Positive Family History Of Depression Research Articles

The interplay of family history of depression and early trauma: associations with lifetime and current depression in the German national cohort (NAKO).

Family history of depression and childhood maltreatment are established risk factors for depression. However, how these factors are interrelated and jointly influence depression risk is not well understood. The present study investigated (i) if childhood maltreatment is associated with a family history of depression (ii) if family history and childhood maltreatment are associated with increased lifetime and current depression, and whether both factors interact beyond their main effects, and (iii) if family history affects lifetime and current depression via childhood maltreatment. Analyses were based on a subgroup of the first 100,000 participants of the German National Cohort (NAKO), with complete information (58,703 participants, mean age = 51.2 years, 53% female). Parental family history of depression was assessed via self-report, childhood maltreatment with the Childhood Trauma Screener (CTS), lifetime depression with self-reported physician's diagnosis and the Mini-International Neuropsychiatric Interview (MINI), and current depressive symptoms with the depression scale of the Patient Health Questionnaire (PHQ-9). Generalized linear models were used to test main and interaction effects. Mediation was tested using causal mediation analyses. Higher frequencies of the childhood maltreatment measures were found in subjects reporting a positive family history of depression. Family history and childhood maltreatment were independently associated with increased depression. No statistical interactions of family history and childhood maltreatment were found for the lifetime depression measures. For current depressive symptoms (PHQ-9 sum score), an interaction was found, with stronger associations of childhood maltreatment and depression in subjects with a positive family history. Childhood maltreatment was estimated to mediate 7%-12% of the effect of family history on depression, with higher mediated proportions in subjects whose parents had a depression onset below 40 years. Abuse showed stronger associations with family history and depression, and higher mediated proportions of family history effects on depression than neglect. The present study confirms the association of childhood maltreatment and family history with depression in a large population-based cohort. While analyses provide little evidence for the joint effects of both risk factors on depression beyond their individual effects, results are consistent with family history affecting depression via childhood maltreatment to a small extent.

The Association between Late Third-Trimester Oxytocin Level and Early-Onset Postpartum Depression Symptoms among Jordanian Mothers: A Cross-sectional Study.

Purpose Oxytocin has been suggested to play a vital role in modulating maternal behavior and stress-related disorders. However, the relationship between antenatal oxytocin and postpartum depression is not well established. We aim to investigate the association between serum oxytocin level in the late third-trimester and early-onset postpartum depression symptoms. Materials and Methods A total of 172 healthy pregnant women participated in this cross-sectional descriptive study. The serum oxytocin level was measured between 34 and 37 weeks. A validated Edinburgh Postnatal Depression Scale (EPDS) was used to assess symptoms of depression four to six weeks postpartum. Participants who scored more than 12 on the EPDS were considered having depressive symptoms. Independent sample t-test and Pearson r were used to examine differences in depression scores. The level of significance was set at α = 0.05. Results 30.8% of the participants experienced depressive symptoms. There was no association between EPDS scores and oxytocin level r(170) = 0.10, p = 0.23. The association also did not exist even among women with a lifetime history of depression r(43) = −0.13, p = 0.37. Participants with low education, low income, previous history of depression, positive family history of depression, positive family issues, and absent emotional family support have scored significantly higher on EPDS scores than their counterparts. The strongest association was with previous lifetime history of depression t(170) = −4.40, p < 0.001. Conclusions Postpartum depression is a major public health problem in Jordan. Late trimester serum oxytocin level has no association with early-onset postpartum depression.

Undiagnosed depression among adults with diabetes mellitus in Jos.

