No predictors of antidepressant patient response to milnacipran were obtained using the three-factor structures of the Montgomery and Asberg Depression Rating Scale in Japanese patients with major depressive disorders

Aims:  Milnacipran, a new specific serotonin and norepinephrine re-uptake inhibitor, is as effective as tricyclic antidepressants. Symptomatological predictors of antidepressant response to milnacipran have not been studied until now.
Methods:  This study included 101 Japanese patients who fulfilled the DSM-IV criteria for the diagnosis of major depressive disorders and whose score on the Montgomery and Åsberg Depression Rating Scale (MADRS) was ≥21. Eighty-three patients were finally included. Patients with a pretreatment MADRS score ≥31 points were defined as severe ( n  = 28), and the rest as non-severe ( n  = 55). The three-factor model of MADRS was used for analysis; the first factor was defined by three items, the second factor was defined by four items and the third factor was defined by three items representing dysphoria, retardation, and vegetative symptoms, respectively. Milnacipran was administered twice daily for 6 weeks. The initial dose was 50 mg/day; after a week it was increased to 100 mg/day.
Results:  No significant difference was observed in the mean score of first factor, second factor and third factor at pretreatment time between responders and non-responders in both severe and non-severe patients.
Conclusions:  No predictor of antidepressant response to milnacipran was obtained using the three-factor structures of the MADRS in Japanese patients with major depressive disorders.     

Predictors of antidepressant response to fluvoxamine obtained using the three-factor structures of the Montgomery and Asberg Depression Rating Scale for major depressive disorders in Japanese patients

Aims:  Fluvoxamine, a selective serotonin reuptake inhibitor, is widely used to treat major depression. However, the symptomatological predictors of the response to fluvoxamine have not been studied.
Methods:  This study included 100 Japanese patients who fulfilled the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV criteria for the diagnosis of major depressive disorders and whose score on the Montgomery and Åsberg Depression Rating Scale (MADRS) was 21 or higher. Eighty-one patients were included. Patients with a pretreatment MADRS score of ≥31 were defined as 'severe' ( n  = 32) and the rest were defined as 'non-severe' ( n  = 49). The three-factor model of MADRS was used for analysis: the first factor was defined by three items, the second factor was defined by four items, and the third factor was defined by three items representing dysphoria, retardation, and vegetative symptoms, respectively. Fluvoxamine (100–200 mg/day) was administered twice daily for 6 weeks.
Results:  In the non-severe patients, the mean factor 3 score of the non-responders at pretreatment was significantly higher than that of the responders. However, a significant difference was observed in the mean factor 3 scores from 1 week onwards between the non-severe responders and non-responders. Furthermore, the fluvoxamine response rate in the severe patients was 75% and higher than that of the non-severe patients (65.3%).
Conclusions:  This study suggested that a low factor 3 score at pretreatment was a good predictor of the response to fluvoxamine in non-severe patients. The marked efficacy of fluvoxamine in the treatment of severe patients was also confirmed.     

Subthreshold depression and cognitive impairment but not demented in stroke patients during their rehabilitation

Background –  Subthreshold depression (sD) and cognitive impairment but not demented (CIND) in stroke patients are associated with poorer rehabilitative outcomes. Their diagnosis can easily be operationalized using validated scales.
Aim –  The aim of the study was to ascertain the prevalence of depressive symptoms and cognitive impairment in stroke patients during three crucial stages of the rehabilitative process, viz. upon admission, upon planned discharges from rehabilitation hospitals and at 6 months post-stroke, using validated scales like the Geriatric Depression Scale and Abbreviated Mental Test (recommended by the British Geriatric Society). Their baseline risk factors were also ascertained.
Results –  On admission, the prevalence of depressive symptoms and cognitive impairment was 60% and 54% respectively. The prevalence upon planned discharges and 6 months post-stroke, respectively, of depressive symptoms was 38% and 34% and that of impaired cognition was 33% and 40%. Baseline independent correlates at 6 months post-stroke depressive symptoms were: recurrent stroke (OR 3.34); on admission cognitive impairment (OR 4.78) and ADL dependence (OR 5.28). And that of cognitive impairment were: increasing age (OR 8.07); post-stroke dysphagia (OR 4.58); on admission cognitive impairment (OR 23.95) and on admission depressive symptoms (OR 3.50).
Conclusions –  Continuous screening and appropriate intervention, especially at baseline, would significantly decrease the burden posed by stroke patients with such psychological impairments in the community.     

