Number Of Past Depressive Episodes Research Articles

Ruminative Inertia and Its Association With Current Severity and Lifetime Course of Depression

Rumination has been consistently shown to play a critical role in the severity and course of depression. Relatively understudied, however, is the nature of rumination across time and how individual differences in the temporal dynamics of rumination may be related to depression. In this study, we investigated the association between ruminative inertia (the degree to which rumination levels are resistant to change from day to day) and both current and past depression in a clinical sample. Participants ( N = 71) completed daily-diary surveys for 3 weeks. Ruminative inertia was positively associated with current depressive symptoms and negatively associated with the number of past depressive episodes. These findings suggest that more severe depressive symptoms are associated with rumination that is more resistant to change over time, whereas a greater number of past depressive episodes is related to less ruminative inertia. Additional research is needed to explore the directionality of these effects.

Mindfulness-based interventions for the treatment of depressive rumination: Systematic review and meta-analysis

Background/Objective: This systematic review aims to evaluate the effect of interventions based on the mindfulness and/or acceptance process on ruminative thoughts, in patients with depression. Method: Electronic searches in Medline, Embase, Cochrane Central, PsycInfo, and Cinahl until December 2016, in addition to hand-searches of relevant studies, identified eleven studies that fulfilling inclusion criteria. Results: A meta-analysis of the effect of the intervention compared to usual care showed a significant and moderate reduction of ruminative thoughts (g=−0.59, 95% CI: −0.77, −0.41; I2=0%). Furthermore, findings suggest that mindfulness/acceptance processes might mediate changes in rumination, and that they in turn mediate in the clinical effects of interventions. A meta-analysis of three studies that compared the intervention to other active treatments (medication, behavioral activation and cognitive-behavioral therapy, respectively) showed no significant differences. Conclusions: Mindfulness-based cognitive therapy compared to usual care, produces a significant and moderate reduction in rumination. This effect seems independent of the treatment phase (acute or maintenance) or the number of past depressive episodes, and it was maintained one month after the end of treatment. However, further controlled studies with real patients that compare the most commonly used cognitive-behavioral techniques to treat ruminative thoughts to the acceptance and mindfulness techniques are needed.

Attentional bias temporal dynamics in remitted depression.

Theory implicates attentional bias (AB) or dysregulated attentional processing of emotional information in the recurrence of major depressive episodes. However, empirical study of AB among remitted depressed patients is limited in scope and has yielded mixed findings. Mixed findings may be accounted for by how the field has conceptualized and thereby studied AB. We propose that a novel temporal dynamic process perspective on AB may help disambiguate extant findings and elucidate the nature of AB in remitted depression. Thus, we reexamined Dot Probe data among remitted depressed patients (RMD; n = 328) and nondepressed controls (NDC; n = 82) that previously yielded null effects when AB was quantified by means of the traditional aggregated mean bias score (Vrijsen et al., 2014). We reanalyzed data using a novel computational approach that extracts a series of bias estimations from trial to trial (Zvielli, Bernstein, & Koster, 2015). Key features of these dynamic process signals revealed moderate to excellent reliability relative to the traditional aggregated mean bias scores. These features of AB dynamics-specifically temporal variability in AB including AB toward and away from emotional stimuli-were significantly elevated among RMDs relative to NDCs. Moreover, among RMDs, a greater number of past depressive episodes were associated with elevation in these features of AB dynamics. Effects were not accounted for by residual depressive symptoms or social anxiety symptoms. Findings indicate that dysregulation in attentional processing of emotional information reflected in AB dynamics may be key to depression vulnerability. (PsycINFO Database Record

