Initial Beck Depression Inventory Score Research Articles

Short-Interval periodic transcranial direct current stimulations may induce long-term remission of symptoms in a patient with poststroke depression

Transcranial direct current stimulation (tDCS) has been shown to be effective in the management of patients with poststroke depression (PSD) but with a high relapse rate. We present a report of a patient with PSD who had long-term mood improvement upon receiving periodic tDCS sessions with short inter-session intervals following a relapse of symptoms at 3 weeks after improvement due to stimulations with long inter-sessions intervals. A 60-year-old patient presented with moderate PSD, having a Beck Depression Inventory (BDI) score of 25. She received anodal tDCS to the left dorsolateral prefrontal cortex using two different application protocols. Initially, a stimulation session of 2 mA intensity for 20 min was given every working day for 2 weeks. After 3 weeks, she then received seven sessions of periodic stimulations of 2 mA intensity for 13 min each with 20 min inter-sessions interval. BDI score was taken before the intervention, immediately after, and at 3 weeks and 6 months postintervention. Immediately following the last session of the initial protocol of stimulation, the BDI score reduced from 25 to 7. However, the symptoms relapsed at 3 weeks postintervention to the initial BDI score of 25. There was no change in the BDI score immediately after follow-up with short interval periodic stimulations. Nevertheless, the BDI score improved to 18 at 3 weeks and later to 7 at 6 months postintervention. Series of periodic tDCS with short-intersession intervals may be more effective in inducing long-term mood improvement in patients with PSD.

The Impact of Gender on Interferon-Associated Depression and Anxiety

Population studies indicate women have higher prevalences of depression and anxiety than men. Interferon (IFN) is a biologic agent that can induce or exacerbate depression and/or anxiety. Whether women are more likely to experience these side effects of IFN during treatment remains to be determined. The aim of this study was to document levels of depression and anxiety in female and male patients before and during IFN-based treatment. This was a prospective open-label study in which depression was measured by Beck Depression Inventory (BDI) and anxiety by Hospital Anxiety and Depression Scale (HADS). Before treatment, the prevalence of depression was higher in females (3/13 [23%]) than males (1/25 [4%]), but the difference did not reach statistical significance (P = 0.12). Initial BDI scores were also higher in females but not significantly (P = 0.07). During treatment, BDI scores increased to a similar extent in both genders. A similar percentage of nondepressed patients at baseline developed depression (females: 50% versus males: 35%, P = 0.45). Before treatment, anxiety was significantly more common in females (7/13 [54%]) than males (3/25 [12%]) (P = 0.016) and median HADS scores were higher in females (P = 0.03). During treatment, increases in HADS scores were similar in the 2 genders. A similar percentage of patients without anxiety at baseline developed anxiety on treatment (females: 50% versus males: 23%, P = 0.31). The frequency and extent of IFN-induced/exacerbated depression and anxiety are not gender dependent.

