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PubMed2000

Tryptophan depletion and risk of depression relapse: a prospective study of tryptophan depletion as a potential predictor of depressive episodes.

BACKGROUND: This study investigated the relationship between depressive symptom response during tryptophan depletion and future depressive episodes. METHODS: Twelve subjects with prior major depressive episodes in remission and medication-free for > or =3 months (patients), and 12 matched healthy (control) subjects received two tryptophan depletion tests 1 week apart. During follow-up the Hamilton Depression Rating Scale was administered weekly for 1 month, monthly for 3 months, and once at 6 and 12 months. RESULTS: With results from both tests, tryptophan depletion has a sensitivity of 78%, specificity of 80%, positive predictive value of 70%, and negative predictive value of 86% to identify future depressive episodes. Survival analysis shows that mood response to tryptophan depletion reliably predicts major depressive episodes during the follow-up year (r =.2725, p =.014). CONCLUSIONS: Tryptophan depletion may be clinically useful in identifying individuals at risk for future major depressive episodes.

Adult↗
PubMed2002

Principal components of the Beck Depression Inventory and regional cerebral metabolism in unipolar and bipolar depression.

BACKGROUND: We determined clustering of depressive symptoms in a combined group of unipolar and patients with bipolar disorder using Principle Components Analysis of the Beck Depression Inventory. Then, comparing unipolars and bipolars, these symptom clusters were examined for interrelationships, and for relationships to regional cerebral metabolism for glucose measured by positron emission tomography. METHODS: [18F]-fluoro-deoxyglucose positron emission tomography scans and Beck Depression Inventory administered to 31 unipolars and 27 bipolars, all medication-free, mildly-to-severely depressed. BDI component and total scores were correlated with global cerebral metabolism for glucose, and voxel-by-voxel with cerebral metabolism for glucose corrected for multiple comparisons. RESULTS: In both unipolars and bipolars, the psychomotor-anhedonia symptom cluster correlated with lower absolute metabolism in right insula, claustrum, anteroventral caudate/putamen, and temporal cortex, and with higher normalized metabolism in anterior cingulate. In unipolars, the negative cognitions cluster correlated with lower absolute metabolism bilaterally in frontal poles, and in right dorsolateral frontal cortex and supracallosal cingulate. CONCLUSIONS: Psychomotor-anhedonia symptoms in unipolar and bipolar depression appear to have common, largely right-sided neural substrates, and these may be fundamental to the depressive syndrome in bipolars. In unipolars, but not bipolars, negative cognitions are associated with decreased frontal metabolism. Thus, different depressive symptom clusters may have different neural substrates in unipolars, but clusters and their substrates are convergent in bipolars.

Adult↗
PubMedDate not supplied

Biological nature of depressive symptoms in borderline personality disorder: endocrine comparison to recurrent brief and major depression.

Borderline personality disorder (BPD) often shows depressive symptoms and their biological nature albeit extensively discussed remains controversial. The knowledge of this nature seems essential as it could imply key therapeutic strategies. We have found BPD and major depression (MD) not to share biological abnormalities. We have proposed BPD to frequently display an affective syndrome distinct from the nonborderline MD both in terms of quality and duration of symptoms and of biological substrate. A substantial number of BPD patients can be diagnosed as having clinical Recurrent Brief Depression (RBD) which has been proposed to overlap with BPD. RBD has been found to share perturbed biological substrate with MD but we have previously not found this abnormal substrate in BPD. Our aim was to study the possibility that BPD patients with depressive symptoms and even clinically diagnosed with RBD have a biological substrate distinct from RBD without BPD and from MD, and therefore an specific affective syndrome. We compared 20 BPD in-patients without co-existing MD to 20 sex- and age-matched non-BPD recurrent brief depressives and to 20 sex- and age-matched non-BPD major depressives on the thyrotropin-releasing hormone stimulation test (TRH-ST) and the dexamethasone suppression test (DST). Twelve BPD patients were diagnosed as having also RBD. BPD had less TRH-ST blunting than MD. TRH-ST did not differentiate BPD from RBD. RBD and MD patients shared equivalent TRH-ST values but BPD patients with clinically diagnosed RBD did not. BPD and RBD showed less perturbed DST than MD. DST did not differentiate BPD from RBD. BPD and RBD share most of the endocrinological normal substrate already described in BPD but RBD also share abnormalities with MD. Whereas we can conceptualize RBD as being an endocrinologically perturbed depressive syndrome, this may not be the case for the possible specific affective syndrome of BPD even if it can be for now diagnosed as being RBD.

