Higher Prevalence Of Major Depressive Disorder Research Articles

Depression and anxiety among patients with epilepsy: A cross-sectional study from Riyadh, Saudi Arabia.

It is well established that epileptic disorders are associated with a wide range of psychosocial issues that overburden the affected individuals and limit their lifestyle. This study aimed to determine the commonalities between depression and anxiety symptoms among patients with epilepsy (PWE). In addition, we assessed whether depression and anxiety rates varied depending on factors related to the disease. A cross-sectional study was conducted between October 2021 and March 2022 among all PWE at Prince Mohammed bin Abdulaziz Hospital, and 147 patients who responded to the questionnaires were included for analysis (65.6% response rate). Depression was measured using the Patient Health Questionnaire depression scale (PHQ-9), while anxiety levels were measured using the Generalized Anxiety Disorder scale (GAD-7). Demographic variables such as sex, age, marital status, and factors related to epilepsy were also recorded. The results showed that 39.5% and 27.9% of participants had major depressive disorder (MDD) and generalized anxiety disorder (GAD), respectively. The presence of factors that increased susceptibility to seizures was associated with a greater expression of depression (P = 0.035) and anxiety (P = 0.002) symptoms. The presence of symptoms/signs that precede seizures was associated with a higher risk of moderate and severe depression (P = 0.001) and moderate and severe anxiety (P < 0.001). Irregular use of medications was associated with a higher risk of moderate and severe depression (P = 0.037); however, lamotrigine was associated with lower rates of depression among the participants (P = 0.023). This study found that PWE had a higher prevalence of MDD and GAD than the general population. However, this accepted paradigm has yet to reflect a meaningful change in constructing condition-specific recommendations for PWE. Our study revealed that the presence of subjectively recognized signs of an impending ictal episode was significantly associated with a higher risk of moderate and severe depression and anxiety. Furthermore, factors that increase the susceptibility to seizures were associated with a higher risk of depression and anxiety. Irregular medication use was associated with a higher risk of moderate and severe depression. However, lamotrigine was associated with lower rates of depression among participants.

Mitochondrial and Cellular Function in Fibroblasts, Induced Neurons, and Astrocytes Derived from Case Study Patients: Insights into Major Depression as a Mitochondria-Associated Disease.

The link between mitochondria and major depressive disorder (MDD) is increasingly evident, underscored both by mitochondria's involvement in many mechanisms identified in depression and the high prevalence of MDD in individuals with mitochondrial disorders. Mitochondrial functions and energy metabolism are increasingly considered to be involved in MDD's pathogenesis. This study focused on cellular and mitochondrial (dys)function in two atypical cases: an antidepressant non-responding MDD patient ("Non-R") and another with an unexplained mitochondrial disorder ("Mito"). Skin biopsies from these patients and controls were used to generate various cell types, including astrocytes and neurons, and cellular and mitochondrial functions were analyzed. Similarities were observed between the Mito patient and a broader MDD cohort, including decreased respiration and mitochondrial function. Conversely, the Non-R patient exhibited increased respiratory rates, mitochondrial calcium, and resting membrane potential. In conclusion, the Non-R patient's data offered a new perspective on MDD, suggesting a detrimental imbalance in mitochondrial and cellular processes, rather than simply reduced functions. Meanwhile, the Mito patient's data revealed the extensive effects of mitochondrial dysfunctions on cellular functions, potentially highlighting new MDD-associated impairments. Together, these case studies enhance our comprehension of MDD.

Biochemical and Sociodemographic Correlates of Major Depressive Disorder in Patients With Chronic Kidney Disease Receiving Hemodialysis.

