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Sample records for depressive episodes results

  1. Major Depressive Episodes and Work Stress: Results From a National Population Survey

    PubMed Central

    Blackmore, Emma Robertson; Stansfeld, Stephen A.; Weller, Iris; Munce, Sarah; Zagorski, Brandon M.; Stewart, Donna E.

    2007-01-01

    Objectives. We determined the proportion of workers meeting criteria for major depressive episodes in the past year and examined the association between psychosocial work-stress variables and these episodes. Methods. Data were derived from the Canadian Community Health Survey 1.2, a population-based survey of 24324 employed, community-dwelling individuals conducted in 2002. We assessed depressive episodes using the Composite International Diagnostic Interview. Results. Of the original sample, 4.6% (weighted n=745948) met criteria for major depressive episodes. High job strain was significantly associated with depression among men (odds ratio [OR]=2.38; 95% confidence interval [CI]=1.29, 4.37), and lack of social support at work was significantly associated with depression in both genders (men, OR=2.70; 95% CI=1.55, 4.71; women, OR=2.37; 95% CI=1.71, 3.29). Women with low levels of decision authority were more likely to have depression (OR=1.59; 95% CI=1.06, 2.39) than were women with high levels of authority. Conclusions. A significant proportion of the workforce experienced major depressive episodes in the year preceding our study. Gender differences appear to affect work-stress factors that increase risk for depression. Prevention strategies need to be developed with employers and employee organizations to address work organization and to increase social support. PMID:17901431

  2. Prevalence and risk factors of depressive episodes among student population in Wroclaw - epidemiological study results.

    PubMed

    Zagdańska, Marta; Kiejna, Andrzej

    2016-01-01

    The aim of this study was to identify risk factors and estimate prevalence of depressive episodes among Wroclaw's universities students. Polish adaptation of the Composite International Diagnostic Interview (CIDI) was implemented to gather epidemiological data from 370 students of public universities in Wroclaw. Proportional stratified sampling was performed to obtain distinct, independent strata representing sex, year of study and educational profiles. Randomisation was ensured by recruitment procedures. Prevalence of depressive episodes among students in Wroclaw is high - 14.7% throughout life, 9.8% within 12 months prior to the interview. High prevalence of severe and moderate depressive episodes seems to be worrisome (respectively 5.1% and 6.6% throughout life, 3.8% and 3.9% within 12 months prior to the study). Year of study, profile and lack of partner relationship remain risk factor for depression. High prevalence of depressive episodes indicates the need for prevention and therapy based on epidemiological data and tailored to the students' needs. Depression among students requires further epidemiological studies.

  3. Emotional Maltreatment and Depression: Prospective Prediction of Depressive Episodes

    PubMed Central

    Liu, Richard T.; Alloy, Lauren B.; Abramson, Lyn Y.; Iacoviello, Brian M.; Whitehouse, Wayne G.

    2010-01-01

    Background Most research to date on the role of maltreatment experiences in depression has focused on physical and sexual maltreatment. However, several researchers have theorized that emotional maltreatment may be more strongly linked to depression. Furthermore, prospective studies in this area are lacking. The present study addressed these issues by examining whether experiences of current emotional maltreatment predicted the development of new prospective episodes of major (MD) or minor depression (MiD), and the subtype of hopelessness depression (HD) in young adults. It also assessed whether current emotional maltreatment from peers and from authority figures separately predicted the occurrence of depressive episodes. Method One hundred and sixty-five participants from the Cognitive Vulnerability to Depression Project were followed prospectively for 2.5 years. Current emotional maltreatment and new depressive episodes were assessed with life event and diagnostic interviews administered every six weeks. Results Greater overall emotional maltreatment predicted shorter time to onset of new MD, MiD, and HD episodes. Peer- and authority-perpetrated emotional maltreatment separately predicted shorter time to development of new HD episodes. Conclusions Greater emotional maltreatment in young adults prospectively predicts onset of depression, particularly HD. These findings highlight the importance of adult emotional maltreatment experiences in determining targets for prevention and treatment. PMID:19152341

  4. Epidemiology of Major Depressive Episode in a Southern European Country: Results from the ESEMeD-Spain Project

    PubMed Central

    Gabilondo, Andrea; Rojas-Farreras, Sonia; Vilagut, Gemma; Haro, Josep M.; Fernández, Ana; Pinto-Meza, Alejandra; Alonso, Jordi

    2013-01-01

    Background Information of the epidemiology of Major Depressive Episode (MDE) in Spain, one of the biggest southern European countries, is scarce and heterogeneous. The objective of this study was to assess the epidemiology of the disorder in the Spanish sample of the ESEMeD project. Methods The ESEMED-Spain project is a cross-sectional, general population, household survey conducted with a representative sample of Spanish non-institutionalized adult population. The survey instrument was the CIDI 3.0, a structured diagnostic interview to assess disorders and treatment. Results Lifetime prevalence was 10.6% while 12-month prevalence was 4.0%. A monotonic increase in lifetime overall prevalence was found from the youngest to the 50–64 cohort, declining then in the oldest group. Median age of onset was 30.0. Being a woman (OR= 2.7), previously married (OR= 1.8), unemployed or disabled to work (OR= 2.9) was associated to higher risk of 12-month-MDE. The highest comorbid associations were with dysthymia (OR= 73.1) and panic disorder (OR= 41.8). Limitations 1. Psychiatric diagnoses were made by trained lay interviewers and this could have an imperfect sensitivity/specificity; 2. Individuals with mental illness could have more frequently rejected to participate in the survey; 3. Age-related recall bias could have affected the accuracy of age of onset estimates. Conclusions The study shows that prevalence MDE in Spain is lower than in other Western countries. Important findings are the early age of onset, the high proportion of chronicity, and the high female/male ratio. Taken together, results offer a complex picture of the epidemiology of MDE in Spain, when compared to other countries in Europe. The role of cultural factors is discussed. PMID:19428121

  5. Autistic traits and empathy in chronic vs. episodic depression.

    PubMed

    Domes, Gregor; Spenthof, Ines; Radtke, Martina; Isaksson, Alexandra; Normann, Claus; Heinrichs, Markus

    2016-05-01

    Difficulties in social interaction are characteristic for depressive disorders and one of the cardinal symptoms of Autism Spectrum Disorders (ASD). It has been proposed that chronically depressed persons have profoundly impaired empathic abilities in comparison to episodically depressed persons, and that specifically they exhibit a deficit in cognitive empathy, but not in affective empathy, a pattern also reported in ASD. This study aimed to explore autistic traits and empathy deficits in chronic depression, and identify specific differences to episodic depression. Autistic traits and multimodal empathy were assessed in chronically depressed patients (n=59), episodically depressed patients (n=40), and a healthy control group (n=55) using standardized questionnaires. Regardless of the disorder's chronicity, depressed patients exhibited higher levels of autistic traits and lower levels of perspective-taking than healthy controls. Chronically depressed patients reported significantly higher impairment in social skills and higher levels of personal distress in social interactions than episodic patients. Our results suggest that patients with chronic depression share two distinct characteristics, namely lower levels of social skills and higher levels of distress in tense social situations than patients with episodic depression. Future studies will need to determine whether the elevated autistic traits in chronic depression are specific to chronic depression, or represent the general tendency to withdraw from social situations. We conclude that chronically depressed patients are not specifically impaired in understanding another person's state of mind, but are unable to deal with another person's suffering or negative affective state. Copyright © 2016 Elsevier B.V. All rights reserved.

  6. Stability of symptoms across major depressive episodes in bipolar disorder

    PubMed Central

    Perlis, Roy H; Ostacher, Michael J; Uher, Rudolf; Nierenberg, Andrew A; Casamassima, Francesco; Kansky, Christine; Calabrese, Joseph R; Thase, Michael; Sachs, Gary S

    2012-01-01

    Objective Some studies suggest that depressive subtypes, defined by groups of symptoms, have predictive or diagnostic utility. These studies make the implicit assumption of stability of symptoms across episodes in mood disorders, which has rarely been investigated. Methods We examined prospective data from a cohort of 3,750 individuals with bipolar I or II disorder participating in the Systematic Treatment Enhancement Program for Bipolar Disorder study, selecting a subset of individuals who experienced two depressive episodes during up to two years of follow-up. Across-episode association of individual depressive or hypomanic/mixed symptoms was examined using the weighted kappa measure of agreement as well as logistic regression. Results A total of 583 subjects experienced two prospectively observed depressive episodes, with 149 of those subjects experiencing a third. Greatest evidence of stability was observed for neurovegetative features, suicidality, and guilt/rumination. Loss of interest and fatigue were not consistent across episodes. Structural equation modeling suggested that the dimensional structure of symptoms was not invariant across episodes. Conclusion While the overall dimensional structure of depressive symptoms lacks temporal stability, individual symptoms including suicidality, mood, psychomotor, and neurovegetative symptoms are stable across major depressive episodes in bipolar disorder and should be considered in future investigations of course and pathophysiology in bipolar disorder. PMID:19922555

  7. Emotional maltreatment and depression: prospective prediction of depressive episodes.

    PubMed

    Liu, Richard T; Alloy, Lauren B; Abramson, Lyn Y; Iacoviello, Brian M; Whitehouse, Wayne G

    2009-01-01

    Most research to date on the role of maltreatment experiences in depression has focused on physical and sexual maltreatment. However, several researchers have theorized that emotional maltreatment may be more strongly linked to depression. Furthermore, prospective studies in this area are lacking. This study addressed these issues by examining whether experiences of current emotional maltreatment predicted the development of new prospective episodes of major (MD) or minor depression (MiD), and the subtype of hopelessness depression (HD) in young adults. It also assessed whether current emotional maltreatment from peers and from authority figures separately predicted the occurrence of depressive episodes. One hundred and sixty-five participants from the Cognitive Vulnerability to Depression Project were followed prospectively for 2.5 years. Current emotional maltreatment and new depressive episodes were assessed with life event and diagnostic interviews administered every 6 weeks. Greater overall emotional maltreatment predicted shorter time to onset of new MD, MiD, and HD episodes. Peer- and authority-perpetrated emotional maltreatment separately predicted shorter time to development of new HD episodes. Greater emotional maltreatment in young adults prospectively predicts onset of depression, particularly HD. These findings highlight the importance of adult emotional maltreatment experiences in determining targets for prevention and treatment. (c) 2009 Wiley-Liss, Inc.

  8. [Management strategies for major depressive episodes as a function of initial response to an SSRI or SNRI antidepressant: results of the ORACLE survey].

    PubMed

    Spadone, C; Sylvestre, M; Chiarelli, P; Richard-Berthe, C

    2005-01-01

    The main aim of the major depressive episode treatment is to obtain a complete remission. However, partial remission (persistence of residual symptoms) is a frequent outcome of major depressive episodes, concerning approximately half of the patients who were responders to the treatment. An inadequate treatment response after three weeks of treatment is considered by the ANAES recommendations as a potential reason to modify the treatment regimen. The primary objectives of this survey were to describe the therapeutic strategies implemented in subjects treated as outpatients for a major depressive episode following evaluation of the initial response to an SSRI or an SNRI antidepressant and to assess by a naturalistic way the impact of these strategies on the extent of remission at three months. The secondary objective was to determine, by multivariate analysis, others factors able to influence the remission. This prospective observational survey concerned 2 138 patients treated by community psychiatrists (n=582) and presenting a major depressive episode in the context of a recurrent depressive disorder. Patients were assessed at inclusion and at Weeks 3, at Week 6 and at Week 12. Changes in score on the Hamilton Depression Scale (Ham-D) and CGI severity between inclusion and Week 3 and improvement scores were evaluated. The therapeutic strategies after evaluation were described. Remission was defined as a score of 1 or 2 on the CGI-improvement scale; a treatment response at Week 3 was defined as a decrease of at least 50% in the Ham-D score. The physician also provided an overall rating of satisfaction with the treatment at Week 3. Data from 1 974 patients were analysed. The mean age at inclusion was 42.7 years, 70% of the patients were women; the mean age at first episode was 32.2 years, the average time since the last episode was 3.6 years. The mean Ham-D score at inclusion was 23.6 +/- 5.8. At Week 3, 29.1% of patients were considered treatment responders. The

  9. Chronic and Episodic Stress in Children of Depressed Mothers.

    PubMed

    Feurer, Cope; Hammen, Constance L; Gibb, Brandon E

    2016-01-01

    The goal of this study was to examine chronic and episodic stress in children of mothers with and without a history of major depressive disorder (MDD) during the children's lives. Participants were 255 mothers selected according to their history of MDD (present vs. absent during child's life) and their children (age 8-14; 53% girls, 81% Caucasian). Mothers' and children's histories of MDD were assessed using diagnostic interviews, and their depressive symptoms were assessed via self-report measures. Children's levels of chronic and episodic stress were assessed using a semistructured contextual threat interview. Children of mothers with a history of recurrent MDD, compared to single MDD or no depression, experienced more chronic stress within several domains including peers, mother-child relations, and other family member relations as well as greater episodic dependent interpersonal stress. Each of these group differences was maintained after excluding children with a history of MDD themselves and controlling for their current depressive symptoms. However, only the group difference in chronic peer stress was maintained when controlling for mothers' current depression. The results suggest that children exposed to recurrent maternal MDD experience higher levels of both chronic and episodic stress, at least some of which they contribute to themselves (dependent interpersonal stress) and which is at least partially independent of the effects of children's depression. In addition, much of this stress is associated primarily with current depression in the mother, though it appears that chronic peer stress may remain elevated even after the remission of maternal depression.

  10. Age differences in the prevalence and comorbidity of DSM-IV major depressive episodes: Results from the WHO World Mental Health Survey Initiative

    PubMed Central

    Kessler, Ronald C.; Birnbaum, Howard; Shahly, Victoria; Bromet, Evelyn; Hwang, Irving; McLaughlin, Katie A.; Sampson, Nancy; Andrade, Laura Helena; de Girolamo, Giovanni; Demyttenaere, Koen; Haro, Josep Maria; Karam, Aimee N.; Kostyuchenko, Stanislav; Kovess, Viviane; Lara, Carmen; Levinson, Daphna; Matschinger, Herbert; Nakane, Yoshibumi; Browne, Mark Oakley; Ormel, Johan; Posada-Villa, Jose; Sagar, Rajesh; Stein, Dan J.

    2011-01-01

    Background Although depression appears to decrease in late life, this could be due to misattribution of depressive symptoms to physical disorders that increase in late life. Methods We investigated this issue by studying age differences in comorbidity of DSM-IV major depressive episodes (MDE) with chronic physical conditions in the WHO World Mental Health (WMH) surveys, a series of community epidemiological surveys carried out in 10 developed countries (n = 51,771) and 8 developing countries (n = 37,265). MDE and other mental disorders were assessed with the Composite International Diagnostic Interview (CIDI). Organic exclusion rules were not used to avoid inappropriate exclusion of cases with physical comorbidity. Physical conditions were assessed with a standard chronic conditions checklist. Results Twelve-month DSM-IV/CIDI MDE was significantly less prevalent among respondents ages 65+ than younger respondents in developed but not developing countries. Prevalence of comorbid mental disorders generally either decreased or remained stable with age, while comorbidity of MDE with mental disorders generally increased with age. Prevalence of physical conditions, in comparison, generally increased with age, while comorbidity of MDE with physical conditions generally decreased with age. Depression treatment was lowest among the elderly in developed and developing countries. Conclusions The weakening associations between MDE and physical conditions with increasing age argue against the suggestion that the low estimated prevalence of MDE among the elderly is due to increased confounding with physical disorders. Future study is needed to investigate processes that might lead to a decreasing impact of physical illness on depression among the elderly. PMID:20037917

  11. Depressive episodes with suicide attempts in severe depression: suicides and controls differ only in the later episodes of unipolar depression.

    PubMed

    Brådvik, Louise; Berglund, Mats

    2010-01-01

    The aim of the present study was to investigate the distribution of suicide attempts across the depressive episodes in suicides and controls with a severe depression. A blind record evaluation was performed of 100 suicide victims and matched controls admitted to the Department of Psychiatry between 1956 and 1969 and monitored to 2006. There was a similar number of episodes in suicides and controls and in the early episodes a similar number of suicide attempts in both groups. However, in the later episodes future suicides showed more suicide attempts as compared to controls. This was found for unipolar depression only. This difference was found despite previously shown similar rates of adequate treatment and improvement. In conclusion, more depressive episodes including suicide attempts appeared to be related to suicide.

  12. Updating emotional content in recovered depressed individuals: Evaluating deficits in emotion processing following a depressive episode.

    PubMed

    Levens, Sara M; Gotlib, Ian H

    2015-09-01

    Previous research has demonstrated that depressed individuals have difficulty both disengaging from negative information and maintaining positive information in working memory (WM). The present study was conducted to examine whether the tendency for depressed individuals to maintain negative content in WM and to experience difficulties maintaining positive content in WM is due to negative mood (in)congruency effects during a depressive episode, or whether these tendencies are evident outside of a depressive episode. Individuals who had recovered from a depressive episode and never disordered controls performed emotion 0-back and 2-back tasks designed to assess biases in updating emotional content in working memory. Similar to currently depressed individuals in previous studies, recovered depressed participants disengaged from happy stimuli more quickly and from sad stimuli more slowly than did their never-depressed counterparts. Despite the extension of a depression-specific finding to recovered depressed individuals, the present study does not test whether the identified emotion updating biases predict long-term relapse or recovery. The obtained results suggest that a decreased ability to disengage from negative content and to maintain positive content in WM represents a trait-like cognitive style that impairs adaptive emotion regulation and may contribute to the recurrent nature of depression. Copyright © 2015 Elsevier Ltd. All rights reserved.

  13. Comprehensive behavioral analysis of patients with a major depressive episode

    PubMed Central

    Rothuber, Helfried; Mitterauer, Bernhard

    2011-01-01

    Summary Background A major depressive episode diagnosed according to DSM-IV criteria can be accompanied by symptoms that DSM-IV does not include. These symptoms are sometimes classified as comorbidities. Our study assessed altered behavioral modes during a major depressive episode; ie, if 1 or more modes of behavior operated less or even not at all (“never”), or if the operation of others was more frequent or even constant (“always”). We hypothesize that these altered behavioral modes, especially the extreme positions “never” (hypomodes) and “always” (hypermodes) might correlate with depression scores and thus represent a typical symptom of depression. Material/Methods We used the 35-item Salzburg Subjective Behavioral Analysis (SSBA) questionnaire to measure altered behavioral modes in 63 depressed patients and 87 non-depressed controls. Depression was assessed using the Hamilton Depression Scale. Results In our test group (n=63) we found a total of 888 extreme positions. The mean number of extreme positions per patient was 11.15±5.173 (SD). Extreme positions were found in all 35 behavioral modes. The mean Hamilton score was 22.08±7.35 (SD). The association of the incidence of extreme positions and the Hamilton score in our test group was highly significant (Spearman’s Rho=0.41; p=.001). In the control group (n=87), only 11 persons were found to display extreme positions, with a total of only 25. Conclusions Although this study has several limitations, such as the small sample or the use of a questionnaire in the validation procedure, the significant correlation of extreme positions and the Hamilton score indicate that altered modes of behavior as detected with the SSBA might be typical symptoms in a major depressive episode. PMID:21525807

  14. Cognitive functions in first-episode depression and recurrent depressive disorder.

    PubMed

    Talarowska, Monika; Zajączkowska, Marlena; Gałecki, Piotr

    2015-03-01

    Cognitive deficits in the course of depressive disorders affect mainly memory, attention and the frontal functions. They are associated with both an earlier onset of symptoms and prolonged episodes. The main aim of the study was to verify the hypothesis of differences in the effectiveness of cognitive processes between patients with a first episode of depression (ED-I) and recurrent depressive disorders (rDD). The study comprised 210 subjects: patients with ED-I (n=60) and patients with rDD (n=150). The assessment of cognitive functions was based on performance of the Trail Making Test, the Stroop Test, the Verbal Fluency Test, the California Verbal Learning Test (CVLT) and the digit span from WAIS-R. There were no statistically significant differences between the analysed groups in the severity of depressive symptoms. The negative impact of depressive symptoms on the effectiveness of cognitive functions was observed. The ED-I group recorded better results compared to the rDD group in terms of the speed of information processing, visual-spatial and auditory-verbal memory and executive functions, auditory-verbal immediate and delayed memory, ability to learn and verbal fluency. The same differences were observed with respect to the patients from the ED-I group and the patients with the second episode of depression (ED-II) in the course of rDD. There are significant differences in cognitive functioning of patients with a depressive episode and recurrent depressive disorders. These differences are already visible from the second episode of a major depressive disorder. Memory, verbal fluency and frontal functions are reduced.

  15. Stability of symptoms across major depressive episodes in bipolar disorder.

    PubMed

    Perlis, Roy H; Ostacher, Michael J; Uher, Rudolf; Nierenberg, Andrew A; Casamassima, Francesco; Kansky, Christine; Calabrese, Joseph R; Thase, Michael; Sachs, Gary S

    2009-12-01

    Some studies suggest that depressive subtypes, defined by groups of symptoms, have predictive or diagnostic utility. These studies make the implicit assumption of stability of symptoms across episodes in mood disorders, which has rarely been investigated. We examined prospective data from a cohort of 3,750 individuals with bipolar I or II disorder participating in the Systematic Treatment Enhancement Program for Bipolar Disorder study, selecting a subset of individuals who experienced two depressive episodes during up to two years of follow-up. Across-episode association of individual depressive or hypomanic/mixed symptoms was examined using the weighted kappa measure of agreement as well as logistic regression. A total of 583 subjects experienced two prospectively observed depressive episodes, with 149 of those subjects experiencing a third. Greatest evidence of stability was observed for neurovegetative features, suicidality, and guilt/rumination. Loss of interest and fatigue were not consistent across episodes. Structural equation modeling suggested that the dimensional structure of symptoms was not invariant across episodes. While the overall dimensional structure of depressive symptoms lacks temporal stability, individual symptoms including suicidality, mood, psychomotor, and neurovegetative symptoms are stable across major depressive episodes in bipolar disorder and should be considered in future investigations of course and pathophysiology in bipolar disorder.

  16. Prevalence, correlates, comorbidity and treatment-seeking among individuals with a lifetime major depressive episode with and without atypical features: Results from the National Epidemiologic Survey on Alcohol and Related Conditions

    PubMed Central

    Blanco, Carlos; Vesga-López, Oriana; Stewart, Jonathan W.; Liu, Shang-Min; Grant, Bridget F.; Hasin, Deborah S.

    2012-01-01

    Objective To examine prevalence, correlates, comorbidity and treatment-seeking among individuals with a lifetime major depressive episode (MDE) with and without atypical features. Methods Data were derived from the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions, a large cross-sectional survey of a representative sample (N = 43,093) of the U.S. population, which assessed psychiatric disorders using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version (AUDADIS-IV). Comparison groups were defined based on the presence or absence of hypersomnia or hyperphagia in individuals who meet criteria for lifetime DSM-IV MDE. Results The presence of atypical features during a MDE was associated with greater rates of lifetime psychiatric comorbidity, including alcohol abuse, drug dependence, dysthymia, social anxiety disorder, specific phobia and any personality disorder (PD), except antisocial PD, than MDE without atypical features. Compared with the later group, MDE with atypical features was associated with female gender, younger age of onset, more MDEs, greater episode severity and disability, higher rates of family history of depression, bipolar I disorder, suicide attempts, and larger mental health treatment-seeking rates. Conclusions Our data provide further evidence for the clinical significance and validity of this depressive specifier. Based on the presence of any of the two reversed vegetative symptoms during an MDE most of the commonly cited validators of atypical depression were confirmed in our study. MDE with atypical features may be more common, severe, and impairing than previously documented. PMID:21939615

  17. Major depressive episodes and diet pills.

    PubMed

    Patten, Scott B

    2002-10-01

    A variety of medications used to assist with weight loss have been implicated in the precipitation or induction of depressive symptoms and disorders. This is true of a large number of phenylethylamine agents possessing psychostimulant properties, non-phenylethylamine psychostimulants (e.g., caffeine) and the serotonergic agent, fenfluramine. There is, as yet, no substantial evidence linking the more modern weight loss drugs, sibutramine and orlistat, to the aetiology of major depression. Nevertheless, when these drugs are used, major depression will continue to be an important clinical consideration because of the elevated frequency with which major depression occurs in obese patients, the contribution that major depression may make to poor outcomes in non-pharmacological weight loss treatment and because of the interplay between symptoms of depression and weight loss treatment.

  18. Life Stress and Family History for Depression: The Moderating Role of Past Depressive Episodes

    PubMed Central

    Monroe, Scott M.; Slavich, George M.; Gotlib, Ian H.

    2014-01-01

    Three of the most consistently reported and powerful predictors of depression are a recent major life event, a positive family history for depression, and a personal history of past depressive episodes. Little research, however, has evaluated the inter-relations among these predictors in depressed samples. Such information is descriptively valuable and potentially etiologically informative. In the present article we summarize the existing literature and test four predictions in a sample of 62 clinically depressed individuals: (1) participants who experienced a major life event prior to onset would be less likely than participants who did not experience a major life event to have a positive family history for depression; (2) participants with a recent major life event would have fewer lifetime episodes of depression than would participants without; (3) participants with a positive family history for depression would have more lifetime episodes of depression than would participants with a negative family history for depression; and (4) we would obtain a 3-way interaction in which participants with a positive family history and without a major life event would have the most lifetime episodes, whereas participants with a negative family history and a major life event would have the fewest lifetime episodes. The first three predictions were confirmed, and the fourth prediction partially confirmed. These novel findings begin to elucidate the complex relations among these three prominent risk factors for depression, and point to avenues of research that may help illuminate the origins of depressive episodes. PMID:24308926

  19. Life stress and family history for depression: the moderating role of past depressive episodes.

    PubMed

    Monroe, Scott M; Slavich, George M; Gotlib, Ian H

    2014-02-01

    Three of the most consistently reported and powerful predictors of depression are a recent major life event, a positive family history for depression, and a personal history of past depressive episodes. Little research, however, has evaluated the inter-relations among these predictors in depressed samples. Such information is descriptively valuable and potentially etiologically informative. In the present article we summarize the existing literature and test four predictions in a sample of 62 clinically depressed individuals: (1) participants who experienced a major life event prior to onset would be less likely than participants who did not experience a major life event to have a positive family history for depression; (2) participants with a recent major life event would have fewer lifetime episodes of depression than would participants without; (3) participants with a positive family history for depression would have more lifetime episodes of depression than would participants with a negative family history for depression; and (4) we would obtain a 3-way interaction in which participants with a positive family history and without a major life event would have the most lifetime episodes, whereas participants with a negative family history and a major life event would have the fewest lifetime episodes. The first three predictions were confirmed, and the fourth prediction partially confirmed. These novel findings begin to elucidate the complex relations among these three prominent risk factors for depression, and point to avenues of research that may help illuminate the origins of depressive episodes.

  20. Seasonal variation in major depressive episode prevalence in Canada.

    PubMed

    Patten, S B; Williams, J V A; Lavorato, D H; Bulloch, A G M; Fiest, K M; Wang, J L; Sajobi, T T

    2017-04-01

    justify the pooling of these estimated proportions, producing large gains in precision. Seasonal variation was clearly evident in the pooled data. The highest proportion of episodes occurred in December, January and February and the lowest proportions occurred in June, July and August. The proportion of respondents reporting MDE in January was 70% higher than August, suggesting an association with implications for health policy. The pattern persisted with stratification for age group, sex and latitude. Seasonal effects in MDE may have been obscured by small sample sizes in prior studies. In Canada, MDE has clear seasonal variation, yet this is not addressed in the planning of services. These results suggest that availability of depression treatment should be higher in the winter than the summer months.

  1. Lack of association between prior depressive episodes and cerebral [11C]PiB binding.

    PubMed

    Madsen, Karine; Hasselbalch, Bo J; Frederiksen, Kristian S; Haahr, Mette E; Gade, Anders; Law, Ian; Price, Julie C; Knudsen, Gitte M; Kessing, Lars V; Hasselbalch, Steen G

    2012-10-01

    Depressive symptoms are frequent in Alzheimer's disease (AD), but it is controversial whether depression is a risk factor for AD. This study measured for the first time cortical amyloid-β (Aβ) levels using [(11)C] Pittsburgh Compound B (PiB) positron emission tomography (PET) in a group of nondemented patients with prior depressive episodes. Twenty-eight elderly patients (mean age 61 years, range 51-75, 18 women) with onset of first depressive episode more than 6 years ago but now remitted from depression and 18 healthy subjects (mean age 61 years, range 50-76, 12 women) were included. All subjects were investigated with cognitive testing, 3T magnetic resonance imaging (MRI) and [(11)C]PiB high resolution research tomography (HRRT) positron emission tomography scan. There was no between-groups difference in [(11)C]PiB binding (p = 0.5) and no associations to number of depressive episodes, cognitive performance, or antidepressant treatment. Patients with late onset of depression had increased severity of white matter lesions (p = 0.04). In this study depressive episodes were not associated with increased levels of [(11)C]PiB. Thus, our results do not support the notion that depressive episodes previously in life are a risk factor for developing AD. Copyright © 2012 Elsevier Inc. All rights reserved.

  2. The association of major depressive episode and personality traits in patients with fibromyalgia

    PubMed Central

    de Melo Santos, Danyella; Lage, Laís Verderame; Jabur, Eleonora Kehl; Kaziyama, Helena Hideko Seguchi; Iosifescu, Dan V; de Lucia, Mara Cristina Souza; Fráguas, Renério

    2011-01-01

    INTRODUCTION: Personality traits have been associated with primary depression. However, it is not known whether this association takes place in the case of depression comorbid with fibromyalgia. OBJECTIVE: The authors investigated the association between a current major depressive episode and temperament traits (e.g., harm avoidance). METHOD: A sample of 69 adult female patients with fibromyalgia was assessed with the Temperament and Character Inventory. Psychiatric diagnoses were assessed with the Mini-International Neuropsychiatric Interview severity of depressive symptomatology with the Beck Depression Inventory, and anxiety symptomatology with the IDATE-state and pain intensity with a visual analog scale. RESULTS: A current major depressive episode was diagnosed in 28 (40.5%) of the patients. They presented higher levels of harm avoidance and lower levels of cooperativeness and self-directedness compared with non-depressed patients, which is consistent with the Temperament and Character Inventory profile of subjects with primary depression. However, in contrast to previous results in primary depression, no association between a major depressive episode and self-transcendence was found. CONCLUSIONS: The results highlight specific features of depression in fibromyalgia subjects and may prove important for enhancing the diagnosis and prognosis of depression in fibromyalgia patients. PMID:21808861

  3. Clinical correlates of acute bipolar depressive episode with psychosis.

    PubMed

    Caldieraro, Marco Antonio; Sylvia, Louisa G; Dufour, Steven; Walsh, Samantha; Janos, Jessica; Rabideau, Dustin J; Kamali, Masoud; McInnis, Melvin G; Bobo, William V; Friedman, Edward S; Gao, Keming; Tohen, Mauricio; Reilly-Harrington, Noreen A; Ketter, Terence A; Calabrese, Joseph R; McElroy, Susan L; Thase, Michael E; Shelton, Richard C; Bowden, Charles L; Kocsis, James H; Deckersbach, Thilo; Nierenberg, Andrew A

    2017-08-01

    Psychotic bipolar depressive episodes remain remarkably understudied despite being common and having a significant impact on bipolar disorder. The aim of this study is to identify the characteristics of depressed bipolar patients with current psychosis compared to those without psychosis. We used baseline data of a comparative effectiveness study of lithium and quetiapine for bipolar disorder (the Bipolar CHOICE study) to compare demographic, clinical, and functioning variables between those with and without psychotic symptoms. Of the 482 participants, 303 (62.9%) were eligible for the present study by meeting DSM-IV criteria for an acute bipolar depressive episode. Univariate analyses were conducted first, and then included in a model controlling for symptom severity. The sample was composed mostly of women (60.7%) and the mean age was 39.5±12.1 years. Psychosis was present in 10.6% (n=32) of the depressed patients. Psychotic patients had less education, lower income, and were more frequently single and unemployed. Psychosis was also associated with a more severe depressive episode, higher suicidality, more comorbid conditions and worse functioning. Most group differences disappeared when controlling for depression severity. Only outpatients were included and the presence of psychosis in previous episodes was not assessed. Psychosis during bipolar depressive episodes is present even in an outpatient sample. Psychotic, depressed patients have worse illness outcomes, but future research is necessary to confirm if these outcomes are only associated with the severity of the disorder or if some of them are independent of it. Copyright © 2017 Elsevier B.V. All rights reserved.

  4. Aberrant topology of striatum's connectivity is associated with the number of episodes in depression.

    PubMed

    Meng, Chun; Brandl, Felix; Tahmasian, Masoud; Shao, Junming; Manoliu, Andrei; Scherr, Martin; Schwerthöffer, Dirk; Bäuml, Josef; Förstl, Hans; Zimmer, Claus; Wohlschläger, Afra M; Riedl, Valentin; Sorg, Christian

    2014-02-01

    In major depressive disorder, depressive episodes reoccur in ∼60% of cases; however, neural mechanisms of depressive relapse are poorly understood. Depressive episodes are characterized by aberrant topology of the brain's intrinsic functional connectivity network, and the number of episodes is one of the most important predictors for depressive relapse. In this study we hypothesized that specific changes of the topology of intrinsic connectivity interact with the course of episodes in recurrent depressive disorder. To address this hypothesis, we investigated which changes of connectivity topology are associated with the number of episodes in patients, independently of current symptoms and disease duration. Fifty subjects were recruited including 25 depressive patients (two to 10 episodes) and 25 gender- and age-matched control subjects. Resting-state functional magnetic resonance imaging, Harvard-Oxford brain atlas, wavelet-transformation of atlas-shaped regional time-series, and their pairwise Pearson's correlation were used to define individual connectivity matrices. Matrices were analysed by graph-based methods, resulting in outcome measures that were used as surrogates of intrinsic network topology. Topological scores were subsequently compared across groups, and, for patients only, related with the number of depressive episodes and current symptoms by partial correlation analysis. Concerning the whole brain connectivity network of patients, small-world topology was preserved but global efficiency was reduced and global betweenness-centrality increased. Aberrant nodal efficiency and centrality of regional connectivity was found in the dorsal striatum, inferior frontal and orbitofrontal cortex as well as in the occipital and somatosensory cortex. Inferior frontal changes were associated with current symptoms, whereas aberrant right putamen network topology was associated with the number of episodes. Results were controlled for effects of total grey matter

  5. [Depressive onset episode of bipolar disorder: clinical and prognostic considerations].

    PubMed

    Besnier, N; Fakra, E; Kaladjian, A; Adida, M; Maurel, M; Azorin, J-M

    2010-01-01

    Both retrospective and high-risk individuals prospective studies show that a high percentage of patients experience one or more depressive episodes previous the diagnosis of bipolar disorder. Depressive onset bipolar disorders begin earlier than the ones with a manic onset, have a higher duration, a chronic course with frequent recurrences, a depressive dominant polarity, a higher lifetime rate of suicidal behaviour, less psychotic symptoms and more rapid cycling. A relation between frequent rapid cycling and previous prescription of antidepressants was suggested but not rigorously demonstrated. Thus, a high percentage of patients presenting a first depressive episode will later develop bipolar disorder. Several risk factors of bipolarity have been identified and might be detected during each depressive episode by using standardised evaluations and family interviews, if necessary. Among them, an early age at first episode, frequent recurrences, a family history of bipolar disorder, atypical features and hypomanic symptoms are particularly associated with the subsequent development of a bipolar disorder. The impact of a high risk of bipolarity on drug prescription is unclear ; however, one can strongly recommend to intensifying clinical monitoring and to proposing adjunctive psychoeducation.

  6. Depression with panic episodes and coronary vasospasm.

    PubMed

    Vidovich, Mladen I; Ahluwalia, Aneet; Manev, Radmila

    2009-01-01

    Variant (Prinzmetal's) angina is an uncommon cause of precordial pain caused by coronary vasospasm and characterized by transient ST elevation and negative markers of myocardial necrosis. This is the case of a female patient with a prior history of depression and panic attacks who presented with recurrent symptoms including chest pain. A cardiac event monitor positively documented coronary vasospasm associated with anxiety-provoking chest pain, whereas the coronary arteries were angiographically normal. We noted that the frequency of angina attacks apparently increased during the period that coincided with the introduction of Bupropion SR for treatment of the patient's depression. Considering the possibility of bupropion-associated negative impact on coronary vasospasm, the antidepressant therapy was adjusted to exclude this drug. Although Prinzmetal's angina is relatively uncommon, we suspect that a routine use of cardiac event monitors in subjects with panic disorder might reveal a greater incidence of coronary vasospasm in this patient population.

  7. Comprehensive behavioral analysis of patients with a major depressive episode.

    PubMed

    Rothuber, Helfried; Mitterauer, Bernhard

    2011-05-01

    A major depressive episode diagnosed according to DSM-IV criteria can be accompanied by symptoms that DSM-IV does not include. These symptoms are sometimes classified as comorbidities. Our study assessed altered behavioral modes during a major depressive episode; ie, if 1 or more modes of behavior operated less or even not at all ("never"), or if the operation of others was more frequent or even constant ("always"). We hypothesize that these altered behavioral modes, especially the extreme positions "never" (hypomodes) and "always" (hypermodes) might correlate with depression scores and thus represent a typical symptom of depression. We used the 35-item Salzburg Subjective Behavioral Analysis (SSBA) questionnaire to measure altered behavioral modes in 63 depressed patients and 87 non-depressed controls. Depression was assessed using the Hamilton Depression Scale. In our test group (n=63) we found a total of 888 extreme positions. The mean number of extreme positions per patient was 11.15±5.173 (SD). Extreme positions were found in all 35 behavioral modes. The mean Hamilton score was 22.08±7.35 (SD). The association of the incidence of extreme positions and the Hamilton score in our test group was highly significant (Spearman's Rho=0.41; p=.001). In the control group (n=87), only 11 persons were found to display extreme positions, with a total of only 25. Although this study has several limitations, such as the small sample or the use of a questionnaire in the validation procedure, the significant correlation of extreme positions and the Hamilton score indicate that altered modes of behavior as detected with the SSBA might be typical symptoms in a major depressive episode.

  8. Within-person Changes in Individual Symptoms of Depression Predict Subsequent Depressive Episodes in Adolescents: A Prospective Study

    PubMed Central

    Kouros, Chrystyna D.; Morris, Matthew C.; Garber, Judy

    2015-01-01

    The current longitudinal study examined which individual symptoms of depression uniquely predicted a subsequent Major Depressive Episode (MDE) in adolescents, and whether these relations differed by sex. Adolescents (N=240) were first interviewed in grade 6 (M=11.86 years old; SD = 0.56; 54% female; 81.5% Caucasian) and then annually through grade 12 regarding their individual symptoms of depression as well as the occurrence of MDEs. Individual symptoms of depression were assessed with the Children’s Depression Rating Scale-Revised (CDRS-R) and depressive episodes were assessed with the Longitudinal Interval Follow-up Evaluation (LIFE). Results showed that within-person changes in sleep problems and low self-esteem/excessive guilt positively predicted an increased likelihood of an MDE for both boys and girls. Significant sex differences also were found. Within-person changes in anhedonia predicted an increased likelihood of a subsequent MDE among boys, whereas irritability predicted a decreased likelihood of a future MDE among boys, and concentration difficulties predicted a decreased likelihood of an MDE in girls. These results identified individual depressive symptoms that predicted subsequent depressive episodes in male and female adolescents, and may be used to guide the early detection, treatment, and prevention of depressive disorders in youth. PMID:26105209

  9. The Neighbourhood Built Environment and Trajectories of Depression Symptom Episodes in Adults: A Latent Class Growth Analysis

    PubMed Central

    Gariepy, Genevieve; Thombs, Brett D.; Kestens, Yan; Kaufman, Jay S.; Blair, Alexandra; Schmitz, Norbert

    2015-01-01

    Aim To investigate the effect of the neighbourhood built environment on trajectories of depression symptom episodes in adults from the general Canadian population. Research Design and Methods We used 10 years of data collection (2000/01-2010/11) from the Canadian National Population Health Study (n = 7114). Episodes of depression symptoms were identified using the Composite International Diagnostic Interview Short-Form. We assessed the presence of local parks, healthy food stores, fast food restaurants, health services and cultural services using geospatial data. We used latent class growth modelling to identify different trajectories of depression symptom episodes in the sample and tested for the effect of neighbourhood variables on the trajectories over time. Results We uncovered three distinct trajectories of depression symptom episodes: low prevalence (76.2% of the sample), moderate prevalence (19.2%) and high prevalence of depression symptom episodes (2.8%). The presence of any neighbourhood service (healthy food store, fast-food restaurant, health service, except for cultural service) was significantly associated with a lower probability of a depression symptom episode for those following a trajectory of low prevalence of depression symptom episodes. The presence of a local park was also a significant protective factor in trajectory groups with both low and moderate prevalence of depression symptom episodes. Neighbourhood characteristics did not significantly affect the trajectory of high prevalence of depression symptom episodes. Conclusions For individuals following a trajectory of low and moderate prevalence of depression symptom episodes, the neighbourhood built environment was associated with a shift in the trajectory of depression symptom episodes. Future intervention studies are recommended to make policy recommendations. PMID:26207368

  10. Cognitive functioning and cortisol profiles in first episode major depression.

    PubMed

    Hansson, Pia Berner; Murison, Robert; Lund, Anders; Hammar, Åsa

    2015-08-01

    Major Depressive Disorder (MDD) is often associated with high levels of stress and disturbances in the Hypothalamic Pituitary Adrenal (HPA) system, yielding high levels of cortisol, in addition to cognitive dysfunction. Previous studies have shown a relationship between cortisol profile and cognitive functioning in recurrent MDD in general. More specifically, the association between hypercortisolism and cognitive functioning, such as memory and Executive Functioning (EF), and also more recently cortisol suppression has been explored. However, no studies have investigated these relationships in patients diagnosed with first episode MDD. The aim of the present study was to examine the relationship between cortisol levels before and after the Dexamethasone suppression test (DST) and cognitive function in first episode MDD patients. Twenty-one patients meeting the DSM-IV criteria for a first episode of MDD diagnosis were included in the study. The control group was matched for age, gender and education level. Cortisol was measured in saliva collected with Salivette sampling devices. Saliva samples were collected 4 times during a 24 hours period over two consecutive days: at awakening, after 45 minutes, after 7 hours and at 11 pm. Dexamethasone (1.0 mg) was given orally on Day 1 at 11 pm. The neuropsychological test battery consisted of standardized tests measuring executive functioning (EF) and memory functioning. Cortisol levels did not differ significantly between patients and controls on Day 1, except for the last sample before Dexamethasone administration, where the control group showed higher levels. Both groups showed suppression after Dexamethasone. On Day 2 there was a significant difference between groups at the third sample, showing a significantly lower level in the control group, suggesting that the controls have a more effective suppression profile than the patients. There were no significant correlations between cortisol levels before or after

  11. [Vortioxetine: a new antidepressant to treat depressive episodes].

    PubMed

    Colle, R; Corruble, E

    2016-02-01

    Vortioxetine is a new antidepressant, which mechanism of action is multimodal, targeting the 5-HT1A, 5-HT1B, 5-HT1D, 5-HT3, 5-HT7 receptors and the serotonin transporter (5-HTT). Its efficacy and safety were assessed in fourteen studies including more than 3700 patients with a major depressive episode and treated with vortioxetine. In short-term studies (8 weeks), vortioxetine is more efficacious than placebo in decreasing depressive symptoms as measured by the MADRS total score, response rate (vortioxetine: 53.2% vs placebo: 35.2%) and remission rate (vortioxetine: 29.2% vs placebo: 19.3%). In a long-term study (52 weeks), vortioxetine is also superior to placebo in preventing relapses and recurrences. Moreover, in second line treatment, after failure of a first line selective serotonin reuptake inhibitor (SSRI) or serotonin norepinephrin reuptake inhibitor (SNRI), vortioxetine is superior to agomelatine in improving depressive symptoms and achieving response and remission. Furthermore, the positive effects of vortioxetine on improvement of cognitive symptoms of major depressive episodes are particularly well established in several clinical trials. The tolerability profile of vortioxetine is favourable. The recommended daily posology of vortioxetine is 10mg/d. Vortioxetine is a new antidepressant drug with a multimodal mechanism of action, well-documented efficacy and safety profiles. Copyright © 2015 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

  12. PATTERNS OF SYMPTOM ONSET AND REMISSION IN EPISODES OF HOPELESSNESS DEPRESSION

    PubMed Central

    Iacoviello, Brian M.; Alloy, Lauren B.; Abramson, Lyn Y.; Choi, Jimmy Y.; Morgan, Julia E.

    2014-01-01

    Background Hopelessness depression (HD) is a subtype of depression postulated by the Hopelessness Theory of Depression to present as a constellation of symptoms occurring when an individual with a specific cognitive vulnerability (negative inferential style) experiences negative life events. In the current study, the course of HD episodes was evaluated prospectively and analyzed to explore patterns of symptom onset and remission. Methods In 169 HD episodes reported by 65 participants, survival analyses were conducted on the time to onset or remission for 29 individual symptoms. Survival analyses yielded probability density graphs for risk of onset and risk of offset that indicated whether the symptom tended to appear or remit early, late, or unpredictably during the episode. Results The symptom of hopelessness often appeared earliest in HD episodes, followed by self-blame, brooding/worry, decreased self-esteem, dependency, and decreased appetite. Hopelessness, decreased self-esteem, self-blame, brooding/worry, dependency, and increased appetite were typically the latest symptoms to remit. Conclusions The current study provided evidence for patterns of symptom onset and remission in HD episodes. Hopelessness and other symptoms predicted to appear according to the Hopelessness Theory were generally the earliest to appear, latest to remit, and appeared to form the core syndrome of these HD episodes. Identifying patterns of symptom onset and remission may provide a tool for subtyping depression episodes. Clinically, these results point to the utility of attending to patterns of symptom onset and remission in patients presenting with HD episodes, particularly for treatment planning and monitoring. PMID:23495016

  13. Difference in the binocular rivalry rate between depressive episodes and remission.

    PubMed

    Jia, Ting; Ye, Xing; Wei, Qiang; Xie, Wen; Cai, Chunlan; Mu, Jingjing; Dong, Yi; Hu, Panpan; Hu, Xinglong; Tian, Yanghua; Wang, Kai

    2015-11-01

    Binocular rivalry refers to a phenomenon in which, when different images are presented to each eye simultaneously, perception alternates spontaneously between monocular views rather than being a superposition of the two images. Recently, the involvement of serotonin systems has been reported to be related to the phenomenon. There is abundant evidence for abnormalities of the serotonin systems in depression and the antidepressants that enhance 5-HT transmission, which in turn improves mood and behavior. However, the available data with respect to rivalry rates in depression are less clear. Therefore, we aimed to explore whether perceptual rivalry was affected by a dysfunctional serotonin system in patients with depression and whether there was a rivalry rate difference between episode and remission states in depression patients. Twenty-eight patients with depression and 30 healthy controls were recruited in the study. We assessed the rivalry rate and the 17-item Hamilton Depression Rating Scale (HAMD) in patients with depression during clinical episode and remission states. The results suggested that alternation rates for patients during episodes were significantly slower than during remission and than in healthy controls. Also, alternation rates for patients during remission were slower than in healthy controls. These results may provide further clues to serotonergic neural systems contributing to the dynamics of perception rivalry and may foster enlightenment regarding the field of binocular rivalry in psychiatric disorders other than bipolar disorder. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Patterns of symptom onset and remission in episodes of hopelessness depression.

    PubMed

    Iacoviello, Brian M; Alloy, Lauren B; Abramson, Lyn Y; Choi, Jimmy Y; Morgan, Julia E

    2013-06-01

    Hopelessness depression (HD) is a subtype of depression postulated by the Hopelessness Theory of Depression to present as a constellation of symptoms occurring when an individual with a specific cognitive vulnerability (negative inferential style) experiences negative life events. In the current study, the course of HD episodes was evaluated prospectively and analyzed to explore patterns of symptom onset and remission. In 169 HD episodes reported by 65 participants, survival analyses were conducted on the time to onset or remission for 29 individual symptoms. Survival analyses yielded probability density graphs for risk of onset and risk of offset that indicated whether the symptom tended to appear or remit early, late, or unpredictably during the episode. The symptom of hopelessness often appeared earliest in HD episodes, followed by self-blame, brooding/worry, decreased self-esteem, dependency, and decreased appetite. Hopelessness, decreased self-esteem, self-blame, brooding/worry, dependency, and increased appetite were typically the latest symptoms to remit. The current study provided evidence for patterns of symptom onset and remission in HD episodes. Hopelessness and other symptoms predicted to appear according to the Hopelessness Theory were generally the earliest to appear, latest to remit, and appeared to form the core syndrome of these HD episodes. Identifying patterns of symptom onset and remission may provide a tool for subtyping depression episodes. Clinically, these results point to the utility of attending to patterns of symptom onset and remission in patients presenting with HD episodes, particularly for treatment planning and monitoring. © 2013 Wiley Periodicals, Inc.

  15. Vitamin D Deficiency and Depressive Symptomatology in Psychiatric Patients Hospitalized with a Current Depressive Episode: A Factor Analytic Study

    PubMed Central

    von Känel, Roland; Fardad, Nasser; Steurer, Nadine; Horak, Nicole; Hindermann, Esther; Fischer, Franz; Gessler, Katharina

    2015-01-01

    Background Low vitamin D levels have been associated with depressive symptoms in population-based studies and non-clinical samples as well as with clinical depression. This study aimed to examine the association of vitamin D levels with the severity and dimensions of depressive symptoms in hospitalized patients with a current episode of depression taking into account confounding variables. Methods We investigated 380 patients (mean age 47±12 years, 70% women) who were consecutively hospitalized with a main diagnosis of an ICD-10 depressive episode. All patients self-rated depressive symptom severity with the Hospital Anxiety and Depression Scale (HADS-D), the Beck Depression Inventory-II (BDI-II), and the Brief Symptom Inventory. A principal component analysis was performed with all 34 items of these questionnaires and serum levels of 25-hydroxyvitamin D3 (25-OH D) were measured. Results Vitamin D deficiency (<50 nmol/l), insufficiency (50–75 nmol/l), and sufficiency (>75 nmol/l) were present in 55.5%, 31.8% and 12.6%, respectively, of patients. Patients with vitamin D deficiency scored higher on the HADS-D scale and on an anhedonia symptom factor than those with insufficient (p-values ≤0.023) or sufficient (p-values ≤0.008) vitamin D. Vitamin D deficient patients also scored higher on the BDI-II scale than those with sufficient vitamin D (p = 0.007); BDI-II cognitive/affective symptoms, but not somatic/affective symptoms, were higher in patients with vitamin D deficiency (p = 0.005) and insufficiency (p = 0.041) relative to those with sufficient vitamin D. Effect sizes suggested clinically relevant findings. Conclusions Low vitamin D levels are frequent in hospitalized patients with a current episode of depression. Especially 25-OH D levels <50 nmol/l were associated with cognitive/affective depressive symptoms, and anhedonia symptoms in particular. PMID:26397113

  16. Serum biomarkers predictive of depressive episodes in panic disorder.

    PubMed

    Gottschalk, M G; Cooper, J D; Chan, M K; Bot, M; Penninx, B W J H; Bahn, S

    2016-02-01

    Panic disorder with or without comorbid agoraphobia (PD/PDA) has been linked to an increased risk to develop subsequent depressive episodes, yet the underlying pathophysiology of these disorders remains poorly understood. We aimed to identify a biomarker panel predictive for the development of a depressive disorder (major depressive disorder and/or dysthymia) within a 2-year-follow-up period. Blood serum concentrations of 165 analytes were evaluated in 120 PD/PDA patients without depressive disorder baseline diagnosis (6-month-recency) in the Netherlands Study of Depression and Anxiety (NESDA). We assessed the predictive performance of serum biomarkers, clinical, and self-report variables using receiver operating characteristics curves (ROC) and the area under the ROC curve (AUC). False-discovery-rate corrected logistic regression model selection of serum analytes and covariates identified an optimal predictive panel comprised of tetranectin and creatine kinase MB along with patient gender and scores from the Inventory of Depressive Symptomatology (IDS) rating scale. Combined, an AUC of 0.87 was reached for identifying the PD/PDA patients who developed a depressive disorder within 2 years (n = 44). The addition of biomarkers represented a significant (p = 0.010) improvement over using gender and IDS alone as predictors (AUC = 0.78). For the first time, we report on a combination of biological serum markers, clinical variables and self-report inventories that can detect PD/PDA patients at increased risk of developing subsequent depressive disorders with good predictive performance in a naturalistic cohort design. After an independent validation our proposed biomarkers could prove useful in the detection of at-risk PD/PDA patients, allowing for early therapeutic interventions and improving clinical outcome.

  17. Reports of the childhood home environment in early-onset dysthymia and episodic major depression.

    PubMed

    Lizardi, H; Klein, D N; Ouimette, P C; Riso, L P; Anderson, R L; Donaldson, S K

    1995-02-01

    This study addressed 2 questions: (a) is early-onset dysthymia associated with reports of a disturbed childhood home environment; and (b) can adverse early experiences account, at least in part, for the differing clinical presentations of dysthymia and major depression? Participants included 97 outpatients with early-onset dysthymia, 45 outpatients with episodic major depression, and 45 normal controls. The early home environment was assessed blind to diagnosis using both interview and self-report measures. Early-onset dysthymia patients reported significantly more physical and sexual abuse and poorer relationships with both parents than normal controls. In addition, patients with dysthymia reported having received significantly poorer parenting than those with episodic major depression. The results could not be accounted for by mood state effects, comorbidity with borderline and antisocial personality disorder, or comorbid major depression.

  18. Depression-like episodes in mice harboring mtDNA deletions in paraventricular thalamus.

    PubMed

    Kasahara, T; Takata, A; Kato, T M; Kubota-Sakashita, M; Sawada, T; Kakita, A; Mizukami, H; Kaneda, D; Ozawa, K; Kato, T

    2016-01-01

    Depression is a common debilitating human disease whose etiology has defied decades of research. A critical bottleneck is the difficulty in modeling depressive episodes in animals. Here, we show that a transgenic mouse with chronic forebrain expression of a dominant negative mutant of Polg1, a mitochondrial DNA (mtDNA) polymerase, exhibits lethargic behavioral changes, which are associated with emotional, vegetative and psychomotor disturbances, and response to antidepression drug treatment. The results suggested a symptomatic similarity between the lethargic behavioral change that was recurrently and spontaneously experienced by the mutant mice and major depressive episode as defined by DSM-5. A comprehensive screen of mutant brain revealed a hotspot for mtDNA deletions and mitochondrial dysfunction in the paraventricular thalamic nucleus (PVT) with similar defects observed in postmortem brains of patients with mitochondrial disease with mood symptoms. Remarkably, the genetic inhibition of PVT synaptic output by Cre-loxP-dependent expression of tetanus toxin triggered de novo depression-like episodes. These findings identify a novel preclinical mouse model and brain area for major depressive episodes with mitochondrial dysfunction as its cellular mechanism.

  19. Depression-like episodes in mice harboring mtDNA deletions in paraventricular thalamus

    PubMed Central

    Kasahara, T; Takata, A; Kato, T M; Kubota-Sakashita, M; Sawada, T; Kakita, A; Mizukami, H; Kaneda, D; Ozawa, K; Kato, T

    2016-01-01

    Depression is a common debilitating human disease whose etiology has defied decades of research. A critical bottleneck is the difficulty in modeling depressive episodes in animals. Here, we show that a transgenic mouse with chronic forebrain expression of a dominant negative mutant of Polg1, a mitochondrial DNA (mtDNA) polymerase, exhibits lethargic behavioral changes, which are associated with emotional, vegetative and psychomotor disturbances, and response to antidepression drug treatment. The results suggested a symptomatic similarity between the lethargic behavioral change that was recurrently and spontaneously experienced by the mutant mice and major depressive episode as defined by DSM-5. A comprehensive screen of mutant brain revealed a hotspot for mtDNA deletions and mitochondrial dysfunction in the paraventricular thalamic nucleus (PVT) with similar defects observed in postmortem brains of patients with mitochondrial disease with mood symptoms. Remarkably, the genetic inhibition of PVT synaptic output by Cre-loxP-dependent expression of tetanus toxin triggered de novo depression-like episodes. These findings identify a novel preclinical mouse model and brain area for major depressive episodes with mitochondrial dysfunction as its cellular mechanism. PMID:26481320

  20. Greater striatal dopamine transporter density may be associated with major depressive episode.

    PubMed

    Amsterdam, Jay D; Newberg, Andrew B; Soeller, Irene; Shults, Justine

    2012-12-10

    We examined striatal dopamine transporter (DAT) distribution volume ratio (DVR) values in subjects with unipolar or bipolar major depressive episode (versus non-depressed healthy volunteers) using the selective DAT radioligand [(99m)Tc]TRODAT-1 and single photon emission computed tomography (SPECT). We hypothesized that striatal DVR values would be greater in depressed versus non-depressed subjects, and that greater DVR values may represent a possible clinical biomarker of depression. [(99m)Tc]TRODAT-1 spect images were acquired from 39 depressed and 103 non-depressed drug-free subjects. The primary outcome measure was the DVR value of [(99m)Tc]TRODAT-1 binding for the putamen region and the combined putamen plus caudate region. DVR values were significantly correlated across all striatal regions within both subject groups (p<0.005). Depressed subjects had significantly greater DVR values (versus non-depressed subjects) in the putamen (p<0.0005) and the combined putamen plus caudate (p<0.0005) regions. There was no difference in DVR values between unipolar (n=24) and bipolar (n=15) depressed subjects, and no difference in DVR values for depressed subjects with or without prior antidepressant exposure. The predictive probability of the putamen or combined putamen plus caudate DVR value to distinguish depressed from non-depressed subjects was significant (p<0.0005). DAT values could potentially be influenced by age, gender, diagnosis, prior psychotropic dug exposure, illness length, or symptom severity. Results confirm prior observations of greater striatal DAT density in depressed versus non-depressed subjects, and suggest that greater DVR values may possibly represent a potential diagnostic biomarker for distinguish depressed from non-depressed individuals. Copyright © 2012 Elsevier B.V. All rights reserved.

  1. Impaired theory of mind in first-episode schizophrenia: comparison with community, university and depressed controls.

    PubMed

    Kettle, Jonathan W L; O'Brien-Simpson, Laurie; Allen, Nicholas B

    2008-02-01

    First order theory of mind, as measured by the 'Reading the Mind in the Eyes Test' Revised, is impaired in schizophrenia. However, no study has investigated whether this occurs in first-episode schizophrenia. Also, it is unclear whether such a deficit is specific to schizophrenia, and whether convenience control samples, particularly undergraduate university students, represent valid comparison groups. This study investigated theory of mind ability, measured by the 'Reading the Mind in the Eyes Test' Revised, in a group of first-episode schizophrenia outpatients (n=13) and three control groups: outpatients with non-psychotic major depression (n=14), individuals from the general community (n=16) and from an undergraduate university course (n=27). The schizophrenia group exhibited significant theory of mind impairments compared to both non-psychiatric control groups but not the depression group. Unexpectedly, the depression group was not significantly impaired compared to the community control group, and the university control group exhibited superior theory of mind ability relative to all three groups. The findings indicate theory of mind deficits in first episode schizophrenia and support the implementation of theory of mind interventions in first-episode schizophrenia treatment programs. Results also indicate that community rather than university control groups represent more valid comparison groups in first-episode schizophrenia research.

  2. Prevalence of metabolic syndrome among patients with major depressive disorder--differences between newly diagnosed first episode and recurrent disease.

    PubMed

    Ljubicic, Rudolf; Jakovac, Hrvoje; Bistrović, Ivana Ljubicić; Franceski, Tanja; Mufić, Ana Kovak; Karlović, Dalibor

    2013-12-01

    The objective of the present study was to assess differences in prevalence of the metabolic syndrome among depressed patients in regard to the duration of the illness (first episode versus recurrent episodes). A total of 190 patients suffering from major depressive disorder were included in the study, diagnosed according to International classification of disorders, 10th revision. The same criteria were used to divide participants into two groups: first episode major depressive disorder and major depressive disorder with recurrent episodes. The metabolic syndrome was defined according to the criteria of the American National Cholesterol Education Program-Treatment Panel III. Results showed that metabolic syndrome is significantly more prevalent in patients with recurrent major depressive disorder (45.2%) compared to patients with first episode of major depressive disorder (27.3%), mainly due to differences in plasma glucose, triglycerides and HDL-cholesterol levels. These findings indicate the importance of the duration of depression and the number of recurring episodes as factors involved in etiopathogenesis of the associated metabolic syndrome.

  3. Overgeneral autobiographical memory at baseline predicts depressive symptoms at follow-up in patients with first-episode depression.

    PubMed

    Liu, Yansong; Zhang, Fuquan; Wang, Zhiqiang; Cao, Leiming; Wang, Jun; Na, Aiguo; Sun, Yujun; Zhao, Xudong

    2016-09-30

    Previous studies have shown that overgeneral autobiographical memory (OGM) is a characteristic of depression. However, there are no studies to explore the association between baseline OGM and depressive symptoms at follow-up in patients with first-episode depression (FE). This study investigated whether baseline OGM predicts depressive symptoms at follow-up in patients with FE. We recruited 125 patients with FE. The participants were divided into remitted group and non-remitted group according to the severity of their depression at 12 months follow-up. The measures consisted of the 17-item Hamilton Depression Rating Scale, Ruminative Response Scale, and Autobiographical Memory Test. Hierarchical linear regression analyses and bootstrap mediation analyses were conducted. The results showed that non-remitted patients had more OGM at baseline. Baseline OGM predicted depressive symptoms at follow-up in patients with FE. Rumination mediated the relationship between baseline OGM and depressive symptoms at follow-up. Our findings highlight OGM as a vulnerability factor involved in the maintenance of depression in patients with FE.

  4. Ongoing episode of major depressive disorder is not associated with elevated plasma levels of kynurenine pathway markers.

    PubMed

    Dahl, Johan; Andreassen, Ole A; Verkerk, Robert; Malt, Ulrik Fredrik; Sandvik, Leiv; Brundin, Lena; Ormstad, Heidi

    2015-06-01

    It has been suggested that the development of depressive symptoms as a result of cytokine therapy is attributable to cytokine-induced elevated activity of the kynurenine pathway. The few studies of this mechanism in patients with common major depressive disorder (MDD) have yielded inconsistent results. The aim of the present study was to identify markers of the kynurenine pathway in a clinical MDD sample with increased cytokine levels. Fifty medication-free MDD patients with a depressive episode and 34 healthy controls were included at baseline; the patients were followed for 12 weeks. Before initiating treatment, the patients were diagnosed and assessed for depressive symptoms and their blood was analyzed for tryptophan and its metabolites in the kynurenine pathway. The clinical assessments and metabolite measurements were repeated after 12 weeks of "treatment as usual". We did not find significant elevation of kynurenine plasma markers in patients with a depressive episode compared to healthy controls, despite elevated cytokine levels in the patients. Clinical depression scores were significantly reduced after 12 weeks, but no significant change in the plasma kynurenine pathway plasma markers was observed. The obtained results do not support the hypothesis that MDD depressive episodes are associated with elevated activity in the kynurenine pathway. This suggests that the pathophysiology underlying depressive episodes in common MDD differs from that of interferon induced depression. Our results warrant further study of the interplay between the kynurenine pathway and the cytokine activation patterns in these conditions. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. Cortisol Responses to Psychosocial Stress Predict Depression Trajectories: Social-Evaluative Threat and Prior Depressive Episodes as Moderators

    PubMed Central

    Morris, Matthew C.; Rao, Uma; Garber, Judy

    2012-01-01

    Background Alterations of hypothalamic-pituitary-adrenal (HPA) function are well-established in adults with current depression. HPA alterations may persist into remission and confer increased risk for recurrence. Methods A modified version of the Trier Social Stress Test (TSST) was administered at baseline to 32 young adults with remitted major depressive disorder and 36 never-depressed controls. Participants were randomly assigned to either a ‘high–stress’ condition involving social evaluation or a ‘low-stress’ control condition. Cortisol concentrations were measured in saliva samples throughout the TSST. Participants were assessed again after 6 months for the occurrence of stressful life events and depressive symptoms/disorders during the follow-up period. Results Participants who exhibited enhanced cortisol reactivity in the low-stress condition showed increases in depressive symptoms over follow-up, after controlling for stressful life events during the follow-up period. Anticipatory stress cortisol and cortisol reactivity each interacted with history of depressive episodes to predict depression trajectories. Limitations The single TSST administration limits conclusions about whether alterations of cortisol reactivity represent trait-like vulnerability factors or consequences (“scars’) of past depression. Conclusions These results extend previous findings on stress sensitivity in depression and suggest that altered HPA function during remission could reflect an endophenotype for vulnerability to depression recurrence. Findings support interactive models of risk for depression recurrence implicating HPA function, depression history, and sensitivity to minor stressors. Results may have implications for interventions that match treatment approaches to profiles of HPA function. PMID:22858210

  6. Metabolic syndrome in subjects with bipolar disorder and major depressive disorder in a current depressive episode: Population-based study: Metabolic syndrome in current depressive episode.

    PubMed

    Moreira, Fernanda Pedrotti; Jansen, Karen; Cardoso, Taiane de Azevedo; Mondin, Thaíse Campos; Magalhães, Pedro Vieira da Silva; Kapczinski, Flávio; Souza, Luciano Dias de Mattos; da Silva, Ricardo Azevedo; Oses, Jean Pierre; Wiener, Carolina David

    2017-09-01

    To assess the differences in the prevalence of the metabolic syndrome (MetS) and their components in young adults with bipolar disorder (BD) and major depressive disorder (MDD) in a current depressive episode. This was a cross-sectional study with young adults aged 24-30 years old. Depressive episode (bipolar or unipolar) was assessed using the Mini International Neuropsychiatric Interview - Plus version (MINI Plus). The MetS was assessed using the National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP III). The sample included 972 subjects with a mean age of 25.81 (±2.17) years. Both BD and MDD patients showed higher prevalence of MetS compared to the population sample (BD = 46.9%, MDD = 35.1%, population = 22.1%, p < 0.001). Higher levels of glucose, total cholesterol and LDL cholesterol, Body Mass Index, low levels of HDL cholesterol, and a higher prevalence of abdominal obesity were observed in both BD and MDD individuals with current depressive episode compared to the general population. Moreover, there was a significant difference on BMI values in the case of BD and MDD subjects (p = 0.016). Metabolic components were significantly associated with the presence of depressive symptoms, independently of the diagnosis. Copyright © 2017. Published by Elsevier Ltd.

  7. Discovery of serum biomarkers predicting development of a subsequent depressive episode in social anxiety disorder.

    PubMed

    Gottschalk, M G; Cooper, J D; Chan, M K; Bot, M; Penninx, B W J H; Bahn, S

    2015-08-01

    Although social anxiety disorder (SAD) is strongly associated with the subsequent development of a depressive disorder (major depressive disorder or dysthymia), no underlying biological risk factors are known. We aimed to identify biomarkers which predict depressive episodes in SAD patients over a 2-year follow-up period. One hundred sixty-five multiplexed immunoassay analytes were investigated in blood serum of 143 SAD patients without co-morbid depressive disorders, recruited within the Netherlands Study of Depression and Anxiety (NESDA). Predictive performance of identified biomarkers, clinical variables and self-report inventories was assessed using receiver operating characteristics curves (ROC) and represented by the area under the ROC curve (AUC). Stepwise logistic regression resulted in the selection of four serum analytes (AXL receptor tyrosine kinase, vascular cell adhesion molecule 1, vitronectin, collagen IV) and four additional variables (Inventory of Depressive Symptomatology, Beck Anxiety Inventory somatic subscale, depressive disorder lifetime diagnosis, BMI) as optimal set of patient parameters. When combined, an AUC of 0.86 was achieved for the identification of SAD individuals who later developed a depressive disorder. Throughout our analyses, biomarkers yielded superior discriminative performance compared to clinical variables and self-report inventories alone. We report the discovery of a serum marker panel with good predictive performance to identify SAD individuals prone to develop subsequent depressive episodes in a naturalistic cohort design. Furthermore, we emphasise the importance to combine biological markers, clinical variables and self-report inventories for disease course predictions in psychiatry. Following replication in independent cohorts, validated biomarkers could help to identify SAD patients at risk of developing a depressive disorder, thus facilitating early intervention. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Personality traits in the differentiation of major depressive disorder and bipolar disorder during a depressive episode.

    PubMed

    Araujo, Jaciana Marlova Gonçalves; dos Passos, Miguel Bezerra; Molina, Mariane Lopez; da Silva, Ricardo Azevedo; Souza, Luciano Dias de Mattos

    2016-02-28

    The aim of this study was to determine the differences in personality traits between individuals with Major Depressive Disorder (MDD) and Bipolar Disorder (BD) during a depressive episode, when it can be hard to differentiate them. Data on personality traits (NEO-FFI), mental disorders (Mini International Neuropsychiatric Interview Plus) and socioeconomic variables were collected from 245 respondents who were in a depressive episode. Individuals with MDD (183) and BD (62) diagnosis were compared concerning personality traits, clinical aspects and socioeconomic variables through bivariate analyses (chi-square and ANOVA) and multivariate analysis (logistic regression). There were no differences in the prevalence of the disorders between socioeconomic and clinical variables. As for the personality traits, only the difference in Agreeableness was statistically significant. Considering the control of suicide risk, gender and anxiety comorbidity in the multivariate analysis, the only variable that remained associated was Agreeableness, with an increase in MDD cases. The brief version of the NEO inventories (NEO-FFI) does not allow for the analysis of personality facets. During a depressive episode, high levels of Agreeableness can indicate that MDD is a more likely diagnosis than BD. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  9. Decreased functional connectivity in the language regions in bipolar patients during depressive episodes but not remission.

    PubMed

    Lv, Dongsheng; Lin, Wuhong; Xue, Zhimin; Pu, Weidan; Yang, Qing; Huang, Xiaojun; Zhou, Li; Yang, Lihua; Liu, Zhening

    2016-06-01

    Retardation of thought is a crucial clinical feature in patients with bipolar depression, characterized by dysfunctional semantic processing and language communication. However, the underlying neuropathological mechanisms remain largely unknown. The objective of this study was to evaluate the disruption in resting-state functional connectivity in 90 different brain regions during the depressive episodes of bipolar disorder and during disease remission. Applying the whole brain and language regions of interest methods to the resting-state functional magnetic resonance imaging data, we explored the discrepancies in 90 brain regions' functional connectivity in 42 patients with bipolar disorder - 23 experiencing a depressive episode and 19 in remission - and 28 healthy controls matched for gender, age, and education. Bipolar depressive patients had significantly reduced connectivity strength in the language regions relative to healthy controls. Specifically, the affected regions included the left triangular part of the inferior frontal gyrus, left opercular part of the inferior frontal gyrus, left middle temporal gyrus, and left angular gyrus. However, no significant differences in these regions were observed between bipolar patients in remission and healthy controls. Furthermore, the decreased connectivity strength between the left middle temporal gyrus and right lingual gyrus showed significant positive correlation with the scores on the Hamilton Depression Rating Scale. Bipolar depressive patients received treatment of benzodiazepines, which may confound the findings. Our results illustrated that connectivity disturbances in the language regions may change depending on the disease phase of bipolar disorder. Copyright © 2016 Elsevier B.V. All rights reserved.

  10. Post-episode depression of GABAergic transmission in spinal neurons of the chick embryo.

    PubMed

    Chub, N; O'Donovan, M J

    2001-05-01

    during the episode at one of three different V(hold): -60 mV, below E(GABAa) resulting in Cl(-) efflux; -30 mV, close to E(GABAa) with minimal Cl(-) flux; and 0 mV, above E(GABAa) resulting in Cl(-) influx during the episode. The amplitude of the evoked I(GABA) changed according to the direction of Cl(-) flux during the episode: at -60 mV a 41% decrease, at -30 mV a 4% reduction, and at 0 mV a 19% increase. These post-episode changes were accompanied by shifts of E(GABAa) of -10, -1.2, and +7 mV, respectively. We conclude that redistribution of intracellular [Cl(-)] during spontaneous episodes is likely to be an important postsynaptic mechanism involved in the post-episode depression of GABAergic transmission in chick embryo spinal neurons.

  11. Selected Executive Skills in Adolescents with Recent First Episode Major Depression

    ERIC Educational Resources Information Center

    Kyte, Zoe A.; Goodyer, Ian M.; Sahakian, Barbara J.

    2005-01-01

    Background: To investigate whether recent first episode major depression in adolescence is characterised by selected executive difficulties in attentional flexibility, behavioural inhibition and decision-making. Methods: Selected executive functions were compared in adolescents with recent (past year) first episode major depression (n = 30) and…

  12. Selected Executive Skills in Adolescents with Recent First Episode Major Depression

    ERIC Educational Resources Information Center

    Kyte, Zoe A.; Goodyer, Ian M.; Sahakian, Barbara J.

    2005-01-01

    Background: To investigate whether recent first episode major depression in adolescence is characterised by selected executive difficulties in attentional flexibility, behavioural inhibition and decision-making. Methods: Selected executive functions were compared in adolescents with recent (past year) first episode major depression (n = 30) and…

  13. Treatment response for acute depression is not associated with number of previous episodes: lack of evidence for a clinical staging model for major depressive disorder.

    PubMed

    Dodd, Seetal; Berk, Michael; Kelin, Katarina; Mancini, Michele; Schacht, Alexander

    2013-09-05

    Mental illness has been observed to follow a neuroprogressive course, commencing with prodrome, then onset, recurrence and finally chronic illness. In bipolar disorder and schizophrenia responsiveness to treatment mirrors these stages of illness progression, with greater response to treatment in the earlier stages of illness and greater treatment resistance in chronic late stage illness. Using data from 5627 participants in 15 controlled trials of duloxetine, comparator arm (paroxetine, venlafaxine, escitalopram) or placebo for the treatment of an acute depressive episode, the relationship between treatment response and number of previous depressive episodes was determined. Data was dichotomised for comparisons between participants who had >3 previous episodes (n=1697) or ≤3 previous episodes (n=3930), and additionally for no previous episodes (n=1381) or at least one previous episode (n=4246). Analyses were conducted by study arm for each clinical trial, and results were then pooled. There was no significant difference between treatment response and number of previous depressive episodes. This unexpected finding suggests that treatments to reduce symptoms of depression during acute illness do not lose efficacy for patients with a longer history of illness.

  14. Aggression Protects Against the Onset of Major Depressive Episodes in Individuals With Bipolar Spectrum Disorder.

    PubMed

    Ng, Tommy H; Freed, Rachel D; Titone, Madison K; Stange, Jonathan P; Weiss, Rachel B; Abramson, Lyn Y; Alloy, Lauren B

    2017-05-01

    A growing body of research suggests that bipolar spectrum disorders (BSDs) are associated with high aggression. However, little research has prospectively examined how aggression may affect time to onset of hypomanic/manic versus major depressive episodes. In a longitudinal study, we tested the hypothesis that aggression would prospectively predict a shorter time to the onset of hypomanic/manic episodes and a longer time to the onset of major depressive episodes, based on the behavioral approach system theory of BSDs. Young adults (N = 120) diagnosed with cyclothymia, bipolar II disorder, or bipolar disorder not otherwise specified were followed every 4 months for an average of 3.55 years. Participants completed measures of depressive and manic symptoms, family history of mood disorder, impulsivity, and aggression at baseline and were followed prospectively with semistructured diagnostic interview assessments of hypomanic/manic and major depressive episodes and treatment seeking for mood problems. Cox proportional hazard regression analyses indicated that overall, physical, and verbal aggression predicted a longer time to major depressive episode onset, even after controlling for baseline depressive and manic symptoms, family history of mood disorder, treatment seeking for mood problems, and impulsivity. Aggression, however, did not significantly predict time to onset of hypomanic/manic episodes, controlling for the same covariates. The findings suggest that approach-related behaviors may be utilized to delay the onset of major depressive episodes among people with BSDs.

