Duration Of Depressive Episode Research Articles

Treatment Seeking for Depression in Canada and the United States

Treatment Seeking for Depression in Canada and the United States

Impaired implicit sequence learning in depression: a probe for frontostriatal dysfunction?

Implicit learning through motor sequencing tasks is sensitive to basal ganglia dysfunction. Consequently, it is ideally suited for testing elements of the frontostriatal model of major depression and performance can be related to key clinical, neuropsychological, vascular and biochemical data. Twenty-one subjects with moderate to severe unipolar depression and 21 age-, sex- and education-matched controls were recruited. Clinical, vascular and biochemical data were recorded. Subjects were administered a battery of neuropsychological tests that assessed speed of processing, working memory, learning, memory, language, perceptual organization and executive functioning. Additionally, subjects were administered a motor sequencing implicit learning task. Implicit learning is assumed when reaction times improve during the sequenced condition as compared to the pseudo-random baseline condition. The rate of implicit learning in persons with depression was only half that of control subjects (3.6% v. 7.3%). Lower rates of implicit learning in patients were associated with poorer performance on neuropsychological tests of visuomotor speed and mental flexibility, longer duration of depressive episode and severity of acute stress. In a small number of subjects, poorer performance was also related to past suicide attempt. Impaired implicit learning in persons with depression is consistent with frontostriatal dysfunction. Performance is related to some clinical characteristics and to neuropsychological functioning on tests of visuomotor speed and mental flexibility.

Contributing factors to changes of cerebral blood flow in major depressive disorder

Background Results of single photon emission computed tomography (SPECT) regarding mood disorders have been inconsistent. The aim of the study was to elucidate factors contributing to changes in cerebral blood flow in patients with major depressive disorder. Methods A total of 89 consecutive patients diagnosed with major depressive disorder using DSM-IV semistructured interviews were evaluated using single photon emission computed tomography, the 17-item Hamilton Rating Scale for Depression (HRSD), and the Global Assessment of Function (GAF) scale. Nineteen of these patients also underwent the same tests during remission. Results Global cerebral blood flow (gCBF) was significantly higher during remission than at the time of enrollment. Significant correlations were seen between gCBF and age, duration of previous episode of depression, and hypochondriasis. However, no correlation was seen between gCBF and HRSD, GAF, severity and duration of depressive episode, or melancholia-type depression. Correlations between gCBF and age were seen only at enrollment and disappeared during remission. No differences in regional cerebral blood flow at any site were seen between time of enrollment and remission for the same patient. Limitation Analysis that adequately accounts for these factors to changes of cerebral blood flow in major depressive disorder will require a large subject population. Conclusions These results suggest that although there is a decrease in gCBF in major depressive disorder, the level of the decrease is determined by conditions present before episode onset, rather than by the characteristics of the episode itself. The findings also suggest that the correlation between gCBF and age is state-dependent.

Self-reported premenstrual exacerbation of depressive symptoms in patients seeking treatment for major depression

Very little research has examined the frequency with which women with major depressive disorder experience premenstrual exacerbation (PME) of depression or the characteristics of those who report such worsening. The NIMH Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study provides a unique opportunity to evaluate PME in depressed women seeking treatment in primary care or psychiatric settings. This report presents data from the first 1500 participants enrolled in the STAR*D study. Premenopausal women with major depressive disorder were asked if they experienced a worsening of their depressive symptoms 5-10 days prior to menses. Those reporting PME were compared with those reporting no PME with regard to sociodemographic characteristics, course of illness features, symptom presentation, general medical co-morbidity, functional impairment, and quality of life. Of 433 premenopausal women not taking oral contraceptives, 64% reported a premenstrual worsening of their depression. Women who reported PME had a longer duration of their current major depressive episode [30.7 (S.D. = 73.7) months versus 13.5 (S.D. = 13.2) months; p=0.001], as well as greater general medical co-morbidity. Women reporting PME were also more likely to endorse symptoms of leaden paralysis, somatic complaints, gastrointestinal complaints, and psychomotor slowing, and were less likely to endorse blunted mood reactivity. PME is endorsed by the majority of premenopausal women with major depressive disorder and appears to be associated with a longer duration of depressive episode. PME is a common and important clinical issue deserving of further attention in both research and practice.

