Depression Disturbance Research Articles

A pilot study of serotonin-1A receptor genotypes and rapid eye movement sleep sensitivity to serotonergic/cholinergic imbalance in humans: a pharmacological model of depression.

RationaleThe serotonergic and cholinergic systems are jointly involved in regulating sleep but this system is theorized to be disturbed in depressed individuals. We previously reported that cholinergic and serotonergic agents induce sleep changes partially consistent with monoamine models of sleep disturbances in depression. One potential cause of disturbed neurotransmission is genetic predisposition. The G(-1019) allele of the serotonin-1A (5-HT1A) receptor promoter region predicts an increased risk for depression compared to the wild-type C(-1019) allele.ObjectiveThe goal of this study was to investigate how serotonin-1A receptor genotypes mediate sleep sensitivity to pharmacological probes modeling the serotonergic/cholinergic imbalance of depression.MethodsSeventeen healthy female participants homozygous for either C (n=11) or G (n=6) alleles aged 18–27 years were tested on four nonconsecutive nights. Participants were given galantamine (an anti-acetylcholinesterase), buspirone (a serotonergic agonist), both drugs together, or placebos before sleeping.ResultsAs reported previously, buspirone significantly increased rapid eye movement (REM) latency (P<0.001), as well as awakenings, percentage of time spent awake, and percentage of time asleep spent in stage N1 (P<0.019). Galantamine increased awakenings, percentage of time spent awake, percentage of time asleep spent in stage N1, and percentage of time asleep spent in REM, and decreased REM latency and percentage of time asleep spent in stage N3 (P<0.019). Galantamine plus buspirone given together disrupted sleep more than either drug alone, lowering sleep efficiency and percentage of time asleep spent in stage N3 and increasing awakenings, percentage of time spent awake, and percentage of time asleep spent in stage N1 (P<0.019). There was no main effect of genotype nor was there a significant multivariate interaction between genotype and drug condition.ConclusionThese findings are partially consistent with the literature about sleep in depression, notably short REM latency, higher percentage of total sleep time spent in REM, lower percentage of time asleep spent in stage N3, and increased sleep fragmentation. The C/G mutation in the serotonin-1A receptor promoter region does not appear to cause noticeable differences in the sleep patterns of a relatively small sample of healthy young females. Future studies with larger sample sizes are required.

Special features of sleep disorders and depressive disturbances in patients with isolated gastroesophageal reflux disease and in conjunction with coronary artery disease

Aim – to study the special features of sleep disorders and depression intensity in patients with gastroesophageal reflux disease (GERD) and GERD in conjunction with coronary artery disease (CAD) by the method of questionnaire and to compare results with clinical and functional manifestations of comorbidity. Methods. There were examined 65 patients with GERD and CAD (group 1) and 29 patients with GERD (group 2). Sleep disorders and depression were studied using questionnaires: subjective sleep characteristics (SSC), (Epworth Sleepiness Scale (ESS),Beck scale for depression (BSD). Results . Sleep disorders took place in 41 (61,54 %) patients from group 1 and 13 (44,83 %) patients from group 2. The mean point of SSC was 17,75±1,98 in group 1 opposite to18,59±1,12 in group 2 (p= 0,043). The mean point of ESS was 9,75±1,59 in group 1opposite to 9,24±1,18 in group 2, p=0,103. The mean point of BDS was 11,89±4,38 in group 1opposite to 8,86±1,30 in group 2, p= 0,004. In the group 1 it was established a correlation between SSC and patient’s age (r=- 0320; p=0,0075), BSD and age (r=0,371; p=0,0024), ESS and body mass index(r=0,291; p=0,0188). There were established correlations between duration of CAD and SSC (r=-0,315; p=0,011), CAD and ESS (r=0,273; p=0,0280), CAD and BSD (r=0,379; p=0,0018), GERD heaviness and SSC (p=0,0498), BSD and SSC (r= - 0,676; p=0,000) and between BSD and ESS (r=0,583; p=0,000) in group 1. In group 2 ESS correlated with age (r=0,379; p=0,0426). Conclusions . The conjunction of GERD and CAD can be considered as two mutually potential pathological processes that have a negative effect on such indicators as sleep and psycho-emotional status of patient

A comparison of monthly symptom reports for older (≥ 70 years) versus younger (&lt; 70 years) women with recurrent ovarian cancer over 1 year.

