Untreated Major Depression Research Articles

Untreated Major Depression During Gestation: The Physical and Mental Implications in Women and Their Offspring

While postpartum depression has been extensively studied and is a concern surrounding major depression in women, the effects of major depression during pregnancy alone should also be considered. The purpose of this review article was to explore in longitudinal fashion, from neonate to adulthood, the lasting physical and mental implications that depression during gestation can present in offspring. Consideration of various sources pulled from the OVID Medline database yielded findings consistent with negative associations between gestational depression and offspring outcomes. In mothers, gestational depression presents with physical implications, such as preeclampsia and preterm delivery, leading to low birth weight and neurodevelopmental complications in neonates. As the children grow older, these complexities manifest as socioemotional, behavioral, and linguistic development delays presenting as increased incidence in attention-deficit/hyperactivity disorder diagnoses, parental attachment issues, and lower emotional and verbal IQ. Research regarding adolescents and adults is sparse in comparison with that of earlier stages, but there are studies that examine the developmental outcomes of certain mood disorders, such as generational depression, in the offspring of birthing parents with prenatal depression. This review presents an extended timeline of the effects of gestational major depression in offspring, and it provides suggestions for future research regarding underlying biological explanations and certain risk outcomes.

Untreated major depression in healthcare workers: Results from the nationwide AMADEUS survey.

Recent studies have suggested increased rates of depression in healthcare workers (HCWs), with direct impact on care quality and productivity. The objective was to determine the proportion of HCWs adequately treated for their major depression in a nationwide survey, the proportion of lifestyle risk factors for depression, and to determine if working in psychiatry department or professional status may modulate these outcomes. The method followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement guidelines. A survey comprising the Center for Epidemiologic Studies-Depression Scale was sent to public and private national healthcare facilities. Overall, 10,325 participants were recruited; 3438 (33.3%) [95% confidence interval 32.4-34.2] met likely diagnostic criteria for clinical depression. Almost 80% of them declared that they had a history of major depressive episode. However, only approximately 23% of them were treated with antidepressants and approximately 13% had a psychiatric follow-up. Depressed HCWs working in psychiatry departments received slightly better care for their depression, but they also consumed more anxiolytics and hypnotics and had more risk factors for depression (including smoking and hazardous drinking). We found specificities according to professions, physicians reported higher rates of hazardous drinking while nurses, nurse assistants, and health executives had higher rates of smoking and twice as much obesity as physicians. Disseminating tools to detect major depression, programs destigmatizing depression and antidepressants, promoting physical activity, weight loss, tobacco cessation and reduced alcohol consumption are promising strategies to improve the care of major depression in HCWs. Reducing depression in healthcare workers is necessary to improve the quality of care, to limit burnout, medical errors, absenteeism and turn-over and globally to improve the wellbeing at work.

Visual pathway function in untreated individuals with major depression.

Major depression (MD) is the one of the most debilitating diseases, affecting millions of people all around the world. To establish visual pathway function in untreated individuals with MD. In 29 untreated, newly diagnosed, ophthalmologically asymptomatic individuals (58 eyes) with MD (mean age: 47.3 years) and in 29 (58 eyes) of age-, sexand refractive error-matched healthy controls (mean age: 46.8 years), the following examinations were performed: 1) best corrected distance visual acuity (BCDVA); 2) intraocular pressure (IOP); 3) and 4) biomicroscopy of anterior and posterior segment of eye; 5) macular structure (SD-OCT-Zeiss); and 6) pattern visual evoked potentials (PVEPs) measurements according to the International Society for Clinical Electrophysiology of Vision (ISCEV) standard (ISCEV-standard PVEPs). An analysis of correlation between the parameters of PVEPs and the depression severity (Hamilton Depression Rating Scale (HAMD)) was performed. To estimate the diagnostic power of PVEPs test, a receiver operating characteristics (ROC) curve was used. Data were analyzed with the significance level of p < 0.05. In the study group and in healthy control, the clinical results and macular structure were normal and not different. In the MD group, in PVEPs test (check size: 1°4'and 0°16'), a significant decrease of amplitudes of P100 (AP100), associated with prolonged P100 peak time (PTP100; check size: 0°16', p < 0.004) were detected. The most frequent abnormality in PVEPs examination in the MD group was AP100 reduction (in 69% of individuals) detected using stimulation check size 0°16'. The statistically significant positive correlation between PTP100 (check size: 0°16') and HAMD score was found in severe MD (p = 0.03). The analysis of ROC curve revealed the highest sensitivity of 0.759 and specificity of 1.0 for AP100 (0°16'). The area under the curve (AUC) was 0.841 (p < 0.001). In individuals with newly diagnosed, ophthalmologically asymptomatic and untreated MD, a dysfunction of visual pathway is present without other signs of ocular pathology. The visual pathway dysfunction measured with ISCEV PVEPs has a potential value to be an objective biomarker of MD.

