Nondepressed Patients Research Articles

Frequency of Utilization of Beta Blockers in Patients With Heart Failure and Depression and Their Effect on Mortality

Beta blockers reduce mortality and morbidity in patients with heart failure. Early reports linking β-blockers with depression may have limited their use in heart failure patients with co-morbid depression. Although more recent studies have challenged the association between β-blocker therapy and depression, patient and physicians remain concerned. The goal of this study is to evaluate the utilization and outcomes of β-blocker therapy in heart failure patients with depression. This is a retrospective cohort study of patients at a multicenter integrated healthcare system with a diagnosis of heart failure from 2008 to 2014. Among 6,915 patients with heart failure with left ventricular ejection fraction of <50%, 1,252 (18.1%) had a diagnosis of depression. Patients with depression were more likely to be women and had a higher prevalence of cardiovascular risk factors. Depression was associated with decreased odds of β-blocker treatment (adjusted odds ratio [OR], 0.77; 95% confidence interval [CI], 0.62 to 0.95; p = 0.016). During a mean follow-up of 2.6 years, 439 (35.1%) patients with depression died compared with 1,549 (27.4%) patients without depression. Depressed patients not treated with β-blocker had higher mortality compared with nondepressed patients (adjusted hazard ratio [HR], 1.4, 95% CI 1.09 to 1.7, p = 0.005). When treated with β-blockers, their risk of mortality was attenuated (HR 1.1, 95% CI 0.97 to 1.2, p = 0.14). In conclusion, β-blocker therapy remains underutilized in heart failure patients with depression, and its underutilization contributes to the reduced survival rate observed in this cohort.

Cognitive therapy for depression: theoretical reflection and personal thinkings

Cognitive therapy did not emerge full-blown but went through many researches before it reached its present form. A. Beck’s first foray into the area of cognition actually occurred as a result of an interaction with depressive patients while practicing psychoanalysis and psychodynamic psychotherapy. When the researcher fitted together the observations of the reported automatic thoughts of these patients and his own introspective explorations, he started to arrive at the beginnings of a cognitive theory and the existence of two systems of thoughts. One system is directed to others and, when freely expressed, consists of the kinds of feelings and thoughts that one commonly communicates to other people. This form of thinking and communicating constitutes “the conversational mode” of thinking, or “the mode of dialogue”. The second system of thoughts is “the self-signalling mode”. It consists of self-monitoring, self-instructions, and self-warnings. It also includes rapid, automatic interpretation of events, self-evaluations, and anticipations. Its function is communication with oneself rather than with other people. The researcher discovered, the internal communication system was the source of much of the patients' problems and by tapping into it we could better understand the patients' difficulties and help them to resolve them. The negativity of depression as a psychological state permeated the patients' internal communications, such as self-evaluation, attributions, expectancies, inferences, and recall, and was manifested in low self-esteem, self-blame and self-criticism, negative predictions, negative interpretations of experiences, and unpleasant recollections. A. Beck observed that the depressed patients were particularly prone to make a negative interpretation when a positive one would seem to be more appropriate. Furthermore, they would not only magnify their own unpleasant experiences but would either blot out their experiences that other people would consider positive. In particular, in the course of investigations it was noted that depressed patients tended to predict specific negative outcomes from tasks that they might undertake and expected long-range, bad outcomes to their life in general. A high degree of such negative expectations (“hopelessness”) appeared to be predictive of suicide. These phenomena appeared to be universal across all types of sub-types of depression, irrespective of whether the primary diagnosis was depression, schizophrenia, or some other disorder. As the depressed patients were filled with covert hostility, the dreams would be a place where this hostility could be identified. It has been proved that the depressed patients showed less hostility in their dreams than did the non-depressed patients. Although the depressed patients had fewer dreams in which they played an aggressive or hostile role, they were the victim of some unpleasant event: they were thwarted, deprived, disappointed and depreciated. By suffering, they would be punishing themselves; that is, inflicting the hostility against themselves. This masochism would be manifested in their self-criticism, courting rejection and suicidal desires. All of the depressed patients had more masochistic dreams than did any of the non-depressed patients. Thus, the preliminary confirmation of the psychoanalytic theory of depression must be both enriched hypothetically by a variety of vantage points and by using differing techniques and psychotherapeutic practice protocol.