85 Background: Approximately 30% of ovarian cancer patients are 70 or older at diagnosis. Evidence to guide treatment in this age group is limited in the recurrent setting due to clinician concerns about toxicities and quality of life. Evidence based on patient-reported outcomes is scarce. The objective of this exploratory analysis is to compare patient-reported symptoms for women with recurrent ovarian cancer &gt; age 70 vs. &lt; age 70. Methods: Ancillary analysis of data from a 3-arm web-based symptom management RCT (NR010735; GOG-259). Eligibility criteria included recurrent or persistent ovarian, fallopian, or primary peritoneal cancer; experiencing 3 or more cancer or treatment-related symptoms. 497 women were accrued; of those, 60 (12%) were &gt; age 70. Monthly severity data for 11 cancer- and treatment-symptoms rated “at their worst in the past week” on a 0 to 10 Likert-type scale are included in this analysis. Time (linear, quadratic, and cubic), age (young vs. old), and time by age group interactions were evaluated using random coefficient modeling for each of the symptoms over 12 months. Results: In general, the severity of these selected symptoms declined significantly (p &lt; .05) either linearly (memory problems and anxiety) or nonlinearly (fatigue, pain, constipation, peripheral neuropathy, nausea, lack of appetite, depression, and sleep disturbances) over time, except for vomiting which did not demonstrate a significant change over time. Age effects or age by time interactions (significant, p &lt; .05, or a trend, .05 &lt; = p &lt; .10) were found for pain, constipation, peripheral neuropathy, vomiting, and sleep disturbances, with generally higher initial values for younger ( &lt; = 70 years) women for pain and sleep disturbances and higher overall means for younger women for vomiting. For constipation and peripheral neuropathy, the nonlinear change over time varied significantly by age group, with the decline over time being more precipitous for older women. Conclusions: A better understanding of the different propensity for symptoms based on age can help clinicians not only address them but also choose chemotherapies to minimize them.

Prevalence and Risk Factors of Depression and Sleep Disturbance in Continuous Ambulatory Peritoneal Dialysis Patients

Prevalence and Risk Factors of Depression and Sleep Disturbance in Continuous Ambulatory Peritoneal Dialysis Patients

Reduced density of glutamine synthetase immunoreactive astrocytes in different cortical areas in major depression but not in bipolar I disorder.

There is increasing evidence for disturbances within the glutamate system in patients with affective disorders, which involve disruptions of the glutamate–glutamine-cycle. The mainly astroglia-located enzyme glutamine synthetase (GS) catalyzes the ATP-dependent condensation of ammonia and glutamate to form glutamine, thus playing a central role in glutamate and glutamine homoeostasis. However, GS is also expressed in numerous oligodendrocytes (OLs), another class of glial cells implicated in mood disorder pathology. To learn more about the role of glia-associated GS in mental illnesses, we decided to find out if numerical densities of glial cells immunostained for the enzyme protein differ between subjects with major depressive disorder, bipolar disorder (BD), and psychically healthy control cases. Counting of GS expressing astrocytes (ACs) and OLs in eight cortical and two subcortical brain regions of subjects with mood disorder (N = 14), BD (N = 15), and controls (N = 16) revealed that in major depression the densities of ACs were significantly reduced in some cortical but not subcortical gray matter areas, whereas no changes were found for OLs. In BD no alterations of GS-immunoreactive glia were found. From our findings we conclude that (1) GS expressing ACs are prominently involved in glutamate-related disturbances in major depression, but not in BD and (2) GS expressing OLs, though being present in significant numbers in prefrontal cortical areas, play a minor (if any) role in mood disorder pathology. The latter assumption is supported by findings of others showing that – at least in the mouse brain cortex – GS immunoreactive oligodendroglial cells are unable to contribute to the glutamate–glutamine-cycle due to the complete lack of amino acid transporters (Takasaki et al., 2010).

The Neurobiological Mechanisms and Treatments of REM Sleep Disturbances in Depression.

Most depressed patients suffer from sleep abnormalities, which are one of the critical symptoms of depression. They are robust risk factors for the initiation and development of depression. Studies about sleep electroencephalograms have shown characteristic changes in depression such as reductions in non-rapid eye movement sleep production, disruptions of sleep continuity and disinhibition of rapid eye movement (REM) sleep. REM sleep alterations include a decrease in REM sleep latency, an increase in REM sleep duration and REM sleep density with respect to depressive episodes. Emotional brain processing dependent on the normal sleep-wake regulation seems to be failed in depression, which also promotes the development of clinical depression. Also, REM sleep alterations have been considered as biomarkers of depression. The disturbances of norepinephrine and serotonin systems may contribute to REM sleep abnormalities in depression. Lastly, this review also discusses the effects of different antidepressants on REM sleep disturbances in depression.