Venlafaxine for Depression and Glossovulvodynia

To the Editor: Gaitonde et al1 first reported a case of a patient with both burning mouth syndrome (BMS) and vulvodynia. Petruzzi et al2 reported 5 serial cases of vulvostomatodynia. They comment that BMS and vulvodynia may share a common cause. The cause of “dynias” is currently unknown. Here, we report a case of a woman with glossovulvodynia and underlying affective disorder. Venlafaxine brought about dramatic improvement in the patient's symptoms. Case report. Ms A, a 48-year-old woman, started to develop a severe burning sensation in the vulva, palate, throat, and tongue in February 2009. She was evaluated by her dermatologist, neurologist, and dentist. A complete laboratory test was undertaken, with vitamins B12 and B6, folic acid, iron, zinc, thyroid hormones, glucose, and autoimmune panel analyzed. Allergologic study findings were within normal limits. There was no evidence of infection, trauma, or dermatitis in the oral cavity or vulva. Temporomandibular joint function was within the normal range, and she had no prosthetic device. Local and systemic diseases were excluded. She was diagnosed with glossovulvodynia. The patient was treated with trazodone, alprazolam, escitalopram, and paroxetine, with no improvement of her symptoms. She was referred to our psychiatric outpatient clinic in June 2009. Ms A said that she had lost interest in activities that she previously found pleasurable. She could not follow a conversation and felt insecurity and pessimism. She said everything was “going bad” and that she did not have enough money to make ends meet. Her family said she was irritable. She was very anxious and exhibited psychomotor restlessness, depressed mood with guilt, and hypochondriac and ruinous delusions. She suffered from global insomnia and hyporexia. She had diminished ability to think or concentrate. Oral and vulvar symptoms were registered using a 10-cm Visual Analog Scale (VAS; 0 = no pain to 10 = extreme pain); her initial VAS score was 9. The patient completed the Beck Depression Inventory (BDI)3; her initial BDI score was 40. She was diagnosed with major depressive disorder, a severe single episode with mood-congruent psychotic features and melancholic symptoms according to DSM-IV-TR classification. We started administration of venlafaxine (the initial dosage was 37.5 mg/d and the dosage was then gradually increased to 225 mg/d) and lorazepam (2.5 mg/d), with excellent progress: after 10 weeks of treatment, dysesthetic sensations disappeared and Ms A's mood improved until total resolution of the disorder (final VAS score = 0, final BDI score = 5). Glossodynia, or BMS, and vulvodynia are among the psychodermatologic disorders. Therefore, strong relationships with psychopathologic disorders exist, basically with affective disorder, as in the case we report.4 Venlafaxine is a serotonin-norepinephrine reuptake inhibitor (SNRI). It has been repeatedly suggested that depression and pain may share a common psychopharmacology. SNRIs have been studied extensively and have demonstrated efficacy for painful symptoms associated with depression, diabetic neuropathy pain, and chronic pain with or without depression. SNRIs produce higher rates of response and remission from major depression than the selective serotonin reuptake inhibitors (SSRIs), and SNRIs are more effective in the treatment of pain than SSRIs.5–7 In the case we report, we think that venlafaxine resolved the dysesthesias due to its antidepressive effect and because of the disappearance of affective disorder. A detailed assessment of the coexisting psychopathologic disorders is necessary to choose the proper treatment of “dynias.” Nevertheless, many studies support the analgesic effect without taking account of antidepressive effect, so it should resolve other “dynias” when the affective component is not so important.5,6

History of Depression and Survival After Acute Myocardial Infarction

To compare survival in post-myocardial (MI) participants from the Enhancing Recovery In Coronary Heart Disease (ENRICHD) clinical trial with a first episode of major depression (MD) and those with recurrent MD, which is a risk factor for mortality after acute MI. Recent reports suggest that the level of risk may depend on whether the comorbid MD is a first or a recurrent episode. Survival was compared over a median of 29 months in 370 patients with an initial episode of MD, 550 with recurrent MD, and 408 who were free of depression. After adjusting for an all-cause mortality risk score, initial Beck Depression Inventory score, and the use of selective serotonin reuptake inhibitor antidepressants, patients with a first episode of MD had poorer survival (18.4% all-cause mortality) than those with recurrent MD (11.8%) (hazard ratio (HR) = 1.4; 95% Confidence Interval (CI) = 1.0-2.0; p = .05). Both first depression (HR = 3.1; 95% CI = 1.6-6.1; p = .001) and recurrent MD (HR = 2.2; 95% CI = 1.1-4.4; p = .03) had significantly poorer survival than did the nondepressed patients (3.4%). A secondary analysis of deaths classified as probably due to a cardiovascular cause resulted in similar HRs, but the difference between depression groups was not significant. Both initial and recurrent episodes of MD predict shorter survival after acute MI, but initial MD episodes are more strongly predictive than recurrent episodes. Exploratory analyses suggest that this cannot be explained by more severe heart disease at index, poorer response to depression treatment, or a higher risk of cerebrovascular disease in patients with initial MD episodes.

