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[Influence of depressive history on biological parameters in major depression].

BACKGROUND: Major depressive disorder is associated with several biological abnormalities. Among them, sleep disturbances and alterations of hypothalamic structures and cortisol system have been largely studied. Most studies have found a relationship between depression and alteration of sleep. Electroencephalic sleep profiles during depression demonstrate abnormalities of sleep continuity, reduction of slow waves sleep and REM pressure (27). The cortisol system, investigated by the Dexamethasone Suppression Test (DST), is abnormal in about an half of the depressed subjects. We confirm a cortisol escape from suppression by dexamethasone (21). A complex dysregulation of the Hypothalamic Pituitary Adrenal axis (HPA) is thought to explain this escape (15, 33). The HPA has been first involved in the theory of stress. There are two ways to study this. First by looking at early adversities and genetic susceptibility to stress, and second by studying acute stressors and depressive reactions (8). The sensitization model postulated that the acute abnormalities of depression may leave biological scares. Those scares could make people more vulnerable to latter depressive triggers (34). We could then suppose that biological correlates of depression become more severe during the course of the illness. The present study further examines relationships between DST, polysomnography and some clinical and epidemiological characteristics of the depressive illness. We tried to examine if there were increasing biological disturbances during the course of the illness. We also examined the effect of the history of illness on the psychosocial stressors, and the effects of those stressors on the biological correlates of depression. METHODS: The DST and polysomnographic recordings were performed in a sample of 130 inpatients with primary major depressive disorder, unipolar form, as defined with the RDC (41). All of those patients have been consecutively admitted to the Sleep Laboratory of the Department of Psychiatry, Erasme Hospital, between 1981 and 1992. This population has been previously reported elsewhere (19, 20, 21). The depressive symptom severity was assessed with the 24-items HRSD (17). The Newcastle Endogenous Depression Diagnostic Index was used to assess the endogenous character of the depressive episode (5). The history of the illness and the impact of psychosocial stressors were assessed retrospectively using the interview associated with the RDC (41), the SADS (7). Psychosocial stressor has been assessed using the item 216 of the SADS. We must remind that it is not a precise measurement of stress. RESULTS: Table I shows clinical characteristics and biological variables in our 130 depressed patients. No correlation were found between number of depressive episodes and DST or EEG sleep records (table II). Age of onset was correlated with DST and all sleep EEG parameters (REM latency, REM density, awakening and slow wave sleep). But the age was a major confounding factor. When corrected the results for age, a significant correlation between age of onset and DST still remained, but no correlation between age of onset and EEG sleep results (table III). The psychosocial stressors were correlated only with awakening. A positive trend was found between an augmentation of psychosocial stressors and the number of episodes (p = 0.06). CONCLUSION: This study does not support the view that the biological correlates of depression are worsening with the course of the illness. We found only correlation between age of onset and DST, but a possible confounding effect of age cannot formerly be excluded. The impact of psychosocial stressors on the biological correlates of depression was minimal. The only significant correlation found was between awakening and psychosocial stressors. We found no correlation between psychosocial stressors and the course of depression. Those results do not support the view of sensitization of the illness, but it should be remember that evaluation of psychosocial stressors by item 216 of the SADS was probably not a sufficient sensitive measure. We suggest thus that the impact of the history of depression on biological correlates of depression is not very strong. An alternative explanation of the lack of correlation found is that we used inaccurate measurement of the course of depression. For example, we had no evaluation of the quality of remission between different episodes of depression and of subsyndromic depression. Recent works show the importance of this (6, 9). The major limitations of this work were the retrospective character of the study and the low precision of the evaluation of psychosocial stressors used.

Adult↗
PubMed2000

Tricyclic drugs for depression in children and adolescents.