Metabolic factors-triggered inflammatory response drives antidepressant effects of exercise in CUMS rats

Chronic stress is a potential contributing factor for depression, accompanying with metabolic and inflammatory response. Exercise is considered as a treatment for depression, but mechanisms underlying its beneficial effects still remain unknown. The objectives of present study were to confirm that metabolic factors-triggered inflammatory response mediates the antidepressant actions of exercise in chronic unpredictable mild stress (CUMS) rats. It has been found that CUMS stimulated expression of ghrelin and its receptor Ghsr, but inhibited expression of leptin and its receptor LepRb. Ghrelin, via binding to Ghsr, induced phosphorylation of GSK-3β on Tyr216 and decreased phosphorylation on Ser9, thus increasing GSK-3β activity. Conversely, ghrelin binding to Ghsr decreased STAT3 activity, through decreasing phosphorylation of STAT3 on Tyr705 and increasing Ser727 phosphorylation. Negatively correlated with ghrelin, leptin binding to LepRb had opposite effects on the activity of GSK-3β and STAT3 via phosphorylation. In addition, decreased leptin level initiated NLRP3 activity via LepRb. Furthermore, GSK-3β inhibited STAT3 activation, thus promoting the expression of NLRP3. Meanwhile, swim improved metabolic and inflammatory response both in CUMS and control rats. Our findings suggest that exercise not only ameliorates metabolic disturbance and inflammatory response in depression, but also contributes to metabolic and inflammatory function in normal conditions.

Female Sexual Function and Depression After Kidney Transplantation: Comparison Between Deceased- and Living-Donor Recipients

Disturbances in sexual function and depression are a common feature in women with chronic renal failure. Living-donor kidney transplantation seems to warrant better results than its cadaveric counterpart in many aspects but its impact on post-transplantation sexual function remains unknown. This study aimed to compare post-transplantation sexual function and depression in women receiving kidney grafts from living and deceased donors. From a single-center prospective database of 2016 renal transplantations between June 2011 and June 2013, we enrolled 50 sexually active women after kidney transplantation. Female sexual function was evaluated with the Female Sexual Function Index Questionnaire (FSFI) and depression was assessed using the Beck Depression Inventory–II (BDI-II) scale. Thirty-four patients referred the questionnaires. The sexual domains of satisfaction and desire were significantly better in living-donor receptors; in all other domains evaluated by FSFI no statistically significant difference was encountered between groups, although living-donor receptors tended to report better function. Total BDI-II was well correlated with total FSFI score in our study cohort (Spearman's rho = −0.80, P < .001). Only 34.6% of women referred to have discussed sexual issues with their physicians before transplantation, whereas 73.1% stated it would have been important. In conclusion, living-donor transplantation exerted a positive effect on women's sexual function.

Depressive symptoms and clustering of cardiovascular disease risk factors in diabetes patients

Depressive symptoms may be related to the development of coronary heart disease (CHD) in patients with diabetes mellitus. The objective of the present study was to investigate the relationship between cardiovascular disease risk factors and depressive symptoms in patients with type 2 diabetes. A total of 179 patients with type 2 diabetes completed a questionnaire and gave a blood sample. The questionnaire consisted of demographics, the medication adherence questionnaire, the summary of diabetes self-care activities questionnaire, and the Beck Depression Inventory II questionnaire. Blood samples were analyzed for glucose and lipid profile. Elevated depression Beck score had a significant relation with female gender, numbness or pain in peripheries, younger age group ≤50 years, and elevated triglycerides (TG). Diabetes complications also had a significant relation with depression and more specifically with performance impairment and depression-nonspecific items. A significant relation was found between uncontrolled diabetes and somatic disturbance. Under-adherence to medications was significantly related to depression-specific items. Obesity was significantly related to depression-nonspecific items. Several factors are correlated with depression symptoms in diabetes patients. Additionally, control of somatic disturbance and performance impairment of depression should be regarded as important components of appropriate diabetes care to ensure diabetes control and medication adherence.

