First Episode Of Major Depression Research Articles

Prevalence and comorbidity of affective disorders in persons making suicide attempts in Hungary: importance of the first depressive episodes and of bipolar II diagnoses

Background: The purpose of this study was to investigate the prevalence and comorbidity of affective disorders, especially current major depressive episode and bipolar disorder among suicide attempters in Hungary. Methods: Using a structured interview (Mini International Neuropsychiatric Interview) determining 16 Axis I psychiatric diagnoses defined by the DSM-IV and a semistructured interview collecting background information, the authors examined 100 consecutive suicide attempters, aged 18–65. Results: Eighty-eight percent of the attempters had one or more current diagnoses on Axis I. In 69% it was major depressive episode and 60% of them were suffering their first episode. Thirty-five percent of the patients with current major depressive episode had had hypomanic ( n=19) or manic ( n=5) episodes in the past. Seventy percent of the individuals received two or more current diagnoses on Axis I. Eighty-six percent of all current Axis I disorders (except major depressive episode) were diagnosed together with a current major depressive episode. The diagnosis of current major depressive episode and the number of current psychiatric disorders was significantly and positively related to the number of suicide attempts, but the diagnosis of past major depressive episode was not. Limitations: This study included suicide attempters who had presented selfpoisoning, but not individuals with very high risk of fatality. Conclusions: In suicide attempters there is a very high prevalence of affective disorders, especially major depression, first episode of major depression and bipolar II disorder. This study underlines the importance of early detection and treatment of psychiatric disorders for the prevention of suicidal behavior.

Depressive Spectrum Disorders in High-Risk Adolescents: Episode Duration and Predictors of Time to Recovery

Durations of first episodes of major depression, dysthymia, adjustment disorders with depressed mood or with mixed emotional features, and minor depressions were examined in a community high-risk adolescent sample. Factors associated with longer recovery times were examined for each disorder. Semistructured diagnostic interviews were conducted annually (6th through 12th grade) to assess children's current and lifetime history of psychopathology. Cox regressions were used to explore factors associated with longer time to recovery. Episode durations were consistent with prior community studies and generally shorter than those reported in clinical samples. A greater number of maternal depressive episodes predicted a more prolonged time to recovery from major depression, and greater adolescent impairment was associated with longer episode duration of both major and minor depression. Treatment and prevention efforts should be directed toward offspring of parents with recurrent mood disorders, particularly adolescents with minor as well as major depression. The authors also recommend that the median rather than the mean be used to evaluate the duration of depressive disorders.

Psychosocial and endocrine features of chronic first-episode major depression in 8–16 year olds

Background: Psychoendocrine processes may have a role in explaining individual differences in the outcome of major depression in 8–16-year-old school children. Methods: Salivary cortisol and dehydroepiandrosterone (DHEA) levels at 8:00 am and 8:00 pm, life events, and comorbidity were assessed at presentation, 36, and 72 weeks in 47 (60%) of 78 clinically referred subjects with a first episode of major depression. Comparisons were made between chronic and nonchronic major depression. Results: Chronic depression was characterized by being older, cortisol hypersecretion at 8:00 pm at all three assessments, increasing depression-dependent life events over the follow-up period, and comorbid obsessive-compulsive disorder (OCD) at presentation and at 36 weeks. Chronicity may be best predicted by increasing depression-dependent events over the 72-week period. Such events are more likely in cases with evening cortisol hypersecretion at entry and persistent OCD. Variations in DHEA levels were not associated with chronicity or increasing life events. Conclusions: During adolescence, but not childhood, the persistence of major depression may occur through an increase of risk for further and particular types of depression-dependent undesirable life events (personal disappointments and/or dangers to the self), that are more likely in those subjects with persisting cortisol hypersecretion and unresolved comorbid OCD.

Strategies to reduce misdiagnosis of bipolar depression.

Research over the past decade indicates that the prevalence of bipolar disorder is similar to that of major depression. The author discusses complexities in the diagnosis of bipolar disorder, especially in distinguishing bipolar from unipolar depression. Bipolar depression is associated with more mood lability, more motor retardation, and greater time spent sleeping. Early age of onset, a high frequency of depressive episodes, a greater percentage of time ill, and a relatively acute onset or offset of symptoms are suggestive of bipolar disorder rather than major depression. Because DSM-IV criteria require a manic or hypomanic episode for a diagnosis of bipolar disorder, many patients are initially diagnosed and treated as having major depression. Treatment of bipolar disorder with antidepressants alone is not efficacious and may exacerbate hypomania, mania, or cycling. It is important that clinicians be alert to any hint of bipolarity developing in the course of antidepressant therapy, especially among patients with first-episode major depression.

