Silent period to transcranial magnetic stimulation: construction and properties of stimulus–response curves in healthy volunteers

Silent period (SP) is widely used in transcranial magnetic stimulation studies. Methodologically, SP is usually elicited at stimulus intensities corresponding to a certain percentage of corticomotor threshold. Because this approach might lead to factitious SP changes, the present study was designed to develop, in a stepwise manner, a method for investigating SP independently of corticomotor threshold. First, stimulus–response (S–R) curves of SP against stimulus intensity (SI) were constructed and quantitatively described in healthy volunteers. Second, various methodological issues such as the optimum model for describing the relationship between SP duration and SI and the importance of the type of stimulating coil were addressed. Finally, the proposed method and a commonly used method (eliciting SPs at 130% MT SI) were directly compared for a group of epileptic patients for whom administration of oxcarbazepine resulted in significant corticomotor threshold elevation. Twenty-one subjects (eleven females, median age, 38 years) were studied. SPs were obtained with a figure-of-eight coil using a standardized procedure (recording, FDI). Pilot experiments indicated that at least four trials were required, at each intensity level, to estimate the mean SP duration within 10% of the true mean. Therefore, SPs were determined from the average of four trials with 5% increments from 5 to 100% maximum SI. In a second set of experiments, SPs were obtained for fifteen subjects using a circular coil. In a third set of experiments, eight epileptic patients were studied before and after administration of oxcarbazepine (mean dose 1553 mg, range 900–1800 mg). The S–R curves were fitted to a Boltzman function and to first-order to fourth-order polynomial and sigmoid functions. The Boltzman function described the data accurately (R²=0.947–0.990). In addition, direct comparison of the six models with an F-test proved the superiority of the first. The best-fit parameters of the reference curve, i.e. the maximum and minimum values, the slope, and V₅₀ (the SI at which SP duration is halfway between Min and Max) were 230.8±3.31 ms (x±SEM), –11.51±3.31 ms, 11.56±0.65%, and 49.82±0.65%, respectively. When the curves obtained with the circular coil were compared with those obtained with the figure-of-eight coil, there were differences between V₅₀ (51.69±0.72 vs 47.95±0.82, P<0.001) and SP threshold (31.15 vs 24.77, P<0.01) whereas the other best-fit values did not differ significantly. Oxcarbazepine increased corticomotor threshold from 45.3±5.8% at baseline to 59.4±10.4% (P<0.001). According to the commonly used method, the drug significantly prolonged SP (from 117.6±42.4 ms to 143.5±46.5 ms, P<0.001) and, consequently, enhanced brain inhibition. In contrast, study of the SP curves led to the conclusion that oxcarbazepine does not affect the Max value and slope but significantly increases V₅₀ and SP threshold (from 54.5±4.9% to 59.9±7.2% and from 29.1±6.4% to 34.6±6.8%, respectively, P<0.01). These findings imply that oxcarbazepine does not enhance brain inhibitory mechanisms. Thus, in situations characterized by significant changes in corticomotor threshold the proposed method provides results clearly different from a commonly used approach. It is concluded that S–R curves obtained with a figure-of-eight coil in 5% increments and fitted to a Boltzman function provide an accurate, comprehensive, and clinically applicable method for exploring SP.Presented in part at the meeting of the EFNS, Helsinki, September 2003     

Is blunted cardiovascular reactivity in depression mood-state dependent? A comparison of major depressive disorder remitted depression and healthy controls

Prior work has repeatedly demonstrated that people who have current major depression exhibit blunted cardiovascular reactivity to acute stressors (e.g., Salomon et al., 2009). A key question regards the psychobiological basis for these deficits, including whether such deficits are depressed mood-state dependent or whether these effects are trait-like and are observed outside of depression episodes in vulnerable individuals. To examine this issue, we assessed cardiovascular reactivity to a speech stressor task and a forehead cold pressor in 50 individuals with current major depressive disorder (MDD), 25 with remitted major depression (RMD), and 45 healthy controls. Heart rate (HR), blood pressure and impedance cardiography were assessed and analyses controlled for BMI and sex. Significant group effects were found for SBP, HR, and PEP for the speech preparation period and HR, CO, and PEP during the speech. For each of these parameters, only the MDD group exhibited attenuated reactivity as well as impaired SBP recovery. Reactivity and recovery in the RMD group more closely resembled the healthy controls. Speeches given by the MDD group were rated as less persuasive than the RMD or healthy controls' speeches. No significant differences were found for the cold pressor. Blunted cardiovascular reactivity and impaired recovery in current major depression may be mood-state dependent phenomena and may be more reflective of motivational deficits than deficits in the physiological integrity of the cardiovascular system.     

