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PubMed1999

Lack of association between alpha1-antichymotrypsin polymorphism and late-onset depressive disorder.

Late-onset depressive disorder (LOD) has been thought to be associated with dementia. Recently, it was reported that the position-15 (alanine) polymorphism of the alpha1-antichymotrypsin gene (ACT*A) was a risk factor for Alzheimer's disease. We wondered whether the ACT*A allele frequency might be elevated in LOD. ACT genotyping was performed as described by Kamboh et al. (Kamboh, M.I., Sanghera D.K., Ferrell R.E., DeKosky, S.T., 1995. APO* E4-associated Alzheimer's disease risk is modified by alpha1-antichymotrypsin polymorphism. Nature Genetics 10, 486-488) in 153 patients with depressive disorders and 107 healthy controls. The patients were subdivided into those with early-onset and late-onset, using 50 years as the cut-off age. There was no statistically significant difference in the age of onset of depressive disorders according to the ACT genotype. There was also no significant association between early-/late-onset depressive disorders and the ACT genotype. In addition, there was no association between the apolipoprotein E epsilon 4 allele and the ACT genotype in LOD. Our results suggest that there is no association between the ACT*A allele and LOD.

Adolescent↗
PubMed2001

Premenstrual dysphoric disorder and risk for major depressive disorder: a preliminary study.

Investigators examined whether premenstrual dysphoric disorder (PMDD) poses a risk for major depressive disorder (MDD). In an initial study, women rated premenstrual symptoms and functional impairment daily for two menstrual cycles. A semistructured diagnostic interview was given to obtain psychiatric histories and differentiate PMDD from premenstrual exacerbations of other disorders. Participants in this pilot study were eight women with PMDD and a random subgroup without PMDD (n = 9) initially. Another semistructured interview was given to diagnose psychiatric disorders occurring during a two-year follow-up interval. In all, seven of the eight women with PMDD developed MDD within two years, including all those who had never had MDD before. The odds that a woman with PMDD developed MDD were 14 times the odds that a woman without PMDD developed MDD ( p <.05). Premenstrual dysphoric disorder may be a prodrome of or causal risk factor for MDD. Preliminary evidence for the diagnostic validity of PMDD is provided.

Adolescent↗
PubMed1994

Prospective follow-up study lasting 2 years in patients with panic disorder with and without depressive disorders.

A group of 52 patients presenting at an outpatient unit for anxiety disorders were included consecutively in a prospective 2-year follow-up study. Patients were administered to a structured interview for DSM-III-R diagnoses, a follow-up interview (LIFE), and various other ratings. Sociodemographic and illness-history characteristics, levels of anxiety and depressive symptoms, as well as psychosocial impairment, were evaluated at baseline and follow-up and compared between patients with panic disorder only and patients with panic disorder and concomitant depressive disorders at index assessment. Cross-sectional and longitudinal differences between patients with panic disorder only and patients with panic disorder and concomitant depression have been found, indicating that patients with comorbid conditions are more severely ill and have a less favorable outcome. For the total sample, however, the 2-year outcome was better than that reported in many other follow-up studies.

Adolescent↗
PubMed2002

Major depressive disorder and health care costs in multiple sclerosis.

OBJECTIVE: Multiple Sclerosis (MS) is associated with elevated levels of depressive symptoms and an elevated frequency of depressive disorders. Depressive disorders, in general, are associated with substantial direct and indirect economic costs, and have been shown to increase the costs associated with the management of medical conditions in a variety of clinical settings. However, the impact of depressive disorders on costs associated with MS have not been evaluated. The objective of this study was to evaluate this association. METHODS: The Composite International Diagnostic Interview (CIDI) was used to identify subjects with major depressive disorder in a sample who had earlier been selected for a broader economic evaluation of the costs associated with MS. Costs were measured in two ways: retrospectively (by questionnaire covering a 2-year period) and prospectively (using a 6-month diary). The proportion of subjects reporting any costs and the proportion exceeding various cost thresholds were calculated in subjects with and without lifetime major depression. These proportions were compared using exact statistical tests and confidence intervals. Non-parametric (rank sum) tests were used to compare median costs. RESULTS: Of 136 subjects, 31 had a lifetime history of major depression. MS-related expenses evaluated retrospectively (e.g., house and vehicle alterations and purchases) did not differ depending on major depression status. In the prospective analysis, subjects with lifetime major depression were more likely to purchase vitamins, herbs, and naturopathic remedies (p < 0.01) and more likely to incur costs associated with utilization of services provided by alternative practitioners (p = 0.04). Other differences (e.g., in mental health care, medical specialists, general practitioner visits) were not observed. CONCLUSIONS: Contrary to expectation, this study did not find increased direct medical costs in persons with comorbid major depressive disorder and multiple sclerosis. Persons with comorbid MS and (lifetime) major depression did not incur greater costs or utilize more services. The Canadian health care system is guided by principles of universality and is publicly funded and administered, however, the lack of an impact of major depression on utilization may reflect limited access to services. The lack of an association between costs and major depression may or may not be generalizable to health care systems in other countries.

