Self rated depression in relation to DSM-III classification: a statistical isolinear multiple components analysis

The Zung Self-Rating Depression Scale (SDS) was presented to 99 depressed inpatients. The patients were categorized according to DSM-III as suffering from minor depression, major depression without melancholia and major depression with melancholia and/or with psychotic features. Differences in self-reported symptoms between these categories were studied with multivariate statistical techniques including linear discriminant analysis (LDA) and statistical isolinear multiple components analysis (SIMCA). Patients with minor depression rate themselves significantly less depressed than those with major depression. Patients with major depression without melancholia are less depressed than those with melancholia and/or psychotic features. The three DSM-III depressive categories can be regarded as belonging to a clinical continuum in which they form relevant levels with quantitative differences in self-reported symptoms. These differences are not only defined by gradual shiftings in the overall severity of illness, but also by quantitative differences in the severity of some target symptoms, i.e. agitation, retardation, diurnal variation, loss of libido, fatiguability, insomnia, anorexia, sadness and anhedonia.     

Clinical subtypes of unipolar depression: Part III. Quantitative differences in various biological markers between the cluster-analytically generated nonvital and vital depression classes

The hypothalamic-pituitary-adrenal (HPA) axis, the hypothalamic-pituitary-thyroid (HPT) axis, and the availability of L-tryptophan (L-TRP) to the brain were studied in their relationships to (1) 14 depressive symptoms measured by the Structured Clinical Interview for DSM-III-R--Patient Version (SCID) and (2) the cluster-analytically generated vital/nonvital classes. The following biological parameters were measured in 100 depressed females: free thyroxine (FT4), baseline thyroid stimulating hormone (TSH), predexamethasone and postdexamethasone cortisol and adrenocorticotropic hormone (ACTH) values, the circulating levels of total L-TRP, and the L-TRP/sum of competing amino acids ratio. We found that the psychopathological correlates of disorders in the HPA/HPT axis and of a decreased availability of L-TRP were vital symptoms, i.e., distinct quality of mood, nonreactivity, early morning awakening, anorexia-weight loss, and psychomotor disorders. There was no significant relationship between those biological markers and the nonvital symptoms of the SCID inventory for depressive symptoms. However, we did not validate our SCID clustering in vital and nonvital classes by qualitative differences in the biological variables. It was concluded that our nonvital/vital clusters should be regarded as continuous categories with regard to the biological markers studied; these clusters constitute relevant stages in the continuum of progressing biological dysfunction.     

Leukocytosis, monocytosis and neutrophilia: hallmarks of severe depression.

To date, there has been a small number of reports that severe depression is accompanied by disturbances in total white blood cell (i.e. leukocytosis) and leukocyte subset (i.e. neutrophilia, monocytosis, lymphopenia) counts. These results, however, have not yet been validated in a large-scale, well-controlled study. To this end, we have counted the number of leukocytes, monocytes, lymphocytes and granulocytes (neutrophils, eosinophils, basophils) in 22 healthy controls and in 109 depressed inpatients. We noted leukocytosis in major depressed patients compared with normal subjects, whilst minor depressives manifested intermediate findings. Leukocytosis was significantly more pronounced in major depressed males compared with major depressed females. Major depression related leukocytosis appears to be characterized by neutrophilia and monocytosis. There was a significant positive relationship between the overall severity of illness on one hand, and the degrees of leukocytosis, neutrophilia and monocytosis on the other. The total number of both phagocytic cell populations (i.e. monocytes and neutrophils) was significantly and positively related. Our results might point to the existence of an inflammatory process in major depressed subjects, particularly in males.     

The Newcastle Index for the diagnosis of endogenous depression. Comparison with the Research Diagnostic Criteria for major depression

The Newcastle index comprises 10 items (with a positive or negative score) the sum of which enables us to separate endogenous and neurotic depressive patients. We applied this index to a sample of 41 depressive inpatients who met Research Diagnostic Criteria (RDC) for major depression. According to Newcastle index, 20 patients were considered to be endogenous and 21 to be neurotic. There was no significant difference between the two groups with regard to sex distribution and mean age. The distribution of scores suggested a trend toward bimodality. Endogenous depressives exhibited higher severity level than neurotic depressives, as shown by the total score on the Hamilton depression scale as well as the scores on various items related to depressive mood, guilt, decreased activity, psychomotor disturbances, genital symptoms, helplessness, hopelessness, and worthlessness. This higher severity level was confirmed by the higher frequency of two symptomatic criteria of major depression among endogenous depressives as compared to neurotic depressives: psychomotor and memory disturbances. Moreover, endogenous depressives defined by Newcastle index were more frequently of primary, endogenous, agitated and simple RDC subtypes whereas neurotic depressives were more frequently of secondary and situational RDC subtypes. Therefore, the results of this preliminary study suggest that the Newcastle index may enable us to define two subtypes of depressive patients characterized by different symptomatic severity levels.     

