Depressed Mood Symptoms Research Articles

Physical and psychosocial wellbeing of nurses in a regional Queensland hospital

Occupational stress is common among nurses. Two factors that may influence stress levels are diet and physical activity. The purpose of this study was to investigate the diets and physical activity levels of nurses and to quantify the relationships between these behaviours and anxiety, depressed mood, stress, and burnout. Nurses (N = 52) from one regional hospital completed a survey assessing physical activity, nutrition, and psychological functioning. Almost two-thirds (65%) of participants had met recommended levels of both moderate and vigorous physical activity in the week prior. Participants met recommended levels for fruit, but not vegetable, consumption. Burnout and stress levels were close to norms for physicians and nurses. Scores for depressed mood, anxiety, and stress symptoms were within one standard deviation of norms for the Australian adult population. Several moderately sized correlations were found between the psychological constructs measured and both physical activity and nutrition. Although most of the participants were physically active and seemed to be consuming nutritious diets, some nurses may need encouragement to adopt similarly healthy behaviours.

Menopausal Symptoms: Is Spirituality Associated with the Severity of Symptoms?

The aim of this study was to explore whether spirituality was associated with menopausal symptoms. Menopausal symptoms, spirituality, health and menopausal status, and socio-demographic variables were assessed in a community sample of 710 peri- and postmenopausal women. A structural model was explored using structural equation modeling. The results evidence spirituality as a significant contributor regarding the severity of most menopausal symptoms. Among others, spirituality had a significant weight in depressive mood (β=-.414; p<.001), anxiety (β=-.308; p<.001), cognitive impairment (β=-.287; p<.001), aches/pain (β=-.148; p<.001), vasomotor (β=-.125; p=.005) and sexual symptoms (β=-.211; p<.001). Some socio-demographic variables, as well as perceived health, also predicted the menopausal symptoms' severity. Therefore, spirituality can have a positive impact on the menopausal symptoms' reporting.

COGNITIVE DYSFUNCTION IN FMR1 PREMUTATION CARRIERS.

Premutation carriers of the fragile X mental retardation gene (especially men) older than 50 may develop a neurodegenerative disease, the fragile X-associated tremor/ataxia syndrome (FXTAS). Carriers may present with varied cognitive impairments. Attention, working memory, declarative and procedural learning, information processing speed, and recall are among the cognitive domains affected. Executive dysfunction is a prominent deficit, which has been demonstrated mostly in men with FXTAS. In more advanced stages of FXTAS, both men and women may develop a mixed cortical-subcortical dementia, manifested by psychomotor slowing and deficits in attention, retrieval, recall, visuospatial skills, occasional apraxia, as well as overt personality changes. Studies have shown dementia rates as high as 37-42% in older men with FXTAS, although more research is needed to understand the prevalence and risk factors of dementia in women with FXTAS. Neuropsychiatric symptoms are common and reflect the dysfunction of underlying frontal-subcortical neural circuits, along with components of the cerebellar cognitive affective syndrome. These include labile or depressed mood, anxiety, disinhibition, impulsivity, and (rarely) psychotic symptoms. In this paper we review the information available to date regarding the prevalence and clinical picture of FXTAS dementia. Differential diagnosis may be difficult, given overlapping motor and non-motor signs with several other neurodegenerative diseases. Anecdotal response to cholinesterase inhibitors and memantine has been reported, while symptomatic treatments can address the neuropsychiatric manifestations of FXTAS dementia.

