Depressive Episodes In Patients Research Articles

Multiple risk factors predict recurrence of major depressive disorder in women

BackgroundIt is difficult to predict recurrence of depressive episodes in patients with major depression (MD): evidence for many risk factors is inconsistent and general prediction algorithms are lacking. The aim of this study was to develop a prediction model for recurrence of depressive episodes in women using improved methodology. MethodsWe used prospective data from a general population sample of female twins with a last-year MD episode (n=194). A rich set of baseline predictors was analyzed with Cox proportional hazards regression subject to elastic net regularization to find a model predicting recurrence of depressive episodes. Prediction accuracy of the model was assessed in an independent test sample (n=133), which was limited by the unavailability of a number of key predictors. ResultsA wide variety of risk factors predicted recurrence of depressive episodes in women: depressive and anxiety symptoms during the index episode, the level of symptoms at the moment of interview, psychiatric and family history, early and recent adverse life events, being unmarried, and problems with friends and finances. Kaplan Meier estimated survival curves showed that the model differentiated between patients at higher and lower risk for recurrence; estimated areas under the curve were in the range of 0.61–0.79. LimitationsDespite our rich set of predictors, certain potentially relevant variables were not available, such as biological measures, chronic somatic diseases, and treatment status. ConclusionsRecurrence of episodes of MD in women is highly multifactorial. Future studies should take this into account for the development of clinically useful prediction algorithms.

Association of Speed of Onset and Speed of Recovery of Depressive Episodes in Patients with Major Depression

Background: Depressive episodes show large interindividual differences concerning their speed of onset and speed of recovery, which might suggest differences in underlying pathophysiological processes. The aim of the present study was to assess whether there is a relationship between the speed of onset and the speed of recovery from depressive episodes. Methods: The speed of onset and the speed of recovery from depression were assessed using a structured patient interview, the Onset of Depression Inventory (ODI). In total, 28 patients with bipolar depression and 91 patients with unipolar depression were included. Results: The mean speed of onset of depression was significantly faster than the mean speed of recovery from depression (35.25, range 0-360 days vs. 59.60, range 0.13-720 days; Z = -3.40; p = 0.001). The correlation between these variables was positive, but numerically low (ρ = 0.22; p = 0.016). The speed of onset of the previous episode and that of the present episode were significantly correlated (ρ = 0.45; p < 0.001). Limitations: Data are based on retrospective patient reports within a naturalistic study. Conclusions: While the speed of onset of depressive episodes has been found to show large interindividual variability and some intraindividual stability, the data of this study do not indicate that the neurobiological processes involved in the onset of and in the recovery from depressive episodes are closely linked.

Role of baseline depressive symptoms in the development of depressive episode in patients receiving antiviral therapy for Hepatitis C infection

ObjectiveThis study aimed to evaluate the symptom profile and the role of baseline depressive symptoms in the development of depressive episode in patients receiving pegylated IFN-alpha and ribavirin. Methods82 consecutive patients with HCV infection in whom combination of pegylated interferon-α 2a/2b and ribavirin was prescribed were assessed at baseline and thereafter at 2, 4, 8 and 12weeks. At the baseline, patients were assessed on Patient Health Questionnaire (PHQ-9), Mini International Neuropsychiatric Interview (MINI) and Beck Depression Inventory (BDI-II). Thereafter patients were assessed on PHQ-9 and when ever found to have Major Depressive Disorder as per PHQ-9, they were assessed on MINI. Those found to have Major Depressive Episode (MDE) on MINI were rated on BDI-II for phenomenology and severity of depression. ResultsCommon symptoms of pegylated IFN-alpha and ribavirin induced MDE include sadness, irritability, work inhibition, sleep disturbance, fatigability and loss of appetite. Presence of certain depressive symptoms i.e., presence of little interest or pleasure in doing things, feeling tired or having little energy, poor appetite, social withdrawal and work inhibition at the baseline were associated with development of depression during the course of pegylated IFN-alpha plus ribavirin therapy. ConclusionDepressive symptoms in patients with pegylated IFN-alpha and ribavirin induced MDE are influenced by the symptoms of depression prior to starting of pegylated IFN-alpha and ribavirin combination. A short screening questionnaire may be constructed which will include the symptoms which predict the development of depression to screen patients at high risk for the development of depression.