BACKGROUND: There is a need to identify effective and safe treatments for depression in children and adolescents. While tricyclic drugs have proven effectiveness in the treatment of depression in adults, individual studies involving children and adolescent have been equivocal. OBJECTIVES: To examine whether orally administered tricyclic antidepressants are superior to placebo in the treatment of child and adolescent depression SEARCH STRATEGY: We searched the literature using CD ROM Silver Platter and On-Line MEDLINE (1966-1997) and Excerpta Medica (June 1974-1997) data bases. Terms used for the search were: the exploded terms child and depression; the Medical Subject Headings of antidepressant drugs, tricyclic and affective disorders; individual tricyclic drugs by name; names of well-known researchers in the field; and school phobia. We searched the trials database of the Cochrane Collaboration Depression, Anxiety and Neurosis Group. Abstracts in English (of English and non-English papers) were reviewed. Bibliographies of previously published reviews and papers describing original research were cross-checked. Current Contents was screened for recent publications. We contacted authors of abstracts describing "work in progress" identified in conference proceedings of the American Academy of Child and Adolescent Psychiatry to determine whether they held data which could be included in the meta-analysis. We have hand searched the Journal of the American Academy of Child and Adolescent Psychiatry to identify randomized controlled trials. SELECTION CRITERIA: Randomized controlled trials comparing the efficacy of orally administered tricyclic medication with placebo in depressed subjects aged 6-18 years. DATA COLLECTION AND ANALYSIS: Most studies reported multiple outcome measures including depression scales and clinical global impression scales. For each study the best available depression measure was taken as the index measure of depression outcome. Predetermined criteria were established to assist in the ranking of measures. Where authors reported categorical outcomes we calculated individual and pooled odds ratios for the odds of improvement in treated compared with control subjects. For continuous outcomes pooled effect sizes were calculated as the number of standard deviations by which the change in depression scores for the treatment group exceeded those for the control groups. MAIN RESULTS: Twelve studies fulfilled the criteria for inclusion in the review, eight from which dichotomous outcome data could be extracted, and eleven from which continuous outcome data could be extracted. Pooled odds ratios calculated from the dichotomous data indicated no advantage of treatment over placebo for children or adolescents (odds ratio = 0.83, 95% confidence interval 0.48 to 1.42). Effect size calculations from the continuous data suggested a statistically significant but small benefit of treatment over placebo in reducing symptoms for the aggregate sample (effect size = -0.38, 95% confidence interval -0.74 to -0.02) with subgroup analyses suggesting a larger benefit among adolescents (effect size = -0.59, 95% confidence interval -1.12 to -0.06), and no benefit among children (effect size = 0.15, 95% confidence interval -0.34 to 0.64). Treatment with a tricyclic antidepressant caused more vertigo (odds ratio = 8.47, 95% confidence interval 1.40 to 51.0), orthostatic hypotension (odds ratio = 4.77, 95% confidence interval 1.11 to 20.49) and dry mouth (odds ratio = 5.19, 95% confidence interval 1.15 to 23.51) than did placebo, but there was no statistically significant difference in other possible adverse effects. REVIEWER'S CONCLUSIONS: Data suggest tricyclic antidepressants are of unlikely benefit in the treatment of depression in pre pubertal children. There is marginal evidence to support the use of tricyclic antidepressants in the treatment of depression in adolescents, although the magnitude of effect is likely to be moderate at best.

Administration, Oral↗
PubMed1997

Short-term outcomes of detected and undetected depressed primary care patients and depressed psychiatric patients.

The aims of this study were to determine whether detection of major depression in primary care was associated with improved outcome, and to compare the 4.5 month outcomes of detected and undetected depressed primary care patients and depressed psychiatric patients. Primary care patients with major depression were recruited from the practices of 50 family physicians in Southeastern Michigan using a two-stage selection procedure employing the Center for Epidemiologic Studies-Depression Scale (CES-D) and the Structured Clinical Interview for DSM-III-R (SCID); clinician detection of depression was ascertained by response to a direct query on a rating form. Depressed patients seeking treatment in an outpatient psychiatric setting also received the CES-D and the SCID. Data on patient demographics and clinical characteristics were obtained for both primary care and psychiatric patients. Initial and 4.5 month scores on the Hamilton Depression Rating Scale (HAM-D) were obtained for 34 undetected and 25 detected depressed primary care and 55 depressed psychiatric patients. Improvement in depression over time was assessed by the change in HAM-D scores over the 4.5 months. The three groups did not differ in initial severity. Both psychiatric and undetected primary care patients showed significant improvement at 4.5 months, whereas detected primary care patients did not improve. At 4.5 months there were no differences in mean HAM-D scores between undetected, depressed primary care patients and depressed psychiatric outpatients. This result did not change after controlling for age and severity of depression at initial presentation, nor did it change after exclusion of cases of mild depression to control for a possible "floor effect." However, differences among groups in the stage of depressive episodes may have affected this comparison. These findings suggest that an exclusive focus on increasing detection of depression in primary care patients is unlikely to improve outcomes, and that undetected depression among primary care patients does not necessarily represent poor quality of care. Although depressed psychiatric patients in this study had better outcomes than detected depressed primary care patients, the presence of unmeasured differences among groups in the stage of the depressive episode makes it impossible to determine whether treatment of depression by psychiatrists is superior to that provided by primary care physicians. These findings should stimulate efforts to examine a more comprehensive model for detection and treatment of depression in primary care.