Validity of the Hamilton Endogenous Subscale: an independent replication

We calculated scores on the Hamilton Endogenous Subscale (HES) (Thase et al., 1983) for 252 depressed inpatients. The HES scores were bimodally distributed, and HES classification was significantly associated with endogenous (Research Diagnostic Criteria) and melancholic (DSM-III) subtyping. Based on a cutoff score of 8, HES classification was not associated with either family history of specific psychiatric illness or abnormal dexamethasone suppression test (DST) results. When the cutoff was raised to 10, DST nonsuppression was more frequent in HES endogenous depressives, although we again failed to find an association with a family history of psychiatric disorders.     

Rate of oxygen consumption in seasonal and non-seasonal depression.

Most depressives suffer from weight loss, anorexia and insomnia, while for winter depressives the typical symptoms are weight gain, carbohydrate craving, overeating, oversleeping and extreme lack of energy. It is important to know whether winter depressives differ from most other depressives on measures of energy regulation. In wintertime, we evaluated the rate of oxygen consumption in relationship to neuro-vegetative depressive symptoms in 92 Siberian women. The seated subjects underwent oxyspirography in the mid-morning (1.5 hours after a standard breakfast). It was found that the oxygen consumption rate was similar in non-depressed women (n = 25) and depressed women with non-seasonal depression (n = 27). The comparatively lower values were obtained in women with winter depression (n = 40). This finding supports the suggestion that the behaviour disturbances typical for winter depression may represent a physiological feedback loop to energy conservation.     

Depressed women with panic attacks

Of a group of 288 depressed female inpatients, 43 (15%) had secondary panic attacks. Compared to other depressives, the subgroup with panic attacks had significantly higher frequencies of anorexia, weight loss, gastrointestinal disturbances, hypochondriasis, and psychomotor agitation, and significantly lower frequencies of melancholic symptoms, including loss of interest in usual activities, guilt feelings, delusional thinking, psychomotor retardation, and orientation or memory impairment. Patients with panic attacks were less likely to have a depressed parent and were more likely to be described as having been nervous, worrisome, sensitive, and sexually dysfunctional before the onset of depression. Phenomenologically, they resembled "anxious depressives" as described by other authors.     

The prediction of suicidal intent in depressed patients

The aim of the present study was to examine the relationships between suicidal ideation or suicidal attempts and severity of depression, presence of personality disorders, and sociodemographic factors in a population of depressed in-patients. A total of 338 adult depressed psychiatric in-patients were examined and classified according to DSM-III criteria as having major depression with or without melancholic or psychotic features, adjustment disorder with depressed mood or dysthymic disorder. Scores on the Hamilton Depression Rating Scale (HDRS), Beck Depression Inventory (BDI) and Zung Self-Rating Depression and Anxiety Scales (SDS and SAS) were measured. We found that suicidal ideation was significantly related to severity of depression (according to the HDRS and all self-rating scales), a lower global assessment of functioning the year before hospitalization, and previous psychiatric hospitalizations. The items with the strongest predictive value for suicidal ideation were hopelessness, depressed mood, feelings of guilt, loss of interest and low self-esteem. These symptoms predicted 43% of the variance in suicidal ideation. None of the above predictors of suicidal ideation was related to suicidal attempts. Depressed patients with a personality disorder attempted significantly more suicidal attempts and showed more suicidal ideation than depressed patients without personality disorder. No significant correlations were found between suicidal ideation or suicide attempts and gender, marital status, employment status or psychosocial stressors during the previous 6 months.     

Depression-related disturbances in mitogen-induced lymphocyte responses and interleukin-1 beta and soluble interleukin-2 receptor production.

In an attempt to delineate the pathophysiology underpinning the previously reported blunted lymphocyte responses to mitogenic stimulation in depressed patients, we measured the following immune variables in 28 depressives and 10 healthy controls: pre- and postdexamethasone (1 mg orally) lymphocyte responses to various mitogens, such as phytohaemagglutinin (PHA), and the PHA-induced accumulation of interleukin-1 beta (Il-1 beta) and soluble interleukin-2-receptors (sIl-2Rs) in culture supernatants. In the predexamethasone state, we found significantly more mitogen-stimulated blastogenesis in minor depressives vs healthy controls and major depressives. In depressed subjects there was a significant inverse relationship between the severity of illness and the mitogen-induced lymphocyte responses. Melancholics exhibited significantly more Il-1 beta accumulation in PHA culture supernatant than healthy controls. In healthy controls--but not in depressed patients--the sIl-2R accumulation perfectly reflects the magnitude of the PHA-induced lymphocyte stimulation. Dexamethasone administration significantly suppressed the lectin-induced blastogenesis and the Il-1 beta production rate in normal volunteers, whereas depressives exhibited dexamethasone nonsuppression in those factors. Healthy controls exhibited significantly less postdexamethasone blast transformation, Il-1 beta and sIl-2Rs accumulation in culture supernatant than the depressed patients.     

