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At least 19 recordsLinked to original sources
PubMed2002

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Unipolar Depressive Disorders, Part 2: Maintenance treatment of major depressive disorder and treatment of chronic depressive disorders and subthreshold depressions.

These practice guidelines for the biological treatment of unipolar depressive disorders were developed by an international Task Force of the World Federation of Societies of Biological Psychiatry (WFSBP). The goal for developing these guidelines was to systematically review all available evidence pertaining to the treatment of the complete spectrum of unipolar depressive disorders, and to produce a series of practice recommendations that are clinically and scientifically meaningful based on the available evidence. These guidelines are intended for use by all physicians seeing and treating patients with these conditions. The data used for developing these guidelines have been extracted primarily from various national treatment guidelines and panels for depressive disorders, as well as from meta-analyses and reviews on the efficacy of antidepressant medications and other biological treatment interventions identified by a search of the MEDLINE database and Cochrane Library. The identified literature was evaluated with respect to the strength of evidence for its efficacy and was then categorized into four levels of evidence (A-D). The first part of these WFSBP guidelines on unipolar depressive disorders covered the acute and continuation treatment of major depressive disorder (Bauer et al 2002). This second part of the guidelines covers the management of the maintenance-phase treatment of major depressive disorder, as well as the treatment of chronic and subthreshold depressive disorders (dysthymic disorder, double depression, minor depressive disorder and recurrent brief depression). These guidelines are primarily concerned with the biological treatment (including antidepressants, lithium, other psychopharmacological and hormonal medications, and electroconvulsive therapy) of young adults and also, albeit to a lesser extent, children, adolescents and older adults.

Adolescent↗
PubMed1980

Children and depression--the children of depressed parents; the childhood of depressed patients; depression in children.

In order to understand the development of depression in children, three types of data are reviewed: (1) studies of the children of depressed parents; (2) studies of the childhood histories of depressed adults; (3) direct studies of depression in children. These data support an increased frequency of depression and other psychopathology in the children of depressed adults. An examination of the homes of children with a depressed parent reveals a disruptive, hostile, and rejecting environment. This atmosphere is also found in the homes of depressed children and in the homes of children who become depressed as adults. Methodological issues are discussed which will help sort out the relative influences of genes and environment in future studies.

Adolescent↗
PubMedDate not supplied

Validity of the beck depression inventory, hospital anxiety and depression scale, SCL-90, and hamilton depression rating scale as screening instruments for depression in stroke patients.

Most instruments used to assess poststroke depression have never been specifically validated in stroke patients. This study evaluated the depression screening abilities of three questionnaires and one observer-rated scale in 202 consecutive patients 1 month after they experienced their first-ever ischemic stroke. At their respective optimum cutoff values, the sensitivity of the self-rated scales varied between 80% and 90%, while the specificity was about 60%. For the observer-rated scale (Hamilton Depression Rating Scale), sensitivity was 78.1%, and specificity was 74.6%. The instruments clearly performed better in men than in women. Despite this difference, it was concluded that all scales were acceptable screening instruments for poststroke depression.

Aged↗
PubMed2000

Antidepressant plus benzodiazepine for major depression.