Adult↗
PubMed2004

Paternal postpartum depression, its relationship to maternal postpartum depression, and implications for family health.

BACKGROUND: Much attention has been paid to the problem of postpartum depression in women. However, there is some indication that men also experience depression after the birth of a child, and that paternal depression is linked to maternal depression. AIMS: The purpose of this integrative review was to examine current knowledge about postpartum depression in fathers. Specific aims were (1) to examine the incidence of paternal depression in the first year after the birth of a child, (2) to identify the characteristics and predictors of paternal postpartum depression, (3) to describe the relationship between maternal and paternal postpartum depression, and (4) to discuss the influence of paternal depression on the family and infant. METHODS: A literature search from 1980 to 2002 was carried out using the CINAHL, PsychInfo, and Medline electronic databases. Twenty research studies were identified that included incidence rates of paternal depression during the first year postpartum. These were further examined and synthesized regarding onset, severity, duration, and predictors of paternal depressive symptoms, and for information about the relationship between maternal and paternal depression. FINDINGS: During the first postpartum year, the incidence of paternal depression ranged from 1.2% to 25.5% in community samples, and from 24% to 50% among men whose partners were experiencing postpartum depression. Maternal depression was identified as the strongest predictor of paternal depression during the postpartum period. The implications of parental depression for family health were discussed. CONCLUSIONS: Postpartum depression in men is a significant problem. The strong correlation of paternal postpartum depression with maternal postpartum depression has important implications for family health and well-being. Consideration of postpartum depression in fathers as well as mothers, and consideration of co-occurrence of depression in couples, is an important next step in research and practice involving childbearing families.

Depression, Postpartum↗
PubMed2006

Familial aggregation of depression, but no familial aggregation of individual depressive symptoms.

BACKGROUND: Familial aggregation of major depression might indicate a genetic liability for the disorder. The complete disorder or, alternatively, only some individual symptoms might be inherited. Under the latter condition, an increased frequency of inherited symptoms might consecutively increase the likelihood to reach the threshold for depression in relatives and, thus, might cause the familial aggregation of depression. Up to now, no study investigated the possibility of a relationship between individual depressive symptoms and the familial aggregation of depression. METHODS: The familial aggregation of early-onset depression (age-at-onset < 60 years, EOD) but less so of late-onset depression (LOD) has been shown in this sample. To assess the hypothesis of an inheritance of individual depressive symptoms as a possible cause of the familial aggregation of depression, frequencies of symptoms were compared in relatives of depressed patients and of controls using forward logistic regression analyses. RESULTS: Some individual depressive symptoms showed clustering in relatives of patients with depression, but the pattern of inheritance was inconsistent, i.e. the clustering of symptoms was different between non-depressed and depressed relatives of patients with EOD and LOD, respectively. No intra-familial clustering of specific depressive symptoms within families of depressed subjects could be observed. CONCLUSIONS: Due to the inconsistencies in the clustering of individual symptoms in non-depressed and depressed relatives and the lack of intra-familial clustering, the familial aggregation of depression is unlikely to be caused by the aggregation of individual depressive symptoms. An inheritance of the vulnerability for complete depressive disorders influenced by environmental factors is more likely.

Age Factors↗
PubMed2006

Relative lack of depressive cognitions in post-myocardial infarction depression.

