Remitted Depression Patients Research Articles

Sexual Dysfunction in Remitted Female Patients with Depression on SSRIs: Associated Factors and Relation to Marital Satisfaction and Quality of Life.

Background:Sexual dysfunction, a potential side effect of selective serotonin reuptake inhibitors (SSRIs), can lead to marital dissatisfaction in remitted depression patients, affecting their quality of life (QOL), and all of these are risk factors for treatment noncompliance. We aimed to estimate the proportion of female sexual dysfunction and its subtypes compared to the general population and correlate it with various factors, including marital satisfaction and QOL, in remitted depressive patients on SSRI treatment.Methods:This analytical cross-sectional study assessed 116 women, comprising 58 patients aged 18– to 45 years with rsemitted depression on SSRI monotherapy for a minimum of six weeks and their age-matched comparative group. Hamilton Depression Rating Scale was used to assess depression severity and Female Sexual Functional Index, to assess sexual dysfunction. Couple Satisfaction Index and WHOQOL-BREF version were used to assess marital satisfaction and QOL, respectively.Results:In total, 56.89% of the patients had sexual dysfunction, compared to 39.65% in the general population. Exploratory analyses revealed that overall sexual functioning had a significant positive correlation with education (P = .002), marital satisfaction (P < .001), and QOL (P < .01), and a significant negative correlation with the age of onset of depression (P = .004), total marital duration (P = .02), and duration of current treatment (P = .02).Conclusion:Sexual dysfunction is common in remitted female depression patients on SSRI treatment, which may further impair their marital satisfaction and QOL. Hence, routine screening for sexual dysfunction is necessary for them.

Internet-delivered cognitive control training as a preventive intervention for remitted depressed patients: Evidence from a double-blind randomized controlled trial study.

Cognitive control impairments may place remitted depressed (RMD) patients at increased risk for developing future depressive symptomatology by disrupting emotion regulation processes. Research has shown that directly targeting cognitive control has beneficial effects on high trait ruminators and clinically depressed patients. The current study tested whether internet-delivered cognitive control training (CCT) can be used as an intervention to increase resilience to depression in RMD patients. Effects of CCT were assessed using a double-blind randomized controlled design. RMD patients performed 10 sessions of a working memory-based CCT (N = 34) or a low cognitive load training (N = 34; active control condition) over a period of 14 days. Assessments took place prior to training, immediately following 2 weeks of training, and at 3 months follow-up. Brooding and depressive symptomatology were selected as primary outcome measures, alternative indicators for emotion regulation and residual symptomatology were selected as secondary outcome measures, along with indicators of functioning. Compared to an active control condition, CCT demonstrated beneficial effects on a cognitive transfer task, brooding, depressive symptomatology, residual complaints, self-reported use of general maladaptive emotion regulation strategies, and resilience after controlling for intention to treat. Furthermore, completers of the CCT reported a reduction in experienced disability and cognitive complaints. However, no beneficial effects were found for self-reported use of adaptive emotion regulation strategies. These findings demonstrate the effectiveness of CCT as an intervention to reduce cognitive vulnerability, residual symptomatology, and foster resilience following recovery from depression. CCT thus holds potential as a preventive intervention for RMD patients. (PsycINFO Database Record

Alleviated negative rather than positive attentional bias in patients with depression in remission: an eye-tracking study.

ObjectiveTo investigate attentional bias toward happy and sad faces in remitted depressed (RD) patients compared with healthy control (HC) subjects.MethodsThis cross-sectional study enrolled RD patients and sex- and age-matched HC subjects. Eye movement data were acquired for all study participants while free viewing a 2 × 2 matrix of emotional faces. The attentional bias toward different emotional faces and whether the attention maintenance components generated attentional bias in the RD patients were analysed by comparing the attentional modes of the RD group with the HC group.ResultsA total of 27 RD patients and 27 HC subjects were analysed in this study. The RD and HC groups exhibited no significant differences toward first fixation location and initial attentional maintenance. In later attentional maintenance, the RD group showed significantly less attentional bias toward happy faces, but there were no significant differences in their attentional bias toward sad faces, compared with the HC group.ConclusionsThis present study showed that the negative attentional bias of RD patients was successfully eased, but their positive attentional bias was still insufficient.