  15. Characterization of Treatment Resistant Depression Episodes in a Cohort of Patients from a US Commercial Claims Database

    PubMed Central

    Kubitz, Nicole; Mehra, Maneesha; Potluri, Ravi C.; Garg, Nitesh; Cossrow, Nicole

    2013-01-01

    Context Treatment Resistant Depression (TRD) is a significant and burdensome health concern. Objective To characterize, compare and understand the difference between TRD and non-TRD patients and episodes in respect of their episode duration, treatment patterns and healthcare resource utilization. Design and Setting Patients between 18 and 64 years with a new diagnosis of major depressive disorder (MDD) and without a previous or comorbid diagnosis of schizophrenia or bipolar disease were included from PharMetrics Integrated Database, a claims database of commercial insurers in the US. Episodes of these patients in which there were at least two distinct failed regimens involving antidepressants and antipsychotics were classified as TRD. Patients 82,742 MDD patients were included in the analysis; of these patients, 125,172 episodes were identified (47,654 of these were drug-treated episodes). Main Outcome Measures Comparison between TRD and non-TRD episodes in terms of their duration, number and duration of lines of treatment, comorbidities, and medical resource utilization. Results Of the treated episodes, 6.6% (N = 3,134) met the criteria for TRD. The median time to an episode becoming TRD was approximately one year. The mean duration of a TRD episode was 1,004 days (vs. 452 days for a non-TRD episode). More than 75% of TRD episodes had at least four lines of therapy; half of the treatment regimens included a combination of drugs. Average hospitalization costs were higher for TRD than non-TRD episodes: $6,464 vs. $1,734, as were all other health care utilization costs. Conclusions While this study was limited to relatively young and commercially covered patients, used a rigorous definition of TRD and did not analyze for cause or consequence, the results highlight high unmet medical need and burden of TRD on patients and health care resources. PMID:24204694

  16. Prevalence and type of functional somatic complaints in patients with first-episode depression.

    PubMed

    Grover, S; Kumar, V; Chakrabarti, S; Hollikatti, P; Singh, P; Tyagi, S; Kulhara, P; Avasthi, A

    2012-12-01

    OBJECTIVE. To study the prevalence and type of functional somatic complaints in patients with first-episode depression. METHODS. A total of 164 patients attending the outpatient department of a general hospital psychiatric unit were evaluated using the Patient Health Questionnaire-15 (PHQ-15) and Hamilton Depression Rating Scale (HDRS). RESULTS. More than half of the sample were male (n = 85; 52%) and most of the subjects were married (n = 128; 78%). The mean (standard deviation) HDRS score was 19.9 (5.4). All patients had at least 1 functional somatic complaint, and that the mean (range) number of functional somatic complaints per patient on the PHQ-15 was 8 (1-15). The most common functional somatic complaints included feeling tired or having little energy (93%); trouble sleeping (80%); nausea, gas and indigestion (68%); headache (68%); pain in arms, legs, or joints (66%); and feeling the heart racing (65%). Total PHQ-15 scores indicated the presence of moderate-to-severe severity of functional somatic complaints. Back pain, as well as pain in arms, legs, or joints, were found to be more common in females. The number and severity of functional somatic complaints did not differ significantly in relation to other socio-demographics (locality, marital status, age, education, income) and clinical variables (duration, physical co-morbidity, and atypical features). CONCLUSIONS. Functional somatic complaints are quite prevalent in subjects with first-episode depression. Hence, clinicians should routinely evaluate patients with depression for these symptoms.

  17. Disturbances in Hypothalamic-Pituitary-Adrenal Axis and Immunological Activity Differentiating between Unipolar and Bipolar Depressive Episodes

    PubMed Central

    Hoencamp, Erik; Penninx, Brenda W. J. H.

    2015-01-01

    Introduction Differentiating bipolar depression (BD) from unipolar depression (UD) is difficult in clinical practice and, consequently, accurate recognition of BD can take as long as nine years. Research has therefore focused on the discriminatory capacities of biomarkers, such as markers of the hypothalamic-pituitary-adrenal (HPA) axis or immunological activity. However, no previous study included assessments of both systems, which is problematic as they may influence each other. Therefore, this study aimed to explore whether cortisol indicators and inflammatory markers were a) independently associated with and/or b) showed effect modification in relation to a lifetime (hypo)manic episode in a large sample of depressed patients. Methods Data were derived from the Netherlands Study of Depression and Anxiety and comprised 764 patients with a DSM-IV depressive disorder at baseline, of which 124 (16.2%) had a lifetime (hypo)manic episode at the 2-year assessment, or a more recent episode at the 4-year or 6-year assessment. Baseline cortisol awakening response, evening cortisol and diurnal cortisol slope were considered as cortisol indicators, while baseline C-reactive Protein (CRP), Interleukin-6 (IL-6), and Tumor Necrosis Factor Alpha (TNF-α) were included as inflammatory markers. Results In depressed men and women, none of the cortisol indicators and inflammatory markers were (independently) associated with a (hypo)manic episode. However, effect modification was found of diurnal cortisol slope and CRP in relation to a (hypo)manic episode. Further analyses showed that depressed men with high levels of diurnal cortisol slope and CRP had an increased odds (OR=10.99, p=.001) of having a (hypo)manic episode. No significant differences were found in women. Conclusion Our findings suggest that the combination of high diurnal cortisol slope and high CRP may differentiate between UD and BD. This stresses the importance of considering HPA-axis and immunological activity

  18. Asthma and major depressive episode in adolescents in France.

    PubMed

    Delmas, Marie-Christine; Guignon, Nathalie; Chee, Christine Chan; Fuhrman, Claire; Herbet, Jean-Baptiste; Gonzalez, Lucie

    2011-08-01

    The association between asthma and anxiety disorders in teenagers is well documented, but data about the association with mood disorders are scarce. We analyzed data from a cross-sectional study conducted among ninth grade schoolchildren in France in 2003-2004. The teenagers were selected by two-stage sampling and interviewed by school doctors/nurses using a standardized questionnaire including questions about asthma and asthma-like symptoms. They also completed a self-administered questionnaire in which the occurrence of major depressive episodes (MDEs) during the past 12 months was assessed by the Composite International Diagnostic Interview-Short Form. A total of 7000 teenagers (mean age 15.1 years) were included. The prevalence of wheezing in the past 12 months was 10.0% and that of current asthma (wheezing in the past 12 months in children who had already had asthma attacks, or treatment for wheezing or asthma in the past 12 months) was 8.5%. The prevalence of MDE during the past year was 14.2% in teenagers with current asthma versus 9.2% among the others. The association between current asthma and past-year MDE remained significant after adjustment for age, gender, family structure, and the father's employment status. Asthma was uncontrolled (at least four attacks of wheezing, one awakening per week due to wheezing, one severe wheezing, four unplanned medical visits, or one hospitalization for a wheezing attack in the past year) in more than half (58.3%) of asthmatic teenagers with an MDE in the past year versus 35.3% of those without an MDE. Asthma is associated with a higher prevalence of MDE. Among adolescents with asthma, MDE is associated with poorer asthma control. These findings highlight the need for a comprehensive care management of asthma in France that takes the psychological dimension into account.

  19. Herbal medicine for hospitalized patients with severe depressive episode: a retrospective controlled study.

    PubMed

    Liu, Lan-Ying; Feng, Bin; Chen, Jiong; Tan, Qing-Rong; Chen, Zheng-Xin; Chen, Wen-Song; Wang, Pei-Rong; Zhang, Zhang-Jin

    2015-01-01

    Herbal medicine is increasingly used in depressed patients. The purpose of this retrospective controlled study was to evaluate the efficacy and safety of herbal medicine treatment of severe depressive episode. A total of 146 severely depressed subjects were selected from patients who were admitted to the Department of Psychosomatics of Tongde Hospital at Hangzhou, China between 1st September 2009 and 30th November 2013. While all were medicated with psychotropic drugs, 78 received additional individualized herbal medicine. The severity of depressive symptoms was measured using 24-item Hamilton Rating Scale for Depression (HAMD-24) at admission and thereafter once weekly during hospital stay. The proportion of patients achieving clinical response and remission and incidence of adverse events were compared. The two groups had similar average length of hospital stay for approximately 28 days and were not different in the use of psychotropic medications. Survival analysis revealed that patients with herbal medicine had significantly higher chance of achieving clinical response [relative risk (RR)=2.179, P<0.001] and remission (RR=5.866, P<0.001) compared to those without herbal medicine. Patients with herbal medicine experienced remarkably fewer incidences of physical tiredness, headache, palpitation, dry mouth and constipation, but had a significantly higher incidence of digestive discomfort compared to patients without herbal medicine. These results indicate that additional treatment with individualized herbal medicine enhances antidepressant response and reduces certain side effects associated with psychotropic medications. Herbal medicine is an effective and relatively safe therapy for severe depressive episode (Trial Registration: ChiCTR-OCH-13003864).

  20. The circadian system of patients with bipolar disorder differs in episodes of mania and depression.

    PubMed

    Nováková, Marta; Praško, Ján; Látalová, Klára; Sládek, Martin; Sumová, Alena

    2015-05-01

    Bipolar disorder is a common psychiatric disease characterized by mood disturbances with alternating episodes of mania and depression. Moreover, disturbances in the sleep/wake cycle are prevalent. We tested a hypothesis that the function of the circadian system, which drives the sleep/wake cycle, may differ in patients with bipolar disorder depending on whether they are experiencing an episode of mania or depression. To assess the functional state of the central circadian clock, daily profiles of melatonin levels in saliva were determined. The functional state of the peripheral clocks was assessed by determining daily profiles of Per1 and Nr1d1 clock gene expression in buccal mucosa cells. Sixteen patients with bipolar disorder in a manic episode, 22 patients in a depressive episode, and 19 healthy control subjects provided samples at regular intervals during a 24-hour cycle. During episodes of mania, the daily profiles of melatonin differed compared with healthy controls and patients in an episode of depression, mainly due to elevated melatonin levels during the daytime. No difference was found between melatonin profiles of control subjects and patients in depression. The Per1 and Nr1d1 profiles were advanced in patients in mania compared with those in depression. Compared with controls, a trend toward an advance was apparent in the profiles of patients during an episode of mania but not depression. The amplitude of the Nr1d1 expression profile was higher in mania than in depression. The data revealed differences in the functional state of the circadian system in patients with bipolar disorder depending on whether they were experiencing a manic or a depressive episode. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  1. Accuracy of three depression screening scales to diagnose major depressive episodes in older adults without neurocognitive disorders.

    PubMed

    Costa, Mônica V; Diniz, Maissa F; Nascimento, Kenia K; Pereira, Kelly S; Dias, Natalia S; Malloy-Diniz, Leandro F; Diniz, Breno S

    2016-01-01

    To determine the sensitivity and specificity of three depression screening scales to diagnose major depressive episodes in the elderly. Participants (n=129, 88% female) answered a semi-structured psychiatric interview (Mini International Neuropsychiatric Interview) to determine the diagnosis of major depressive disorder. After this, depressive symptoms in depressed and non-depressed subjects were assessed by independent administration of the 15-item Geriatric Depression Scale (GDS-15), Patient Health Questionnaire-9 (PHQ-9), and 17-item Hamilton Rating Scale for Depression (HDRS-17). Patients with major depression and controls did not differ in age and gender distribution. The sensitivity and specificity of all scales to identify a major depressive episode in older adults were ≥ 90%. There were no significant differences between the areas under the curve for PHQ-9 vs. HDRS-17 (z = 1.2, p = 0.2), PHQ-9 vs. GDS-15 (z = 0.26, p = 0.8), or HDRS-17 vs. GDS-15 (z = 1.2, p = 0.2). This study provides evidence supporting the use of PHQ-9 and GDS-15, both of which are simple to administer and easy to interpret, to diagnose major depressive episodes in older adults without neurocognitive disorders.

  2. Personality and social support as predictors of first and recurrent episodes of depression.

    PubMed

    Noteboom, Annemieke; Beekman, Aartjan T F; Vogelzangs, Nicole; Penninx, Brenda W J H

    2016-01-15

    Depression is a prevalent psychiatric disorder with high personal and public health consequences, partly due to a high risk of recurrence. This longitudinal study examines personality traits, structural and subjective social support dimensions as predictors of first and recurrent episodes of depression in initially non-depressed subjects. Data were obtained from the Netherlands Study of Depression and Anxiety (NESDA). 1085 respondents without a current depression or anxiety diagnosis were included. 437 respondents had a prior history of depression, 648 did not. Personality dimensions were measured with the NEO-FFI, network size, partner-status, negative and positive emotional support were measured with the Close Person Questionnaire. Logistic regression analyses (unadjusted and adjusted for clinical variables and sociodemographic variables) examined whether these psychosocial variables predict a new episode of depression at two year follow up and whether this differed among persons with or without a history of depression. In the unadjusted analyses high extraversion (OR:.93, 95% CI (.91-.96), P<.001), agreeableness (OR:.94, 95% CI (.90-.97), P<.001), conscientiousness (OR:.93, 95% CI (.90-.96), P<.001) and a larger network size (OR:.76, 95% CI (.64-.90), P=.001) significantly reduced the risk of a new episode of depression. Only neuroticism predicted a new episode of depression in both the unadjusted (OR:1.13, 95% CI (1.10-1.15), P<.001) and adjusted analyses (OR:1.06, 95% CI (1.03-1.10), P<.001). None of the predictors predicted first or recurrent episodes of depression differently. we used a relatively short follow up period and broad personality dimensions. Neuroticism seems to predict both first and recurrent episodes of depression and may be suitable for screening for preventive interventions. Copyright © 2015 Elsevier B.V. All rights reserved.

  3. Symptom characteristics of depressive episodes prior to the onset of mania or hypomania.

    PubMed

    Pfennig, A; Ritter, P S; Höfler, M; Lieb, R; Bauer, M; Wittchen, H-U; Beesdo-Baum, K

    2016-03-01

    Depressive episodes are typically the initial presentation of bipolar disorder. The evidence as to whether depressive episodes occurring in persons who later convert to bipolar disorder are symptomatically distinct from episodes of unipolar depression remains controversial. As there are crucial differences in the therapeutic management, symptom profiles indicating subsequent bipolar conversion may aid in appropriate treatment. A representative community sample of originally N = 3021 adolescents and young adults aged 14-24 years at baseline was assessed up to four times over 10 years. Assessment of symptoms was conducted by clinically trained interviewers using the standardized M-CIDI. Symptom profiles of depressive episodes were compared via logistic regression between subjects that subsequently developed (hypo-)manic episodes (n = 35) or remained unipolar depressive (n = 659). Initial depression amongst prospective converters was characterized by significantly increased suicidality (odds ratio, OR = 2.31), higher rates of feelings of worthlessness and excessive guilt (OR = 2.52), complete loss of pleasure (OR = 2.53) and diurnal variation (OR = 4.30). No differences were found for hyperphagia, hypersomnia and psychomotor alterations. Findings suggest that the symptom profile of initial depressive episodes may be useful in the identification of subjects with an elevated risk for the subsequent conversion to bipolar disorder. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  4. Cost effectiveness of quetiapine in patients with acute bipolar depression and in maintenance treatment after an acute depressive episode.

    PubMed

    Ekman, Mattias; Lindgren, Peter; Miltenburger, Carolin; Meier, Genevieve; Locklear, Julie C; Chatterton, Mary Lou

    2012-06-01

    Bipolar disorder has a significant impact upon a patient's quality of life, imposing a considerable economic burden on the individual, family members and society as a whole. Several medications are indicated for the acute treatment of mania and depression associated with bipolar disorder as well as for maintenance therapy; however, these have varying efficacy, tolerability and costs. The objective of this study was to develop a new discrete-event simulation model to analyse the long-term consequences of pharmacological therapy for the management of bipolar I and II disorders (acute treatment of episodes of mania and depression as well as maintenance therapy). Probabilities of remission and relapse were obtained from clinical trial data and meta-analyses. Costs (year 2011 values) were assessed from a UK healthcare payer's perspective, and included pharmacological therapy and resource use associated with the treatment of mood events and selected adverse events. The health effects were measured in terms of QALYs. For a patient starting with acute depression or in remission at 40 years of age (which was the average age in the clinical trials), quetiapine 300 mg/day was a cost-effective strategy compared with olanzapine 15 mg/day over a 5-year time frame. With acute bipolar depression as a starting episode, the 5-year medical costs were £323 higher and QALYs were 0.038 higher for quetiapine compared with olanzapine, corresponding to a cost-effectiveness ratio of £8600 per QALY gained. Compared with olanzapine, the results suggest that quetiapine is cost effective as a maintenance treatment for bipolar depression.

  5. Is the Ultimate Treatment Response Predictable with Early Response in Major Depressive Episode?

    PubMed Central

    ÇİFTÇİ, Aslı; ULAŞ, Halis; TOPUZOĞLU, Ahmet; TUNCA, Zeliha

    2016-01-01

    Introduction New evidence suggests that the efficacy of antidepressants occurs within the first weeks of treatment and this early response predicts the later response. The purpose of the present study was to investigate if the partial response in the first week predicts the response at the end of treatment in patients with major depressive disorder who are treated with either antidepressant medication or electroconvulsive therapy. Methods Inpatients from Dokuz Eylül University Hospital with a major depressive episode, treated with antidepressant medication (n=52) or electroconvulsive therapy (ECT) (n=48), were recruited for the study. The data were retrospectively collected to decide whether a 25% decrease in the Hamilton Depression Rating Scale (HDRS) score at the first week of treatment predicts a 50% decrease at the third week using validity analysis. In addition, the effects of socio-demographic and clinical variables on the treatment response were assessed. Results A 25% decrease in the HDRS score in the first week of treatment predicted a 50% decrease in the HDRS score in the third week with a 78.3% positive predictive value, 62.1% negative predictive value, 62.1% sensitivity, and 78.3% specificity for antidepressant medications and an 88% positive predictive value, 52.2% negative predictive value, 66.7% sensitivity, and 80% specificity for ECT. The number of previous hospitalizations, comorbid medical illnesses, number of depressive episodes, duration of illness, and duration of the current episode were related to the treatment response. Conclusion Treatment response in the first week predicted the response in the third week with a high specificity and a high positive predictive value. Close monitoring of the response from the first week of treatment may thus help the clinician to predict the subsequent response. PMID:28373802

  6. DEPRESSIVE EPISODE INCIDENCE IN PATIENTS WITH CHRONIC HEPATITIS C TREATED WITH PEGYLATED INTERFERON AND RIBAVIRIN.

    PubMed

    Vabo, Izabella Liguori Corsino; Ferreira, Lincoln Eduardo Villela Vieira de Castro; Pace, Fábio Heleno Lima

    2016-01-01

    The effectiveness of antiviral therapy with pegylated interferon and ribavirin for chronic hepatitis C is far from ideal and presents several adverse events. Among such events, there is the depressive episode that can even lead to treatment discontinuity. Analyze the incidence of depressive episodes in patients with chronic hepatitis C treated with pegylated interferon (IFN-PEG) and ribavirin, as well as the possible factors associated with its occurrence and its impact on patients' sustained virological response. People with chronic hepatitis C undergoing antiviral therapy were interviewed at the baseline, at the 4th, 12th, 24th and 48th treatment weeks and 4 weeks after the end of it, using the HADS scale for tracking the depressive episode. Patients with HADS ≥9 were subjected to Beck Depression Inventory (BDI-II) to grade the episode. Clinical, sociodemographic, laboratorial and histological variables were obtained to identify factors related to the onset of depression. The sustained virological response rate (negative HCV-RNA 6 months after end of therapy) was compared among patients with and without depressive symptoms. The study comprised 32 patients, most men (59%) with mean age of 54±11.13 years old. Genotype non-1 was prevalent (56%) and 81% of the patients were non-cirrhotic. The depressive episode was diagnosed in 25% of the patients and the peak incidence was found in the 12th treatment week. The depressive episode was moderate in 87% of the patients and only one patient abandoned the treatment. None of the analyzed factors was associated with depressive episode onset. A trend was observed in female patients ( P =0.08). The sustained virological response rate was of 75% and 67% in patients with and without depressive episode, respectively ( P =0.66). The incidence of depressive episodes in patients with chronic hepatitis C undergoing antiviral therapy was of 25% and the 12th treatment week was the most critical one. The presence of depressive

  7. Remission of Episodic Sweating Attacks and Comorbid Depression in Shapiro Syndrome: Case Report

    PubMed Central

    BOZKURT ZİNCİR, Selma; ZİNCİR, Serkan; KABAK, Sevgi Gül

    2014-01-01

    Shapiro syndrome, a rare disorder originally described by Shapiro and Plum in 1967, is characterized by episodic hypothermia and hyperhydrosis associated with agenesis of the corpus callosum. Proposed hypotheses to explain the clinical features of this syndrome include changes in the set point of the hypothalamic thermostat, increased norepinephrine (NE) release, and decreased plasma NE clearance. It was emphasized that the recognition of Shapiro syndrome in the evaluation of episodic hyperhydrosis is important. Here, we described a case with Shapiro syndrome who presented to our psychiatry clinic with recurrent episodic profuse sweating and depression. Sweating attacks and depression remitted after successful treatment with amitriptyline. PMID:28360663

  8. Maternal Depressive Symptoms as a Predictor of Alcohol Use Onset and Heavy Episodic Drinking in Youths

    ERIC Educational Resources Information Center

    Lamis, Dorian A.; Malone, Patrick S.; Lansford, Jennifer E.; Lochman, John E.

    2012-01-01

    Objective: The current study addressed a gap in the literature by investigating the association between maternal depressive symptoms and subsequent timing of their children's alcohol use onset and heavy episodic drinking (HED). Childhood depression/dysthymia symptoms, harsh discipline, and parental positive regard were examined as potential…

  9. Maternal Depressive Symptoms as a Predictor of Alcohol Use Onset and Heavy Episodic Drinking in Youths

    ERIC Educational Resources Information Center

    Lamis, Dorian A.; Malone, Patrick S.; Lansford, Jennifer E.; Lochman, John E.

    2012-01-01

    Objective: The current study addressed a gap in the literature by investigating the association between maternal depressive symptoms and subsequent timing of their children's alcohol use onset and heavy episodic drinking (HED). Childhood depression/dysthymia symptoms, harsh discipline, and parental positive regard were examined as potential…

  10. Altered neural function during episodic memory encoding and retrieval in major depression.

    PubMed

    Dietsche, Bruno; Backes, Heidelore; Stratmann, Mirjam; Konrad, Carsten; Kircher, Tilo; Krug, Axel

    2014-09-01

    Memory impairments are common in major depression. Neural processing during non-emotional episodic memory in depressed patients has only sparsely been investigated, since the majority of studies have focused on emotional stimuli. The aim of this study was to explore neural correlates of episodic memory in depressive patients and to assess brain regions related to subsequent memory performance. Forty-six participants (23 depressed patients) performed a non-emotional episodic memory encoding and retrieval task while brain activation was measured with functional magnetic resonance imaging. Patients with depression showed decreased activation in the right prefrontal cortex and right cingulate cortex during memory encoding, but increased activation in the right inferior frontal gyrus (IFG) during recognition memory. While a strong association between hippocampal and parahippocampal activation during memory encoding with subsequent memory performance became evident in healthy controls, this relationship was absent in patients with depression. Taken together, these findings demonstrate that memory related brain regions are affected in their appropriate functioning during memory encoding in depressed patients. Therefore, patients with depression may rely to a greater degree on other brain regions such as the IFG during episodic memory retrieval. Copyright © 2014 Wiley Periodicals, Inc.

  11. Clinical features distinguishing grief from depressive episodes: A qualitative analysis.

    PubMed

    Parker, Gordon; McCraw, Stacey; Paterson, Amelia

    2015-05-01

    The independence or interdependence of grief and major depression has been keenly argued in relation to recent DSM definitions and encouraged the current study. We report a phenomenological study seeking to identify the experiential and phenomenological differences between depression and grief as judged qualitatively by those who had experienced clinical (n=125) or non-clinical depressive states (n=28). Analyses involving the whole sample indicated that, in contrast to grief, depression involved feelings of hopelessness and helplessness, being endless and was associated with a lack of control, having an internal self-focus impacting on self-esteem, being more severe and stressful, being marked by physical symptoms and often lacking a justifiable cause. Grief was distinguished from depression by the individual viewing their experience as natural and to be expected, a consequence of a loss, and with an external focus (i.e. the loss of the other). Some identified differences may have reflected the impact of depressive "type" (e.g. melancholia) rather than depression per se, and argue for a two-tiered model differentiating normative depressive and grief states at their base level and then "clinical" depressive and 'pathological' grief states by their associated clinical features. Comparative analyses between the clinical and non-clinical groups were limited by the latter sub-set being few in number. The provision of definitions may have shaped subjects׳ nominated differentiating features. The study identified a distinct number of phenomenological and clinical differences between grief and depression and few shared features, but more importantly, argued for the development of a two-tiered model defining both base states and clinical expressions. Copyright © 2015 Elsevier B.V. All rights reserved.

  12. The Association between Anomalous Self-experiences, Self-esteem and Depressive Symptoms in First Episode Schizophrenia

    PubMed Central

    Haug, Elisabeth; Øie, Merete G.; Andreassen, Ole A.; Bratlien, Unni; Romm, Kristin L.; Møller, Paul; Melle, Ingrid

    2016-01-01

    Background: Anomalous self-experiences (ASEs) aggregate in schizophrenia spectrum disorders, but the relationship between ASEs, and depression has been studied to a limited extent. Lower self-esteem has been shown to be associated with depression in early psychosis. Our hypothesis is that ASEs in early phases of schizophrenia are linked to lower levels of self-esteem, which in turn is associated with depression. Aim: The aim is to examine the relationship between ASEs, self-esteem and depression in first-episode schizophrenia spectrum disorders. Method: ASEs were assessed in 55 patients with first-episode schizophrenia by means of the Examination of anomalous Self-Experience (EASE) instrument. Assessment of depression was based on the Calgary Depression Scale for Schizophrenia (CDSS). Self-esteem was measured using the Rosenberg Self-Esteem Scale (RSES). Symptom severity was assessed using the Structured Clinical Interview for the Positive and Negative Syndrome Scale (SCI-PANSS). Substance misuse was measured with the Drug Use Disorder Identification Test (DUDIT), and alcohol use was measured with the Alcohol Use Disorder Identification Test (AUDIT). Data on childhood adjustment were collected using the Premorbid Adjustment Scale (PAS). Data on childhood trauma were collected using the Norwegian version of the Childhood Trauma Questionnaire, short form (CTQ-SF). Results: Analyses detected a significant association between current depression and ASEs as measured by the EASE in women, but not in men. The effect of ASEs on depression appeared to be mediated by self-esteem. No other characteristics associated with depression influenced the relationship between depression, self-esteem and ASEs. Conclusion: Evaluating ASEs can assist clinicians in understanding patients' experience of self-esteem and depressive symptoms. The complex interaction between ASEs, self-esteem, depression and suicidality could be a clinical target for the prevention of suicidality in this

  13. The Association between Anomalous Self-experiences, Self-esteem and Depressive Symptoms in First Episode Schizophrenia.

    PubMed

    Haug, Elisabeth; Øie, Merete G; Andreassen, Ole A; Bratlien, Unni; Romm, Kristin L; Møller, Paul; Melle, Ingrid

    2016-01-01

    Background: Anomalous self-experiences (ASEs) aggregate in schizophrenia spectrum disorders, but the relationship between ASEs, and depression has been studied to a limited extent. Lower self-esteem has been shown to be associated with depression in early psychosis. Our hypothesis is that ASEs in early phases of schizophrenia are linked to lower levels of self-esteem, which in turn is associated with depression. Aim: The aim is to examine the relationship between ASEs, self-esteem and depression in first-episode schizophrenia spectrum disorders. Method: ASEs were assessed in 55 patients with first-episode schizophrenia by means of the Examination of anomalous Self-Experience (EASE) instrument. Assessment of depression was based on the Calgary Depression Scale for Schizophrenia (CDSS). Self-esteem was measured using the Rosenberg Self-Esteem Scale (RSES). Symptom severity was assessed using the Structured Clinical Interview for the Positive and Negative Syndrome Scale (SCI-PANSS). Substance misuse was measured with the Drug Use Disorder Identification Test (DUDIT), and alcohol use was measured with the Alcohol Use Disorder Identification Test (AUDIT). Data on childhood adjustment were collected using the Premorbid Adjustment Scale (PAS). Data on childhood trauma were collected using the Norwegian version of the Childhood Trauma Questionnaire, short form (CTQ-SF). Results: Analyses detected a significant association between current depression and ASEs as measured by the EASE in women, but not in men. The effect of ASEs on depression appeared to be mediated by self-esteem. No other characteristics associated with depression influenced the relationship between depression, self-esteem and ASEs. Conclusion: Evaluating ASEs can assist clinicians in understanding patients' experience of self-esteem and depressive symptoms. The complex interaction between ASEs, self-esteem, depression and suicidality could be a clinical target for the prevention of suicidality in this

  14. Incident Major Depressive Episodes increase the severity and risk of apathy in HIV infection

    PubMed Central

    Kamat, Rujvi; Cattie, Jordan E.; Marcotte, Thomas D.; Woods, Steven Paul; Franklin, Donald R.; Corkran, Stephanie H.; Ellis, Ronald J.; Grant, Igor; Heaton, Robert K.

    2015-01-01

    Apathy and depression are inter-related yet separable and prevalent neuropsychiatric disturbances in persons infected with HIV. In the present study of 225 HIV+ persons, we investigated the role of an incident depressive episode in changes in apathy. Participants completed the apathy subscale of the Frontal Systems Behavior Scale during a detailed neuropsychiatric and neuromedical evaluation at visit 1 and again at approximately a 14 month follow-up. The Composite International Diagnostic Interview was used to obtain diagnoses of a new major depressive disorder. At their follow-up visit, participants were classified into four groups depending on their visit 1 elevation in apathy and new major depressive episode (MDE) status. Apathetic participants at baseline with a new MDE (n=23) were at risk for continued, clinically elevated apathy at follow-up, although severity of symptoms did not increase. Of the 144 participants without clinically elevated apathy at visit 1, those who developed a new MDE (n=16) had greater apathy symptomatology at follow-up than those without MDE. These findings suggest that HIV+ individuals, who do not as yet present with elevated apathy, may be at greater risk of elevated psychiatric distress should they experience a new/recurrent depressive episode. Thus, in the context of previous findings, it appears that although apathy and depression are separable constructs, they interact such that a new depressive episode is a risk factor for incident apathy. PMID:25679203

  15. Incident major depressive episodes increase the severity and risk of apathy in HIV infection.

    PubMed

    Kamat, Rujvi; Cattie, Jordan E; Marcotte, Thomas D; Woods, Steven Paul; Franklin, Donald R; Corkran, Stephanie H; Ellis, Ronald J; Grant, Igor; Heaton, Robert K

    2015-04-01

    Apathy and depression are inter-related yet separable and prevalent neuropsychiatric disturbances in persons infected with HIV. In the present study of 225 HIV+ persons, we investigated the role of an incident depressive episode in changes in apathy. Participants completed the apathy subscale of the Frontal Systems Behavior Scale during a detailed neuropsychiatric and neuromedical evaluation at visit 1 and again at approximately a 14 month follow-up. The Composite International Diagnostic Interview was used to obtain diagnoses of a new major depressive disorder. At their follow-up visit, participants were classified into four groups depending on their visit 1 elevation in apathy and new major depressive episode (MDE) status. Apathetic participants at baseline with a new MDE (n=23) were at risk for continued, clinically elevated apathy at follow-up, although severity of symptoms did not increase. Of the 144 participants without clinically elevated apathy at visit 1, those who developed a new MDE (n=16) had greater apathy symptomatology at follow-up than those without MDE. These findings suggest that HIV+ individuals, who do not as yet present with elevated apathy, may be at greater risk of elevated psychiatric distress should they experience a new/recurrent depressive episode. Thus, in the context of previous findings, it appears that although apathy and depression are separable constructs, they interact such that a new depressive episode is a risk factor for incident apathy.

  16. Abnormal Default-Mode Network Homogeneity in First-Episode, Drug-Naive Major Depressive Disorder

    PubMed Central

    Guo, Wenbin; Liu, Feng; Zhang, Jian; Zhang, Zhikun; Yu, Liuyu; Liu, Jianrong; Chen, Huafu; Xiao, Changqing

    2014-01-01

    Background Default mode network (DMN) is one of the most commonly recognized resting-state networks in major depressive disorder (MDD). However, the homogeneity of this network in MDD is poorly understood. As such, this study was conducted to determine whether or not an abnormal network homogeneity (NH) of DMN is observed in patients with first-episode and drug-naive MDD. Methods Twenty-four first-episode drug-naive patients with MDD and twenty-four healthy control subjects participated in the study. NH and independent component analysis (ICA) methods were used to analyze data. Results Depressed patients exhibited a significantly increased NH in the left dorsal medial prefrontal cortex (MPFC) and decreased NH in the right inferior temporal gyrus (ITG) compared with the healthy control subjects. Receiver operating characteristic curves (ROC) were analyzed and results revealed that the NH values of MPFC and ITG could be applied as candidate markers with relatively high sensitivity and specificity to distinguish patients from healthy control subjects. No correlation was observed between the NH values of the two regions and clinical variables. Conclusions Our findings suggested that an abnormal DMN homogeneity could be observed in MDD, which highlight the importance of the DMN in the pathophysiology of MDD. PMID:24609111

  17. Persistent Depression as a Novel Diagnostic Category: Results from the Menderes Depression Study

    PubMed Central

    ILDIRLI, Saliha; ŞAİR, Yaşan Bilge; DEREBOY, Ferhan

    2015-01-01

    Introduction Persistent depressive disorder (PDD) introduced in the Diagnostic and Statistical Manual of Mental Disorders (DSM) 5 as a novel diagnostic category represents a consolidation of two separate DSM-IV categories, chronic major depressive disorder (MDD) and dysthymic disorder. The present study aims to investigate the frequency and clinical as well as socio-demographic correlates of PDD in comparison with those of episodic MDD among patients seeking treatment for depressive symptoms. Methods Participants were 140 depressive out-and in-patients under treatment at the psychiatry clinic of the Adnan Menderes University Research Hospital. Each patient was assessed by means of a structured clinical interview (SCID-I) and relevant psychometric instruments including the Hamilton Depression Inventory and Eskin Suicidal Behavior Inventory. Results Among the depressive patients, 61% fulfilled the criteria for PDD and 39% for episodic MDD. As compared with patients with episodic MDD, the PDD patients were older (d=.54), lower in educational attainment (d=.55), more likely to have comorbid generalized anxiety disorder (OR=3.7), and more prone to report symptoms of anxiety, hopelessness, pessimism, and somatic complaints. Nevertheless, the PDD patients displayed heterogeneous characteristics with respect to clinical severity and suicidal behavior. Conclusion Our findings suggest that majority of depressive patients, including those fulfilling the criteria for MDD, have been suffering from a persistent ailment rather than an episodic disorder. Clinicians with a cross-sectional perspective are more likely to diagnose MDD, whereas those with a longitudinal perspective are more likely to identify PDD in the majority of depressive patients. The incorporation of both of these perspectives into DSM-5 in a complementary manner will possibly enhance our insight into depressive disorders and improve our treatment results. PMID:28360740

  18. Anxiety, depression and school absenteeism in youth with chronic or episodic headache

    PubMed Central

    Rousseau-Salvador, Céline; Amouroux, Rémy; Annequin, Daniel; Salvador, Alexandre; Tourniaire, Barbara; Rusinek, Stéphane

    2014-01-01

    BACKGROUND: Chronic daily headache (CDH) in children has been documented in general and clinical populations. Comorbid psychological conditions, risk factors and functional outcomes of CDH in children are not well understood. OBJECTIVES: To examine anxiety and depression, associated risk factors and school outcomes in a clinical population of youth with CDH compared with youth with episodic headache (EH). METHODS: Data regarding headache characteristics, anxiety, depression and missed school days were collected from 368 consecutive patients eight to 17 years of age, who presented with primary headache at a specialized pediatric headache centre. RESULTS: A total of 297 patients (81%) were diagnosed with EH and 71 were diagnosed with CDH. Among those with CDH, 78.9% presented with chronic tension-type headache and 21.1% with chronic migraine (CM). Children with CDH had a higher depression score than the standardized reference population. No difference was observed for anxiety or depression scores between children with CDH and those with EH. However, children with CM were more anxious and more depressed than those with chronic tension-type headache. Youth experiencing migraine with aura were three times as likely to have clinically significant anxiety scores. Headache frequency and history were not associated with psychopathological symptoms. Children with CDH missed school more often and for longer periods of time. CONCLUSIONS: These findings document the prevalence of anxiety, depression and school absenteeism in youth with CDH or EH. The present research also extends recent studies examining the impact of aura on psychiatric comorbidity and the debate on CM criteria. PMID:24911174

  19. Increased activities of both superoxide dismutase and catalase were indicators of acute depressive episodes in patients with major depressive disorder.

    PubMed

    Tsai, Meng-Chang; Huang, Tiao-Lai

    2016-01-30

    Oxidative stress may play an important role in the pathophysiology of major depressive disorder (MDD). The aim of this study was to investigate the serum levels of oxidative stress biomarkers and S100B in patients with MDD in an acute phase, and evaluate the changes in superoxide dismutase (SOD), protein carbonyl content (PCC), glutathione peroxidase (GPX), 8-hydroxy 2'-deoxyguanosine after treatment (8-OHdG), catalase (CAT), thiobarbituric acid reactive substances (TBARS) and S100B. We consecutively enrolled 21 MDD inpatients in an acute phase and 40 healthy subjects. Serum oxidative stress markers were measured with assay kits. Serum SOD and CAT activities in MDD patients in an acute phase were significantly higher than those of healthy subjects, and serum PCC levels were significantly lower. The HAM-D scores had a significantly positive association with S100B levels. Eighteen depressed patients were followed up, and there was no significant difference among all of the markers after treatment. In conclusion, our results suggest that increased activities of both SOD and CAT might be indicators of acute depressive episodes in MDD patients.

  20. Vitamin D Deficiency and Depressive Symptomatology in Psychiatric Patients Hospitalized with a Current Depressive Episode: A Factor Analytic Study.

    PubMed

    von Känel, Roland; Fardad, Nasser; Steurer, Nadine; Horak, Nicole; Hindermann, Esther; Fischer, Franz; Gessler, Katharina

    2015-01-01

    Low vitamin D levels have been associated with depressive symptoms in population-based studies and non-clinical samples as well as with clinical depression. This study aimed to examine the association of vitamin D levels with the severity and dimensions of depressive symptoms in hospitalized patients with a current episode of depression taking into account confounding variables. We investigated 380 patients (mean age 47 ± 12 years, 70% women) who were consecutively hospitalized with a main diagnosis of an ICD-10 depressive episode. All patients self-rated depressive symptom severity with the Hospital Anxiety and Depression Scale (HADS-D), the Beck Depression Inventory-II (BDI-II), and the Brief Symptom Inventory. A principal component analysis was performed with all 34 items of these questionnaires and serum levels of 25-hydroxyvitamin D3 (25-OH D) were measured. Vitamin D deficiency (< 50 nmol/l), insufficiency (50-75 nmol/l), and sufficiency (> 75 nmol/l) were present in 55.5%, 31.8% and 12.6%, respectively, of patients. Patients with vitamin D deficiency scored higher on the HADS-D scale and on an anhedonia symptom factor than those with insufficient (p-values ≤ 0.023) or sufficient (p-values ≤ 0.008) vitamin D. Vitamin D deficient patients also scored higher on the BDI-II scale than those with sufficient vitamin D (p = 0.007); BDI-II cognitive/affective symptoms, but not somatic/affective symptoms, were higher in patients with vitamin D deficiency (p = 0.005) and insufficiency (p = 0.041) relative to those with sufficient vitamin D. Effect sizes suggested clinically relevant findings. Low vitamin D levels are frequent in hospitalized patients with a current episode of depression. Especially 25-OH D levels < 50 nmol/l were associated with cognitive/affective depressive symptoms, and anhedonia symptoms in particular.

  1. Two Prospective Studies of Changes in Stress Generation across Depressive Episodes in Adolescents and Emerging Adults

    PubMed Central

    Morris, Matthew C.; Kouros, Chrystyna D.; Hellman, Natalie; Rao, Uma; Garber, Judy

    2014-01-01

    The stress generation hypothesis was tested in two different longitudinal studies examining relations between weekly depression symptom ratings and stress levels in adolescents and emerging adults at varied risk for depression. Participants in Study 1 included 240 adolescents who differed with regard to their mother’s history of depressive disorders. Youth were assessed annually across 6 years (Grades 6 through 12). Consistent with the depression autonomy model, higher numbers of prior major depressive episodes (MDEs) were associated with weaker stress generation effects, such that higher levels of depressive symptoms predicted increases in levels of dependent stressors for adolescents with ≤ 2 prior MDEs, but depressive symptoms were not significantly related to dependent stress levels for youth with ≥ 3 prior MDEs. In Study 2, participants were 32 remitted-depressed and 36 never-depressed young adults who completed a psychosocial stress task to determine cortisol reactivity and were re-assessed for depression and stress approximately eight months later. Stress generation effects were moderated by cortisol responses to a laboratory psychosocial stressor, such that individuals with higher cortisol responses exhibited a pattern consistent with the depression autonomy model, whereas individuals with lower cortisol responses showed a pattern more consistent with the depression sensitization model. Finally, comparing across the two samples, stress generation effects were weaker for older participants and for those with more prior MDEs. The complex, multi-factorial relation between stress and depression is discussed. PMID:25422968

  2. Predictors of neurocognitive impairment at 2years after a first-episode major depressive disorder.

    PubMed

    Gu, Chuan-Zheng; He, Hui-Li; Duan, Hui-Feng; Su, Zhong-Hua; Chen, Hong; Gan, Jing-Li

    2016-07-01

    Neurocognitive impairment is a contributor to major depressive disorder (MDD). However, MDD patients show great variability in the level and course of deficits. The present longitudinal study was to identify predictors of neurocognitive impairment in first-episode MDD patients. Neurocognitive performance was analyzed in a cohort of 100 patients at 2years after a first-episode MDD. Subgroups, deficit type vs. non-deficit type, were compared on baseline clinical, neuropsychological, premorbid and sociodemographic characteristics. The analysis was performed using the multivariate logistic regression to obtain a model for neurocognitive impairment determination. The predicted probabilities of multivariate logistic regression were analyzed using receiver operating characteristic (ROC) curve. Fifty-two percent of MDD participants presented general neurocognitive impairment. The regression analyses demonstrated that clinical and sociodemographic characteristics were not predictive variables. A model composed of processing speed, executive function, and attention, dexterity correctly classified 85.8% of the MDD patients with deficit type. ROC curve indicated that the changes of these three cognitions could identify MDD with deficit type from MDD with non-deficit type. In addition, ROC curve also indicated that processing speed and executive function could identify MDD from CN subjects. Finally, processing speed performance was negatively correlated with Hamilton Depression Scale scores in both MDD with deficit and non-deficit type. The present study provides novel insights on frequency and neurocognitive profile of subtypes of patients showing impairment. Our results suggest that processing speed impairment is a trait dimension of the disorder related to specific cognitive dysfunctions and the severity of depression. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Inter-episode affective intensity and instability: predictors of depression and functional impairment in bipolar disorder.

    PubMed

    Gershon, Anda; Eidelman, Polina

    2015-03-01

    Dysregulated affect is a hallmark feature of acute episodes of bipolar disorder (BD) and persists during inter-episode periods. Its contribution to course of illness is not yet known. The present report examines the prospective influence of inter-episode affect dysregulation on symptoms and functional impairment in BD. Twenty-seven participants diagnosed with inter-episode bipolar I disorder completed daily measures of negative and positive affect for 49 days (±8 days) while they remained inter-episode. One month following this daily assessment period, symptom severity interviews and a measure of functional impairment were administered by telephone. More intense negative affect and positive affect during the inter-episode period were associated with higher depressive, but not manic, symptoms at the one-month follow-up assessment. More intense and unstable negative affect, and more unstable positive affect, during the inter-episode period were associated with greater impairment in home and work functioning at the follow-up assessment. All associations remained significant after controlling for concurrent symptom levels. The findings need to be confirmed in larger samples with longer follow-up periods. A more comprehensive assessment of functional impairment is also warranted. The findings suggest that a persistent affective dysregulation between episodes of BD may be an important predictor of depression and functional impairment. Monitoring daily affect during inter-episode periods could allow for a more timely application of interventions that aim to prevent or reduce depressive symptoms and improve functioning for individuals with BD. Copyright © 2014 Elsevier Ltd. All rights reserved.

  4. Decreased serum zinc concentration during depressive episode in patients with bipolar disorder.

    PubMed

    Siwek, Marcin; Sowa-Kućma, Magdalena; Styczeń, Krzysztof; Szewczyk, Bernadeta; Reczyński, Witold; Misztak, Paulina; Topór-Mądry, Roman; Nowak, Gabriel; Dudek, Dominika; Rybakowski, Janusz K

    2016-01-15

    Zinc may be involved in the pathophysiology and treatment of depressive disorder. However, data on this issue in bipolar disorder (BD) are limited. The aim of the study was to assess zinc concentrations in the blood serum of patients at various phases and stages of bipolar disorder. The study included 129 patients with a diagnosis of bipolar disorder type I (n=69) or type II (n=60). Fifty-eight were in a depressive episode, 23 in a manic episode and 48 in remission. Fifty healthy volunteers made a control group. Zinc concentration was measured using flame atomic absorption spectrometry. Serum zinc level in patients diagnosed with BD type I in the depressive phase was significantly reduced as compared with mania, remission and healthy subjects. In the BD type II, serum zinc level in hypomania, depression or remission phase was not significantly different from the control group. In the whole group, lower level of zinc in depression compared to remission and control subjects was found during late stage of the illness but not in the early stage. Zinc concentration was not dependent on the severity of manic or depressive symptoms and subtype of depression but correlated positively with the number of manic/hypomanic relapses in the past year. Lack of prospective model, heterogeneity of pharmacological treatment, small number of subgroups presenting specified clinical features. Decreased serum zinc concentration occurs in depression in BD type I and probably in depression in the late stage of BD. Copyright © 2015 Elsevier B.V. All rights reserved.

  5. Phosphorylation of leukocyte glucocorticoid receptor in patients with current episode of major depressive disorder.

    PubMed

    Simic, Iva; Maric, Nadja P; Mitic, Milos; Soldatovic, Ivan; Pavlovic, Zorana; Mihaljevic, Marina; Andric, Sanja; Radojcic, Marija B; Adzic, Miroslav

    2013-01-10

    The impaired glucocorticoid receptor (GR) signaling has long been considered one of the cornerstones in understanding the pathophysiology of depression. Since the phosphorylation of GR is very important for GR function, in this study we investigated whether GR phosphorylation at serine 211 (pGR-S211) and serine 226 (pGR-S226) is altered in patients with current episode of major depressive disorder (MDD). Particularly, in 30 MDD patients and 35 controls we assessed the levels of nuclear total GR (tGR), pGR-S211 and pGR-S226 in peripheral blood mononuclear cells (PBMC) using Western blot technique, along with plasma cortisol concentrations from the same blood samples. Our results demonstrated increased phosphorylation of GR at S226 (p<0.001) and, to a less extent, at S211 (p<0.05) in MDD patients compared to controls. Consequently, the pGR-S211/pGR-S226 ratio was decreased (p<0.05) implying reduced transcriptional activity of GR in MDD patients. MDD subjects had higher cortisol levels than controls and cortisol concentrations were positively correlated with PBMC pGR-S226 levels from the same blood samples. There was no difference in the levels of tGR between MDD and control subjects. The study showed that altered phosphorylation of GR could contribute to impaired GR function related to the pathophysiology of depression. Copyright © 2012 Elsevier Inc. All rights reserved.

  6. Anxiety disorders, subsyndromic depressive episodes, and major depressive episodes: do they differ on their impact on the quality of life of patients with epilepsy?

    PubMed

    Kanner, Andres M; Barry, John J; Gilliam, Frank; Hermann, Bruce; Meador, Kimford J

    2010-07-01

    To compare the impact of anxiety disorders, major depressive episodes (MDEs), and subsyndromic depressive episodes (SSDEs) on the quality of life of patients with epilepsy (PWEs), and to identify the variables predictive of poor quality of life. A psychiatric diagnosis according to DSM-IV-TR criteria was established in 188 consecutive PWEs with the MINI International Neuropsychiatric Interview. Patients also completed the Beck Depression Inventory-II (BDI-II), the Centers for Epidemiologic Studies-Depression (CES-D), and the Quality of Life in Epilepsy-89 (QOLIE-89). A diagnosis of SSDE was made in any patient with total scores of the BDI-II >12 or CES-D >16 in the absence of any DSM-IV diagnosis of mood disorder according to the MINI. Patients with SSDEs (n = 26) had a worse quality of life than asymptomatic patients (n = 103). This finding was also observed among patients with MDEs only (n = 10), anxiety disorders only (n = 21), or mixed MDEs/anxiety disorders (n = 28). Furthermore, having mixed SSDEs/anxiety disorders yielded a worse quality of life than having only SSDEs. Independent predictors of poor quality of life included having a psychiatric disorder and persistent epileptic seizures in the last 6 months. Although isolated mood and anxiety disorders, including SSDE, have a comparable negative impact on the quality of life of PWEs; the comorbid occurrence of mood and anxiety disorders yields a worse impact. In addition, seizure freedom in the previous 6 months predicts a better quality of life.

  7. Church Attendance and New Episodes of Major Depression in a Community Study of Older Adults: The Cache County Study

    PubMed Central

    Norton, Maria C.; Singh, Archana; Skoog, Ingmar; Corcoran, Christopher; Tschanz, JoAnn T.; Zandi, Peter P.; Breitner, John C. S.; Welsh-Bohmer, Kathleen A.; Steffens, David C.

    2009-01-01

    We examined the relation between church attendance, membership in the Church of Jesus Christ of Latter-Day Saints (LDS), and major depressive episode, in a population-based study of aging and dementia in Cache County, Utah. Participants included 2,989 nondemented individuals aged between 65 and 100 years who were interviewed initially in 1995 to 1996 and again in 1998 to 1999. LDS church members reported twice the rate of major depression that non-LDS members did (odds ratio = 2.56, 95% confidence interval = 1.07-6.08). Individuals attending church weekly or more often had a significantly lower risk for major depression. After controlling for demographic and health variables and the strongest predictor of future episodes of depression, a prior depression history, we found that church attendance more often than weekly remained a significant protectant (odds ratio = 0.51, 95% confidence interval = 0.28-0.92). Results suggest that there may be a threshold of church attendance that is necessary for a person to garner long-term protection from depression. We discuss sociological factors relevant to LDS culture. PMID:18559677

  8. Church attendance and new episodes of major depression in a community study of older adults: the Cache County Study.

    PubMed

    Norton, Maria C; Singh, Archana; Skoog, Ingmar; Corcoran, Christopher; Tschanz, Joann T; Zandi, Peter P; Breitner, John C S; Welsh-Bohmer, Kathleen A; Steffens, David C

    2008-05-01

    We examined the relation between church attendance, membership in the Church of Jesus Christ of Latter-Day Saints (LDS), and major depressive episode, in a population-based study of aging and dementia in Cache County, Utah. Participants included 2,989 nondemented individuals aged between 65 and 100 years who were interviewed initially in 1995 to 1996 and again in 1998 to 1999. LDS church members reported twice the rate of major depression that non-LDS members did (odds ratio = 2.56, 95% confidence interval = 1.07-6.08). Individuals attending church weekly or more often had a significantly lower risk for major depression. After controlling for demographic and health variables and the strongest predictor of future episodes of depression, a prior depression history, we found that church attendance more often than weekly remained a significant protectant (odds ratio = 0.51, 95% confidence interval = 0.28-0.92). Results suggest that there may be a threshold of church attendance that is necessary for a person to garner long-term protection from depression. We discuss sociological factors relevant to LDS culture.

  9. The Neighbourhood Built Environment and Trajectories of Depression Symptom Episodes in Adults: A Latent Class Growth Analysis.

    PubMed

    Gariepy, Genevieve; Thombs, Brett D; Kestens, Yan; Kaufman, Jay S; Blair, Alexandra; Schmitz, Norbert

    2015-01-01

    To investigate the effect of the neighbourhood built environment on trajectories of depression symptom episodes in adults from the general Canadian population. We used 10 years of data collection (2000/01-2010/11) from the Canadian National Population Health Study (n = 7114). Episodes of depression symptoms were identified using the Composite International Diagnostic Interview Short-Form. We assessed the presence of local parks, healthy food stores, fast food restaurants, health services and cultural services using geospatial data. We used latent class growth modelling to identify different trajectories of depression symptom episodes in the sample and tested for the effect of neighbourhood variables on the trajectories over time. We uncovered three distinct trajectories of depression symptom episodes: low prevalence (76.2% of the sample), moderate prevalence (19.2%) and high prevalence of depression symptom episodes (2.8%). The presence of any neighbourhood service (healthy food store, fast-food restaurant, health service, except for cultural service) was significantly associated with a lower probability of a depression symptom episode for those following a trajectory of low prevalence of depression symptom episodes. The presence of a local park was also a significant protective factor in trajectory groups with both low and moderate prevalence of depression symptom episodes. Neighbourhood characteristics did not significantly affect the trajectory of high prevalence of depression symptom episodes. For individuals following a trajectory of low and moderate prevalence of depression symptom episodes, the neighbourhood built environment was associated with a shift in the trajectory of depression symptom episodes. Future intervention studies are recommended to make policy recommendations.

  10. Explanatory models in patients with first episode depression: a study from north India.

    PubMed

    Grover, Sandeep; Kumar, Vineet; Chakrabarti, Subho; Hollikatti, Prabhakar; Singh, Pritpal; Tyagi, Shikha; Kulhara, Parmanand; Avasthi, Ajit

    2012-09-01

    The purpose of this work was to study the explanatory models of patients with first episode depression presenting to a tertiary care hospital located in North-western India. One hundred sixty four consecutive patients with diagnosis of first episode depression (except severe depression with psychotic symptoms) according to the International Classification of Diseases-10th Revision (ICD-10) and ≥18 years of age were evaluated for their explanatory models using the causal models section of Explanatory Model Interview Catalogue (EMIC). The most common explanations given were categorized into Karma-deed-heredity category (77.4%), followed by psychological explanations (62.2%), weakness (50%) and social causes (40.2%). Among the various specific causes the commonly reported explanations by at least one-fourth of the sample in decreasing order were: will of god (51.2%), fate/chance (40.9%), weakness of nerves (37.8%), general weakness (34.7%), bad deeds (26.2%), evil eye (24.4%) and family problems (21.9%). There was some influence of sociodemographic features on the explanations given by the patients. From the study, it can be concluded that patients with first episode depression have multiple explanatory models for their symptoms of depression which are slightly different than those reported in previous studies done from other parts of India. Understanding the multiple explanatory models for their symptoms of depression can have important treatment implications. Copyright © 2012 Elsevier B.V. All rights reserved.

  11. Volumetric MRI study of the habenula in first episode, recurrent and chronic major depression.

    PubMed

    Carceller-Sindreu, M; de Diego-Adeliño, J; Serra-Blasco, M; Vives-Gilabert, Y; Martín-Blanco, A; Puigdemont, D; Álvarez, E; Pérez, V; Portella, M J

    2015-11-01

    The habenula (Hb) can play an important role in major depressive disorder (MDD) as it is a key node between fronto-limbic areas and midbrain monoaminergic structures. In vivo neuroimaging studies have shown reductions in Hb volume in a post-mortem sample of patients with affective disorders but findings in unipolar MDD are not consistent. The current study aimed to investigate whether the Hb volume differed between patients with different stages of unipolar MDD and healthy subjects. We also explored differences in grey (GM) and white matter (WM) volumes and potential age and gender effects. High-resolution images were acquired using a 3T-scanner from 95 participants (21 with first-episode MDD; 20 with remitted-recurrent MDD; 20 with treatment-resistant/chronic MDD; and 34 healthy controls).Two researchers blinded to clinical data manually delineated habenular nuclei, with excellent inter-rater agreement. Multivariate analysis of covariance revealed a significant group-by-gender interaction (F9,258=2.22; p=0.02). Univariate effects emerged for Hb-WM volumes (F3,86=3.12; p=0.03) but not for total Hb volumes (F3,86=0.59; p=0.62) or Hb-GM volumes (F3,86=2.01; p=0.12). Women with a first-episode MDD had greater Hb-WM volumes than healthy controls and patients with treatment-resistant/chronic MDD (p<0.01). These findings remained unaltered when controlled for total intracranial volume or medication load. Our results do not support decreased total Hb volumes in unipolar MDD, in patients with first-episode or in patients with long-lasting recurrent or chronic depression. However, the increased Hb-WM volume we observed in women with a first-episode suggests involvement of Hb and its projections in early stages of the recovery process and in the course of MDD. Copyright © 2015 Elsevier B.V. and ECNP. All rights reserved.

  12. The Early Course of Depression: A Longitudinal Investigation of Prodromal Symptoms and Their Relation to the Symptomatic Course of Depressive Episodes

    PubMed Central

    Iacoviello, Brian M.; Alloy, Lauren B.; Abramson, Lyn Y.; Choi, Jimmy Y.

    2010-01-01

    The current study explored longitudinal evidence for prodromal symptoms of depression episodes. A model based on previous findings of the relations between prodromal and residual symptoms was described and used to generate hypotheses tested in this study. Data were analyzed from 160 participants from the Cognitive Vulnerability to Depression (CVD) Project (Alloy & Abramson, 1999) who experienced an episode of depression during the prospective follow-up period and 60 CVD participants who did not. Congruent with the hypothesis, individuals who subsequently developed an episode of depression experienced significantly greater numbers of depression symptoms in the period of time leading up to the acute episode compared with those who did not develop a depressive episode. Seven depression symptoms were particularly likely to appear before the onset of an acute episode. Further, all three predictions from the model were supported: the durations of prodromal and residual phases were correlated, the prodromal and residual symptom profiles were quite similar, and the order of symptom onset was significantly and highly negatively correlated with the order of symptom remission. Additionally, residual symptom profiles were similar to subsequent prodromal symptom profiles in individuals who experienced more than one depressive episode. These findings are discussed in terms of the importance of understanding the earliest prodromal symptoms to appear and their relation to the symptomatic course of depression episodes. Implications for early intervention are also discussed. PMID:20677835

  13. Predictors of first lifetime episodes of major depression in midlife women.

    PubMed

    Bromberger, J T; Kravitz, H M; Matthews, K; Youk, A; Brown, C; Feng, W

    2009-01-01

    Little is known about factors that predict first lifetime episodes of major depression in middle-aged women. It is not known whether health-related factors and life stress pose more or less of a risk to the onset of clinical depression than does the menopausal transition. The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) was used to assess diagnoses of lifetime, annual and current major depression in a community-based sample of premenopausal or early perimenopausal African American and White women. Menstrual cycle characteristics, psychosocial and health-related factors, and blood samples for assay of reproductive hormones were obtained annually. Two hundred and sixty-six women without a history of major depression at baseline constituted the cohort for the current analyses. Over 7 years of follow-up, 42 (15.8%) women met criteria for a diagnosis of major depression. Frequent vasomotor symptoms (VMS; hot flashes and/or night sweats) (HR 2.14, p=0.03) were a significant predictor of major depression in univariate analyses. After simultaneous adjustment for multiple predictors in Cox proportional hazards analyses, frequent VMS were no longer significant; lifetime history of an anxiety disorder (HR 2.20, p=0.02) and role limitations due to physical health (HR 1.88, p=0.07) at baseline and a very stressful life event (HR 2.25, p=0.04) prior to depression onset predicted a first episode of major depression. Both earlier (e.g. history of anxiety disorders) and more proximal factors (e.g. life stress) may be more important than VMS in contributing to a first episode of major depression during midlife.

  14. Manic symptoms during depressive episodes in 1,380 patients with bipolar disorder: findings from the STEP-BD.

    PubMed

    Goldberg, Joseph F; Perlis, Roy H; Bowden, Charles L; Thase, Michael E; Miklowitz, David J; Marangell, Lauren B; Calabrese, Joseph R; Nierenberg, Andrew A; Sachs, Gary S

    2009-02-01

    Little is known about how often bipolar depressive episodes are accompanied by subsyndromal manic symptoms in bipolar I and II disorders. The authors sought to determine the frequency and clinical correlates of manic symptoms during episodes of bipolar depression. From among 4,107 enrollees in the National Institute of Mental Health's Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), 1,380 individuals met criteria for bipolar I or II depressive syndromes at the time of enrollment and were assessed for concomitant manic symptoms. Illness characteristics were compared in patients with pure bipolar depressed episodes and those with mixed depressive presentations. Two-thirds of the subjects with bipolar depressed episodes had concomitant manic symptoms, most often distractibility, flight of ideas or racing thoughts, and psychomotor agitation. Patients with any mixed features were significantly more likely than those with pure bipolar depressed episodes to have early age at illness onset, rapid cycling in the past year, bipolar I subtype, history of suicide attempts, and more days in the preceding year with irritability or mood elevation. Manic symptoms often accompany bipolar depressive episodes but may easily be overlooked when they appear less prominent than depressive features. Subsyndromal manic symptoms during bipolar I or II depression demarcate a more common, severe, and psychopathologically complex clinical state than pure bipolar depression and merit recognition as a distinct nosologic entity.

  15. Atypical major depressive episode as initial presentation of intracranial germinoma in a male adolescent

    PubMed Central

    Chen, Yi-Ting; Su, Kuan-Pin; Chang, Jane Pei-Chen

    2017-01-01

    A 17-year-old adolescent boy presented with atypical major depressive episode (MDE) without specific focal neurological signs for 6 months. He had a diagnosis of intra-cranial germinoma, and the atypical MDE symptoms subsided after the operation. However, he had a relapse of atypical MDE 7 months after the first surgery. His mood and binge eating symptoms subsided, but intractable body weight gain only partially improved after treatment. When encountering manifestations of depression with atypical features, especially with binge eating symptoms in male children and adolescents, with early onset age, no family history, and prolonged depressive episodes, clinicians should consider not only mood disorders including bipolar spectrum disorders but also organic brain lesions such as intracranial germinoma. PMID:28053535

  16. Depressive symptoms in first-episode psychosis: a 10-year follow-up study.

    PubMed

    Sönmez, Nasrettin; Røssberg, Jan Ivar; Evensen, Julie; Barder, Helene Eidsmo; Haahr, Ulrik; Ten Velden Hegelstad, Wenche; Joa, Inge; Johannessen, Jan Olav; Langeveld, Hans; Larsen, Tor Ketil; Melle, Ingrid; Opjordsmoen, Stein; Rund, Bjørn Rishovd; Simonsen, Erik; Vaglum, Per; McGlashan, Thomas; Friis, Svein

    2016-06-01

    The present study examined if any patient characteristics at baseline predicted depressive symptoms at 10 years and whether patients prone to depressive symptoms in the first year of treatment had a different prognosis in the following years. A total of 299 first-episode psychosis (FEP) patients with schizophrenia spectrum disorders were assessed for depressive symptoms with PANSS depression item (g6) at baseline, and 1, 2, 5 and 10 years of follow up. At 10 years, depressive symptoms were also assessed with Calgary Depression Scale for Schizophrenia (CDSS). A PANSS g6 ≥ 4 and CDSS score ≥ 6 were used as a cut-off score for depression. A total of 122 (41%) patients were scored as depressed at baseline, 75 (28%) at 1 year, 50 (20%) at 2 years, 33 (16%) at 5 years, and 35 (19%) at 10 years of follow up. Poor childhood social functioning and alcohol use at baseline predicted depression at 10 years of follow up. Thirty-eight patients were depressed at both baseline and 1 year follow up. This group had poorer symptomatic and functional outcome in the follow-up period compared to a group of patients with no depression in the first year of treatment. Depressive symptoms are frequent among FEP patients at baseline but decrease after treatment because their general symptoms have been initiated. Patients with poor social functioning in childhood and alcohol use at baseline are more prone to have depressive symptoms at 10 years of follow up. Patients struggling with depressive symptoms in the first year of treatment should be identified as having poorer long-term prognosis. © 2014 Wiley Publishing Asia Pty Ltd.

  17. New episodes of depression among Medicare beneficiaries with chronic obstructive pulmonary disease.

    PubMed

    Albrecht, Jennifer S; Huang, Ting-Ying; Park, Yujin; Langenberg, Patricia; Harris, Ilene; Netzer, Giora; Lehmann, Susan W; Khokhar, Bilal; Simoni-Wastila, Linda

    2016-05-01

    Depression is a common comorbidity of chronic obstructive pulmonary disease (COPD) and is associated with increased exacerbations, healthcare utilization, and mortality. Among Medicare beneficiaries newly diagnosed with COPD, the objectives of this study were to (1) estimate the rate of new episodes of depression and (2) identify factors associated with depression. We identified beneficiaries with a first diagnosis of COPD during 2006-2012 using a 5% random sample of Medicare administrative claims data by searching for ICD-9-CM codes 490, 491.x, 492.x, 494.x, or 496. We identified episodes of depression using ICD-9-CM codes 296.2x, 296.3x, and 311.xx. We calculated incidence rates and their 95% confidence intervals (95% CI) and used a discrete time analysis to identify factors associated with development of depression. Between 2006 and 2012, 125,348 beneficiaries meeting inclusion criteria were newly diagnosed with COPD. Twenty-three percent developed depression following COPD diagnosis. The annualized incidence rate of depression per 100 beneficiaries following COPD diagnosis was 9.4 (95% CI 9.3, 9.5). Rates were highest in the first 2 months following COPD diagnosis. COPD diagnosis was associated with increased risk of depression (risk ratio 1.76; 95% CI 1.73, 1.79) as were COPD-related hospitalizations (risk ratio 4.59; 95% CI 4.09, 5.15), a measure of COPD severity. Diagnosis of COPD increases the risk of depression. This study will aid in the allocation of resources to monitor and provide support for individuals with COPD at high risk of developing depression. Copyright © 2015 John Wiley & Sons, Ltd.

  18. Dysregulation of miR-499, miR-708 and miR-1908 during a depression episode in bipolar disorders.

    PubMed

    Banach, Ewa; Dmitrzak-Weglarz, Monika; Pawlak, Joanna; Kapelski, Pawel; Szczepankiewicz, Aleksandra; Rajewska-Rager, Aleksandra; Slopien, Agnieszka; Skibinska, Maria; Czerski, Piotr; Hauser, Joanna

    2017-07-27

    Affective disorders include unipolar disorder (UP) (depression episodes) and bipolar disorder (BP) (depression and mania episodes). Currently, no biological markers are known that can help to differentiate these disorders. However, recent studies have suggested that psychiatric disorders can be connected with small, non-coding RNA, like microRNA. The objective of this study was to analyse the expression level of three microRNAs (miR-499, miR-708, miR-1908) in bipolar and unipolar disorder during depression episodes and after entering the remission state. The group consisted of adult women only, 17 UP (age: 50±17) and 15 BP (age: 33±13) patients. The expression level of miRNAs was investigated by RT-qPCR with the TaqMan assay. Our study has shown a lower expression level of miR-499 (p=0.008), miR-708 (p=0.02) and miR-1908 (p=0.004) in depression episodes of the bipolar disorder patients in comparison to remission state. We have not found similar differences in unipolar disorder and between those types in acute phase of depression and during remission. Obtained results indicate that miRNAs: miR-499, miR-708 and miR-1908 are the most promising candidates for biomarkers of depression episodes of bipolar disorder. Copyright © 2017 Elsevier B.V. All rights reserved.

  19. Social class mobility in first episode psychosis and the association with depression, hopelessness and suicidality.

    PubMed

    O'Donoghue, Brian; Lyne, John P; Fanning, Felicity; Kinsella, Anthony; Lane, Abbie; Turner, Niall; O'Callaghan, Eadbhard; Clarke, Mary

    2014-08-01

    Psychotic disorders are associated with a significant impairment in occupational functioning that can begin in the prodromal phase of the disorder. As a result, individuals with a psychotic disorder may not maintain their social class at birth. The aim of this study was to examine the distribution of the social classes of individuals presenting with a first episode of psychosis (FEP) compared to the general population and to their family of origin. We evaluated whether social drift was associated with depression, hopelessness and suicidality at first presentation. All individuals with a FEP presenting to a community mental health service between 1995 and 1999 and to an early intervention service between 2005 and 2011were included. Diagnosis was established using the Structured Clinical Interview for DSM IV diagnoses and clinical evaluations included the Calgary Depression Scale for Schizophrenia, Beck Hopelessness Scale and the Suicidal Intent Scale. 330 individuals were included in the study and by the time of presentation, individuals with a FEP were more likely to be represented in the lower social classes compared to the general population. 43% experienced a social drift and this was associated with a diagnosis of a non-affective disorder, co-morbid cannabis abuse and a longer DUP. Individuals who did not experience a social drift had a higher risk of hopelessness. Social drift is common in psychotic disorders; however, individuals who either maintain their social class or experience upward social class mobility are more susceptible to hopelessness. Copyright © 2014 Elsevier B.V. All rights reserved.

  20. A randomised cross-over study assessing the "blue pyjama syndrome" in major depressive episode.

    PubMed

    Delmas, Hélèna; Batail, Jean-Marie; Falissard, Bruno; Robert, Gabriel; Rangé, Maxence; Brousse, Stéphane; Soulabaille, Jacques; Drapier, Dominique; Naudet, Florian

    2017-06-01

    This paper introduces a "blue pyjama syndrome" (whereby wearing hospital pyjamas results in an exaggerated impression of severity). We performed a 5-day, prospective, randomized, cross-over study in a French mood disorder unit for inpatients. At Day 1 (D1) and Day 5 (D5), two 5-minute video interviews were recorded with patients in pyjamas or in day clothes (the sequence was randomly allocated). Psychiatrists unaware of the study objective assessed the videos and scored their clinical global impressions (CGI, with scores ranging from 1 to 7). Of 30 participants with major depressive episode selected for inclusion, 26 participants (69% women) provided useable data for an evaluation by 10 psychiatrists. Pyjamas significantly increased the psychiatrists' CGI ratings of disease severity by 0·65 [0·27; 1·02] points. The psychiatrists' global impressions also rated patients as significantly less severe at D5 in comparison with D1 by -0·66 [-1·03; -0·29] points. The "blue pyjama syndrome" is in the same order of magnitude as the difference observed after a week of hospitalisation. This potentially calls into question the reliability and validity of observer ratings of depression.

  1. Depression and anxiety in episodic and chronic cluster headache: a pilot study.

    PubMed

    Robbins, Matthew S; Bronheim, Rachel; Lipton, Richard B; Grosberg, Brian M; Vollbracht, Sarah; Sheftell, Fred D; Buse, Dawn C

    2012-04-01

    In contrast to migraine and tension-type headache, the psychiatric comorbidities of cluster headache (CH) have not been well-studied. We assessed the presence of depression and anxiety in groups of episodic CH (ECH) and chronic CH (CCH) patients and compared CH patients with and without depression and anxiety. Sociodemographics, comorbidities, and selected headache features were ascertained from a clinic-based sample in a cross-sectional fashion from January 2007 to July 2010. Active depression and anxiety were assessed using the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder 7-item (GAD-7) scales. Of 49 CH patients, ECH patients (n=32) had an earlier age of onset and consumed less caffeine than CCH patients (n=17). Rates of depression as defined by a PHQ-9 score ≥10 were low in both ECH (6.3%) and in CCH (11.8%) with similar mean PHQ-9 scores (3.1 vs 3.7, P=.69). Rates of anxiety as defined by a GAD-7 score ≥10 were also low in both ECH (15.6%) and CCH (11.8%) with similar mean GAD-7 scores (3.8 vs 3.4, P=.76). ECH patients in and out of active attack periods had similar levels of depression and anxiety. Depression and anxiety usually occurred together in ECH and CCH patients. CH patients who were depressed or anxious were more likely to present at a younger age and have attack-related nausea and prodromal symptoms. Depressed CH patients were also more likely to have another pain disorder and had undertaken twice as many prophylactic medication trials. In this clinic-based cross-sectional study, ECH and CCH patients had similarly low rates of depression and anxiety. Rates were lower than those reported for both episodic and chronic migraine. © 2011 American Headache Society.

