Predictors for 2-year outcome of major depressive episode

In this 2-year prospective study, we searched for predictive factors influencing the 2-year outcome of major depressive episodes. Demographic characteristics (age, gender, education, employment), illness-related variables (severity, age at onset, number and duration of previous episodes), personality characteristics (DSM-IV personality disorders, trait anxiety, coping style), life context factors (life events before and during the depressive episode, social support, social adjustment), and biological markers (dexamethasone suppression test, thyroid stimulating hormone levels) of 117 inpatients with major depressive episode were assessed. A structural equation model was used to test the proposed correlational structure of the relevant variables. The non-remission of the depressive symptoms by the end of a 6-week acute treatment phase was found to be the most relevant factor predicting sustained non-remission at the end of a 2-year follow-up period. At the end of the sixth week, the severity of depression depended on the level of social support and on the severity of depression at baseline. Among the baseline variables, anxious personality traits and a lower level of education predicted a high level of depressive symptoms at the end of the 2-year follow-up. Life events before and during the depressive episode, and the biological markers at baseline had no direct effect on the outcome. The rapid remission of the depressive symptoms is the most important predictor for the favorable long-term outcome of a depressive episode. Personality characteristics, social support and level of education,--interacting with each other--also play a significant role.     

The development of major depressive episodes during the course of dysthymic and episodic major depressive disorders: a retrospective examination of life events

BACKGROUND: The present study examined whether stressful life events are associated with the development of major depressive episodes (MDEs) in a longitudinal, retrospective study of dysthymic and episodic major depressive disorders. METHODS: Sixty-seven outpatients with DSM-III-R dysthymia and 38 outpatients with non-chronic major depression were followed up 30-60 months after entry into the study. Follow-up assessments included a modified version of Paykel's (1997) Interview for Recent Life Events (IRLE) and Keller et al.'s (1987) Longitudinal Interval Follow-up Evaluation. Life events were assessed retrospectively in the 6 months before the most recent MDE or in the 6 months before follow-up for patients without a MDE. RESULTS: In dysthymic patients, MDEs were significantly associated with a new life event in the context of an ongoing chronic stressor. In episodic major depressive patients, relapses were associated with new life events regardless of an ongoing chronic stressor. LIMITATIONS: This was a retrospective study. It was also a conservative test of the association between life events and MDEs as the follow-up period over which life events were assessed was long, increasing the possibility of forgetting; events occurring less than 1 month before relapse were excluded to avoid confounding the event with the MDE; life events were assessed for a more distant time period for patients who experienced MDEs than those who did not; and an abbreviated version of the IRLE was used which may have failed to identify less severe events. CONCLUSIONS: This study suggests that life events may play a role in the onset of MDEs in persons with dysthymic disorder and those with major depressive disorder. Thus, clinicians should monitor dysthymic patients after a stressful life event, particularly if it occurs in the context of a chronic, ongoing stressor.     

Life events in depression. Relationship to subtypes

Life events that had occurred in the 6 months before the onset of depression were recorded in 40 depressed patients and 41 normal controls. The depressed patients had experienced significantly more life events and significantly more undesirable life events than the controls. The 20 patients with a DSM-III diagnosed major depressive episode (MDE) without melancholia had experienced significantly more life events in the 6 months before the onset of depression than the 20 patients with a major depressive episode with melancholia. The patients with MDE without melancholia, but not the MDE with melancholia patients, had also experienced significantly more life events than a group of age- and sex-matched normal controls.     

Major depressive disorder: A prospective study of residual subthreshold depressive symptoms as predictor of rapid relapse

