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Unipolar Depression (unipolar + depression)
Selected AbstractsUnipolar depression with racing thoughts: A bipolar spectrum disorder?PSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 5 2005FRANCO BENAZZI md Abstract Major depressive disorder (MDD) with racing/crowded thoughts is understudied. Kraepelin classified ,depression with flight of ideas' in the mixed states of his manic-depressive insanity. The aim of the study was to test whether MDD with racing/crowded thoughts was close to bipolar disorders. Consecutive 379 bipolar-II disorder (BP-II) and 271 MDD depressed outpatients were interviewed using the Structured Clinical Interview for DSM-IV, the Hypomania Interview Guide, and the Family History Screen, by a senior psychiatrist in a private practice. Intra-depression hypomanic symptoms were systematically assessed. Mixed depression was defined as a major depressive episode (MDE) plus three or more intra-MDE hypomanic symptoms. MDD with racing/crowded thoughts was compared to MDD without racing/crowded thoughts on classic bipolar validators (young onset age, many recurrences, atypical and mixed depression, bipolar family history). Frequency of MDD with racing/crowded thoughts was 56.4%. MDD with racing/crowded thoughts, versus MDD without racing/crowded thoughts, had significantly lower age at onset, more MDE severity, more psychotic, melancholic, atypical, and mixed depressions, and more bipolar family history. Of the intra-MDE hypomanic symptoms, irritability, psychomotor agitation and distractibility were significantly more common in MDD with racing/crowded thoughts. Compared to BP-II on bipolar validators, validators were less common in MDD with racing/crowded thoughts. MDD with racing/crowded thoughts seemed to be a severe variant of MDD. MDD with racing/crowded thoughts versus MDD without racing/crowded thoughts, and versus BP-II, had significant differences on bipolar validators, suggesting that it may lie along a continuum linking MDD without racing/crowded thoughts and BP-II. [source] Interrelationship of childhood trauma, neuroticism, and depressive phenotypeDEPRESSION AND ANXIETY, Issue 3 2007Valentina Moskvina Ph.D. Abstract Both childhood trauma (CT) and genetic factors contribute to the pathophysiology of depression. We studied the relationship of CT to age of onset (AO) of depression, personality traits, and expression of symptom dimensions in 324 adults with recurrent unipolar depression. Subjects received structured psychiatric interviews and completed CT, depressive symptom, and personality rating questionnaires. Experience of at least one type of trauma was reported by 79.9% of subjects, and the most common forms of trauma were physical neglect, emotional abuse, and emotional neglect. There was an earlier AO of depression in the groups that reported CT compared to those that reported none, with earliest AO occurring in those who had experienced the highest levels of CT. There were no significant correlations between overall CT scores and neuroticism or extraversion. Total CT was a significant (P=.008) predictor of the Mood symptom dimension, mostly accounted for by emotional abuse (P=.019), and physical neglect predicted the Anxiety symptom dimension (P=.002). All types of CT are commonly reported in individuals with depression, and emotional abuse and physical neglect, though previously less well identified, appear to have an important role in the pathogenesis of depressive disorders. The effect of CT on individuals with an underlying genetic vulnerability to depression may result in differences in depressive phenotype characterized by earlier AO of depression and the expression of specific depressive symptom dimensions. Depression and Anxiety 24:163,168, 2007. © 2006 Wiley-Liss, Inc. [source] Treatment-resistant bipolar depression: towards a new definitionACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2009I. Pacchiarotti Objective:, To summarize the conceptual and operational definitions of treatment-resistant bipolar depression and to review the evidence-based therapeutic options. Method:, Structured searches of PubMed, Index Medicus, Excerpta Medica and Psyclit conducted in December 2008. Results:, Criteria for treatment resistance in bipolar depression are commonly based on concepts stemming from treatment resistance as defined for unipolar depression, an approach that proved to be inadequate. In fact, the addition of an ad hoc criterion based on lithium and other mood stabilizer unresponsiveness after reaching adequate plasma levels appears to be a patch that attempts to take into account the uniqueness of bipolar depression but fails to become operational. Recent data from randomized clinical trials of new anticonvulsants and second-generation antipsychotics should lead to the development of a modern definition of treatment-resistant bipolar depression, and specific therapeutic algorithms. Conclusion:, We suggest a redefinition of resistant bipolar I and II depression. We propose different degrees of severity