2227-PUB: Relationship between Depression and Cardiovascular Outcomes in T2DM Patients: A Propensity Score-Matched Analysis of ACCORD Trial

Background: Despite the fact that depression increases risk for cardiovascular disease (CVD), there has met a controversy that evidences linking well depression management to CVD outcomes improvement have yet to be established. In this study, we aim to explore relationship between depression and CVD outcomes among T2DM patients in intensive and standard glycemic therapy cohort. Method: The ACCORD database was divided into intensive glycemic therapy cohort and standard cohort. And we applied logistic regression model to assess the association between depression and CVD outcomes (primary outcome and secondary outcomes), using the propensity score method to adjust for age, gender, BMI, waist, CVD history, race, live alone, education, SBP, DBP, TRIG, CPK, alcohol, VLDL, heart failure and smoke in each cohort. Result: 2272 patients were included in the standard glycemic therapy cohort and 2192 in the intensive cohort finally. Propensity score adjusted logistic models showed that there was no significant difference in CVD outcomes between depressed and non-depressed patients in the standard glycemic therapy cohort. While in the intensive glycemic therapy cohort, the risk of congestive heart failure was significantly higher in patients with depression than in the non-depressed group (p=0.019, OR: 1.608, 95% CI: 1.082-2.39). Besides, depressed patients seemed to more likely to develop non-fatal myocardial infarction (P=0.058, OR: 1.417, 95% CI: 0.989-2.032). Conclusion: On equal terms, T2DM patients with depression have a greater risk of congestive heart failure in patients receiving intensive glycemic therapy, while a larger prospective randomized controlled trial focusing on this endpoint is needed to verify our result. Disclosure Y. Chen: None. D. Zhuang: None. H. Liang: None. X. Chen: None. X. Xu: None.

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.

Masked Depression: Profile and Severity of Symptoms and Impulsivity in Patients with Generalized Anxiety Disorder

Major depressive disorder may remain underdiagnosed as it can be hidden behind somatic complaints or behavioral problems such as impulsivity, making other symptoms difficult to be recognized. The aim of the study was to determine the presence of depression in a sample of patients first-time diagnosed with generalized anxiety disorder that do not refer symptoms related to depression and to compare anxiety symptoms profile and impulsivity features between depressed and non-depressed patients. A total of 86 patients with DSM-IV diagnosis of GAD were recruited from the outpatient psychiatric services of the General Hospital of Comalcalco, Tabasco. Anxiety symptom severity and impulsivity were assessed with previously validated instruments. Depression was rated with the Hamilton Depression Rating Scale and the sample was categorized in depressed and non-depressed patients. More than half of the patients (54.7%) were identified as clinically depressed. These patients reported more severe anxiety symptomatology and more impulsivity than non-depressed patients; depressed patients also reported more somatic symptoms (e.g., gastrointestinal and hypochondriasis) which patients might identify as anxiety symptoms. In Latin-America, it is very common to use somatic symptoms as idioms of expression of emotional distress. Therefore, in patients with GAD with high levels of somatic complaints and impulsivity, depression should be evaluated.

Depression and risk of hip fracture: a systematic review and meta-analysis of cohort studies.