Background: The study tested whether level of recovery from major depressive episodes (MDEs) predicts duration of recovery in unipolar major depressive disorder (MDD) patients. Methods: MDD patients seeking treatment at five academic centers were followed naturalistically for 10 years or longer. Patients were divided on the basis of intake MDE recovery into residual depressive symptoms (SSD; N=82) and asymptomatic (N=155) recovery groups. They were compared on time to first episode relapse/recurrence, antidepressant medication, and comorbid mental disorders. Recovery level was also compared to prior history of recurrent MDEs (>4 lifetime episodes) as a predictor of relapse/recurrence. Results: Residual SSD compared to asymptomatic recovery patients relapsed to their next MDE >3 times faster (median=68 vs. 23 weeks) and to any depressive episode >5 times faster (median=33 vs. 184 weeks). Residual SSD recovery status was significantly associated with early episode relapse (OR=3.65) and was stronger than history of recurrent MDEs (OR=1.64). Rapid relapse in the SSD group could not be attributed to higher comorbidity or lower antidepressant treatment. Limitations: Although inter-rater agreement on weekly depressive symptom ratings was very high (ICC>0.88), some error may exist in assigning recovery levels. Antidepressant treatments were recorded, but were not controlled. Conclusions: MDE recovery is a powerful predictor of time to episode relapse/recurrence. Residual SSD recovery is associated with very rapid episode relapse which supports the idea that SSD is an active state of illness. Asymptomatic recovery is associated with prolonged delay in episode recurrence. These findings of this present study have important implications for the goals of treatment of MDD and for defining true MDE recovery.     

Factors associated with major depressive disorder occurring after the onset of obsessive-compulsive disorder

BACKGROUND: We aimed to investigate the correlates of major depressive disorder (MDD) occurring after the onset of obsessive-compulsive disorder (OCD). METHODS: Forty-three OCD patients who developed MDD after the onset of OCD (OCD-MDD group) and 67 OCD patients without MDD (non-MDD, NMDD group) were compared with regard to sociodemographic characteristics, clinical history, symptom severity, types of obsessions and compulsions, insight degree, comorbid axis I and axis II diagnosis and quality-of-life level. RESULTS: The OCD-MDD group scored significantly higher on measures of obsessions, compulsions and depression severity than did the NMDD. Significantly more aggressive obsessions were identified in the OCD-MDD group than in the NMDD group. The OCD-MDD group was also significantly more likely than the NMDD group to have generalized anxiety disorder (GAD). There was no significant difference in the rate of personality disorders between the groups. The OCD-MDD group reported significantly lower levels of quality of life (QOL) in the domains of physical health, psychological health and social relationships. Depression severity was associated with obsession but not with compulsion severity. In a logistic regression model, obsession severity, presence of GAD and aggressive obsessions emerged as the factors associated with the occurrence of MDD. LIMITATIONS: To exclude ineligible patients, we gathered the information about past mood episodes cross-sectionally. CONCLUSIONS: These results suggest that psychopathological processes mediated by specific obsessions as well as excessive anxiety and worries may render the neurocircuities more vulnerable to the development of MDD. The occurrence of MDD in OCD cannot sufficiently be explained as a secondary complication to the disability of OCD.     

Categoric overgeneral autobiographical memory in adolescents with major depressive disorder

BACKGROUND: Categoric, overgeneral autobiographical memory is more common in depressed adults than controls and predicts persistence of depression. This cross-sectional study investigated whether, compared with non-depressed psychiatric cases and community controls, first episode major depressive disorder (MDD) in adolescents is associated with categoric overgeneral memory retrieval. METHODS: Ninety-six clinically referred adolescents (aged 12-17 years) with MDD, 26 non-depressed psychiatric cases and a sample of 33 community controls were recruited. All subjects were assessed using the Kiddie-Schedule for Schizophrenia and Affective Disorders, and completed Williams' cued Autobiographical Memory Test and the Mood and Feelings Questionnaire. Hamilton Depression Rating Scales were completed with MDD subjects, as an index of depression severity. RESULTS: Adolescents with current first episode MDD retrieved more categoric overgeneral memories than controls, but not than non-depressed psychiatric cases. Adolescents in full remission from a recent episode of MDD retrieved more categoric memories to positive cues than controls. Categoric memory in MDD was related to observer-rated and self-reported severity, but not to the pattern of co-morbid diagnoses. There were negative correlations between IQ and categoric memories in both clinical cases and controls. A positive correlation between categoric memory to negative cues and self-reported depressive symptoms was found in clinical cases (but not controls). CONCLUSIONS: In adolescents, increased categoric overgeneral memory is associated with, but not specific to first episode MDD. Positive categoric memories are also increased in fully remitted MDD as compared to controls.     

Major depressive disorder with anger: a bipolar spectrum disorder?

