Primary Major Depressive Disorder Research Articles

Serotonin uptake in panic disorder and agoraphobia.

Because of reports of reduced serotonin uptake in depression and the frequent association between panic disorder and depression, this study was designed to assess the neurobiologic relationship between panic disorder and depression. Platelet serotonin uptake studies were done on 47 patients with panic disorder, 17 patients with primary major depression, and 15 healthy volunteers. The authors found that the rate of uptake of serotonin to platelets (Bmax) was significantly lower in both the depressed and panic disorder groups than the healthy control group. The panic disorder patients with a present or past history of major depression had slightly higher values than the panic disorder patients without such a history.

A family study of chronic schizophrenia : M. Alda, M. Dvorákova, P. Zvolsky and H. Papezová Psychiatric Research Unit, Charles University, Prague, Czechoslovakia

This is a study of the familial transmission of Primary Major Depressive Disorder in the families of 235 probands with this disorder ascertained as part of the NIMH-CRB Collaborative Depression Program. Eight hundred and twenty-six interviewed first degree relatives and 109 spouses are included. Research Diagnostic Criteria have been used and interviews were done using the SADS-L schedule.Prior analyses of these data have established the presence of strong secular trends in the age-of-onset and prevalence of Major Depressive Disorder in these families. Accordingly, new methods for the analysis of family data which incorporate secular variation were developed.Non-parametric Survival Analysis, using the Cox Proportional Hazards Model, guided the formulation of a quantitative family transmission model. Then a family analysis was conducted with the Multifactorial Model of Disease Transmission and the Tau Path Analytic Model.Using the non-parametric approach, only the sibs birth cohort, sex and affectational status of the mother were significantly related to the time of onset of illness in siblings. Proband sex, age-of-onset, and the presence of illness in the father were not significant.The quantitative analysis confirmed that more recently born cohorts of individuals had an increased expected lifetime prevalence and a decreased age-of-onset of Primary Major Depressive Disorder. Assortative mating was present and environmental factors common to siblings did not make a significant contribution to the phenotypic variance. Sex specific transmissibilities were found and the transmissibility in females (t2 = 0.62) was significantly greater than that of males (t2 = 0.28). There was a trend for the transmissibility of Primary Major Depressive Disorder to be greater in more recently born cohorts.

The Newcastle Chronic Depression Study. Patient characteristics and factors associated with chronicity.

Chronic depression is defined as "symptomatic non-recovery for a period of 2 or more years". Chronic primary major depressives (n = 24) were compared retrospectively with a control group of primary major depressives (n = 20) who had recovered from their illness episode within 2 years. The former had a significantly higher familial loading for affective disorder and showed an increased incidence of independent undesirable life events during the 6 months prior to and 2 years after the onset of their illness. Female chronic depressives also had a significantly greater number of previous illness episodes and a more frequent history of thyroid dysfunction. Personality as measured on the EPO, psychiatric problems arising as secondary complications of the depressive illness, and developmental object loss did not differentiate chronic from non-chronic depressives.

Primary early-onset dysthymia: comparison with primary nonbipolar nonchronic major depression on demographic, clinical, familial, personality, and socioenvironmental characteristics and short-term outcome.

Primary early-onset dysthymia: comparison with primary nonbipolar nonchronic major depression on demographic, clinical, familial, personality, and socioenvironmental characteristics and short-term outcome.

Prognostic validity of the familial subtypes of depression.

We examined the prognostic validity of Winokur's familial subtypes of depression in 184 in-patients with primary unipolar major depression. Patients with familial pure depressive disease had a more favorable hospital course and reported less symptoms during a 6-month follow-up evaluation than patients with depressive spectrum disease or sporadic depressive disease. Consistent with previous studies of the validity of the familial subtypes, the use of stringent thresholds to diagnose the patient's relatives increased the validity of classification.

Comorbidity among childhood anxiety disorders.