BACKGROUND: Anxiety frequently coexists with depression. There is no systematic review to show if adding benzodiazepines to antidepressants can bring about any advantage over antidepressants alone in the treatment of depression, although such a combination prescription appears to be widely practiced worldwide OBJECTIVES: To determine whether, among adult patients with major depression, adding benzodiazepines to antidepressants brings about any benefit in terms of symptomatic recovery or side-effects in the short term (less than 8 weeks) and long term (more than 2 months), in comparison with treatment by antidepressants alone. SEARCH STRATEGY: Electronic searches of MEDLINE, EMBASE, International Pharmaceutical Abstracts, Biological Abstracts, LILACS, PsycLit, the Cochrane Library and the trial register of the Cochrane Depression, Anxiety and Neurosis Group (January 1972 to December 1998), combined with hand searching, reference searching, SciSearch and personal contacts. SELECTION CRITERIA: All randomized controlled trials that compared combined antidepressant-benzodiazepine treatment with antidepressant alone for adult patients with major depression (Feighner criteria, RDC, DSM-III, DSM-III-R, DSM-IV or ICD-10). Exclusion criteria are: antidepressant dosage lower than 100 mg of imipramine or its equivalent daily and duration of trial shorter than 4 weeks. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed the eligibility and quality of the studies. Two reviewers independently extracted the data. Standardized weighted mean differences and relative risks were estimated with random effects model. The dropouts were assigned the least favorable outcome. Two sensitivity analyses examined the effect of this assumption as well as the effect of including medium quality studies. Three a priori subgroup analyses were performed with regard to the patients with or without comorbid anxiety and with regard to the types of benzodiazepines tested. MAIN RESULTS: Aggregating nine studies with a total of 679 patients, the combination therapy group was 37% (95%CI: 19 to 51%) less likely to drop out than the antidepressant alone group. The intention-to-treat analysis showed that the former were 63% (18 to 127%) to 38% (15 to 66%) more likely to show response (defined as 50% or greater reduction in the depression scale from baseline) up to 4 weeks. REVIEWER'S CONCLUSIONS: The potential benefits of adding a benzodiazepine to an antidepressant must be balanced judiciously against possible harms including development of dependence and accident proneness, on the one hand, and against continued suffering following no response and drop-out, on the other.

Adult↗
PubMed1996

Major depression, minor depression, and double depression: are they distinct clinical entities?

The clinical concept of "double depression," i.e., the superimposition of a major depressive disorder in a patient with dysthymic disorder, implies that there are at least some differences between dysthymia, major depression, and double depression. However, the relationship between these two syndromes remains unclear. The present study uses genetic methodology to explore any possible relationship between minor depression, double depression, and major depression. From 1988-1990, all consecutive unrelated inpatients and outpatients (index cases) presenting to a university-based mood disorders service had detailed family histories taken, using modification of the "family history method." Diagnoses for index cases and their first-degree relatives were made according to Research Diagnostic Criteria. For all index cases with a diagnosis of minor or intermittent depression, and minor/intermittent depression plus either single or recurrent depression ("double depression"), morbidity risks for mood disorders were calculated for first-degree relatives (parents, siblings, and children) using the maximum likelihood approach. Results showed no significant differences in morbidity risk calculations to first-degree relatives of index cases with minor/intermittent depression, major depression, or double depression. The data from this genetic perspective suggest that single depression, recurrent depression, minor depression, and double depression are indistinguishable.

Depression↗
PubMed1991

[The family physician and depression in the elderly. A pilot study of prevalence of depressive symptoms and depression in the elderly in 2 family practices].

A pilot-study on the prevalence of depressive symptoms and GPs' assessment of depressed mood in elderly attenders of two general practices. The aim of this pilot was to gather information on both depressive symptoms and GP's' assessments of depressive mood in persons over 65 coming for a consultation in two general practices. To assess the prevalence of depressive symptomatology, 87 patients were asked to complete the Zung Self-Rating Depression Scale (ZSDS) and the Geriatric Depression Scale (GDS). Six patients were identified as having depressive symptoms on the ZSDS and seven on the GDS. Information on GP's' assessments of depressive mood was gathered by asking GP's to what extent they thought patients had been depressed recently. With regard to patients identified by the GP's as being mildly or severely depressed, the GP's answered additional questions on diagnostic and therapeutic approaches. The GP's identified eleven out of 87 patients as being mildly depressed, nobody was classified as being severely depressed. Five out of six patients with a ZSDS score of 50 and higher were not identified by the GP's as being mildly depressed. The prevalence of depressive symptoms based on ZSDS-scores was somewhat lower than expected (7.5%).

Aged↗
PubMed1991

Examining the world of the depressed: do depressed people prefer others who are depressed?

Two studies were conducted to examine the interpersonal world of the depressed person. In Study 1, depression levels and perceptions of depressed and nondepressed people and their best friend were assessed to test the hypothesis that depressed Ss have best friends who are themselves more depressed than the best friends of nondepressed Ss. The hypothesis was confirmed, suggesting that depressed persons may prefer others who also tend toward depression. To examine this possibility, in Study 2 depressed and nondepressed college students spoke with one another in either depressed-depressed, nondepressed-depressed, or nondepressed-nondepressed pairs. It was found that depressed Ss felt worse than nondepressed Ss after speaking with nondepressed targets, but not after speaking with depressed targets. There were no differences in liking or in perceived similarity between the groups. Implications for the social world of the depressed person are discussed.

