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PubMed1996

[The Depression Recognition Scale: and aid in the diagnosis of depression in family practice].

OBJECTIVE: To assess the reliability, positive predictive value and concurrent validity of a brief and simple interview to diagnose major depression in general practice, the Depression recognition scale (DRS). DESIGN: Descriptive. SETTING: University of Leiden, the Netherlands. METHODS: The DRS was compared with a semi-structured psychiatric interview to assess major depression and with the depression items of the Symptom checklist-90 (SCL-90), a self-rating scale for perceived symptoms. RESULTS: The study consisted of 233 subsequent patients of II general practices who were screened for an interview; 95 patients were actually interviewed, 15 of these patients had a major depression (15/233; 6%). The DRS was also compared with the SCL-90 among 428 other patients. The validity was 0.73 and 0.66 and the internal consistency (Cronbach's alpha) was 0.63 and 0.75, respectively. If the DRS were used only for patients the general practitioner considers mildly depressed (43/233 = 18%), few cases of major depression would be missed (2/15). CONCLUSION: The DRS appears a practical, reliable and valid diagnostic tool.

Adult↗
PubMed1998

[Depression and aggression. A control group study on the aggression hypothesis in depressive disorders based on the Buss-Durkee Questionnaire].

PURPOSE: The aim of this study was to prove the hypothesis that covert or inhibited aggression/hostility as described in psychoanalytic literature is part of the psychogenetic development of depression. METHOD: We compared 50 consecutively admitted depressed inpatients to 50 healthy people of the regionally living general population, matched by sex and age, using the Buss-Durkee Hostility Inventory. RESULTS: Depressed patients have significantly higher values in the BDHI subscales "total aggression", especially in irritability, negativism, resentment, suspicion and guilt, also in "attitudional component", "inhibited aggression" and "covert hostility". No differences were found in "assault" and "indirect aggression", controls got significantly higher values in "verbal aggression". A comparison of depressed patients with suicide attempts versus depressed patients without such behaviour showed no significant differences. CONCLUSION: The psychoanalytic hypothesis seems to be useful for depression but not for the suicidal behaviour of depressive patients.

Adult↗
PubMed1999

Diagnostic efficiency of the Rorschach schizophrenia and depression indices in identifying first-episode schizophrenia and severe depression

We studied the diagnostic efficiency of the Rorschach schizophrenia (SCZI) and depression (DEPI) indices for detecting first-episode schizophrenia and severe depression with and without psychotic features using DSM-IV as a gold standard measure. Twenty-seven patients with first-episode schizophrenia, 13 with bipolar I disorder, 28 with psychotic depression, 29 with non-psychotic depression, and 60 healthy controls were recruited for the study. The SCZI was highly specific with a very low false positive rate. The lowest positive value of 4, however, may yield false positives, especially among manic patients. The DEPI identified severe non-psychotic depression but not psychotic depression, suggesting that these patient groups invoke different perceptual-cognitive processes in formulating and articulating their Rorschach responses. Anyway, both the SCZI and the DEPI based on the psychological organization and functioning that are known to play a clearly formulated role in schizophrenia and depression, respectively, provide a valuable addition for diagnostics characterized by overt symptoms.

Journal Article↗
PubMed2003

Confirmation of the neurophysiologically predicted therapeutic effects of trazodone on its target symptoms depression, anxiety and insomnia by postmarketing clinical studies with a controlled-release formulation in depressed outpatients.