Risk factors for depression in residents of gerontology center in Sarajevo

Introduction: Depression is the most common mental problem in elderly and is often under-recognized or is inadequately treated, thus significantly affecting the quality of life of elderly people. The reasons for the occurrence of depression in the elderly are multiple. The most common are neurobiological and psychosocial risk factors as well as physical illness. The aim of this study is to determine the presence of the most common risk factors related to the degree of depression, determined by the geriatric depression scale.Methods: This is cross-sectional, descriptive and analytical study undertaken on the sample of 150 psychologically and physically capable residents of the "The Gerontology Center" in Sarajevo older than 65 years. The following instruments were used for research: the Geriatric Depression Scale (GDS) and the modified questionnaire on risk factors important in the depression development.Results: Women are more depressed than men (p&lt;0.01). Depression severity increases with age (p=0.008). The marital status of respondents was significant factor affecting the GDS scores (p=0.009). GDS score and education are weakly correlated (p=0.07) and more educated are less depressed. Also, independently mobile elderly are less depressed (p&lt;0.0005). GDS scores and presence of depression in younger age are dependent (p=0.004). Depression and subjective sleep disturbances are dependent (p=0.002).Conclusion: The most common risk factors for depression in elderly are gender, age, marital status, history of depression in younger age and mobility.

P0128 : Low testosterone levels are associated with sarcopenia in cirrhotic patients

anger, depression, sleep & wake disturbances were predictive. Thus PROMIS results add to prognostication provided by HE alone. Conclusions: Patient reported QOL outcomes add to current prognostic models of death/transplant and hospitalizations in cirrhosis independent of HE status and liver disease severity. Inclusion of patient-reported outcomes could improve our study of cirrhosis research effectiveness and encourage inquiry into QOL issues.

Interoceptive dysfunction: toward an integrated framework for understanding somatic and affective disturbance in depression.

Depression is characterized by disturbed sleep and eating, a variety of other nonspecific somatic symptoms, and significant somatic comorbidities. Why there is such close association between cognitive and somatic dysfunction in depression is nonetheless poorly understood. An explosion of research in the area of interoception-the perception and interpretation of bodily signals-over the last decade nonetheless holds promise for illuminating what have until now been obscure links between the social, cognitive-affective, and somatic features of depression. This article reviews rapidly accumulating evidence that both somatic signaling and interoception are frequently altered in depression. This includes comparative studies showing vagus-mediated effects on depression-like behaviors in rodent models as well as studies in humans indicating both dysfunction in the neural substrates for interoception (e.g., vagus, insula, anterior cingulate cortex) and reduced sensitivity to bodily stimuli in depression. An integrative framework for organizing and interpreting this evidence is put forward which incorporates (a) multiple potential pathways to interoceptive dysfunction; (b) interaction with individual, gender, and cultural differences in interoception; and (c) a developmental psychobiological systems perspective, emphasizing likely differential susceptibility to somatic and interoceptive dysfunction across the lifespan. Combined with current theory and evidence, it is suggested that core symptoms of depression (e.g., anhedonia, social deficits) may be products of disturbed interoceptive-exteroceptive integration. More research is nonetheless needed to fully elucidate the relationship between mind, body, and social context in depression.

Motion and emotion: depression reduces psychomotor performance and alters affective movements in caregiving interactions.

Background: Impaired social functioning is a well-established feature of depression. Evidence to date suggests that disrupted processing of emotional cues may constitute part of this impairment. Beyond processing of emotional cues, fluent social interactions require that people physically move in synchronized, contingent ways. Disruptions to physical movements are a diagnostic feature of depression (psychomotor disturbance) but have not previously been assessed in the context of social functioning. Here we investigated the impact of psychomotor disturbance in depression on physical responsive behavior in both an experimental and observational setting.Methods: In Experiment 1, we examined motor disturbance in depression in response to salient emotional sounds, using a laboratory-based effortful motor task. In Experiment 2, we explored whether psychomotor disturbance was apparent in real-life social interactions. Using mother-infant interactions as a model affective social situation, we compared physical behaviors of mothers with and without postnatal depression (PND).Results: We found impairments in precise, controlled psychomotor performance in adults with depression relative to healthy adults (Experiment 1). Despite this disruption, all adults showed enhanced performance following exposure to highly salient emotional cues (infant cries). Examining real-life interactions, we found differences in physical movements, namely reduced affective touching, in mothers with PND responding to their infants, compared to healthy mothers (Experiment 2).Conclusions: Together, these findings suggest that psychomotor disturbance may be an important feature of depression that can impair social functioning. Future work investigating whether improvements in physical movement in depression could have a positive impact on social interactions would be of much interest.