A neurochemical theory of appetite and weight changes in depressive states

The literature concerning appetite and weight changes in depressive illness is reviewed. Diminished appetite and weight loss have for about 100 years been regarded as prominent symptoms of depressive illness. A tendency for some depressives to gain weight has also been recognized. About 85 % of depressives lose weight and 15 % gain weight. There appears to be a tendency for weight gain to be commoner in milder depressions. Carbohydrate craving is also described in association with some depressed states. The neurochemical control of appetite in health is surveyed. Norepinephrine appears to be necessary for the intake of food, and drugs which raise intrasynaptic levels of norepinephrine stimulate feeding. Serotonin seems to be associated with satiety and in experimental animals decreased intrasynaptic levels of serotonin produce carbohydrate hunger. The neurochemical control of appetite is discussed in relation to the amine theories of depression. A number of hypotheses are drawn from this discussion.     

HEALTH,HEALTH BEHAVIOUR AND FUNCTIONAL ABILITY PREDICTING DEPRESSION IN OLD AGE: A LONGITUDINAL STUDY

The predictive value of health, health behaviour and functional ability for the occurrence of depression in elderly Finns is described using a longitudinal design. The persons determined as not being depressed (DSM-III criteria) in an epidemiological study in 1984–85 were interviewed and examined in a follow-up study in 1989–90 (N=679). The risk factors were analysed by contrasting the persons depressed in 1989–90 with those not depressed. Of the symptoms, recurrent falling and a loss of appetite in men, and palpitation, dyspnoea at rest, tremor in the hands, nausea, dizziness, recurrent falling, apathy and feebleness, fatigue and weakness, restlessness and sight disturbances in women predicted depression. Certain depressive symptoms, such as crying spells, psychomotor agitation, irritability, self-deprecation and suicidal thoughts in men, and sadness, tachycardia, a loss of concentration, psychomotor retardation and indecisiveness in women, also predicted depression. Numerous somatic and psychosomatic symptoms and numerous depressive symptoms were risk factors for women. Old age, poor self-perceived health, dependence on outside help in negotiating stairs and dependence on outside help in washing oneself were risk factors for men. A previous episode of depression was a predictor in both sexes. Sex was not related to the risk of depression. Both in men and women, an impairment of functional abilities during the follow-up was related to depression. A decline of self-perceived health, an occurrence of a serious disease and a decrease in the amount of physical exercise among women and moving into long-term institutional care and a decline of self-perceived health during the follow-up among men were associated with a greater risk. The occurrence of genitourinary diseases in men and the occurrence of vascular, cerebrovascular, thyroid or neurological disease in women during the follow-up were related to a high risk. The results support the hypotheses of a multifactorial aetiology and a relapsing and episodic course of depression in old age.     

Plasma postdexamethasone cortisol levels in schizoaffective disorder

The degree of hypothalamic-pituitary-adrenal (HPA) axis dysregulation in depressed patients with schizoaffective disorder was compared to that seen in patients with major depressive disorder with and without delusional features. The frequency of nonsuppression to dexamethasone was similar for all three diagnostic groups. Maximum postdexamethasone plasma cortisol was greater for delusional depressives, but did not differ between patients with major depressive and schizoaffective disorders. Modest correlations were found between postdexamethasone plasma cortisol levels, severity of illness, age, and recent weight loss, for patients with both major depressive disorder and delusional depression. For schizoaffective patients, associations between postdexamethasone plasma cortisol levels and various measures of severity of illness, but not age and recent weight loss, were found. Although HPA axis dysregulation occurs more frequently in all three of the studied diagnostic groups than in normal individuals, factors contributing to this dysregulation may be qualitatively different for schizoaffective patients.     

Dipeptidyl peptidase IV and adenosine deaminase activity. Decrease in depression

Dipeptidyl peptidase IV (DPPIV) and adenosine deaminase (ADA), two T cell associated enzymes, are known to have a possible interaction and play essential roles in immune system functioning. On the other hand, depression has been shown to be accompanied with some immune-inflammatory alterations. In this regard, in order to make a contribution to the understanding of the ongoing immune disturbances in depression, serum DPPIV and ADA activities were determined in minor and major depressives and compared with healthy controls. Both enzyme activities were found to be decreased in major depressives compared to controls while only DPPIV activity was significantly lower in major depressives than the minor depressives. There were significant inverse relationships between enzyme activities and the severity of depression. Moreover, a positive intracorrelation was found between decreased DPPIV and ADA levels. The correlated decrease in DPPIV and ADA, might be a further support for their possible association. Results also suggest that decreased enzyme activities might reflect the impaired immune state in depression while major depressed patients might have a greater tendency to immune dysfunction than the minor depressed ones.     