BACKGROUND: Depression has been associated with adverse clinical events in myocardial infarction (MI) patients, but many questions about the nature of post-MI depression remain unanswered. We examined whether depressive cognitions characteristic of depression in psychiatric patients are also present in post-MI patients with major depression (MD). METHODS: Non-depressed (n=40) and depressed (n=40) post-MI patients, and psychiatric outpatients (n=40) treated for clinical depression, matched on age and sex, were interviewed using a structured clinical interview to diagnose DSM-IV MD. All patients also completed the Beck Depression Inventory (BDI) and the Beck Cognition Checklist-Depression subscale (CCL-D). RESULTS: Mean levels of depressive cognitions were considerably higher in depressed psychiatric patients compared with depressed post-MI patients (34.9 versus 28.0; p=.013), and higher in depressed post-MI patients compared with non-depressed post-MI patients (28.0 versus 17.8; p<.0001), adjusted for age, sex, educational level, and marital status. Younger age (p=.024), absence of a partner (p=.016) and depressed psychiatric status (p=.016) were independently associated with depressive cognitions. Psychiatric patients also had higher mean levels of depressive symptoms as compared to depressed post-MI patients (25.1 versus 17.8; p=.001). LIMITATIONS: This study is based on a cross-sectional design. CONCLUSIONS: The symptom presentation of MD in post-MI patients is both quantitatively and qualitatively different from that seen in psychiatric patients, suggesting that depressive symptoms in post-MI patients differ in content from those in psychiatric patients. These findings could have important consequences for the design and contents of therapeutic programs for treating depression in post-MI patients.

Adult↗
PubMed1987

Depressive thinking and depression: relations with personality and social resources.

The mechanisms by which social supports and personality variables may buffer against psychopathology are not well understood. We studied depression, depressive cognitions, social supports, and self-esteem in a sample of 68 spouse-caregivers of patients with Alzheimer's Disease in an attempt to identify possible buffering mechanisms of the latter two variables. Specifically, we hypothesized that the well-known relation of depressive cognitions to depression would vary as a function of satisfaction with social supports and with level of self-esteem. Hierarchical multiple regression analyses conducted to predict depression revealed significant and independent main effects for depressive cognitions (p less than .01), social supports (p less than .025), and self-esteem (p less than .001), with depressive cognitions associated with higher depression and the other two variables associated with reduced depression (R2 = .53 for the three main effects). In addition, the relation of depressive cognitions with depression varied substantially depending on the level of social supports (p less than .01); caregivers with high levels of depressive cognitions had high levels of depression only if social supports were low (R2 = .61 including interaction). Self-esteem and depressive cognitions showed a similar interaction, but it failed to reach significance. Analyses to determine whether self-esteem and social supports were directly associated with lower depressive cognitive activity yielded a main effect for self-esteem only (p less than .03). Thus, whereas social supports and self-esteem were directly associated with lower depression, only the social supports variable was further associated with reduced depression because it apparently buffered the impact of depressive thinking. Self-esteem was also indirectly associated with lower depression via its relation with lower depressive thinking. Implications of our results for cognitive theories of depression and for the psychosocial mechanisms of stress buffering are discussed.

Adult↗
PubMed1998

Family environments of adolescents with lifetime depression: associations with maternal depression history.

OBJECTIVE: To assess family functioning of adolescents with a history of depression, taking into account maternal history of depression. METHOD: Lifetime major depression was assessed with standardized interviews in an epidemiological sample of adolescent twins and their parents. Family members completed questionnaires measuring family functioning. The families of three groups of adolescents were compared: ever-depressed adolescents with ever-depressed mothers (n = 37), ever-depressed adolescents with never-depressed mothers (n = 42), and never-depressed control adolescents (n = 82). RESULTS: A greater proportion of ever-depressed adolescents had ever-depressed mothers than did control adolescents (47% versus 18%); rates of paternal depression did not differ between the two groups. Ever-depressed adolescents with ever-depressed mothers described poorer family functioning than did ever-depressed adolescents with never-depressed mothers and controls. Relative to control mothers, mothers of both groups of ever-depressed adolescents reported family difficulties, particularly in the father-adolescent relationship. Fathers' descriptions of family relationships did not differ among the three groups. Ever-depressed adolescents came disproportionately from divorced families. CONCLUSIONS: These results highlight the importance of considering parental depression in the treatment of adolescent depression and underscore the need to understand the interactional patterns in families of depressed youth, particularly those with multiple depressed members.

Adolescent↗
PubMed2003

Interpersonal impairment and the prediction of depressive symptoms in adolescent children of depressed and nondepressed mothers.

