Unipolar Major Depressive Episode Research Articles

Comparative study of sleep and circadian rhythms in patients presenting unipolar or bipolar major depressive episodes

Currently, there is a major challenge in distinguishing between unipolar and bipolar major depressive episode. A significant body of research has been dedicated to identifying biomarkers that can aid in this differentiation due to its crucial implications, particularly for therapeutic and prognostic purposes. Among the biomarkers of interest, markers related to sleep and circadian rhythms show promise and could potentially aid in making this distinction. Nevertheless, no study has simultaneously examined sleep-wake disorders, circadian rhythms, and seasonal patterns using both subjective and objective measures. This study aims to characterize and compare the sleep-wake and rhythm disorders including patients with unipolar major depressive episode (n = 72) and with bipolar major depressive episode (n = 43) using both subjective markers (using self-report questionnaires and sleep complaints) and objective markers (using actigraphy). Patients with unipolar major depressive episode seem to experience significantly poorer quality of sleep, more symptoms of insomnia and lower sleep efficiency compared to patients with bipolar major depressive episode. On the other hand, patients with bipolar major depressive episode exhibit significantly more symptoms of motor retardation and hypersomnia compared to patients with unipolar disorder. These results hold significant implications for identifying individuals with unipolar major depressive episode or bipolar major depressive episode using sleep and circadian markers, and for developing recommended and personalized therapeutic strategies.

Hospital room exposure to daylight and clinical improvement in unipolar depressed inpatients

Light therapy is an effective treatment for unipolar Major Depressive Episodes (MDE). Exposure to daylight, depending on hospital room orientation, could influence clinical improvement. We aim to show greater clinical improvement 1 month after venlafaxine treatment in depressed inpatients staying in South/East facing room compared to inpatients staying in North/West facing rooms. A nested case-control study was performed within the DEP-ARREST- CLIN, a prospective and monocentric cohort. We analyzed patients with a current MDE in the context of Major Depressive Disorder who stayed at least one month in either South/East or North/West facing hospital rooms. Clinical improvement was assessed with the Hamilton Depressive Rating Scale (HAMD-17) before and after 1 month of venlafaxine treatment. 44 patients were analyzed. The average HAMD-17 score at inclusion was 26.3 (±5.5). Clinical improvement of inpatients staying in South/East facing rooms (56.8 % HAMD-17 improvement) did not differ from inpatients staying in North/West facing rooms (65.6% HAMD-17 improvement, p=0.21) after 1 month of venlafaxine treatment. Subgroup analyses revealed no associations between clinical improvement and East vs West or South vs North facing rooms or winter vs summer inpatients. Limited sample size and non-randomized study. In our sample, we observed no association between room exposure to daylight and clinical improvement after treatment in unipolar depressed inpatients.

The impact of lifestyle on adherence to treatment in a sample of patients with Major Depression

