Changes In Depressed Mood Research Articles

Cerebral perfusion and changes in depressed mood

Cerebral perfusion and changes in depressed mood

Determinants of psychological distress and its course in the first year after diagnosis in rheumatoid arthritis patients.

In order to examine determinants of psychological distress and its course in the first year after diagnosis in rheumatoid arthritis patients, self-report data and clinical and laboratory measures were collected in 91 patients (70% female, mean age 57 years) shortly after diagnosis and 1 year later. Multiple regression analysis indicated that sex, pain and functional status, disease impact on daily life, life events, and perceived social support were related to psychological distress (anxiety and depressed mood) shortly after diagnosis. Coping strategies were related to distress levels only 1 year later. Multiple regression analysis of change in anxiety and depressed mood revealed that a decrease of psychological distress after 1 year could be predicted by male sex, an initially less severe inflammatory activity and an initially more extended social network. In addition, a decrease in distress was related to parallel improvements in clinical status. Results indicate the importance of a multimodal assessment of demographic variables, clinical and life stressors and social resources for the understanding of distress and the identification of risk factors in the first stage of the disease. Personal coping resources appear to become more important predictors of distress in a later phase of the disease.

Anxiety, Depression, and Their Comorbidity: An Experience Sampling Test of the Helplessness-Hopelessness Theory

This prospective study applied the experience sampling method to test the helplessness-hopelessness theory of anxiety and depression (Alloy, Kelly, Mineka, & Clements, 1990). Forty-four subjects with attributional styles at high or low risk for depression were signaled five times daily by electronic pagers to provide reports of negative events, attributions, and anxious and depressed moods. Consistent with the theory, causal attributions of stability and globality explained increases in depressed mood immediately after negative events. Attributional style predicted these causal attributions but did not directly explain changes in postevent depressed mood. Despite support for more established components of the theory, no support was found for newer aspects concerning the relationship of control attributions to anxious mood. The implications for understanding the helplessness-hopelessness theory and anxiety and depression comorbidity are discussed.

Linear and Nonlinear Changes in Mood Between Psychotherapy Sessions: Implications for Treatment Outcome and Relapse Risk

This study examined between-session changes in depressive mood among 91 older men and women receiving 16–20 sessions of outpatient psychotherapy. The majority of patients who recovered during treatment showed small between-session reductions in depression as measured by the Short Form Beck Depression Inventory. Still, nonlinearity in change was common, with most recovered patients experiencing two or more instances of major shifts toward mood worsening or improvement. The overall level of nonlinearity in change was positively correlated with recovery rate. Yet, high numbers of major mood shifts was linked with relapse risk. Patients who had relapsed at a 3-month follow-up experienced twice as many instances of major mood shifts during therapy as those who maintained their recovery.

Drug-Induced Actions on Brain Neurotransmitter Systems and Changes in the Behaviors and Emotions of Depressed Patients

Despite cumulative evidence that the tricyclic drugs result in significant changes in the functioning of brain serotonergic (5-HT) and nordrenergic (NE) systems, such changes have not been found to be associated with recovery from depression. Based upon evidence that the 5-HT and NE systems were associated with different emotions, it was hypothesized that changes in these systems were associated with different components of behavior in drug-responsive patients and not with changes in the "whole" disorder. Findings from this multihospital study of 104 unipolar and bipolar depressed patients showed early drug-associated reductions in anxiety and hostility in treatment responders to precede changes in motor retardation and depressed mood. Adopting this approach of looking for relationships between changes in components of major depression and changes in neurotransmitter system function, decreases in 5-HT and NE metabolite concentrations in cerebrospinal fluid (CSF) in patients treated with tricyclics, were found to be correlated with changes in specific behaviors. Results indicated the following: (1) drug-induced changes in the 5-HT system to be associated with mood aspects, notably anxiety, and depressed mood; changes in NE primarily with the psychomotor, secondarily with the mood components of the depressed state; (2) the pattern of relationships between changes in 5-HT and in mood in the unipolar was different than that in the bipolar subtype. The results indicate that in determining the relationships of biochemical changes to behavioral ones, that it is important to take into account the type of depression (bipolar or unipolar), as well as examining individually and over time those components that make up the disorder of depression. These results support evidence that tricyclics have multiple behavioral actions, that response is mediated through changes in specific behaviors and that this approach warrants further application in prospective studies of antidepressant drug mechanisms and their therapeutic actions.

