Ham-D) in patients with Parkinson's disease (PD). Forty-six non-demented PD patients were assessed by a neurologist on the Ham-D. Patients also completed four mood rating scales: the HADS, the GDS, the VAS and the Face Scale. For the HADS and the GDS, Receiver Operating Characteristics (ROC) curves were obtained and the positive and negative predictive values (PPV, NPV) were calculated for different cut-off scores. Maximum discrimination between depressed and non-depressed PD patients was reached at a cut-off score of 10/11 for both the HADS and the GDS. At the same cut-off score of 10/11 for both the HADS and the GDS, the high sensitivity and NPV make these scales appropriate screening instruments for depression in PD. A high specificity and PPV, which is necessary for a diagnostic test, was reached at a cut-off score of 12/13 for the GDS and at a cut-off score of 11/12 for the HADS. The results indicate the validity of using the HADS and the GDS to screen for depressive symptoms and to diagnose depressive illness in PD.

Aged↗