Severe Depressive Disorder Research Articles

P.500 Do CYP2C19 polymorphisms predict treatment response to escitalopram in moderate and severe depressive disorder?

The natural variant of the cytochrome P450 enzyme CYP2D6.1, CYP2D6.17, is most common in African populations, has three amino acid substitutions (T107I, R296C, and S486T) compared to the wild-type, and is known to have a different ligand preference from CYP2D6.1. It is becoming increasingly important to understand differences in the metabolism of medicines in different ethnic groups in order to assess the relevance of clinical data from different countries. This study investigated differences in the inhibition profiles of drugs for CYP2D6 with respect to gene polymorphisms. Firstly, we used computer docking with six drugs to several CYP2D6.1 structures, sampled from the trajectory of MD simulations, and calculated MM-GB/SA scores representing binding free energies. We then used regression analysis to predict the potency with which drugs inhibited CYP2D6.1 based on MM-GB/SA scores. The pKi-values obtained were in good agreement with experimental values measured for the six drugs (r2 = 0.81). We carried out the same analysis for CYP2D6.17 and the pKi-values calculated were also in good agreement with experimental values (r2 = 0.92). Finally, we were able to successfully explain the different abilities of CYP2D6.1 and CYP2D6.17 to metabolize drugs in different ethnic groups with reference to their 3D-structures.

The distinctions of higher nervous activity disorders during the long-term period of military injury of the Donbass defenders

In Donbass getting 55% of military injuries is related to extremities injuries. It was surveyed 83 soldiers who had surgery on the extremities injuries; research was conducted 3–4 years later after sustained injuries. Overwhelming majority of defenders have mine-explosive injuries (MEI) - 49 people, 34 people have gun-shot injuries (GSI). During research the following methods were used: Montreal Cognitive Assessment (МоСА), Hospital Anxiety and Depression Scale (HADS), and the Fatigue Severity Scale (FSS). Mild cognitive impairments were diagnosed in 25.2% of patients suffering from the mine-explosive injuries (MEI), in 18.4% of patients suffering from the gun-shot injuries (GSI). Moderate cognitive impairments were detected in 21.1% of defenders suffering from mine-explosive injuries (MEI) and in 15.4% of defenders suffering from gun-shot injuries (GSI). These patients have violated working memory, disorders of attention and delayed recall. Moderate depressive disorders were diagnosed in the 23 patients suffering from the mine-explosive injuries (MEI),12 patients suffering from the gun-shot injuries (GSI). Severe somatogenic depression were diagnosed in 7 patients suffering from the mine-explosive injuries (MEI) and 2 patients suffering from gun-shot injuries (GSI). The Montreal Cognitive Assessment (МоСА) scale for persons suffering from mild depressive disorders had following results: 23.21 ± 1.34 points; Montreal Cognitive Assessment (МоСА) scale for persons suffering from the severe depressive disorders - 23.01 ± 1.15 points. Asthenic disorders were detected in 36.2% of the examined individuals. In the long-term rehabilitation period, patients who have military injuries as the bone injuries and joints damages often require corrections of the cognitive and psychoemotional disorders.

A 6-day combined wake and light therapy trial for unipolar depression

BackgroundThere are a dozen studies on double or triple chronotherapy in depression (sleep deprivation [wake therapy] + light therapy + sleep advance/stabilization). We investigated efficacy and feasibility of a modified triple chronotherapy protocol. MethodsThirty-five hospitalized patients with moderately severe non-seasonal depressive disorder, mostly free from antidepressants, underwent a 6-day protocol consisting of partial sleep deprivation late in the second half of the night (from 4:00 to 8:00) in a light therapy room (blue-enhanced white light increased hourly from 600→1300→2200→2800 lx) alternating with recovery nights with morning light treatment from 7:00 to 8:00. Patients were randomized to wear glasses with no filter (clear, N = 19) or filtering blue wavelength (orange-appearance, light intensity diminution by ∼70%, N = 16) during the treatments. Sleep was targeted to be shifted at least 1 h earlier. Depression was scored using HDRS-17 (Hamilton Depression Rating Scale) and BDI-II (Beck Depression Inventory-II) – before and after the 6-days treatment, HDRS-6-SR – daily, and visual analogue scales (VAS) for mood and energy – several times every day. ResultsDepression levels significantly declined following the first night and after 6-days treatment, with no difference between white and orange lights. Nevertheless, some superiority of white light emerged with respect to response rate (mood VAS), immediate effect during the 4-h treatment sessions (energy VAS), and expected treatment outcomes. All patients successfully advanced bedtime/wake-up (by 30–40 minutes) and resisted naps during daytime. LimitationsRelatively small sample size. ConclusionsThe modified triple chronotherapy was well tolerated and improved depression. Light spectrum/intensity plays some role in the response.