Adult↗
PubMed2006

Predicting the onset of major depressive disorder and dysthymia in older adults with subthreshold depression: a community based study.

BACKGROUND: It is well-established that the incidence of major depressive disorder is increased in subjects with subthreshold depression. A new research area focuses on the possibilities of preventing the onset of major depressive disorders in subjects with subthreshold depression. An important research question for this research area is which subjects with subthreshold depression will develop a full-blown depressive disorder and which will not. METHODS: We selected 154 older subjects with subthreshold depression (CES-D>16) but no DSM mood disorder from a longitudinal study among a large population based cohort aged between 55 and 85 years in The Netherlands. Of these subjects, 31 (20.1%) developed a mood disorder (major depression and/or dysthymia) at three-year or six-year follow-up. We examined risk factors and individual symptoms of mood disorder as predictors of onset of mood disorder. RESULTS: Two variables were found to be significant predictors in both bivariate and multivariate analyses: eating problems and sleep problems. The incidence of mood disorders differed strongly for different subpopulations, varying from 9% (for those not having any of the two risk factors) to 57% (for those having both risk factors). CONCLUSIONS: It appears to be possible to predict to a certain degree whether a subject with subthreshold depression will develop a mood disorder during the following years.

Aged↗
PubMed1982

An hypothesis regarding the commonality of right-hemisphere involvement in learning disability, attentional disorder, and childhood major depressive disorder.

Learning disability, attentional disorder, and childhood major depression are frequent clinical diagnoses for children who show behavioral disturbances and impaired school performance. We suggest that all three of these conditions may be associated with dysfunction of the right cerebral hemisphere. Anatomical disturbance of right-hemisphere function is often associated with learning disability or attentional deficits. The physiological disturbance of right-hemisphere function by a major depressive episode may produce or exacerbate learning disability or attentional disorder.

Attention↗
PubMed1985

Comparison of whole blood serotonin and platelet MAO in children with schizophrenia and major depressive disorder.

Whole blood serotonin and platelet monoamine oxidase (MAO) activity in boys with schizophrenia, schizotypal personality disorder, or major depressive disorder was compared with that of boys serving as controls. Boys with schizophrenia and schizotypal personality disorder had significantly higher platelet MAO than boys with major depressive disorder or controls. Boys with major depressive disorder had lower whole blood serotonin than boys with schizophrenia or schizotypal personality disorder.

Adolescent↗
PubMed2002

[Diagnosis of depressive disorder and so-called exhaustion depression. Self-esteem--a central concept].

Depressive disorders can be recognized by the loss of self-esteem; this contrasts with mourning and neurasthenic reactions, in which self-esteem remains intact. Just as depression can result from the gradual reduction and eventual loss of self-esteem, mourning and neurasthenic reactions can evolve into true depressive states. "Exhaustion depression", a new diagnostic category connected to "burnout" situations, should be applied only when criteria for depressive disorder are fulfilled, including loss of self-esteem. When these criteria are lacking we should refer only to an exhaustion state provoked by stress. Neurotic mechanisms may represent a special class of relevant stress factors, but are not seen in manifest neurasthenic reactions and exhaustion depression.

Asthenia↗
PubMed1990

Maternal expressed emotion and parental affective disorder: risk for childhood depressive disorder, substance abuse, or conduct disorder.

Expressed emotion (EE) refers to a set of emotional aspects of speech for which ratings have been derived. Seven independent studies have established that higher EE ratings in the relatives of patients with schizophrenia predict higher rates of relapse in these patients and two studies have established an association of higher EE in spouses with relapse of depression in their mate. There are no previous studies of parental EE as a predictor of childhood affective disorder or other disorders not in the schizophrenia spectrum. In this study we investigated the relationship between the level of maternal EE and the incidence of DSM-III affective disorder (major depression or mania or dysthymia), substance abuse, or conduct disorder in 273 children. We found that a higher degree of maternal expressed emotion was associated with a three-fold increase in a child's risk (odds multiplier) for having at least one of the following diagnoses: depressive disorder (major depression or dysthymia), substance abuse, or conduct disorder. This increased risk acts in addition to the increased risk of child diagnosis associated with parental affective illness. Research and clinical implications are discussed.

