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A comparison of depressive symptoms in stroke and primary care: applying Rasch models to evaluate the center for epidemiologic studies-depression scale.

OBJECTIVES: Clinical trials and community-based studies often include the Center for Epidemiologic Studies-Depression scale (CES-D) as a measure of depression outcome. We compared responses to symptom-related items on the CES-D by depressed stroke and primary-care patients for several purposes: 1) to illustrate the use of Item Response Theory (IRT)-based (Rasch) models for comparing scale functioning across different patient subgroups; and 2) to inform clinicians and outcome researchers about scale functioning and depressive symptomatology in stroke- compared with primary care-based depression. METHODS: Two data sources were analyzed, including 32 depressed patients who were 3 months poststroke, and 366 depressed primary-care patients. Presence of depression was based on a CES-D score 16 or higher. Rasch models were used to assess item fit and compare item hierarchies between depressed primary-care and stroke patients. RESULTS: Item hierarchies were similar for poststroke depression and primary care-based depression. Interpersonal disruption items were the most difficult to endorse for both groups. No items misfit the scale in primary-care depression. Items relating to restless sleep, unfriendliness, and crying slightly misfit the scale in stroke patients, that is, may measure a different trait. Differential item functioning (DIF) between the groups was identified for items relating to appetite, restless sleep, crying, and feeling disliked. CONCLUSIONS: Results generally supported the use of the CES-D as measure of depression outcome, particularly in primary care-based depression. DIF may imply that slightly different clusters of depressive symptoms are reported by depressed stroke patients compared with primary care, but this is conjectural given the small stroke sample size and the same items have been previously associated with bias in studies of large nonstroke samples. This study found Rasch models to be useful tools to investigate scale performance for different clinical applications.

Adult↗

Depressed mood states and their inter-relationship with clinical depression.

A study was conducted to contrast depressed mood states in those positive and negative for lifetime depressive syndromes. A non-clinical cohort of 156 subjects was assessed on four occasions over 15 years, with 35% having had a major depression and 22% a minor depression at the most recent assessment. At 5-yearly reviews, estimates were obtained of episode frequency, duration and symptom patterns during depressed mood states. Such characteristics were then contrasted across the three groups of those who had experienced major depression, those who had suffered minor depression and lifetime non-cases. Depressive states were affirmed by at least 96% of subjects at each assessment, with the mean number of episodes per assessment year ranging from 8.6 to 21.2. Those who had experienced a lifetime episode of major depression differed from the two contrast groups (i.e. those with minor depression: non-cases) in having more episodes and more features during episodes. By contrast, there was a gradient across the three groups for two other examined features, with those having major depression being more likely than those with minor depression, who in turn were more likely than the non-cases to have longer episodes and a greater number of symptoms. The greater frequency, severity and duration of depressed mood states in those who met lifetime criteria for a major depressive episode suggest that their threshold to onset and persistence of a variety of depressive experiences is lowered, so supporting a general vulnerability hypothesis.

Adult↗

Lifetime depressive and somatic symptoms as preclinical markers of late-onset depression.

BACKGROUND: Several risk factors of depression, i. e., female gender and life-stress, have been identified. Few studies have focussed on symptoms as preclinical markers of depression. In these studies current symptoms like dysphoria, tiredness and increased appetite predicted later depression. Even though of possible interest for treatment, no study focussed on lifetime symptoms as preclinical markers of depression. Consequently, we examined lifetime depressive and somatic symptoms with respect to later development of late-onset depression. METHODS: 664 non-depressed elderly subjects without lifetime diagnoses of depression at the initial examination were selected for a prospective follow-up study (mean follow-up +/- SD: 5.02 +/- 2.44 years). 51 subjects (mean age +/- SD: 66.6 +/- 11.3) developing late-onset depression (defined as depression starting after age 60) were compared to those remaining non-depressed (mean age +/- SD: 59.1 +/- 16.0) during follow-up using the CIDI. To determine the influence of lifetime symptoms on the development of depression, chi-square statistics and multivariate logistic regression analyses were performed. RESULTS: The following symptoms being present over a period longer than two weeks were individual preclinical markers of late-onset depression: dysphoria, increased appetite, insomnia, lack of energy, morning depth, lack of joy and interest, inferiority feeling, lack of self-confidence, poor concentration, indecisiveness, thinking about death, wish to die and joint pain. The most important symptoms elevating the risk of late-onset depression in a multivariate model were lack of joy and interest, poor concentration, increased appetite, lack of energy and joint pain. CONCLUSIONS: Different symptoms can be used individually and in combination to predict later depression. This might allow early treatment.