Reliable, fast antidepressant treatment: restating the case for electroconvulsive therapy

Reliable, fast antidepressant treatment: restating the case for electroconvulsive therapy

The use of psychometric methods for the diagnosis of anxiety and depressive disorders in patients with a general somatic profile

Aim. To identify and compare the level of anxiety and depression in therapeutic patients with somatic pathology, establish the structure of the gender distribution of anxiety and depressive disorders.
 Methods. The study involved 126 people: 74 (58.73%) women and 52 (41.27%) men aged 21–59 years. 59 patients had diseases of the respiratory system (chronic bronchitis in the acute stage with an asthmatic component), 67 patients with cardiovascular diseases (40 subjects with coronary heart disease, 27 subjects with arterial hypertension). In 11 patients with coronary artery disease and 13 patients with hypertension, type I thyrotoxicosis was diagnosed. Clinical psychopathological, psychometric, psychological and statistical methods were used in the study. Psychometric tests were used: the Depression Scale of the Center for Epidemiological Research; Hospital Anxiety and Depression Scale and Taylor Anxiety Disorder Scale adapted by T.A. Nemchinova and V.G. Norakidze, adapted standardized multivariate questionnaire for personality research.
 Results. According to the severity of anxiety and depressive disorders, patients were divided into the groups: group 1 with severe level, group 2 with a moderate (subclinical) level, and group 3 with mild (not exceeding the norm) anxiety and depressive disorders. Severe and moderate disorders are most characteristic for the pathology of cardiovascular system. In coronary artery disease and arterial hypertension, abnormal (severe and moderate) anxiety and depressive disorders were observed in 24/29 (82.76%) and 20/22 (90.9%) patients, respectively. In patients with abnormal anxiety and depressive disorders, the number of women prevailed over men in the subgroup with hypertension (80% versus 20%, p=0.025) as well as in combination of hypertension with type 1 thyrotoxicosis (85.7% versus 14.3%, р=0.029).
 Conclusion. In patients, severe and moderate anxiety and depressive disorders are associated with the development of the pathology of cardiovascular system: coronary heart disease and arterial hypertension.

Effect of Electroconvulsive Therapy on Health-Related Quality of Life in Older Depressed Patients

Research has shown large improvements in quality of life after a course of electroconvulsive therapy (ECT) for severe depressive disorder. The effect of ECT on health-related quality of life (HRQOL) in the Australian older population has not been explored. This study aimed to investigate the impact of ECT on HRQOL in older patients with severe major depression and confirm that ECT in these participants is associated with an improvement in depression and no change in cognition. Data on 34 patients from a Public Older Persons Mental Health Service in Queensland were collected. The Quality of Life Enjoyment and Satisfaction Questionnaire Short Form, Montgomery-Asberg Depression Rating Scale (MADRS), and Montreal Cognitive Assessment (MoCA) were used pre- and post-ECT. The Wilcoxon signed rank test, Friedman test, and Kendall τ correlation coefficient were performed. A significant improvement in Quality of Life Enjoyment and Satisfaction Questionnaire Short Form was demonstrated post-ECT. Montgomery-Asberg Depression Rating Scale scores decreased significantly post-ECT. Montreal Cognitive Assessment score increased significantly post-ECT. Significant results were sustained at the 3-month time point. An acute course of ECT for severe depressive disorder was associated with clinically and statistically significant improvement in HRQOL. There was also clinical and statistical improvement in depression and no significant decrease in global cognitive function, memory, or executive function domains after ECT compared with baseline. In fact, the cohort showed improvement on measures of cognition post-ECT.