Introduction Chronic kidney disease (CKD) is a chronic disabling illness with multiple physical and psychosocial consequences. A major treatment modality for CKD is renal replacement therapy in the form of hemodialysis. A bidirectional relationship between depression and CKD is proposed, as depressive symptoms lead to poorer outcomes in CKD and vice versa. This study aimed to determine the prevalence of major depressive disorder (MDD) in CKD patients on maintenance hemodialysis and find any sociodemographic, clinical, or biochemical correlates. Material and methods This was a cross-sectional study conducted at a tertiary care teaching hospital in north India. We used clinical interviews for diagnosing MDD according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The severity was quantified using Hamilton Depression Rating Scale (HAM-D) in those diagnosed with MDD. Results A total of 77 patients were included in the study. The prevalence of MDD in patients with CKD undergoing hemodialysis was 31.17%, much higher than in the general population. Most of those who were depressed had moderate to severe depression. Male gender and lower socioeconomic status were significantly associated with the diagnosis of MDD. Those undergoing dialysis less frequently or having more work days lost due to CKD were more likely to be depressed. Additionally, patients with MDD were found to have significantly lower blood hemoglobin levels, lower serum ionized calcium levels, and a lower urea reduction ratio compared to those who did not have MDD. Conclusion The high prevalence of MDD in patients with CKD undergoing hemodialysis suggests that clinicians should actively evaluate for depressive symptoms in this patient population and refer them to mental health services when required, especially those with the above-identified sociodemographic and biochemical risk factors.

National screening for anxiety and depression in Saudi Arabia 2022.

Mental health disorders, such as major depressive disorder (MDD) and generalized anxiety disorder (GAD), represent a significant public health concern in Saudi Arabia. This study aims to provide a recent mental health screening prevalence, including anxiety and depression screening in the general public and to explore the associated risk factors. A cross-sectional study was conducted, employing a phone interview survey with 6,015 participants, using a quota sampling strategy to ensure equal representation of both sexes and administrative regions. The study assessed the prevalence of MDD and GAD risk and examined demographic, socioeconomic, and lifestyle factors associated with these mental health disorders. The national prevalence of people at risk of MDD and GAD were found to be 12.7 and 12.4%, respectively. Low diagnosis and treatment rates were observed, with only 1.5 and 0.5% of participants currently diagnosed and treated for depression and anxiety, respectively. Risk factors for MDD and GAD included female sex, lower education and income levels, smoking, and waterpipe use. Protective factors included physical activity, participation in volunteering activities and the practice of daily hobbies in the last 30 days. The relatively high prevalence of MDD and GAD risk and low diagnosis and treatment rates in Saudi Arabia emphasize the need for increased mental health promotion, early detection, and treatment accessibility. The study highlights the importance of addressing modifiable risk factors and fostering protective factors through targeted interventions. Future research should focus on longitudinal associations, potential mediators and moderators, and the development of culturally appropriate and evidence-based interventions to enhance mental health outcomes in the region.

Economic burden of major depressive disorder: a case study in Southern Iran

BackgroundDepression disorders are a leading cause of disability in the world which imposes a significant economic burden on patients and societies The present study aimed to determine the economic burden of Major Depressive Disorder (MDD) on the patients referred to the reference psychiatric single-specialty hospitals in southern Iran in 2020.MethodsThis cross-sectional research is a partial economic evaluation and a cost-of-illness study conducted in southern Iran in 2020. A total of 563 patients were enrolled through the census method, and a researcher-made data collection form was used to gather the required information. The prevalence-based and the bottom-up approaches were also used to collect the cost information and calculate the costs, respectively. The data on direct medical, direct non-medical, and indirect costs were obtained using the information in the patients’ medical records and insurance bills as well as their self-reports or those of their companions. To calculate the indirect costs, the human capital approach was used as well.ResultsThe results showed that the annual cost of MDD was $ 2717.41 Purchasing Power Parity (PPP) (USD 2026.13) per patient in 2020. Direct medical costs accounted for the largest share of the costs (73.68%), of which hoteling and regular beds expenses were the highest (57.70% of the total direct medical costs). The shares of direct non-medical and indirect costs were 7.52 and 18.80%, respectively, and the economic burden of the disease in the country was estimated at $7,120,456,596 PPP (USD 5,309,088,699).ConclusionIn general, due to the high prevalence of MDD and the chronicity of the disease, the costs of its treatment can impose a heavy economic burden on the society, healthcare system, insurance system, and the patients themselves. Therefore, it is suggested that health policymakers and managers should take appropriate measures to increase the basic and supplemental insurance coverage of these patients. In addition, in order to reduce the costs, proper and equitable distribution of psychiatrists and psychiatric beds, expansion of home care services, and use of Internet-based technologies and the cyberspace to follow up the treatment of these patients are recommended.