within bipolar depression in a stepwise manner. [source] Is bipolar II depression phenotypically distinctive?ACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2009G. B. Parker Objective:, We examine the depressive symptom profile of bipolar II disorder patients compared with a comparator (composite) group of those with unipolar depression, with stratification by melancholic and non-melancholic subtypes. Method:, Out-patients (n = 394) attending a specialist depression clinic comprised the sample. Data on severity and prototypic status of depressive symptoms were analysed. Results:, Age-matched analyses revealed minimal differentiation between bipolar II and composite unipolar groups. Stratified analyses suggested that ,bipolar II depression' more closely approximated melancholic depression in terms of psychomotor and cognitive slowing. Severity-based analyses and prototypic symptom patterns yielded differing results, suggesting that definition of bipolar II depression is influenced by rating strategies, and age. Conclusion:, We found limited differentiation of bipolar II depression from unipolar, melancholic and non-melancholic depression. Differences suggested previously may reflect age, gender and severity differences, highlighting the need for appropriately matched groups in defining bipolar II depression. [source] Gender differences in unipolar depression: an update of epidemiological findings and possible explanationsACTA PSYCHIATRICA SCANDINAVICA, Issue 3 2003C. Kuehner Objective: To give an update on epidemiological findings on sex differences in the prevalence of unipolar depression and putative risk factors. Material and methods: Systematic review of the literature. Results: Recent epidemiological research yields additional evidence for a female preponderance in unipolar depression, holding true across different cultural settings. Current explanations include artefacts, genetic, hormonal, psychological and psychosocial risk factors. Rather consistently, intrapsychic and psychosocial gender role related risk factors have been identified which may contribute to the higher depression risk in women. Gender role aspects are also reflected in endocrine stress reactions and possibly influence associated neuropsychological processes. Conclusion: There is a need for more integrative models taking into account psychological, psychosocial, and macrosocial risk factors as well as their interactions, which also connect these factors with physiological and endocrine responses. Furthermore, it is conceivable that across the life span, as well as across cultural settings, individual risk factors will add with varying emphasis to the higher prevalence of depression in women. [source] Possible predictors of response to clonazepam augmentation therapy in patients with protracted depressionHUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 1 2007Shigeru Morishita Abstract Introduction Clonazepam has been shown to be an effective supplementary treatment for depression. Thus, it would be useful to determine which patient characteristics are associated with response to clonazepam. Aims The purpose of this study was to examine the possible predictors of response to clonazepam in the treatment of depression. Method A retrospective cohort analysis was carried out in 120 patients with protracted depression who were being treated with clonazepam. Results A variety of clinical factors, including age, gender, type of depression, frequency of episodes, family history; and daily dose of clonazepam, were analyzed as possible predictors of response to clonazepam. A Weibull regression analysis showed that the factors that best predicted improvement with clonazepam augmentation were negative family history of psychiatric illness (ecoef,=,0.378), daily clonazepam dose of 2.5,4.0,mg (ecoef,=,0.160), and unipolar depression (ecoef,=,0.147). Conclusions These factors should be considered when clonazepam augmentation therapy is selected for protracted depression. Copyright © 2007 John Wiley & Sons, Ltd. [source] Continuation and long-term maintenance treatment with Hypericum extract WS® 5570 after successful acute treatment of mild to moderate depression , rationale and study designINTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 3 2004Chairman, S. Kasper Professor Abstract Unipolar major depression is often a chronic disease that may require lifelong prophylaxis. Recovery from an acute episode is followed by 4-6 months of relapse prevention. After that, long-term maintenance treatment is administered to avoid recurrence. We present the rationale and design of an ongoing double-blind, randomized, placebo-controlled trial investigating the efficacy of Hypericum extract WS® 5570 in relapse prevention in recurrent unipolar depression. An estimated sample of 425 adults with recurrent, mild to moderate major depression (ICD-10 and DSM-IV criteria), ,3 previous episodes (last 5 years) and a total score ,20 points on the 17-item Hamilton Rating Scale for Depression (HAMD) will be included. After a one-week wash out patients