Vasopressin, major depression, and hypothalamic–pituitary–adrenocortical desensitization

Background: The hypothalamic neuropeptide arginine vasopressin is thought to play an important role in the pathophysiology of affective disorders and the hyperactivity of the hypothalamic–pituitary–adrenocortical system that frequently accompanies them. Postmortem studies as well as clinical investigations have described elevated levels of vasopressin in the brain and plasma of depressed patients, and this finding has been suggested to contribute to depressive symptomatology. Methods: The case of a 47-year-old patient displaying chronically elevated plasma vasopressin levels due to paraneoplastic vasopressin secretion by an olfactory neuroblastoma and the first episode of major depression is presented. Results: Depressive symptoms improved markedly after surgical resection of the tumor and subsequent normalization of plasma vasopressin levels. Unexpectedly, neither corticotropin nor cortisol secretion could be stimulated by an intravenous corticotropin-releasing hormone challenge under the condition of chronically elevated plasma vasopressin levels in this patient. Conclusions: Chronically elevated plasma vasopressin levels may induce depressive symptomatology, and—in contrast to the potent corticotropin secretagogue effects of acute vasopressin administration—lead to a marked desensitization of the hypothalamic–pituitary–adrenocortical system.

Anxiety disorders in major depression

The prevalence and clinical impact of anxiety disorder comorbidity in major depression were studied in 255 depressed adult outpatients consecutively enrolled in our Depression Research Program. Comorbid anxiety disorder diagnoses were present in 50.6% of these patients and included social phobia (27.0%), simple phobia (16.9%), panic disorder (14.5%), generalized anxiety disorder ([GAD] 10.6%), obsessive-compulsive disorder ([OCD]) 6.3%, and agoraphobia (5.5%). While both social phobia and generalized anxiety preceded the first episode of major depression in 65% and 63% of cases, respectively, panic disorder (21.6%) and agoraphobia (14.3%) were much less likely to precede the first episode of major depression than to emerge subsequently. Although comorbid groups were not distinguished by depression, anxiety, hostility, or somatic symptom scores at the time of study presentation, patients with comorbid anxiety disorders tended to be younger during the index episode and to have an earlier onset of the major depressive disorder (MDD) than patients with major depression alone. Our results support the distinction between anxiety symptoms secondary to depression and anxiety disorders comorbid with major depression, and provide further evidence for different temporal relationships with major depression among the several comorbid anxiety disorders.

First-episode major depression in adolescents. Affective, cognitive and endocrine characteristics of risk status and predictors of onset.

There is little information on whether patterns of steroids precede and are associated with depressive onset. To establish whether there is an association between salivary cortisol and/or dihydroepiandrosterone (DHEA) levels and depression independent of psychosocial risk. Two subgroups of adolescents in the community at high (n = 181) and low (n = 65) risk for psychopathology were interviewed for recent psychiatric disorder at entry and again at 12 months. Salivary samples (08.00 and 20.00 h) for hormone estimations and self-reports on current mood and cognitive style were obtained at both assessments. Neither hormone was associated with risk status, current mood or cognitive style at entry. Of 31 onsets of major depression that occurred over the next 12 months, 30 came from the high-risk group but were not associated with any particular pattern of risk. Increased negative mood and feelings and DHEA (08.00 h) hypersecretion at entry were associated with subsequent major depression. Both negative mood and feelings and alterations in adrenal steroid function precede the onset of first-episode major depression in adolescents. Variation in levels of hormones may arise from more distal origins than recent life events and current ongoing difficulties.

Relative memory deficits in recurrent versus first-episode major depression on a word-list learning task.

Relative memory deficits in recurrent versus first-episode major depression on a word-list learning task.

Posttraumatic stress disorder in response to HIV infection

This study investigated the psychological impact of HIV infection through assessment of posttraumatic stress disorder in response to HIV infection. Sixty-one HIV-positive homosexual/bisexual men were assessed for posttraumatic stress disorder in response to HIV infection (PTSD-HIV) using a modified PTSD module of the DIS-III-R. Thirty percent met criteria for a syndrome of posttraumatic stress disorder in response to HIV diagnosis (PTSD-HIV). In over one-third of the PTSD cases, the disorder had an onset greater than 6 months after initial HIV infection diagnosis. PTSD-HIV was associated with other psychiatric diagnoses, particularly the development of first episodes of major depression after HIV infection diagnosis. PTSD-HIV was significantly associated with a pre-HIV history of PTSD from other causes, and other pre-HIV psychiatric disorders and neuroticism scores, indicating a similarity with findings in studies of PTSD from other causes. The findings from this preliminary study suggest that a PTSD response to HIV diagnosis has clinical validity and requires further investigation in this population and other medically ill groups. The results support the inclusion of the diagnosis of life-threatening illness as a traumatic incident that may lead to a posttraumatic stress disorder, which is consistent with the DSM-IV criteria.