This paper reports on 73 consecutive admissions to an outpatient anxiety disorder clinic for children and adolescents. Patients were evaluated with a structured diagnostic interview for primary and secondary disorders with DSM-III criteria in order to examine patterns of comorbidity. The most common primary diagnoses for the sample included separation anxiety disorder (33%), overanxious disorder (15%), social phobia of school (15%), and major depression (15%). Children with a primary diagnosis of separation anxiety disorders were most likely to receive a concurrent diagnosis of overanxious disorder. Alternatively, children with a primary diagnosis of overanxious disorder were most likely to receive an additional diagnosis indicative of a social anxiety problem, either social phobia or avoidant disorder. Children with a primary major depression most often exhibited social phobia and/or overanxious disorder. No clear-cut pattern of comorbidity emerged for the social phobic (school) group. These findings are discussed in terms of their comparability with results recently obtained from an adult anxiety clinic population.

Psychophysiological aspects of depressive syndromes.

Compared to 30 healthy controls, 59 drug free patients with primary major depression exhibited significantly higher rates of heart beat, respiration, and eye blinking; longer simple and associative reaction times; fewer spontaneous fluctuations of skin resistance, a lower salivation rate, a faster habituation rate of skin resistance orienting response, and a smaller CNV area in the EEG. Skin resistance level, speech pause time, N1P2 amplitudes of acoustically evoked potentials and the postimperative negative variation (PINV) in the EEG did not differ between groups. All deviations are nosologically unspecific; they can be regarded as signs of overarousal, as deficits, or as the result of protective inhibition. In all subjects the investigation was repeated twice, while the patients were treated with either amitriptyline or oxaprotiline, repetition of measurement influenced several variables, but most patient/control differences remained unaffected--irrespective of the drug applied.

Weight loss, cortisol levels, and dexamethasone suppression in major depressive disorder.

Appetite and/or weight loss are integral, albeit not necessary, symptoms of depression. We explored the contribution of diminished appetite and/or weight loss ascertained by history to the hypothalamic-pituitary-adrenocortical (HPA) axis dysregulation in 120 patients with primary major depressive disorder. Significant positive relationship for both appetite and weight loss with cortisol levels in plasma and cerebrospinal fluid (CSF) were observed. Plasma cortisol levels were consistently higher in patients who noted both appetite and weight loss as opposed to patients without appetite or weight loss. Depressed patients with weight loss showed higher rates of dexamethasone-nonsuppression. Age and severity of depression influenced but did not eliminate the significance of the findings, suggesting that weight loss accounts in part for the HPA-axis function changes observed in depression.

Chronic pain and depression. IV. DST as a discriminator between chronic pain and depression

In an attempt to clarify the relationship between chronic pain and depression, the authors studied the plasma cortisol response to dexamethasone in a group of 73 consecutive chronic low back pain patients admitted to a pain unit and 34 consecutive patients admitted to an affective disorders unit with the principal diagnosis of primary major depression. Patients with chronic pain were evaluated as to the presence or absence of major depression and patients with primary major depression were evaluated as to the presence or absence of pain complaints as part of their presenting symptomatology. Chronic pain patients with major depression differed significantly from chronic pain patients without major depression (3.4 ± 3.33 μg/dl versus 1.6 ± 0.9 μg/dl, P < 0.05). Chronic pain patients with major depression also differed from patients with primary major depression with pain complaints (3.4 ± 3.3 μg/dl versus 10.7± 8 μg/dl, P < 0.0005). The values given are post-dexamethasone plasma cortisol levels. Patients having primary major depression with pain complaints do not significantly differ from patients having primary major depression without pain complaints. The dexamethasone suppression test may be a useful method in discriminating those patients with chronic pain versus those with primary major depression, chronic pain patients with major depression versus those with primary major depression and chronic pain patients with major depression versus those with chronic pain and no depression.