Predictors of functional outcome after a manic episode

BackgroundThe identification of functional outcome predictors after acute episodes of bipolar disorders (BD) may allow designing appropriate treatment aiming at restoring psychosocial functioning. Our objective was to identify the best functional outcome predictors at a 6-month follow-up after an index manic episode. MethodsWe conducted a naturalistic trial (MANACOR) focusing on the global burden of BD, with special emphasis on manic episode-associated costs. We observed patients with BD seen in services of four hospitals in Catalonia (Spain).The total sample included 169 patients with chronic DSM-IV-TR BD I suffering from an acute manic episode who were followed-up for 6 months. In this subanalysis we report the results of a stepwise multiple regression conducted by entering in the model those clinical and sociodemographic variables that were identified through preliminary bivariate Pearson correlations and using total scores on the Functioning Assessment Short Test (FAST) at the 6-month follow-up as the dependent variable. ResultsNumber of previous depressive episodes (Beta=3.25; t=3.23; p=0.002), presence of psychotic symptoms during the manic index episode (Beta=7.007; t=2.2; p=0.031) and the Body Mass Index (BMI) at baseline (Beta=0.62; t=2.09; p=0.041) were best predictors of functional outcome after a manic episode. LimitationsThe main limitations of this study include the retrospective assessment of the episodes, which can be a source of bias, and the 6-month follow-up might have been too short for assessing the course of a chronic illness. ConclusionsPsychotic symptoms at index episode, number of past depressive episodes, and BMI predict worse outcome after 6 months follow-up after a manic episode, and may constitute the target of specific treatment strategies.

Acquired Resistance in Unipolar Depression

It has been proposed that depressive episodes could be “neurotoxic”, decreasing memory skills and/or regularly increasing neurocognitive retardation with the repetition of episodes. We describe two protocols which could reinforce the likelihood of this neurotoxic hypothesis, and a study showing that it is indeed possible to reduce the time before getting treatment response. On the first protocol a large sample of depressed outpatients was tested for narrative delayed memory (Weschleer paragraph), before and after antidepressant treatment (Gorwood et al., 2008). Delayed memory skills after treatment response was strongly correlated to the length and the number of past depressive episodes. The second protocol assessed neurocognitive retardation during a depressive episode and after clinical remission is obtained. Once again we observed that neurocognitive retardation (TMT-A and -B) in remitted patients was highly correlated to the number of past depressive episodes (Gorwood et al., 2014). We then tested if treatment resistance could be detected a bit earlier than the 4 to 6 weeks observation usually considered as required. Indeed, we found that a two weeks observation is enough to decide if we should continue or change the present treatment. We furthermore saw that assessing emotions rather than depressive symptoms might be even more predictive of the chances of treatment success. These studies reinforce the concept of neurotoxicity of depressive disorder, wich means that an important part of treatment resistence is acquired during the process of the disorder, and therefore stress the importance of treating early and completely each depressive episode, not only for an acute relief, but also to improve the long term prognosis of mood disorders.

Comparison of effects of bright light therapy alone or combined with fluoxetine on severity of depression, circadian rhythms, mood disturbance, and sleep quality, in patients with non-seasonal depression

Correspondence: Gokben Hizli Sayar Department of Psychiatry, Uskudar University, Neuropsychiatry Istanbul Hospital, Alemdag Caddesi Site Yolu No 29 Umraniye, Istanbul, Turkey Tel +90 216 633 0649 Fax +90 216 634 1250 Email gokben.hizlisayar@uskudar.edu.tr Purpose: To compare effects of bright light therapy (BLT) alone or combined with the selective serotonin reuptake inhibitor (SSRI) fluoxetine, on severity of depression, circadian rhythms, mood disturbance, and sleep quality, in patients with non-seasonal depression. Patients and methods: Drug-free patients who were administered 10,000 lux of BLT for 30 minutes for 7 days comprised the BLT group (n = 7), while patients who started fluoxetine as an add-on treatment day comprised the SSRI + BLT group (n = 8). The primary outcomes were severity of depression, measured using the Hamilton Depression Rating Scale (HAM-D) and the Beck Depression Inventory (BDI); chronotype, measured using the Morningness Eveningness Questionnaire (MEQ); mood disturbance, measured using the Profile of Mood States (POMS) survey; and sleep quality, measured using the Pittsburgh Sleep Quality Index (PSQI), before and after treatment in both groups. Results: All patients completed the study, and none reported obvious side effects. The mean onset age of depression was 26.1 years ± 5.3 years in the BLT group and 27 years ± 9.5 years in the SSRI + BLT group (P = 0.425). The number of past depressive episodes was 1.29 ± 0.76 in the BLT group, and 1.5 ± 0.8 in the SSRI + BLT group (P = 0.427). The difference between preand posttreatment scores revealed no significant difference between groups for the HAM-D scale, BDI, MEQ, POMS survey, and the PSQI. Conclusion: This study suggests that BLT is effective with respect to the severity of depression, circadian rhythms, mood disturbance, and sleep quality, in non-seasonal depression. However, there was no evidence in favor of adjunctive fluoxetine with BLT in the treatment of non-seasonal depression, for any of the rating scales used in our study.