Are there gender differences in major depression and its response to antidepressants?

BACKGROUND: The prevalence of major depression for women is about twice that for men. This gender difference in prevalence rates has led to much research addressing gender differences in the presentation and features of major depression, and, to a lesser extent, research addressing gender differences in treatment response and personality. However, studies differ considerably in the population sampled, and findings vary significantly. In the current retrospective examination of data, we investigated all of these variables in one single sample of outpatients with major depression seen in a tertiary care centre. METHODS: A sample of 139 men and 246 women with major depression receiving antidepressant treatment (SSRIs, TCAs, SNRIs, MAOIs, or RIMAs) in an outpatient setting were contrasted with regard to symptoms and severity of depression, course of illness, treatment response, and personality. RESULTS: Women were found to experience more vegetative and atypical symptoms, anxiety, and anger than men, and to report higher severity of depression on self-report measures. Regarding personality, women scored higher on conscientiousness, the extraversion facet warmth, the openness facet feelings, and sociotropy. Effect sizes were small to moderate. No differences were found in the course of the illness and treatment response. LIMITATIONS: Findings are not generalizable to inpatient or community samples, and some of the gender differences may be accounted for by gender differences in treatment seeking behaviour. CONCLUSIONS: While men and women receiving antidepressant treatment show some gender differences in the psychopathology of major depression, these differences do not appear to translate into differences in response to antidepressants. Gender differences in personality appear less profound than in the average population, indicating the potential role of a certain personality type that predisposes individuals to develop clinical depression, independent of gender. CLINICAL RELEVANCE: The current examination underscores the role gender plays in the presentation and treatment of major depression.     

Nitric oxide and interleukin-1β mediate noradrenergic induced corticotrophin-releasing hormone release in organotypic cultures of rat paraventricular nucleus

Noradrenergic inputs from the brainstem are critical for the central stress response. It has been suggested that endogenous interleukin-1β (IL-1β) is involved in norepinephrine (NE)-induced release of corticotropin-releasing hormone (CRH) from the paraventricular nucleus of the hypothalamus (PVN). However, no IL-1 receptor on PVN CRH neurons has been identified. Therefore we hypothesized that the action of IL-1β in the PVN requires downstream modulators that eventually lead to CRH release by PVN neurons. In the current study, we used organotypic cultures from neonatal rat PVN which display neuroendocrine characteristics suitable for in vitro studies. Pharmacological treatments with NE or IL-1β elicited nitric oxide (NO) release from the PVN cultures, implying that local NO might be a candidate for modulating the action of IL-1β. In addition, NE treatments significantly increased IL-1β and CRH release. Treatment with IL-1β or sodium nitroprusside also induced CRH release. Next, we also showed that either an IL-1 receptor antagonist or NOS inhibitor Nω-nitro-l-arginine (l-NNA) attenuated the NE-induced CRH release. These results suggest that IL-1β and NO are involved in NE-induced CRH release. Moreover, we found that application of l-NNA attenuated IL-1β-induced CRH release, indicating that NO likely mediates this process. In summary, the current study demonstrates that IL-1β plays a significant role in NE-induced CRH release, and that neuroendocrine response in the PVN may depend on local NO action.     

Does early response predict outcome in psychotherapy and combined therapy for major depression?

BACKGROUND: To examine the predictive value of early response for final outcome of psychotherapy and combined therapy in major depression. METHODS: Mild- to moderately depressed patients were treated with either Short-Term Psychodynamic Supportive Psychotherapy (SPSP) (N=63) only, or combined with an antidepressant (N=127). Early response was defined as a reduction of more than 25% on the HAM-D-17 after 2 months. Outcome was determined in terms of complete nonresponse and remission rates. Associations between early response and outcome were examined using logistic regression analysis. RESULTS: In SPSP, early nonresponse was clearly related to final nonresponse (OR=3.57). Nevertheless, remission was not predicted by early response, and 26% of the early nonresponders ultimately achieved remission. In combined therapy, both final nonresponse (OR 7.13) and remission (OR 3.66) were associated with early nonresponse. LIMITATIONS: In this study, SPSP was the only psychotherapy examined. The design did not provide feedback to the therapist of the independently measured depression score after two months. CONCLUSION: Although a number of early nonresponsive patients will achieve remission, this study points out that these patients are at risk factor for ultimate treatment failure. This could be an indication for clinicians to adapt their treatment strategy.     