The familial transmission of primary major depressive disorder

This is a study of the familial transmission of Primary Major Depressive Disorder in the families of 235 probands with this disorder ascertained as part of the NIMH-CRB Collaborative Depression Program. Eight hundred and twenty-six interviewed first degree relatives and 109 spouses are included. Research Diagnostic Criteria have been used and interviews were done using the SADS-L schedule. Prior analyses of these data have established the presence of strong secular trends in the age-of-onset and prevalence of Major Depressive Disorder in these families. Accordingly, new methods for the analysis of family data which incorporate secular variation were developed. Non-parametric Survival Analysis, using the Cox Proportional Hazards Model, guided the formulation of a quantitative family transmission model. Then a family analysis was conducted with the Multifactorial Model of Disease Transmission and the Tau Path Analytic Model. Using the non-parametric approach, only the sibs birth cohort, sex and affectational status of the mother were significantly related to the time of onset of illness in siblings. Proband sex, age-of-onset, and the presence of illness in the father were not significant. The quantitative analysis confirmed that more recently born cohorts of individuals had an increased expected lifetime prevalence and a decreased age-of-onset of Primary Major Depressive Disorder. Assortative mating was present and environmental factors common to siblings did not make a significant contribution to the phenotypic variance. Sex specific transmissibilities were found and the transmissibility in females ( t 2 = 0.62) was significantly greater than that of males ( t 2 = 0.28). There was a trend for the transmissibility of Primary Major Depressive Disorder to be greater in more recently born cohorts.

Interface of panic and depression: Clinical and sleep EEG correlates

Four groups of subjects were compared with respect to their clinical and demographic status and electroencephalographic (EEG) characteristics, namely: primary major depressive disorder (PRI MDD); panic disorder (Panic); “Mixed” group comprising patients meeting full syndromal criteria for MDD and panic occuring concomitantly; and normal controls. The “Mixed” (MDD + Panic) patients were characterized by earlier age of onset of psychiatric illness, longer duration of current episode, greater intensity of symptoms, higher impairment of functioning, increased miscellaneous psychopathology, and greater objective stress and anger. With respect to sleep EEG variables, PRI MDD patients were clearly different from the other three groups. The sleep profile of the “Mixed” group occupies an intermediate position between the “pure” Panic and MDD groups. Classification of the “Mixed” patients based on the discriminant function coefficients of the Schedule for Affective Disorders and Schizophrenia and sleep analysis of the “pure” groups (PRI MDD and Panic) reveals that some patients are classified as true PRI MDD while others are classified as falling somewhere along the PRI-MDD/Panic spectrum. The separation of the PRI MDD from Panic and Normals, however, is clear, suggesting that sleep can be successfully used as a physiological marker in the separation of these conditions.

Is chronic primary major depression a distinct depression subtype?

Eighteen chronic primary major depressives differed little from 106 nonchronic primary major depressives when compared on multiple clinical variables, including symptoms, longitudinal course, and family history. Chronic depressives had an earlier age of illness onset, more depressive episodes and were more likely to have attempted suicide at some time in their life. It is our interpretation that this data leaves open the issue of whether chronic depression is a distinct depressive subtype.

Differentiation of depressive disorders from generalized anxiety by the beck depression inventory

The Beck Depression Inventory (BDI) was administered to 35 outpatients diagnosed according to the DSM-III as primary generalized anxiety disorders and 101 outpatients diagnosed as primary major-depression and dysthymic disorders. A backward stepwise-discriminant analysis revealed that Sadness and Loss of Libido were the only two symptoms that meaningfully distinguished between the two groups. The depressed patients were sadder and complained of more loss of libido than did the anxious patients. It was concluded that the BDI is a powerful tool for differentiating the depressive from generalized anxiety disorders.

Adrenocortical function and suicidal behavior in depressive disorders

In order to examine the hypothesis that abnormal adrenocortical function is associated with suicidal behavior, morning and afternoon plasma cortisols and 1-mg dexamethasone suppression tests (DSTs) were performed in 65 patients with primary major depressive disorder. Patients with recent suicide attempts (within 28 days before DST) were compared to patients who had made past attempts and those who had never made suicide attempts with respect to age, gender, severity of depression, and plasma cortisol levels. Plasma cortisol levels did not differ significantly among the three groups. Nonsuppression on the DST was associated with presence of delusions, increasing age, and global severity of depression, but not with suicide attemps.

Relationships between EEG and clinical characteristics in major depressive disorder.