The mediator role of ruminative thinking style in the relationship between dysfunctional attitudes and depression

BackgroundThe main aim of the present study was to examine whether ruminative thinking styles (brooding and reflection) mediate the effects of dysfunctional attitudes on depressive symptoms. Methods120 psychotropic drug-naive first episode depression patients recruited from Bulent Ecevit University School of Medicine psychiatry department and Zonguldak State Hospital psychiatry department outpatient clinics were involved in the study. Participants completed the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Beck Depression Inventory (BDI), Dysfunctional Attitude Scale (DAS) and Ruminative Responses Scale (RRS-short version). Regression analyses together with the Sobel tests were performed for testing the mediator hypothesis. ResultsAccording to the path model, the level of brooding fully mediated the relationship between dysfunctional attitudes and depressive symptomatology but reflection did not play a mediator role in the relationship between dysfunctional attitudes and depressive symptoms. ConclusionsAssessment of brooding with both mental status examination and specific measurements and focusing on brooding as an intervention strategy would be beneficial components for an effective treatment of depression.

Age at onset, course of illness and response to psychotherapy in bipolar disorder: results from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD).

The course of bipolar disorder progressively worsens in some patients. Although responses to pharmacotherapy appear to diminish with greater chronicity, less is known about whether patients' prior courses of illness are related to responses to psychotherapy. Embedded in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) was a randomized controlled trial of psychotherapy for bipolar depression comparing the efficacy of intensive psychotherapy with collaborative care (a three-session psycho-educational intervention). We assessed whether the number of previous mood episodes, age of illness onset, and illness duration predicted or moderated the likelihood of recovery and time until recovery from a depressive episode in patients in the two treatments. Independently of treatment condition, participants with one to nine prior depressive episodes were more likely to recover and had faster time to recovery than those with 20 or more prior depressive episodes. Participants with fewer than 20 prior manic episodes had faster time to recovery than those with 20 or more episodes. Longer illness duration predicted a longer time to recovery. Participants were more likely to recover in intensive psychotherapy than collaborative care if they had 10-20 prior episodes of depression [number needed to treat (NNT) = 2.0], but equally likely to respond to psychotherapy and collaborative care if they had one to nine (NNT = 32.0) or >20 (NNT = 9.0) depressive episodes. Number of previous mood episodes and illness duration are associated with the likelihood and speed of recovery among bipolar patients receiving psychosocial treatments for depression.

Effect of inflammatory cytokines of blood serum on cell metabolism of bilateral hippocampus in the first episode depression: a magnetic resonance spectroscopy study

Objective To explore the cell metabolism of the bilateral hippocampus effected by the inflammatory factor of blood serum in the development of the depression. Methods Using Proton magnetic resonance spectroscopy 1H-MRS technology to detect multiple metabolic indices of the bilateral hippocampus of 20 first episode depression patients and 20 healthy persons, and detecting the levels of IL-6, IL-2, IL-10 in blood serum were detected.Finally the correlation between them was analyzed. Results Compared with the healthy group, the values of Glx/ Cr and NAA/ Cr were reduced in left hippocampus(Glx/Cr: (0.82±0.48), t=2.69, P<0.05; NAA/Cr: (1.12±0.44), t=2.81, P<0.05)and the value of Cho/ Cr was increased in left hippocampus((2.49±0.78), t=2.36, P<0.05), but only the value of Glx/ Cr were reduced in right hippocampus((0.84±0.47), t=2.43, P<0.05), and the other metabolic indices changed unobvious.The depressive group had the significantly higher levels of IL-6, IL-2 in blood serum(IL-6: (12.47±3.19)ng/L, t=4.53, P<0.05; IL-2: (29.44±5.72)ng/L, t=2.44, P<0.05), but no significant difference was found in the IL-10 level in blood serum. The Glx/ Cr of bilateral hippocampus level was negatively correlated to the IL-6 and IL-2 level in blood serum(left: (IL-6: r=-0.555, P<0.05; IL-2: r=-0.624, P<0.05); right: (IL-6: r=-0.575, P<0.05; IL-2: r=-0.523, P<0.05)). The NAA/ Cr of left hippocampus level was negatively correlated to the IL-6 and IL-2 level in blood serum(IL-6: r=-0.582, P<0.05; IL-2: r=-0.607, P<0.05). The Cho/Cr of left hippocampus level was negatively correlated to the IL-6 and IL-2 level in blood serum(IL-6: r=0.601, P<0.05; IL-2: r=0.552, P<0.05). Conclusion The abnormal of glutamic acid system in bilateral hippocampus maybe the important performance and the potential originating link, the changes of the inflammatory cytokines level maybe the factor of these abnormal changes. Key words: Inflammatory cytokines; Magnetic Resonance Spectrum; First episode depression; Hippocampus

