Major depressive disorder viewed as a dysfunction in astroglial bioenergetics

For many years scientists and physicians have pondered upon the apparent connection between depressive disorder and diabetes mellitus. Several epidemiologic studies confirm that diabetics have increased incidence of depression, and vice versa. In addition: depressive, non-diabetic patients have several insulin- and glucose-metabolism disturbances, probably exerting a compensatory reaction to the malfunction in the depressed brain as these disturbances are normalised in remission. After the discovery of PET-scanning, such studies have shown that patients with depressive disorder have reduced glucose metabolism in frontal parts of the brain. The present hypothesis regards the PET findings as observations of the primary pathophysiology of depression. Furthermore: two studies of post mortem samples from depressed patients show reduced numbers of astroglia. This is in accordance to the mentioned insulin disturbances, as only astroglia, not neurons, have insulin-sensitive glucose metabolism. Hence: the astroglia, not necessarily the neurons, are proposed to be the type of cells in which the disease resides. Most probably depressive disorder is a multitude of diseases, explaining the apparent multitude of symptoms, and the fact that different patients do respond to different drugs. Therefore: one can only formulate the hypothesis by mentioning a common denominator to these specific malfunctions, namely: disturbed glucose metabolism in the depressed brain. The present paper reviews several findings and proposes that attenuated cerebral glucose metabolism in frontal parts of the brain, in the astroglia, is the cause of depressive disorder.     

Major depressive disorder during pregnancy and emotional attachment to the fetus

While there is good evidence that depression negatively impacts mother-to-infant emotional attachment in the postpartum period, the impact of depression in pregnancy on maternal emotions and cognitions about the fetus (often termed “maternal–fetal attachment” or MFA) is unclear. This study compared MFA scores from women meeting clinical criteria for Major Depressive Disorder (MDD) with scores from nondepressed women. Participants were 161 women enrolled at 23–36 weeks gestation, of whom 65 met criteria for MDD via the Structured Clinical Interview for the DSM-IV-TR during their second and/or third trimesters. Cranley’s Maternal Fetal Attachment Scale was administered at 26 and 36 weeks gestation. Generalized linear modeling was used to assess the effect of MDD, anxiety, and antidepressant use on MFA. MDD was negatively related to MFA (LR) = 4.58, df = 1, p < 0.04). Neither anxiety (LR = 0.22, p < 0.64), nor antidepressant use (LR = 0.20, df = 1, p < 0.66) were related to MFA. Depression severity was negatively related to MFAS scores (B = −0.005, SE = .002, p < 0.0012) when including the interaction of MDD group and HRSD scores in the model. This study is the first to demonstrate that clinically defined MDD during pregnancy negatively impacts MFA, suggesting that the basis for poor mother-to-infant attachment in postpartum MDD may have roots in pregnancy.     

Major depressive disorder: probiotics may be an adjuvant therapy

Major depressive disorder (MDD) is an extremely complex and heterogeneous condition. Emerging research suggests that nutritional influences on MDD are currently underestimated. MDD patients have been shown to have elevated levels of pro-inflammatory cytokines, increased oxidative stress, altered gastrointestinal (GI) function, and lowered micronutrient and omega-3 fatty acid status. Small intestinal bacterial overgrowth (SIBO) is likely contributing to the limited nutrient absorption in MDD. Stress, a significant factor in MDD, is known to alter GI microflora, lowering levels of lactobacilli and bifidobacterium. Research suggests that bacteria in the GI tract can communicate with the central nervous system, even in the absence of an immune response. Probiotics have the potential to lower systemic inflammatory cytokines, decrease oxidative stress, improve nutritional status, and correct SIBO. The effect of probiotics on systemic inflammatory cytokines and oxidative stress may ultimately lead to increased brain derived neurotrophic factor (BDNF). It is our contention that probiotics may be an adjuvant to standard care in MDD.     

Major depressive disorder predicts cardiac events in patients with coronary artery disease

Fifty-two patients undergoing cardiac catheterization and subsequently found to have significant coronary artery disease (CAD) were given structured psychiatric interviews before catheterization. Nine of these patients met criteria for major depressive disorder. All 52 patients were contacted 12 months after catheterization, and the occurrence of myocardial infarction, angioplasty, coronary bypass surgery and death was determined. Results of the study show that major depressive disorder was the best predictor of these major cardiac events during the 12 months following catheterization. The predictive effect was independent of the severity of CAD, left ventricular ejection fraction, and the presence of smoking. Furthermore, with the exception of smoking, there were no statistically significant differences between those patients with major depressive disorder and the remaining patients on any variable studied. The possible mechanisms relating major depressive disorder to subsequent cardiac events are discussed. It is concluded that major depressive disorder is an important independent risk factor for the occurrence of major cardiac events in patients with CAD.     

