Mild Depressive Disorder Research Articles

Employer burden of mild, moderate, and severe major depressive disorder: mental health services utilization and costs, and work performance

Treatment utilization/costs and work performance for persons with major depressive disorder (MDD) by severity of illness is not well documented. Using National Comorbidity Survey-Replication (2001-2002) data, US workforce respondents (n=4,465) were classified by clinical severity (not clinically depressed, mild, moderate, severe) using a standard self-rating scale [Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR)]. Outcomes included 12-month prevalence of medical services/medications use/costs and workplace performance. Treatment costs (employer's perspective) were estimated by weighing utilization measures by unit costs obtained for similar services used by MDD patients in claims data. Descriptive analysis across three severity groups generated chi(2) results. Using a sample of 539 US workforce respondents with MDD, 13.8% were classified mild, 38.5% moderate, and 47.7% severe cases. Mental health services usage, including antidepressants, increased significantly with severity, with average treatment costs substantially higher for severe than for mild cases both regarding mental health services ($697 vs. $388, chi(2)=4.4, P=.019) and antidepressants ($256 vs. $88, chi(2)=9.0, P=.001). Prevalence rates of unemployment/disability increased significantly (chi(2)=11.7, P=.003) with MDD severity (15.7, 23.3, and 31.3% for mild, moderate, and severe cases). Severely and moderately depressed workers missed more work than nondepressed workers; the monthly salary-equivalent lost performance of $199 (severely depressed) and $188 (moderately depressed) was significantly higher than for nondepressed workers (chi(2)=10.3, P<.001). Projected to the US workforce, monthly depression-related worker productivity losses had human capital costs of nearly $2 billion. MDD severity is significantly associated with increased treatment usage/costs, treatment adequacy, unemployment, and disability and with reduced work performance.

Treatment of Depressive Disorders: The Value of Psychotherapeutic Methods in Treating Depression

The CME article is biased in its unilateral evaluation in favor of pharmacological therapy with antidepressants and at expense of psychotherapeutic therapeutic options. The stipulated division of therapy into phases thus implies a psychopharmacological approach; authors cite a publication that is 35 years old and published by pharmaceutical industry. The treatment setting that is discussed subsequently does include basic therapy provided by general practitioner, as well as psychiatric referral, but up to this point, no psychological or medical psychotherapists or psychosomatic specialists are mentioned. What follows is somewhat blurred, when an algorithm of whatever preference would be helpful here: in mild and moderate depressive disorders—the vast majority—the authors prefer monotherapy, whether as pharmacotherapy or psychotherapy; differential indication in authors’ view being availability of service provision and patient preference. Even psychosomatically oriented compendia (1) offer more helpful, more objective approaches. The decisive effective factor of specific psychotherapy (which includes both psychoanalytical and cognitive behavior therapies)—the therapeutic relationship (2)—is stripped of its value and misunderstood in its essence if authors stipulate conversation with an empathic and understanding physician, sensing the physician’s acceptance of his or her worries and fears and should feel relieved as a result of therapeutic interview as basis of depression treatment beyond specific psychotherapy. Outside setting of specific psychotherapy these are platitudes that every patient would desire and appreciate. A more honest title of article would have restricted itself to pharmacological therapy, as authors themselves do in their algorithm-based stepwise treatment regimen for depressive disorders; psychotherapy does not exist here. The opportunity was sadly missed, to provide a summarizing overview of psychotherapeutic approaches in depressive disorders and of their value and differential indications (as done in locations that are not always easily accessible[3]).

