Depressed Patients In Remission Research Articles

Longitudinal early epigenomic signatures inform molecular paths of therapy response and remission in depressed patients.

The etiology of major depressive disorder (MDD) involves the interaction between genes and environment, including treatment. Early molecular signatures for treatment response and remission are relevant in a context of personalized medicine and stratification and reduce the time-to-decision. Therefore, we focused the analyses on patients that responded or remitted following a cognitive intervention of 8 weeks. We used data from a randomized controlled trial (RCT) with MDD patients (N = 112) receiving a cognitive intervention. At baseline and 8 weeks, blood for DNA methylation (Illumina Infinium MethylationEPIC 850k BeadChip) was collected, as well as MADRS. First, responders (N = 24; MADRS-reduction of at least 50%) were compared with non-responders (N = 60). Then, we performed longitudinal within-individual analyses, for response (N = 21) and for remission (N = 18; MADRS smaller or equal to 9 and higher than 9 at baseline), respectively, as well as patients with no change in MADRS over time. At 8 weeks the sample comprised 84 individuals; 73 patients had DNA methylation for both time-points. The RnBeads package (R) was used for data cleaning, quality control, and differential DNA-methylation (limma). The within-individual paired longitudinal analysis was performed using Welch's t-test. Subsequently gene-ontology (GO) pathway analyses were performed. No CpG was genome-wide significant CpG (p < 5 × 10-8). The most significant CpG in the differential methylation analysis comparing response versus non-response was in the IQSEC1 gene (cg01601845; p = 1.53 × 10-6), linked to neurotransmission. The most significant GO-terms were linked to telomeres. The longitudinal response analysis returned 67 GO pathways with a p < 0.05. Two of the three most significant pathways were linked to sodium transport. The analysis for remission returned 46 GO terms with a p-value smaller than 0.05 with pathways linked to phosphatase regulation and synaptic functioning. The analysis with stable patients returned mainly GO-terms linked to basic cellular processes. Our result suggest that DNA methylation can be suitable to capture early signs of treatment response and remission following a cognitive intervention in depression. Despite not being genome-wide significant, the CpG locations and GO-terms returned by our analysis comparing patients with and without cognitive impairment, are in line with prior knowledge on pathways and genes relevant for depression treatment and cognition. Our analysis provides new hypotheses for the understanding of how treatment for depression can act through DNA methylation and induce response and remission.

The Olfactory Deficits of Depressed Patients are Restored After Remission With Venlafaxine Treatment

It is unclear whether olfactory deficits improve after remission in depressed patients. Therefore, we aimed to assess the olfactory performance of drug-free patients with major depressive episodes (MDE) and its change after antidepressant treatment.

Machine learning to predict clinical remission in depressed patients after acute phase selective serotonin reuptake inhibitor treatment

ObjectiveSelective serotonin reuptake inhibitors (SSRIs) are suggested as the first-line treatment for patients with major depressive disorder (MDD), but the remission rate is unsatisfactory. We aimed to establish machine learning models and explore variables available at baseline to predict the 8-week outcome among patients taking SSRIs. MethodsData from 400 patients were used to build machine learnings. The last observation carried forward approach was used to determine the remitter/non-remitter status of the patients at week 8. Using least absolute shrinkage and selection operator (LASSO) to select features, we built 4 different machine learning algorithms including gradient boosting decision tree, support vector machine (SVM), random forests, and logistic regression with five-fold cross-validation. Then, we adopted Shapley additive explanations (SHAP) values to interpret the model output. ResultsThe remission rate is 67.8%. We obtained 78 features from the baseline characteristics, including 25 sociodemographic characteristics, 31 clinical features, 15 psychological traits and 7 neurocognitive functions, and 13 of these features were selected to establish SVM. The accuracy of the SVM prediction is 74.49%, reaching an average area under the curve of 0.734±0.043. The sensitivity is 0.899±0.038 with a positive predictive value of 0.776±0.028. The specificity is 0.422±0.091 with a negative predictive value of 0.674±0.086. According to the SHAP values, neurocognitive functions and anxiety and hypochondriasis symptoms were important predictors. ConclusionOur study supports the utilization of machine learning approaches with inexpensive and highly accessible variables to accurately predict the 8-week treatment outcome of SSRIs in patients with MDD.

The olfactory deficits of depressed patients are restored after remission with venlafaxine treatment.