Recently published studies on the association between depression and hip fracture (HF) are inconsistent. Therefore, we performed this meta-analysis with the main aim to clarify the association between depression and HF, and also to identify possible susceptible groups. Relevant literature published until February 2019 was obtained and screened according to established inclusion criteria. Two researchers independently processed quality assessment and data extraction prior to the meta-analysis. Pooled hazard ratios (HRs) with 95%CI (confidence intervals) were calculated. To explore the sources of heterogeneity, subgroup analyses were performed based on study design, study region, NOS scores, follow-up duration, diagnostic criteria, sex, national income level, and adjustments (bone mineral density (BMD), antidepressant, calcium intake, and smoking). Ten studies with 13 estimates, involving 375,438 participants and 4576 HFs, were included. It was found that patients with depression had a higher risk of HF than non-depressed patients (HR = 1.21; 95%CI 1.11-1.31). Sensitivity analysis results show that the association is relatively stable. The studies that were not adjusted for confounders (e.g., antidepressant, BMD, calcium intake, and smoking) had higher overall HR compared to the studies that adjusted for the corresponding confounding factors. HFs are more likely to occur in European and male depression patients. This meta-analysis provided evidence of a modest positive association between depression and the risk of HFs, and the association is stronger in European and male patients. Implementation of practical measures to prevent and treat depression is of great public health significance.

Objective diagnosis of post-stroke depression using NMR-based plasma metabonomics.

Background: Post-stroke depression (PSD) is a frequent and serious complication of stroke. However, the underlying molecular basis of PSD remains largely unknown, and no empirical laboratory tests were available to diagnose this disorder.Materials and methods: A proton nuclear magnetic resonance (1H NMR)-based metabonomic approach was employed to profile plasma samples from 32 PSD, 35 stroke patients and 35 healthy comparison subjects (the training set) in order to identify metabolite biomarkers for PSD. Then, 10 PSD, 11 stroke patients and 11 healthy comparison subjects (test set) were used to validate the diagnostic performance of these biomarkers.Results: The multivariate statistical analysis demonstrated that PSD group was significantly distinguishable from non-PSD groups (non-depression stroke patients and healthy comparison group). Five plasma metabolites (phenylalanine, tyrosine, 1-methylhistidine, 3-methylhistidine and LDL CH3-(CH2)n-) were identified responsible for distinguishing PSD from non-PSD subjects. These metabolites were mainly involved in neurotransmitter metabolism and oxidative stress. The biomarker panel composing of these metabolites was capable of distinguishing test samples with a sensitivity of 100.0% and a specificity of 95.5%.Conclusion: Our findings suggest that plasma disturbances of neurotransmitter levels and oxidative stress were implicated in the onset of PSD; these disturbed metabolites biomarkers facilitate to the development of diagnostic tool for PSD.

Depression and financial capacity assessment in Parkinson's disease with dementia: Overlooking an important factor?

Depression affects cognitive abilities, such as thinking, concentration and making decisions in both young adults and elders. However, financial capacity (which consists of multiple cognitive domains and specific skills) and depression in Parkinson's disease with dementia (PDD) are little investigated. Sixty participants divided into four groups (PDD with and without depressive symptoms, non-demented elders with and without depression) were examined with the Mini-Mental State Examination (MMSE), the Geriatric Depression Scale (GDS-15) and the Legal Capacity for Property Law Transactions Assessment Scale (LCPLTAS) - full and short form. Results indicated that PDD patients' performance in cognitive functioning and financial capacity is severely impaired, while there is a statistically significant difference between depressed and non-depressed PDD patients. Differences in financial capacity performance indicate that depression should not be disregarded. Further studies on larger PDD population are necessary in order to investigate the decisive role of depression on financial capacity impairment.

&lt;p&gt;Effect of pretransplant depression on neutrophil recovery following hematopoietic stem cell transplantation&lt;/p&gt;