Age of Onset↗

Chronic pain and depression. IV. DST as a discriminator between chronic pain and depression.

In an attempt to clarify the relationship between chronic pain and depression, the authors studied the plasma cortisol response to dexamethasone in a group of 73 consecutive chronic low back pain patients admitted to a pain unit and 34 consecutive patients admitted to an affective disorders unit with the principal diagnosis of primary major depression. Patients with chronic pain were evaluated as to the presence or absence of major depression and patients with primary major depression were evaluated as to the presence or absence of pain complaints as part of their presenting symptomatology. Chronic pain patients with major depression differed significantly from chronic pain patients without major depression (3.4 +/- 3.33 micrograms/dl versus 1.6 +/- 0.9 micrograms/dl, P less than 0.05). Chronic pain patients with major depression also differed from patients with primary major depression with pain complaints (3.4 +/- 3.3 micrograms/dl versus 10.7 +/- 8 micrograms/dl, P less than 0.0005). The values given are post-dexamethasone plasma cortisol levels. Patients having primary major depression with pain complaints do not significantly differ from patients having primary major depression without pain complaints. The dexamethasone suppression test may be a useful method in discriminating those patients with chronic pain versus those with primary major depression, chronic pain patients with major depression versus those with primary major depression and chronic pain patients with major depression versus those with chronic pain and no depression.

Aged↗

A continuity between bipolar II depression and major depressive disorder?

BACKGROUND: A recent series of studies has questioned the current categorical split of mood disorders into bipolar and depressive disorders. Mixed states, especially mixed depression (i.e., depression plus co-occurring, noneuphoric, hypomanic symptoms) might support a continuity between bipolar II (BP-II) depression and major depressive disorder (MDD). The aim of the study was to assess the distribution of intradepressive hypomanic symptoms rating between BP-II and MDD depressions. A bi-modal distribution would support a categorical distinction, and no bi-modality would support continuity. METHODS: Consecutive 389 BP-II and 261 MDD major depressive episode (MDE) outpatients were interviewed (off psychoactive drugs) with the Structured Clinical Interview for DSM-IV, the Hypomania Interview Guide (HIG, to assess intradepressive hypomanic symptoms), and the Family History Screen, by a mood specialist psychiatrist in a private practice. Mixed depression was defined as MDE plus 3 or more intradepressive, noneuphoric hypomanic symptoms, a definition validated by Akiskal and Benazzi. The distribution of intradepressive hypomanic symptoms rating was studied by Kernel density estimate and by histogram. RESULTS: BP-II depression, versus MDD depression, had significantly lower age at onset, was significantly more likely to be atypical and mixed, had more depression recurrences, and a higher bipolar family history loading. BP-II depression, versus MDD depression, had significantly more irritability, racing/crowded thoughts, distractibility, psychomotor agitation, talkativeness, increased goal-directed activity, and excessive risky activities. HIG scores were significantly higher in BP-II. The distribution of intradepressive hypomanic symptoms rating showed no bi-modality in the entire depression sample. CONCLUSIONS: Interpretation of study findings relies on the method used to define a categorical disorder. By using classic diagnostic validators (such as family history and age at onset), BP-II and MDD depressions would seem to be distinct disorders. Instead, by using the 'bi-modality' approach, a continuity would seem to be supported. Which of these methods for classification is the best has yet to be shown.

Adult↗

Irritable psychomotor elation in depressed inpatients: a factor validation of mixed depression.