Is gender a factor in psychiatrists' evaluation and treatment of patients with major depression?

BACKGROUND: Gender differences in clinical assessment and treatment have been reported in several areas of medicine. We examine whether differences exist in the routine outpatient psychiatric management of men and women with major depression. METHODS: Psychiatrists practicing in the community completed case forms on a systematic sample of their adult outpatients with major depression. Comparisons are presented between male (n=261) and female (n=472) patients focusing on their background characteristics, clinical presentation, assessment, and treatment. Significant gender disparities in assessment and treatment are also examined with respect to the gender of the treating psychiatrist. RESULTS: Although male and female patients had generally similar clinical profiles, a significantly greater proportion of males than females had psychomotor retardation and substance use disorders. No significant gender differences were observed in the assessment of depressive symptoms, psychiatric comorbidities, and treatment with antidepressant medications or psychotherapy. However, a significantly smaller percentage of depressed women than men received assessments of sexual function and medication-related sexual side effects. Female patients were also less likely to have discussed their treatment preferences with their psychiatrists. LIMITATIONS: Only a minority (33.2%) of psychiatrists invited to participate contributed patients to this study. The results are based on structured assessments completed by practicing psychiatrists rather than patient self-assessments or independent research assessments. CONCLUSIONS: Although we find overall little evidence of gender bias in the clinical management of major depression, both male and female psychiatrists need to further explore sexual function and treatment preferences in female patients.     

Imipramine and phenelzine decrease glutamate overflow in the prefrontal cortex--a possible mechanism of neuroprotection in major depression?

Antidepressant drugs have been used for decades, but the neurobiological substrate of their efficacy is not completely understood. Although these drugs have well-established effects on monoamines, evidence is emerging that they may also affect other neurotransmitter systems. It has been shown that treatment with a wide range of antidepressants changes the binding characteristics of the N-methyl-D-aspartate type of glutamate receptor. This change is delayed and occurs only in the cortex. The mechanism that triggers it is unknown. We hypothesized that N-methyl-D-aspartate receptor alterations may be due to changes in the dynamics of cortical excitatory amino acid release. Such changes are of particular interest in areas such as the prefrontal cortex, a region involved in stress responses and affected in major depression. We investigated the effects of two antidepressants with different modes of action, imipramine and phenelzine, on glutamate and aspartate outflow in rat prefrontal cortex and striatum. We showed that antidepressants significantly decreased stimulated glutamate outflow. The effect had a rapid onset, was sustained during chronic administration and was only seen in the prefrontal cortex. This change may initiate receptor alterations. Furthermore, if antidepressants can dampen states of hyperglutamatergic activity and the subsequent excitotoxicity, their chronic use may have a considerable neuroprotective potential in major depression.     

Pretreatment cerebral metabolic activity correlates with antidepressant efficacy of vagus nerve stimulation in treatment-resistant major depression: A potential marker for response?

BackgroundPretreatment brain activity in major depressive disorder correlates with response to antidepressant therapies, including pharmacotherapies and transcranial magnetic stimulation. The purpose of this trial was to examine whether pretreatment regional metabolic activity in selected regions of interest (ROIs) predicts antidepressant response following 12 months of vagus nerve stimulation (VNS) in 15 patients with treatment-resistant major depression (TRMD).MethodsFluorodeoxyglucose positron emission tomography (FDG PET) was used to assess regional mean relative cerebral metabolic rate for glucose (CMRGlu) in four ROIs (anterior insular, orbitofrontal, anterior cingulate, and dorsolateral prefrontal cortices) at baseline (prior to VNS activation). Depression severity was assessed at baseline and after 12 months of VNS using the Hamilton Depression Rating Scale (HDRS), with response defined as ≥ 50% reduction in HDRS from baseline.ResultsBaseline CMRGlu in the anterior insular cortex differentiated VNS responders (n = 11) from nonresponders (n = 4) and correlated with HDRS change (r = .64, p = .01). In a regression analysis, lower anterior insular cortex CMRGlu (p = .004) and higher orbitofrontal cortex CMRGlu (p = .047) together predicted HDRS change (R² = .58, p = .005). In a whole brain, voxel-wise analysis, baseline CMRGlu in the right anterior insular cortex correlated with HDRS change (r = .78, p = .001).LimitationsSample size was small, limiting statistical power; patients remained on their psychiatric medications; study was open-label and uncontrolled.ConclusionsThis preliminary study suggests that pretreatment regional CMRGlu may be useful in predicting response to VNS in TRMD patients.     

