Depression and major depressive disorder in patients with Parkinson's disease

The prevalence of depression in Parkinson's disease (PD) varies greatly. In this study, we investigated major depressive disorder (MDD) and depressive symptoms without MDD in patients with PD. The psychopathological characteristics of depressive symptoms were assessed by a psychiatric interview. A total of 105 Japanese patients with PD without dementia were included. The Japanese version of the Beck Depression Inventory‐II (BDI‐II) with a cutoff score of 13/14 was used to screen for depression. Using a structured interview, a comprehensive psychiatric evaluation of patients with BDI‐II scores >13 (high BDI patients) was completed using the criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM)‐IV‐TR. Forty patients (38%) had a BDI‐II >13, but 29 did not show any depressed mood. Five cases met the criteria for MDD (three current, two past) and one patient was diagnosed with minor depressive disorder. A slight depressed mood that was associated with worrying about PD was seen in 6 of 34 patients without any depressive disorder and fluctuated with aggravation of PD symptoms in two of these patients. For the diagnosis of MDD, the number of positive items from the DSM‐IV‐TR definition of MDD is most important and useful for differentiating MDD and non‐MDD. The low‐prevalence rate of MDD in our patient population suggests that PD may be a psychological stressor for MDD, but does not necessarily induce MDD. © 2009 Movement Disorder Society     

Open-label nefazodone in patients with a major depressive episode and alcohol dependence

PURPOSE: Major depressive disorder (MDD) and alcohol dependence (AD) frequently occur together. However, MDD clinical trials generally exclude patients with alcohol-related disorders. GENERAL METHODS: A 12-week, open-label trial of nefazodone in a group of people (n=13) with both a current major depressive episode and current AD was conducted to examine the effect of this antidepressant on depressive symptoms, alcohol use, and cognition. FINDINGS: Scores on the Hamilton Rating Scale for Depression (HRSD) and Hamilton Rating Scale for Anxiety (HRSA) significantly decreased from baseline to exit. In addition, significant reduction in alcohol craving, drinks/week, and days of alcohol use/week was found. Scores on the Rey Auditory Verbal Learning Test (RAVLT) did not significantly improve during the study. Changes in mood/anxiety and memory did not correlate with changes in alcohol use. CONCLUSIONS: Thus, nefazodone therapy was associated with improvement in mood/anxiety and alcohol use, which seem to be independent of each other in this patient sample. However, declarative memory, which was low average at baseline, did not show statistically significant improvement during the 12 weeks of the study.     

Effect of reboxetine on depression in Parkinson's disease patients

BACKGROUND: Depression occurs frequently in patients with Parkinson's disease and appears to be associated with increased disability and reduced quality of life. Pharmacologic treatment with tricyclic antidepressants or serotonin reuptake inhibitors may produce adverse effects on cognition or motor functions in Parkinson's disease patients. The efficacy of reboxetine, a novel norepinephrine reuptake inhibitor, has been shown in major depressive disorder, with specific effects on motivation and negligible effects on psychomotor and cognitive function. METHOD: The effects of reboxetine on depression were investigated in 16 patients with idiopathic Parkinson's disease in an open, prospective study. Prior antidepressant medication was stopped because of lack of efficacy or intolerable side effects. Severity of depressive symptoms was assessed by the Hamilton Rating Scale for Depression, the Self-Rating Depression Scale, the Snaith-Hamilton Pleasure Scale, and the Social Adaptation Self-Evaluation Scale during the study period of 4 weeks. RESULTS: A significant improvement in depression scores was observed after 4 weeks (z = -3.31, p < .008). In 1 subject, reboxetine treatment was discontinued because of psychotic symptoms. Seven patients experienced transient side effects, including restlessness, insomnia, and increased sweating. There were no significant changes in parkinsonian motor symptoms or dosage of levodopa. CONCLUSION: Reboxetine appears to be effective and well tolerated in Parkinson's disease patients receiving 4 weeks of treatment of moderate-to-severe depression. There are good theoretical and clinical reasons, including pharmacologic specificity of effects and low incidence of side effects, to consider reboxetine for treatment of depression in Parkinson's disease.     