Diabetes mellitus (DM) and depression are common chronic disease states of public health importance with huge burden and the potential to impact many aspects of life. They are said to be related though this relationship is not fully understood. The presence of depression among patients with DM is associated with poor glycemic control, complications, and poor self-care. This was a descriptive cross-sectional study conducted at the Diabetes Clinic of the Jos University Teaching Hospital. Three hundred and ten (310) patients with diabetes mellitus were recruited consecutively. The depression module of the Mini International Neuropsychiatric Interview (M.I.N.I.) version 5.0 was used to ascertain depression among these patients. Other demographic data were obtained using a questionnaire. Blood pressure, weight, and height were also measured and the body mass index (BMI) calculated. One hundred and eighty four (59.35%) of the study population were females and the mean age (SD) of the study population was 54 ± 12 years. The mean age (SD) of the females was 53 ± 11 years and that of the males was 54 ± 12 years with no significant statistical difference (P = 0.35). Two hundred and forty nine (80.32%) of the study population were urban dwellers with 140 (45.16%) earning less than N500, 000 (794 USD) yearly. Current major depression was found in 35 (11.3%) patients, among whom 7 (2.3%) had recurrent depression. The presence of DM complications (OR: 3.50, 95% CI 1.16-10.61) and a positive family history of depression (OR: 4.03, 95% CI 1.32-12.29) were found to be correlates of current major depression. The prevalence of current major depression among patients with diabetes mellitus in this study is high. We recommend that all patients with DM should be screened for depression and treated appropriately to reduce its consequences.

Clinical Predictors of Response to Magnetic Seizure Therapy in Depression: A Preliminary Report.

Magnetic seizure therapy (MST) is a novel convulsive brain stimulation method in clinical testing, which is used as an alternative for electroconvulsive therapy in patients with treatment-resistant depression (TRD). Preliminary studies have suggested that MST leads to fewer cognitive adverse effects than electroconvulsive therapy but has similar efficacy. However, the clinical predictors of response to MST have not been evaluated yet. This study aimed to investigate whether these predictors can be identified in patients with TRD. Thirty-eight patients with TRD were included. As clinical predictors for treatment response, we used the diagnosis, sex, age, family history, and severity of depression, as well as the melancholic, psychotic, anxiety, and atypical depression symptoms. A response was defined as an improvement higher than 50% on the 28-item Hamilton Rating Scale for Depression. The binary logistic regression, stepwise linear regression, and effect sizes were calculated. We found that 68.4% of the patients responded to MST. The responders had significantly fewer previous depressive episodes, less severe depression, and fewer melancholic (anhedonia) and anxiety symptoms than the nonresponders. In addition, responders were more likely to have a positive family history of depression than nonresponders. In particular, the number of previous episodes and a family history of depression were significant predictors of the response to MST. We demonstrate that the chronicity, severity, and family history of depression, as well as the presence of melancholic and anxiety symptoms, can serve as clinical predictors of the response to MST. Further research with a larger sample size will be required to verify these preliminary findings.

The association of depressive symptoms in patients with acute myocardial infarction in a regional hospital in Durban, South Africa

Objective: To examine the association of depressive symptoms and contributing psychosocial factors during hospitalisation and 1-month post discharge in patients with acute myocardial infarction (MI). Methods and results: The study population comprised consecutive patients from a multi-ethnic background, admitted June 2015 - November 2015 to the Coronary Care Unit at R. K. Khan Hospital, Durban, South Africa, with a diagnosis of MI. Demographic and clinical data stored in a specialised electronic cardiac database were extracted for all patients. Patients were screened for depressive symptoms using the Cardiac Depression Scale (CDS). Levels of perceived stress were evaluated using the 4-item Perceived Stress Scale (4-PSS). The study cohort consisted of 117 patients with a mean age of 58.16 ± 11.12 years, the majority of whom were males (70%, mean age 56.54 ± 1.23 years) and 30% females (mean age 61.97 ± 1.75 years). Forty-nine percent of the participants were diagnosed with depressive symptoms with a significantly greater number of females experiencing depressive symptoms compared to males (p <0.01). Patients with depressive symptoms were more likely to have a previous history of depression (p=0.02), positive family history of depression (p=0.04), greater non-adherence to their medication (p <0.01) and lower levels of physical activity (p <0.01). Depressed patients also reported higher levels of stress on voluntary (p <0.01) and subjective rating (p <0.01), experienced greater financial stress (p <0.01), major life events (p <0.01) and had higher 4–PSS scores (p <0.01). Thirteen percent of patients experienced major adverse cardiac events (MACE) with a significantly greater number of events found in those with depressive symptoms (p <0.01). Conclusion: Depressive symptoms are a common finding in a South African population presenting with MI. They are linked to higher rates of MACE, a previous history and/or family history of depression, greater stress levels and major life events. Females with MI are significantly more likely to present with depressive symptoms. These findings suggest that patients with MI should be screened for depressive symptoms and psychosocial factors as this may serve as an important arena for research and therapeutic intervention.

