Is antidepressant-associated mania always an evidence of a bipolar spectrum disorder? A case report and review of the literature

Objective

The authors consider the clinical implications of characterizing every case of antidepressant-induced mania as evidence of an underlying bipolar diathesis.

Method

The authors report the case of a 45-year-old man, with no personal or family history of bipolar symptoms, who developed manic symptoms after sertraline initiation for a first lifetime depressive episode.

Results

The patient's manic symptoms resolved rapidly with cessation of sertraline. His depressive symptoms responded to mirtazapine, and he had no further mood episodes during 2-year follow-up.

Discussion

It may not always be appropriate to identify selective serotonin reuptake inhibitor-induced manic symptoms as pathognomonic for the bipolar diathesis, particularly as the bipolar formulation has distinct implications for future pharmacologic choices.     

The clinical impact of mood disorder comorbidity on social anxiety disorder

Background

High comorbidity rates of mood disorders have been reported in patients with social anxiety disorder (SAD). Our study aims to identify the frequency of comorbid Axis I disorders in patients with SAD and to investigate the impact of psychiatric comorbidity on SAD.

Methods

The study included 247 patients with SAD. Thirty eight patients with bipolar depression (SAD-BD), 150 patients with major depressive disorder (SAD-MDD) and 25 patients who do not have any mood disorder comorbidity (SAD-NOMD) were compared.

Results

Around 90% of SAD patients had at least one comorbid disorder. Comorbidity rates of lifetime MDD and BD were 74.5% and 15.4%, respectively. There was no comorbidity in the SAD-NOMD group. Atypical depression, total number of depressive episodes and rate of PTSD comorbidity were higher in SAD-BD than in SAD-MDD. Additionally, OCD comorbidity was higher in SAD-BD than in SAD-NOMD. SAD-MDD group had higher social anxiety severity than SAD-NOMD.

Conclusions

Mood disorder comorbidity might be associated with increased severity and decreased functionality in patients with SAD.     

Eating disorder symptoms and comorbid psychopathology among male and female veterans

Objective

Eating disorder (ED) symptoms have gone mostly unexamined among veterans. The current study assessed rates of bulimia nervosa (BN) and binge eating disorder (BED) symptoms and diagnoses and their associations with common comorbidities among male and female veterans.

Method

Participants were US military veterans who screened positive for trauma histories and/or a probable Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM-IV) posttraumatic stress disorder (PTSD) diagnosis (n= 499). Symptoms of PTSD were assessed using the Clinician-Administered PTSD Scale, and symptoms of EDs, mood, and substance use disorders were assessed using the Structured Clinical Interview for the DSM-IV.

Results

Lifetime rates of BN and BED diagnoses were comparable to civilian populations, and a considerable range of lifetime and current BN and BED symptoms were identified. In multivariate models, PTSD and depression severity were most consistently associated with BN and BED symptom severity, with depression most strongly associated with EDs for women.

Conclusions

Findings highlight the importance of screening for ED symptoms among male and female veterans, particularly those that present with PTSD and depression symptomatology. Future examinations of the temporal order of such relationships and the degree to which ED symptoms and associated symptoms impact veteran functioning are warranted.     

Seasonal variation of depressive symptoms in unipolar major depressive disorder

Objectives

Retrospective and cross-sectional studies of seasonal variation of depressive symptoms in unipolar major depression have yielded conflicting results. We examined seasonal variation of mood symptoms in a long-term prospective cohort – the Collaborative Depression Study (CDS).

Methods

The sample included 298 CDS participants from five academic centers with a prospectively derived diagnosis of unipolar major depression who were followed for at least ten years of annual or semi-annual assessments. Generalized linear mixed models were utilized to investigate the presence of seasonal patterns. In a subset of 271 participants followed for at least 20 years, the stability of a winter depressive pattern was assessed across the first two decades of follow-up.

Results

A small increase in proportion of time depressed was found in the months surrounding the winter solstice, although the greatest symptom burden was seen in December through April with a peak in March. The relative burden of winter depressive symptoms in the first decade demonstrated no relationship to that of the second decade. The onset of new episodes was highest October through January, peaking in January.

Conclusions

There exists a small but statistically significant peak in depressive symptoms from the month of the winter solstice to the month of the spring equinox. However, the predominance of winter depressive symptoms did not appear stable over the long-term course of illness.     

Prevalence of depressive symptoms and predictors of treatment among U.S. adults from 2005 to 2010

Objectives

To determine nationally representative estimates of the prevalence of depressive symptoms and factors associated with treatment among those with moderate to severe symptoms.