Adult↗
PubMed2001

A comparison between the Beck Depression Inventory (BDI) and the self-rating version of the Montgomery Asberg Depression Rating Scale (MADRS).

BACKGROUND: The Beck Depression Inventory BDI is the most often used self-rating instrument for depressive symptoms. In the present study, the BDI was compared with a self-rating version of the Montgomery Asberg Depression Rating Scale (MADRS-S) in 86 psychiatric patients with mainly affective and anxiety disorders. METHODS: The patients were interviewed with the SCID-I Interview for a DSM-IV Major depression, and self-assessed the BDI and the MADRS. They were rated to have either mild, moderate or severe depressive symptomatology. After recovery, criteria for DSM-IV Personality disorders were self-assessed. RESULTS: The instruments were about equal in differentiating between different Axis-I diagnoses and did not differ according to sensitivity to change during antidepressive treatment. Although the scales were highly intercorrelated (r=0.869), the BDI was demonstrated to tap more maladaptive personality traits compared to the MADRS-S. LIMITATIONS: Because the sample consisted of psychiatric patients with prominent psychiatric symptomatology, the discriminative power of the BDI and the MADRS-S should be further evaluated in a sample with milder symptoms. CONCLUSIONS: The MADRS-S is equivalent to the BDI as a self-assessment instrument for depression, but the MADRS-S focuses on core depressive symptoms, and is less influenced by maladaptive personality traits.

Adult↗
PubMed2001

Unsuspected depressive mania in pre-pubertal Hispanic children referred for the treatment of 'depression' with history of social 'deviance'.

BACKGROUND: Despite an emerging Literature on the mixed nature of pediatric mania, initial presentation with conduct problems continues to mislead mental health clinicians. The present report focuses on Hispanic pre-pubertal children referred for the treatment of depression in the context of conduct problems. METHODS: Eleven boys and two girls received a structured psychiatric assessment in a practice setting to make sense of the presenting clinical complexity. Diagnoses were assigned using the DSM-IV criteria. RESULTS: Ten of the boys and both girls met criteria for depressive mania. Their family histories were replete with affective disorder. Five (50%) of the boys and both of the girls (100%) with depressive mania had family histories of bipolar disorder. Six (60%) of the boys and neither of the girls with depressive mania had psychotic features. Those with depressive mania exhibited clear-cut circadian changes in symptomatology. Euphoria, oscillating with affective states indicative of psychic pain, was characteristically restricted to the evenings or nighttime. However, the drive to seek treatment had stemmed from social 'deviance'. CONCLUSION: Children with depressive mania are often unrecognized in clinical settings. Boys with conduct problems may be disproportionately represented among such children. These data support Akiskal's hypothesis that externalizing (conduct) problems in clinically referred children with depression are indicative of bipolar disorder.

Bipolar Disorder↗
PubMed2004

Can we identify mothers at risk for postpartum depression in the immediate postpartum period using the Edinburgh Postnatal Depression Scale?

BACKGROUND: Postpartum depression is a major health issue for many women around the world with well-documented negative health consequences for the mother, child and family. While research has demonstrated the amenability of postpartum depression to treatment, there is preliminary evidence suggesting maternal mood in the immediate postpartum period may be predictive of postpartum depression such that secondary preventive interventions may be implemented. METHODS: A population-based sample of 594 mothers completed the Edinburgh Postnatal Depression Scale (EPDS) at 1, 4 and 8 weeks postpartum. The sensitivity, specificity and predictive power of the 1-week EPDS in relation to identifying mothers with elevated EPDS scores at 4 and 8 weeks was determined. The predictive power of the 1-week EPDS was further assessed using odds ratios and receiver operator characteristic (ROC) curves. RESULTS: At 1 week postpartum, 29.5% of mothers scored >9 on the EPDS, decreasing to 23% at 4 weeks and 20.5% at 8 weeks. Using the cut-off score of 9/10, the 1-week EPDS accurately classified 85.4% mothers at 4 weeks and 82.5% mothers at 8 weeks with or without postpartum depression symptomatology. The 1-week EPDS was significantly correlated to the 4-week (r=0.72, P<0.001) and 8-week (r=0.65, P<0.001) EPDS. Mothers with a 1-week EPDS score >9 were 30.3 times more likely at 4 weeks (95% CI=17.5-42.3) and 19.1 times more likely at 8 weeks (95% CI=11.0-32.9) to exhibit postpartum depression symptomatology. LIMITATIONS: Psychiatric interviews were not completed in collaboration with the EPDS. CONCLUSION: The EPDS administered in the 1st week postpartum was predictive of maternal mood at 4 and 8 weeks postpartum. To identify mothers at high risk for postpartum depression, health care professionals could consider screening all new mothers in the immediate postpartum period such that secondary preventive interventions may be implemented.