Major depressive disorder and inflammatory markers in elderly patients with heart failure

The authors evaluated levels of inflammatory markers in 34 chronic heart failure (CHF) out-patients age 65 years and over, with (N=18) and without (N=16) major depressive disorder (MDD), and healthy-control subjects (N=13). Patients with CHF had left-ventricular ejection fractions <0.40 and were in the New York Heart Association functional class II or III. The authors used the SCID DSM-IV to diagnosis MDD. High-sensitivity C-reactive protein levels were significantly higher in patients with CHF and MDD as compared with healthy-control subjects. No differences regarding tumor necrosis factor(alpha) or interleukin(6) were found among the three groups.     

How depressing life is--life-long morbidity risk for depressive disorder in the general population

We present estimates of lifetime risk and of cumulative risk up to each age for depressive disorder for the population of an inner city area (Camberwell, SE London). Estimates are based on an incidence study for the year 1976 which drew from the records of a case register. The estimates of lifetime risk obtained, 12% for men and 20% for women, are similar to those previously published in the literature. Inception risk by age and risks for in-patient treatment are also presented for men and women. The method of calculation is discussed and we show how to obtain an upper limit for the effect of the increased mortality associated with the disorder. We noted an apparent decline over the 'seventies' in inception rates for depression, and we consider the comparability of our statistics with risks calculated using complete psychiatric history data.     

Major depressive disorder in adolescents: family psychiatric history predicts severe behavioral disinhibition

BACKGROUND: Major Depressive Disorder (MDD) becomes increasingly prevalent during adolescence and is associated with substantial psychiatric comorbidity and psychosocial impairment. The marked behavioral heterogeneity evident among adolescents with MDD suggests the possibility of distinct subtypes. This study was designed to determine whether family psychiatric histories differ between groups of MDD adolescents defined by the presence or absence of severe behavioral disinhibition. METHODS: Adolescents with MDD (n = 71) completed the Buss-Durkee Hostility Inventory--Adapted, Adolescent Aggressive Incidents Interview (AAII), Measure of Aggression, Violence, and Rage in Children, Diagnostic Interview Schedule for Children, Suicidal Ideation Questionnaire-JR., Suicidal Behavior Inventory, and Reynolds Adolescent Depression Scale. Parents completed the Family Informant Schedule and Criteria, Children's Affective Liability Scale, AAII, and a partial DISC. Behavioral disinhibition (BD) measures were used to assign adolescents to MDD+BD (n = 41) and MDD-BD (n = 30) groups. RESULTS: The MDD+BD group had a higher prevalence of drug use disorders in biological fathers than the MDD-BD group. The MDD+BD group also had higher proportions of paternal second degree relatives with alcohol use disorders, drug use disorders, and psychiatric hospitalizations, and a higher proportion of maternal second degree relatives with antisocial personality disorder. LIMITATIONS: Limitations include reliance on single informants for family psychiatric histories and the failure to distinguish between child- and adolescent-onset depression. CONCLUSIONS: Family psychiatric histories differentiated MDD adolescents grouped by the presence or absence of behavioral disinhibition, suggesting possible etiologic mechanisms. Further research on subtypes or comorbid presentations may assist in the development of targeted treatment strategies.     

Anthropometric determinants of risk factors in an African American population

This study assessed the association of biological markers, including cholesterol, HDL, LDL, triglycerides, ApoA-1, and ApoB, with estimates of the body composition, including the conicity index (CI), BMI, bioelectrical impedance analysis, and the waist-to-hip ratio (WHR). One hundred-twenty-six African American adults (43-males, 83-females) from a public housing community in the District of Columbia were recruited. Females were four times more likely to be obese than were males. Among the four anthropometric indicators, the WHR was the best method to explain the variances in biological markers, including cholesterol and ApoB levels in females. The CI showed relationships with log triglyceride levels in females, while percentage body fat (%BF) explained the variances of log HDL and log ApoA-1 in males. For cholesterol, log triglycerides and ApoB, mean values were positively associated with tertiles of the WHR, whereas mean values of log HDL and log ApoA-1 were negatively associated with tertiles of %BF. The WHR and CI, indicators of relative body fat distribution, are more related to risk factors for CVD and diabetes among females than is the BMI. Am. J. Hum. Biol. 10:249–258, 1998. © 1998 Wiley-Liss, Inc.     

The use of psychiatric medications to treat depressive disorders in African American women

Review of the current literature confirms that African American women as a group are underdiagnosed and undertreated for psychiatric disorders. Hence, much effort is targeted towards awareness, screening, and improving access to health care for this population. However, once an African American woman is diagnosed with a major mental health disorder, determining the optimal course of treatment is a process that must be approached carefully because of gender and racial/ethnic differences in response and metabolism of psychiatric medications. African American women fall into both of these understudied categories. Given the small numbers of African American women represented in the clinical trials on which clinical practice is based, one must consider the limitations of current knowledge regarding psychoactive medications in this population. Culturally based attitudes or resistance to pharmacotherapy can complicate the use of psychoactive medicines, often a first-line approach in primary care clinics. Communication with patients is key, as well as openness to patient concerns and tolerance of these medications.     