Ethological assessment of the DSM-III subtyping of unipolar depression

An ethological method was employed to validate the DSM-III subtyping of unipolar, nondelusional depression. The nonverbal behavior of 44 depressed outpatients was video-recorded during psychiatric interview. The DSM-III subtyping was not significantly associated with sex or level of education. Patients with major depression (with or without melancholia) were significantly older than those with dysthymic disorder. The Hamilton Rating Scale for Depression (HRSD) scores of the 3 diagnostic groups indicated a progressive increase in symptom severity across DSM-III subtypes (dysthymic disorder less than major depression without melancholia less than major depression with melancholia). Ethological assessment failed to find any evidence for the validity of the DSM-III subtyping of unipolar depression. Of the 8 behavioral categories analyzed in this study, none showed statistically significant differences between the 3 diagnostic groups. Our interpretation of these results is that, whereas the DSM-III subtyping primarily reflects illness severity, the ethological profile measures a dimension of depression largely independent from severity, as indicated by the lack of correlation between the HRSD score and the categories of nonverbal behavior.     

History of separation anxiety in patients with panic disorder and depression and normal controls

The frequency and severity of separation anxiety for subjects with panic disorder and major depression was compared with that for normal controls. The subjects were diagnosed according to DSM-III criteria. Each subject completed a questionnaire consisting of 9 items derived from DSM-III criteria for separation anxiety disorder. The incidence of separation anxiety and its severity were significantly higher for the panic disorder subjects than for normal controls but there was no significant difference between depressed and panic disorder subjects. Panic disorder subjects with a history of separation anxiety disorder had a significantly earlier onset of panic attacks.     

Symptom profiles of biological markers in depression: a multivariate study

The dexamethasone suppression test (DST), the thyrotropin releasing hormone (TRH) test, and the ratio of plasma L-tryptophan to competing amino acids (L-TRP/CAA) were studied in relation to the 21 items of the Hamilton Depression Rating Scale (HDRS) in 123 depressed patients categorized according to DSM-III. The relationships between the biological data and the items or item clusters of the HDRS were assessed by multivariate analyses. The psychopathological correlates of increased post-dexamethasone cortisol and decreased thyroid stimulating hormone (TSH) responsivity to TRH were middle and delayed insomnia and weight loss. The symptom correlates of decreased availability of L-TRP to the brain were psychic anxiety, depersonalization, obsessions and paranoid symptoms. Core depressive symptoms, i.e. depression, loss of interest, feelings of guilt and suicidal thoughts, were not related to the biological markers.     

The nature of depression in borderline depressed patients.

The symptomatology of 15 borderline (BDL) depressed and 45 non-BDL depressed consecutive inpatients was assessed using the Hamilton depression scale (HAM-D) and the 90-item Symptoms Checklist (SCL-90) self-rating questionnaire. No significant differences were found in the total scorings of the two instruments in the two groups of patients. However, while non-BDL depressive rated significantly higher in items related to melancholic forms of depression, BDL depressives showed less specific symptoms, and the persistence, or possibly the magnification, of their maladaptive personologic structure. Two discriminant analyses, performed on the ratings at the HAM-D and SCL-90 of the two groups of patients, suggested that although the total degree of severity may be the same, the depressive episodes of BDL patients are qualitatively different from those of patients with less maladaptive personologic traits.     

Clinician-rated symptoms and signs of depression in aged Finns

The study describes symptoms and signs of depression in elderly (60 years or over) Finns. Lists of symptoms and signs assessed by the examining physicians in a population study were used in rating, and the symptoms and signs of persons diagnosed as depressed were compared to those of persons who were not depressed. The commonest symptoms both in men and women were sleep disturbances, fatiguability, loss of interest, depressed mood, loss of activity, pains, pessimism and sense of uselessness. In addition, worry was a common symptom in women. Hallucinations and other delusions than those about unforgivable behaviour were very uncommon. Loss of libido did not strongly indicate occurrence of depression, and in persons aged 70 years or over it could not be included in symptoms of depression. Sex differences in the commonest symptoms of depression were evident: worry, crying spells, helplessness, loneliness, suicidal ideas and pains were more common in depressed women than in depressed men. Some age differences in symptoms were also found both in men and in women. Sad expression was a common sign of depression in both sexes. In addition, slow movements, scarcity of gestures and slow speech were quite common signs in depressed men and stooping posture was quite common in depressed women.