The associations of insomnia symptoms and chronotype with daytime sleepiness,mood symptoms and suicide risk in adolescents

ObjectivesTo investigate the association of insomnia and chronotype preference with daytime impairment and psychopathology in a community sample of adolescents in Hong Kong.MethodsThis was a cross-sectional study that included seven local secondary schools in Hong Kong. A total of 1667 adolescents (mean age: 14.8 ± 1.6 years old; boys: 56.5%) returned a battery of self-report questionnaires including Insomnia Severity Index (ISI) and reduced Horne and Östberg Morningness and Eveningness Questionnaire (rMEQ) for assessing insomnia symptoms and chronotype preference, respectively. A subset of adolescent samples (n = 768) were additionally assessed for suicidal ideation. Potential confounders including age, gender and sleep duration were controlled for in the analyses.ResultsThe prevalence of insomnia symptoms and eveningness chronotype was 37% and 25.6%, respectively. Regression models indicated that insomnia and eveningness were independently associated with excessive daytime sleepiness (insomnia: adjusted OR [AdjOR] = 3.8; 95% confidence interval [C.I.] = 2.9–5.0; eveningness: AdjOR = 2.6; 95% C.I. = 1.9–3.7), and an increased risk of depression (insomnia: AdjOR = 3.5, 95% C.I. = 2.5–5.0; eveningness: AdjOR = 2.0, 95% C.I. = 1.3–3.2). The odds ratio increased to 8.7 (95% C.I. = 6.1–12.3, p < 0.001) for excessive daytime sleepiness and 4.8 (95% C.I. = 3.2–7.2, p < 0.001) for depression among adolescents with both insomnia and eveningness. Insomnia symptoms, but not eveningness, were associated with anxiety symptoms (AdjOR = 5.8; 95% C.I. = 3.6–9.4) and suicidal ideation (AdjOR = 2.1, 95% C.I. = 1.4–3.2).ConclusionsThe present study provided further evidence that insomnia and eveningness uniquely contributed to poor daytime functioning and mood related outcomes, while the co-existence of these two conditions could confer a greater risk in adolescents. However, insomnia, but not eveningness, was significantly linked to suicidality after controlling for mood symptoms. Our findings highlighted the necessity of timely management of sleep and circadian issues in adolescents.     

Sleep disturbance, circadian preference and symptoms of adult attention deficit hyperactivity disorder (ADHD)

Inattention is a core symptom of attention deficit hyperactivity disorder (ADHD) and one of the main impairments resulting from insomnia disorders. These disorders have also been reported to be linked with disturbances in circadian rhythms and with increased eveningness. To explore these associations, more than 550 adults were surveyed across Romania. Using self-reported questionnaires, the presence and severity of ADHD and insomnia symptoms were determined, together with sleep and circadian typology parameters. ADHD symptoms were more frequent and severe among younger individuals. Subjects with probable ADHD complained more frequently of sleep disturbance of the insomnia type (more than 50?%) and reported shorter sleep durations and longer sleep latencies and more frequent unwanted awakenings. Individuals likely to suffer from ADHD and/or insomnia disorder were significantly more evening oriented than controls. Inattention was associated with both insomnia and eveningness, while impulsivity was associated with poor sleep. Hyperactivity and sleep timing were associated with poor sleep only in probable insomnia group. These findings highlight the reciprocal links between ADHD symptoms, sleep and diurnal preference.     