Disparity in posttraumatic stress disorder diagnosis among African American pregnant women

To determine whether African American women expecting their first infant carry a disproportionate burden of posttraumatic stress disorder morbidity, we conducted a comparative analysis of cross-sectional data from the initial psychiatric interview in a prospective cohort study of posttraumatic stress disorder effects on childbearing outcomes. Participants were recruited from maternity clinics in three health systems in the Midwestern USA. Eligibility criteria were being 18 years or older, able to speak English, expecting a first infant, and less than 28 weeks gestation. Telephone interview data was collected from 1,581 women prior to 28 weeks gestation; four declined to answer racial identity items (n = 1,577), 709 women self-identified as African American, 868 women did not. Measures included the Life Stressor Checklist, the National Women’s Study Posttraumatic Stress Disorder Module, the Composite International Diagnostic Interview, and the Centers for Disease Control’s Perinatal Risk Assessment Monitoring System survey. The 709 African American pregnant women had more trauma exposure, posttraumatic stress disorder symptoms and diagnosis, comorbidity and pregnancy substance use, and had less mental health treatment than 868 non-African Americans. Lifetime prevalence was 24.0% versus 17.1%, respectively (OR = 1.5, p = 0.001). Current prevalence was 13.4% versus 3.5% (OR = 4.3, p < 0.001). Current prevalence of posttraumatic stress disorder (PTSD) was four times higher among African American women. Their risk for PTSD did not differ by sociodemographic status, but was explained by greater trauma exposure. Traumatic stress may be an additional, addressable stress factor in birth outcome disparities.     

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

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

Major depressive and post-traumatic stress disorder comorbidity in female victims of intimate partner violence

BACKGROUND & METHODS: Victims of intimate partner violence (IPV) often develop psychiatric disorders. We examined the extent and correlates of comorbidity between two of the disorders most frequently linked to trauma--major depressive disorder (MDD) and post-traumatic stress disorder (PTSD)--in a group of 44 women who were victims of IPV within the preceding 2 years. RESULTS: MDD (68.2%) and PTSD (50.0%) were highly prevalent on a lifetime basis in female victims of IPV. On a current basis, MDD (18.2%) and IPV-related PTSD (31.8%) were more frequently comorbid (42.9% of cases of current IPV-related PTSD also had MDD) than would be expected by chance (P<0.001). Most cases of current MDD occurred in persons who also had current IPV-related PTSD. Severity of depressive and PTSD symptoms were highly correlated (r=0.84). Although women with PTSD were significantly more disabled than women without PTSD, persons with comorbid PTSD and MDD were not significantly more disabled than those with PTSD alone. LIMITATIONS: Cross-sectional study; entry criteria for study may limit generalizability. CONCLUSIONS: PTSD and MDD symptoms are frequently seen in the aftermath of IPV, and often co-occur. The usefulness of the distinction between PTSD and MDD in this context remains to be determined, both in terms of diagnostic classification and prognostic implications.     

Longitudinal relations between employment and depressive symptoms in low-income, suicidal African American women

Unemployment and depression are problematic at both individual and societal levels, and research suggests that the two phenomena are related. More thorough and longitudinal analyses, particularly ones within low-income minority populations, are needed to guide the development of programs to increase employment in persons with mental health problems. The current study aimed to specify the relations over time between depressive symptoms and employment status within a sample of 46 low-income African American women participating in an intervention study for intimate partner violence and suicidal behavior. Hierarchical logistic regression analysis indicated that baseline levels of depressive symptoms predicted employment status at the end of a 10-week intervention period, controlling for baseline employment status. Chi-square analysis and qualitative analyses of trends in depression scores showed that changes in employment status during the 10-week intervention period predicted 6-month and one-year follow-up levels of depressive symptoms. Results imply that, for women in the currently sampled population, depressive symptoms create vulnerability for job loss, but the ability to gain employment despite high levels of depressive symptoms is linked to lowered depression levels over the long term. Community programs assisting such women could therefore not just lower the vulnerability to job loss by treating depressive symptoms, but they could potentially lower long-term depression levels through interventions that enhance employability and motivation to pursue work.     

抑郁障碍的研究进展

抑郁障碍是临床常见的神经精神疾病 ,其发病机理较为复杂 ,患者免疫功能低下 ,与IL - 1、IL -2、IL - 6等细胞因子有关 ,抑郁时各种神经递质通过对HPA轴的影响 ,作用并损伤各种脑区 ,产生各种抑郁症状。长期抑郁引起脑病理学改变 ,神经元数目减少 ,脑裂加深扩大等 ,其fos .jun等蛋白表达也异常 ,进一步表明抑郁障碍是分子疾病