Visual–vestibular stimulation interferes with information processing in young and older humans

Attention has been implicated in postural control and other tasks requiring sensory integration. The purpose of this study was to investigate the role of attention in sensory-motor processing of vestibular and combined visual–vestibular information during seated rotations using a dual-task interference approach. We hypothesized that auditory information processing would be influenced by concurrent visual-ocular, vestibulo-ocular, or combined visual-vestibulo-ocular processing. We further hypothesized that the effect would be greater in older subjects. Twenty older subjects (10 women, 10 men, 69.3±3.2 years) and 20 young subjects (10 women, 10 men, 23.5±2.9 years) were asked to perform information-processing tasks while they underwent several types of vestibular, visual–vestibular, and ocular motor paradigms. The information-processing tasks were: (1) an auditory simple reaction-time task (SRT), (2) an auditory go–no-go (disjunctive) reaction-time task (DRT), and (3) an auditory forced-choice task (CRT). The visual–vestibular-ocular motor conditions included: (1) no movement/darkness (NO), (2) no movement/fixation (FIX), (3) no movement/pursuit (P), (4) earth-vertical axis rotation (EVAR) in darkness, (5) EVAR with fixation (E-FIX), (6) off-vertical axis rotation (OVAR) in darkness, and (7) OVAR with fixation (O-FIX). Results showed that older subjects had longer reaction times for all combinations of stimulus condition and reaction-time task compared with young subjects. Compared with the NO baseline, reaction times during EVAR were longer for young and older subjects and during OVAR were longer for the young subjects. For FIX and P, the reaction times during P exceeded those during FIX and during NO for both groups. For E-FIX and O-FIX, reaction times did not differ from those during EVAR and OVAR. The interference with information processing by concurrent vestibular stimulation in the dark may be based upon cortical inhibition of auditory processes by vestibular stimulation. Eye movements induced by EVAR showed an increased phase lead during reaction-time tasks, suggesting altered vestibulo-ocular reflex (VOR) dynamics, possibly based on cerebellar-mediated changes in velocity storage. Since fixation of a head-fixed visual target did not add to the effect of rotation in the dark, a further implication of our results is that VOR-fixation while performing a concurrent information-processing task may be accomplished primarily by VOR suppression rather than by VOR cancellation.Abbreviations NO Stationary in darkness - FIX Stationary while viewing a stationary target - P Stationary while pursuing a moving target - EVAR Earth-vertical axis rotation - OVAR Off-vertical axis rotation - EFIX Earth-vertical axis rotation while viewing a head-fixed visual target - OFIX Off-vertical axis rotation while viewing a head-fixed visual target - SRT Simple reaction-time task - DRT Disjunctive reaction-time task - CRT Choice reaction-time task - VOR Vestibulo-ocular reflex - Task Type of reaction-time task - VVC Visual–vestibular condition - Group Age group - Block First or second repetition     

Reduced specificity of autobiographical memory: a mediator between rumination and ineffective social problem-solving in major depression?

BACKGROUND: Depressed individuals display a deficit in effectively solving social problem situations (e.g., []). Recent research suggests that rumination may interfere with such effective problem-solving (e.g., []). However, little is known, as yet, about the mechanisms that are underlying this relation between rumination and poor problem-solving. The present study investigated the role of reduced specificity of autobiographical memories as a mediator of this relationship. METHODS: 24 depressed patients (15 women) completed the Autobiographical Memory Test (AMT), the Means-Ends Problem-Solving Task (MEPS), the Ruminative Response Scale (RRS) and the Rumination on Sadness Scale (RSS). RESULTS: Consistent with previous studies, rumination, ineffective problem-solving and reduced memory specificity were significantly associated. Regression analyses further extended these findings by showing that reduced memory specificity mediated the association between rumination and problem-solving effectiveness. LIMITATIONS: The correlational nature of this study limits to some extent the conclusions that can be drawn on the directionality of the observed relationships. CONCLUSIONS: Results offer support for the idea that lack of autobiographical memory specificity mediates the known relationship between rumination and poor problem-solving.     

Are there sex differences in the reliability of a lifetime history of major depression and its predictors?