Depressive disorders were the fourth leading cause of global disease burden in the year 2000

Ustun TB, Ayuso-Mateos JL, Chatterji S, et al . Global burden of depressive disorders in the year 2000. Br J Psychiatry 2004;184:386–92. [OpenUrl][1][Abstract/FREE Full Text][2] Q What is the contribution...

Depression Most Costly Illness for Employers

Depression Most Costly Illness for Employers

JAMA Depression Issue Highlights Reasons for Concern

<i>JAMA</i> Depression Issue Highlights Reasons for Concern

Practical Geriatrics: Clinically Significant Nonmajor Geriatric Depression

Practical Geriatrics: Clinically Significant Nonmajor Geriatric Depression

Negative Cognitive Styles and Stress-Reactive Rumination Interact to Predict Depression: A Prospective Study

Research on cognitive theories of depression has identified negative cognitive styles and rumination in response to depressed mood as risk factors for depressive episodes. In addition, a general self-focusing style has been suggested to increase vulnerability to depression. The present study used a behavioral high-risk paradigm to test whether the interaction of negative cognitive styles and rumination predicted the prospective onset, number, and duration of depressive episodes in a sample of 148 initially nondepressed undergraduates over a 2.5-year follow-up. In addition, rumination was assessed specifically as the tendency to focus on maladaptive self-referential thoughts following stressful events (stress-reactive rumination; SRR). The principal hypotheses tested were (1) the interaction of negative cognitive styles and SRR increases risk for developing depressive episodes as well as longer duration depressive episodes; and (2) this interaction would not be obtained when a trait measure of general self-focus or a measure of rumination in response to depressed mood is used instead of the measure of SRR. After controlling for subsyndromal depressive symptoms and the main effects of negative cognitive styles and SRR, the interaction of negative cognitive styles and SRR was found to predict the prospective onset, number, and duration of major depressive and hopelessness depressive episodes. These interactions were not obtained when other measures of trait self-focus and depressive rumination were used instead of SRR.

Gabapentin augmentation therapy in bipolar depression

Gabapentin (GBP) may be useful in bipolar disorders, including as adjunctive therapy for bipolar depression, although controlled studies suggest inefficacy as primary treatment for mania or treatment-resistant rapid cycling. We performed a 12-week trial of open GBP (mean dose 1725 mg/day) added to stable doses of mood stabilizers or atypical antipsychotics in 22 (10 women, mean age 38.4 years) depressed (28-item Hamilton Depression Rating Scale (HDRS) > 18] bipolar (10 bipolar I, 12 bipolar II) disorder outpatients. Mean illness duration was 18.6 years, current depressive episode duration was 18.0 weeks. Prospective 28-item HDRS, Young Mania Rating Scale (YMRS) and Clinical Global Impression-Severity (CGI-S) ratings were obtained. Overall, HDRS ratings decreased 53% from 32.5 +/- 7.7 at baseline to 16.5 +/- 12.8 at week 12 (p < 0.0001). Twelve of 22 (55%) patients had moderate to marked improvement (HDRS decrease = 50%) with HDRS decreasing 78% from 27.9 +/- 6.2 to 6.2 +/- 4.5 (p < 0.0001). Eight of 22 (36%) patients remitted (HDRS > or = 8). In non-responders, HDRS decreased from 38.0 +/- 5.4 to 28.9 +/- 6.7 (p = 0.005). Ten of 13 (77%) mild to moderately depressed (baseline HDRS > 18 and <35) patients responded, while only two of nine patients (22%) with severe depression (HDRS > or = 35) responded (p < 0.03). Both groups, however, had similar, statistically significant HDRS decreases. GBP was well tolerated. Open adjunctive GBP was effective and well tolerated in patients with mild to moderate bipolar depression. This open pilot study must be viewed with caution, and randomized controlled studies are warranted.

Personality disorders and the duration of depressive episode: a retrospective study.