Methods

A cross-sectional, retrospective analysis of adults age ≥ 18 years in the 2005–2010 National Health and Nutrition Examination Survey data who responded to the Patient Health Questionnaire (PHQ-9) was conducted (n= 13,320). Depressive symptoms and severity were defined by PHQ-9 scores. Depression treatment was defined as either receiving antidepressants or seeing a mental health professional. Multivariable logistic regression analyses using population weights identified factors associated with having depressive symptoms and receipt of any treatment.

Results

The prevalence of depressive symptoms increased from 20.92% to 25.66% over 6 years. Among patients with moderate to severe depression, 38.66% received treatment. Multivariable analyses found that being female, other Hispanic, younger age, having certain chronic comorbidities or previous hospitalization, no health insurance and in poverty status were associated with having depressive symptoms (P< .05). Among patients with moderate to severe depression, being female, white, younger age, having comorbidities (arthritis and hypertension) or previous hospitalization were associated with receipt of treatment (P< .05).

Conclusions

The prevalence of depressive symptoms is high, and only a small portion of patients with moderate to severe depression received treatments. Treatment disparities exist and need improvement.     

Understanding catastrophic worry in eating disorders: process and content characteristics

Background and objectives

The majority of people with eating disorders (ED) experience high levels of comorbid anxiety and depression, yet the maintenance processes of these in ED remain largely unknown. Worry, a defining cognitive feature and important maintenance factor of anxiety, has not been well-studied amongst people with ED. This is the first study to explore both the process and content characteristics of catastrophic worry in ED.

Methods

Twenty-nine patients with anorexia nervosa (AN), 15 patients with bulimia nervosa (BN) and 37 healthy controls (HC) completed measures assessing anxiety, depression, worry and eating disorder pathology. Catastrophic worry was assessed using the Catastrophizing Interview and catastrophic worry content was explored using qualitative Thematic Analysis.

Results

Compared to HCs, ED groups had higher levels of anxiety, depression and worry and they generated a greater number of catastrophic worry steps. Worry was further found associated with depressive symptomatology in those with ED. Worry content for the ED groups included ED themes, but also themes reflecting broader inter and intrapersonal concerns.

Limitations

The degree to which worry is driven by depressive versus anxious symptomatology remains unclear. The current study does not include an anxious or depressed control group, and results should be considered in the light of relatively small samples sizes.

Conclusion

Findings indicate that interventions that target worry processes may be a useful adjunct to treatment for those ED patients with clinical worry levels.     

Anger with murderous impulse induced by lamotrigine

Objective

To report two cases of major depressive disorder in which lamotrigine (LTG) induced anger with murderous impulse.

Patients

Case 1 was a 22-year-old man with symptoms of obsessive–compulsive disorder who developed major depressive disorder with antidepressant-induced hypomanic episodes. Case 2 was a 23-year-old woman experiencing an antidepressant-refractory depressive episode for whom remission was achieved by switching to a mood stabilizer and antipsychotics. In both cases LTG was started to treat the depressive episode.

Results

Case 1 manifested with anger and murderous impulse when taking 125 mg/day of LTG. A reduction to 75 mg/day calmed this anger. Case 2 manifested with the same symptom when taking 25 mg/day of LTG, and the symptom immediately disappeared upon stopping LTG.

Conclusions

Use of LTG for epilepsy in intellectually disabled patients was reported to be associated with onset or exacerbation of aggressive or violent behavior. The two cases would suggest that LTG may cause anger so severe as to be accompanied with murderous impulse when administered to patients with mood disorders. Physicians should be cognizant of this possible, albeit infrequent, adverse effect even in use of LTG for mood disorders.     

The presence of a depressive episode predicts lower return to work rate after myocardial infarction

Context

No studies have evaluated whether the presence of a depressive episode is associated with an increased risk of not returning to work following myocardial infarction (MI).

Objectives

To examine the prospective associations between depressive episode and anxiety disorders with return to work (RTW) after MI at 3 and 12 months based on International Classification of Diseases, 10th Revision.

Design

Prospective cohort study.

Setting

Four hospitals in the North of The Netherlands.

Participants

From a sample of patients hospitalized for MI (n= 487), we selected those who had a paid job at the time of the MI (N= 200).

Main exposure measures

Presence of a depressive episode and presence of any anxiety disorder during the first 3 months post-MI.

Main outcome measures

RTW at 12 months post-MI.