OBJECTIVE: Different pathways to youth depression should be explored. Based on an interpersonal impairment perspective on depression, the currently depressed children of depressed mothers were hypothesized to differ in predictors of their depression compared with depressed children of nondepressed mothers. Chronic social difficulties were expected to be more predictive of depressive symptoms in offspring of depressed women, while recent stressful life events were expected to predict depression in offspring of never-depressed women. METHOD: A community sample of 812 fifteen-year-old children of depressed and nondepressed women was studied in Queensland, Australia, between 1996 and 1999; chronic and episodic stress in the past 6 to 12 months were examined in relation to current depressive disorders. RESULTS: Depressive states in children of depressed mothers were more associated with chronic interpersonal difficulties than were the depressions of children of nondepressed women, and the latter group had greater increases in depression level associated with episodic stressors than did children of depressed women. CONCLUSIONS: The results may reflect greater depression reactivity to chronic social difficulties among offspring of depressed mothers. Depressive experiences may have different predictors in subgroups of depressed youths and imply potentially different courses and needs for treatment.

Adolescent↗
PubMed2003

Comparative assessment of Yale Single Question and Beck Depression Inventory Scale in screening for depression in multiple sclerosis.

OBJECTIVES: To examine if depression in multiple sclerosis (MS) can be accurately recognized using the Yale Single Question (YSQ) screen as compared with the Beck Depression Inventory (BDI), a 21-item self-report rating scale for depression. In addition, we sought to assess the sensitivity, specificity the positive predictive value (PPV) and the negative predictive value (NPV) of the YSQ. BACKGROUND: Depression associated with MS is a major contributor to morbidity. Screening for depression in patients with MS currently includes the BDI, which measures characteristic attitudes and symptoms of depression. However, in a busy outpatient clinic, the BDI might not be the most appropriate instrument, particularly if depression screening can be assessed accurately using simpler techniques that are easy to administer and consume less time. We compared the accuracy of the YSQ screen response against the BDI to screen for depression in MS patients, in an outpatient setting. METHODS: This is a comparative outcome study of two 'instruments' used for screening depression in MS patients in an academic outpatient setting. All patients were initially screened for depression by asking patients the YSQ--'Do you frequently feel sad or depressed?', followed by BDI administration. Depression was defined as a score of > or = 13 on the BDI. One hundred and twenty successive patients who presented to the MS clinic at Washington University School of Medicine and met the criteria for diagnosis of MS were screened for depression. All patients diagnosed as having MS, regardless of type, were included in the study. RESULTS: Of the 120 patients studied, a total of 49 of 120 were clinically depressed as defined by a BDI cut-off of > or = 13; 71 of 120 were not. The sensitivity of the YSQ was 32 of 49 = 65.3% with a 95% confidence interval (0.50, 0.78), specificity was 62 of 71 = 87.3% (0.77, 0.94), PPV was 32 of 41 = 78.0% (0.62, 0.89) and NPV was 62 of 79 = 78.5% (0.68, 0.87). Of the 49 patients depressed by BDI criteria, 17 responded 'no' to the YSQ, yielding a false-negative rate of 34.7% (0.22, 0.50). The Wilcoxon-Mann-Whitney test for difference in age among those on antidepressants compared with those who were not showed no statistical difference (P = 0.35). For patients on antidepressants, the mean BDI score was 16.0+/-8.9 (mean+/-SD) and 9.5+/-8.7 for those not on antidepressants. Differences in BDI scores among patients on antidepressants versus those who were not were statistically significant (P < 0.0001). Patients on antidepressants had significantly higher BDI scores. CONCLUSIONS: Our results show that the YSQ cannot replace the BDI as a screening instrument for depression in MS. The YSQ could not identify 34.7% of patients who were depressed by BDI criteria. However, as reported in a published study, BDI missed 30% of cases with early depression in MS when a cut-off of > or = 13 was used. The YSQ appears to be specific in ruling out depression when a patient is not depressed. MS is a chronic disease and since prevalence of depression varies, it is important to screen patients repeatedly over time so as not to miss the diagnosis. That BDI scores were higher among those taking antidepressants underscores the fact that this subset of patients need to be on medication, but the higher scores could also represent a sampling error since the duration of antidepressant use was not studied.

Adult↗
PubMed2004

Treatment of depressed mothers of depressed children: pilot study of feasibility.