Clinical significance of night-to-night sleep variability in insomnia

ObjectivesTo evaluate the clinical relevance of night-to-night variability of sleep schedules and insomnia symptoms.MethodsThe sample consisted of 455 patients (193 men, mean age = 48) seeking treatment for insomnia in a sleep medicine clinic. All participants received group cognitive behavioral therapy for insomnia (CBTI). Variability in sleep parameters was assessed using sleep diary data. Two composite scores were computed, a behavioral schedule composite score (BCS) and insomnia symptom composite score (ICS). The Insomnia Severity Index, the Beck Depression Inventory, and the Morningness–Eveningness Composite Scale were administered at baseline and post-treatment.ResultsResults revealed that greater BCS scores were significantly associated with younger age, eveningness chronotype, and greater depression severity (p < 0.001). Both depression severity and eveningness chronotype independently predicted variability in sleep schedules (p < 0.001). Finally, CBTI resulted in reduced sleep variability for all sleep diary variables except bedtime. Post-treatment symptom reductions in depression severity were greater among those with high versus low baseline BCS scores (p < 0.001).ConclusionsResults suggest that variability in sleep schedules predict reduction in insomnia and depressive severity following group CBTI. Schedule variability may be particularly important to assess and address among patients with high depression symptoms and those with the evening chronotype.     

The assessment of depression in Parkinson's disease

Background:  Motor symptoms form the hallmark of Parkinson's Disease (PD), although features like depression are often present. Depression rating scales [e.g. Montgomery-Åsberg Depression Rating Scale (MADRS)] used in PD measure affective, cognitive and somatic symptoms. An important clinical question is which items of the MADRS are likely to be influenced by PD symptoms.
Methods:  Depression was assessed in 43 PD patients who scored below the cut-off of the MADRS and who differed widely in motor severity.
Results:  Parkinson's Disease patients scored relatively highest on Concentration difficulties, Reduced sleep and Inner tension. Reduced sleep, Lassitude and Suicidal thoughts were associated with motor severity and specifically with Bradykinesia, Rigidity and Axial impairment, however not with Tremor.
To avoid a possible influence on our results of coincidentally included PD patients with a depression, all associations between somatic MADRS items and motor severity were corrected for the influence of affective symptoms of depression. All associations remained significant.
Discussion:  In conclusion, the items Reduced sleep and Lassitude of the MADRS are likely to be influenced by motor symptoms. The high score on Concentration difficulties is suggested to be a reflection of cognitive dysfunction in PD. Thus, when assessing depression in PD, using a depression rating scale like the MADRS, adjusted cut-off scores are required.     

Circadian rhythm in bipolar disorder: A review of the literature

Sleep disturbances and circadian rhythm dysfunction have been widely demonstrated in patients with bipolar disorder (BD). Irregularity of the sleep–wake rhythm, eveningness chronotype, abnormality of melatonin secretion, vulnerability of clock genes, and the irregularity of social time cues have also been well‐documented in BD. Circadian rhythm dysfunction is prominent in BD compared with that in major depressive disorders, implying that circadian rhythm dysfunction is a trait marker of BD. In the clinical course of BD, the circadian rhythm dysfunctions may act as predictors for the first onset of BD and the relapse of mood episodes. Treatments focusing on sleep disturbances and circadian rhythm dysfunction in combination with pharmacological, psychosocial, and chronobiological treatments are believed to be useful for relapse prevention. Further studies are therefore warranted to clarify the relation between circadian rhythm dysfunction and the pathophysiology of BD to develop treatment strategies for achieving recovery in BD patients.     