BACKGROUND: Early authors described hypomanic symptoms as mixed features in depressive episode, but this syndrome has not been sufficiently explored in previous studies. METHODS: 958 consecutive depressed patients were assessed by using a standardized method in terms of 43 psychiatric symptoms at hospitalization. RESULTS: A principal component analysis, followed by varimax rotation, extracted six interpretable factors: typical vegetative symptoms, depressive retardation/loss of feeling, hypomanic syndrome, anxiety, psychosis, and depressive mood/hopelessness. The extracted factor structure was relatively stable among several patient groups. There was no evidence that the hypomanic factor was exaggerated by antidepressant pretreatments before hospitalization. Bipolar diagnoses were associated with higher scores on depressive retardation and hypomanic symptoms, and a lower score on anxiety. LIMITATIONS: Psychiatric syndromes and their interrelationships, found in the present study, may be strongly influenced by the rating instrument used. The sample of this study was depressed inpatients. The results should not be generalized for depressed outpatients or epidemiological depressed populations. CONCLUSIONS: Hypomanic symptoms, as characterized by the flight of ideas, racing thought, increased drive, excessive social contact, irritability, and aggression are a salient syndrome in acutely ill depressed patients, lending support to the factor validity of mixed depression. The symptoms may not be related to pretreatments with antidepressants, or comorbidity of substance abuse, suggesting that they reflect various natural phenomenological manifestations of depressive episodes. Anxiety is unlikely to play a major role in the core phenomenological features of mixed depression. Hypomanic symptoms during a depressive episode were more represented in bipolar disorders, which may serve for further clarifications of latent bipolarity in unipolar depression, and prediction of switch into maniform states under biological depression treatments.

Adult↗

Remitted depression studies as tests of the cognitive vulnerability hypotheses of depression onset: a critique and conceptual analysis.

Investigations of cognitive patterns among individuals who have recovered from a depressive episode (i.e., remitted depressives) have figured importantly in evaluations of the validity of the vulnerability hypotheses of the cognitive theories of depression. However, we suggest that remitted depression studies as typically conducted and interpreted are inadequate tests of the cognitive vulnerability hypotheses of depression onset for four reasons: (1) remitted depression studies are based on the erroneous assumption that cognitive vulnerability should be an immutable trait; (2) remitted depression studies use a logically "backward" participant selection strategy in which participants are selected on the basis of the "dependent" variable (depression) and then compared on the "independent" variable (cognitive vulnerability), which is likely to result in heterogeneity of cognitive vulnerability among both the remitted depressed as well as the nondepressed groups given the causal relations specified in the cognitive theories of depression; (3) many remitted depression studies have ignored the possible activating role of stress in the cognitive vulnerability-stress theories, particularly Beck's theory, and thus, may attempt to assess cognitive vulnerability at a time when it is not operative (i.e., priming hypothesis); and (4) remitted depression studies inappropriately use postmorbid participants to test causal hypotheses, and therefore, are ambiguous about whether negative cognitive styles observed in remitted depressed persons are vulnerabilities as opposed to consequences of depression (i.e., scar hypothesis). As a remedy, we advocate the use of a theory-guided behavioral high-risk strategy to more adequately test the cognitive vulnerability hypotheses of depression onset.

Cognition↗

Clinical correlates and symptom patterns of anxious depression among patients with major depressive disorder in STAR*D.

BACKGROUND: Anxious depression, defined as Major Depressive Disorder (MDD) with high levels of anxiety symptoms, may represent a relatively common depressive subtype, with distinctive features. OBJECTIVE: The objective of this study was to determine the prevalence of anxious depression and to define its clinical correlates and symptom patterns. METHOD: Baseline clinical and sociodemographic data were collected on 1450 subjects participating in the STAR*D study. A baseline Hamilton Rating Scale for Depression (HAM-D) Anxiety/ Somatization factor score of > or =7 was considered indicative of anxious depression. The types and degree of concurrent psychiatric symptoms were measured using the Psychiatric Diagnostic Screening Questionnaire (PDSQ), by recording the number of items endorsed by study participants for each diagnostic category. MDD symptoms were assessed by clinical telephone interview with the 30-item Inventory of Depressive Symptomatology (IDS-C30). RESULTS: The prevalence of anxious depression in this population was 46 %. Patients with anxious MDD were significantly more likely to be older, unemployed, less educated, more severely depressed, and to have suicidal ideation before and after adjustment for severity of depression. As far as concurrent psychiatric symptoms are concerned, patients with anxious depression were significantly more likely to endorse symptoms related to generalized anxiety, obsessive compulsive, panic, post-traumatic stress, agoraphobia, hypochondriasis, and somatoform disorders before and after adjustment for severity of depression. Anxious-depression individuals were also significantly less likely to endorse IDS-C30 items concerning atypical features, and were significantly more likely to endorse items concerning melancholic/endogenous depression features. CONCLUSION: This study supports specific clinical and sociodemographic correlates of MDD associated with high levels of anxiety (anxious depression).