receive 3 × 300 mg/day WS® 5570 single-blind for 6 weeks. Responders are randomized to 26 weeks of double-blind continuation treatment with 3 × 300 mg/day WS® 5570 or placebo. Patients completing continuation treatment without relapse enter 52 weeks of double-blind maintenance treatment, where those treated with WS® 5570 are re-randomized to 3 × 300 mg/day WS® 5570 or placebo. The primary outcome measure is the time to relapse during continuation treatment (HAMD ,16, clinical diagnosis of depression, or premature treatment termination for inefficacy). Hypericum extract, with its favourable tolerability profile, could be an interesting option for long-term prophylaxis. The trial was designed according to current consensus and guidance. Notably, it includes long-term prophylactic treatment with the same drug and the same therapeutic dose applied during acute treatment, uses well-defined outcome measures and provides a clear distinction between relapse and recurrence. Copyright © 2004 Whurr Publishers Ltd. [source] Early- and late-onset startle modulation in unipolar depressionPSYCHOPHYSIOLOGY, Issue 3 2004Gabriel S. Dichter Abstract In two experimental sessions, we assessed early- and late-onset acoustic startle eyeblink modulation and subjective ratings of emotional pictures by nondepressed participants and by unipolar depressed participants. Depressed participants were assessed before and after treatment with the antidepressant medication Bupropion SR. Both depressed and nondepressed participants exhibited arousal-dependent startle modulation to early probes occurring 300 ms after picture onset. Nondepressed participants demonstrated the expected valence-dependent startle modulation to late probes (3,500,4,500 ms post-onset). In contrast, the late-probe blink magnitudes of depressed patients were unrelated to picture valence. This pattern of group differences was not moderated by treatment. There were no between-group differences in self-report ratings to pictures. These results suggest that depression may be characterized by anomalous responses to affective stimuli and that startle modulation can be a more sensitive index of affective response deficits linked to depression than self-report measures. [source] The mood spectrum: improving the diagnosis of bipolar disorderBIPOLAR DISORDERS, Issue 2005Jules Angst Although the distinction between bipolar and unipolar disorders served our field well in the early days of psychopharmacology, in clinical practice it is apparent that their phenotypes are only partially described by current diagnostic classification systems. A substantial body of evidence has accrued suggesting that clinical variability needs to be viewed in terms of a broad conceptualization of mood disorders and their common threshold or subthreshold comorbidity. The spectrum model provides a useful dimensional approach to psychopathology and is based on the assumption that early-onset and enduring symptoms shape the adult personality and establish a vulnerability to the subsequent development of Axis-I disorders. To obtain a clearer understanding of the depressive phenotype, it is pivotal that we increase our detection of hypomanic symptoms so that clinicians can better distinguish bipolar II disorder from unipolar depression. Diagnostic criteria sensitive to hypomanic symptoms have been identified that suggest bipolar II disorder is at least as prevalent as major depression. Moreover, the comorbidities of these illnesses are very different and alcoholism in particular appears to be a greater problem in bipolar II disorder than in unipolar depression. Structured clinical interviews and patient self-report questionnaires have also successfully identified the presence of hypomanic symptoms in patients with unipolar disorder and support the concept of a spectrum of bipolar illness. In conclusion, the importance of subthreshold syndromes should not be underestimated as failure to recognize bipolar spectrum disorder could delay treatment and worsen prognosis. [source] Bipolar depression: phenomenological overview and clinical characteristicsBIPOLAR DISORDERS, Issue 6 2004Philip B Mitchell Objectives:, There has been increasing interest in the depressed phase of bipolar disorder (bipolar depression). This paper aims to review the clinical characteristics of bipolar depression, focusing upon its prevalence and phenomenology, related neuropsychological dysfunction, suicidal behaviour, disability and treatment responsiveness. Methods:, Studies on the prevalence of depression in bipolar disorder, the comparative phenomenology of bipolar and unipolar depression, as well as neuropsychology and brain imaging studies, are reviewed. To identify relevant papers, a literature search using MEDLINE and PubMed was undertaken. Results:, Depression is the predominant mood disturbance in bipolar disorder, and most frequently presents as subsyndromal, minor or dysthymic depression. Compared with major depressive disorder (unipolar depression), bipolar depression is more likely to manifest with psychosis, melancholic