Early human pharmaco-EEG and subsequent sleep laboratory studies identified trazodone, a 5-HT(2) antagonist and 5-HT reuptake inhibitor (SARI), as an antidepressant with therapeutic effects on its target symptoms depressed mood, anxiety and insomnia. On the occasion of the introduction of a controlled-release (CR) formulation (Trittico 150 mg retard, marketed in Austria by CSC Pharmaceuticals Handels GmbH, Vienna, Austria) in Austria in July 2000, a multi-center, open, clinical post-marketing study on the therapeutic effects, safety and target symptoms of trazodone CR in depression was carried out at 80 offices of Austrian neuropsychiatrists. 549 outpatients (63% females) of all age groups suffering from five different subtypes of depression were enrolled in the study. After a 2-week fixed dose-titration regimen up to 150 mg and a 4-week adjustment period to the optimum dose, 66% of the patients remained on 150 mg, 20% increased the dose and 11% decreased it. Only 3.7% discontinued treatment. Rating by the neuropsychiatrists based on the Clinical Global Impression showed very much to much improvement in 78.3% of the patients, and no change or a deterioration in only 3.6%. In the Hamilton Depression Scale (HAMD) a statistically significant improvement from a baseline score of 21 to a score of 14 after 2 weeks was found, and a normalization to a score of 8 after 6 weeks. Therapeutic effects were similar in the five groups suffering from different subtypes of depression and in patients with and without comedication. Self-rating by the patients based on the Zung Self-Rating Depression Scale (SDS) and Zung Self-Rating Anxiety Scale (SAS) also showed a significant improvement in the 2nd and 6th week of therapy. Evaluation of the target symptoms of trazodone by ranking the most improved symptoms identified insomnia as the most improved psychopathological item in all three scales. While in the observer ratings also suicidal tendencies and weight loss were found much improved, in the self-rated Zung SDS sadness and loss of drive came second and third in the improvement ranking, in the self-rated Zung SAS anxiety and the feeling of falling apart. Tolerability was very good. In the 2nd week only 16.9% and in the 6th week only 7.6% of the patients reported side effects, mostly characterized by tiredness and rarely by nausea and vertigo. The present clinical study is in agreement with previous studies identifying trazodone as a safe and effective antidepressant, specifically regarding its target symptoms insomnia, depression and anxiety. It also confirms our own early predictions based on neurophysiological investigations concerning the mode of action of the drug.

Adolescent↗
PubMed2005

Outbreeding depression, but no inbreeding depression in haplodiploid Ambrosia beetles with regular sibling mating.

In sexual reproduction the genetic similarity or dissimilarity between mates strongly affects offspring fitness. When mating partners are too closely related, increased homozygosity generally causes inbreeding depression, whereas crossing between too distantly related individuals may disrupt local adaptations or coadaptations within the genome and result in outbreeding depression. The optimal degree of inbreeding or outbreeding depends on population structure. A long history of inbreeding is expected to reduce inbreeding depression due to purging of deleterious alleles, and to promote outbreeding depression because of increased genetic variation between lineages. Ambrosia beetles (Xyleborini) are bark beetles with haplodiploid sex determination, strong local mate competition due to regular sibling mating within the natal chamber, and heavily biased sex ratios. We experimentally mated females of Xylosandrus germanus to brothers and unrelated males and measured offspring fitness. Inbred matings did not produce offspring with reduced fitness in any of the examined life-history traits. In contrast, outcrossed offspring suffered from reduced hatching rates. Reduction in inbreeding depression is usually attributed to purging of deleterious alleles, and the absence of inbreeding depression in X. germanus may represent the highest degree of purging of all examined species so far. Outbreeding depression within the same population has previously only been reported from plants. The causes and consequences of our findings are discussed with respect to mating strategies, sex ratios, and speciation in this unusual system.

Analysis of Variance↗
PubMed2004

Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents With Depression Study (TADS) randomized controlled trial.