IntroductionPoor adherence to treatment is currently stated to be one of the causes of depression relapse and recurrence.ObjectivesAim of the present study was to assess potential differences in terms of clinical and socio-demographic characteristics specifically related to adherence to treatment features, medical comorbidities, and substance abuse in a sample of patients diagnosed with Major Depression in an Italian psychiatric department.MethodsPatients with a DSM-5 diagnosis of Unipolar or Bipolar Major Depressive Episode, of either gender or any age were recruited from the Psychiatry Department of Luigi Sacco University Hospital in Milan. Main clinical and socio-demographic variables were collected reviewing patients’ medical records. Moreover, adherence to psychopharmacological treatment was assessed using the Clinician Rating Scale (CRS; Kemp et al, 1996; 1998). Adherence was defined as ratings of > or =5 on the CRS. Descriptive and association analyzes were performed, setting the significance level at p<.05.Results80 patients with a diagnosis of Unipolar Major depressive episode (48.9%) and Bipolar Major Depressive Episode (51.1%) were included. For the purposes of the study, the total sample was divided into two subgroups based on adherence to pharmacological treatment (A+ vs A-). Significantly higher rates of inpatients from psychiatric ward were A- compared to A+ patients (84.6% vs 48.1%, p=.011). A- patients were significantly more unemployed (57.9% vs 23.8%, p=.015), were mostly living in their family of origin (50% vs 21.4%, p=.027), and had fewer years of education compared to A+ subgroup (10.52±3.28 vs 12.2±3.1 years, p=.053). Higher rates of Bipolar Depression diagnosis and a prevalent manic polarity lifetime emerged in A- compared to the A+ group (73.1% vs 42.3%, p=.010; 30.8% vs 3%, p=.011, respectively). Moreover, A+ reported significantly higher rates of depressive prevalent polarity lifetime (72.7% vs 30.8%, p=.011). A- reported significantly higher rates of comorbidity with alcohol or other substance use disorders lifetime (46.2% vs 5.7%, p=.006) and almost one involuntary commitment lifetime (23.1% vs 11.1%, p=.013).ConclusionsIn our sample adherence to treatments showed significant differences in terms of clinical and socio-demographic characteristics. Low levels of adherence have been associated with higher hospitalization rates, involuntary commitments, greater comorbidity with alcohol or drugs. Our data therefore seem to suggest that less adherence leads to a worse disease course and a worse quality of life. It therefore appears useful to include an assessment of adherence in the clinical practice and implement interventions to improve therapeutic adherence and ensure a better quality of life.Disclosure of InterestNone Declared

Interrogating Associations Between Polygenic Liabilities and Electroconvulsive Therapy Effectiveness

BackgroundElectroconvulsive therapy (ECT) is the most effective treatment for severe major depressive episodes (MDEs). Nonetheless, firmly established associations between ECT outcomes and biological variables are currently lacking. Polygenic risk scores (PRSs) carry clinical potential, but associations with treatment response in psychiatry are seldom reported. Here, we examined whether PRSs for major depressive disorder, schizophrenia (SCZ), cross-disorder, and pharmacological antidepressant response are associated with ECT effectiveness. MethodsA total of 288 patients with MDE from 3 countries were included. The main outcome was a change in the 17-item Hamilton Depression Rating Scale scores from before to after ECT treatment. Secondary outcomes were response and remission. Regression analyses with PRSs as independent variables and several covariates were performed. Explained variance (R2) at the optimal p-value threshold is reported. ResultsIn the 266 subjects passing quality control, the PRS-SCZ was positively associated with a larger Hamilton Depression Rating Scale decrease in linear regression (optimal p-value threshold = .05, R2 = 6.94%, p < .0001), which was consistent across countries: Ireland (R2 = 8.18%, p = .0013), Belgium (R2 = 6.83%, p = .016), and the Netherlands (R2 = 7.92%, p = .0077). The PRS-SCZ was also positively associated with remission (R2 = 4.63%, p = .0018). Sensitivity and subgroup analyses, including in MDE without psychotic features (R2 = 4.42%, p = .0024) and unipolar MDE only (R2 = 9.08%, p < .0001), confirmed the results. The other PRSs were not associated with a change in the Hamilton Depression Rating Scale score at the predefined Bonferroni-corrected significance threshold. ConclusionsA linear association between PRS-SCZ and ECT outcome was uncovered. Although it is too early to adopt PRSs in ECT clinical decision making, these findings strengthen the positioning of PRS-SCZ as relevant to treatment response in psychiatry.

Complete evaluation of retinal function in Major Depressive Disorder: From central slowdown to hyperactive periphery