Altered empathic responding in major depressive disorder: Relation to symptom severity, illness burden, and psychosocial outcome

Individuals with major depressive disorder (MDD) demonstrate deficits in multiple social cognitive domains; however, systematic investigations of empathic responding have not been performed. Twenty patients with MDD completed two measures of empathy, the Interpersonal Reactivity Index (IRI: Davis, 1980, 1983) and the Toronto Empathy Questionnaire (TEQ: Spreng et al., 2009). Relative to matched controls, patients with MDD reported significantly reduced levels of empathy measured broadly on the TEQ and specifically in cognitive (‘Perspective Taking’) and affective (‘Empathic Concern’) domains captured by the IRI. A higher illness burden (i.e., greater number of past depressive episodes) was associated with greater reductions in perspective taking ability. This study provides early evidence of impaired empathic abilities in patients with MDD that may worsen with illness progression. Alternatively, reductions in perspective taking ability may contribute to a more severe course of illness in this population. Further longitudinal work is needed to characterize the relation between social cognitive performance and social functioning in this population.

The structure of past and future lives in depression.

This study assessed the organization of past autobiographical knowledge in individuals with either current major depressive disorder (MDD), MDD in remission, or no history of MDD (the control group). Participants generated personal lists of "life chapters," dividing both their past and potential future into subjectively meaningful episodes or themes (e.g., "married life"). They were then given a list of potentially chapter-descriptive positive or negative attributes and sorted them according to the different chapters. Results revealed that, relative to the control group, MDD participants selected more negative attributes overall, showed greater redundancy for negative attributes (i.e., using the same ones repeatedly across chapters) and reduced redundancy for positive attributes, and exhibited greater compartmentalization (i.e., the negative and positive attributes were clustered separately across different chapters). A similar pattern emerged for the remitted MDD group relative to controls, with the exception of negative redundancy, which was not elevated. For future chapters, there were no group differences. Finally, a greater number of past depressive episodes was associated with increasingly reduced positive redundancy. These data reveal a "depressogenic" structuring of past (but not future) knowledge in MDD that is also evident in a remitted MDD group, with the exception of negative redundancy, which appears to be a marker of the acute state. These findings shed light on important aspects of the organization of past knowledge that are likely to be linked to maladaptive processing biases in those with a depression history.

Transition to Mania During Treatment of Bipolar Depression

Some individuals with bipolar disorder transition directly from major depressive episodes to manic, hypomanic, or mixed states during treatment, even in the absence of antidepressant treatment. Prevalence and risk factors associated with such transitions in clinical populations are not well established, and were examined in the Systematic Treatment Enhancement Program for Bipolar Disorder study, a longitudinal cohort study. Survival analysis was used to examine time to transition to mania, hypomania, or mixed state among 2166 bipolar I and II individuals in a major depressive episode. Cox regression was used to examine baseline clinical and sociodemographic features associated with hazard for such a direct transition. These features were also examined for interactive effects with antidepressant treatment. In total, 461/2166 subjects in a major depressive episode (21.3%) transitioned to a manic/hypomanic or mixed state before remission, including 289/1475 (19.6%) of those treated with antidepressants during the episode. Among the clinical features associated with greatest transition hazard were greater number of past depressive episodes, recent or lifetime rapid cycling, alcohol use disorder, previous suicide attempt, and history of switch while treated with antidepressants. Greater manic symptom severity was also associated with risk for manic transition among both antidepressant-treated and antidepressant-untreated individuals. Three features, history of suicide attempt, younger onset age, and bipolar subtype, exhibited differential effects between individuals treated with antidepressants and those who were not. These results indicate that certain clinical features may be associated with greater risk of transition from depression to manic or mixed states, but the majority of them are not specific to antidepressant-treated patients.