Gilles de la Tourette Syndrome, Depression, Depressive Illness, and Correlates in a Child and Adolescent Population.

Gilles de la Tourette syndrome (GTS) and depression are both common disorders. It has been suggested that depression occurs in 13%-76% GTS patients. Despite this, there are few studies into the specific relationships and correlates between the two disorders. There is only some consensus as to the precise relationship between the two disorders. We undertook the study to investigate the relationship between depressive symptomatology and the core clinical features of GTS in a well-characterized clinical population of youth with this disorder. Our aim was to verify the association between depression and comorbid obsessive-compulsive disorder and explore further other potential associations highlighted in some, but not all, of the studies focused on this topic. Our results demonstrated that (1) the GTS patients were significantly older than the controls, (2) the GTS patients were significantly more depressed than controls, (3) depression was associated with tic severity, (4) the Diagnostic Confidence Index scores were higher in GTS patients without depression, (5) anxiety, attention-deficit/hyperactivity disorder (ADHD), conduct disorder (CD), and behavioral problems were significantly associated with depression, and (6) finally, patients with GTS and depression have a positive family history of depression. However, obsessionality (CY-BOCS) did not differentiate between depressed and not depressed GTS patients. Depression is common in patients with GTS and occurs significantly more in GTS than in controls. Depression is significantly associated with GTS factors such as tic severity, comorbidity with ADHD, and the presence of coexistent anxiety, CDs, and behavior problems. Depression is importantly significantly associated with a positive family history of depression. Intriguingly, depression in our sample was not related to obsessionality.

Study of prodromal and residual symptoms of depression.

Background:The definitive diagnosis of depression calls for fulfillment of certain criteria in terms of symptoms, severity, and duration, but subthreshold cases are not uncommon. These may evolve to become clinically diagnosable depression preceded by prodrome. The current study was conducted to study prodromal and residual symptoms in depression.Materials and Methods:Eighty follow-up patients of depressive episode (F32, International Classification of Diseases-10) in remission defined by Hamilton Depression Rating Scale score <8 were interviewed. A symptom was identified as prodromal if it appeared at any time before the period of onset of symptoms sufficient to fulfill the criteria to make a diagnosis of depressive episode. Clinical Interview for Depression and Related Syndromes was used to identify the presence of symptoms. Statistical analysis was done with McNemar test and Pearson's Chi-square test using SPSS software version 20.0.Results:The mean age of patients was 41.25 (±8.58) years and the sample was predominately female patients (80%). All the eighty patients had at least one prodromal symptom. The mean duration of prodrome was 115 (±64.46) days. Irritability (45%), insomnia (45%), and reduced energy (43.8%) were the most frequent prodromal symptoms. Frequency of irritability was comparable in prodromal and residual phases of depression (P = 0.074) and significantly associated with a positive family history of depression (P = 0.004).Conclusion:Prodrome is present in most cases of depression lasting from weeks to months. Prodrome is frequented by irritability, anxiety, sleep problems, and fatigability. Irritability is associated with genetic loading of depression and likely to present as residual symptom if it is present in prodromal phase.