Symptom indicator of severity of depression in cancer patients: a comparison of the DSM-IV criteria with alternative diagnostic criteria

Objective The objective of this study was to explore the performances of several diagnostic criteria items for judging the severity of major depression among cancer patients. Method Using modern item response theory, we examined the performances of the diagnostic criteria outlined by the DSM-IV and two sets of conceptual diagnostic criteria (the Endicott and the Cavanaugh criteria) in a series of 728 cancer patients who had been diagnosed with major depression using an inclusive approach. Results While all the DSM-IV diagnostic criteria, including feelings of worthlessness and suicidal ideation, had a low ability for discriminating the severity of depression, two proposed items (not participating in medical care and social withdrawal) appeared to be good markers of moderately severe major depressive disorder among cancer patients. In addition, the items “fearfulness or depressed appearance in face or body posture” and “brooding, self-pity or pessimism” may be good markers for mild major depressive disorders, while the item “cannot be cheered up, doesn't smile, no response to good news or funny situations” may be a good marker for severe major depressive disorder. Conclusions The findings of the present study suggest that alternative criteria may have utility in diagnosing depression severity in cancer patients.

EFFICACY OF CHRONIC HEART FAILURE COMBINED THERAPY DURING PERLINDOL USAGE IN ELDERLY POST INFARCTION PATIENTS WITH PSYCHOSOMATIC DISORDERS

Aim. To study the efficacy and safety of reversible MAO inhibitor pirlindol (Pyrazidol) in elderly post infarction patients with chronic heart failure (CHF) and affective disorders. Material and methods. 60 patients with CHF of II-III NYHA class 3-4 weeks after myocardial infarction with and anxious and depressive disorders were involved into the study. The patients were randomized in two groups. Patients of the first group received standard therapy (bisoprolol, lizinopril, simvastatin, acetylsalicylic acid, nitrates and diuretcs as required) in combination with pirlindol for 12 weeks. Patients of the second group received standard therapy alone. The follow-up period was 6 months. At baseline and after 12 and 24 weeks of therapy psychosomatic status was examined with the Beck questionnaire and HADS scale. Quality of life (QoL) survey with the Minnesota, Seattle and MOS SF- 36 questionnaires were performed as well as ECG with assessment of heart rate variability (HRV) and echocardiography. Results. Pirlindol improved QoL and was effective in correction of anxious and depressive disorders in CHF patients. At the end of the follow-up period normal Beck scores were registered in 90% and mild depression scores - in 10% of patients in pirlindol group. At the same time all patients of control group had depressive disorders of different intensity. Significant increase of left ventricular ejection fraction was observed in pirlindol group vs control group (20,9 vs -2,5%). Heart morphometric parameters improved in both groups, but left ventricle size reduction was more prominent in pirlindol group (-10,69 vs -5,34%). According to the spectral and time indexes of HRV, pirlindol treatment led to normalization of autonomic balance. Sympathetic overdrive was observed in patients of the control group. Conclusion. In elderly patients with CHF after myocardial infarction pirlindol taken additionally to the standard therapy is well tolerated, effectively eliminate psychosomatic disorders, results in significant improvement of morphofunctional cardiac condition and decrease of sympathetic over activity. Pirlindol can be recommended for the management of mild and moderate depressive disorders in elderly patients with CHF.

Duloxetine appears to be efficacious in patients with mild, moderate or severe major depressive disorder,

Duloxetine appears to be efficacious in patients with mild, moderate or severe major depressive disorder,

Antidepressant Effects of Soyo-san on Immobilization Stress in Ovariectomized Female Rats

Soyo-san is a traditional oriental medicinal formula, a mixture of 9 crude drugs, and it has been clinically used for treating mild depressive disorders. The purpose of the study was to examine the effect of Soyo-san on repeated stress-induced alterations of learning and memory on a Morris water maze (MWM) task and also the anxiety-related behavior on the elevated pulse maze (EPM) in ovariectomized female rats. We assessed the changes in the reactivity of the cholinergic system by measuring the immunoreactive neurons of choline acetyltransferase (ChAT) and reactivity of acetylcholinesterase (AChE) in the hippocampus, and the serum levels of corticosterone were assessed after behavioral testing. The female rats were randomly divided into three groups: the nonoperated and nonstressed group (normal), the ovariectomized and stressed group (control), and the ovariectomized, stressed and Soyo-san treated group (SOY). The rats were exposed to immobilization stress (IMO) for 14 d (2 h/d), and Soyo-san (400 mg/kg, i.p.) was administered 30 min before IMO stress. Treatments with SOY caused significant reversals of the stress-induced deficits in learning and memory on a spatial memory task, and it also produced an anxiolytic-like effect on the EPM, and increased the ChAT and AChE reactivities (p<0.05, respectively). The serum level of corticosterone in the SOY group was significantly lower than that in the control group (p<0.05). These results suggest that Soyo-san might prove to be an effective antidepressant agent.