Behavioral Approach System and Behavioral Inhibition System sensitivities and bipolar spectrum disorders: prospective prediction of bipolar mood episodes

Objectives:  Research has found that bipolar spectrum disorders are associated with Behavioral Approach System (BAS) hypersensitivity and both unipolar and bipolar depression are associated with high Behavioral Inhibition System (BIS) sensitivity, but prospective studies of these relationships are lacking. We tested whether BAS and BIS sensitivities prospectively predicted the time to new onsets of major depressive and hypomanic and manic episodes in bipolar spectrum individuals.
Methods:  We followed 136 bipolar II or cyclothymic and 157 demographically matched normal control individuals prospectively for an average of 33 months. Participants completed the BIS/BAS scales and symptom measures at Time 1 and semi-structured diagnostic interviews every four months of follow-up.
Results:  The bipolar spectrum group exhibited higher Time 1 BAS, but not BIS, scores than the normal controls, controlling for Time 1 symptoms. Among bipolar spectrum participants, high BAS sensitivity prospectively predicted a shorter time to onset of hypomanic and manic episodes, whereas high BIS sensitivity predicted less survival time to major depressive episodes, controlling for initial symptoms.
Conclusions:  Consistent with the BAS hypersensitivity model of bipolar disorder, a highly responsive BAS provides vulnerability to onsets of (hypo)manic episodes. In addition, a highly sensitive BIS increases risk for major depressive episodes.     

Increased soluble tumor necrosis factor-α receptors in patients with major depressive disorder

Aim:  Several lines of evidence suggest that major depressive disorder is associated with an inflammatory status. Tumor necrosis factor-α has been investigated as a potential molecular target in mood disorders. Tumor necrosis factor-α exerts its activity through binding to specific cell membrane receptors named as TNFR1 and TNFR2. The aim of the present study was to investigate soluble plasma TNFR1 (sTNFR1) and TNFR2 levels (sTNFR2) in major depressive disorder patients.
Methods:  Female outpatients with major depressive disorder ( n  = 30) were compared with a healthy control group ( n  = 19). Severity of depressive symptoms was evaluated on Beck Depression Inventory; post-traumatic stress disorder (PTSD) symptoms were evaluated on PTSD Checklist–Civilian Version; and childhood abuse and neglect on the Childhood Trauma Questionnaire. Plasma tumor necrosis factor-α and its soluble receptors were measured by ELISA.
Results:  Patients had no changes in tumor necrosis factor-α concentrations but did have increased sTNFR1 ( P  < 0.001) and sTNFR2 ( P  < 0.001) levels compared to controls. Plasma level of sTNFR1 was positively predicted by age (B = 0.25, P  = 0.05) and PTSD-like symptoms (B = 0.41, P  = 0.002) and plasma levels of sTNFR2 by depression severity (B = 0.67, P  < 0.001).
Conclusions:  Soluble tumor necrosis factor-α receptors could be reliable markers of inflammatory activity in major depression.     

Clinical psychological tests useful for differentiating depressive state with Alzheimer's disease from major depression of the elderly

Background:  A depressive state with Alzheimer's disease (AD) is difficult to differentiate from major depression (MD) in many cases. The purpose of this study was to identify differences between the two disorders using a battery of clinically available psychological tests.
Methods:  We evaluated depression and apathy using the Geriatric Depression Scale consisting of 30 items (GDS30) and Apathy Scale in 38 patients with AD and 31 with MD who were diagnosed based on clinical symptoms and radiological findings. In addition, the Cornel Medical Index (CMI) was employed to compare the psychological features of the two disorders.
Results:  In AD patients, the Apathy Scale score was greater than the GDS30 score, suggesting a strong tendency toward apathy. There was a significant difference in the GDS30/Apathy Scale score ratio between the two groups ( P  < 0.05, OR: 3.11). When examining the downstream mental items of the CMI, the values of tension-category parameters were significantly greater in AD patients, whereas those of depression-category parameters were significantly higher in MD patients. In individual patients, we compared the scores for the two categories, and there was a marked difference ( P  < 0.001, OR: 10.6).
Conclusion:  These results suggest that the GDS30, Apathy Scale, and CMI are useful for differentiating MD from AD and evaluating their psychological features.     