New WHO prevalence estimates of mental disorders in conflict settings: a systematic review and meta-analysis

SummaryBackgroundExisting WHO estimates of the prevalence of mental disorders in emergency settings are more than a decade old and do not reflect modern methods to gather existing data and derive estimates. We sought to update WHO estimates for the prevalence of mental disorders in conflict-affected settings and calculate the burden per 1000 population.MethodsIn this systematic review and meta-analysis, we updated a previous systematic review by searching MEDLINE (PubMed), PsycINFO, and Embase for studies published between Jan 1, 2000, and Aug 9, 2017, on the prevalence of depression, anxiety disorder, post-traumatic stress disorder, bipolar disorder, and schizophrenia. We also searched the grey literature, such as government reports, conference proceedings, and dissertations, to source additional data, and we searched datasets from existing literature reviews of the global prevalence of depression and anxiety and reference lists from the studies that were identified. We applied the Guidelines for Accurate and Transparent Health Estimates Reporting and used Bayesian meta-regression techniques that adjust for predictors of mental disorders to calculate new point prevalence estimates with 95% uncertainty intervals (UIs) in settings that had experienced conflict less than 10 years previously.FindingsWe estimated that the prevalence of mental disorders (depression, anxiety, post-traumatic stress disorder, bipolar disorder, and schizophrenia) was 22·1% (95% UI 18·8–25·7) at any point in time in the conflict-affected populations assessed. The mean comorbidity-adjusted, age-standardised point prevalence was 13·0% (95% UI 10·3–16·2) for mild forms of depression, anxiety, and post-traumatic stress disorder and 4·0% (95% UI 2·9–5·5) for moderate forms. The mean comorbidity-adjusted, age-standardised point prevalence for severe disorders (schizophrenia, bipolar disorder, severe depression, severe anxiety, and severe post-traumatic stress disorder) was 5·1% (95% UI 4·0–6·5). As only two studies provided epidemiological data for psychosis in conflict-affected populations, existing Global Burden of Disease Study estimates for schizophrenia and bipolar disorder were applied in these estimates for conflict-affected populations.InterpretationThe burden of mental disorders is high in conflict-affected populations. Given the large numbers of people in need and the humanitarian imperative to reduce suffering, there is an urgent need to implement scalable mental health interventions to address this burden.FundingWHO; Queensland Department of Health, Australia; and Bill & Melinda Gates Foundation.

837-P: Diabetes Support Needs in People with Severe Mental Illness and Diabetes

Background: People with severe mental illness (SMI) have a two to three-fold higher risk of developing diabetes. Mental healthcare providers have an important role in supporting people with SMI in diabetes management, but little is known about preferences for diabetes support among people with SMI and diabetes. The aim of the study was to explore the needs and preferences for diabetes support in this population. Method: Semi-structured interviews were conducted with 15 adults with SMI and diabetes recruited from four psychiatric outpatient clinics in Denmark. Interviews were transcribed and analyzed using systematic text condensation. Results: Participants’ mean age was 47 years, 40% were women, and 80% had T2DM. Mental health diagnoses included schizophrenia, bipolar disorder, severe depression, and personality disorder. Four main themes emerged in relation to support needs and preferences: 1) mental illness care significantly overshadowed diabetes care. It was difficult for people with SMI to prioritize diabetes management; 2) emotional state influenced diabetes management e.g., anxiety was linked to higher fat and sugar intake, and isolation lead to physical inactivity; 3) daily routines were experienced as difficult making diabetes routines even harder to perform, e.g., planning and preparing healthy meals and participating in routine diabetes health visits; 4) support from mental healthcare providers was perceived as crucial for managing diabetes for people with SMI. However, people with SMI experienced that the healthcare providers payed little attention to their physical health including their diabetes. Conclusions: This study highlights difficulties of living with SMI and managing diabetes care. The results can facilitate the shaping of tailored interventions to support people with SMI in their diabetes management. Further studies are needed to develop and test relevant diabetes support for people with SMI and diabetes including training of mental healthcare providers. Disclosure V. Stenov: None. I. Willaing: None. L. Knudsen: None. D.L. Hansen: None. L.E. Joensen: None.

Assesment of Depression in Patients Having Chronic Obstructive Pulmonary Disease

Depression in COPD patients is one of commonest problem arising now a days. Most of patients are affected by severe depressive symptoms or clinical depression. It is not easy to diagnose depression in COPD patients because of overlapping symptoms between COPD and depression. Quality of life is strongly impaired in COPD patients and patient’s quality of life emerges to be more correlated with the presence of depressive symptoms than with the severity of COPD. In this study four-item Hamilton Depression Subscale appears to be a useful screening tool. In patients with milder depression, pulmonary rehabilitation as well as cognitive-behavioral therapy are effective.

Whole-body Hyperthermia for Moderate to Severe Depressive Disorder

Whole-body Hyperthermia for Moderate to Severe Depressive Disorder

Institutional betrayal following military sexual trauma is associated with more severe depression and specific posttraumatic stress disorder symptom clusters.

