Recurrent Depressive Patients Research Articles

P.2.a.026 Persistent verbal episodic memory deficits in recurrent depressed patients despite response to antidepressant treatment: preliminary results

P.2.a.026 Persistent verbal episodic memory deficits in recurrent depressed patients despite response to antidepressant treatment: preliminary results

Frequency and characteristics of recurrent major depressed patients with unimpaired executive functions

Major depression is associated with impairment of cognitive functions, and especially higher-order cognitive processes referred to as executive functions (EF). Whether this is a general finding is unclear. Patients without EF impairment may have different treatment needs than patients with EF impairment, and will probably have a better everyday functioning. Thus, it is important to identify the prevalence and characteristics of depressed patients without EF impairment. Forty-three patients with recurrent major depressive disorder (19–51 years) and 50 healthy controls were included in the study. The subjects were assessed with neuropsychological tests selected to measure central areas of EF, and screened on clinical and demographic variables. Within the depressed group, a total of 56% were defined as EF unimpaired. These patients were characterised by higher intellectual abilities and fewer depression episodes than the subgroup of patients with EF impairment. The subgroups were similar in age at debut of illness, severity of depression, general psychopathology and global level of functioning. In conclusion, about half of patients with recurrent major depression have normal EF. Since cognitive impairment and depressive symptomatology seems to be distinct dimensions, a neuropsychological investigation could help to ensure optimal treatment in patients with recurrent major depression.

Emotional information processing in first and recurrent major depressive episodes

Depressive states are classically associated to increased sensitivity to negative events. However this hypersensitivity may not be stable in time, being absent in remission periods or further reinforced with recurrent depressive episodes, or may concern positive stimuli instead, e.g. in young depressive patients. To study the evolution of the processing of emotional information in depression we recorded late components of evoked potentials in first-episode and recurrent depressed patients before and after recovery. We used a visual attentional paradigm manipulating the processing of emotional information. Subjects first counted words with positive valence, and then words with negative valence from lists of usual words. The results showed that recurrent patients had increased P300 amplitudes for negative words selection only in negative words counting situation, while first-episode patients had decreased P300 amplitudes for positive words selection. After clinical improvement, the negative biases in recurrent patients group disappeared but P300 amplitudes of first-episode patients remained significantly low for positive words. First-episode depressed patients show a selective impairment for positive stimuli, with decreased response to pleasant stimuli, while recurrent depressive subjects show signs of hyperesthesia for negative stimuli. These results suggest that responses to emotional stimuli in word processing are related to the duration of the mood disorders.

L’architecture cognitive des états dépressifs

The main purpose of these studies was to assess the organization of information processing in depressed patients. We studied the effects of several experimental conditions (signal degradation, stimulus-response compatibility and preparatory period) on event-related brain potentials (ERPs), reaction time (RT) and intervals between ERP peak latencies. According to Sandersˈmodel, these variables influence feature extraction, response choice and motor adjustment stages respectively. These stages have been studied in recurrent depressed patients and in first depressive episode patients before and after a clinical improvement. Results show an overall disorganization of the temporal architecture of information processing in depression. This organization evolves differently according to the number of previous episodes.

Noradrenergic dysfunction and antidepressant treatment response

The purpose of this study was to investigate differences in outcome following treatment with two different antidepressants in depressed patients according to their pretreatment hormonal response to clonidine. In all, 62 drug-free DSM-IV recurrent major depressed patients and 20 normal controls were studied. Patients were subsequently treated for 4 weeks with fluoxetine ( n=28), or amitriptyline ( n=34), and were then classified as responders or nonresponders according to their final Hamilton depression scale score. Compared to controls, depressed patients showed lower GH response to CLO (ΔGH) ( P<0.0002). One control (5%) and 35 depressed patients (56%) had blunted ΔGH values. The efficacy of the two antidepressants was not significantly different: 15 patients responded to AMI (44%), seven patients responded to FLUOX (25%) ( P>0.15). However, in the subgroup of patients with blunted ΔGH levels, the rate of responders was higher for AMI (11/21) compared to FLUOX (1/14) treated patients ( P<0.01). These results suggest that in depressed patients a blunted GH response to CLO could predict antidepressant response.