Sparse factors for the positive and negative syndrome scale: Which symptoms and stage of illness?

The Positive and Negative Syndrome Scale (PANSS) is frequently described with five latent factors, yet published factor models consistently fail to replicate across samples and related disorders. We hypothesize that (1) a subset of the PANSS, instead of the entire PANSS scale, would produce the most replicable five-factor models across samples, and that (2) the PANSS factor structure may be different depending on the treatment phase, influenced by the responsiveness of the positive symptoms to treatment. Using exploratory factor analysis, confirmatory factor analysis and cross validation on baseline and post-treatment observations from 3647 schizophrenia patients, we show that five-factor models fit best across samples when substantial subsets of the PANSS items are removed. The optimal model at baseline (five factors) omits 12 items: Motor Retardation, Grandiosity, Somatic Concern, Lack of Judgment and Insight, Difficulty in Abstract Thinking, Mannerisms and Posturing, Disturbance of Volition, Preoccupation, Disorientation, Excitement, Guilt Feelings and Depression. The PANSS factor models fit differently before and after patients have been treated. Patients with larger treatment response in positive symptoms have larger variations in factor structure across treatment stage than the less responsive patients. Negative symptom scores better predict the positive symptoms scores after treatment than before treatment. We conclude that sparse factor models replicate better on new samples, and the underlying disease structure of Schizophrenia changes upon treatment.

Autobiographical Memory Disturbances in Depression: A Novel Therapeutic Target?

Major depressive disorder (MDD) is characterized by a dysfunctional processing of autobiographical memories. We review the following core domains of deficit: systematic biases favoring materials of negative emotional valence; diminished access and response to positive memories; a recollection of overgeneral memories in detriment of specific autobiographical memories; and the role of ruminative processes and avoidance when dealing with autobiographical memories. Furthermore, we review evidence from functional neuroimaging studies of neural circuits activated by the recollection of autobiographical memories in both healthy and depressive individuals. Disruptions in autobiographical memories predispose and portend onset and maintenance of depression. Thus, we discuss emerging therapeutics that target memory difficulties in those with depression. We review strategies for this clinical domain, including memory specificity training, method-of-loci, memory rescripting, and real-time fMRI neurofeedback training of amygdala activity in depression. We propose that the manipulation of the reconsolidation of autobiographical memories in depression might represent a novel yet largely unexplored, domain-specific, therapeutic opportunity for depression treatment.

Use of Human Embryonic Stem Cells in the Treatment of Parkinsons Disease: A Case Report

Parkinson’s disease (PD), a progressive disorder of the central nervous system, affects every 1 in 100 persons, aged around 70 in Europe. PD is characterized by abnormalities affecting both the motor system and the non-motor systems that include tremor, gait disorder, bradykinesia, depression, cognitive impairments, dysautonomia and sleep disturbances. Both surgical and drug treatments are available for the treatment of PD, but none has been able to halt the progression of the degenerative disease. We present the case of 65-year old male patient with PD who was treated with human embryonic stem cells (hESCs). The patient showed significant improvement in his health following the treatment; such as reduction in tremors, bradykinesia, muscle rigidity, pain and stiffness in the neck, shoulder and low back and improvement in the range of movements of the neck. The patient was able to balance himself while walking, had reduction in numbness in his left hand and both of his legs. He was able to speak louder and had improved writing skills. No adverse event or teratoma formation was observed. hESC therapy in our study showed beneficial effects in the patient with PD, but future clinical trials are needed to gather more evidence to support our findings.

Psychiatric Disorders and Polyphenols: Can They Be Helpful in Therapy?