  2. Transnational Ties and Past-Year Major Depressive Episodes among Latino Immigrants

    PubMed Central

    Alcántara, Carmela; Chen, Chih-Nan; Alegría, Margarita

    2014-01-01

    Objective Latino immigrants live in an increasingly global world where maintaining contact with kin in the home country is easier than ever. We examined: (a) the annual distribution of remittances burden (percentage of remittances/household income) and visits to the home country; (b) the association of these transnational ties with odds of a past-year major depressive episode (MDE); and (c) moderation by Latino sub-ethnicity or gender. Methods We conducted weighted logistic regression analyses with the Latino immigrant subsample (N=1614) of the National Latino and Asian American Study. Results Mexican and Other Latino immigrants had greater remittances burden than Puerto Rican migrants. Cuban immigrants made fewer visits back home than Puerto Rican migrants. After adjustment for socio-demographics and pre-migration psychiatric history, a percentage increase in remittances burden decreased odds of MDE (OR=0.80 [95%CI:0.67–.0.98]), whereas visits back home increased odds of MDE (OR=1.04 [95%CI:1.01–1.06]). Latino sub-ethnicity was not a significant moderator. Visits back home were more strongly linked to depression among women than men. Conclusions The distribution of transnational ties differs by Latino subgroup, although its association with depression is similar across groups. Monetary giving in the form of remittances might promote a greater sense of self-efficacy, social integration, and caregiving for relatives back home that positively affect mental health. Visits back home, especially for women, might signal social stress from strained relationships with kin/spouses/children left behind, or increased caregiving demands that negatively affect mental health. Clinical practice with immigrants should routinely assess the social resources and strains that fall outside national borders. PMID:25090146

  3. Cross-national epidemiology of DSM-IV major depressive episode

    PubMed Central

    2011-01-01

    Background Major depression is one of the leading causes of disability worldwide, yet epidemiologic data are not available for many countries, particularly low- to middle-income countries. In this paper, we present data on the prevalence, impairment and demographic correlates of depression from 18 high and low- to middle-income countries in the World Mental Health Survey Initiative. Methods Major depressive episodes (MDE) as defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DMS-IV) were evaluated in face-to-face interviews using the World Health Organization Composite International Diagnostic Interview (CIDI). Data from 18 countries were analyzed in this report (n = 89,037). All countries surveyed representative, population-based samples of adults. Results The average lifetime and 12-month prevalence estimates of DSM-IV MDE were 14.6% and 5.5% in the ten high-income and 11.1% and 5.9% in the eight low- to middle-income countries. The average age of onset ascertained retrospectively was 25.7 in the high-income and 24.0 in low- to middle-income countries. Functional impairment was associated with recency of MDE. The female: male ratio was about 2:1. In high-income countries, younger age was associated with higher 12-month prevalence; by contrast, in several low- to middle-income countries, older age was associated with greater likelihood of MDE. The strongest demographic correlate in high-income countries was being separated from a partner, and in low- to middle-income countries, was being divorced or widowed. Conclusions MDE is a significant public-health concern across all regions of the world and is strongly linked to social conditions. Future research is needed to investigate the combination of demographic risk factors that are most strongly associated with MDE in the specific countries included in the WMH. PMID:21791035

  4. Improving Major Depressive Episode Assessment: A New Tool Developed by Formal Psychological Assessment

    PubMed Central

    Serra, Francesca; Spoto, Andrea; Ghisi, Marta; Vidotto, Giulio

    2017-01-01

    Aim: Major depressive episode (MDE) can manifest with different features. Discriminating between different types of MDEs is crucial for proper treatment. The aim of this study is to propose a new tool for MDE assessment in bipolar disorder (BD) or major depressive disorder (MDD) to overcome some limitations of current rating scales. The proposed tool investigates all of the clinical features of different MDEs and gives qualitative information, differentiating patients with the same score but different symptoms and psychopathology severity. To achieve this purpose authors used a new methodology called Formal Psychological Assessment (FPA). FPA allows creating relations between the items of an assessment tool, and the set of diagnostic criteria of a given clinical disorder. In the application at hand, given the capability to analyze all clinical features, FPA appears a useful way to highlight and differentiate between inhibited and agitated depressive symptoms. Method: The new tool contains 41 items constructed through 23 clinical criteria from the DSM-5 and literature symptoms. In line with FPA, starting from a set of items and a set of clinical criteria, a Boolean matrix was built assigning to each item its own set of clinical criteria. The participants include 265 in the control group and 38 patients with MDE (diagnosed with MDD or BD) who answered the QuEDS. After 1 month, 63 participants performed the test again and 113 took the Depression-Anxiety-Stress Scale to analyze convergent—divergent validity. Results: The scale showed adequate reliability and validity. A hierarchical confirmatory factor analysis highlighted the presence of three sub factors (affective, somatic, and cognitive) and one high-order factor (depression). Conclusions: The new tool is potentially able to inform clinicians about the patients' most likely diagnostic configuration. Indeed, the clinical state of a patient consists of the subset of items he/she answered affirmatively, along with

  5. Improving Major Depressive Episode Assessment: A New Tool Developed by Formal Psychological Assessment.

    PubMed

    Serra, Francesca; Spoto, Andrea; Ghisi, Marta; Vidotto, Giulio

    2017-01-01

    Aim: Major depressive episode (MDE) can manifest with different features. Discriminating between different types of MDEs is crucial for proper treatment. The aim of this study is to propose a new tool for MDE assessment in bipolar disorder (BD) or major depressive disorder (MDD) to overcome some limitations of current rating scales. The proposed tool investigates all of the clinical features of different MDEs and gives qualitative information, differentiating patients with the same score but different symptoms and psychopathology severity. To achieve this purpose authors used a new methodology called Formal Psychological Assessment (FPA). FPA allows creating relations between the items of an assessment tool, and the set of diagnostic criteria of a given clinical disorder. In the application at hand, given the capability to analyze all clinical features, FPA appears a useful way to highlight and differentiate between inhibited and agitated depressive symptoms. Method: The new tool contains 41 items constructed through 23 clinical criteria from the DSM-5 and literature symptoms. In line with FPA, starting from a set of items and a set of clinical criteria, a Boolean matrix was built assigning to each item its own set of clinical criteria. The participants include 265 in the control group and 38 patients with MDE (diagnosed with MDD or BD) who answered the QuEDS. After 1 month, 63 participants performed the test again and 113 took the Depression-Anxiety-Stress Scale to analyze convergent-divergent validity. Results: The scale showed adequate reliability and validity. A hierarchical confirmatory factor analysis highlighted the presence of three sub factors (affective, somatic, and cognitive) and one high-order factor (depression). Conclusions: The new tool is potentially able to inform clinicians about the patients' most likely diagnostic configuration. Indeed, the clinical state of a patient consists of the subset of items he/she answered affirmatively, along with his

  6. The course of social cognitive and metacognitive ability in depression: Deficit are only partially normalized after full remission of first episode major depression.

    PubMed

    Ladegaard, Nicolai; Videbech, Poul; Lysaker, Paul H; Larsen, Erik R

    2016-09-01

    Research has suggested that patients suffering from major depressive disorder (MDD) experience deficits in the related domains of social cognition and metacognition. Most research has focused on detecting deficits among persons who are acutely symptomatic. Thus, little is known about whether these deficits persist after symptoms have remitted. As a first, this study investigated social cognitive and metacognitive deficits in patients with MDD in the acute and remitted state. Longitudinal case-control. Forty-four drug-naïve depressed patients and an equal number of matched healthy controls were assessed in multiple domains of social cognition including theory of mind, social perception, and metacognition. Additionally, a comprehensive neurocognitive (non-social) test battery was utilized. Following baseline assessment, patients were enrolled in an outpatient treatment programme. Patients reaching remission within 6 months (n = 29) were reassessed 6 months post-remission. Included for analysis were only patients who followed a course of remission (n = 29) and their paired healthy controls (n = 29). Analyses of variance revealed that remitted patients performed significantly better at retest than at baseline on nearly all measures. These effects withstood adjusting for test-retest effects. Moreover, remitted patients performed up to level of healthy controls on some but not all social cognitive tasks and metacognition at retest. Overall, results suggests that social cognitive and metacognitive ability may improve with symptom remission in major depression although it may not reach a level equal to persons who have never experienced depression. Many with first-episode depression experience deficits in social cognition. When first-episode depression remits, social cognition may improve. After remission, first-episode depressed patients may still experience deficits in social cognition. We have yet to determine whether social cognitive deficits existed prior to

  7. Fusion analysis of first episode depression: where brain shape deformations meet local composition of tissue.

    PubMed

    Ramezani, Mahdi; Abolmaesumi, Purang; Tahmasebi, Amir; Bosma, Rachael; Tong, Ryan; Hollenstein, Tom; Harkness, Kate; Johnsrude, Ingrid

    2015-01-01

    Computational neuroanatomical techniques that are used to evaluate the structural correlates of disorders in the brain typically measure regional differences in gray matter or white matter, or measure regional differences in the deformation fields required to warp individual datasets to a standard space. Our aim in this study was to combine measurements of regional tissue composition and of deformations in order to characterize a particular brain disorder (here, major depressive disorder). We use structural Magnetic Resonance Imaging (MRI) data from young adults in a first episode of depression, and from an age- and sex-matched group of non-depressed individuals, and create population gray matter (GM) and white matter (WM) tissue average templates using DARTEL groupwise registration. We obtained GM and WM tissue maps in the template space, along with the deformation fields required to co-register the DARTEL template and the GM and WM maps in the population. These three features, reflecting tissue composition and shape of the brain, were used within a joint independent-components analysis (jICA) to extract spatially independent joint sources and their corresponding modulation profiles. Coefficients of the modulation profiles were used to capture differences between depressed and non-depressed groups. The combination of hippocampal shape deformations and local composition of tissue (but neither shape nor local composition of tissue alone) was shown to discriminate reliably between individuals in a first episode of depression and healthy controls, suggesting that brain structural differences between depressed and non-depressed individuals do not simply reflect chronicity of the disorder but are there from the very outset.

  8. Fusion analysis of first episode depression: Where brain shape deformations meet local composition of tissue

    PubMed Central

    Ramezani, Mahdi; Abolmaesumi, Purang; Tahmasebi, Amir; Bosma, Rachael; Tong, Ryan; Hollenstein, Tom; Harkness, Kate; Johnsrude, Ingrid

    2014-01-01

    Computational neuroanatomical techniques that are used to evaluate the structural correlates of disorders in the brain typically measure regional differences in gray matter or white matter, or measure regional differences in the deformation fields required to warp individual datasets to a standard space. Our aim in this study was to combine measurements of regional tissue composition and of deformations in order to characterize a particular brain disorder (here, major depressive disorder). We use structural Magnetic Resonance Imaging (MRI) data from young adults in a first episode of depression, and from an age- and sex-matched group of non-depressed individuals, and create population gray matter (GM) and white matter (WM) tissue average templates using DARTEL groupwise registration. We obtained GM and WM tissue maps in the template space, along with the deformation fields required to co-register the DARTEL template and the GM and WM maps in the population. These three features, reflecting tissue composition and shape of the brain, were used within a joint independent-components analysis (jICA) to extract spatially independent joint sources and their corresponding modulation profiles. Coefficients of the modulation profiles were used to capture differences between depressed and non-depressed groups. The combination of hippocampal shape deformations and local composition of tissue (but neither shape nor local composition of tissue alone) was shown to discriminate reliably between individuals in a first episode of depression and healthy controls, suggesting that brain structural differences between depressed and non-depressed individuals do not simply reflect chronicity of the disorder but are there from the very outset. PMID:25610773

  9. Depression

    MedlinePlus

    ... The depression generally lifts during spring and summer. Bipolar disorder is different from depression but is included in this list is because someone with bipolar disorder experiences episodes of extreme low moods (depression). But ...

  10. Predictors of the onset of manic symptoms and a (hypo)manic episode in patients with major depressive disorder.

    PubMed

    Boschloo, Lynn; Spijker, Annet T; Hoencamp, Erik; Kupka, Ralph; Nolen, Willem A; Schoevers, Robert A; Penninx, Brenda W J H

    2014-01-01

    One third of patients with a major depressive episode also experience manic symptoms or, even, a (hypo)manic episode. Retrospective studies on the temporal sequencing of symptomatology suggest that the majority of these patients report depressive symptoms before the onset of manic symptoms. However, prospective studies are scarce and this study will, therefore, prospectively examine the onset of either manic symptoms or a (hypo)manic episode in patients with a major depressive disorder. In addition, we will consider the impact of a large set of potential risk factors on both outcomes. Four-year follow-up data were used to determine the onset of manic symptoms as well as a CIDI-based (hypo)manic episode in a large sample (n = 889, age: 18-65 years) of outpatients with a major depressive disorder and without manic symptoms at baseline. Baseline vulnerability (i.e., sociodemographics, family history of depression, childhood trauma, life-events) and clinical (i.e., isolated manic symptoms, depression characteristics, and psychiatric comorbidity) factors were considered as potential risk factors. In our sample of depressed patients, 15.9% developed manic symptoms and an additional 4.7% developed a (hypo)manic episode during four years. Baseline isolated manic symptoms and comorbid alcohol dependence predicted both the onset of manic symptoms and a (hypo)manic episode. Low education only predicted the onset of manic symptoms, whereas male gender, childhood trauma and severity of depressive symptoms showed strong associations with, especially, the onset of (hypo)manic episodes. A substantial proportion (20.6%) of patients with a major depressive disorder later developed manic symptoms or a (hypo)manic episode. Interestingly, some identified risk factors differed for the two outcomes, which may indicate that pathways leading to the onset of manic symptoms or a (hypo)manic episode might be different. Our findings indirectly support a clinical staging model.

  11. Serum neurotrophin-3 is increased during manic and depressive episodes in bipolar disorder.

    PubMed

    Walz, Julio C; Andreazza, Ana C; Frey, Benício N; Cacilhas, Alice A; Ceresér, Keila M M; Cunha, Angelo B M; Weyne, Fernanda; Stertz, Laura; Santin, Aida; Gonçalves, Carlos A; Kapczinski, Flávio

    2007-03-19

    Accumulating evidence suggest that neural changes and cognitive impairment may accompany the course of bipolar disorder. Such detrimental effects of cumulative mood episodes may be related to changes in neurotrophins that take place during mood episodes but not during euthymic phases. The present study investigated serum neurotrophin-3 (NT-3) levels in patients with bipolar disorder during manic, depressed, and euthymic states, using an enzyme-linked immunosorbent assay (sandwich-ELISA). Serum NT-3 levels were increased in manic (p<0.001) and depressed (p<0.001) BD patients, as compared with euthymic patients and normal controls. These findings suggest that the NT-3 signaling system may play a role in the pathophysiology of BD.

  12. Does age at onset of first major depressive episode indicate the subtype of major depressive disorder?: the clinical research center for depression study.

    PubMed

    Park, Seon-Cheol; Hahn, Sang-Woo; Hwang, Tae-Yeon; Kim, Jae-Min; Jun, Tae-Youn; Lee, Min-Soo; Kim, Jung-Bum; Yim, Hyeon-Woo; Park, Yong Chon

    2014-11-01

    The purpose of this study was to evaluate the effects of age at onset of the first major depressive episode on the clinical features of individuals with major depressive disorder (MDD) in a large cohort of Korean depressed patients. We recruited 419 MDD patients of age over 18 years from the Clinical Research Center for Depression study in South Korea. At the start of the study, the onset age of the first major depressive episode was self-reported by the subjects. The subjects were divided into four age-at-onset subgroups: childhood and adolescent onset (ages <18), early adult onset (ages 18-44), middle adult onset (ages 45-59), and late onset (ages 60+). Using analysis of covariance (ANCOVA) and ordinal logistic regression analysis with adjusting the effect of age, the relationships between clinical features and age at onset of MDD were evaluated. There was an apparent, but inconsistent correlation between clinical features and age at onset. Earlier onset MDD was significantly associated with higher proportion of female gender [adjusted odds ratio (AOR)=0.570, p=0.022], more previous suicide attempts (AOR=0.635, p=0.038), greater number of previous depressive episodes (F=3.475, p=0.016) and higher scores on the brief psychiatric rating scale (F=3.254, p=0.022), its negative symptom subscale (F=6.082, p<0.0001), and the alcohol use disorder identification test (F=7.061, p<0.0001). Early age at onset may increase the likelihood of distinguishable MDD subtype, and age at onset of the first major depressive episode is a promising clinical indicator for the clinical presentation, course, and outcome of MDD.

  13. Efficacy and Mood Conversion Rate of Short-Term Fluoxetine Monotherapy of Bipolar II Major Depressive Episode

    PubMed Central

    Amsterdam, Jay D.; Shults, Justine

    2010-01-01

    Objective As part of a long-term, relapse-prevention study of anti-depressant versus mood stabilizer monotherapy of bipolar II major depressive episode, we prospectively examined the efficacy and mood conversion rate of initial fluoxetine monotherapy. We hypothesized that there would be a statistically significant reduction in depressive symptoms without a clinically meaningful increase in mood conversion symptoms. Methods Patients received open-label fluoxetine monotherapy 10 to 80 mg daily for up to 14 weeks. Primary outcome was change over time in Hamilton Depression Rating score, with secondary outcomes including the proportion of treatment responders and remitters, change over time in Young Mania Rating Scale (YMRS) score, and frequency of mood conversion episodes. Results One hundred forty-eight patients had at least 1 post-baseline measurement. Mean Hamilton Depression Rating score decreased by 9.0 points (P < 0.0005). There were 88 responder patients (59.5%; 95% confidence interval [CI], 51.1%–67.4%) (P < 0.0005) and 86 remitter patients (58.1%; 95% CI, 49.7%–66.2%) (P < 0.0005). Mean time to remission was 64.4 days (95% CI, 59.1–69.7 days). Six patients (4.1%; 95% CI, 1.5%–8.6%) (P < 0.0005) had hypomania, and 29 patients (19.6%; 95% CI, 13.5%–26.9%) (P < 0.0005) had subsyndromal hypomania, which did not result in treatment discontinuation. Six patients (4.1%; 95% CI, 1.5%–8.6%) had a YMRS score of 8 or greater (P < 0.0005), and 4 patients (2.7%; 95% CI, 0.7%–6.8%) (P < 0.0005) had a YMRS score of 12 or greater at any study visit. Conclusions Although design limitations constrain the interpretation of the current findings, fluoxetine monotherapy may be an effective short-term treatment of bipolar II major depressive episode with a relatively low rate of syndromal hypomanic episodes. PMID:20473068

  14. Cognitive Vulnerability and Frontal Brain Asymmetry: Common Predictors of First Prospective Depressive Episode

    PubMed Central

    Nusslock, Robin; Shackman, Alexander J.; Harmon-Jones, Eddie; Alloy, Lauren B.; Coan, James A.; Abramson, Lyn Y.

    2011-01-01

    The hopelessness theory of depression proposes that individuals with a depressogenic cognitive style are more likely to become hopeless and experience depression following negative life events. Although the neurophysiological underpinnings of cognitive style remain speculative, research indicates that decreased relative left-frontal brain electrical activity holds promise as a trait-like marker of depression. This begs the question: do measures of depressogenic cognitive style and resting frontal brain asymmetry index a common vulnerability? The present study provides preliminary support for this hypothesis. At baseline assessment, increased cognitive vulnerability to depression was associated with decreased relative left-frontal brain activity at rest in individuals with no prior history of, or current, depression. Following baseline assessment, participants were followed prospectively an average of 3.0 years with structured diagnostic interviews at 4-month intervals. Both cognitive vulnerability and asymmetric frontal cortical activity prospectively predicted onset of first depressive episode in separate univariate analyses. Furthermore, multivariate analyses indicated that cognitive vulnerability and frontal asymmetry represented shared, rather than independent, predictors of first depression onset. PMID:21381804

  15. Cognitive vulnerability and frontal brain asymmetry: common predictors of first prospective depressive episode.

    PubMed

    Nusslock, Robin; Shackman, Alexander J; Harmon-Jones, Eddie; Alloy, Lauren B; Coan, James A; Abramson, Lyn Y

    2011-05-01

    The hopelessness theory of depression proposes that individuals with a depressogenic cognitive style are more likely to become hopeless and experience depression following negative life events. Although the neurophysiological underpinnings of cognitive style remain speculative, research indicates that decreased relative left frontal brain electrical activity holds promise as a traitlike marker of depression. This begs the question: Do measures of depressogenic cognitive style and resting frontal brain asymmetry index a common vulnerability? The present study provides preliminary support for this hypothesis. At baseline assessment, increased cognitive vulnerability to depression was associated with decreased relative left frontal brain activity at rest in individuals with no prior history of, or current, depression. Following baseline assessment, participants were followed prospectively an average of 3 years with structured diagnostic interviews at 4-month intervals. Both cognitive vulnerability and asymmetric frontal cortical activity prospectively predicted onset of first depressive episode in separate univariate analyses. Furthermore, multivariate analyses indicated that cognitive vulnerability and frontal asymmetry represented shared, rather than independent, predictors of first depression onset.

  16. TRAJECTORIES OF DEPRESSIVE EPISODES AND HYPERTENSION OVER 24 YEARS: THE WHITEHALL II PROSPECTIVE COHORT STUDY

    PubMed Central

    Nabi, Hermann; Chastang, Jean-François; Lefèvre, Thomas; Dugravot, Aline; Melchior, Maria; Marmot, Michael G.; Shipley, Martin J.; Kivimäki, Mika; Singh-Manoux, Archana

    2011-01-01

    Prospective data on depressive symptoms and blood pressure (BP) are scarce, and the impact of age on this association is poorly understood. The present study examines longitudinal trajectories of depressive episodes and the probability of hypertension associated with these trajectories over time. Participants were 6,889 men and 3,413 women London based civil servants, aged 35–55 years at baseline, followed for 24 years between 1985 and 2009. Depressive episode (defined as scoring 4 or more on the General Health Questionnaire-Depression subscale or using prescribed antidepressant medication) and hypertension (systolic/diastolic blood pressure ≥ 140/90 mm Hg or use of antihypertensive medication) were assessed concurrently at five medical examinations. In the fully adjusted longitudinal logistic regression analyses based on Generalized-Estimating-Equations using age as the time scale, participants in the “increasing depression” group had a 24% (p<0.05) lower risk of hypertension at ages 35–39, compared to those in the “low/transient depression” group. However, there was a faster age-related increase in hypertension in the “increasing depression” group, corresponding to a 7% (p<0.01) greater increase in the odds of hypertension for every each five-year increase in age. A higher risk of hypertension in the first group of participants was not evident before age 55. A similar pattern of association was observed in men and women although it was stronger in men. This study suggests that the risk of hypertension increases with repeated experience of depressive episodes over time and becomes evident in later adulthood. PMID:21339474

  17. First Episode of Depression in Children at Low and High Familial Risk for Depression

    ERIC Educational Resources Information Center

    Williamson, Douglas E.; Birmaher, Boris; Axelson, David A.; Ryan, Neal D.; Dahl, Ronald E.

    2004-01-01

    Objective: To examine the development of first-onset major depressive disorder (MDD) in children at high and low familial risk for depression in a prospective study. Method: High-risk children (n = 76) who were free of any lifetime affective disorder and had at least one first-degree and one second-degree relative with a lifetime history of…

  18. First Episode of Depression in Children at Low and High Familial Risk for Depression

    ERIC Educational Resources Information Center

    Williamson, Douglas E.; Birmaher, Boris; Axelson, David A.; Ryan, Neal D.; Dahl, Ronald E.

    2004-01-01

    Objective: To examine the development of first-onset major depressive disorder (MDD) in children at high and low familial risk for depression in a prospective study. Method: High-risk children (n = 76) who were free of any lifetime affective disorder and had at least one first-degree and one second-degree relative with a lifetime history of…

  19. Experience of stigma and discrimination reported by people experiencing the first episode of schizophrenia and those with a first episode of depression: The FEDORA project.

    PubMed

    Corker, Elizabeth A; Beldie, Alina; Brain, Cecilia; Jakovljevic, Miro; Jarema, Marek; Karamustafalioglu, Oguz; Marksteiner, Josef; Mohr, Pavel; Prelipceanu, Dan; Vasilache, Anamaria; Waern, Margda; Sartorius, Norman; Thornicroft, Graham

    2015-08-01

    To record and measure the nature and severity of stigma and discrimination experienced by people during a first episode of schizophrenia and those with a first episode of major depressive disorder. The Discrimination and Stigma Scale (DISC-12) was used in a cross-sectional survey to elicit service user reports of anticipated and experienced discrimination by 150 people with a diagnosis of first-episode schizophrenia and 176 with a diagnosis of first-episode major depressive disorder in seven countries (Austria, Croatia, Czech Republic, Poland, Romania, Sweden and Turkey). Participants with a diagnosis of major depressive disorder reported discrimination in a greater number of life areas than those with schizophrenia, as rated by the total DISC-12 score (p = .03). With regard to specific life areas, participants with depression reported more discrimination in regard to neighbours, dating, education, marriage, religious activities, physical health and acting as a parent than participants with schizophrenia. Participants with schizophrenia reported more discrimination with regard to the police compared to participants with depression. Stigma and discrimination because of mental illness change in the course of the mental diseases. Future research may take a longitudinal perspective to better understand the beginnings of stigmatisation and its trajectory through the life course and to identify critical periods at which anti-stigma interventions can most effectively be applied. © The Author(s) 2014.

  20. Mental health and urban living in sub-Saharan Africa: major depressive episodes among the urban poor in Ouagadougou, Burkina Faso.

    PubMed

    Duthé, Géraldine; Rossier, Clémentine; Bonnet, Doris; Soura, Abdramane Bassiahi; Corker, Jamaica

    2016-01-01

    In sub-Saharan African cities, the epidemiological transition has shifted a greater proportion of the burden of non-communicable diseases, including mental and behavioral disorder, to the adult population. The burden of major depressive disorder and its social risk factors in the urban sub-Saharan African population are not well understood and estimates vary widely. We conducted a study in Ouagadougou, Burkina Faso, in order to estimate the prevalence of major depressive episodes among adults in this urban setting. The Ouagadougou Health and Demographic System Site (HDSS) has followed the inhabitants of five outlying neighborhoods of the city since 2008. In 2010, a representative sample of 2,187 adults (aged 15 and over) from the Ouaga HDSS was interviewed in depth regarding their physical and mental health. Using criteria from the Mini International Neuropsychiatric Interview (MINI), we identified the prevalence of a major depressive episode at the time of the interview among respondents and analyzed its association with demographic, socioeconomic, and health characteristics through a multivariate analysis. Major depressive episode prevalence was 4.3 % (95 % CI: 3.1-5.5 %) among the survey respondents. We found a strong association between major depressive episode and reported chronic health problems, functional limitations, ethnicity and religion, household food shortages, having been recently a victim of physical violence and regularly drinking alcohol. Results show a U-shaped association of the relationship between major depressive episode and standard of living, with individuals in both the poorest and richest groups most likely to suffer from major depressive disorder than those in the middle. Though, the poorest group remains the most vulnerable one, even when controlling by health characteristics. Major depressive disorder is a reality for many urban residents in Burkina Faso and likely urbanites throughout sub-Saharan Africa. Countries in the region

  1. Lithium increases nitric oxide levels in subjects with bipolar disorder during depressive episodes.

    PubMed

    de Sousa, Rafael T; Zanetti, Marcus V; Busatto, Geraldo F; Mouro, Margaret G; Zarate, Carlos A; Gattaz, Wagner F; Higa, Elisa M; Machado-Vieira, Rodrigo

    2014-08-01

    Altered nitric oxide (NO) signaling has been associated with the pathophysiology of Bipolar Disorder (BD), directly affecting neurotransmitter release and synaptic plasticity cascades. Lithium has shown to regulate NO levels in preclinical models. However, no study has addressed peripheral NO levels in unmedicated BD. Also, lithium's effects on NO levels have not been studied in humans. Plasma NO was evaluated in subjects with BD I and II during a depressive episode (n = 26). Subjects had a score of ≥18 in the 21-item Hamilton Depression Rating Scale and were followed-up during a 6-week trial with lithium. Plasma NO levels were also compared to matched healthy controls (n = 28). NO was determined by chemiluminescence method. Lithium treatment significantly increased plasma NO levels after 6 weeks of treatment in comparison to baseline levels in bipolar depression (p = 0.016). Baseline NO levels during depressive episodes showed no difference when matching up to healthy controls (p = 0.66). The present findings suggest that lithium upregulates NO signaling in unmedicated BD with short illness duration. Further studies with larger samples are needed to confirm the effects of lithium on NO pathway and its association with synaptic plasticity and therapeutics of BD. Published by Elsevier Ltd.

  2. Diagnostic criteria for bipolarity based on an international sample of 5,635 patients with DSM-IV major depressive episodes.

    PubMed

    Angst, J; Gamma, A; Bowden, C L; Azorin, J M; Perugi, G; Vieta, E; Young, A H

    2012-02-01

    To assess the clinical validity of individual DSM-IV criteria for hypomania. In an international sample of 5,635 patients with major depressive episodes (Bridge Study), DSM-IV criteria for hypomania (stem questions, number and quality of symptoms, duration and exclusion criteria) were systematically assessed and their validity analysed on the basis of clinical data including family history, course, and other clinical characteristics. Three stem questions for hypomania, irritability, elevated mood and the added question of increased activity, showed comparable validity. The results support the current DSM-IV requirement for a higher symptom threshold (4 of 7 hypomanic symptoms) in cases of irritable mood. Longer durations of hypomanic episodes were associated with higher scores on all validators. The results did not support the DSM-IV durational requirements for hypomanic episodes (4 days) and manic episodes (7 days). Brief hypomanic episodes of 1, 2 or 3 days were valid and would meet validity criteria for inclusion. The three exclusion criteria in DSM-IV (hypomania due to the use of antidepressants or of other substances, or to other medical conditions) were found to exclude patients with bipolar depression and should therefore not be retained. These results support several revisions of the DSM-IV concept of hypomanic episodes: specifically, the inclusion of increased activity as a gate question, the inclusion of 1 or 2 to 3-day episodes and the elimination of all exclusion criteria.

  3. Anxiety, depression and school absenteeism in youth with chronic or episodic headache.

    PubMed

    Rousseau-Salvador, Céline; Amouroux, Rémy; Annequin, Daniel; Salvador, Alexandre; Tourniaire, Barbara; Rusinek, Stéphane

    2014-01-01

    Chronic daily headache (CDH) in children has been documented in general and clinical populations. Comorbid psychological conditions, risk factors and functional outcomes of CDH in children are not well understood. To examine anxiety and depression, associated risk factors and school outcomes in a clinical population of youth with CDH compared with youth with episodic headache (EH). Data regarding headache characteristics, anxiety, depression and missed school days were collected from 368 consecutive patients eight to 17 years of age, who presented with primary headache at a specialized pediatric headache centre. A total of 297 patients (81%) were diagnosed with EH and 71 were diagnosed with CDH. Among those with CDH, 78.9% presented with chronic tension-type headache and 21.1% with chronic migraine (CM). Children with CDH had a higher depression score than the standardized reference population. No difference was observed for anxiety or depression scores between children with CDH and those with EH. However, children with CM were more anxious and more depressed than those with chronic tension-type headache. Youth experiencing migraine with aura were three times as likely to have clinically significant anxiety scores. Headache frequency and history were not associated with psychopathological symptoms. Children with CDH missed school more often and for longer periods of time. These findings document the prevalence of anxiety, depression and school absenteeism in youth with CDH or EH. The present research also extends recent studies examining the impact of aura on psychiatric comorbidity and the debate on CM criteria.

  4. The association of major depressive episodes with income inequality and the human development index.

    PubMed

    Cifuentes, Manuel; Sembajwe, Grace; Tak, SangWoo; Gore, Rebecca; Kriebel, David; Punnett, Laura

    2008-08-01

    The aim of this study was to estimate the association between country income distribution and human development with the 12-month occurrence of major depressive episodes across countries. A total of 251,158 people surveyed by the World Health Organization from 2002 to 2003 from 65 countries were included in the study. The survey contained items for identifying major depressive episodes (MDE) in the previous 12 months, attained education (used as an indicator of individual socioeconomic status) and other demographic information. Income inequality was measured with the Gini index, a national-level indicator; the United Nations human development index (HDI) measured overall country development. Country-level and multilevel linear regression models were utilized to study the associations. We found that moderately developed countries had the lowest adjusted prevalence of MDE followed by high and low developed countries. The Gini index was positively associated with major depressive episodes, but only among high HDI countries. After adjusting for age, gender, marital status, education and HDI, the multilevel prevalence ratio indicated a 4% increase in risk of MDE for a person living in a country associated with a 1% increment in income equality. This finding means, for example, that comparing two highly developed countries, one with low income inequality (Gini=0.25) with another with high income inequality (Gini=0.39), one would expect to see an increase in the prevalence of MDE from 4.0% to 6.2%. These findings raise important questions about the role of income inequality on social forces that can lead to depression.

  5. Responder and nonresponder patients exhibit different peripheral transcriptional signatures during major depressive episode

    PubMed Central

    Belzeaux, R; Bergon, A; Jeanjean, V; Loriod, B; Formisano-Tréziny, C; Verrier, L; Loundou, A; Baumstarck-Barrau, K; Boyer, L; Gall, V; Gabert, J; Nguyen, C; Azorin, J-M; Naudin, J; Ibrahim, E C

    2012-01-01

    To date, it remains impossible to guarantee that short-term treatment given to a patient suffering from a major depressive episode (MDE) will improve long-term efficacy. Objective biological measurements and biomarkers that could help in predicting the clinical evolution of MDE are still warranted. To better understand the reason nearly half of MDE patients respond poorly to current antidepressive treatments, we examined the gene expression profile of peripheral blood samples collected from 16 severe MDE patients and 13 matched controls. Using a naturalistic and longitudinal design, we ascertained mRNA and microRNA (miRNA) expression at baseline, 2 and 8 weeks later. On a genome-wide scale, we detected transcripts with roles in various biological processes as significantly dysregulated between MDE patients and controls, notably those involved in nucleotide binding and chromatin assembly. We also established putative interactions between dysregulated mRNAs and miRNAs that may contribute to MDE physiopathology. We selected a set of mRNA candidates for quantitative reverse transcriptase PCR (RT-qPCR) to validate that the transcriptional signatures observed in responders is different from nonresponders. Furthermore, we identified a combination of four mRNAs (PPT1, TNF, IL1B and HIST1H1E) that could be predictive of treatment response. Altogether, these results highlight the importance of studies investigating the tight relationship between peripheral transcriptional changes and the dynamic clinical progression of MDE patients to provide biomarkers of MDE evolution and prognosis. PMID:23149449

  6. Increased frequency of first episode poststroke depression following discontinuation of escitalopram

    PubMed Central

    Mikami, Katsunaka; Jorge, Ricardo E.; Moser, David J.; Arndt, Stephan; Jang, Mijin; Solodkin, Ana; Small, Steven L.; Fonzetti, Pasquale; Hegel, Mark T.; Robinson, Robert G.

    2011-01-01

    Background and Purpose To compare escitalopram, problem-solving therapy (PST), and placebo, to prevent poststroke depression during 6 months after discontinuation of treatment. Methods We examined for depression, 33 patients assigned to placebo, 34 to escitalopram, and 41 to PST. Results After controlling for age, gender, prior mood disorder, and severity of stroke, new onset major depression and Hamilton Depression scores were significantly higher 6 months after escitalopram was discontinued, compared to the PST or placebo groups. Conclusions Discontinuation of escitalopram may increase poststroke depressive symptoms. PMID:21868736

  7. Increased Translocator Protein Distribution Volume, A Marker of Neuroinflammation, in the Brain During Major Depressive Episodes

    PubMed Central

    Setiawan, Elaine; Wilson, Alan A.; Mizrahi, Romina; Rusjan, Pablo M.; Miler, Laura; Rajkowska, Grazyna; Suridjan, Ivonne; Kennedy, James L.; Rekkas, P. Vivien; Houle, Sylvain; Meyer, Jeffrey H.

    2016-01-01

    Importance The neuroinflammatory hypothesis of major depressive disorder (MDD) is supported by several main findings: First, in humans and animals, activation of the immune system causes sickness behaviors that present during a major depressive episode (MDE) such as low mood, anhedonia, anorexia and weight loss. Second, peripheral markers of inflammation are frequently reported in MDD. Third, neuroinflammatory illnesses are associated with high rates of MDE. However, a fundamental limitation of the neuroinflammatory hypothesis is a paucity of evidence for brain inflammation during MDE. To investigate whether microglial activation, an important aspect of neuroinflammation, is present during MDE, [18F]FEPPA positron emission tomography (PET) was applied to measure translocator protein total distribution volume (TSPO VT), an index of TSPO density. Translocator protein density is elevated in activated microglia. Objective To determine whether TSPO VT, is elevated in the prefrontal cortex, anterior cingulate cortex (ACC) and insula in MDE secondary to MDD. Design Case-control study. Setting Tertiary care psychiatric hospital. Participants 20 subjects with MDE secondary to MDD and 20 healthy controls, underwent an [18F]FEPPA PET scan. MDE subjects were medication-free for at least 6 weeks. All participants were otherwise healthy, and non-smoking. Main Outcome Measure TSPO VT was measured in the prefrontal cortex, ACC, and insula. Results In MDE, TSPO VT was significantly elevated in all brain regions examined (multivariate analysis of variance, F15,23=4.46, P=0.001).TSPO VT was increased, on average, by 30% in the prefrontal cortex, ACC and insula. In MDE, greater TSPO VT in the ACC correlated with greater depression severity (ACC: r=0.628, P=0.005). Conclusions and Relevance This finding provides the most compelling evidence to date for brain inflammation, and more specifically microglial activation, in MDE. This is important for improving treatment since it implies

  8. Hippocampus, glucocorticoids and neurocognitive functions in patients with first-episode major depressive disorders.

    PubMed

    Kaymak, Semra Ulusoy; Demir, Başaran; Sentürk, Senem; Tatar, Ilkan; Aldur, M Mustafa; Uluğ, Berna

    2010-04-01

    The aim of this study was to determine whether there was any relationship between hippocampal volume, and glucocorticoid regulation, and cognitive dysfunctions in drug-naïve major depressive disorder (MDD) patients during their first episode. Twenty drug-free female MDD patients in their first episode and 15 healthy females as control subjects were included in the study. All subjects underwent 3.0 Tesla (T) magnetic resonance imaging (MRI), comprehensive neuropsychological testing and dexamethasone suppression tests (DST). The volumes of the right and left hippocampus of the patients were found to be significantly smaller than those of the controls. Patients were found to have significantly lower scores on measures of attention, working memory, psychomotor speed, executive functions, and visual and verbal memory fields. The performance of the patients only in the recollection memory and memory of reward-associated rules were positively correlated with hippocampal volumes. The volumes of the left and right hippocampus did not correlate with basal or post-dexamethasone cortisol levels. Our findings indicate that depressed patients have smaller hippocampi even in the earlier phase of their illness. Further research efforts are needed to explain the mechanisms that are responsible for the small hippocampus in depressed patients.

  9. Goethe's anxieties, depressive episodes and (self-)therapeutic strategies: a contribution to method integration in psychotherapy.

    PubMed

    Holm-Hadulla, Rainer M

    2013-01-01

    In psychiatry and psychotherapy, abstract scientific principles need to be exemplified by narrative case reports to gain practical precision. Goethe was one of the most creative writers, productive scientists, and effective statesmen that ever lived. His descriptions of feelings, emotions, and mental states related to anxieties, depressive episodes, dysthymia, and creativity are unique in their phenomenological precision and richness. His life and work can thus serve as an excellent example enhancing our understanding of the relationship between anxiety, depression and creativity. Furthermore, he described (self-)therapeutic strategies that reinforce and refine modern views. Goethe's self-assessments in his works and letters, and the descriptions by others are analyzed under the perspective of current psychiatric classification. His therapeutic techniques and recommendations are compared with cognitive-behavioral, psychodynamic, and existential psychotherapy to amplify modern concepts of psychotherapy. From a scientific perspective, several distinctive depressive episodes can be diagnosed in Goethe's life. They were characterized by extended depressive moods, lack of drive, and loss of interest and self-esteem combined with social retreat. Goethe displayed diffuse and phobic anxieties as well as dysthymia. His (self-)therapeutic strategies were: (a) the systematic use of helping alliances, (b) behavioral techniques, (c) cognitive reflection on meanings and beliefs, (d) psychodynamic and psychoanalytic remembering, repeating, and working through, and (e) existential striving for self-actualization, social commitment, meaning, and creativity. In Goethe's life, creative incubation, illumination, and elaboration appear to have been associated with psychic instability and dysthymia, sometimes with depressive episodes in a clinical sense. On the one hand, his creative work was triggered by anxieties, dysthymia, and depressive moods. On the other hand, his creativity

  10. Effects of asenapine on depressive symptoms in patients with bipolar I disorder experiencing acute manic or mixed episodes: a post hoc analysis of two 3-week clinical trials

    PubMed Central

    2011-01-01

    Background Asenapine demonstrated superiority over placebo for mania in bipolar I disorder patients experiencing acute current manic or mixed episodes in 2 randomized, placebo-and olanzapine-controlled trials. We report the results of exploratory pooled post hoc analyses from these trials evaluating asenapine's effects on depressive symptoms in patients from these trials with significant baseline depressive symptoms. Methods In the original trials (A7501004 [NCT00159744], A7501005 [NCT00159796]), 977 patients were randomized to flexible-dose sublingual asenapine (10 mg twice daily on day 1; 5 or 10 mg twice daily thereafter), placebo, or oral olanzapine 5-20 mg once daily for 3 weeks. Three populations were defined using baseline depressive symptoms: (1) Montgomery-Asberg Depression Rating Scale (MADRS) total score ≥20 (n = 132); (2) Clinical Global Impression for Bipolar Disorder-Depression (CGI-BP-D) scale severity score ≥4 (n = 170); (3) diagnosis of mixed episodes (n = 302) by investigative site screening. For each population, asenapine and olanzapine were independently compared with placebo using least squares mean change from baseline on depressive symptom measures. Results Decreases in MADRS total score were statistically greater with asenapine versus placebo at days 7 and 21 in all populations; differences between olanzapine and placebo were not significant. Decreases in CGI-BP-D score were significantly greater with asenapine versus placebo at day 7 in all categories and day 21 in population 1; CGI-BP-D score reductions were significantly greater with olanzapine versus placebo at day 21 in population 1 and day 7 in populations 2 and 3. Conclusions These post hoc analyses show that asenapine reduced depressive symptoms in bipolar I disorder patients experiencing acute manic or mixed episodes with clinically relevant depressive symptoms at baseline; olanzapine results appeared to be less consistent. Controlled studies of asenapine in patients with acute

  11. Association of Major Depressive Episode with Negative Outcomes of Tuberculosis Treatment

    PubMed Central

    Ugarte-Gil, Cesar; Ruiz, Paulo; Zamudio, Carlos; Canaza, Luz; Otero, Larissa; Kruger, Hever; Seas, Carlos

    2013-01-01

    Background Pulmonary tuberculosis (TB) persists an important contributor to the burden of diseases in developing countries. TB control success is based on the patient’s compliance to the treatment. Depressive disorders have been negatively associated with compliance of therapeutic schemes for chronic diseases. This study aimed to estimate the significance and magnitude of major depressive episode as a hazard factor for negative outcomes (NO), including abandon or death in patients receiving TB treatment. Methodology/Principal Findings A longitudinal study was conducted to evaluate the association of major depressive episode (MDE), as measured by a 5-item version of the Center for Epidemiological Studies Depression Scale (CES-D) with NO to TB treatment. Patients with confirmed TB were enrolled before the start of TB treatment. Baseline measurements included socio-demographic variables as well as the CES-D, which was also applied every month until the end of the treatment. Death and treatment default were assessed monthly. Survivor function (SF) for NO according to MDE status (CES-D≥6) at baseline (MDEb) was estimated. Cox’s Regression was performed for bivariate analyses as well as for the multivariate model. A total of 325 patients accepted to participate in the study, of which 34 where excluded for diagnosis of MDR-TB. NO was observed in 24 patients (8.2%); 109 (37%) presented MDEb. Statistically significant difference was found on the SF of patients with and without MDEb (0.85 vs. 0.96, p-value = 0.002). The hazard ratio for NO, controlled for age, sex, marital status and instruction level was 3.54 (95%CI 1.43–8.75; p-value = 0.006). Conclusion The presence of MDE at baseline is associated to NO of TB treatment. Targeting detection and treatment of MDE may improve TB treatment outcomes. PMID:23922728

  12. Effects of asenapine on depressive symptoms in patients with bipolar I disorder experiencing acute manic or mixed episodes: a post hoc analysis of two 3-week clinical trials.

    PubMed

    Szegedi, Armin; Zhao, Jun; van Willigenburg, Arjen; Nations, Kari R; Mackle, Mary; Panagides, John

    2011-06-20

    Asenapine demonstrated superiority over placebo for mania in bipolar I disorder patients experiencing acute current manic or mixed episodes in 2 randomized, placebo-and olanzapine-controlled trials. We report the results of exploratory pooled post hoc analyses from these trials evaluating asenapine's effects on depressive symptoms in patients from these trials with significant baseline depressive symptoms. In the original trials (A7501004 [NCT00159744], A7501005 [NCT00159796]), 977 patients were randomized to flexible-dose sublingual asenapine (10 mg twice daily on day 1; 5 or 10 mg twice daily thereafter), placebo, or oral olanzapine 5-20 mg once daily for 3 weeks. Three populations were defined using baseline depressive symptoms: (1) Montgomery-Asberg Depression Rating Scale (MADRS) total score ≥20 (n = 132); (2) Clinical Global Impression for Bipolar Disorder-Depression (CGI-BP-D) scale severity score ≥4 (n = 170); (3) diagnosis of mixed episodes (n = 302) by investigative site screening. For each population, asenapine and olanzapine were independently compared with placebo using least squares mean change from baseline on depressive symptom measures. Decreases in MADRS total score were statistically greater with asenapine versus placebo at days 7 and 21 in all populations; differences between olanzapine and placebo were not significant. Decreases in CGI-BP-D score were significantly greater with asenapine versus placebo at day 7 in all categories and day 21 in population 1; CGI-BP-D score reductions were significantly greater with olanzapine versus placebo at day 21 in population 1 and day 7 in populations 2 and 3. These post hoc analyses show that asenapine reduced depressive symptoms in bipolar I disorder patients experiencing acute manic or mixed episodes with clinically relevant depressive symptoms at baseline; olanzapine results appeared to be less consistent. Controlled studies of asenapine in patients with acute bipolar depression are necessary to

  13. Associations between subtypes of major depressive episodes and substance use disorders

    PubMed Central

    Marmorstein, Naomi R.

    2010-01-01

    The goal of this study was to examine whether certain subtypes of major depressive episodes (MDEs)—defined by their particular constellations of symptoms—were more strongly associated with substance use disorders (SUDs), compared to other subtypes of MDEs. Participants were adults in the National Comorbidity Survey-Replication sample who met DSM criteria for at least one lifetime MDE (n=1829). Diagnostic assessments were conducting using structured interviews. The following MDE subtypes were examined: atypical, psychomotor agitation, psychomotor retardation, melancholic, and suicidal. The results indicated that: (1) suicidal MDEs were associated with increased risk for all SUDs; (2) melancholic MDEs were associated with increased risk for alcohol use disorders; and (3) psychomotor agitation was associated with increased risk for alcohol dependence. These associations did not differ significantly by gender. Adjusting for age, the severity of the MDE, the age of onset of the first MDE, and psychiatric comorbidity did not substantially change the results. Supplemental analyses examining only diagnoses that occurred in the year prior to the assessment demonstrated a similar pattern (with MDEs characterized by psychomotor agitation being associated with drug use disorders as well). Exploratory order-of-onset analyses indicated that participants with lifetime MDEs and SUDs tended to report an MDE onset prior to the SUD onset, and those who experienced a suicidal MDE at some time in their lives were particularly likely to have had their first MDE prior to developing a SUD. Therefore, risk for lifetime SUDs differs according to the particular set of symptoms experienced during MDEs. PMID:21035193

  14. Quitting smoking does not increase the risk of major depressive episodes among users of Internet smoking cessation interventions

    PubMed Central

    Torres, L. D.; Barrera, A. Z.; Delucchi, K.; Penilla, C.; Pérez-Stable, E. J.; Muñoz, R. F.

    2011-01-01

    Background Limited evidence has suggested that quitting smoking increases the incidence of major depressive episodes (MDEs), particularly for smokers with a history of depression. Further evidence for this increase would have important implications for guiding smoking cessation. Method Spanish- and English-speaking smokers without a current MDE (n=3056) from an international, online smoking cessation trial were assessed for abstinence 1 month after their initial quit date and followed for a total of 12 months. Incidence of screened MDE was examined as a function of abstinence and depression history. Results Continued smoking, not abstinence, predicted MDE screened at 1 month [smoking 11.5% v. abstinence 7.8%, odds ratio (OR) 1.36, 95% confidence interval (CI) 1.04–1.78, p=0.02] but not afterwards (smoking 11.1% v. abstinence 9.8%, OR 1.05, 95% CI 0.77–1.45, p=0.74). Depression history predicted MDE screened at 1 month (history 17.1% v. no history 8.6%, OR 1.71, 95% CI 1.29–2.27, p<0.001) and afterwards (history 21.7% v. no history 8.3%, OR 3.87, 95% CI 2.25–6.65, p<0.001), although the interaction between history and abstinence did not. Conclusions Quitting smoking was not associated with increased MDE, even for smokers with a history of depression, although a history of depression was. Instead, not quitting was associated with increased MDE shortly following a quit attempt. Results from this online, large, international sample of smokers converge with similar findings from smaller, clinic-based samples, suggesting that in general, quitting smoking does not increase the incidence of MDEs. PMID:19627638

  15. Phenomenology of first-episode psychosis in schizophrenia, bipolar disorder, and unipolar depression: a comparative analysis.

    PubMed

    Rosen, Cherise; Marvin, Robert; Reilly, James L; Deleon, Ovidio; Harris, Margret S H; Keedy, Sarah K; Solari, Hugo; Weiden, Peter; Sweeney, John A

    2012-10-01

    This study sought to identify similarities and differences in symptom characteristics at initial presentation of first psychotic episodes in schizophrenia, bipolar disorder and unipolar depression. The Structured Interview for DSM-IV (SCID) and Positive and Negative Syndrome Scale (PANSS) were administered to consecutive admission study-eligible patients (n=101) presenting for treatment during their first acute phase of psychotic illness. Forty-nine percent of patients met diagnostic criteria for schizophrenia, 29% for psychotic bipolar disorder and 22% for unipolar depression with psychosis. The PANSS was analyzed using five-factor scoring that included Positive, Negative, Cognitive, Excitement, and Depression factors, and composite cluster scores that assessed Anergia, Thought Disturbance, and Paranoia. Schizophrenia and bipolar disorder patients demonstrated significantly more Positive symptoms, Thought Disturbance and Paranoia than unipolar depressed patients. Schizophrenia and unipolar depressed patients demonstrated significantly more Negative symptoms and Anergia than bipolar patients. Patients with schizophrenia reported more severe Cognitive Disorganization than patients with either bipolar disorder or uni-polar depression (p<.05). Findings from this study demonstrate an informative pattern of similarities and differences in the phenomenology of psychotic disorders at first illness presentation. Commonalities in symptom profiles reflect considerable symptom overlap among psychotic disorders and, thus, the importance of multidimensional differential diagnosis for these conditions. The differences across disorders in Positive and Negative symptom severity, Thought Disorder, Paranoia, and Anergia, and especially the higher level of Cognitive Disorganization seen in schizophrenia patients, point to clinically informative differences across these disorders that are relevant to clinical diagnostic practice and models of psychopathology.

  16. Altered functional connectivity of the dorsolateral prefrontal cortex in first-episode patients with major depressive disorder.

    PubMed

    Ye, Ting; Peng, Jing; Nie, Binbin; Gao, Juan; Liu, Jiangtao; Li, Yang; Wang, Gang; Ma, Xin; Li, Kuncheng; Shan, Baoci

    2012-12-01

    The aim of this study was to investigate resting-state functional connectivity alteration of the right dorsolateral prefrontal cortex (DLPFC) in patients with first-episode major depressive disorder (MDD). Twenty-two first-episode MDD patients and thirty age-, gender- and education-matched healthy control subjects were enrolled. Rest state functional magnetic resonance images and structure magnetic resonance images were scanned. The functional connectivity analysis was done based on the result of voxel-based morphometry (VBM). And the right DLPFC was chosen as the seed region of interests (ROI), as its gray matter density (GMD) decreased in the MDD patients compared with controls and its GMD values were negative correlation with the Hamilton Depression Rating Scale (HDRS) scores. Compared to healthy controls, the MDD patients showed increased functional connectivity with right the DLPFC in the left dorsal anterior cingulate cortex (ACC), left parahippocampal gyrus (PHG), thalamus and precentral gyrus. In contrast, there were decreased functional connectivity between the right DLPFC and right parietal lobe. By applying the VBM results to the functional connectivity analysis, the study suggested that abnormality of GMD in right DLPFC might be related to the functional connectivity alteration in the pathophysiology of MDD, which might be useful in further characterizing structure-function relations in this disorder. Copyright © 2012. Published by Elsevier Ireland Ltd.

  17. Short-term venlafaxine v. lithium monotherapy for bipolar type II major depressive episodes: effectiveness and mood conversion rate

    PubMed Central

    Amsterdam, Jay D.; Lorenzo-Luaces, Lorenzo; Soeller, Irene; Li, Susan Qing; Mao, Jun J.; DeRubeis, Robert J.

    2016-01-01

    Background Controversy exists over antidepressant use in bipolar II depression. Aims To compare the safety and effectiveness of antidepressant v. mood stabiliser monotherapy for bipolar type II major depressive episodes. Method Randomised, double-blind, parallel-group, 12-week comparison of venlafaxine (n = 65) v. lithium (n = 64) monotherapy in adult out-patients (trial registration number NCT00602537). Results Primary outcome – venlafaxine produced a greater response rate (67.7%) v. lithium (34.4%, P<0.001). Secondary outcomes – venlafaxine produced a greater remission rate (58.5% v. 28.1%, P<0.001); greater decline in depression symptom scores over time (β = −5.32, s.e. = 1.16, χ2 = 21.19, P<0.001); greater reduction in global severity scores over time (β = −1.05, s.e. = 0.22, w2 = 22.33, P<0.001); and greater improvement in global change scores (β = −1.31, s.e. = 0.32, χ2 = 16.95, P<0.001) relative to lithium. No statistically significant or clinically meaningful differences in hypomanic symptoms were observed between treatments. Conclusions These findings suggest that short-term venlafaxine monotherapy may provide effective antidepressant treatment for bipolar II depression without a statistically significant increase in hypomanic symptoms relative to lithium. PMID:26892848

  18. Comparison of non-directive counselling and cognitive behaviour therapy for patients presenting in general practice with an ICD-10 depressive episode: a randomized control trial.

    PubMed

    King, M; Marston, L; Bower, P

    2014-07-01

    Most evidence in the UK on the effectiveness of brief therapy for depression concerns cognitive behaviour therapy (CBT). In a trial published in 2000, we showed that non-directive counselling and CBT were equally effective in general practice for patients with depression and mixed anxiety and depression. Our results were criticized for including patients not meeting diagnostic criteria for a depressive disorder. In this reanalysis we aimed to compare the effectiveness of the two therapies for patients with an ICD-10 depressive episode. Patients with an ICD-10 depressive episode or mixed anxiety and depression were randomized to counselling, CBT or usual general practitioner (GP) care. Counsellors provided nondirective, interpersonal counselling following a manual that we developed based on the work of Carl Rogers. Cognitive behaviour therapists provided CBT also guided by a manual. Modelling was carried out using generalized estimating equations with the multiply imputed datasets. Outcomes were mean scores on the Beck Depression Inventory, Brief Symptom Inventory, and Social Adjustment Scale at 4 and 12 months. A total of 134 participants were randomized to CBT, 126 to counselling and 67 to usual GP care. We undertook (1) an interaction analysis using all 316 patients who were assigned a diagnosis and (2) a head-to-head comparison using only those 130 (41%) participants who had an ICD-10 depressive episode at baseline. CBT and counselling were both superior to GP care at 4 months but not at 12 months. There was no difference in the effectiveness of the two psychological therapies. We recommend that national clinical guidelines take our findings into consideration in recommending effective alternatives to CBT.

  19. Creativity and executive function across manic, mixed and depressive episodes in bipolar I disorder.

    PubMed

    Soeiro-de-Souza, Márcio Gerhardt; Dias, Vasco Videira; Bio, Danielle Soares; Post, Robert M; Moreno, Ricardo A

    2011-12-01

    Creativity is a complex construct involving affective and cognitive components. Bipolar Disorder (BD) has been associated with creativity and is characterized by a wide range of affective and cognitive symptoms. Although studies of creativity in BD have tended to focus on creativity as a trait variable in medicated euthymic patients, it probably fluctuates during symptomatic states of BD. Since creativity is known to involve key affective and cognitive components, it is plausible to speculate that cognitive deficits and symptoms present in symptomatic BD could interfere with creativity. Sixty-seven BD type I patients medication free, age 18-35 years and experiencing a maniac, mixed, or depressive episodes, were assessed for creativity, executive functioning, and intelligence. Manic and mixed state patients had higher creativity scores than depressive individuals. Creativity was influenced by executive function measures only in manic patients. Intelligence did not influence creativity for any of the mood episode types. We propose that creativity in BD might be linked to the putative hyperdopaminergic state of mania and be dependent on intact executive function. Future studies should further explore the role of dopaminergic mechanisms in creativity in BD. Copyright © 2011 Elsevier B.V. All rights reserved.

  20. Photothrombotic infarction triggers multiple episodes of cortical spreading depression in distant brain regions.

    PubMed

    Dietrich, W D; Feng, Z C; Leistra, H; Watson, B D; Rosenthal, M

    1994-01-01

    The purposes of this study were to determine whether cortical spreading depression occurs outside of the infarct produced by photothrombotic vascular occlusion, and also the direction of spreading. Focal cerebral thrombotic infarction was produced by irradiating the exposed skull of anesthetized rats with green light (560 nm) following systemic injection of rose bengal dye. At proximal sites (approximately 2 mm anterior to the infarct border), transient, severe hyperemic episodes (THEs) lasting 1-2 min were intermittently recorded. THE frequency was greatest in the first hour and declined over a 3-h period. THEs were accompanied (and usually preceded) by a precipitous rise in [K+]0 (from approximately 3 to > 40 mM) and were associated with increases in local tissue oxygen tension (tPO2). Following the rise in [K+]0, clearance of [K+]0 to its pre-THE baseline preceded baseline recovery of CBF. These data indicate that THEs were reactive to physiologic events resembling cortical spreading depression (CSD), which provoked increased demand for oxygen and blood flow, and which spread from proximal sites to areas more distal (approximately 4 mm) from the rim of the evolving infarct. MK-801 (1 mg/kg, i.v.) inhibited subsequent CSD-like episodes. We conclude that photothrombosis-induced ischemia provoked CSD which was triggered either within the infarct core or in the infarct rim and spread to more distal sites. Whether multiple episodes of CSD during infarct generation are responsible for the remote consequences of focal brain injury remains to be determined.

  1. Perinatal alcohol exposure in rat induces long-term depression of respiration after episodic hypoxia.

    PubMed

    Kervern, Myriam; Dubois, Christophe; Naassila, Mickael; Daoust, Martine; Pierrefiche, Olivier

    2009-04-01

    Little is known about the effects of alcohol exposure during pregnancy, which is responsible for fetal alcohol syndrome and the respiratory network functions, especially respiratory network plasticity (e.g., long-term facilitation) elicited after repeated short-lasting hypoxic episodes. The mechanism of induction of respiratory long-term facilitation involves 5-HT(2A/2C) receptors, which also participate in the response to hypoxia. Because fetal alcohol exposure is known to reduce serotonin centrally, and synaptic plasticity in the hippocampus, we hypothesized that alcohol exposure during gestation might impair respiratory long-term facilitation after hypoxic episodes. To analyze the effects of prenatal and postnatal alcohol exposure on respiratory long-term facilitation in 5- to 7-day-old rats. Respiratory frequency and amplitude were measured in vivo and in an in vitro rhythmic medullary slice before and after three hypoxia episodes or three applications of a 5-HT(2A/2C) receptor agonist in vitro. 5-HT(2A/2C) receptor mRNA was measured from the slice. Alcohol exposure impaired respiratory long-term facilitation and induced long-term depression of respiration in both in vivo and in vitro models. Alcohol altered 5-HT(2A/2C) mRNA expression, although 5-HT(2A/2C) agonist efficacy was not altered in increasing rhythmic activity in slices. However, a higher concentration of 5-HT(2A/2C) agonist was necessary to induce transient facilitation in slices from ethanol-exposed animals, suggesting disturbances in induction and maintenance mechanisms of respiratory long-term facilitation. Respiratory facilitation after repeated hypoxia was converted to long-term depression in rats treated with alcohol in utero. Alcohol exposure during pregnancy may therefore induce long-term maladaptive behavior of the respiratory system in neonates.

  2. Fish Consumption and Omega-3 Polyunsaturated Fatty Acids in Relation to Depressive Episodes: A Cross-Sectional Analysis

    PubMed Central

    Suominen-Taipale, Anna Liisa; Partonen, Timo; Turunen, Anu W.; Männistö, Satu; Jula, Antti; Verkasalo, Pia K.

    2010-01-01

    High fish consumption and omega-3 polyunsaturated fatty acid (PUFA) intake are suggested to benefit mental well-being but the current evidence is conflicting. Our aim was to evaluate whether a higher level of fish consumption, a higher intake of omega-3 PUFAs, and a higher serum concentration of omega-3 PUFAs link to a lower 12-month prevalence of depressive episodes. We used data from the nationwide Health 2000 Survey (n = 5492) and the Fishermen Study on Finnish professional fishermen and their family members (n = 1265). Data were based on questionnaires, interviews, health examinations, and blood samples. Depressive episodes were assessed with the M-CIDI (the Munich version of the Composite International Diagnostic Interview) and a self-report of two CIDI probe questions, respectively. Fish consumption was measured by a food frequency questionnaire (g/day) and independent frequency questions (times/month). Dietary intake (g/day) and serum concentrations (% from fatty acids) of PUFAs were determined. Fish consumption was associated with prevalence of depressive episodes in men but not in women. The prevalence of depressive episodes decreased from 9% to 5% across the quartiles of fish consumption (g/day) in men of the Health 2000 Survey (p for linear trend = 0.01), and from17% to 3% across the quartiles of fish consumption (times/month) in men of the Fishermen Study (p for linear trend = 0.05). This association was modified by lifestyle; in the Health 2000 Survey a higher level of fish consumption was related to a lower prevalence of depressive episodes in men who consumed the most alcohol, were occasional or former smokers, or had intermediate physical activity. The associations between depressive episodes and the intake or serum concentrations of omega-3 PUFAs were not consistent. In men, fish consumption appears as a surrogate for underlying but unidentified lifestyle factors that protect against depression. PMID:20479881

  3. Dependent stressful life events and prior depressive episodes in the prediction of major depression: the problem of causal inference in psychiatric epidemiology.

    PubMed

    Kendler, Kenneth S; Gardner, Charles O

    2010-11-01

    Most environmental risk factors for psychiatric disorders cannot be studied experimentally, making causal attributions difficult. Can we address this question by using together 2 major methods for causal inference: natural experiments and specialized statistical methods? To determine the causal relationship between dependent stressful life events (dSLEs) and prior depressive episodes (PDEs) and major depression (MD). Assessment of risk factors and episodes of MD at interview. Statistical analyses used the co-twin control and propensity score-matching methods. General community. Four thousand nine hundred ten male and female twins from the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders. Episodes of MD. We found that dSLEs were strongly associated with risk for MD in female (odds ratio [OR], 5.85) and male (4.55) twins in the entire sample and, at considerably lower levels, in female (2.29) and male (2.19) monozygotic twins discordant for dSLE exposure. A case-control sample matched on propensity score showed a moderate association in female (OR, 1.79) and male (1.53) twins. A PDE strongly predicted risk for MD in female (OR, 3.68) and male (5.20) twins in the entire sample. In monozygotic pairs discordant for exposure, the association was weaker in male (OR, 1.41) and absent in female (1.00) twins. A case-control sample matched on propensity score showed a moderate association between PDE and depressive episodes in male (OR, 1.58) and female twins (1.66). Although dSLEs have a modest causal effect on the risk for MD, a large proportion of the observed association is noncausal. The same pattern is seen for PDEs, although the causal impact is somewhat more tenuous. For environmental exposures in psychiatry that cannot be studied experimentally, co-twin control and propensity scoring methods--which have complementary strengths and weaknesses--can provide similar results, suggesting their joint use can help with the critical question of causal

  4. Suicidality and symptoms of anxiety, irritability, and agitation in patients experiencing manic episodes with depressive symptoms: a naturalistic study

    PubMed Central

    Eberhard, Jonas; Weiller, Emmanuelle

    2016-01-01

    Purpose Patients with a bipolar I disorder (BD-I) manic episode meeting the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), criteria for “with mixed features” have a high incidence of suicide attempts and of anxiety, irritability, and agitation (AIA) symptoms. The aim of this analysis was to explore the relationship between suicidality and AIA symptoms in patients with BD-I experiencing mania with depressive symptoms, using data from a previous naturalistic study. Patients and methods Psychiatrists completed an online questionnaire about their adult patients who had a current BD-I manic episode. Questions covered the DSM-5 “with mixed features” specifier, the severity of AIA symptoms, the frequency and controllability of suicidal ideation, and the number of suicide attempts. Results Of 1,035 patients with BD-I mania who were included in the analyses, 348 (33.6%) met the criteria for the DSM-5 “with mixed features” specifier (three or more depressive symptoms). These patients were further stratified according to the severity of their AIA symptoms: “mild AIA” (zero or one AIA symptom above a severity threshold; 105 patients) or “severe AIA” (all three AIA symptoms above a severity threshold; 167 patients). A greater incidence of suicidal ideation was observed in the severe AIA group (71.9%) than in the mild AIA group (47.6%). Twice as many patients had easily controlled suicidal ideation than difficult-to-control suicidal ideation in both subgroups. The mean number of suicide attempts was higher in the severe AIA group than in the mild AIA group, during the current episode (0.84 vs 0.34 attempts, respectively; P<0.05) and over the patient’s lifetime (1.56 vs 1.04 attempts, respectively). Conclusion The high risk of suicide among BD-I mania patients with depressive symptoms is further increased when they experience severe AIA symptoms. Recognizing AIA symptoms in BD-I mania could provide a means of identifying

  5. Impact of depressive episodes on cognitive deficits in early bipolar disorder: data from the Systematic Treatment Optimization Programme for Early Mania (STOP-EM).

    PubMed

    Muralidharan, Kesavan; Torres, Ivan J; Silveira, Leonardo E; Kozicky, Jan-Marie; Bücker, Joana; Fernando, Nadeesha; Yatham, Lakshmi N

    2014-07-01

    Although manic episodes reportedly contribute to cognitive deficits in bipolar I disorder, the contribution of depressive episodes is poorly researched. We investigated the impact of depressive episodes on cognitive function early in the course of bipolar I disorder. A total of 68 patients and 38 controls from the Systematic Treatment Optimization Programme for Early Mania (STOP-EM) first-episode mania programme were examined. We conducted (a) a cross-sectional analysis of the impact of prior depressive episodes on baseline cognitive function and (b) a prospective analysis assessing the contribution of depression recurrence within 1 year following a first episode of mania on cognitive functioning. The cross-sectional analysis showed no significant differences between patients with past depressive episodes compared with those without, on overall or individual domains of cognitive function (all P>0.09). The prospective analysis failed to reveal a significant group×time interaction for cognitive decline from baseline to 1 year (P = 0.99) in patients with a recurrence of depressive episodes compared with those with no recurrence. However, impaired verbal memory at baseline was associated with a depression recurrence within 1 year. Although deficits in all domains of cognitive function are seen in patients early in the course of bipolar disorder, depressive episodes do not confer additional burden on cognitive function. However, poorer verbal memory may serve as a marker for increased susceptibility to depression recurrence early in the course of illness. Royal College of Psychiatrists.

  6. [Integral Care Guide for Early Detection and Diagnosis of Depressive Episodes and Recurrent Depressive Disorder in Adults. Integral Attention of Adults with a Diagnosis of Depressive Episodes and Recurrent Depressive Disorder: Part III: Treatment of Resistant Depression and Psychotic Depression, Occupational Therapy and Day Hospital Treatment].

    PubMed

    Gómez-Restrepo, Carlos; Peñaranda, Adriana Patricia Bohórquez; Valencia, Jenny García; Guarín, Maritza Rodríguez; Ángel, Juliana Rodríguez; Jaramillo, Luis Eduardo; Acosta, Carlos Alberto Palacio; Pedraza, Ricardo Sánchez; Díaz, Sergio Mario Castro; de la Hoz Bradford, Ana María

    2012-12-01

    This article presents recommendations based on the evidence gathered to answer a series of clinical questions concerning the depressive episode and the recurrent depressive disorder. Emphasis was given to general treatment issues of resistant depression and psychotic depression, occupational therapy and day hospital treatment so as to grant diagnosed adult patients the health care parameters based on the best and more updated evidence available and achieve minimum quality standards. A practical clinical guide was elaborated according to standards of the Methodological Guide of the Ministry of Social Protection. Recommendation from NICE90 and CANMAT guides were adopted and updated so as to answer the questions posed while de novo questions were developed. Recommendations 23-25 corresponding to the management of depression are presented. Copyright © 2012 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  7. Prevalence and characteristics of undiagnosed bipolar disorders in patients with a major depressive episode: the BRIDGE study.

    PubMed

    Angst, Jules; Azorin, Jean-Michel; Bowden, Charles L; Perugi, Giulio; Vieta, Eduard; Gamma, Alex; Young, Allan H

    2011-08-01

    Major depressive disorder, the most common psychiatric illness, is often chronic and a major cause of disability. Many patients with major depressive episodes who have an underlying but unrecognized bipolar disorder receive pharmacologic treatment with ineffective regimens that do not include mood stabilizers. To determine the frequency of bipolar disorder symptoms in patients seeking treatment for a major depressive episode. Multicenter, multinational, transcultural, cross-sectional, diagnostic study. The study arose from the initiative Bipolar Disorders: Improving Diagnosis, Guidance and Education (BRIDGE). Community and hospital psychiatry departments. Participants included 5635 adults with an ongoing major depressive episode. The frequency of bipolar disorder was determined by applying both DSM-IV-TR criteria and previously described bipolarity specifier criteria. Variables associated with bipolarity were assessed using logistic regression. A total of 903 patients fulfilled DSM-IV-TR criteria for bipolar disorder (16.0%; 95% confidence interval, 15.1%-17.0%), whereas 2647 (47.0%; 95% confidence interval, 45.7%-48.3%) met the bipolarity specifier criteria. Using both definitions, significant associations (odds ratio > 2; P < .001) with bipolarity were observed for family history of mania/hypomania and multiple past mood episodes. The bipolarity specifier additionally identified significant associations for manic/hypomanic states during antidepressant therapy, current mixed mood symptoms, and comorbid substance use disorder. The bipolar-specifier criteria in comparison with DSM-IV-TR criteria were valid and identified an additional 31% of patients with major depressive episodes who scored positive on the bipolarity criteria. Family history, illness course, and clinical status, in addition to DSM-IV-TR criteria, may provide useful information for physicians when assessing evidence of bipolarity in patients with major depressive episodes. Such an assessment is

  8. Disparities in adequate mental health care for past-year major depressive episodes among Caucasian and Hispanic youths.

    PubMed

    Alexandre, Pierre K; Martins, Silvia S; Richard, Patrick

    2009-10-01

    Following efforts made in recent years to provide effective mental health treatments based on evidence-based guidelines, a working definition was developed in the literature detailing a minimum level of "adequate mental health care" for serious mental illness. However, little is known about racial or ethnic disparities in receipt of adequate mental health care for individuals affected with serious mental illness. The objective of this study was to examine disparities among Caucasian and Hispanic youths in receipt of adequate mental health care for past-year major depressive episodes. Data for this study were drawn from the 2005 National Survey on Drug Use and Health. The study sample was composed of 1,169 Caucasian youths and 316 Hispanic youths aged 12 to 17 with past-year major depressive episodes. The percentages of youths in the sample who received adequate mental health care for past-year major depressive episodes were estimated, and the correlates of receipt of adequate mental health care were examined. Thirty-four percent of the full sample received adequate mental health care for past-year major depressive episodes, but separate analyses indicated that adequate mental health care was received by a significantly higher proportion of Caucasian youths (36%) than Hispanic youths (27%). The odds of receiving adequate mental health care for past-year major depressive episodes for Caucasians were 1.55 times that of Hispanics (p=.01). Having Medicaid or coverage via the State Children's Health Insurance Program significantly increased the odds of receiving adequate mental care for past-year major depressive episodes for both Hispanics and Caucasians. As mental health problems of adolescents from diverse racial or ethnic backgrounds become more easily identified and a larger proportion of these groups is referred to mental health treatment services, it is important to examine the degree to which treatment should be tailored to engage and retain specific racial or

  9. Discovery of a Partner Affair and Major Depressive Episode in a Probability Sample of Married or Cohabiting Adults.

    PubMed

    Whisman, Mark A

    2016-12-01

    Prior research has found that humiliating marital events are associated with depression. Building on this research, the current study investigated the association between one specific humiliating marital event-discovering that one's partner had an affair-and past-year major depressive episode (MDE) in a probability sample of married or cohabiting men and women who were at high risk for depression based on the criterion that they scored below the midpoint on a measure of marital satisfaction (N = 227). Results indicate that (i) women were more likely than men to report discovering their partner had an affair in the prior 12 months; (ii) discovering a partner affair was associated with a higher prevalence of past-year MDE and a lower level of marital adjustment; and (iii) the association between discovering a partner affair and MDE remained statistically significant when holding constant demographic variables and marital adjustment. These results support continued investigation into the impact that finding out about an affair has on the mental health of the person discovering a partner affair. © 2015 Family Process Institute.

  10. Residual symptoms in patients with partial versus complete remission of a major depressive disorder episode: patterns of painful physical symptoms in depression

    PubMed Central

    Harada, Eiji; Satoi, Yoichi; Kikuchi, Toshiaki; Watanabe, Koichiro; Alev, Levent; Mimura, Masaru

    2016-01-01

    Objective The patterns of residual painful physical symptoms (PPS) and emotional symptoms among patients with partial remission (PR) or complete remission (CR) of a major depressive disorder (MDD) episode were compared. Methods This is a multicenter, cross-sectional, observational study. Patients who had originally been diagnosed with MDD, were treated with an antidepressant for 12 weeks for that episode, and achieved either PR or CR at study entry were enrolled in the study. Using the 17-item Hamilton Rating Scale for Depression (HAM-D17), PR was defined as a score of ≥8 and ≤18 and CR as a score of ≤7. Residual symptoms were assessed using the Brief Pain Inventory-Short Form (BPI-SF) and the HAM-D17. Results A total of 323 patients (CR =158, PR =165) were included in the study. Patients in the PR group had a higher mean (standard deviation) score in the HAM-D17 than those in the CR group (11.8 [3.1] and 4.4 [2.0], respectively). BPI-SF results showed that “at least moderate PPS” (score ≥3 on BPI-SF question 5) was significantly more prevalent among patients with PR than those with CR (37.0% vs 16.5%, respectively; odds ratio =3.04; P<0.001). Presence of pain (any severity) was also more prevalent among patients with PR than those with CR (54.5% vs 35.4%, respectively). The HAM-D17 results for individual items indicated that impaired work and activities, depressed mood, psychological and somatic anxiety, and general somatic symptoms were observed in at least 75% of patients with PR. Conclusion PR was associated with a higher prevalence of at least moderate PPS. Other residual symptoms commonly observed in patients with PR included typical core emotional symptoms (eg, loss of interest, depressed mood, and psychological anxiety). These results underline the importance of PPS, because PPS is clinically relevant for the patients but difficult to assess with the commonly used depression evaluation scale. PMID:27418827

  11. Is there a cerebellar compensatory effort in first-episode, treatment-naive major depressive disorder at rest?

    PubMed

    Guo, Wenbin; Liu, Feng; Liu, Jianrong; Yu, Liuyu; Zhang, Zhikun; Zhang, Jian; Chen, Huafu; Xiao, Changqing

    2013-10-01

    This study was undertaken to explore whether there is a cerebellar compensatory response in patients with first-episode, treatment-naive major depressive disorder (MDD). The cerebellar compensatory response is defined as a cerebellar hyperactivity which would be inversely correlated with both the activation of the functionally connected cerebral regions and the depression severity. Resting-state functional magnetic resonance imaging (fMRI) data of 24 patients with MDD and 24 healthy subjects were analyzed with the fractional amplitude of low-frequency fluctuations (fALFF) and functional connectivity (FC) methods. The structural images were processed with the voxel-based morphometry (VBM) method. Compared to healthy controls, depressed patients had significantly increased fALFF in the left Crus I and the left cerebellar lobule VI. FC analysis of these two seeded regions found that depressed patients had increased FC between the left Crus I and the right hippocampus, but had decreased FC between the left Crus I and the left inferior parietal lobule (IPL), and between the left cerebellar lobule VI and bilateral inferior temporal gyrus. No correlation was observed between the abnormal fALFF of the seeds and their connected regions and the depression severity or the executive function. The VBM results did not show significant reduction in gray or white matter volume in any above-mentioned region. Our findings suggest that increased cerebellar activity at resting state may be a disease state phenomenon but not a compensatory response to the dysfunction of the default mode network (DMN) in MDD. Copyright © 2013 Elsevier Inc. All rights reserved.

  12. Air pollution as a risk factor for depressive episode in patients with cardiovascular disease, diabetes mellitus, or asthma.