Wilson disease in septuagenarian siblings

Wilson Disease (WD) usually presents in the first decades of life, although rare patients have a later presentation. We report the clinical features, diagnostic evaluation, and outcome with treatment of two septuagenarian siblings evaluated as part of a research trial for treatment of neurological WD. The index case was a 72-year-old woman who suffered progressive neurological disability, then developed sub-fulminant liver failure. Her sibling was a 70-year-old man with minimal neurological symptoms and a mild depressive disorder. His liver biopsy revealed only steatosis and minimal fibrosis and an elevated hepatic copper content (671 mug/g dry weight liver). Molecular studies demonstrated compound heterozygosity for disease specific ATP7B mutations E1064A and H1069Q in both patients. Both individuals were treated with trientine and Zn followed by Zn maintenance therapy. Over the last 5 years, the clinical course stabilized and improved, although the index case recently died from bronchopneumonia. In conclusion, advanced age and different clinical presentations of these two subjects with identical ATP7B mutations raises the question of the degree of penetrance for these and other ATP7B mutations. Environmental and extragenic factors are pivotal determinants of disease phenotype. We suggest that WD must be considered at all ages in patients with hepatic disease, neurological disease, or psychiatric symptoms.

P.1.081 Vardenafil temporally improves erectilefunction and depression intensity in men with mild major depressive disorder and erectile dysfunction

Symptoms of agitation, anxiety and insomnia are frequent among patients with major depressive disorder (MDD) during the first weeks of psychiatric care. But a substantial number of patients declines taking pharmaceutical medication to avoid side effects. Therefore, an alternative herbal medication is needed. Clinical studies demonstrated that lavender oil capsules, termed Lasea®, have an anxiolytic effect comparable to Lorazepam and significantly reduce insomnia and agitation in non-depressed patients. Therefore, the aim of this retrospective case series was to analyze the effectiveness of Lasea® for patients with MDD and symptoms of anxiety, insomnia and psychomotor agitation.Eight cases were analyzed retrospectively regarding the dosage, length of treatment, possible side effects and effectiveness of Lasea®.All cases were treated at the Department of Psychiatry at Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin in a naturalistic setting.Effectiveness was measured by a change in the Hamilton Rating Scale for Depression (HAMD-17) total score and subscores.In 6 cases, the combination of Lasea® and an antidepressant resulted in a reduction of MDD. Lasea® also reduced agitation in 6 cases. Psychological anxiety was reduced in 5, somatic anxiety in 4 cases whereas sleep-onset and sleep-maintenance insomnia improved in 3 cases each.The results demonstrate that Lasea® reduces some of the anxiety related symptoms and sleep disturbances in MDD patients. Furthermore Lasea® significantly reduces psychomotor agitation. Additionally, the results indicate a significant global improvement stemming from the combinational therapy of Lasea® and antidepressant medication.

LB14 Efficacy and tolerability of vardenafil in men with mild major depressive disorder and erectile dysfunction: The depression related improvement with vardenafil for erectile response (driver) study

LB14 Efficacy and tolerability of vardenafil in men with mild major depressive disorder and erectile dysfunction: The depression related improvement with vardenafil for erectile response (driver) study

Efficacy of a triple herbal preparation in mild depressive disorders: results of a randomised placebo‐controlled trial

Efficacy of a triple herbal preparation in mild depressive disorders: results of a randomised placebo‐controlled trial

Role of estrogen in the treatment of depression.