In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project we examined the relationship between chronicity of depression and personality disorders. Three hundred and eighty-five depressed outpatients were evaluated with semi-structured interviews. Duration of depression was analyzed as a continuous variable, and by subdividing patients by the DSM-IV (APA, 1994) chronic specifier (i.e., more or less than 2 years). Two separate regression analyses addressed the association between major depressive episode duration and each of the ten personality disorders found on Axis II. Although there was some difference between particular personality disorders associated with the two indicators of depressive duration, the results of the regression analyses indicate that the chronicity of depression is associated with personality disorders.

Association of self-preoccupation and self-reported duration and severity of depressive episodes.

The present study investigated the relation of self-preoccupation, i.e., the tendency to focus more on the self than on external objects and to maintain this self-focused attention, with the duration and severity of depressive episodes. The hypotheses were that, compared with people low on self-preoccupation, people scoring higher on self-preoccupation may experience more long-lasting depressive episodes and during such episodes they may experience a greater number of depressive symptoms. The present study examined association of self-esteem with the severity or duration of depressive episodes. A total of 1,076 undergraduates (361 men, 700 women, 15 unknown) from nine universities in the Tokyo metropolitan area participated. Of the total, 246 undergraduates (55 men and 191 women) reported that they had experienced a depressive episode continuing four or more days; these data were analyzed and are reported here. Self-preoccupation, self-esteem, and depressive episodes within 12 mo. were measured by a self-report questionnaire. The results tentatively supported the hypotheses. Specifically, rated self-esteem was significantly correlated with the number of depressive symptoms reported in a depressive episode but not with the duration of the episode. However, rated self-preoccupation was correlated with the severity and duration of the depressive episode, although the correlation of self-preoccupation scale scores with the duration of the episode was quite weak and requires further research.

Body dysmorphic disorder in outpatients with major depression

Background: Body dysmorphic disorder (BDD) is a distressing and impairing preoccupation with an imagined or slight defect in appearance, with depression as its most frequent comorbid condition. The purpose of this study was to evaluate the rate of BDD in a cohort of consecutive outpatients with typical and atypical major depressive disorder. Methods: Three hundred and fifty consecutive outpatient subjects with major depression who entered an antidepressant treatment study were evaluated drug-free with the SCID-P, SCID-II, a diagnostic module for BDD, and other measures. Depressed subjects with comorbid BDD were compared to those without BDD with regard to demographics, course of depression, comorbid conditions, and other relevant variables. Results: Twenty-eight (8.0%) subjects had a lifetime history of BDD and 23 (6.6%) had current BDD. Those with comorbid lifetime BDD had an earlier age of onset of depression and longer duration of the current episode, but not a greater number of depressive episodes or greater severity of depression. Subjects with and without BDD were similar with respect to age, gender, and marital status. There was a higher rate of lifetime and current BDD in subjects with atypical depression than in those with non-atypical depression (14.4% compared to 5.1%; χ 2=6.63; P=0.01: 11.6% vs. 4.1%; χ 2=7.02; P=0.02). Subjects with BDD also had higher rates of social phobia, any eating disorder, and any somatoform disorder but not obsessive compulsive disorder. They also had higher rates of avoidant, histrionic, and dependent personality disorders. Limitations: As we did not specifically examine bipolar spectrum conditions, the present study cannot address to what extent BDD is comorbid with Bipolar-II disorder. Conclusions: BDD is frequently comorbid with major depression, is associated with an earlier age of onset of depression and longer duration of depressive episodes, and is found more frequently with atypical than non-atypical depression.

Major depression and its association with long-term medical conditions.

To replicate previously reported associations between major depressive episodes (MDEs) and long-term medical conditions in a Canadian community sample. A sample of 2542 household residents was selected using random digit dialing (RDD). Data were collected by telephone interview. The Composite International Diagnostic Interview (CIDI)-Short Form for major depression (CIDI-SFMD) was used to identify MDEs occurring in the previous 12 months. Long-term medical conditions were identified by self-report. The prevalence of MDE was elevated in those subjects who reported 1 or more long-term medical conditions. The association was not due to confounding by age, sex, social support, or stressful recent life events. This study replicates a previously reported association between depressive disorders and long-term medical conditions. These cross-sectional associations suggest that medical conditions may increase the risk of major depression or that major depression may increase the risk of medical conditions. Alternatively, comorbid medical conditions may influence the duration of depressive episodes, or vice versa. These explanations are not mutually exclusive.