Continuing medical education: SSRIs and pregnancy

Byline: Chittaranjan. Andrade CME Questions In euthymic women with a history of major depression, the planned, voluntary withdrawal of antidepressant medication prior to conception (as compared with the continuation of medication all through pregnancy) is associated with a five-fold increase in the risk of relapse during pregnancy. A longer duration of illness and a larger number of past depressive episodes each predict an increased risk of relapse. About half of the relapses occur during the first trimester.[sup] [1] Untreated depression during pregnancy is itself associated with a large number of adverse maternal and fetal outcomes. These include an increased risk of maternal mortality,[sup] [2] poor weight gain, alcohol or illicit drug use, toxemias of pregnancy, and poor mother-child bonding[sup] [3],[4] and an increased risk of pre-term delivery, low birth weight, operative delivery, and neonatal ICU admission.[sup] [5],[6],[7] There is now an increasing trend to prescribe selective serotonin reuptake inhibitors (SSRIs) to treat depression during pregnancy; in fact, SSRIs are now first-line antidepressants during pregnancy in Denmark and many other European countries.[sup] [8],[9] The epidemiology of SSRI and antidepressant use during pregnancy has been described by Tuccori et al .[sup] [10] With this background, mark True or False against each of the statements in sets A and B: A) Teratogenicity of SSRIs after first-trimester exposure: *SSRIs increase the overall risk of major congenital malformations *SSRIs increase the overall risk of minor congenital malformations *SSRIs increase the risk of septal heart defects *SSRIs increase the risk of certain specific but rare congenital malformations B) Other pregnancy outcomes after exposure to SSRIs *SSRIs increase the risk of spontaneous abortions *SSRIs increase the risk of preterm delivery *SSRIs are associated with low Apgar scores after birth *SSRIs are associated with an approximately 500 g decrease in mean birth weight *SSRIs are associated with decreased head circumference in the newborn *SSRIs increase the risk of persistent pulmonary hypertension in the newborn *SSRI exposure during late pregnancy is associated with a neonatal SSRI withdrawal syndrome C) SSRI-exposed vs. SSRI-unexposed pregnancies in depressed women *It is better to treat depression during pregnancy than to leave it untreated because neonatal outcomes in SSRI-treated depressed women are better than those in untreated depressed women. View Answer CME Answers A) Teratogenicity of SSRIs after first-trimester exposure: 1. False; 2. False; 3. True. 4. True Pedersen et al ,[sup] [11] describe a large, population-based, retrospective cohort study of the teratogenicity of SSRIs using data extracted from four nationwide registers in Denmark. Major and minor congenital malformations were studied in live born children in whom these malformations were detected within a year of birth. Data were excluded if women had used non-SSRI psychotropic drugs or drugs for a variety of medical indications. There were 1370 infants who had been exposed to SSRIs and 493,113 infants who had not been exposed. In this connection, exposure was defined as the redemption of at least two prescriptions for SSRIs from 28 days before conception to 112 days after conception; the assumption was that filling repeated prescriptions implied that the women were actually taking their medications. The risks of teratogenicity with SSRIs were calculated after adjusting for maternal age, marital status, income, smoking, and other variables. This is because women who used SSRIs were more likely to have risk factors such as greater age, living alone, unmarried status, smoking etc. Pedersen et al ,[sup] [11] found that the risk of major malformations in SSRI-exposed vs. unexposed infants was 4.0% vs. …