BACKGROUND: Depression with anger may be more common in bipolar disorders. The aim of the study was to assess whether major depressive disorder (MDD) with anger could be included in the bipolar spectrum, by comparing it to MDD without anger and to bipolar II disorder. METHODS: Consecutive outpatients (281 bipolar II disorder and 202 MDD) presenting for major depressive episode (MDE) treatment were interviewed with the DSM-IV structured clinical interview. Clinical variables used to support the inclusion of MDD with anger in the bipolar spectrum were age of onset, many MDE recurrences, atypical features of depression, depressive mixed state (an MDE plus some concurrent hypomanic symptoms), and bipolar family history. RESULTS: Frequency of MDE with anger was 50.5% [61.2% in bipolar II, and 35.6% in MDD (z = 5.5, p = 0.0000, 95% CI 16.8-43.3%)]. Logistic regression of MDE with anger (dependent variable) versus bipolar variables showed that MDE with anger was significantly associated with all bipolar variables, apart from recurrences. MDD with anger, compared with MDD without anger, had significantly lower age of onset, more marked depressive mixed state, a bipolar family history with more cases, but comparable atypical features and Global Assessment of Functioning scores. MDD with anger, compared with bipolar II disorder, had significantly higher age of onset, less atypical features, and a bipolar family history with less cases. CONCLUSIONS: MDE with anger was common in outpatients (more in bipolar II disorder). MDD with anger may be midway between MDD without anger and bipolar II disorder, and might be included into the bipolar spectrum. However, MDD with anger does not appear to be associated with the often reported negative response to monotherapy with antidepressants.     

Cognitive behavioral therapy for insomnia enhances depression outcome in patients with comorbid major depressive disorder and insomnia

STUDY OBJECTIVE: Insomnia impacts the course of major depressive disorder (MDD), hinders response to treatment, and increases risk for depressive relapse. This study is an initial evaluation of adding cognitive behavioral therapy for insomnia (CBTI) to the antidepressant medication escitalopram (EsCIT) in individuals with both disorders. DESIGN AND SETTING: A randomized, controlled, pilot study in a single academic medical center. PARTICIPANTS: 30 individuals (61% female, mean age 35 +/- 18) with MDD and insomnia. INTERVENTIONS: EsCIT and 7 individual therapy sessions of CBTI or CTRL (quasi-desensitization). Measurements and results: Depression was assessed with the HRSD17 and the depression portion of the SCID, administered by raters masked to treatment assignment, at baseline and after 2, 4, 6, 8, and 12 weeks of treatment. The primary outcome was remission of MDD at study exit, which required both an HRSD17 score < or =7 and absence of the 2 core symptoms of MDD. Sleep was assessed with the insomnia severity index (ISI), daily sleep diaries, and actigraphy. EsCIT + CBTI resulted in a higher rate of remission of depression (61.5%) than EsCIT + CTRL (33.3%). EsCIT + CBTI was also associated with a greater remission from insomnia (50.0%) than EsCIT + CTRL (7.7%) and larger improvement in all diary and actigraphy measures of sleep, except for total sleep time. CONCLUSIONS: This pilot study provides evidence that augmenting an antidepressant medication with a brief, symptom focused, cognitive-behavioral therapy for insomnia is promising for individuals with MDD and comorbid insomnia in terms of alleviating both depression and insomnia.     

Reconfirming the role of life events for the timing of depressive episodes. A two-year prospective follow-up study