Treatments for Acute Bipolar Depression: Meta-analyses of Placebo-controlled, Monotherapy Trials of Anticonvulsants, Lithium and Antipsychotics

Optimal treatments for bipolar depression, and the relative value of specific drugs for that purpose, remain uncertain, including agents other than antidepressants. We searched for reports of placebo-controlled, monotherapy trials of mood-stabilizing anticonvulsants, second-generation antipsychotics, or lithium for acute major depressive episodes in patients diagnosed with type I or II bipolar disorder and applied random-effects meta-analysis to evaluate their efficacy, comparing outcomes based on standardized mean drug-placebo differences (SMD) in improvement, relative response rates (RR), and number-needed-to-treat (NNT). We identified 24 trials of 10 treatments (lasting 7.5 weeks, with ≥ 50 collaborating sites/trial) that met eligibility criteria: lamotrigine (5 trials), quetiapine (5), valproate (4), 2 each for aripiprazole, olanzapine, ziprasidone, and 1 each for carbamazepine, lithium, lurasidone, and olanzapine-fluoxetine. Overall, pooled drug-over-placebo responder-rate superiority (RR) was moderate (29% [CI: 19-40%]), and NNT was 8.2 (CI: 6.4-11). By SMD, apparent efficacy ranked: olanzapine + fluoxetine ≥ valproate > quetiapine > lurasidone > olanzapine, aripiprazole, and carbamazepine; ziprasidone was ineffective, and lithium remains inadequately studied. Notably, drugs were superior to placebo in only 11/24 trials (5/5 with quetiapine, 2/4 with valproate), and only lamotrigine, quetiapine and valproate had > 2 trials. Treatment-associated mania-like reactions were uncommon (drugs: 3.7%; placebo: 4.7%). Controlled trials of non-antidepressant treatments for bipolar depression remain scarce, but findings with olanzapine-fluoxetine, lurasidone, quetiapine, and perhaps carbamazepine and valproate were encouraging; lithium requires adequate testing.

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

BackgroundThere 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. MethodsSubjects 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. ResultsSO2, 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. LimitationsOur data may include a misclassification bias due to the validity of a diagnosis determined from medical services utilization data. ConclusionsSO2, 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.

EPA-1038 – From the first episode to recurrences: the role of automatic thoughts and dysfunctional attitudes in major depressive disorder

Introduction - Objecives According to the cognitive theory, negative automatic thoughts (NAT) and dysfunctional attitudes (DA) are important causal factors for the onset and maintanence of depression. There is limited data on the effects of NATs and DAs on the recurrence of depressive episodes. This study aims to compare the NATs and DAs of first versus recurrent episode depressive patients. The hypothesis of the study is that the intensity of negative cognitions will parallel the number of recurrences. Methods For the study, 100 first episode and 100 recurrent episode major depressive disorder diagnosed outpatients and 100 healthy volunteers presenting to the psychiatry clinics of three hospitals in Turkey were recruited. The participants were diagnosed by MINI, asked to complete the BDI, ATQ and DAS. Statistical analyses were undertaken to predict the variables affecting recurrence. Results The groups were not statistically different on sociodemographic variables. The mean NAT and DA scores were highest in the recurrent depression group. Regression analyses for the prediction of recurrence revealed that perfectionistic attitude, severity of depression and number of hospitalizations were the most correlated variables. The number of recurrences was correlated with the perfectionistic attitude scores. Conclusion These results show that the NATs and DAs of first episode depression patients differ from those of the recurrent episode depression patients, and the number of recurrences are predicted by perfectionistic attitudes. This has clinical implications in the treatment of depression, particularly points out to the need to manage perfectionistic attitudes to prevent recurrences.