Food insecurity and symptoms of anxiety and depression disorder during the COVID- 19 pandemic: COVID-Inconfidentes, a population-based survey

This study aimed to investigate the association between adult food insecurity (FI) and symptoms of generalized anxiety disorder (GAD) and major depressive disorder (MDD) in two Brazilian cities during the coronavirus disease (COVID-19) pandemic. This study used data derived from a cross-sectional survey of 1693 adults. Interviews were conducted using an electronic questionnaire. The FI was measured using the Brazilian Food Insecurity Scale. The Generalized Anxiety Disorder-7 was used to measure the symptoms of GAD. The Patient Health Questionnaire-9 was used for MDD symptoms. The association between FI, GAD, and MDD symptoms was investigated using a Poisson regression model with robust variance to estimate the prevalence ratio and 95% confidence interval (95% CI). In regression models, a linear association between FI levels and outcomes was observed, with severe food insecurity having a 3.56 higher prevalence of GAD symptoms (95% CI: 2.23, 5.68) and a 3.03 higher prevalence of MDD (95% CI: 1.55, 5.90). In the stratified analyses, worse results were observed for females and males, individuals with non-white race/skin color, those without children, and those with lower monthly family income. In conclusion, the FI was associated with symptoms of GAD and MDD, and the sociodemographic characteristics interfered in this association. Therefore, we recommend the improvement of public health and social protection policies for food-insecure people.

Is the Severity of the Clinical Expression of Anorexia Nervosa Influenced by an Anxiety, Depressive, or Obsessive-Compulsive Comorbidity Over a Lifetime?

Purpose: The relationship between anxiety or depressive comorbidities, their chronology of onset, and the severity of anorexia nervosa (AN) is not well-studied. We hypothesize that the existence of a comorbidity, particularly before the onset of AN, is associated with greater severity of AN.Methods: One hundred seventy-seven subjects were assessed. The prevalence of major depressive disorder (MDD), obsessive-compulsive disorder (OCD), generalized anxiety disorder (GAD), and social phobia (SP) as well as their chronology of onset were studied. The assessment criteria of AN severity were the overall clinical condition, body mass index (BMI) on admission, lowest BMI, intensity of the eating symptoms, age at the onset of AN, illness duration, number of hospitalizations, and quality of life.Results: Patients with AN had the greatest clinical severity when they had a comorbid disorder over their lifetime, such as MDD, GAD, or SP. These comorbidities along with OCD were associated with a higher level of eating symptoms and a more altered quality of life. A profile of maximum severity was associated with a higher prevalence of MDD and GAD. Concerning the chronology of onset, the age at the start of AN was later in cases of MDD or GAD prior to AN.Conclusion: There seems to be an association between severity of AN and both MDD and GAD. The chronology of onset of the comorbidity did not seem to be associated with the severity.

A prospective study of major depressive disorder among COVID 19 survivors at a tertiary care hospital

Background: The COVID-19 pandemic has impacted physical health, wellbeing, and mental health, which has a disastrous effect on the health system. Among disorders emerging in the aftermath of a disaster, depression is the second most common.Aim: The current study was aimed to estimate the prevalence of major depressive disorder (MDD) at two-time points in individuals who have been hospitalized for the treatment of COVID 19.Materials and Methods: A prospective study was carried out from May 2020 to October 2020 at a tertiary care center among patients discharged after recovery from novel coronavirus (COVID 19). A diagnostic clinical interview was conducted to diagnose MDD, and its severity in patients who had recovered from COVID 19 using “Patient Health Questionnaire (PHQ-9)” at the time of discharge and 1 month after their discharge from the hospital.Statistical Analysis: Descriptive statistics and Chi-square test were used for the analysis, P < 0.05 was considered statistically significant.Results: A total of 440 participants participated in the study. Out of them, 30.90% of participants met the criteria for MDD at the time of discharge and 19.5% at 1 month post-discharge. Participants who stayed for more than 14 days, were admitted to intensive care unit (ICU) and those with co-morbid medical illness had a higher prevalence of MDD.Conclusion: High prevalence of MDD was observed at the time of discharge among hospitalized participants. Longer duration of hospital stay and admission in ICU is associated with more unpleasant events, subsequently resulting in higher rates of morbidity, such as depression.