Adolescent↗

Screening for depressive symptoms among HCV-infected injection drug users: examination of the utility of the CES-D and the Beck Depression Inventory.

The prevalence of depression is high among injection drug users (IDUs) and among those infected with the hepatitis C virus (HCV). Moreover, one of the drugs used in the standard treatment for HCV infection (interferon) has been known to exacerbate underlying psychiatric disorders such as depression and has been associated with the development of major depressive disorder among HCV-infected patients. For these reasons, the most recent National Institutes of Health consensus statement on the management of HCV infection recommends the identification and treatment of depression prior to the start of HCV treatment. This study aimed to examine the extent of current moderate/severe depressive symptoms in a cohort of HCV-infected IDUs as measured by two screening tools, the Center for Epidemiologic Studies Depression Scale (CES-D) and the Beck Depression Inventory (BDI). Subjects were participants in a multisite behavioral intervention trial among HCV-seropositive, human immunodeficiency virus-negative IDUs aged 18-35 years; the trial was designed to prevent secondary transmission of HCV and to enhance uptake of HCV treatment. Baseline data on demographics, risk behaviors, depression, alcohol use, and health care utilization were measured via audio computer-assisted self-interview. A factor analysis was conducted on each scale to examine the clustering of items used in each to measure depressive symptoms. Baseline depressive symptoms, as measured via the CES-D and the BDI, were also compared using Pearson's correlation coefficient. Of 193 HCV-infected individuals enrolled to date, 75.6% were male, and 65.3% were white. Median age was 25.8 years. Factor analyses revealed that these scales measured depression differently; a distinct somatic component was present in the BDI, but not the CES-D. Using cutoff scores of 23 for the CES-D and 19 for the BDI, 44.0% and 41.5% of the participants were identified as having moderate/severe depressive symptoms, respectively. Over half (56.0%) were identified as having depressive symptoms by either scale. However, there was only moderate agreement between the two scales (kappa=0.46). Depressive symptoms were highly prevalent in this cohort of HCV-infected IDUs. Results indicated that both scales should be used in tandem to have the most sensitive detection of depressive symptoms, thereby maximizing the potential for HCV treatment success.

Adolescent↗

Medical illness, past depression, and present depression: a predictive triad for in-hospital mortality.

OBJECTIVE: The authors' objectives were to determine 1) whether major depressive disorder diagnosed according to DSM-IV criteria modified for the medically ill predicted in-hospital mortality better than major depressive disorder diagnosed according to inclusive DSM-IV criteria and 2) whether a history of depression and current depression predicted mortality independent of severity of physical illness. METHOD: Of 392 consecutive medical inpatients, 241 were interviewed within the first 3 days of admission and 151 were excluded from the study. Chart review and a clinical interview that included the Schedule for Affective Disorders and Schizophrenia were used to determine demographic variables, past psychiatric history, psychiatric diagnoses, and illness measures. Diagnoses included major depressive disorder and minor depression diagnosed according to DSM-IV criteria that included all symptoms regardless of etiology and according to criteria modified for the medically ill (hopelessness, depression, or anhedonia were used as the qualifying affective symptoms; depressive symptoms were eliminated if easily explained by medical illness, treatments, or hospitalization). The Charlson combined age-comorbidity index was used to measure severity of illness. RESULTS: A diagnosis of major depressive disorder based on criteria modified for patients with medical illness better predicted mortality than a diagnosis based on inclusive criteria. A past history of depression and the Charlson combined age-comorbidity index predicted in-hospital mortality, but demographic variables, pain, discomfort, length of stay, medical diagnoses, and minor depression did not. In the final multivariate logistic regression model, the Charlson combined age-comorbidity index, a modified diagnosis of major depressive disorder, and a history of depression were independent predictors of in-hospital death. CONCLUSIONS: Severity of medical illness, a diagnosis of major depressive disorder based on modified criteria, and a past history of depression independently predicted in-hospital mortality in medical inpatients.

Comorbidity↗

The relation between anger expression, depression, and somatic symptoms in depressive disorders and somatoform disorders.