    PubMed

    Cho, Jaelim; Choi, Yoon Jung; Suh, Mina; Sohn, Jungwoo; Kim, Hyunsoo; Cho, Seong-Kyung; Ha, Kyoung Hwa; Kim, Changsoo; Shin, Dong Chun

    2014-03-01

    There is currently insufficient evidence to confirm the effect of ambient air pollution on mental disorders, especially among susceptible populations. This study investigated the short-term effect of ambient air pollution on the risk of depressive episode and the effect modification across disease subpopulations. Subjects who visited the emergency department (ED) for depressive episode from 2005 to 2009 (n=4985) in Seoul, Republic of Korea were identified from medical claims data. We conducted a time-stratified case-crossover study using conditional logistic regression. Subgroup analyses were conducted after the subjects were stratified by underlying disease (cardiovascular disease, diabetes mellitus, chronic obstructive pulmonary disease, asthma, and depressive disorder). The risk was expressed as an odds ratio (OR) per 1 standard deviation of each air pollutant. SO2, PM10, NO2, and CO were positively associated with ED visits for depressive episode. The maximum risk was observed in the distributed lag 0-3 model for PM10 (OR, 1.120; 95% confidence interval, 1.067-1.176). PM10, NO2, and CO significantly increased the risks of ED visits for depressive episode in subjects with either underlying cardiovascular disease, diabetes mellitus, asthma, or depressive disorder. Our data may include a misclassification bias due to the validity of a diagnosis determined from medical services utilization data. SO2, PM10, NO2, and CO significantly increased the risk of ED visits for depressive episode, especially among individuals with pre-existing cardiovascular disease, diabetes mellitus, or asthma. Copyright © 2014 Elsevier B.V. All rights reserved.

  13. Residual symptoms in patients with partial versus complete remission of a major depressive disorder episode: patterns of painful physical symptoms in depression.

    PubMed

    Harada, Eiji; Satoi, Yoichi; Kikuchi, Toshiaki; Watanabe, Koichiro; Alev, Levent; Mimura, Masaru

    2016-01-01

    The patterns of residual painful physical symptoms (PPS) and emotional symptoms among patients with partial remission (PR) or complete remission (CR) of a major depressive disorder (MDD) episode were compared. This is a multicenter, cross-sectional, observational study. Patients who had originally been diagnosed with MDD, were treated with an antidepressant for 12 weeks for that episode, and achieved either PR or CR at study entry were enrolled in the study. Using the 17-item Hamilton Rating Scale for Depression (HAM-D17), PR was defined as a score of ≥8 and ≤18 and CR as a score of ≤7. Residual symptoms were assessed using the Brief Pain Inventory-Short Form (BPI-SF) and the HAM-D17. A total of 323 patients (CR =158, PR =165) were included in the study. Patients in the PR group had a higher mean (standard deviation) score in the HAM-D17 than those in the CR group (11.8 [3.1] and 4.4 [2.0], respectively). BPI-SF results showed that "at least moderate PPS" (score ≥3 on BPI-SF question 5) was significantly more prevalent among patients with PR than those with CR (37.0% vs 16.5%, respectively; odds ratio =3.04; P<0.001). Presence of pain (any severity) was also more prevalent among patients with PR than those with CR (54.5% vs 35.4%, respectively). The HAM-D17 results for individual items indicated that impaired work and activities, depressed mood, psychological and somatic anxiety, and general somatic symptoms were observed in at least 75% of patients with PR. PR was associated with a higher prevalence of at least moderate PPS. Other residual symptoms commonly observed in patients with PR included typical core emotional symptoms (eg, loss of interest, depressed mood, and psychological anxiety). These results underline the importance of PPS, because PPS is clinically relevant for the patients but difficult to assess with the commonly used depression evaluation scale.

  14. Role of translocator protein density, a marker of neuroinflammation, in the brain during major depressive episodes.

    PubMed

    Setiawan, Elaine; Wilson, Alan A; Mizrahi, Romina; Rusjan, Pablo M; Miler, Laura; Rajkowska, Grazyna; Suridjan, Ivonne; Kennedy, James L; Rekkas, P Vivien; Houle, Sylvain; Meyer, Jeffrey H

    2015-03-01

    The neuroinflammatory hypothesis of major depressive disorder is supported by several main findings. First, in humans and animals, activation of the immune system causes sickness behaviors that present during a major depressive episode (MDE), such as low mood, anhedonia, anorexia, and weight loss. Second, peripheral markers of inflammation are frequently reported in major depressive disorder. Third, neuroinflammatory illnesses are associated with high rates of MDEs. However, a fundamental limitation of the neuroinflammatory hypothesis is a paucity of evidence of brain inflammation during MDE. Translocator protein density measured by distribution volume (TSPO VT) is increased in activated microglia, an important aspect of neuroinflammation. To determine whether TSPO VT is elevated in the prefrontal cortex, anterior cingulate cortex (ACC), and insula in patients with MDE secondary to major depressive disorder. Case-control study in a tertiary care psychiatric hospital from May 1, 2010, through February 1, 2014. Twenty patients with MDE secondary to major depressive disorder and 20 healthy control participants underwent positron emission tomography with fluorine F 18-labeled N-(2-(2-fluoroethoxy)benzyl)-N-(4-phenoxypyridin-3-yl)acetamide ([18F]FEPPA). Patients with MDE were medication free for at least 6 weeks. All participants were otherwise healthy and nonsmokers. Values of TSPO VT in the prefrontal cortex, ACC, and insula. In MDE, TSPO VT was significantly elevated in all brain regions examined (multivariate analysis of variance, F15,23 = 4.5 [P = .001]). The magnitude of TSPO VT elevation was 26% in the prefrontal cortex (mean [SD] TSPO VT, 12.5 [3.6] in patients with MDE and 10.0 [2.4] in controls), 32% in the ACC (mean [SD] TSPO VT, 12.3 [3.5] in patients with MDE and 9.3 [2.2] in controls), and 33% in the insula (mean [SD] TSPO VT, 12.9 [3.7] in patients with MDE and 9.7 [2.3] in controls). In MDE, greater TSPO VT in the ACC correlated with greater

  15. What is the contribution of different cognitive biases and stressful childhood events to the presence and number of previous depressive episodes?

    PubMed

    Vrijsen, Janna N; Becker, Eni S; Arias-Vásquez, Alejandro; van Dijk, Maarten K; Speckens, Anne; Oostrom, Iris van

    2014-07-30

    Negative cognitive biases as well as stressful childhood events are well-known risk factors for depression. Few studies have compared the association of different types of biases and events with depression. The current study examined whether different cognitive biases and stressful childhood events variables were associated with depression and recurrence. Three types of childhood events were assessed in 83 never-depressed and 337 formerly depressed individuals: trauma within the family, trauma outside the family, and adverse events. Furthermore, after a sad mood induction procedure, participants executed a Dot Probe task (selective attentional bias), an Emotional Stroop task (attentional interference bias) and an incidental learning task (memory bias). The association of these measures with case status and recurrence status (one or multiple past episodes) was examined. Negative memory bias and traumatic childhood events within the family were associated with case status, whereas none of the bias measures or childhood events variables were associated with recurrence status. The results indicate that memory bias as well as the experience of aggression and/or abuse within the family during childhood are independently associated with depression. Biases and stressful childhood events did not offer differentiation between individuals with one or multiple past episodes. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  16. Identifying Personality Pathology Associated With Major Depressive Episodes: Incremental Validity of Informant Reports

    PubMed Central

    Galione, Janine N.; Oltmanns, Thomas F.

    2016-01-01

    Major limitations are associated with the use of a single source of information to assess personality pathology. The construct validity of standardized interviews and informant reports on personality pathology has been established relative to other measures of personality pathology, but it is also important to consider these measures in relation to other constructs that should be related to personality pathology. One example is major depression. In this study, we evaluated whether less common clinical methods of assessment for measuring the same personality pathology constructs, including semistructured interviews and informant reports, demonstrate unique validity, using major depressive episode (MDE) as the external criterion. This analysis focuses on a representative, community-based sample of 1,437 participants and informants. We conducted a hierarchical logistic regression analysis and determined the order of entering the predictor variables based on likelihood of being used in a clinical setting as well as empirical recommendations. Each step of our regression model significantly increased our ability to predict lifetime MDE, including self, interviewer, and informant reports of personality pathology. Overall, these findings indicate that multiple sources of personality assessment provide unique information about the relationship between maladaptive personality traits and a history of MDE. Thus, semistructured diagnostic interviews and informant reports can be used as a resource to improve the validity of personality assessments. PMID:24004355

  17. The Epidemiology of Major Depressive Episode in the Iraqi General Population

    PubMed Central

    Al-Hamzawi, Ali Obaid; Bruffaerts, Ronny; Bromet, Evelyn J.; AlKhafaji, Abdulzahra Mohammed; Kessler, Ronald C.

    2015-01-01

    Objective To assess the prevalence, symptom severity, functional impairment, and treatment of major depressive episode (MDE) in the Iraqi general population. Methods The Iraq Mental Health Survey is a nationally representative face-to-face survey of 4,332 non-institutionalized adults aged 18+ interviewed in 2006–2007 as part of the WHO World Mental Health Surveys. Prevalence and correlates of DSM-IV MDE were determined with the WHO Composite International Diagnostic Interview (CIDI). Findings Lifetime and 12-month prevalence of MDE were 7.4% and 4.0%, respectively. Close to half (46%) of the 12-month MDE cases were severe/very severe. MDE was more common among women and those previously married. Median age of onset was 25.2. Only one-seventh of 12-month MDE cases received treatment despite being associated with very substantial role impairment (on average 70 days out of role in the past year). Conclusions MDE is a commonly occurring disorder in the Iraqi general population and is associated with considerable disability and low treatment. Efforts are needed to decrease the barriers to treatment and to educate general medical providers in Iraq about the recognition and treatment of depression. PMID:26230265

  18. Suicide attempts in major depressive episode: evidence from the BRIDGE-II-Mix study.

    PubMed

    Popovic, Dina; Vieta, Eduard; Azorin, Jean-Michel; Angst, Jules; Bowden, Charles L; Mosolov, Sergey; Young, Allan H; Perugi, Giulio

    2015-11-01

    The Bipolar Disorders: Improving Diagnosis, Guidance, and Education (BRIDGE-II-Mix) study aimed to estimate the frequency of mixed states in patients with a major depressive episode (MDE) according to different definitions and to compare their clinical validity, looking into specific features such as suicidality. A total of 2,811 subjects were enrolled in this multicenter cross-sectional study. Psychiatric symptoms, and sociodemographic and clinical variables were collected. The analysis compared the characteristics of patients with MDE with (MDE-SA group) and without (MDE-NSA) a history of suicide attempts. The history of suicide attempts was registered in 628 patients (22.34%). In the MDE-SA group, women (72.5%, p = 0.028), (hypo)mania in first-degree relatives (20.5%, p < 0.0001), psychotic features (15.1%, p < 0.0001), and atypical features (9.2%, p = 0.009) were more prevalent. MDE-SA patients' previous responses to treatment with antidepressants included more (hypo)manic switches [odds ratio (OR) = 1.97, 95% confidence interval (CI): 1.58-2.44, p < 0.0001], treatment resistance (OR = 2.07, 95% CI: 1.72-2.49, p < 0.0001), mood lability (OR = 1.98, 95% CI: 1.65-2.39, p < 0.0001), and irritability (OR = 1.80, 95% CI: 1.48-2.17, p < 0.0001). Multivariate analysis evidenced that risky behavior, psychomotor agitation and impulsivity, and borderline personality and substance use disorders were the variables most frequently associated with previous suicide attempts. In the MDE-SA group, 75 patients (11.9%) fulfilled Diagnostic and Statistical Manual (DSM)-5 criteria for MDE with mixed features, and 250 patients (39.8%) fulfilled research-based diagnostic criteria for a mixed depressive episode. Important differences between MDE-SA and MDE-NSA patients have emerged. Early identification of symptoms such as risky behavior, psychomotor agitation, and impulsivity in patients with MDE, and treatment of mixed depressive states could represent a major step in suicide

  19. Comparison of hair thyroid hormones between first-episode and recurrent patients with depression in female Chinese.

    PubMed

    Yang, Xiao; Sun, Guizhi; Wei, Jinxue; Huang, Bin; Zhao, Liansheng; Wang, Yingcheng; Zhou, Bo; Tao, Li; Ma, Xiaohong

    2016-12-01

    The aim of this study was to compare hair thyroid hormone (TH) levels among first-episode patients with major depressive disorder (F-MDD), recurrent patients with major depressive disorder (R-MDD) and healthy controls (HC). The Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) were used to evaluate the clinical symptoms of patients. Electrochemiluminescence immunoassay was used to measure the hair TH levels. We compared the differences in hair TH levels among F-MDD patients, R-MDD patients, and HC. Before the disease episode, hair T3 levels differed significantly between F-MDD patients and HC. In the disease episode, hair T3 levels differed significantly between F-MDD or R-MDD patients and HC; and hair T4 levels differed significantly between R-MDD patients and HC. Hair T3 levels significantly negative correlated with HAMD scores in F-MDD patients. Our findings suggested that disease duration of recurring episodes of depression may influence hair TH levels. © 2015 Wiley Publishing Asia Pty Ltd.

  20. Identifying Risk for Onset of Major Depressive Episodes in Low-Income Latinas during Pregnancy and Postpartum

    ERIC Educational Resources Information Center

    Le, Huynh-Nhu; Munoz, Ricardo F.; Soto, Jose A.; Delucchi, Kevin L.; Ippen, Chandra Ghosh

    2004-01-01

    This study aimed to identify subgroups of pregnant women at imminent (1 year) risk for major depressive episodes. Participants were 84 low-income, predominantly Mexican women using public sector obstetrics services who participated in monthly interviews during pregnancy and up to 6 months postpartum. Participants were designated a priori as "more…

  1. Identifying Risk for Onset of Major Depressive Episodes in Low-Income Latinas during Pregnancy and Postpartum

    ERIC Educational Resources Information Center

    Le, Huynh-Nhu; Munoz, Ricardo F.; Soto, Jose A.; Delucchi, Kevin L.; Ippen, Chandra Ghosh

    2004-01-01

    This study aimed to identify subgroups of pregnant women at imminent (1 year) risk for major depressive episodes. Participants were 84 low-income, predominantly Mexican women using public sector obstetrics services who participated in monthly interviews during pregnancy and up to 6 months postpartum. Participants were designated a priori as "more…

  2. Noradrenaline plays a critical role in the switch to a manic episode and treatment of a depressive episode

    PubMed Central

    Kurita, Masatake

    2016-01-01

    Although antidepressants may increase the risk of switching to mania in bipolar disorder (BD), clinicians have been using antidepressants to treat patients with bipolar depression. Appropriate treatments for bipolar depression remain controversial. In BD, antidepressants comprise a double-edged sword in terms of their efficacy in treating depression and the increased risk of switching. This review presents an important table outlining the benefit in terms of depression improvement and the risk of switching in the clinical setting. It also proposes strategies based on the characteristics of antidepressants such as their pharmacology, specifically the equilibrium dissociation constant (KD) of the noradrenaline transporter. This table will be useful for clinicians while considering benefit and risk. Antidepressants augmenting noradrenaline may be effective in bipolar depression. However, it is easily presumed that such antidepressants may also have a risk of switching to mania. Therefore, antidepressants augmenting noradrenaline will be the recommended treatment in combination with an antimanic agent, or they may be used for short-term treatment and early discontinuation. The corresponding medical treatment guidelines probably need to be reevaluated and updated based on biological backgrounds. From previous studies, we understand that the stability of noradrenaline levels is important for BD amelioration, based on the pathophysiology of the disorder. It is hoped that researchers will reevaluate BD by conducting studies involving noradrenaline. PMID:27703355

  3. Association of major depressive episodes with stroke risk in a prospective study of 0.5 million Chinese adults

    PubMed Central

    Sun, Jie; Ma, Hongxia; Yu, Canqing; Lv, Jun; Guo, Yu; Bian, Zheng; Yang, Ling; Chen, Yiping; Shen, Hongbing; Chen, Zhengming; Hu, Zhibin; Li, Liming

    2016-01-01

    Background and Purpose Although the relationship between depression and stroke risk has been investigated, findings in previous reports were conflicting. The aim of this study was to prospectively examine the effect of major depressive episodes (MDE) on stroke incidence and further assess the potential dose-response relationship between numbers of depression symptoms and subsequent stroke risk in Chinese population. Methods A total of 199 294 men and 288 083 women aged 30 to 79 years without a prior history of stroke, heart disease and cancer in the China Kadoorie Biobank cohort were followed from 2004 to 2013. A World Health Organization Composite International Diagnostic Interview-Short Form was used to access MDE according to Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV criteria. Stroke events were ascertained through death certificates, medical records and health insurance data. Results Past year MDE was marginally associated with a 15% increased risk of stroke (adjusted hazard ratio = 1.15, 95% confidence interval = 0.99-1.33) in the fully-adjusted model, and the association was steeper and statistically significant in individuals aged <50 years, smokers, drinkers, those with higher education degree, BMI <24.0 kg/m2 and no history of diabetes. Moreover, there was a positive dose-response relationship between the number of depression symptoms and increased stroke risk (Ptrend = 0.011). Additionally, smoking status significantly interacted with MDE on stroke onset (P for multiplicative interaction = 0.025). Conclusions Findings from this large prospective study suggest that the presence of MDE is a risk factor for stroke, especially in smokers. PMID:27470992

  4. Predicting the onset and persistence of episodes of depression in primary health care. The predictD-Spain study: Methodology

    PubMed Central

    Bellón, Juan Ángel; Moreno-Küstner, Berta; Torres-González, Francisco; Montón-Franco, Carmen; GildeGómez-Barragán, María Josefa; Sánchez-Celaya, Marta; Díaz-Barreiros, Miguel Ángel; Vicens, Catalina; de Dios Luna, Juan; Cervilla, Jorge A; Gutierrez, Blanca; Martínez-Cañavate, María Teresa; Oliván-Blázquez, Bárbara; Vázquez-Medrano, Ana; Sánchez-Artiaga, María Soledad; March, Sebastia; Motrico, Emma; Ruiz-García, Victor Manuel; Brangier-Wainberg, Paulette Renée; del Mar Muñoz-García, María; Nazareth, Irwin; King, Michael

    2008-01-01

    Background The effects of putative risk factors on the onset and/or persistence of depression remain unclear. We aim to develop comprehensive models to predict the onset and persistence of episodes of depression in primary care. Here we explain the general methodology of the predictD-Spain study and evaluate the reliability of the questionnaires used. Methods This is a prospective cohort study. A systematic random sample of general practice attendees aged 18 to 75 has been recruited in seven Spanish provinces. Depression is being measured with the CIDI at baseline, and at 6, 12, 24 and 36 months. A set of individual, environmental, genetic, professional and organizational risk factors are to be assessed at each follow-up point. In a separate reliability study, a proportional random sample of 401 participants completed the test-retest (251 researcher-administered and 150 self-administered) between October 2005 and February 2006. We have also checked 118,398 items for data entry from a random sample of 480 patients stratified by province. Results All items and questionnaires had good test-retest reliability for both methods of administration, except for the use of recreational drugs over the previous six months. Cronbach's alphas were good and their factorial analyses coherent for the three scales evaluated (social support from family and friends, dissatisfaction with paid work, and dissatisfaction with unpaid work). There were 191 (0.16%) data entry errors. Conclusion The items and questionnaires were reliable and data quality control was excellent. When we eventually obtain our risk index for the onset and persistence of depression, we will be able to determine the individual risk of each patient evaluated in primary health care. PMID:18657275

  5. Associations between compulsive buying and substance dependence/abuse, major depressive episodes, and generalized anxiety disorder among men and women.

    PubMed

    Zhang, Chenshu; Brook, Judith S; Leukefeld, Carl G; Brook, David W

    2016-01-01

    The objective of this study was to examine the associations between compulsive buying and substance dependence/abuse, major depressive episodes, and generalized anxiety disorder at the mean age of 43. Participants came from a community-based random sample of residents in 2 New York counties in 1975 (N = 548). The participants were followed from adolescence to early midlife. The mean age of participants at the most recent interview was 43.0 (standard deviation = 2.8). Of the participants, 55% were females. Over 90% of the participants were Caucasian. The prevalence of substance dependence/abuse, major depressive episodes, and generalized anxiety disorder (during the past 5 years before the interviews) was 6.6, 13.7, and 11.5%, respectively. Logistic regression analyses showed that compulsive buying was significantly associated with substance dependence/abuse (adjusted odds ratio = 1.60), major depressive episodes (adjusted odds ratio = 1.70), and generalized anxiety disorder (adjusted odds ratio = 1.63), despite controlling for substance dependence/abuse, major depressive episodes, and generalized anxiety disorder, respectively, at the mean age of 37, and demographic factors. Since the study sample is limited to predominantly Caucasian participants (over 90%) with a close association to a small geographic area, the findings may not be generalizable to racial/ethnic minority groups or individuals living in other parts of the country. Nevertheless, it is important that clinicians treating substance dependence/abuse, major depressive episodes, and generalized anxiety disorder consider the role of compulsive buying.

  6. Downward social mobility and major depressive episodes among Latino and Asian-American immigrants to the United States.

    PubMed

    Nicklett, Emily J; Burgard, Sarah A

    2009-09-15

    The authors analyzed the association between downward social mobility in subjective social status among 3,056 immigrants to the United States and the odds of a major depressive episode. Using data from the National Latino and Asian American Study (2002-2003), the authors examined downward mobility by comparing immigrants' subjective social status in their country of origin with their subjective social status in the United States. The dependent variable was the occurrence of a past-year episode of major depression defined according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. Logistic regression models were used to control for a variety of sociodemographic and immigration-related characteristics. Analyses suggested that a loss of at least 3 steps in subjective social status is associated with increased risk of a depressive episode (odds ratio = 3.0, 95% confidence interval: 1.3, 6.6). Other factors independently associated with greater odds of depression included Latino ethnicity, female sex, having resided for a longer time in the United States, and being a US citizen. The findings suggest that immigrants who experience downward social mobility are at elevated risk of major depression. Policies or interventions focused only on immigrants of low social status may miss another group at risk: those who experience downward mobility from a higher social status.

  7. Personality Disorders Predict Relapse after Remission from an Episode of Major Depressive Disorder: A Six-year Prospective Study

    PubMed Central

    Grilo, Carlos M.; Stout, Robert L.; Markowitz, John C.; Sanislow, Charles A.; Ansell, Emily B.; Skodol, Andrew E.; Bender, Donna S.; Pinto, Anthony; Shea, M. Tracie; Yen, Shirley; Gunderson, John G.; Morey, Leslie C.; Hopwood, Christopher J.; McGlashan, Thomas H.

    2015-01-01

    Objective To examine prospectively the course of major depressive disorder (MDD) and to test for the moderating effects of personality disorder (PD) co-morbidity on relapse after remission from an episode of MDD. Method Participants were 303 patients (196 women and 107 men) with current MDD at baseline enrollment in the Collaborative Longitudinal Personality Disorders Study. MDD and Axis I psychiatric disorders were assessed with the Structured Clinical Interview for DSM-IV and Axis II PDs were assessed with the Diagnostic Interview for DSM-IV PD. The course of MDD was assessed with the Longitudinal Interval Follow-up Evaluation at 6- and 12-months and then yearly through 6 years. Survival analyses were used to analyze time to remission and time to relapse. Results 260 (86%) of 303 patients remitted from MDD; lifetable survival analyses revealed that patients with MDD who had PDs at baseline had significantly longer time to remission from MDD than patients without PDs. Among the 260 patients whose MDD remitted, 183 (70%) relapsed. MDD patients with PDs -- specifically those with borderline and obsessive-compulsive PDs -- at baseline had significantly shorter time to relapse than MDD patients without PDs. Cox proportional hazards regression analyses revealed that the presence of PDs at baseline (hazard ratio 1.5) and recurrent-type MDD (hazard ratio 2.2), but not gender (hazard ratio 1.03) or dysthymic disorder (hazard ratio 0.97), significantly predicted time to relapse. Conclusions PDs at baseline were robust predictors prospectively of accelerated relapse after remission from an episode of MDD. PDs at baseline significantly moderated eventual time to relapse in MDD among patients who remitted from an episode of MDD, even when controlling for other potential negative prognostic predictors. PMID:20584514

  8. The roles of personality traits and negative life events on the episodes of depressive symptoms in nonreferred adolescents: a 1-year follow-up study.

    PubMed

    Yang, Hao-Jan; Chiu, Yu-Ju; Soong, Wei-Tsuen; Chen, Wei J

    2008-04-01

    To evaluate the influences of personality traits and nonsevere life events on depressive episodes in a 1-year follow-up in nonreferred adolescents. Participants were 2,773 students aged 12 to 16 years randomly selected from six middle schools in Taiwan who were assessed both at baseline for personality traits and depressive symptoms and at 1 year later for negative life events and depressive symptoms. Two, single, or no episodes of depression were based on whether the scores of the Center for Epidemiologic Studies Depression crossed over the cutoff of 28 at two time points. Multinomial logistic regression analyses were used to correlate personality or negative life events, which were trichotomized by means of tertiles or number of events, with the episodes of depressive symptoms. After controlling for possible confounders, only elevated neuroticism was associated with a single episode of depressive symptoms, whereas a medium level or above of neuroticism, extraversion, or negative life events all exhibited association with the occurrence of two episodes. No interactions were found between all personality traits or between personality and negative life events. The relations of personality traits or nonsevere life events to depressive symptoms depend on whether the episode is an initial one. A high level in neuroticism is a critical vulnerability factor for the initiation of depressive symptoms in adolescents. Once the threshold has been surpassed, the influences of various personality traits and nonsevere life events on the subsequent depressive symptoms become cumulative and exhibit a dose-response relationship.

  9. A Controlled Study of Serum Lipid Profiles in Indian Patients with Depressive Episode

    PubMed Central

    Patra, Bichitra Nanda; Khandelwal, Sudhir K.; Chadda, Rakesh K.; Ramakrishnan, Lakshmy

    2014-01-01

    Background: Lower levels of circulating lipid fractions and cholesterol are risk factors for impulsivity and depressive disorder. A lower level of serum cholesterol is also associated with patients presenting with history of self-harm. Materials and Methods: A total of 30 depressive patients and 30 healthy matched control subjects were recruited from the department of Psychiatry of a tertiary care hospital. We measured serum total cholesterol (TC), low-density lipoprotein (LDL) and high-density lipoprotein cholesterol and triglyceride levels of both patient and control group. Results: The serum TC and LDL-cholesterol levels were found to be significantly lower in study group than that of control group. Conclusion: Lower levels of serum cholesterol are associated with depressive disorder. PMID:24860211

  10. Rumination and Default Mode Network Subsystems Connectivity in First-episode, Drug-Naive Young Patients with Major Depressive Disorder

    PubMed Central

    Zhu, Xueling; Zhu, Qiuling; Shen, Huaizhen; Liao, Weihua; Yuan, Fulai

    2017-01-01

    Neuroimaging evidence implicates the association between rumination and default mode network (DMN) in major depressive disorder (MDD). However, the relationship between rumination and DMN subsystems remains incompletely understood, especially in patients with MDD. Thirty-three first-episode drug-naive patients with MDD and thirty-three healthy controls (HCs) were enrolled and underwent resting-sate fMRI scanning. Functional connectivity analysis was performed based on 11 pre-defined regions of interest (ROIs) for three DMN subsystems: the midline core, dorsal medial prefrontal cortex (dMPFC) and medial temporal lobe (MTL). Compared with HCs group, patients with MDD exhibited increased within-system connectivity in the dMPFC subsystem and inter-system connectivity between the dMPFC and MTL subsystems. Decreased inter-system connectivity was identified between the midline core and dMPFC subsystem in MDD patients. Depressive rumination was positively correlated with within-system connectivity in the dMPFC subsystem (dMPFC-TempP) and with inter-system connectivity between the dMPFC and MTL subsystems (LTC-PHC). Our results suggest MDD may be characterized by abnormal DMN subsystems connectivity, which may contribute to the pathophysiology of the maladaptive self-focus in MDD patients. PMID:28225084

  11. [Antidepressive Combination Treatment in Patients with Severe Depressive Episode: The Practice of Prescription in a Clinical Sample 2012].

    PubMed

    Schmidt-Kraepelin, Christian; Horstkötter, Eva; Zielasek, Jürgen; Otten, Marina; Cordes, Joachim

    2017-07-01

    Objectives Polypharmacy in the treatment of severe psychiatric disorders may include promising treatment options, yet may also be subject to additional side effects and interactions. In patients with severe depression, the prevalence of antidepressive (AD) combination treatment has not been thoroughly assessed yet. Methods We assessed the prevalence of antidepressive combination treatment in a sample of hospital patients at the LVR-Clinic in Düsseldorf, Germany in 2012. Results 1.198 residential or semi-residential patients were diagnosed with severe depressive episode and were treated with at least one antidepressant. 25.1 % of those received a combination of at least two antidepressants. The most frequent combination approaches were tri- and tetracyclic AD with selective serotonin reuptake inhibitors (SSRI) yet various other combination approaches were observed. Conclusions Combination treatment is a common strategy. Future trends could be monitored via electronic prescription software, yet prospective confirmatory trials are needed to assess the rationale of different combination treatment approaches. © Georg Thieme Verlag KG Stuttgart · New York.

  12. Is video gaming, or video game addiction, associated with depression, academic achievement, heavy episodic drinking, or conduct problems?

    PubMed

    Brunborg, Geir Scott; Mentzoni, Rune Aune; Frøyland, Lars Roar

    2014-03-01

    While the relationships between video game use and negative consequences are debated, the relationships between video game addiction and negative consequences are fairly well established. However, previous studies suffer from methodological weaknesses that may have caused biased results. There is need for further investigation that benefits from the use of methods that avoid omitted variable bias. Two wave panel data was used from two surveys of 1,928 Norwegian adolescents aged 13 to 17 years. The surveys included measures of video game use, video game addiction, depression, heavy episodic drinking, academic achievement, and conduct problems. The data was analyzed using first-differencing, a regression method that is unbiased by time invariant individual factors. Video game addiction was related to depression, lower academic achievement, and conduct problems, but time spent on video games was not related to any of the studied negative outcomes. The findings were in line with a growing number of studies that have failed to find relationships between time spent on video games and negative outcomes. The current study is also consistent with previous studies in that video game addiction was related to other negative outcomes, but it made the added contribution that the relationships are unbiased by time invariant individual effects. However, future research should aim at establishing the temporal order of the supposed causal effects. Spending time playing video games does not involve negative consequences, but adolescents who experience problems related to video games are likely to also experience problems in other facets of life.

  13. Migraine generator network and spreading depression dynamics as neuromodulation targets in episodic migraine

    NASA Astrophysics Data System (ADS)

    Dahlem, Markus A.

    2013-12-01

    Migraine is a common disabling headache disorder characterized by recurrent episodes sometimes preceded or accompanied by focal neurological symptoms called aura. The relation between two subtypes, migraine without aura (MWoA) and migraine with aura (MWA), is explored with the aim to identify targets for neuromodulation techniques. To this end, a dynamically regulated control system is schematically reduced to a network of the trigeminal nerve, which innervates the cranial circulation, an associated descending modulatory network of brainstem nuclei, and parasympathetic vasomotor efferents. This extends the idea of a migraine generator region in the brainstem to a larger network and is still simple and explicit enough to open up possibilities for mathematical modeling in the future. In this study, it is suggested that the migraine generator network (MGN) is driven and may therefore respond differently to different spatio-temporal noxious input in the migraine subtypes MWA and MWoA. The noxious input is caused by a cortical perturbation of homeostasis, known as spreading depression (SD). The MGN might even trigger SD in the first place by a failure in vasomotor control. As a consequence, migraine is considered as an inherently dynamical disease to which a linear course from upstream to downstream events would not do justice. Minimally invasive and noninvasive neuromodulation techniques are briefly reviewed and their rational is discussed in the context of the proposed mechanism.

  14. The association between suicide risk and self-esteem in Japanese university students with major depressive episodes of major depressive disorder

    PubMed Central

    Mitsui, Nobuyuki; Asakura, Satoshi; Shimizu, Yusuke; Fujii, Yutaka; Toyomaki, Atsuhito; Kako, Yuki; Tanaka, Teruaki; Kitagawa, Nobuki; Inoue, Takeshi; Kusumi, Ichiro

    2014-01-01

    Background The suicide risk among young adults is related to multiple factors; therefore, it is difficult to predict and prevent suicidal behavior. Aim We conducted the present study to reveal the most important factors relating to suicidal ideation in Japanese university students with major depressive episodes (MDEs) of major depressive disorder (MDD). Methods The subjects were 30 Japanese university students who had MDEs of MDD, and were aged between 18 and 26 years old. They were divided into two groups – without suicide risk group (n=15), and with suicide risk group (n=15) – based on the results of the Mini-International Neuropsychiatric Interview. Additionally, healthy controls were recruited from the same population (n=15). All subjects completed the self-assessment scales including the Beck Depression Inventory 2nd edition (BDI-II), the Beck Hopelessness Scale (BHS), Rosenberg’s Self-Esteem Scale (RSES), and SF-36v2™ (The Medical Outcomes Study 36-item short-form health survey version 2), and they were all administered a battery of neuropsychological tests. Results The RSES score of the suicide risk group was significantly lower than the RSES score of the without suicide risk group, whereas the BDI-II score and the BHS score were not significantly different between the two groups. The mean social functioning score on the SF-36v2 of the with suicide risk group was significantly lower than that of the without suicide risk group. Conclusion The individual’s self-esteem and social functioning may play an important role in suicide risk among young adults with MDEs of MDD. PMID:24868158

  15. Transcranial direct current stimulation for acute major depressive episodes: meta-analysis of individual patient data

    PubMed Central

    Brunoni, André R.; Moffa, Adriano H.; Fregni, Felipe; Palm, Ulrich; Padberg, Frank; Blumberger, Daniel M.; Daskalakis, Zafiris J.; Bennabi, Djamila; Haffen, Emmanuel; Alonzo, Angelo; Loo, Colleen K.

    2016-01-01

    Background Transcranial direct current stimulation (tDCS) is a non-pharmacological intervention for depression. It has mixed results, possibly caused by study heterogeneity. Aims To assess tDCS efficacy and to explore individual response predictors. Method Systematic review and individual patient data meta-analysis. Results Data were gathered from six randomised sham-controlled trials, enrolling 289 patients. Active tDCS was significantly superior to sham for response (34% v. 19% respectively, odds ratio (OR) = 2.44, 95% CI 1.38–4.32, number needed to treat (NNT) = 7), remission (23.1% v. 12.7% respectively, OR = 2.38, 95% CI 1.22–4.64, NNT = 9) and depression improvement (B coefficient 0.35, 95% CI 0.12–0.57). Mixed-effects models showed that, after adjustment for other predictors and confounders, treatment-resistant depression and higher tDCS ‘doses’ were, respectively, negatively and positively associated with tDCS efficacy. Conclusions The effect size of tDCS treatment was comparable with those reported for repetitive transcranial magnetic stimulation and antidepressant drug treatment in primary care. The most important parameters for optimisation in future trials are depression refractoriness and tDCS dose. PMID:27056623

  16. The volumetric and shape changes of the putamen and thalamus in first episode, untreated major depressive disorder.

    PubMed

    Lu, Yi; Liang, Hongmin; Han, Dan; Mo, Yin; Li, Zongfang; Cheng, Yuqi; Xu, Xiufeng; Shen, Zonglin; Tan, Chunyan; Zhao, Wei; Zhu, Yun; Sun, Xuejin

    2016-01-01

    Previous MRI studies confirmed abnormalities in the limbic-cortical-striatal-pallidal-thalamic (LCSPT) network or limbic-cortico-striatal-thalamic-cortical (LCSTC) circuits in patients with major depressive disorder (MDD), but few studies have investigated the subcortical structural abnormalities. Therefore, we sought to determine whether focal subcortical grey matter (GM) changes might be present in MDD at an early stage. We recruited 30 first episode, untreated patients with major depressive disorder (MDD) and 26 healthy control subjects. Voxel-based morphometry was used to evaluate cortical grey matter changes, and automated volumetric and shape analyses were used to assess volume and shape changes of the subcortical GM structures, respectively. In addition, probabilistic tractography methods were used to demonstrate the relationship between the subcortical and the cortical GM. Compared to healthy controls, MDD patients had significant volume reductions in the bilateral putamen and left thalamus (FWE-corrected, p < 0.05). Meanwhile, the vertex-based shape analysis showed regionally contracted areas on the dorsolateral and ventromedial aspects of the bilateral putamen, and on the dorsal and ventral aspects of left thalamus in MDD patients (FWE-corrected, p < 0.05). Additionally, a negative correlation was found between local atrophy in the dorsal aspects of the left thalamus and clinical variables representing severity. Furthermore, probabilistic tractography demonstrated that the area of shape deformation of the bilateral putamen and left thalamus have connections with the frontal and temporal lobes, which were found to be related to major depression. Our results suggested that structural abnormalities in the putamen and thalamus might be present in the early stages of MDD, which support the role of subcortical structure in the pathophysiology of MDD. Meanwhile, the present study showed that these subcortical structural abnormalities might be the potential

  17. Lithium increases platelet serine-9 phosphorylated GSK-3β levels in drug-free bipolar disorder during depressive episodes.

    PubMed

    de Sousa, Rafael T; Zanetti, Marcus V; Talib, Leda L; Serpa, Mauricio H; Chaim, Tiffany M; Carvalho, Andre F; Brunoni, Andre R; Busatto, Geraldo F; Gattaz, Wagner F; Machado-Vieira, Rodrigo

    2015-03-01

    Glycogen synthase kinase-3 β (GSK3β) is an intracellular enzyme directly implicated in several neural processes relevant to bipolar disorder (BD) pathophysiology. GSK3β is also an important target for lithium and antidepressants. When phosphorylated at serine-9, GSK3β becomes inactive. Few studies evaluated serine-9 phosphorylated GSK3β (phospho-GSK3β) levels in BD subjects in vivo and no study has assessed it specifically in bipolar depression. Also, the effect of lithium monotherapy on GSK3β has never been studied in humans. In 27 patients with bipolar depression, total GSK3β and phospho-GSK3β were assessed in platelets by enzyme immunometric assay. Subjects were evaluated before and after 6 weeks of lithium treatment at therapeutic levels. Healthy subjects (n = 22) were used as a control group. No differences in phospho-GSK3β or total GSK3β were observed when comparing drug-free BD subjects in depression and healthy controls. Baseline HAM-D scores were not correlated with phospho-GSK3β and total GSK3β levels. From baseline to endpoint, lithium treatment inactivated GSK3β by significantly increasing phospho-GSK3β levels (p = 0.010). Clinical improvement (baseline HAM-D - endpoint HAM-D) negatively correlated with the increase in phospho-GSK3β (p = 0.03). The present results show that lithium inactivates platelet GSK3β in BD during mood episodes. No direct association with pathophysiology of BD was observed. Further studies are needed to clarify the role of GSK3β as a key biomarker in BD and its association with treatment response as well as the relevance of GSK3β in other neuropsychiatric disorders and as a new therapeutic target per se. Published by Elsevier Ltd.

  18. Temperament and character profiles of Japanese university students with depressive episodes and ideas of suicide or self-harm: a PHQ-9 screening study.

    PubMed

    Mitsui, Nobuyuki; Asakura, Satoshi; Shimizu, Yusuke; Fujii, Yutaka; Kako, Yuki; Tanaka, Teruaki; Oba, Koji; Inoue, Takeshi; Kusumi, Ichiro

    2013-11-01

    The aim of our study was to reveal the personality traits of individuals with major and other depressive episodes among the young adult population. Furthermore, character traits of individuals with ideas of suicide or self-harm were also investigated in this study. The subjects of this study were 1421 university students who completed the Patient Health Questionnaire (PHQ-9) and the Temperament and Character Inventory (TCI). The subjects were divided into three separate groups: the major depressive episode group (N = 41), the other depressive episode group (N = 97), and the non-depressive controls (N = 1283). This separation was achieved using the PHQ-9 algorithm diagnosis. We compared the TCI scores using an analysis of variance. Moreover, the Cochran-Armitage trend test was used to determine the diagnosis, ideas of suicide or self-harm, and analysis of character profiles. The major depressive episode group had significantly higher HA (P < 0.001), lower RD (P < 0.001), lower SD (P < 0.001), and lower C (P < 0.001) scores than non-depressive controls. The other depressive episode group had significantly higher HA scores (P < 0.001) and lower SD scores (P < 0.001) than non-depressive controls. The Cochran-Armitage trend test revealed that the prevalence of depressive episodes decreased as the character profiles matured (χ(2)(trend) = 57.2, P < 0.0001). The same tendency was observed in individuals who had ideas of suicide or self-harm (χ(2)(trend) = 49.3, P < 0.0001). High HA and low SD scores were common personality traits among young adults with major depressive episodes. Furthermore, the immaturity of character profiles was clearly associated with depressive episodes and ideas of suicide or self-harm. Copyright © 2013 Elsevier Inc. All rights reserved.

  19. Gender differences in the treatment of first-episode schizophrenia: Results from the European First Episode Schizophrenia Trial.

    PubMed

    Ceskova, Eva; Prikryl, Radovan; Libiger, Jan; Svancara, Jan; Jarkovsky, Jiri

    2015-12-01

    Gender differences in the response to antipsychotic treatment have been detected in the past, but not studied in great detail. The results of the European First-Episode Schizophrenia Trial (EUFEST) were analyzed with a focus on gender differences in the response to randomized treatment of first-episode schizophrenia. A total of 498 patients (298 men and 200 women) were randomly assigned by a web-based online system to open-label treatment with haloperidol, amisulpride, olanzapine, quetiapine, and ziprasidone. Treatment response was evaluated using the positive and negative syndrome scale (PANSS). Data were collected at baseline and then prospectively for one year. Baseline characteristics (age and proportion of patients assigned to individual antipsychotics) were the same between the male and female patients with the exception of ziprasidone: significantly fewer men, proportionately, were prescribed ziprasidone. There was no significant difference between genders between the initial total PANSS and subscale scores. A significant interaction between time and gender was found, with more robust PPANSS and TPANSS score improvement in women during the course of treatment. Of all of the antipsychotics used, only olanzapine led to significantly greater improvement in the total PANSS score in women during the follow-up period. Gender differences should be given more attention in research and clinical practice. Their causes require clarification, and future strategies for dealing with them may be considered in early intervention programs and guidelines. Copyright © 2015 Elsevier B.V. All rights reserved.

  20. The association between suicide risk and self-esteem in Japanese university students with major depressive episodes of major depressive disorder.

    PubMed

    Mitsui, Nobuyuki; Asakura, Satoshi; Shimizu, Yusuke; Fujii, Yutaka; Toyomaki, Atsuhito; Kako, Yuki; Tanaka, Teruaki; Kitagawa, Nobuki; Inoue, Takeshi; Kusumi, Ichiro

    2014-01-01

    The suicide risk among young adults is related to multiple factors; therefore, it is difficult to predict and prevent suicidal behavior. We conducted the present study to reveal the most important factors relating to suicidal ideation in Japanese university students with major depressive episodes (MDEs) of major depressive disorder (MDD). The subjects were 30 Japanese university students who had MDEs of MDD, and were aged between 18 and 26 years old. They were divided into two groups - without suicide risk group (n=15), and with suicide risk group (n=15) - based on the results of the Mini-International Neuropsychiatric Interview. Additionally, healthy controls were recruited from the same population (n=15). All subjects completed the self-assessment scales including the Beck Depression Inventory 2nd edition (BDI-II), the Beck Hopelessness Scale (BHS), Rosenberg's Self-Esteem Scale (RSES), and SF-36v2™ (The Medical Outcomes Study 36-item short-form health survey version 2), and they were all administered a battery of neuropsychological tests. The RSES score of the suicide risk group was significantly lower than the RSES score of the without suicide risk group, whereas the BDI-II score and the BHS score were not significantly different between the two groups. The mean social functioning score on the SF-36v2 of the with suicide risk group was significantly lower than that of the without suicide risk group. The individual's self-esteem and social functioning may play an important role in suicide risk among young adults with MDEs of MDD.

  1. Comparative study of efficacy of l-5-hydroxytryptophan and fluoxetine in patients presenting with first depressive episode.

    PubMed

    Jangid, Purushottam; Malik, Prerna; Singh, Priti; Sharma, Minakshi; Gulia, Anil Kumar D

    2013-02-01

    Role of l-5-hydroxytryptophan (l-5-HTP) in depression is relatively less studied but the literature has shown its robust role in depression. The present randomized double blind study was undertaken to assess the role of l-5-HTP as an antidepressant and to compare its antidepressant efficacy with fluoxetine in first depressive episode patients of Indian population. A total of 70 patients of first depressive episode, all of whom were diagnosed with ICD-10 criteria, were recruited but only 60 patients completed the study and were randomly divided into two groups, receiving l-5-HTP and fluoxetine, respectively, for a period of 8weeks. All patients were administered Hamilton Rating Scale for Depression (HAM-D) to assess severity of depression at baseline, 2weeks, 4weeks and 8weeks. The efficacy of treatment was assessed by comparing HAM-D scores obtained at these examinations with the baseline examination; final evaluation of both efficacy and tolerance was assessed using the Clinical Global Impression (CGI) scale at the end of study. Both treatment groups showed significant and nearly equal reduction in HAM-D scores beginning at week two and continuing through week eight. Twenty-two patients (73.33%) in the l-5-HTP group and 24 patients (80%) in the fluoxetine group showed positive response at the end of the study. l-5-HTP has definitely got antidepressant effect in patients of depression. Antidepressant effect was seen within 2weeks of treatment and was apparent in all degrees of depression. The therapeutic efficacy of l-5-HTP was considered as equal to that of fluoxetine. Copyright © 2012 Elsevier B.V. All rights reserved.

  2. The subjective experience and phenomenology of depression following first episode psychosis: a qualitative study using photo-elicitation.

    PubMed

    Sandhu, Amrita; Ives, Jonathan; Birchwood, Max; Upthegrove, Rachel

    2013-07-01

    Depression following first episode psychosis (FEP) is a frequent occurrence, with profound impact on recovery and outcome. Whilst many theories exist about the causes of depression here, research to date has been based on nosology imported wholesale from affective disorder, with little primary research on the subjective experience. This study aimed to explore the subjective experience and phenomenological features of post-psychotic depression in FEP. A qualitative methodology, photo-elicitation, together with unstructured interviews, was used to characterise aspects of depression following FEP and analysed using contemporary framework analysis. Depression was reported by participants as linked to the experience of and recovery from psychosis. The psychotic episode was a traumatic event followed by subjective doubt, shame and embarrassment. Loss and social isolation were central. Core biological symptoms did not feature. Despite the relatively small sample size, this study was able to generate in-depth data that provides useful and novel insight. Whilst generalisability is incompatible with qualitative methodology, further research using the same methodology would generate a wider range of experiences and perspectives. Understanding this dimension of psychosis in and of itself has the potential to improve and aid development of more effective and appropriately targeted interventions and associated outcomes. Crown Copyright © 2013. Published by Elsevier B.V. All rights reserved.

  3. What is the role of conventional antidepressants in the treatment of major depressive episodes with Mixed Features Specifier?

    PubMed

    Faedda, Gianni L; Marangoni, Ciro

    2017-04-01

    The newly introduced Mixed Features Specifier of Major Depressive Episode and Disorder (MDE/MDD) is especially challenging in terms of pharmacological management. Prior to the publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, the symptoms of the mixed features specifier were intradepressive hypomanic symptoms, always and only associated with bipolar disorder (BD). Intradepressive hypomanic symptoms, mostly referred to as depressive mixed states (DMX), have been poorly characterized, and their treatment offers significant challenges. To understand the diagnostic context of DMX, we trace the nosological changes and collocation of intradepressive hypomanic symptoms, and examine diagnostic and prognostic implications of such mixed features. One of the reasons so little is known about the treatment of DMX is that depressed patients with rapid cycling, substance abuse disorder, and suicidal ideation/attempts are routinely excluded from clinical trials of antidepressants. The exclusion of DMX patients from clinical trials has prevented an assessment of the safety and tolerability of short- and long-term use of antidepressants. Therefore, the generalization of data obtained in clinical trials for unipolar depression to patients with intradepressive hypomanic features is inappropriate and methodologically flawed. A selective review of the literature shows that antidepressants alone have limited efficacy in DMX, but they have the potential to induce, maintain, or worsen mixed features during depressive episodes in BD. On the other hand, preliminary evidence supports the effective use of some atypical antipsychotics in the treatment of DMX.

  4. Episodic acidification of streams in the northeastern United States: Chemical and biological results of the episodic response project. Final report

    SciTech Connect

    Wigington, P.J.; Baker, J.P.; DeWalle, D.R.; Kretser, W.A.; Murdoch, P.S.

    1993-10-01

    The document is the result of a cooperative research effort involving scientists from several agencies as part of the Aquatic Effects Research Program (AERP) of the U.S. Environmental Protection Agency (EPA). The Episodic Response Project (ERP) is an intensive study conducted at a limited number of sites, rather than an extensive regional study. The three areas targeted by the ERP are the Northern Appalachian Plateau of Pennsylvania, and the Adirondack and Catskill Mountains of New York. Each stream was monitored from fall 1988 through spring 1990, with continuous measurement of discharge and automated water sampling at fixed time intervals or at specified stage level changes. The water samples underwent chemical analysis for acid neutralizing capacity (ANC), pH, total dissolved aluminum, dissolved organic carbon (DOC), sulfate, nitrate, chloride, calcium, magnesium, potassium, and sodium. Furthermore, a subset of samples were analyzed for inorganic aluminum. Specific streams, participating institutions and cooperators, methods, and results are presented in the report.

  5. Serum Brain-Derived Neurotrophic Factors in Taiwanese Patients with Drug-Naïve First-Episode Major Depressive Disorder: Effects of Antidepressants.

    PubMed

    Chiou, Yu-Jie; Huang, Tiao-Lai

    2016-11-17

    Brain-derived neurotrophic factors are known to be related to the psychopathology of major depressive disorder. However, studies focusing on drug-naïve first-episode patients are still rare. Over a 6-year period, we examined the serum brain-derived neurotrophic factors levels in patients with first-episode drug-naïve major depressive disorder and compared them with sex-matched healthy controls. We also investigated the relationships between serum brain-derived neurotrophic factors levels, suicidal behavior, and Hamilton Depression Rating Scale scores before and after a 4-week antidepressant treatment. The baseline serum brain-derived neurotrophic factors levels of 71 patients were significantly lower than those of the controls (P=.017), and the Hamilton Depression Rating Scale scores in 71 patients did not correlate with brain-derived neurotrophic factor levels. Brain-derived neurotrophic factor levels were significantly lower in 13 suicidal major depressive disorder patients than in 58 nonsuicidal major depressive disorder patients (P=.038). Among 41 followed-up patients, there was no alteration in serum brain-derived neurotrophic factors levels after treatment with antidepressants (P=.126). In receiver operating characteristic curve analysis of using pretreatment brain-derived neurotrophic factors to estimate the response to treatment, the area under the curve was 0.684. The most suitable cut-off point was 6.1 ng/mL (sensitivity=78.6%, specificity = 53.8%). Our data support the serum brain-derived neurotrophic factor levels in patients with drug-naïve first-episode major depressive disorder were lower than those in the healthy controls, and patients with pretreatment brain-derived neurotrophic factors >6.1 ng/mL were more likely to be responders. Although the relationship of our results to the mechanism of drug action and pathophysiology of depression remains unclear, the measure may have potential use as a predictor of response to treatment. In the future

  6. [Management of a first depressive episode in the primary care setting. Use of antidepressants and referrals].

    PubMed

    López-Lanza, J R; Villa Puente, M; Lopez Videras, R; Arribas, I; Pandiella, M J; Sineiro, E

    2016-03-01

    The majority of patients who have a first depressive episode are treated by Primary Care physicians. The aim of this study was to evaluate the use of antidepressants and referrals to mental health and the treatment modifications made by psychiatrists. A descriptive, retrospective study was conducted on patients from 64 Primary Care clinics, distributed in five Spanish provinces. The clinical history data, regarding use of antidepressants, criteria for referral, and response of psychiatric services were evaluated from June 2008 to June 2011. The study included 324 patients. The most commonly prescribed medication was escitalopram, with selective serotonin reuptake inhibitors (SSRI) making up 73.5% of the total. More than two-thirds (69.7%) of the patients were on treatment for at least 6 months, with no reason recorded for the 40.4% drop-outs. A large majority of professionals (76.9%) wait at least 3 weeks before modifying the medication, especially changing antidepressant. The Primary Care physicians referred 39.2% of patients to psychiatry, although much of these referrals (43.9%) had no justification. There was a lower referral rate to psychology (23.1%). An antidepressant was given to a large number of patients on multiple medications, without taking into account the risk of interactions in a high percentage. The Primary Care physician appropriately uses the antidepressants of the first choice, but does not pay attention to the risks in complex patients. There must be an appropriate duration of treatment and an improvement of the criteria for referral to mental health services. Copyright © 2014 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  7. Prevalence and predictors of bipolar disorders in patients with a major depressive episode: the Japanese epidemiological trial with latest measure of bipolar disorder (JET-LMBP).

    PubMed

    Inoue, Takeshi; Inagaki, Yoshifumi; Kimura, Toshifumi; Shirakawa, Osamu

    2015-03-15

    For patients with a major depressive episode, early differential diagnosis of bipolar disorder and subsequent appropriate treatment are critical. This study, conducted in clinical settings in Japan, examined patients with a major depressive episode to investigate the prevalence and predictors of bipolar disorders. A total of 448 patients with a major depressive episode were interviewed using the Mini-International Neuropsychiatric Interview to determine the presence of mood episodes and psychiatric comorbidities. The diagnosis of bipolar disorder was based on the collected information according to the DSM-IV-TR. Of the 448 patients with a major depressive episode, 114 patients (25.4%) were diagnosed with bipolar disorder. Multivariate logistic regression identified five predictors that were significantly correlated with bipolar disorder: antidepressant-related switch to mania/hypomania, mixed depression, two or more previous mood episodes within the past year, early age at the onset of a major depressive episode (<25 years), and a history of suicide attempts. The area under the curve of receiver operating characteristic analysis based on the multivariate logistic regression of the five predictors was 0.849. The diagnosis of bipolar disorder in patients was already conclusively confirmed by long illness observations but was not confirmed by a prospective study. In patients with a major depressive episode, the differential diagnosis of bipolar disorder and major depressive disorder, which exhibit similar depressive symptoms, is essential. Several predictors identified in the present study may be useful in supporting a differential diagnosis of these disorders in routine clinical practice. Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.

  8. Is video gaming, or video game addiction, associated with depression, academic achievement, heavy episodic drinking, or conduct problems?

    PubMed Central

    Brunborg, Geir Scott; Mentzoni, Rune Aune; Frøyland, Lars Roar

    2014-01-01

    Background and aims: While the relationships between video game use and negative consequences are debated, the relationships between video game addiction and negative consequences are fairly well established. However, previous studies suffer from methodological weaknesses that may have caused biased results. There is need for further investigation that benefits from the use of methods that avoid omitted variable bias. Methods: Two wave panel data was used from two surveys of 1,928 Norwegian adolescents aged 13 to 17 years. The surveys included measures of video game use, video game addiction, depression, heavy episodic drinking, academic achievement, and conduct problems. The data was analyzed using first-differencing, a regression method that is unbiased by time invariant individual factors. Results: Video game addiction was related to depression, lower academic achievement, and conduct problems, but time spent on video games was not related to any of the studied negative outcomes. Discussion: The findings were in line with a growing number of studies that have failed to find relationships between time spent on video games and negative outcomes. The current study is also consistent with previous studies in that video game addiction was related to other negative outcomes, but it made the added contribution that the relationships are unbiased by time invariant individual effects. However, future research should aim at establishing the temporal order of the supposed causal effects. Conclusions: Spending time playing video games does not involve negative consequences, but adolescents who experience problems related to video games are likely to also experience problems in other facets of life. PMID:25215212

  9. Frequency of bipolar affective disorder in patients with major depressive episode with or without psychiatric co-morbid disorders.

    PubMed

    Kučukalić, Abdulah; Bravo-Mehmedbašić, Alma; Kulenović, Alma Džubur

    2012-10-01

    Epidemiological studies indicate that only 20% of patients with Bipolar Affective Disorder are diagnosed on time while in 35% of patients diagnosis is 10 years late. Unipolar depression represents the most frequent misdiagnosis. The aim of this study was to determine the frequency of BAD in subjects diagnosed with Major Depressive Episode with or without co-morbid disorders. The study was a part of a large international, multi-center, non-interventional study that was conducted in 14 countries between May and November 2008. Sample in Bosnia and Herzegovina included 200 adult subjects with MDE according to the DSM IV diagnostic criteria who consented to take part in the study, who did not exhibit symptoms of acute somatic condition at the time, and who were capable of filling the HCL-32 checklist. The following assessment instruments were used: CRF (Case Report Form) that includes general psychiatric assessment, GAF (Global Assessment of Functioning) and HCL-32 (Hypomania Symptom Checklist). Bipolar Affective Disorder was diagnosed in 67.84% of the study subjects, and MDE in 32.16%. At least one co-morbid psychiatric disorder was present in 77.78% of subjects with BAD and in 22.22% of subjects with MDE. Anxiety disorders co-morbidity was present in 61.9% of subjects with BAD and in 38.10% of subjects with MDE. Our results confirm previous research about underdiagnosing of BAD. This has unforeseen consequences on the course and prognosis of the disorder significantly affecting quality of life of the patients.

  10. [Are intravenous immunoglobulins useful in severe episodes of autoimmune hemolytic anemia?: Comparative results in 21 episodes from a single centre].

    PubMed

    Gil-Fernández, Juan José; Flores Ballester, Elena; González Martínez, María; Arévalo-Serrano, Juan; Tamayo Martín, Ana Teresa; Burgaleta Alonso de Ozalla, Carmen

    2013-09-07

    To analyze haemolytic episodes in patients with warm antibody autoimmune haemolytic anemia (AIHA) and compare corticosteroids treatment with intravenous immunoglobulins (IVIG) (group A) or without IVIG (group B). Observational study that includes 21 haemolytic episodes occurred in 17 patients (9 males and 12 females), with a median age of 59 years (26-82). In group A, 8 episodes received IGIV + corticosteroids and in group B, 12 episodes received only corticosteroids and one rituximab. Hemoglobin (Hb) value at diagnosis was 1.8 g/dl lower (95% confidence interval: 0.6 to 3.1; P = .007) in group A, with a median Hb of 6.3g/dl in this group vs 7.9 g/dl in group B. There were non-significant differences in red blood cells transfusion (50 vs 23%; P > .20) and global increase of Hb values (7.3 vs 5.6; P > .20). Overall hematological responses were similar: 88 vs 92% (P > .20). Hematological response achieved in more severe episodes with the use of IVIG was similar to non-severe episodes treated without IVIG. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  11. Associations Between Compulsive Buying and Substance Dependence/Abuse, Major Depressive Episode, and Generalized Anxiety Disorder Among Men and Women

    PubMed Central

    Zhang, Chenshu; Brook, Judith S.; Leukefeld, Carl G.; Brook, David W.

    2016-01-01

    Aims The objective of this study was to examine the associations between compulsive buying (CB) and substance dependence/abuse, major depressive episode (MDE), and generalized anxiety disorder (GAD) at mean age 43. Methods Participants came from a community-based random sample of residents in two New York counties (N=548). The participants were followed from adolescence to early midlife. The mean age of participants at the most recent interview was 43.0 (SD=2.8). Fifty five percent of the participants were females. Over 90% of the participants were white. The prevalence of substance dependence/abuse, MDE, and GAD (during the past 5 years before the interviews) was 6.6%, 13.7, and 11.5%, respectively. Results Logistic regression analyses showed that CB was significantly associated with substance dependence/abuse [Adjusted Odds Ratio (A.O.R.) = 1.60], MDE (A.O.R. = 1.70), and GAD (A.O.R. = 1.63), despite controlling for substance dependence/abuse, MDE, and GAD, respectively, at mean age 37, and demographic factors. Discussion Since the study sample is limited to predominantly white participants (over 90%) with a close association to a small geographic area, the findings may not be generalizable to racial/ethnic minority groups or individuals living in other parts of the country. Nevertheless, it is important that clinicians treating substance dependence/abuse, MDE, and GAD consider the role of CB. PMID:27215919

  12. A New Empirical Definition of Major Depressive Episode Recovery and Its Positive Impact on Future Course of Illness.

    PubMed

    Judd, Lewis L; Schettler, Pamela J; Rush, A John; Coryell, William H; Fiedorowicz, Jess G; Solomon, David A

    2016-08-01

    To provide the first head-to-head test of the predictive validity of 2 resolution levels included in the current consensus definition of major depressive episode (MDE) recovery and provide an empirically based, clinically useful definition of the end of an MDE. 322 participants entering the National Institute of Mental Health Collaborative Depression Study with MDE (diagnosed by Research Diagnostic Criteria) in 1978-1981, and followed thereafter for up to 31 years, were divided into those with 8 consecutive weeks of asymptomatic MDE recovery or residual subsyndromal depressive symptom (SSD) resolution of their index MDE. These 2 levels of recovery were defined based on weekly symptom status on all depressive conditions, assessed by Longitudinal Interval Follow-Up Evaluation (LIFE) interviews conducted every 6 months. Primary measures of validity of these 2 alternative definitions were first well interval duration and long-term depressive illness burden. Groups were also compared on clinical variables, antidepressant treatment, and psychosocial function. 61.2% of subjects recovered asymptomatically from their index MDE. By survival analysis, they remained free of a depressive episode relapse or recurrence 4.2 times longer than those with SSD resolution (median = 135 vs 32 weeks; χ² = 70.65; P < .0001). This was not attributable to a difference in intensity of antidepressant medication. Compared to asymptomatic recovery, SSD resolution was associated with significantly longer and more severe index MDEs, with more miscellaneous psychopathology as well as increased long-term psychosocial dysfunction and a greater depressive illness burden during the ensuing 10 or 20 years. Asymptomatic MDE resolution was a stronger predictor of time well than any of 18 other predictors, singly or combined. Eight consecutive weeks of asymptomatic recovery had 93% overlap with a 4-week definition and conferred little benefit over 4 weeks. Four consecutive weeks of asymptomatic recovery

  13. First episode drug-naïve major depressive disorder with panic disorder: gray matter deficits in limbic and default network structures.

    PubMed

    Lai, Chien-Han; Hsu, Yuan-Yu; Wu, Yu-Te

    2010-10-01

    This study was designed to investigate the structural differences in the brains of first episode, drug-naïve patients with major depressive disorder and panic disorder versus healthy control subjects. High-resolution brain magnetic resonance images were performed on patients and health control subjects (age, sex and handedness matched). Structural magnetic resonance images of brain were estimated by optimized voxel-based morphometry of FSL (FMRIB Software Library). Patients had deficits of gray matter volumes over right anterior cingulate cortex, right medial frontal gyrus, left posterior cingulate cortex, right parahippocampal gyrus, limbic areas, occipital lingual gyrus and bilateral cerebellums when compared to controls. These results suggested that this group of patients has possible deficits of gray matter volumes over the default-mode network, fronto-cingulate and limbic structures. The decline of gray matter volumes might have started since the first episode. Copyright 2010 Elsevier B.V. and ECNP. All rights reserved.

  14. [Integral Care Guide for Early Detection and Diagnosis of Depressive Episodes and Recurrent Depressive Disorder in Adults. Integral Attention of Adults with a Diagnosis of Depressive Episodes and Recurrent Depressive Disorder: Part II: General Aspects of Treatment, Management of the Acute Phase, Continuation and Maintenance of Patients with a Depression Diagnosis].

    PubMed

    Peñaranda, Adriana Patricia Bohórquez; Valencia, Jenny García; Guarín, Maritza Rodríguez; Borrero, Álvaro Enrique Arenas; Díaz, Sergio Mario Castro; de la Hoz Bradford, Ana María; Riveros, Patricia Maldonado; Jaramillo, Luis Eduardo; Brito, Enrique; Acosta, Carlos Alberto Palacio; Pedraza, Ricardo Sánchez; González-Pacheco, Juan; Gómez-Restrepo, Carlos

    2012-12-01

    This article presents recommendations based on evidence gathered to answer a series of clinical questions concerning the depressive episode and the recurrent depressive disorder, with emphasis on general treatment aspects, treatment in the acute phase and management of the continuation/maintenance, all intended to grant health care parameters based on the best and more updated available evidence for achieving minimum quality standards with adult patients thus diagnosed. A practical clinical guide was elaborated according to standards of the Methodological Guide of the Ministry of Social Protection. Recommendation from NICE90 and CANMAT guides were adopted and updated so as to answer the questions posed while de novo questions were developed. Recommendations 5-22 corresponding to management of depression are presented. Copyright © 2012 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  15. Modeling Neural Immune Signaling of Episodic and Chronic Migraine Using Spreading Depression In Vitro

    PubMed Central

    Mitchell, Heidi M.; Kraig, Richard P.

    2011-01-01

    Migraine and its transformation to chronic migraine are healthcare burdens in need of improved treatment options. We seek to define how neural immune signaling modulates the susceptibility to migraine, modeled in vitro using spreading depression (SD), as a means to develop novel therapeutic targets for episodic and chronic migraine. SD is the likely cause of migraine aura and migraine pain. It is a paroxysmal loss of neuronal function triggered by initially increased neuronal activity, which slowly propagates within susceptible brain regions. Normal brain function is exquisitely sensitive to, and relies on, coincident low-level immune signaling. Thus, neural immune signaling likely affects electrical activity of SD, and therefore migraine. Pain perception studies of SD in whole animals are fraught with difficulties, but whole animals are well suited to examine systems biology aspects of migraine since SD activates trigeminal nociceptive pathways. However, whole animal studies alone cannot be used to decipher the cellular and neural circuit mechanisms of SD. Instead, in vitro preparations where environmental conditions can be controlled are necessary. Here, it is important to recognize limitations of acute slices and distinct advantages of hippocampal slice cultures. Acute brain slices cannot reveal subtle changes in immune signaling since preparing the slices alone triggers: pro-inflammatory changes that last days, epileptiform behavior due to high levels of oxygen tension needed to vitalize the slices, and irreversible cell injury at anoxic slice centers. In contrast, we examine immune signaling in mature hippocampal slice cultures since the cultures closely parallel their in vivo counterpart with mature trisynaptic function; show quiescent astrocytes, microglia, and cytokine levels; and SD is easily induced in an unanesthetized preparation. Furthermore, the slices are long-lived and SD can be induced on consecutive days without injury, making this preparation the

  16. Results from a trial of an unsupported internet intervention for depressive symptoms

    PubMed Central

    Leykin, Yan; Muñoz, Ricardo F.; Contreras, Omar; Latham, Melissa D.

    2014-01-01

    Internet interventions provide an option for those who either cannot or choose not to engage with traditional treatments. Most research on internet interventions involves guided or supported interventions. However, unsupported interventions offer considerably more scalability and cost-effectiveness, which makes them attractive for large-scale implementation. In this study, 309 participants recruited via Google AdWords entered an unsupported cognitive-behavioral internet intervention for depressive symptoms. To maximize the ecological validity of the study, participants received no incentives or live contact with study personnel. Furthermore, the study was open to individuals at any level of depressive symptoms, and all participants received the active intervention. The main outcome measures were depressive symptom level and self-efficacy in managing depressive symptoms. At follow-up, depression scores were significantly lower than baseline scores at each follow-up point (1, 2, 4, and 7 months), with pre-post effect sizes ranging from medium to large. Follow-up depression self-efficacy scores were significantly higher than baseline scores at each follow-up point, with pre-post effect sizes in the medium range. The results remained significant when analyzing only participants with depression scores indicative of a presence of a major depressive episode; results likewise remained significant when employing the conservative last observation carried forward convention, even in the presence of high attrition observed in this study. The results illustrate the potential of unsupported internet intervention to address the health needs of the global community. PMID:25485233

  17. Increased frequency of first-episode poststroke depression after discontinuation of escitalopram.

    PubMed

    Mikami, Katsunaka; Jorge, Ricardo E; Moser, David J; Arndt, Stephan; Jang, Mijin; Solodkin, Ana; Small, Steven L; Fonzetti, Pasquale; Hegel, Mark T; Robinson, Robert G

    2011-11-01

    The purpose of this study was to compare escitalopram, problem-solving therapy, and placebo to prevent poststroke depression during 6 months after discontinuation of treatment. We examined for depression 33 patients assigned to placebo, 34 to escitalopram, and 41 to problem-solving therapy. After controlling for age, gender, prior mood disorder, and severity of stroke, new-onset major depression and Hamilton Depression scores were significantly higher 6 months after escitalopram was discontinued compared with the problem-solving therapy or placebo groups. Discontinuation of escitalopram may increase poststroke depressive symptoms.

  18. Motivational deficits in effort-based decision making in individuals with subsyndromal depression, first-episode and remitted depression patients.

    PubMed

    Yang, Xin-Hua; Huang, Jia; Zhu, Cui-Ying; Wang, Ye-Fei; Cheung, Eric F C; Chan, Raymond C K; Xie, Guang-Rong

    2014-12-30

    Anhedonia is a hallmark symptom of major depressive disorder (MDD). Preliminary findings suggest that anhedonia is characterized by reduced reward anticipation and motivation of obtaining reward. However, relatively little is known about reward-based decision-making in depression. We tested the hypothesis that anhedonia in MDD may reflect specific impairments in motivation on reward-based decision-making and the deficits might be associated with depressive symptoms severity. In study 1, individuals with and without depressive symptoms performed the modified version of the Effort Expenditure for Rewards Task (EEfRT), a behavioral measure of cost/benefit decision-making. In study 2, MDD patients, remitted MDD patients and healthy controls were recruited for the same procedures. We found evidence for decreased willingness to make effort for rewards among individuals with subsyndromal depression; the effect was amplified in MDD patients, but dissipated in patients with remitted depression. We also found that reduced anticipatory and consummatory pleasure predicted decreased willingness to expend efforts to obtain rewards in MDD patients. For individuals with subsyndromal depression, the impairments were correlated with anticipatory anhedonia but not consummatory anhedonia. These data offer novel evidence that motivational deficits in MDD are correlated with depression severity and predicted by self-reported anhedonia.

  19. Clinical features of and risk factors for major depression with history of postpartum episodes in Han Chinese women: A retrospective study.

    PubMed

    Yang, Fuzhong; Gardner, Charles O; Bigdeli, Tim; Gao, Jingfang; Zhang, Zhen; Tao, Ming; Liu, Ying; Li, Youhui; Wang, Gang; Shi, Jianguo; Gao, Chengge; Zhang, Kerang; Li, Kan; Wang, Xumei; Liu, Lanfen; Sun, Jing; Du, Bo; Shi, Shenxun; Zhang, Jingbei; Wu, Wenyuan; Wang, Xueyi; Shen, Jianhua; Liu, Tiebang; Gu, Danhua; Liang, Wei; Deng, Hong; Pan, Jiyang; Yang, Lijun; Jian, Hu; Jiang, Guoqin; Meng, Huaqing; Miao, Guodong; Li, Yi; Hu, Chunmei; Huang, Guoping; Zhang, Yutang; Chen, Yunchun; Ha, Baowei; Gao, Shu; Fang, Xiang; Mei, Qiyi; Hong, Xiaohong; Yang, Donglin; Liu, Tieqiao; Fengyu, Yu; Zhong, Hui; Sang, Hong; Chen, Guibing; Cai, Min; Song, Yan; Dong, Jicheng; Shen, Zhenmin; Zhang, Wei; Wang, Xiaoping; Pan, Runde; Liu, Xiaojuan; Li, Yi; Liu, Zhengrong; Zhang, Qiwen; Li, Gongying; Flint, Jonathan; Kendler, Kenneth S

    2015-09-01

    We sought to investigate the clinical features of and risk factors for recurrent major depression (MD) with history of postpartum episodes (PPD) in Han Chinese women and the differences between first-onset postpartum MD (MD that has its first lifetime depressive episode in the postpartum period) and first-onset non-postpartum MD (MD with history of PPD and has its first lifetime depressive episode in a period other than postpartum). Data were derived from the China, Oxford and Virginia Commonwealth University Experimental Research on Genetic Epidemiology (CONVERGE) study (N=6017 cases) and analyzed in two steps. We first examined the clinical features of and risk factors for MD patients with (N=981) or without (N=4410) a history of PPD. We then compared the differences between first-onset postpartum MD (N=583) and first-onset non-postpartum MD (N=398) in those with a history of PPD. Linear, logistic and multinomial logistic models were employed to measure the associations. A history of PPD was associated with more guilt feelings, greater psychiatric comorbidity, higher neuroticism, earlier onset and more chronicity (OR 0.2-2.8). Severe premenstrual symptoms (PMS) and more childbirths increased the risk of PPD, as did a family history of MD, childhood sexual abuse, stressful life events and lack of social support (OR 1.1-1.3). In the MD with history of PPD subsample, first-onset postpartum MD was associated with fewer recurrent major depressive episodes, less psychiatric comorbidity, lower neuroticism, less severe PMS and fewer disagreements with their husbands (OR 0.5-0.8), but more childbirths (OR 1.2). Data were obtained retrospectively through interview and recall bias may have affected the results. MD with history of PPD in Han Chinese women is typically chronic and severe, with particular risk factors including severe PMS and more childbirths. First-onset postpartum MD and first-onset non-postpartum MD can be partly differentiated by their clinical features

  20. Occupations and the prevalence of major depressive episode in the National Survey on Drug Use and Health.

    PubMed

    Woodward, Albert; Lipari, Rachel; Eaton, William

    2017-06-01

    This study explores the relationship of occupations to major depressive episode (MDE). National Survey on Drug Use and Health (NSDUH) data from the civilian noninstitutionalized United States population are analyzed regarding mental illnesses, employment, and specific occupations and industries. This analysis uses combined 2005 to 2014 NSDUH data, comprising a sample of 433,000 adults aged 18 to 64 years old, of whom 22,700 were both employed and had experienced an MDE in the past year. The findings focus on 30 occupations with the highest prevalence of MDE (greater than 9.0%). There is no simple overarching concept that describes these occupations, although common factors suggest hypotheses about the relationship of occupation to depression. The findings suggest the possibility of prioritizing available preventive and treatment interventions to occupational settings with the highest prevalence of MDE. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  1. Cortical thickness, cortical and subcortical volume, and white matter integrity in patients with their first episode of major depression.

    PubMed

    Han, Kyu-Man; Choi, Sunyoung; Jung, Jeyoung; Na, Kyoung-Sae; Yoon, Ho-Kyoung; Lee, Min-Soo; Ham, Byung-Joo

    2014-02-01

    The uncertainty over the true morphological changes in brains with major depressive disorder (MDD) underlines the necessity of comprehensive studies with multimodal structural brain imaging analyses. This study aimed to evaluate the differences in cortical thickness, cortical and subcortical volume, and white matter integrity between first episode, medication-naïve MDD patients and healthy controls. Subjects with their first episode of MDD whose illness duration had not exceeded 6 months (n=20) were enrolled in this study and were compared to age-, sex-, and education level-matched healthy controls (n=22). All participants were subjected to T1-weighted structural magnetic resonance imaging (MRI). We used an automated procedure of FreeSurfer and Tract-based spatial statistics (TBSS) to analyze differences in cortical thickness, cortical and subcortical volume, and white matter integrity between two groups. The patients with first episode MDD exhibited significantly reduced cortical volume in the caudal anterior cingulate gyrus (P<0.0015) compared to healthy controls. We also observed altered white matter integrity in the body of the corpus callosum (P<0.01), reduced cortical volume of the caudal middle frontal gyrus and medial orbitofrontal gyrus, and enlarged hippocampal volume in the first episode MDD patients. We relied on a relatively small sample size and cortical volume reduction in several brain regions was not replicated in the analysis of cortical thickness. Using multimodal imaging analyses on medication-naïve first episode MDD patients, we demonstrated fundamental structural alteration of brain gray and white matter, such as reduced cortical volume of the caudal ACC and white matter integrity in the body of the corpus callosum. © 2013 The Authors. Published by Elsevier B.V. All rights reserved.