Preliminary research suggests that perceptions of institutional betrayal are associated with more severe symptoms of posttraumatic stress disorder (PTSD) and depression, as well as suicide attempts in military sexual trauma (MST) survivors. However, results have not been replicated. Additionally, associations of institutional betrayal with specific PTSD symptom clusters or sexual function are understudied. Female service members/veterans who reported experiencing MST (N = 679) completed self-report measures of PTSD and depression symptom severity, suicidal ideation, and sexual function. Institutional betrayal was assessed from free-text descriptions of self-reported index traumas. Institutional betrayal was significantly associated with more severe depression and PTSD symptoms, including avoidance, negative alterations in cognitions and mood, re-experiencing, and dysphoric arousal. Targeting specific PTSD and depressive symptoms through evidence-based treatment may be important for managing institutional betrayal sequelae. Future research should identify specific strategies to help support survivors in their recovery following institutional betrayal.

Severe Recurrent Depressive Disorder with atypical features in a prepubertal child

Major depressive disorder (MDD) is a major public health concern. Preadolescent onset depression can be severe and can lead to serious consequences. MDD often has onsetearly in life and frequently follows a recurrent course. MDD though not so common in children, its presentation may be atypical leading to underdiagnosis and undertreatment. The diagnosis and management of childhood-onset depression poses a lot of challenge due to different and atypical presentations in children. We report a case of an 8- year - old boy, with the diagnosis of MDD, recurrent episode, severe, full remission, with atypical features by using DSM-5 criteria after repeated mental state examinations, rating scale, exploring history from parents, family members and observation in the ward. There was a significant improvement in his illness following three weeks of treatment with fluoxetine, lithium and supportive psychotherapy.

Depressive Disorder yang Dialami Tokoh Kayoko Numata dalam Drama Kazoku Game

The title of this research is “Depressive Disorder of Kayoko Numata’s Character in Kazoku Game Drama”. The research aims to provide psychological knowledge about psychiatric illness especially depressive disorder in the literature work. The research method used was descriptive analysis. There were three theories used in this research, they were the psychology literature theory by Wellek and Warren (2016), theory of depressive disorder by Fawcett (2013), and theory of how to overcome depressive disorder by Sharf (2010) as well as concept of depressive disorder by Holland (2015). The results obtained from this research are Kayoko Numata character suffered from psychiatric disease called depressive disorder with major type of depressive disorder or severe depression disorder in accordance with the symptoms shown, namely (1) dejected mood; (2) diminished interest in others or activities; (3) weight loss; (4) insomnia; (5) psychomotor agitation; (6) decreased ability to think and; (7) attempted suicide. Kayoko character showed seven of the nine major depressive disorder symptoms and has shown symptoms for more than two weeks. Depressive disorder in the Kayoko character was caused by his efforts in maintaining his marriage and his relationship with his children. Kayoko also had no major events during her life so she often thought of doing something that could change her life. How to overcome depressive disorder on the Kayoko character is with therapy, namely family therapy system and interpersonal therapy. The therapy helps Kayoko to be able to deal with and solve problems in her family, and to make her be more positive in facing the future.

"…and How Are the Kids?" Psychoeducation for Adult Patients With Depressive and/or Anxiety Disorders: A Pilot Study.

Depressive and anxiety disorders are highly prevalent and form a substantial burden for individuals and their family members. A recent study showed that approximately two-thirds of the children of patients with severe depressive and/or anxiety disorders develop one of these disorders themselves before 35 years of age. In the Netherlands, various preventive interventions are available for children of parents with mental illnesses. However, the actual reach of interventions is small (< 1% of all children participate). A major barrier appeared to be parents' hesitancy to let children participate in preventive programs. In order to address this barrier, we designed a pilot study to implement a psychoeducation program on parenting and mental illnesses. The main aim of this study was to investigate how a preventive family-focused approach can be embedded in routine adult psychiatric care. The pilot started in April 2017 and has ended in September 2018. It was conducted in the University Center Psychiatry (UCP) in Groningen, The Netherlands. This article describes the implementation process so far. The main intervention was a monthly organized group-psychoeducation called “parenting and a mental illness,” which could be attended by parents currently treated in the UCP. In 18 months, implementation activities were divided in four phases; (1) Creating awareness, (2) Adoption of the intervention, (3) Implementation and evaluation, and (4) Continuation phase. The program development process was evaluated using both qualitative and quantitative data. Based on the pilot study we were able to make recommendations for the further implementation of this approach so that more parents can be reached in future. Further study with follow-up activities is needed to measure the effects of the psychoeducation, for instance on parenting functioning and the quality of the parent-child interaction.