BACKGROUND: Since the 1960s the association of stressful life events and depression seemed to be firmly established. However, a few recent studies did not confirm those earlier findings. One of the reasons discussed for the inconsistencies was the sampling of milder depressed neurotic out-patients in the earlier studies vs. more severely ill endogenous type in-patients in recent studies. METHODS: This investigation was carried out with 50 consecutively admitted in-patients with endogenous depression according to ICD 9 and unipolar major depression according to DSM-III-R as ascertained by SCID. The control sample consisted of 26 healthy volunteers. Life events and chronic distressing life conditions were recorded with the Munich Interview for the Assessment of Life Events and Conditions (MEL) every 3 months over a period of 2 years along with psychopathological symptoms and recurrencies. Hence the design was prospective in the sense that life events were recorded for one 3-month cross-section, the depressive reaction for the subsequent one. BDI scores taken at the respective cross section were used to control for depressive bias of the subjective part of the patient's life event evaluation. RESULTS: Three months prior to the index hospitalization patients were more often affected by life events and conditions than controls. The number of stressful conditions prior to the index hospitalization indicated the time to relapse after discharge. Controls showed more desirable positive conditions than patients. Relapse patients suffered more often stressful life events and conditions than non-relapsers 3 months prior to their relapse. Multivariate analysis indicates that the cumulative number of life events within the 2-year course is the best predictor of the BDI score at the end of the follow-up period. Limitations: Since the subjective component of life event assessment by MEL displayed a higher impact on the course of depression than the objective part of the assessment, confounding of subjective ratings, attributional styles, and depressive symptoms may be a problem although controlled for in this study. CONCLUSION: The results support the importance of stressful life events and chronic distressing conditions for the 2-year course and outcome of major depression in an in-patient sample. Since the overall consistency of significant results was more pronounced in the subjective than in the objective part of the MEL the results fit best a circular pathogenetic model of interactions between life events, their individual evaluation by the patient, and depressive symptoms.     

Psychiatric and psychosocial outcome of orthotopic liver transplantation

BACKGROUND: The study aimed to explore the prevalence of psychiatric disorders among orthotopic liver transplantation (OLT) recipients, and to investigate how psychiatric morbidity was linked to health-related quality of life (HRQOL). METHODS: We recruited 75 patients who had undergone OLT a median of 3.8 years previously (range = 5-129 months). Psychiatric morbidity was assessed using the Structural Clinical Interview for the DSM-III-R. Psychometric observer-rating and self-rating scales were administered to evaluate cognitive functioning (SKT), depressive symptomatology (HAMD(17)), posttraumatic stress symptoms (PTSS-10), social support (SSS), and HRQOL (SF-36 Health Status Questionnaire). Treatment characteristics were obtained from medical records. RESULTS: 22.7% (n = 17) of our sample had a current or probable psychiatric diagnosis according to DSM-III-R: 2.7% full posttraumatic stress disorder (PTSD) (n = 2), 2.7% major depressive disorder (MDD) comorbid to full PTSD (n = 2), 1.3% MDD comorbid to partial PTSD (n = 1), and 16% partial PTSD (n = 12). Patients with PTSD symptoms demonstrated lower cognitive performance, higher severity of depressive symptoms and more unfavorable perception of social support. OLT-related PTSD symptomatology was associated with maximal decrements in HRQOL. The duration of intensive care treatment, the number of medical complications, and the occurrence of acute rejection were positively correlated with the risk of PTSD symptoms subsequent to OLT. CONCLUSION: OLT-related PTSD symptomatology impairing HRQOL is a complication for a subgroup of OLT recipients. Health-care providers should be aware of the possible presence of PTSD in OLT survivors.     

Antidepressant dose reduction and the risk of relapse in major depressive disorder

BACKGROUND: Whether the dose of antidepressants can be reduced following clinical improvement without subsequently increasing the likelihood of depressive relapse has not been established. Thus, the aim of this work was to compare relapse rates among patients with major depressive disorder (MDD) randomized to either continue receiving the full versus a reduced dose of antidepressants following partial or full improvement of symptoms. METHODS: Five double-blind, randomized clinical trials involving 1,009 patients with MDD randomized to either continue receiving the full versus a reduced dose of antidepressants following partial or full improvement of symptoms were pooled using a random-effect meta-analysis model. RESULTS: Patients randomized to continue treatment with lower doses of antidepressants were more likely to experience a depressive relapse than patients who continued treatment with the full dose (risk ratio 1.62, 95% confidence interval: 1.52-2.80, p = 0.001). Pooled relapse rates were 25.3 and 15.1% for the two treatment groups. CONCLUSIONS: Decreasing the antidepressant dose following partial or full symptom improvement is associated with an increased risk of relapse in MDD.     