Attitude↗
PubMed2001

Emergence of depression during early abstinence in depressed and non-depressed women smokers.

The emergence of depression early in a quit attempt and its relationship to ability to maintain abstinence were studied in 99 depressed and non-depressed women smokers. Participants rated withdrawal symptomatology during a baseline week and the first two weeks of a quit attempt, during which they used a 21-mg nicotine patch and received behavioral counseling. Depressed women experienced greater difficulty maintaining early abstinence than non-depressed women. They were significantly more likely to smoke on the first day of abstinence and smoked marginally more days during the first week. Among participants who relapsed during the first two weeks, latency to relapse was significantly shorter for depressed women. Although craving and all withdrawal symptoms except insomnia showed significant increases over baseline, only depression showed significant group differences, with trend analyses suggesting that depression asymptotes in non-depressed women after the first week but continues increasing in depressed women. Larger increases in depression on the first day of abstinence were associated with earlier lapse. Because depression is relatively infrequent as a withdrawal symptom, it may not be a "true" withdrawal symptom except in depressed people. Identification of depressed smokers and anticipation of their increased need for support during this period may help to counteract the "first-day effect" and difficulties during early abstinence.

Administration, Cutaneous↗
PubMed2001

Monitoring improvement using a patient-rated depression scale during treatment with anti-depressants in general practice. A validation study on the Goldberg Depression Scale.

OBJECTIVE: To perform a pilot study on the value of the Goldberg Depression Scale as an instrument for monitoring improvement in depressed patients treated with anti-depressants in general practice. DESIGN: A comparative study using simultaneous ratings on the observer-based 17-item Hamilton Depression Scale and the patient-rated Goldberg Depression Scale. SETTING: General practice. PATIENTS: Twenty-one patients meeting the ICD-10 criteria of a moderate depressive episode were assessed at the time of inclusion and through three follow-up visits. MAIN OUTCOME MEASURES: Scores on the Goldberg Depression Scale compared to the Hamilton Depression Scale. RESULTS: An acceptable internal and external validity of the Goldberg Depression Scale was demonstrated. The Loevinger coefficient varied from 0.25 at the time of diagnosis to 0.57, 0.65 and 0.69 by visits two, three and four. Factor analysis identified only one general factor explaining 50% or more of the variants, except at visit 1. When the Goldberg Depression Scale was correlated to the Hamilton Depression Scales, a coefficient of 0.74 was obtained (p < 0.001). CONCLUSION: This pilot study indicates that the Goldberg Depression Scale is suitable for monitoring improvement in depressed patients treated in general practice. Further studies are recommended.

Antidepressive Agents↗
PubMedDate not supplied

Atypical bipolar II depression compared with atypical unipolar depression and nonatypical bipolar II depression.

Aim of the study was to find out whether atypical bipolar II depression was distinct from both atypical unipolar depression and nonatypical bipolar II depression. Seventy-nine consecutive atypical bipolar II depressed outpatients were compared with 42 consecutive atypical unipolar depressed outpatients and with 53 consecutive nonatypical bipolar II depressed outpatients. Among the variables studied (age at intake, age at onset, female gender, duration of illness, psychosis, comorbidity, chronicity, recurrences, severity), age at intake and onset were significantly lower in the atypical bipolar II group than in the other groups. The other variables, apart from psychosis, were not significantly different. Findings suggest that atypical bipolar II depression may have an age at onset different from that of atypical unipolar depression and nonatypical bipolar II depression. As different ages at onset may identify distinct subtypes of depression, this finding might suggest that atypical bipolar II depression may be distinct from both atypical unipolar depression and nonatypical bipolar II depression.

Adult↗
PubMed2001

Is clinical depression distinct from subthreshold depressive symptoms? A review of the continuity issue in depression research.