CONTEXT: Initial treatment of major depressive disorder in adolescents may include cognitive-behavioral therapy (CBT) or a selective serotonin reuptake inhibitor (SSRI). However, little is known about their relative or combined effectiveness. OBJECTIVE: To evaluate the effectiveness of 4 treatments among adolescents with major depressive disorder. DESIGN, SETTING, AND PARTICIPANTS: Randomized controlled trial of a volunteer sample of 439 patients between the ages of 12 to 17 years with a primary Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnosis of major depressive disorder. The trial was conducted at 13 US academic and community clinics between spring 2000 and summer 2003. INTERVENTIONS: Twelve weeks of (1) fluoxetine alone (10 to 40 mg/d), (2) CBT alone, (3) CBT with fluoxetine (10 to 40 mg/d), or (4) placebo (equivalent to 10 to 40 mg/d). Placebo and fluoxetine alone were administered double-blind; CBT alone and CBT with fluoxetine were administered unblinded. MAIN OUTCOME MEASURES: Children's Depression Rating Scale-Revised total score and, for responder analysis, a (dichotomized) Clinical Global Impressions improvement score. RESULTS: Compared with placebo, the combination of fluoxetine with CBT was statistically significant (P =.001) on the Children's Depression Rating Scale-Revised. Compared with fluoxetine alone (P =.02) and CBT alone (P =.01), treatment of fluoxetine with CBT was superior. Fluoxetine alone is a superior treatment to CBT alone (P =.01). Rates of response for fluoxetine with CBT were 71.0% (95% confidence interval [CI], 62%-80%); fluoxetine alone, 60.6% (95% CI, 51%-70%); CBT alone, 43.2% (95% CI, 34%-52%); and placebo, 34.8% (95% CI, 26%-44%). On the Clinical Global Impressions improvement responder analysis, the 2 fluoxetine-containing conditions were statistically superior to CBT and to placebo. Clinically significant suicidal thinking, which was present in 29% of the sample at baseline, improved significantly in all 4 treatment groups. Fluoxetine with CBT showed the greatest reduction (P =.02). Seven (1.6%) of 439 patients attempted suicide; there were no completed suicides. CONCLUSION: The combination of fluoxetine with CBT offered the most favorable tradeoff between benefit and risk for adolescents with major depressive disorder.

Adolescent↗
PubMed1998

Epidemiology of DSM-III-R major depression and minor depression among adolescents and young adults in the National Comorbidity Survey.

Data on the prevalences, comorbidities, and cohort effects of DSM-III-R major depression (MD) and minor depression (mD) are reported for the nationally representative sample of n = 1,769 adolescents and young adults who participated in the National Comorbidity Survey. Lifetime prevalences are 15.3% (MD) and 9.9% (mD), while 30-day prevalences are 5.8% (MD) and 2.1% (mD). Most cases reported recurrent episodes (73.9% of those with MD and 69.2% with mD) and significant role impairment, including attempted suicide among 21.9% of those with MD. The majority of lifetime cases (76.7% of those with MD and 69.3% with mD) reported other comorbid lifetime NCS/ DSM-III-R disorders. Depression was temporally secondary in the majority of these cases. Number of prior disorders was more important than type of disorders in predicting subsequent depression, raising the possibility that secondary depression is a nonspecific severity marker for earlier disorders. A cohort effect for both MD and mD was documented that persisted even for episodes lasting a year or longer. Increasing prevalences of prior comorbid disorders were found to play an important part in explaining the cohort effect for depression.

Adolescent↗
PubMed2004

The criterion validity of the Center for Epidemiological Studies Depression Scale (CES-D) in a sample of self-referred elders with depressive symptomatology.

BACKGROUND: The criterion validity of the Center for Epidemiological Studies Depression scale (CES-D) was assessed in a group of elderly Dutch community-residents who were self-referred to a prevention program for depression. METHODS: Paper-and-pencil administration of the CES-D to 318 elders (55-85 years). Criterion validity was evaluated with the Mini International Neuropsychiatric Interview (MINI), a clinical diagnostic interview based on DSM-IV. Sensitivity and specificity for various cut-off scores of CES-D were compared with the DSM-IV major depressive disorder (MDD) and with clinically relevant depression (CRD), a composite diagnosis of MDD, subthreshold depression or dysthymia. Furthermore the characteristics of true versus false positives were analyzed. RESULTS: For MDD, the optimal cut-off score was 25, (sensitivity 85%, specificity 64%, and positive predicted value of 63%). For CRD, the optimal cut-off was 22 (sensitivity 84%, specificity 60%, and positive predicted value 77%). True positives, MDD and CRD, reported significantly more anxiety symptomatology and more co-morbid anxiety disorders, false positives reported more previous depressive episodes. CONCLUSIONS: The criterion validity of the CES-D for MDD and CRD was satisfactory in this semi-clinical sample of elders. Subjects scoring >/=25 constitute a target group for further diagnostic assessment in order to determine appropriate treatment.