Interaction of Amygdala Reactivity, Other Risk Factors Tied to Depression

Back to table of contents Previous article Next article Full AccessInteraction of Amygdala Reactivity, Other Risk Factors Tied to DepressionAaron LevinAaron LevinSearch for more papers by this authorPublished Online:16 Jan 2015https://doi.org/10.1176/appi.pn.2015.1b18AbstractMixing a family history of depression, stressful lives, and fMRI data gives insight into the amygdala at work.A family history of depression or stressful life events may contribute to altered reactivity in the amygdala during adolescence and a subsequent increased risk for depression, according to a study published online December 19, 2014, in AJP in Advance.Typically, the amygdala, the brain’s advance warning system, becomes less reactive during adolescent development. Increased amygdala reactivity to images of emotional facial expressions is associated with depression, but whether that occurs before or after the onset of depression was not clear.So researchers tested 157 adolescents aged 11 to 15 with diagnostic interviews and functional MRI scans twice, two years apart. They evaluated participants with (the high-risk group) and without (the low-risk group) a family history of depression and with and without a history of stressful life events.Amygdalae in children with high risk and high stress became more reactive as the children advanced through adolescence. Also, greater amygdala reactivity appeared before the emergence of clinical symptoms, the researchers found.“Adolescents with a positive family history of depression consistently evidenced a pattern of increasing amygdala reactivity with age, even if they experienced relatively mild life stress in early adolescence,” concluded Johnna Swartz, Ph.D., a postdoctoral associate in the Department of Psychology and Neuroscience at Duke University; Ahmad Hariri, Ph.D., a professor of psychology and neuroscience at Duke University; and Douglas Williamson, Ph.D., an associate professor of psychiatry, epidemiology, and biostatistics at the University of Texas Health Science Center at San Antonio. The result was reflected in both amygdalae but was significant only in the left.Participants in the low-risk group not exposed to high stress demonstrated decreasing reactivity, as expected. However, low-risk youth who experienced high life stress had levels of amygdala reactivity similar to those of the high-risk group.“This interaction suggests that two distinct risk factors—family history of depression and life stress—may influence risk for depression by a common developmental pathway of altered development of amygdala reactivity during adolescence,” said the authors. The change over time suggests that differences in reactivity also increase over time, but the study could not determine whether the changes were also influenced by other factors tied to adolescence, such as puberty or social changes.The observed effects accounted for only 11 percent of the total variance of amygdala reactivity, leaving room for additional study, of genetic, epigenetic, and environmental influences, said the authors. Further work also may clarify whether imaging the amygdala might serve as a biomarker of risk prior to the onset of depression or other internalizing disorders and eventually “could be of clinical utility in the early detection of risk,” they said.This report was part of the Teen Alcohol Outcomes Study, which will follow the young participants through late adolescence into early adulthood, providing more insight into the developmental trajectory of amygdala reactivity.Funding for the study came from the National Institute on Alcohol Abuse and Alcoholism, the National Institute of Child Health and Human Development, and the Genetic and Environmental Risk endowment from the Dielmann Family. ■An abstract of “Developmental Change in Amygdala Reactivity During Adolescence: Effects of Family History of Depression and Stressful Life Events” can be accessed here. ISSUES NewArchived

Decision making in young people at familial risk of depression.

Major depression is associated with abnormalities in reward processing at neural and behavioural levels. Neural abnormalities in reward have been described in young people at familial risk of depression but behavioural changes in reward-based decision making have been less studied in this group. We studied 63 young people (mean age 18.9 years) with a parent with a diagnosis of major depression but who had never been depressed themselves, that is with a positive family history of depression (the FH+ group). Participants performed the Cambridge Gambling Task (CGT), which provides several measures of decision making including deliberation time, quality of decision making, risk taking, risk adjustment and delay aversion. A control group of 49 age- and gender-matched young people with no history of mood disorder in a first-degree relative undertook the same task. Both FH+ participants and controls had low and equivalent scores on anxiety and depression self-rating scales. Compared to controls, the FH+ participants showed overall lower risk taking, although like controls they made more risky choices as the odds of a favourable outcome increased. No other measures of decision making differed between the two groups. Young people at increased familial risk of depression have altered risk taking that is not accounted for by current affective symptomatology. Lowered risk taking might represent an impairment in reward seeking, which is one of several changes in reward-based behaviours seen in acutely depressed patients; however, our findings suggest that decreased reward seeking could be part of a risk endophenotype for depression.