BackgroundDeveloping easy-to-access biomarkers is crucial in Major Depressive Disorder. The retina has already been suggested as relevant. However, there is a need for a global and local assessment of whole retinal function using a reproducible, standardized protocol allowing for comparison across studies. Our aim is to assess whole retinal function in patients with actual unipolar Major Depressive Episode (MDE) using pattern, flash and multifocal electroretinogram (ERG) according to the International Society for Clinical Electrophysiology of Vision standardized protocols. MethodsWe assessed retinal function in 14 males and females with MDE, diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders, and in age- and sex-matched healthy controls. ResultsComparing the patients with the controls, we observed the following using multifocal ERG: a significant increase in N1 peak time in ring 3 and a decrease in P1 amplitude in ring 2; using pattern ERG: a significant increase in P50 peak time; using flash ERG: a decrease in a- and b-wave peak time and an increase in the b-wave amplitude in dark-adapted 3.0, a decrease in a- and b-wave peak time and an increase in both wave amplitudes in light-adapted 3.0, and a decrease in the b-wave peak time in light-adapted flicker. LimitationsSample size. Contribution of pharmacological treatments to the outcomes cannot be formally excluded. ConclusionsPatients with MDE exhibit delayed signaling in the central retina and hyperreactivity to light in the periphery. Central retinal function may be a marker of psychomotor retardation and cognitive impairment in MDE.

Depression in a youth population-based sample from Brazil: Prevalence and symptom structure

BackgroundWe aimed to examine the occurrence of major depressive disorder (MDD) in a population-based youth sample, assessing both categorical and dimensional presentations of the disorder and its clinical and sociodemographic correlates. MethodsWe analyzed cross-sectional data from the latest assessment of the 1993 Pelotas Birth Cohort (n = 3,780), a population-based study from Brazil that followed individuals up to age 22 years. We estimated point-prevalence for categorical diagnosis of MDD and comorbid diagnoses using DSM criteria in a structured interview by trained psychologists. Dimensional symptomatology was assessed with the Brazilian Portuguese version of the Center for Epidemiological Studies–Depression Scale–Revised (CES-D-R). ResultsPoint-prevalence of a current unipolar major depressive episode was 2.85% (95%CI 2.37-3.43%). The CES-D-R showed a mean of 9.20 (SD=9.72), with an area under the curve of 0.93 (95%CI 0.91 to 0.95) for the categorical diagnosis of MDD using a cutoff point of 16. Sad mood and somatic symptoms were the most frequent, and also had lower levels of latent values required for endorsement. Sad mood and anhedonia items were the most central items in the network structure. ConclusionsIn a population-based sample of youths from a middle-income country, MDD prevalence estimates and comorbidity profile were consistent with previous global literature. A focus on symptoms might advance our understanding about MDD among youths by disentangling the heterogeneity of the disorder.

Presence and Overlap of Bipolar Symptoms and Borderline Features during Major Depressive Episodes

BackgroundBipolar symptoms and borderline personality features occur in both unipolar and bipolar major depressive episodes (MDEs). We investigated their prevalence, severity, co-occurrence and overlap. MethodsWe interviewed 124 psychiatric outpatients with MDE using the Structured Clinical Interview for DSM-IV-TR Axis I and II Disorders, the Borderline Personality Disorder Severity Index (BPDSI-IV), and about past (hypo)manic episodes, and stratified them according to the principal diagnosis into subcohorts of major depressive disorder (MDD, n = 50), bipolar disorder (BD, n = 43), and borderline personality disorder (BPD, n = 31). We quantified (hypo)manic symptoms using a novel semi-structured interview (MIXed symptoms during MDE, MIX-MDE) with good psychometric qualities. ResultsThe subcohorts did not differ in MDE severity. They differed significantly in some (hypo)manic symptoms being present on most days in 24% of MDD, 30% of BD, and 42% of BPD subcohort, but only 5% of the BD subcohort fulfilled the DSM-5 mixed features. The mean MIX-MDE scores were 5.7 (SD 4.0), 12.0 (8.2) and 10.5 (7.5), and BPDSI-IV scores 15.6 (7.0), 17.2 (6.2) and 26.9 (8.7), respectively (both p < 0.001). (Hypo)manic days and unspecific symptoms of distractibility and irritability inflated the correlation of observed (hypo)manic symptoms and borderline features. LimitationsModerate sample size, limited age variation (18-50 years); no previous validation of MIX-MDE. ConclusionsPresence of some mixed and borderline features is common in MDEs, with overlap and diagnosis-specific differences. Unspecific symptoms of irritability and distractibility and the aggravating impact of hypomania on perceived BPD features blur the differential diagnosis.