It is unclear whether olfactory deficits improve after remission in depressed patients. Therefore, we aimed to assess in drug-free patients the olfactory performance of patients with major depressive episodes (MDE) and its change after antidepressant treatment. In the DEP-ARREST-CLIN study, 69 drug-free patients with a current MDE in the context of major depressive disorder (MDD) were assessed for their olfactory performances and depression severity, before and after 1 (M1) and 3 (M3) months of venlafaxine antidepressant treatment. They were compared to 32 age- and sex-matched healthy controls (HCs). Olfaction was assessed with a psychophysical test, the Sniffin' Sticks test (Threshold: T score; Discrimination: D score; Identification: I score; total score: T + D + I = TDI score) and Pleasantness (pleasantness score: p score; neutral score: N score; unpleasantness score: U score). As compared to HCs, depressed patients had lower TDI olfactory scores [mean (s.d.) 30.0(4.5) v. 33.3(4.2), p < 0.001], T scores [5.6(2.6) v. 7.4(2.6), p < 0.01], p scores [7.5(3.0) v. 9.8(2.8), p < 0.001)] and higher N scores [3.5(2.6) v. 2.1(1.8), p < 0.01]. T, p and N scores at baseline were independent from depression and anhedonia severity. After venlafaxine treatment, significant increases of T scores [M1: 7.0(2.6) and M3: 6.8(3.1), p < 0.01] and p scores [M1: 8.1(3.0) and M3: 8.4(3.3), p < 0.05] were evidenced, in remitters only (T: p < 0.01; P: p < 0.01). Olfaction improvement was mediated by depression improvement. The olfactory signature of MDE is restored after venlafaxine treatment. This olfaction improvement is mediated by depression improvement.

Predictors of poor 6-week outcome in a cohort of major depressive disorder patients treated with antidepressant medication: the role of entrapment

Background Only a small number of consistent processes predict which depressed patients will achieve remission with antidepressant medication. One set of processes is that of social ranking strategies/variables that are related to life events and severe difficulties. Particularly, defeat and entrapment predict poorer response to antidepressants. However, results are inconsistent. Aim The current study aimed to evaluate evolutionary strategies, childhood maltreatment, neglect and life events and difficulties (LEDs) as predictors of remission in depressed patients undergoing pharmacological treatment in a psychiatric outpatient sample. Methods A cohort of 139 depressed outpatients undergoing pharmacological treatment was followed prospectively in a naturalistic study for 6 weeks. Two major evaluations were considered at baseline and 6 weeks. We allocated patients to a pharmacological treatment algorithm for depression – the Texas Medication Algorithm Project. Variables evaluated at baseline and tested as predictors of remission included demographic and clinical data, severity of depression, social ranking, evolution informed variables, LEDs and childhood maltreatment. Results Of the 139 patients, only 24.5% were remitted at week 6. In univariate analyses, non-remitted patients scored significantly higher in all psychopathology and vulnerability scales except for submissive behaviour and internal entrapment. For the logistic regression, a higher load of LEDs of the entrapment and humiliation dimension in the year before the index episode (OR = 6.62), and higher levels external entrapment in the Entrapment Scale (OR = 1.10) predicted non-remission. These variables accounted for 28.7% of the variance. Conclusions Multivariate analysis revealed that external entrapment was the only predictor of non-remission.

Early improvement in HAMD-17 and HAMD-7 scores predict response and remission in depressed patients treated with fluoxetine or electroconvulsive therapy

BackgroundCompared to the 17-Item Hamilton Rating Scale for Depression (HAMD-17), the 7-Item Hamilton Rating Scale for Depression (HAMD-7) would be more practical for use in busy clinical settings. Herein, we aim to evaluate (1) whether the HAMD-7 is a reliable and valid measure that is sensitive to changes in depressive symptoms, and (2) whether early improvement of depressive symptoms, as measured by the HAMD-7, is capable of predicting response and remission in patients with major depressive disorder (MDD) during acute treatment with fluoxetine or electroconvulsive therapy (ECT). MethodsThis is a post-hoc analysis of two clinical trials in MDD. Internal consistency, validity, and sensitivity-to-change of the HAMD-17 and HAMD-7 were compared during acute treatment and at 3-month follow-up. Receiver operating characteristic analyses were used to evaluate the discriminative capacity of the HAMD-17 and HAMD-7. ResultsThe HAMD-7 is a reliable and valid measure that is sensitive to changes in depressive symptoms. Early improvement, as measured by either the HAMD-17 or HAMD-7, was capable of predicting response and remission to acute treatment with fluoxetine or ECT with good discriminative capacity. LimitationsThis is a post-hoc analysis of two open-label clinical trials with limited sample sizes. All patients were Taiwanese, which limits the generalizability of our results. ConclusionsHAMD-7 is a clinically useful measure that is capable of detecting early improvement of depressive symptoms. The HAMD-7 may have the potential to inform clinical assessment as part of measurement-based care.

