Duration Of Depressive Episode Research Articles

The SSRI antidepressants: Exploring their “other” possible properties

Background: Anecdotal reports suggest that the SSRIs may have important properties in addition to their antidepressant effects, possibly modifying mediating variables that dispose to and maintain depression. This preliminary study seeks to identify any such potential variables. Methods: Fifty three subjects who had reported substantial general benefit to their clinician after treatment with an SSRI were requested to retrospectively rate change across a range of constructs assessed by questionnaire. Results: Differential effects were identified. Irritability, trait depression, worry and neuroticism scores showed the most marked improvement, with cognitive style components also showing significant positive change. Equally importantly, there was no evidence of a positive response bias across all constructs. Conclusion: We suggest that the SSRIs may act as “antiworry” agents and reduce irritability, neuroticism and dysfunctional attributions. Limitations: Our study was retrospective and relied on self-report by volunteer patients who had been previously depressed. The study design cannot exclude the possibility that improvement reported on a number of measures may have been due to the amelioration of residual depression. Clinical relevance: The SSRIs, recognised as having antidepressant and anti-obsessional properties, may also have the capacity to lower irritability, worrying and neuroticism. This capacity could be useful per se but may, in addition, reduce the occurrence and duration of depressive episodes, particularly by reducing “anxious worrying”.

The depressive spectrum: diagnostic classification and course

The spectrum of depression is much wider than that reflected in the current diagnostic nomenclature. A large proportion of subjects with depression both in treatment and in the community fail to meet diagnostic criteria for either major depressive disorder (MDD) or dysthymia. Inclusion of subthreshold categories of depression dramatically improves the coverage of treated depression, particularly in community samples, and better enables the characterization of its longitudinal course.This paper investigates the application of diagnostic criteria for both threshold and subthreshold categories of depression in a prospective longitudinal community study of young adults from Zurich, Switzerland. We present the prevalence and treatment rates of each of the depressive subtypes, the degree of diagnostic overlap and the longitudinal stability of subthreshold and threshold categories of depression.The findings indicate that the prevalence rates of subthreshold categories of depression are quite high in the community, and that a substantial proportion of subthreshold depressives, particularly those with recurrent depression, receive treatment. There is a strong tendency for individuals to meet multiple depressive subtypes over time, with little stability of individual categories among those who continue to manifest depression over a 15-year period. The prospective longitudinal data reveal that major depression is both an antecedent to and sequela of subthreshold categories, providing evidence for the validity of the spectrum concept of depression. However, the need for a threshold for the symptom criteria is suggested by the lack of predictive value of minor depression and depressive symptoms only.These results suggest that both the current symptom threshold for a depressive syndrome and recurrence, but not the minimum duration of depressive episodes, are important components of the classification of depression.

The Limits of History-Taking in Geriatric Depression

The authors assessed the limits of reliable history-taking in depressed elderly patients (N = 20) with some cognitive impairment. Each subject and an informant was interviewed with structured instruments by two trained raters. An expert panel formed consensus judgments after reviewing information reported by the patients, the informants, and each of the clinical raters. Intraclass correlation between the two raters was 0.99 for the duration of depressive episodes and 0.88 for age at onset. The raters agreed on the duration of major depressive episodes in 85% of cases and on age at onset in 80% of cases. The duration of previous depressive episodes and age at depression onset cannot always be determined reliably even when informants and structured interviews are used. Greater difficulties may be encountered in patients with minor depression or chronic intermittent depression and early-onset depression. Clinicians should obtain history from as many reliable sources as possible and critically evaluate this information while considering the entire clinical picture. The aggregate kappa statistic can provide a clinically meaningful way of assessing interrater reliability of psychopathological constructs for which several definitions are used.

Recurrent brief depression: A review

Recurrent brief depression (RBD) is a common affective disorder that compromises working capacity and activities of daily living as much as major depression. RBD has been found to be similar to major depressive disorder in many aspects, including severity of symptoms, association with somatic and psychiatric disorders, age of onset, family history, and longitudinal course but not in duration of depressive episodes. The length of the symptomatic periods is in most cases from 2 to 4 days. Here we describe the present knowledge about the prevalence, symptom picture, and psychopharmacologic treatment options of RBD.

Responses to depression and their effects on the duration of depressive episodes.

Responses to depression and their effects on the duration of depressive episodes.

Primary and secondary depression in alcoholism — clinical features and family history

One hundred thirty-six alcoholic inpatients were studied with regard to the association between alcoholism and depression. They fell into three groups: primary depression, secondary depression and non-depressive alcoholism. The main results obtained are as follows: (1) Depression was found in 46 patients (33.8%) in the present or past history; 13 were regarded as primary depression and 33 as secondary depression. (2) The clinical symptoms and the background of the primary group resembled those of endogenous depression. (3) The clinical features, including the duration of depressive episodes in the secondary depression group differed from those in the primary group. (4) No statistically significant differences were noted as to the rates of family-history of alcoholism and depression among the three groups. Clinical and biological differences between the primary and secondary groups were discussed on the basis of these results.

Responses to depression and their effects on the duration of depressive episodes.

I propose that the ways people respond to their own symptoms of depression influence the duration of these symptoms. People who engage in ruminative responses to depression, focusing on their symptoms and the possible causes and consequences of their symptoms, will show longer depressions than people who take action to distract themselves from their symptoms. Ruminative responses prolong depression because they allow the depressed mood to negatively bias thinking and interfere with instrumental behavior and problem-solving. Laboratory and field studies directly testing this theory have supported its predictions. I discuss how response styles can explain the greater likelihood of depression in women than men. Then I intergrate this response styles theory with studies of coping with discrete events. The response styles theory is compared to other theories of the duration of depression. Finally, I suggest what may help a depressed person to stop engaging in ruminative responses and how response styles for depression may develop.

Recurrent brief depression: a new subtype of affective disorder

This paper presents the diagnostic criteria for a new subtype of affective disorder, recurrent brief depression (RBD). Data from a prospective longitudinal cohort of young adults from the general population of Zurich, Switzerland, showed that a substantial proportion, met all of the criteria for major depression in current diagnostic systems except duration. The validity of the subtype of RBD was examined according to clinical manifestations, severity, longitudinal course, and family history. RBD was found to be similar to major depressive disorder (MDD) on most of the indicators of validity including symptomatology, association with somatic and psychiatric disorders, age at onset, family history, longitudinal course and levels of impairment, except duration of depressive episodes. This suggests that RBD constitutes a valid subtype of affective disorder. The major implications of these findings are that both recurrence and duration should be considered in developing diagnostic thresholds for depression and in assessing the severity of affective disorders.

The Effect of Duration of Depressive Episode on the Response of Others

This experiment examined an interpersonal-process view of depression by assessing subjects' reactions to a request for help from a hypothetical person with whom they had been acquainted for a relatively short (2 weeks) or long (1 year) period of time and who had been depressed for either a relatively short (a few days) or long (most of 9 months) period of time. Subjects responded to each of the four hypothetical persons by indicating their probable affective reactions to the request, the number of minutes they would be willing to help, their desire for future social contact, and their expectations of future requests for help. Requests from long-duration depressives elicited significantly more anger regardless of length of acquaintance. Duration of depression × length of acquaintance interaction effects supported the prediction of a reduction in social support and an increase in rejection of the depressed person over the course of a relatively long depressive episode. Path analyses provided limited support...

Thyrotropin responses to TRH in depressive illness: relation to clinical subtypes and prolonged duration of depressive episode.

Thyrotropin responses to TRH in depressive illness: relation to clinical subtypes and prolonged duration of depressive episode.