Cognitive Dysfunction in FMR1 Premutation Carriers

Premutation carriers of the fragile X mental retardation gene (especially men) older than 50 may develop a neurodegenerative disease, the fragile X-associated tremor/ataxia syndrome (FXTAS). Carriers may present with varied cognitive impairments. Attention, working memory, declarative and procedural learning, information processing speed, and recall are among the cognitive domains affected. Executive dysfunction is a prominent deficit, which has been demonstrated mostly in men with FXTAS. In more advanced stages of FXTAS, both men and women may develop a mixed cortical-subcortical dementia, manifested by psychomotor slowing and deficits in attention, retrieval, recall, visuospatial skills, occasional apraxia, as well as overt personality changes. Studies have shown dementia rates as high as 37-42% in older men with FXTAS, although more research is needed to understand the prevalence and risk factors of dementia in women with FXTAS. Neuropsychiatric symptoms are common and reflect the dysfunction of underlying frontal-subcortical neural circuits, along with components of the cerebellar cognitive affective syndrome. These include labile or depressed mood, anxiety, disinhibition, impulsivity, and (rarely) psychotic symptoms. In this paper we review the information available to date regarding the prevalence and clinical picture of FXTAS dementia. Differential diagnosis may be difficult, given overlapping motor and non-motor signs with several other neurodegenerative diseases. Anecdotal response to cholinesterase inhibitors and memantine has been reported, while symptomatic treatments can address the neuropsychiatric manifestations of FXTAS dementia.

Neurophysiological correlates of anhedonia in feedback processing

Disturbances in feedback processing and a dysregulation of the neural circuit in which the cingulate cortex plays a key role have been frequently observed in depression. Since depression is a heterogeneous disease, instead of focusing on the depressive state in general, this study investigated the relations between the two core symptoms of depression, i.e., depressed mood and anhedonia, and the neural correlates of feedback processing using fMRI. The focus was on the different subdivisions of the anterior cingulate cortex (ACC). Undergraduates with varying levels of depressed mood and anhedonia performed a time-estimation task in which they received positive and negative feedback that was either valid or invalid (i.e., related vs. unrelated to actual performance). The rostral cingulate zone (RCZ), corresponding to the dorsal part of the ACC, was less active in response to feedback in more anhedonic individuals, after correcting for the influence of depressed mood, whereas the subgenual ACC was more active in these individuals. Task performance was not affected by anhedonia, however. No statistically significant effects were found for depressed mood above and beyond the effects of anhedonia. This study therefore implies that increasing levels of anhedonia involve changes in the neural circuitry underlying feedback processing.

Data-driven subtypes of major depressive disorder: a systematic review

BackgroundAccording to current classification systems, patients with major depressive disorder (MDD) may have very different combinations of symptoms. This symptomatic diversity hinders the progress of research into the causal mechanisms and treatment allocation. Theoretically founded subtypes of depression such as atypical, psychotic, and melancholic depression have limited clinical applicability. Data-driven analyses of symptom dimensions or subtypes of depression are scarce. In this systematic review, we examine the evidence for the existence of data-driven symptomatic subtypes of depression.MethodsWe undertook a systematic literature search of MEDLINE, PsycINFO and Embase in May 2012. We included studies analyzing the depression criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) of adults with MDD in latent variable analyses.ResultsIn total, 1176 articles were retrieved, of which 20 satisfied the inclusion criteria. These reports described a total of 34 latent variable analyses: 6 confirmatory factor analyses, 6 exploratory factor analyses, 12 principal component analyses, and 10 latent class analyses. The latent class techniques distinguished 2 to 5 classes, which mainly reflected subgroups with different overall severity: 62 of 71 significant differences on symptom level were congruent with a latent class solution reflecting severity. The latent class techniques did not consistently identify specific symptom clusters. Latent factor techniques mostly found a factor explaining the variance in the symptoms depressed mood and interest loss (11 of 13 analyses), often complemented by psychomotor retardation or fatigue (8 of 11 analyses). However, differences in found factors and classes were substantial.ConclusionsThe studies performed to date do not provide conclusive evidence for the existence of depressive symptom dimensions or symptomatic subtypes. The wide diversity of identified factors and classes might result either from the absence of patterns to be found, or from the theoretical and modeling choices preceding analysis.