Aged↗
PubMed2006

Enhanced long-term synaptic depression in an animal model of depression.

BACKGROUND: A growing body of evidence suggests a disturbance of brain plasticity in major depression. In contrast to hippocampal neurogenesis, much less is known about the role of synaptic plasticity. Long-term potentiation (LTP) and long-term depression (LTD) regulate the strength of synaptic transmission and the formation of new synapses in many neural networks. Therefore, we examined the modulation of synaptic plasticity in the chronic mild stress animal model of depression. METHODS: Adult rats were exposed to mild and unpredictable stressors for 3 weeks. Thereafter, long-term synaptic plasticity was examined in the hippocampal CA1 region by whole-cell patch clamp measurements in brain slices. Neurogenesis was assessed by doublecortin immunostaining. RESULTS: Exposure to chronic mild stress facilitated LTD and had no effect on LTP. Chronic application of the antidepressant fluvoxamine during the stress protocol prevented the facilitation of LTD and increased the extent of LTP induction. Neurogenesis in the dentate gyrus was impaired after chronic stress. CONCLUSIONS: In addition to neurogenesis, long-term synaptic plasticity is an important and ubiquitous form of brain plasticity that is disturbed in an animal model of depression. Facilitated depression of synaptic transmission might impair function and structure of brain circuits involved in the pathophysiology of major depression. Antidepressants might counteract these alterations.

Animals↗
PubMed2005

Major depression and risk of depressive symptomatology associated with short-term and low-dose interferon-alpha treatment.

OBJECTIVE: The objective of this study is to identify early patients who are at-risk for major depression (MD) induced by interferon-alpha (IFN-alpha) and evaluate the response of depressive symptoms to antidepressants. METHODS: Thirty-six consecutive patients were treated with IFN-alpha. Psychiatric evaluations were performed prior to, and at 1 and 2 months after onset of therapy and upon completion of the study. Diagnoses were made according to DSM-IV criteria, and the severity of depressive symptoms was determined by the Hamilton Depression Rating Scale score (HDRSS). RESULTS: Of the 36 patients studied, 7 (19%) had MD before IFN-alpha treatment, 6 of which manifested a worsening of the depressive symptomatology during treatment. Of the remaining 29 patients, 9 (31%) developed MD during treatment. The median time required for the appearance or worsening of the depressive symptoms was 15 days (range 7-25). The median HDRSS before IFN-alpha in the 36 patients was 3 (range 1-20), whereas after 1 month of therapy, it was 10 (range 1-24; P=.000004). There was a strong positive correlation in the HDRSS before and 1 month after the initiation of treatment (r=.863). Of the 14 patients with a HDRSS of 1-2 before IFN-alpha treatment, only 1 (7%) developed MD, whereas of the 15 patients with a score >3, 8 (53%) developed MD. Antidepressants resulted in a decrease of the HDRSS to the IFN-alpha pretreatment values. CONCLUSION: One third of those treated with IFN-alpha developed MD. The HDRSS before treatment reveals the high- and low-risk patients for developing MD. Psychiatric evaluation should be performed prior to IFN-alpha treatment.

Adolescent↗
PubMed1984

Chronic depressions. Part 2. Sleep EEG differentiation of primary dysthymic disorders from anxious depressions.

In this clinical, psychometric and polysomnographic study, primary dysthymics (N = 20) were compared with anxious depressives (N = 22), and non-psychiatric controls (N = 11). Beck and MMPI depression scores were similar in the two affective groups. Prominent insomnia occurred in 82% of the anxious group; hypersomnia was more characteristic of the dysthymic group. On night 1, the anxious group had the poorest sleep efficiency (P less than 0.001), while dysthymics had the highest REM% (P less than 0.05) and shortest REM latency (P less than 0.01). On night 2, differences tended to be minimized, although the number of awakenings was still high (P less than 0.05) in the anxious group, and REM% was highest (P less than 0.01) and REM latency shortest (P less than 0.01) in the dysthymics. These findings suggest that patients with primary anxiety disorders experience greater sleep continuity difficulties on the adaptation night. Despite significant clinical overlap in depressive symptomatology between the two groups, REM% and REM latency appear as sturdy psychophysiological markers in differentiating primary dysthymics and anxious depressives on both nights. These data suggest that distinct anxious depressive and subaffective dysthymic subtypes can be distinguished within the universe of the atypical depressions.