Cariprazine as a treatment across the bipolar I spectrum from depression to mania: mechanism of action and review of clinical data.

Cariprazine is one of the newest dopamine-serotonin partial agonists, also known as ‘atypical’ second generation antipsychotics. Originally approved for acute and maintenance treatment of schizophrenia as well as for acute mania and mixed mania/depression, cariprazine has now been approved for bipolar I depression. Additionally, post hoc analyses of bipolar I depressed subjects show that both those with and those without concurrent manic features were improved following treatment with cariprazine. Maintenance studies are in progress in bipolar disorder, as are studies to augment antidepressants in unipolar major depressive episodes insufficiently responsive to treatment. Here, we review specifically the efficacy and safety data of cariprazine in bipolar I disorder and discuss the hypothesized mechanism of action of cariprazine and how it could theoretically be linked to caprazine’s broad therapeutic actions across the mood disorder spectrum.

Difference of olfactory deficit in patients with acute episode of schizophrenia and major depressive episode

AimOlfactory deficits are potential markers of early diagnosis, monitoring progress and predicting outcome in patients with schizophrenia and depression. We aimed to investigate differences in patterns and influencing factors of olfactory deficits between patients with acute episode of schizophrenia and major depressive episode (MDE). MethodsFifty-two patients with acute episode of schizophrenia, 75 patients with unipolar MDE and 199 healthy controls were included in this retrospective study. Following a structured interview, participants underwent olfactory tests (Sniffin' Sticks), assessment of psychiatric symptoms (Positive and Negative Syndrome Scale), depressive symptoms (Hamilton Depression Rating Scale), and cognitive function (color-word test and word generation test). ResultsBoth patients with schizophrenia and MDE exhibited significant olfactory deficits, and MDE patients have poorer olfactory sensitivity than schizophrenia. Patients with MDE had a higher proportion of olfactory deficits (45.3% and 28%, respectively) but a better self-awareness (21.3% and 9.6%, respectively) than patients with schizophrenia. In patients with schizophrenia, PANSS scores was positively associated with olfactory sensitivity but negatively associated with olfactory identification, and olfactory discrimination was associated with word generation. In patients with MDE, olfactory discrimination was associated with word generation and age, but not disease severity. First-episode schizophrenia group showed significantly lower threshold scores than recurrent schizophrenia group, and first-episode MDE group had significantly lower threshold scores and higher discrimination scores than the recurrent MDE group. ConclusionsPatterns and modulating factors of olfactory deficits in acute episode of schizophrenia and MDE are different, their differences should be considered when using olfactory deficits as marker in clinical practice.

Uses of Electroconvulsive Therapy in Conditions Other than Major Depressive Episode

The effectiveness of electroconvulsive therapy (ECT) in the treatment of unipolar and bipolar major depressive episodes (MDE) is well known, and the US Food and Drug Administration has recently reclassified ECT devices to a less restrictive category for treatment of MDE and catatonia. In this review, we look at the existing evidence supporting the use of ECT in conditions other than MDE, such as bipolar mania and mixed states, schizophrenia, catatonia, Parkinson's disease, agitation in dementia, and status epilepticus. [ Psychiatr Ann . 2019;49(4):157–163.]

Switching to Imipramine Versus Add-on Mirtazapine in Venlafaxine-Resistant Major Depression: A 10-Week Randomized Open Study.