Effect of Cognitive Behavioural Therapy (CBT) on Depressed Female University Students in Karachi

Problem statement of the study was to explore the effectiveness of cognitive behavioral interventions, including cognitive restructuring, psycho-education or re-education and guided discovery techniques on depressive or low mood symptoms of young females aged between 18 to 25 years.Objective The aim of this study was to evaluate the effectiveness of Cognitive Behavioral Therapy (CBT) on depressive symptoms of female university students in Karachi, Pakistan. In Pakistan more Scientist Practitioners who practice evidence based therapies are needed. The present study was planned within this scientist practitioner model of clinical research and practice. Method: The study sample comprised of 50 female university students, who came to seek help from students counselling centre at a well known University in Karachi, Pakistan. The in- campus counsellors were qualified clinical psychologists trained in cognitive behavioral therapeutic interventions. Within group experimental research design was used to assess the levels of depression before and after therapeutic sessions in experimental group and comparison between experimental and control group was also checked quantitatively. Hypotheses: It was hypothesized that cognitive behavioral therapy will alleviate depression in depressed female university students. It was also assumed that females receiving cognitive behavioral interventions would score low on the Physician Depression Questionnaire (PDQ-9, U.S. Preventive Services Task Force, 2009) as compared to those females receiving no interventions. The students who consented to participate and fulfilled suitability criteria for Cognitive Behavioral Therapy (CBT) were offered to participate in trial. Students were randomly distributed into intervention and control groups. Assessments were to be carried out at baseline and end of therapy sessions. Individual, face to face therapy was offered to participants following a structured manual of CBT by Naeem, Kingdom (2010). The total program comprised of 12 sessions, these sessions were offered over the period of 12 weeks.Findings and Conclusion Both descriptive and inferential statistics were used for the statistical analysis of the data. The hypotheses were significant at p<0.05.This indicates that Cognitive Behavioral Therapy (CBT) is effective with depressed female university students in Karachi.

Effect of aerobic training on hot flushes and quality of life—a randomized controlled trial

Background and objective. To estimate whether aerobic training has an effect on frequency of hot flushes or quality of life.Design. A randomized controlled trial.Participants and setting. Symptomatic, sedentary women (n = 176), 43–63 years, no current use of hormone therapy.Intervention. Unsupervised aerobic training for 50 minutes four times per week during 6 months.Outcomes. Hot flushes as measured with Women's Health Questionnaire (WHQ) and Health-Related Quality of Life (HRQoL, SF-36), daily reported hot flushes on phone-based diary, cardiorespiratory fitness (CRF), and body composition.Results. Intervention group had larger decrease in the frequency of night-time hot flushes based on phone diary (P for month × group = 0.012), but not on WHQ scale. Intervention group had less depressed mood (P = 0.01) than control women according to change in WHQ score. Changes in WHQ score in depressed mood (P = 0.03) and menstrual symptoms (P = 0.01) in the intervention group were significantly dependent on frequency of training sessions. HRQoL was improved among the intervention group women in physical functioning (P = 0.049) and physical role limitation (P = 0.017). CRF improved (P = 0.008), and lean muscle mass increased (P = 0.046) significantly in the intervention group as compared to controls.Conclusions. Aerobic training may decrease the frequency of hot flushes and improve quality of life among slightly overweight women.

The Latent Structure of the Center for Epidemiological Studies-Depression Scale

Taxometric analyses were used to assess the latent structure of depressive symptoms as measured by the Center for Epidemiological Studies Depression (CES-D) scale. Participants were 3,395 college students enrolled in Introductory Psychology classes at a mid-size university. Analyses included data simulation strategies to assure that the data was appropriate for interpreting skewed indicators and small putative taxa. Four indicators (depressed mood, positive affect, somatic, and interpersonal symptoms) were derived from principal components analysis. Taxometric analyses indicated that distributions of the four CES-D factor based indicators were dimensional. Results are consistent with a continuity model of the latent structure of questionnaire measures of depressive symptoms in this young adult population, of which approximately 15% scored above the clinical cut-point for the CES-D scale.