Divalproex therapy in medication-naive and mood-stabilizer-naive bipolar II depression

Background: There have been few systematic studies of the treatment of bipolar II depression. While divalproex sodium (DVPX) is effective in acute mania, there are few data on the antidepressant effects of DVPX. Similarly, little is known regarding the use of DVPX administered in a single daily dose. Method: We performed a 12-week open trial of DVPX monotherapy (mean dose 882 mg qhs, mean level 80.7 μg/ml) in nineteen (thirteen women, six men, mean age 29) bipolar II depressed outpatients. Eleven patients (six women, five men) were medication-naive (MN) and eight (seven women, one man) were mood stabilizer-naive (MSN), having had prior trials of antidepressants or stimulants. Mean illness and current depressive episode duration were 15.4 years and 11.8 weeks, respectively. DVPX was given as a single dose each evening starting with 250 mg at bedtime and increased by 250 mg at bedtime every 4 days until symptom relief or adverse effects were noted. Weekly prospective Hamilton Depression, Young Mania and Clinical Global Impression ratings were obtained. Results: DVPX therapy was generally well tolerated. Twelve of nineteen patients (63%) responded (>50% decrease in Hamilton Depression ratings). MN patients compared to MSN patients tended to have a higher response rate (9/11 versus 3/8, P<0.08). Mean Hamilton scores decreased from 22.2 to 9.6 ( P<0.0001) in the entire group, from 20.6 to 6.6 ( P<0.0003) in MN patients, and from 24.2 to 14.7 ( P=0.008) in MSN patients. Conclusion: Single daily dose DVPX monotherapy appeared to be well tolerated and substantially benefited 63% of patients with bipolar II depression. The trend towards a higher rate of antidepressant response to DVPX in MN patients (82%) compared to MSN patients (38%) could be due to a milder form or earlier phase of illness and the lack of prior medication exposure or failures. This uncontrolled open pilot study must be viewed with caution, and randomized double-blind placebo controlled studies of DVPX in bipolar II depression are warranted to confirm the possibility that single daily dose DVPX is an effective, well-tolerated, first-line monotherapy in this population.

Mental health and use of care in people receiving a French social benefit.

This paper presents and epidemiological survey of 300 adults randomly sampled among the Parisian population and 207 randomly sampled recipients of a social benefit. The RMI (Revenu Minimal d'Insertion) provides a regular minimal income to any person with resources below a certain level. It is not targeted at people with mental health problems. The subjects were evaluated by trained interviewers using collateral information provided by an informant, together with CIDIS, a simplified version of the CIDI, covering: somatisation, panic attack, phobias, generalised anxiety, major depression and alcohol and illegal drug abuse (DSM-III-R and ICD-10 classifications). The response rate was 79% for the Parisian sample and 75% for the RMI recipients. As expected, the sociodemographic composition of the two groups adjusted for age differed considerably: RMI recipients were likely to be unemployed and single or divorced. The collateral information showed that psychoses of all types were more frequent among RMI recipients (4.2% vs 1.2%, P < 0.02). There were large differences in rates for substance abuse and dependence, antisocial personality and lifetime depressive disorders, but no difference for mental deficiency. This corresponded partly with the direct CIDIS measure: male RMI recipients suffered significantly more from severe depression than male Parisian controls: 16.7% compared to 3.4% (P < 0.01 lifetime) and from drug and alcohol abuse or dependency disorders. Depressed RMI recipients made less use of available medical care for their depression than Parisians controls, mainly because RMI recipients did not consult psychiatrists, whereas controls did (21%, P < 0.0001). On average, the duration of depressive episodes is longer in RMI recipients, especially in women. The high rate of psychiatric disorders and poor access to resources in RMI recipients have implications for the health system. Care would be improved if social workers administering the benefit were better trained to recognise psychiatric problems, and able to link their clients with (particularly) primary care services.