Adult↗
PubMed2000

Mixed anxiety-depressive disorder and major depressive disorder: comparison of the severity of illness and biological variables.

Mixed anxiety-depressive disorder (MADD) is a new diagnostic category defining patients who suffer from both anxiety and depressive symptoms of limited and equal intensity accompanied by at least some autonomic features. Patients do not meet the criteria for specific anxiety or depressive disorders. The emergence of the symptoms is independent of stressful life events. There are many issues presently under investigation about the validity of this clinical entity. In this study, a group of 29 patients with MADD was compared with a group of 31 patients with major depressive disorder (MDD) to assess the differences and similarities between these two disease categories in terms of severity measures and biological variables. The dexamethasone suppression test (DST) was employed, and thyroid hormones and thyrotropin (TSH) levels were measured for the evaluation of hypothalamic-pituitary-adrenal (HPA) and hypothalamic-pituitary-thyroid (HPT) axes, respectively. The patients with MADD were found to be less depressive and more anxious compared to those with MDD. DST responses and thyroid functions were found to be similar in the two groups. When severity of depression was controlled, k(max) and 2300-h cortisol values were found to be significantly higher in the MADD group. Although the patients with MDD and MADD presented with relatively different clinical features, there is not enough biological evidence indicating that MADD represents a discrete diagnostic category. However, there may be relatively higher HPA activity in MADD patients.

Adult↗
PubMed2000

Criterion validation of the Edinburgh postnatal depression scale as a screening tool for depression in patients with advanced metastatic cancer.

It is estimated that 25% of palliative care patients will have identifiable symptoms of depression. Near the end of life, the distinction between what can be called "appropriate sadness" and depression may be difficult. Many palliative care units use rating scales to help identify patients who may be depressed. It is believed that symptoms such as guilt, worthlessness, and hopelessness may be more discriminating than other symptoms for depression within this population. The Edinburgh postnatal depression scale (EPDS) was devised for use in women in the postnatal period and does not contain any somatic-type symptoms. It consists of 10 items, each rated on a four-point scale, and includes items on guilt, thoughts of self-harm, and hopelessness. It has not previously been used for screening in cancer patients. In a study of 100 inpatients receiving palliative care, a cutoff of 13 on the EPDS had a sensitivity of 81% and a specificity of 79% for detecting cases of depression. There was a low rate of misclassifications. This study suggests that the EPDS may be useful as a screening instrument for palliative care patients.

Adult↗
PubMed1983

Urbanicity and depression reconsidered. The evidence regarding depressive symptomatology.

Evidence regarding the recent suggestion of greater prevalence of depressive symptoms in urban than in rural communities is evaluated. National data are reviewed which indicate that, whereas depressive symptoms may be less prevalent in rural than in urban communities, mean depression scores of residents of rural farm areas outside of standard metropolitan statistical areas are almost as high as scores of center city residents. Further data are presented from a study of urban and rural Florida residents which indicate a significantly higher mean number of depressive symptoms in urban than rural areas, though this difference was eliminated by controls for income, education, age, and sex. When persistent depressive symptoms were examined, urban-rural differences were not significant. The implications of the present findings for urban-rural differences in depressive disorder are considered and the need to examine the urbanicity hypothesis on a data base allowing appropriate controls for socioeconomic status-related variables and migration is emphasized.

Age Factors↗
PubMed1983

Observations on the relationship between anxiety and depressive symptoms during the course of depressive illnesses.