symptoms, psychomotor retardation (in bipolar I disorder) and ,atypical' symptoms. The few neuropsychological studies undertaken indicate greater impairment in bipolar depression. Suicide rates are high in bipolar disorder, with suicidal ideation, suicide attempts and completed suicides all occurring predominantly in the depressed phase of this condition. Furthermore, the depressed phase (even subsyndromal) appears to be the major contributant to the disability related to this condition. Conclusions:, The significance of the depressed phase of bipolar disorder has been markedly underestimated. Bipolar depression accounts for most of the morbidity and mortality due to this illness. Current treatments have significant limitations. [source] Volumetric MRI studies of mood disorders: do they distinguish unipolar and bipolar disorder?BIPOLAR DISORDERS, Issue 2 2002Stephen M Strakowski The authors reviewed magnetic resonance imaging volumetric imaging results in major mood disorders, particularly comparing similarities and differences from studies of bipolar disorder and unipolar major depression. Abnormalities of cerebral brain regions appear inconsistently in mood disorders and, when present, typically consist of decreased frontal or prefrontal cortical volumes in both unipolar depression and bipolar disorder. In contrast, subcortical and medial temporal abnormalities are more commonly observed and are different between these two major classes of affective illness. Specifically, whereas structural enlargement of the basal ganglia and amygdala have been observed in bipolar disorder, in unipolar depression, these structures appear to be smaller in patients than healthy subjects. These findings suggest that affective illnesses may share in common an underdeveloped or atrophied prefrontal region, leading to loss of cortical modulation of limbic emotional networks. The effect of this loss results in unipolar depression or cycling (mania with depression) depending on the abnormalities of the subcortical structures involved. The cerebellum may also play a role in the presentation of mood disorders. This hypothesis remains speculative as much more research is needed to specifically examine how morphometric brain abnormalities translate into the neurophysiologic deficits that produce mood disorders. [source] Volumetric brain imaging findings in mood disordersBIPOLAR DISORDERS, Issue 2 2002John L Beyer Volumetric neuroimaging is increasingly being used by researchers of affective disorders to assess potential involvement of different brain structures in mood regulation and to test neuroanatomic models of mood disorders. In unipolar depression, findings suggest abnormalities in the frontal lobe (particularly the subgenual prefrontal cortex), basal ganglia (particularly the caudate and putamen), cerebellum, and hippocampus/amygdala complex. In bipolar disorder, abnormalities in the third ventricle, frontal lobe, cerebellum, and possibly the temporal lobe are noted. We review the findings for the various regions of the brain, and discuss the implications on the understanding of mood disorders. Directions for future research in volumetric imaging is then discussed. [source] The validity and internal structure of the Bipolar Depression Rating Scale: data from a clinical trial of N-acetylcysteine as adjunctive therapy in bipolar disorderACTA NEUROPSYCHIATRICA, Issue 5 2010Michael Berk Berk M, Dodd S, Dean OM, Kohlmann K, Berk L, Malhi GS. The validity and internal structure of the Bipolar Depression Rating Scale: data from a clinical trial of N-acetylcysteine as adjunctive therapy in bipolar disorder. Background: The phenomenology of unipolar and bipolar disorders differ in a number of ways, such as the presence of mixed states and atypical features. Conventional depression rating instruments are designed to capture the characteristics of unipolar depression and have limitations in capturing the breadth of bipolar disorder. Method: The Bipolar Depression Rating Scale (BDRS) was administered together with the Montgomery Asberg Rating Scale (MADRS) and Young Mania Rating Scale (YMRS) in a double-blind randomised placebo-controlled clinical trial of N-acetyl cysteine for bipolar disorder (N = 75). Results: A factor analysis showed a two-factor solution: depression and mixed symptom clusters. The BDRS has strong internal consistency (Cronbach's alpha = 0.917), the depression cluster showed robust correlation with the MADRS (r = 0.865) and the mixed subscale correlated with the YMRS (r = 0.750). Conclusion: The BDRS has good internal validity and inter-rater reliability and is sensitive to change in the context of a clinical trial. [source] Perceived criticism, marital interaction and relapse in unipolar depression,findings from a Korean sampleCLINICAL PSYCHOLOGY AND PSYCHOTHERAPY (AN INTERNATIONAL JOURNAL OF THEORY & PRACTICE), Issue 5 2006Jung-Hye Kwon Perceived criticism by partner (PC) has been demonstrated to be a powerful predictor of depressive relapse. The purpose of this prospective 11-month study was to replicate this finding