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Journal of affective disorders [journal]
- Discrepancy between self- and observer-rated depression severities as a predictor of vulnerability to suicide in patients with mild depression. [Journal Article]
- J Affect Disord 2014 Jun.:144-9.
Discrepancies in depression severity between the Hamilton Depression Rating Scale (HAMD) and the Beck Depression Inventory (BDI) have been reported. However, whether these discrepancies impact vulnerability to suicide in patients with major depressive disorder (MDD) remains unclear.Patients with mild MDD (n=161) were enrolled in the study and divided into the following 3 groups: (1) patients with MDD with the discrepancy (n=45), i.e., those with low HAMD17 scores (8-13) and high BDI-II scores (≥29), (2) patients with MDD without the discrepancy (n=46), i.e., those with low HAMD17 scores and low BDI-II scores (≤28), and (3) patients not currently depressed (n=70), i.e., those with HAMD17 scores ≤7 (affective controls). We examined the relationship of demographic, clinical, and neuropsychological variables with any discrepancy between self-rating and observer rating.Patients with MDD with the discrepancy had significantly higher hopelessness than those without the discrepancy and affective controls. Verbal fluency task performance of patients with MDD with the discrepancy was significantly impaired compared with that of those without the discrepancy and affective controls. Stepwise logistic regression analysis revealed that a history of suicide attempt [odds ratio (OR), 3.57; 95% confidence interval (CI), 1.12-11.37] and hopelessness (OR, 1.23; 95% CI, 1.09-1.38) increased odds of the discrepancy.Results require replication.Clinicians should examine discrepancies between self- and observer-rated depression severities, which are associated with vulnerability to suicide in patients with MDD, even if objectively evaluated as mild.
- Commonalities in grief responding across bereavement and non-bereavement losses. [Journal Article]
- J Affect Disord 2014 Jun.:136-43.
Despite implications for theory and treatment, commonality in responding to non-bereavement and bereavement losses are not well explicated.This study identified the factor structure of the three most common responses to bereavement, prolonged grief, posttraumatic stress, and major depression in a bereaved community sample (n=151, 59% female, 68% white) from the U.S. recruited from Amazon's MTurk using a cross-sectional survey design, then cross-validated the structure in samples where people had lost other potentially self-defining roles; one's employment (n=157, 47% female, 69% white) and one's marriage (n=116, 62% female, 80% white).Results indicated that symptoms of prolonged grief, posttraumatic stress, and major depression were distinct factors in the bereaved sample, the three-factor solution was a good fit for the job-loss and divorce samples, and levels of grief in each sample appeared to be best predicted by time since loss and centrality of the loss to one's identity.Limitations include potential sample bias due to convenience sampling, and the cross-sectional design did not allow examination of the stability of factors over time.These results suggest that grief is not a unique response to loss of loved one but instead may be a common phenomenology across types of loss. This implies that facilitating meaningful engagement in self-defining activities that compensate for the disrupting loss might be efficacious in promoting grief resolution without the need for working through individuals' emotional attachment to a specific individual or processing one's emotional responses to the loss.
- Predictive value of baseline resistance in early response to antidepressants. [Journal Article]
- J Affect Disord 2014 Jun.:127-35.
Major Depressive Disorder (MDD) is the 3rd source for burden worldwide according to the World Health Organization (WHO). This comes partly from unsatisfactory response rates after usual treatment, highlighting the need for early indicators such as early improvement of depressive symptoms to adapt treatment strategies, especially for severe inpatients. Thus our objective was to assess the predictive value of baseline partial resistance in early antidepressant response (EAR), hypothesizing that previous treatment failures would decrease the probability of early response.We included 122 consecutive inpatients with current unipolar MDE. The Mini-Neuropsychiatric Interview was used to ascertain DSM-IV diagnoses of MDD as well as psychiatric comorbidities, and to exclude patients with a history of bipolar disorder. A specifically designed questionnaire was used to collect data on previous treatment trials for the current episode so as to generate scores on the five existing methods for quantifying treatment resistance. We prospectively assessed EAR, defined as a 50% decrease in MADRS after 14 days of steady regimen of antidepressant.In the per protocol sample (N=76), multivariate analyses showed that psychotic features at baseline remained an independent predictor of absence of EAR (p<.01), unlike baseline partial resistance, which may rather be associated with a lack of any improvement.Lack of data about further response and non-randomized treatment allocation.Available methods for quantifying treatment resistance are heterogeneous and do not predict short-term response among severely depressed inpatients, despite potential usefulness in predicting a lack of early improvement.
- Both body weight and BMI predicts improvement in symptom and functioning for patients with major depressive disorder. [Journal Article]
- J Affect Disord 2014 Jun.:123-6.