BACKGROUND: Although lifetime major depression (LTMD) is assessed with only moderate reliability in community samples, some predictors have emerged for 'reliable' LTMD. Given the large impact of sex on risk for LTMD, it is of interest to know if there are sex differences in the reliability of LTMD and its predictors. METHODS: A total of 5603 members of male-male and male-female twin pairs from a population-based registry were interviewed twice with a mean inter-interview interval of 19 months. LTMD was assessed on each occasion using DSM-III-R criteria. Univariate and multivariate logistic regression analyses were used, combining forward and back-prediction. RESULTS: The long-term test-retest reliability of LTMD was moderate (kappa = +0.48) and did not differ significantly between males and females. In a multivariate model, the significant predictors of a stable diagnosis of LTMD, none of which differed across sex, were younger age at onset, older current age, history of treatment, increasing number of symptoms, level of impairment or level of distress, longer duration of episodes, higher current level of depression and the presence during the depressive episode of sad mood, weight loss, hypersomnia or fatigue. Using these variables, it was not possible to predict 'stably diagnosed' LTMD with both high sensitivity and high specificity. CONCLUSION: In community samples, LTMD is diagnosed with moderate reliability. Although diagnostic stability can be predicted by variables related to severity, distress and treatment-seeking (probably acting to make depressive episodes more 'memorable'), highly accurate prediction of stably diagnosed cases is not possible. Long-term recall is also significantly influenced by current symptoms. Neither the stability of LTMD nor its predictors differ in men and women.     

Perceived and observed mother–child interaction at time of hospitalization and release in postpartum depression and psychosis

Summary Introduction: A pilot study was conducted which compared perceived mother–infant bonding in women admitted with postpartum depression or psychosis, with observations of mother–infant interaction by the nursing staff at both the time of hospitalization and that of release. Method: 25 mother–infant pairs admitted to a psychiatric unit were included in this study. The Postpartum Bonding Questionnaire was used to assess the perceived mother–infant bond and the observation of mother–infant interaction was assessed with the Bethlem Mother–Infant Interaction Scale. Results: At the time of both hospitalization and release postpartum depressed women experienced the bond with their child significantly more negative than women with postpartum psychosis. In contrast to women with postpartum psychosis, the experience of postpartum depressed women was significantly correlated with the observations of the nursing staff at time of release. Conclusion: Treatment that focuses on a mother’s experience of the bond with her child could be especially beneficial for mothers with postpartum depression. Correspondence: Mijke P. van den Berg, MA, MD, PhD, Department of Psychiatry, Erasmus Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands     

Is high-frequency neuromuscular electrical stimulation a suitable tool for muscle performance improvement in both healthy humans and athletes?

We aimed at providing an overview of the currently acknowledged benefits and limitations of neuromuscular electrical stimulation (NMES) training programs in both healthy individuals and in recreational and competitive athletes regarding muscle performance. Typical NMES resistance exercises are performed under isometric conditions and involve the application of electrical stimuli delivered as intermittent high frequencies trains (>40–50 Hz) through surface electrodes. NMES has been acknowledged as an efficient modality leading to significant improvements in isometric maximal voluntary strength. However, the resulting changes in dynamic strength, motor performance skills and explosive movements (i.e., jump performance, sprint ability) are still ambiguous and could only be obtained when NMES is combined with voluntary dynamic exercise such as plyometrics. Additionally, the effects of NMES on muscle fatigability are still poorly understood and required further investigations. While NMES effectiveness could be partially related to several external adjustable factors such as training intensity, current characteristics (e.g., intensity, pulse duration…) or the design of training protocols (number of contractions per session, number of sessions per week…), anatomical specificities (e.g., morphological organization of the axonal branches within the muscle) appear as the main factor accounting for the differences in NMES response. Overall, NMES cannot be considered as a surrogate training method, but rather as an adjunct to voluntary resistance training. The combination of these two training modalities should optimally improve muscle function.     

Genetic risk factors for major depression in men and women: similar or different heritabilities and same or partly distinct genes?