The role of estrogen in the treatment of depression is reviewed. The relation is examined in studies of perimenopausal and postmenopausal women with depressed mood, in studies of depressive disorders, and in studies of estrogen as an adjunct to antidepressant medication. The literature has many methodologic shortcomings, including combining women of various ages, failure to confirm life stage, the use of different types of estrogens, the inclusion of women with a range of mood disturbances, and the enrollment of women with concurrent psychiatric illness. There are few controlled evaluations of the use of estrogen to supplement ongoing antidepressant treatment. Estrogen alone seems to be beneficial for improving mood in perimenopausal and postmenopausal women. Estrogen is superior to placebo for reproductive-related mood disorders, including postpartum depression and mild depressive disorders during perimenopause. Replication is necessary, especially in moderate to severe levels of major depression. Estrogen may augment antidepressant treatment. Assessment and treatment implications are discussed.

Dual diagnosis in offenders with intellectual disability: setting research priorities: a review of research findings concerning psychiatric disorder (excluding personality disorder) among offenders with intellectual disability

Studies of so-called 'dual diagnosis', i.e. intellectual disability (ID) with an additional psychiatric disorder, are reviewed with particular reference to offending behaviour. Because of the paucity of studies of psychopathology in offenders with ID, the present paper opens with studies of broader issues of psychopathology among people with ID, notably those with depression, schizophrenia, mild depressive disorder, other major psychotic disorders, anxiety/neurotic disorder, autistic spectrum disorders and attention deficit hyperactivity disorder. There follows a review of the most established and commonly used measurement scales for dual diagnosis in ID. The review then focuses directly on those studies which have looked at the issues of dual diagnosis among offenders with ID. In keeping with other reviews in this series, the latter studies are classified according to the same criteria. Based on this review, it is apparent that there are high-priority research questions which concern the extent and nature of psychopathology among offenders with ID, most notably those with autistic spectrum disorders.

Quantitative analysis of the active components and the by‐products of eight dry extracts of Hypericum perforatum L. (St John's wort)

The major components of eight different batches of commercially available dry extracts of Hypericum perforatum L. were quantified. Hyperforin (1), hypericin (2) and flavonoids, which are considered to play key roles in the treatment of mild and moderate depressive disorders, were determined by HPLC methods. The contents of 1, 2 and flavonoids were found to be in the range of 1.3-3.9%, 0.19-0.30%, and 4.8-11.4%, respectively. Generally extracts contained, besides the so-called active components, a wide variety of by-products which may act partially as co-effectors and affect the technological properties of the extracts. Water-soluble sugars form one of the main groups of these by-products, and a procedure for the purification and quantification of such sugars in H. perforatum using HPLC with refractive index detection has been established. Native fructose, glucose and sucrose, as well as lactose added during the processing of the extracts, were determined. The total sugar content in the dry herbal extracts varied from 19 to 25% by weight. Further, citric acid (0.9-2.3%) and malic acid (2.3-3.1%) were determined by HPLC, tannins (6.2-9.0%) and total ash (4.9-8.4%) were quantified according to the methods described in the European Pharmacopoeia, and the content of the total protein (3.9-8.3%) was estimated by elemental analysis. Thus, 60-70% of the compounds of the H. perforatum dry extracts have been quantified.

Potential treatment for subthreshold and mild depression: A comparison of St. John's wort extracts and fluoxetine