Obesity has shown a positive association with depression. We aimed to investigate the relationships among body weight, body mass index (BMI=kg/m(2)), change in a depression rating scale, and change in a functional scale with fluoxetine treatment for hospitalized patients with major depressive disorder (MDD).A total of 131 acutely ill inpatients with MDD were enrolled to receive 20mg of fluoxetine daily for 6 weeks. The 17-item Hamilton Depression Rating Scale (HAMD-17) for symptom and the Work and Social Adjustment Scale (WSAS) for functioning were assessed at weeks 0, 1, 2, 3, 4, and 6. Remission was defined as a score of≤7 on the HAMD-17 at endpoint. Body weight, body length, and BMI were measured at baseline. Pearson correlation coefficients (r) were calculated among body weight, BMI, HAMD-17 score change, and WSAS score change.Of the 131 participants, 126 (96.2%) had at least one post-baseline assessment and were included in the analysis. Significant differences in body weight and BMI existed between remitters and nonremitters. There were statistically significant relationships among baseline body weight, baseline BMI, HAMD-17 score change, and WSAS score change at end point.This is a short-term trial with relatively small sample size.Nonremitters had greater body weight and BMI before treatment. Increased body weight and BMI is correlated with the decreased improvement in symptom and functioning at end point. Depression and obesity should be treated concurrently to optimize clinical outcomes for the treatment of depression.
- Risk for suicidal behaviors associated with PTSD, depression, and their comorbidity in the U.S. Army. [Journal Article]
- J Affect Disord 2014 Jun.:116-22.
Suicide rates have risen considerably in the United States Army in the past decade. Suicide risk is highest among those with past suicidality (suicidal ideation or attempts). The incidence of posttraumatic stress disorder (PTSD) and depressive illnesses has risen concurrently in the U.S. Army. We examined the relationship of PTSD and depression, independently and in combination, and rates of past-year suicidality in a representative sample of U.S. Army soldiers.This study used the DoD Survey of Health Related Behaviors Among Active Duty Military Personnel (DoD HRB) (N=5927). Probable PTSD and depression were assessed with the PTSD Checklist (PCL) and the 10-item short form of the Center for Epidemiologic Studies Depression Scale (CES-D), respectively. Past-year suicidality was assessed via self-report.Six percent of Army service members reported suicidality within the past year. PTSD and MDD were each independently associated with past-year suicidality. Soldiers with both disorders were almost three times more likely to report suicidality within the past year than those with either diagnosis alone. Population-attributable risk proportions for PTSD, depression, and both disorders together were 24%, 29%, and 45%, respectively.The current study is subject to the limitations of a cross-sectional survey design and the self-report nature of the instruments used.PTSD and depression are each associated with suicidality independently and in combination in the active duty component of the U.S. Army. Soldiers presenting with either but especially both disorders may require additional outreach and screening to decrease suicidal ideation and attempts.
- Association of affective temperaments measured by TEMPS-A with cognitive deficits in patients with bipolar disorder. [Journal Article]
- J Affect Disord 2014 Jun.:109-15.
Affective temperaments such as cyclothymia, which may be the fundamental substrates for bipolar disorder and bipolar II in particular, have been reported to be associated with abnormalities in the regions that are related to cognitive deficits in bipolar disorder. However, few studies have examined the effects of affective temperaments on neuropsychological performance in individuals with bipolar disorder.In a six-week prospective study, we administered Chinese version of TEMPS-A (Temperament Evaluation of Memphis, Pisa, San Diego-Autoquestionnair) to 93 patients with bipolar I depression, 135 patients with bipolar II depression, and 101 healthy controls. Cognitive function was assessed with a battery of neuropsychological tasks, including attention, processing speed, set shifting, planning, verbal working memory, verbal fluency, and visual spatial memory. Mixed-effects statistical models were used to assess the effects of affective temperaments on cognitive function.Bipolar patients with hyperthymic temperament showed greater cognitive deficits in set shifting (p=0.05) and verbal working memory (p=0.026) than did bipolar patients with non-predominant temperaments (predominant temperament was defined as one standard deviation above the mean). The differences in estimated marginal means were -0.624 (95% CI, -1.25 to 0) and -0.429 (95% CI, -0.81 to -0.05), respectively. Significant temperament X bipolar subtype interaction effects were observed for set shifting (Wald X(2)=18.161, p<0.001), planning (Wald X(2)=7.906, p=0.048), and visual spatial memory (Wald X(2)=16.418, p=0.001).The anxious temperament was not evaluated.Our data suggest that hyperthymic temperament may be associated with cognitive deficits in some specific domains in bipolar disorder; and that the effect of temperaments may be different across subtypes of bipolar disorder.
- Association between family history of mood disorders and clinical characteristics of bipolar disorder: Results from the Brazilian bipolar research network. [Journal Article]
- J Affect Disord 2014 Jun.:104-8.