Emotional Biases and Recurrence in Major Depressive Disorder. Results of 2.5 Years Follow-Up of Drug-Free Cohort Vulnerable for Recurrence.

An interesting factor explaining recurrence risk in Major Depressive Disorder (MDD) may be neuropsychological functioning, i.e., processing of emotional stimuli/information. Negatively biased processing of emotional stimuli/information has been found in both acute and (inconclusively) remitted states of MDD, and may be causally related to recurrence of depression. We aimed to investigate self-referent, memory and interpretation biases in recurrently depressed patients in remission and relate these biases to recurrence. We included 69 remitted recurrent MDD-patients (rrMDD-patients), 35–65 years, with ≥2 episodes, voluntarily free of antidepressant maintenance therapy for at least 4 weeks. We tested self-referent biases with an emotional categorization task, bias in emotional memory by free recall of the emotion categorization task 15 min after completing it, and interpretation bias with a facial expression recognition task. We compared these participants with 43 never-depressed controls matched for age, sex and intelligence. We followed the rrMDD-patients for 2.5 years and assessed recurrent depressive episodes by structured interview. The rrMDD-patients showed biases toward emotionally negative stimuli, faster responses to negative self-relevant characteristics in the emotional categorization, better recognition of sad faces, worse recognition of neutral faces with more misclassifications as angry or disgusting faces and less misclassifications as neutral faces (0.001 < p < 0.05). Of these, the number of misclassifications as angry and the overall performance in the emotional memory task were significantly associated with the time to recurrence (p ≤ 0.04), independent of residual symptoms and number of previous episodes. In a support vector machine data-driven model, prediction of recurrence-status could best be achieved (relative to observed recurrence-rate) with demographic and childhood adversity parameters (accuracy 78.1%; 1-sided p = 0.002); neuropsychological tests could not improve this prediction. Our data suggests a persisting (mood-incongruent) emotional bias when patients with recurrent depression are in remission. Moreover, these persisting biases might be mechanistically important for recurrence and prevention thereof.

Adding mindfulness-based cognitive therapy to maintenance antidepressant medication for prevention of relapse/recurrence in major depressive disorder: Randomised controlled trial

BackgroundMindfulness-based cognitive therapy (MBCT) and maintenance antidepressant medication (mADM) both reduce the risk of relapse in recurrent depression, but their combination has not been studied. Our aim was to investigate whether the addition of MBCT to mADM is a more effective prevention strategy than mADM alone. MethodsThis study is one of two multicenter randomised trials comparing the combination of MBCT and mADM to either intervention on its own. In the current trial, recurrently depressed patients in remission who had been using mADM for 6 months or longer (n=68), were randomly allocated to either MBCT+mADM (n=33) or mADM alone (n=35). Primary outcome was depressive relapse/recurrence within 15 months. Key secondary outcomes were time to relapse/recurrence and depression severity. Analyses were based on intention-to-treat. ResultsThere were no significant differences between the groups on any of the outcome measures. LimitationsThe current study included patients who had recovered from depression with mADM and who preferred the certainty of continuing medication to the possibility of participating in MBCT. Lower expectations of mindfulness in the current trial, compared with the parallel trial, may have caused selection bias. In addition, recruitment was hampered by the increasing availability of MBCT in the Netherlands, and even about a quarter of participants included in the trial who were allocated to the control group chose to get MBCT elsewhere. ConclusionsFor this selection of recurrently depressed patients in remission and using mADM for 6 months or longer, MBCT did not further reduce their risk for relapse/recurrence or their (residual) depressive symptoms.

Depressed patients in remission show an interaction between variance in the mineralocorticoid receptor NR3C2 gene and childhood trauma on negative memory bias.