İlk atak ve rekürren major depresyon hastalarının kognitif işlevler açısından karşılaştırılması

Comparison of first episode and recurrent major depression patients in terms of cognitive function Objective: Cognitive impairment is one of the most important causes of disability in depression. There are conflicting results about the nature of cognitive impairment with some studies finding a difference between first episode (FE) and recurrent depression (RD) and a correlation between cognitive impairment and depression severity while others do not. Our aim was to compare cognitive function in FE and RD patients and to see if cognitive impairment is correlated with depression severity and number of depressive episodes. Method: Unmedicated 33 FE and 37 RD outpatients with no additional Axis I disorder or physical disorder likely to affect cognition were included into the study and cognitive function was evaluated with verbal memory, verbal fluency, Stroop, Benton facial recognition and Boston naming tests. Results: There were no cognitive differences between FE and RD groups or between RD patients with more or less than 3 depressive episodes. But severely depressed patients had lower naming and immediate memory scores. Depression severity was positively correlated with Stroop color word reading time and negatively correlated with verbal memory learning score. Perseveration scores were positively correlated with total depressive episode duration. Discussion: Depression severity seems to be more effective on cognitive function than the number of depressive episodes. Results indicate that simple attention, encoding, learning, naming and mental speed is affected negatively from depression severity and cognitive flexibility was negatively affected by total

May oxytocin be a trait marker for bipolar disorder?

There is evidence to suggest that oxytocin is effective in stabilizing mood in humans. Lower plasma oxytocin levels have been reported in patients with major depression. The objective of this study was to investigate serum oxytocin levels during manic and depressive episodes and in the remission period in patients with bipolar disorder. Twenty-two patients in manic episode, 21 in depressive episode, and 24 in remission at the initial phase, ranging from 18 to 65 years of age, who were diagnosed with BD Type I and 24 healthy individuals were included in this study. Blood samples were collected from subjects in the morning at the beginning of the study. A second blood sampling was obtained from manic and depressive patients after response to treatment. MANCOVA was performed to compare the oxytocin values of the groups. The serum oxytocin levels of patients in manic episode were statistically significantly higher than those of the depressive episode and remission groups and of the healthy subjects. The serum oxytocin levels of patients in the depressive episode group and in the remission group were statistically significantly higher than those of the control group. The serum oxytocin levels of the manic episode and depressive episode patients after response to treatment were statistically significantly higher than those of the control group, and there was no statistically significant difference between the patient groups in serum oxytocin levels. The higher oxytocin levels observed in patient groups, compared to the controls, before and after response to treatment suggest that oxytocin may be a trait marker in BD.

Quetiapine monotherapy in bipolar II depression: combined data from four large, randomized studies.

BackgroundDespite being present in up to 1% of the population, few controlled trials have examined the efficacy of treatments for bipolar II depression. Pooled data are presented from four placebo-controlled studies (BOLDER I [5077US/0049] and II [D1447C00135]; EMBOLDEN I [D1447C00001] and II [D1447C00134]) that evaluated the efficacy of quetiapine monotherapy for depressive episodes in patients with bipolar II disorder.MethodsAll studies included an 8-week, double-blind treatment phase in which patients were randomly assigned to treatment with quetiapine 300 mg/day, quetiapine 600 mg/day, or placebo. Outcome measures included the change from baseline in MADRS total score at week 8, effect sizes, and MADRS response and remission rates.Results and discussionImprovements in mean MADRS total scores from baseline to week 8 were significantly greater with quetiapine 300 and 600 mg/day (−15.58 [n = 283] and −14.88 [n = 289]; p < 0.001) compared with placebo (−11.61 [n = 204]). The MADRS effect sizes were 0.44 for quetiapine 300 mg/day and 0.47 for 600 mg/day (p < 0.001 vs placebo). Significantly higher proportions of patients receiving quetiapine, at both doses, than placebo-treated patients achieved response and remission at week 8 (p < 0.01). Common adverse events associated with quetiapine (both doses) included dry mouth, somnolence, sedation, dizziness, and headache. Rates of mania and hypomania were similar for quetiapine and placebo. Quetiapine monotherapy demonstrated significant efficacy compared with placebo and was generally well tolerated in the treatment of bipolar II depression.

Are variations in whole blood BDNF level associated with the BDNF Val66Met polymorphism in patients with first episode depression?