BACKGROUND: In previous studies, the relationship between either anger suppression and depression or anger suppression and somatic symptoms was examined. However, the relationship between anger expression, depression, and somatic symptoms was not examined in depressive disorders and somatoform disorders. METHOD: The DSM-IV-diagnosed subjects included 73 patients with depressive disorders and 47 patients with somatoform disorders. The Anger Expression Scale was used to assess the level of anger expression or suppression. The severity of depression was assessed using the Symptom Checklist-90-Revised (SCL-90-R). The Somatization Rating Scale and the SCL-90-R somatization subscale were used to assess the severity of somatic symptoms. Data were collected from March 2000 to March 2001. RESULTS: The results of the path analyses showed that in depressive disorder patients, anger expression had a stronger effect on somatic symptoms through depression than did anger suppression, although both anger expression and anger suppression had a significant indirect effect on somatic symptoms. The depressive disorder group also showed a significant but negative direct effect of anger suppression on anger expression in the path from anger suppression to anger expression to depression to somatic symptoms. However, only anger suppression had an indirect effect on somatic symptoms through depression in somatoform disorder patients. CONCLUSIONS: The results suggest that anger expression might play a more predominant role in depression and somatic symptoms of depressive disorder patients than anger suppression, but only anger suppression might be associated with depression and somatic symptoms of somatoform disorder patients. In addition, incomplete anger suppression followed by anger expression is likely to be associated with depression and somatic symptoms in depressive disorders.

Adult↗

[Post-traumatic stress, post-traumatic depression and major depressive episode: literature].

Although they are likely to add their effects, physical and psychic traumata (or traumas) can provoke in different ways the appearance of depressive symptoms sometimes common. Post-traumatic depression, reactional depression, major depressive disorder and post-traumatic stress disorder represent different clinical and nosographic disorders in despite of their occasionally common symptomatic core. Historically, it is interesting to note during the XXth century the true semantic change of the terms of trauma from the somatic field to the psychic sphere. Physical traumatism is often represented by a material shock for the subject and by its organic consequences. It is defined as an event that leaves its mark which itself inflicts and handicaps the vital trajectory of the subject. It primarily comprises brain and rachis injuries, whose evolution is frequently characterized by the occurrence/appearance of a depressive disorder, whose genesis rests on psychological but also neurobiologic and physical arguments. Thus major depressive disorders are often present in the course of various physical traumatisms mainly related to nervous system. In accordance with several studies, the prevalence of major depressive disorders ranges from 25% to 50%. These mood disorders occur in the year which follows the accidental event. Their average time of revelation is estimated at four months and their average duration lies between three and six months. Lastly, although these depressive illnesses present clinical symptoms comparable with those observed in other contexts, some nuances can be raised. Nonetheless, they confine sometimes with true clinical forms depending on the intensity, the form, the circumstances or the consequences of the trauma. Psychic traumatism doesn't have the same profile and rests for much dedicated with the reexperiencing. Thus for some authors, depression illness represents a disorder that occurs after a traumatic event whereas others see a differential diagnosis which exludes or which represents a comorbidity with post-traumatic stress disorder. The review of the literature allows us to emphasize the complexity of the links as well as the clinical and epidemiologic differences between stress disorder and major depressive disorder. From the clinical point of view, the major features of PTSD are articulated around a triad of symptoms. They include the reexperiencing symptoms of the traumatic event such as intrusive memories and recurrent nightmares, the protective reactions such as avoidance of the stimuli associated with the trauma and emotional numbing, and the arousal symptoms such as the startled response and hypervigilance. The complexity of this syndrom is due to the frequent combination of these symptoms with other nonspecific ones. As far as the mood is concerned (the mood symptoms are concerned), the regrouping of some of these symptoms allows the clinician to sometimes releave a depressive symptomatology without being able to assess the DSM diagnosis of major depressive disorder. Epidemiologic studies dealing with the risk of installation of a PTSD after a traumatic event reveal differences in the prevalence depending on the nature of the traumatic events: ranging from 1% in general population to 80% following some situations of extreme and durable psychic suffering. Between both poles, one finds a prevalence ranging between 20 and 50% following other events such as serious accidents, natural disasters or criminal assaults. The clinical features of depressive episodes comorbid or associated with PTSD have some characteristics making it possible to individualize various clinical forms as a function of traumatic event type: asthenic, characterial or with somatic symptoms. According to the majority of authors, the co-occurrence of post-traumatic stress disorder and major depressive disorder is high although differential diagnosis is sometimes difficult. However, conceptual differences remain and two conceptions are distinguished. For some authors, like Bleich and Shalev, there would not be true chronological evolution from PTSD to MDD. Moreover the presence of symptoms considered as pertaining to the mood register within the criteria of PTSD would be clearly predictive of the occurrence and the severity of the diagnosis but not of the chronicity. For others, there would be a continuity between post-traumatic stress disorder and major depressive disorder. It is the case in many studies of veterans but also for civilian traumatic events. It is also the case for the American national study of comorbidity in which Kessler concludes that for 78% of the subjects who present a comorbidity PTSD/MDD (comorbidity raised for 48% of the 5,877 subjects included), the mood disorder is secondary to PTSD. (ABSTRACT TRUNCATED)

Comorbidity↗

[Asymptomatic cerebral infarction and depression--the concept of vascular depression].