Influence of depressed mood and psychological stress symptoms on perceived oral contraceptive side effects and discontinuation in young minority women

BackgroundWe examined the influence of depressed mood and psychological stress on oral contraceptive (OC) side effects and discontinuation. Study DesignWe administered standard psychological instruments to 354 young women (13–24 years old) beginning a 6-month OC continuation intervention trial and questions on OC side effects and use at 6 months. Logisitic regression determined the relationships between psychological conditions, perceived OC side effects and continuation rates. ResultsBaseline depressed mood (21%) and stress (19%) and 6-month mood (25%) and weight changes (57%) were relatively common. Only 38% continued OCs at 6 months. Depressed mood [odds ratio (OR) 2.27, confidence interval (CI) 1.25–4.15, p=.007] and stress (OR 2.07, CI 1.12–3.82, p=.02) were associated with perceived OC-related moodiness; depressed mood was associated with perceived weight loss (OR 1.89, CI 1.01–3.55, p=.05). Depressed mood (OR 0.54, CI 0.29–0.99, p=.04), stress (OR 0.48, CI 0.25–0.91, p=.03) and perceived weight change (OR 0.60, CI 0.38–0.94, p=.03) all reduced the likelihood of OC continuation. ConclusionYoung women with adverse psychological symptoms are at risk for perceived OC side effects and discontinuation.

Effect of aerobic training on menopausal symptoms—a randomized controlled trial

The aim of this study was to assess whether aerobic training affects menopausal symptoms in recently postmenopausal sedentary women. Symptomatic women aged 45 to 63 years (N = 176; 3-36 months since last menstruation) were randomly assigned to an aerobic training or a control group. The intervention included unsupervised aerobic training for 50 minutes four times weekly for 24 weeks, whereas the control group attended health lectures twice a month. Symptoms were reported twice a day using a mobile phone. The perceived disturbance of menopausal symptoms (night sweats, mood swings, irritability, depressive mood, headache, vaginal dryness, and urinary symptoms) was evaluated on a scale from 1 (low) to 5 (high). Multilevel mixed-effect ordinal regression models were based on 17,000 responses during 24 weeks. One hundred fifty-four women continued until the end of the study (88% compliance rate). Baseline prevalence was as follows: night sweats, 50% to 60%; irritability and depression, 20% to 25%; mood swings, 25% to 30%; headache and urinary problems, 15% to 20%; and vaginal dryness, 10% to 15%. The prevalence of all symptoms except vaginal dryness decreased among intervention groups. According to multilevel mixed-effect ordinal regression analysis, night sweats and mood swings (P < 0.001) and disturbance of the mood swings (P < 0.001) and irritability (P < 0.001) were reduced more among the women in the intervention group than in the control group. In sedentary women, aerobic training for 6 months may decrease the typical menopausal symptoms, especially night sweats, mood swings, and irritability.

Short Sleep as an Environmental Exposure: A Preliminary Study Associating 5-HTTLPR Genotype to Self-Reported Sleep Duration and Depressed Mood in First-Year University Students

This study examined whether the 5-HTTLPR polymorphism in the SLC6A4 gene is associated with self-reported symptoms of depressed mood in first-year university students with a persistent pattern of short sleep. Students provided DNA samples and completed on-line sleep diaries and a mood scale during the first semester. A priori phenotypes for nocturnal sleep and mood scores were compared for the distribution of genotypes. Brown University, Providence, Rhode Island. A sample of 135 first-year students, 54 male, 71 Caucasian, mean age 18.1 (± 0.5) yr. None. Students completed on-line sleep diaries daily across the first term (21-64 days; mean = 51 days ± 11) and Center for Epidemiologic Studies-Depression (CES-D) mood scale after 8 wk. DNA was genotyped for the triallelic 5-HTTLPR polymorphism. Low-expressing S and L(G)polymorphisms were designated S', and high-expressing L(A) was designated L'. Phenotype groups were identified from a combination of CES-D (median split: high > 12; low < 13) and mean nocturnal total sleep time (TST) from diaries: (shorter ≤ 7 hr; longer ≥ 7.5 hr). Three genotypes were identified (S'S', S'L', L'L'); the S'S' genotype was present in a higher proportion of Asian than non-Asian students. FOUR PHENOTYPE GROUPS WERE COMPARED: 40 students with shorter TST/high CES-D; 34 with shorter TST/low CES-D; 29 with longer TST/high CES-D; 32 with longer TST/low CES-D. Female:male distribution did not vary across phenotype groups (chi-square = 1.39; df = 3; P = 0.71). S'S' participants (n = 23) were overrepresented in the shorter TST/high CES-D group (chi- square = 15.04; df = 6; P < 0.02). This association was sustained after removing participants with preexisting evidence of depressed mood (chi-square = 12.90; df = 6; P = 0.045). These data indicate that young adults who reported shorter nocturnal sleep and higher depressed mood are more likely than others to carry a variant of the SLC6A4 gene associated with low expression of the serotonin transporter.