Withdrawal reaction associated with venlafaxine

Nottingham Healthcare NHS Trust, Wells Road Centre, Nottingham NG3 3AA We report an apparent withdrawal reaction to venlafaxine, a recently introduced serotonin noradrenaline reuptake inhibitor antidepressant whose use is increasing....

Improved diagnostic assessment of major depression in psychiatric outpatient care in Finland.

The accuracy of diagnosis of major depression by psychiatrists, psychiatric residents, and other physicians in outpatient psychiatric care settings in Finland was examined. A total of 232 patients who visited four mental health centers in the hospital district of Satakunta during three years (1989, 1992, and 1995) were retrospectively given a diagnosis of first-episode major depression by researchers, based on chart reviews. These diagnoses were compared with those made by the evaluating clinicians. Accurate diagnosis was associated with the specialty of the physician and the location of the mental health center. Recognition of major depression significantly improved over the time period, which could be attributed to educational efforts, increasing familiarity with DSM-III-R criteria, and use of new antidepressants.

Comorbid OCD, higher score on the MFQ, and older age at presentation predicted persistence of major depression in children and adolescents

Goodyer IM, Herbert J, Secher SM, et al. Short-term outcome of major depression: I. Comorbidity and severity at presentation as predictors of persistent disorder. J Am Acad Child Adolesc Psychiatry1997...

Improved pharmacotherapy of major depression in psychiatric outpatient care

We studied the ability of mental health care to treat major depression in accordance with given standards. The treatment procedures for 232 patients with first-episode major depression (DSM-III-R) in 3 study years (1989, 1992, 1995) were circumstantially and retrospectively evaluated from documents in community psychiatric outpatient care in Finland. In total, two-fifths of the patients received probably inadequate pharmacotreatment. However, there was a clear improvement in pharmacotreatment of major depression during the study years. The adequacy of given antidepressant medication was associated with high basic education of the patients, accuracy of diagnosis, and new antidepressants.

First-episode major depression. Few sex differences in course.

There is a sex difference in the prevalence of unipolar major depression. This study sought to determine whether there is a sex difference in its course. The National Institute of Mental Health Collaborative Program on the Psychobiology of Depression-Clinical Studies provided data on 96 male and 101 female subjects who were diagnosed as having a first episode of unipolar major depressive disorder at intake and on whom prospective data were available. We looked for differences at intake in factors other than sex that might affect the course of illness: demographic factors, characteristic features of the first depressive episode, psychiatric history, and family history of depression. We then examined the course of depression of these subjects during the following 15 years. The subjects were similar at intake, enabling us to focus on sex when we looked for differences in the course. Most subjects recovered from their first episode of major depression, but the majority had at least 1 recurrence in the following 5 years. During the following 15 years, male and female subjects did not differ significantly in the time to recovery, the overall time to first recurrence, of the number or severity of recurrences of major depressive episodes. There was no evidence for a more chronic course of depression in women. There were few significant sex differences in the course of major depressive disorder in this study population.

Short-Term Outcome of Major Depression: II. Life Events, Family Dysfunction, and Friendship Difficulties as Predictors of Persistent Disorder

To determine whether there is a pattern of social characteristics that specifically predicts persistent major depression at 36 weeks follow-up. Sixty-eight consecutive cases with a first-episode DSM-III-R diagnosis of major depression completed a life events and friendship difficulties interview at presentation and again at 36 weeks. Four factors were associated with persistent psychiatric disorder in general: lack of a maternal confiding relationship with current partner, family dysfunction and poor friendships at presentation, and severely disappointing events between presentation and follow-up. There was no association between these adverse experiences. No combination of long-term or recent life events or difficulties was, however, specifically associated with persistent depression. Nonsocial factors may need to be taken into account to specifically explain the phenotypic persistence of major depressive disorder in first-episode nonrecovered cases within a year of presentation. Psychosocial interventions with first-degree relatives and current close friendships should be considered as a part of the treatment strategy for first-episode major depression.

Confirmation of an association between family history of affective disorder and the depressive syndrome in Alzheimer's disease.

The authors' goal was to replicate an earlier finding of a familial liability for depression in Alzheimer's disease. The family histories of depression and dementia were compared in 28 patients experiencing a first episode of major depression after onset of Alzheimer's disease and 74 nondepressed patients with Alzheimer's disease. Significantly more families of depressed dementia patients included depressed first-degree relatives. There was no difference between Alzheimer's disease patients with and without depression in the proportion of families with a history of dementia. Major depression in Alzheimer's disease is associated with a familial liability for depression that is independent of any familial liability for dementia.