Brain derived neurotrophic factor (BDNF) seems to play an important role in the pathophysiology of affective disorders. The current study investigated whether blood level BDNF is correlated with the severity of depressive symptoms and recent (six months prior to onset of depression) experience of stressful life events (SLE) in a cohort of patients with a first depressive episode. 262 patients with first episode depression (females 174, males 88, age range 18–70, mean age 41) participated and control sample of 84 participants was included (females 52, males 32, age range 22–70, mean age 42). Symptomatology was rated using Hamilton Rating Scale for Depression (HAMD-17) and Becks Depression Inventory (BDI 21).No differences in whole blood BDNF was seen in relation to the BDNF Val66Met polymorphism and no significant correlations between whole blood BDNF and HAMD-17 or BDI 21 scores were found. No significant associations between the experiences of SLE before onset of depression and BDNF level were observed. Finally, peripheral BDNF differentiated between patients and healthy control persons.In the current sample of first episode depressed patients, the Val66Met polymorphism was not associated with whole blood BDNF and whole blood BNDF level was not associated with the experience of recent SLE.

Lurasidone in Schizophrenia: New Information About Dosage and Place in Therapy

Lurasidone is a newer "atypical" or "secondgeneration" antipsychotic that has received regulatory approval in the US and Canada for the treatment of schizophrenia. Recent changes in lurasidone product labeling include an expansion of the recommended dose range from 40-80 mg/day to 40-160 mg/day, administered once-daily with food. The recommended starting dose is 40 mg/day. Initial dose titration is not required. Efficacy for the treatment of acute episodes of schizophrenia was established in five, 6-week, fixed-dose, randomized, placebo-controlled trials. Additional short-term studies in patients with schizophrenia include a 3-week, randomized, double-blind trial comparing lurasidone with ziprasidone on safety and tolerability outcomes, and a 6-week, randomized, open-label switch study. Available long-term data includes a 12-month, doubleblind safety and tolerability study comparing lurasidone with risperidone; a 6-month, openlabel extension study for one of the shortterm registration studies where patients were initially randomized to receive lurasidone, olanzapine, or placebo; and a 12-month, doubleblind extension study comparing lurasidone with quetiapine extended-release after having received lurasidone, quetiapine extendedrelease, or placebo for 6 weeks. The totality of the evidence supports the overall tolerability of lurasidone, with minimal weight gain and no clinically-meaningful alterations in glucose, lipids, or the electrocardiogram corrected QT (ECG QTc) interval. The most commonly encountered adverse events that can be observed with lurasidone are somnolence, akathisia, nausea, and parkinsonism. Additional clinical trials are underway for the use of lurasidone in patients with bipolar disorder, including major depressive episodes in patients with bipolar I disorder, and in bipolar and schizophrenia maintenance. Principal advantages over some other second-generation antipsychotics are lurasidone's highly favorable metabolic profile and once-daily dosing regimen. Additional studies are desirable to directly compare and contrast lurasidone's efficacy with other antipsychotic agents.

The cumulative load of depressive illness is associated with cognitive function in the remitted state of unipolar depressive disorder

ObjectiveTo investigate whether the cumulative number, duration and subtypes (severity and presence of psychotic features) of previous episodes of depression in patients with unipolar depressive disorder in a remitted state are associated with decreased global cognitive function. MethodsVia the Danish registers individuals between 40 and 80 years of age were identified: (1) patients with a diagnosis of unipolar disorder at their first discharge from a psychiatric hospital in the period 1994 to 2002, and (2) gender and age matched control individuals. The participants were assessed with the Cambridge Cognitive Examination (CAMCOG), which provides a composite measure of global cognitive function. ResultsA total of 88 patients and 50 controls accepted our invitation to participate, fulfilled the selection criteria and were included in the study. The cumulative duration of depressive episodes was associated with a decreased CAMCOG score adjusted for age, gender, education, premorbid IQ and residual depressive symptoms (B=−0.14, 95% C.I. (−0.26, −0.02), R2adj=0.31, P=.02). Significant associations were also found between CAMCOG score and the cumulative duration and total number of depressive episodes with psychotic features, respectively. ConclusionOur findings suggest that cognitive dysfunction is associated with the cumulative duration of depressive episodes, and that, in particular, depressive episodes with psychotic features in the course of illness may be a significant predictor of future impairment of cognitive function.