‘I Know I Can Help You’: Parental Self‐efficacy Predicts Adolescent Outcomes in Family‐based Therapy for Eating Disorders

Family-based therapy is regarded as best practice for the treatment of eating disorders in adolescents. In family-based therapy, parents play a vital role in bringing their child or adolescent to health; however, little is known about the parent-related mechanisms of change throughout treatment. The present study examines parent and adolescent outcomes of family-based therapy as well as the role of parental self-efficacy in relation to adolescent eating disorder, depressed mood and anxiety symptoms. Forty-nine adolescents and their parents completed a series of measures at assessment, at 3-month post-assessment and at 6-month follow-up. Results indicate that, throughout treatment, parents experienced an increase in self-efficacy and adolescents experienced a reduction in symptoms. Maternal and paternal self-efficacy scores also predicted adolescent outcomes throughout treatment. These results are consistent with the philosophy of the family-based therapy model and add to the literature on possible mechanisms of change in the context of family-based therapy.

Reliability and validity of the Center for Epidemiological Studies Depression Scale in 2 special adult samples from rural China

Few studies on the validation of the Center for Epidemiological Studies Depression Scale (CES-D) in Chinese have been conducted in the samples from rural area, whereas the mental health problems among rural Chinese deserve more attention. For instance, the suicide rate in rural China is about 3 times that of the urban rate. This study aimed at assessing reliability and validity of the CES-D in 2 special adult samples in rural China, with data obtained by face-to-face interviews. One sample consisted of the proxy informants for subjects who committed suicide, and the other was of the proxy informants for living controls. For each person who committed suicide and each control, a family member and close friend served as informants. This study focused on informants themselves (not the persons who committed suicide or the living control himself/herself). Suicide informants (n = 781) who had experienced the suicide of a relative or close friend in the past 6 months were compared with the control informants (n = 832) who had no such experience. Internal reliability was satisfactory (Cronbach coefficients were .949 for suicide informants and .880 for control informants). Good concurrent validity and criterion validity were found by analyzing the relations to negative life events and the Scale for Suicide Ideation. Confirmatory factor analyses indicated that 3-factor structure (positive affect, interpersonal problems, depressive mood and somatic symptoms combined) had good fit in rural Chinese. These findings suggested that the CES-D had good reliability and validity when applied in these 2 adult samples in rural China. Factor structure analyses of the CES-D indicated that “somatization” process of expressing depressive symptoms still existed among rural Chinese.

Abstract 2657: Younger age correlates with depression but not adaptive maturity in adult cancer patients