The interplay between cognitive risk and resilience factors in remitted depression: A network analysis

BackgroundIndividuals in remission from depression are at increased risk for developing future depressive episodes. Several cognitive risk- and resilience factors have been suggested to account for this vulnerability. In the current study we explored how risk- and protective factors such as cognitive control, adaptive and maladaptive emotion regulation, residual symptomatology, and resilience relate to one another in a remitted depressed (RMD) sample. MethodsWe examined the relationships between these constructs in a cross-sectional dataset of 69 RMD patients using network analyses in order to obtain a comprehensive, data-driven view on the interplay between these constructs. We subsequently present an association network, a concentration network, and a relative importance network. ResultsIn all three networks resilience formed the central hub, connecting perceived cognitive control (i.e., working memory complaints), emotion regulation, and residual symptomatology. The contribution of the behavioral measure for cognitive control in the network was negligible. Moreover, the directed relative importance network indicates bidirectional influences between these constructs, with all indicators of centrality suggesting a key role of resilience in remission from depression. LimitationsThe presented findings are cross-sectional and networks are limited to a fixed set of key constructs in the literature pertaining cognitive vulnerability for depression. ConclusionsThese findings indicate the importance of resilience to successfully cope with stressors following remission from depression. Further in-depth studies will be essential to identify the specific underlying resilience mechanisms that may be key to successful remission from depression.

Attentional Bias in Remitted Depressed Patients: Evidence from an Eye- Tracking Study

Objectives: To investigate the attentional characteristics of remitted depressed (RD) patients toward both happy and sad facial expressions. Methods: Eye-movement data for the free-viewing facial expressions information of two groups (RD patients and healthy control (HC)) were acquired using the eye-tracking technique. The RD patients’ initial attentional orientation toward different pieces of emotional information and their attentional related to the attention-maintenance components were analyzed. Results: (1) On the initial orienting indicators (direction of initial gaze and initial fixation latency) and the initial attention maintenance indicators (first fixation duration), the RD patients showed no attentional toward the emotional faces; (2) For the late-stage attention maintenance indicators (total fixation time), both the RD group and the HC group exhibited attentional toward happy faces; the was smaller in the RD group than in the HC group; (3) For the RD group, there was a positive correlation between the direction of the initial gaze toward happy faces and total fixation time and a negative correlation between the initial fixation latency toward happy faces and total fixation time, whereas there were no such correlations in the HC group. Conclusions: The RD group displayed an attentional trend for happy faces, and this increase in the positive reflected the RD patients’ subjective, active efforts to establish a protective bias that would both alleviate and improve depressive symptoms.

Alteration of spontaneous neuronal activity within the salience network in partially remitted depression

Of major depression patients, 29–66% show only partial remission on a single antidepressant trial. Such patients are characterized by residual depressive symptoms such as anhedonia, psychic anxiety, sleep disturbance, and cognitive dysfunction. Despite having a tremendous impact on outcomes such as future relapse, morbidity, and mortality, the neural mechanisms of partially remitted depression remain unclear. Using the amplitude of low-frequency fluctuations (ALFF) approach, we investigated the intrinsic neural oscillation alterations during resting state in partially remitted depression. A total of 23 partially remitted depression patients and 68 healthy controls underwent magnetic resonance imaging for functional imaging. We compared ALFF differences between groups as well as correlations between clinical measurements and ALFF in the brain regions showing significant group differences. Compared with healthy controls, partially remitted depression patients showed increased ALFF in the left ventral anterior insula, bilateral posterior insula, and bilateral supramarginal gyrus, and decreased ALFF in the left calcarine gyrus. A trend positive correlation between the number of depressive episodes and ALFF values was found in the right posterior insula in the partially remitted depression group. In addition, the ALFF in the right supramarginal gyrus were negatively correlated with Hamilton Depression Rating Scale scores. Consistent with the emerging theory of the role of the salience network in sensing the changes of homeostasis that contributes to partially remitted depression, the current findings suggest that the increased intrinsic neural oscillation of the insula is related to the refractoriness to treatment and may be an imaging marker for predicting future depression recurrence.