Vulnerability to perimenstrual mood change: the relevance of a past history of depressive disorder.

A past history of depressive illness, defined in terms of treatment by antidepressants, was found to be more common in women seeking help for premenstrual syndrome (PMS) (31.3%; N = 83) than in women complaining of menorrhagia (8.9%; N = 90) or controls (5.8%; N = 104) with dysmenorrhea sufferers (22%; N = '50) reporting intermediate rates. Such a history in the clinical groups was associated with a tendency for premenstrual depression to be relatively prolonged (i.e., persisting through the menstrual phase and sometimes into the postmenstrual week) and with more severe depressive symptoms during the premenstrual, menstrual, and to a lesser extent, postmenstrual phases of the cycle. This, association was not evident for reported heaviness of menstrual bleeding and only weakly evident for severity of pain during the menstrual phase. Women with a depressive history gave higher neuroticism scores. A history of depression, as defined, seems to increase the vulnerability of women to depressive perimenstrual mood change in terms of both duration and severity. This effect on duration may hitherto have served to obscure the relationship between history of depression and premenstrual syndrome.

Is disease progression the major factor in morphine ‘tolerance’ in cancer pain treatment?

To assess the contribution of pharmacological tolerance to increasing doses of morphine, 29 cancer patients requiring oral morphine to treat pain were studied by two teams working independently. The first team assessed physical impairment, pain intensity and pain treatment. The second team assessed depressive disorders (DSM III criteria), emotional and behavioural depressive patterns (Retardation Depressive Scale, Polydimensional Mood Scale). All patients were seen at the initiation of morphine therapy and followed to the first morphine dose modification. Evaluations were carried out in out-patient clinics except staging investigations which were undertaken at the beginning and at the end of the study. Our results showed that 1. (1) in 24 of the 25 patients for whom morphine doses were increased, progressive disease was recorded; 2. (2) in 4 patients, morphine doses were not increased and in these patients their disease was stable or in remission; and 3. (3) changes in depressed mood were not correlated with pain intensity. These data strongly suggest that, instead of pharmacological tolerance, the main factor resulting in increasing oral morphine requirement in cancer pain management is pain increase due to disease progression.

Mental Health and Social Adaptation Following the Transition From High School

Through a two-wave panel analysis, we examine the effects of the transition from high school on changes in depressed mood, drinking, and delinquent behavior. Two models are examined. A model of life change-stress mediation posits that transitions such as graduation from high school bring about either improvement or worsening in critical arenas of functioning, in turn affecting these mental health outcomes. An interactive model of stress vulnerability posits that developmental status will alter the longitudinal associations of stressful life conditions, personal and social resources, and prior functioning with measures of adaptation. Based on a sample of 920 students randomly selected from three public schools in the Boston area, analyses indicate lower levels of depressed mood and delinquent behavior among the graduates, a change that is largely mediated by improvements in relations with parents. Further, prior mental health and behavioral problems are less predictive of post-transition outcomes among the...

Depressed patients' parental representations: stability across changes in depressed mood and specificity across diagnoses

Parental representations of a Dutch sample of psychiatric patients with diagnoses of dysthymia and unipolar depression were compared with those of a matched sample of non-depressed patients and a matched sample of healthy controls. No differences in recalled parental rearing styles were found between depressives with a diagnosis of dysthymia and those with a diagnosis of unipolar depression. Depressive did not differ from the mixed (but non-depressed) sample of psychiatric patients, whereas both the depressed and the mixed group of patients reported more adverse parenting than the healthy controls. Analysis of repeated measurements of parental representations showed that memories of parental behavior were highly stable across clinically significant changes in depressed mood, so that it seems unlikely that patients' relatively negative recollections of their parents' behavior were due to mood state dependent recall. Results are discussed within the framework of depression theories and with regard to the validity and utility of self-report instruments for parental rearing styles.