Prevalence of Mental Disorders and Suicidality in Canadian Provinces.

There is limited information to guide health-care service providers and policy makers on the burden of mental disorders and addictions across the Canadian provinces. This study compares interprovincial prevalence of major depressive disorder (MDD), bipolar disorder, generalized anxiety disorder (GAD), alcohol use disorder, substance use disorders, and suicidality. Data were extracted from the 2012 Canadian Community Health Survey-Mental Health (n = 25,113), a representative sample of Canadians over the age of 15 years across all provinces. Cross tabulations and logistic regression were used to determine the prevalence and odds of the above disorders for each province. Adjustments for provincial sociodemographic factors were performed. The past-year prevalence of all measured mental disorders and suicidality, excluding GAD, demonstrated significant interprovincial differences. Manitoba exhibited the highest prevalence of any mental disorder (13.6%), reflecting high prevalence of MDD and alcohol use disorder compared to the other provinces (7.0% and 3.8%, respectively). Nova Scotia exhibited the highest prevalence of substance use disorders (2.9%). Quebec and Prince Edward Island exhibited the lowest prevalence of any mental disorder (8.5% and 7.7%, respectively). Manitoba also exhibited the highest prevalence of suicidal ideation (5.1%); however, British Columbia and Ontario exhibited the highest prevalence of suicidal planning (1.4% and 1.3%, respectively), and Ontario alone exhibited the highest prevalence of suicide attempts (0.7%). Significant interprovincial differences were found in the past-year prevalence of mental disorders and suicidality in Canada. More research is necessary to explore these differences and how they impact the need for mental health services.

SA37 - NEUROINFLAMMATORY GENE EXPRESSION IN HIPPOCAMPUS IN MAJOR DEPRESSIVE DISORDER

Background Major Depressive Disorder (MDD) is a common psychiatric disease for which available medications are often not effective. Full remission from depression is achieved by less than 50 percent of patients using medications that mainly target serotonin or norepinephrine systems (Berton and Nestler, 2006; Rush et al., 2006). The economic burden of depression in the U.S., along with comorbid conditions, is estimated at over $170B and depressive disorders are the leading contributors to global burden of disease (Greenberg et al., 2015; Whiteford et al., 2013). The high prevalence of MDD and modest response to existing therapies compels efforts to better understand and treat the disorder. One promising avenue of research suggests that decreases in hippocampal volume with increasing duration of depression results from a decrease in neurogenesis or altered gene expression (Sheline et al., 1996, Cobb et al., 2013). Methods Tissue punches from the dentate gyrus were collected from 23 subjects (MDD, medication-free) and 23 demographically-matched normal controls. Of the 23 subjects with MDD, 17 died by suicide and 17 had multiple depressive episodes. High quality total RNA, RNA Quality Index > 6, was isolated and whole transcriptome paired-end shotgun sequencing was performed using an Illumina NextSeq. 500. For each sample, raw RNA-seq reads (adapter-trimmed fastq files) were aligned to the Ensembl GRCh38 human reference genome using GSNAP (Genomic Short-read-Nucleotide Alignment Program). Differential gene expression was determined using cuffdiff, and core biological processes, molecular networks, and pathways pathologically disrupted in MDD were identified using Ingenuity Pathway Analysis. Results For each sample, 37 to 112 million reads were obtained and 64 to 96% were mapped successfully to the human genome, with most samples mapping above 85%. ‘Cuffdiff’ analysis in the Tuxedo suite revealed 30 significant genes differentially expressed in all MDD compared to controls (Lumenogix™, FDR Discussion The key finding in the primary MDD dataset as well as in the subsets is the overrepresentation of neuroinflammation related genes. Inflammatory and neurogenesis-related (ERK/MAPK) signaling pathways were significantly altered in the hippocampal dentate gyrus in MDD, with cytokine signaling and inflammatory pathways preferentially altered in MDD-suicide vs. MDD-non-suicide. Together this suggests that neuroinflammation, mediated by microglia and astrocytes may play a crucial role in major depressive disorder. These findings suggest a novel approach by seeking targets for new treatment of MDD that includes anti-inflammatory and neuroprotective properties.