Abstract Background: In a previous study, we found that Immature adaptive mechanism (ego defense mechanism) endorsement independently predicted 5-year survival in adult cancer patients. Depression symptom severity, however, did not predict survival in the same sample. While empirical evidence suggests that adaptive maturity increases with age in the general population, the influence of age on depression in cancer patients remains unclear. In this investigation, we hypothesized that increased age would be associated with 1) mature adaption and with 2) fewer depression symptoms. Methods: Participants in this IRB approved study included adult cancer outpatients at the University of Colorado Cancer Center (N=293). All participants provided informed consent and demographic data, and completed the Defense Style Questionnaire (DSQ) and Beck Depression Inventory (BDI). Exclusion criteria were extreme pain, delirium, and neuroendocrine neoplasm that could mimic depression. Additional data collected included gender, cancer type and stage, time since diagnosis, treatment modality, psychiatric history, current medications, and current antidepressant use. For analysis, we used Spearman's correlation statistic with probability set at p&amp;lt;0.05. Results: Data analysis indicated no statistical association between age and adaptive maturity. By contrast, age correlated significantly and negatively with total BDI scores (r= −0.23, p&amp;lt;0.0001), as well as BDI sub-scale mood symptom scores (r= −0.26, p&amp;lt;0.0001), and somatic symptom scores (r= −0.12, p=0.037). Factors associated with BDI mood symptom scores included self-reported current medications that affect mood (r= 0.21, p&amp;lt;0.001), psychiatric history (r= 0.15, p=0.009), current antidepressants (r= 0.14, p=0.02), and ratio of Mature/Immature DSQ scores (r= −0.24, p&amp;lt;0.0001). Gender, cancer stage, time since diagnosis, and treatment modality did not reach correlation significance with age, adaptive maturity, or BDI score. Conclusion: These data suggest that depression symptoms may occur more frequently in younger rather than older cancer patients, and that age does not appear associated with adaptive maturity in this clinical sample. Mood symptoms of depression stood out as highly and inversely correlated with age. Possible variables that may affect this relationship include medications that affect mood, as well as measured adaptive maturity level, with probable contributions from previous psychiatric history and current antidepressant use. Unexpectedly, antidepressant use appeared associated with more, rather than fewer, depressive mood symptoms. Further prospective research should focus on investigating the factors that affect depression in younger adult cancer patients. For example, antidepressant treatment in this age group will require trials to establish an age specific clinical improvement. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 2657. doi:1538-7445.AM2012-2657

Delirium masquerading as depression

Despite the high prevalence of delirium in palliative care settings, this diagnosis is frequently missed, particularly in patients with hypoactive delirium. These patients are also commonly misdiagnosed with depression because of the overlap in symptoms between the two diagnoses. Failure to promptly diagnose delirium can have significant ramifications in terms of delirium reversal, subsequent patient involvement in end-of-life decision making, and the recognition and treatment of other symptoms. We report a case of a 63-year-old French-speaking woman admitted to our inpatient palliative care unit with colorectal cancer and a history of depression. This case report highlights the major challenges associated with making the diagnosis of delirium in a patient with a complex medical history, including depression. The patient presented with symptoms of depressed mood and fluctuation in psychomotor activity, but failed to respond to an increase in her fluoxetine treatment in addition to methylphenidate and treatment of her hypothyroidism. A psychiatric assessment in her own language detected features of inattention and confirmed a diagnosis of delirium that was multifactorial, secondary to a combination of posterior reversible encephalopathy syndrome (PRES), hypothyroidism, hepatic dysfunction, and medication. Subsyndromal delirium may present with mood lability, and as delirium and depression can coexist, clinicians should perform a delirium screen for all patients presenting with symptoms of depression, preferably in the patient's first language. Cognitive testing can be particularly helpful in distinguishing delirium, especially hypoactive delirium, from depression.

Suboptimal glycemic control in type 2 diabetes: A key role for anhedonia?

Recent studies examining the relationship between depression and glycosylated hemoglobin (HbA1c) concentrations in patients with type 2 diabetes have yielded mixed findings. One explanation may lie in the heterogeneity of depression. Therefore, we examined whether distinct features of depression were differentially associated with suboptimal glycemic control.Cross-sectional baseline data from a dynamic cohort study of primary care patients with type 2 diabetes from the Eindhoven region, The Netherlands, were analyzed. A total of 5772 individuals completed baseline measurements of demographic, clinical, lifestyle and psychological factors between 2005 and 2009. The Edinburgh Depression Scale was used to assess symptoms of depressed mood, anhedonia and anxiety. Suboptimal glycemic control was defined as HbA1c values ≥7%, with 29.8% of the sample (n=1718) scoring above this cut-off. In univariate logistic regression analyses, anhedonia was significantly associated with suboptimal glycemic control (OR 1.29, 95% CI 1.09–1.52), while both depressed mood (OR 1.04, 0.88–1.22) and anxiety (OR 0.99, 0.83–1.19) were not. The association between anhedonia and glycemic control remained after adjustment for the other depression measures (OR 1.33, 1.11–1.59). Alcohol consumption and physical activity met criteria for mediation, but did not attenuate the association between anhedonia and glycemic control by more than 5%. Although diabetes duration was identified as a confounder and controlled for, the association was still significant (OR 1.20, 1.01–1.43). Studying different symptoms of depression, in particular anhedonia, may add to a better understanding of the relationship between depression and glycemic control.