Ageing and problems in differential diagnosis of psychoorganic syndromes

Depressive syndrome was investigated in 132 psychiatric and neurologic patients by Zung's self-rating depression scale. The dexamethasone suppression test (DST) was carried out in 62 patients. Visual evoked potentials (VEP) (stimulation with flash (F-VEP) and pattern (P-VEP)), serum levels of LH, FSH, prolactin, ACTH, estradiol and cortisol were measured in 15 female patients between 85 and 94 years of age. Abnormal DST results indicated depression rather than dementia. P-VEP latencies correlated with cognitive symptoms, while F-VEP latencies correlated with affective symptoms. Gonadotropin levels were lowered in senility in comparison with the climacteric period of life. Depressive, anxious, cognitive, anorexic, sexual and disturbed diurnal mood changes syndromes could be separated by factor analysis. The severity of the cognitive depressive syndrome correlated negatively with estradiol serum levels. The total scores of Zung's self-rating depression scales correlated positively with ACTH and negatively with FSH serum levels.

Mood and memories of parental rearing styles: A comparison of mood effects on questionnaire-cued and free recall of autobiographical memories

The relationship between memories of childhood experiences (e.g., adverse parenting) and adult depression often found raises questions of interpretation. On the one hand, both laboratory studies and clinicians' experiences suggest that subjects in a depressed mood frequently show a negative bias in perceptions and memories. Negative childhood memories in depressed persons might, therefore, be interpreted as epiphenomena of depressed mood instead of etiological factors. On the other hand, memories of childhood experiences seem remarkably stable across changes in depressed mood, especially when memories are elicited by means of standardized questionnaires. In the mood and memory literature several explanations for this stability are offered. For one thing, highly structured cues to elicit memories (such as in questionnaires) are hypothesized to be less susceptible to mood bias than unstructured memory cues (such as in free recall procedures). On the other hand, resource allocation theorists suggest that childhood memories, being well established and rehearsed, are relatively impervious to mood bias no matter how they are elicited. In this study we examined whether different methods of eliciting childhood memories (i.e., free recall and questionnaire-cued) are differentially susceptible to mood bias. To this aim, we used a mood induction procedure to induce depressed, neutral, and elated mood and assessed childhood memories both before and after the mood induction using both questionnaires and free recall to elicit memories. Results suggested that memories elicited by means of free recall as well as by means of questionnaire-cued recall were susceptible to depressed and elated mood bias. The implications for research addressing the link between childhood experiences and depression are discussed.

Relations between depressed mood and vocal parameters before, during and after sleep deprivation: a circadian rhythm study

The mechanism underlying improvement after total sleep deprivation (TSD) was studied in 14 major depressed patients. The suggestions that (1) circadian processes and/or (2) dimensions of arousal may play a role in the response to TSD were investigated. Diurnal variation of depressed mood and of mood- and arousal-related vocal parameters was studied in relation to the effect of TSD on depressed mood and vocal parameters. During 3 baseline days, during TSD and 2 days after TSD vocal parameters and depressed mood were assessed 6 and 3 times daily respectively. The mean fundamental frequency (frequency of vocal fold vibration, F0) (presumably reflecting aspects of arousal) as well as the range of the F0 (proposed to reflect sadness) showed a clear circadian pattern with a peak at about 4.00 p.m. TSD affected the circadian organization of the mean F0 and advanced the peak of the curve. After one night of subsequent sleep this effect disappeared. In addition, improvement after TSD coincided with an increase of the mean F0. The diurnal variation of mood before TSD predicted the mood response to TSD, whereas diurnal variation of vocal parameters did not. Moreover, circadian changes in vocal parameters were not related to changes in depressed mood. These findings suggest that the diurnal variations in mood and vocal parameters are regulated by different mechanisms. Data support the presumption that circadian as well as arousal processes are involved in the mood response to TSD. Circadian changes in vocal parameters due to TSD are not likely to reflect changes in the biological clock.