Efficacy of tianeptine vs placebo in the long-term treatment (16.5 months) of unipolar major recurrent depression*

To compare the efficacy and acceptability of tianeptine vs placebo in the long-term treatment of unipolar major recurrent depression, 268 hospitalized and ambulatory patients meeting DSM III-R criteria for major depression with a 21-item Hamilton depression rating scale (HDRS) score >/= 17 and at least one episode in the previous 5 years received tianeptine in a 6-week multicenter open study. At D42, 185 responders (intention-to-treat population) were randomized for ethical reasons into two unbalanced groups to receive tianeptine 37.5 mg/day (n= 111) or placebo (n= 74) for 16.5 months; 173 of the 185 responders were defined as strict responders (per-protocol population) by an HDRS score which was both < 15 and at least halved vs D1, combined with clinical confirmation by the investigator. The groups were similar at baseline except in the severity of the depressive episode (greater in the tianeptine group: 33 vs 18%, p= 0.018). Relapse (before 6 months) and recurrence (after 6 months) were defined by an HDRS score >/= 15 and/or clinical global impression score >/= 4, and clinical confirmation by the investigator. Visits were at D63 and M3, M6, M9, M12, M15, and M18. Efficacy was measured by the number of relapses and recurrences and their time of onset (Kaplan-Meier survival curve analysis). Between D42 and M18 (intention-to-treat population), relapse and recurrence were less frequent on tianeptine vs placebo (16 vs 36%, p= 0.002). Comparison over time also showed a higher proportion of patients without relapse or recurrence on tianeptine (p< 0.001); the intergroup difference increased with follow-up duration. Secondary analysis of relapse in the intention-to-treat group showed a higher proportion on placebo (p= 0.002); secondary analysis of recurrence over time showed that the difference in the percentages of recurrence-free patients was nonsignificant in the intention-to-treat population (p= 0.067) but significant in the per-protocol population (p= 0.036) in favor of tianeptine. Acceptability did not differ between the groups. Treatment-induced adverse events were rare and mild in both groups. These data support the use of tianeptine in the long-term treatment of unipolar major recurrent depression. Relapse and recurrence were decreased two- to threefold on tianeptine vs placebo with no difference in acceptability between the two groups. Copyright 1997 Doin Editeurs

Alterations in membrane molecular dynamics in erythrocytes of patients with affective illness

AbstractOver the past twenty years, evidence has accumulated in support of membrane alterations in bipolar affective illness. In addition there is now substantial evidence that membrane phospholipid composition and molecular dynamics can alter the activity of membrane proteins such as receptors, channels and enzymes. The present study demonstrates distinct alterations in erythrocyte membrane molecular dynamics in medication free bipolar I patients but not in recurrent depressed patients. The findings are the same for bipolar I patients whether in the manic or depressed state (inpatients and outpatients), and do not correlate significantly with depression and mania scores or with the length of illness. It also is observed that medications can modify membrane molecular dynamics but cannot produce the alterations demonstrated. These findings suggest possible enzymatic defects which could be responsible for the molecular psychobiology of bipolar illness. Depression 1:88–100 (1993). © 1993 Wiley‐Liss, Inc.

Imipramine metabolism in recurrent depressive episodes

The long-term maintenance of major affective disorders with tricyclic antidepressants is of obvious interest. However, discrete predictors identifying subgroups ‘at-risk’ for higher recurrence rates have infrequently been cited. The clinical course of 32 major recurrent depressive patients was monitored over 2 years. Analysis of the total tricyclic concentration and the parent: desmethylated ratio revealed that those subjects in a depressive recurrence previously had had a lower imipramine: desipramine ratio (despite matched dosing and nonsignificant total plasna concentrations) than nonrecurrents. Several hypotheses are discussed.