Abnormal spontaneous neural activity in the anterior insular and anterior cingulate cortices in anxious depression

ObjectiveAnxious depression is a distinct clinical subtype of major depressive disorder (MDD) characterized by palpitations, somatic complaints, altered interoceptive awareness, high risk of suicide, and poor response to pharmacotherapy. However, the neural mechanisms of anxious depression are still not well understood. In this study we investigated changes in neural oscillation during the resting-state of patients with anxious depression by measuring differences in the amplitude of low-frequency fluctuation (ALFF). MethodsResting-state functional magnetic resonance imaging was acquired in 31 patients with anxious depression, 18 patients with remitted depression, as well as 68 gender- and age-matched healthy participants. We compared the differences both in the ALFF and fractional ALFF (fALFF) among the three groups. We also examined the correlation between the ALFF/fALFF and the severity of anxiety as well as depression. ResultsAnxious depression patients showed increased ALFF/fALFF in the right dorsal anterior insular cortex and decreased ALFF/fALFF in the bilateral lingual gyrus relative to remitted depression patients and healthy controls. The increased ALFF in the dorsal anterior insula was also positively correlated with stronger anxiety in the anxious depression group. Anxious depression patients also displayed increased fALFF in the right ventral anterior cingulate cortex (ACC) compared to remitted depression patients and healthy controls. ConclusionsOur results suggest that alterations of the cortico-limbic networks, including the right dorsal anterior insula and right ventral ACC, may play a critical role in the physiopathology of anxious depression.

Relationship of temperament and character in remitted depressed patients with suicidal ideation and suicide attempts--results from the CRESCEND study.

The aim of this study was to evaluate the Temperament and Character Inventory (TCI) scores of a sample of Korean patients with remitted depression who had attempted suicide and reported suicidal ideation and to compare their scores with those of remitted depressed patients without suicidal ideation. Adult depression patients who had completed 12 weeks of follow-up (N = 138) were divided into three groups: patients with a history of suicide attempts (N = 23); patients with current suicidal ideation (N = 59); and patients without current suicidal ideation (N = 56). After controlling for covariates, no significant differences were found among the three groups on any measure of temperament or character except self-directedness and self-transcendence. The self-transcendence scores of the lifetime suicide-attempt group were significantly higher compared with those of the suicidal-ideation group; post hoc analysis revealed that self-directedness was significantly lower in the suicide-attempt group compared with the non-suicidal group. The results from the present study suggest that remitted depression patients with a history of suicide attempts do not differ from non-attempters in temperament, but do differ in certain character traits.

A study of remitted and treatment-resistant depression using MMPI and including pessimism and optimism scales.

BackgroundThe psychological aspects of treatment-resistant and remitted depression are not well documented.MethodsWe administered the Minnesota Multiphasic Personality Inventory (MMPI) to patients with treatment-resistant depression (n = 34), remitted depression (n = 25), acute depression (n = 21), and healthy controls (n = 64). Pessimism and optimism were also evaluated by MMPI.ResultsANOVA and post-hoc tests demonstrated that patients with treatment-resistant and acute depression showed similarly high scores for frequent scale (F), hypochondriasis, depression, conversion hysteria, psychopathic device, paranoia, psychasthenia and schizophrenia on the MMPI compared with normal controls. Patients with treatment-resistant depression, but not acute depression registered high on the scale for cannot say answer. Using Student's t-test, patients with remitted depression registered higher on depression and social introversion scales, compared with normal controls. For pessimism and optimism, patients with treatment-resistant depression demonstrated similar changes to acutely depressed patients. Remitted depression patients showed lower optimism than normal controls by Student's t-test, even though these patients were deemed recovered from depression using HAM-D.ConclusionsThe patients with remitted depression and treatment-resistant depression showed subtle alterations on the MMPI, which may explain the hidden psychological features in these cohorts.