Cognitive therapy for depressed adults with comorbid social phobia

BACKGROUND: Evidence suggests that comorbid depression influences the outcome of cognitive-behavioral treatment for patients presenting with social phobia. Little is known, however, about the influence of comorbid social phobia on the response to cognitive therapy (CT) for depression among adults presenting with recurrent major depressive disorder (MDD). These analyses seek to clarify this relationship. METHODS: Patients (N=156) with recurrent DSM-IV MDD entered CT (20% also met DSM-IV criteria for social phobia). Every week during the course of CT, clinicians assessed depressive symptoms and patients completed self-report instruments measuring severity of depression and anxiety. RESULTS: At presentation, outpatients with comorbid social phobia reported greater levels of depressive symptoms and clinicians rated their impairment as more severe, compared to their counterparts without social phobia. Patients with or without comorbid social phobia did not differ significantly in (1) attrition rates; (2) response or sustained remission rates; (3) time to response or sustained remission; or (4) rate of improvement in symptoms of depression or anxiety. LIMITATIONS: The lack of domain-specific measures limits inference with respect to the improvements in social anxiety that occur with CT of depression. CONCLUSIONS: These findings introduce the hypothesis that CT for depression may be flexible enough to treat the depressive symptoms of patients presenting with MDD who also suffer from social phobia.     

影响抑郁症出院病人抑郁程度的多因素分析

目的探讨生活事件、自动思维、社会支持与应付方式对抑郁症出院病人抑郁严重程度的影响。方法对97例抑郁症患者在其出院时进行测评,测评工具包括自评抑郁量表(Self-Rating DepressionScale,SDS)、生活事件量表、社会支持量表、自动思维问卷和应付方式问卷,此外对100例正常对照亦进行上述测评。结果与正常对照组相比,抑郁症患者经历的应激性生活事件较多(131.4±105.2/103.0±93.3,t=2.0,P<0.05),得到较多的总社会支持(40.8±8.0/38.2±8.5,t=2.3,P<0.05)、客观和主观社会支持(t=2.1、3.0,P<0.05),较少采用幻想、求助、合理化、解决问题等应付方式(t=-3.3、-2.1、-2.6、-5.3,P<0.05)。logistic回归分析显示生活事件、自动思维、幻想、自责、解决问题五个指标对抑郁严重程度的影响有显著性。进一步路径分析表明,自动思维、自责、解决问题对抑郁程度有直接影响,自动思维对SDS的直接影响最大(路径系数为0.474,P<0.01),自责、解决问题为其次(路径系数分别为0.237、-0.150,P<0.01),而生活事件、幻想对抑郁严重程度的影响是间接的。结论生活事件、自动思维、幻想、自责、解决问题五个指标对出院病人抑郁严重程度的影响有显著性。     

Role of gender in depressive disorder outcome for individual and group cognitive-behavioral treatment

Gender in cognitive-behavioral therapy (CBT) for outcome for depression has been inadequately examined in previous research. Thirty-five men and 55 women diagnosed with a depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association, 1994) completed individual CBT at an outpatient community mental health clinic and 56 men and 105 women completed group CBT. Depression severity was measured before treatment and at endpoint using the Beck Depression Inventory-II (Beck, Steer, & Brown, 1996) along with secondary outcomes of anxiety (Beck Anxiety Inventory; Beck, Epstein, Brown, & Steer, 1988) and quality of life (Quality of Life Enjoyment and Satisfaction Questionnaire; Endicott, Nee, Harrison, & Blumenthal, 1993). Men and women demonstrated equivalent pretreatment and posttreatment illness severity, a comparable gradient of improvement on outcomes, and attainment of clinically meaningful benchmarks.     

The DSM-IV and ICD-10 categories of recurrent [major] depressive and bipolar II disorders: evidence that they lie on a dimensional spectrum