Altered neuro-inflammatory gene expression in hippocampus in major depressive disorder

Major Depressive Disorder (MDD) is a common psychiatric disorder for which available medications are often not effective. The high prevalence of MDD and modest response to existing therapies compels efforts to better understand and treat the disorder. Decreased hippocampal volume with increasing duration of depression suggests altered gene expression or even a decrease in neurogenesis. Tissue punches from the dentate gyrus were collected postmortem from 23 subjects with MDD and 23 psychiatrically-normal control subjects. Total RNA was isolated and whole transcriptome paired-end RNA-sequencing was performed using an Illumina NextSeq 500. For each sample, raw RNA-seq reads were aligned to the Ensembl GRCh38 human reference genome. Analysis revealed 30 genes differentially expressed in MDD compared to controls (FDR<0.05). Down-regulated genes included several with inflammatory function (ISG15, IFI44L, IFI6, NR4A1/Nur-77) and GABBR1 while up-regulated genes included several with cytokine function (CCL2/MCP-1), inhibitors of angiogenesis (ADM, ADAMTS9), and the KANSL1 gene, a histone acetyltransferase. Similar analyses of specific subsets of MDD subjects (suicide vs. non-suicide, single vs. multiple episodes) yielded similar, though not identical, results. Enrichment analysis identified an over-representation of inflammatory and neurogenesis-related (ERK/MAPK) signaling pathways significantly altered in the hippocampal dentate gyrus in MDD. Together, these data implicate neuro-inflammation as playing a crucial role in MDD. These findings support continued efforts to identify adjunctive approaches towards the treatment of MDD with drugs including anti-inflammatory and neuroprotective properties.

Major depressive disorder in patients with type 2 diabetes mellitus: Prevalence and clinical characteristics

BackgroundThis study investigated the prevalence of major depressive disorder (MDD) among Taiwanese patients with type 2 diabetes mellitus (T2DM). MethodsWe enrolled patients with at least one service claim for ambulatory or inpatient care with a principal diagnosis of MDD and at least two service claims for ambulatory care or one service claim for inpatient care with a principal diagnosis of T2DM, as listed in Taiwan's National Health Insurance database. ResultsWe enrolled 715,756 people from the general population (GP), 61,589 patients with T2DM but without MDD, and 778 patients with both T2DM and MDD. The prevalence of MDD increased from 0.70% to 1.25% in the patients with T2DM, whereas it increased from 0.25% to 0.67% in the GP from 2000 to 2010. The higher prevalence of MDD was associated with the female sex, residing in the southern regions of Taiwan, and having comorbidities of cerebrovascular disease and anxiety disorder as well as higher comorbidity severity (Charlson comorbidity index, 1–2 and > 2). LimitationsOne limitation is the use of secondary data on diagnoses of MDD and T2DM. Another limitation is that we could not access some crucial related variables. ConclusionsThe prevalence of MDD was higher in the patients with T2DM than in the GP. In this study, the prevalence of MDD in the patients with T2DM was lower than that reported in Western countries.