At 1997, Alexopoulos and Krishnan coined the term "vascular depression" to describe depression associated with cerebrovascular disease. Vascular depression included both post-stroke depression, depression occurring after a stroke, and MRI-defined vascular depression in which cerebral infarction is detected by magnetic resonance imaging findings. Post-stroke depression is well known as showing cerebral infarction on imaging modalities as well as clinical symptoms such as localized neurological symptoms related to infarcts. MRI-defined vascular depression demonstrates cerebral infarction on imaging modalities, but there are no clinical symptoms such as localized neurological symptoms or stroke. MRI-defined vascular depression is equivalent to the term "depression with silent cerebral infarction", a condition we studied in the past decade. When the accumulation of infarct lesions induces obstruction in the neuron network related to mood and will exceeds a certain threshold, the patient becomes predisposed to vascular depression. Neurological factors are more prominent than genetic factors or psychosocial stressors in patients with vascular depression due to an accumulation of infarct lesions. Anti-cholinergic drugs and anti-dopaminergic drugs easily induce adverse central nervous system reactions in patients with vascular depression demonstrating prominent neurological factors. Research on vascular depression has contributed to clarifying the onset mechanism of endogenous depression.

Cerebrovascular Disorders↗

The detection of postnatal depression in general practice using the Edinburgh postnatal depression scale.

AIM: To determine how many women with postnatal depression were detected with the Edinburgh postnatal depression scale at the 6 week postnatal examination. METHOD: One hundred and twenty-one women attending this general practice for their six week postnatal examination completed the Edinburgh postnatal depression scale (EPDS); a score of greater than 12.5 was used to predict the likelihood of postnatal depression. Postnatal depression was defined as a major depressive illness according to the DSM III criteria, occurring in the 12 months following delivery. RESULTS: Seven women had postnatal depression and six of these women scored over 12.5 with the EPDS. Eight women had other depressive disorders (depressive disorders that did not reach DSM III criteria) and five of these scored over 12.5. Those scoring over 12.5 had a 64% risk of having some form of depressive disorder. Those scoring under 12.5 had only a 4% risk of postnatal depressive disorder. (1% risk of postnatal depression and 3% risk of other depression). CONCLUSION: The EPDS is an easily completed and well accepted 5 minute questionnaire which reliably identified most women with postnatal depression and other depressive disorders in this general practice.

Depressive Disorder↗

Tryptophan and 5-hydroxytryptophan for depression.

BACKGROUND: 5 Hydroxytryptophan (5-HTP) and tryptophan are so-called natural alternatives to traditional antidepressants, used to treat unipolar depression and dysthymia. OBJECTIVES: To determine whether 5-HTP and tryptophan are more effective than placebo, and whether they are safe to use to treat depressive disorders in adults. SEARCH STRATEGY: Trials were searched in computerized general (Medline, Psychlit, and Embase) and specialized databases (Cochrane Controlled Clinical Trials Register, Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trial Register); by checking reference lists of relevant articles; by handsearching relevant specialist journals; and by contacting relevant authors where appropriate. Publications in all languages were sought. SELECTION CRITERIA: Trials were included if they were randomized, included patients with unipolar depression or dysthymia, compared preparations of 5-HTP or tryptophan with placebo, and included clinical outcomes assessed by scales assessing depressive symptoms. DATA COLLECTION AND ANALYSIS: Data was extracted independently by the three reviewers, onto data collection forms. Inclusion criteria were applied to all potential studies independently and a coefficient of agreement (Kappa) was calculated for them. Disagreement was resolved by reaching consensus. Trial quality was scored according to risk of bias. Analysis for 5-HTP and tryptophan were combined due to the small number of included trials. MAIN RESULTS: 108 trials were located using the specified search strategy. Of these, only two trials, involving a total of 64 patients, were of sufficient quality to meet inclusion criteria. The available evidence suggests these substances were better than placebo at alleviating depression (Peto Odds Ratio 4.10; 95% confidence interval 1.28-13.15; RD 0.36; NNT 2.78). However, the evidence was of insufficient quality to be conclusive. REVIEWER'S CONCLUSIONS: A large number of studies appear to address the research questions, but few are of sufficient quality to be reliable. Available evidence does suggest these substances are better than placebo at alleviating depression. Further studies are needed to evaluate the efficacy and safety of 5-HTP and tryptophan before their widespread use can be recommended. The possible association between these substances and the potentially fatal Eosinophilia-Myalgia Syndrome has not been elucidated. Because alternative antidepressants exist which have been proven to be effective and safe the clinical usefulness of 5-HTP and tryptophan is limited at present.