Paediatrician identification of psychological factors associated with general paediatric consultations

In a study of children 7–12 yr of age referred to general paediatric clinics, paediatricians reported psychological factors associated to somatic presentations in 47% of the children. These cases presented with a variety of somatic symptoms, but abdominal/chest/joint pains and soiling were particularly common. From research interviews with the parents we found increased rates of psychiatric disorder (abnormalities of emotions, behaviour or relationships) amongst them. The most common psychiatric symptoms were depressive mood changes and relationship problems. We also identified an excess of certain personality features in the children and of family health problems in this group. Paediatricians commonly identify psychosomatic issues in children attending general paediatric clinics and independent evidence supports the validity of their assessments.

Vulnerability to depressive mood: An examination of the temporal consistency of the reformulated learned helplessness model

The present study used a prospective design to assess the ability of the reformulated learned helplessness model of depression to predict affective reactions to a stressful event. A total of 131 university students completed measures of depressive attributional style, trait depression, and performance aspirations for an upcoming course examination. Immediately following the exam, subjects completed a state depression measure; subjects again reported their state depression immediately following receipt of their examination grades. The discrepancy between subjects' grade aspirations and their achieved grades was used as a measure of subjective stress. Analyses indicated that a depressive attributional style interacted with this measure of subjective stress to predict changes in depressive mood following the examination, but not after receipt of their grades. The pattern of results is discussed in light of (a) the need for research investigating temporal factors in vulnerabilities for depressive mood and (b) the limitations of the study.

Attributional style and depressive mood reactions.

According to the reformulated learned helplessness model of depression, individuals who characteristically attribute negative events to internal-stable-global causes become depressed when confronted with negative life events. This proposition was tested in a field and a laboratory study in settings with an interpersonal, socially relevant character. In the field study, the attributional style of 86 female college students was investigated before Christmas, and their mood was recorded both before and after Christmas. The laboratory study recorded the mood of 46 female students before and after either success or failure. In both studies changes in depressive mood were predicted by the Attribution X Outcome interaction. The direction and form of the interaction were in line with the diathesis-stress model. In the field study, but not the laboratory study, outcome was a significant predictor of changes in depressive mood.

Mortality and morbidity in transsexual patients with cross-gender hormone treatment

Sex steroid treatment is associated with side effects. The number of deaths and morbidity cases in 425 transsexual patients treated with cross-gender hormones were evaluated retrospectively and compared with the expected number in a similar reference group of the population. The number of deaths in male-to-female transsexuals was five times the number expected, due to increased numbers of suicide and death of unknown cause. Combined treatment with estrogen and cyproterone acetate in 303 male-to-female transsexuals was associated with a 45-fold increase of thromboembolic events, hyperprolactinemia (400-fold), depressive mood changes (15-fold), and transient elevation of liver enzymes. Androgen treatment in 122 female-to-male transsexuals was associated with weight increase >10% (17.2%) and acne (12.3%). In both groups persistent liver enzyme abnormalities could be attributed to other causes than sex steroids (hepatitis B and alcohol abuse). Much of the morbidity was minor and reversible with appropriate treatment or temporary discontinuation of hormone treatment. Thus, the dilemma of prescribing cross gender hormones in view of the needs of these patients is not resolved. Explanation of possible side effects and careful clinical judgment remain the cornerstone of the clinical decision to prescribe cross-gender hormones. Furthermore, follow up of this relatively young population to disclose long-term side effects and to elucidate the association of sex steroids with coronary heart disease, as well as efforts to reduce the risk of thromboembolic events, are required.

Cyclizine abuse among a group of opiate dependents receiving methadone.