Recovery from a recurrent major depressive episode

Episode-related factors and antidepressant treatment adequacy may be important determinants of recovery from a major depressive episode (MDE). We compared recovered and nonrecovered patients on baseline sociodemographic, clinical and episode-related measurements. Twenty-five inpatients with recurrent major depressive disorder diagnosed by SADS-L participated in this naturalistic, prospective, longitudinal study. Recovery, which was defined as a sustained return to non-depressed status lasting > or = 8 consecutive weeks, was assessed at 6- and 12-month follow-up with the Streamlined Longitudinal Interval Continuation Evaluation (SLICE). Thirteen (52%) patients met recovery criteria. The cumulative proportion remaining depressed for at least 52 weeks was 42.5%. Recovered patients had shorter episodes preceding the index hospitalization (P = .01). Despite adequate antidepressant pharmacotherapy, the length of the current episode remains the most important correlate of recovery from MDE recurrence. Our small sample size and the uncontrolled nature of treatment may limit the generalizability of these findings.     

Stroke lesion in cortical neural circuits and post-stroke incidence of major depressive episode: A 4-month prospective study

Abstract

Objective. Little is known about the relevance of lesion in neural circuits reported to be associated with major depressive disorder. We investigated the association between lesion stroke size in the limbic-cortical-striatal-pallidal-thalamic (LCSPT) circuit and incidence of major depressive episode (MDE). Methods. We enrolled 68 patients with first-ever ischemic stroke and no history of major depressive disorder. Neurological and psychiatric examinations were performed at three time-points. We diagnosed major depressive episode, following DSM-IV criteria. Lesion location and volume were determined with magnetic resonance imaging, using a semi-automated method based on the Brodmann Cytoarchitectonic Atlas. Results. Twenty-one patients (31%) experienced major depressive episode. Larger lesions in the left cortical regions of the LCSPT circuit (3,760 vs. 660 mm³; P = 0.004) were associated with higher incidence of MDE. Secondary analyses revealed that major depressive episode was associated with larger lesions in areas of the medial prefrontal cortex including the ventral (BA24) and dorsal anterior cingulate cortex (BA32) and subgenual cortex (BA25); and also the subiculum (BA28/36) and amygdala (BA34). Conclusions Our findings indicate that depression due to stroke is aetiologically related to the disruption of the left LCSPT circuit and support the relevance of the medial prefrontal cortex dysfunction in the pathophysiology of depression.     

Search for abnormal proteins in erythrocytes and plasma from patients with a major depressive episode

A sensitive double-label two dimensional gel electrophoresis procedure has been used to search for abnormal proteins in plasma and erythrocyte plasma membranes from patients with major depressive illness. For both plasma and erythrocytes, minor qualitative and quantitative differences between the proteins in pooled samples from depressed and normal subjects were observed; however, these were shown to be artifacts and no consistent differences were found.     

Prospective study of clinical predictors of suicidal acts after a major depressive episode in patients with major depressive disorder or bipolar disorder

OBJECTIVE: The authors investigated the predictive potential of a stress-diathesis model for suicidal behavior based on correlates of past suicidal acts. In this model, suicidal acts are precipitated by stressors such as life events or a major depressive episode in the setting of a propensity for acting on suicidal urges. This diathesis is expressed as the tendency to develop more pessimism in response to a stressor and/or the presence of aggressive/impulsive traits. The predictive potential of the diathesis was tested by determining whether clinical correlates of past suicidal behavior predict suicidal acts during a 2-year follow-up of patients with a major depressive episode. METHOD: Patients with DSM-III-R major depressive disorder or bipolar disorder (N=308) were assessed at presentation for treatment of a major depressive episode. Potential predictors of suicidal acts in the 2 years after study enrollment were identified on the basis of an association with previous suicidal behavior and were tested by using Cox proportional hazards regression analysis. In addition, pessimism and aggression/impulsivity factors were generated, and their predictive ability was tested by using Cox proportional hazards regression analysis. RESULTS: The three most powerful predictors of future suicidal acts were a history of suicide attempt, subjective rating of the severity of depression, and cigarette smoking, each of which had an additive effect on future risk. The pessimism and aggression/impulsivity factors both predicted suicidal acts, and each factor showed an additive effect. CONCLUSIONS: In addition to obtaining a history of suicidal behavior, clinicians may find it useful to assess patients' current level of pessimism, aggressive/impulsive traits, and comorbidity with substance use disorders, including nicotine-related disorders, to help identify patients at risk for suicidal behavior after major depression. Interventions such as aggressive pharmacotherapeutic prophylaxis to prevent relapse or recurrence of depressive symptoms may protect such at-risk individuals from future suicidal behavior.     