Genetic, environmental, and cognitive factors play a role in the development and recurrence of depression. More specifically, cognitive biases have been associated with depression risk genes and life events. Recently, the mineralocorticoid receptor NR3C2 gene, and in particular the rs5534 polymorphism, has been associated with negative memory bias, at least in healthy individuals who experienced severe life adversity. The current study examined the interaction between the rs5534 genotype and different types of adverse life events in a sample of depressed patients in remission. A total of 298 depressed patients in remission performed an incidental emotional memory task (negative and positive words). Life adversity, childhood trauma, and recent adversity were measured using a self-report questionnaire. NR3C2 rs5534 by life adversity, as well as childhood trauma and recent adversity interactions were analyzed for negative and positive memory bias using analyses of covariance. The significant interaction between rs5534 and childhood trauma on negative memory bias (P=0.046) indicated that risk 'A' allele carriers with childhood trauma tended to show more negative memory bias compared to individuals homozygous for the G allele who had experienced childhood trauma and A allele carriers without childhood trauma. No interaction effects with life adversity or recent adversity were found. Also, no main effect of rs5534 on memory bias was found, although we had insufficient power for this analysis. An association of the NR3C2 gene and childhood trauma with negative memory bias was found in depressed patients in remission, which extends previous findings in a healthy population.

The Three-Month Effect of Mobile Internet-Based Cognitive Therapy on the Course of Depressive Symptoms in Remitted Recurrently Depressed Patients: Results of a Randomized Controlled Trial

Background: Internet-based cognitive therapy with monitoring via text messages (mobile CT), in addition to treatment as usual (TAU), might offer a cost-effective way to treat recurrent depression. Method: Remitted patients with at least 2 previous episodes of depression were randomized to mobile CT in addition to TAU (n = 126) or TAU only (n = 113). A linear mixed model was used to examine the effect of the treatment condition on a 3-month course of depressive symptoms after remission. Both an intention-to-treat analysis (n = 239) and a completer analysis (n = 193) were used. Depressive symptoms were assessed using the Inventory of Depressive Symptomatology (IDS-SR₃₀) at baseline and 1.5 and 3 months after randomization. Results: Residual depressive symptoms showed a small but statistically significant decrease in the intention-to-treat group over 3 months in the mobile CT group relative to the TAU group (difference: -1.60 points on the IDS-SR₃₀ per month, 95% CI = -2.64 to -0.56, p = 0.003). The effect of the treatment condition on the depressive symptomatology at the 3-month follow-up was small to moderate (Cohen's d = 0.44). All analyses among completers (≥5 modules) showed more pronounced treatment effects. Adjustment for unequally distributed variables did not markedly affect the results. Conclusions: Residual depressive symptoms after remission showed a more favorable course over 3 months in the mobile CT group compared to the TAU group. These results are a first indication that mobile CT in addition to TAU is effective in treating recurrently depressed patients in remission. However, demonstration of its long-term effectiveness and replication remains necessary.

Cognitive Distortions in Depressed Women: Trait, or State Dependent?

Objective: According to the cognitive theory developed by Beck, cognitive distortions are important mediators for the onset and maintenance of depressive disorders. It has not been researched if these cognitive distortions are more frequently encountered during the depressive episode, or if they are trait-like features. This study aims to investigate this. The hypothesis of the study is that cognitive distortions are state dependent. Method: Three groups of outpatients (n=178 patients in acute major depressive episode, n=168 depressive patients in remission, n=177 healthy controls) presenting to the psychiatry clinics of three different state hospitals were recruited for the study. The participants were diagnostically interviewed by the MINI according to the DSM-IV criteria. The participants were asked to complete the Cognitive Distortions Scale and the severity of their depression was measured by the Inventory for Depressive Symptomatology. Results: According to the cognitive distortion subscales, except for the self-blame subscale, the acute depressive group scored the highest. Also it was found that the cognitive distortions of the depressive populations, except for the self-blame related ones, statistically differed from the healthy controls’. Self-blame related distortions were mood state dependent. Conclusion: The results have revealed that self-criticism, helplessness, hopelessness and preoccupation with danger related distortions had trait-like features, whereas self-blame related distortions were state dependent. This has clinical implications for the psychotherapeutic treatment of cognitive distortions in depression. Specifically, self-criticism related distortions should be managed during cognitive therapy for depression since the other subscales seem rather problematic.