Evaluating the Impact of Perinatal Depression on Fetal and Childhood Development

Perinatal maternal depression leads to a variety of biochemical and behavioral changes in utero. These alterations are linked to impaired fetal development and may also be detrimental to future neonatal, pediatric, and adolescent health. There is a marked rise in the incidence of atopic triad conditions, such as dermatitis and asthmatic wheezing, in children of pregnant mothers with antepartum depression, possibly due to an aberrant TH2 immunologic response and increased fetal oxidative stress. Maternal antepartum depression may also contribute to small-for-gestational age birth status, anomalous fetal neurotransmitter levels, and depression throughout infancy and adolescence. Cortisol has been implicated as a common causative factor responsible for many of these negative offspring outcomes. Minimal research on untreated major depression in pregnancy has been conducted. However, current studies emphasize the importance of holistically evaluating the risks associated with untreated major depression in pregnancy in order to minimize harmful effects on children.

The Importance of Ki67, Glial Fibrillar Acidic Protein and Vitamin D Receptor in the Central Nervous System of Postmortem Suicide Cases

Death by suicide is a tragic public health problem. Major depressive patients constitute some of these deaths. Although the etiology of major depression has not been clarified, there are studies suggesting that the hippocampus and caudate nucleus may be effective. In this study, it was aimed to compare vitamin D receptor (VDR), Ki67 and glial fibrial acidic protein (GFAP) antibodies in the brain tissues (hippocampus and caudate nucleus) of untreated major depression patients who died because of suicide with the control group. Left hippocampus and caudate nuclei of seven patients with untreated major depression who died of suicide in a one-year period and six psychiatrically normal patients were taken during autopsy. The hippocampus was stained with VDR, GFAP and Ki67 antibodies, and the caudate nucleus was stained with VDR and GFAP antibodies. There was no significant difference in the number of Ki67-positive cells in the anterior and posterior dentate gyrus between the major depression and control groups (P > 0.05). In the major depression group, a negative correlation was reported between the number of Ki67-positive cells in the anterior dentate gyrus and age (r: 0.867, P < 0.05). In the anterior dentate gyrus, posterior dentate gyrus and caudate nucleus, there was no significant difference between the suicide and control groups in the fraction of the immunoreactive area with GFAP antibodies (P > 0.05). While the percentage of immunoreactive granular cells for vitamin D receptor in the anterior dentate gyrus was significantly higher than the control group (P <0.05), no significant difference was reported in the posterior dentate gyrus. Vitamin D receptor immunoreactive neuron positivity in the caudate nucleus was not significantly different between the major depression and control groups (P > 0.05). In untreated major depression, additional immunohistochemical changes are observed in the anterior hippocampus, and the vitamin D receptor increases in the granular cells as a protective factor.

Treatment outcomes for depression: challenges and opportunities

Treatment outcomes for depression: challenges and opportunities

Prediction of remission in pharmacotherapy of untreated major depression: development and validation of multivariable prediction models.