Adolescent↗
PubMed2004

Is there evidence for a male depressive syndrome in inpatients with major depression?

BACKGROUND: The question is investigated whether atypical depressive symptoms such as irritability, anger attacks, aggressiveness or abusive behavior, which are hypothesized to indicate a hypothetical male depressive syndrome are more prevalent in male than in female inpatients with unipolar major depression. METHODS: Data were obtained from 2411 patients who had been consecutively admitted to the Department of Psychiatry of the Ludwig-Maximilians-University of Munich. Psychopathological symptoms had been assessed by a standardized documentation system (AMDP). RESULTS: Neither frequency nor mean scores of most of the symptoms describing a male depressive syndrome differed between males and females. There were no gender differences in symptoms with respect to severity of depression, first hospitalization and duration of illness. However, gender differences emerged when regarding symptom patterns by factor analysis. LIMITATIONS: Only inpatients were studied, and comorbidity was not considered. CONCLUSIONS: The hypothesis of a male depressive syndrome needs further research, focusing on the gradual development of (masked) depression by men in mainly non-clinical samples.

Depressive Disorder↗
PubMed2005

A different depression: clinical distinctions between bipolar and unipolar depression.

Delayed diagnosis or misdiagnosis can prolong the suffering of patients with bipolar disorder. Accurate early diagnosis is sometimes difficult, however, particularly because patients often present in the depressive phase, which can easily be mistaken for unipolar depression. Unfortunately, therapy appropriate for unipolar depression can increase the risk of manic switch or cycle acceleration in bipolar disorder, especially in those with a family history of bipolarity and suicide, although some antidepressants may be useful in some bipolar patients. In addition, most currently available mood stabilizers, though effective in managing mania, do not effectively resolve depression. In contrast, lamotrigine has shown activity in bipolar depression and has a very low risk of manic switch. Bipolar depression, compared with unipolar depression, is more likely to be associated with hypersomnia, motor retardation, mood lability, early onset, and a family history of bipolar disorder. Awareness of these distinctions can greatly improve diagnosis of bipolar disorder and provide an opportunity for effective therapeutic intervention.

Antidepressive Agents↗
PubMed1997

Prevalence, correlates, and course of minor depression and major depression in the National Comorbidity Survey.

Data from the National Comorbidity Survey are used to study the lifetime prevalences, correlates, course and impairments associated with minor depression (mD), major depression 5-6 symptoms (MD 5-6), and major depression with seven or more symptoms (MD 7-9) in an effort to determine whether mD is on a continuum with MD. There is a monotonic increase in average number of episodes, average length of longest episode, impairment, comorbidity, and parental history of psychiatric disorders as we go from mD to Md 5-6 to MD 7-9. In most of these cases, though, the differences between mD and MD 5-6 are no longer than the differences between MD 5-6 and MD 7-9, arguing for continuity between mD and MD. Coupled with the finding from earlier studies that subclinical depression is a significant risk factor for major depression, these results argue that minor depression is a variant of depressive disorder that should be considered seriously both as a target for preventive intervention and for treatment. The paper closes with suggestions regarding the analysis of mD subtypes in future longitudinal studies.

Adolescent↗
PubMed1997

Cluster analytic validation of the DSM melancholic depression. The threshold model: integration of quantitative and qualitative distinctions between unipolar depressive subtypes.

Cluster analysis was performed on the DSM-III symptoms of major depression and symptoms of melancholia identified in a study group consisting of 220 unipolar depressed inpatients a melancholic and non-melancholic cluster. Patients allocated to the melancholic cluster were more severely depressed and they were characterized by psychomotor disorders, a distinct quality of mood, diurnal variation, early morning awakening, and non-reactivity. Our results support the construct validity of the DSM-III melancholic subtype of major depression. This study supports the integrated threshold model:. (i) melancholic and non-melancholic depression may be regarded as continuous classes in terms of overall severity of depression; and (ii) both groups form discrete categories with regard to the melancholic symptoms, which emerge as the severity of depression increases.

Adjustment Disorders↗
PubMed2002

Clinical profiles relating gender and depressive symptoms among adolescents ascertained by the Beck Depression Inventory II.