Severity of mood symptoms and work productivity in people treated for bipolar disorder

Objective:  To evaluate the relationship between mood symptoms and work productivity in people with bipolar disorder.
Methods:  A total of 441 outpatients treated for bipolar disorder were enrolled from mental health clinics of a health plan in Washington State. A baseline assessment included confirmation of diagnosis (using the Structured Clinical Interview for DSM-IV) as well as assessment of employment status, functional impairment, and days missed from work. Eight follow-up interviews over 24 months included self-reported employment status, self-reported days missed from work due to illness, and assessment of current and interval mood symptoms using the Longitudinal Interval Follow-up Examination.
Results:  Averaged over four assessments, patients with current major depression were 15% less likely to be employed than those without significant depressive symptoms [odds ratio (OR) = 0.84, 95% confidence interval (CI): 0.76–0.92]. Manic or hypomanic symptoms were not significantly associated with probability of employment (OR = 0.93, CI: 0.83–1.04). Among those employed, major depression was associated with 4.06 additional days of work missed per month (CI: 1.05–7.06) compared to those without significant depressive symptoms. Meeting criteria for manic or hypomanic episode was associated with a similar number of missed work days, but this difference was not statistically significant (adjusted difference = 4.11 days, CI: -0.18–8.40).
Conclusions:  Among patients with bipolar disorder, depression is strongly and consistently associated with decreased probability of employment and more days missed from work due to illness. Symptoms of mania or hypomania have more variable effects on work productivity.     

Alterations in prefrontal cortical activity in the course of treatment for late-life depression as assessed on near-infrared spectroscopy

Aim:  To evaluate the severity of depression by measuring alterations in prefrontal cortical activity associated with mood disorders, as assessed on near-infrared spectroscopy.
Methods:  Ten of 27 subjects hospitalized for late-life depression from May 2006 to June 2007, were examined. In these 10 subjects changes in hemoglobin concentration were measured on near-infrared spectroscopy during two types of the rock, paper, scissors game as the cognitive tasks affecting prefrontal cortical activity on 2 days, including 1 day on which depressive symptoms had slightly improved due to treatment, and then on another day >4 weeks later. Severity of depression and cognitive impairment were also simultaneously assessed.
Results:  The change in oxygenated hemoglobin concentration during a difficult task (intentional loss task) was significantly larger than that during an easy task (try to win task) on the left side (left, P  = 0.010; right, P  = 0.059). On the left side there was a significant negative correlation between the ratio of oxygenated hemoglobin measurements on the second day to those on the first day, and the severity of depression on the second day (left, P  = 0.012; right, P  = 0.090). Thus, the more left prefrontal cortical activity tended to increase, the fewer depressive symptoms tended to be present on the second day of testing.
Conclusions:  Measuring of alterations in prefrontal cortical activity associated with mood disorders, as assessed on near-infrared spectroscopy, is feasible in subjects with depression.     

Increase in eveningness and insufficient sleep among adults in population-based cross-sections from 2007 to 2017

ObjectivesShort or long sleep duration, insufficient sleep, and Evening chronotype associate with many health issues and increased risk for mortality. Understanding population-level changes in sleep and chronotype frequencies is important for assessing the prospective health status of the society and future challenges on health care at a national level. This study examines the cross-sectional differences in sleep duration, insufficient sleep, and chronotype frequencies indicated by both circadian preference and habitual sleep-wake rhythm among adults living in Finland during a 10-year period of 2007–2017.MethodsThe study sample (N = 18 039) was derived from he National FINRISK 2007 and 2012 Studies, and The FinHealth 2017 Study, each consisting of a random sample of adults, aged 25–74 years and as stratified by age and sex, and providing the self-reported data on their circadian preference, habitual daily sleep duration, insufficient sleep and bedtimes.TResultsDuring the 10 years, sleep duration decreased, insufficient sleep increased and circadian preference towards eveningness increased significantly in each 10-year age group and among both sexes. In general, eveningness was more common among younger adults in all the study years but, as compared to 2012, in 2017 bedtimes and midpoint of sleep were more advanced among this age group while sleep-wake rhythm became more delayed in older adults. The decrease in sleep duration and the increase in insufficient sleep were emphasized in younger adults and especially in women, whereas the increase in eveningness in older adults and in men.ConclusionsThe evolution of sleep and chronotype frequencies from 2007 to 2017 is alarming, as these might lead to a poorer health status in the adult population and thus cause more strain to the public health. The mismatch between sleep-wake behavior and circadian preference was emphasized in young adults, indicating a greater risk for circadian misalignment in the Finnish adult population in the future, if there will not be any interventions to correct this mismatch.     