Purpose: Pre-transplantation depression is known to exert negative effects on clinical outcomes after hematopoietic stem cell transplantation (HSCT). Accumulating evidence shows a bidirectional association between inflammation and depression. Systemic inflammation can affect clinical outcomes after transplantation, such as time to engraftment. This study evaluated the effect of pre-transplantation depression and serum level of proinflammatory and anti-inflammatory cytokines on clinical outcomes such as neutrophil recovery time and mortality in patients undergoing HSCT. Patients and methods: In this cross-sectional study, we recruited 73 patients who were autologous or allogeneic HSCT candidates. Hospital Anxiety and Depression Scale questionnaire was used to assess depression in the first 2 days after their hospital admission. Serum levels of IL-10, IL-6, and hs-CRP were measured at the same time. Neutrophil engraftment time, length of hospitalization, rate of mortality, relapses, readmissions, and occurrence of major complications following HSCT in a 1-year follow-up period were recorded as comparative outcomes. Results: Thirty-five patients with depression and 38 patients without depression participated in the study. Among the related outcomes, time of engraftment (P=0.020) and mortality rate (P=0.059) were statistically different between the two groups. Depressed patients had longer neutrophil engraftment time and higher mortality rate 1 year following transplantation (14.14±3.95 days and 31.43) in comparison to non-depressed patients (12.21±2.81 days and 13.16). Depressed patients showed significantly higher serum levels of IL-6 and IL-6-to-IL-10 ratio compared to non-depressed participants (P<0.001 and P=0.004). Conclusion: According to the results, pre-transplant depression can negatively impact neutrophil recovery time and mortality rate following HSCT. Higher levels of inflammatory factors in depressed patients might be one of the mechanisms that negatively affect clinical outcomes after HSCT. © 2019 Tavakoli-Ardakani et al.

Incremental hospital utilization and mortality associated with co-morbid depression in pediatric hospitalizations

ObjectiveThe objective of this study was to evaluate the association between hospital utilization and mortality and the presence of co-morbid depression in pediatric hospitalizations. MethodsUsing the Kids' Inpatient Database (KID) for 2012, a nationally representative database of all inpatient admissions in the United States of America for patients younger than 21 years of age compiled by the Health Care Utilization Project (HCUP), we obtained hospital records for children aged 6–20 years with any one of the 10 most common diagnoses in this population excluding affective disorders. After using one to one propensity score matching on age, race, gender, obesity, insurance type, hospital location and hospital size to ensure exchangeability between the groups, we compared the Length of Stay (LOS), Total Hospital Costs (THC) and mortality in children with and without reported comorbidity depression. We employed descriptive statistics and linear regression methods in our analyses ResultsA total of 667,968 discharges were extracted estimating a total of 937,971 discharges for children aged 6 - 20 with a primary diagnosis of any one of the 10 most common non-affective diagnoses in 2012. The prevalence of comorbid depression was about 2.9%. Propensity score matching produced 17,071 pairs. The mean LOS among patients with comorbid depression (4.63 days) was 0.89 days (95% CI: 0.74–1.05 days) higher than among patients without comorbid depression (3.74 days). The mean THC among patients with comorbid depression ($10,643) was $2,961 (95% CI: $2,401–$3,512) higher than among children without comorbid depression ($7,682). The odds of death as an outcome among the depressed was 1.77 (95% CI 1.13–2.77) times the odds among non-depressed patients. ConclusionsThese findings show that comorbid depression significantly increases hospital utilization and mortality in childhood hospitalizations.

Depression and glycemic control in adolescent diabetics: evaluating possible association between depression and hemoglobin A1c

ObjectivesThe objective of this study was to test whether glycemic control varies between adolescent patients diagnosed with type 1 or type 2 diabetes who are depressed and those who are not, after controlling for confounding factors. We hypothesized that diabetic children who have depression or a high risk to develop depression will have worse glycemic control, as indicated by higher hemoglobin A1c (HbA1c) values. Study designThis was a retrospective case-control study. MethodsA chart review was conducted in the Section of Endocrinology at St. Christopher's Hospital for Children in Philadelphia. Multivariate linear regression was used to determine effects of individual variables. ResultsA total of 214 records were included out of 263 reviewed. Significant differences were observed in type 1 diabetics (n = 156) between depressed and non-depressed patients in the percentage of females in the group (P = .002), the duration of diabetes (P = .005), age at diagnosis (P = .01), hemoglobin A1c (P = .03), and the percentage of those with a HbA1c greater than 14% (P = .03). Depression was associated with significant increases in HbA1c values in type 1 diabetics (P < .001). An interaction effect (P = .055) was observed between sex and depression. Given the small sample of children with type 2 diabetes, we were unable to perform any meaningful statistical analysis in this subgroup of patients. ConclusionsWe have detected a significant association between depression and glycemic control in adolescent girls with type 1 diabetes. This association appears to be moderated by sex. Depressed patients with type 2 diabetes generally display higher HbA1c values than their non-depressed counterparts.