Twenty opiate dependents receiving long-term prescriptions of oral methadone, were identified as being habitual abusers of the anti-emetic drug cyclizine. A semi-structured interview elicited the dosage of cyclizine used, its effects, the reasons for starting and persisting with abuse of cyclizine and the attitudes of the patients to it. Cyclizine was taken in large doses intravenously with methadone. The effects initially were of intense stimulation, often with hallucinations, sometimes with aggressive behaviour, and occasionally with epileptic fits. Subsequent depressive mood changes occurred often accompanied by a craving for cyclizine. Tolerance to the drug occurred but no clear cut withdrawal syndrome is apparent. It seems that dependence upon cyclizine occurs. The significance of these findings for doctors, pharmacists and for drug treatment units is discussed. The paucity of information on the pharmacology and pharmacokinetics is noted.

Validation of a measure of perfectionism.

This article describes perfectionism, or the holding of and striving for unrealistically high standards, and presents two studies undertaken to investigate the convergent, discriminant, and predictive validity of the Perfectionism Scale (PS; Burns, 1980). College students in the first study completed the PS, several other measures of high standards, and measures of constructs that, conceptually, are differentially related to perfectionism. Correlational analyses indicated that the Perfectionism Scale has convergent and discriminant validity and seems to measure self-oriented perfectionism. The second study attempted to determine the predictive validity of the PS by testing a vulnerability model of subclinical depression outlined in Hewitt and Dyck (1986). PS scores were used to predict depressed mood changes in female college students following failure on important and unimportant tasks. As expected, the results indicated that perfectionism interacted with failure on important versus unimportant tasks to produce dysphoric mood. Evidence for the predictive validity of the PS was thus shown. Several directions for future research are discussed.

Contraception with norplant® implants and NORPLANT®-2 implants (two covered rods): Results from a comparative clinical study in Sweden

Two-hundred-and-forty healthy women, ages 18 to 40 years, were randomized in a ratio of 2:5 to use NORPLANT® implants or NORPLANT®-2 implants. Through three years of use, no pregnancies were recorded among women using NORPLANT® implants and two pregnancies were noted among women using NORPLANT®-2 implants resulting in a cumulative net pregnancy rate of 1.3 ± 0.9 per 100 acceptors (mean ± SE) by the end of year three. This difference was not statistically significant. During the fourth year, no pregnancies were observed in the NORPLANT® group, but 4 pregnancies occurred in the NORPLANT-2 group. The most common reason for terminating the study was bleeding disturbances. During the first year there were significantly more terminations due to bleeding problems in the NORPLANT® group than in the NORPLANT®-2 group. However, during the second year of use the proportion of women discontinuing for bleeding problems dropped considerably among NORPLANT® users and during the third year very few women in either group discontinued because of bleeding problems. The continuation rates after one year were for NORPLANT® users 59.4 % and for NORPLANT®-2 users 77.2 %. Corresponding figures after three years of use were 46.1 % and 51.7 %, respectively. The second most common reason for discontinuation was depression and other mood changes. In both groups we noted a slight increase in weight during the study and a slight decrease in blood pressure and hemoglobin levels with time. In conclusion, both NORPLANT® and NORPLANT®-2 implants are very effective methods for contraception. The efficacy of NORPLANT®-2 implants, however, was not acceptable during the fourth year of use in this study. The latter system could, however, become a suitable three-year contraceptive method, possibly with less bleeding disturbances than NORPLANT® in the first year.

Distraction in neurotic and endogenous depression: an investigation of negative thinking in major depressive disorder.

The effects on depressive thinking and depressed mood of a brief, standardized distraction procedure were examined. In low endogenous patients (scoring 3 or less on the Newcastle Diagnosis Scale (NDS)), distraction significantly reduced the frequency of depressing thoughts. Consistent with Beck's cognitive model of depression, these patients were significantly less depressed after distraction than after a control procedure. In high endogenous patients (scoring 4 or more on the NDS), distraction produced less marked reductions in frequency of depressing thoughts, and no significant change in depressed mood. It is suggested that the relationship between negative thinking and depressed mood differs in the two patient groups.