Indicators of pretreatment suicidal ideation in adults with major depressive disorder

In order to evaluate the presence of treatment emergent suicidal ideation (SI), it becomes necessary to identify those patients with SI at the onset of treatment. The purpose of this report is to identify sociodemographic and clinical features that are associated with SI in major depressive disorder (MDD) patients prior to treatment with a selective serotonin reuptake inhibitor. This multisite study enrolled 265 out-patients with non-psychotic MDD. Sociodemographic and clinical features of participants with and without SI were compared post hoc. Social phobia, bulimia nervosa, number of past depressive episodes, and race were independently associated with SI by one or more SI measure. Concurrent social phobia and bulimia nervosa may be potential risk factors for SI in patients with non-psychotic MDD. Additionally, patients with more than one past depressive episode may also be at increased risk of SI.

Depression relapse prophylaxis with Mindfulness-Based Cognitive Therapy: Replication and extension in the Swiss health care system

Background Mindfulness-Based Cognitive Therapy (MBCT) is a group intervention that integrates elements of Cognitive Behavioural Therapy (CBT) with components of mindfulness training to prevent depressive relapse. The efficacy of MBCT compared to Treatment As Usual (TAU), shown in two randomized controlled trials indicates a significant decrease in 1-year relapse rates for patients with at least three past depressive episodes. The present study is the first independent replication trial comparing MBCT + TAU to TAU alone across both language and culture (Swiss health care system). Methods Sixty unmedicated patients in remission from recurrent depression (≥ 3 episodes) were randomly assigned to MBCT + TAU or TAU. Relapse rate and time to relapse were measured over a 60 week observation period. The frequency of mindfulness practices during the study was also evaluated. Results Over a 14-month prospective follow-up period, time to relapse was significantly longer with MBCT + TAU than TAU alone (median 204 and 69 days, respectively), although both groups relapsed at similar rates. Analyses of homework adherence revealed that following treatment termination, the frequency of brief and informal mindfulness practice remained unchanged over 14 months, whereas the use of longer formal meditation decreased over time. Limitations Relapse monitoring was 14 months in duration and prospective reporting of mindfulness practice would have yielded more precise frequency estimates compared to the retrospective methods we utilized. Conclusions Further studies are required to determine which patient characteristics, beyond the number of past depressive episodes, may predict differential benefits from this therapeutic approach.

Unmet Need for Treatment of Major Depression in the United States

This study examined the extent and correlates of perceived unmet need for treatment among individuals with depression in the U.S. general population. Analyses were based on a representative sample of 6,510 adult participants in the 2005 and 2006 National Surveys on Drug Use and Health who reported a major depressive episode in the past 12 months. A total of 3,568 (62.4%) participants had sought mental health treatment in the past 12 months, and 2,942 (37.6%) had not; 34.9% and 26.8% of these groups, respectively, reported unmet need for treatment. In both groups, older age was associated with a lower likelihood of reporting unmet need for treatment, whereas greater distress and impairment and higher education were associated with a greater likelihood of reporting unmet need. Among treatment seekers, treatment from general medical providers was associated with greater likelihood of unmet need, and more outpatient visits and insurance coverage for the full year were associated with a lower likelihood of unmet need. The most common reason for not seeking needed treatment was a concern about costs (cited as a reason by 46.0% of the total sample). Even though rates of treatment seeking have increased, many persons with major depression continue to experience unmet need for treatment, which in this study was mainly attributable to concerns about treatment costs.