Genetic and Environmental Contribution to Major Depressive Disorder and Self-declared Depression

Major depressive disorder (MDD) is a high-prevalence disease (~ 15%) that is the fifth leading disease contributing to disability-adjusted life years (DALYs) in the US (Murray et al., 2013). The pathogenesis of MDD is still partially unknown, consequently diagnosis is based on clinical criteria. However, MDD is a clinically heterogeneous disorder and this probably reflects heterogeneity in the underlying biology. Since ~ 20 years, genetic variants are known to be involved in MDD biology thanks to family studies (Sullivan et al., 2000) and recently genome-wide association studies (GWAS) (Hyde et al., 2016). The estimation of genetic variants contribution and the identification of specific variants involved have been difficult partly because of the heterogeneity and high prevalence of MDD (Gratten et al., 2014). The consequent large sample sizes required to provide adequate statistical power are difficult to recruit and self-declared depression (SDD) is an interesting option to face this issue.

Electroencephalographic changes following trigeminal nerve stimulation for major depressive disorder: study protocol for a randomized sham-controlled trial

Background: Major depressive disorder (MDD) is one of the most common psychiatric disorders. Trigeminal nerve stimulation (TNS) is a novel neuromodulation technology with impressive initial results in the treatment of MDD that lacks a better evaluation of neurobiological mechanisms of action. Methods/Design: This is a two-arm, randomized, double-blind, sham-controlled trial to evaluate the effect of TNS on severe MDD through quantitative electroencephalography (QEEG) pre and post intervention. Forty-four patients diagnosed with severe MDD will be randomly assigned to either a 10-session treatment protocol of real TNS or a 10-session treatment protocol of sham TNS. Outcome measures will be evaluated at baseline, at the end of the stimulation protocol and 30 days after the end of the 10-day treatment period. The primary outcome is changes in the previously established frequency band ranges in QEEG during resting state. The secondary outcome is heart rate variability for better evaluation of the sympathetic and parasympathetic changes after TNS. Discussion: Due to the high prevalence of MDD, the limited effect of antidepressant medications, the high rate of intolerable adverse events, and the high rate of refractoriness, we believe non-invasive neuromodulation strategies, e.g., TNS can be a useful tool for the treatment of MD. The evaluation of the effect of TNS with QEEG before and after stimulation may help us clarify the mechanisms involved in the clinical responses. Trial registration: ClinicalTrials.gov identifier: NCT02562703, registered on 25 September 2015. Ethics: This study protocol has been approved by the institutional review board (IRB) (approval number: 30960814.7.0000.5479) and will be performed in accordance with the Declaration of Helsinki. Informed consent: Patients will sign an informed consent prior to participation in the study.

Major Depressive Disorder and Bipolar Disorder Predispose Youth to Accelerated Atherosclerosis and Early Cardiovascular Disease: A Scientific Statement From the American Heart Association.

In the 2011 "Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents," several medical conditions among youth were identified that predispose to accelerated atherosclerosis and early cardiovascular disease (CVD), and risk stratification and management strategies for youth with these conditions were elaborated. Major depressive disorder (MDD) and bipolar disorder (BD) among youth satisfy the criteria set for, and therefore merit inclusion among, Expert Panel tier II moderate-risk conditions. The combined prevalence of MDD and BD among adolescents in the United States is ≈10%, at least 10 times greater than the prevalence of the existing moderate-risk conditions combined. The high prevalence of MDD and BD underscores the importance of positioning these diseases alongside other pediatric diseases previously identified as moderate risk for CVD. The overall objective of this statement is to increase awareness and recognition of MDD and BD among youth as moderate-risk conditions for early CVD. To achieve this objective, the primary specific aims of this statement are to (1) summarize evidence that MDD and BD are tier II moderate-risk conditions associated with accelerated atherosclerosis and early CVD and (2) position MDD and BD as tier II moderate-risk conditions that require the application of risk stratification and management strategies in accordance with Expert Panel recommendations. In this scientific statement, there is an integration of the various factors that putatively underlie the association of MDD and BD with CVD, including pathophysiological mechanisms, traditional CVD risk factors, behavioral and environmental factors, and psychiatric medications.