Anxiety symptoms among remitted depressed outpatients: Prevalence and association with quality of life and psychosocial functioning

BackgroundPrior studies of remission from depression have only examined the impact of residual depressive, but not anxiety, symptoms. Given that anxiety comorbidity in currently depressed patients is common and is associated with poorer outcomes, residual anxiety symptoms may play a significant role in remitted patients' well-being and vulnerability to relapse. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we examined the frequency of residual anxiety symptoms among depressed outpatients in remission based on the HAM-D and associations among residual anxiety, psychosocial functioning and quality of life. MethodsWe interviewed 274 psychiatric outpatients diagnosed with DSM-IV major depressive disorder. Patients completed measures of depression and anxiety symptoms, psychosocial functioning, and quality of life. ResultsNearly three-quarters of remitted depressed patients endorsed at least one residual anxiety symptom, with a majority experiencing more than one symptom. Anxiety severity was associated with reduced functioning and quality of life across all life domains. Controlling for depression severity, anxiety symptoms were independently related to reduced functioning and quality of life in several domains. LimitationsWe did not assess for specific pre-existing DSM-IV anxiety disorders nor particular treatments patients received, which may have influenced residual anxiety symptoms. Future studies should replicate the results using other measures of remission. ConclusionsAnxiety symptoms are common in depressed patients in remission, and independently related to reduced functioning and quality of life. Thus, it is important to consider anxiety symptoms in evaluating the completeness of treatment response of depressed patients.

Incorporating Multidimensional Patient-Reported Outcomes of Symptom Severity, Functioning, and Quality of Life in the Individual Burden of Illness Index for Depression to Measure Treatment Impact and Recovery in MDD

The National Institute of Mental Health Affective Disorders Workgroup identified the assessment of an individual's burden of illness as an important need. The Individual Burden of Illness Index for Depression (IBI-D) metric was developed to meet this need. To assess the use of the IBI-D for multidimensional assessment of treatment efficacy for depressed patients. Complete data on depressive symptom severity, functioning, and quality of life (QOL) from depressed patients (N = 2280) at entry and exit of level 1 of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study (12-week citalopram treatment) were used as the basis for calculating IBI-D and self-rating scale changes. Principal component analysis of patient responses at the end of level 1 of STAR*D yielded a single principal component, IBI-D, with a nearly identical eigenvector to that previously reported. While changes in symptom severity (Quick Inventory of Depressive Symptomatology-Self Report) accounted for only 50% of the variance in changes in QOL (Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form) and 47% of the variance in changes in functioning (Work and Social Adjustment Scale), changes in IBI-D captured 83% of the variance in changes in QOL and 80% in functioning, while also capturing 79% of the variance in change in symptom severity (Quick Inventory of Depressive Symptomatology-Self Report). Most importantly, the changes in IBI-D of the 36.6% of remitters who had abnormal QOL and/or functioning (mean [SD], 2.98 [0.35]) were significantly less than the changes in IBI-D of those who reported normal QOL and functioning (IBI-D = 1.97; t = 32.6; P < 10(-8)) with an effect size of a Cohen d of 2.58. In contrast, differences in symptom severity, while significant, had a Cohen d of only 0.78. Remission in depressed patients, as defined by a reduction in symptom severity, does not denote normal QOL or functioning. By incorporating multidimensional patient-reported outcomes, the IBI-D provides a single measure that adequately captures the full burden of illness in depression both prior to and following treatment; therefore, it offers a more accurate metric of recovery. clinicaltrials.gov Identifier: NCT00021528.

Predicting disagreement between physicians and patients on depression response and remission

Demographic, personality, and disease-related factors all contribute when patients disagree with physicians on the severity of subjective symptoms. This study aims to create a model, on the basis of patient factors at treatment initiation, for longitudinal prediction of disagreement on treatment response and remission in depressed patients. Four hundred patients with major depressive disorder were studied during a clinical drug trial. Repeated assessments with the Montgomery-Åsberg Depression Rating Scale (MADRS) and the self-rating version (MADRS-S) were used to indicate response or remission. Factors at baseline and week 2 were tested for inclusion in a model for the prediction of discordance on remission and response between patients and physicians at week 8. The models were then tested, in the same population, at weeks 12, 16, and 24. Model AUCs ranged from 0.71 to 0.74 for week 8. The models that were validated at weeks 12, 16, and 24 indicated stability in the predictive value of the models. The risk for longitudinal disagreement in the evaluation of depression treatment response and remission in clinical practice and drug trials can be predicted using factors at study initiation and at week 2.