Depression is increasingly recognized as a chronic and relapsing disorder. However, an important minority of patients who start treatment for their major depressive episode recover to euthymia. It is clinically important to be able to predict such individuals. The study is a secondary analysis of a recently completed pragmatic megatrial examining first- and second-line treatments for hitherto untreated episodes of non-psychotic unipolar major depression (n = 2011). Using the first half of the cohort as the derivation set, we applied multiply-imputed stepwise logistic regression with backward selection to build a prediction model to predict remission, defined as scoring 4 or less on the Patient Health Quetionnaire-9 at week 9. We used three successively richer sets of predictors at baseline only, up to week 1, and up to week 3. We examined the external validity of the derived prediction models with the second half of the cohort. In total, 37.0% (95% confidence interval 34.8-39.1%) were in remission at week 9. Only the models using data up to week 1 or 3 showed reasonable performance. Age, education, length of episode and depression severity remained in the multivariable prediction models. In the validation set, the discrimination of the prediction model was satisfactory with the area under the curve of 0.73 (0.70-0.77) and 0.82 (0.79-0.85), while the calibration was excellent with non-significant goodness-of-fit χ2 values (p = 0.41 and p = 0.29), respectively. Patients and clinicians can use these prediction models to estimate their predicted probability of achieving remission after acute antidepressant therapy.

Optimising first- and second-line treatment strategies for untreated major depressive disorder \u2014 the SUN\u263aD study: a pragmatic, multi-centre, assessor-blinded randomised controlled trial

BackgroundFor patients starting treatment for depression, current guidelines recommend titrating the antidepressant dosage to the maximum of the licenced range if tolerated. When patients do not achieve remission within several weeks, recommendations include adding or switching to another antidepressant. However, the relative merits of these guideline strategies remain unestablished.MethodsThis multi-centre, open-label, assessor-blinded, pragmatic trial involved two steps. Step 1 used open-cluster randomisation, allocating clinics into those titrating sertraline up to 50 mg/day or 100 mg/day by week 3. Step 2 used central randomisation to allocate patients who did not remit after 3 weeks of treatment to continue sertraline, to add mirtazapine or to switch to mirtazapine. The primary outcome was depression severity measured with the Patient Health Questionnaire-9 (PHQ-9) (scores between 0 and 27; higher scores, greater depression) at week 9. We applied mixed-model repeated-measures analysis adjusted for key baseline covariates.ResultsBetween December 2010 and March 2015, we recruited 2011 participants with hitherto untreated major depression at 48 clinics in Japan. In step 1, 970 participants were allocated to the 50 mg/day and 1041 to the 100 mg/day arms; 1927 (95.8%) provided primary outcomes. There was no statistically significant difference in the adjusted PHQ-9 score at week 9 between the 50 mg/day arm and the 100 mg/day arm (0.25 point, 95% confidence interval (CI), − 0.58 to 1.07, P = 0.55). Other outcomes proved similar in the two groups.In step 2, 1646 participants not remitted by week 3 were randomised to continue sertraline (n = 551), to add mirtazapine (n = 537) or to switch to mirtazapine (n = 558): 1613 (98.0%) provided primary outcomes. At week 9, adding mirtazapine achieved a reduction in PHQ-9 scores of 0.99 point (0.43 to 1.55, P = 0.0012); switching achieved a reduction of 1.01 points (0.46 to 1.56, P = 0.0012), both relative to continuing sertraline. Combination increased the percentage of remission by 12.4% (6.1 to 19.0%) and switching by 8.4% (2.5 to 14.8%). There were no differences in adverse effects.ConclusionsIn patients with new onset depression, we found no advantage of titrating sertraline to 100 mg vs 50 mg. Patients unremitted by week 3 gained a small benefit in reduction of depressive symptoms at week 9 by switching sertraline to mirtazapine or by adding mirtazapine.Trial registrationClinicalTrials.gov, NCT01109693. Registered on 23 April 2010.

Comparative effects of antidepressant medications and untreated major depression on pregnancy outcomes: a systematic review.