Gender-based differences in oxidative stress parameters do not underlie the differences in mood disorders susceptibility between sexes

The present study aimed to determine whether any gender-related difference exists concerning oxidative stress parameters in a population of 231 subjects, and if these changes might be related to gender-associated differences in major depressive disorder (MDD) or bipolar disorder (BD) vulnerability. This is a case-control nested in a population-based study. The initial psychopathology screen was performed with the Mini-International Neuropsychiatric Interview and the diagnostic was further confirmed with the Structured Clinical Interview for DSM-IV. Blood samples were obtained after the interview and the oxidative stress parameters such as uric acid, advanced oxidation protein product (PCC) and lipid hydroperoxides (TBARS) were determined. Our results indicated a higher prevalence of MDD and BD in women when compared to men. In addition, significant gender differences were found in the levels of PCC (0.27±0.27 vs. 0.40±0.31nmol CO/mg protein, men vs. women, respectively; P=0.02) and uric acid (4.88±1.39mg/dL vs. 3.53±1.02mg/dL, men vs. women, respectively; P=0.0001), but not in TBARS (0.013±0.01nmol/mg of protein vs. 0.017±0.02nmol/mg of protein, men vs. women respectively; P=0.243). After sample stratification by gender, no association was found between oxidative stress parameters and clinical diagnosis of MDD and BD for women (P=0.516 for PCC; P=0.620 for TBARS P=0.727 for uric acid) and men (P=0.367 for PCC; P=0.372 for TBARS P=0.664 for uric acid). In this study, women seem more susceptible to oxidative stress than male. However, these gender-based differences do not seem to provide a biochemical basis for the epidemiologic differences in mood disorders susceptibility between sexes.

Can an Integrative Approach to the Management of Depression Help Patients Achieve Functional Recovery? A Review of Current Literature

The neurobiology of emotion regulation is complex and multifactorial. Current models suggest that connections between information processing by the brain and its communications with the mind and body are impaired by chronic stress and the system is dysregulated in Major Depressive Disorder (MDD). Despite the high prevalence of MDD, the condition remains poorly managed with current treatment approaches, which have traditionally been aimed at correcting a single level of dysfunction, notably in neurotransmitters. A substantial proportion of patients who achieve symptomatic improvement with conventional therapy continue to report residual depressive symptoms and/or poor psychosocial functioning. Few clinical trials have been powered to detect changes in measures of functioning, resulting in a lack of evidence-based guidance for clinicians. The present paper reviews the evidence for an integrated, multipronged approach to the management of depression that may involve pharmacotherapy, psychotherapy, Complementary and Alternative Medicine (CAM) approaches such as yoga/meditation, exercise, diet and dietary supplements, and social support groups. The author advocates for the use of a patient-centric approach founded on a strong patientprovider alliance for the management of MDD. A shared decision-making approach should consider the potential role of pharmacotherapy, psychotherapy and CAM, which may enhance symptomatic remission and functional recovery in patients with MDD. These results may be mediated, at least in part, through improved regulation of the Hypothalamic- Pituitary-Adrenal (HPA) axis, and reduced allostatic stress load.

Are Menopausal Women with Epilepsy at Higher Risk for Mood Disorders and Suicide Risk? (P01.043)