Association of depression with type 2 diabetes and relevant factors.

Background:Based on the high prevalence of diabetes and depression in Rasht, we conducted a study to evaluate the prevalence of depression in type 2 diabetic patients, and its association with glycemic control, chronic complications, and some clinical and paraclinical parameters in this northern state of Iran.Materials and Methods:Beck depression inventory was used for evaluating depression on 90 type 2 diabetics and 90 healthy controls selected. Information on demographic and clinical and paraclinical characteristics was collected by interviews and from medical records.Results:This cross-sectional study was performed on 90 type 2 diabetic patients (63 female and 27 male with a mean age of 54.17 ± 10.57 years) and 90 healthy matched controls. Overall, depression was significantly more prevalent in case group [37.8% vs. 16%, odds ratio (OR) = 3.29, P = 0.001]. The prevalence of depression in diabetic women was significantly higher than nondiabetic ones (39.7% vs. 15%, P = 0.002). We could not find any significant correlation between depression and positive family history of depression, duration of diabetes, HBA1c level, and body mass index. The prevalence of depression was prominently more in diabetic patients with retinopathy than in those without this complication (55.6% vs. 24%, P = 0.015). Logistic regression analysis indicated that diabetes itself was the only significant determinant of having depression (OR = 3.29, P = 0.005, 95% confidence interval: 0.118-0.667).Conclusion:There was a prominent prevalence of depression in type 2 diabetics overall. Depression was not correlated with duration of diabetes and glycemic control. There was a significant association between depression and retinopathy in diabetic patients. Diabetes itself was the only significant determinant of having depression after matching with other variables.

Filicide as a part of extended suicide: An experience of psychotherapy with the survivor.

The tragedy of maternal filicide and extended suicides has occurred throughout history. Maternal filicide–suicide perpetrators most often suffer from depression, suicidality, or psychosis. Interventions in such cases are not commonly reported in the psychiatric settings, and the components of psychotherapeutic approach and its efficacy are also not known. Here we present a long-term therapy carried out with a 36-year-old married lady, with the complaints of low mood, suicidal ideation, severe guilt feelings, and depressive cognitions. There was positive family history of depression, past history of dysthymia, suicidal attempt, and severe marital discord. Therapy was carried out for a period of 9 months with follow-up for 4 years and addressed existential issues and grief with the components of existential therapy, grief therapy, narratives, religious beliefs, and interpersonal acceptance. The case highlights the need for blending of multiple approaches to meet the challenges such cases can pose.

Correlates of Depression in the Slovenian Working Population

This multicentre, cross-sectional observational study aimed to determine the prevalence of depression among the working population of Slovenia and identify factors correlating with higher prevalence of depression. It was conducted in three occupational medicine practices within major Slovenian primary health care centres. The study population consisted of 1,474 respondents [73.7% of the invited participants, 889 (60.3%) men and 585 (39.7%) women with mean age of (40.5±9.8) years] who visited these practices for their regular check-ups from November 2010 to June 2012 and were asked to fill in a self-developed questionnaire and score depression on the Zung's self-rating depression scale. According to the rating, 50 (3.4%) respondents suffered from depression. In the multivariate analysis, depression correlated with the following independent variables: self-perceived exposure to chronic stress, positive family history of depression, and primary school education.