Psychopharmacological treatment of pregnant women is an area of continued controversy; extensive observational research on the use of antidepressant medications in pregnancy has found these medications to be associated with increased risk of spontaneous abortion, preterm delivery, and low birth weight. However, depression itself has also been associated with increased risk of those same outcomes, and only recently have researchers begun trying to compare treated with untreated depression. The purpose of this study was to conduct a systematic review of the literature to integrate those comparative studies and compare risks and benefits. PubMed, PsycInfo, and CINAHL searches; study selection; and data extraction were carried out using PRISMA guidelines. Eleven prospective observational and case-control studies were selected for final inclusion. Risk of low birth weight and related outcomes do not differ between antidepressant-treated pregnant women and untreated depressed women. Average gestational lengths tend to be slightly shorter with antidepressant use but it is unclear whether these differences are clinically meaningful or extend to preterm delivery. Very limited research on spontaneous abortion did not allow conclusions to be drawn regarding that outcome. The low number of studies meeting criteria highlights the need for further research to aid in risk-benefit analysis for women considering antidepressant use in pregnancy. While further research is necessary, discontinuing antidepressant treatment of major depression in pregnancy due to concerns about length of gestation, birth weight, or spontaneous abortion is not supported by the evidence available at this time.

Must we fear antidepressants in adolescents?

IntroductionEpidemiological studies have established that teenager's prevalence rates of major depression are significant (10%). The media has given a good deal of attention to the potential risks of antidepressants and their connection to increased suicidality (especially in children and adolescents). These concerns have had a significant impact on both the prescribing of antidepressants and the parental fears about their use. It is interesting to note that in large groups’ studies of adolescents treated with selective serotonin reuptake inhibitors there have been no evidence of increased suicidal risk.ObjectiveUnderstand if there is a significant association between antidepressant treatment and suicidality in a 3-months follow-up study of the adolescent's consultation of Centro Hospitalar Lisboa Norte.MethodsAnalysis of 81 adolescents with an initial diagnosis of major depression treated with an antidepressant for at least 3 months.ResultsAfter the follow-up period there has been an improvement in sadness in 92.6% of the adolescents, a remission of death thoughts in 98.8% and an absence of suicides attempts. In 61.7%, it was necessary to introduce also an antipsychotic in a low dose and in 12.3% another antidepressant with a hypnotic effect.ConclusionIt is clear that untreated major depression carries significant suffering and disability. Although treatment with antidepressants may take several weeks before clinical improvement appear and depression may worsen in the first days, its therapeutic effect should not be underestimated even if becomes necessary to add another medication in the first days. In evaluating these kinds of concerns, we must always differentiate between media hype and scientific data.Disclosure of interestThe authors have not supplied their declaration of competing interest.

α2-adrenoceptor binding in Flinders-sensitive line compared with Flinders-resistant line and Sprague-Dawley rats.

Disturbances in the noradrenergic system, including alterations in the densities of α2-adrenoceptors, are posited to be involved in the pathophysiology of depression. In this study, we investigate the binding of α2-adrenoceptors in regions relevant to depression in an animal model of depression. Using in vitro autoradiography techniques and the selective α2-ligand, [3H]RX 821002, we investigated the density of α2-adrenoceptors in female Flinders-sensitive line (FSL) rats, a validated model of depression, and in two traditional control groups - female Flinders-resistant line (FRL) and Sprague-Dawley (SD) rats. The α2-adrenoceptor density was increased in most regions of the FSL rat brain when compared with SD rats (10% across regions). Moreover, the α2-adrenoceptor density was further increased in the FRL rats compared with both FSL (10% across regions) and SD rats (24% across regions). The increase in α2-adrenoceptor binding in cortical regions in the FSL strain compared with the SD control strain is in accord with α2-adrenoceptor post-mortem binding data in suicide victims with untreated major depression. However, the differences in binding observed in the two control groups were unexpected and suggest the need for further studies in a larger cohort of animals of both sexes.