Fatigue, depression and disability accumulation in multiple sclerosis: a cross-sectional study

Objective:  To investigate the influence of disability and the speed of disability accumulation on fatigue and depression in a large cohort of patients with multiple sclerosis (MS).
Methods:  A total of 412 patients completed the Fatigue Severity Scale (FSS) and Center for Epidemiological Studies Depression Scale (CESD). The patients were registered at our outpatient department and demographic and disease specific data were compared between patients with and without severe fatigue (FSS ≥ 5.0) and clinically significant depressive symptoms (CESD ≥ 16). We investigated the association of Expanded Disability Status Scale (EDSS) scores, multiple sclerosis severity scores (MSSS) and either CESD scores or FSS-scores with severe fatigue and clinically significant depressive symptoms in a multivariable logistic regression model, with adjustment for possible confounders.
Results:  Only CESD scores were independently associated with severe fatigue. FSS scores and female gender were independently associated with clinically significant depressive symptoms. Neither EDSS nor MSSS scores were independently associated with fatigue or depression.
Conclusion:  In patients with MS, fatigue and depression are strongly associated with each other but not with the degree of disability or the speed of disability accumulation.     

Relationship between body-mass index and depressive symptoms in patients with major depression.

BACKGROUND: Appetite and weight changes are commonly occurring symptoms of depressive illness. The occurrence of these symptoms may not only be related to depressive mood but may also be related to body weight. AIM: To examine the relationship between symptoms of depression and body weight. METHODS: Symptoms of depression were assessed by the Montgomery-Asberg depression rating scale (MADRS) in 1694 patients seeking medical help and fulfilling DSM-IV criteria for a major depressive episode. The level of anxiety was evaluated by Covi's anxiety scale. Body weight was expressed as body-mass index (BMI, kg/m(2)) and treated both categorically and continuously. RESULTS: The total MADRS score was not statistically different across the four BMI categories (underweight: 32.3 +/- 0.6, normal weight: 30.9 +/- 0.2, grade 1: 30.6 +/- 0.3, and 2 overweight: 30.6 +/- 0.6, P = 0.053 (NS)). In women with BMI 相似文献   

Determinants of social functioning in bipolar disorder

Background:  Evidence indicates that social outcomes in bipolar disorders (BP) are poorer than previously assumed. This study explores determinants of the quality and quantity of social activity.
Methods:  Seventy-seven subjects with BP completed self-report and observer-rated questionnaires assessing demographic and clinical factors, personality and social functioning.
Results:  Quality of functioning and spectrum of activity were found to be independent. The best determinants of the quality of functioning, accounting for 33% of the variance, were premorbid neuroticism and the current level of depressive symptoms. Only 30% of subjects were active in all social domains, and the quantity of social activity was largely explained by social circumstances, namely, living with someone else and later age of illness onset.
Conclusions:  The implications of these findings are discussed in this paper. We suggest that future studies need to differentiate between factors associated with the quality of functioning as compared with the quantity of social activity.     

Fatigue and its association with sleep disorders,depressive symptoms and anxiety in patients with multiple sclerosis