Twenty-five patients with major depressive disorder (MDD) according to RDC were examined with computerized EEG before antidepressive treatment was initiated. Relationships between EEG parameters and clinical characteristics were studied. Age and pharmacological treatment were taken into account. Primary MDD was associated with an increase of delta amplitude. Retarded MDD was associated with an increase of delta and theta amplitudes and EEG variability. Recurrent unipolar MDD was related to a decrease of total alpha symmetry. Thus, subdiagnoses according to RDC were validated. The anxiety subsyndrome and to some extent vital symptoms, depressed mood, and CPRS total sum, were associated with asymmetry of the EEG pattern, whereas retardation was not. The number of former depressive episodes was positively correlated to amplitude of beta activity and negatively correlated to symmetry of EEG in the delta frequency band.

Sleep electroencephalographic measures in primary major depressive disorder: Distinction between DST suppressor and nonsuppressor patients

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Somatization disorder: Psychologic symptoms, social disability, and diagnosis

The authors examined 50 outpatient women with somatization disorder (Briquet's syndrome) and 25 control women with primary major depression. Somatizers had many psychologic symptoms besides physical complaints and were often misdiagnosed. The somatizers were more socially disabled than the controls, particularly at work and as parents. The authors also review the history of somatization disorder, recent literature on psychological symptoms of somatization disorder, and make recommendations on the management, classification, and diagnosis of somatization disorder.

Tritiated imipramine binding distinguishes among subtypes of depression.

We studied 45 depressed patients and 20 healthy controls in order to determine if tritiated imipramine binding distinguished among subtypes of primary major depressive disorder. Mean (+/- standard deviation) values for maximal concentration of tritiated imipramine binding sites on platelet membranes were significantly lower in patients with bipolar and familial pure depressive disease (754 +/- 149 and 870 +/- 241 femtomoles [fmole]/mg of protein, respectively) than in patients with depressive spectrum and sporadic depressive disease (1,236 +/- 241 and 1,188 +/- 325 fmole/mg of protein, respectively), neither of which differed from healthy controls (1,238 +/- 201 fmole/mg of protein). Multiple linear regression analysis revealed that these differences could not be attributed to differences in age, sex, Hamilton Rating Scale score, presence of psychotic features, hospitalization status, or medication history. This association of a biological finding with distinct clinically defined subtypes of depression may lead to a classification of affective disorders useful in further research.

Cholinergic REM induction response: Separation of anxiety and depression

Five groups of subjects underwent EEG sleep recordings, arecoline rapid eye movement (REM) induction response testing, and Schedule for Affective Disorders and Schizophrenia (SADS) interview. Group I: 20 patients with primary major depressive disorder (MDD) (endogenous) without any coexisting anxiety disorder; Group II: 19 primary MDD (endogenous) patients with secondary panic, GAD, or phobic disorders; Group III: 18 patients with primary anxiety disorder without coexisting MDD; Group IV: 14 patients with primary anxiety plus secondary MDD; Group V: 26 normal controls. Modified Research Diagnostic Criteria (RDC) were used for diagnosis, based on the SADS interview. There was considerable overlap of SADS scaled scores between patient groups, which is consistent with a heterogeneous clinical presentation of depressive and anxiety states. REM latency was significantly shorter in patients with primary MDD (without anxiety) as compared with that in patients with primary anxiety (no MDD) and normals. Arecoline REM induction response time was significantly shorter in both primary affective groups (I and II) as compared with primary anxiety (no MDD) patients and normal controls. REM latency and arecoline REM induction time was not significantly different between the primary anxiety groups (III and IV) and normals. The study highlights the use of biological markers in differentiating between clinical syndromes confounded by mixed or overlapping phenomenology.

"I don't know" responses in elderly depressives and in dementia.

"I don't know" responses were recorded during administration of the Mini-Mental State Examination in elderly patients with primary degenerative dementia and primary major depression. More "I don't know" responses were given by patients with degenerative dementia; however, demented patients did not differ overall from depressives in the proportion of Not Correct responses consisting of "I don't know" responses. These responses were positively correlated with age and with Hollingshead education and social class scores in depressives but not in demented patients. A higher proportion of Not Correct responses consisting of "I don't know" responses needs to be demonstrated in depressive pseudomentia than in degenerative dementia if this clinical sign is to be used in helping to differentiate the two disorders.