Prediction of response to fluoxetine and placebo in children and adolescents with major depression: a hypothesis generating study

Background: The results of multivariate analyses to identify potential predictors of response to fluoxetine or placebo separately in 96 child and adolescent outpatients with major depressive disorder from a recent controlled trial are presented. Methods: A variety of clinical, demographic and laboratory factors were examined as possible predictors of response to fluoxetine or placebo using logistic regression models. Results: No single variable or combination of variables strongly predicted response to fluoxetine. For the placebo group, a younger age, a shorter duration of depressive episode, and a lower socioeconomic status predicted response with an overall predictive power of 81%. Conclusions: This study is limited by the small sample size and should be considered hypothesis generating rather than confirming.

Training primary-care physicians to recognize, diagnose and manage depression: does it improve patient outcomes?

We developed a comprehensive, 20-hour training programme for primary-care physicians, that sought to improve their ability to detect, diagnose and manage depression. We evaluated the effects of physician training on patient outcomes, using a pre-post design. In the pre-training phase of the study, we sampled 1834 consecutive patients of 17 primary-care physicians and evaluated 518 of these patients for the presence of depression. We measured outcomes of all patients with depression at 3 months and 1 year. The outcome measures were: severity of psychopathology; duration of depressive episode; and level of daily functioning. After the 17 physicians completed the training, we drew a new sample from their practices (498 of 1785 consecutive patients were evaluated for depression) and measured outcomes for the depressed patients. We found an effect of the training on short-term outcome, particularly for patients with a recent-onset depression. At 3-month follow-up depressed patients whose physicians had received training had less severe psychopathology and patients with recent-onset depression also showed higher levels of daily functioning than patients of the same physicians prior to the training. The patients with a recent-onset depression that was recognized by trained physicians had shorter depressive episodes, but this was not statistically significant. At 1-year follow-up, all training effects had faded away. Training primary-care physicians to recognize, diagnose and manage depression can improve short-term patient outcomes, especially for patients with a recent onset of depression. Patients suffering from a recurrent or chronic depression may need more specific interventions, both for acute treatment and long-term management.

Psychosocial processes underlying the maintenance and persistence of depression: Implications for understanding chronic depression

The three major theoretical perspectives on the maintenance and persistence of depression in the psychological literature are reviewed. Cognitive theorists, such as Teasdale and Nolen-Hoeksema, focus on how a reciprocal relationship between depressed mood and the individual’s processing of, and response to, their symptoms maintains and prolongs the duration of depressive episodes. Interpersonal theorists, such as Lewinsohn and Coyne, hypothesize that the depressed person’s interpersonal behavior elicits negative reactions from the social environment, leading to a downward spiral of persistent depression. Finally, recent studies have indicated that individuals who experienced childhood adversity are more susceptible to a chronic course of depression. Although these three perspectives vary somewhat in the degree of support they have accumulated, each exhibits some promise for helping to elucidate the maintenance and persistence of depression. However, much of the available empirical literature suffers from a number of critical limitations, including the lack of clinical samples, longitudinal studies, and adequate attention to confounding variables, such as the severity and duration of depression at baseline and comorbid psychopathology. We conclude by suggesting a number of ways in which cognitive and interpersonal factors and early adversity may interact to maintain and prolong depressive episodes.

Long-term medical conditions and major depression in the Canadian population.

To evaluate associations between long-term medical conditions and major depression in the Canadian population, and to examine the impact of these conditions on health care service use and disability. Data from the first wave of the Canadian National Population Health Survey (NPHS) were used. The NPHS used a probability sample of 17,626 Canadians and included questions about long-term medical conditions, health care service use, and disability and a brief predictor of major depression. Contingency tables and graphical techniques were used to evaluate associations between the variables of interest. Various chronic medical conditions were associated with an elevated prevalence of major depression. There was no evidence that subjects with major depression and comorbid medical conditions were more likely to be admitted to hospital or to be high users of physician services. However, major depression comorbid with chronic medical conditions was associated with a greater than expected extent of activity limitations. Chronic illness may increase the risk of depression or the duration of depressive episodes; either effect could lead to an increased prevalence. Alternatively, major depression may predispose individuals to certain chronic illnesses. Comorbid major depression and chronic medical conditions are associated with a considerable burden of disability in the Canadian population but not excessive use of physician services.