Depression and Angina Among Patients Undergoing Chronic Total Occlusion Percutaneous Coronary Intervention: The OPEN-CTO Registry

ObjectivesThis study sought to examine depression prevalence among chronic total occlusion (CTO) patients and compared symptom improvement among depressed and nondepressed patients after percutaneous coronary intervention (PCI). BackgroundDepression in cardiovascular patients is common, but its prevalence among CTO patients and its association with PCI response is understudied. MethodsAmong 811 patients from the OPEN-CTO (Outcomes, Patient Health Status, and Efficiency in Chronic Total Occlusion Hybrid Procedures) registry, we evaluated change in health status between baseline and 1-year post-PCI, as measured by the Seattle Angina Questionnaire (SAQ) and the Rose Dyspnea Score. Depression was defined using the Personal Health Questionnaire-8. The independent association between health status and depression following PCI was assessed using multivariable regression. ResultsAmong the 811 patients, 190 (23%) screened positive for major depression, of whom 6.3% were on antidepressant therapy at intervention. Depressed patients experienced more baseline angina, but by 1-year post-PCI they experienced greater improvements than nondepressed patients (change in SAQ Summary: 31.4 ± 22.4 vs. 24.2 ± 20.0; p < 0.001). After adjustment, baseline depressed patients had more improvement in health status (adjusted difference in SAQ Summary improvement, depressed vs. nondepressed: 5.48 ± 1.81; p = 0.003). ConclusionsDepression is common among CTO PCI patients, but few were treated with antidepressants at baseline. Depressed patients had more severe baseline angina and significant improvement in health status after PCI. (Outcomes, Patient Health Status, and Efficiency in Chronic Total Occlusion [OPEN-CTO]; NCT02026466)

Serotonergic Regulation and Cognition after Stroke: The Role of Antidepressant Treatment and Genetic Variation

Introduction: Serotonin affects several brain functions including cognition. The serotonin transporter (SERT) regulates brain serotonin levels through reuptake into neurons. The gene encoding this transporter, the SERT gene, has several functional polymorphisms affecting the number of transporters and thereby the serotonin levels. SERT gene expression may be important for cognition and selective serotonin reuptake inhibitors (SSRI) may improve cognition post stroke. We therefore examined the association between SERT genotypes, cognitive function and early treatment with the SSRI citalopram among non-depressed Caucasian stroke patients. Patients and Methods: SERT gene polymorphisms in 270 non-depressed first-ever acute ischemic stroke patients randomized to citalopram, n = 130, or placebo, n = 140, were investigated. Patients were genotyped for a length polymorphism (L = long and S = short allele) and a single nucleotide polymorphism (A/G substitution) dividing the L-allele into L_A and L_G. According to these genotypes, patients were further grouped according to low (S/S, L_G/S and L_G/L_G), medium (S/L_A and L_G/L_A), or high functional gene expression (L_AL_A). Cognition was measured by the Symbol Digit Modalities Test (SDMT) at 1 and 6 months. Mean SDMT scores according to genotype and randomization groups were compared using multiple logistic regression adjusting for age, stroke severity, premorbid functional status, and vascular risk factors including smoking, hypertension, and diabetes. Results: Stratified by genotype groups, there were no statistically significant differences in SDMT scores between randomization groups. Placebo-treated patients with low SERT expression genotypes, however, tended to have lower mean SDMT scores (at 1 month: 30.2, SD 10.8) compared to citalopram-treated patients (33.6, SD 13.7). Within the placebo group, the low genotype expression patients had significantly lower adjusted mean SDMT scores at 1 month compared to the high genotype expression patients (adjusted mean difference of –6 points, CI –12.0 to –0.05). We found similar results at 6 months, although not statistically significant. The genotype expression was not associated with SDMT scores among citalopram-treated patients. Conclusion: There was no difference in cognition between citalopram and placebo-treated patients according to the genotype group. Our results indicate, however, that low expression SERT genotype may contribute to reduced cognitive function post stroke as placebo-treated patients with low SERT expression tended to score lower on the SDMT. The significant difference in SDMT scores between low and high expression patients was present only in the placebo-treated group, thereby warranting further exploration of the potential effect of early citalopram treatment on cognitive functioning. Our results are preliminary and need replication in larger-scale studies.