A three-year follow-up study of patients with the respiratory subtype of panic disorder after treatment with clonazepam

The demographic, clinical and therapeutic features of the respiratory subtype of panic disorder (PD) versus the non-respiratory subtype were studied in a prospective design. Sixty-seven PD outpatients (DSM-IV), who had previously been categorized into respiratory ( n = 35) and non-respiratory ( n = 32) subgroups, were openly treated with clonazepam for a 3-year period. The principal measure of efficacy was the number of panic attacks, obtained from the Sheehan Panic and Anticipatory Anxiety Scale. In the first 8 weeks of treatment (acute phase), the respiratory subtype group had a significantly faster response to clonazepam. During the follow-up (weeks 12-156), the two subgroups did not differ significantly in the number of panic attacks experienced from baseline to end point. Patients in the respiratory subtype were characterized by a later onset of disorder and a family history of PD. Patients in the non-respiratory subgroup had a significantly higher number of past depressive episodes than those in the respiratory subgroup. The respiratory subgroup had a faster response after 8 weeks of treatment and an equivalent response in the 3-year follow-up period. Clonazepam had a sustained therapeutic effect over the entire treatment period.

Antidepressant utilization in Canada

Antidepressant utilization can be used as an indicator of appropriate treatment for major depression. The objective of this study was to characterize antidepressant utilization in Canada, including the relationships of antidepressant use with sociodemographic variables, past-year and lifetime depression, number of past depressive episodes, and other possible indications for antidepressants. We examined data from the Canadian Community Health Survey (CCHS) Cycle 1.2. The CCHS was a nationally representative mental health survey (N=36,984) conducted in 2002 that included a diagnostic instrument for past-year and lifetime major depressive episodes and other psychiatric disorders and a record of past-year antidepressant use. Overall, 5.8% of Canadians were taking antidepressants, higher than the annual prevalence of major depressive episode (4.8%) in the survey. Among persons with a past-year major depressive episode, the frequency of antidepressant use was 40.4%. After application of adjustments for probable successful outcomes of treatment, the estimated frequency of antidepressant use for major depression was more than 50%. Frequency of antidepressant treatment among those with a history of depression but without a past-year episode increased with the number of previous episodes. Among those taking antidepressants over the past year, only 33.1% had had a past-year episode of major depression. Migraine, fibromyalgia, anxiety disorder, or past depression was present in more than 60% of those taking antidepressants without a past-year episode of depression. The CCHS results suggest that antidepressant use has increased substantially since the early 1990s, and also that these medications are employed extensively for indications other than depression.

Stability of Retrospective Reports in Depression: Traumatic Events, Past Depressive Episodes, and Parental Psychopathology

Research findings based on the retrospective reports of depressed individuals have long been held suspect because of possible negative reporting biases associated with depression. In the present study we assess the stability of retrospective reports of past traumatic events, past depressive episodes, parental depression, and parental substance abuse in a sample of 234 adults whose depression status changed over two assessments conducted one year apart. Depression status was found to affect reporting of number of past depressive episodes and past traumatic events, but not reporting of parental psychopathology. Implications of these findings are discussed for research that relies on the retrospective self-reports of depressed participants.

Low amounts of the α subunit of GTP-binding protein Go in orbital frontal cortex of schizophrenic brain: Biochemical evidence of the hypofrontality hypothesis of schizophrenia

The hypothalamic-pituitary-adrenal (HPA) axis is dysregulated in many patients with major depressive disorder (MDD). To determine whether or not a past history of depressive episodes is associated with this dysregulation, we studied the relationships among number of past depressive episodes, number of previous hospitalizations for depression, and number of years since first depressive episode and biological markers of depression (postdexamethasone plasma cortisol levels and dexamethasone suppressor/nonsuppressor status). No significant relationships were detected.

Multiple depressive episodes and plasma postdexamethasone cortisol levels

The hypothalamic-pituitary-adrenal (HPA) axis is dysregulated in many patients with major depressive disorder (MDD). To determine whether or not a past history of depressive episodes is associated with this dysregulation, we studied the relationships among number of past depressive episodes, number of previous hospitalizations for depression, and number of years since first depressive episode and biological markers of depression (postdexamethasone plasma cortisol levels and dexamethasone suppressor/nonsuppressor status). No significant relationships were detected.