BACKGROUND: Presently it is a hotly debated issue whether unipolar and bipolar disorders are categorically distinct or lie on a spectrum. We used the ongoing Ravenna-San Diego Collaboration database to examine this question with respect to major depressive disorder (MDD) and bipolar II (BP-II). METHODS: The study population in FB's Italian private practice setting comprised consecutive 650 outpatients presenting with major depressive episode (MDE) and ascertained by a modified version of the Structured Clinical Interview for DSM-IV. Differential assignment of patients into MDD versus BP-II was made on the basis of discrete hypomanic episodes outside the timeframe of an MDE. In addition, hypomanic signs and symptoms during MDE (intra-MDE hypomania) were systematically assessed and graded by the Hypomania Interview Guide (HIG). The frequency distributions of the HIG total scores in each of the MDD, BP-II and the combined entire sample were plotted using the kernel density estimate. Finally, bipolar family history (BFH) was investigated by structured interview (the Family History Screen). RESULTS: There were 261 MDD and 389 BP-II. As in the previous smaller samples, categorically defined BP-II compared with MDD had significantly earlier age at onset, higher rates of familial bipolarity (mostly BP-II), history of MDE recurrences (>or=5), and atypical features. However, examining hypomania scores dimensionally, whether we examined the MDD, BP-II, or the combined sample, kernel density estimate distribution of these scores had a normal-like shape (i.e., no bimodality). Also, in the combined sample of MDE, we found a dose-response relationship between BFH loading and intra-MDE hypomania measured by HIG scores. LIMITATIONS: Although the interviewer (FB) could not be blind to the diagnostic status of his private patients, the systematic rigorous interview process in a very large clinical population minimized any unintended biases. CONCLUSIONS: Unlike previous studies that have examined the number of DSM-IV hypomanic signs and symptoms both outside and during MDE, the present analyses relied on the more precise hypomania scores as measured by the HIG. The finding of a dose-response relationship between BFH and HIG scores in the sample at large strongly suggests a continuity between BP-II and MDD. Our data indicate that even in those clinically depressed patients without past hypomanic episodes (so-called "unipolar" MDD), such scores are normally rather than bimodally distributed during MDE. Moreover, the absence of a 'zone of rarity' in the distribution of hypomanic scores in the combined total, MDD and BP-II MDE samples, indicates that MDD and BP-II exist on a dimensional spectrum. From a nosologic perspective, our data are contrary to what one would expect from a categorical unipolar-bipolar distinction. In practical terms, intra-MDE hypomania and BFH, especially in recurrent MDD, represent strong indicators of bipolarity.     

Sex- and age-related differences in major depressive disorder with comorbid anxiety treated with fluoxetine

Summary Objective: To examine sex- and age-related differences of treatment outcome in a cohort of outpatients with major depressive disorder (MDD), with and without comorbid anxiety, treated with fluoxetine.Methods: Outpatients with a SCID-diagnosis of MDD aged 18 to 65 years were treated openly with fluoxetine (20mg/day) for 8 weeks. The 17-item Hamilton Depression Rating Scale (HAM-D-17) was administered at baseline, and at weeks 2, 4, 6 and 8. Remission of MDD was defined as a HAM-D-17 score 7 at week 8. Rates of remission and change of depressive symptoms of MDD were compared among women aged <45 years and 45 years. The analyses were then repeated in men. The presence of comorbid anxiety disorders was included in the prediction model for change of depressive symptoms of MDD across age and sex.Results: 176 women and 153 men were included in this analysis. Remission of MDD occurred in 57.1% and 50% of younger and older women respectively. Similar rates were present in men (57.2% and 49.1%, respectively). Age did not predict remission of depression or change of depressive symptoms of MDD, in both women and men. Anxious and non-anxious subtypes of depression did not present sex- or age-related differences in treatment outcome.Conclusion: In this cohort of outpatients with MDD, we observed no sex- or age-related differences in response to an 8-week treatment with the SSRI fluoxetine. Similarly, there were no age-related differences among women with anxious and non-anxious subtype of depression.     

Course and outcome of major depressive disorder in non-referred adolescents

BACKGROUND: Although major depressive disorder (MDD) is one of the most common disorders in adolescence, little is known about its course and outcome in non-referred adolescents. Therefore, the aims of this article were to examine the course and outcome of MDD in non-referred adolescents, and to examine factors related to its stability. METHODS: Five hundred and twenty-three adolescents were interviewed twice at an interval of about 15 months using the computerized Munich version of the Composite International Diagnostic Interview. RESULTS: Of the 90 adolescents who met the diagnosis of MDD at T1, 22 (24.4%) still met the same diagnosis at T2. Sixty-eight (75.6%) of them no longer met the diagnosis of MDD at T2, and in some of these cases, their depression was replaced by several other disorders; 44 adolescents received no diagnostic criteria for any DSM-IV disorders. The factors that were significantly associated with the stability of MDD included the presence of substance use disorders and parental alcohol problems, negative life events and negative coping, past suicidal attempt, suicidal thought, and concrete suicidal plan at the T1-interview. Adolescents with "chronic" (T1 and T2) compared to "transient" (only T1) MDD and those without any disorders were significantly more impaired in various life domains. LIMITATIONS: This study was based on a small number of adolescents with a chronic MDD. CONCLUSIONS: The course and outcome of MDD in majority of the adolescents seemed to have a favourable course, whereas in some adolescents, it tended to have a heterogeneous pattern.     