Thrombotic Thrombocytopenic Purpura (TTP) Patient Attitudes Regarding Depression Management: a Qualitative Study

▪Introduction: Recovery from an acute episode of TTP was previously thought to be complete except for a risk for relapse. However, the Oklahoma TTP-HUS Registry has documented that patients have multiple health problems that persist following recovery, including an increased prevalence of major depression (Blood122:2023;2013). Untreated major depression impacts daily functioning, quality of life and is a risk factor for suicide. Recognizing depression and establishing effective treatment should be a critical part of TTP follow-up care. The objective of our study was to identify TTP patient attitudes regarding treatments for depression.Methods: The study was based on the theoretical framework of the Theory of Planned Behavior (TPB). The theory suggests that intention is the immediate predictor of behavior. Intention is determined by 3 factors: attitude toward a behavior, subjective norms, and perceived behavioral control. This study focused on attitude; therefore, patients were primarily asked if there were any advantages or disadvantages of treating depression with either pharmacotherapy or counseling.One-on-one semi-structured interviews were conducted by the first author. Interviews were transcribed verbatim and content analysis was conducted by 3 qualitative researchers and facilitated by using the NVivo 10 software. A codebook was developed to guide the data analysis. Similar beliefs were grouped into themes and key ideas.Patients: Registry patients whose initial episode was associated with severe ADAMTS13 deficiency (<10%), 1995-2012, and who had major depression on at least 1 screening evaluation from 2004-2012. Qualitative purposeful sampling was used instead of random sampling. Patients were stratified by previous/current or no pharmacotherapy treatment regardless of counseling history.Results: Fifty-six ADAMTS13-deficient patients in clinical remission had been screened for depression; 50 patients were alive in 2013; 24 had a score of major depression at least once. Of the 24 patients, 12 (50%) had taken pharmacotherapy for their depression and 12 (50%) patients had never taken pharmacotherapy.Data saturation was achieved after interviewing 16 patients (9 pharmacotherapy; 7 no pharmacotherapy). Fourteen patients (88%) were women, 9 (56%) were black, and the median age was 49 years (range 28-69). Patients were a median of 8.5 years from their most recent TTP episode (range 2-17 years), 5 (31%) had relapsed, and 7 (44%) had been treated with rituximab.Interviews among all patients revealed that a TTP diagnosis was 'life-altering’ and 'traumatic’. Many patients felt the residual effects of TTP (a fear of relapsing, fatigue, and mild cognitive impairment) were related to their depression. A major theme across groups was that patients had a positive attitude toward counseling and believed counseling could be an effective way to treat depression. However, a history of a negative counseling experience seemed to discourage many patients from continuing counseling. Additionally, regardless of previous counseling experience, a key idea across groups was mistrust toward the mental healthcare provider’s ability. However, this mistrust was only a perception among those who had never tried counseling. Within the pharmacotherapy group, patients believed that medication was an effective way to treat depression; however, many patients reported side effects (feeling 'sluggish’ and 'not caring about anything’) as the reasons for stopping the medication. On the contrary, among the non-pharmacotherapy group patients were unsure if pharmacotherapy actually worked-'Uh, I guess it kind of would keep you steady-minded I guess’. The fear of side effects and the fear of addiction were the biggest barriers among the non-pharmacotherapy group for using pharmacotherapy.Conclusion:Hematologists need to recognize that TTP is a long-term life-altering diagnosis following recovery. Identifying and managing depression is a critical issue that can save lives. TTP patients seem to have a positive attitude toward counseling and a mixed attitude toward pharmacotherapy. Whether these fears are valid is beyond the scope of this study; however, it is imperative that hematologists discuss the issue of depression in depth with their patients and address the barriers to acceptance of treatment. This study is a first step in identifying barriers to depression treatment in TTP survivors. DisclosuresNo relevant conflicts of interest to declare.