Newer-generation antidepressants used in monotherapy or in combination with other newer-generation antidepressants or other psychotropic drugs are usually preferred as first- or second-step treatment options in resistant depression. According to our clinical experience, tricyclic antidepressants still are one of our preferred first choices in treatment-resistant moderate to severe unipolar major depressive episodes. This 10-week open-design randomized study assessed the effectiveness of switching to imipramine (adjusted to plasma levels) compared with add-on mirtazapine (30 mg/d) for treatment of moderate to severe unipolar major depressive episodes after a 10-week unsuccessful venlafaxine regimen (225-300 mg/d). Efficacy analyses examined the change in depressive symptoms severity from baseline visit to endpoint and the comparative remission rate between treatment subgroups. The randomized sample consisted of 112 venlafaxine-resistant moderate to severe unipolar major depressed patients. Both the percentage of remitters (71.43% vs 39.28%) and the mean reduction of the Hamilton Depression Rating Scale score (76.94% vs 50.72%) were significantly larger in the imipramine subgroup. Even though we should be cautious about generalizing these results to patients with a less severe unipolar major episodes, our study suggest that switching to imipramine is a very effective treatment option in unipolar major depressive episodes after an unsuccessful venlafaxine regimen.

The Catechol-O-methyltransferase Val(108/158)Met Genetic Polymorphism cannot be Recommended as a Biomarker for the Prediction of Venlafaxine Efficacy in Patients Treated in Psychiatric Settings.

The antidepressant venlafaxine is known to increase the turnover of cerebral monoamines, which are catabolized by the catechol-O-methyltransferase (COMT). The COMT (Val(108/158)Met, rs4680) genetic polymorphism affects the cerebral COMT activity. But whether this genetic polymorphism is associated with response to venlafaxine remains unclear. We assessed the impact of the COMT Val(108/158)Met, rs4680 genetic polymorphism on the efficacy of venlafaxine in depressed patients. This study was nested in the METADAP cohort, a real-world naturalistic treatment study in psychiatric settings. A total of 206 Caucasian patients with a unipolar major depressive episode (DSM-IVTR) treated with venlafaxine and evaluated with the Hamilton Depression Rating Scale (HDRS) were studied. One hundred and eighty patients were genotyped for the COMT Val(108/158)Met, rs4680 genetic polymorphism and classified into three genotype subgroups: Val/Val, Val/Met and Met/Met. The COMT genotype was the explanatory variable, and the variables to be explained were HDRS score, HDRS score improvement over time, response rate and remission rate. Venlafaxine had a trend to higher efficacy in the Val/Val patients as compared to Met/Met carriers, as shown by the HDRS score improvement after 3months of treatment, but this result was not significant in mixed models [Val/Val: 59.78% (±22.4); Val/Met: 51.64% (±26.3); Met/Met: 39.52% (±27.6)]. The percentage of responders and remitters after 3months of treatment was not significantly different in the three genotype groups, although coherent trends were shown. The COMT Val(108/158)Met, rs4680 genetic polymorphism cannot be recommended as a biomarker for the prediction of venlafaxine efficacy in patients treated in psychiatric settings.

Strategic use of new generation antidepressants for depression: SUN(^_^) D protocol update and statistical analysis plan.

BackgroundSUN(^_^)D, the Strategic Use of New generation antidepressants for Depression, is an assessor-blinded, parallel-group, multicenter pragmatic mega-trial to examine the optimum treatment strategy for the first- and second-line treatments for unipolar major depressive episodes. The trial has three steps and two randomizations. Step I randomization compares the minimum and the maximum dosing strategy for the first-line antidepressant. Step II randomization compares the continuation, augmentation or switching strategy for the second-line antidepressant treatment. Step III is a naturalistic continuation phase. The original protocol was published in 2011, and we hereby report its updated protocol including the statistical analysis plan.ResultsWe implemented two important changes to the original protocol. One is about the required sample size, reflecting the smaller number of dropouts than had been expected. Another is in the organization of the primary and secondary outcomes in order to make the report of the main trial results as pertinent and interpretable as possible for clinical practices. Due to the complexity of the trial, we plan to report the main results in two separate reports, and this updated protocol and the statistical analysis plan have laid out respective primary and secondary outcomes and their analyses. We will convene the blind interpretation committee before the randomization code is broken.ConclusionThis paper presents the updated protocol and the detailed statistical analysis plan for the SUN(^_^)D trial in order to avoid reporting bias and data-driven results.Trial registrationClinicalTrials.gov: NCT01109693 (registered on 21 April 2010).