A reduced concentration of brain interstitial amino acids is associated with depression in subarachnoid hemorrhage patients

The amino-acids tryptophan, phenylalanine and tyrosine seem to play an important role in the pathophysiology of depressive disorders. We measured daily brain extracellular levels of these amino-acids using cerebral microdialysis (CMD) and high performance liquid chromatography in 26 consecutive subarachnoid hemorrhage (SAH) patients and associated them with the presence of depressive disorders. Patients were grouped as follows: medical history of depression (prior to SAH), antidepressant intake 12 months after SAH (but not before), or neither. CMD-tryptophan, CMD-phenylalanine and CMD-tyrosine levels were significantly lower in patients with preexisting depressive disorders compared to those without depression (p < 0.01). Disease severity and SAH-related complications were not associated with amino-acid concentrations. We found a positive correlation between nutritionally administered and brain interstitial levels of tryptophan and phenylalanine in non-depressed patients (R = 0.26 and R = 0.24, p < 0.05), which was not present in patients with preexisting depression (p > 0.1). In conclusion, brain interstitial levels of tryptophan, phenylalanine and tyrosine measured in the context of the clinical management of SAH were significantly decreased in patients with a medical history of depression. This study supports the hypothesis that the availability of these neurotransmitter precursor amino-acids in the human brain may play an important role in the pathophysiology of depressive disorders.

Plasma concentrations of oleoylethanolamide in a primary care sample of depressed patients are increased in those treated with selective serotonin reuptake inhibitor-type antidepressants

Oleoylethanolamide (OEA) is a non-cannabinoid acylethanolamide with multiple physiological roles that has been proposed to have antidepressant-like activity in preclinical models. OEA shares biosynthetic pathways with anandamide (AEA) a transmitter involved in affective disorders and anxiety in humans. However, although the participation of OEA in depression has been proposed, both, the contribution of OEA to the depressive phenotype and the effect of antidepressant therapy on circulating levels of this and related non-cannabinoid acylethanolamides in humans are basically unknown. The main objective of this study is to compare the plasma concentrations of OEA and related acylethanolamides in a sample of primary care patients with depression (n = 69) with those of healthy non-depressed patients (n = 47). At the time of admission to the study, 22 patients were under selective serotonin reuptake inhibitor (SSRI) antidepressant treatment and 47 patients were not receiving any type of intervention. In addition, plasma concentrations of the endocannabinoid 2-AG and two related monoacylglycerols were monitored. Plasma OEA concentrations were found to be elevated in depressed patients and to correlate with somatic symptoms of depression. Plasma concentrations of both, AEA and 2-AG, were found to be elevated also in depressed patients. Further analysis demonstrated that the elevation observed in the plasma concentrations of both, OEA and 2-AG, was associated to SSRI antidepressant therapy at the time of recruitment. Further clinical research is needed to understand whether SSRI-induced elevations in OEA levels contribute to the response to SSRI in depressed patients as described in preclinical models.

Comparison of Quantitative Electroencephalogram During Sleep in Depressed and Non-Depressed Patients with Parkinson's Disease.