A survey of body dysmorphic disorder in plastic surgery patients

The objective of the study was to investigate the statement made by the US Department of Health and Human Services' Clinical Practice Guidelines of Major Depression in Primary Care (1993) that clinical management (CM) leads to remission in 20%-30% of the cases. A consecutive sample of 326 patients with major depression in primary care were randomized to a 6-month, double-blind treatment study of CM + placebo (PL) or one of two active drug arms: sertraline (S) + CM or mianserin (M) + CM. Patients were classified as responders if they fulfilled all three of the following criteria: 1) at least 50% reduction of the total MADRS score; 2) current state within no mental i l lness--mild depression severity (CGI); and 3) rated as much or very much improved (CGI) by the physician. Of patients with a first episode of major depression, 58% (n = 15) were responders to PL + CM after 8 weeks and 77% (n = 13) after 6 months of treatment. The efficacy of the active drug combinations did not differ statistically from CM + PL. If dropouts were included in the analyses (intention to treat data), percent of responders to placebo + CM was 50%. In patients with recurrent depression, 50% (n = 38) were responders to PL + CM after 8 weeks of treatment and 72% (n = 36) after 6 months. In comparison, 72% (n = 54) responded to CM + S after 8 weeks (p = 0.009) and 86% (n = 51) after 6 months; p = 0.06). The remission rate of depression following CM + PL in first episodes of major depression in primary care is higher than previously estimated and comparable to the remission rate achieved by adding an active drug. The findings question recent guidelines for the treatment of depression and suggest that recurrent depressions are neurobiologically different from first episodes.

Prevalence, onset, and risk of psychiatric disorders in men with chronic low back pain: a controlled study

This study used structured diagnostic interviews and DSM-III criteria to assess lifetime prevalence and pre-morbid risk of psychiatric disorder in a sample of men with long-standing chronic back pain (CLPB) attending a primary care clinic. A control group of age and demographically matched men without history of back pain was also studied. Compared to controls, men with CLBP had significantly higher lifetime rates of major depression (32% vs. 16%), alcohol use disorder (64.9% vs. 38.8%), and a major anxiety disorder (30.9% vs. 14.3%). Almost all CLBP men ever experiencing a mood disorder reported recurrent, not single, episodes. The 6 month point prevalence of major depression, but not other disorders, was also significantly elevated for men with CLBP. In CLBP, the first episode of major depression generally (58.1%) followed pain onset. While the initial major depressive episode usually commenced within the first 2 years of established pain, late onset mood disorder was also common. By comparison in most cases (81%) onset of alcohol use disorders considerably preceded pain. When an age-matching procedure was used to gauge relative vulnerability to psychiatric illness in patients and controls, CLBP patients had significantly higher pre-pain rates of alcohol use disorder but not depression. After age of pain onset, CLBP subjects had over 9 times the risk of developing major depression, but had similar rates of developing alcoholism. We conclude that (1) alcohol use disorders rather than depression may increase risk of developing CLBP, and (2) risk of new onset and recurrent major depression remains high for men throughout their pain career. This suggests that psychological adaptation to long-standing pain may be less successful than previously thought, especially with regard to recurrent mood disorder.

Association between family history of affective disorder and the depressive syndrome of Alzheimer's disease

For each of 41 index patients with probable Alzheimer's disease and a first episode of major depression and 71 nondepressed Alzheimer's disease patients, two first-degree relatives were interviewed by a rater blind to presence or absence of depression in the proband. The depressed patients had significantly more first- and second-degree relatives with depression than did control subjects. The lifetime risk for major depression, adjusted for differences in age distribution, was significantly greater in first-degree relatives of index patients, suggesting that depression in Alzheimer's disease is genetically related to primary affective disorder. Alzheimer's disease may be useful for studying aspects of depressive pathophysiology.

Depressive disorders in childhood. II. A longitudinal study of the risk for a subsequent major depression.

As part of a longitudinal nosologic study of major depressive disorder, dysthymic disorder (DD), and adjustment disorder with depressed mood ( ADDM ) in a school-aged cohort, the predictive validity of each diagnosis was examined. Using all available data on the course of the disorders, the criterion was the first subsequent major depressive episode. Major depressive disorder and DD signaled a similarly high risk of a new bout of depressive illness. For the children who recovered from their first episode of major depression and then had their second one (40%), the free interval did not exceed two years; an underlying dysthymia increased the risk of recurrence. Major depression and dysthymia were distinct from ADDM and a set of control disorders; the latter two diagnostic groups were associated with a minimal risk for major depression.