Abstract
BackgroundMajor depressive disorder (MDD) has been associated with adverse medical consequences, including cardiovascular disease and osteoporosis. Patients with MDD may be classified as having melancholic, atypical, or undifferentiated features. The goal of the present study was to assess whether these clinical subtypes of depression have different endocrine and metabolic features and consequently, varying medical outcomes.MethodsPremenopausal women, ages 21 to 45 years, with MDD (N = 89) and healthy controls (N = 44) were recruited for a prospective study of bone turnover. Women with MDD were classified as having melancholic (N = 51), atypical (N = 16), or undifferentiated (N = 22) features. Outcome measures included: metabolic parameters, body composition, bone mineral density (BMD), and 24 hourly sampling of plasma adrenocorticotropin (ACTH), cortisol, and leptin.ResultsCompared with control subjects, women with undifferentiated and atypical features of MDD exhibited greater BMI, waist/hip ratio, and whole body and abdominal fat mass. Women with undifferentiated MDD characteristics also had higher lipid and fasting glucose levels in addition to a greater prevalence of low BMD at the femoral neck compared to controls. Elevated ACTH levels were demonstrated in women with atypical features of depression, whereas higher mean 24-hour leptin levels were observed in the melancholic subgroup.ConclusionsPre-menopausal women with various features of MDD exhibit metabolic, endocrine, and BMD features that may be associated with different health consequences.Trial RegistrationClinicalTrials.gov NCT00006180
Highlights
Major Depressive Disorder (MDD) is a common condition with a lifetime prevalence of 20.8% [1]
Melancholic depression is characterized by anhedonia, lack of reactivity to pleasurable stimuli and three or more of the following: loss of appetite or weight, insomnia, psychomotor retardation or agitation, sense of guilt, early awakening, depression that is worse in the morning, and a distinct quality of depressed mood
We have recently summarized the most important findings of this study [24]: Major depressive disorder (MDD) was associated with osteopenia, an increased risk for insulin resistance and cardiovascular disease, a chronic state of subclinical inflammation, increased diathesis to coagulopathy states, major endocrine, immune and neuropeptide alterations, and increased propensity to chronic pain
Summary
Major Depressive Disorder (MDD) is a common condition with a lifetime prevalence of 20.8% [1]. According to the Diagnostic and Statistical Manual of Mental Disorders, (DSM-IV), an episode of MDD can be classified clinically as depression with melancholic features and depression with atypical features. To further define phenotypes of depressive episodes, distinctive features of clinical subtypes have been studied, including behavioral manifestations, response to antidepressants, regional differences in cerebral blood flow, perceptual asymmetries, electroencephalographic sleep recordings, and endocrine dysregulations [2,3,4,5,6,7,8]. Major depressive disorder (MDD) has been associated with adverse medical consequences, including cardiovascular disease and osteoporosis. The goal of the present study was to assess whether these clinical subtypes of depression have different endocrine and metabolic features and varying medical outcomes
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