  2. The level of recognition of physical symptoms in patients with a major depression episode in the outpatient psychiatric practice in Puerto Rico: An observational study

    PubMed Central

    Tamayo, Jorge M; Román, Karis; Fumero, Juan J; Rivas, María

    2005-01-01

    Background This study was designed to evaluate the psychiatrists' level of recognition of somatic symptoms associated to a major depressive episode (MDE) (DSM-IV-TR criteria) and the impact of those somatic symptoms on the treatment effectiveness. Methods This non-interventional study was conducted in 25 medical offices in Puerto Rico from February to December 2003. It had 2 visits separated by 8 weeks. The level of recognition was determined by: the correlation between the physician clinical evaluation and their patients' self-evaluations through different validated instruments using kappa statistics. Chi-square test was used to evaluate the impact of somatic symptoms on treatment antidepressants' effectiveness. Results All the 145 recruited patients reported the presence of at least one somatic symptom associated with their current MDE. In the two visits covered by the study, a fair agreement between the psychiatrists' and the patients' reports was noted for headache, abdominal pain and upper limb pains (0.4003 ≤ κ ≥ 0.6594). For other painful symptoms and painless somatic symptoms, the Kappa values obtained were non-significant. Slight but significant reductions in depression and painful symptoms severity were observed after 8 weeks of treatment. A proportional relationship between the pain and depression severity was observed (p < 0.0001). Conclusion The study results show that somatic symptoms: are very common in depressed Puerto Rican patients; are significant under-reported by psychiatrists; and have a significant impact on the antidepressant effectiveness. PMID:15967039

  3. Episodic Visual Learning/Memory and Attentional Flexibility in Patients With Major Depressive Disorder After Clinically Effective Electroconvulsive Therapy.

    PubMed

    Kalogerakou, Stamatina; Oulis, Panagiotis; Anyfandi, Eleni; Konstantakopoulos, George; Papakosta, Vasiliki-Maria; Kontis, Dimitrios; Theochari, Eirini; Angelopoulos, Elias; Zervas, Ioannis M; Mellon, Robert C; Papageorgiou, Charalambos C; Tsaltas, Eleftheria

    2015-12-01

    This study is a follow-up of a previous one reporting that the neuropsychological profile of pharmacoresistant patients with major depressive disorder referred for electroconvulsive therapy (ECT, ECT group) contrasted with that of their pharmacorespondent counterparts (NECT group). The NECT group exhibited severe visuospatial memory and minor executive deficits; the ECT group presented the reverse pattern. In that same ECT group, the current follow-up study examined the effects of clinically effective ECT on both cognitive domains 2 months later. Fifteen ECT patients were administered Hamilton Depression (HAMD-24), Hamilton Anxiety (HAMA), Mini-Mental State Examination Scales and 5 tests of Cambridge Neuropsychological Test Automated Battery at intake (pre-ECT), end of ECT course (post-ECT), and 2 months thereafter (follow-up). Electroconvulsive therapy was effective in relieving clinical depression. After a post-ECT decline, the patients exhibited significant improvement in both Cambridge Neuropsychological Test Automated Battery, paired associate learning, and Stockings of Cambridge. By contrast, their major pre-ECT deficit in intra/extradimensional set shifting remained virtually unaffected. Our findings suggest that attentional flexibility deficits may constitute a neuropsychological trait-like feature of pharmacoresistant, ECT-referred major depressive disorder patients. However, this deficit does not seem generalized, given patient improvement in episodic visual learning/memory and some indication of improvement in spatial planning after ECT.

  4. Short-term venlafaxine v. lithium monotherapy for bipolar type II major depressive episodes: effectiveness and mood conversion rate.

    PubMed

    Amsterdam, Jay D; Lorenzo-Luaces, Lorenzo; Soeller, Irene; Li, Susan Qing; Mao, Jun J; DeRubeis, Robert J

    2016-04-01

    Controversy exists over antidepressant use in bipolar II depression. To compare the safety and effectiveness of antidepressantv.mood stabiliser monotherapy for bipolar type II major depressive episodes. Randomised, double-blind, parallel-group, 12-week comparison of venlafaxine (n= 65)v.lithium (n= 64) monotherapy in adult out-patients (trial registration numberNCT00602537). Primary outcome - venlafaxine produced a greater response rate (67.7%)v lithium (34.4%,P<0.001). Secondary outcomes - venlafaxine produced a greater remission rate (58.5%v 28.1%,P<0.001); greater decline in depression symptom scores over time (β = -5.32, s.e. = 1.16, χ(2)= 21.19,P<0.001); greater reduction in global severity scores over time (β = -1.05, s.e. = 0.22, w(2)= 22.33,P<0.001); and greater improvement in global change scores (β = -1.31, s.e. = 0.32, χ(2)= 16.95,P<0.001) relative to lithium. No statistically significant or clinically meaningful differences in hypomanic symptoms were observed between treatments. These findings suggest that short-term venlafaxine monotherapy may provide effective antidepressant treatment for bipolar II depression without a statistically significant increase in hypomanic symptoms relative to lithium. © The Royal College of Psychiatrists 2016.

  5. Rates and predictors of remission, recurrence and conversion to bipolar disorder after the first lifetime episode of depression--a prospective 5-year follow-up study.

    PubMed

    Bukh, J D; Andersen, P K; Kessing, L V

    2016-04-01

    In depression, non-remission, recurrence of depressive episodes after remission and conversion to bipolar disorder are crucial determinants of poor outcome. The present study aimed to determine the cumulative incidences and clinical predictors of these long-term outcomes after the first lifetime episode of depression. A total of 301 in- or out-patients aged 18-70 years with a validated diagnosis of a single depressive episode were assessed from 2005 to 2007. At 5 years of follow-up, 262 patients were reassessed by means of the life chart method and diagnostic interviews from 2011 to 2013. Cumulative incidences and the influence of clinical variables on the rates of remission, recurrence and conversion to bipolar disorder, respectively, were estimated by survival analysis techniques. Within 5 years, 83.3% obtained remission, 31.5% experienced recurrence of depression and 8.6% converted to bipolar disorder (6.3% within the first 2 years). Non-remission increased with younger age, co-morbid anxiety and suicidal ideations. Recurrence increased with severity and treatment resistance of the first depression, and conversion to bipolar disorder with treatment resistance, a family history of affective disorder and co-morbid alcohol or drug abuse. The identified clinical characteristics of the first lifetime episode of depression should guide patients and clinicians for long-term individualized tailored treatment.

  6. Mindfulness-Based Interventions for People Diagnosed with a Current Episode of an Anxiety or Depressive Disorder: A Meta-Analysis of Randomised Controlled Trials

    PubMed Central

    Strauss, Clara; Cavanagh, Kate; Oliver, Annie; Pettman, Danelle

    2014-01-01

    Objective Mindfulness-based interventions (MBIs) can reduce risk of depressive relapse for people with a history of recurrent depression who are currently well. However, the cognitive, affective and motivational features of depression and anxiety might render MBIs ineffective for people experiencing current symptoms. This paper presents a meta-analysis of randomised controlled trials (RCTs) of MBIs where participants met diagnostic criteria for a current episode of an anxiety or depressive disorder. Method Post-intervention between-group Hedges g effect sizes were calculated using a random effects model. Moderator analyses of primary diagnosis, intervention type and control condition were conducted and publication bias was assessed. Results Twelve studies met inclusion criteria (n = 578). There were significant post-intervention between-group benefits of MBIs relative to control conditions on primary symptom severity (Hedges g = −0.59, 95% CI = −0.12 to −1.06). Effects were demonstrated for depressive symptom severity (Hedges g = −0.73, 95% CI = −0.09 to −1.36), but not for anxiety symptom severity (Hedges g = −0.55, 95% CI = 0.09 to −1.18), for RCTs with an inactive control (Hedges g = −1.03, 95% CI = −0.40 to −1.66), but not where there was an active control (Hedges g = 0.03, 95% CI = 0.54 to −0.48) and effects were found for MBCT (Hedges g = −0.39, 95% CI = −0.15 to −0.63) but not for MBSR (Hedges g = −0.75, 95% CI = 0.31 to −1.81). Conclusions This is the first meta-analysis of RCTs of MBIs where all studies included only participants who were diagnosed with a current episode of a depressive or anxiety disorder. Effects of MBIs on primary symptom severity were found for people with a current depressive disorder and it is recommended that MBIs might be considered as an intervention for this population. PMID:24763812

  7. Chronic and Episodic Interpersonal Stress as Statistically Unique Predictors of Depression in Two Samples of Emerging Adults

    PubMed Central

    Vrshek-Schallhorn, Suzanne; Stroud, Catherine B.; Mineka, Susan; Hammen, Constance; Zinbarg, Richard; Wolitzky-Taylor, Kate; Craske, Michelle G.

    2016-01-01

    Few studies comprehensively evaluate which types of life stress are most strongly associated with depressive episode onsets, over and above other forms of stress, and comparisons between acute and chronic stress are particularly lacking. Past research implicates major (moderate to severe) stressful life events (SLEs), and to a lesser extent, interpersonal forms of stress; research conflicts on whether dependent or independent SLEs are more potent, but theory favors dependent SLEs. The present study used five years of annual diagnostic and life stress interviews of chronic stress and SLEs from two separate samples (Sample 1 N = 432; Sample 2 N = 146) transitioning into emerging adulthood; one sample also collected early adversity interviews. Multivariate analyses simultaneously examined multiple forms of life stress to test hypotheses that all major SLEs, then particularly interpersonal forms of stress, and then dependent SLEs would contribute unique variance to major depressive episode (MDE) onsets. Person-month survival analysis consistently implicated chronic interpersonal stress and major interpersonal SLEs as statistically unique predictors of risk for MDE onset. In addition, follow-up analyses demonstrated temporal precedence for chronic stress; tested differences by gender; showed that recent chronic stress mediates the relationship between adolescent adversity and later MDE onsets; and revealed interactions of several forms of stress with socioeconomic status (SES). Specifically, as SES declined, there was an increasing role for non-interpersonal chronic stress and non-interpersonal major SLEs, coupled with a decreasing role for interpersonal chronic stress. Implications for future etiological research were discussed. PMID:26301973

  8. Vulnerability for new episodes in recurrent major depressive disorder: protocol for the longitudinal DELTA-neuroimaging cohort study

    PubMed Central

    Mocking, Roel J T; Figueroa, Caroline A; Rive, Maria M; Geugies, Hanneke; Servaas, Michelle N; Assies, Johanna; Koeter, Maarten W J; Vaz, Frédéric M; Wichers, Marieke; van Straalen, Jan P; de Raedt, Rudi; Bockting, Claudi L H; Harmer, Catherine J; Schene, Aart H; Ruhé, Henricus G

    2016-01-01

    Introduction Major depressive disorder (MDD) is widely prevalent and severely disabling, mainly due to its recurrent nature. A better understanding of the mechanisms underlying MDD-recurrence may help to identify high-risk patients and to improve the preventive treatment they need. MDD-recurrence has been considered from various levels of perspective including symptomatology, affective neuropsychology, brain circuitry and endocrinology/metabolism. However, MDD-recurrence understanding is limited, because these perspectives have been studied mainly in isolation, cross-sectionally in depressed patients. Therefore, we aim at improving MDD-recurrence understanding by studying these four selected perspectives in combination and prospectively during remission. Methods and analysis In a cohort design, we will include 60 remitted, unipolar, unmedicated, recurrent MDD-participants (35–65 years) with ≥2 MDD-episodes. At baseline, we will compare the MDD-participants with 40 matched controls. Subsequently, we will follow-up the MDD-participants for 2.5 years while monitoring recurrences. We will invite participants with a recurrence to repeat baseline measurements, together with matched remitted MDD-participants. Measurements include questionnaires, sad mood-induction, lifestyle/diet, 3 T structural (T1-weighted and diffusion tensor imaging) and blood-oxygen-level-dependent functional MRI (fMRI) and MR-spectroscopy. fMRI focusses on resting state, reward/aversive-related learning and emotion regulation. With affective neuropsychological tasks we will test emotional processing. Moreover, we will assess endocrinology (salivary hypothalamic-pituitary-adrenal-axis cortisol and dehydroepiandrosterone-sulfate) and metabolism (metabolomics including polyunsaturated fatty acids), and store blood for, for example, inflammation analyses, genomics and proteomics. Finally, we will perform repeated momentary daily assessments using experience sampling methods at baseline. We

  9. Rorschach variables and dysfunctional attitudes as measures of depressive vulnerability: a 9-year follow-up study of individuals with different histories of major depressive episodes.

    PubMed

    Hartmann, Ellen; Halvorsen, Marianne; Wang, Catharina E A

    2013-01-01

    Forty-six individuals with different histories of major depressive episodes (MDEs) completed the Rorschach (Exner, 2003 ) and the Dysfunctional Attitude Scale (DAS; Weissman & Beck, 1978) at 2 assessment points (T1, T2) over a 9-year follow-up. At T1, history of MDE and the Rorschach variable MOR (associated with negative self-image) emerged as significant predictors of number of MDEs over the follow-up. At T2, Rorschach markers of depressive vulnerability and scars were identified (i.e., WSum6, related to illogical thinking; X+%, related to conventional perception and social adjustment; X-%, linked to erroneous judgments; MQ-, associated with impaired social relations; and MOR). Test-retest analyses displayed significant temporal stability in Rorschach variables, with r ranging from .34 to .67 and in the DAS, r = .42. Our findings highlight MDE as a recurrent and serious disorder, number of MDEs as a risk factor for future depressions, and Rorschach variables as markers of depressive vulnerability and scars.

  10. Compensatory cognitive training for people with first-episode schizophrenia: results from a pilot randomized controlled trial.

    PubMed

    Mendella, Paul D; Burton, Cynthia Z; Tasca, Giorgio A; Roy, Paul; St Louis, Lea; Twamley, Elizabeth W

    2015-03-01

    Cognitive training or remediation now has multiple studies and meta-analyses supporting its efficacy in improving cognition and functioning in people with schizophrenia. However, relatively little is known about cognitive training outcomes in early psychosis. We conducted a pilot randomized controlled trial of Compensatory Cognitive Training (CCT) compared to Treatment as Usual (TAU) in 27 participants with first-episode psychosis who had received treatment for psychosis for less than six months. Assessments of cognition (MATRICS Consensus Cognitive Battery; MCCB) and functional capacity (UCSD Performance-Based Skills Assessment-Brief; UPSA-B) were administered at baseline and following the 12-week treatment. The CCT condition, compared to TAU, was associated with significant improvements on the MCCB composite score, as well as MCCB subtests measuring processing speed (Trail Making) and social cognition (Mayer-Salovey-Caruso Emotional Intelligence Test), with large effects on these three outcome measures. There were no significant CCT-associated effects on the UPSA-B or on positive, negative, or depressive symptoms. CCT treatment of cognitive impairments in first-episode schizophrenia is feasible and can result in large effect size improvements in global cognition, processing speed, and social cognition.

  11. Rumination as a Vulnerability Factor to Depression in Adolescents in Mainland China: Lifetime History of Clinically Significant Depressive Episodes

    ERIC Educational Resources Information Center

    Hong, Wei; Abela, John R. Z.; Cohen, Joseph R.; Sheshko, Dana M.; Shi, Xiao Ting; Hamel, Anton Van; Starrs, Claire

    2010-01-01

    The current study tested the vulnerability and sex differences hypotheses of the response styles theory of depression (Nolen-Hoeksema, 1991). Participants included 494 tenth-grade students (M = 15.25 years, SD = 0.47) recruited from two secondary schools in Beijing, China. Participants completed self-report measures assessing rumination and…

  12. Rumination as a Vulnerability Factor to Depression in Adolescents in Mainland China: Lifetime History of Clinically Significant Depressive Episodes

    ERIC Educational Resources Information Center

    Hong, Wei; Abela, John R. Z.; Cohen, Joseph R.; Sheshko, Dana M.; Shi, Xiao Ting; Hamel, Anton Van; Starrs, Claire

    2010-01-01

    The current study tested the vulnerability and sex differences hypotheses of the response styles theory of depression (Nolen-Hoeksema, 1991). Participants included 494 tenth-grade students (M = 15.25 years, SD = 0.47) recruited from two secondary schools in Beijing, China. Participants completed self-report measures assessing rumination and…

  13. Depression in bipolar disorder versus major depressive disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions

    PubMed Central

    Moreno, Carmen; Hasin, Deborah S.; Arango, Celso; Oquendo, Maria A.; Vieta, Eduard; Liu, Shangmin; Grant, Bridget F.; Blanco, Carlos

    2012-01-01

    Objectives To compare the clinical features and course of major depressive episodes (MDE) occurring in subjects with bipolar I disorder (BD-I), bipolar II disorder (BD-II), and major depressive disorder (MDD). Methods Data were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions (2001–2002), a nationally representative face-to-face survey of more than 43,000 adults in the United States, including 5,695 subjects with lifetime MDD, 935 with BD-I and lifetime MDE, and 494 with BD-II and lifetime MDE. Differences on sociodemographic characteristics and clinical features, course, and treatment patterns of MDE were analyzed. Results Most depressive symptoms, family psychiatric history, anxiety disorders, alcohol and drug use disorders, and personality disorders were more frequent—and number of depressive symptoms per MDE were higher—among subjects with BD-I, followed by BD-II, and MDD. BD-I individuals experienced a higher number of lifetime MDE, had the worst quality of life, and received significantly more treatment for MDE than BD-II and MDD subjects. Individuals with BD-I and BD-II experienced their first mood episode about 10 years earlier than those with MDD (21.2, 20.5, and 30.4 years, respectively). Conclusions Our results support the existence of a spectrum of severity of MDE, with highest severity for BD-I, followed by BD-II and MDD, suggesting the utility of dimensional assessments in current categorical classifications. PMID:22548900

  14. Different serum BDNF levels in depression: results from BDNF studies in FYR Macedonia and Bulgaria.

    PubMed

    Ristevska-Dimitrovska, Gordana; Shishkov, Rinaldo; Gerazova, Vesna Pejoska; Vujovik, Viktorija; Stefanovski, Branislav; Novotni, Antoni; Marinov, Petar; Filov, Izabela

    2013-06-01

    A growing body of evidence shows that brain-derived neurotrophic factor (BDNF) plays a role in depressive disorder. Serum BDNF levels are lower in depressed patients and they increase after a long course of antidepressant treatment. Our study aims to test the effect of antidepressant treatment on serum BDNF levels in patients with a depressive episode, after they have achieved remission in two studies in Macedonia and Bulgaria. In the Macedonian study 23 patients were included (11 female, 12 male) diagnosed with a first depressive episode according to ICD-10, as well as 23 control subjects age- and sex-matched without a history of psychiatric disorder. In the Bulgarian study 10 female patients with depression and 10 control subjects were included. We have applied the Hamilton Depression Rating Scale (HDRS) to assess depression severity. Blood samples were collected before antidepressive treatment and after remission was achieved (decrease to 7 points or less on HDRS). In the Macedonian study, mean serum BDNF level at baseline was 13.15±6.75 ng/ml and the mean HDRS score was 28.52±4.02. Untreated depressed patients showed significantly lower serum BDNF levels compared to the control group (25.95±9.17 ng/ml). After remission was achieved, the mean serum BDNF level was 24.73±11.80 ng/ml whereas the mean HDRS score was 7.04±3.15. After 8 weeks of treatment there was no statistically significant difference in the serum BDNF levels between the two groups. In the Bulgarian study, baseline mean serum BDNF levels were 26.84±8.66 ng/ml, after 3 weeks treatment and remission was achieved mean serum BDNF levels were 30.33±9.25 ng/ml and in the control group mean serum BDNF levels were 25.04±2.88 ng/ml. Integrated results showed baseline mean serum BDNF levels of 17.30±9.66 ng/ml, after achieved remission 26.43±11.25 ng/ml and in the control group mean serum BDNF levels of 25.68±7.76 ng/ml. The Bulgarian results showed no statistical difference between the depressed

  15. Temperament and prodromal symptoms prior to first manic/hypomanic episodes: results from a pilot study.

    PubMed

    Zeschel, Eike; Bingmann, Tiffany; Bechdolf, Andreas; Krüger-Oezguerdal, Seza; Correll, Christoph U; Leopold, Karolina; Pfennig, Andrea; Bauer, Michael; Juckel, Georg

    2015-03-01

    Prodromal symptoms prior to first episode mania/hypomania have been reported. However, the relationship between temperament and manic/hypomanic prodromal symptoms has not been investigated. We hypothesized that subjects scoring higher on cyclothymic and irritable temperament scales show more manic/hypomanic prodromal symptoms. Euthymic patients diagnosed with bipolar-I or -II disorder within 8 years underwent retrospective assessments with the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-autoquestionnaire (TEMPS-A) and the Bipolar Prodrome Symptom Scale-Retrospective (BPSS-R). Among 39 subjects (36.1 ± 9.9 years, females = 59%, bipolar-I = 62%) 100% and 92.3% reported subthreshold mania (mean = 7.4 ± 2.9) or subthreshold depressive symptoms (mean = 2.4 ± 1.5), and 87.2% and 43.6% reported general psychopathology (mean = 3.2 ± 2.0) or subthreshold psychotic symptoms (mean = 0.7 ± 1.0) prior to their first hypo-/manic episode. Subjects with higher cyclothymic and irritable temperament scores showed more subthreshold symptoms prior to the first manic/hypomanic episode, mainly subthreshold hypo-/manic symptoms (cyclothymic temperament r = 0.430; p = 0.006; irritable temperament r = 0.330; p = 0.040), general psychopathology symptoms (cyclothymic temperament r = 0.316; p = 0.05; irritable temperament r = 0.349; p = 0.029) and subthreshold psychotic symptoms (cyclothymic temperament r = 0.413; p = 0.009). In regression analyses, cyclothymic temperament explained 16.1% and 12.5% of the variance of the BPSS-R total score (p = 0.045) and psychosis subscore (p = 0.029). Retrospective study, no control group, small sample size. We present data, which indicate a relationship between cyclothymic and irritable temperament and prodromal symptoms prior to the first manic/hypomanic episode. These findings support the notion that assessing cyclothymic temperament to identify people at-risk of developing bipolar-I and -II disorder may help to increase the

  16. [Integral Care Guide for Early Detection and Diagnosis of Depressive Episodes and Recurrent Depressive Disorder in Adults. Integral Attention of Adults with a Diagnosis of Depressive Episodes and Recurrent Depressive Disorder: Part I: Risk Factors, Screening, Suicide Risk Diagnosis and Assessment in Patients with a Depression Diagnosis].

    PubMed

    Gómez-Restrepo, Carlos; Peñaranda, Adriana Patricia Bohórquez; Valencia, Jenny García; Guarín, Maritza Rodríguez; Narváez, Eliana Bravo; Jaramillo, Luis Eduardo; Acosta, Carlos Alberto Palacio; Pedraza, Ricardo Sánchez; Díaz, Sergio Mario Castro

    2012-12-01

    Depression is an important cause of morbidity and disability in the world; however, it is under-diagnosed at all care levels. The purpose here is to present recommendations based on the evidence gathered to answer a series of clinical questions concerning risk factors, screening, suicide risk diagnosis and evaluation in patients undergoing a depressive episode and recurrent depressive disorder. Emphasis has been made upon the approach used at the primary care level so as to grant adult diagnosed patients the health care guidelines based on the best and more updated evidence available thus achieving minimum quality standards. A practical clinical guide was elaborated according to standards of the Methodological Guide of the Ministry of Social Protection. Recommendation from guides NICE90 and CANMAT were adopted and updated so as to answer the questions posed while de novo questions were developed. Recommendations 1-22 corresponding to screening, suicide risk and depression diagnosis were presented. The corresponding degree of recommendation is included. Copyright © 2012 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  17. Criticism and Depression among the Caregivers of At-Risk Mental State and First-Episode Psychosis Patients.

    PubMed

    Hamaie, Yumiko; Ohmuro, Noriyuki; Katsura, Masahiro; Obara, Chika; Kikuchi, Tatsuo; Ito, Fumiaki; Miyakoshi, Tetsuo; Matsuoka, Hiroo; Matsumoto, Kazunori

    2016-01-01

    Expressed emotion (EE), especially criticism, is an important predictor of outcomes for the patient for a wide range of mental health problems. To understand complex links between EE and various relevant variables in early phase psychosis, this study examined criticism, distress of caregivers, other patients', and caregivers' variables, and links between criticism and these variables in those with at-risk mental state (ARMS) for psychosis and first-episode psychosis (FEP). The participants were 56 patients (mean age 18.8 ± 4.2 years) with ARMS and their caregivers (49.4 ± 5.8 years) and 43 patients (21.7 ± 5.2 years) with FEP and their caregivers (49.3 ± 7.4 years). We investigated criticisms made by caregivers using the Japanese version of the Family Attitude Scale and caregiver depressive symptoms via the self-report Beck Depression Inventory. We also assessed psychiatric symptoms and functioning of the patients. Approximately one-third of caregivers of patients with ARMS or FEP had depressive symptoms, predominately with mild-to-moderate symptom levels, whereas only a small portion exhibited high criticism. The level of criticism and depression were comparable between ARMS and FEP caregivers. The link between criticism, caregivers' depression, and patients' symptoms were observed in FEP but not in ARMS caregivers. These findings imply that the interaction between criticism and caregivers' and patients' mental states may develop during or after the onset of established psychosis and interventions for the caregivers should be tailored to the patient's specific stage of illness. Interventions for FEP caregivers should target their emotional distress and include education about patient's general symptoms.

  18. Depression in bipolar disorder versus major depressive disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions.

    PubMed

    Moreno, Carmen; Hasin, Deborah S; Arango, Celso; Oquendo, Maria A; Vieta, Eduard; Liu, Shangmin; Grant, Bridget F; Blanco, Carlos

    2012-05-01

    To compare the clinical features and course of major depressive episodes (MDEs) occurring in subjects with bipolar I disorder (BD-I), bipolar II disorder (BD-II), and major depressive disorder (MDD). Data were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions (2001-2002), a nationally representative face-to-face survey of more than 43000 adults in the USA, including 5695 subjects with lifetime MDD, 935 with BD-I and lifetime MDE, and 494 with BD-II and lifetime MDE. Differences on sociodemographic characteristics and clinical features, course, and treatment patterns of MDE were analyzed. Most depressive symptoms, family psychiatric history, anxiety disorders, alcohol and drug use disorders, and personality disorders were more frequent-and number of depressive symptoms per MDE was higher-among subjects with BD-I, followed by BD-II, and MDD. BD-I individuals experienced a higher number of lifetime MDEs, had a poorer quality of life, and received significantly more treatment for MDE than BD-II and MDD subjects. Individuals with BD-I and BD-II experienced their first mood episode about ten years earlier than those with MDD (21.2, 20.5, and 30.4 years, respectively). Our results support the existence of a spectrum of severity of MDE, with highest severity for BD-I, followed by BD-II and MDD, suggesting the utility of dimensional assessments in current categorical classifications. © 2012 John Wiley and Sons A/S.

  19. [Results of the MMPI-2 test among patients suffer from depressive disorders and organic depressive disorders].

    PubMed

    Talarowska, Monika; Zboralski, Krzysztof; Gałecki, Piotr

    2012-03-01

    The Minnesota Multiphasic Personality Inventory (MMPI) is a psychological tool used in the diagnosis of various disorders and a helpful tool in determining the direction of the planned psychotherapeutic interactions. Is considered as a gold standard for diagnosis. The aim of the study was to compare the MMPI-2 test in patients with depressive disorders and organic depressive disorders. The study involved 79 people (41 women, 38 men), hospitalized in the Department of Adult Psychiatry Medical University of Łódź. The subjects were divided into two groups: patients with depressive disorders (DD, n = 53) and patients with organic depressive disorders (ODD, n = 26). The study used MMPI-2 test. There were no statistically significant differences between the two groups in MMPI-2 test. Patients with DD have obtained higher scores on scales forming 'neurotic triad' (hypochondria, depression, hysteria), on a scale of psychopathy, psychasthenia and each of the five subscales of depression scale. Patients with depressive disorders achieved higher results than patients with depressive disorders in hypochondria, depression, hysteria, psychopathy, psychasthenia, social introversion scale and each of the five subscales of depression scale. Patients with organic depressive disorders in the test MMPI-2 tend to aggravation (unconscious exaggeration of symptoms), and elevated results on a scale of paranoia, schizophrenia, mania and masculinity-femininity.

  20. Reexamining associations between mania, depression, anxiety and substance use disorders: results from a prospective national cohort.

    PubMed

    Olfson, M; Mojtabai, R; Merikangas, K R; Compton, W M; Wang, S; Grant, B F; Blanco, C

    2017-02-01

    Separate inheritance of mania and depression together with high rates of clinical overlap of mania with anxiety and substance use disorders provide a basis for re-examining the specificity of the prospective association of manic and depression episodes that is a hallmark of bipolar disorder. We analyzed information from 34 653 adults in Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions, a longitudinal nationally representative survey of US adults interviewed 3 years apart. Psychiatric disorders were assessed by a structured interview. We used logistic regression analyses to estimate the strength of associations between Wave 1 manic episodes and Wave 2 depression, anxiety and substance use disorders controlling for background characteristics and lifetime Wave 1 disorders. Corresponding analyses examined associations between Wave 1 major depressive episode with manic episodes and other psychiatric disorders. In multivariable models, Wave 1 manic episodes significantly increased the odds of Wave 2 major depressive episodes (adjusted odds ratio (AOR): 1.7; 95% confidence interval: 1.3-2.2) and any anxiety disorder (AOR: 1.8; 1.4-2.2), although not of substance use disorders (AOR: 1.2; 0.9-1.5). Conversely, Wave 1 major depressive episodes significantly increased risk of Wave 2 manic episodes (AOR: 2.2; 1.7-2.9) and anxiety disorders (AOR: 1.7; 1.5-2.0), although not substance use disorders (AOR: 1.0; 0.9-1.2). Adults with manic episodes have an approximately equivalent relative risk of developing depression episodes and anxiety disorders. Greater research and clinical focus is warranted on connections between manic episodes and anxiety disorders.

  1. Number of Childhood Abuse Perpetrators and the Occurrence of Depressive Episodes in Adulthood

    ERIC Educational Resources Information Center

    Liu, Richard T.; Jager-Hyman, Shari; Wagner, Clara A.; Alloy, Lauren B.; Gibb, Brandon E.

    2012-01-01

    Objective: Although past research has documented a link between adverse childhood experiences--particularly childhood emotional (CEA), physical (CPA), and sexual abuse (CSA)--and depression, relatively few studies have examined the unique impact of each of these highly co-occurring abuse types. Moreover, relatively little is known about the…

  2. Life Stress and Treatment Course of Recurrent Depression: 1. Response during Index Episode.

    ERIC Educational Resources Information Center

    Monroe, Scott M.; And Others

    1992-01-01

    Conducted prospective study of 91 individuals treated for recurrent depression. Specific forms of stress occurring before treatment entry or during first 6 weeks of treatment predicted poor clinical response both after 16 weeks and after more extended intervention period. Severe stress occurring early in treatment predicted loner time to attain…

  3. Number of Childhood Abuse Perpetrators and the Occurrence of Depressive Episodes in Adulthood

    ERIC Educational Resources Information Center

    Liu, Richard T.; Jager-Hyman, Shari; Wagner, Clara A.; Alloy, Lauren B.; Gibb, Brandon E.

    2012-01-01

    Objective: Although past research has documented a link between adverse childhood experiences--particularly childhood emotional (CEA), physical (CPA), and sexual abuse (CSA)--and depression, relatively few studies have examined the unique impact of each of these highly co-occurring abuse types. Moreover, relatively little is known about the…

  4. The number of past manic episodes is the best predictor of antidepressant-emergent manic switch in a cohort of bipolar depressed patients.

    PubMed

    Gorwood, Philip; Richard-Devantoy, Stéphane; Sentissi, Othman; Le Strat, Yann; Olié, Jean Pierre

    2016-06-30

    The present study sought to identify factors associated with the onset of a manic or hypomanic episode during the month following a new antidepressant therapy in depressed bipolar patients. Patients receiving mood stabilizers for ≥3 months were screened from 400 French centers and were assessed for a 4-week period following prescription of a first or a new antidepressant. Of the 1242 included participants, 4.8% (n=60) experienced antidepressant-emergent manic switch (AEMS). AEMS was more frequently associated with lifetime manic, depressive, and total mood episodes, and with past AEMS. A higher score at two items of the Montgomery-Åsberg Depression Rating Scale (pessimistic and suicidal thoughts) were significantly associated with AEMS. Logistic regression analysis showed that the number of lifetime manic episodes and past AEMS were the two most factors associated with an AEMS. Having more than four past manic episodes was associated with a 2.84 fold increased risk of AEMS. Cumulative number of past mood episodes seems to be the most important factor for switching to a manic episode following antidepressants in patients with bipolar disorder. Longer-term studies are required to further delineate antidepressant causality from natural disease course.

  5. Association of Major Depressive Episodes With Stroke Risk in a Prospective Study of 0.5 Million Chinese Adults.

    PubMed

    Sun, Jie; Ma, Hongxia; Yu, Canqing; Lv, Jun; Guo, Yu; Bian, Zheng; Yang, Ling; Chen, Yiping; Shen, Hongbing; Chen, Zhengming; Hu, Zhibin; Li, Liming

    2016-09-01

    Although the relationship between depression and stroke risk has been investigated, findings in previous reports were conflicting. The aim of this study was to prospectively examine the effect of major depressive episodes (MDE) on stroke incidence and further assess the potential dose-response relationship between number of depression symptoms and subsequent stroke risk in Chinese population. A total of 199 294 men and 288 083 women aged 30 to 79 years without a history of stroke, heart disease, and cancer in the China Kadoorie Biobank cohort were followed from 2004 to 2013. A World Health Organization Composite International Diagnostic Interview-Short Form was used to access MDE according to Diagnostic and Statistical Manual of Mental Disorders-IV criteria. Stroke events were ascertained through death certificates, medical records, and health insurance data. Past year MDE was marginally associated with a 15% increased risk of stroke (adjusted hazard ratio, 1.15; 95% confidence interval, 0.99-1.33) in the fully adjusted model, and the association was steeper and statistically significant in individuals aged <50 years, smokers, drinkers, those with higher education degree, body mass index <24.0 kg/m(2), and no history of diabetes mellitus. Moreover, there was a positive dose-response relationship between the number of depression symptoms and increased stroke risk (Ptrend=0.011). In addition, smoking status significantly interacted with MDE on stroke onset (P for multiplicative interaction=0.025). Findings from this large prospective study suggest that the presence of MDE is a risk factor for stroke, especially in smokers. © 2016 American Heart Association, Inc.

  6. Efficacy and safety of antidepressant's use in the treatment of depressive episodes in bipolar disorder - review of research.

    PubMed

    Antosik-Wójcińska, Anna Zofia; Stefanowski, Bogdan; Święcicki, Łukasz

    2015-01-01

    The use of antidepressants in treatment of depression in course of bipolar disorders (BD) is controversial. In case of no improvement during monotherapy with mood stabilizer, the use of antidepressants is often necessary. The safety of this group (in context of phase change, mixed states and rapid cycling) is essential and is the subject of many research. In the paper, the authors review the literature concerning efficacy and safety of use of antidepressants in the treatment of affective disorders and long-term impact on the course of the disease. Selection of articles have been made by searching the Medline and Pubmed databases using keywords: antidepressant drugs, bipolar depression, bipolar disorder, efficacy, safety, mania, hypomania. The risk of mania is greater in bipolar disorder type I, than in type II or during treatment with Tricyclic antidepressants (TCAs) and treatment with venlafaxine. The use of SSRIs and bupropion is associated with a relatively small increase of phase change risk. There are different opinions concerning recommended duration of antidepressant treatment. Generally antidepressant use should end after 2-3 months of remission, the risk of recurrence of depression after discontinuation of antidepressants is, however, higher than in case of continuation. In BD type II or BD spectrum, antidepressant monotherapy is allowed in severe depression. In bipolar disorder type I and in case of phase change after antidepressants use in the past, use of antidepressants should be very cautious. Antidepressants are contraindicated in rapid cycling and in mixed episodes. Further work is needed to evaluate the efficacy and safety of antidepressants use.

  7. Two-year course of depressive and anxiety disorders: results from the Netherlands Study of Depression and Anxiety (NESDA).

    PubMed

    Penninx, Brenda W J H; Nolen, Willem A; Lamers, Femke; Zitman, Frans G; Smit, Johannes H; Spinhoven, Philip; Cuijpers, Pim; de Jong, Peter J; van Marwijk, Harm W J; van der Meer, Klaas; Verhaak, Peter; Laurant, Miranda G H; de Graaf, Ron; Hoogendijk, Witte J; van der Wee, Nic; Ormel, Johan; van Dyck, Richard; Beekman, Aartjan T F

    2011-09-01

    Whether course trajectories of depressive and anxiety disorders are different, remains an important question for clinical practice and informs future psychiatric nosology. This longitudinal study compares depressive and anxiety disorders in terms of diagnostic and symptom course trajectories, and examines clinical prognostic factors. Data are from 1209 depressive and/or anxiety patients residing in primary and specialized care settings, participating in the Netherlands Study of Depression and Anxiety. Diagnostic and Life Chart Interviews provided 2-year course information. Course was more favorable for pure depression (n=267, median episode duration = 6 months, 24.5% chronic) than for pure anxiety (n=487, median duration = 16 months, 41.9% chronic). Worst course was observed in the comorbid depression-anxiety group (n=455, median duration > 24 months, 56.8% chronic). Independent predictors of poor diagnostic and symptom trajectory outcomes were severity and duration of index episode, comorbid depression-anxiety, earlier onset age and older age. With only these factors a reasonable discriminative ability (C-statistic 0.72-0.77) was reached in predicting 2-year prognosis. Depression and anxiety cases concern prevalent - not incident - cases. This, however, reflects the actual patient population in primary and specialized care settings. Their differential course trajectory justifies separate consideration of pure depression, pure anxiety and comorbid anxiety-depression in clinical practice and psychiatric nosology. Copyright © 2011 Elsevier B.V. All rights reserved.

  8. Causal connectivity alterations of cortical-subcortical circuit anchored on reduced hemodynamic response brain regions in first-episode drug-naïve major depressive disorder

    PubMed Central

    Gao, Qing; Zou, Ke; He, Zongling; Sun, Xueli; Chen, Huafu

    2016-01-01

    Some efforts were done to investigate the disruption of brain causal connectivity networks involved in major depressive disorder (MDD) using Granger causality (GC) analysis. However, the homogenous hemodynamic response function (HRF) assumption over the brain may disturb the inference of temporal precedence. Here we applied a blind deconvolution approach to examine the altered HRF shape in first-episode, drug-naïve MDD patients. The regions with abnormal HRF shape in patients were chosen as seeds to detect the GC alterations in MDD. The results demonstrated significantly decreased magnitude of spontaneous hemodynamic response of the orbital frontal cortex (OFC) and the caudate nucleus (CAU) in MDD comparing to healthy controls, suggesting MDD patients likely had alterations in neurovascular coupling and cerebrovascular physiology in these two regions. GC mapping showed increased/decreased GC in OFC-/CAU centered networks in MDD. The outgoing GC values from OFC to anterior cingulate cortex and occipital regions were positively correlated with Hamilton Depression Scale (HAMD) scores, while the incoming GC from insula, middle and superior temporal gyrus to CAU were negatively correlated with HAMD scores of MDD. The abnormalities of directional connections in the cortico-subcortico-cerebellar network may lead to unbalanced integrating the emotional-related information for MDD, and further exacerbating depressive symptoms. PMID:26911651

  9. A comparison of neuropsychological dysfunction in first-episode psychosis patients with unipolar depression, bipolar disorder, and schizophrenia.

    PubMed

    Hill, S Kristian; Reilly, James L; Harris, Margret S H; Rosen, Cherise; Marvin, Robert W; Deleon, Ovidio; Sweeney, John A

    2009-09-01

    The severity and profile of cognitive dysfunction in first episode schizophrenia and psychotic affective disorders were compared before and after antipsychotic treatment. Parallel recruitment of consecutively admitted study-eligible first-episode psychotic patients (30 schizophrenia, 22 bipolar with psychosis, and 21 psychotic depression) reduced confounds of acute and chronic disease/medication effects as well as differential treatment and course. Patient groups completed a neuropsychological battery and were demographically similar to healthy controls (n=41) studied in parallel. Prior to treatment, schizophrenia patients displayed significant deficits in all cognitive domains. The two psychotic affective groups were also impaired overall, generally performing intermediate between the schizophrenia and healthy comparison groups. No profile differences in neuropsychological deficits were observed across patient groups. Following 6 weeks of treatment, no patient group improved more than practice effects seen in healthy individuals, and level of performance improvement was similar for affective psychosis and schizophrenia groups. Although less severe in psychotic affective disorders, similar profiles of generalized neuropsychological deficits were observed across patient groups. Recovery of cognitive function after clinical stabilization was similar in mood disorders and schizophrenia. To the extent that these findings are generalizable, neuropsychological deficits in psychotic affective disorders, like schizophrenia, may be trait-like deficits with persistent functional implications.

  10. Increased Brain Lactate During Depressive Episodes and Reversal Effects by Lithium Monotherapy in Drug-Naive Bipolar Disorder: A 3-T 1H-MRS Study.

    PubMed

    Machado-Vieira, Rodrigo; Zanetti, Marcus V; Otaduy, Maria C; De Sousa, Rafael T; Soeiro-de-Souza, Marcio G; Costa, Alana C; Carvalho, Andre F; Leite, Claudia C; Busatto, Geraldo F; Zarate, Carlos A; Gattaz, Wagner F

    2017-02-01

    Mitochondrial dysfunction and energy metabolism impairment are key components in the pathophysiology of bipolar disorder (BD) and may involve a shift from aerobic to anaerobic metabolism. Measurement of brain lactate in vivo using proton magnetic resonance spectroscopy (H-MRS) represents an important tool to evaluate mitochondrial and metabolic dysfunction during mood episodes, as well as to monitor treatment response. To date, very few studies have quantified brain lactate in BD. In addition, no study has longitudinally evaluated lactate using H-MRS during depressive episodes or its association with mood stabilizer therapy. This study aimed to evaluate cingulate cortex (CC) lactate using 3-T H-MRS during acute depressive episodes in BD and the possible effects induced by lithium monotherapy. Twenty medication-free outpatients with short length of BD (80% drug-naive) in a current major depressive episode were matched with control subjects. Patients were treated for 6 weeks with lithium monotherapy at therapeutic doses in an open-label trial (blood level, 0.48 ± 0.19 mmol/L). Cingulate cortex lactate was measured before (week 0) and after lithium therapy (week 6) using H-MRS. Antidepressant efficacy was assessed with the 21-item Hamilton Depression Rating Scale as the primary outcome. Subjects with BD depression showed a significantly higher CC lactate in comparison to control subjects. Furthermore, a significant decrease in CC lactate was observed after 6 weeks of lithium treatment compared with baseline (P = 0.002). CC Lactate levels was associated with family history of mood disorders and plasma lithium levels. This is the first report of increased CC lactate in patients with bipolar depression and lower levels after lithium monotherapy for 6 weeks. These findings indicate a shift to anaerobic metabolism and a role for lactate as a state marker during mood episodes. Energy and redox dysfunction may represent key targets for lithium's therapeutic actions.

  11. Authoritarian parenting and youth depression: Results from a national study.

    PubMed

    King, Keith A; Vidourek, Rebecca A; Merianos, Ashley L

    2016-01-01

    Depression is a prevalent illness affecting youth across the nation. The study purpose was to examine depression and authoritarian parenting among youth from 12 to 17 years of age. A secondary data analysis of the National Survey on Drug Use and Health was performed in the present study. All participants in the present study were youth (N = 17,399) nationwide. The results revealed that 80.6% of youth participants reported having five or more depressive symptoms. Parenting styles based on depression significantly differed among males, females, 12-13-year-olds, 14-15-year-olds, and 16-17-year-olds. Specifically, those who reported experiencing authoritarian parenting practices were more likely to report depressive symptoms compared to their counterparts who experienced authoritative parenting practices. Emphasizing the role of the parents and teaching positive parenting practices and authoritative parenting styles may increase success of prevention programs.

  12. Early maladaptive schema-related impairment and co-occurring current major depressive episode-related enhancement of mental state decoding ability in borderline personality disorder.

    PubMed

    Unoka, Zsolt Szabolcs; Fogd, Dóra; Seres, Imola; Kéri, Szabolcs; Csukly, Gábor

    2015-04-01

    Disturbed interpersonal relationships specific to borderline personality disorder (BPD) suggest biased processing of social information. The goal of this study was to examine alterations in mental state decoding (MSD) and their associations with early maladaptive schemas (EMS) that may lead to the misinterpretation of incoming information. In addition, the authors' aim was to evaluate the effects of a co-occurring current major depressive episode (MDE) on the MSD performance of BPD patients. Seventy-eight BPD patients (34 with MDE) and 76 matched healthy controls (HC) were assessed for Reading the Mind in the Eyes Test (RMET) and the level of EMS. The authors found that impairment in the total RMET performance, as well as specific impairment regarding the recognition of positive and neutral items, was associated with EMS, and enhanced vigilance to negative mental states was characteristic to BPD with MDE. Results suggest that MSD ability is altered in two independent ways in BPD.

  13. A double-blind comparison of sertraline and fluoxetine in the treatment of major depressive episode in outpatients.

    PubMed

    Sechter, D; Troy, S; Paternetti, S; Boyer, P

    1999-03-01

    Depression is associated with considerable morbidity and mortality. As depressive disorders carry a high risk of relapse, treatment strategies include the use of a 6-month continuation period after resolution of the acute episode. Tolerability is of major importance when determining compliance and outcome during long-term therapy. Due to the superior tolerability profile of the selective serotonin reuptake inhibitors (SSRIs) over the older tricyclic antidepressants (TCAs), the former may be more suitable for extended therapy. Comparative studies have not shown differences between the SSRIs in terms of efficacy, but side-effect profiles may vary. A multicenter, double-blind, comparative study of sertraline and fluoxetine was carried out in outpatients fulfilling DSM-III-R criteria for major depressive disorder. Patients were randomised to receive sertraline (50-150 mg, n = 118) or fluoxetine (20-60 mg, n = 120) for 24 weeks. Assessments for depression (HAM-D, HAD, CGI-I, CGI-S), anxiety (Covi), sleep (Leeds Sleep Evaluation scale) and quality of life (SIP) were made at study entry and at weeks 2, 4, 8, 12, 18 and 24. All adverse events were recorded to allow evaluation of tolerability. In total, 88 patients in the sertraline group completed the study compared with 79 in the fluoxetine group. Side effects were responsible for the premature treatment withdrawal of seven (6%) sertraline patients and 12 (10%) fluoxetine patients. Two-hundred and thirty-four patients were included in an ITT analysis up to last visit (116 sertraline, 118 fluoxetine). At study endpoint, both treatments produced a significant improvement over baseline on all efficacy variables (P < 0.001). Although the magnitude of global changes in depression, anxiety, and quality of life was larger with sertraline than fluoxetine, none of the between-group differences reached statistical significance. However, significant differences in favour of sertraline were observed for individual HAM-D items

  14. Cognitive functioning in the first-episode of major depressive disorder: A systematic review and meta-analysis.

    PubMed

    Ahern, Elayne; Semkovska, Maria

    2017-01-01

    Cognitive deficits are frequently observed in major depression. Yet, when these deficits emerge and how they relate to the depressed state is unclear. The aim of this 2-part systematic review and meta-analysis is to determine the pattern and extent of cognitive deficits during a first-episode of depression (FED) and their persistence following FED remission. Published, peer-reviewed articles on cognitive function in FED patients through October 2015 were searched. Meta-analyses with random-effects modeling were conducted. Part 1 assessed weighted, mean effect sizes of cognitive function in FED patients relative to healthy controls. Moderator analyses of clinical and demographical variables effects were conducted. Part 2 assessed weighted, mean effect sizes of change in cognitive function at remission compared with acute FED performance in longitudinal studies. Thirty-one studies including 994 FED patients were retained in Part 1. Relative to healthy controls, small to large impairments were observed across most cognitive domains. Remission was associated with a normalization of function in processing speed, learning and memory, autobiographical memory, shifting, and IQ. Lower FED age was associated with higher IQ, but more impairment in word-list delayed memory. Four studies including 92 FED patients were retained in Part 2. Following remission, FED patients showed small improvements in processing speed and shifting but persistent impairment in inhibition and verbal fluency. Significant cognitive deficits are already identifiable during a FED, with some functions showing persistent impairment upon remission. Clinicians must consider cognitive impairment alongside mood symptoms to ensure functional recovery from the FED. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  15. [Risk factors associated to the presentation of episodes of major depression in a population of outpatients with Parkinson's disease].

    PubMed

    Chaná-Cuevas, P; Juri-Claverías, C; Alburquerque, D; Soto-Olmedo, M J; Benavides-Canales, O

    Depression is a frequently occurring problem in Parkinson's disease (PD). The purpose of this study is to describe the characteristics of episodes of major depression (EMD) in a population of outpatients with PD and the risk factors linked to their appearance. We conducted an open study involving 85 patients with PD; their mean age was 65.8 +/- 12.3 years and the mean length of time since disease onset was 7.2 +/- 5 years. Data that was collected included information from the patient record, evaluation with the Motor Examination section of the Unified PD Rating Scale (UPDRS-III), the Parkinson Mini-Mental test, the Neuropsychiatric Inventory (NPI) and the short version of Beck's Depression Inventory (BDI). EMD were diagnosed clinically by means of a semi-structured interview that allowed us to examine the symptoms that are included in the DSM-IV criteria for diagnosis of EMD. In 21 cases (24.7%) DSM-IV criteria for EMD were satisfied, with a BDI score (mean +/- standard deviation) of 17.5 +/- 6.2. In 64 cases (75.3%) who did not fulfil the criteria for EMD, the BDI score was 6.4 +/- 4.7 (p < 0.001). The items on the UPDRS-III related to the dopaminergic response in patients with EMD were 24.9 +/- 11.9 and in patients without EMD the values were 21.2 +/- 10.9 (NS). Those not related to the dopaminergic response in patients with EMD were 9.9 +/- 5.3 and in those without EMD the values were 6.2 +/- 4.6 (p < 0.001). In our sample, the presence of motor symptoms that do not respond to levodopa in patients with PD is a risk factor for the appearance of EMD.

  16. Insomnia brings soldiers into mental health treatment, predicts treatment engagement, and outperforms other suicide-related symptoms as a predictor of major depressive episodes.

    PubMed

    Hom, Melanie A; Lim, Ingrid C; Stanley, Ian H; Chiurliza, Bruno; Podlogar, Matthew C; Michaels, Matthew S; Buchman-Schmitt, Jennifer M; Silva, Caroline; Ribeiro, Jessica D; Joiner, Thomas E

    2016-08-01

    Given the high rates of suicide among military personnel and the need to characterize suicide risk factors associated with mental health service use, this study aimed to identify suicide-relevant factors that predict: (1) treatment engagement and treatment adherence, and (2) suicide attempts, suicidal ideation, and major depressive episodes in a military sample. Army recruiters (N = 2596) completed a battery of self-report measures upon study enrollment. Eighteen months later, information regarding suicide attempts, suicidal ideation, major depressive episodes, and mental health visits were obtained from participants' military medical records. Suicide attempts and suicidal ideation were very rare in this sample; negative binomial regression analyses with robust estimation were used to assess correlates and predictors of mental health treatment visits and major depressive episodes. More severe insomnia and agitation were significantly associated with mental health visits at baseline and over the 18-month study period. In contrast, suicide-specific hopelessness was significantly associated with fewer mental health visits. Insomnia severity was the only significant predictor of major depressive episodes. Findings suggest that assessment of sleep problems might be useful in identifying at-risk military service members who may engage in mental health treatment. Additional research is warranted to examine the predictive validity of these suicide-related symptom measures in a more representative, higher suicide risk military sample.

  17. Modulation of the Default Mode Network in First-Episode, Drug-Naïve Major Depressive Disorder via Acupuncture at Baihui (GV20) Acupoint

    PubMed Central

    Deng, Demao; Liao, Hai; Duan, Gaoxiong; Liu, Yanfei; He, Qianchao; Liu, Huimei; Tang, Lijun; Pang, Yong; Tao, Jien

    2016-01-01

    Background: Previous neuroimaging studies have revealed that acupuncture modulates the default mode network (DMN) in healthy subjects and patients with certain disorder. However, few studies have been performed to investigate whether or not acupuncture might modulate the DMN in patients with major depressive disorder (MDD). Thereby, the aim of the present study was to assess alterations of the DMN induced by acupuncture stimulation in patients with first-episode, drug-naïve MDD. Materials and Methods: Twenty nine patients with first-episode, drug-naïve MDD and 29 healthy subjects were enrolled in this study. All the healthy subjects underwent 6-min resting-state functional magnetic resonance imaging (R-fMRI) scan. While patients underwent acupuncture stimulation for 20-min electro-acupuncture stimulation (EAS) at Baihui acupoint (GV20) and two 6-min R-fMRI scans before and after EAS. Based on the precuneus/posterior cingulate cortex (PC/PCC) as the seed region, functional connectivity (FC) method was adopted to examine abnormal DMN in patients by comparing with healthy subjects and to evaluate the influence of EAS on intrinsic connectivity within the DMN in patients with MDD. Results: Compared to healthy subjects, MDD patients had abnormal DMN. Moreover, results showed that EAS at GV20 induced increased FC between the PC/PCC and bilateral anterior cingulate cortex (ACC), and decreased FC between the PC/PCC and left middle prefrontal cortex, left angualr gyrus and bilateral hippocampus/parahippocampus (HIPP/paraHIPP) in patients with MDD, which were the main brain regions showing significant differences between the patients and healthy subjects. Conclusion: Our findings provide imaging evidence to support that GV20-related acupuncture stimulation may modulate the DMN in patients with first-episode, drug-naïve MDD. This study may partly interpret the neural mechanisms of acupuncture at GV20 which is used to treat patients with MDD in clinical. PMID:27242492

  18. Headache impact of chronic and episodic migraine: results from the American Migraine Prevalence and Prevention study.

    PubMed

    Buse, Dawn; Manack, Aubrey; Serrano, Daniel; Reed, Michael; Varon, Sepideh; Turkel, Catherine; Lipton, Richard

    2012-01-01

    The Headache Impact Test-6 (HIT-6) has been demonstrated to be a reliable and valid measure that assesses the impact of headaches on the lives of persons with migraine. Originally used in studies of episodic migraine (EM), HIT-6 is finding increasing applications in chronic migraine (CM) research. (1) To examine the headache-impact on persons with migraine (EM and CM) using HIT-6 in a large population sample; (2) to identify predictors of headache-impact in this sample; (3) to assess the magnitude of effect for significant predictors of headache-impact in this sample. The American Migraine Prevalence and Prevention study is a longitudinal, population-based study that collected data from persons with severe headache from 2004 to 2009 through annual, mailed surveys. Respondents to the 2009 survey who met International Classification of Headache Disorders 2 criteria for migraine reported at least 1 headache in the preceding year, and completed the HIT-6 questionnaire were included in the present analysis. Persons with migraine were categorized as EM (average <15 headache days per month) or CM (average ≥15 headache days per month). Predictors of headache-impact examined include: sociodemographics; headache days per month; a composite migraine symptom severity score (MSS); an average pain severity rating during the most recent long-duration headache; depression; and anxiety. HIT-6 scores were analyzed both as continuous sum scores and using the standard, validated categories: no impact; some impact; substantial impact; and severe impact. Group contrasts were based on descriptive statistics along with linear regression models. Multiple imputation techniques were used to manage missing data. There were 7169 eligible respondents (CM = 373, EM = 6554). HIT-6 scores were normally distributed. After converting sum HIT-6 scores to the standard categories, those with CM were significantly more likely to experience "severe" headache impact (72.9% vs 42.3%) and had higher odds

  19. Cognitive remediation for depressed inpatients: Results of a pilot randomized controlled trial.

    PubMed

    Trapp, Wolfgang; Engel, Sinha; Hajak, Goeran; Lautenbacher, Stefan; Gallhofer, Bernd

    2016-01-01

    Neurocognitive deficits that persist despite antidepressive treatment and affect social and vocational functioning are well documented in major depressive disorder. Cognitive training approaches have proven successful in ameliorating these deficits in other psychiatric groups, but very few studies have been conducted in unipolar depressive patients by now. In contrast to previous studies solely including outpatients, effects of a cognitive remediation intervention on neurocognitive functioning of depressed inpatients were assessed by the present study. A randomized controlled trial was carried out with 46 depressed inpatients of a psychiatric hospital. Patients were randomly assigned to either a control group that received standard drug and non-drug (cognitive behavioural, occupational, sports, relaxation and music therapy) antidepressive treatment or a remediation group that additionally received 12 sessions of cognitive training for a total of 4 weeks (three sessions per week). An intent to treat analysis and a last observation carried forward method was used for data analyses. Patients of the remediation group demonstrated greater improvements in neurocognitive measures of verbal and nonverbal memory, working memory and executive function (Cohen's d effect sizes between .52 and .98). These results provide preliminary evidence that cognitive remediation interventions can be successfully applied also in psychiatric inpatients experiencing an acute depressive episode. © The Royal Australian and New Zealand College of Psychiatrists 2015.

  20. Dentate gyrus-cornu ammonis (CA) 4 volume is decreased and associated with depressive episodes and lipid peroxidation in bipolar II disorder: Longitudinal and cross-sectional analyses.

    PubMed

    Elvsåshagen, Torbjørn; Zuzarte, Pedro; Westlye, Lars T; Bøen, Erlend; Josefsen, Dag; Boye, Birgitte; Hol, Per K; Malt, Ulrik F; Young, L Trevor; Andreazza, Ana C

    2016-12-01

    Reduced dentate gyrus volume and increased oxidative stress have emerged as potential pathophysiological mechanisms in bipolar disorder. However, the relationship between dentate gyrus volume and peripheral oxidative stress markers remains unknown. Here, we examined dentate gyrus-cornu ammonis (CA) 4 volume longitudinally in patients with bipolar II disorder (BD-II) and healthy controls and investigated whether BD-II is associated with elevated peripheral levels of oxidative stress. We acquired high-resolution structural 3T-magnetic resonance imaging (MRI) images and quantified hippocampal subfield volumes using an automated segmentation algorithm in individuals with BD-II (n=29) and controls (n=33). The participants were scanned twice, at study inclusion and on average 2.4 years later. In addition, we measured peripheral levels of two lipid peroxidation markers (4-hydroxy-2-nonenal [4-HNE] and lipid hydroperoxides [LPH]). First, we demonstrated that the automated hippocampal subfield segmentation technique employed in this work reliably measured dentate gyrus-CA4 volume. Second, we found a decreased left dentate gyrus-CA4 volume in patients and that a larger number of depressive episodes between T1 and T2 predicted greater volume decline. Finally, we showed that 4-HNE was elevated in BD-II and that 4-HNE was negatively associated with left and right dentate gyrus-CA4 volumes in patients. These results are consistent with a role for the dentate gyrus in the pathophysiology of bipolar disorder and suggest that depressive episodes and elevated oxidative stress might contribute to hippocampal volume decreases. In addition, these findings provide further support for the hypothesis that peripheral lipid peroxidation markers may reflect brain alterations in bipolar disorders. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  1. Adolescent depression and educational attainment: results using sibling fixed effects.

    PubMed

    Fletcher, Jason M

    2010-07-01

    This paper contributes to the literature on the relationship between adolescent depression and educational attainment in several ways. First, while cross-sectional data are normally used, this paper uses longitudinal data in order to defend against the potential of reverse causality. Second, this is the first paper in the literature to control for sibling-fixed effects in examining the relationship between adolescent depressive symptoms and human capital accumulation. Importantly, this eliminates omitted factors such as family and neighborhood characteristics common to siblings that affect both depressive symptoms and educational attainments (e.g. neighborhood crime, and family resources). Third, this paper examines the effects of both an indicator and scale of depressive symptoms and finds important associations with these depressive symptoms and human capital accumulation. Though the results cannot be given a causal interpretation, the findings show a negative relationship between depressive symptoms and years of schooling. The relationship appears to be driven primarily through increasing the chances of dropping out but may have small impacts on the likelihood of college attendance (conditional on high school graduation). In particular, preferred estimates suggest that a standard deviation increase in depressive symptoms is associated with a 25-30% increase in the likelihood of dropping out. Copyright (c) 2009 John Wiley & Sons, Ltd.

  2. PCLO rs2522833-mediated gray matter volume reduction in patients with drug-naive, first-episode major depressive disorder.

    PubMed

    Igata, R; Katsuki, A; Kakeda, S; Watanabe, K; Igata, N; Hori, H; Konishi, Y; Atake, K; Kawasaki, Y; Korogi, Y; Yoshimura, R

    2017-05-30

    Major depressive disorder (MDD) has been linked to differences in the volume of certain areas of the brain and to variants in the piccolo presynaptic cytomatrix protein (PCLO), but the relationship between PCLO and brain morphology has not been studied. A single-nucleotide polymorphism (SNP) in PCLO, rs2522833, is thought to affect protein stability and the activity of the hypothalamic-pituitary-adrenal axis. We investigated the relationship between cortical volume and this SNP in first-episode, drug-naive patients with MDD or healthy control subjects. Seventy-eight participants, including 30 patients with MDD and 48 healthy control subjects, were recruited via interview. PCLO rs2522833 genotyping and plasma cortisol assays were performed, and gray matter volume was estimated using structural magnetic resonance images. Among the individuals carrying the C-allele of PCLO rs2522833, the volume of the left temporal pole was significantly smaller in those with MDD than in healthy controls (family-wise error-corrected, P=0.003). No differences were detected in other brain regions. In addition, the C-carriers showed a larger volume reduction in the left temporal pole than those in the individuals with A/A genotype (P=0.0099). Plasma cortisol levels were significantly higher in MDD-affected C-carriers than in the healthy control C-carriers (12.76±6.10 vs 9.31±3.60 nm, P=0.045). We conclude that PCLO SNP rs2522833 is associated with a gray matter volume reduction in the left temporal pole in drug-naive, first-episode patients with MDD carrying the C-allele.

  3. Self-blame-Selective Hyperconnectivity Between Anterior Temporal and Subgenual Cortices and Prediction of Recurrent Depressive Episodes.

    PubMed

    Lythe, Karen E; Moll, Jorge; Gethin, Jennifer A; Workman, Clifford I; Green, Sophie; Lambon Ralph, Matthew A; Deakin, John F W; Zahn, Roland

    2015-11-01

    Patients with remitted major depressive disorder (MDD) were previously found to display abnormal functional magnetic resonance imaging connectivity (fMRI) between the right superior anterior temporal lobe (RSATL) and the subgenual cingulate cortex and adjacent septal region (SCSR) when experiencing self-blaming emotions relative to emotions related to blaming others (eg, "indignation or anger toward others"). This finding provided the first neural signature of biases toward overgeneralized self-blaming emotions (eg, "feeling guilty for everything"), known to have a key role in cognitive vulnerability to MDD. It is unknown whether this neural signature predicts risk of recurrence, a crucial step in establishing its potential as a prognostic biomarker, which is urgently needed for stratification into pathophysiologically more homogeneous subgroups and for novel treatments. To use fMRI in remitted MDD at baseline to test the hypothesis that RSATL-SCSR connectivity for self-blaming relative to other-blaming emotions predicts subsequent recurrence of depressive episodes. A prospective cohort study from June 16, 2011, to October 10, 2014, in a clinical research facility completed by 75 psychotropic medication-free patients with remitted MDD and no relevant comorbidity. In total, 31 remained in stable remission, and 25 developed a recurring episode over the 14 months of clinical follow-up and were included in the primary analysis. Thirty-nine control participants with no personal or family history of MDD were recruited for further comparison. Between-group difference (recurring vs stable MDD) in RSATL connectivity, with an a priori SCSR region of interest for self-blaming vs other-blaming emotions. We corroborated our hypothesis that during the experience of self-blaming vs other-blaming emotions, RSATL-SCSR connectivity predicted risk of subsequent recurrence. The recurring MDD group showed higher connectivity than the stable MDD group (familywise error-corrected P

  4. Empirical typology of bipolar I mood episodes*

    PubMed Central

    Solomon, David A.; Leon, Andrew C.; Endicott, Jean; Coryell, William H.; Li, Chunshan; Fiedorowicz, Jess G.; Keller, Martin B.

    2009-01-01

    Background Much remains unknown about the phenomenology of bipolar I disorder. Aims To determine the type of bipolar I mood episodes that occur over time, and their relative frequency. Method A total of 219 individuals with Research Diagnostic Criteria bipolar I disorder were prospectively followed for up to 25 years (median 20 years). Psychopathology was assessed with the Longitudinal Interval Follow-up Evaluation. Results Overall, 1208 mood episodes were prospectively observed. The episodes were empirically classified as follows: major depression, 30.9% (n = 373); minor depression, 13.0% (n = 157); mania, 20.4% (n = 246); hypomania, 10.4% (n = 126); cycling, 17.3% (n = 210); cycling plus mixed state, 7.8% (n = 94); and mixed, 0.2% (n = 2). Conclusions Cycling episodes constituted 25% of all episodes. Work groups revising ICD–10 and DSM–IV should add a category for bipolar I cycling episode. PMID:19949203

  5. Understanding and responding to severe and enduring patient distress resulting from episodes of healthcare.

    PubMed

    Kenward, Linda

    2017-03-29

    This article focuses on the severe, long-term and debilitating distress that may be experienced by patients as a result of their interactions with healthcare professionals and services. It is essential for healthcare professionals to be able to respond effectively to severe patient distress resulting from episodes of healthcare. Severe and enduring patient distress can occur in response to neglect - even when unintentional, misdiagnosis, surgical errors and/or deficits in the quality of care. Severe and enduring distress experienced by patients may go unacknowledged; the long-term consequences may not be recognised, or resolution may be presumed following formal apologies or receipt of compensation. An emphasis on the duty of candour has increased awareness of the importance of honesty and acknowledgement of adverse events or 'near misses' in the healthcare setting, in improving the relationship between patients and healthcare professionals.

  6. The patient experience of depression and remission: focus group results.

    PubMed

    Frank, Lori; Matza, Louis S; Hanlon, Jennifer; Mannix, Sally; Revicki, Dennis A; Feltner, Douglas; Morlock, Robert J

    2007-08-01

    Few depression measures were developed with the patient perspective. To obtain patient views on depression and early symptom resolution, 4 focus groups (N=31) were conducted. Patients also completed the Quick Inventory of Depressive Symptomology (Self-Report), SF-36, and a rating of the bothersomeness and significance of 12 symptoms of depression. Transcripts were reviewed for major themes. Irritability was a key symptom and it remitted earlier than others. Important to participants were low mood, low energy, lack of motivation, lack of focus/concentration, feelings of guilt, self-critical thoughts, feeling overwhelmed, lack of enjoyment, hypersomnia, restlessness, anger, and irritability. Gender differences emerged; most men reported irritability as one of the first symptoms to remit; for women, motivation level and energy commonly remitted first. Results suggest that new measures of treatment outcome should encompass irritability, anger, and ability to cope with life stressors.

  7. Elevated monoamine oxidase a binding during major depressive episodes is associated with greater severity and reversed neurovegetative symptoms.

    PubMed

    Chiuccariello, Lina; Houle, Sylvain; Miler, Laura; Cooke, Robert G; Rusjan, Pablo M; Rajkowska, Grazyna; Levitan, Robert D; Kish, Stephen J; Kolla, Nathan J; Ou, Xiaoming; Wilson, Alan A; Meyer, Jeffrey H

    2014-03-01

    Inadequate treatment response occurs in approximately 40% of major depressive episodes (MDEs), and one approach to solve this is careful matching of treatment to the specific pathologies of MDE. One such biological abnormality is elevated monoamine oxidase A (MAO-A) levels, which occurs in the prefrontal and anterior cingulate cortex (PFC and ACC) during MDE; however, the subtypes for which this abnormality is most prominent are unknown. We hypothesized that MAO-A levels in the PFC and ACC are most elevated in MDE with greater severity and reversed neurovegetative symptoms (hypersomnia and either hyperphagia or weight gain). MAO-A VT (an index of MAO-A density) was measured using [(11)C]harmine positron emission tomography (PET) in 42 subjects with MDEs secondary to major depressive disorder and 37 healthy controls. The effect of severity and reversed neurovegetative symptoms on MAO-A VT in the PFC and ACC was analyzed using a multivariate analysis of variance (MANOVA). Greater severity and reversed neurovegetative symptoms were associated with elevated MAO-A VT in the PFC and ACC (MANOVA, severity: F(2,38)=5.44, p=0.008; reversed neurovegetative symptoms: F(2,38)=5.13, p=0.01). Increased MAO-A level, when greater severity and reversed neurovegetative symptoms are present, may explain the association of these clinical features with a preferential response to MAO inhibitors, which is especially well-evidenced for reversed neurovegetative symptoms in MDE. As MAO-A creates oxidative stress, facilitates apoptosis, and metabolizes monoamines, therapeutics opposing these processes are predicted to best treat MDE with greater severity and reversed neurovegetative symptoms.

  8. Workplace social capital and the onset of major depressive episode among workers in Japan: a 3-year prospective cohort study.

    PubMed

    Sakuraya, Asuka; Imamura, Kotaro; Inoue, Akiomi; Tsutsumi, Akizumi; Shimazu, Akihito; Takahashi, Masaya; Totsuzaki, Takafumi; Kawakami, Norito

    2017-06-01

    This study examined the prospective association of workplace social capital (WSC) with major depressive episode (MDE) among Japanese employees. A 3-year prospective cohort study was conducted among 1058 employees from a private think-tank company who participated in a baseline survey; after excluding those with MDE in the past 12 months, 929 were followed up. WSC at baseline was measured using a 3-item scale. MDE was assessed at baseline and at follow-up every year, by using a web-based, self-administered version of the WHO Composite International Diagnostic Interview (WHO-CIDI) 3.0 depression section, based on the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition: Text Revision (DSM-IV-TR)/DSM-5 criteria. Cox discrete-time hazards analyses were used to estimate HRs and 95% CIs, adjusting for covariates. A group with middle-level WSC scores had the lowest risk of MDE after being fully adjusted (HR 0.34, 95% CI 0.14 to 0.84, p=0.02). The relationship between WSC and MDE was U-shaped, although a non-linear model fit better than a linear model, with only marginally statistical significance (p=0.06). Dichotomised and continuous variables of WSC scores were significantly and negatively associated with MDE (p=0.03 and p<0.01, respectively). The current study replicated a previous finding from Finland that WSC was a protective factor of the onset of MDE in Japan. The slightly U-shaped relationship, that is, the group with high WSC having a small elevated risk of MDE, may reflect a dark side of WSC in a country with collectivity-oriented and hierarchy-oriented culture, such as Japan. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  9. Episodic Recollection Difficulties in ASD Result from Atypical Relational Encoding: Behavioral and Neural Evidence

    PubMed Central

    Bowler, Dermot M.; Ecker, Christine; Calvo‐Merino, Beatriz; Murphy, Declan G.

    2015-01-01

    Memory functioning in Autism Spectrum Disorder (ASD) is characterized by impairments in the encoding of relational but not item information and difficulties in the recollection of contextually rich episodic memories but not in the retrieval of relatively context‐free memories through processes of familiarity. The neural underpinnings of this profile and the extent to which encoding difficulties contribute to retrieval difficulties in ASD remain unclear. Using a paradigm developed by Addis and McAndrews [2006; Neuroimage, 33, 1194–1206] we asked adults with and without a diagnosis of ASD to study word‐triplets during functional Magnetic Resonance Imaging (fMRI) scanning that varied in the number of category relations amongst component words. Performance at test confirmed attenuated recollection in the context of preserved familiarity based retrieval in ASD. The results also showed that recollection but not familiarity based retrieval increases as a function of category relations in word triads for both groups, indicating a close link between the encoding of relational information and recollection. This link was further supported by the imaging results, where blood oxygen level dependent (BOLD) signal responses in overlapping regions of the inferior prefrontal cortex were sensitive to the relational encoding manipulation as well as the contrast between recollection versus familiarity based retrieval. Interestingly, however, there was no evidence of prefrontal signal differentiation for this latter contrast in the ASD group for whom signal changes in a left hippocampal region were also marginally attenuated. Together, these observations suggest that attenuated levels of episodic recollection in ASD are, at least in part, attributable to anomalies in relational encoding processes. Autism Res 2015, 8: 317–327. © 2015 International Society for Autism Research, Wiley Periodicals, Inc. PMID:25630307

  10. Alcohol Involvement as a Function of Co-Occurring Alcohol Use Disorders and Major Depressive Episode: Evidence from the National Epidemiologic Survey on Alcohol and Related Conditions

    PubMed Central

    Nolen-Hoeksema, Susan; Zucker, Robert A.

    2011-01-01

    Background Co-occurring alcohol use disorder and major depression (C-ALDP) is a major public health problem. Yet, the available evidence is mixed regarding the implications of C-ALDP for alcohol involvement. The purpose of this research was to examine the associations between past 12-month co-occurring AUDs (abuse and dependence) and major depressive episode (MDE) and alcohol involvement in a representative community sample. Design The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) is a national household survey of 43,083 adults ages 18 and older. For the NESARC, the target population is the civilian noninstitutionalized population, 18 years of age and older, living in the United States and the District of Columbia. Methods All NESARC interviews were conducted with the Alcohol Use Disorder and Associated Disabilities Interview Schedule – DSM IV Version (AUDADIS-IV; Grant et al., 2003). Results Prevalence of past 12-month co-occurring AUD (abuse or dependence) and MDE was 1.2%, corresponding to about 2.4 million adults ages 18 and older. Among males with alcohol dependence, comorbid MDE was associated with a greater number of days drinking at home alone. Among females and males with alcohol abuse and dependence, comorbid MDE was associated with higher prevalence of drinking to enhance depressed mood. Comorbid MDE was also associated with lower levels of some drinking behaviors among those with alcohol abuse. Conclusions Co-occurring AUDs and MDE are associated with specific dimensions of alcohol involvement, and this association is more consistent for alcohol dependence than abuse. PMID:21440383

  11. Gender Differences in Depressive Symptom Profile: Results from Nationwide General Population Surveys in Korea

    PubMed Central

    Kim, Ji-Hyun; Cho, Maeng Je; Hong, Jin Pyo; Bae, Jae Nam; Cho, Seong-Jin; Hahm, Bong-Jin; Lee, Dong-Woo; Park, Jong-Ik; Lee, Jun-Young; Jeon, Hong Jin

    2015-01-01

    This study investigated gender differences in symptom profiles of major depressive disorder (MDD) in the Korean general population. Data were pooled from the series of nationwide Korean Epidemiologic Catchment Area surveys conducted in 2001, 2006 and 2011, respectively. Of the 18,807 participants, 507 (397 women and 110 men) were diagnosed with MDD within the prior 12 months. In agreement with previous studies, women with MDD appeared to be more vulnerable to experiencing atypical depressive episodes defined as depression with two or more symptoms of fatigue, increased appetite and hypersomnia (P < 0.001). In terms of individual symptoms, female gender was significantly related with higher prevalence of fatigue (P = 0.008), hypersomnia (P = 0.001), noticeable psychomotor retardation (P = 0.029) and suicidal attempts (P = 0.016) with adjustment for birth cohort effect, partner status, and employment status. In the same analysis, men with MDD appeared more vulnerable to decreased libido than women (P = 0.009). This is the first report to demonstrate gender differences in symptomatology of MDD in the general Korean population, and the results are comparable to previous investigations from western societies. Assumingly, the intercultural similarity in female preponderance to atypical depression might reflect the common biological construct underlying the gender difference in mechanism of MDD. In clinical settings, gender differences of MDD should be carefully considered, because these features could be related with treatment response and drug side effects. PMID:26539012

  12. Relation of depression to perceived social support: results from a randomized adolescent depression prevention trial.