Objective: To compare the prevalence of mood and anxiety disorders and suicide risk in premenopausal and menopausal women with epilepsy. Background The risk for mood and anxiety disorders during the menopause period among women with epilepsy have not been systematically investigated. The prevalence of psychiatric disorders in patients with epilepsy is higher than the general population. During the menopausal transition women are at increased risk for depression. Thus, we hypothesize that psychiatric co-morbidities are higher in menopausal women with epilepsy as well. Design/Methods: Women with epilepsy admitted to the Cleveland Clinic Epilepsy Monitoring Unit were invited to participate. Subjects were interviewed by a psychiatrist or neurologist using the Mini-International Neuropsychiatry Interview (MINI), which is a validated and standardized psychiatric diagnostic interview. The study was IRB approved. Statistical analysis was descriptive as the study is on going. Results: Fifty five women with epilepsy participated. Subjects had a mean age of 39 year (19-67); 80% were Caucasian. Epilepsy classification includes temporal lobe (32%), extra temporal (23%), undefined focal epilepsy (36%), generalized (5%), and multifocal (2%). Average seizure frequency was 77 per 6 months and the average age of epilepsy onset was 24. In regards to AED, majority of patients were on polytherapy (84%). Based on MINI, 27% women met criteria for major depressive disorder (MDD), 9% generalized anxiety disorder (GAD), and 34.5% had suicidal ideation. Compared to premenopausal women, menopausal women experienced a higher prevalence of MDD (34.7% vs. 22%), GAD (13% vs. 6%), and suicide ideation (39% vs. 31%). Conclusions: This study suggests that menopausal women with epilepsy have a higher prevalence of MDD, GAD, and suicide ideation compared with premenopausal women. Further investigation on the psychiatric effects of menopause in this population is needed to increase awareness and enhance quality of patient care. Disclosure: Dr. Patel has nothing to disclose. Dr. Foldvary-Schaefer has received personal compensation for activities with Jazz Pharma and UCB Pharma. Dr. Foldvary-Schaefer has received research support from UCB Pharma, CleveMed, and Lundbeck. Dr. Jehi has nothing to disclose. Dr. Tesar has nothing to disclose. Dr. Viguera has nothing to disclose.

Does the Aging Males’ Symptoms scale assess major depressive disorder?: A pilot study

Objectives The objectives of the study were to find the prevalence of major depressive disorder (MDD) in male climacteric outpatients in Japan, and to determine whether symptoms on the Aging Males’ Symptoms (AMS) scale scores differed between patients with and without MDD, with the aim of increasing the specificity of future symptoms scales for partial androgen deficiency of the aging male (PADAM). Methods Eighty-three patients aged 40–70 who visited the male-climacteric services as outpatients were assessed using three items: a self-administered questionnaire corresponding to diagnosis for MDD, the Beck Depression Inventory, and the AMS scale. Results Almost half the patients had MDD. The total AMS score, the scores on the AMS psychological, somatic and sexual subscales, and the scores for all except three questionnaire symptoms were higher in patients with MDD. There were strong correlations between the AMS scale and the Beck Depression Inventory. Conclusions There is a higher prevalence of MDD in male-climacteric outpatients and scores on most items of the AMS scale were higher for patients with MDD. We suggest that only those symptoms whose scores did not differ between patients with and without MDD are used to assess symptoms of PADAM in the presence of MDD, or that the current AMS is used only after diagnosis of MDD and elimination of these patients. Then the relevance of each item of the AMS to testosterone levels should be simultaneously examined in the future study, which will determine the items highly specific to PADAM symptoms.

Quality of life assessments in major depressive disorder: a review of the literature

According to the DSM-IV classification, a diagnosis of Major Depressive Disorder (MDD) is possible only when there is evidence of significant inference with functioning. However, despite the high prevalence of MDD in the general population [1], it is uncommon for clinicians to assess overall functioning in a systematic way before making such diagnosis. An important correlate of functioning is quality of life, which is typically defined as “patients' own assessments of how they feel about what they have, how they are functioning, and their ability to derive pleasure from their life activities” [2]. In the present article, we review studies focusing on the relationship between depression and quality of life, particularly focusing on the impact of the treatment of depression on quality of life. Studies focusing on the quality of life in MDD are reviewed. Candidate studies published between 1970 and recently were initially identified by Pubmed and Ovid search cross-referencing the terms “quality of life,” “psychosocial functioning” with “major depression” and “treatment.” A number of studies report poorer quality of life in MDD patients compared to controls. Several studies also report an improvement in quality of life measures during various phases of treatment with antidepressants and/or psychotherapy. However, trials comparing the role of newer psychopharmacologic agents in the acute phase of treatment, and the role of newer psychotherapies in the continuation and maintenance phases of treatment in restoring psychosocial functioning and improving the quality of life in MDD are lacking. Exploring the impact of these modalities on psychosocial function and quality of life in MDD are necessary to help translate clinical response into restoration of psychosocial function and to thus further improve the standard of care.