Numerous studies have shown that depression is highly familial and impairing and that a history of depression in a parent is the strongest risk factor for depression in a child. Many of the parents in these studies have never received sustained treatment despite histories of recurrent depression. None of the studies have examined the effects of maternal symptom remission on offspring symptom or functioning. We sought to determine the feasibility of treating depressed mothers who brought an offspring for the treatment of depression and to examine the relationship between improved maternal depression and symptomatic improvement and social functioning in their offspring. Nine mothers bringing their offspring for treatment of depression, and who were evaluated and found to be currently depressed, completed a 12-week open trial of interpersonal psychotherapy. Mothers and their depressed offspring were assessed by independent evaluators at weeks 0, 6, and 12 for depressive symptomatology and social functioning. Although the rates of depression were high among the mothers, few eligible mothers agreed to participate. Of the 12 who entered treatment, 9 (75%) completed it. Mothers and offspring improved with regard to depressive symptomatology and global functioning over the course of the trial. Improvement in maternal depression was significantly associated with improvement in offspring functioning but not symptom reduction. Improvement of maternal depression may be associated with improved outcomes in depressed offspring. However, it is difficult to engage depressed mothers in treatment for themselves if they come to the clinic to bring their child for treatment of depression. It may be more feasible to study the effect of improved maternal depression on offspring by sampling depressed mothers coming for their own treatment and then assessing their children over the course of maternal treatment.

Adolescent↗
PubMed2004

Minor depression: risk profiles, functional disability, health care use and risk of developing major depression.

BACKGROUND: minor depression has been found to affect quality of life, result in a increased service utilization, and lead to an increased risk of developing a major depression. In this study we examine risk profiles, functional disability, service utilization and the risk of developing major depression in minor depression. METHODS: a random sample of the Dutch population (n=7076) was interviewed at baseline and 1 and 3 years later (response rate: 69.7%). Five categories of depression status were defined: major depression with seven to nine symptoms; with five or six symptoms; minor depression; one key symptom only; no depressive symptoms. Independent variables included: functional disability; care utilization; sociodemographic characteristics. RESULTS: functional disability was more pronounced in more severe categories of depression. Health care use was also found to be most intensive for more severe depression. The risk of developing major depression in subjects with minor depression was found to be 8.0% after 2 years. LIMITATIONS: there had already been some attrition from the study when minor depression was measured. A definition of minor depression which approached the DSM-IV definition. Absence of homeless individuals in the dataset. CONCLUSIONS: depressive disorders seem to exist on a continuum, rather than in separate categories. Subjects with minor depression make less use of professional services than subjects with major depression, but because minor depression is more prevalent than major depression, the absolute number of subjects with minor depression receiving professional help is considerable.

Adult↗
PubMed2005

Agitated "unipolar" depression re-conceptualized as a depressive mixed state: implications for the antidepressant-suicide controversy.