Taste identification used as a potential discriminative test among depression and Alzheimer׳s disease in elderly: A pilot study

Major Depression and Alzheimer׳s disease (AD) are two diseases in the elderly characterized by an overlap of early symptoms including memory and emotional disorders. The identification of specific markers would facilitate their diagnosis. The aim of this study was to identify such markers by investigating gustatory function in depressed and AD patients. We included 20 patients with unipolar major depressive episodes (MDE), 20 patients with mild to moderate AD and 24 healthy individuals. We investigated the cognitive profile (depression, global cognitive efficiency and social/physical anhedonia) and gustatory function (ability to identify four basic tastes and to judge their intensity and hedonic value) in all participants. We found that AD patients performed worse than healthy participants in the taste identification test (for the analysis of all tastants together); however, this was not the case for depressed patients. We found no significant differences among the three groups in their ability to evaluate the intensity and hedonic value of the four tastes. Overall, our findings suggest that a taste identification test may be useful to distinguish AD and healthy controls but further investigation is required to conclude whether such a test can differentiate AD and depressed patients.

Association between core-assigned melancholia and the melancholia subscale of the HAM-D

BackgroundClinical observation and research data suggest that major depression (MD) is a heterogeneous disorder, possibly representing a group of different clinical entities. The identification of more homogeneous subtypes of depression could enhance research and enable development of more specific treatments. A melancholic subtype of MD, defined by the presence of observable psychomotor disturbance (PMD), is proposed to be more homogeneous and associated with biological determinants. The aim of this study was to investigate the homogeneity of this melancholic subtype in terms of symptoms by searching for an association between melancholia and a unidimensional subscale of the Hamilton Depression Rating Scale (HAM-D) proposed to have biological validity (HAM-D6). MethodsA cross-sectional assessment of 385 outpatients presenting with a unipolar major depressive episode was carried out to evaluate depressive symptoms using the HAM-D and melancholic or nonmelancholic subtype, according to the CORE measure of PMD. ResultsMelancholic patients exhibited more severe depressive symptoms, mainly associated with the HAM-D6. The items of this melancholia subscale represent 42.3% of the total HAM-D and were responsible for 59.4% of between-group differences. Correlation analysis showed similar results. LimitationsMost patients received previous treatment, and some were not at the nadir of the episode when assessed. This could have lowered the CORE measure sensibility. ConclusionMelancholic depression, as assigned by the CORE measure, represents a more severe and homogeneous subtype of MD. This observation may allow identification of proper biomarkers and development of more specific treatments.

Long-term odor recognition memory in unipolar major depression and Alzheimer׳s disease

Major depression and Alzheimer׳s disease (AD) are often observed in the elderly. The identification of specific markers for these diseases could improve their screening. The aim of this study was to investigate long-term odor recognition memory in depressed and AD patients, with a view to identifying olfactory markers of these diseases. We included 20 patients with unipolar major depressive episodes (MDE), 20 patients with mild to moderate AD and 24 healthy subjects. We investigated the cognitive profile and olfactory memory capacities (ability to recognize familiar and unfamiliar odors) of these subjects. Olfactory memory test results showed that AD and depressed patients were characterized by significantly less correct responses and more wrong responses than healthy controls. Detection index did not differ significantly between patients with major depression and those with AD when the results were analyzed for all odors. However, MDE patients displayed an impairment of olfactory memory for both familiar and unfamiliar odors, whereas AD subjects were impaired only in the recognition of unfamiliar odors, with respect to healthy subjects. If preservation of olfactory memory for familiar stimuli in patients with mild to moderate AD is confirmed, this test could be used in clinical practice as a complementary tool for diagnosis.