5-Hydroxytryptophan↗

Public attitudes to depression in urban Turkey - the influence of perceptions and causal attributions on social distance towards individuals suffering from depression.

BACKGROUND: The aim of this study was to determine public attitudes towards patients with depression and the influence of perception and causal attributions on social distance towards individuals suffering from depression in urban areas. METHODS: This study was carried out with a representative sample in Istanbul which is the biggest metropolis in Turkey. Seven hundred and seven subjects completed the public survey form which consisted of ten items screening the demographic features and health status of the participants, and 32 items rating attitudes towards depression. RESULTS: The respondents' attitudes towards depression were very negative and nearly half of the subjects perceived people with depression as dangerous. More than half of the subjects stated that they would not marry a person with depression, and nearly half of the subjects stated that they would not rent their house to a person with depression. One-quarter of the subjects stated that depressive patients should not be free in the community. The subjects who considered depression as a disease and who believed that weakness of personality and social problems cause depression had negative attitudes towards depression. CONCLUSIONS: In Istanbul, people recognise depression well, but their attitudes towards it are fairly negative. The urban public has unfavourable attitudes towards depression and a tendency to isolate patients from the society. Notwithstanding the high prevalence, there is still considerable stigmatisation associated with depression.

Adolescent↗

Depressed mood and major depressive disorder in two ethnic groups.

This study examines the relation of depressive mood, measured using the Center for Epidemiologic Studies Depression scale, with major depression, assessed using the Diagnostic Interview Schedule. Data are from 1244 Mexican American and 1149 non-Hispanic white randomly-selected community residents. Major depression is strongly related to depressed mood, irrespective of the persistence or content of mood, with some components of depressed mood (negative affect and somatic disturbance) more strongly associated with major depression than other components (lack of positive affect and interpersonal problems). Low socioeconomic status and social isolation contribute to depressed mood independent of major depression. Low education is associated with persistent depressed mood. Mexican Americans report more overall depressive mood than non-Hispanic whites, but there is no ethnic difference in major depression or in the mood symptoms most strongly related to major depression. Mexican Americans report more persistent symptoms than non-Hispanic whites in every content category. Ethnic differences in education appear to account for ethnic differences in all components of depressed mood except lack of positive affect, which may be attributable to language differences.

Adolescent↗

Delinquency and the profile of offences among depressed and non-depressed adolescents.

BACKGROUND: Depression has previously been found to be closely connected to adolescent delinquency, but little is known about how depression is related to different types of delinquency. AIM: To investigate patterns of criminal behaviour according to depression among repeatedly delinquent adolescents. METHOD: The sample was 14- to 16-year-old repeatedly delinquent adolescents (n 3679) taking part in the Finnish School Health Promotion Study, surveyed for versatility and specialization of delinquency in relation to depression. RESULTS: Patterns of criminal behaviour differed between depressed and non-depressed delinquent adolescents. The delinquent behaviour of depressed adolescents was more versatile than that of non-depressed adolescents who mainly specialized in one offence type. Non-depressed delinquent boys had most often specialized in violence. Most depressed delinquent boys had committed a variety of offences, but among those who did specialize the specialist category was violent offences. Non-depressed delinquent girls had specialized in shoplifting. Among depressed delinquent girls vandalism was the most typical offence. CONCLUSION: Differences in the delinquent behaviour of depressed and non-depressed delinquent adolescents suggest the value of including clinical assessment, and treatment for some, in an appropriately comprehensive pattern of management.

Adolescent↗