PURPOSE: Depressive disorders (DD) in adolescence are often misdiagnosed and under-recognised. A major clinical problem regards the high rate of co-morbidity with other disorders, namely substance abuse. The aim of this study was to assess the discriminative power of the Beck Depression Inventory II (BDI-II) to characterise specific social-demographic variables related to DD in adolescence. METHODS: A Portuguese version of the BDI-II and a social-demographic questionnaire were administered to 775 Portuguese adolescents (312 males, 463 females; mean age: 16.9 years); 83 adolescents performed a clinical interview following DSM-IV criteria. RESULTS: Mean BDI-II Portuguese version (BDI-II-P) total score was 10.31 (standard deviation: 8.4), with females reporting more depressive symptoms than males (P < 0.001). Low academic achievement, sleep disturbances, and alcohol consumption were consistently associated with depressive symptoms for both genders. Higher tobacco consumption was significantly associated with depressive symptoms in females. Familial factors did not appear to be associated with depressive symptoms in males. However, a higher frequency of siblings, having separated parents as well as a more extreme perception of the mother's educational style were consistently associated with depressive symptoms in females. CONCLUSION: The BDI-II-P showed discriminative power to characterise social-demographic variables related to DD especially in adolescent females.

Adolescent↗
PubMed2003

Relationship between body-mass index and depressive symptoms in patients with major depression.

BACKGROUND: Appetite and weight changes are commonly occurring symptoms of depressive illness. The occurrence of these symptoms may not only be related to depressive mood but may also be related to body weight. AIM: To examine the relationship between symptoms of depression and body weight. METHODS: Symptoms of depression were assessed by the Montgomery-Asberg depression rating scale (MADRS) in 1694 patients seeking medical help and fulfilling DSM-IV criteria for a major depressive episode. The level of anxiety was evaluated by Covi's anxiety scale. Body weight was expressed as body-mass index (BMI, kg/m(2)) and treated both categorically and continuously. RESULTS: The total MADRS score was not statistically different across the four BMI categories (underweight: 32.3 +/- 0.6, normal weight: 30.9 +/- 0.2, grade 1: 30.6 +/- 0.3, and 2 overweight: 30.6 +/- 0.6, P = 0.053 (NS)). In women with BMI <or= 18.5 kg/m(2) MADRS was significantly higher than that in other BMI categories (underweight: 32.4 +/- 0.6, normal weight: 30.6 +/- 0.2, grade 1: 30.6 +/- 0.4, and 2 overweight: 30.6 +/- 0.6: P = 0.036). Increasing BMI was related to a linear decrease in symptoms "Reduced appetite" (P < 0.0001) and "Pessimistic thoughts" (P < 0.003). The presence of melancholic or atypical features was not associated with lower or higher BMI, respectively. CONCLUSIONS: In patients with major depression higher body weight is likely to be associated with less reduction in appetite and less pessimistic thoughts.

Adult↗
PubMed2001

The prolactin response to sulpiride in major depression: the role of the D2 receptor in depression.

Multiple lines of investigations have implicated the role of the dopaminergic system in depression. The aim of the study was to characterise the Dopamine D2 receptor sensitivity status in depressed patients versus controls by means of a novel neuro-endocrine challenge test, the prolactin response to sulpiride. In this intervention, ten patients and ten age matched male volunteers were studied. The patients were diagnosed according to DSM-IV criteria, and Montgomery Asberg and Zung scales were done. There was no significant difference in baseline levels of prolactin between the depressed and control groups. Significantly higher prolactin levels after sulpiride challenge were however found in depressed patients than controls at all time points after sulpiride administration. This neuroendocrine challenge paradigm suggests that the prolactin response to sulpiride, a D2 receptor antagonist, is enhanced in depression, which suggests that this receptor might be supersensitive in depression compared to controls. This adds to the data implicating the dopaminergic system in the pathophysiology of depression, and suggests that dopaminergic mechanisms might be a target of therapeutic interest.

Adult↗
PubMed2002

Neuroticism, extraversion, life events and depression. The Cardiff Depression Study.

BACKGROUND: Certain personality traits may mediate the relationship between familiality and adversity in causing depression. AIMS: To examine whether the neuroticism and extraversion scales of the Eysenck Personality Inventory (EPI) represent enduring traits underlying the vulnerability to respond to adversity by developing depressive episodes. METHOD: A total of 108 subjects with depression and their siblings were compared with 105 healthy control subjects and their siblings. All were interviewed using the Schedules for the Clinical Assessment of Neuropsychiatry and the Life Events and Difficulties Schedule. Subjects also completed the EPI. RESULTS: Both neuroticism and extraversion were familial and correlated with mood and life event measures. There were no differences on either measure between the never-depressed siblings of probands with depression and controls. Regression analyses showed that the major influence on neuroticism was current mood. CONCLUSIONS: Neither extraversion nor neuroticism measures trait vulnerability to depression, and neuroticism scores mainly reflect symptoms of depression.