Long-Term Follow-Up of a Clinical Replication of the Peniston Protocol for Chemical Dependency

ABSTRACT Introduction. This study is a long-term follow-up of an early replication of the Peniston EEG biofeedback (EEG-BFB) Protocol for chemical dependency (Peniston & Kulkosky, 1989, 1990). Method. This clinical trial included 16 chemically dependent adult participants treated with the Peniston Protocol in a university outpatient clinic between 1993 and 1995. Ten participants were probationers classified as high risk for rearrest. Treatment effects were assessed using pre/posttreatment measures (Beck Depression Inventory, Minnesota Multiphasic Personality Inventory-2) and long-term follow-up of abstinence and rearrest rates. Probationer rearrest rates were compared to an equivalent probation sample (n = 24) that did not receive EEG-BFB. Results. Initial Beck Depression Inventory scores indicated mild/moderate depression but were significantly reduced posttreatment to within normal limits. Substantial differences were noted posttreatment on 7 Minnesota Multiphasic Personality Inventory-2 clinical scales...

Recovery from Depression: A Two-Year Follow-Up Study of General Population Subjects

The recovery from depression and factors associated with it are not well known in the general population. To conduct a two-year follow-up of general population subjects and investigate their recovery from depression. Individuals who were assessed as suffering from depression on the basis of Beck Depression Inventory (BDI) scores were monitored for two years. Sixty-five per cent were still depressed after two years of follow-up. Negative life events had occurred more often in those who had remained depressed than in the others. Logistic regression analysis revealed that a high initial BDI score and a worsening of a subject's economic situation during the follow-up period were associated with failure to recover. Lack of use of health services was associated with non-recovery. Depression may be more chronic in the general population than previously has been thought.

Mood Scores in Relation to Hormone Replacement Therapies during Menopause: A Prospective Randomized Trial

There is lack of studies in literature about the long-term effects of hormone replacement therapies and cholesterol levels on mood scores in menopause. In the present study we have investigated whether serum lipid levels affect mood scores in menopause and evaluated the long-term effects of the combined hormone replacement regimens (HRT) on depressive symptoms in postmenopausal women. In this prospective-randomized, placebo-controlled, double-blind study, 286 women in menopause were divided into four groups according to therapeutic regimens they received; 1) Conjugated equine estrogen (CEE) of 0.625 mg plus medroxyprogesterone acetate (MPA) of 2.5 mg (n = 79), 2) CEE (0.625 mg) plus MPA of 5 mg (n = 77), 3) tibolone of 2.5 mg (a selective tissue estrogenic activity regulator) (n = 76), and 4) Calcium (Ca) of 1,000 mg (n = 54). Beck Depression Inventory (BDI), and serum levels of lipoprotein lipids were assessed before and after 12-months of treatment with oral continuous HRT and Ca supplementation. BDI scores in the study groups were not correlated with lipid profiles. We compared two subgroups of patients with initial BDI scores 0-14 (normal mood scores) in order to asses for the possible relation between the lipid profile and mood. Following treatment, first subgroup had increased scores to 15-30 (mildly depressed women, n = 27) and the second subgroup preserved BDI scores of 0-14 (normal mood scores, n = 23). Serum levels of total cholesterol, high-density lipoprotein, low-density lipoprotein and body mass index were found to be similar between these two groups. BDI scores decreased significantly in all HRT groups after 12 months of treatment, compared to Ca group (p < 0.05). We did not observe any correlation between BDI scores and lipid profiles before and following continuous HRT or Ca supplementation. Continuous combined hormone replacement regimens, CEE + MPA and tibolone, have superior long-term effects on mood scores in menopause and should be considered during the decision process for use of HRT due to menopausal symptoms.

Depression and its association with peritonitis in long-term peritoneal dialysis patients

Background:Depression is the most common psychological disorder among patients with end-stage renal disease and has been associated with mortality in patients maintained on hemodialysis therapy. Peritonitis is the leading cause of technique failure among long-term peritoneal dialysis (PD) patients. This prospective study is designed to examine the relationship between depression and peritonitis. Methods:All patients on long-term PD therapy in our unit between January 1, 1997, and January 31, 2002, completed a Beck Depression Inventory (BDI) assessment at 6-month intervals. BDI scores were analyzed 2 ways. First, patients were placed into either group I (BDI score < 10) or group II (BDI score ≥ 11) and were reclassified based on subsequent scores. Second, multivariable analysis was performed looking at initial BDI score as a risk factor for peritonitis, adjusting for age older than 65 years, diabetes, coronary artery disease, and race. Results:One hundred sixty-two patients were enrolled, and 281 individual BDI assessments were completed. There was a significantly greater incidence of diabetes and coronary artery disease in group II. Rates for overall and gram-positive peritonitis were significantly greater in group II patients compared with group I patients. Using Cox regression, only BDI score of 11 or greater was associated with the development of peritonitis (hazard ratio, 2.7; 95% confidence interval, 1.2 to 6.0). Conclusion:There is an association between BDI score of 11 or greater and the development of peritonitis. Whether treatment of depression can impact on the rate of peritonitis remains to be examined.