Background and purposeThe aetiopathogenesis of fatigue in multiple sclerosis (MS) is not clear. It could be associated with structural changes of the central nervous system, but also with mood and sleep disorders. The purpose of the study was to evaluate frequency of fatigue and its association with sleep and mood disorders in MS patients.Material and methodsThe examined group consisted of 122 MS patients (mean age 37.7 ± 10.8 years). The following questionnaires were used: Fatigue Severity Scale (FSS), Epworth Sleepiness Scale (ESS), Athens Insomnia Scale (AIS), Montgomery-Asberg Depression Rating Scale (MADRS), and Hospital Anxiety and Depression Scale (HADS).ResultsFatigue was present in 75 MS patients (61.5%). Excessive daytime sleepiness was observed in 25 (20.5%), insomnia in 73 patients (59.8%). According to MADRS, depressive symptoms were present in 33 (27%), according to HADS in 15 people (12.3%). Anxiety was present in 32 patients (26.2%). We observed an association between fatigue (FSS) and sleep disorders (ESS, AIS) and also between fatigue and either depression (MADRS, HADS-D) or anxiety (HADS-A). The FSS score was not associated with age, sex, disease course and duration, Expanded Disability Status Stage (EDSS), treatment or level of education in MS patients. In inactive professionally people we noted significantly higher FSS scores (44.8 ± 13.8) in comparison with active individuals (37.2 ± 14.9; p = 0.0053).ConclusionsFatigue is a very common symptom in MS, sometimes associated with sleep disorders, depressive symptoms or anxiety. The treatable causes of fatigue in MS such as sleep and mood disturbances should be identified and treated.     

Total antioxidant capacity and total oxidant status in patients with major depression: Impact of antidepressant treatment

Aim:  The purpose of the present study was to investigate whether total antioxidant capacity (TAC) and total oxidant status (TOS) are associated with major depressive disorder (MDD) and to evaluate the impact of antidepressant treatment on TAC and TOS in MDD.
Methods:  Fifty-seven MDD patients and 40 healthy controls participated in the study. Serum TAC and TOS were measured both in patients and controls using Erel's methods. Patients were treated with antidepressant drugs for 12 weeks. The treatment course was evaluated using the Montgomery–Asberg Depression Rating Scale (MADRS) in all patients.
Results:  TOS and oxidative stress index (OSI) were higher ( P  = 0.0001 for both) and TAC was lower ( P  = 0.0001) in the MDD group compared with those of the controls. After 3 months of antidepressant treatment, TOS and OSI were decreased and TAC was increased compared with the pretreatment values ( P  = 0.0001, for all). Furthermore, there were significant positive correlations between the severity of the disease and serum TOS and OSI (r = 0.584, P  = 0.0001; r = 0.636, P  = 0.0001, respectively). A negative correlation was found between the severity of the disease and serum TAC (r = −0.553, P  = 0.0001) at the pre-treatment stage.
Conclusion:  Treatment administered for 3 months to MDD patients increases TAC while decreasing TOS and OSI.     

Eveningness and poor sleep quality independently contribute to self-reported depression severity in psychiatric inpatients with affective disorder

Background Chronotype and insomnia have been related to the development and to an unfavourable course of depression. However, the mutual relationship of both risk factors is as yet unclear, especially in acute, clinically manifest depressive disorders. Aims The present study was carried out to elucidate the separate direct and indirect influence of chronotype and poor sleep quality on depression severity in patients hospitalized for depression. Methods Depression severity (BDI-II), chronotype (Morningness–Eveningness Questionnaire), and subjective sleep quality (Pittsburgh Sleep Quality Index total score) were assessed concurrently in inpatients with a depressive syndrome and insomnia during routine treatment. Correlations, multiple regression and bootstrapping methods for testing mediation models were applied to assess the independent direct and indirect effects of chronotype and sleep quality on depression severity, after adjusting for effects of age and gender. Results Data from 57 consecutively admitted patients (88% with major depression) were analyzed (68% women, mean age 41?±?13 years). Significant correlations between morningness–eveningness (p?<0.05) or sleep quality (p?<0.01) and depression severity were found; in a multiple regression model comprising chronotype, sleep quality, age and gender, only chronotype (p?<0.05) and sleep disturbances (p?<0.01) remained as independent significant concurrent predictors of depression severity (R²?=?0.184, p?<0.01). Two mediation models revealed no significant results. Conclusions Eveningness and poor subjective sleep quality were independently and directly associated with higher depression severity in inpatients with depressive syndromes. Chronotype and sleep quality should be taken into account not only in risk assessment and prevention but also in hospitalized patients to develop and improve treatment options.