Adult↗
PubMed1995

Familial depression versus depression identified in a control group: are they the same?

Subjects who meet the criteria for an affective syndrome possibly are aetiologically heterogeneous. An approach to this possibility involves examining affectively ill subjects obtained by different methods of ascertainment. This study compares depressed and manic subjects who are related to affectively ill probands with affectively ill subjects who were obtained from a study of a control population, and, therefore, were less likely to be familial. The subjects were identified in a large collaborative study of depression where both family members as well as controls were personally interviewed and followed up for 6 years after admission to the study. Data were obtained on subtypes of affective disorder using the Research Diagnostic Criteria and information was gathered about psychiatric hospitalizations, suicide attempts, alcoholism and psychological functioning prior to admission. Similar assessments were made for the comparison groups for the 6 year period between intake and follow-up. Relatives of bipolar I/schizoaffective manic probands were more likely to show mania than affectively ill controls or relatives of unipolar/schizoaffective depressed probands. Affectively ill controls were less likely to be hospitalized and less likely to suffer from an incapacitating depression. They were also likely to have functioned in a more healthy fashion than the affectively ill relatives of the bipolars and unipolars, in the 5 years before admission to the study. In the 6 year follow-up, both the subjects themselves and raters assessed the depressed controls as functioning better than the affectively ill relatives of the probands. Further, assessment of global adjustment during the 6 year period was worse for the relatives of affectively ill probands than for the depressed controls. Length of major depression was longer in relatives of bipolar and unipolar probands than in controls. Though all of the subjects in this study met research criteria for an affective illness, there were marked differences in the qualitative aspects of these illnesses with the relatives of affectively ill probands, who functioned less well and had longer and more severe episodes and more hospitalizations.

Adaptation, Psychological↗
PubMed2003

The internal and external validity of the Major Depression Inventory in measuring severity of depressive states.

BACKGROUND: We have developed the Major Depression Inventory (MDI), consisting of 10 items, covering the DSM-IV as well as the ICD-10 symptoms of depressive illness. We aimed to evaluate this as a scale measuring severity of depressive states with reference to both internal and external validity. METHOD: Patients representing the score range from no depression to marked depression on the Hamilton Depression Scale (HAM-D) completed the MDI. Both classical and modern psychometric methods were applied for the evaluation of validity, including the Rasch analysis. RESULTS: In total, 91 patients were included. The results showed that the MDI had an adequate internal validity in being a unidimensional scale (the total score an appropriate or sufficient statistic). The external validity of the MDI was also confirmed as the total score of the MDI correlated significantly with the HAM-D (Pearson's coefficient 0.86, P < or = 0.01, Spearman 0.80, P < or = 0.01). CONCLUSION: When used in a sample of patients with different states of depression the MDI has an adequate internal and external validity.

Adult↗
PubMed2000

Coping with depression and anxiety: preliminary results of a standardized course for elderly depressed women.

The experiences of 51 elderly depressed female patients with a standardized course "Coping with Depression and Anxiety" were investigated. Preliminary findings concerning the effectiveness of this course in 34 patients who completed the course will also be presented. This course consisted of psychoeducation and skills training. Depressive symptoms were scored by using the SCL-90 depression scale and the Geriatric Depression Scale. Results indicate that patients were very enthusiastic about the course and that there was no need to make major changes in its structure and content. Also, depressive symptoms were significantly reduced after completion of the course, which emphasizes the importance of this psychoeducational program in the treatment of depression in elderly female patients.

Adaptation, Psychological↗
PubMed2001

Depression in primary care. 1: elderly patients' disclosure of depressive symptoms to their doctors.

BACKGROUND: This article examines some of the factors responsible for older patients' decision to report current depressive symptoms to their general medical practitioner. A companion article considers factors contributing to general practitioners' (GPs') recognition of major depressive episode when it was present. METHODS: A survey was conducted of a stratified sample of 1,021 patients aged 70+ years of 30 GPs in Melbourne, Australia, to gauge the prevalence of depressive symptoms, the frequency with which patients had informed GPs of their symptoms, and GPs' recognition of major depressive episodes. Patients and informants were questioned using the Canberra Interview for the Elderly, which generates rigorous ICD-10 research diagnoses. RESULTS: Logistic regression analysis showed that symptom disclosure was associated in descending order of importance with higher depressive scores, previous contact with a psychiatrist, and female gender. Even so, 48% of persons with ICD-10 moderate or severe depressive episode had not reported any current complaints to their doctor at the time of interview. CONCLUSION: Older patients often do not report depressive symptoms to their medical practitioner. Men and patients lacking "psychological mindedness" may be at special risk.

Aged↗