An open trial of reboxetine in HIV-seropositive outpatients with major depressive disorder

BACKGROUND: The prevalence of major depressive disorder (MDD) in human immunodeficiency virus (HIV)-seropositive patients is higher than in the general population. The treatment of comorbidities of HIV infection, such as depression, is an important target in the clinical management of these patients. The use of antidepressants in HIV patients can be complicated by the pharmacokinetic interaction between antidepressants and antiretroviral agents. Several antidepressants and antiretrovirals are metabolized by cytochrome P450 (CYP450). Reboxetine is a noradrenergic antidepressant that is not metabolized by CYP450 and may offer a valuable option in the treatment of MDD in HIV-seropositive patients. METHOD: Twenty HIV-infected outpatients with MDD according to DSM-IV criteria were treated with reboxetine, 8 mg/day, for 12 weeks within an open trial design. Outcome measures included the Montgomery-Asberg Depression Rating Scale (MADRS) and a side effect profile. Data were gathered from July 2000 to March 2001. RESULTS: Seventy-five percent of patients (N = 15) completed the trial. All patients who completed the trial had an improvement equal to or higher than a 50% reduction in their MADRS scores at endpoint. The most frequent adverse effects were insomnia, sweating, and shivering. CONCLUSION: Within this open trial, reboxetine was found to be effective in reducing depressive symptoms in HIV illness. The rate of dropout (25%) suggests that reboxetine may be well tolerated in this population.     

Induction of a mixed depressive episode during rTMS treatment in a patient with refractory major depression.

Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive experimental technique which has mostly been investigated in the treatment of mood disorders with possible efficacy in depression. Among its potential side effects, there have been some reports of rTMS-induced (hypo)mania in the literature but none for rTMS-induced mixed episodes. We report the case of a 39-year-old woman suffering from refractory chronic major depression who developed a depressive mixed episode associated with a mild serotonin syndrome during her second week of rTMS treatment. She was receiving a combination of antidepressants, the doses of which were kept unchanged during rTMS treatment. Mixed as well as manic episodes may be induced by transcranial magnetic stimulation, complications already observed with antidepressants and electroconvulsive therapy. Therefore, caution should be exercised among clinicians using this experimental procedure, particularly in the treatment of bipolar depressed patients.     

Electroconvulsive therapy in a patient with severe tic and major depressive episode

A patient with a disabling tic and a major depressive episode responded partially to phenelzine, but relapsed after medication was withdrawn because of hypertensive and hepatotoxic reactions. The patient's motor and affective symptoms resolved after electroconvulsive therapy, and he remains asymptomatic after 1 year.     

Cortisol responses to combined dexamethasone/CRH test in outpatients with a major depressive episode

The DEX/CRH test is now a well established method to test the hypothalamic–pituitary–adrenal (HPA) axis for depressed patients in an inpatient setting. The aim of this study was to evaluate this test in an outpatient population suffering from major depression compared to a healthy control group. The main result is a statistically significant difference concerning the delta value for cortisol plasma value on the DEX/CRH test for depressed patients with two or more previous episodes compared to healthy controls. On the contrary, the difference was not statistically significant for patients with only one or no previous episodes. In future studies, it could be interesting to use this test more specifically by dividing ambulatory patients into subgroups according to their past depressive history. It could also be interesting to measure the ACTH level.     

Cognitive therapy for a major depressive episode in residual schizophrenia

The present paper describes cognitive approaches to the treatment of a major depressive episode in a patient with residual schizophrenia. The goal of therapy was to increase and stabilize the patient's physical activity through decreasing dysfunctional cognition pertinent to inertia. A therapeutic strategy of 'scheduling activities' was first selected, but to no effect. The vicious circle of alternating excessive activity and total inertia remained unchanged. Based on a revised cognitive case conceptualization, a second strategy, 'scheduling inertia', was then introduced, in which the patient was asked to stay in bed or take a rest for planned periods of time every day. This intervention helped the patient to counteract her perfectionist beliefs. The results suggest that 'scheduling inertia' may be a useful strategy for improving inactivity in a major depressive episode during the residual phase of schizophrenia.     

伴精神病性症状及童年期创伤的重度抑郁发作青少年患者执行功能情况

背景 有无精神病性症状的重度抑郁发作患者执行功能存在差异,且童年期创伤可能影响重度抑郁发作患者的执行功能,既往研究对象大多为成年抑郁发作患者,缺少对重度抑郁发作青少年患者的相关研究。目的 比较有无精神病性症状及童年期创伤的重度抑郁发作青少年患者执行功能的差异。方法 纳入2020年8月-2021年11月在深圳市康宁医院儿少精神科住院的、符合《国际疾病分类（第10版）》（ICD-10）重度抑郁发作诊断标准的青少年患者共112例,同期通过公开宣传招募健康对照组27例。使用剑桥神经心理自动化成套测试（CANTAB）中的运动控制任务（MOT）、空间工作记忆（SWM）、快速视觉信息处理（RVP）三个任务评定患者的执行功能,采用儿童期创伤问卷（CTQ-SF）评定童年期创伤类型。结果 与健康对照组相比,重度抑郁发作患者MOT任务平均延迟时更长（Z=-3.407,P=0.001）,SWM任务中的组间错误反应总数更多（Z=-3.291,P=0.001）、组内错误反应总数更多（Z=-3.461,P=0.001）、双重错误反应总数更多（Z=-3.218,P=0.001）、错误反应总数更多（Z=-3.312,P...     