Results

Of the patients with work prior to MI, 75% had returned to work at 12 months. The presence of a depressive episode during the first 3 months (prevalence: 19.4%) was a significant predictor of no RTW at 12 months post-MI, also after controlling for confounders [odds ratio (OR) 3.48; 95% confidence interval (CI): 1.45–8.37]. The presence of an anxiety disorder (prevalence: 11.9%) had a borderline significant association with no RTW as well. This association remained after controlling for confounders (OR 2.90; 95% CI: 1.00–6.38) but diminished when controlling for depression.

Conclusions

The presence of a depressive episode was associated with an increased risk of no RTW in MI patients. The association between anxiety and risk of no RTW could in part be explained by the presence of depression. Further studies may address the possibility of countering the effect of depression by effective treatment.     

Executive function performance is reduced during occupational burnout but can recover to the level of healthy controls

Background

Burnout is a work-related syndrome that comprises physical fatigue, emotional exhaustion and cognitive weariness and is considered to be a risk factor for the development of major depression. While cognitive impairments in major depression persist even after remission of mood symptoms, the role of cognitive impairments in burnout is less clear. The hypothesis tested in the present study submits that executive function performance is reduced during burnout compared to healthy subjects but can recover to normal levels.

Methods

12 male subjects (mean age 45.8 ± 6.8 years) suffering from occupational burnout took part in the study. They completed questionnaires related to burnout severity and underwent testing of executive functions twice at baseline and at follow-up 12 weeks later. Between baseline and follow-up burnout participants performed regular aerobic exercise training. Executive function performance at baseline and follow-up was compared to 12 matched healthy controls.

Results

Executive functioning was significantly reduced during acute burnout compared to healthy controls. At follow-up, both burnout severity and executive functioning were improved. Changes in burnout severity and executive function performance were not related.

Conclusions

Data suggest that executive function performance is impaired during acute burnout but can recover to the level of healthy controls. This finding is at odds with the finding of persistent deficits in the same tests found in major depression even after remission of depressive mood. Results may indicate that the pathophysiological changes underlying the impaired executive functioning during burnout are less pronounced compared to those in major depression.     

The prevalence of depression and anxiety disorders in patients with euthyroid Hashimoto’s thyroiditis: a comparative study

Objective

The aim of this study was to examine the current prevalence of major depression and anxiety disorders in patients with euthyroid Hashimoto’s thyroiditis (HT) and euthyroid goiter.

Method

The study sample was formed by consecutive 51 and 45 patients who were admitted to the endocrinology outpatient clinic and diagnosed with euthyroid HT and endemic/nonendemic goiter, respectively, and 68 healthy controls. Current diagnoses of psychiatric disorders were determined using the Structured Clinical Interview for DSM-IV. Beck Depression Inventory and Beck Anxiety Inventory were applied to the participants.

Results

There was a statistically significant difference among the three groups in terms of major depression (P=.001), any mood or anxiety disorder (P=.000), any depressive disorder (P=.020), any anxiety disorder (P=.016) and obsessive–compulsive disorder (OCD) (P=.013). In the HT group, the prevalence of depression (P=.000), OCD (P=.005) and panic disorder (P=.041) was significantly higher than that in the control group. In the goiter group, depression (P=.006), any depressive disorder (P=.03), and any mood or anxiety disorder (P=.000) were significantly common in comparison to the control group. No significant difference was found between the HT and goiter groups.

Conclusions

Euthyroid HT and euthyroid goiter increase predisposition to major depression and anxiety disorders, and thyroid autoimmunity and other thyroid pathologies should be investigated in euthyroid patients with chronic and treatment-resistant complaints.     

Comparison of personality beliefs between depressed patients and healthy controls

Introduction

According to the cognitive model, the common mechanism underlying all psychological disorders is distorted or dysfunctional thoughts that affect mood and behaviors. Dysfunctional thoughts predispose an individual to depression and are among the processes that form the basis of personality traits. Elucidating the personality beliefs associated with depression and dysfunctional thoughts is important to understanding and treating depression. The aim of the present study is to determine whether depressed patients exhibited pathological personality beliefs compared with healthy controls. Furthermore, we investigated which personality beliefs were more common among such depressed patients.

Methods

A total of 70 patients who were admitted to the Department of Psychiatry at Ankara Diskapi Yildirim Beyazit Training and Research Hospital (Ankara, Turkey) and diagnosed with major depressive disorder according to The Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) diagnostic criteria were included in the study. Additionally, 70 healthy controls matched for age, marital status, and education were included in the study. The Sociodemographic Data Form and Personality Belief Questionnaire-Short form (PBQ-SF) were administered to the participants.