Using family history and health risk behaviors to determine predictors of depressive symptoms in Central American immigrant mothers

In this study, depressive symptomatology in Central American immigrant mothers with adolescent daughters living in the USA was explored. Using the Center for Epidemiologic Studies Depression Short Scale, the Family History Scale, an Acculturation Scale, and the core section of the Youth Conduct Disorder scale from the National Health and Nutrition Examination Survey, 101 Central American mothers were analyzed to identify predictors of depressive symptoms. Over one-third of the participants had depressive symptoms. There were no significant findings for acculturation as a predictor of depressive symptoms. Predictors that related to depressive symptomatology were a positive family history of depression, marital status (divorced), and having a daughter engaged in health risk behaviors. Clinicians working with mothers from Central America should consider risk of depression, whether there is a family history of depression; and additional stresses, such as the health risk behaviors of adolescents. Unprecedented levels of immigration around the world underscore the importance of meeting the healthcare needs of culturally-diverse groups.

Sub-syndromal depression in adolescents attending primary care: frequency, clinical features and 6 months outcome

The nature of adolescent sub-syndromal depression has not been investigated in primary care. To document frequency, characteristics and 6 month outcome of sub-syndromal depression amongst adolescent primary care attenders. Primary care attenders (13-18 years) completed depression screening questionnaires (Mood and Feelings Questionnaires) at consultation and at 6 month follow-up. Those screening positive were interviewed with the K-SADS. Sub-syndromal depression was defined as high levels of depressive symptoms in the absence of depressive disorder. Two hundred and seventy four questionnaires were completed at consultation: the estimated rate of sub-syndromal depression was 25 %. These young people were clinically intermediary between those without depressive symptoms and those with depressive disorder; at 6-months follow-up 57 % had persistent depressive symptoms and 12 % had developed a depressive disorder. Negative life events during the follow-up period and a positive family history of depression were the strongest predictors of symptom persistence and the development of depressive disorder, respectively. Sub-syndromal depression is common and persistent, in adolescent primary care attenders and it deserves attention.

Neural expression of nicotine's antidepressant properties during tryptophan depletion: An EEG study in healthy volunteers at risk for depression

Nicotine amelioration of serotonergically mediated mood dysregulation may contribute to the comorbidity between cigarette smoking and depression, a disorder which is associated with aberrant activation and hemispheric asymmetry in frontal and posterior cortical regions. This randomized, double-blind study in 20 healthy volunteers with a positive family history of depression examined the effects of transdermal nicotine on mood and EEG changes accompanying transient reductions in serotonin induced by acute tryptophan depletion (ATD). Increased self-ratings of depressed mood and elevation in left frontal high alpha power (decreased activation) were evidenced with ATD (vs. balanced mixture) in participants treated with the placebo but not the nicotine treated group. Nicotine alone increased vigor and posterior high alpha bilaterally, and during ATD it prevented the reduction in left frontal high alpha that was evident in the placebo patch group.These findings indicate that in depression prone individuals, nicotine acts to stabilize the mood lowering and associated frontal functional asymmetry elicited by an acute decrease in brain serotonin.

Integrating science and clinical practice in the understanding and treatment of mood disorders