Role of REM sleep and dream variables in the prediction of remission from depression

To test the hypothesis that REM sleep and/or dreams contribute to overnight mood regulation, 61 subjects were tested on the Beck Depression Inventory (BDI), and for 3 nights of monitored sleep on two occasions, once close to, and 1 year after, a marital separation. Forty-nine percent of the variance in the follow-up BDI could be accounted for by the initial BDI score, and three sleep and dream variables associated with the mood regulatory hypothesis: eye movement density in the first REM, strength of the affect in the first dream and total number of negative dreams recalled from REM awakenings. Among the 39 who met BDI depression criteria initially, 71.8% could be classified correctly as remitted or not remitted at follow-up by discriminant function analysis based on the presence of negative dreams the first vs. second half of the night. Subjects reporting more negative dreams at the beginning and fewer at the night's end were more likely to be in remission 1 year later than were those with fewer negative dreams at the beginning and more at the end of the night. Early negative dreams may reflect a within-sleep mood regulation process taking place, while those that occur later may indicate a failure in the completion of this process.

Concurrent Validity and Psychometric Properties of the Beck Depression Inventory in Outpatient Adolescents

The concurrent validity of the Beck Depression Inventory (BDI) was evaluated in 122 outpatient adolescents referred to a clinic for depression. Criterion validators were Kiddie-Schedule for Affective Disorders and Schizophrenia (K-SADS) generated diagnoses and a 17-item clinician-rated depression scale extracted from the K-SADS. Initial BDI scores of greater than 13 yielded sensitivity, specificity, and positive predictive powers of 86%, 82%, and 83%, respectively, in differentiating syndromal major depressive disorder (MDD) from nonaffective disordered patients. In repeated interviews in 2 weeks with a BDI score of greater than 13, these parameters were 89%, 88%, and 93%, respectively, in those meeting MDD criteria. The BDI correlated significantly with the 17-item depression score in depressed females but not depressed males because BDI scores were more than 30% higher in females. BDI internal consistency among all cases was 0.91 and was higher in depressed than nondepressed patients.

Patterns of substance abuse in psychiatric inpatients

257 of the initial 26 patients no longer satisfied the criteria for depression. Initial Beck Depression Inventory (BDI) scores were significantly elevated as compared to the two week follow up (pc.001). Although analysis of variance of initial BDI scores showed a trend toward increased depressive symptomatology among women and polysubstance abusers, the two week follow up suggested that persistence of depressive symptoms was greatest in women (p = .48) and those with additional substance use disorders (p = .025) with an interaction (p = 309). These results confirm the utility of a drug free period in the assessment of depression among hospitalized alcoholics.

Predictors of dropout and outcome in cognitive therapy for depression in a private practice setting

The efficacy of cognitive therapy was examined for 70 depressed private practice patients. Although these patients had a broader range of psychopathology than patients in controlled outcome studies of cognitive therapy, they had comparably large reductions in Beck Depression Inventory (BDI) scores. Patients who completed treatment had an average reduction in BDI scores of 65.5%. Initial BDI scores, endogenous symptoms, compliance with homework, and the interaction between homework and initial BDI scores were statistically significant predictors of end-of-treatment BDI scores. The squared correlation between the observed end-of-treatment BDI scores and the estimated expected value was .81. Controlling for other factors, patients who did homework improved three times as much as those who did not. The effect of homework was substantially larger for patients with high initial BDI scores; thus, studies that include only patients with high initial BDI scores may overstate the importance of homework on a general population. In spite of significant improvement, 50% of patients terminated treatment prematurely, premature termination was most likely in patients with personality disorders, high initial BDI scores, and no endogeneous symptoms.