Overt Irritability/Anger in Unipolar Major Depressive Episodes

Although symptoms of irritability or anger are not central to the diagnosis of unipolar major depressive episodes (MDEs), these symptoms have been found, in cross-sectional studies, to be highly prevalent and associated with increased comorbidity and depressive illness burden. To determine the prevalence of overtly expressed irritability/anger and its effect on intake presentation and the long-term course of illness. A prospective, naturalistic investigation of patients with unipolar MDEs, studied systematically at intake and during up to 31 years of follow-up. Five US academic medical centers. Patients entered the National Institute of Mental Health Collaborative Depression Study during an MDE in 1978, 1979, 1980, or 1981. Patients with unipolar MDE at intake (n = 536) were divided into those with and those without current comorbid overtly expressed irritability/anger. In this observational, longitudinal study, patients received treatment that was recorded but not controlled. Groups were compared on illness severity and chronicity, psychosocial impairment, quality of life, suicidal behavior, lifetime comorbid diagnoses, impulse control, and measures associated with bipolarity. Overt irritability/anger was present in 292 of 536 participants with a unipolar MDE at study intake (54.5%). It was associated with significantly increased depressive severity, longer duration of the index MDE, poorer impulse control, a more chronic and severe long-term course of illness, higher rates of lifetime comorbid substance abuse and anxiety disorder, more antisocial personality disorders, greater psychosocial impairment before intake and during follow-up, reduced life satisfaction, and a higher rate of bipolar II disorder in relatives. No association was found with increased suicidal ideation or behavior. Results were not explained by comorbidity or other manic spectrum symptoms. This study extends results of cross-sectional investigations and indicates that irritability/anger during MDEs is a highly prevalent clinical marker of a more severe, chronic, and complex depressive illness. Findings have important implications for assessment and treatment.

Does obesity predict bipolarity in major depressive patients?

BackgroundDifferential association of obesity in bipolar and unipolar Major Depressive Episode (MDE) has not been systematically studied. We explore the relationships between obesity and history of manic and hypomanic symptoms in a large national clinical sample of MDE patients. MethodThe sample comprised 571 consecutive patients with a DSM-IV diagnosis of MDE enrolled in a 7 months period. The study involved 30 psychiatric facilities for outpatients, distributed throughout Italy. Diagnosis was formulated by psychiatrists with extensive clinical experience in the diagnosis and treatment of mood disorders. In all patients height (meters) and weight (kilograms) were systematically measured at the moment of the clinical evaluation. The severity of depressive and anxious symptomatology was self-evaluated by the means of Zung's questionnaires for depression and anxiety. For the evaluation of lifetime manic or hypomanic features, Hypomania Check List-32 was also administered. Obese and Non-Obese subgroups were identified on the basis of a >30 BMI cut off point. ResultsBMI ≤30 was observed in 86 (15.1%) of our MDE patients. The Obese and Non-Obese subgroups did not report differences as regards to age and gender distribution. Obese patients reported a lower number of years of education in comparison with Non-Obese patients. As regards to marital status, Obese patients were more frequently married in comparison with the Non-Obese patients. Obese patients were more frequently belonging to the bipolar group than Non-Obese patients. Obese subjects also reported more frequently than Non-Obese an HCL total score >14. The effect of educational level, marital status and bipolar–unipolar distinction on the probability of Obese group membership was analyzed by stepwise logistic regression. Bipolar subtype resulted to be the strongest predictor of Obesity. LimitationsPharmacological treatments and co-morbidity with other psychiatric disorders are not explored and accounted for in our analyses. ConclusionsObesity in our national sample of patients with MDE is associated with bipolar subtype and (hypo)manic symptoms. These findings suggest the possibility that the presence of obesity in patients with MDE might be related to bipolarity. A common impulsive-addictive diathesis is proposed as mediating mechanism. Further longitudinal studies in clinical and non-clinical populations are necessary to better define the burden and the role of the association between obesity and bipolarity.