P-501 - Use of donepezil for the treatment of depression in the absence of cognitive impairment

Background Donepezil is a reversible, centrally-acting acetylcholinesterase inhibitor used in the treatment of mild to moderate symptoms of dementia associated with Alzheimer's disease. In recent years, there has been emerging evidence of its use in other conditions, such as Lewy Body dementia and autism. However, there have been few reports of the use of Donepezil to treat depression in the absence of cognitive impairment. Methods This is a case report of a 62-year old female with a long-standing history of major depressive disorder with no history of cognitive impairment, who failed to respond to antidepressants with augmentation therapy including antipsychotics, lithium and methylphenidate; but eventually improved on Donepezil. Results A then-56-year old Chinese lady diagnosed with major depressive disorder, was treated with several antidepressants with poor response. Despite augmentation with dual antidepressants, antipsychotics, methylphenidate and lithium, her symptoms of avolition, depressed mood and irritability persisted. After 4 years of antidepressant treatment, she was started on donepezil 5 mg. Within a month of augmentation, significant improvement in symptoms were reported, notably in mood and volition, and the patient was able to engage in an active and meaningful lifestyle of semblance to her pre-morbid mental state. Conclusion This case highlights the possibility of Donepezil being used as an adjunctive therapy in major depressive disorder, even in the absence of cognitive impairment. Future studies to investigate the use of Donepezil may therefore be worthwhile to explore its use in this population of patients.

Depressive moods and marital happiness: Within-person synchrony, moderators, and meaning.

Recent studies using within-persons designs conceptually replicate and substantively extend prior research that has shown marital distress to be a robust risk factor for depression. The present investigation further extends this within-persons research tradition by increasing the frequency of assessments and by adding new moderators and measures in a sample of both newlywed (n = 24) and maritally distressed (n = 31) wives. In both samples, the average within-persons association between 21 daily assessments of wives' depressed mood and marital happiness approximated previous estimates of analogous effects (overall r = -.54). Wives reported worse depressive mood symptoms on days they experienced lower marital happiness, even after accounting for time and between-person variation in marital happiness. Each participant's within-persons mood and marital happiness association was then treated as a dependent variable to be predicted from theoretically relevant individual differences. Multilevel modeling showed that the negative within-person association between daily depressed mood and daily marital happiness was especially strong for women who were relatively high in depressive symptoms, who had avoidant attachment styles, and who were relatively low in marital adjustment.

General and specific components of depression and anxiety in an adolescent population

BackgroundDepressive and anxiety symptoms often co-occur resulting in a debate about common and distinct features of depression and anxiety.MethodsAn exploratory factor analysis (EFA) and a bifactor modelling approach were used to separate a general distress continuum from more specific sub-domains of depression and anxiety in an adolescent community sample (n = 1159, age 14). The Mood and Feelings Questionnaire and the Revised Children's Manifest Anxiety Scale were used.ResultsA three-factor confirmatory factor analysis is reported which identified a) mood and social-cognitive symptoms of depression, b) worrying symptoms, and c) somatic and information-processing symptoms as distinct yet closely related constructs. Subsequent bifactor modelling supported a general distress factor which accounted for the communality of the depression and anxiety items. Specific factors for hopelessness-suicidal thoughts and restlessness-fatigue indicated distinct psychopathological constructs which account for unique information over and above the general distress factor. The general distress factor and the hopelessness-suicidal factor were more severe in females but the restlessness-fatigue factor worse in males. Measurement precision of the general distress factor was higher and spanned a wider range of the population than any of the three first-order factors.ConclusionsThe general distress factor provides the most reliable target for epidemiological analysis but specific factors may help to refine valid phenotype dimensions for aetiological research and assist in prognostic modelling of future psychiatric episodes.