BACKGROUND: Although women are at consistently greater risk for major depression (MD) than men, it is unclear whether sex modifies the aetiological impact of genetic factors on MD. Is the heritability of MD different in men and women? Do the same genetic risk factors predispose to MD in the two sexes? METHODS: We obtained a lifetime history of MD by personal interview on two occasions from 6672 individual twins and 2974 complete twin pairs. Three diagnostic criteria of increasing narrowness were employed: DSM-III-R, DSM-III-R plus impairment and Washington University. To increase power by controlling for unreliability of assessment, we evaluated sex differences on genetic risk for MD using a structural equation measurement model. RESULTS: Using DSM-III-R criteria, but not the two narrower definitions, heritability of MD was significantly greater in women than in men. In the three diagnostic systems, the genetic correlation in liability to MD in men and women was estimated at between +0.50 and +0.65. These estimates differed significantly from unity for the two broader definitions. CONCLUSION: Using broad but not narrower definitions of illness, genetic factors play a greater role in the aetiology of MD in women than in men. The genes that influence risk for MD in the two sexes are correlated but are probably not entirely the same. These results raise the possibility that, in linkage and association studies, the impact of some loci on risk for MD will differ in men and women.     

Determinants of vitamin D status in healthy men and women aged 40–80 years

ObjectivesTo determine the contribution of life style and health related factors on vitamin D status in middle-aged and older men and women.Study designA cross-sectional single-center study in 400 male subjects (40–80 years) and 402 postmenopausal female subjects (56–73 years), conducted in a University Medical Center in the central part of the Netherlands (52 degrees northern latitude).Main outcome measuresMedical history, vitamin D, calcium and alcohol intake, physical activity, Body Mass Index, Blood pressure, smoking, total fat body mass and total lean body mass were measured using DEXA. Laboratory analysis included 25-hydroxyvitamin D (25OHD) and sex hormones.ResultsThirty-six percent of men and 51% of women had 25OHD less than 50 nmol/L. In summertime men had significant higher 25OHD as compared to women (81.5 vs 53.3 nmol/L, P = .000) but this difference disappeared come winter. In a saturated model, male gender (B = .16, P = .008), and season (summer vs winter B = .30, P = .000) remained statistically significant. In men, physical activity and season explained 21% of the variance. In women, household physical activity (B = .13, P = .03), sport physical activity (B = .02, P = .02) and estradiol (B = ?.003, P = .048) remained in the model,.ConclusionIn healthy middle-aged and older men and postmenopausal women, male gender and season were important predictors of vitamin D status. In men, physically activity and season, explained 21% of the variance in vitamin D status. In women, physical activity and estradiol explained 9.3% of the variance in vitamin D.     

Effect of molsidomine on ex vivo platelet aggregation and plasma guanosine 3′∶5′-cyclic monophosphate levels in healthy volunteers

Summary To find out whether 3-morpholino-sydnonimine (SIN 1), the active metabolite of molsidomine, exerts its antiaggregatory effects not only in vitro but also in vivo, we tested ex vivo aggregation before and after intravenous application of molsidomine in healthy volunteers. We also measured plasma levels of guanosine 35-cyclic monophosphate (cyclic GMP) as SIN 1, the bioactive metabolite of molsidomine, becomes effective via activation of soluble guanylate cyclase. In eight out of ten subjects molsidomine had an inhibitory effect on platelet aggregation and a higher threshold concentration of platelet-activating factor was required after molsidomine application to induce irreversible aggregation. Despite the effect on platelets, plasma cyclic GMP levels did not increase. These results suggest that the nitric oxide-containing SIN 1 inhibits platelet aggregation not only in vitro but also in vivo and that this property can be a beneficial effect in antianginal therapy.Abbreviations Cyclic GMP guanosine 35-cyclic monophosphate - NO nitric oxide - PAF platelet-activating factor - PRP platelet-rich plasma - SIN 1 3-morpholino-sydnonimine     

Assessment and prevalence of depression in women 45–55 years of age visiting gynecological clinics in Poland

Summary ¶The aims of the Polish survey were to assess efficacy of screening for depression in gynecological practice and to estimate prevalence of depressive disorders in midlife women visiting gynecologists. The study included 2262 female outpatients aged 45–55, who were screened by 120 gynecologists throughout Poland. Patients completed the Becks Depression Inventory (BDI) and were assessed by gynecologists to verify the presence of symptoms of a current Depressive Episode according to ICD-10 diagnostic criteria. Patients who obtained a score of 12 points or more on the BDI were referred for psychiatric evaluation, including the modified version of Mini International Neuropsychiatric Interview (MINI). The study showed that gynecologists in Poland are able to perform screenings for depression effectively in outpatient settings. Results also suggested that about 19% of women aged 45 to 55 years visiting gynecologists may suffer from depressive disorders.Received December 4, 2003; accepted May 9, 2003 Published online July 3, 2003