Single Major Depressive Episode Research Articles

241. Thyroid axis dysfunction is related to the longitudinal course of depression

The aim of this study was to investigate whether dysfunction of the thyroid axis is related to clinical characteristics in major depression. Thyrotropin (TSH) responses to 8 AM and 11 PM protirelin challenges (TRH, 200 μg IV) were examined, on the same day, in 108 drug-free DSM-IV euthyroid major depressed inpatients. Twenty six patients had a single major depressive episode; the remaining 82 patients were classified according to the course of recurrent episodes: 53 with full interepisode recovery, 29 without full interepisode recovery. Based on their TRH-TSH test responses, patients were also classified according to stage of thyroid axis dysfunction (i.e. stage 1: blunted ΔΔTSH alone [i.e. abnormally low difference between 11 PM-ΔTSH and 8 AM-ΔTSH]; stage 2: combination of blunted ΔΔTSH and 11 PM-ΔTSH; stage 3: combination of blunted ΔΔTSH, 11 PM-ΔTSH and 8 AM-ΔTSH). The degree of thyroid dysfunction was moderate in patients with a single major depressive episode (no thyroid dysfunction: 35%; stage 1: 35%; stage 2: 27%; stage 3: 3%); intermediate in patients with full interepisode recovery (no thyroid dysfunction: 21%; stage 1: 45%; stage 2: 19%; stage 3: 15%); and marked in patients without full interepisode recovery (no thyroid dysfunction: 3%; stage 1: 24%; stage 2: 27%; stage 3: 46%) (χ2 = 22.8, df = 6, p = 0.0008). These differences could not be explained by differences in age, gender distribution, or severity or subtype of depression. Our results suggest that level of thyroid axis dysfunction is related to longitudinal course of depression.

Presentation and management of depression in people with learning disability

The occurrence of depression in people with learning disability is not a late-20th century phenomenon. Reports were first published in the 1800s describing the existence of depression in individuals with intellectual impairment (Clouston, 1883). However, as we enter a new millennium, the appropriate diagnosis, assessment and treatment of depression, and indeed all forms of mental illness in people with learning disability, will become the focus of considerable concern for all professionals working in this field. With recent national trends towards de-institutionalisation, referral of individuals with learning disability to psychiatrists to ‘rule out a possible depressive illness' and to ‘advise about further treatment’ will increase. It remains essential for all psychiatrists in learning disability to continue to improve their diagnostic skills to better manage depressive episodes and, where possible, to learn how to prevent a future relapse. This review highlights the important presentation and management issues relating to depression in the field of learning disability. Depression in this review implies a single major depressive episode, irrespective of whether or not it conforms to any given classification system.

Predictors of a Chronic Course of Depression

Although there are many effective treatments for a single major depressive episode, as many as 50% of patients develop a chronic or relapsing course.

Major Depressive Disorder

A random sample of 3258 adult household residents of Edmonton, Alberta, Canada, were interviewed by trained lay interviewers, using the Diagnostic Interview Schedule (DIS), which generated DSM‐III diagnosis data. This paper reports results for major depressive disorder (MDD). MDD was found to affect women more than men by a ratio of nearly 2 to 1. The lifetime prevalence rate for both sexes combined was 8.6%. The period prevalence rates for both sexes combined were 3.2% and 4.6%, for six month and one year, respectively. The presence of a recurrent Major Depressive Disorder was associated with an increased risk of substance abuse, panic disorder and dysthymia, whereas a single major depressive episode was not associated with increased comorbidity.

Practical observations on the good and bad properties of the colours used by artists

Mood disorders (including major depressive disorder and bipolar disorder) affect 10% to 20% of the population. They range from brief, mild episodes to severe, incapacitating conditions that markedly impact lives. Multiple approaches have shown considerable sharing of risk factors across mood disorders despite their diagnostic distinction.To clarify the shared molecular genetic basis of major depressive disorder and bipolar disorder and to highlight disorder-specific associations, we meta-analyzed data from the latest Psychiatric Genomics Consortium genome-wide association studies of major depression (including data from 23andMe) and bipolar disorder, and an additional major depressive disorder cohort from UK Biobank (total: 185,285 cases, 439,741 controls; nonoverlapping N = 609,424).Seventy-three loci reached genome-wide significance in the meta-analysis, including 15 that are novel for mood disorders. More loci from the Psychiatric Genomics Consortium analysis of major depression than from that for bipolar disorder reached genome-wide significance. Genetic correlations revealed that type 2 bipolar disorder correlates strongly with recurrent and single-episode major depressive disorder. Systems biology analyses highlight both similarities and differences between the mood disorders, particularly in the mouse brain cell types implicated by the expression patterns of associated genes. The mood disorders also differ in their genetic correlation with educational attainment—the relationship is positive in bipolar disorder but negative in major depressive disorder.The mood disorders share several genetic associations, and genetic studies of major depressive disorder and bipolar disorder can be combined effectively to enable the discovery of variants not identified by studying either disorder alone. However, we demonstrate several differences between these disorders. Analyzing subtypes of major depressive disorder and bipolar disorder provides evidence for a genetic mood disorders spectrum.