    PubMed

    Stice, Eric; Rohde, Paul; Gau, Jeff; Ochner, Chris

    2011-05-01

    Theorists posit that certain behaviors exhibited by depressed individuals (e.g., negative self-statements, dependency, reassurance seeking, inappropriate or premature disclosures, passivity, social withdrawal) reduce social support, yet there have been few experimental tests of this hypothesis. Using data from a randomized depression prevention trial (N=253) involving adolescents (M age=15.5, SD=1.2), we tested whether a cognitive behavioral group intervention that significantly reduced depressive symptoms relative to bibliotherapy and educational brochure control conditions through 2-year follow-up produced improvements in perceived parental and friend social support and whether change in depressive symptoms mediated the effect on change in social support. Cognitive behavioral group participants showed significantly greater increases in perceived friend social support through 1-year follow-up relative to bibliotherapy and brochure controls, but there were no significant effects for perceived parental support. Further, change in depressive symptoms appeared to mediate the effects of the intervention on change in perceived friend support. Results provide experimental support for the theory that depressive symptoms are inversely related to perceived social support, but imply that this effect may be specific to friend vs. parental support for adolescents.

  13. Validity of retrospective measures of early maltreatment and depressive episodes using the Childhood Experience of Care and Abuse (CECA) instrument -- A life-course study of adult chronic depression - 2.

    PubMed

    Brown, George W; Craig, Tom K J; Harris, Tirril O; Handley, Rachel V; Harvey, Anna L

    2007-11-01

    A previous paper, using data collected retrospectively from sister pairs, reported substantial associations of adult depressive episodes lasting at least 12 months with childhood maltreatment [Brown, G.W., Craig, T.K.J., Harris, T.O. Handley, R.V. & Harvey, A.L. 2007a-this issue. Development of a retrospective interview measure of parental maltreatment using the Childhood Experience of Care & Abuse (CECA) instrument - a life-course study of adult chronic depression - 1. J. Affect. Disord. doi:10.1016/j.jad.2007.05.022]. Risk was far less when depressive episodes of any duration were considered. This paper considers how much scientific weight can be placed on these findings in the light of doubt often expressed about retrospective collection of childhood and adult data. The retrospectively gathered material was obtained from adult sister pairs within 5 years of age, comprising a high-risk series (n = 118) where the first sister was selected as likely to have experienced childhood abuse or neglect, and a comparison series (n = 80) where she was selected at random. Current age ranged between early 20s and 50s. Data was collected by semi-structured interviews, using investigator-based ratings covering a wide range of parental behaviour and childhood behaviour. A series of analyses failed to reveal evidence of significant bias in the collection of material about adult depression or parental maltreatment. There was, however, some evidence of under reporting. Conclusions from such analyses can only be judged in terms of degree of plausibility. Nothing emerged to suggest the presence of significant bias in the aetiological findings of our earlier paper. There is evidence of some underreporting of both early adverse experience and adult depressive episodes, but this is unlikely to threaten the conclusions drawn about the link of parental maltreatment with adult chronic depressive episodes.

  14. Comorbid trajectories of substance use as predictors of Antisocial Personality Disorder, Major Depressive Episode, and Generalized Anxiety Disorder.

    PubMed

    Brook, Judith S; Zhang, Chenshu; Rubenstone, Elizabeth; Primack, Brian A; Brook, David W

    2016-11-01

    To determine longitudinal associations between patterns of comorbid cigarette, alcohol, and marijuana use and Antisocial Personality Disorder (ASPD), Major Depressive Episode (MDE), and Generalized Anxiety Disorder (GAD) in adulthood. A random community-based sample [X̅ age=36.6 (SD=2.8)] from the Children and Adults in the Community Study, an on-going investigation of substance use and psychiatric disorders. Data were collected at six time waves. Conjoint trajectories of cigarette, alcohol, and marijuana use spanning adolescence to adulthood were determined; multivariable logistic regression analyses assessed associations between trajectory group membership and having ASPD, MDE, or GAD in adulthood. Five conjoint trajectory groups were obtained: HHH (chronic cigarette, alcohol, and marijuana use), DDD (delayed/late-starting cigarette, alcohol, and marijuana use), LML (low/no smoking, moderate alcohol use, occasional marijuana use), HMN (chronic smoking, moderate alcohol use, no marijuana use), and NON (occasional alcohol use only). Compared with members of the NON group, those in the HHH group had significantly greater odds for having ASPD (Adjusted Odds Ratio [AOR]=28.52, 95% Confidence Interval [CI]=9.44-86.17), MDE (AOR=2.67, 95% CI=1.14-6.26), and GAD (AOR=6.39, 95% CI=2.62-15.56). Members of the DDD, LML, and HMN groups had weaker and less consistent associations with the three psychiatric outcomes. In a large, community-based sample, long-term concurrent use of more than one substance was associated with both externalizing and internalizing psychiatric disorders in adulthood. Prevention and treatment programs might target individuals in the community and general clinical populations with comorbid substance use, even if they haven't been identified as having a substance use disorder. Copyright © 2016 Elsevier Ltd. All rights reserved.

  15. Hydrologic and geomorphic changes resulting from episodic glacial lake outburst floods: Rio Colonia, Patagonia, Chile

    NASA Astrophysics Data System (ADS)

    Jacquet, J.; McCoy, S. W.; McGrath, D.; Nimick, D. A.; Fahey, M.; O'kuinghttons, J.; Friesen, B. A.; Leidich, J.

    2017-01-01

    Glacial lake outburst floods (GLOFs) are a prominent but poorly understood cryospheric hazard in a warming climate. We quantify the hydrologic and geomorphic response to 21 episodic GLOFs that began in April 2008 using multitemporal satellite imagery and field observations. Peak discharge exiting the source lake became progressively muted downstream. At 40-60 km downstream, where the floods entered and traveled down the main stem Rio Baker, peak discharges were generally < 2000 m3 s-1, although these flows were still >1-2 times the peak annual discharge of this system, Chile's largest river by volume. As such, caution must be applied to empirical relationships relating lake volume to peak discharge, as the latter is dependent on where this observation is made along the flood path. The GLOFs and subsequent periods of free drainage resulted in > 40 m of incision, the net removal of 25 × 106 m3 of sediment from the source lake basin, and a nonsteady channel configuration downstream. These results demonstrate that GLOFs sourced from low-order tributaries can produce significant floods on major main stem rivers, in addition to significantly altering sediment dynamics.

  16. Efficacy of Hypericum extract WS(®) 5570 compared with paroxetine in patients with a moderate major depressive episode - a subgroup analysis.

    PubMed

    Seifritz, Erich; Hatzinger, Martin; Holsboer-Trachsler, Edith

    2016-09-01

    efficacy and tolerability of WS(®) 5570 for the treatment of acute mild-to-moderate depression, has been demonstrated in various studies. Here, we present a subgroup analysis of a double blind, randomised trial to compare the therapeutic efficacy of WS(®) 5570 with paroxetine in patients suffering from a major depressive episode with moderate symptom intensity. moderate depression was defined by a baseline Hamilton Depression Rating Scale (HAM-D) total score between 22 and 25. Patients received, after a single blind placebo run-in phase of 3-7 d, either 3 × 300 mg/d WS(®) 5570 or 20 mg/d paroxetine for six weeks. The change of the HAM-D total score was used to describe the efficacy of WS(®) 5570 compared with paroxetine in the subgroup of patients with moderate depression. the reductions of the HAM-D total score were significantly more pronounced in patients treated with 3 × 300 mg/d WS(®) 5570 compared to 20 mg/d paroxetine. patients treated with WS(®) 5570 not only showed a reduction in depression severity score but also yielded greater response and remission rates compared with patients treated with paroxetine. Keypoints Various studies showed the efficacy and tolerability of WS(®) 5570 for the treatment of acute mild-to-moderate depression. Beneficial effects of WS(®) 5570 have been also shown in patients with moderate-to-severe depression. In this study reductions of the HAM-D total score were significantly more pronounced in patients with moderate depression treated with WS(®) 5570 compared with paroxetine. Patients treated with WS(®) 5570 not only showed a reduction in depression severity score but also yielded greater response and remission rates compared with patients treated with paroxetine.

  17. Identify changes of brain regional homogeneity in early and later adult onset patients with first-episode depression using resting-state fMRI

    PubMed Central

    Yang, Shuran; Ye, Jing; Dai, Nan; Liu, Xiaoyan; Li, Na; Lu, Jin; Liu, Fang; Lu, Yi; Sun, Xuejin; Cheng, Yuqi

    2017-01-01

    Objective Previous work exhibited different brain grey matter volume (GMV) changes between patients with early adult onset depression (EOD, age 18–29) and later adult onset depression (LOD, age 30–44) by using 30-year-old as the cut-off age. To identify whether regional homogeneity (ReHo) changes are also different between EOD and LOD by using same cut-off age, we used resting-state functional magnetic resonance imaging (fMRI) to detect the abnormal ReHo between patients with EOD and LOD in the present study. Methods Resting-state fMRI scans of 58 patients with EOD, 62 patients with LOD, 60 young healthy controls (HC), and 52 old HC were obtained. The ReHo approach was used to analyze the images. Results The ANOVA analysis revealed that the ReHo values in the frontoparietal, occipital, and cerebellar regions were significantly different among the four groups. Relative to patients with LOD, patients with EOD displayed significantly increased ReHo in the left precuneus, and decreased ReHo in the right fusiform. The ReHo values in the left precuneus and the right fusiform had no significant correlation with the score of the depression rating scale or illness duration in both patient subgroups. Compared to young HC, patients with EOD showed significantly increased ReHo in the right frontoparietal regions and the right calcarine. Furthermore, the increased ReHo in the right frontoparietal regions, right insula and left hippocampus, and decreased ReHo in the left inferior occipital gyrus, right middle occipital gyrus, left calcarine, and left supplementary motor area were observed in patients with LOD when compared to old HC. Conclusions The ReHo of brain areas that were related to mood regulation was changed in the first-episode, drug-naive adult patients with MDD. Adult patients with EOD and LOD exhibited different ReHo abnormalities relative to each age-matched comparison group, suggesting that depressed adult patients with different age-onset might have different

  18. Episodic acidification of small streams in the northeastern united states: ionic controls of episodes

    USGS Publications Warehouse

    Wigington, P.J.; DeWalle, David R.; Murdoch, Peter S.; Kretser, W.A.; Simonin, H.A.; Van Sickle, J.; Baker, J.P.

    1996-01-01

    As part of the Episodic Response Project (ERP), we intensively monitored discharge and stream chemistry of 13 streams located in the Northern Appalachian region of Pennsylvania and in the Catskill and Adirondack Mountains of New York from fall 1988 to spring 1990. The ERP clearly documented the occurrence of acidic episodes with minimum episodic pH ??? 5 and inorganic monomeric Al (Alim) concentrations >150 ??g/L in at least two study streams in each region. Several streams consistently experienced episodes with maximum Alim concentrations >350 ??g/L. Acid neutralizing capacity (ANC) depressions resulted from complex interactions of multiple ions. Base cation decreases often made the most important contributions to ANC depressions during episodes. Organic acid pulses were also important contributors to ANC depressions in the Adirondack streams, and to a lesser extent, in the Catskill and Pennsylvania streams. Nitrate concentrations were low in the Pennsylvania streams, whereas the Catskill and Adirondack study streams had high NO3- concentrations and large episodic pulses (???54 ??eq/L). Most of the Pennsylvania study streams also frequently experienced episodic pulses of SO42- (???78 ??eq/L), whereas the Adirondack and Catskill streams did not. High baseline concentrations of SO42- (all three study areas) and NO3- (Adirondacks and Catskills) reduced episodic minimum ANC, even when these ions did not change during episodes. The ion changes that controlled the most severe episodes (lowest minimum episodic ANC) differed from the ion changes most important to smaller, more frequent episodes. Pulses of NO3- (Catskills and Adirondacks), SO42- (Pennsylvania), or organic acids became more important during major episodes. Overall, the behavior of streamwater SO42- and NO4- is an indicator that acidic deposition has contributed to the severity of episodes in the study streams.

  19. Risk of psychosis and internal migration: Results from the Bologna First Episode Psychosis study.

    PubMed

    Tarricone, Ilaria; Boydell, Jane; Kokona, Arnisa; Triolo, Federico; Gamberini, Lisa; Sutti, Enrico; Marchetta, Michela; Menchetti, Marco; Di Forti, Marta; Murray, Robin M; Morgan, Craig; Berardi, Domenico

    2016-05-01

    Incidence of psychotic disorders is higher in many migrant groups; however little is known about internal migrants (IM). This study aims to describe the IR in natives (NA), IM and external migrants (EM). All patients aged 18-64years, with First Episode Psychosis (FEP), who made contact with the Bologna West psychiatric services, between 2002 and 2010, were included. 187 cases were included. Age and sex adjusted IR of psychosis per 100,000per year were: 12.6 for NA, 25.3 for IM and 21.4 for EM. The IRR was 1.93 (1.19-3.13, P=0.007) for IM and 1.79 (1.06-3.02, P=0.03) for EM compared to NA. Rates of psychosis were significantly elevated in IM as well as in EM. This result adds evidence as to the role of migration itself (versus ethnicity) on the risk of psychosis. Copyright © 2016 Elsevier B.V. All rights reserved.

  20. Depressive Symptoms Are More Strongly Related to Executive Functioning and Episodic Memory Among African American compared with Non-Hispanic White Older Adults

    PubMed Central

    Zahodne, Laura B.; Nowinski, Cindy J.; Gershon, Richard C.; Manly, Jennifer J.

    2014-01-01

    We examined whether the reserve capacity model can be extended to cognitive outcomes among older African Americans. Two hundred and ninety-two non-Hispanic Whites and 37 African Americans over age 54 participated in the normative study for the NIH Toolbox for the Assessment of Neurological and Behavioral Function. Multiple-group path analysis showed that associations between depressive symptoms and cognition differed by race, independent of age, education, reading level, income, health, and recruitment site. Depressive symptoms were associated with slowed processing speed among Whites and worse task-switching, inhibition, and episodic memory among African Americans. African Americans may be more vulnerable to negative effects of depression on cognition than non-Hispanic Whites. Further research is needed to explicate the psychological and neurobiological underpinnings of this greater vulnerability. PMID:25280795

  1. External validation of the international risk prediction algorithm for major depressive episode in the US general population: the PredictD-US study.

    PubMed

    Nigatu, Yeshambel T; Liu, Yan; Wang, JianLi

    2016-07-22

    Multivariable risk prediction algorithms are useful for making clinical decisions and for health planning. While prediction algorithms for new onset of major depression in the primary care attendees in Europe and elsewhere have been developed, the performance of these algorithms in different populations is not known. The objective of this study was to validate the PredictD algorithm for new onset of major depressive episode (MDE) in the US general population. Longitudinal study design was conducted with approximate 3-year follow-up data from a nationally representative sample of the US general population. A total of 29,621 individuals who participated in Wave 1 and 2 of the US National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and who did not have an MDE in the past year at Wave 1 were included. The PredictD algorithm was directly applied to the selected participants. MDE was assessed by the Alcohol Use Disorder and Associated Disabilities Interview Schedule, based on the DSM-IV criteria. Among the participants, 8 % developed an MDE over three years. The PredictD algorithm had acceptable discriminative power (C-statistics = 0.708, 95 % CI: 0.696, 0.720), but poor calibration (p < 0.001) with the NESARC data. In the European primary care attendees, the algorithm had a C-statistics of 0.790 (95 % CI: 0.767, 0.813) with a perfect calibration. The PredictD algorithm has acceptable discrimination, but the calibration capacity was poor in the US general population despite of re-calibration. Therefore, based on the results, at current stage, the use of PredictD in the US general population for predicting individual risk of MDE is not encouraged. More independent validation research is needed.

  2. Amplitude of Low-Frequency Oscillations in First-Episode, Treatment-Naive Patients with Major Depressive Disorder: A Resting-State Functional MRI Study

    PubMed Central

    Wang, Li; Dai, Wenji; Su, Yunai; Wang, Gang; Tan, Yunlong; Jin, Zhen; Zeng, Yawei; Yu, Xin; Chen, Wei; Wang, Xiaodong; Si, Tianmei

    2012-01-01

    Background Resting-state fMRI is a novel approach to measure spontaneous brain activity in patients with major depressive disorder (MDD). Although most resting-state fMRI studies have focused on the examination of temporal correlations between low-frequency oscillations (LFOs), few studies have explored the amplitude of these LFOs in MDD. In this study, we applied the approaches of amplitude of low-frequency fluctuation (ALFF) and fractional ALFF to examine the amplitude of LFOs in MDD. Methodology/Principal Findings A total of 36 subjects, 18 first-episode, treatment-naive patients with MDD matched with 18 healthy controls (HCs) completed the fMRI scans. Compared with HCs, MDD patients showed increased ALFF in the right fusiform gyrus and the right anterior and posterior lobes of the cerebellum but decreased ALFF in the left inferior temporal gyrus, bilateral inferior parietal lobule, and right lingual gyrus. The fALFF in patients was significantly increased in the right precentral gyrus, right inferior temporal gyrus, bilateral fusiform gyrus, and bilateral anterior and posterior lobes of the cerebellum but was decreased in the left dorsolateral prefrontal cortex, bilateral medial orbitofrontal cortex, bilateral middle temporal gyrus, left inferior temporal gyrus, and right inferior parietal lobule. After taking gray matter (GM) volume as a covariate, the results still remained. Conclusions/Significance These findings indicate that MDD patients have altered LFO amplitude in a number of regions distributed over the frontal, temporal, parietal, and occipital cortices and the cerebellum. These aberrant regions may be related to the disturbances of multiple emotion- and cognition-related networks observed in MDD and the apparent heterogeneity in depressive symptom domains. Such brain functional alteration of MDD may contribute to further understanding of MDD-related network imbalances demonstrated in previous fMRI studies. PMID:23119084

  3. Work Engagement as a Predictor of Onset of Major Depressive Episode (MDE) among Workers, Independent of Psychological Distress: A 3-Year Prospective Cohort Study

    PubMed Central

    Imamura, Kotaro; Kawakami, Norito; Inoue, Akiomi; Shimazu, Akihito; Tsutsumi, Akizumi; Takahashi, Masaya; Totsuzaki, Takafumi

    2016-01-01

    Objective This study investigated work engagement as a baseline predictor of onset of major depressive episode (MDE). Methods The study used a prospective cohort design, conforming to the STROBE checklist. Participants were recruited from the employee population of a private think tank company (N = 4,270), and 1,058 (24.8%) of them completed a baseline survey, of whom 929 were included in this study. Work engagement and psychological distress at baseline were assessed as predictor variables. MDE was measured at baseline and at each of the follow-ups as the outcome, using the web-based, self-administered version of the Japanese WHO-CIDI 3.0 depression section based upon DSM-IV-TR/DSM-5 criteria. Cox discrete-time hazards analyses were conducted to estimate hazard ratios (95% confidence intervals CIs). Results Follow-up rates of participants (N = 929) were 78.4%, 67.2%, and 51.6% at 1-, 2-, and 3-year follow-ups, respectively. The association between work engagement at baseline and the onset of MDE was U-shaped. Compared with a group with low work engagement scores, groups with the middle and high scores showed significantly (HR = 0.19, 95% CI = 0.05 to 0.64; p = 0.007) and marginally significantly (HR = 0.48, 95% CI = 0.20 to 1.15, p = 0.099) lower risks of MDE, respectively, over the follow-ups, after adjusting for covariates. The pattern remained the same after additionally adjusting for psychological distress. Conclusions The present study first demonstrated work engagement as an important predictor of the onset of MDE diagnosed according to an internationally standard diagnostic criteria of mental disorders. PMID:26841020

  4. Fatigue, sleep-wake pattern, depressive and anxiety symptoms and body-mass index: analysis in a sample of episodic and chronic migraine patients.

    PubMed

    Lucchesi, Cinzia; Baldacci, Filippo; Cafalli, Martina; Dini, Elisa; Giampietri, Linda; Siciliano, Gabriele; Gori, Sara

    2016-06-01

    Migraine clinical presentation and life-time course can be highly heterogeneous, with a subgroup of patients developing chronic migraine; moreover, migraine clinical spectrum is expanded by the association with different coexisting conditions and interictal dysfunctions. The aim of this study was to systematically evaluate migraine clinical features, daily functioning parameters, sleep pattern, presence of depressive-anxiety symptoms and body mass index (BMI) in a sample of 75 episodic and 75 chronic migraine without aura patients. Migraine-related disability, fatigue, daily sleepiness, subjective sleep quality, anxiety and depressive symptoms were, respectively, evaluated using the following questionnaires: Fatigue Severity Scale (FSS), Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index (PSQI), Generalized Anxiety Disorder 7-item Scale (GAD-7), Patient Health Questionnaire 9-item Scale (PHQ-9). Mean FSS score (p < 0.001), PSQI score (p = 0.015), GAD-7 score (p = 0.019), PHQ-9 score (p < 0.001) and BMI score (p = 0.012) were significantly higher in chronic compared to episodic migraineurs. Additionally, a correlation analysis carried out in the total sample of 150 migraine patients documented a statistically significant, positive correlation between monthly frequency of migraine attacks and FSS score (p < 0.001), PSQI score (p = 0.006), GAD-7 score (p = 0.019), PHQ-9 score (p < 0.001) and BMI score (p = 0.049). Data from the present report seem to expand the concept of migraine as a continuum or spectrum, with greater occurrence of fatigue, poor sleep quality, anxiety-depressive symptoms and higher BMI score in chronic compared to episodic migraine patients; further investigation is certainly necessary to better define the biological basis and mechanisms associated with migraine transformation from episodic to chronic pattern.

  5. Major depressive episodes over the course of 7 years and hippocampal subfield volumes at 7 tesla MRI: the PREDICT-MR study.

    PubMed

    Wisse, L E M; Biessels, G J; Stegenga, B T; Kooistra, M; van der Veen, P H; Zwanenburg, J J M; van der Graaf, Y; Geerlings, M I

    2015-04-01

    Smaller hippocampal volumes have been associated with major depressive disorder (MDD). The hippocampus consists of several subfields that may be differentially related to MDD. We investigated the association of occurrence of major depressive episodes (MDEs), assessed five times over seven years, with hippocampal subfield and entorhinal cortex volumes at 7 tesla MRI. In this prospective study of randomly selected general practice attendees, MDEs according to DSM-IV-R criteria were assessed at baseline and after 6, 12, 39 and 84 months follow-up. At the last follow-up, a T2 (0.7 mm(3)) 7 tesla MRI scan was obtained in 47 participants (60±10 years). The subiculum, cornu ammonis (CA) 1 to 3, dentate gyrus&CA4 and entorhinal cortex volumes were manually segmented according a published protocol. Of the 47 participants, 13 had one MDE and 5 had multiple MDEs. ANCOVAs, adjusted for age, sex, education and intracranial volume, revealed no significant differences in hippocampal subfield or entorhinal cortex volumes between participants with and without an MDE in the preceding 84 months. Multiple episodes were associated with smaller subiculum volumes (B=-0.03 mL/episode; 95% CI -0.06; -0.003), but not with the other hippocampal subfield volumes, entorhinal cortex, or total hippocampal volume. A limitation of this study is the small sample size which makes replication necessary. In this exploratory study, we found that an increasing number of major depressive episodes was associated with smaller subiculum volumes in middle-aged and older persons, but not with smaller volumes in other hippocampal subfields or the entorhinal cortex. Copyright © 2014 Elsevier B.V. All rights reserved.

  6. Epidemiological and clinical characterization following a first psychotic episode in major depressive disorder: comparisons with schizophrenia and bipolar I disorder in the Cavan-Monaghan First Episode Psychosis Study (CAMFEPS).

    PubMed

    Owoeye, Olabisi; Kingston, Tara; Scully, Paul J; Baldwin, Patrizia; Browne, David; Kinsella, Anthony; Russell, Vincent; O'Callaghan, Eadbhard; Waddington, John L

    2013-07-01

    While recent research on psychotic illness has focussed on the nosological, clinical, and biological relationships between schizophrenia and bipolar disorder, little attention has been directed to the most common other psychotic diagnosis, major depressive disorder with psychotic features (MDDP). As this diagnostic category captures the confluence between dimensions of psychotic and affective psychopathology, it is of unappreciated heuristic potential to inform on the nature of psychotic illness. Therefore, the epidemiology and clinical characteristics of MDDP were compared with those of schizophrenia and bipolar disorder within the Cavan-Monaghan First Episode Psychosis Study (n = 370). Epidemiologically, the first psychotic episode of MDDP (n = 77) was uniformly distributed across the adult life span, while schizophrenia (n = 73) and bipolar disorder (n = 73) were primarily disorders of young adulthood; the incidence of MDDP, like bipolar disorder, did not differ between the sexes, while the incidence of schizophrenia was more common in males than in females. Clinically, MDDP was characterized by negative symptoms, executive dysfunction, neurological soft signs (NSS), premorbid intellectual function, premorbid adjustment, and quality of life similar to those for schizophrenia, while bipolar disorder was characterized by less prominent negative symptoms, executive dysfunction and NSS, and better quality of life. These findings suggest that what we currently categorize as MDDP may be more closely aligned with other psychotic diagnoses than has been considered previously. They indicate that differences in how psychosis is manifested vis-à-vis depression and mania may be quantitative rather than qualitative and occur within a dimensional space, rather than validating categorical distinctions.

  7. Do Different Tests of Episodic Memory Produce Consistent Results in Human Adults?

    ERIC Educational Resources Information Center

    Cheke, Lucy G.; Clayton, Nicola S.

    2013-01-01

    A number of different philosophical, theoretical, and empirical perspectives on episodic memory have led to the development of very different tests with which to assess it. Although these tests putatively assess the same psychological capacity, they have rarely been directly compared. Here, a sample of undergraduates was tested on three different…

  8. Do Different Tests of Episodic Memory Produce Consistent Results in Human Adults?

    ERIC Educational Resources Information Center

    Cheke, Lucy G.; Clayton, Nicola S.

    2013-01-01

    A number of different philosophical, theoretical, and empirical perspectives on episodic memory have led to the development of very different tests with which to assess it. Although these tests putatively assess the same psychological capacity, they have rarely been directly compared. Here, a sample of undergraduates was tested on three different…

  9. Extreme Attributions Predict the Course of Bipolar Depression: Results from the STEP-BD Randomized Controlled Trial of Psychosocial Treatment

    PubMed Central

    Stange, Jonathan P.; Sylvia, Louisa G.; da Silva Magalhães, Pedro Vieira; Miklowitz, David J.; Otto, Michael W.; Frank, Ellen; Berk, Michael; Nierenberg, Andrew A.; Deckersbach, Thilo

    2013-01-01

    Objective Little is known about predictors of recovery from bipolar depression or moderators of treatment response. In the present study we investigated attributional style (a cognitive pattern of explaining the causes of life events) as a predictor of recovery from episodes of bipolar depression and as a moderator of response to psychotherapy for bipolar depression. Method 106 depressed outpatients with DSM-IV bipolar I or II disorder enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) were randomized to intensive psychotherapy for depression (n=62), or collaborative care (n=44), a minimal psychoeducational intervention. The primary outcome was recovery status at each study visit as measured by the Clinical Monitoring Form. Attributional style was measured at baseline using the Attributional Style Questionnaire. Data were collected between 1998 and 2005. Results All analyses were by intention to treat. Extreme attributions predicted a lower likelihood of recovery (p=.01, OR=0.93, 95% CI=.88-.98) and longer time until recovery (p<.01, OR=0.96, 95% CI=.93-.99), independent of the effects of initial depression severity. Among individuals with more pessimistic attributional styles, initial depression severity predicted a lower likelihood of recovery (p=.01, OR=0.64, 95% CI=.45-.91) and longer time until recovery (p<.001, OR=0.76, 95% CI=.66-.88). There was no difference in recovery rates between intensive psychotherapy and collaborative care (OR=0.90, 95% CI=0.40-2.01) in the full sample. Conclusions These results suggest that extreme, rigid attributions may be associated with a more severe course of depression, and that evaluating attributional style may help clinicians to identify patients who are at risk for experiencing a more severe course of depression. PMID:23561230

  10. IRRITABLE MOOD IN ADULT MAJOR DEPRESSIVE DISORDER: RESULTS FROM THE WORLD MENTAL HEALTH SURVEYS

    PubMed Central

    Kovess-Masfety, Viviane; Alonso, Jordi; Angermeyer, Matthias; Bromet, Evelyn; de Girolamo, Giovanni; de Jonge, Peter; Demyttenaere, Koen; Florescu, Silvia E.; Gruber, Michael J.; Gureje, Oye; Hu, Chiyi; Huang, Yueqin; Karam, Elie G.; Jin, Robert; Lépine, Jean-Pierre; Levinson, Daphna; McLaughlin, Katie A.; Medina-Mora, María E.; O’Neill, Siobhan; Ono, Yutaka; Posada-Villa, José A.; Sampson, Nancy A.; Scott, Kate M.; Shahly, Victoria; Stein, Dan J.; Viana, Maria C.; Zarkov, Zahari; Kessler, Ronald C.

    2014-01-01

    Background Although irritability is a core symptom of DSM-IV major depressive disorder (MDD) for youth but not adults, clinical studies find comparable rates of irritability between nonbipolar depressed adults and youth. Including irritability as a core symptom of adult MDD would allow detection of depression-equivalent syndromes with primary irritability hypothesized to be more common among males than females. We carried out a preliminary examination of this issue using cross-national community-based survey data from 21 countries in the World Mental Health (WMH) Surveys (n = 110,729). Methods The assessment of MDD in the WHO Composite International Diagnostic Interview includes one question about persistent irritability. We examined two expansions of the definition of MDD involving this question: (1) cases with dysphoria and/or anhedonia and exactly four of nine Criterion A symptoms plus irritability; and (2) cases with two or more weeks of irritability plus four or more other Criterion A MDD symptoms in the absence of dysphoria or anhedonia. Results Adding irritability as a tenth Criterion A symptom increased lifetime prevalence by 0.4% (from 11.2 to 11.6%). Adding episodes of persistent irritability increased prevalence by an additional 0.2%. Proportional prevalence increases were significantly higher, but nonetheless small, among males compared to females. Rates of severe role impairment were significantly lower among respondents with this irritable depression who did not meet conventional DSM-IV criteria than those with DSM-IV MDD. Conclusion Although limited by the superficial assessment in this single question on irritability, results do not support expanding adult MDD criteria to include irritable mood. PMID:23364997

  11. From the third month of pregnancy to 1 year postpartum. Prevalence, incidence, recurrence, and new onset of depression. Results from the perinatal depression-research & screening unit study.

    PubMed

    Banti, Susanna; Mauri, Mauro; Oppo, Annalisa; Borri, Chiara; Rambelli, Cristina; Ramacciotti, Daniele; Montagnani, Maria S; Camilleri, Valeria; Cortopassi, Sonia; Rucci, Paola; Cassano, Giovanni B

    2011-01-01

    Perinatal depression is a particular challenge to clinicians, and its prevalence estimates are difficult to compare across studies. Furthermore, to our knowledge, there are no studies that systematically assessed the incidence of perinatal depression. The aim of this study is to estimate the prevalence, incidence, recurrence, and new onset of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, minor and major depression (mMD) in an unselected population of women recruited at the third month of pregnancy and followed up until the 12th month postpartum. One thousand sixty-six pregnant women were recruited. Minor and major depression was assessed in a naturalistic, longitudinal study. The Edinburgh Postnatal Depression Scale and the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Disorders were administered at different time points during pregnancy and in the postpartum period. The period prevalence of mMD was 12.4% in pregnancy and 9.6% in the postpartum period. The cumulative incidence of mMD in pregnancy and in the postpartum period was 2.2% and 6.8%, respectively. Thirty-two (7.3%) women had their first episode in the perinatal period: 1.6% had a new onset of depression during pregnancy, 5.7% in the postpartum period. Our postpartum prevalence figures, which are lower than those reported in the literature, may reflect treatment during the study, suggesting that casting a multiprofessional network around women in need of support may be potentially useful for reducing the effects of this disorder on the mother and the newborn child. Furthermore, our results indicate that women with a history of depression have a 2-fold risk of developing mMD in the perinatal period. Copyright © 2011 Elsevier Inc. All rights reserved.

  12. Pseudo-continuous arterial spin labeling imaging of cerebral blood perfusion asymmetry in drug-naïve patients with first-episode major depression

    PubMed Central

    Chen, Guangdong; Bian, Haiman; Jiang, Deguo; Cui, Mingwei; Ji, Shengzhang; Liu, Mei; Lang, Xu; Zhuo, Chuanjun

    2016-01-01

    Many previous studies have reported that regional cerebral blood flow (rCBF) aberrations may be one of the pathological characteristics of depression and rCBF has demonstrated a certain degree of asymmetry. However, studies investigating the cerebral blood perfusion asymmetry changes of drug-naïve patients experiencing their first episode of major depression using pseudo-continuous arterial spin labeling (pCASL) are rare. Ten drug-naïve patients experiencing their first major depression episode and 15 healthy volunteers were enrolled in the current study. A novel pCASL method was applied to whole brain MRI scans of all of the samples. The Statistics Parameter Mapping and Relative Expression Software Tool software packages were used for the pre-processing and statistical analysis of the two sets of images, and the differences in the cerebral blood perfusion at the whole brain level were compared between the two groups. Compared with the healthy control group, the cerebral perfusion of the depression patients showed an asymmetric pattern. Decreased cerebral blood perfusion regions were primarily located in the left hemisphere, specifically in the left temporal lobe, frontal lobe and cingulate cortex [P<0.05 and cluster size ≥30 with false discovery rate (FDR) correction]. Simultaneously, increased perfusion regions were predominantly located in the right hemisphere, specifically in the right cerebellum, thalamus, frontal lobe and anterior cingulate cortex (P<0.05 and cluster size ≥30, with FDR correction). Thus, pCASL may characterize the alterations in cerebral blood perfusion of patients with depression. PMID:28101340

  13. Transcranial Magnetic Stimulation of Left Dorsolateral Prefrontal Cortex Induces Brain Morphological Changes in Regions Associated with a Treatment Resistant Major Depressive Episode: An Exploratory Analysis.

    PubMed

    Lan, Martin J; Chhetry, Binod Thapa; Liston, Conor; Mann, J John; Dubin, Marc

    2016-01-01

    Repetitive transcranial magnetic stimulation (TMS) is an FDA-approved antidepressant treatment but little is known of its mechanism of action. Specifically, downstream effects of TMS remain to be elucidated. This study aims to identify brain structural changes from TMS treatment of a treatment resistant depressive episode through an exploratory analysis. Twenty-seven subjects in a DSM-IV current major depressive episode and on a stable medication regimen had a 3T magnetic resonance T1 structural scan before and after five weeks of standard TMS treatment to the left dorsolateral prefrontal cortex. Twenty-seven healthy volunteer (HVs) subjects had the same brain MRI acquisition. Voxel-based morphometry was performed using high dimensional non-linear diffusomorphic anatomical registration (DARTEL). Six clusters of gray matter volume (GMV) that were lower in pre-treatment MRIs of depressed subjects than in HVs. GMV in four of these regions increased in MDD after TMS treatment by 3.5-11.2%. The four brain regions that changed with treatment were centered in the left anterior cingulate cortex, the left insula, the left superior temporal gyrus and the right angular gyrus. Increases in the anterior cingulate GMV with TMS correlated with improvement in depression severity. To our knowledge, this is the first study of brain structural changes during TMS treatment of depression. The affected brain areas are involved in cognitive appraisal, decision-making and subjective experience of emotion. These effects may have potential relevance for the antidepressant action of TMS. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Changes of grey matter volume in first-episode drug-naive adult major depressive disorder patients with different age-onset.

    PubMed

    Shen, Zonglin; Cheng, Yuqi; Yang, Shuran; Dai, Nan; Ye, Jing; Liu, Xiaoyan; Lu, Jin; Li, Na; Liu, Fang; Lu, Yi; Sun, Xuejin; Xu, Xiufeng

    Little is known about the pathological mechanism of early adult onset depression (EOD) and later adult onset depression (LOD). We seek to determine whether grey matter volume (GMV) change in EOD and LOD are different, which could also delineate EOD and LOD. In present study, 147 first-episode, drug-naive patients with major depressive disorder (MDD), age between 18 and 45, were divided into two groups on the basis of age of MDD onset: the early adult onset group (age 18-29) and the later adult onset group (age 30-44), and a total of 130 gender-, and age-, matched healthy controls (HC) were also divided into two groups which fit for each patient group. Magnetic resonance imaging was conducted on all subjects. The voxel-based morphometry (VBM) approach was employed to analyze the images. Widespread abnormalities of GMV throughout parietal, temporal, limbic regions, occipital cortex and cerebellum were observed in MDD patients. Compare to young HC, reduced GMV in right fusiform gyrus, right middle temporal gyrus, vermis III and increased GMV in right middle occipital gyrus were seen in the EOD group. In contrast, relative to old HC, decreased GMV in the right hippocampus and increased GMV in the left middle temporal gyrus were observed in the LOD group. Compared to the LOD group, the EOD group had smaller GMV in right posterior cingulate cortex. There was no significant correlation between GMV of the right posterior cingulate cortex and the score of the depression rating scale in patients group. The GMV of the brain areas that were related to mood regulation was decreased in the first-episode, drug-naive adult patients with MDD. Adult patients with EOD and LOD exhibited different GMV changes relative to each age-matched comparison group, suggesting depressed adult patients with different age-onset might have different pathological mechanism.

  15. Treatment for Adolescents With Depression Study (TADS): Safety Results

    PubMed Central

    Emslie, Graham; Kratochvil, Christopher; Vitiello, Benedetto; Silva, Susan; Mayes, Taryn; McNulty, Steven; Weller, Elizabeth; Waslick, Bruce; Casat, Charles; Walkup, John; Pathak, Sanjeev; Rohde, Paul; Posner, Kelly; March, John

    2012-01-01

    Objective To compare the rates of physical, psychiatric, and suicide-related events in adolescents with MDD treated with fluoxetine alone (FLX), cognitive-behavioral therapy (CBT), combination treatment (COMB), or placebo (PBO). Method Safety assessments included adverse events (AEs) collected by spontaneous report, as well as systematic measures for specific physical and psychiatric symptoms. Suicidal ideation and suicidal behavior were systematically assessed by self- and clinician reports. Suicidal events were also reanalyzed by the Columbia Group and expert raters using the Columbia-Classification Algorithm for Suicidal Assessment used in the U.S. Food and Drug Administration reclassification effort. Results Depressed adolescents reported high rates of physical symptoms at baseline, which improved as depression improved. Sedation, insomnia, vomiting, and upper abdominal pain occurred in at least 2% of those treated with FLX and/or COMB and at twice the rate of placebo. The rate of psychiatric AEs was 11% in FLX, 5.6% in COMB, 4.5% in PBO, and 0.9% in CBT. Suicidal ideation improved overall, with greatest improvement in COMB. Twenty-four suicide-related events occurred during the 12-week period: 5 patients (4.7%) in COMB, 10 (9.2%) in FLX, 5 (4.5%) in CBT, and 3 (2.7%) in placebo. Statistically, only FLX had more suicide-related events than PBO (p = .0402, odds ratio [OR] = 3.7, 95% CI 1.00–13.7). Only five actual attempts occurred (2 COMB, 2 FLX, 1 CBT, 0 PBO). There were no suicide completions. Conclusions Different methods for eliciting AEs produce different results. In general, as depression improves, physical complaints and suicidal ideation decrease in proportion to treatment benefit. In this study, psychiatric AEs and suicide-related events are more common in FLX-treated patients. COMB treatment may offer a more favorable safety profile than medication alone in adolescent depression. PMID:17135989

  16. The Clinical and Cost Effectiveness of Vortioxetine for the Treatment of a Major Depressive Episode in Patients With Failed Prior Antidepressant Therapy: A Critique of the Evidence.

    PubMed

    Lomas, James; Llewellyn, Alexis; Soares, Marta; Simmonds, Mark; Wright, Kath; Eastwood, Alison; Palmer, Stephen

    2016-09-01

    The National Institute for Health and Care Excellence (NICE) invited the manufacturer of vortioxetine (Lundbeck) to submit clinical and cost-effectiveness evidence for vortioxetine for the treatment of major depressive episodes (MDEs), as part of the Institute's Single Technology Appraisal (STA) process. The Centre for Reviews and Dissemination and Centre for Health Economics at the University of York were commissioned to act as the independent Evidence Review Group (ERG). This article provides a description of the company submission, the ERG review and the resulting NICE guidance TA367 issued in November 2015. The ERG critically reviewed the evidence presented in the manufacturer's submission and identified areas requiring clarification, for which the manufacturer provided additional evidence. Two phase III randomised controlled trials for a second-line population involving vortioxetine were identified-REVIVE and TAK318. These two trials represent only 972 of over 7000 patients included in trials of vortioxetine. In REVIVE, there was a statistically significant difference in depression scores favouring vortioxetine compared with agomelatine [mean Montgomery-Åsberg Depression Rating Scale (MADRS) score difference of 2.16 points; 95 % confidence interval 0.81-3.51]. The ERG concluded that, based on all the evidence, rather than the substantially restricted subset of evidence originally considered by the manufacturer, vortioxetine is likely to be similar in efficacy to other analysed antidepressants [citalopram, sertraline, escitalopram and venlafaxine extended release (XR)], and may be more efficacious than agomelatine and inferior to duloxetine. The ERG concluded that vortioxetine may be more tolerable than other analysed antidepressants (sertraline, venlafaxine XR and bupropion), although the limited data prevent firm conclusions. The base-case incremental cost-effectiveness ratio (ICER) of vortioxetine reported by the manufacturer was £378 per quality

  17. Perceived Pain Extent is Not associated with Widespread Pressure Pain Sensitivity, Clinical Features, Related-Disability, Anxiety, or Depression in Women with Episodic Migraine.

    PubMed

    Fernández-de-Las-Peñas, Cesar; Falla, Deborah; Palacios-Ceña, María; Fuensalidad-Novo, Stella; Arias-Buría, Jose L; Schneebeli, Alessandro; Arend-Nielsen, Lars; Barbero, Marco

    2017-07-20

    People with migraine present with varying pain extent and an expanded distribution of perceived pain may reflect central sensitization. The relationship between pain extent and clinical features, psychological outcomes, related-disability and pressure pain sensitivity in migraine has been poorly investigated. Our aim was to investigate whether the perceived pain extent, assessed from pain drawings, relates to measures of pressure pain sensitivity, clinical, psychological outcomes, and related-disability in women with episodic migraine. Seventy-two women with episodic migraine completed pain drawings which were subsequently digitized allowing pain extent to be calculated utilising novel software. Pressure pain thresholds (PPT) were assessed bilaterally over the temporalis muscle (trigeminal area), the cervical spine (extra-trigeminal area) and tibialis anterior muscle (distant pain-free area). Clinical features of migraine, migraine related-disability (migraine disability assessment questionnaire, MIDAS), anxiety and depression (Hospital Anxiety-Depression Scale, HADS) were also assessed. Spearman rho correlation coefficients were computed to reveal correlations between pain extent and the remaining outcomes. No significant associations were observed between pain extent and PPTs in trigeminal, extra-trigeminal or distant pain-free areas, migraine pain features, or psychological variables including anxiety or depression and migraine related-disability. Pain extent within the trigemino-cervical area was not associated with any of the measured clinical outcomes and not related to the degree of pressure pain sensitization in women with episodic migraine. Further research is needed to determine if the presence of expanded pain areas outside of the trigeminal area can play a relevant role in the sensitization processes in migraine.

  18. Inoculation of Bacillus Calmette-Guerin to mice induces an acute episode of sickness behavior followed by chronic depressive-like behavior

    PubMed Central

    Moreau, Maïté; André, Caroline; O’Connor, Jason C.; Dumich, Sara A.; Woods, Jeffrey A.; Kelley, Keith W.; Dantzer, Robert; Lestage, Jacques; Castanon, Nathalie

    2010-01-01

    Although cytokine-induced sickness behavior is now well-established, the mechanisms by which chronic inflammation and depression are linked still remain elusive. Therefore this study aimed to develop a suitable model to identify the neurobiological basis of depressive-like behavior induced by chronic inflammation, independently of sickness behavior. We chose to measure the behavioral consequences of chronic inoculation of mice with Bacillus Calmette-Guerin (BCG), which has been shown to chronically activate both lung and brain indoleamine 2,3-dioxygenase (IDO), a tryptophan-catabolizing enzyme that mediates the occurrence of depressive-like behavior following acute innate immune system activation. BCG inoculation induced an acute episode of sickness (approximately 5 days) that was followed by development of delayed depressive-like behaviors lasting over several weeks. Transient body weight loss, reduction of motor activity and the febrile response to BCG were dissociated temporarily from a sustained increase in the duration of immobility in both forced swim and tail suspension tests, reduced voluntary wheel running and decreased preference for sucrose (a test of anhedonia). Moreover, we show that a distinct pattern of cytokine production and IDO activation parallels the transition from sickness to depression. Protracted depressive-like behavior, but not sickness behavior, was associated with sustained increase in plasma interferon-γ and TNF-α concentrations and peripheral IDO activation. Together, these promising new data establish BCG inoculation of mice as a reliable rodent model of chronic inflammation-induced depressive-like behaviors that recapitulate many clinical observations and provide important clues about the neurobiological basis through which cytokines may have an impact on affective behaviors. PMID:18479887

  19. Persistent disparity in prevalence of current cigarette smoking between US adolescents with vs. without a past-year major depressive episode.

    PubMed

    Polednak, Anthony P

    2014-02-01

    Using data from annual (2004-2010) cross-sectional surveys of nationally representative samples, the prevalence rate of current (i.e., past 30 days) cigarette smoking among US adolescents age 12-17 years was twice as high for those with vs. without a past-year major depressive episode (PYMDE) (22 vs. 11% in the 2004 survey and 16 vs. 8% in the 2010 survey). The proportion of all US adolescent current smokers who had a PYMDE was about 24% for females; 70-80% of all smokers with PYMDE were females. The persistently higher smoking rates in US adolescents with vs. without PYMDE emphasizes the need for interventions.

  20. Episodic memory impairment in Addison's disease: results from a telephonic cognitive assessment.

    PubMed

    Henry, Michelle; Thomas, Kevin G F; Ross, Ian L

    2014-06-01

    Patients with Addison's disease frequently self-report memory and attention difficulties, even when on standard replacement therapy. However, few published studies examine, using objective measures and assessing across multiple domains, the cognitive functioning of Addison's disease patients relative to healthy controls. The primary aim of this study was to investigate whether the previously reported subjective cognitive deficits in Addison's disease are confirmed by objective measures. Conducting comprehensive neuropsychological assessments of patients with relatively rare clinical disorders, such as Addison's disease, is challenging because access to those patients is often limited, and because their medical condition might prevent extended testing sessions. Brief telephonic cognitive assessments are a useful tool in such circumstances. Hence, we administered the Brief Test of Adult Cognition by Telephone to 27 Addison's disease patients and 27 matched healthy controls. The instrument provides objective assessment of episodic memory, working memory, executive functioning, reasoning, and speed of processing. Statistical analyses confirmed that, as expected, patients performed significantly more poorly than controls on the episodic memory subtest. There were, however, no significant between-group differences on the attention, executive functioning, reasoning, and speed of processing subtests. Furthermore, patients with a longer duration of illness performed more poorly across all domains of cognition. We conclude that, for Addison's disease patients, previously reported subjective cognitive deficits are matched by objective impairment, but only in the domain of episodic memory. Future research might investigate (a) whether these memory deficits are material-specific (i.e., whether non-verbal memory is also affected), and (b) the neurobiological mechanisms underlying these deficits.

  1. Acute renal failure induced by markedly decreased appetite secondary to a depressive episode after discontinuation of long-term lithium therapy in an elderly patient with bipolar disorder.

    PubMed

    Okada, Akira

    2014-05-16

    Some elderly patients on chronic lithium therapy for bipolar disorder and their doctors may be faced with a therapeutic dilemma over whether or not to continue prescribing/taking lithium given their increased risk of reduced renal function. We present the case of a 78-year-old woman with bipolar disorder who discontinued lithium therapy due to increased risk factors for renal injury. After discontinuation, she experienced markedly decreased appetite secondary to a depressive episode, and developed acute renal failure, which subsequently progressed to a more advanced stage of chronic kidney disease. This case suggests that extreme care must be taken to prevent the recurrence of depression in elderly patients with bipolar disorder who discontinue lithium therapy, even when they had been emotionally stable for a long time while receiving lithium. Medications other than lithium for bipolar disorder may be needed at the time lithium therapy is discontinued.

  2. Mindfulness-based interventions for people diagnosed with a current episode of an anxiety or depressive disorder: a meta-analysis of randomised controlled trials.

    PubMed

    Strauss, Clara; Cavanagh, Kate; Oliver, Annie; Pettman, Danelle

    2014-01-01

    Mindfulness-based interventions (MBIs) can reduce risk of depressive relapse for people with a history of recurrent depression who are currently well. However, the cognitive, affective and motivational features of depression and anxiety might render MBIs ineffective for people experiencing current symptoms. This paper presents a meta-analysis of randomised controlled trials (RCTs) of MBIs where participants met diagnostic criteria for a current episode of an anxiety or depressive disorder. Post-intervention between-group Hedges g effect sizes were calculated using a random effects model. Moderator analyses of primary diagnosis, intervention type and control condition were conducted and publication bias was assessed. Twelve studies met inclusion criteria (n = 578). There were significant post-intervention between-group benefits of MBIs relative to control conditions on primary symptom severity (Hedges g = -0.59, 95% CI = -0.12 to -1.06). Effects were demonstrated for depressive symptom severity (Hedges g = -0.73, 95% CI = -0.09 to -1.36), but not for anxiety symptom severity (Hedges g = -0.55, 95% CI = 0.09 to -1.18), for RCTs with an inactive control (Hedges g = -1.03, 95% CI = -0.40 to -1.66), but not where there was an active control (Hedges g = 0.03, 95% CI = 0.54 to -0.48) and effects were found for MBCT (Hedges g = -0.39, 95% CI = -0.15 to -0.63) but not for MBSR (Hedges g = -0.75, 95% CI = 0.31 to -1.81). This is the first meta-analysis of RCTs of MBIs where all studies included only participants who were diagnosed with a current episode of a depressive or anxiety disorder. Effects of MBIs on primary symptom severity were found for people with a current depressive disorder and it is recommended that MBIs might be considered as an intervention for this population.

  3. Neural correlates of strategic processes underlying episodic memory in women with major depression: A 15O-PET study.

    PubMed

    Ottowitz, William E; Deckersbach, Thilo; Savage, Cary R; Lindquist, Martin A; Dougherty, Darin D

    2010-01-01

    To evaluate the functional integrity of brain regions underlying strategic mnemonic processing in patients with major depressive disorder, the authors administered a modified version of the California Verbal Learning Test to depressed patients during presentation of lists of unrelated words and, conversely, during presentation of lists of related words with and without orientation regarding the relatedness of the words (eight healthy females, IQ=122, and eight depressed females, IQ=107). Brain function evaluated across all three conditions showed that patients with major depressive disorder revealed activation of the right anterior cingulate cortex, left ventrolateral prefrontal cortex, both hippocampi, and the left orbitofrontal cortex. Further analysis showed that patients with major depressive disorder had greater activation of the right anterior cingulate cortex during semantic organization and the right ventrolateral prefrontal cortex during strategy initiation.

  4. Family-focused treatment for childhood-onset depressive disorders: results of an open trial.

    PubMed

    Tompson, Martha C; Pierre, Claudette B; Haber, Fawn McNeil; Fogler, Jason M; Groff, April R; Asarnow, Joan R

    2007-07-01

    Study objectives were to develop a treatment manual for a family-focused intervention for depressed school-aged children, evaluate its feasibility and acceptability, and complete an initial open trial to examine treatment effects. Nine young people meeting criteria for depression (major depressive disorder, dysthymic disorder, or depression not otherwise specified), completed a 12-week family intervention, and were assessed immediately and at 9 months following treatment completion. The intervention presented an interpersonal model of how depressive symptoms are maintained, and emphasized developing family strategies for altering interpersonal processes, supporting recovery and enhancing resilience. At posttreatment 66% of the young people had recovered from their depressive episodes; by 9 months posttreatment 77% had recovered. Significant improvements in global functioning were noted. There were no relapses in the follow-up period and no instances of suicidal behavior during the intervention or follow-up. Mothers' and fathers' Child Behavior Checklist reports and children's self reports indicated significant symptom reductions. Exploratory analyses suggest particular benefit for young people with parents high in criticism. The family-focused intervention for childhood-onset depression demonstrated gains similar to those seen with empirically supported treatments for depressed adolescents and superior to those seen in naturalistic studies of depression outcomes. This favorable risk/benefit profile supports the value of a randomized controlled trial.

  5. High-field magnetic resonance imaging of structural alterations in first-episode, drug-naive patients with major depressive disorder

    PubMed Central

    Chen, Z; Peng, W; Sun, H; Kuang, W; Li, W; Jia, Z; Gong, Q

    2016-01-01

    Previous structural imaging studies have found evidence of brain morphometric changes in patients with major depressive disorder (MDD), but these studies rarely excluded compounding effects of certain important factors, such as medications and long duration of illnesses. Furthermore, the neurobiological mechanism of the macroscopic findings of structural alterations in MDD patients remains unclear. In this study, we utilized magnetization transfer imaging, a quantitative measure of the macromolecular structural integrity of brain tissue, to identify biophysical alterations, which are represented by a magnetization transfer ratio (MTR), in MDD patients. To ascertain whether MTR changes occur independent of volume loss, we also conduct voxel-based morphometry (VBM) analysis. The participants included 27 first-episode, drug-naive MDD patients and 28 healthy controls matched for age and gender. Whole-brain voxel-based analysis was used to compare MTR and gray matter volume across groups and to analyse correlations between MTR and age, symptom severity, and illness duration. The patients exhibited significantly lower MTR in the left superior parietal lobule and left middle occipital gyrus compared with healthy controls, which may be related to the attentional and cognitive dysfunction in MDD patients. The VBM analysis revealed significantly increased gray matter volume in right postcentral gyrus in MDD patients. These findings in first-episode, drug-naive MDD patients may reflect microstructural gray matter changes in the parietal and occipital cortices close to illness onset that existed before volume loss, and thus potentially provide important new insight into the early neurobiology of depression. PMID:27824357

  6. High-field magnetic resonance imaging of structural alterations in first-episode, drug-naive patients with major depressive disorder.

    PubMed

    Chen, Z; Peng, W; Sun, H; Kuang, W; Li, W; Jia, Z; Gong, Q

    2016-11-08

    Previous structural imaging studies have found evidence of brain morphometric changes in patients with major depressive disorder (MDD), but these studies rarely excluded compounding effects of certain important factors, such as medications and long duration of illnesses. Furthermore, the neurobiological mechanism of the macroscopic findings of structural alterations in MDD patients remains unclear. In this study, we utilized magnetization transfer imaging, a quantitative measure of the macromolecular structural integrity of brain tissue, to identify biophysical alterations, which are represented by a magnetization transfer ratio (MTR), in MDD patients. To ascertain whether MTR changes occur independent of volume loss, we also conduct voxel-based morphometry (VBM) analysis. The participants included 27 first-episode, drug-naive MDD patients and 28 healthy controls matched for age and gender. Whole-brain voxel-based analysis was used to compare MTR and gray matter volume across groups and to analyse correlations between MTR and age, symptom severity, and illness duration. The patients exhibited significantly lower MTR in the left superior parietal lobule and left middle occipital gyrus compared with healthy controls, which may be related to the attentional and cognitive dysfunction in MDD patients. The VBM analysis revealed significantly increased gray matter volume in right postcentral gyrus in MDD patients. These findings in first-episode, drug-naive MDD patients may reflect microstructural gray matter changes in the parietal and occipital cortices close to illness onset that existed before volume loss, and thus potentially provide important new insight into the early neurobiology of depression.

  7. Routine evaluation in first episode psychosis services: feasibility and results from the MiData project.

    PubMed

    Fisher, Helen; Theodore, Kate; Power, Paddy; Chisholm, Brock; Fuller, Jo; Marlowe, Karl; Aitchison, Katherine J; Tanna, Raj; Joyce, John; Sacks, Maxine; Craig, Thomas; Johnson, Sonia

    2008-12-01

    Early intervention services (EIS) for psychosis are becoming widespread. Structured methods of assessment are advocated in these services, but a consensus is still needed on a package of measures with good psychometric properties that is feasible and reliable for routine use in this setting. A computerised assessment package (MiData) was designed to provide clinicians with easy-to-understand feedback about clients' progress and to allow evaluation of the whole service for both audit and research purposes. Core areas include symptoms, duration of untreated psychosis (DUP), pathways into care, social functioning, and substance misuse at initial intake and annually thereafter. MiData has been adopted by EIS throughout London and in some other centres. Baseline data are now available regarding 533 first-episode psychosis patients who presented to 8 London teams. The completeness of the data varied across teams and measures, with fullest completion for sociodemographic data (99% on some measures) and poorest for DUP. The average London EIS client is male, single, unemployed and comes from Black or Minority Ethnic group. Most (70%) demonstrated poor social functioning at intake, over a third (38%) reported substance abuse problems and 23% had harmed themselves or others in the previous 6 months. MiData provides a clinician-friendly system of evaluating first-episode psychosis services but requires further refinement and dedicated resources to improve completion rates. This method of collecting routine data is of use to clinicians, managers, health service researchers and commissioners and potentially it may enable naturalistic comparisons between different models of care.

  8. Cross-country variation in the sociodemographic factors associated with major depressive episode in Norway, the United Kingdom, Ghana, and Kenya.

    PubMed

    Ambugo, Eliva A

    2014-07-01

    Studies based on Western samples generally show that status characteristics like gender or marital status are associated with better mental health for individuals who occupy advantageous positions, such as men or the married. However, these patterns may not hold in developing regions that differ in important ways from the West. Guided by the Stress Process Model (SPM), this study uses logistic regression to examine the effect of gender, education, and other status characteristics on major depressive episode (MDE). Similarities and differences in these associations across two Western and two African countries are also assessed. Nationally representative data for adults ages 18 years and older are from the World Health Surveys (2002-2004) for Norway (N = 943), the United Kingdom (UK: N = 1195), Ghana (N = 3922), and Kenya (N = 4331). Results indicate a mixed pattern of associations between status characteristics and MDE across the four countries. Norwegian men face higher risk of MDE than Norwegian women-an anomalous finding. With some exceptions, education and employment status are not significantly related to MDE across the countries, providing little support for SPM. Marital status differences in risk of MDE are largest for Norway and smallest for Ghana. For the UK, men face lower risk of MDE than women across levels of mastery, and the gender gap in MDE is larger at higher levels of mastery. Overall, there is some heterogeneity in the associations between status characteristics and MDE even in somewhat similar environments like Ghana and Kenya. This study extends the reach of SPM to settings in sub-Saharan Africa, and contributes to the sparse empirical literature on the prevalence and sociodemographic correlates of MDE in the general populations of Ghana and Kenya. Copyright © 2014 Elsevier Ltd. All rights reserved.

  9. Cross-Country Variation in the Sociodemographic Factors Associated with Major Depressive Episode in Norway, the United Kingdom, Ghana, and Kenya

    PubMed Central

    Ambugo, Eliva A.

    2014-01-01

    Studies based on Western samples generally show that status characteristics like gender or marital status are associated with better mental health for individuals who occupy advantageous positions, such as men or the married. However, these patterns may not hold in developing regions that differ in important ways from the West. Guided by the Stress Process Model (SPM), this study uses logistic regression to examine the effect of gender, education, and other status characteristics on major depressive episode (MDE). Similarities and differences in these associations across two Western and two African countries are also assessed. Nationally representative data for adults ages 18 years and older are from the World Health Surveys (2002-2004) for Norway (N = 943), the United Kingdom (UK: N = 1,195), Ghana (N = 3,922), and Kenya (N = 4,331). Results indicate a mixed pattern of associations between status characteristics and MDE across the four countries. Norwegian men face higher risk of MDE than Norwegian women—an anomalous finding. With some exceptions, education and employment status are not significantly related to MDE across the countries, providing little support for SPM. Marital status differences in risk of MDE are largest for Norway and smallest for Ghana. For the UK, men face lower risk of MDE than women across levels of mastery, and the gender gap in MDE is larger at higher levels of mastery. Overall, there is some heterogeneity in the associations between status characteristics and MDE even in somewhat similar environments like Ghana and Kenya. This study extends the reach of SPM to settings in sub-Saharan Africa, and contributes to the sparse empirical literature on the prevalence and sociodemographic correlates of MDE in the general populations of Ghana and Kenya. PMID:24875047

  10. Psychosocial, Physical, and Autonomic Correlates of Depression in Korean Adults: Results from a County-Based Depression Screening Study

    PubMed Central

    Kim, Ki Won; Kim, Seok Hyeon; Shin, Jin Ho; Choi, Bo Yul; Nam, Jung Hyun

    2014-01-01

    Objective We aimed to investigate the prevalence and psychosocial and neurophysiological correlates of depression in a large county-based cohort of Korean adults. Methods We recruited 2355 adults from a rural county-based health promotion program. The following psychometric scales were used: the Center for Epidemiologic Studies Depression scale (CES-D) was used to assess depression, the General Health Questionnaire (GHQ) was used to evaluate stress, and the Medical Outcome Study Social Support Survey (MOS-SSS) was used to determine perceived social support. Heart rate variability (HRV) was used to assess neurophysiological properties. The psychosocial and neurophysiological variables of adults with depression (CES-D score ≥25) and without depression (CES-D score <25) were statistically compared. A logistic regression model was constructed to identify factors independently associated with depression. Results We estimated that 17.7% of the subjects had depression, which was associated with old age, being female, being single, less religious affiliation, high education, low body mass index (BMI), low levels of aerobic exercise, low social support, and a low HRV triangular index. The explanatory factors of depression included high education, less religious affiliation, low levels of current aerobic exercise, low BMI, and low social support. Conclusion Given the relatively high prevalence of overall depression, subsyndromal depression should also be regarded as an important issue in screening. The independent factors associated with depression suggest that practical psychosocial intervention, including brief psychotherapy, aerobic exercise, and other self-help methods should be considered. In addition, the HRV results suggest that further depression screening accompanied by neurophysiological features would require fine methodological modifications with proactive efforts to prevent depressive symptoms. PMID:25395971

  11. Depression, subthreshold depression and comorbid anxiety symptoms in older Europeans: results from the EURODEP concerted action.

    PubMed

    Braam, Arjan W; Copeland, John R M; Delespaul, Philippe A E G; Beekman, Aartjan T F; Como, Ariel; Dewey, Michael; Fichter, Manfred; Holwerda, Tjalling J; Lawlor, Brian A; Lobo, Antonio; Magnússon, Hallgrímur; Prince, Martin J; Reischies, Friedel; Wilson, Kenneth C; Skoog, Ingmar

    2014-02-01

    In the epidemiology of late life depression, few insights are available on the co-occurrence of subthreshold depression and comorbid symptoms of anxiety. The current study aims to describe prevalence patterns of comorbid anxiety symptoms across different levels of depression in old age, and to describe the burden of depressive symptoms and functional disability across patterns of comorbidity. Respondents were older adults in the community, age 65-104 (N=14,200), from seven European countries, with in total nine study centres, collaborating in the EURODEP concerted action. Depression and anxiety were assessed using the Geriatric Mental State examination (GMS-AGECAT package), providing subthreshold level and case-level diagnoses. Presence of anxiety symptoms was defined as at least three distinct symptoms of anxiety. Number of depressive symptoms was assessed with the EURO-D scale. The prevalence of anxiety symptoms amounts to 32% for respondents without depression, 67% for those with subthreshold depression, and 87% for those with case-level depression. The number of depressive symptoms is similar for those with subthreshold-level depression with comorbid anxiety, compared to case-level depression without symptoms of anxiety. In turn, at case level, comorbid symptoms of anxiety are associated with higher levels of depressive symptoms and more functional disability. GMS-AGECAT is insufficiently equipped with diagnostic procedures to identify specific types of anxiety disorders. Anxiety symptoms in late life depression are highly prevalent, and are likely to contribute to the burden of symptoms of the depression, even at subthreshold level. © 2013 Published by Elsevier B.V.

  12. Effectiveness of psychological and/or educational interventions to prevent the onset of episodes of depression: A systematic review of systematic reviews and meta-analyses.

    PubMed

    Bellón, Juan Ángel; Moreno-Peral, Patricia; Motrico, Emma; Rodríguez-Morejón, Alberto; Fernández, Ana; Serrano-Blanco, Antoni; Zabaleta-del-Olmo, Edurne; Conejo-Cerón, Sonia

    2015-07-01

    To determine the effectiveness of psychological and/or educational interventions to prevent the onset of episodes of depression. Systematic review of systematic reviews and meta-analyses (SR/MA). We searched PubMed, PsycINFO, Cochrane Database of Systematic Reviews, OpenGrey, and PROSPERO from their inception until February 2014. Two reviewers independently evaluated the eligibility criteria of all SR/MA, abstracted data, and determined bias risk (AMSTAR). Twelve SR/MA (156 non-repeated trials and 56,158 participants) were included. Of these, 142 (91%) were randomized-controlled, 13 (8.3%) controlled trials, and 1 (0.6%) had no control group. Five SR/MA focused on children and adolescents, four on specific populations (women after childbirth, of low socioeconomic status, or unfavorable circumstances; patients with severe traumatic physical injuries or stroke) and three addressed the general population. Nine (75%) SR/MA concluded that interventions to prevent depression were effective. Of the 156 trials, 137 (87.8%) reported some kind of effect size calculation. Effect sizes were small in 45 (32.8%), medium in 26 (19.1%), and large in 25 (18.2%) trials; 41 (29.9%) trials were not effective. Of the 141 trials for which follow-up periods were available, only 34 (24.1%) exceeded 12 months. Psychological and/or educational interventions to prevent onset of episodes of depression were effective, although most had small or medium effect sizes. Copyright © 2014. Published by Elsevier Inc.

  13. Strategies to mitigate dissociative and psychotomimetic effects of ketamine in the treatment of major depressive episodes: a narrative review.

    PubMed

    Cooper, Matthew D; Rosenblat, Joshua D; Cha, Danielle S; Lee, Yena; Kakar, Ron; McIntyre, Roger S

    2016-03-16

    Objectives Replicated evidence has demonstrated that ketamine exerts rapid-acting and potent antidepressant effects. Notwithstanding, its promise to mitigate depressive symptoms and suicidality in antidepressant-resistant populations, several limitations and safety concerns accompany ketamine including, but not limited to, the potential for abuse and psychotomimetic/dissociative experiences. The focus of the current narrative review is to synthesise available evidence of strategies that may mitigate and fully prevent treatment-emergent psychotomimetic and dissociative effects associated with ketamine administration. Methods PubMed, Google Scholar and ClinicalTrials.gov were searched for relevant articles. Results Potential avenues investigated to minimise psychotomimetic effects associated with ketamine administration include the following: (1) altering dosing and infusion rates; (2) route of administration; (3) enantiomer choice; (4) co-administration with mood stabilisers of antipsychotics; and (5) use of alternative N-methyl-d-aspartate (NMDA)-modulating agents. Emerging evidence indicates that dissociative experiences can be significantly mitigated by using an intranasal route of administration, lower dosages, or use of alternative NMDA-modulating agents, namely lanicemine (AZD6765) and GLYX-13. Conclusions Currently, intranasal administration presents as the most promising strategy to mitigate dissociative and psychotomimetic effects; however, studies of strategies to mitigate the adverse events of ketamine are limited in number and quality and thus further investigation is still needed.

  14. Monitoring candidate gene expression variations before, during and after a first major depressive episode in a 51-year-old man

    PubMed Central

    2014-01-01

    Background Although psychiatric disorders are frequently characterized by clinical heterogeneity, high recurrence, and unpredictable prognosis, studies of mRNA expression variations in blood cells from psychiatric patients constitute a promising avenue to establish clinical biomarkers. We report here, to our knowledge, the first genetic monitoring of a major depressive episode (MDE). Case presentation The subject is a 51-year-old male, who was healthy at baseline and whose blood mRNA was monitored over 67 weeks for expression variations of 9 candidate genes. At week 20 the subject experienced a mild to moderate unexpected MDE, and oral antidepressant treatment was initiated at week 29. At week 36, the patient recovered from his MDE. After 6 months, antidepressant treatment was discontinued and the subject remained free of depressive symptoms. Genetic monitoring revealed that mRNA expression of SLC6A4/5HTT increased with the emergence of a depressive state, which later returned to basal levels after antidepressant treatment and during MDE recovery. PDLIM5, S100A10 and TNF mRNA showed also an interesting pattern of expression with regards to MDE evolution. Conclusion This case demonstrated the applicability of peripheral mRNA expression as a way to monitor the natural history of MDE. PMID:24620999

  15. Lifetime history of depression and anxiety disorders as a predictor of quality of life in midlife women in the absence of current illness episodes.

    PubMed

    Joffe, Hadine; Chang, Yuefang; Dhaliwal, Sammy; Hess, Rachel; Thurston, Rebecca; Gold, Ellen; Matthews, Karen A; Bromberger, Joyce T

    2012-05-01

    It is unknown whether a history of depression, anxiety disorders, or comorbid depression and anxiety affects subsequent health-related quality of life (HRQOL) during midlife in women when vasomotor symptoms (VMS) and sleep disturbance commonly disrupt QOL. To evaluate whether previous affective illness is associated with low HRQOL during midlife in the absence of current illness episodes and whether low HRQOL is explained by VMS or sleep disruption. Longitudinal, community-based study. Western Pennsylvania. A total of 425 midlife women in the Study of Women's Health Across the Nation who completed the Structured Clinical Interview for DSM-IV (SCID) and the 36-Item Short Form Health Survey (SF-36) annually during 6 years of follow-up. Scores on the SF-36 scales of social functioning (SF), role-emotional (RE), role-physical (RP), body pain (BP), and vitality. Ninety-seven women (22.8%) had comorbid affective illness histories, 162 (38.1%) had previous depression only, and 21 (4.9%) had previous anxiety only. Those with comorbid illness histories and depression alone were more likely to report low HRQOL on the SF, RE, RP, and BP domains (odds ratio [OR] = 2.31-3.54 and 1.59-2.28, respectively) than were women with neither disorder. After adjustment for VMS and sleep disturbance, the comorbid group continued to have low HRQOL on these domains (OR = 2.13-3.07), whereas the association was significant on SF and BP only for the depression-alone group (OR = 2.08 and 1.95, respectively). Compared with women with neither disorder, the anxiety-only group had low HRQOL on the RP domain (OR = 2.60). Sleep disturbance, but not VMS, was independently associated with low HRQOL on all the domains except RE. A history of both depression and anxiety has the most robust negative effect on HRQOL in women during midlife, an association not explained by VMS or sleep disturbance. For the depression-alone group, sleep disturbance may partially explain the negative impact of previous

  16. Relationship between atypical depression and social anxiety disorder.

    PubMed

    Koyuncu, Ahmet; Ertekin, Erhan; Ertekin, Banu Aslantaş; Binbay, Zerrin; Yüksel, Cağrı; Deveci, Erdem; Tükel, Raşit

    2015-01-30

    In this study, we aimed to investigate the effects of atypical and non-atypical depression comorbidity on the clinical characteristics and course of social anxiety disorder (SAD). A total of 247 patients with SAD were enrolled: 145 patients with a current depressive episode (unipolar or bipolar) with atypical features, 43 patients with a current depressive episode with non-atypical features and 25 patients without a lifetime history of depressive episodes were compared regarding sociodemographic and clinical features, comorbidity rates, and severity of SAD, depression and functional impairment. Thirty four patients with a past but not current history of major depressive episodes were excluded from the comparisons. 77.1% of current depressive episodes were associated with atypical features. Age at onset of SAD and age at initial major depressive episode were lower in the group with atypical depression than in the group with non-atypical depression. History of suicide attempts and bipolar disorder comorbidity was more common in the atypical depression group as well. Atypical depression group has higher SAD and depression severity and lower functionality than group with non-atypical depression. Our results indicate that the presence of atypical depression is associated with more severe symptoms and more impairment in functioning in patients with SAD. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  17. Criterion Validity of the Mood and Feelings Questionnaire for Depressive Episodes in Clinic and Non-Clinic Subjects

    ERIC Educational Resources Information Center

    Daviss, W. Burleson; Birmaher, Boris; Melhem, Nadine A.; Axelson, David A.; Michaels, Shana M.; Brent, David A.

    2006-01-01

    Background: Previous measures of pediatric depression have shown inconsistent validity in groups with differing demographics, comorbid diagnoses, and clinic or non-clinic origins. The current study re-examines the criterion validity of child- and parent-versions of the Mood and Feelings Questionnaire (MFQ-C, MFQ-P) in a heterogeneous sample of…

  18. Personality disorder, depression and functioning: results from the ODIN study.

    PubMed

    Casey, Patricia; Birbeck, Gail; McDonagh, Catherine; Horgan, Ann; Dowrick, Chris; Dalgard, Odd; Lethinen, Ville; Ayuso-Mateos, Jose Luis; Dunn, Graham; Page, Helen; Wilkinson, Claire; Wilkinson, Greg; Vazquez-Barquero, Jose Luis

    2004-10-15

    There is little information of the prevalence of personality disorder (PD) in those with depressive disorder in community samples; neither is there any data on the impact of PD on service utilisation or outcome in this setting. A two stage screening study to identify cases of depressive disorder using SCAN in five European countries. Personality assessed 6 months after the diagnostic interview. Follow-up for 1 year using symptom and social function measures. Personality disorder is present in 22% of a community sample with depressive disorders but the range varied from 13.7% to 33.3% across countries. Cluster C formed 43% of the total. Long-term psychotropic drug use was more common in the PD group even after depression was controlled. Those with PD had higher symptom scores at the outset and, although the PD group was more likely to be cases at follow-up, this disappeared when the depression score was co-varied. Only initial social function predicted outcome at 6 and 12 months. The use of a non-treatment seeking population may limit the application of the findings to clinical populations. PD is common even in a non-treatment seeking population with depressive disorder. It impacts upon outcome at 6 and 12 months but this is related to the initial severity of depressed mood. Social function is the only independent predictor of outcome and should be assessed separately.

  19. Intensive Psychosocial Intervention Enhances Functioning in Patients With Bipolar Depression: Results From a 9-Month Randomized Controlled Trial

    PubMed Central

    Miklowitz, David J.; Otto, Michael W.; Frank, Ellen; Reilly-Harrington, Noreen A.; Kogan, Jane N.; Sachs, Gary S.; Thase, Michael E.; Calabrese, Joseph R.; Marangell, Lauren B.; Ostacher, Michael J.; Patel, Jayendra; Thomas, Marshall R.; Araga, Mako; Gonzalez, Jodi M.; Wisniewski, Stephen R.