BackgroundDepression is one of the most important factors affecting quality of life in Parkinson’s patients. Most research on Parkinson’s disease with depression has focused on neuroimaging, and there have been few quantitative electroencephalogram studies. Sleep is a biomarker for depression; therefore, the aim of this study was to identify differences in quantitative electroencephalograms during sleep in depressed and non-depressed patients with Parkinson’s disease.Material/MethodsWe assessed 38 Parkinson’s disease patients (26 depressed patients, 12 non-depressed patients) and 20 normal subjects using the Geriatric Depressive Scale for Depressive Symptoms and quantitative electroencephalogram analysis of amplitude of different frequency bands in different sleep stages using Met-lab software and Fast Fourier Transformation.ResultsNon-rapid eye moment 2 and the Frontal 4 Electrode amplitude in the delta and theta ranges were progressively and significantly greater in the depressed-Parkinson’s disease group (p<0.05) than in the control group. In the depressed Parkinson’s disease group, from the comparison of non-rapid eye moment 2 and rapid eye moment, in Frontal 4 the amplitude in the delta ranges of non-rapid eye moment 2 was greater than in the non-depressed group, and in Central 3, Central 4, Occipital 1, and Occipital 2, the amplitudes in the beta ranges of rapid eye moment were greater (p<0.05) than in the non-depressed group.ConclusionsThe higher amplitude in theta in frontal areas in NREM2 and the higher amplitude in beta in parietal and occipital lobe areas in REM relative to NREM2 were significantly different in depressed and non-depressed patients with Parkinson’s disease.

Depression predicts longitudinal declines in social support among women with newly diagnosed breast cancer.

Among breast cancer survivors, low social support is associated with adverse clinical and psychosocial outcomes. This study prospectively examined longitudinal trends in perceived social support in women with newly diagnosed breast cancer as a function of depression status prior to initiation of cancer treatment. One hundred ten patients with newly diagnosed breast cancer and 59 age-matched noncancer controls completed behavioral measures at four assessments: prior to treatment and at 1month, 1year, and 2years post-treatment. Participants reported their perceived tangible and emotional/informational support using the Medical Outcomes Study Social Support Survey and were categorized as "depressed" or "non-depressed" based on the Brief Symptom Inventory-18 (BSI-18). Analyses first compared longitudinal trends in support between patients and controls and then examined differences in longitudinal trends as a function of depression status in patients only, controlling for key covariates. Both tangible and emotional/informational support decreased among breast cancer patients but increased or remained unchanged among noncancer controls across the assessments. Among patients, depressed individuals experienced a significant decline in both tangible (P=0.004) and emotional/informational support (P=0.013) between 1month and 1year post-treatment, which remained unchanged between 1year and 2years post-treatment. In contrast, nondepressed individuals had stable levels across all assessments. Depressed patients also had lower levels of both support types compared with nondepressed patients across all assessments. Breast cancer patients with depressive symptomatology have an elevated risk for declines in perceived social support over time.

A Pilot Study Using EMR (Electronic Medical Record) and BMT (Bone Marrow Transplant) Registry Data to Evaluate Health Service Utilization in BMT Patients with Depression and Comorbid Conditions at an Academic Cancer Center

Introduction and Objectives Depression has been shown to increase health service utilization in cancer patients. Using data from EMR and BMT Registry we evaluated the impact of depression and comorbidity in BMT patients at our center. Methods A retrospective review of EMR of autologous (AUTO) and allogeneic (ALLO) stem cell transplant patients in UCSD Moores Cancer Center from 2012 to 2017. All diagnoses were defined by ICD-9/ICD-10 codes. Between group differences were assessed by t-test and chi-square test. Negative binomial modeling was performed to evaluate predictors of length of stay in the hospital (LOS) and clinic visits. The analyses were adjusted for age, gender, cancer diagnosis, comorbid conditions, GVHD status (for ALLO patients only) and Charlson Comorbidity Index (CCI). Results A total of 731 patients of whom 22.3% had depression were identified: AUTO Patients (N = 472; 18% Depressed [85]); ALLO patients (N = 259; 30.1% depressed [78]). For the entire population, we compared depressed patients (n = 540) to non-depressed patients (n = 158). Significant differences were observed for LOS (days), clinic visits, and CCI: 59.58+/-49.48 vs. 40.28 (p For AUTO patients, the corresponding LOS, clinic visit, and CCI were 35.31+/-26.14 vs. 25.40+/-22.89 days (p = 0.002), 16.3+/-11.87 vs. 10.77+/-7.29 (p For AUTO patients, depression and infection were significant predictors for increased LOS and frequent clinic visits. For ALLO patients, significant predictors for increased LOS includes COPD and chronic GVHD which was a significant predictor for frequent clinic visits (Table 1). Conclusion Depression and comorbidities had a significant impact on health service utilization. Clinicians and health systems should recognize the importance of providing care in BMT patients with depression and managing comorbid conditions.