Association of Five-Factor Model Personality Domains and Facets with Presence, Onset, and Treatment Outcomes of Major Depression in Older Adults

To assess the relationship of multiple domains and facets of the five-factor model of personality with presence, onset, and severity of late-life depression.Cross-sectional analysis of depression status, and age of onset. Retrospective analysis of baseline severity. Longitudinal analysis of severity after 3 and 12 months of psychiatric treatment.Private university-affiliated medical center in the Southeastern United States.One hundred twelve psychiatric patients with a current episode of unipolar major depression, and 104 nondepressed comparison subjects, age 60 and older (mean: 70, SD: 6).Revised NEO Personality Inventory, Diagnostic Interview Schedule, and Montgomery-Åsberg Depression Rating Scale.Binary logistic regression found that depression was related to higher neuroticism (and all its facets) and to lower extraversion (and facets of assertiveness, activity, and positive emotionality) and conscientiousness (and facets of competence, order, dutifulness, and self-discipline). Multinomial logistic regression found some of these relationships held only for depression with onset before age 50 (hostility, self-consciousness, extraversion, assertiveness, positive emotions, order, and dutifulness). Linear regression found that personality was unrelated to depression severity at the beginning of treatment, but improvement after 3 months was related to lower neuroticism (and facets depressiveness and stress-vulnerability) and higher warmth and competence. Improvement after 12 months was related to lower neuroticism, depressiveness, and stress-vulnerability.Specific personality facets are related with depression and treatment outcomes. Screening for certain personality traits at the start of treatment may help identify patients at risk of worse response to treatment after 3 months.

Predisposition for Self-Destruction? Affective Temperaments as a Suicide Risk Factor in Patients With Mood Disorders

Because suicide is overall a relatively rare event, its prediction in individual cases remains very difficult. Suicidal behavior (both fatal and nonfatal) is, however, quite frequent among psychiatric patients who have contacted different levels of the health-care system some weeks or months before their attempt (Luoma, Martin, & Pearson, 2002). Untreated unipolar or bipolar major depressive episode is the main clinical substrate of suicide, accounting for 56–87% of the cases. What is most important in this respect is that suicidal behavior in mood disorder patients is a phenomenon dependent on the state and severity of the underlying disease, and that suicidality decreases/vanishes after clinical recovery (Rihmer, 2007). But because the majority of depressed patients never complete suicide and about half of them never attempt it, special clinical, psychological, and psychosocial risk factors also play a significant role (Rihmer, 2007). A look at these factors may help us to identify patients who are at an especially high risk for suicide. As to psychological characteristics, it has been well known for many decades that suicidality is also associated with certain personality features, such as aggressive/impulsive traits, hopelessness and pessimism, and that the risk increases if these traits are present in combination (Mann, Waternaux, Haas, & Malone, 1999; Oquendo et al., 2004; MacKinnon et al., 2005). Impulsivity, a characteristic trait in bipolar patients, has been associated with nonlethal suicide attempts in general samples, and in affective patients it is also associated with severe suicide attempts and completed suicide (Swann et al., 2005). Impulsivity distinguishes suicidal and nonsuicidal affective inpatients and controls, and in bipolar patients suicidal intent is correlated with impulsivity even when controlling for aggression. Impulsivity increases suicide risk when combined with depression; even modest manic symptoms during bipolar depressive episodes are associated with a greater level of impulsivity and higher rate of suicide attempts (Swann et al., 2007). In the case of bipolar disorder, suicidal behavior was also associated with aggressive traits (Grunebaum et al., 2006). Bipolar patients with family history of suicidal behavior and exposed to childhood physical and/or sexual abuse are at greater risk for suicide attempts (Carballo et al, 2008), and impulsivity seems to be the link between childhood abuse and suicidal behavior (Braquehais, Oquendo, Baca-Garcia, & Sher, 2010). In a study on bipolar patients, harm avoidance and persistence as measured by Cloninger’s TCI were significantly related to prior suicide attempts (Engstrom, Brandstrom, Sigvardsson, Cloninger, & Nylander, 2004). Hostility was also found to be a risk factor for suicide attempt, with reasons for living being an important protective factor in bipolar disorder (Chaudhury et al., 2007). Only in the last decade, however, has it become clear that affective temperaments – known to be subclinical manifestations and precursors of major mood disorders – also predispose risk for suicidal behavior. Classically, temperament has included the temporally stable biological “core” of an individual’s personality and plays a role in establishing activity level, rhythms, moods, and related cognitions as well as their variability. Personality, on the other hand,