The prevalence of psychiatric disorders permanently increases. Polyphenolic compounds can be involved in modulation of mental health including brain plasticity, behaviour, mood, depression, and cognition. In addition to their antioxidant ability other biomodulating properties have been observed. In the pathogenesis of depression disturbance in neurotransmitters, increased inflammatory processes, defects in neurogenesis and synaptic plasticity, mitochondrial dysfunction, and redox imbalance are observed. Ginkgo biloba, green tea, and Quercus robur extracts and curcumin can affect neuronal system in depressive patients. ADHD patients treated with antipsychotic drugs, especially stimulants, report significant adverse effects; therefore, an alternative treatment is searched for. An extract from Ginkgo biloba and from Pinus pinaster bark, Pycnogenol, could become promising complementary supplements in ADHD treatment. Schizophrenia is a devastating mental disorder, with oxidative stress involved in its pathophysiology. The direct interference of polyphenols with schizophrenia pathophysiology has not been reported yet. However, increased oxidative stress caused by haloperidol was inhibited ex vivo by different polyphenols. Curcumin, extract from green tea and from Ginkgo biloba, may have benefits on serious side effects associated with administration of neuroleptics to patients suffering from schizophrenia. Polyphenols in the diet have the potential to become medicaments in the field of mental health after a thorough study of their mechanism of action.

Sleep Disturbances in Depression.

Major depressive disorder is frequently accompanied by sleep disturbances such as insomnia or hypersomnia and polysomnographic sleep findings of increased rapid-eye-movement sleep and decreased slow wave sleep. For many patients, insomnia persists even after mood symptoms have been adequately treated. These patients have poorer outcomes than patients without sleep problems. These outcomes suggest that overlapping neural mechanisms regulate sleep and mood. Treatment of these patients can incorporate sedating antidepressants, nonbenzodiazepine γ-aminobutyric acid agonists, and cognitive behavioral therapy. Sleep restriction has been found to improve mood in depressed patients; however, the benefits typically disappear after recovery sleep.

Functional and structural alterations in the cingulate motor area relate to decreased fronto-striatal coupling in major depressive disorder with psychomotor disturbances.

Psychomotor disturbances are a classic feature of major depressive disorders. These can manifest as lack of facial expressions and decreased speech production, reduced body posture and mobility, and slowed voluntary movement. The neural correlates of psychomotor disturbances in depression are poorly understood but it has been suggested that outputs from the cingulate motor area (CMA) to striatal motor regions, including the putamen, could be involved. We used functional and structural magnetic resonance imaging to conduct a region-of-interest analysis to test the hypotheses that neural activation patterns related to motor production and gray matter volumes in the CMA would be different between depressed subjects displaying psychomotor disturbances (n = 13) and matched healthy controls (n = 13). In addition, we conducted a psychophysiological interaction analysis to assess the functional coupling related to self-paced finger-tapping between the caudal CMA and the posterior putamen in patients compared to controls. We found a cluster of increased neural activation, adjacent to a cluster of decreased gray matter volume in the caudal CMA in patients compared to controls. The functional coupling between the left caudal CMA and the left putamen during finger-tapping task performance was additionally decreased in patients compared to controls. In addition, the strength of the functional coupling between the left caudal CMA and the left putamen was negatively correlated with the severity of psychomotor disturbances in the patient group. In conclusion, we found converging evidence for involvement of the caudal CMA and putamen in the generation of psychomotor disturbances in depression.

Latent Bipolarity In Unipolar Depression: Experimental Findings, Conceptual Analysis And Implications For Treatment Strategies.

Previous studies have suggested that the two opposite poles of psychomotor disturbances in unipolar depression (UD) - retardation and agitation - require different treatment strategies as the psychomotor overactivation requires an augmentation of the antidepressant therapy with mood stabilizers and/or atypical antipsychotics. The aim of the present study was to objectively identify and measure the psycho-motor disturbances in UD using differentiation between activity and reactivity. An equilibriometric movement pattern analysis system that allows differentiation between psychomotor activity and reactivity was applied in 58 unipolar depressive patients and 76 healthy controls. Compared to controls, the patients as a group were significantly slower in their psychomotor reactivity. However, the subsequent subgrouping according to the direction of deviation of their objective psychomotor parameters revealed a disinhibition of psychomotor activity and/or reactivity in about one half of them. Such a contradictory combination of clinically manifested depressive mood and subclinically detected manic-like psychomotor overactivation might be regarded as belonging to the bipolar spectrum, since it was admitted that manic psychomotor disinhibition in unipolar depressive patients uncovers a latent bipolarity. Not only prototypical depressive inhibition, but also prototypical manic-like disinhibition may underlie clinically manifested UD. Since the combination between depressive mood and psychomotor overactivation multiplies the suicidal risk, we may presume that the timely detection of this combination at a subclinical level would contribute to an earlier and more effective suicidal prevention by an objectively-guided optimization of pharmacological treatment.