Efficacy of ketamine therapy in the treatment of depression.

Background:Severe depressive disorder is among most debilitating condition. Conventional pharmacotherapy usually takes several weeks (usually 4–12 weeks) to improve symptoms. Ketamine is an N–methyl-D aspartate receptor antagonist having rapid action on depressive symptoms.Objectives:The effect of subanesthetic dose of ketamine was assessed on depressive and anxiety symptoms. Illness severity and improvement were assessed after treatment with ketamine.Materials and Methods:Twenty-five drug-free/naïve patients of the male sex, with severe depression having no previous history of psychotic disorder, head injury, organic disorder, cardiological problem, or substance abuse were admitted for the study. Assessments were made at baseline and injection ketamine hydrochloride was given at a subanesthetic dose of 0.5 mg/kg intravenous bolus after preparation. Assessments were repeated 1 h after the first dose. Six doses were given over 2 weeks and assessments were repeated. Final assessments were made after 1 month of the last dose.Results:There was a significant improvement in depression, anxiety, and the severity of illness after 2 weeks and 1 month of the last dose of ketamine. Significant improvement at 1 st h of the first dose was seen in depression and anxiety and not for illness severity. There were transient adverse effects observed in some patients which subsided within 1 h.Conclusion:Ketamine has a robust and rapid effect on depression, which was seen immediately after the administration of ketamine and sustained at the end of 1 month.

Maternal Infanticide and Filicide in a Psychiatric Custodial Institution in Hong Kong

The aim of this study was to review the history, legislation, and psychiatric perspective of filicide, to compare the characteristics of mothers who committed neonaticide versus infanticide, and to discuss the infanticide law in Hong Kong. Data of mothers remanded to the Siu Lam Psychiatric Centre from 2008 to 2016 for filicide were reviewed, as were data of filicide from the Child Fatality Review Reports published by the Social Welfare Department. From 2008 to 2016, eight mothers were remanded to Siu Lam Psychiatric Centre for filicide. Four were convicted of infanticide; the other four were convicted of manslaughter. Those convicted of infanticide were single and aged <18 years. They had concealed their pregnancies and received no antenatal care. They delivered at home and then either smothered or abandoned the newborn. They reported no suicidal attempts after the index offence and had no record of mental illness. They were given supervision orders instead of prison sentences. In contrast, those convicted of manslaughter were in their 30s and married. They were documented to have killed the victims by charcoal burning, strangulation, mutilation, or defenestration. They all attempted suicide immediately after the killing and had histories of mental illness: paranoid schizophrenia (n = 2), severe depressive disorder with psychotic symptoms (n = 1), and recurrent depressive disorder (n = 1). They were sentenced to Hospital Orders for unspecified periods. In Hong Kong, the incidence of maternal filicide is low. However, the infanticide provision grants leniency to mothers, including those who show no evidence of mental illness.

Inflammatory profiles of severe treatment-resistant depression.

Treatment-resistant depression (TRD) contributes substantially to the burden of mood disorders and is undoubtedly an important subpopulation in whom there are clear unmet treatment needs. Despite a paucity of research focusing specifically on TRD, recent studies indicate that inflammatory activity may be particularly elevated in these patients. 36 patients with TRD were investigated longitudinally before and after undertaking a specialist inpatient treatment program. 27 inflammatory proteins were compared between patients and a matched sample of non-depressed controls, as well as between treatment responders and non-responders. Treatment outcomes were calculated from depression severity scores before and after admission, and at a long-term follow-up 3-12 months after discharge. TRD patients had higher levels of numerous inflammatory proteins than controls, and elevated interleukins 6 and 8, tumour necrosis factor, c-reactive protein and macrophage inflammatory protein-1 were associated with poorer treatment outcomes. A separate set of proteins (either anti-inflammatory in nature or attenuated at baseline) showed increases during treatment, regardless of clinical response. Participants with the greatest elevations in inflammation tended to be older, more cognitively impaired and more treatment-resistant at baseline. The small sample and large number of comparisons examined in this study must be taken into account when interpreting these results. However, this study provides empirical support for theories that more severe, chronic or treatment-resistant depressive disorders are associated with dysregulated inflammatory activity. If a predictor or predictors of response in TRD are established, improved and targeted care might be more reliably provided to this vulnerable population.