Screening for major depressive episodes in Japanese patients with epilepsy: Validation and translation of the Japanese version of Neurological Disorders Depression Inventory for Epilepsy (NDDI-E)

We validated and translated into Japanese the English version of the screening instrument Neurological Disorders Depression Inventory for Epilepsy (NDDI‐E) to identify major depressive episodes in patients with epilepsy. A total of 159 Japanese subjects with epilepsy underwent a psychiatric structured interview with the Japanese version of the Mini International Neuropsychiatric Interview (M.I.N.I.-J) followed by completion of the Japanese version of NDDI-E (NDDI-E-J). Twelve participants met the M.I.N.I.-J criteria of current major depressive episode. Participants had no difficulties completing the NDDI-E-J. Its Cronbach's alpha coefficient was 0.83 and a cut-off score greater than 16 provided a sensitivity of 0.92, a specificity of 0.89, and a negative predictive value of 0.99. The NDDI-E-J appears to be useful for primary care clinicians to screen for major depressive episodes in epilepsy patients. Routine use of this brief and self-administered instrument in busy clinical settings will likely improve management of depression in Japanese individuals with epilepsy.

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

IntroductionRole 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. MethodsA 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. ResultsBoth 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. Conclusionl-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.

Utility and limitations of PHQ-9 in a clinic specializing in psychiatric care

BackgroundThe Patient Health Questionnaire-9 (PHQ-9), despite its excellent reliability and validity in primary care, has not been examined for administration to psychiatric patients. This study assesses the accuracy of PHQ-9 in screening for major depressive episode and in diagnosing major depressive episode in patients of a psychiatric specialty clinic.MethodsWe compared operational characteristics of PHQ-9 as a screening and diagnostic instrument to DSM-IV-TR diagnosis by a trained psychiatrist as a reference standard. The reference criteria were “current major depressive episode” or “current major depressive episode with major depressive disorder”. PHQ-9 was used with two thresholds: diagnostic algorithm and summary scores (PHQ-9 ≥ 10). The optimal cut-off points of PHQ-9 summary scores were analyzed using a receiver operational characteristics (ROC) curve.ResultsFor “current major depressive episode”, PHQ-9 showed high sensitivity and high negative predictive value at both thresholds, but its specificity and positive predictive value were low. For “current major depressive episode with major depressive disorder”, PHQ-9 also showed high sensitivity and high negative predictive value at both thresholds, but the positive predictive value decreased more than that for “current major depressive episode”. The ROC analysis showed the optimal cut-off score of 13/14 for “current major depressive episode”.ConclusionsPHQ-9 is useful for screening, but not for diagnosis of “current major depressive episode” in a psychiatric specialty clinic.

Longitudinal studies of cerebral glucose metabolism in late‐life depression and normal aging

Late-life depression (LLD) has a substantial public health impact and is both a risk factor for and a prodrome of dementia. Positron emission tomography (PET) studies of cerebral glucose metabolism have demonstrated sensitivity in evaluating neural circuitry involved in depression, aging, incipient cognitive decline, and dementia. The present study evaluated the long term effects of a course of antidepressant treatment on glucose metabolism in LLD patients. Nine LLD patients and seven non-depressed control subjects underwent clinical and cognitive evaluations as well as brain magnetic resonance imaging and PET studies of cerebral glucose metabolism at baseline, after 8 weeks of treatment with citalopram for a major depressive episode (patients only), and at an approximately 2-year follow-up. The majority of LLD patients were remitted at follow-up (7/9). Neither patients nor controls showed significant cognitive decline. The patients showed greater increases in glucose metabolism than the controls in regions associated with mood symptoms (anterior cingulate and insula). Both groups showed decreases in metabolism in posterior association cortices implicated in dementia. Longitudinal changes in cerebral glucose metabolism are observed in controls and in LLD patients without significant cognitive decline that are more extensive than the decreases in brain volume. Longer duration follow-up studies and the integration of other molecular imaging methods will have implications for understanding the clinical and neurobiological significance of these metabolic changes.

Seroquel XL: add‐on treatment for major depressive disorder

AbstractQuetiapine prolonged release (Seroquel XL) now has a licence extension as an addon treatment of major depressive episodes in patients with major depressive disorder. Dr Sameer Jauhar presents the clinical data relating to its efficacy and adverse effects and discusses its place in treatment. Copyright © 2011 Wiley Interface Ltd