Preoperative Depression Symptom Severity and Its Impact on Adherence to Preoperative Beta-Blocker Therapy

To test the association among depression symptoms, distressed personality type, and preoperative beta-blocker nonadherence and to estimate the prevalence of untreated major depression in this population. Prospective observational study. A veterans hospital. One hundred twenty patients on outpatient beta-blocker therapy presenting for surgery. The Patient Health Questionnaire (PHQ)-9, the D-Scale-14 (DS14), and Modified Morisky Scale (MMS) questionnaires. Of 99 participants who presented for surgery, the incidence of preoperative nonadherence was 14.1% (95% confidence interval 7%-21%), consistent with prior research. Nonadherence was 9.5% among those with no depression, 27.8% among those with mild depression, and 28.6% among those with moderate-to-severe depression (Cochran-Armitage test for trend p = 0.03). Distressed personality type was found in 35% of the cohort (95% confidence interval 26-45%) and was not associated with beta-blocker nonadherence (Fisher's exact test, p = 0.24). Among participants with symptoms of major depressive disorder (n = 25, 25.3%), more than half (n = 14, 56%) had no indication of depression listed at their most recent primary care visit. Patients with symptoms of depression on chronic beta-blocker therapy are susceptible to medication nonadherence on the day of surgery. Most surgical patients with symptoms of major depression lack a diagnosis of depression. Preoperative depression screening may thus (1) identify a population at increased risk of beta-blocker withdrawal, and (2) identify patients who may benefit from anesthesiologist-initiated referral for this treatable condition.

To Treat or Not to Treat Perinatal Depression With Antidepressant Medication: Effects on Infant Growth

To Treat or Not to Treat Perinatal Depression With Antidepressant Medication: Effects on Infant Growth

Hippocampal Granule Neuron Number and Dentate Gyrus Volume in Antidepressant-Treated and Untreated Major Depression

Smaller hippocampal volume is reported in major depressive disorder (MDD). We hypothesize that it may be related to fewer granule neurons (GN) in the dentate gyrus (DG), a defect possibly reversible with antidepressants. We studied age-, sex-, and postmortem interval-matched groups: no major psychopathology (controls); unmedicated-MDD; and MDD treated with serotonin reuptake inhibitors (MDD*SSRI) or tricyclics (MDD*TCA). Frozen right hippocampi were fixed, sectioned (50 μm), immunostained with neuronal nuclear marker (NeuN), and counterstained with hematoxylin. GN and glial number, and DG and granule cell layer (GCL) volumes were stereologically estimated. Fewer GNs in the anterior DG were present in unmedicated-MDDs compared with controls (p=0.013). Younger age of MDD onset correlated with fewer GNs (p=0.021). Unmedicated-MDDs had fewer mid-DG GNs than MDD*SSRIs (p=0.028) and controls (p=0.032). Anterior GCL glial number did not differ between groups. Anterior/mid GCL volume was smaller in unmedicated-MDDs vs controls (p=0.008) and larger in MDD*SSRIs vs unmedicated-MDDs (p<0.001), MDD*TCAs (p<0.001), and controls (p<0.001). Anterior GCL volume and GN number (r=0.594, p=0.001), and mid DG volume and GN number (r=0.398, p=0.044) were correlated. Anterior DG capillary density correlated with GN number (p=0.027), and with GCL (p=0.024) and DG (r=0.400, p=0.047) volumes. Posterior DG volume and GN number did not differ between groups. Fewer GNs in unmedicated-MDD without fewer neuronal progenitor cells, as previously reported, suggests a cell maturation or survival defect, perhaps related to MDD duration. This may contribute to a smaller hippocampus and is potentially reversed by SSRIs. Postmortem studies are correlative and animal studies are needed to test implied causal relationships.

Estimating remission from untreated major depression: a systematic review and meta-analysis

Few studies have examined spontaneous remission from major depression. This study investigated the proportion of prevalent cases of untreated major depression that will remit without treatment in a year, and whether remission rates vary by disorder severity. Wait-list controlled trials and observational cohort studies published up to 2010 with data describing remission from untreated depression at ≤ 2-year follow-up were identified. Remission was defined as rescinded diagnoses or below threshold scores on standardized symptom measures. Nineteen studies were included in a regression model predicting the probability of 12-month remission from untreated depression, using logit transformed remission proportion as the dependent variable. Covariates included age, gender, study type and diagnostic measure. Wait-listed compared to primary-care samples, studies with longer follow-up duration and older adult compared to adult samples were associated with lower probability of remission. Child and adolescent samples were associated with higher probability of remission. Based on adult samples recruited from primary-care settings, the model estimated that 23% of prevalent cases of untreated depression will remit within 3 months, 32% within 6 months and 53% within 12 months. It is undesirable to expect 100% treatment coverage for depression, given many will remit before access to services is feasible. Data were drawn from consenting wait-list and primary-care samples, which potentially over-represented mild-to-moderate cases of depression. Considering reported rates of spontaneous remission, a short untreated period seems defensible for this subpopulation, where judged appropriate by the clinician. Conclusions may not apply to individuals with more severe depression.