Levels of depressive symptoms in spouses of people with lung cancer: effects of personality, social support, and caregiving burden

The authors sought to identify the personality correlates of depressive symptoms in 120 spouses of people with lung cancer. Spouses completed questionnaires, including measures of personality (neuroticism, extraversion, and interpersonal self-efficacy), social support, and caregiving burden. Their level of depressive symptoms was measured with self-report (Center for Epidemiologic Studies Depression Scale) and interviewer (Hamilton Depression Rating Scale) ratings. Structural equation modeling showed that neuroticism was directly associated with greater depressive symptoms and indirectly associated with less social support and greater caregiving burden. Interpersonal self-efficacy was indirectly associated with the severity of depressive symptoms through both social support and caregiving burden. These findings have implications for identifying spouses of individuals with lung cancer who are vulnerable to depression and could inform the design of programs to reduce depressive symptoms in the context of cancer caregiving.     

Treatment-associated suicidal ideation and adverse effects in an open, multicenter trial of fluoxetine for major depressive episodes

BACKGROUND: Some reports suggest that a subset of depressed patients may experience suicidality - that is increase or emergence of suicidal ideation (SI) or behavior--after initiation of an antidepressant. The time course and clinical correlates of this phenomenon have not been characterized in detail. METHOD: We conducted a secondary analysis of a multicenter, prospective, open, 12-week trial of fluoxetine 20 mg in outpatients with nonpsychotic major depressive episodes. Adverse effects and other clinical features associated with the emergence of suicidality, defined using item 3 of the Hamilton Depression Rating Scale, were examined using Cox regression models. RESULTS: Among 414 subjects without SI at baseline, 59 (14.3%) reported SI on at least 1 postbaseline visit. In a Cox regression, emergence of activation and worsening of depression severity were independently associated with emergence of SI, along with female gender, younger age and having thoughts that life was not worth living prior to treatment. Treatment response and remission were significantly less likely among subjects who developed SI. CONCLUSIONS: New SI was relatively common in this trial of fluoxetine and associated with the emergence of activation and overall symptomatic worsening. Whether prophylaxis against or aggressive treatment of adverse events can decrease emergence of SI merits further study.     

Potential Relationship between Season of Birth and Clinical Characteristics in Major Depressive Disorder in Koreans: Results from the CRESCEND Study

We aimed to examine the potential relationship between season of birth (SOB) and clinical characteristics in Korean patients with unipolar non-psychotic major depressive disorder (MDD). Using data from the Clinical Research Center for Depression (CRESCEND) study in South Korea, 891 MDD patients were divided into two groups, those born in spring/summer (n=457) and those born in autumn/winter (n=434). Measurement tools comprising the Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Brief Psychiatric Rating Scale, Scale for Suicidal Ideation, Clinical Global Impression of severity, Social and Occupation Functional Assessment Scale, WHO Quality of Life assessment instrument-abbreviated version, Alcohol Use Disorder Identification Test, and Temperament and Character Inventory were used to evaluate depression, anxiety, overall symptoms, suicidal ideation, global severity, social function, quality of life, drinking, and temperament and character, respectively. Using independent t-tests for continuous variables and χ² tests for discrete variables, the clinical characteristics of the two groups were compared. MDD patients born in spring/summer were on average younger at onset of first depressive episode (t=2.084, p=0.038), had greater loss of concentration (χ²=4.589, p=0.032), and were more self-directed (t=2.256, p=0.025) than those born in autumn/winter. Clinically, there was a trend for the MDD patients born in spring/summer to display the contradictory characteristics of more severe clinical course and less illness burden; this may have been partly due to a paradoxical effect of the 5-HT system.