Results

A comparison of the depression group with the healthy controls revealed higher scores in dependent, passive–aggressive, obsessive–compulsive, antisocial, histrionic, paranoid, borderline, and avoidant personality subscales in the depressive group.

Conclusions

These results suggest that personality beliefs at the pathological level are more common in depressive patients and that the detection of these beliefs would be useful for predicting the prognosis of the disease and determining appropriate treatment methods.     

Mood and anxiety disorders among inpatients of a university hospital in Turkey

Objective

The aim of the study was to assess the prevalence of mood and anxiety disorders among inpatients and the relationship between sociodemographic factors, medical illnesses and treatments.

Methods

In the present study, we selected 650 inpatients from all clinics except psychiatry and pediatrics in a general hospital by a simple random sampling method. Based on the exclusion criteria, 57 patients were excluded. Mood and anxiety disorders were determined by means of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.

Results

Of the participants, 226 (37.5%) had a psychiatric disorder, 87 (14.4) had a mood disorder and 146 (24.2%) had an anxiety disorder. The most common specific diagnoses were not otherwise specified as anxiety disorder (9.5%), major depression (8.6%) and generalized anxiety disorder (7.6%). While the overall prevalence was highest in the hematology clinic (60.0%), it was lowest in the clinic of infectious diseases (22.7%). Logistic regression analysis indicated that the independent factors associated with psychiatric disorders were being of the female gender and a personal history of psychiatric disorders.

Conclusions

In conclusion, results of the present study suggest that mood and anxiety disorders were frequently observed among inpatients, particularly in female patients and those with an individual history of psychiatric disorder. Successful treatment of these disorders may positively contribute to the course of the disease in inpatients. However, this assumption should be confirmed by further studies.     

An exploratory study on emotion recognition in patients with a clinically isolated syndrome and multiple sclerosis

Objectives

Multiple sclerosis (MS) is a chronic multifocal CNS disorder which can affect higher order cognitive processes. Whereas cognitive disturbances in MS are increasingly better characterised, emotional facial expression (EFE) has rarely been tested, despite its importance for adequate social behaviour.

Patients and methods

We tested 20 patients with a clinically isolated syndrome suggestive of MS (CIS) or MS and 23 healthy controls (HC) for the ability to differ between emotional facial stimuli, controlling for the influence of depressive mood (ADS-L). We screened for cognitive dysfunction using The Faces Symbol Test (FST).

Results

The patients demonstrated significant decreased reaction-times regarding emotion recognition tests compared to HC. However, the results also suggested worse cognitive abilities in the patients. Emotional and cognitive test results were correlated.

Conclusion

This exploratory pilot study suggests that emotion recognition deficits might be prevalent in MS. However, future studies will be needed to overcome the limitations of this study.     

A systematic review of studies of depression prevalence in university students

Background

Depression is a common health problem, ranking third after cardiac and respiratory diseases as a major cause of disability. There is evidence to suggest that university students are at higher risk of depression, despite being a socially advantaged population, but the reported rates have shown wide variability across settings.

Purpose

To explore the prevalence of depression in university students.

Method

PubMed, PsycINFO, BioMed Central and Medline were searched to identify studies published between 1990 and 2010 reporting on depression prevalence among university students. Searches used a combination of the terms depression, depressive symptoms, depressive disorders, prevalence, university students, college students, undergraduate students, adolescents and/or young adults. Studies were evaluated with a quality rating.

Results

Twenty-four articles were identified that met the inclusion and exclusion criteria. Reported prevalence rates ranged from 10% to 85% with a weighted mean prevalence of 30.6%.

Conclusions

The results suggest that university students experience rates of depression that are substantially higher than those found in the general population. Study quality has not improved since 1990.     

Dimensions underlying psychotic and manic symptomatology: Extending normal-range personality traits to schizophrenia and bipolar spectra

Objective

Covariance among psychiatric disorders can be accounted for by higher-order internalizing, externalizing, and psychosis dimensions, but placement of bipolar disorder within this framework has been inconsistent. Moreover, whether deviations in normal-range personality can explain psychosis and vulnerability to severe mood lability, as seen in schizophrenia and bipolar disorder, remains unclear.

Methods

Exploratory factor analysis of interviewer-rated clinical symptoms in patients with schizophrenia or bipolar disorder, their first-degree biological relatives, and nonpsychiatric controls (total N = 193), followed by examination of associations between symptom dimensions and self reports on personality questionnaires.