    2013-01-01

    Objective Psychosocial interventions are effective adjuncts to pharmacotherapy in delaying recurrences of bipolar disorder; however, to date their effects on life functioning have been given little attention. In a randomized trial, the authors examined the impact of intensive psychosocial treatment plus pharmacotherapy on the functional outcomes of patients with bipolar disorder over the 9 months following a depressive episode. Method Participants were 152 depressed outpatients with bipolar I or bipolar II disorder in the multisite Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study. All patients received pharmacotherapy. Eighty-four patients were randomly assigned to intensive psychosocial intervention (30 sessions over 9 months of interpersonal and social rhythm therapy, cognitive behavior therapy [CBT], or family-focused therapy), and 68 patients were randomly assigned to collaborative care (a 3-session psychoeducational treatment). Independent evaluators rated the four subscales of the Longitudinal Interval Follow-Up Evaluation–Range of Impaired Functioning Tool (LIFE-RIFT) (relationships, satisfaction with activities, work/role functioning, and recreational activities) through structured interviews given at baseline and every 3 months over a 9-month period. Results Patients in intensive psychotherapy had better total functioning, relationship functioning, and life satisfaction scores over 9 months than patients in collaborative care, even after pretreatment functioning and concurrent depression scores were covaried. No effects of psychosocial intervention were observed on work/role functioning or recreation scores during this 9-month period. Conclusions Intensive psychosocial treatment enhances relationship functioning and life satisfaction among patients with bipolar disorder. Alternate interventions focused on the specific cognitive deficits of individuals with bipolar disorder may be necessary to enhance vocational functioning

  20. Does Internet-based cognitive behavioral therapy (iCBT) prevent major depressive episode for workers? A 12-month follow-up of a randomized controlled trial.

    PubMed

    Imamura, K; Kawakami, N; Furukawa, T A; Matsuyama, Y; Shimazu, A; Umanodan, R; Kawakami, S; Kasai, K

    2015-07-01

    In this study we investigated whether an Internet-based computerized cognitive behavioral therapy (iCBT) program can decrease the risk of DSM-IV-TR major depressive episodes (MDE) during a 12-month follow-up of a randomized controlled trial of Japanese workers. Participants were recruited from one company and three departments of another company. Those participants who did not experience MDE in the past month were randomly allocated to intervention or control groups (n = 381 for each). A 6-week, six-lesson iCBT program was provided to the intervention group. While the control group only received the usual preventive mental health service for the first 6 months, the control group was given a chance to undertake the iCBT program after a 6-month follow-up. The primary outcome was a new onset of DSM-IV-TR MDE during the 12-month follow-up, as assessed by means of the web version of the WHO Composite International Diagnostic Interview (CIDI), version 3.0 depression section. The intervention group had a significantly lower incidence of MDE at the 12-month follow-up than the control group (Log-rank χ2 = 7.04, p < 0.01). The hazard ratio for the intervention group was 0.22 (95% confidence interval 0.06-0.75), when estimated by the Cox proportional hazard model. The present study demonstrates that an iCBT program is effective in preventing MDE in the working population. However, it should be noted that MDE was measured by self-report, while the CIDI can measure the episodes more strictly following DSM-IV criteria.

  1. [Implementation Plan for Two Clinical Practice Guides (CPGs) Contained in the Integral Care Guides (ICGs) of the General System of Social Health Care in Colombia: A) "Early Detection of Depressive Episode and Recurrent Depressive Disorder in Adults. Integral Attention of Adults with Diagnosis of Depressive Episode or Recurrent Depressive Disorder (CPG-Depression)". B) "Early Detection, Diagnosis and Treatment of the Acute Intoxication Phase In 18-Years-Old Patients with Alcohol Abuse or Dependence (CPG-Alcohol)"].

    PubMed

    Díaz, Natalia Sánchez; Osorio, Andrés Duarte

    2012-12-01

    Clinical practice guides (CPGs) are systematically recommended, with the best clinical evidence available, to help physicians and patients in decision-making concerning the most adequate sanitary care as well as the selection of the best diagnostic and therapeutic options when facing a health problem or a clinical condition. After obtaining these recommendations, it is crucial to adopt them in daily clinical practice; the process through which this change is sought is known as implementation. This document contains recommendations for implementing CPGs in two psychiatric pathologies: 1) depressive episode and recurrent depressive disorder in adults, and 2) acute intoxication phase in cases of alcohol abuse or dependence. The recommended implementation process is described; besides, barriers and facilitators found in the two guides, together with the list of management indicators and clinical outcomes, are identified for their monitoring within the General Health Social Security System of Colombia. CPGs contain recommendations with the best clinical evidence available. The challenge is achieving the adoption of such tool by users, being therefore necessary to follow the diffusion, dissemination and implementation plan, overcoming barriers and resorting to intrinsic and extrinsic facilitators for CPGs as well as performing monitoring with indicators described for measuring the implementation process (management indicators) and the effect of CPGs in clinical practice (indicators of clinical outcome.). Copyright © 2012 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  2. Disrupted Structural and Functional Connectivity in Prefrontal-Hippocampus Circuitry in First-Episode Medication-Naïve Adolescent Depression.

    PubMed

    Geng, Haiyang; Wu, Feng; Kong, Lingtao; Tang, Yanqing; Zhou, Qian; Chang, Miao; Zhou, Yifang; Jiang, Xiaowei; Li, Songbai; Wang, Fei

    2016-01-01

    Evidence implicates abnormalities in prefrontal-hippocampus neural circuitry in major depressive disorder (MDD). This study investigates the potential disruptions in prefrontal-hippocampus structural and functional connectivity, as well as their relationship in first-episode medication-naïve adolescents with MDD in order to investigate the early stage of the illness without confounds of illness course and medication exposure. Diffusion tensor imaging and resting-state functional magnetic resonance imaging (rs-fMRI) data were acquired from 26 first-episode medication-naïve MDD adolescents and 31 healthy controls (HC). Fractional anisotropy (FA) values of the fornix and the prefrontal-hippocampus functional connectivity was compared between MDD and HC groups. The correlation between the FA value of fornix and the strength of the functional connectivity in the prefrontal cortex (PFC) region showing significant differences between the two groups was identified. Compared with the HC group, adolescent MDD group had significant lower FA values in the fornix, as well as decreased functional connectivity in four PFC regions. Significant negative correlations were observed between fornix FA values and functional connectivity from hippocampus to PFC within the HC group. There was no significant correlation between the fornix FA and the strength of functional connectivity within the adolescent MDD group. First-episode medication-naïve adolescent MDD showed decreased structural and functional connectivity as well as deficits of the association between structural and functional connectivity shown in HC in the PFC-hippocampus neural circuitry. These findings suggest that abnormal PFC-hippocampus neural circuitry may present in the early onset of MDD and play an important role in the neuropathophysiology of MDD.

  3. Similarities and differences of functional connectivity in drug-naïve, first-episode adolescent and young adult with major depressive disorder and schizophrenia

    PubMed Central

    Wei, Shengnan; Womer, Fay; Geng, Haiyang; Jiang, Xiaowei; Zhou, Qian; Chang, Miao; Zhou, Yifang; Tang, Yanqing; Wang, Fei

    2017-01-01

    Major depressive disorder (MDD) and schizophrenia (SZ) are considered two distinct psychiatric disorders. Yet, they have considerable overlap in symptomatology and clinical features, particularly in the initial phases of illness. The amygdala and prefrontal cortex (PFC) appear to have critical roles in these disorders; however, abnormalities appear to manifest differently. In our study forty-nine drug-naïve, first-episode MDD, 45 drug-naïve, first-episode SZ, and 50 healthy control (HC) participants from 13 to 30 years old underwent resting-state functional magnetic resonance imaging. Functional connectivity (FC) between the amygdala and PFC was compared among the three groups. Significant differences in FC were observed between the amygdala and ventral PFC (VPFC), dorsolateral PFC (DLPFC), and dorsal anterior cingulated cortex (dACC) among the three groups. Further analyses demonstrated that MDD showed decreased amygdala-VPFC FC and SZ had reductions in amygdala-dACC FC. Both the diagnostic groups had significantly decreased amygdala-DLPFC FC. These indicate abnormalities in amygdala-PFC FC and further support the importance of the interaction between the amygdala and PFC in adolescents and young adults with these disorders. Additionally, the alterations in amygdala-PFC FC may underlie the initial similarities observed between MDD and SZ and suggest potential markers of differentiation between the disorders at first onset. PMID:28287187

  4. Increased prefrontal and parietal cortical thickness does not correlate with anhedonia in patients with untreated first-episode major depressive disorders.

    PubMed

    Yang, Xin-hua; Wang, Yi; Huang, Jia; Zhu, Cui-ying; Liu, Xiao-qun; Cheung, Eric F C; Xie, Guang-rong; Chan, Raymond C K

    2015-10-30

    Cerebral morphological abnormalities in major depressive disorder (MDD) may be modulated by antidepressant treatment and course of illness in chronic medicated patients. The present study examined cortical thickness in patients with untreated first-episode MDD to elucidate the early pathophysiology of this illness. Here, we examined cortical thickness in patients with first-episode MDD (N=27) and healthy controls (N=27) using an automated surface-based method (in FreeSurfer). By assessing the correlation between caudate volume and cortical thickness at each vertex on the cortical surface, a caudate-cortical network was obtained for each group. Subsequent analysis was performed to assess the effect of anhedonia by the Temporal Experience of Pleasure Scale. We observed increased cortical thickness at the right orbital frontal cortex and the left inferior parietal gyrus in MDD patients compared with healthy controls. Furthermore, morphometric correlational analysis using cortical thickness measurement revealed increased caudate-cortical connectivity in the bilateral superior parietal gyrus in MDD patients. All changes were not related to anhedonia. These preliminary findings may reflect disorder manifestation close to illness onset and may provide insight into the early neurobiology of MDD.

  5. Randomized trial of clozapine vs. risperidone in treatment-naïve first-episode schizophrenia: results after one year.

    PubMed

    Sanz-Fuentenebro, Javier; Taboada, Diana; Palomo, Tomás; Aragües, María; Ovejero, Santiago; Del Alamo, Cristina; Molina, Vicente

    2013-09-01

    In first-episode patients with psychosis, clozapine may be potentially valuable as an initial treatment seeking to limit early on clinical and cognitive deterioration. Nevertheless, until recently its restricted use has limited the study of this possibility. Our research group is developing a non-commercial, multicentric and open label study on the differential efficacy between clozapine and risperidone in first-episode schizophrenia. In this paper, we present the results related to clinical variables after a one-year follow-up. So far, we have recruited 30 patients diagnosed with schizophrenia or schizophreniform disorder with illness duration of less than two years. The patients had not received any previous treatment and they were randomized to treatment with clozapine or risperidone. Our results indicate that on average, patients on clozapine adhered to their original treatment for a longer time period than patients on risperidone. By last observation carried forward (LOCF) analysis, patients on clozapine and risperidone displayed similar clinical improvements, although marginally greater improvements in positive and total symptoms scores were found in the clozapine group. At the 12-month point we observed a marginal improvement in negative symptom scores in patients on clozapine. Subjective secondary effects, as measured with the Udvalg for KliniskeUndersøgelser (UKU) scale, correlated negatively with negative symptoms at follow-up. Our data, although preliminary, suggest that clozapine may have a slightly superior efficacy in the initial year of treatment of first-episode treatment-naïve patients with schizophrenia, and this can be explained for the most part by greater adherence to this treatment. © 2013.

  6. Seasonality in depressive and anxiety symptoms among primary care patients and in patients with depressive and anxiety disorders; results from the Netherlands Study of Depression and Anxiety

    PubMed Central

    2011-01-01

    Background Little is known about seasonality of specific depressive symptoms and anxiety symptoms in different patient populations. This study aims to assess seasonal variation of depressive and anxiety symptoms in a primary care population and across participants who were classified in diagnostic groups 1) healthy controls 2) patients with a major depressive disorder, 3) patients with any anxiety disorder and 4) patients with a major depression and any anxiety disorder. Methods Data were used from the Netherlands Study of Depression and Anxiety (NESDA). First, in 5549 patients from the NESDA primary care recruitment population the Kessler-10 screening questionnaire was used and data were analyzed across season in a multilevel linear model. Second, in 1090 subjects classified into four groups according to psychiatric status according to the Composite International Diagnostic Interview, overall depressive symptoms and atypical versus melancholic features were assessed with the Inventory of Depressive Symptoms. Anxiety and fear were assessed with the Beck Anxiety Inventory and the Fear questionnaire. Symptom levels across season were analyzed in a linear regression model. Results In the primary care population the severity of depressive and anxiety symptoms did not show a seasonal pattern. In the diagnostic groups healthy controls and patients with any anxiety disorder, but not patients with a major depressive disorder, showed a small rise in depressive symptoms in winter. Atypical and melancholic symptoms were both elevated in winter. No seasonal pattern for anxiety symptoms was found. There was a small gender related seasonal effect for fear symptoms. Conclusions Seasonal differences in severity or type of depressive and anxiety symptoms, as measured with a general screening instrument and symptom questionnaires, were absent or small in effect size in a primary care population and in patient populations with a major depressive disorder and anxiety disorders. PMID

  7. Effects of an internet-based cognitive behavioural therapy intervention on preventing major depressive episodes among workers: a protocol for a randomised controlled trial

    PubMed Central

    Imamura, Kotaro; Kawakami, Norito; Furukawa, Toshi A; Matsuyama, Yutaka; Shimazu, Akihito; Kasai, Kiyoto

    2015-01-01

    Introduction The aim of this study is to examine the effects of an internet-based cognitive behavioural therapy (iCBT) program on decreasing the risk of major depressive episodes (MDEs) among workers employed in a private corporate group in Japan, using a randomised controlled trial design. Methods and analysis All of the workers in a corporate group (n=20 000) will be recruited through an invitation email. Participants who fulfil the inclusion criteria will be randomly allocated to intervention or control groups (planned N=4050 for each group). They will be allowed to complete the six lessons of the iCBT program within 10 weeks after the baseline survey. Those in the control group will receive the same iCBT after 12 months. The program includes several CBT skills: self-monitoring, cognitive restructuring, assertiveness, problem-solving and relaxation. The primary outcome measure is no new onset of MDE (using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR)/DSM-5 criteria) during the 12-month follow-up. Assessment will use the web version of the WHO Composite International Diagnostic Interview V.3.0 depression section. Ethics and dissemination The Research Ethics Review Board of Graduate School of Medicine, the University of Tokyo (No. 3083-(2)), approved the study procedures. Trial registration number The study protocol is registered at the UMIN Clinical Trials Registry (UMIN-CTR; ID=UMIN000014146). PMID:25968004

  8. Concordance between telephone survey classification and face-to-face interview diagnosis of one-year major depressive episode in Hong Kong.

    PubMed

    Lee, Sing; Tsang, Adley; Mak, Arthur; Lee, Athene; Lau, Lisa; Ng, K L

    2010-10-01

    Community-based telephone surveys of depression have generated reliable findings but their concordance with standardized clinical diagnostic interviews is uncommonly examined, especially in non-western populations. 106 consenting participants from a previous telephone-based population survey of major depressive episode (MDE) using a structured questionnaire were re-assessed face-to-face by clinical interviewers using the Structured Clinical Interview for DSM-IV Axis I Disorder (SCID-I). Receiver operating characteristic and other predictive indicators were used to investigate the concordance between the telephone survey instrument and SCID interview. The telephone survey instrument adequately classified MDE when the DSM-IV symptom number standard was fulfilled at moderate to severe levels of distress and impairment. It performed best when the cut-off was set at a severe level of distress or impairment in any one of four domains of functioning (AUC=0.76). Feeling useless, fatigue, loss of motivation and difficulty in concentration were the most prominent items for increasing the certainty of SCID-MDE diagnosis. Classification of MDE by telephone-based structured interview of MDE exhibited generally good agreement with face-to-face clinical interview diagnosis in the Chinese population of Hong Kong. Further research on the telephone-based methodology should address inter-rater reliability, specificity of diagnosis, and variability of concordance across different mental disorder diagnoses and criteria of clinically significant impairment. Copyright 2010 Elsevier B.V. All rights reserved.

  9. Prevalence, Recurrence, and Incidence of Current Depressive Symptoms among People Living with HIV in Ontario, Canada: Results from the Ontario HIV Treatment Network Cohort Study

    PubMed Central

    Choi, Stephanie K. Y.; Boyle, Eleanor; Cairney, John; Collins, Evan J.; Gardner, Sandra; Bacon, Jean; Rourke, Sean B.

    2016-01-01

    Introduction Current studies of depression among people living with HIV focus on describing its point prevalence. Given the fluctuating nature of depression and its profound impacts on clinical and quality-of-life outcomes, this study aimed to examine the prevalence, recurrence and incidence of current depressive symptoms and its underlying catalysts longitudinally and systematically among these individuals. Methods We conducted a prospective cohort study between October 1, 2007 and December 31, 2012 using longitudinal linked data sources. Current depressive symptoms was identified using the Centre for Epidemiologic Studies Depression Scale or the Kessler Psychological Distress Scale, first at baseline and again during follow-up interviews. Multivariable regressions were used to characterize the three outcomes. Results Of the 3,816 HIV-positive participants, the point prevalence of depressive symptoms was estimated at 28%. Of the 957 participants who were identified with depressive symptoms at baseline and who had at least two years of follow-up, 43% had a recurrent episode. The cumulative incidence among 1,745 previously depressive symptoms free participants (at or prior to baseline) was 14%. During the five-year follow-up, our multivariable models showed that participants with greater risk of recurrent cases were more likely to feel worried about their housing situation. Participants at risk of developing incident cases were also likely to be younger, gay or bisexual, and unable to afford housing-related expenses. Conclusions Depressive symptoms are prevalent and likely to recur among people living with HIV. Our results support the direction of Ontario’s HIV/AIDS Strategy to 2026, which addresses medical concerns associated with HIV (such as depression) and the social drivers of health in order to enhance the overall well-being of people living with or at risk of HIV. Our findings reinforce the importance of providing effective mental health care and

  10. Alcohol involvement as a function of co-occurring alcohol use disorders and major depressive episode: evidence from the National Epidemiologic Survey on Alcohol and Related Conditions.

    PubMed

    Cranford, James A; Nolen-Hoeksema, Susan; Zucker, Robert A

    2011-09-01

    Co-occurring alcohol use disorder and major depression (C-ALDP) is a major public health problem. Yet, the available evidence is mixed regarding the implications of C-ALDP for alcohol involvement. The purpose of this research was to examine the associations between past 12-month co-occurring AUDs (abuse and dependence) and major depressive episode (MDE) and alcohol involvement in a representative community sample. The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) is a national household survey of 43,093 adults ages 18 and older. For the NESARC, the target population is the civilian noninstitutionalized population, 18 years of age and older, living in the United States and the District of Columbia. All NESARC interviews were conducted with the Alcohol Use Disorder and Associated Disabilities Interview Schedule--DSM IV Version (AUDADIS-IV; Grant et al., 2003a). Prevalence of past 12-month co-occurring AUD (abuse or dependence) and MDE was 1.2%, corresponding to about 2.4 million adults ages 18 and older. Among males with alcohol dependence, comorbid MDE was associated with a greater number of days drinking at home alone. Among females and males with alcohol abuse and dependence, comorbid MDE was associated with higher prevalence of drinking to enhance depressed mood. Comorbid MDE was also associated with lower levels of some drinking behaviors among those with alcohol abuse. Co-occurring AUDs and MDE are associated with specific dimensions of alcohol involvement, and this association is more consistent for alcohol dependence than abuse. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  11. Does lithium reduce acute suicidal ideation and behavior? A protocol for a randomized, placebo-controlled multicenter trial of lithium plus Treatment As Usual (TAU) in patients with suicidal major depressive episode.

    PubMed

    Lewitzka, U; Jabs, B; Fülle, M; Holthoff, V; Juckel, G; Uhl, I; Kittel-Schneider, S; Reif, A; Reif-Leonhard, C; Gruber, O; Djawid, B; Goodday, S; Haussmann, R; Pfennig, A; Ritter, P; Conell, J; Severus, E; Bauer, M

    2015-05-19

    Lithium has proven suicide preventing effects in the long-term treatment of patients with affective disorders. Clinical evidence from case reports indicate that this effect may occur early on at the beginning of lithium treatment. The impact of lithium treatment on acute suicidal thoughts and/or behavior has not been systematically studied in a controlled trial. The primary objective of this confirmatory study is to determine the association between lithium therapy and acute suicidal ideation and/or suicidal behavior in inpatients with a major depressive episode (MDE, unipolar and bipolar disorder according to DSM IV criteria). The specific aim is to test the hypothesis that lithium plus treatment as usual (TAU), compared to placebo plus TAU, results in a significantly greater decrease in suicidal ideation and/or behavior over 5 weeks in inpatients with MDE. We initiated a randomized, placebo-controlled multicenter trial. Patients with the diagnosis of a moderate to severe depressive episode and suicidal thoughts and/or suicidal behavior measured with the Sheehan-Suicidality-Tracking Scale (S-STS) will be randomly allocated to add lithium or placebo to their treatment as usual. Change in the clinician administered S-STS from the initial to the final visit will be the primary outcome. There is an urgent need to identify treatments that will acutely decrease suicidal ideation and/or suicidal behavior. The results of this study will demonstrate whether lithium reduces suicidal ideation and behavior within the first 5 weeks of treatment. ClinicalTrials.gov identifier: NCT02039479.

  12. Independence of familial transmission of mania and depression: results of the NIMH family study of affective spectrum disorders.

    PubMed

    Merikangas, K R; Cui, L; Heaton, L; Nakamura, E; Roca, C; Ding, J; Qin, H; Guo, W; Shugart, Y Y; Yao-Shugart, Y; Zarate, C; Angst, J

    2014-02-01

    The goal of this study is to investigate the familial transmission of the spectrum of bipolar disorder in a nonclinical sample of probands with a broad range of manifestations of mood disorders. The sample included a total of 447 probands recruited from a clinically enriched community screening and their 2082 adult living and deceased first-degree relatives. A best estimate diagnostic procedure that was based on either direct semistructured interview or structured family history information from multiple informants regarding non-interviewed relatives was employed. Results revealed that there was specificity of familial aggregation of bipolar I (BP I; odds ratio (OR)=8.40; 3.27-20.97; h2=0.83) and major depressive disorder (OR=2.26; 1.58-3.22; h2=0.20), but not BP II. The familial aggregation of BP I was primarily attributable to the familial specificity of manic episodes after adjusting for both proband and relative comorbid anxiety and substance use disorders. There was no significant cross-aggregation between mood disorder subtypes suggesting that the familial transmission of manic and major depressive episodes is independent despite the high magnitude of comorbidity between these mood states. These findings confirm those of earlier studies of the familial aggregation of bipolar disorder and major depression in the first nonclinical sample, and the largest family study of bipolar disorder in the USA using contemporary nonhierarchical diagnostic criteria for mood and anxiety disorders. The results suggest that these major components of bipolar disorder may represent distinct underlying pathways rather than increasingly severe manifestations of a common underlying diathesis. Therefore, dissection of the broad bipolar phenotype in genetic studies could actually generate new findings that could index novel biologic pathways underlying bipolar disorder.

  13. Predicting episodic memory performance using different biomarkers: results from Argentina-Alzheimer’s Disease Neuroimaging Initiative

    PubMed Central

    Russo, María Julieta; Cohen, Gabriela; Chrem Mendez, Patricio; Campos, Jorge; Nahas, Federico E; Surace, Ezequiel I; Vazquez, Silvia; Gustafson, Deborah; Guinjoan, Salvador; Allegri, Ricardo F; Sevlever, Gustavo

    2016-01-01

    Purpose Argentina-Alzheimer’s Disease Neuroimaging Initiative (Arg-ADNI) is the first ADNI study to be performed in Latin America at a medical center with the appropriate infrastructure. Our objective was to describe baseline characteristics and to examine whether biomarkers related to Alzheimer’s disease (AD) physiopathology were associated with worse memory performance. Patients and methods Fifteen controls and 28 mild cognitive impairment and 13 AD dementia subjects were included. For Arg-ADNI, all biomarker parameters and neuropsychological tests of ADNI-II were adopted. Results of positron emission tomography (PET) with fluorodeoxyglucose and 11C-Pittsburgh compound-B (PIB-PET) were available from all participants. Cerebrospinal fluid biomarker results were available from 39 subjects. Results A total of 56 participants were included and underwent baseline evaluation. The three groups were similar with respect to years of education and sex, and they differed in age (F=5.10, P=0.01). Mean scores for the baseline measurements of the neuropsychological evaluation differed significantly among the three groups at P<0.001, showing a continuum in their neuropsychological performance. No significant correlations were found between the principal measures (long-delay recall, C-Pittsburgh compound-B scan, left hippocampal volume, and APOEε4) and either age, sex, or education (P>0.1). Baseline amyloid deposition and left hippocampal volume separated the three diagnostic groups and correlated with the memory performance (P<0.001). Conclusion Cross-sectional analysis of baseline data revealed links between cognition, structural changes, and biomarkers. Follow-up of a larger and more representative cohort, particularly analyzing cerebrospinal fluid and brain biomarkers, will allow better characterization of AD in our country. PMID:27695331

  14. Geodetic results in Afar: The rifting episode of November 1978 in the Asal-Ghoubbet rift

    NASA Astrophysics Data System (ADS)

    Kasser, M.; Lepine, J. C.; Ruegg, J. C.; Tarantula, A.

    1981-01-01

    A seismo-tectonic and volcanic crisis occurred in November 1978 in the Asal-Ghoubbet rift, first subaerial section of the accreting plate boundary between the African and Arabian plates (Allard et al., 1979; Abdallah et al., 1979; Le Dain et al., 1980). The activity was located in the center of a geodetic network set up in the winter 1972-1973 by the Institut Géographique National in collaboration with the Institut de Physique du Globe de Paris. Simultaneously, a precise levelling line of about 100 km was established across the area (I.G.N., 1973). The resurveying of both the geodetic network and the levelling line was carried out after the crisis, between November 1978 and March 1979. Extensions up to 2.4 m and vertical displacements up to 0.7 m were measured. Operating techniques and results of the resurveying are described in Kasser et al. (1979) and Ruegg et al. (1979). Figure 1 shows the horizontal displacements (relating to point B and to the direction BT) and figure 2 shows the vertical displacements relating to the two external points. Tarantola et al. (1979, 1980) have shown that these results can be geodynamically interpreted by a mechanism of sudden breaking and elastic rebound after an elastic stretching of the crust due to the relative drift of the plates. The breaking is triggered by magmatic fracturing of the crust, with dykes injection from a magmatic chamber which has fed the basaltic fissurai eruption. The horizontal and vertical displacements outside the broken zone of the Inner Floor are predicted by a numerical model based on this interpretation which fit very well the experimental data.

  15. Postnatal episodic ozone results in persistent attenuation of pulmonary and peripheral blood responses to LPS challenge

    PubMed Central

    Maniar-Hew, Kinjal; Postlethwait, Edward M.; Fanucchi, Michelle V.; Ballinger, Carol A.; Evans, Michael J.; Harkema, Jack R.; Carey, Stephan A.; McDonald, Ruth J.; Bartolucci, Alfred A.

    2011-01-01

    Early life is a dynamic period of growth for the lung and immune system. We hypothesized that ambient ozone exposure during postnatal development can affect the innate immune response to other environmental challenges in a persistent fashion. To test this hypothesis, we exposed infant rhesus macaque monkeys to a regimen of 11 ozone cycles between 30 days and 6 mo of age; each cycle consisted of ozone for 5 days (0.5 parts per million at 8 h/day) followed by 9 days of filtered air. Animals were subsequently housed in filtered air conditions and challenged with a single dose of inhaled LPS at 1 yr of age. After completion of the ozone exposure regimen at 6 mo of age, total peripheral blood leukocyte and polymorphonuclear leukocyte (PMN) numbers were reduced, whereas eosinophil counts increased. In lavage, total cell numbers at 6 mo were not affected by ozone, however, there was a significant reduction in lymphocytes and increased eosinophils. Following an additional 6 mo of filtered air housing, only monocytes were increased in blood and lavage in previously exposed animals. In response to LPS challenge, animals with a prior history of ozone showed an attenuated peripheral blood and lavage PMN response compared with controls. In vitro stimulation of peripheral blood mononuclear cells with LPS resulted in reduced secretion of IL-6 and IL-8 protein in association with prior ozone exposure. Collectively, our findings suggest that ozone exposure during infancy can result in a persistent effect on both pulmonary and systemic innate immune responses later in life. PMID:21131396

  16. [Fatigue and depression].

    PubMed

    Hell, Daniel

    2015-04-22

    Fatigue is characterised in an overview of the literature as a specific phenomenon of depression. Its differential diagnosis is discussed. Distinctions and correspondences to burnout are elaborated. Fatigue is not an obligatory symptom of depressive episodes, although it can contribute to depressive developments. The importance of fatigue in depressive episodes and its therapy is shown with the help of a circular model of depression.

  17. Abnormal neural activities in first-episode, treatment-naïve, short-illness-duration, and treatment-response patients with major depressive disorder: a resting-state fMRI study.

    PubMed

    Guo, Wen-bin; Liu, Feng; Xue, Zhi-min; Yu, Yan; Ma, Chao-qiong; Tan, Chang-lian; Sun, Xue-li; Chen, Jin-dong; Liu, Zhe-ning; Xiao, Chang-qing; Chen, Hua-fu; Zhao, Jing-ping

    2011-12-01

    Abnormality of limbic-cortical networks was postulated in depression. Using a regional homogeneity (ReHo) approach, we explored the regional homogeneity (ReHo) of the brain regions in patients with first-episode, treatment-naïve, short-illness-duration, and treatment-response depression in resting state to test the abnormality hypothesis of limbic-cortical networks in major depressive disorder (MDD). Seventeen patients with treatment-response MDD and 17 gender-, age-, and education-matched healthy subjects participated in the resting-state fMRI scans. Our findings suggested the abnormality of limbic-cortical networks in first-episode, treatment-naïve, short-illness-duration, and treatment-response MDD patients, and added an expanding literature to the abnormality hypothesis of limbic-cortical networks in MDD. Copyright © 2011 Elsevier B.V. All rights reserved.

  18. Extreme Thinking in Clinically Depressed Adolescents: Results from the Treatment for Adolescents with Depression Study (TADS)

    PubMed Central

    Jacobs, Rachel H.; Reinecke, Mark A.; Gollan, Jackie K.; Jordan, Neil; Silva, Susan G.; March, John S.

    2010-01-01

    The purpose of this report is to examine relations between extreme thinking, as measured by the Dysfunctional Attitudes Scale, and the maintenance of gains among adolescents who participated in the Treatment for Adolescents with Depression Study (TADS). We examine extreme thinking among 327 adolescents (mean age = 14.56, 57% female, 75% White) who received cognitive behavior therapy (CBT), fluoxetine (FLX), or a combination of CBT and FLX (COMB). Among those who met remission status on the Children's Depression Rating Scale – Revised (CDRS-R ≤ 28; 56 at week 12, 79 at week 18) extreme thinking did not predict failure to maintain remission. This is in contrast to findings with depressed adults. Treatment influenced level of extreme thinking, and this appeared to be driven by greater endorsement of positively valenced beliefs as opposed to a decrease in negatively valenced beliefs. Developmental or investigation characteristics may account for the discrepancy in findings. PMID:20843506

  19. Relative effects on a low-volume road system of landslides resulting from episodic storms in northern Idaho

    USGS Publications Warehouse

    McClelland, D.E.; Foltz, R.B.; Falter, C.M.; Wilson, W.D.; Cundy, T.; Schuster, R.L.; Saurbier, J.; Rabe, C.; Heinemann, R.

    1999-01-01

    In late November to early December 1995 and February 1996, northern Idaho was hit by heavy rains on a deep snowpack, resulting in two flood and landslide events of historic magnitude. Each of these storms was larger than the previous significant storm, which occurred in January 1974. A study was initiated by the U.S. Department of Agriculture Forest Service to survey and study the effects of the resultant landslides on the Clearwater National Forest, including the effects on the aquatic ecosystem. The results of this study were compared with the estimated average natural sediment resulting from landslides to evaluate the incremental impacts of these recent episodic landslides. They were also compared with the results of a study conducted on the landslides resulting from the January 1974 storm to determine if the landscape was responding more severely to large storms as a result of Forest Service management activities over the past 21 years. The general results of this study indicate that, of the Forest Service management activities, roads are the major contributor; however, they contribute less sediment than natural landslides. The total resultant sediment appears to be within the transport capacity of the aquatic system, and the landslide response in 1974 was similar to the 1995-1996 response. The results of the aquatic ecosystem study were generally mixed, with some habitat parameters indicating degradation, some unchanged, and some improved as a result of the flooding or flooding with landslide sediment.

  20. Identify changes of brain regional homogeneity in early and later adult onset patients with first-episode depression using resting-state fMRI.

    PubMed

    Shen, Zonglin; Jiang, Linling; Yang, Shuran; Ye, Jing; Dai, Nan; Liu, Xiaoyan; Li, Na; Lu, Jin; Liu, Fang; Lu, Yi; Sun, Xuejin; Cheng, Yuqi; Xu, Xiufeng

    2017-01-01

    Previous work exhibited different brain grey matter volume (GMV) changes between patients with early adult onset depression (EOD, age 18-29) and later adult onset depression (LOD, age 30-44) by using 30-year-old as the cut-off age. To identify whether regional homogeneity (ReHo) changes are also different between EOD and LOD by using same cut-off age, we used resting-state functional magnetic resonance imaging (fMRI) to detect the abnormal ReHo between patients with EOD and LOD in the present study. Resting-state fMRI scans of 58 patients with EOD, 62 patients with LOD, 60 young healthy controls (HC), and 52 old HC were obtained. The ReHo approach was used to analyze the images. The ANOVA analysis revealed that the ReHo values in the frontoparietal, occipital, and cerebellar regions were significantly different among the four groups. Relative to patients with LOD, patients with EOD displayed significantly increased ReHo in the left precuneus, and decreased ReHo in the right fusiform. The ReHo values in the left precuneus and the right fusiform had no significant correlation with the score of the depression rating scale or illness duration in both patient subgroups. Compared to young HC, patients with EOD showed significantly increased ReHo in the right frontoparietal regions and the right calcarine. Furthermore, the increased ReHo in the right frontoparietal regions, right insula and left hippocampus, and decreased ReHo in the left inferior occipital gyrus, right middle occipital gyrus, left calcarine, and left supplementary motor area were observed in patients with LOD when compared to old HC. The ReHo of brain areas that were related to mood regulation was changed in the first-episode, drug-naive adult patients with MDD. Adult patients with EOD and LOD exhibited different ReHo abnormalities relative to each age-matched comparison group, suggesting that depressed adult patients with different age-onset might have different pathological mechanism.

  1. A History of Childhood Trauma and Response to Treatment With Antipsychotics in First-Episode Schizophrenia Patients: Preliminary Results.

    PubMed

    Misiak, Błażej; Frydecka, Dorota

    2016-10-01

    In this study, we aimed to investigate whether a history of childhood trauma (CT) can help predict early response to antipsychotic treatment in patients with first-episode schizophrenia (FES). We recruited 64 FES patients who were followed up after 12 weeks of treatment with second-generation antipsychotics. Symptomatic manifestation was examined using the Positive and Negative Syndrome Scale (PANSS). Childhood adversities were assessed using the Early Trauma Inventory Self-Report-Short Form. Nonresponders had significantly higher general trauma score, emotional abuse score, total trauma score, and baseline PANSS negative factor score. A history of CT was significantly more frequent among nonresponders. Logistic regression analysis revealed that positive history of CT, higher emotional abuse score, and higher baseline PANSS negative factor score are significant predictors of poor response to treatment. Our results indicate that a history of CT, especially emotional abuse, and higher severity of negative symptoms are independent predictors of poor response to treatment with antipsychotics.

  2. Antecedents of Manic versus Other First-Psychotic Episodes in 263 Bipolar-I Disorder Patients

    PubMed Central

    Salvatore, Paola; Baldessarini, Ross J.; Khalsa, Hari-Mandir K.; Vázquez, Gustavo; Perez, Jesus; Faedda, Gianni L.; Amore, Mario; Maggini, Carlo; Tohen, Mauricio

    2013-01-01

    Objective Since initial episode-type can predict later morbidity in bipolar disorder, we tested the hypothesis that clinical antecedents might predict initial episode-types. Method We studied 263 first-episode, adult, DSM-IV-TR type-I bipolar disorder (BD-I) subjects within the McLean-Harvard-International First-Episode Project. Based on blinded assessments of antecedents from SCID examinations and clinical records, we compared first-lifetime Manic vs. Other (mixed, depressive, or nonaffective) major psychotic-episodes. Results We identified 32 antecedents arising at early, intermediate or later times, starting 12.3±10.7 years prior to first-lifetime major psychotic-episodes. Based on multivariate modeling, antecedents associated significantly and independently with Other (n=113) more than Manic (n=150) first-lifetime major psychotic-episodes ranked by Odds Ratio: more early attentional disturbances, more late depression, more early perplexity, more detoxification, more early unstable-mixed affects, more antidepressants, more early dysphoria, more intermediate depression, more early impulsivity, more late anhedonia, longer early-to-intermediate intervals, more intermediate substance abuse, more family history of major depression, and younger at earliest antecedents. Antecedents selectively preceding Manic more than Other first-psychotic episodes included more late behavioral problems and more risk of familial BD-I. Conclusion Clinical antecedents in adult, BD-I patients, beginning a decade before first major-episodes and progressing through sequential stages were dissimilar in Manic versus Other first-psychotic-episodes. PMID:23837831

  3. Depression prevalence and primary care among vulnerable patients at a free outpatient clinic in Paris, France, in 2010: results of a cross-sectional survey

    PubMed Central

    2013-01-01

    Background Data on the prevalence of depression and on how a depressive episode prompts the sufferer to seek primary care are not scarce, but the available evidence on the prevalence of depression among immigrants and poor people who frequent general practice facilities is scarce. The Baudelaire Outpatient Clinic at the Saint-Antoine Hospital in Paris provides free medical and social assistance to the poor and/or uninsured. The goal of our study was to estimate the prevalence of depression among these outpatients, to characterize this depressed population, and to analyze its demand for primary care for depressive episodes. Methods From September to December 2010, we conducted a cross-sectional, observational survey among users of the Baudelaire Outpatient Clinic. French-speaking patients attending the clinic between September 15 and December 30, 2010 who agreed to answer a questionnaire administered face-to-face before their consultation were included in the study. The chi-squared test (or Fisher’s exact test for small samples) was used for the comparisons of proportions. Logistic regression models were estimated, along with the odds ratios (OR) and their 95% confidence intervals (95% CIs), for the multivariate analysis of factors associated with depression and healthcare-seeking. Models were estimated separately for men and women, since sex was an interaction factor. The statistical analyses were performed using Stata v. 10 software (StataCorp LP, College Station, Texas, USA). Results Of the 250 patients included (mean age: 45 years), 52.0% were men and 52.4% were immigrants. Close to 40% of them reported having no supplemental health insurance. The estimated prevalence of depression in this population was 56.7%. Depression was more prevalent among the women, immigrants, and people from the poorer socioeconomic groups. Only half of these depressed patients, mostly women, reported having discussed their depression with a physician. French nationality and complete

  4. Episodic Memories

    ERIC Educational Resources Information Center

    Conway, Martin A.

    2009-01-01

    An account of episodic memories is developed that focuses on the types of knowledge they represent, their properties, and the functions they might serve. It is proposed that episodic memories consist of "episodic elements," summary records of experience often in the form of visual images, associated to a "conceptual frame" that provides a…

  5. Episodic Memories

    ERIC Educational Resources Information Center

    Conway, Martin A.

    2009-01-01

    An account of episodic memories is developed that focuses on the types of knowledge they represent, their properties, and the functions they might serve. It is proposed that episodic memories consist of "episodic elements," summary records of experience often in the form of visual images, associated to a "conceptual frame" that provides a…

  6. Gender differences in major depressive disorder: results from the Netherlands study of depression and anxiety.

    PubMed

    Schuch, Jérôme J J; Roest, Annelieke M; Nolen, Willem A; Penninx, Brenda W J H; de Jonge, Peter

    2014-03-01

    Although an overall gender difference in prevalence of major depressive disorder (MDD) has been well established, several questions concerning gender differences in the clinical manifestation of depression remain. This study aims to identify gender differences in psychopathology, treatment, and public health consequences in patients with MDD. Baseline data from the Netherlands Study of Depression and Anxiety (NESDA) were used, including 1115 participants (364 men, 751 women, mean age 41 years) with a DSM-IV diagnosis of current MDD. Characteristics studied included symptom profiles, comorbidity, treatment, and public health consequences. Women reported a younger age of onset of single (27.8 years vs. 31.6 years; p=0.001) and recurrent MDD (24.8 years vs. 27.6 years; p=0.014), a higher comorbidity of panic disorder with agoraphobia (24.9% vs. 17.3%; p=0.006) and life-time overall anxiety disorder (77.6% vs. 71.4%; p=0.029) than men. More men than women suffered from comorbid alcohol dependence or abuse (48.1% vs. 24.5%; p<0.001). An increased prevalence of atypical depression in women (24.6% vs. 17.3%; p=0.009) was found. Women were treated more frequently by an alternative caretaker (20.6% vs. 14.8%; p=0.025), men more often in mental health care organizations (61.0% vs. 53.7%; p=0.025). No gender differences in frequency of medication use or counseling were found. Cross sectional design. Main gender differences in the clinical presentation of MDD concerned a younger age of onset, higher anxiety and lower alcohol use comorbidity and higher prevalence of atypical depression in women. These differences were accompanied by differences in health care use. Copyright © 2013 Elsevier B.V. All rights reserved.

  7. The interrelation between premenstrual syndrome and major depression: Results from a population-based sample

    PubMed Central

    2011-01-01

    Background Research about the relationship between premenstrual syndrome (PMS) and major depression is limited. This study examined the relationship between moderate to severe PMS and major depression in a population-based sample of women of reproductive age. The objectives of the study were to assess the association between premenstrual syndrome and major depression, to analyse how PMS and major depression differ and to characterise the group of women who report both PMS and major depression. Methods Data were obtained from the Swiss Health Survey 2007. Included in the analysis was data from women under the age of 55 without hysterectomy and who answered the questions on PMS symptoms. The population-based sample consisted of 3518 women. Weighted prevalence rates were calculated and relative risk ratios for PMS, major depression and women who reported both PMS and major depression, were calculated with logistic multinominal logit regression. Results The prevalence of major depression was 11.3% in women screening positive for moderate PMS and 24.6% in women screening positive for severe PMS. Compared to women without any of these conditions, women who reported moderate to severe alcohol consumption had a lower risk for PMS. Women reporting use of antidepressants, and use of oral contraceptives had a higher risk for major depression compared to women without any of these conditions. Women reporting work dissatisfaction had a higher risk for PMS. A higher relative risk to report both PMS and major depression compared to women without PMS or major depression was related to factors such as high psychological distress, low mastery, psychotropic drug consumption, and low self-rated health. Conclusions The results suggested that women who suffer from both PMS and major depression are more impaired compared to women with only one disorder. The results further indicated that PMS and major depression are different disorders that can, however, co-occur. PMID:21992230

  8. Work Engagement as a Predictor of Onset of Major Depressive Episode (MDE) among Workers, Independent of Psychological Distress: A 3-Year Prospective Cohort Study.

    PubMed

    Imamura, Kotaro; Kawakami, Norito; Inoue, Akiomi; Shimazu, Akihito; Tsutsumi, Akizumi; Takahashi, Masaya; Totsuzaki, Takafumi

    2016-01-01

    This study investigated work engagement as a baseline predictor of onset of major depressive episode (MDE). The study used a prospective cohort design, conforming to the STROBE checklist. Participants were recruited from the employee population of a private think tank company (N = 4,270), and 1,058 (24.8%) of them completed a baseline survey, of whom 929 were included in this study. Work engagement and psychological distress at baseline were assessed as predictor variables. MDE was measured at baseline and at each of the follow-ups as the outcome, using the web-based, self-administered version of the Japanese WHO-CIDI 3.0 depression section based upon DSM-IV-TR/DSM-5 criteria. Cox discrete-time hazards analyses were conducted to estimate hazard ratios (95% confidence intervals CIs). Follow-up rates of participants (N = 929) were 78.4%, 67.2%, and 51.6% at 1-, 2-, and 3-year follow-ups, respectively. The association between work engagement at baseline and the onset of MDE was U-shaped. Compared with a group with low work engagement scores, groups with the middle and high scores showed significantly (HR = 0.19, 95% CI = 0.05 to 0.64; p = 0.007) and marginally significantly (HR = 0.48, 95% CI = 0.20 to 1.15, p = 0.099) lower risks of MDE, respectively, over the follow-ups, after adjusting for covariates. The pattern remained the same after additionally adjusting for psychological distress. The present study first demonstrated work engagement as an important predictor of the onset of MDE diagnosed according to an internationally standard diagnostic criteria of mental disorders.

  9. Effects of an internet-based cognitive behavioural therapy intervention on preventing major depressive episodes among workers: a protocol for a randomised controlled trial.

    PubMed

    Imamura, Kotaro; Kawakami, Norito; Furukawa, Toshi A; Matsuyama, Yutaka; Shimazu, Akihito; Kasai, Kiyoto

    2015-05-12

    The aim of this study is to examine the effects of an internet-based cognitive behavioural therapy (iCBT) program on decreasing the risk of major depressive episodes (MDEs) among workers employed in a private corporate group in Japan, using a randomised controlled trial design. All of the workers in a corporate group (n=20,000) will be recruited through an invitation email. Participants who fulfil the inclusion criteria will be randomly allocated to intervention or control groups (planned N=4050 for each group). They will be allowed to complete the six lessons of the iCBT program within 10 weeks after the baseline survey. Those in the control group will receive the same iCBT after 12 months. The program includes several CBT skills: self-monitoring, cognitive restructuring, assertiveness, problem-solving and relaxation. The primary outcome measure is no new onset of MDE (using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR)/DSM-5 criteria) during the 12-month follow-up. Assessment will use the web version of the WHO Composite International Diagnostic Interview V.3.0 depression section. The Research Ethics Review Board of Graduate School of Medicine, the University of Tokyo (No. 3083-(2)), approved the study procedures. The study protocol is registered at the UMIN Clinical Trials Registry (UMIN-CTR; ID=UMIN000014146). Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  10. Low socioeconomic position and depression persistence: longitudinal results from the GAZEL cohort study.

    PubMed

    Melchior, Maria; Chastang, Jean-François; Leclerc, Annette; Ribet, Céline; Rouillon, Frédéric

    2010-05-15

    Research examining the association between socioeconomic position and depression course has yielded inconsistent results. We tested the association between low socioeconomic position and 7-year depression persistence among 298 community-based individuals with depression (subset of the GAZEL cohort study based in France). Data were analyzed using Generalized Estimating Equation (GEE models). Low socioeconomic position predicted depression persistence (men: low vs. intermediate/high income: OR: 2.52, 95% CI 1.28-4.95; women: low vs. intermediate/high occupational grade: OR: 2.25, 95% CI 1.06-4.80). These associations were reduced and became statistically nonsignificant after controlling for baseline sociodemographic characteristics and stressful life events (men and women), overall health (men), and the severity of mental health difficulties (men and women). Overall, depressed individuals with low socioeconomic position appear disproportionately likely to experience multiple risk factors of long-term depression.

  11. Depression, desperation, and suicidal ideation in college students: results from the American Foundation for Suicide Prevention College Screening Project at Emory University.

    PubMed

    Garlow, Steven J; Rosenberg, Jill; Moore, J David; Haas, Ann P; Koestner, Bethany; Hendin, Herbert; Nemeroff, Charles B

    2008-01-01

    The objective of this investigation was to examine suicidal ideation and depression in undergraduate college students who participated in the American Foundation for Suicide Prevention-sponsored College Screening Project at Emory University. The principal measure of depressive symptoms was the nine-item depression module from the Patient Health Questionnaire (PHQ-9). Additional questions were focused on current suicidal ideation, past suicide attempts, and episodes of deliberate self-harm and on symptoms of anxiety and distress. Seven hundred and twenty-nine students participated over a 3-school-year interval (2002-2005). Most notably, 11.1% of the students endorsed current (past 4 weeks) suicidal ideation and 16.5% had a lifetime suicide attempt or self-injurious episode. Students with current suicidal ideation had significantly higher depression symptom severity than those without suicidal ideation (t = -9.34, df = 706, P<.0001, d = 1.9), and 28.5% of the students with PHQ-9 scores of 15 or higher reported suicidal ideation compared to 5.7% of those with lower scores (chi(2) = 56.29, df = 1, P<.0001, two-tailed). Suicidal ideation was prominently associated with symptoms of desperation (odds ratio 2.6, 95% CI 1.5-4.6, P<.001). The vast majority of students with moderately severe to severe depression (85%) or current suicidal ideation (84%) were not receiving any psychiatric treatment at the time of assessment. These results suggest that there is a strong relationship between severity of depressive symptoms and suicidal ideation in college students, and that suicidal feelings and actions are relatively common in this group. This underscores the need to provide effective mental health outreach and treatment services to this vulnerable population. As this analysis was based on data collected at a single institution, the results may not be representative of all college students or young adults.

  12. Female sexual dysfunction: A comparative study in drug naive 1st episode of depression in a general hospital of South Asia

    PubMed Central

    Roy, Payel; Manohar, Shivananda; Raman, Rajesh; Sathyanarayana Rao, T. S.; Darshan, M. S.

    2015-01-01

    Background: Women's sexual dysfunction is found to be highly prevalent in western and Indian literature. Limited studies are available on drug naive depression in western literature and in Indian population. Aim: To determine the prevalence rate and symptom profile of female sexual dysfunctions in patients with untreated depression. Design: A cross-sectional study in the psychiatry out-patient department of general hospital in South India. Materials and Methods: Following written informed consent female sexual functioning index (FSFI) and Arizona Sexual Experience Scale (ASEX) – female version and Hamilton Depression Rating Scale (HAMD - 17 item) on 30 cases and 30 controls was administered. Sociodemographic data, pattern and type of sexual dysfunctions were enquired. Data were analyzed using descriptive statistics, contingency co-efficient analysis and stepwise multiple regression. Results: The mean score of HAMD 17 item in study group was 19.13. The study showed that female sexual dysfunction was 70.3% in study group compared to 43.3% in control FSFI scores above 16 in HAMD had dysfunction of 76% with FSFI in study group. With ASEX-F sexual dysfunction was 73.3% in study compared to 20% in control. Scores above 16 in HAMD had 80% of sexual dysfunction with ASEX-F in study group. Conclusion: The study found that ASEX-F co-related better with HAMD 17 item. Following the onset of depression, the incidence of sexual dysfunction started at an early age in women. PMID:26600576

  13. New results on Late Quaternary stratigraphy of Manych depression

    NASA Astrophysics Data System (ADS)

    Kurbanov, Redzhep; Yanina, Tamara; Borisova, Olga

    2017-04-01

    Manych-strait connected Black sea and Caspian Sea in Pleistocene is a great event in the history of the Ponto-Caspian region. The strait located within such geological structure as Manych Depression which is extended sublatitudinally from the west coast of Nothern Caspian to the north-west of the Azov sea. The existence of the Manych-strait is essentially for the stratigraphy and paleogeography. There were several stages when marine waters spilled over from Black sea to Caspian and alternatively. Due to the alternation of sedimentary layers it is possible to correlate pleistocene deposits and paleogeographic events. Nowadays there are a lot of materials and data about the history of Manych-strait. In the profile are distinguished interbedding marine deposits with lacustrine and alluvial formations and subaerial deposit on top. The main question is the paleogeographical reconstruction. We try to solve this problem using our new data and elaborating available information. In February 2016 complex geomorphologic and paleogeographic works in central part of depression on northern coast of Manych-Gudilo lake were carried out. We performed cable drilling of 2 cores (depth of each 45 m) and hand hammer drilling (8 boreholes, max. depth 12 m) of covering Holocene sediments on different geomorphological levels of depression. From the core (3 cm diameter) continuous sampling was made for spore-pollen, lithological and geochemical analyzes. The stratigraphic subdivision of the core is based on facial-lithology and macro-malakofaunistic analisys. In the lower part of both cores there is barren formation of interbedding layers of sand and clays. The bottom line is precise, below lays a marine Carangat formation (MIS-5) of sand and clay with well-preserved Black Sea marine mollusk shells (Cardium edule, Paphia senescens, Ostrea edulis, Loripes lacteus, Chione gallina, Chlamys glabra). Higher in the core there is a loam-clay layer including both Black Sea (euryhaline species

  14. Intractable episodic bradycardia resulting from progressive lead traction in an epileptic child with a vagus nerve stimulator: a delayed complication.

    PubMed

    Clark, Aaron J; Kuperman, Rachel A; Auguste, Kurtis I; Sun, Peter P

    2012-04-01

    Vagus nerve stimulation (VNS) is used as palliation for adult and pediatric patients with intractable epilepsy who are not candidates for curative resection. Although the treatment is generally safe, complications can occur intraoperatively, perioperatively, and in a delayed time frame. In the literature, there are 2 reports of pediatric patients with implanted VNS units who had refractory bradycardia that resolved after the stimulation was turned off. The authors report the case of a 13-year-old boy with a history of vagus nerve stimulator placement at 2 years of age, who developed intractable episodic bradycardia that persisted despite the cessation of VNS and whose imaging results suggested vagus nerve tethering by the leads. He was subsequently taken to the operating room for exploration, where it was confirmed that the stimulator lead was exerting traction on the vagus nerve, which was displaced from the carotid sheath. After the vagus nerve was untethered and the leads were replaced, the bradycardia eventually resolved with continual effective VNS therapy. When placing a VNS unit in a very young child, accommodations must be made for years of expected growth. Delayed intractable bradycardia can result from a vagus nerve under traction by tethered stimulator leads.

  15. Depression

    MedlinePlus

    ... the winter months, when there is less natural sunlight. Return to top What causes depression? There is ... alone. Others with moderate to severe depression might benefit from antidepressants. It may take a few weeks ...

  16. Depressants

    MedlinePlus

    ... judgment and mental functioning nausea and vomiting memory loss (depressants can cause users to have no memory of events that happened while they were under the influence) Long-Term Effects When people misuse depressants over a long ...

  17. Depression

    MedlinePlus

    ... the birth of a baby. Some people get seasonal affective disorder in the winter. Depression is one part of bipolar disorder. There are effective treatments for depression, including antidepressants, talk therapy, or ...

  18. Depressants

    MedlinePlus

    ... of depressants, including alcohol and the illegal drugs GHB and Rohypnol , come in liquid or powder form ... by prescription only. Some depressants, including Rohypnol and GHB, are illegal in the United States. Illegal possession ...

  19. Cardiometabolic risk in patients with first-episode schizophrenia spectrum disorders: baseline results from the RAISE-ETP study.

    PubMed

    Correll, Christoph U; Robinson, Delbert G; Schooler, Nina R; Brunette, Mary F; Mueser, Kim T; Rosenheck, Robert A; Marcy, Patricia; Addington, Jean; Estroff, Sue E; Robinson, James; Penn, David L; Azrin, Susan; Goldstein, Amy; Severe, Joanne; Heinssen, Robert; Kane, John M

    2014-12-01

    The fact that individuals with schizophrenia have high cardiovascular morbidity and mortality is well established. However, risk status and moderators or mediators in the earliest stages of illness are less clear. To assess cardiometabolic risk in first-episode schizophrenia spectrum disorders (FES) and its relationship to illness duration, antipsychotic treatment duration and type, sex, and race/ethnicity. Baseline results of the Recovery After an Initial Schizophrenia Episode (RAISE) study, collected between July 22, 2010, and July 5, 2012, from 34 community mental health facilities without major research, teaching, or clinical FES programs. Patients were aged 15 to 40 years, had research-confirmed diagnoses of FES, and had less than 6 months of lifetime antipsychotic treatment. Prebaseline antipsychotic treatment was based on the community clinician's and/or patient's decision. Body composition and fasting lipid, glucose, and insulin parameters. In 394 of 404 patients with cardiometabolic data (mean [SD] age, 23.6 [5.0] years; mean [SD] lifetime antipsychotic treatment, 47.3 [46.1] days), 48.3% were obese or overweight, 50.8% smoked, 56.5% had dyslipidemia, 39.9% had prehypertension, 10.0% had hypertension, and 13.2% had metabolic syndrome. Prediabetes (glucose based, 4.0%; hemoglobin A1c based, 15.4%) and diabetes (glucose based, 3.0%; hemoglobin A1c based, 2.9%) were less frequent. Total psychiatric illness duration correlated significantly with higher body mass index, fat mass, fat percentage, and waist circumference (all P<.01) but not elevated metabolic parameters (except triglycerides to HDL-C ratio [P=.04]). Conversely, antipsychotic treatment duration correlated significantly with higher non-HDL-C, triglycerides, and triglycerides to HDL-C ratio and lower HDL-C and systolic blood pressure (all P≤.01). In multivariable analyses, olanzapine was significantly associated with higher triglycerides, insulin, and insulin resistance, whereas quetiapine

  20. Green Space and Depression during Pregnancy: Results from the Growing Up in New Zealand Study

    PubMed Central

    Nichani, Vikram; Bird, Amy; Grant, Cameron

    2017-01-01

    Background: Antenatal depression is an important contributor to poor maternal health experienced by some women. This study aimed to determine whether exposure to green space during pregnancy is associated with less depression, and whether this association is moderated by relevant factors, such as age, education, self-identified ethnicity, physical activity, residential rurality, and socioeconomic status. Methods: Health data were sourced from the cohort study “Growing Up in New Zealand” comprised of 6772 participants. Green space was estimated based on the proportion of green space within the Census Area Unit. Adjusted logistic mixed effect models were used to investigate the association between green space and antenatal depression after controlling for confounding variables. Results: Maternal exposure to green space were not associated with lower odds of antenatal depression. Indications of effect modifications due to relevant factors were not observed. Conclusions: This study did not determine an association between access to green space (measured based on the distance to the nearest green space) and antenatal depression. Therefore, a link between green space and antenatal depression was not established. For that reason, ensuring residential areas contain adequate green space may or may not be helpful in preventing antenatal depression and adverse health outcomes associated with this depression. More studies focusing on pregnant women in a range of social contexts, and considering both exposure and access to green space, are warranted to determine the relationships between green space and antenatal depression. PMID:28927014

  1. Green Space and Depression during Pregnancy: Results from the Growing Up in New Zealand Study.

    PubMed

    Nichani, Vikram; Dirks, Kim; Burns, Bruce; Bird, Amy; Grant, Cameron

    2017-09-18

    Background: Antenatal depression is an important contributor to poor maternal health experienced by some women. This study aimed to determine whether exposure to green space during pregnancy is associated with less depression, and whether this association is moderated by relevant factors, such as age, education, self-identified ethnicity, physical activity, residential rurality, and socioeconomic status. Methods: Health data were sourced from the cohort study "Growing Up in New Zealand" comprised of 6772 participants. Green space was estimated based on the proportion of green space within the Census Area Unit. Adjusted logistic mixed effect models were used to investigate the association between green space and antenatal depression after controlling for confounding variables. Results: Maternal exposure to green space were not associated with lower odds of antenatal depression. Indications of effect modifications due to relevant factors were not observed. Conclusions: This study did not determine an association between access to green space (measured based on the distance to the nearest green space) and antenatal depression. Therefore, a link between green space and antenatal depression was not established. For that reason, ensuring residential areas contain adequate green space may or may not be helpful in preventing antenatal depression and adverse health outcomes associated with this depression. More studies focusing on pregnant women in a range of social contexts, and considering both exposure and access to green space, are warranted to determine the relationships between green space and antenatal depression.

  2. Ultra-short screening instruments for major depressive episode and generalized anxiety disorder in epilepsy: The NDDIE-2 and the GAD-SI.

    PubMed

    Micoulaud-Franchi, Jean-Arthur; Bartolomei, Fabrice; McGonigal, Aileen

    2017-03-01

    Systematic screening is recommended for major depressive episode (MDE) with the Neurological Disorders Depression Inventory for Epilepsy NDDI-E, 6 items and generalized anxiety disorder (GAD) with the GAD 7 items in patients with epilepsy (PWE). Shorter versions of the NDDI-E and the GAD-7 could facilitate increased screening by busy clinicians and be more accessible to patients with mild cognitive and/or language impairments. The effectiveness of ultra-short versions of the NDDI-E (2 items) and the GAD-7 (the GAD-2, 2 items, and the GAD-SI with a single item) in comparison with the original versions were statistically tested using ROC analysis. ROC analysis of the NDDIE-2 showed an AUC of 0.926 (p<0.001), a sensitivity of 81.82% and a specificity of 89.16%, without significant difference with the NDDI-E (z=1.582, p=0.11). ROC analysis of the GAD-SI showed an AUC of 0.872 (p<0.001), a sensitivity of 83.67% and a specificity of 82.29%, without significant difference with the GAD-7 (z=1.281, p=0.2). The GAD-2 showed poorer psychometric properties. The limitation is the use of data from previously reported subjects in a single language version, the NDDIE-2 that lacks detection of dysphoric symptoms in comparison with the NDDIE-6 and the GAD-SI that exhibited a more than 10% lower sensitivity than the GAD-7. This study highlights the potential utility of the NDDIE-2 and the GAD-SI as ultra-short screening tools for MDE and GAD respectively in PWE. Further studies in a larger population, including multi-lingual versions, could be a valuable next step. However, the brevity and simplicity of this tool could be an advantage in PWE who present cognitive difficulties, especially attentional or language deficits. Copyright © 2017 Elsevier B.V. All rights reserved.

  3. Maternal depression and bullying victimization among adolescents: Results from the 2004 Pelotas cohort study.

    PubMed

    Azeredo, Catarina Machado; Santos, Iná S; Barros, Aluísio J D; Barros, Fernando C; Matijasevich, Alicia

    2017-10-01

    Maternal depression impacts on several detrimental outcomes during a child's life course, and could increase their risk of victimization. This longitudinal study examined the association between antenatal maternal depression, postnatal trajectories, and current maternal depression and offspring bullying victimization at 11 years. We included 3,441 11-year-old adolescents from the 2004 Pelotas Cohort Study. Antenatal maternal depression, postnatal trajectories, and current maternal depression data were assessed during the follow-up waves. Bullying victimization was self-reported by the adolescents. We used ordinal logistic regression to estimate the odds ratio (OR) and 95% confidence intervals (CIs), for the association between maternal depression and offspring bullying victimization. The most prevalent type of bullying was verbal victimization (37.9%). We observed a positive association between antenatal maternal depression, postnatal trajectories, and current maternal depression and physical bullying victimization. Maternal mood symptoms during pregnancy were associated with physical (OR = 1.30, 95%CI = 1.11-1.53), verbal (OR = 1.29, 95%CI = 1.12-1.49), and any victimization (OR = 1.22, 95%CI = 1.05-1.41). Severe current maternal depression was associated with physical (OR = 1.34, 95%CI = 1.10-1.62), social manipulation (OR = 1.29, 95%CI = 1.08-1.53), attacks on property (OR = 1.30, 95%CI = 1.08-1.57) and any victimization (OR = 1.32, 95%CI = 1.12-1.56). Regarding maternal depression trajectories, the "chronic-high" group was associated with higher risk of social manipulation, attacks on property and any victimization, than the "low" group. Our results strengthen the evidence of association between maternal depression and offspring bullying victimization, and physical victimization appears to be the main component. Further studies are warranted to confirm our findings and to elucidate the theoretical pathways for this longitudinal association. © 2017 Wiley

  4. Prevention of episodic migraines with topiramate: results from a non-interventional study in a general practice setting.

    PubMed

    Nelles, Gereon; Schmitt, Lukas; Humbert, Thomas; Becker, Veit; Sandow, Petra; Bornhoevd, Karin; Fritzsche, Dirk; Schäuble, Barbara

    2010-02-01

    The majority of patients with migraine headaches are treated in non-specialized institutions though data on treatment outcomes are largely derived from tertiary care centers. The current non-interventional study explores efficacy and tolerability outcomes of patients with episodic migraines receiving topiramate as preventive agent in a general practice setting. A total of 366 patients (87% female, mean age 41.8 +/- 11.6 years) were eligible for migraine prevention and treated with flexible dose topiramate for 6 months (core phase), and optionally for a total of 12 months (follow-up phase). Overall, 261 patients (77.7% of safety analysis set, SAF) completed the core phase. Reasons for discontinuation included adverse events (2.1%), lost to follow-up (1.8%), other reasons (1.5%), and end of therapy (0.3%) though in the majority of patients who discontinued no reasons were listed. The median daily dose at endpoint was 50 mg/day (range, 25-187.5 mg/day). The median days with migraine headaches decreased from 6.0 to 1.2 days (p < 0.001), median pain intensity score decreased from 17.0 to 3.2 points (p < 0.001). In women with reported menstruation-associated migraine, the median number of migraine attacks decreased from 4.0 to 0.9 (p < 0.001). Absenteeism as well as triptan use decreased significantly, and significant improvements in activities of daily living and quality of life were reported. The most frequently reported AEs were paraesthesia (4.2%) and nausea (3%). Results suggest that migraine prevention with topiramate in a general practice is generally well tolerated and associated with a significant improvement in migraine headaches and related functional impairment.

  5. [Results of the Benton Visual Retention Test and the Bender Visual--Motor Gestalt Test among patients suffer from depressive disorders and organic depressive disorders].

    PubMed

    Talarowska, Monika; Florkowski, Antoni; Zboralski, Krzysztof; Gałecki, Piotr

    2011-01-01

    The comorbidity of depression and dementia has been extensively studied. Four main hypotheses have been suggested to explain the relationship between depression and dementia: 1. depression may be a psychological reaction to perceived cognitive decline, 2. depression may be an early symptom of dementia, 3. depression may be an etiologic risk factor for the onset of dementia, and 4. dementia and depression share common risk factors. The objective of this study was to examine the differences between depressive disorders and organic depressive disorders by using two neuropsychological tests. A sample of 61 persons aged 23-62 years participated in the study. Patients who took part in the investigation were divided into two groups: depressive disorders (DD, n = 30), organic depressive disorders (ODD, n = 31). Cognitive functions were evaluated by the Benton Visual Retention Test (BVRT) and Bender Visual-Motor Gestalt Test (BVMGT). Relevant statistical differences among examined group were observed: in BVRT correct answers (p = 0.006), errors (p < 0.001); in BVMGT: (p < 0.001). DD patients achieved higher results in psychological test than ODD patients. DD group (average) in BVRT: correct answers (-1.33), errors (2.31); BVMGT (average): (50.37). ODD group (average) in BVRT: correct answers (-2.71), errors (5.81); BVMGT (average): (72.01). Patients with organic depressive disorders achieved significantly lower results than patients with depressive disorders in BVRT and BVMGT.

  6. [Depressive symptoms in Alzheimer's disease: preliminary results of the REAL.FR study].

    PubMed

    Arbus, C; Andrieu, S; Amouyal-Barkate, K; Nourhashémi, F; Schmitt, L; Vellas, B

    2003-10-01

    The Alzheimer's disease (AD) is today regarded as a degenerative pathology with a serious and common complication: occurrence of mental and behavioral disturbances. Among this neuropsychiatrics symptoms, the depressive symptoms occupy a significant place by their frequency and their consequences on the caregiver's burden. The prevalence of such disorders is very variously appreciated in the literature. To assess with precision depressive symptoms in a population with Alzheimer's disease rated on neuropsychiatric inventory NPI. Cross-sectional study of patients with AD presenting at the consultation of psycho-geriatic, geriatric or neurologic services in 16 french university hospitals. The frequency of the depression was evaluated with the NPI on a population of 578 subjects with AD. We studied the association existing between these symptoms and the antecedents of depression and we studied the gravity of these disorders according to the cognitive status. Caregivers describe less one depressive symptom for approximately 40% of the subjects included in the study n = 229. The average score of gravity is close to 4 and is thus clinically significant. More the stage of dementia is severe more the number of subjects presenting a clinically significant score is important. Scores of depression evolve parallel to the stage of dementia. The antecedents of depression are a risk factor for depressive symptoms in the AD p < 0.001. These results confirm those of primary studies. In our study, more than the prevalence of depressive symptoms it seems that is the severity of the disorder which is associated with the dementia severity. The continuation of this work will allow a prospective evaluation of depressive symptoms in the AD.

  7. [Progression from episodic migraine to chronic migraine].

    PubMed

    Yamane, Kiyomi

    2014-01-01

    Migraine is, essentially, an episodic disease. However, characteristics of headache of some episodic migraine change like as tension-type headache and number of headache days also increased, as a result, develop into chronic migraine.However, it is difficult to distinguish chronic migraine and medication oversuse headache. For this reason, and because of the general rule, The international Classification of Headache Disorders, 3rd edition, beta version (ICHD- 3beta) defined the patients meeting criteria for chronic migraine and for medication overuse headache should be given both diagnoses. The pathophysiology of transformation from episodic to chronic migraine is still unknown. Epidemiological study revealed several risk factors such as medication overusue, frequency of headache, obesity, low education, low income, snoring, depression, neck/head trauma and so on. It is important to control these risk factors for migraine chronification.

  8. The Influence of Comorbid Disorders on the Episodicity of Bipolar Disorder in Youth

    PubMed Central

    Yen, Shirley; Stout, Robert; Hower, Heather; Killam, Matthew A.; Weinstock, Lauren M.; Topor, David R.; Dickstein, Daniel P.; Hunt, Jeffrey I.; Gill, Mary Kay; Goldstein, Tina R.; Goldstein, Benjamin I.; Ryan, Neal D.; Strober, Michael; Sala, Regina; Axelson, David A.; Birmaher, Boris; Keller, Martin B.

    2015-01-01

    Objective Bipolar Disorder (BP) frequently co-occurs with other psychiatric disorders. We examine whether course of anxiety disorders (ANX), attention deficit hyperactivity disorder (ADHD), disruptive behavior disorders (DBD), and substance use disorders (SUD) influence likelihood of recovery and recurrence of depression and mania in BP youth. Method Weekly ratings of psychiatric disorder intensity were obtained from 413 participants of the Course and Outcome of BP Youth project, followed for an average of 7.75 years. Multiple-event Cox proportional hazards regression analyses examined worsening of comorbid disorders as predictors of mood episode recovery and recurrence. Results Increased severity in ANX and SUD predicted longer time to recovery and less time to next depressive episode, and less time to next manic episode. Multivariate models with ANX and SUD found that significant effects of ANX remained, but SUD only predicted longer time to depression recovery. Increased severity of ADHD and DBD predicted shorter time to recurrence for depressive and manic episodes. Conclusion There are significant time-varying relationships between the course of comorbid disorders and episodicity of depression and mania in BP youth. Worsening of comorbid conditions may present as a precursor to mood episode recurrence or warn of mood episode protraction. PMID:26475572

  9. Examining Duration of Binge Eating Episodes in Binge Eating Disorder

    PubMed Central

    Schreiber-Gregory, Deanna N.; Lavender, Jason M.; Engel, Scott G.; Wonderlich, Steve A.; Crosby, Ross D.; Peterson, Carol B.; Simonich, Heather; Crow, Scott; Durkin, Nora; Mitchell, James E.

    2013-01-01

    Objective The primary goal of this paper is to examine and clarify characteristics of binge eating in individuals with binge eating disorder (BED), particularly the duration of binge eating episodes, as well as potential differences between individuals with shorter compared to longer binge eating episodes. Method Two studies exploring binge eating characteristics in BED were conducted. Study 1 examined differences in clinical variables among individuals (N = 139) with BED who reported a short (< 2 hours) versus long (≥ 2 hours) average binge duration. Study 2 utilized an ecological momentary assessment (EMA) design to examine the duration and temporal pattern of binge eating episodes in the natural environment in a separate sample of nine women with BED. Results Participants in Study 1 who were classified as having long duration binge eating episodes displayed greater symptoms of depression and lower self-esteem, but did not differ on other measures of eating disorder symptoms, compared to those with short duration binge eating episodes. In Study 2, the average binge episode duration was approximately 42 minutes, and binge eating episodes were most common during the early afternoon and evening hours, as well as more common on weekdays versus weekends. Discussion Past research on binge episode characteristics, particularly duration, has been limited to studies of binge eating episodes in BN. This study contributes to the existing literature on characteristics of binge eating in BED. PMID:23881639

  10. Depression.

    ERIC Educational Resources Information Center

    Strock, Margaret

    Approximately ten percent of the population suffers from a depressive illness each year. Although the economic cost is high, the cost in human suffering is immeasurable. To help educate the population about this disorder, this paper presents a definition of depression and its common manifestations. The symptoms that people often experience are…

  11. [Exploratory study of amitriptyline resistance in depressed patients: results of WHO French collaborating center on depressions resistant to treatments].

    PubMed

    Loas, G; Rose, D; Nowaczkowski, P; Lernout, P; Duron, B

    1996-06-01

    A multicountry, multicentre double-blind study in a group of depressives, coordinated by the Mental Health Division of the World Health Association (WHO) has been done. The goal of the study is to determine whether the therapeutic effects of amitriptyline can be enhanced and potentiated by combining it with an antioxydant (gingko biloba). An exploratory study has preceded the main study which had the objective to estimate the proportion of non-response patient to amitriptyline. We report the results concerning the French center. 23 inpatients meet the ICD-10 criteria for depression (F32 and F33) and were treated during 6 weeks by amitriptyline with the initial daily dose of 50 mg until the maximum dose of 200 mg. The proportion of non-responsive patient to amitriptyline was 34.78 (95% confidence interval : 15.32 to 54.24%), all clinically deteriorated.

  12. Efficacy of depression treatments for immigrant patients: results from a systematic review

    PubMed Central

    2014-01-01

    Background The unprecedented rates of global migration present unique challenges to mental health services in migrant receiving countries to provide efficacious and culturally salient treatment for mental health conditions including depression. This review aimed to identify and evaluate the effectiveness of depression interventions specifically directed towards first-generation immigrant populations. Methods We conducted a systematic review of original research published between 2000 and 2013 that investigated depression interventions in first generation immigrants. Results Fifteen studies were included; the majority focused on Latino immigrants living in the United States (US). Twelve studies investigated the use of psychotherapies; the remainder examined collaborative care models and physical exercise-based interventions. Cognitive Behavioral Therapy and Behavioral Activation tended to improve depressive symptoms, especially when culturally adapted to suit clients while Problem Solving Therapy improved depressive symptomology with and without adaptations. Collaborative care and exercise did not significantly improve depressive symptoms. Conclusion Depression may be effectively treated by means of psychotherapies, especially when treatments are culturally adapted. However the reviewed studies were limited due to methodological weaknesses and were predominantly undertaken in the US with Latino patients. To improve generalizability, future research should be undertaken in non-US settings, amongst diverse ethnic groups and utilize larger sample sizes in either randomized clinical trials or observational cohort studies. PMID:24930429

  13. Hydrologic and Geomorphic Changes Resulting from the Onset of Episodic Glacial Lake Outburst Floods: Colonia River, Chile

    NASA Astrophysics Data System (ADS)

    Jacquet, J.; McCoy, S. W.; McGrath, D.; Nimick, D.; Friesen, B.; Fahey, M. J.; Leidich, J.; Okuinghttons, J.