To compare clinical characteristics of bipolar disorder (BD) in patients with and without a family history of mood disorders (FHMD) in a large sample from the Brazilian Research Network of Bipolar Disorders.Four-hundred eighty-eight DSM-IV BD patients participating in the Brazilian Research Network of Bipolar Disorders were included. Participants were divided between those with FHMD (n=230) and without FHMD (n=258). We compared these two groups on demographic and clinical variables and performed a logistic regression to identify which variables were most strongly associated with positive family history of mood disorders.BD patients with FHMD presented with significantly higher lifetime prevalence of any anxiety disorder, obsessive-compulsive disorder, social phobia, substance abuse, and were more likely to present history of suicide attempts, family history of suicide attempts and suicide, and more psychiatric hospitalizations than BD patients without FHMD. Logistic regression showed that the variables most strongly associated with a positive FHMD were any comorbid anxiety disorder, comorbid substance abuse, and family history of suicide.Cross-sectional study and verification of FHMD by indirect information.BD patients with FHMD differ from BD patients without FHMD in rates of comorbid anxiety disorder and substance abuse, number of hospitalizations and suicide attempts. As FHMD is routinely assessed in clinical practice, these findings may help to identify patients at risk for particular manifestations of BD and may point to a common, genetically determined neurobiological substrate that increases the risk of conditions such as comorbidities and suicidality in BD patients.
- The role of spousal loss in the development of depressive symptoms in the elderly - Implications for diagnostic systems. [Journal Article]
- J Affect Disord 2014 Jun.:97-103.
In the revised version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) the Mood Disorder Workgroup for DSM-V the bereavement exclusion criterion for the diagnosis of major depression has been eliminated.To investigate the impact of bereavement on the incidence of depression and depressive symptoms in the elderly.Participants over 75 years from the longitudinal German Study on Ageing, Cognition, and Dementia in Primary Care Patients (AgeCoDe) that were still married at baseline were investigated (n=1,193). Data from four follow-ups (time frame: 6 years) were investigated. The response rate at baseline was 50.3%. Three clinical endpoints were analyzed: depressive symptoms according to Geriatric Depression Scale (1) GDS≥6, (2) GDS≥10, and (3) Major Depression (MD). The effect of loss was investigated using random-effects regression models.Experiencing a loss of spouse was predictive of a higher incidence in GDS≥6 (OR 4.52, 95% CI 2.6-7.9) and 10 (OR 5.59, 95% CI 1.8-17.0) even after adjusting for age, gender, impairment at baseline, and GDS score at baseline. Associations with MD were not significant (OR 1.77, 96% CI 0.9-3.5).Older adults experiencing the loss of their spouse are more likely to display elevated levels of depressive symptoms, that may reach a concerning level of severity.
- Associations between the SS variant of 5-HTTLPR and PTSD among adults with histories of childhood emotional abuse: Results from two African American independent samples. [Journal Article]
- J Affect Disord 2014 Jun.:91-6.
Prior studies have found that the 5-HTTLPR polymorphism in the promoter region of the serotonin transporter gene (SLC6A4) interacts with stressful life events to increase general risk for PTSD, but this association has not extended to African American samples. Further, little is known about the effects of this interaction on specific PTSD symptom clusters, despite indications that clusters may have different biological substrates. The current study examined the interaction between exposure to childhood emotional abuse and 5-HTTLPR genotype on risk for PTSD symptom severity and severity of specific PTSD symptom clusters in two African American samples.Participants were 136 African American household residents from Detroit, MI and 546 African American patients recruited from waiting rooms in primary care clinics in Atlanta, GA. Participants reported emotional abuse exposure and PTSD symptom severity, and provided DNA for triallelic 5-HTTLPR genotyping. Analysis of covariance (ANCOVA) was used to examine main effects and interactions.In both African American samples, 5-HTTLPR genotype modified the effect of emotional abuse on PTSD symptom severity. Participants with the low-expression SS genotype who were exposed to emotional abuse had significantly lower reexperiencing and arousal symptom severity scores.The DNHS genetic sample size was small, and abuse data were assessed retrospectively.The SS variant of 5-HTTLPR appears to buffer against developing the reexperiencing and arousal symptoms of PTSD in two independent African American samples exposed to childhood emotional abuse. Findings also highlight the importance of considering emotional abuse experiences in patients with suspected PTSD.
- Augmentative therapies do not potentiate the antidepressant-like effects of deep brain stimulation in rats. [Journal Article]
- J Affect Disord 2014 Jun.:87-90.
Clinical trials have shown promising results with the use of subcallosal cingulate gyrus deep brain stimulation (DBS) for treatment-resistant depression. However, strategies to manage patients who do not respond to this therapy have not been explored in detail. In rats, DBS in the ventromedial prefrontal cortex (vmPFC) induces a significant antidepressant-like response in the forced swim test (FST). We have used this test to investigate potential interactions between DBS and clinically used augmentative regimens.Rats undergoing the FST were treated with vmPFC DBS along with different augmentative drugs, namely buspirone, risperidone and pindolol. Locomotor activity was tested in an open field.DBS induced a significant reduction in immobility scores as compared to saline treated controls. These antidepressant-like effects, however, were not potentiated by the co-administration of buspirone, risperidone or pindolol.Despite having good predictive validity, animal models are limited from a translational perspective.Our results indicate that that the antidepressant-like effects of vmPFC DBS in the FST are not enhanced by augmentative therapies.