Association of Genetic Variation at AQP4 Locus with Vascular Depression.

Despite its substantial clinical importance, specific genetic variants associated with depression have not yet been identified. We sought to identify genetic variants associated with depression by (a) focusing on a more homogenous subsample (vascular depression) and (b) applying a three-stage approach. First, we contacted 730 participants with a confirmed atherosclerotic disease (coronary artery disease) from a population-based study population (German Myocardial Infarction Family Study IV) for psychiatric assessment with the Mini International Neuropsychiatric Interview. Second, we genotyped these patients using genome-wide single nucleotide polymorphism (SNP) arrays. Third, we characterized the SNP via in-silico analysis. The final sample consisted of 342 patients (78.3% male, age = 63.2 ± 9.9 years), 22.8% with a severe depressive disorder. Variant rs528732638 on chromosome 18q11.2 was a genome-wide significant variant and was associated with 3.6-fold increase in the odds of lifetime depression. The locus belongs to a linkage disequilibrium block showing expression quantitative trait loci effects on three putative cis-regulated genes, including the aquaporin 4 (AQP4) locus. AQP4 is already known to mediate the formation of ischemic edema in the brain and heart, increasing the size and extent of resulting lesions. Our findings indicate that AQP4 may also play a role in the etiopathology of vascular depression.

Treatment of Depressive Conditions in Pregnancy.

BACKGROUND:Mother’s mental state during pregnancy is of substantial importance for the mother, but also for the infant and his/her future growth and development. Depressive maternal disorders during pregnancy have a significant influence on the development of the baby during pregnancy as well as on the future development and mother-baby relation, the breastfeeding process and care for the baby.AIM:This study aimed to determine the influence of SSRI antidepressant therapy and psychosocial and therapeutic interventions on depression during pregnancy. It was also our aim to determine the relation between severity of depression and sociodemographic characteristics.METHODS:The study included 40 women, with diagnosis F32 and F33 according to ICD 10, that is, with severe depressive disorder within depressive episodes or recurrent depressive disorder. Patients were evaluated at the beginning of the treatment and 3 months after antidepressant treatment. They were followed-up for two years.RESULTS:The results obtained have shown that a larger number of mothers treated with antidepressant medications, had normal childbirth with the unremarkable condition of both, the mother and the newborn baby.CONCLUSION:A well-combined treatment of maternal depression during pregnancy reduces the risk of postpartum depression, which is by itself a prerequisite for normal emotional and behavioural development of the child.

Nesfatin-1 and cortisol: potential novel diagnostic biomarkers in moderate and severe depressive disorder.

BackgroundThis study aimed to determine whether plasma nesfatin-1, cortisol, and inflammatory cytokines could be used as novel noninvasive biomarkers for the diagnosis of moderate and severe depressive disorder (MSDD).Materials and methodsA total of 70 patients with MSDD and 70 healthy subjects were assessed. Patients with MSDD were selected from Hefei Fourth People’s Hospital, Anhui Mental Health Center, and subjects in the control group were selected from healthy volunteers. Hamilton Depression Rating Scale-17 (HAMD-17) was used to evaluate the two groups. ELISA was used for the measurement of plasma nesfatin-1, cortisol, IL-6, C-reactive protein (CRP), and tumor necrosis factor-α (TNF-α) levels. The diagnostic value of plasma nesfatin-1, cortisol, IL-6, CRP, and TNF-α for MSDD was assessed.ResultsCompared to healthy controls, the HAMD-17 scores and average nesfatin-1, cortisol, IL-6, and CRP levels in patients with MSDD were significantly increased. Moreover, multivariate linear regression analysis showed that HAMD-17 score was positively associated with plasma nesfatin-1 and cortisol. Furthermore, the results of the receiver operating characteristic (ROC) curve analysis revealed an area under curve (AUC) of 0.985 with 94.3% sensitivity and 97.1% specificity of nesfatin-1, and an AUC of 0.957 with 91.4% sensitivity and 85.7% specificity of cortisol in discriminating patients with MSDD from healthy volunteers. A combined ROC analysis using nesfatin-1 and cortisol revealed an AUC of 0.993 with a sensitivity of 97.1% and a specificity of 98.6% in separating patients with MSDD from healthy volunteers.ConclusionThese results suggest that plasma nesfatin-1 and cortisol might be potential novel biomarkers for the diagnosis of MSDD.