Metabolic syndrome in subjects with bipolar disorder and major depressive disorder in a current depressive episode: Population-based study: Metabolic syndrome in current depressive episode

ObjectiveTo assess the differences in the prevalence of the metabolic syndrome (MetS) and their components in young adults with bipolar disorder (BD) and major depressive disorder (MDD) in a current depressive episode.MethodsThis was a cross-sectional study with young adults aged 24–30 years old. Depressive episode (bipolar or unipolar) was assessed using the Mini International Neuropsychiatric Interview – Plus version (MINI Plus). The MetS was assessed using the National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP III).ResultsThe sample included 972 subjects with a mean age of 25.81 (±2.17) years. Both BD and MDD patients showed higher prevalence of MetS compared to the population sample (BD = 46.9%, MDD = 35.1%, population = 22.1%, p < 0.001). Higher levels of glucose, total cholesterol and LDL cholesterol, Body Mass Index, low levels of HDL cholesterol, and a higher prevalence of abdominal obesity were observed in both BD and MDD individuals with current depressive episode compared to the general population. Moreover, there was a significant difference on BMI values in the case of BD and MDD subjects (p = 0.016).ConclusionMetabolic components were significantly associated with the presence of depressive symptoms, independently of the diagnosis.     

Effect of reboxetine on major depressive disorder in breast cancer patients: an open-label study

BACKGROUND: Depression is a common disorder in cancer patients, and it is associated with reduced quality of life, abnormal illness behavior, pain, and suicide risk. A few studies have investigated the effects of tricyclic antidepressants and serotonin reuptake inhibitors in cancer patients. No data are available regarding the use of reboxetine, a norepinephrine reuptake inhibitor that has been shown to be safe (e.g., absence of clinically significant drug-drug interactions and cytochrome P450 metabolism) and effective in the treatment of depressed patients, including those with medical illness (e.g., Parkinson's disease, human immunodeficiency virus infection). METHOD: The effects of reboxetine were investigated in 20 breast cancer patients with a DSM-IV diagnosis of major depressive disorder in an open, prospective 8-week trial. Severity of depression was assessed with the 17-item Hamilton Rating Scale for Depression (HAM-D). Psychiatric symptoms (Brief Symptom Inventory [BSI]), styles of coping with cancer (Mini-Mental Adjustment to Cancer [Mini-MAC]), quality of life (European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire C30 [EORTC-QLQ-C30]), and Clinical Global Impressions scale scores were also monitored. RESULTS: At 8 weeks, a significant (p <.01) reduction was observed in HAM-D scores, several BSI dimension scores, and Mini-MAC hopelessness and anxious preoccupation scores. A significant (p <.05) improvement from baseline to endpoint was found on the EORTC-QLQ-C30 subfactors emotional, cognitive, dyspnea, sleep, and global. Discontinuation was necessary in 1 subject because of hypomanic switch and in another because of side effects (tachycardia, tension). Seven patients experienced transient side effects (e.g., mild anxiety, insomnia, sweating). CONCLUSION: In this open trial, reboxetine appeared to be well tolerated and promising in reducing depressive symptoms and maladjusted coping styles and in improving scores on quality-of-life parameters.     

Frequency and treatment of depressive symptoms in a Parkinson's disease registry

Purpose of this cross-sectional study was to estimate the occurrence of depressive symptoms, as related to other clinical data, in a sample of Parkinson's disease (PD) patients (n = 226). Furthermore, we examined the medical care of depressive symptoms in this sample.H&Y stages, cognitive status, sleeping disorders, and dysphagia resulted as significant predictors for depression. Prevalence of depressive symptoms was 35.4%. Only 25.0% of patients suffering from moderate to severe depressive symptoms were prescribed antidepressants.This study supports the view that depression may be underrecognized and undertreated in PD patients. A significant proportion of patients continues to experience depressive symptoms despite antidepressive medication. Recognition and treatment of depression remains a challenge for management of PD. Possible coexisting depressive symptoms should be revealed and assessed by standardized interviews in everyday clinical routine. Large scale randomized controlled trials examining efficacy and safety of antidepressants in PD patients are urgently required.