    2015-12-01

    The Colonia river system, draining the eastern edge of the Northern Patagonia Icefield, Chile, has experienced a dramatic shift in flow regime from one characterized by seasonal discharge variability to one dominated by episodic glacial lake outburst floods (GLOFs). We use multi-temporal visible satellite images, high-resolution digital elevation models (DEMs) derived from stereo image pairs, and in situ observations to quantify sediment and water fluxes out of the dammed glacial lake, Lago Cachet Dos (LC2), as well as the concomitant downstream environmental change. GLOFs initiated in April 2008 and have since occurred, on average, two to three times a year. Differencing concurrent gage measurements made on the Baker River upstream and downstream of the confluence with the Colonia river finds peak GLOF discharges of ~ 3,000 m3s-1, which is ~ 4 times the median discharge of the Baker River and over 20 times the median discharge of the Colonia river. During each GLOF, ~ 200,000,000 m3 of water evacuates from the LC2, resulting in erosion of valley-fill sediments and the delta on the upstream end of LC2. Differencing DEMs between April 2008 and February 2014 revealed that ~ 2.5 x 107 m3 of sediment was eroded. Multi-temporal DEM differencing shows that erosion rates were highest initially, with > 20 vertical m of sediment removed between 2008 and 2012, and generally less than 5 m between 2012 and 2014. The downstream Colonia River Sandur also experienced geomorphic changes due to GLOFs. Using Landsat imagery to calculate the normalized difference water index (NDWI), we demonstrate that the Colonia River was in a stable configuration between 1984 and 2008. At the onset of GLOFs in April 2008, a change in channel location began and continued with each subsequent GLOF. Quantification of sediment and water fluxes due to GLOFs in the Colonia river valley provides insight on the geomorphic and environmental changes in river systems experiencing dramatic shifts in flow

  14. Co-occurrence of major depressive episode and posttraumatic stress disorder among survivors of war: how is it different from either condition alone?

    PubMed

    Morina, Nexhmedin; Ajdukovic, Dean; Bogic, Marija; Franciskovic, Tanja; Kucukalic, Abdulah; Lecic-Tosevski, Dusica; Morina, Lendite; Popovski, Mihajlo; Priebe, Stefan

    2013-03-01

    Major depressive episode (MDE) and posttraumatic stress disorder (PTSD) have been shown to be the most common mental disorders following traumatic war experiences and have been found to frequently co-occur. This study, designed as a randomized cross-sectional interview survey, aimed to identify whether the co-occurence of MDE and PTSD following exposure to war-related experiences is associated with different demographics, exposure to previous traumatic events, and clinical characteristics than either condition alone. After a random-walk technique was used to randomly select participants, face-to-face interviews were conducted among war-affected community samples in 5 Balkan countries (N = 3,313) in the years 2006 and 2007. The mean age of participants was 42.3 years, and all participants had experienced potentially traumatic events during war in the countries of the former Yugoslavia. Current prevalence rates of MDE and PTSD and suicide risk were assessed using the Mini-International Neuropsychiatric Interview. Levels of general psychological distress, posttraumatic stress, and quality of life were assessed with self-reports. 30.5% of the sample met DSM-IV diagnostic criteria for either MDE or PTSD, and 9.1% had both disorders. Participants with concomitant MDE and PTSD reported significantly higher numbers of prewar and postwar traumatic events than participants with PTSD only and higher numbers of war-related events than those with MDE only (all P values < .001). Participants with both MDE and PTSD had significantly higher levels of general psychological and posttraumatic stress symptoms, a higher suicide risk, and lower levels of quality of life than participants with either condition alone (all P values < .001). Concomitant MDE and PTSD are associated with the experience of different traumatic events and are characterized by more general psychological distress than either condition alone. The assessment of concomitant MDE and PTSD can facilitate better

  15. Are symptom features of depression during pregnancy, the postpartum period and outside the peripartum period distinct? Results from a nationally representative sample using Item Response Theory (IRT)

    PubMed Central

    Hoertel, Nicolas; López, Saioa; Peyre, Hugo; Wall, Melanie M.; González-Pinto, Ana; Limosin, Frédéric; Blanco, Carlos

    2014-01-01

    Background Whether there are systematic differences in depression symptom expression during pregnancy, the postpartum period and outside these periods (i.e., outside the peripartum period) remains debated. The aim of this study was to use methods based on item response theory (IRT) to examine, after equating for depression severity, differences in the likelihood of reporting DSM-IV symptoms of major depressive episode (MDE) in women of childbearing age (i.e., aged 18-50) during pregnancy, the postpartum period and outside the peripartum period. Method We conducted these analyses using a large, nationally representative sample of women of childbearing age from the USA (n = 11,256) who participated in the second wave of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Results The overall 12-month prevalence of all depressive criteria (except for worthlessness/guilt) was significantly lower in pregnant women than in women of childbearing age outside the peripartum period, whereas the prevalence of all symptoms (except for “psychomotor symptoms”) were not significantly different between the postpartum and the non-peripartum group. There were no clinically significant differences in the endorsement rates of symptoms of MDE by pregnancy status when equating for levels of depression severity. Conclusions This study suggests that the clinical presentation of depressive symptoms in women of childbearing age does not differ during pregnancy, the postpartum period and outside the peripartum period. These findings do not provide psychometric support for the inclusion of the peripartum onset specifier for major depressive disorder in the DSM-5. PMID:25424539

  16. [Concept and results of an awareness campaign: the "Nuremberg Alliance against Depression"].

    PubMed

    Althaus, D; Hegerl, U

    2003-03-10

    Currently, only a small percentage of patients with depressive disorders receive adequate pharmacological or psychotherapeutic treatment. Apart from deficits in diagnosis and treatment, misconceptions and prejudice with regard to depression on the part of the public at large are major reasons for this situation. Fear of medical treatment, in particular, is common. Within the framework of a multilevel depression and suicide prevention program conducted in Nuremberg ("Nuremberg Alliance against Depression") in the years 2001 and 2002, an intensive public awareness campaign was undertaken; two telephone surveys were carried out to evaluate the outcome in comparison with a control region. The results revealed that awareness and knowledge of the condition among the public was considerably improved,while negative attitudes towards antidepressant medication remained unchanged.

  17. Monoamine oxidase A inhibitor occupancy during treatment of major depressive episodes with moclobemide or St. John’s wort: an [11C]-harmine PET study

    PubMed Central

    Sacher, Julia; Houle, Sylvain; Parkes, Jun; Rusjan, Pablo; Sagrati, Sandra; Wilson, Alan A.; Meyer, Jeffrey H.

    2011-01-01

    Background Monoamine oxidase A (MAO-A) inhibitor antidepressants raise levels of multiple monoamines, whereas the selective serotonin reuptake inhibitors (SSRIs) only raise extracellular serotonin. Despite this advantage of MAO-A inhibitors, there is much less frequent development of MAO inhibitors compared with SSRIs. We sought to measure brain MAO-A occupancy after 6 weeks of treatment in depressed patients with a clinically effective dose of a selective MAO-A inhibitor and measure MAO-A occupancy after repeated administration of St. John’s wort, an herb purported to have MAO-A inhibitor properties. Methods Participants underwent 2 [11C]-harmine positron emission tomography scans. Healthy controls completed a test–retest condition, and depressed patients were scanned before and after repeated administration of moclobemide or St. John’s wort for 6 weeks at the assigned dose. We measured MAO-A VT, an index of MAO-A density, in the prefrontal, anterior cingulate and anterior temporal cortices, putamen, thalamus, midbrain and hippocampus. Results We included 23 participants (10 controls and 13 patients with major depressive disorder [MDD]) in our study. Monoamine oxidase A VT decreased significantly throughout all regions after moclobemide treatment in patients with MDD compared with controls (repeated-measures analysis of variance, F1,15 = 71.08–130.06, p < 0.001 for all regions, mean occupancy 74% [standard deviation 6%]). Treatment with St. John’s wort did not significantly alter MAO-A VT. Limitations The occupancy estimates are limited by the sample size of each treatment group; hence, our estimate for the overall moclobemide occupancy of 74% has a 95% confidence interval of 70%–78%, and we can estimate with 95% certainty that the occupancy of St. John’s wort is less than 5%. Conclusion For new MAO-A inhibitors, about 74% occupancy at steady-state dosing is desirable. Consistent with this, St. John’s wort should not be classified as an MAO

  18. The effects of anti-depressants on depression symptom scores at 12 months follow-up in patients with cardiometabolic disease: Results from a large primary care cohort

    PubMed Central

    Jani, Bhautesh Dinesh; Purves, David; Barry, Sarah J. E.; McCowan, Colin; Cavanagh, Jonathan; Mair, Frances S.

    2015-01-01

    Background: Evidence on the long-term usefulness of anti-depressants in managing depression in cardiometabolic disease is limited. Aim: We examined the effects of anti-depressant prescribing on depressive symptoms at 12 months follow-up in patients with cardiometabolic disease and a positive depression screening result at baseline. Design and Setting: We retrospectively reviewed routine UK primary care data for patients with coronary heart disease, diabetes and previous stroke for the year 2008–2009. 35,537 patients with one of the three above diseases underwent depression screening using the Hospital Anxiety and Depression Scale (HADS-D). Of 7080 patients with a positive screening result (HADS-D ≥ 8), 3933 (55.5%) patients had a repeat HADS-D recorded at 12 months follow-up. Methods: We compared the change in HADS-D at follow-up and remission rate in those who were prescribed anti-depressants (n = 223) against those who were not (n = 3710). Results: The mean change in HADS-D from baseline, for the nonprescribed group was similar to the reduction observed in patients who were continuously prescribed (n = 93) with anti-depressants during follow-up. Patients who were prescribed intermittently (n = 72) or only one (n = 58) prescription during follow-up had a lower reduction in HADS-D compared to the nonprescribed group. There was no difference in remission rates between continuously prescribed and the nonprescribed group, but remission was lower in patients prescribed intermittently and single prescription. Conclusion: Improvement in depressive symptoms in patients with cardiometabolic disease at 12 months was not any better in patients prescribed with anti-depressants compared to the nonprescribed group. The role of anti-depressants in the management of depression in cardiometabolic disease merits further investigation. PMID:26286616

  19. Exercise training improves depressive symptoms in people with multiple sclerosis: results of a meta-analysis.

    PubMed

    Ensari, Ipek; Motl, Robert W; Pilutti, Lara A

    2014-06-01

    There is a high prevalence, yet under-treatment of depressive disorder and symptoms by conventional therapy in people with multiple sclerosis (MS). We conducted a meta-analysis examining the overall effect of exercise training on depressive symptoms in MS. We searched PubMed for randomized controlled trials (RCT) of exercise training and depression as an outcome in samples with MS. There were 13 RCTs that met inclusion criteria and yielded data for effect size (ES) generation (Cohen's d). An overall ES was calculated using a random effects model and expressed as Hedge's g. The weighted mean ES was small, but statistically significant (Hedge's g=0.36, SE=0.09, 95% CI=0.18-0.54, z=3.92, p<.001) indicating the exercise training resulted in an improvement in depressive symptoms compared to control. The overall effect was not heterogeneous (Q=16.46, df=12, p=0.17, I2=27.08); and post-hoc, exploratory analyses only identified depression symptom scale as a potential moderator variable (p=0.04). The cumulative evidence indicates that exercise training can yield a small, yet statistically significant and reliable reduction in depressive symptoms for people with MS. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. The Association between Serum Leptin and Post Stroke Depression: Results from a Cohort Study

    PubMed Central

    Zhang, Hua-jing; Zhao, Wen-li

    2014-01-01

    Background Depression is a frequent mood disorder that affects around a third of stroke patients and has been associated with poorer outcomes. Our aim was to determine whether there was a relationship between inflammatory markers (leptin) and post-stroke depression (PSD). Methods One hundred and ninety-one ischemic stroke patients admitted to the hospital within the first 24 hours after stroke onset were consecutively recruited and followed up for 3 months. Enzyme-linked immunosorbent assay (ELISA) was used to measure serum levels of leptin at admission. Based on the symptoms, diagnoses of depression were made in accordance with DSM-IV criteria for post-stroke depression at 3 month. Results Forty-four patients (23.0%) were diagnosed as having major depression at 3 month. Patients with depression showed higher serum leptin levels at 3 month after stroke (32.2 [IQR, 20.8–57.7] v. 9.9 [IQR, 4.6–13.1]ng/ml, respectively; P = 0.000). Serum levels of leptin ≥20 ng/ml were independently associated with PSD [odds ratio (OR) 20.23, 95% confidence interval (CI) 9.11–51.26, P =  0.000], after adjusting for possible confounders. Conclusions Serum leptin levels elevated at admission were found to be associated with PSD and may provide a new proposal for the treatment of PSD. PMID:25061971

  1. Ethnic differences in the association between depression and chronic pain: cross sectional results from UK Biobank.

    PubMed

    Nicholl, Barbara I; Smith, Daniel J; Cullen, Breda; Mackay, Daniel; Evans, Jonathan; Anderson, Jana; Lyall, Donald M; Fawns-Ritchie, Chloe; McIntosh, Andrew M; Deary, Ian J; Pell, Jill P; Mair, Frances S

    2015-10-06

    over the body 3.31 (2.05, 5.33). When current depressive symptoms were considered these relationships were attenuated. Chronic pain and depression reporting varies across ethnic groups. Differences in health seeking behaviour between ethnic groups may impact on the results reported. Clinicians, particularly in primary care, need to be aware of the cultural barriers within certain ethic groups to expressing concern over mood and to consider their approach accordingly.

  2. Stress sensitivity interacts with depression history to predict depressive symptoms among youth: prospective changes following first depression onset.

    PubMed

    Technow, Jessica R; Hazel, Nicholas A; Abela, John R Z; Hankin, Benjamin L

    2015-04-01

    Predictors of depressive symptoms may differ before and after the first onset of major depression due to stress sensitization. Dependent stressors, or those to which characteristics of individuals contribute, have been shown to predict depressive symptoms in youth. The current study sought to clarify how stressors' roles may differ before and after the first depressive episode. Adolescents (N = 382, aged 11 to 15 at baseline) were assessed at baseline and every 3 months over the course of 2 years with measures of stressors and depressive symptoms. Semi-structured interviews were conducted every 6 months to assess for clinically significant depressive episodes. Hierarchical linear modeling showed a significant interaction between history of depression and idiographic fluctuations in dependent stressors to predict prospective elevations of symptoms, such that dependent stressors were more predictive of depressive symptoms after onset of disorder. Independent stressors predicted symptoms, but the strength of the association did not vary by depression history. These results suggest a synthesis of dependent stress and stress sensitization processes that might maintain inter-episode depressive symptoms among youth with a history of clinical depression.

  3. Stress sensitivity interacts with depression history to predict depressive symptoms among youth: Prospective changes following first depression onset

    PubMed Central

    Technow, Jessica R.; Hazel, Nicholas A.; Abela, John R. Z.; Hankin, Benjamin L.

    2015-01-01

    Predictors of depressive symptoms may differ before and after the first onset of major depression due to stress sensitization. Dependent stressors, or those to which characteristics of individuals contribute, have been shown to predict depressive symptoms in youth. The current study sought to clarify how stressors’ roles may differ before and after the first depressive episode. Adolescents (N = 382, aged 11 to 15 at baseline) were assessed at baseline and every three months over the course of two years with measures of stressors and depressive symptoms. Semi-structured interviews were conducted every 6 months to assess for clinically significant depressive episodes. Hierarchical linear modeling showed a significant interaction between history of depression and idiographic fluctuations in dependent stressors to predict prospective elevations of symptoms, such that dependent stressors were more predictive of depressive symptoms after onset of disorder. Independent stressors predicted symptoms, but the strength of the association did not vary by depression history. These results suggest a synthesis of stress sensitization and generation processes that might maintain inter-episode depressive symptoms among youth with a history of clinical depression. PMID:25123081

  4. The Use and Effectiveness of Mobile Apps for Depression: Results From a Fully Remote Clinical Trial

    PubMed Central

    Arean, Patricia A; Hallgren, Kevin A; Jordan, Joshua T; Gazzaley, Adam; Atkins, David C; Heagerty, Patrick J

    2016-01-01

    Background Mobile apps for mental health have the potential to overcome access barriers to mental health care, but there is little information on whether patients use the interventions as intended and the impact they have on mental health outcomes. Objective The objective of our study was to document and compare use patterns and clinical outcomes across the United States between 3 different self-guided mobile apps for depression. Methods Participants were recruited through Web-based advertisements and social media and were randomly assigned to 1 of 3 mood apps. Treatment and assessment were conducted remotely on each participant’s smartphone or tablet with minimal contact with study staff. We enrolled 626 English-speaking adults (≥18 years old) with mild to moderate depression as determined by a 9-item Patient Health Questionnaire (PHQ-9) score ≥5, or if their score on item 10 was ≥2. The apps were (1) Project: EVO, a cognitive training app theorized to mitigate depressive symptoms by improving cognitive control, (2) iPST, an app based on an evidence-based psychotherapy for depression, and (3) Health Tips, a treatment control. Outcomes were scores on the PHQ-9 and the Sheehan Disability Scale. Adherence to treatment was measured as number of times participants opened and used the apps as instructed. Results We randomly assigned 211 participants to iPST, 209 to Project: EVO, and 206 to Health Tips. Among the participants, 77.0% (482/626) had a PHQ-9 score >10 (moderately depressed). Among the participants using the 2 active apps, 57.9% (243/420) did not download their assigned intervention app but did not differ demographically from those who did. Differential treatment effects were present in participants with baseline PHQ-9 score >10, with the cognitive training and problem-solving apps resulting in greater effects on mood than the information control app (χ22=6.46, P=.04). Conclusions Mobile apps for depression appear to have their greatest impact on

  5. Evaluating depressive symptoms in hypomanic and manic episodes using a structured diagnostic tool: validation of a new Mini International Neuropsychiatric Interview (M.I.N.I.) module for the DSM-5 'With Mixed Features' specifier.

    PubMed

    Hergueta, Thierry; Weiller, Emmanuelle

    2013-01-01

    The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), includes a new 'With Mixed Features' specifier for mood episodes. In (hypo-)manic episodes, the specifier is given if three or more depressive symptoms are present nearly every day during the episode. A new module of the Mini International Neuropsychiatric Interview (M.I.N.I.) has been developed as a patient-completed questionnaire to evaluate the DSM-5 specifier for (hypo-)manic episodes. The objective of this study was to validate this new module. In Phase I, patients with a manic episode in the past 6 months completed the module and were asked whether the wording was clear, understandable, relevant and specific. Based on their feedback, the module was refined and finalised. In Phase II, psychiatrists each invited five patients to complete the module. The psychiatrists completed record forms for these five patients, which included their diagnoses, made according to DSM-5 criteria during clinical interviewing. The module was validated by comparing depressive symptoms reported by the patients themselves using the M.I.N.I. module with those evaluated by their psychiatrist using DSM-5 criteria during clinical interviewing. In Phase I, a few changes were made to the M.I.N.I. module based on feedback from 20 patients (60% of whom had mixed features). In Phase II, 23 psychiatrists completed record forms for 115 patients, 99 (86.1%) of whom completed the M.I.N.I. module. Agreement between psychiatrists' DSM-5 diagnoses and patients' M.I.N.I. responses was substantial (Cohen's kappa coefficient, 0.60). The overall sensitivity of the M.I.N.I. was 0.91 and its specificity was 0.70. Sensitivity ranged from 0.63 for psychomotor retardation to 0.90 for suicidal thoughts. Specificity ranged from 0.63 for diminished interest/pleasure to 0.90 for suicidal thoughts. The module's positive and negative predictive values were 0.72 and 0.90, respectively. In summary, the M.I.N.I. module demonstrated good

  6. Relationship between dopamine deficit and the expression of depressive behavior resulted from alteration of serotonin system.

    PubMed

    Lee, Minkyung; Ryu, Young Hoon; Cho, Won Gil; Kang, Yeo Wool; Lee, Soo Jin; Jeon, Tae Joo; Lyoo, Chul Hyoung; Kim, Chul Hoon; Kim, Dong Goo; Lee, Kyochul; Choi, Tae Hyun; Choi, Jae Yong

    2015-09-01

    Depression frequently accompanies in Parkinson's disease (PD). Previous research suggested that dopamine (DA) and serotonin systems are closely linked with depression in PD. However, comprehensive studies about the relationship between these two neurotransmitter systems are limited. Therefore, the purpose of this study is to evaluate the effect of dopaminergic destruction on the serotonin system. The interconnection between motor and depression was also examined. Two PET scans were performed in the 6-hydroxydopamine (6-OHDA) lesioned and sham operated rats: [(18) F]FP-CIT for DA transporters and [(18) F]Mefway for serotonin 1A (5-HT(1A)) receptors. Here, 6-OHDA is a neurotoxin for dopaminergic neurons. Behavioral tests were used to evaluate the severity of symptoms: rotational number for motor impairment and immobility time, acquired from the forced swim test for depression. Region-of-interests were drawn in the striatum and cerebellum for the DA system and hippocampus and cerebellum for the 5-HT system. The cerebellum was chosen as a reference region. Nondisplaceable binding potential in the striatum and hippocampus were compared between 6-OHDA and sham groups. As a result, the degree of DA depletion was negatively correlated with rotational behavior (R(2)  = 0.79, P = 0.003). In 6-OHDA lesioned rats, binding values for 5-HT(1A) receptors was 22% lower than the sham operated group. This decrement of 5-HT(1A) receptor binding was also correlated with the severity of depression (R(2)  = 0.81, P = 0.006). Taken together, this research demonstrated that the destruction of dopaminergic system causes the reduction of the serotonergic system resulting in the expression of depressive behavior. The degree of dopaminergic dysfunction was positively correlated with the impairment of the serotonin system. Severity of motor symptoms was also closely related to depressive behavior.

  7. Petrologic constraints on rift-zone processes - Results from episode 1 of the Puu Oo eruption of Kilauea volcano, Hawaii

    USGS Publications Warehouse

    Garcia, M.O.; Ho, R.A.; Rhodes, J.M.; Wolfe, E.W.

    1989-01-01

    The Puu Oo eruption in the middle of Kilauea volcano's east rift zone provides an excellent opportunity to utilize petrologic constraints to interpret rift-zone processes. Emplacement of a dike began 24 hours before the start of the eruption on 3 January 1983. Seismic and geodetic evidence indicates that the dike collided with a magma body in the rift zone. Most of the lava produced during the initial episode of the Puu Oo eruption is of hybrid composition, with petrographic and geochemical evidence of mixing magmas of highly evllved and more mafic compositions. Some olivine and plagioclase grains in the hybrid lavas show reverse zoning. Whole-rock compositional variations are linear even for normally compatible elements like Ni and Cr. Leastsquares mixing calculations yield good residuals for major and trace element analyses for magma mixing. Crystal fractionation calculations yield unsatisfactory residuals. The highly evolved magma is similar in composition to the lava from the 1977 eruption and, at one point, vents for these two eruptions are only 200 m apart. Possibly both the 1977 lava and the highly evolved component of the episode 1 Puu Oo lava were derived from a common body of rift-zone-stored magma. The more mafic mixing component may be represented by the most mafic lava from the January 1983 eruption; it shows no evidence of magma mixing. The dike that was intruded just prior to the start of the Puu Oo eruption may have acted as a hydraulic plunger causing mixing of the two rift-zone-stored magmas. ?? 1989 Springer-Verlag.

  8. The Use and Effectiveness of Mobile Apps for Depression: Results From a Fully Remote Clinical Trial.

    PubMed

    Arean, Patricia A; Hallgren, Kevin A; Jordan, Joshua T; Gazzaley, Adam; Atkins, David C; Heagerty, Patrick J; Anguera, Joaquin A

    2016-12-20

    Mobile apps for mental health have the potential to overcome access barriers to mental health care, but there is little information on whether patients use the interventions as intended and the impact they have on mental health outcomes. The objective of our study was to document and compare use patterns and clinical outcomes across the United States between 3 different self-guided mobile apps for depression. Participants were recruited through Web-based advertisements and social media and were randomly assigned to 1 of 3 mood apps. Treatment and assessment were conducted remotely on each participant's smartphone or tablet with minimal contact with study staff. We enrolled 626 English-speaking adults (≥18 years old) with mild to moderate depression as determined by a 9-item Patient Health Questionnaire (PHQ-9) score ≥5, or if their score on item 10 was ≥2. The apps were (1) Project: EVO, a cognitive training app theorized to mitigate depressive symptoms by improving cognitive control, (2) iPST, an app based on an evidence-based psychotherapy for depression, and (3) Health Tips, a treatment control. Outcomes were scores on the PHQ-9 and the Sheehan Disability Scale. Adherence to treatment was measured as number of times participants opened and used the apps as instructed. We randomly assigned 211 participants to iPST, 209 to Project: EVO, and 206 to Health Tips. Among the participants, 77.0% (482/626) had a PHQ-9 score >10 (moderately depressed). Among the participants using the 2 active apps, 57.9% (243/420) did not download their assigned intervention app but did not differ demographically from those who did. Differential treatment effects were present in participants with baseline PHQ-9 score >10, with the cognitive training and problem-solving apps resulting in greater effects on mood than the information control app (χ22=6.46, P=.04). Mobile apps for depression appear to have their greatest impact on people with more moderate levels of depression. In

  9. Correlates and Predictors of Depression in College Students: Results from the Spring 2000 National College Health Assessment

    ERIC Educational Resources Information Center

    Leino, E. Victor; Kisch, Jeremy

    2005-01-01

    The present analyses used depression-related items and co-factors from the National College Health Assessment (NCHA), Spring 2000. The results indicate 10.3 % of college students (6.2% male and 12.6% female) reported ever having been diagnosed with depression. Of those ever diagnosed with depression, 39% were diagnosed in the last year, 27% were…

  10. Time to lack of persistence with pharmacological treatment among patients with current depressive episodes: a natural study with 1-year follow-up

    PubMed Central

    Li, Kanglai; Wei, Qinling; Li, Guanying; He, Xiangjun; Liao, Yingtao; Gan, Zhaoyu

    2016-01-01

    Introduction Medication nonadherence remains a big challenge for depressive patients. This study aims to assess and compare the medication persistence between unipolar depression (UD) and bipolar depression (BD). Methods A total of 146 UD and 187 BD patients were recruited at their first index prescription. Time to lack of persistence with pharmacological treatment (defined as a gap of at least 60 days without taking any medication) was calculated, and clinical characteristics were collected. Final diagnosis was made at the end of 1-year follow-up. Results A total of 101 (69.2%) UD and 126 (67.4%) BD patients discontinued the treatment, with a median duration of 36 days and 27 days, respectively. No significant difference was found between UD and BD in terms of time to lack of persistence with pharmacological treatment. The highest discontinuation rate (>40%) occurred in the first 3 months for both groups of patients. For UD patients, those with a higher risk of suicide (odds ratio [OR] =0.696, P=0.035) or comorbidity of any anxiety disorder (OR =0.159, P<0.001) were less likely to prematurely drop out (drop out within the first 3 months), while those with onset in the summer (OR =4.702, P=0.049) or autumn (OR =7.690, P=0.012) were more likely to prematurely drop out than those with onset in the spring (OR =0.159, P<0.001). For BD patients, being female (OR =2.250, P=0.012) and having a history of spontaneous remission or switch to hypomania (OR =2.470, P=0.004) were risk factors for premature drop out, while hospitalization (OR =0.304, P=0.023) and misdiagnosis as UD (OR =0.283, P<0.001) at the first index prescription were protective factors. Limitation Conservative definition of nonadherence, low representativeness of sample. Conclusion Treatment discontinuation was frequently seen in patients with UD or BD, especially in the first 3 months of treatment. In spite of the similar pattern of medication persistence, UD and BD differ from each other in predictors of

  11. Assessing Rates and Predictors of Tachyphylaxis During the Prevention of Recurrent Episodes of Depression With Venlafaxine ER for Two Years (PREVENT) Study

    PubMed Central

    Rothschild, Anthony J.; Dunlop, Boadie W.; Dunner, David L.; Friedman, Edward S.; Gelenberg, Alan; Holland, Peter; Kocsis, James H.; Kornstein, Susan G.; Shelton, Richard; Trivedi, Madhukar H.; Zajecka, John M.; Goldstein, Corey; Thase, Michael E.; Pedersen, Ron; Keller, Martin B.

    2013-01-01

    Background Antidepressant tachyphylaxis describes the return of apathetic depressive symptoms, such as fatigue and decreased motivation, despite continued use of a previously effective treatment. Methods Data were collected from a multiphase, double-blind, placebo-controlled study that assessed the efficacy of venlafaxine extended release (ER) during 2 sequential 1-year maintenance phases (A and B) in patients with recurrent major depressive disorder (MDD). The primary outcome was the cumulative probability of tachyphylaxis in patients receiving venlafaxine ER, fluoxetine, or placebo. Tachyphylaxis was defined as Rothschild Scale for Antidepressant Tachyphylaxis (RSAT) scored ≥ 7 in patients with prior satisfactory therapeutic response. A Kaplan-Meier estimate of the cumulative probability of not experiencing tachyphylaxis, and a 2-sided Fisher exact test was used to assess the relationship between tachyphylaxis and recurrence. Results The maintenance phase A population was comprised of 337 patients (venlafaxine ER [n = 129], fluoxetine [n = 79], placebo [n = 129]), whereas 128 patients (venlafaxine ER [n = 43], fluoxetine [n = 45], placebo [n = 40]) were treated during maintenance phase B. No difference in the probability of experiencing tachyphylaxis were observed between the active treatment groups during either maintenance phase; however, a significant difference between venlafaxine ER and placebo was observed at the completion of maintenance phase A. A significant relationship between tachyphylaxis and recurrence was observed. Limitations Despite demonstrating psychometric validity and reliability, the current definition of tachyphylaxis has not been widely studied Conclusions Although no significant differences were observed in the probability of tachyphylaxis among patients receiving active treatment, the relationship between tachyphylaxis and recurrence suggests that tachyphylaxis may be a predrome of recurrence. PMID:19752838

  12. Risk Factors for Anxiety in Major Depressive Disorder Patients

    PubMed Central

    Xin, Li-Min; Chen, Lin; Ji, Zhen-Peng; Zhang, Suo-Yuan; Wang, Jun; Liu, Yan-Hong; Chen, Da-Fang; Yang, Fu-De; Wang, Gang; Fang, Yi-Ru; Lu, Zheng; Yang, Hai-Chen; Hu, Jian; Chen, Zhi-Yu; Huang, Yi; Sun, Jing; Wang, Xiao-Ping; Li, Hui-Chun; Zhang, Jin-Bei; Si, Tian-Mei

    2015-01-01

    Objective To analyze the sociodemographic and clinical factors related to anxiety in patients with major depressive disorder (MDD). Methods This study involved a secondary analysis of data obtained from the Diagnostic Assessment Service for People with Bipolar Disorders in China (DASP), which was initiated by the Chinese Society of Psychiatry (CSP) and conducted from September 1, 2010 to February 28, 2011. Based on the presence or absence of anxiety-related characteristics, 1,178 MDD patients were classified as suffering from anxious depression (n=915) or non-anxious depression (n=263), respectively. Results Compared with the non-anxious group, the anxious-depression group had an older age at onset (t=−4.39, p<0.001), were older (t=−4.69, p<0.001), reported more lifetime depressive episodes (z=−3.24, p=0.001), were more likely to experience seasonal depressive episodes (χ2=6.896, p=0.009) and depressive episodes following stressful life events (χ2=59.350, p<0.001), and were more likely to have a family history of psychiatric disorders (χ2=6.091, p=0.014). Their positive and total scores on the Mood Disorder Questionnaire (MDQ) and the 32-item Hypomania Checklist (HCL-32) (p<0.05) were also lower. The logistic regression analysis indicated that age (odds ratio [OR]=1.03, p<0.001), a lower total MDQ score (OR=0.94, p=0.011), depressive episodes following stressful life events (OR=3.04, p<0.001), and seasonal depressive episodes (OR=1.75, p=0.039) were significantly associated with anxious depression. Conclusion These findings indicate that older age, fewer subclinical bipolar features, an increased number of depressive episodes following stressful life events, and seasonal depressive episodes may be risk factors for anxiety-related characteristics in patients with MDD. PMID:26598584

  13. Depression

    MedlinePlus

    ... Watch for changes in school work, sleep, and behavior. If you wonder whether your child might be depressed, talk with your health care ... families. This may be due to your genes, behaviors you learn at home, or your ... life events, such as job loss, divorce, or death of a spouse or other family ...

  14. Depression

    MedlinePlus

    ... treatment, the depression will lift Where can I go for help? If you are unsure where to go for help, ask your health provider or check ... one’s health professional. Call 911 for emergency services. Go to the nearest hospital emergency room. Call the ...

  15. Depressants

    MedlinePlus

    ... GHB and Rohypnol ® are also misused to facilitate sexual assault. Affect on mind Depressants used therapeutically do what they are prescribed for to put you to sleep, relieve anxiety and muscle spasms, and prevent seizures. They also: cause amnesia, leaving no memory of events that occur ...

  16. Methodology and preliminary results from the Neurobiology of Late-life Depression study

    PubMed Central

    Steffens, David C.; Manning, Kevin J.; Wu, Rong; Grady, James J.; Fortinsky, Richard H.; Tennen, Howard A.

    2015-01-01

    Background We sought to investigate the relationship between neuroticism and depression in an elderly cohort. In this paper, we describe the methods of an NIMH-supported study and present findings among the cohort enrolled to date. Methods We used the NEO Personality Inventory to assess neuroticism, and we employed several cognitive neuroscience-based measures to examine emotional control. Results Compared with a group of 27 non-depressed older control subjects, 33 older depressed subjects scored higher on measures of state and trait anxiety and neuroticism. On our experimental neuroscience-based measures, depressed subjects endorsed more negative words compared with controls on an emotional characterization test. In addition, we found a significant group-by-congruency effect on an emotional interference test where subjects were asked to identify the face’s emotional expression while ignoring the words “fear” or “happy” labeled across the face. Conclusion Thus, in this preliminary work, we found significant differences in measures of neuroticism and emotional controls among older adults with and without depression. PMID:26323208

  17. Does occasional cannabis use impact anxiety and depression treatment outcomes?: Results from a randomized effectiveness trial.

    PubMed

    Bricker, Jonathan B; Russo, Joan; Stein, Murray B; Sherbourne, Cathy; Craske, Michelle; Schraufnagel, Trevor J; Roy-Byrne, Peter

    2007-01-01

    This study investigated the extent to which occasional cannabis use moderated anxiety and depression outcomes in the Collaborative Care for Anxiety and Panic (CCAP) study, a combined cognitive-behavioral therapy (CBT) and pharmacotherapy randomized effectiveness trial. Participants were 232 adults from six university-based primary care outpatient clinics in three West Coast cities randomized to receive either the CCAP intervention or the usual care condition. Results showed significant (P<.01) evidence of an interaction between treatment group (CCAP vs. usual care) and cannabis use status (monthly vs. less than monthly) for depressive symptoms, but not for panic disorder or social phobia symptoms (all P>.05). Monthly cannabis users' depressive symptoms improved in the CCAP intervention just as much as those who used cannabis less than monthly, whereas monthly users receiving usual care had significantly more depressive symptoms than those using less than monthly. A combined CBT and medication treatment intervention may be a promising approach for the treatment of depression among occasional cannabis users. (c) 2006 Wiley-Liss, Inc.

  18. QuickStats: Percentage* of Medically Attended Injury Episodes(†) That Resulted in Time Lost from Work(§) or School,(¶) by Number of Days Lost - National Health Interview Survey, United States, 2011-2014.

    PubMed

    2016-07-08

    During 2011-2014, an average of 15.6 million medically attended injury episodes were reported annually among employed persons aged ≥13 years. Nearly half of these injury episodes resulted in time lost from work: 7% for <1 day, 26% for 1-5 days, and 15% for ≥6 days. An average of 9.4 million medically attended injury episodes were reported annually among persons aged ≥5 years who attended school. More than one third of these injury episodes resulted in time lost from school: 9% for <1 day, 25% for 1-5 days, and 3% for ≥6 days.

  19. Adaptive learning can result in a failure to profit from good conditions: implications for understanding depression

    PubMed Central

    Trimmer, Pete C.; Higginson, Andrew D.; Fawcett, Tim W.; McNamara, John M.; Houston, Alasdair I.

    2015-01-01

    Background and objectives: Depression is a major medical problem diagnosed in an increasing proportion of people and for which commonly prescribed psychoactive drugs are frequently ineffective. Development of treatment options may be facilitated by an evolutionary perspective; several adaptive reasons for proneness to depression have been proposed. A common feature of many explanations is that depressive behaviour is a way to avoid costly effort where benefits are small and/or unlikely. However, this viewpoint fails to explain why low mood persists when the situation improves. We investigate whether a behavioural rule that is adapted to a stochastically changing world can cause inactivity which appears similar to the effect of depression, in that it persists after the situation has improved. Methodology: We develop an adaptive learning model in which an individual has repeated choices of whether to invest costly effort that may result in a net benefit. Investing effort also provides information about the current conditions and rates of change of the conditions. Results: An individual following the optimal behavioural strategy may sometimes remain inactive when conditions are favourable (i.e. when it would be better to invest effort) when it is poorly informed about the current environmental state. Initially benign conditions can predispose an individual to inactivity after a relatively brief period of negative experiences. Conclusions and implications: Our approach suggests that the antecedent factors causing depressed behaviour could go much further back in an individual s history than is currently appreciated. The insights from our approach have implications for the ongoing debate about best treatment options for patients with depressive symptoms. PMID:25916884

  20. Depression.

    PubMed

    Choe, Christine J; Emslie, Graham J; Mayes, Taryn L

    2012-10-01

    This article reviews the assessment and treatment for depression in children and adolescents, emphasizing the implementation of evidence-based treatments into clinical care. Past trials of antidepressant medications are reviewed, as well as the clinical use of antidepressants and pharmacologic strategies for refractory illness or in the context of comorbid conditions. Clinicians who treat youth now have a body of empiric research to help guide treatment decisions; however, personalized treatment based on associated symptoms, comorbid conditions, contextual factors, and psychiatric history is essential. Further research is needed in the pharmacologic treatment of depressed youth, including expanding the study of non-SSRI antidepressants, augmentation and adjunctive strategies, and treatment in patients with comorbid conditions. Copyright © 2012 Elsevier Inc. All rights reserved.

  1. Effect of adjuvant sleep hygiene psychoeducation and lorazepam on depression and sleep quality in patients with major depressive disorders: results from a randomized three-arm intervention

    PubMed Central

    Rahimi, Alireza; Ahmadpanah, Mohammad; Shamsaei, Farshid; Cheraghi, Fatemeh; Sadeghi Bahmani, Dena; Holsboer-Trachsler, Edith; Brand, Serge

    2016-01-01

    Background Sleep disturbances are a common co-occurring disturbance in patients with major depressive disorders (MDDs) and accordingly deserve particular attention. Using a randomized design, we investigated the effects of three different adjuvant interventions on sleep and depression among patients with MDD: a sleep hygiene program (SHP), lorazepam (LOR), and their combination (SHP–LOR). Methods A total of 120 outpatients with diagnosed MDD (mean age: 48.25 years; 56.7% females) and treated with a standard SSRI (citalopram at 20–40 mg at therapeutic level) were randomly assigned to one of the following three conditions: SHP (n=40), LOR (1 mg/d; n=40), SHP–LOR (1 mg/d; n=40). At the beginning and at the end of the study 8 weeks later, patients completed two questionnaires, the Pittsburgh Sleep Quality Index to assess sleep and the Beck Depression Inventory to assess symptoms of depression. Results Sleep disturbances decreased over time and in all groups. No group differences or interactions were observed. Symptoms of depression decreased over time and in all three groups. Reduction in symptoms of depression was greatest in the SHP–LOR group and lowest in the LOR group. Conclusion The pattern of results suggests that all three adjuvant treatments improved symptoms of sleep disturbances and depression, with greater benefits for the SHP–LOR for symptoms of depression, but not for sleep. Nevertheless, risks and benefits of benzodiazepine prescriptions should be taken into account. PMID:27382293

  2. Seismological Constraints on the Magmato-tectonic Behavior of the Asal-Ghoubbet Rift (Afar Depression, Republic of Djibouti) Since the Last 1978-Rifting Episode

    NASA Astrophysics Data System (ADS)

    Doubre, C.; Manighetti, I.; Bertil, D.; Dorbath, C.; Dorbath, L.; Jacques, E.

    2004-12-01

    The Asal-Ghoubbet rift was the locus of a seismic and volcanic crisis in 1978 followed by 8 years of rapid opening (60 mm/yr) before returning to its long-term opening rate of 16 mm/yr. We analyze the space-time evolution of the seismicity that occurred in the rift between 1979 and 2001. The data recorded by the Djibouti Observatory provide only hypocentral locations before 1995 and P and S-wave arrival times since 1996. Additional data acquired during a five months experiment in 2000-2001 allowed us to determine a 3D-velocity model of the rift, used to precisely relocate post 1996 events. The 2545 small-magnitude earthquakes (Md ≤ 3.2) recorded in the rift since the 1978 crisis provide a negligible contribution to the total extension across the rift, which occurs essentially aseismically. The temporal evolution of the seismicity reveals two distinct phases consistent with those observed in the geodetic data. The post-crisis period (1979-1986) is characterized by large-magnitude earthquakes exclusively located below the northern rift shoulder. These events are associated with the contraction of the side of the rift resulting from the fast opening of the central dyke system. The subsequent period (1987-2001) corresponding to normal opening rate across the rift is characterized by a micro-seismicity essentially located below the major rift caldera (Fieale). Most recorded events during this period concentrate within the rift inner floor at the top of an aseismic, low velocity zone located below the Fiale caldera, which we interpret as hot material above the magma chamber. Outside from post-crisis periods, the seismicity tends to cluster in time in response to stress changes in the brittle layer induced by episodic magmatic movements.

  3. Disorder-specific automatic self-associations in depression and anxiety: results of The Netherlands Study of Depression and Anxiety.

    PubMed

    Glashouwer, K A; de Jong, P J

    2010-07-01

    Cognitive theory points to the importance of negative self-schemas in the onset and maintenance of depression and anxiety disorders. Hereby, it is important to distinguish between automatic and explicit self-schemas, reflecting different cognitive-motivational systems. This study tested whether patients with a current major depression and/or anxiety disorder are characterized by automatic self-anxious and self-depressive associations and whether these associations are disorder specific. Patients (n=2329) and non-clinical controls (n=652) were tested as part of The Netherlands Study of Depression and Anxiety, a multi-center, longitudinal, cohort study with patients from different health care settings. Patient groups and non-clinical controls (18-65 years of age) were compared with regard to automatic self-anxious and self-depressive associations measured with the Implicit Association Test. Individuals with an anxiety disorder showed enhanced self-anxious associations, whereas individuals with a depression showed enhanced self-depressive associations. Individuals with co-morbid disorders scored high on both automatic self-associations. Although remitted individuals showed weaker automatic self-associations than people with a current disorder, their automatic self-anxious/depressed associations were still significantly stronger than those of the control group. Importantly, automatic self-associations showed predictive validity for the severity of anxious and depressive symptoms over and above explicit self-beliefs. This study represents the first evidence that automatic self-anxious and self-depressive associations are differentially involved in anxiety disorders and depression. This may help to explain the refractoriness of these disorders and points to the potential importance of automatic self-associations in the development of psychopathological symptoms.

  4. Depression.

    PubMed

    McCarron, Robert M; Vanderlip, Erik R; Rado, Jeffrey

    2016-10-04

    This issue provides a clinical overview of depression, focusing on screening, diagnosis, treatment, and practice improvement. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of additional science writers and physician writers.

  5. An Integrated, Acceptance-Based Behavioral Approach for Depression With Social Anxiety: Preliminary Results.

    PubMed

    Dalrymple, Kristy L; Morgan, Theresa A; Lipschitz, Jessica M; Martinez, Jennifer H; Tepe, Elizabeth; Zimmerman, Mark

    2014-07-01

    Depression and social anxiety disorder (SAD) are highly comorbid, resulting in greater severity and functional impairment compared with each disorder alone. Although recently transdiagnostic treatments have been developed, no known treatments have addressed this comorbidity pattern specifically. Preliminary support exists for acceptance-based approaches for depression and SAD separately, and they may be more efficacious for comorbid depression and anxiety compared with traditional cognitive-behavioral approaches. The aim of the current study was to develop and pilot test an integrated acceptance-based behavioral treatment for depression and comorbid SAD. Participants included 38 patients seeking pharmacotherapy at an outpatient psychiatry practice, who received 16 individual sessions of the therapy. Results showed significant improvement in symptoms, functioning, and processes from pre- to post-treatment, as well as high satisfaction with the treatment. These results support the preliminary acceptability, feasibility, and effectiveness of this treatment in a typical outpatient psychiatry practice, and suggest that further research on this treatment in larger randomized trials is warranted. © The Author(s) 2014.

  6. An Integrated, Acceptance-Based Behavioral Approach for Depression With Social Anxiety: Preliminary Results

    PubMed Central

    Dalrymple, Kristy L.; Morgan, Theresa A.; Lipschitz, Jessica M.; Martinez, Jennifer H.; Tepe, Elizabeth; Zimmerman, Mark

    2016-01-01

    Depression and social anxiety disorder (SAD) are highly comorbid, resulting in greater severity and functional impairment compared with each disorder alone. Although recently transdiagnostic treatments have been developed, no known treatments have addressed this comorbidity pattern specifically. Preliminary support exists for acceptance-based approaches for depression and SAD separately, and they may be more efficacious for comorbid depression and anxiety compared with traditional cognitive-behavioral approaches. The aim of the current study was to develop and pilot test an integrated acceptance-based behavioral treatment for depression and comorbid SAD. Participants included 38 patients seeking pharmacotherapy at an outpatient psychiatry practice, who received 16 individual sessions of the therapy. Results showed significant improvement in symptoms, functioning, and processes from pre- to post-treatment, as well as high satisfaction with the treatment. These results support the preliminary acceptability, feasibility, and effectiveness of this treatment in a typical outpatient psychiatry practice, and suggest that further research on this treatment in larger randomized trials is warranted. PMID:24402463

  7. Cost and predictors of lost productive time in chronic migraine and episodic migraine: results from the American Migraine Prevalence and Prevention (AMPP) Study.

    PubMed

    Serrano, Daniel; Manack, Aubrey N; Reed, Michael L; Buse, Dawn C; Varon, Sepideh F; Lipton, Richard B

    2013-01-01

    To quantify the cost differences and predictors of lost productive time (LPT) in persons with chronic migraine (CM) and episodic migraine (EM). The American Migraine Prevalence and Prevention (AMPP) study is a US national longitudinal survey of severe headache. Cost estimates were obtained via U.S. Census income data. To elucidate the unique predictors of LPT, the optimal distribution for modeling was determined. Zero inflation models for LPT were predicted from sociodemographics, headache features, characteristics and disability, medication use, and depression. The interaction between headache status and age was the primary effect of interest. The eligible sample included 6329 persons with EM and 374 persons with CM. Men with CM aged 45 to 54 years cost employers nearly $200 per week more than do their EM counterparts. Likewise, for women, costs were higher for CM, with the cost differential between EM and CM being $90 per week. After comprehensive adjustment, increases in LPT with age were significantly higher in CM than in EM (rate ratio 1.03; 95% confidence interval 1.01-1.05). When age was recoded to a decade, metric rates of LPT increased 25% more per decade for CM than for EM (rate ratio 1.25; 95% confidence interval 1.004-1.5). LPT is more costly and increases more rapidly for those with CM than for those with EM as age increases. Copyright © 2013 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  8. Depressive Symptoms in Youth With Type 1 or Type 2 Diabetes: Results of the Pediatric Diabetes Consortium Screening Assessment of Depression in Diabetes Study.

    PubMed

    Silverstein, Janet; Cheng, Peiyao; Ruedy, Katrina J; Kollman, Craig; Beck, Roy W; Klingensmith, Georgeanna J; Wood, Jamie R; Willi, Steven; Bacha, Fida; Lee, Joyce; Cengiz, Eda; Redondo, Maria J; Tamborlane, William V

    2015-12-01

    To evaluate the frequency of depressive symptoms and the diagnosis and management of depression in youth with type 1 diabetes (T1D) and type 2 diabetes (T2D) enrolled in the Pediatric Diabetes Consortium T1D and T2D registries. The Children's Depression Inventory (CDI) 2 Self-Report (Short) version was completed by 261 T1D and 339 T2D youth aged 10-17 years. Symptoms of depression were identified in 13% of T1D and 22% of T2D (P = 0.007) participants; of these, only 4% of T1D and 9% of T2D youth were treated by a therapist within the prior 12 months. Depressive symptoms were associated with lower family income (P = 0.006) and obesity (P = 0.002) in T1D but not T2D youth. Depressive symptoms are more frequent than diagnosed depression in youth with T1D or T2D. These results underscore the need for regular depression screening and appropriate referral for youth with diabetes. © 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

  9. Effect of adjuvant sleep hygiene psychoeducation and lorazepam on depression and sleep quality in patients with major depressive disorders: results from a randomized three-arm intervention.

    PubMed

    Rahimi, Alireza; Ahmadpanah, Mohammad; Shamsaei, Farshid; Cheraghi, Fatemeh; Sadeghi Bahmani, Dena; Holsboer-Trachsler, Edith; Brand, Serge

    2016-01-01

    Sleep disturbances are a common co-occurring disturbance in patients with major depressive disorders (MDDs) and accordingly deserve particular attention. Using a randomized design, we investigated the effects of three different adjuvant interventions on sleep and depression among patients with MDD: a sleep hygiene program (SHP), lorazepam (LOR), and their combination (SHP-LOR). A total of 120 outpatients with diagnosed MDD (mean age: 48.25 years; 56.7% females) and treated with a standard SSRI (citalopram at 20-40 mg at therapeutic level) were randomly assigned to one of the following three conditions: SHP (n=40), LOR (1 mg/d; n=40), SHP-LOR (1 mg/d; n=40). At the beginning and at the end of the study 8 weeks later, patients completed two questionnaires, the Pittsburgh Sleep Quality Index to assess sleep and the Beck Depression Inventory to assess symptoms of depression. Sleep disturbances decreased over time and in all groups. No group differences or interactions were observed. Symptoms of depression decreased over time and in all three groups. Reduction in symptoms of depression was greatest in the SHP-LOR group and lowest in the LOR group. The pattern of results suggests that all three adjuvant treatments improved symptoms of sleep disturbances and depression, with greater benefits for the SHP-LOR for symptoms of depression, but not for sleep. Nevertheless, risks and benefits of benzodiazepine prescriptions should be taken into account.

  10. Clinical Significance of the Number of Depressive Symptoms in Major Depressive Disorder: Results from the CRESCEND Study.

    PubMed

    Park, Seon-Cheol; Sakong, Jeongkyu; Koo, Bon Hoon; Kim, Jae-Min; Jun, Tae-Youn; Lee, Min-Soo; Kim, Jung-Bum; Yim, Hyeon-Woo; Park, Yong Chon

    2016-04-01

    Our study aimed to establish the relationship between the number of depressive symptoms and the clinical characteristics of major depressive disorder (MDD). This would enable us to predict the clinical significance of the number of depressive symptoms in MDD patients. Using data from the Clinical Research Center for Depression (CRESCEND) study in Korea, 853 patients with DSM-IV MDD were recruited. The baseline and clinical characteristics of groups with different numbers of depressive symptoms were compared using the χ(2) test for discrete variables and covariance (ANCOVA) for continuous variables. In addition, the scores of these groups on the measurement tools were compared by ANCOVA after adjusting the potential effects of confounding variables. After adjusting the effects of monthly income and history of depression, a larger number of depressive symptoms indicated higher overall severity of depression (F [4, 756] = 21.458, P < 0.001) and higher levels of depressive symptoms (F [4, 767] = 19.145, P < 0.001), anxiety symptoms (F [4, 765] = 12.890, P < 0.001) and suicidal ideation (F [4, 653] = 6.970, P < 0.001). It also indicated lower levels of social function (F [4, 760] = 13.343, P < 0.001), and quality of life (F [4, 656] = 11.975, P < 0.001). However, there were no significant differences in alcohol consumption (F [4, 656] = 11.975, P < 0.001). The number of depressive symptoms can be used as an index of greater illness burden in clinical psychiatry.

  11. Clinical Significance of the Number of Depressive Symptoms in Major Depressive Disorder: Results from the CRESCEND Study

    PubMed Central

    2016-01-01

    Our study aimed to establish the relationship between the number of depressive symptoms and the clinical characteristics of major depressive disorder (MDD). This would enable us to predict the clinical significance of the number of depressive symptoms in MDD patients. Using data from the Clinical Research Center for Depression (CRESCEND) study in Korea, 853 patients with DSM-IV MDD were recruited. The baseline and clinical characteristics of groups with different numbers of depressive symptoms were compared using the χ2 test for discrete variables and covariance (ANCOVA) for continuous variables. In addition, the scores of these groups on the measurement tools were compared by ANCOVA after adjusting the potential effects of confounding variables. After adjusting the effects of monthly income and history of depression, a larger number of depressive symptoms indicated higher overall severity of depression (F [4, 756] = 21.458, P < 0.001) and higher levels of depressive symptoms (F [4, 767] = 19.145, P < 0.001), anxiety symptoms (F [4, 765] = 12.890, P < 0.001) and suicidal ideation (F [4, 653] = 6.970, P < 0.001). It also indicated lower levels of social function (F [4, 760] = 13.343, P < 0.001), and quality of life (F [4, 656] = 11.975, P < 0.001). However, there were no significant differences in alcohol consumption (F [4, 656] = 11.975, P < 0.001). The number of depressive symptoms can be used as an index of greater illness burden in clinical psychiatry. PMID:27051248

  12. Estimating net drawdown resulting from episodic withdrawals at six well fields in the coastal plain physiographic province of Virginia

    USGS Publications Warehouse

    Focazio, M.J.; Speiran, G.K.

    1993-01-01

    The groundwater-flow system of the Virginia Coastal Plain consists of areally extensive and interconnected aquifers. Large, regionally coalescing cones of depression that are caused by large withdrawals of water are found in these aquifers. Local groundwater systems are affected by regional pumping, because of the interactions within the system of aquifers. Accordingly, these local systems are affected by regional groundwater flow and by spatial and temporal differences in withdrawals by various users. A geographic- information system was used to refine a regional groundwater-flow model around selected withdrawal centers. A method was developed in which drawdown maps that were simulated by the regional groundwater-flow model and the principle of superposition could be used to estimate drawdown at local sites. The method was applied to create drawdown maps in the Brightseat/Upper Potomac Aquifer for periods of 3, 6, 9, and 12 months for Chesapeake, Newport News, Norfolk, Portsmouth, Suffolk, and Virginia Beach, Virginia. Withdrawal rates were supplied by the individual localities and remained constant for each simulation period. This provides an efficient method by which the individual local groundwater users can determine the amount of drawdown produced by their wells in a groundwater system that is a water source for multiple users and that is affected by regional-flow systems.

  13. Impact evaluation of two different general anesthesia protocols (TIVA with propofol vs isoflurane) on the total number of interventions to treat cardiovascular depression or arousal/movement episodes in dogs undergoing orthopedic surgery receiving an intrathecal anesthesia

    PubMed Central

    SAROTTI, Diego; RABOZZI, Roberto; FRANCI, Paolo

    2016-01-01

    The aim of this prospective, randomized clinical trial was to compare the total number of anesthetic interventions (TNAI) performed by the anesthetist to treat cardiovascular depression or arousal/movement episodes in dogs receiving intrathecal and general anesthesia (GA), maintained using propofol-based TIVA (group P) or isoflurane (group I). Mean arterial pressure (MAP) before (T0) and 12 min after intrathecal anesthesia (T1) and intraoperative vasoactive consumption were also compared. The TNAI to deepen the anesthetic plane or to treat hemodynamic depression in the pre-surgical and intra-surgical period was calculated in forty-two client-owned dogs randomly assigned to group P or I. Ten dogs for each group complied with the inclusion criteria and were analyzed. In pre-surgical period, the TNAI was higher in Group I [2 (0–5)] than Group P [0 (0–2)] (P=0.022), and ephedrine consumption was also higher in Group I [75 (0–200) µg/kg)] than Group P [(0 (0–50)] (P=0.016). MAP (mmHg) in Group P was 79 (66–95) at T0 and 65 (59–86) at T1 and 67.5 (50–73) and 57 (53–66) in Group I, respectively. At T0 and T1, MAP was higher in Group P (P=0.005 and P=0.006, respectively). No differences were found between the two groups in the intrasurgical period (P>0.05). This study shows that the GA protocol can have a relevant impact on the TNAI performed by the anesthetist in the pre-surgical period of anesthesia, to treat cardiovascular depression or arousal/movement episodes in dogs receving intrathecal anesthesia. PMID:27334295

  14. Impact evaluation of two different general anesthesia protocols (TIVA with propofol vs isoflurane) on the total number of interventions to treat cardiovascular depression or arousal/movement episodes in dogs undergoing orthopedic surgery receiving an intrathecal anesthesia.

    PubMed

    Sarotti, Diego; Rabozzi, Roberto; Franci, Paolo

    2016-11-01

    The aim of this prospective, randomized clinical trial was to compare the total number of anesthetic interventions (TNAI) performed by the anesthetist to treat cardiovascular depression or arousal/movement episodes in dogs receiving intrathecal and general anesthesia (GA), maintained using propofol-based TIVA (group P) or isoflurane (group I). Mean arterial pressure (MAP) before (T0) and 12 min after intrathecal anesthesia (T1) and intraoperative vasoactive consumption were also compared. The TNAI to deepen the anesthetic plane or to treat hemodynamic depression in the pre-surgical and intra-surgical period was calculated in forty-two client-owned dogs randomly assigned to group P or I. Ten dogs for each group complied with the inclusion criteria and were analyzed. In pre-surgical period, the TNAI was higher in Group I [2 (0-5)] than Group P [0 (0-2)] (P=0.022), and ephedrine consumption was also higher in Group I [75 (0-200) µg/kg)] than Group P [(0 (0-50)] (P=0.016). MAP (mmHg) in Group P was 79 (66-95) at T0 and 65 (59-86) at T1 and 67.5 (50-73) and 57 (53-66) in Group I, respectively. At T0 and T1, MAP was higher in Group P (P=0.005 and P=0.006, respectively). No differences were found between the two groups in the intrasurgical period (P>0.05). This study shows that the GA protocol can have a relevant impact on the TNAI performed by the anesthetist in the pre-surgical period of anesthesia, to treat cardiovascular depression or arousal/movement episodes in dogs receving intrathecal anesthesia.

  15. Importance of Depression in Diabetes.

    ERIC Educational Resources Information Center

    Lustman, Patrick J.; Clouse, Ray E.; Anderson, Ryan J.

    Depression doubles the likelihood of comorbid depression, which presents as major depression in 11% and subsyndromal depression in 31% of patients with the medical illness. The course of depression is chronic, and afflicted patients suffer an average of one episode annually. Depression has unique importance in diabetes because of its association…

  16. Compassion satisfaction, compassion fatigue, anxiety, depression and stress in registered nurses in Australia: study 1 results.

    PubMed

    Hegney, Desley G; Craigie, Mark; Hemsworth, David; Osseiran-Moisson, Rebecca; Aoun, Samar; Francis, Karen; Drury, Vicki

    2014-05-01

    To explore compassion fatigue and compassion satisfaction with the potential contributing factors of anxiety, depression and stress. To date, no studies have connected the quality of work-life with other contributing and co-existing factors such as depression, anxiety and stress. A self-report exploratory cross sectional survey of 132 nurses working in a tertiary hospital. The reflective assessment risk profile model provides an excellent framework for examining the relationships between the professional quality of work factors and contributing factors within the established risk profiles. The results show a definite pattern of risk progression for the six factors examined for each risk profile. Additionally, burnout and secondary traumatic stress were significantly related to higher anxiety and depression levels. Higher anxiety levels were correlated with nurses who were younger, worked full-time and without a postgraduate qualification. Twenty percent had elevated levels of compassion fatigue: 7.6% having a very distressed profile. At-risk nurses' stress and depression scores were significantly higher than nurses with higher compassion satisfaction scores. The employed nurse workforce would benefit from a psychosocial capacity building intervention that reduces a nurse's risk profile, thus enhancing retention. © 2013 John Wiley & Sons Ltd.

  17. Internet use, Facebook intrusion, and depression: Results of a cross-sectional study.

    PubMed

    Błachnio, A; Przepiórka, A; Pantic, I

    2015-09-01

    Facebook has become a very popular social networking platform today, particularly among adolescents and young adults, profoundly changing the way they communicate and interact. However, some reports have indicated that excessive Facebook use might have detrimental effects on mental health and be associated with certain psychological problems. Because previous findings on the relationship between Facebook addiction and depression were not unambiguous, further investigation was required. The main objective of our study was to examine the potential associations between Internet use, depression, and Facebook intrusion. A total of 672 Facebook users took part in the cross-sectional study. The Facebook Intrusion Questionnaire and the Center for Epidemiologic Studies Depression Scale were used. For collecting the data, the snowball sampling procedure was used. We showed that depression can be a predictor of Facebook intrusion. Our results provides additional evidence that daily Internet use time in minutes, gender, and age are also predictors of Facebook intrusion: that Facebook intrusion can be predicted by being male, young age, and an extensive number of minutes spent online. On the basis of this study, it is possible to conclude that there are certain demographic - variables, such as age, gender, or time spent online - that may help in outlining the profile of a user who may be in danger of becoming addicted to Facebook. This piece of knowledge may serve for prevention purposes. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  18. Seasonality in depressive and anxiety symptoms among primary care patients and in patients with depressive and anxiety disorders; results from the Netherlands Study of Depression and Anxiety.

    PubMed

    Winthorst, Wim H; Post, Wendy J; Meesters, Ybe; Penninx, Brenda W H J; Nolen, Willem A

    2011-12-19

    Little is known about seasonality of specific depressive symptoms and anxiety symptoms in different patient populations. This study aims to assess seasonal variation of depressive and anxiety symptoms in a primary care population and across participants who were classified in diagnostic groups 1) healthy controls 2) patients with a major depressive disorder, 3) patients with any anxiety disorder and 4) patients with a major depression and any anxiety disorder. Data were used from the Netherlands Study of Depression and Anxiety (NESDA). First, in 5549 patients from the NESDA primary care recruitment population the Kessler-10 screening questionnaire was used and data were analyzed across season in a multilevel linear model. Second, in 1090 subjects classified into four groups according to psychiatric status according to the Composite International Diagnostic Interview, overall depressive symptoms and atypical versus melancholic features were assessed with the Inventory of Depressive Symptoms. Anxiety and fear were assessed with the Beck Anxiety Inventory and the Fear questionnaire. Symptom levels across season were analyzed in a linear regression model. In the primary care population the severity of depressive and anxiety symptoms did not show a seasonal pattern. In the diagnostic groups healthy controls and patients with any anxiety disorder, but not patients with a major depressive disorder, showed a small rise in depressive symptoms in winter. Atypical and melancholic symptoms were both elevated in winter. No seasonal pattern for anxiety symptoms was found. There was a small gender related seasonal effect for fear symptoms. Seasonal differences in severity or type of depressive and anxiety symptoms, as measured with a general screening instrument and symptom questionnaires, were absent or small in effect size in a primary care population and in patient populations with a major depressive disorder and anxiety disorders.

  19. Ambient Air Pollution and Depressive Symptoms in Older Adults: Results from the MOBILIZE Boston Study

    PubMed Central

    Wang, Yi; Eliot, Melissa N.; Koutrakis, Petros; Gryparis, Alexandros; Schwartz, Joel D.; Coull, Brent A.; Mittleman, Murray A.; Milberg, William P.; Lipsitz, Lewis A.

    2014-01-01

    Background: Exposure to ambient air pollution, particularly from traffic, has been associated with adverse cognitive outcomes, but the association with depressive symptoms remains unclear. Objectives: We investigated the association between exposure to ambient air and traffic pollution and the presence of depressive symptoms among 732 Boston-area adults ≥ 65 years of age (78.1 ± 5.5 years, mean ± SD). Methods: We assessed depressive symptoms during home interviews using the Revised Center for Epidemiological Studies Depression Scale (CESD-R). We estimated residential distance to the nearest major roadway as a marker of long-term exposure to traffic pollution and assessed short-term exposure to ambient fine particulate matter (PM2.5), sulfates, black carbon (BC), ultrafine particles, and gaseous pollutants, averaged over the 2 weeks preceding each assessment. We used generalized estimating equations to estimate the odds ratio (OR) of a CESD-R score ≥ 16 associated with exposure, adjusting for potential confounders. In sensitivity analyses, we considered CESD-R score as a continuous outcome and mean annual residential BC as an alternate marker of long-term exposure to traffic pollution. Results: We found no evidence of a positive association between depressive symptoms and long-term exposure to traffic pollution or short-term changes in pollutant levels. For example, we found an OR of CESD-R score ≥ 16 of 0.67 (95% CI: 0.46, 0.98) per interquartile range (3.4 μg/m3) increase in PM2.5 over the 2 weeks preceding assessment. Conclusions: We found no evidence suggesting that ambient air pollution is associated with depressive symptoms among older adults living in a metropolitan area in attainment of current U.S. regulatory standards. Citation: Wang Y, Eliot MN, Koutrakis P, Gryparis A, Schwartz JD, Coull BA, Mittleman MA, Milberg WP, Lipsitz LA, Wellenius GA. 2014. Ambient air pollution and depressive symptoms in older adults: results from the MOBILIZE Boston

  20. Magnesium, C-reactive protein, and cortisol in drug-naïve patients with short illness-duration, first episode major depressive disorder: possible immunomodulatory role for magnesium.

    PubMed

    Cubała, Wiesław Jerzy; Landowski, Jerzy; Dziadziuszko, Małgorzata; Chrzanowska, Anna; Wielgomas, Bartosz

    2016-04-01

    Plasma magnesium concentration alterations, hypercortisolaemia, and systemic inflammation are observed in major depressive disorder (MDD). This exploratory study examined whether, and to what extent, plasma magnesium is related to C-reactive protein (CRP) levels and cortisolaemia in MDD. The concentrations of plasma magnesium, salivary CRP, and baseline plasma cortisol were studied in 20, treatment-naïve MDD patients with short-illness-duration, first affective episodes and 20 matched controls. Depressed patients showed a basal score higher than 20 on the Hamilton Rating Scale for Depression (HAMD-17). Significantly higher magnesium (p = 0.016) and baseline cortisol (p = 0.01) concentrations were observed in MDD as compared to controls. No significant difference in CRP concentrations between the MDD and control groups was observed. A significant negative correlation was seen between magnesium and CRP in MDD (p<0.01), whereas no correlation was found in controls. A significant positive correlation was found between cortisol and CRP, both in MDD subjects (p = 0.008) and controls (p = 0.004). No significant correlations were observed between magnesium and cortisol levels. The study supports data for hypercortisolaemia in MDD, but provides no evidence of primary hypomagnesaemia or elevated CRP levels in drug-naïve MDD patients with short-illness-duration. The study supports the hypothesis linking hypercortisolaemia to systemic inflammation, with hypermagnesaemia exerting an immunomodulatory action at early stages of the disease.

  1. [A strategy for therapy of depressive disorders and anxiety disorders by a health education intervention in medical consultations: the results of the APRAND program].

    PubMed

    Godard, C; Chevalier, A; Siret, B; Giorla, J-F; Hergueta, T; Lecrubier, Y; Bauer, J-G; Bolle, C; Coste, J; Sperte, J-P; Lault, T; Lahon, G

    2007-04-01

    Studies devoted to the detection and treatment of anxiety and depression in adult populations show that at least 10% meet ICD10 criteria for an anxiety or a depressive disorder, but only half are diagnosed as such and only one third of those receive appropriate treatment. The goal of the APRAND program was to explore the possibility of improving management strategies via health education during doctors' visits. In 2001, EDF-GDF conducted an experimental program in which 21 physicians from its in-house health insurance program used the MINI mental state examination to screen for ICD10 criteria for anxiety and depressive disorders in 9743 employees on sick leave. A "here-elsewhere" epidemiologic study evaluated the program, recording the initial diagnoses and studying a year later the outcome of the persons identified with these disorders in 8 active centers (with prevention activities) and in 13 control centers (without prevention activities). The activities consisted of explanations of the disorders identified, delivery of the test results, delivery of leaflets based on the WHO guidelines, and strong recommendations to see a general practitioner, or a psychiatrist, or the occupational physician, if necessary. Logistic regressions compared the two groups, taking into account sex, age, geographic region, comorbidity, and medical care at screening. Preventive activities were significantly associated with the disappearance at 1 year of depressive episodes (OR=1.93; CI 95%; 1.3-2.84) and of phobic or panic disorders (OR=1.98; CI 95%; 1.14-3.44). The only other variables affecting prognosis were age and sex. The probability of recovery or remission increased by 10 to 20% at active centers, according to age, sex and disorder. Moreover, the physicians reported that they learned a great deal from the program, which thus also improved their practices. Diagnosis and prognosis of depressive episodes and phobic and panic disorders in adult populations can be improved by a

  2. Identifying depressive subtypes in a large cohort study: results from the Netherlands Study of Depression and Anxiety (NESDA).

    PubMed

    Lamers, Femke; de Jonge, Peter; Nolen, Willem A; Smit, Johannes H; Zitman, Frans G; Beekman, Aartjan T F; Penninx, Brenda W J H

    2010-12-01

    The heterogeneity of depression in the current classification system remains a point of discussion in the psychiatric field, despite previous efforts to subclassify depressive disorders. Data-driven techniques may help to come to a more empirically based classification. This study aimed to identify depressive subtypes within a large cohort of subjects with depression. Baseline data from 818 persons with a DSM-IV diagnosis of current major depressive disorder or minor depression who participated in the Netherlands Study of Depression and Anxiety were used. Respondents were recruited in the community, in primary care, and in specialized mental health care from September 2004 through February 2007. Latent classes were derived from latent class analysis using 16 depressive symptoms from the Composite International Diagnostic Interview and the Inventory of Depressive Symptomatology. Classes were characterized using demographic, clinical psychiatric, psychosocial, and physical health descriptors. Three classes were identified: a severe melancholic class (prevalence, 46.3%), a severe atypical class (prevalence, 24.6%), and a class of moderate severity (prevalence, 29.1%). Both severe classes were characterized by more neuroticism (melancholic OR = 1.05 [95% CI, 1.01-1.10]; atypical OR = 1.07 [95% CI, 1.03-1.12]), more disability (melancholic OR = 1.07 [95% CI, 1.05-1.09]; atypical OR = 1.06 [95% CI, 1.04-1.07]), and less extraversion (melancholic OR = 0.95 [95% CI, 0.92-0.99]; atypical OR = 0.95 [95% CI, 0.92-0.99]) than the moderate class. Comparing the melancholic class with the atypical class revealed that the melancholic class had more smokers (atypical OR = 0.57 [95% CI, 0.39-0.84]) and more childhood trauma (atypical OR = 0.86 [95% CI, 0.74-1.00]), whereas the atypical class had more women (atypical OR = 1.52 [95% CI, 0.99-2.32]), a higher body mass index (atypical OR = 1.13 [95% CI, 1.09-1.17]), and more metabolic syndrome (atypical OR = 2.17 [95% CI, 1

  3. Evidence for the Continuous Latent Structure of Mania and Depression in Outpatients with Bipolar Disorder: Results from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD)

    PubMed Central

    Prisciandaro, James J.; Tolliver, Bryan K.

    2016-01-01

    Background Evidence supporting the continuous latent structure of mood phenomena has not been incorporated into psychiatric diagnostic systems, in part because the evidence has been incomplete. For example, no studies have investigated the boundary between "sick" and "well" periods in individuals with bipolar disorder, despite agreement that characterization of mood disorders as having a discrete episodic course is inaccurate. The present study examined the validity of mood episode symptom thresholds in outpatients with bipolar disorder using multiple methodologies: taxometrics and information-theoretic latent distribution modeling (ITLDM), to evaluate the continuity/discontinuity of mood symptoms, and structural equation mixture modeling (SEMM), to evaluate the continuity/discontinuity of associations between mood symptoms and general functioning. Methods 3,721 outpatients with bipolar disorder from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) were available for analysis. Data were collected at participants' baseline STEP-BD visit. Taxometric (MAXCOV/MAMBAC with simulated comparison data), ITLDM, and SEMM methods were applied twice, once to the Montgomery-Asberg Depression Rating Scale and again to the Young Mania Rating Scale. Results Taxometric results unequivocally supported a continuous interpretation of the data. ITLDM results favored many-valued "discrete metrical" models suggesting that mood symptoms have continuous, but potentially non-normally distributed, latent structures in outpatients with bipolar disorder. Finally, SEMM results demonstrated that latent associations between mood symptoms and general functioning were linear. Conclusions Results from the present study argue against the validity of DSM mood episode thresholds and argue for a graded continuum of care of bipolar symptom management. PMID:25881582

  4. Detailed course of depressive symptoms and risk for developing depression in late adolescents with subthreshold depression: a cohort study

    PubMed Central

    Jinnin, Ran; Okamoto, Yasumasa; Takagaki, Koki; Nishiyama, Yoshiko; Yamamura, Takanao; Okamoto, Yuri; Miyake, Yoshie; Takebayashi, Yoshitake; Tanaka, Keisuke; Sugiura, Yoshinori; Shimoda, Haruki; Kawakami, Norito; Furukawa, Toshi A; Yamawaki, Shigeto

    2017-01-01

    Purpose Despite its clinical importance, adolescent subthreshold depression remains a largely neglected topic. The aims of this study were to accurately identify the natural course of depressive symptoms and the risk for developing major depressive episode (MDE) in late adolescents with subthreshold depression over 1 year. Patients and methods One hundred and seventy-two participants <20 years of age (mean age: 18.32 years, standard deviation: 0.50), who did not meet the full criteria for an MDE, were selected from 2,494 screened freshmen based on the Beck Depression Inventory, 2nd edition (BDI-II). We conducted a cohort study of three groups (low-, middle-, and high-symptom groups) divided based on BDI-II scores, over a 1 year period with the use of bimonthly assessments. Temporal changes of depressive symptoms were analyzed using linear mixed modeling and growth mixture modeling. Results First, we found that late adolescents with subthreshold depression (high depressive symptoms) were split between the increasing and decreasing depressive symptoms groups, whereas the majority of the less-symptoms group remained stable during 1 year. Second, in comparison with late adolescents with less depressive symptoms, those with subthreshold depression had an elevated risk of later depression. Conclusion Some late adolescents with subthreshold depression had increased depressive symptoms and developed an MDE during 1 year. Therefore, it is necessary for us to rigorously assess the changes in subthreshold depressive symptoms over time in late adolescents. PMID:28053534

  5. Intensive psychosocial intervention enhances functioning in patients with bipolar depression: results from a 9-month randomized controlled trial.

    PubMed

    Miklowitz, David J; Otto, Michael W; Frank, Ellen; Reilly-Harrington, Noreen A; Kogan, Jane N; Sachs, Gary S; Thase, Michael E; Calabrese, Joseph R; Marangell, Lauren B; Ostacher, Michael J; Patel, Jayendra; Thomas, Marshall R; Araga, Mako; Gonzalez, Jodi M; Wisniewski, Stephen R

    2007-09-01

    Psychosocial interventions are effective adjuncts to pharmacotherapy in delaying recurrences of bipolar disorder; however, to date their effects on life functioning have been given little attention.