The Hippocratic humoral theory is upheld in modern neuropharmacologic investigations showing depressive relapse with catecholamine-depleting agents. Serotonin dysregulation is supported, especially in females, in reduced 5-HT2A receptors in PET studies. Furthermore, the ancient concept of temperament and its role in depression is supported by current psychometric research. Despite increasing clinical and public health recognition, sophisticated research strategies and the broad availability of relatively safer agents for treatment, depression continues to be a prevalent group of illnesses which often pursue a recurrent and chronically relapsing course with considerable morbidity and mortality. Etiology is multifactorial, involving, among others, familial-genetic, demographic, developmental, personality, seasonal-circadian, experiential, interpersonal, conjugal, cultural and economic factors. Grief, losses and other life events, emphasized in Freud's and Bowlby's writings, as well as current clinical research experience, together with Darwin's landmark work on evolution, place sadness and related emotions in an adaptive context. Current evidence indicates that experiencing life events depends on a familial diathesis for depression, and that temperament increases reactivity to the very life events that precipitate depression. Even social support, a factor that buffers the depressant effect of life events, appears to be dependent on familial factors. Finally, a positive family history of depression, seems to involve the amygdala. It is of great theoretical and clinical interest that the responsivity of the amygdala is mediated through such conditions as anxiety, bipolar II and related affective personality styles. Response of aversive stimuli, too, appears to be processed through the limbic structures. Many medically associated somatic complaints--fibromyalgia, irritable bowel syndrome and migraine--appear to be part of the foregoing affective spectrum. Depression may precede, follow or complicate such common diseases as diabetes, myocardial infarction, stroke, and treatment of the associated depression often improves the prognosis of the underlying disease. Another provocative development is the continuity of unipolar and bipolarI II doisorders, which may in selected patients necessitate the use of antidepressant augmentation strategies. Current treatment research involves complex methodologies in both the psychosocial and psychopharmacologic realms, which each clinician must practice as an art. Medications are best administered in the context of of an ongoing therapeutic alliance. Prototypes of modern mood stabilizers [lithium, carbamazepine, divalproex, topiramate, gabapentin, lamotrigene] are efficaceous via somewhat overlapping yet distinct mechanisms. Many antipsychotics [eg, perphenazine, risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole] exercise prominent mood stabilizing effects. Finally, prototypes of antidepressants exert thymoleptic action via putative noradrenergic [desipramine], serotoninergic [fluoxetine], or dual chemical action[ venlafaxine], possibly dopaminergic [bupropion?], and in the case of MAOIs such as tranylcypromine appear to involve all three neurotransmitters. Glutaminergic action represents a new fascinating vista beyond the scope of this presentation. Given that mood disorders do occur in a distinct minority of eminent and creative individuals, the clinician can appropriately weigh the relative advantages and limitations of these agents as well as their different side-effect profiles for a given patient in these populations.

Support for Two Subcategories of Depression with Different Vasopressinergic Mechanisms in the Field of Melancholia

This review presents recent evidence of a differentiation in the field of melancholic depression into two subcategories: Highly anxious-retarded depression and depression with above-normal plasma vasopressin (AVP) concentration. This differentiation has been enabled by the use of multidimensional structures of psychopathology, character and temperament, and different vasopressinergic parameters. Melancholia was multi-dimensionally redefined as the highly anxious-retarded subcategory. This subcategory was subsequently validated by relations with the character trait of low Self-Directedness, late remission, correlating vasopressin (AVP) and cortisol concentrations, and a positive family history of depression. The other subcategory, with above-normal plasma AVP concentration, related significantly with familial depression, and was further validated by correlating AVP and cortisol concentrations, the character trait of low Cooperativeness, a state-dependent reduction of the temperament of Reward-Dependence, and correlating anxiety and retardation scores. These data suggest that increased responsivity of the vasopressin V1b receptor is involved in the highly anxiousretarded subcategory, and genetically increased release of AVP, stimulating V1a and V1b receptors, in depression with above-normal plasma AVP. The multilevel and multidimensional clinical description may be useful in other fields of psychiatry. Keywords: Melancholia, anxiety, retardation, social behavior, temperament, character, vasopressin, animal models