1 Roth et al. (1972) have proposed that within the affective disorders there are two distinct syndromes--anxiety and depression--differentiated by the relative predominance of these symptoms, the presence or absence of premorbid maladaptive traits, and the natural outcome of the disorder. 2 Goldberg (1982) on the other hand has suggested that there is a substantial overlap between the two syndromes, and the symptoms of anxiety and depression correlate highly with each other. 3 Patients tend to be treated with an anxiolytic or an antidepressant drug according to the predominance of anxiety or depressive symptoms. 4 There is conflicting evidence regarding the relative effectiveness of tricyclic antidepressants in psychotic (or endogenous) and neurotic (or reactive) depressive illness. Paykel (1972), however, found that the psychotic-neurotic dichotomy was not helpful in predicting outcome, whereas anxious depressives tended to respond poorly. 5 In three patients with affective illness, tested at regular intervals over the course of several weeks, anxiety and depressive symptoms fluctuated in a way which suggested that they were yoked to each other. A worsening indicated simultaneous deterioration of these symptoms. When they improved, this may have been due to the beneficial effects of the antidepressant drug administered. These findings suggest that antidepressants act, or fail to act, in a fundamental manner on the illness itself rather than on individual symptoms.

Anxiety↗
PubMed1986

Depression and depressive symptoms in preschool children from the general population.

This multiphasic study used four independent sources of information to investigate depression and depressive symptoms in a sample of preschool-age children from a general population. The study provides evidence that major depressive disorder exists in preschoolers and that stressful life events are associated with depressive symptoms; it underscores the importance of the teacher's report for identifying the presence of depression in this age group. Details of the findings, including a new scale for rating depression in young children, are discussed.

Age Factors↗
PubMed2002

Depressive symptoms in adolescence as predictors of early adulthood depressive disorders and maladjustment.

OBJECTIVE: The authors examined the association between self-reported depressive symptoms in adolescence and mental well-being in early adulthood. METHOD: A questionnaire assessing psychosocial well-being was given to a group of subjects (N=651) in their last 3 years of high school (mean age=16.8 years) and again when these subjects reached early adulthood (mean age=21.8 years). Diagnostic interview data were obtained from a subgroup of the young adults (N=245). Adolescents' depressive symptoms were analyzed in relation to their early adulthood mental health outcome data. RESULTS: Depressive symptoms in adolescence predicted early adulthood depressive disorders (major depression and dysthymia), comorbidity, psychosocial impairment, and problem drinking. CONCLUSIONS: Depressive symptoms in adolescence deserve attention as a potential risk for early adulthood mental disorders.

Adjustment Disorders↗
PubMed2004

Clinical characteristics of depressive symptoms in children and adolescents with major depressive disorder.

OBJECTIVE: Very few studies have compared the symptoms of major depressive disorder (MDD) and rates of comorbid psychiatric disorders between depressed children and adolescents. The aim of this study was to reproduce and extend these findings. METHOD: The Kiddie Schedule for Affective Disorders and Schizophrenia, present version (KSADS-P) was administered to parents (about their children) and in face-to-face interviews with 916 subjects aged 5.6 to 17.9 years with MDD (DSM criteria) (715 adolescents and 201 children; 348 male and 568 female). The subjects were consecutive referrals to an outpatient mood and anxiety disorders clinic. RESULTS: Depressed adolescents had significantly more hopelessness/helplessness, lack of energy/tiredness, hypersomnia, weight loss, and suicidality compared with children (p values < or = .001). In comparison with children, adolescents had significantly more substance abuse and less comorbid separation anxiety disorder and attention-deficit/hyperactivity disorder (p values < or = .001). Depressed female adolescents had significantly more suicidality than depressed male adolescents (p < or = .001). There were no other sex differences between males and females. The symptoms of depressed adolescents grouped into 3 factors (endogenous, negative cognitions/suicidality, and appetite/weight), whereas the symptoms in children grouped into 2 factors (endogenous/negative cognitions/suicidality and appetite/weight). CONCLUSIONS: These results provide further evidence for the continuity of MDD from childhood to adolescence.

Adolescent↗