Event-related brain potentials reflect increased concentration ability after mindfulness-based cognitive therapy for depression: A randomized clinical trial

Mindfulness-based cognitive therapy (MBCT) effectively prevents relapse/recurrence in major depression. The ability to deploy and maintain attention on a particular focus is considered as a prerequisite for ‘mindful’, ‘metacognitive’ awareness, and hence crucial for therapy success. Accordingly, sustained concentration is the skill most extensively taught in MBCT. The goal of the present study was to test whether this ability increases after MBCT, as assumed. The late component of the contingent negative variation (CNV), an event-related brain potential (ERP), known to reflect the allocation of attentional resources, was used as the measure of concentration ability. In the main phase of the study, 91 recurrently depressed patients in remission were randomly assigned to eight-week treatment by either MBCT or waiting (WAIT for delayed MBCT). The CNV response to an auditory test stimulus was measured pre- and post-treatment in a ‘mindfulness task’, in which patients were instructed to focus on their breath, as taught in MBCT. The late CNV (LCNV) was increased only after MBCT (and not after WAIT). This result reflects patients' improved ability to shift their attention toward current moment experience and away from potentially depressogenic thinking or rumination during mild dysphoric states—a known risk factor for depressive relapse/recurrence.

Support and Undermining in Interpersonal Relationships Are Associated with Symptom Improvement in a Trial of Antidepressant Medication

The purpose of this study was to investigate the relationships of chronic stress, social undermining, and social support with symptom reduction and remission in depressed patients treated with antidepressant medication (citalopram), and to determine whether these relationships were moderated by ethnicity. A sample of 301 treatment-seeking adult patients with non-psychotic depression, including 169 African American and 132 Caucasian men and women, were enrolled in an eight week, dose-escalation clinical trial. Intent-to-treat analyses indicated that, consistent with expectations, more baseline social support was associated with greater symptom reduction and higher likelihood of remission, especially at higher levels of social undermining. Additionally, increases in social support from baseline to last visit were associated with more symptom reduction and higher likelihood of remission. However, contrary to expectations, higher levels of baseline social undermining were associated with more symptom reduction in Caucasians, but not in African Americans. Results supported the treatment-enhancing effect of available social support at the beginning of treatment and over the course of treatment. Efforts to enhance social support for patients on antidepressants should be considered as part of comprehensive treatment.

Antidepressant Monotherapy vs Sequential Pharmacotherapy and Mindfulness-Based Cognitive Therapy, or Placebo, for Relapse Prophylaxis in Recurrent Depression

Mindfulness-based cognitive therapy (MBCT) is a group-based psychosocial intervention designed to enhance self-management of prodromal symptoms associated with depressive relapse. To compare rates of relapse in depressed patients in remission receiving MBCT against maintenance antidepressant pharmacotherapy, the current standard of care. Patients who met remission criteria after 8 months of algorithm-informed antidepressant treatment were randomized to receive maintenance antidepressant medication, MBCT, or placebo and were followed up for 18 months. Outpatient clinics at the Centre for Addiction and Mental Health, Toronto, Ontario, Canada, and St Joseph's Healthcare, Hamilton, Ontario. One hundred sixty patients aged 18 to 65 years meeting DSM-IV criteria for major depressive disorder with a minimum of 2 past episodes. Of these, 84 achieved remission (52.5%) and were assigned to 1 of the 3 study conditions. Patients in remission discontinued their antidepressants and attended 8 weekly group sessions of MBCT, continued taking their therapeutic dose of antidepressant medication, or discontinued active medication and were switched to placebo. Relapse was defined as a return, for at least 2 weeks, of symptoms sufficient to meet the criteria for major depression on module A of the Structured Clinical Interview for DSM-IV. Intention-to-treat analyses showed a significant interaction between the quality of acute-phase remission and subsequent prevention of relapse in randomized patients (P = .03). Among unstable remitters (1 or more Hamilton Rating Scale for Depression score >7 during remission), patients in both MBCT and maintenance treatment showed a 73% decrease in hazard compared with placebo (P = .03), whereas for stable remitters (all Hamilton Rating Scale for Depression scores ≤7 during remission) there were no group differences in survival. For depressed patients achieving stable or unstable clinical remission, MBCT offers protection against relapse/recurrence on a par with that of maintenance antidepressant pharmacotherapy. Our data also highlight the importance of maintaining at least 1 long-term active treatment in unstable remitters.