Adolescent↗
PubMed2000

Presenilin-1 in late-onset depressive disorder.

Late-onset depressive disorder (LOD) is thought to be associated with dementia. Allele 1 in the presenilin-1 (PS-1) gene is a risk factor for Alzheimer's disease. An association study on this polymorphism was performed in depressive patients and control subjects. The patients were subdivided into those with early onset and late onset, using 50 years as the cut-off age. There was no statistically significant difference in the age of onset of depressive disorders according to the PS-1 genotype. There was also no association between early/late-onset depressive disorders and the PS-1 genotype. Our results suggest there is no association between the PS-1 allele and LOD.

Aged↗
PubMed2025

ADHD in Youth With Major Depressive Disorder in the Texas Youth Depression and Suicide Research Network (TX-YDSRN): Clinical Correlates and Moderators.

OBJECTIVE: Depression is a major public health concern with a 19% lifetime prevalence in youth, often precipitating other concerns, including suicidal behavior, poor school performance, and worsened peer relationships. ADHD is also common among youth and frequently presents alongside major depressive disorder (MDD), with this comorbidity associated with increased impairment. More research is needed to elucidate the clinical characteristics of this comorbidity (MDD&#x2009;+&#x2009;ADHD), especially as it relates to youth with MDD and no ADHD (MDD&#x2009;-&#x2009;ADHD). The present study examined the clinical correlates of MDD&#x2009;+&#x2009;ADHD in youth and the presence of an ADHD diagnosis as a moderator of the relationship between depressive symptoms and suicidality, peer relationships, and school functioning, respectively. METHODS: Our sample included 797 youth with MDD ages 8 to 20&#x2009;years (Mage&#x2009;=&#x2009;15.5&#x2009;years) with and without ADHD. RESULTS: Youth with MDD&#x2009;+&#x2009;ADHD experienced more severe depressive symptoms, higher levels of suicidality, impulsivity, and irritability, and worse academic performance compared to those with MDD&#x2009;-&#x2009;ADHD. ADHD diagnosis did not moderate the relationships between depression severity and suicidality, peer relationships, or school functioning, respectively, suggesting that having an ADHD diagnosis may not affect these outcomes in depressed youth in this way. CONCLUSION: Findings shed light on the impact of ADHD in depressed youth, which may allow for earlier and more tailored intervention efforts aimed at identifying and targeting depression, suicidality, peer relationships, and school functioning.

Humans↗
PubMed2006

Distress and functioning in mixed anxiety and depressive disorder.

The aim of the present study was to evaluate the validity of mixed anxiety and depressive disorder (MADD) with reference to functional characteristics and symptomatic characteristics in comparison with anxiety disorders, depressive disorders, and groups showing subthreshold symptoms (exclusively depressive or anxiety related). The present study was carried out in the following three medical settings: two psychiatric and one primary care. Patients seeking care in psychiatric institutions due to anxiety and depressive symptoms and attending primary medical settings for any reason were taken into account. A total of 104 patients (65 women and 39 men, mean age 41.1 years) were given a General Health Questionnaire (GHQ-30), Global Assessment of Functioning (GAF) and Present State Examination questionnaire, a part of Schedules for Clinical Assessment in Neuropsychiatry, Version 2.0. There were no statistically relevant differences between MADD and anxiety disorders in median GHQ score (19 vs 16) and median GAF score (median 68.5 vs 65). When considering depressive disorders the median GHQ score (28) was higher, and median GAF score (59) was lower than that in MADD. In groups with separated subthreshold anxiety or depressive symptoms, median GHQ scores (12) were lower and median GAF scores (75) were higher than that in MADD. The most frequent symptoms of MADD are symptoms of generalized anxiety disorder (GAD) and depression. Mixed anxiety and depressive disorder differs significantly from GAD only in higher rates of depressed mood and lower rates of somatic anxiety symptoms. Distinction from depression was clearer; six of 10 depressive symptoms are more minor in severity in MADD than in the case of depression. Distress and interference with personal functions in MADD are similar to that of other anxiety disorders. A pattern of MADD symptoms locates this disorder between depression and GAD.

Adult↗
PubMed1988

Is there a long-term protective effect of mood-altering agents in unipolar depressive disorder?