Motivational deficits in effort-based decision making in individuals with subsyndromal depression, first-episode and remitted depression patients

Anhedonia is a hallmark symptom of major depressive disorder (MDD). Preliminary findings suggest that anhedonia is characterized by reduced reward anticipation and motivation of obtaining reward. However, relatively little is known about reward-based decision-making in depression. We tested the hypothesis that anhedonia in MDD may reflect specific impairments in motivation on reward-based decision-making and the deficits might be associated with depressive symptoms severity. In study 1, individuals with and without depressive symptoms performed the modified version of the Effort Expenditure for Rewards Task (EEfRT), a behavioral measure of cost/benefit decision-making. In study 2, MDD patients, remitted MDD patients and healthy controls were recruited for the same procedures. We found evidence for decreased willingness to make effort for rewards among individuals with subsyndromal depression; the effect was amplified in MDD patients, but dissipated in patients with remitted depression. We also found that reduced anticipatory and consummatory pleasure predicted decreased willingness to expend efforts to obtain rewards in MDD patients. For individuals with subsyndromal depression, the impairments were correlated with anticipatory anhedonia but not consummatory anhedonia. These data offer novel evidence that motivational deficits in MDD are correlated with depression severity and predicted by self-reported anhedonia.

Dysfunctional attitudes in remitted depression patients with and without personality disorders

Objective To compare the differences of dysfunctional attitudes between depressive patients in remission with and without personality disorder (PD).Methods A total of 72 patients with remitted depression were assessed with Personality Diagnostic Questionnaire-4 (PDQ-4) and Dysfunctional Attitudes Scale (DAS).They were divided into PD group ( n = 20 ) and non-PD group ( n = 31 ) according to their PDQ-4 scores.The differences of dysfunctional attitudes between the two groups were compared.Results The total score and seven factors' scores of DAS of the PD group were ( ( 142.40 ± 20.68 ), ( 16.55 ± 3.76), ( 16.35 ± 5.45 ),( 18.35 ± 4.15 ), ( 17.90 ± 3.55 ), ( 18.85 ± 5.72 ), ( 18.25 ± 4.82 ), ( 20.75 ± 5.54) respectively) significantly higher than the counterparts of the non-PD group, which were( ( 113.61 ± 19.08 ), (13.71 ± 2.88 ), ( 12.45 ±2.87) ,(12.55 ±3.60),(13.90 ±3.72) ,(14.68 ±3.51),(14.16 ±4.12),(15.81 ±4.78)) respectively (P＜ 0.01 ).Conclusion Remitted depressive patients with personality disorders have more cognitive distortions than those without personality disorders. Key words: Depression ; Dysfunctional attitudes ; Personality disorders ;

Effects of Rapid Tryptophan Depletion on Sleep Electroencephalogram and Mood in Subjects with Partially Remitted Depression on Bupropion

Serotonin has been implicated in both sleep and mood regulation. When central serotonin was depleted with a tryptophan-free amino acid drink (TFD), some studies have reported that the antidepressant benefits were reversed in partially remitted patients treated with SSRIs. Other studies showed that the TFD increased rapid eye movement (REM) sleep in both normal males and in remitted depression patients on selective serotonin reuptake inhibitors (SSRIs) without affecting mood. In this study, we administered a TFD to patients with remitted depression who were being treated with bupropion, an antidepressant whose mechanism of action apparently does not affect the serotonin system. We hypothesized that the TFD would increase the propensity for REM sleep without affecting depression ratings. Eight partially remitted depression subjects on bupropion were administered a TFD and a control drink containing tryptophan in double-blind, random order on separate days. The effects of these drinks were monitored with sleep electroencephalograms, mood ratings, and plasma tryptophan measures comparing baseline, TFD, and control nights. The TFDs reduced REM latency and stage 2 percent and increased REM time and percent. Subjective measures of elation, vigor, and friendliness significantly decreased on both TFD and control drinks but depression ratings did not. Plasma levels of tryptophan decreased with the TFD. Although the TFD altered REM sleep, certain mood measures, and plasma tryptophan levels, no relapses into depression were seen with our subjects. Bupropion alone did not affect sleep measures.