Results

Covariance in symptoms was accounted for by five factors: positive symptoms of psychosis, negative symptoms of psychosis, disorganization, mania, and depression/anxiety. Schizophrenia and bipolar patients/relatives reported elevated negative emotionality and absorption and lower positive emotionality relative to controls. Personality did not differ between schizophrenia and bipolar patients/relatives, but there was a different pattern of associations between symptoms and personality in these groups.

Conclusions

Discrete dimensions reflecting psychotic, manic, and depressive symptoms emerge when a broad set of clinical symptoms is examined in a sample overrepresented by psychotic experiences and affective disturbances. Although normal-range personality traits index common phenotypes spanning schizophrenia and bipolar spectra, the same symptoms may carry different significance across disorders.     

Electrodermal hyporeactivity as a trait marker for suicidal propensity in uni- and bipolar depression

Background

A meta-analysis of studies investigating electrodermal activity in depressed patients, suggested that electrodermal hyporeactivity is sensitive and specific for suicide.

Aims

To confirm this finding and to study electrodermal hyporeactivity relative to type and severity of depression, trait anxiety, its stability and independence of depressive state.

Method

Depressed inpatients (n = 783) were tested for habituation of electrodermal responses and clinically assessed using the Beck Depression Inventory (BDI) and the STAI-Trait scale for trait anxiety.

Results

The high sensitivity and raw specificity of electrodermal hyporeactivity for suicide were confirmed. Its prevalence was highest in bipolar disorders and was independent of severity of depression, trait anxiety, gender and age. Hyporeactivity was stable, while reactivity changed into hyporeactivity in a later depressive episode.

Conclusions

The findings support the hypothesis that electrodermal hyporeactivity is a trait marker for suicidal propensity in depression.     

Depression in multiple sclerosis

Introduction

Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system. Prevalence of depression in MS is significant. Existence of mood disorders alters the patients’ life quality.

Objective

To determine the prevalence of depression in MS and establish the relationship between the severity of the disease, the onset of depression and their correlation with neuroimaging.

Methods

Fifty patients with MS aged 20 to 50 years followed at the Neurology Department of Charles-Nicolle Hospital from 2008 to 2012 participated in this study. The evaluation included a neuropsychological assessment, physical examination with EDSS and MRI.

Results

Association between MS and depression is common and known. In our study, prevalence of depression was 65%. Coexistence of other psychiatric disorders was found in around 10% of patients. Mood disorder was inaugural in some cases and delayed in others. This suggests that depression in MS may be linked to the disease or a result of a functional disability process. Occurrence of depression was not directly related to disease severity in all cases studied.

Conclusion

Depression is a possible manifestation of MS. This mood disorder is due to the demyelinating brain damage or to a genetic susceptibility. However, a fortuitous association cannot be excluded.     

A case of bupropion-induced stuttering

Objective

Stuttering is a frequent side effect of many psychotropic drugs, particularly antidepressants.

Method

This is a case report of a woman presenting with stuttering after starting bupropion treatment for her depression.

Results

The patient's stuttering resolved after discontinuing the bupropion.

Conclusion

Neuroimaging and pharmacological studies have implicated dopamine in the pathophysiology of stuttering. Bupropion's ability to increase dopamine in the frontal cortex was suspected to have been involved in this patient's stuttering. However, further research is needed before causality can be assured.     

Extreme attributions predict transition from depression to mania or hypomania in bipolar disorder

Background

Relatively little is known about psychological predictors of the onset of mania among individuals with bipolar disorder, particularly during episodes of depression. In the present study we investigated attributional style as a predictor of onset of hypomanic, manic or mixed episodes among bipolar adults receiving psychosocial treatment for depression. We hypothesized that “extreme” (i.e., excessively pessimistic or optimistic) attributions would predict a greater likelihood of developing an episode of mood elevation.

Method

Outpatients with DSM-IV bipolar I or II disorder (N = 105) enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) were randomly allocated to one of three types of intensive psychotherapy for depression or a brief psychoeducational intervention. Patients completed a measure of attributional style at baseline and were followed prospectively for up to one year. All analyses were by intent to treat.

Results

Logistic regressions and Cox proportional hazards models indicated that extreme (both positively- and negatively-valenced) attributions predicted a higher likelihood of (and shorter time until) transition from depression to a (hypo)manic or mixed episode (ps < .04), independent of the effects of manic or depressive symptom severity at baseline. Extreme attributions were also retrospectively associated with more lifetime episodes of (hypo)mania and depression (ps < .05).

Conclusions

Evaluating extreme attributions may help clinicians to identify patients who are at risk for experiencing a more severe course of bipolar illness, and who may benefit from treatments that introduce greater cognitive flexibility.