Disrupted Regional Spontaneous Neural Activity in Mild Cognitive Impairment Patients with Depressive Symptoms: A Resting-State fMRI Study.

Depressive symptoms are common in individuals with mild cognitive impairment (MCI) who have an increased risk of dementia. It is currently unclear whether the pattern of spontaneous brain activity in patients with MCI differs between subjects with and without depressive symptoms. The current study sought to investigate the features of spontaneous brain activity in MCI patients with depressive symptoms (D-MCI) using coherence regional homogeneity (CReHo) analysis with resting-state functional magnetic resonance imaging (rsfMRI). We obtained rsfMRI data in 16 MCI patients with depressive symptoms and 18 nondepressed MCI patients (nD-MCI) using a 3 T scanner. Statistical analyses were performed to determine the regions in which ReHo differed between the two groups in specific frequency bands, slow-4 (0.027–0.073 Hz) and slow-5 (0.010–0.027 Hz), and typical bands (0.01–0.08 Hz). Correlation analyses were performed between the CReHo index of these regions and clinical variables to evaluate the relationship between CReHo and pathophysiological measures in the two groups. Our results showed that D-MCI patients exhibited significantly higher CReHo in the left Heschl's gyrus and left thalamus and lower CReHo in the left postcentral gyrus in the typical frequency band. In the slow-4 frequency band, D-MCI patients showed significantly higher CReHo in the left Heschl's gyrus and left thalamus. In the slow-5 frequency band, D-MCI patients exhibited significantly lower CReHo in the superior medial prefrontal gyrus. In addition, the results revealed that CReHo values in the left thalamus were positively correlated with Hamilton Depression Rating Scale (HAMD) scores in D-MCI patients. These results suggest that the sensorimotor network may be one of the main pathophysiological factors in D-MCI.

A cross-sectional study to assess the association between major depression and inflammatory markers in patients with acute ischemic stroke.

Background:Increased interest in the relationship between affective disorder and long-term health consequences has generated recent examinations of depression and stroke. Observations suggest that depressive disorder is associated with abnormal physiological and immunological responses and a resultant increase in inflammatory markers. Given the high prevalence of stroke and associated costs for the community, it is important to understand the mechanisms that may impact on the outcome to achieve the best possible prognosis.Aims:The view that inflammatory factors contribute to depression is predicated on findings that circulating cytokines and other inflammatory factors are increased in depressed patients. Therefore, it has been hypothesized that inflammation could be one of the mechanisms by which depression increases risk for ischemic stroke. Our aim was to determine whether there is any relationship between major depression and tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), IL-18, brain-derived neurotrophic factor (BDNF), and neuron-specific enolase (NSE) in patients with acute ischemic stroke (AIS).Study Design:This was as a cross-sectional design.Materials and Methods:This study has a cross-sectional design, and it was conducted in Necmettin Erbakan University, the Meram Faculty of Medicine in Konya, Turkey, between 2014 and 2015. Fifty-three AIS patients admitted to the hospital within the first 24 h after stroke onset were recruited. Major depression was ascertained by means of the structured clinical interview for the diagnostic and statistical manual of mental disorders, Fourth Edition/Clinical Version. The enzyme-linked immunosorbent assay was used to measure the serum levels of TNF-α, IL-1 β, IL-18, BDNF, and NSE at admission.Results:A total of 53 patients with a mean age of 65.9 years were recruited. Of these patients, 17 (32.1%) had major depression. Depressive and nondepressive patients had similar demographical and clinical features. There was no significant statistical difference between depressive and nondepressive patients with AIS with respect to levels of TNF-α, IL-1 β, IL-18, BDNF, and NSE.Conclusion:This study suggests that in patients who have experienced AIS, there is no significant relationship between major depression and basal proinflammatory cytokines (TNF-α, IL-1 β, IL-18), BDNF, and NSE.