Subthreshold depressive disturbances and depressive episodes of mild severity are frequently associated with disability and socioeconomic burden, and often show an increase in symptomatology over time if untreated. Thus, there is an urgent need for antidepressant active compounds that are more readily available than those that must be obtained by prescription. To get an impression of the efficacy of the widely used phytopharmaceutical St. John's wort, the antidepressant efficacy in mild depressive disorders was compared with that of the standard antidepressant fluoxetine. The present overview includes controlled trials of fluoxetine in depression with a mean initial score on the Hamilton Rating Scale for Depression (HAM-D) < or =24, which were compared to the respective studies on St. John's wort. The mean HAM-D reduction of all St. John's wort studies was 10.2 (52.9%), and the respective figures for fluoxetine were 12.5 points and 55.5%. Thus, no relevant efficacy difference between the groups of investigations was found based on the studies included. The most important restrictions of this overview are no meta-analysis was performed, the studies were performed with heterogeneous methodological standards, and the St. John's wort extracts used were very different. However, St. John's wort might be a treatment option to reduce symptoms in patients not suffering from full-blown depressive disorder.

Early postnatal depressive mood: Associations with obstetric and psychosocial factors

The central purpose of this investigation was to detect incidence and influencing factors on early postnatal depressive mood in a large hospital sample. By means of an interview we acquired information on sociodemographic data, physical and psychiatric anamnesis, and obstetric and psychologic variables. The Edinburgh Postnatal Depression Scale (EPDS) served to determine the depressive mood of our patients. The interview was carried out on 1250 women at two postnatal wards 5 days after delivery. According to the results of the German validation of the EPDS, where a cutoff of 9/10 indicates at least mild depressive disorder, the whole sample was divided into group A (EPDS score ⩽9; n=996, 79.7%) and group B (EPDS score ⩾10; n=254, 20.3%). Early postnatal depressive mood, as assessed by the EPDS, appeared with 20% of all women taking part in our investigation on the fifth postnatal day. Subjective measurements such as high childbirth burden, elevated trait anxiety, low life satisfaction and lower social class, and low birth weight of the infant seem to be of predominant relevance for early postnatal depressive mood.

Prävalenz depressiver Störungen im frühen Wochenbett

Fragestellung: Ziel dieser Untersuchung war es, die Prävalenz depressiver Störungen am fünften Tag postpartum mit der Edinburgh Postnatal Depression Scale (EPDS) zu untersuchen und Zusammenhänge mit geburtshilflichen und psychosozialen Variablen darzustellen. Methoden: Die Erfassung soziodemographischer Daten, somatischer und psychiatrischer Anamnesen sowie geburtshilflicher und psychologischer Variablen erfolgte mittels Interview bzw. der Krankengeschichte. An der Untersuchung nahmen 1250 Wöchnerinnen 5 Tage nach der Geburt teil. Ergebnisse: Gemäss den Resultaten der deutschen Validierung der EPDS zeigte sich für 254 (20,3%) Wöchnerinnen eine zumindest leichte depressive Störung. Der Vergleich zwischen nichtdepressiven Frauen (EPDS ≤9, n = 996) und depressiven Frauen (EPDS ≥10, n = 254) erbrachte folgende Risikofaktoren für eine depressive Störung: subjektiv erhöhte Geburtsbelastung, höhere Angstneigung, ungünstige Partnerbeziehung, niederer Sozialstatus und geringere Berufszufriedenheit. Hinsichtlich geburtshilflicher Variablen erwiesen sich vermehrte Schwangerschaftsrisiken, Fehlgeburten in der Anamnese, niederes Geburtsgewicht und Kaiserschnittentbindungen als Risikofaktoren. Schlussfolgerungen: Depressive Störungen im frühen Wochenbett treten bei 20% der Wöchnerinnen auf. Entsprechend der Literatur stellt diese Gruppe von Frauen das Risikokollektiv für eine spätere postpartale Depression dar. Unter Beachtung der psychosozialen und geburtshilflichen Risikovariablen sind präventive psychotherapeutische Interventionen bereits an der Wochenstation sinnvoll.

The three faces of the antidepressants: a critical commentary on the clinical-economic context of diagnosis.