Plasma Nitrate Levels and Flow-Mediated Vasodilation in Untreated Major Depression

Findings from several studies have revealed that major depression is associated with an increased cardiovascular risk. The physiopathologic mechanisms of this association remain unclear, although recently, it has been hypothesized that a decreased production of nitric oxide could be a potential contributor to vascular dysfunction in depressive patients. The objective of this study was to evaluate nitric oxide production and vascular endothelial function in treatment-naive young healthy adults with a first episode of major depression. A case-control study in 50 treatment-naive young adults with a first episode of major depression and 50 healthy control subjects was conducted. Plasma levels of nitric oxide metabolites (nitrates/nitrites) were determined using a colorimetric assay based on Griess reaction. Endothelial function was assessed by flow-mediated vasodilation measurements after reactive hyperemia. The mean age of the depressed patients was 22.6 (standard deviation [SD], 4.6) years, whereas the controls were 23.4 (SD, 4.8) years. Sixteen men (32%) and 34 women (68%) were included in each group. The plasma nitrite/nitrate concentrations were significantly lower in depressive subjects compared with healthy controls (17.5 [SD, 4.9] μmol/L versus 21.6 [SD, 7.0] μmol/L, p < .001); however, flow-mediated vasodilation values were similar in both groups (13.1% [SD, 4.3%] versus 12.1% [SD, 5.0%], p = .10). Decreased plasma concentrations of nitric oxide metabolites are not associated with vascular endothelial dysfunction in young subjects with a first episode of major depression. Reduced nitrate/nitrite levels could reflect a decreased nitric oxide production in the central nervous system of depressed subjects. Further studies are needed to confirm this hypothesis.

Parkinson disease and down in the dumps

Depression is a common problem in Parkinson disease (PD), occurring in approximately 50% of patients throughout the disease course.1 It can be distressing to both patients and their families and results in both increased functional disability2 and cognitive impairment.3 It is unclear whether depression in PD is associated with neuroanatomic or neurochemical changes in the brain, although hippocampal atrophy can occur in depression, especially with untreated major depression.4 Treatment for depression currently assumes neurochemical imbalance of noradrenergic and serotonergic systems. However, future approaches to treatment may need to take into account any associated neuronal loss. Epidemiologic studies have reported that depression may precede the onset of PD symptoms,5 and therefore a neuroanatomic signature of depression in PD could be a useful biomarker to predict the development of PD in depressed patients. A further complexity is whether depression preceding the onset of PD has the same neuroanatomic correlates as depression occurring after the onset of PD. The study by Kostic et al.6 appearing in this issue …

Geriatric Depression - Review for Primary Care

Late-life depression is the most common mood disorder in the geriatric population. Often encountered in the primary care setting, geriatric depression needs to be appropriately diagnosed and differentiated from medical conditions that can mimic it or present with mood symptoms. This review will help psychiatrists and primary care physicians to screen for, identify possible medical confounders, and treat depression in the elderly. Untreated major depression may lead to increased morbidity and mortality from medical illnesses, and is the strongest risk factor for late-life suicide. Pharmacological approaches should be used in combination with psychotherapies, several of which have solid evidence in geriatric depression.

Assessing Risk and Benefit: To Treat or Not to Treat Major Depression During Pregnancy With Antidepressant Medication

Assessing Risk and Benefit: To Treat or Not to Treat Major Depression During Pregnancy With Antidepressant Medication