Dysfunctional attitudes in remitted depression patients with and without personality disorders

Objective To compare the differences of dysfunctional attitudes between depressive patients in remission with and without personality disorder (PD).Methods A total of 72 patients with remitted depression were assessed with Personality Diagnostic Questionnaire-4 (PDQ-4) and Dysfunctional Attitudes Scale (DAS).They were divided into PD group ( n = 20 ) and non-PD group ( n = 31 ) according to their PDQ-4 scores.The differences of dysfunctional attitudes between the two groups were compared.Results The total score and seven factors' scores of DAS of the PD group were ( ( 142.40 ± 20.68 ), ( 16.55 ± 3.76), ( 16.35 ± 5.45 ),( 18.35 ± 4.15 ), ( 17.90 ± 3.55 ), ( 18.85 ± 5.72 ), ( 18.25 ± 4.82 ), ( 20.75 ± 5.54) respectively) significantly higher than the counterparts of the non-PD group, which were( ( 113.61 ± 19.08 ), (13.71 ± 2.88 ), ( 12.45 ±2.87) ,(12.55 ±3.60),(13.90 ±3.72) ,(14.68 ±3.51),(14.16 ±4.12),(15.81 ±4.78)) respectively (P＜ 0.01 ).Conclusion Remitted depressive patients with personality disorders have more cognitive distortions than those without personality disorders. Key words: Depression ; Dysfunctional attitudes ; Personality disorders ;

Hormonal responses to the 5-HT1A agonist buspirone in remitted endogenous depressive patients after long-term imipramine treatment

The serotonin-1A (5-HT1A) receptor subtypes are considered as targets of a variety of antidepressant drugs. Previous studies have suggested different adaptive changes in pre- and post-synaptic 5-HT receptors in the brain after treatment with non-selective tricyclic antidepressants (TCA) and selective 5-HT re-uptake inhibitors (SSRIs). The present study aimed to investigate the adaptive effect of the TCA imipramine on the post-synaptic 5-HT1A receptor function in the hypothalamus. A longitudinal design was used in 14 patients with major depressive disorder (DSM-IV) with endogenous features (Newcastle Scale) in order to assess the functional status of post-synaptic 5-HT1A receptors before and after successful antidepressant treatment with imipramine. The effect of the 5-HT1A receptor agonist, buspirone, on ACTH, cortisol, and prolactine (PRL) plasma levels was used to assess the functional status of hypothalamic 5-HT1A receptors. A group of 15 concurrent normal subjects were used as control. Endogenous depressed patients in remission and currently receiving treatment with imipramine (mean length of treatment 145 days, SD=27) presented significantly lower buspirone responses to ACTH and cortisol than in the pre-treatment condition (Deltamax p< or =.05; AUC p<.001) and to ACTH in comparison with healthy controls (Deltamax p<.01; AUC p<.05). No significant differences were found between the post-treatment and pre-treatment PRL responses, or between patients in both conditions and controls; nevertheless, the PRL response in patients in remission and receiving treatment almost reached the values seen in controls. This study extends previous findings from our group using the SSRI citalopram as an antidepressant. Imipramine and citalopram induce similar changes in the endocrine response to buspirone in depressed patients. As the direction of change in ACTH-cortisol and PRL responses after treatment is the opposite, we cannot substantiate increases or decreases in the sensitivity of post-synaptic 5-HT1A receptors in the hypothalamus by long-term imipramine treatment and/or resolution of illness. Therefore, the hormonal changes may result from different or multiples unknown mechanisms.

Successful Retrial of ECT Two Months After ECT-Induced Takotsubo Cardiomyopathy

heart failure; however, recovery of cardiac function is often complete within the first week following the insult. Cardiac enzymes may be mildly elevated, but on cardiac catheterization there is usually no evidence of coronary artery disease, or only "mild luminal irregularities" may be noted (7). Contraction band necrosis may be seen on biopsy in the more serious cases. The cause of takotsubo cardiomyopathy is unknown, but several mechanisms have been suggested, including ischemia from coronary artery spasm, microvascular spasm, and direct myocyte injury (5).