Depression was infrequently diagnosed before the advent of the antidepressants but has now apparently become a major public health problem. National campaigns are organized aimed at increasing recognition of the condition and at commencing treatment for sufferers. Implicit in these approaches is the premise that treatment will necessarily reduce disability and ultimately lower suicide rates. This is by no means certain. The treatment effect size of many antidepressants is modest, the burden of side effects they produce has never been established, and data on the quality of life during treatment is absent. It remains possible that mild depressive disorders confer a protective effect against suicide and that injudicious or unmonitored treatment may increase that risk. In their concern to help patients, physicians appear to have systematically overlooked the risks they expose patients to as part of their therapeutic effort to minimize the risks posed by the patient's condition. Their propensity to overlook the risks posed by therapy may stem in part from the availability of antidepressant treatments on prescription only. Remedying this situation will require first of all a recognition of the biases that prescription-only status introduces into therapeutics. Current pharmacological and neuroscientific developments have the potential to make alternative health care frameworks possible. Whether these alternatives are adopted will probably depend on the capacity of all interested parties to reform the present arrangements. Future concepts of depressive disorders will probably reflect the regulatory arrangements adopted.

Psychological treatment of depression in children and adolescents. A review of treatment research.

This paper reviews research on the psychological treatment of depression in children. Manual and computer literature searches were performed. The most promising psychological interventions for depression in children are individual rather than family therapies. Cognitive--behavioural therapy seems to be an effective treatment for depressive symptoms and mild depressive disorders. It may also be a useful preventive intervention, though this remains to be conclusively demonstrated. There have been no systematic studies comparing psychological treatments with medication. Studies comparing psychological treatments and medication are now required.

Plasma corticotropin-releasing factor in depressive disorders

Background: The aim of this work was to investigate alterations of plasma corticotropin-releasing factor (CRF) levels in depressive states. We have also measured plasma cortisol and corticotropin (ACTH) concentrations and examined their correlation with the peripheral CRF values. Methods: Thirty-six outpatients from the psychiatric department of a Barcelona hospital who were diagnosed as having major depressive disorder ( n = 26) and dysthymic depressive disorder ( n = 10) were studied. Among the major depressed patients, 10 suffered from severe depressive disorder and 16 from mild or moderate depressive disorder. The comparison group consisted of 17 healthy volunteers. Cortisol, ACTH, and CRF concentrations were determined by iodine-125 radioimmunoassay; CRF measurements were performed on C 18 extracted samples. Results: CRF and cortisol plasma concentrations were significantly higher in major depression and dysthymia than in the comparison group. The major depressed patients did not show significantly different CRF and cortisol levels than the dysthymic. Severe major depressive disorder exhibited significantly higher CRF plasma levels than the mild or moderate episodes. Plasma cortisol and CRF concentrations correlated significantly. Conclusions: The results obtained indicate that plasma CRF values are altered in depressive disorders and suggest that these determinations could be important for understanding the pathophysiology in affective illness.

Young immigrants on long‐term sick‐leave

Sickness certification data for all immigrants 16–45 years of age on long‐term sick‐leave enlisted at a local health insurance office were studied. The diagnostic pattern was remarkably homogeneous, characterized by imprecise pain and/or imprecise mental disorders. Clinical data were provided by a multiaxial evaluation of 52 people (mean age 38 years, mean length of sick‐leave 1 year, full‐time). Ratings of pain behavior and functional ability regarding occupational duties were also included. Nearly half (44%) had few social contacts both within their ethnic group and Swedish society. Half (58%) were assessed as being exposed to moderate or severe psychosocial stressors, and many had an associated mild or moderate depressive disorder. Muscular pain was the most frequent physical disorder. Pain behavior was common and was associated with the length of sick‐leave. Two‐thirds were assessed as being able to work at least part‐time. The multiaxial evaluation system proved useful for differentiating important incapacitating diagnostic factors. Nevertheless, the examining doctors seemed to have been influenced by the participants' pain presentations when rating their functional ability. The study thus illustrates the ease with which a vicious circle of pain behavior and further sickness certification could be created. In conclusion, social distress and iatrogenic factors may have played an important part in the sick‐leave pattern seen in this group of young immigrants.