Resolving whether subthreshold depressive symptoms exist on a continuum with unipolar clinical depression is important for progress on both theoretical and applied issues. To date, most studies have found that individuals with subthreshold depressive symptoms resemble cases of major depressive disorder along many important dimensions (e.g., in terms of patterns of functional impairment, psychiatric and physical comorbidity, familiality, sleeping EEG, and risk of future major depression). However, such manifest similarities do not rule out the possibility of a latent qualitative difference between subthreshold and diagnosable depression. Formal taxonomic analyses, intended to resolve the possibility of a latent qualitative distinction, have so far yielded contradictory findings. Several large-sample latent class analyses (LCA) have identified latent clinical and nonclinical classes of unipolar depression, but LCA is vulnerable to identification of spurious classes. Paul Meehl's taxometric methods provide a potentially conservative alternative way to identify latent classes. The one comprehensive taxometric analysis reported to date suggests that self-report depression symptoms occur along a latent continuum but exclusive reliance on self-report depression measures and incomplete information regarding sample base rates of depression makes it difficult to draw strong inferences from that report. We conclude that although most of the evidence at this time appears to favor both a manifest and latent continuum of unipolar depression symptomatology, several important issues remain unresolved. Complete resolution of the continuity question would be speeded by the application of both taxometric techniques and LCA to a single large sample with a known base rate of lifetime diagnosed depressives.

Depressive Disorder↗
PubMedDate not supplied

The National Depressive and Manic-Depressive Association consensus statement on the undertreatment of depression.

OBJECTIVE: A consensus conference on the reasons for the undertreatment of depression was organized by the National Depressive and Manic Depressive Association (NDMDA) on January 17-18, 1996. The target audience included health policymakers, clinicians, patients and their families, and the public at large. Six key questions were addressed: (1) Is depression undertreated in the community and in the clinic? (2) What is the economic cost to society of depression? (3) What have been the efforts in the past to redress undertreatment and how successful have they been? (4) What are the reasons for the gap between our knowledge of the diagnosis and treatment of depression and actual treatment received in this country? (5) What can we do to narrow this gap? (6) What can we do immediately to narrow this gap? PARTICIPANTS: Consensus panel members were drawn from psychiatry, psychology, family practice, internal medicine, managed care and public health, consumers, and the general public. The panelists listened to a set of presentations with background papers from experts on diagnosis, epidemiology, treatment, and cost of treatment. EVIDENCE: Experts summarized relevant data from the world scientific literature on the 6 questions posed for the conference. CONSENSUS PROCESS: Panel members discussed openly all material presented to them in executive session. Selected panelists prepared first drafts of the consensus statements for each question. All of these drafts were read by all panelists and were edited and reedited until consensus was achieved. CONCLUSIONS: There is overwhelming evidence that individuals with depression are being seriously undertreated. Safe, effective, and economical treatments are available. The cost to individuals and society of this undertreatment is substantial. Long suffering, suicide, occupational impairment, and impairment in interpersonal and family relationships exist. Efforts to redress this gap have included provider educational programs and public educational programs. Reasons for the continuing gap include patient, provider, and health care system factors. Patient-based reasons include failure to recognize the symptoms, underestimating the severity, limited access, reluctance to see a mental health care specialist due to stigma, noncompliance with treatment, and lack of health insurance. Provider factors include poor professional school education about depression, limited training in interpersonal skills, stigma, inadequate time to evaluate and treat depression, failure to consider psychotherapeutic approaches, and prescription of inadequate doses of antidepressant medication for inadequate durations. Mental health care systems create barriers to receiving optimal treatment. Strategies to narrow the gap include enhancing the role of patients and families as participants in care and advocates; developing performance standards for behavioral health care systems, including incentives for positive identification, assessment, and treatment of depression; enhancing educational programs for providers and the public; enhancing collaboration among provider subtypes (eg, primary care providers and mental health professionals); and conducting research on development and testing of new treatments for depression.

Antidepressive Agents↗
PubMed1998

Interactional processes in families with depressed and non-depressed adolescents: reinforcement of depressive behavior.