Major depression is common, often severe, and usually recurrent, and it carries an excess risk of mortality due to medical illness as well as suicide. At referral centers, recurrence risk averages 85% within 2-3 years of full recovery from an acute episode. The natural history of major depression is highly variable, but typically episodes las ca. 6 months, with cycles of ca. 2 years. Yet, most long-term treatment studies are limited to the year or two following recovery from an acute episode. Accordingly, available evidence best supports a relapse-preventing effect of tri-cyclic antidepressants or lithium within the first months after apparent recovery but is less compelling regarding prevention of later recurrences of new episodes. Other treatments have not been evaluated systematically. The hypothesis that bipolarlike, but apparently unipolar, patients might respond selectively to lithium maintenance requires further testing. Knowledge of long-term dose-benefit and dose-risk relationships is starting to emerge for lithium, but these relationships remain inadequately tested for antidepressants. Actual levels of clinical treatment of major depression appear to fall short of the ideal, and much additional research and education is required to improve care in this very common disorder.

Antidepressive Agents↗
PubMed1988

Children with schizophrenia spectrum and depressive disorders: a comparative study of premorbid adjustment, onset pattern and severity of impairment.

Premorbid adjustment, onset patterns, and severity of impairment were examined in 66 child psychiatric inpatients with diagnoses of schizophrenia, schizotypal personality disorder, major depression, and dysthymic disorder. When compared to children with depressive disorders, schizophrenic and schizotypal children showed poorer premorbid adjustments, lower IQs, greater impairment at hospitalization, and more chronic dysfunctions. Similar developmental patterns were found for children with schizophrenic and schizotypal disorders, and for children with major depression and dysthymic disorders. The findings underscore the severe impairment in social adaptation shown by schizophrenic and schizotypal children and the relatively good premorbid adjustments of most depressed children.

Achievement↗
PubMed1995

Advances in understanding major depressive disorder.

1. Major depressive disorder is recognized by different, frequently recurring patterns of signs and symptoms that are suggestive of specific subtypes of the disorder, including melancholic, atypical, and psychotic. 2. MDD occurs at younger ages, twice as frequently in women, in conjunction with other psychiatric disorders, in persons with a family history of mood disorders, and is associated with high use of medical services. 3. Research on the biological basis of depression has focused on neurotransmission, neuroendocrine dysregulation, and genetic transmission. 4. Advances in understanding MDD have important implications for nursing assessment, diagnosis, outcome planning, intervention, and evaluation with depressed clients.

Depressive Disorder↗
PubMed2002

Current comorbidity of psychiatric disorders among DSM-IV major depressive disorder patients in psychiatric care in the Vantaa Depression Study.

BACKGROUND: While numerous studies have documented the high comorbidity of major depressive disorder (MDD) with individual mental disorders, no published study has reported overall current comorbidity with all Axis I and II disorders among psychiatric patients with MDD, nor systematically investigated variations in current comorbidity by sociodemographic factors, inpatient versus outpatient status, and number of lifetime depressive episodes. METHOD: Psychiatric outpatients and inpatients in Vantaa, Finland, were prospectively screened for an episode of DSM-IV MDD, and 269 patients with a new episode of MDD were enrolled in the Vantaa Depression MDD Cohort Study. Axis I and II comorbidity was assessed via semistructured Schedules for Clinical Assessment in Neuropsychiatry, version 2.0, and Structured Clinical Interview for DSM-II-R personality disorders interviews. RESULTS: The great majority (79%) of patients with MDD suffered from 1 or more current comorbid mental disorders, including anxiety disorder (57%), alcohol use disorder (25%), and personality disorder (44%). Several anxiety disorders were associated with specific Axis II clusters, and panic disorder with agoraphobia was associated with inpatient status. The prevalence of personality disorders varied with inpatient versus outpatient status, number of lifetime depressive episodes, and type of residential area, and the prevalence of substance use disorders varied with gender and inpatient versus outpatient status. CONCLUSION: Most psychiatric patients with MDD have at least 1 current comorbid disorder. Comorbid disorders are associated not only with other comorbid disorders, but also with sociodemographic factors, inpatient versus outpatient status, and lifetime number of depressive episodes. The influence of these variations on current comorbidity patterns among MDD patients needs to be taken account of in treatment facilities.

Adult↗
PubMed1982

Right hemisphere involvement in learning disability, attention deficit disorder, and childhood major depressive disorder.

Learning disability, attentional disorder and childhood major depression are frequent diagnoses in children with behavioral disturbances and impaired school performance. All three disorders are associated with right cerebral hemisphere dysfunction. Anatomical disturbance of right hemisphere function results in learning disability and/or attentional disorder. The physiological disturbance of right hemisphere function produced by a major depressive episode results in additional learning disability and/or attentional disorder.

Attention↗