Family History of Depression and Therapeutic Outcome

It is unclear whether a positive family history of depression affects the clinical presentation or effectiveness of treatment for major depressive disorder (MDD). We aimed to determine whether depressed patients with a positive family history of depression differed from those without in terms of baseline sociodemographic and clinical characteristics, including concurrent comorbid conditions and treatment outcome with citalopram in a large, multicenter effectiveness trial. Clinical outcome and sociodemographic information were collected on 2876 participants with DSM-IV MDD enrolled from July 2001 through April 2004 in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. Participants with and without a family history of depression, as determined by self-report at initial assessment, were compared. Over half (55.6%) (1585/2853) of the evaluable sample reported a positive family history of depression. A positive family history of depression was associated with an earlier age at onset of MDD, a longer length of illness, and more comorbid generalized anxiety disorder and prior suicide attempts. These participants had a slightly faster onset of remission, and slightly greater side effect burden, but they did not differ overall in response or remission rates. A family history of depression was associated with several clinical characteristics, although its usefulness as a predictor of treatment outcome is questionable. The slightly faster remission with an SSRI despite the slightly greater side effect burden indicates the effectiveness of using an SSRI in treating depressed patients both with and without a family history of depression. clinicaltrials.gov Identifier: NCT00021528.

Reduced cooperativeness and reward-dependence in depression with above-normal plasma vasopressin concentration

The neuropeptide vasopressin is centrally involved in the regulation of social behaviour and response to stress. We previously found support for a subcategory of depression defined by above-normal plasma vasopressin (AVP) concentration. This subcategory is validated by a positive family history of depression and correlating plasma AVP and cortisol concentrations. The data support the validity of above-normal plasma AVP concentration as a genetically determined biological marker for a subcategory of depression. The aim of the present study was to test whether above-normal plasma AVP concentration in depression is related to personality characteristics reflecting a specific social behaviour style. The data of 78 patients from a previously investigated sample were reanalysed. Fifty-eight patients were available after 2 years, 15 of whom with initially above-normal plasma AVP. The dimensions of the Temperament and Character Inventory (TCI) were scored, with particular focus on the dimensions of Cooperativeness (CO) and Reward-dependence (RD). Normative subjects and other depressed subjects were used as controls. After full remission, patients with initially above-normal AVP had low CO compared with normal and patient controls. During depression, these patients had both low CO and low RD compared with normal controls and low RD compared with patient controls. Low CO is a presumably premorbid trait and reduced RD a state-dependent characteristic in depression with above-normal plasma AVP. The low CO further supports the validity of above-normal plasma AVP concentration as a genetically determined biological marker for a subcategory of depression.

Dex/CRH-test response and sleep in depressed patients and healthy controls with and without vulnerability for affective disorders

Sleep electroencephalographic (EEG) abnormalities and increased hypothalamo–pituitary–adrenal (HPA) axis activity are the most prominent neurobiological findings in depression and were suggested as potential biomarker for depression. In particular, increased rapid eye movement sleep (REM) density, deficit in slow wave sleep and excessive stress hormone response are associated with an unfavorable long-term outcome of depression. Recent studies indicate that the sleep and endocrine parameters are related to each other. This study investigated the association of sleep structure including a quantitative EEG analysis with the results of the combined dexamethasone (Dex)/corticotropin-releasing hormone (CRH)-test in 14 patients with a severe major depression, 21 healthy probands with a positive family history of depression (HRPs) and 12 healthy control subjects without personal and family history for psychiatric disorders. As expected patients with depression showed an overactivity of the HPA axis, disturbed sleep continuity and prolonged latency until slow wave sleep in the first sleep cycle. Differences in microarchitecture of sleep were less prominent and restricted to a higher NonREM sigma power in the HRP group. Dexamethasone suppressed cortisol levels were positively associated with higher NonREM sigma power after merging the three groups. We also observed an inverse association between the ACTH response to the Dex/CRH-test and rapid eye movement sleep (REM) density in HRPs, with suggestive evidence also in patients, but not in controls. This contra-intuitive finding might be a result of the subject selection (unaffected HRPs, severely depressed patients) and the complementarity of the two markers. HRPs and patients with high disease vulnerability, indicated by an elevated REM density, seem to have a lower threshold until an actual disease process affecting the HPA axis translates into depression, and vice versa. To summarize, our findings provide further evidence that the HPA axis is involved in the sleep regulation in depression. These associations, however, are not unidimensional, but dependent on the kind of sleep parameters as well as on the selection of the subjects.