BACKGROUND: The nosologic status of agitated depression is unresolved. Are they unipolar (UP) or bipolar (BP)? Are they mixed states? Even more controversial is the notion that antidepressants might play some role in the suicidality of such patients (Akiskal and Mallya, 1987) [Akiskal, H.S., Mallya, G., 1987. Criteria for the "soft" bipolar spectrum: treatment implications. Psychopharmacol Bull. 23, 68-73]. METHODS: After excluding all patients with history of hypomanic episodes occurring outside the frame of a major depressive episode (MDE), even those with a shorter duration of hypomanic symptoms than stipulated in DSM-IV, the remaining consecutive 254 unipolar major depressive disorder (MDD) private adult (> 21 years old) outpatients were interviewed (off psychoactive drugs for 2 weeks) with the Structured Clinical Interview for DSM-IV (SCID-CV), the Hypomania Interview Guide (HIGH-C), and the Family History Screen. Intra-MDE hypomanic symptoms were systematically assessed, with > or = 3 such symptoms required for a diagnosis of depressive mixed state (DMX). Agitated depression was defined as an MDE with HIGH-C psychomotor agitation score > or = 2. Logistic regression was used to study associations and control for confounding variables. RESULTS: In this strictly defined unipolar sample, agitated depression was present in 19.7%. Compared with its non-agitated counterpart, it had significantly fewer recurrences, less chronicity, higher rate of family history for bipolar disorder, and DMX; and, among the intra-depressive non-euphoric hypomanic symptoms (in decreasing order of frequency), distractibility, racing/crowded thoughts, irritable mood, talkativeness, and risky behavior. The most striking finding was the robust association between agitated depression and DMX (OR = 36.9). Furthermore, patients with psychomotor agitation had significantly higher rate of weight loss and suicidal ideation. Of DMX symptoms, we found an association between suicidal ideation, psychomotor activation, and racing thoughts. Agitated depression was tested by forward stepwise logistic regression versus all variables significantly different in the pairwise comparisons, yielding DMX, talkativeness, and suicidal ideation as the independent significant positive predictors. LIMITATIONS: No suicidal ideation scale was used. CONCLUSIONS: Agitated depression emerges as a distinct affective syndrome with weight loss, pressure of speech, racing thoughts and suicidal ideation. Psychomotor activation and racing thoughts during MDD independently predicted suicidal ideation. In this "unipolar" MDD sample, agitated depression had a strong clustering of intra-episode non-euphoric hypomanic symptoms (i.e. DMX) which, coupled with its association with bipolar family history, support its link with the bipolar spectrum. Agitated depression is therefore best regarded as "pseudo-unipolar." These findings overall accord with classical German concepts of agitated depression as a mixed state. Given that these patients are typically activated along the lines of risk-taking behavior, Kraepelin's rubric of "excited (mixed) depression" appears to us the preferred terminology over "agitated depression". CLINICAL IMPLICATIONS: The data reported herein, placed in the setting of the literature reviewed in the discussion suggest that the reports of increased risk of suicidal ideation and/or behavior in some depressed patients treated by antidepressant monotherapy or combinations thereof might be attributed to baseline psychomotor activation/agitation as part of an unrecognized bipolar mixed state. Whether antidepressants induce de novo suicidality in MDD cannot be answered without adequately powered prospective double-blind studies, unlikely to be conducted because of ethical constraints. Nonetheless, we submit that agitated, activated, or otherwise excited depressions (which we consider as depressive mixed states) overlap considerably with the so-called antidepressant "activation syndrome." Furthermore, the rare occurrence of suicidality on antidepressants should not obscure the fact that the advent of the new antidepressants is associated with worldwide decline in suicide rates. We finally wish to point out that our formal nosology (i.e. DSM-IV and ICD-10), in its failure to recognize the bipolar nature of depressive mixed states, thereby fails to shield pseudo-unipolar patients from antidepressant monotherapy, which is inappropriate for such patients.

Adult↗
PubMed2005

Impact of the selective serotonin reuptake inhibitor citalopram on insulin sensitivity, leptin and basal cortisol secretion in depressed and non-depressed euglycemic women of reproductive age.

INTRODUCTION: Major depression in women of reproductive age may be accompanied by multiple endocrine and metabolic disturbances, which, in turn, may affect reproductive functioning. Enhanced cortisol synthesis, impaired leptin production and diminished insulin sensitivity have been reported in some depressed populations. We sought to determine whether an 8-week administration of citalopram would have an effect on these endocrine factors in a group of euglycemic depressed and non-depressed women of reproductive age. MATERIALS AND METHODS: Fourteen depressed and 18 non-depressed women (diagnosed by structured clinical interview) aged between 18 and 45 years completed an 8-week study. All depressed women were treated with citalopram and non-depressed subjects randomized to citalopram or no treatment in an open label cohort study. An oral glucose tolerance test with insulin levels was performed at baseline and at the end of the 8-week trial. Weight, blood pressure, fasting serum cortisol, fasting serum leptin and Beck Depression Inventory were assessed at baseline, 2, 4 and 8 weeks. RESULTS: Citalopram significantly improved depressive symptoms and Beck Depression Inventory scores in the depressed cohort. Cortisol production was higher in depressed women but did not diminish with citalopram therapy over 8 weeks. Indices of insulin sensitivity and leptin production were similar between depressed and non-depressed women and did not change despite citalopram therapy. CONCLUSION: . Insulin sensitivity in moderately depressed women of reproductive age does not differ from that in a similar group of non-depressed women. Insulin sensitivity, cortisol secretion and leptin production do not change significantly in depressed women following an 8-week course of citalopram despite substantial improvement in depression scores.

Administration, Oral↗
PubMedDate not supplied

A comparative study of nonspecific depressive symptoms and minor depression regarding functional impairment and associated characteristics in primary care.