Problem-solving interactions were observed in 86 families of depressed adolescents and 408 families of non-depressed adolescents. Sequential analyses indicated that mothers of depressed adolescents were more likely than mothers of non-depressed adolescents to increase facilitative behavior in response to adolescent depressive behavior. Additionally, fathers of depressed adolescents were more likely than their counterparts in families of non-depressed adolescents to decrease aggressive behavior subsequent to adolescent depressive behavior. These analyses suggest that parents of depressed adolescents may be inadvertently reinforcing depressive behavior. Decreases in adolescent depressive symptomatology from year 1 to year 2 were not accompanied by changes in family interaction patterns.

Adolescent↗
PubMed2003

Screening for postnatal depression. Validation of the Norwegian version of the Edinburgh Postnatal Depression Scale, and assessment of risk factors for postnatal depression.

OBJECTIVE: The Edinburgh Postnatal Depression Scale (EPDS) is a self-rating scale developed to screen for postnatal depression. The aim of this study was to validate a Norwegian translation of the EPDS, study its psychometric properties, and identify risk factors for postnatal depression. METHOD: EPDS was filled in by 411 women at 6-12 weeks postpartum. Of these, 100 were interviewed using the Mini International Neuropsychiatric Interview for DSM-IV major and minor depressive disorders. RESULTS: When using a cut-off of 11 on the EPDS, 26 of 27 women with major depression were identified (sensitivity 96%, specificity 78%). An aggregate point prevalence of 10.0% of major and minor depression was found. A one-factor model accounted for 46.6% of the variance. Strongest risk factors for postpartum depression were previous depression, depression in current pregnancy, and current somatic illness. LIMITATIONS: Women screened using the EPDS who had a score above threshold, yet did not attend the diagnostic interview could cause the point prevalence of depression to be higher than indicated here. CONCLUSION: The Norwegian translation of EPDS functions equally well as other translations as a screening tool for postnatal depression. The risk factors that were found are compatible with other studies.

Adult↗
PubMed1982

"Double depression": superimposition of acute depressive episodes on chronic depressive disorders.

Although "double depression"--major depressive disorder superimposed on an underlying chronic depression--is a frequent phenomenon, the concept has not been well formulated clinically and has rarely been described in the research literature. The authors found that 1) 26% of l0l patients who met the criteria for major depressive disorder had an underlying chronic depressive disorder of at least 2 years' duration, 2) "recovery" rates for patients with superimposed depression differed greatly depending on whether recovery was defined as recovery from the major depressive disorder only or recovery from both disorders, and 3) patients with superimposed depression relapsed at a significantly higher rate immediately after recovery from the acute episode of depression than did patients without superimposed depression.

Acute Disease↗
PubMed1998

Depressive personality characteristics: state dependent concomitants of depressive disorder and traits independent of current depression.

Depressive personality disorder (DPD) characteristics may reflect both state dependent concomitants and traits independent of current depression. In all, 30 clinically, 30 formerly, and 30 never depressed participants were given the Diagnostic Interview for Depressive Personality (J. G. Gunderson, K. A. Phillips, J. Triebwasser, & R. M. A. Hirschfeld, 1994). Negative reactivity, remorsefulness, a limited capacity for fun, gloominess, pessimism, difficulty being critical or angry, unassertiveness, self-denial, and seriousness differentiated depressed and nondepressed participants, indicating that they are primarily concomitants of depression. Self-criticalness differentiated formerly from never depressed participants after subclinical symptoms were controlled, suggesting that it is a trait independent of current depression. Low self-esteem, feeling burdened, and counterdependency manifested both state and trait components. If DPD is placed on Axis II, it should be defined by traits at least partly independent of depression.

Adult↗
PubMed1977

Symptom patterns in primary and secondary depression. A comparison of primary depressives with depressed opiate addicts, alcoholics, and schizophrenics.

The primary-secondary distinction in affective disorders has been proposed to reduce the heterogeneity of depression. An investigation of the frequency of secondary depression and its nature in depressed opiate addicts, alcoholics, and schizophrenics was undertaken. Findings show that secondary depression in ambulatory patients with other psychiatric disorders is relatively common. The sociodemographic characteristics of the secondary depressive are consistent with the population from which they derive but differ from primary depressives. The symptom patterns of secondary depressives are similar to primary depressives but are overall less severe. These findings give further support to the value of separating out secondary from primary depression in future research studies.

Adult↗