BACKGROUND: Milder forms of depression are highly prevalent in the clinical setting as well as in primary care. However, it is still unclear whether there are distinguishable groups among the various subthreshold syndromes and to what extent they are associated with impairment, thus requiring treatment. Therefore, the study aimed at comparing the degree of impairment in 2 groups of subthreshold depressive patients (nonspecific and minor depressive) with nondepressive patients and with major depressive patients. Another aim of the study was to evaluate the spectrum hypothesis of depressive syndromes. SAMPLING AND METHODS: A sample of 619 primary care patients was studied using the self-administered Patient Health Questionnaire (PHQ). After defining subthreshold depressive syndromes on a criterion basis, frequencies, sociodemographic factors, and impairment of nondepressive, subthreshold depressive, and major depressive patients were compared. RESULTS: Nonspecific depressive symptoms (NDS) were diagnosed in 9.1% of the study subjects and minor depression in 6.2%. Subjects with subthreshold depressive disorders did not differ from each other or from subjects with major depression regarding sociodemographic risk factors such as age, sex, or marital status. Yet, a continually increasing impairment from NDS to minor depression to major depression could be found. Moreover, the investigated groups differed with regard to the severity index. CONCLUSIONS: The results of the study are in accordance with the spectrum hypothesis of depressive syndromes ranging from NDS to minor depression to major depression. Patients with subsyndromal depression showed significant functional impairment to the extent that at least some of these patients probably had a disorder requiring treatment.

Activities of Daily Living↗
PubMed2006

Does depression prior to caregiving increase vulnerability to depressive symptoms among caregivers of persons with Alzheimer's disease?

Based on the vulnerability model of depression, this study tested the hypothesis that caregivers with prior depression are more likely to be depressed during caregiving than caregivers without prior depression. We further hypothesized an interaction effect in which caregivers with prior depression would be affected more by care-recipient dependency in activities of daily living and care-recipient depressive symptoms than those without prior depression. In a sample of 111 caregivers of persons with Alzheimer's disease, in an additive regression model, neither 'prior depressive symptoms' nor the clinically more serious 'prior depressive syndrome' was related to depressive symptoms during caregiving. In an interaction model, for caregivers with either 'no prior depression' or 'prior depressive symptoms,' the greater the care-recipient dependencies in instrumental activities of daily living (IADL), the greater were the depressive symptoms during caregiving. For caregivers with a 'prior depressive syndrome', however, the greater the IADL dependency, the fewer were the depressive symptoms during caregiving. This unexpected finding suggests that caregivers with a history of clinically significant depression are not necessarily more prone to depressive symptoms when caregiving responsibilities, at least for instrumental activities, are high. This result questions the vulnerability model of depression when applied to older caregivers.

Activities of Daily Living↗
PubMed1994

Subthreshold depression and depressive disorder: clinical characteristics of general medical and mental health specialty outpatients.

OBJECTIVE: The authors examined the clinical significance of depressive symptoms below the threshold for depressive disorder in outpatient samples. METHOD: The subjects were 775 adult patients with current depressive disorder, 1,420 patients with subthreshold depression, and 1,767 hypertensive patients with and without depression, all of whom were visiting the offices of mental health specialists and general medical care providers in three U.S. cities. Data on demographic characteristics, severity of depression, extent of psychiatric and medical comorbidity, family psychiatric history, and treatment history for the patients with depressive disorder and those with subthreshold depression were compared. RESULTS: The percentage of patients with subthreshold depression who had a family history of depression (41%) was nearly as high as that of the patients with depressive disorder (59%). The two groups of patients had similar levels of medical and psychiatric comorbidity except for anxiety disorders, which were greater among the patients with depressive disorder. Among the hypertensive patients in the general medical sector, those with subthreshold depression were more similar to those with depressive disorder than to the nondepressed hypertensive patients. Treatment rates were considerably lower for patients with subthreshold depression than for patients with depressive disorder in the general medical sector, but they were similar in the mental health specialty sector. CONCLUSIONS: In these outpatients, subthreshold depression appeared to be a variant of affective disorder and was treated as such in the mental health specialty sector but not in the general medical sector. The findings emphasize the importance of treatment outcome studies of patients with subthreshold depression.

Adult↗