in an outpatient series of married women in Korea, but also to further explore the nature of PC in terms of qualities of the marital relationship and dysfunctional attitudes. The subjects consisted of 27 married female outpatients who had all been treated for major depression, but were in recovery at time of first contact or shortly after. All were interviewed at time 1 and then again after 11 months at time 2 to ascertain major depressive episode using the Korean version of SADS as well as completing the BDI. At first contact, questionnaire and interview assessments were used for marital quality and dysfunctional attitudes denoting dependency. There was a significant relationship between the single-item PC and depressive relapse at follow-up as predicted. This relationship was not enhanced by using the expanded item scale. PC and/or PC-E were significantly correlated with marital quality variables, specifically lack of emotional support from partner, negative interaction and dependence on partner. The study shows that perceived criticism by spouse is a predictor of depressive relapse in Korean outpatients and that this appears to reflect actual negative characteristics of the marital relationship as well as the depressed person's high dependence on the relationship. These results support the importance of improving marital interactions in preventing relapse in depression.,Copyright © 2006 John Wiley & Sons, Ltd. [source] Emanuel Miller Lecture: Early onset depressions , meanings, mechanisms and processesTHE JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY AND ALLIED DISCIPLINES, Issue 12 2008Ian M. Goodyer Background:, Depressive syndromes in children and adolescents constitute a serious group of mental disorders with considerable risk for recurrence. A more precise understanding of aetiology is necessary to improve treatment and management. Methods:, Three neuroactive agents are purported to be involved in the aetiology of these disorders: serotonin, brain-derived neurotrophic factor and cortisol. A literature review was conducted to determine their contributions to the emergence of unipolar depressions in the adolescent years. Results:, Serotonin, brain-derived neurotrophic factor and cortisol may operate in concert within two distinct functional frameworks: atypical early epigenesis arising in the first few years of life and resulting in the formation of a vulnerable neuronal network involving in particular the amygdala and ventral prefrontal cortex. Individuals with this vulnerability are likely to show impaired mood regulation when faced with environmental demands during adolescence and over the subsequent decades; and acquired neuroendangerment, a pathological brain process leading to reduced synaptic plasticity, in particular in the hippocampus and perhaps the nucleus accumbens and ventral tegmentum. This may result in motivational, cognitive and behavioural deficits at any point in the lifespan most apparent at times of environmental demand. Conclusions:, The characteristics, course and outcome of a depressive episode may depend on the extent of the involvement of both atypical early neurogenesis and acquired neuroendangerment. [source] Identification of bipolar disorder in women with postpartum depressionBIPOLAR DISORDERS, Issue 3 2010Verinder Sharma Sharma V, Khan M. Identification of bipolar disorder in women with postpartum depression. Bipolar Disord 2010: 12: 335,340. © 2010 The Authors. Journal compilation © 2010 John Wiley & Sons A/S. Objective:, No studies to date have assessed the pharmacological management of treatment-resistant postpartum depression. We reviewed the pharmacological treatment of postpartum depression in patients diagnosed with treatment-resistant ,unipolar' depression. Methods:, We conducted a chart review of patients treated consecutively at a perinatal clinic. Treatment-resistant postpartum depression was defined as a failure to respond to at least one adequate antidepressant trial. Patients were diagnosed using the DSM-IV criteria, and the Clinical Global Impression,Improvement (CGI-I) rating scale was used to assess response to various pharmacological interventions. Results:, The majority of patients (57%, 34/60) referred for postpartum depression actually suffered from bipolar disorder. All patients were on antidepressants at the time of referral, but by the end of the study 37% (22/60) continued on antidepressants alone or in combination with other medications. CGI-I ratings showed appreciable improvement in depression at the end of six months following the initial consultation. Very much improvement was noted in 65% (39/60) of patients, and 22% (13/60) were considered much improved. The most common change in medication was a switch to or addition of an atypical neuroleptic. Limitations:, Retrospective design, small sample size, and lack of a control group. Conclusions:, Management of treatment resistance in women with postpartum depression should be considered within the context of types of mood disorders. Atypical neuroleptics and mood stabilizers used alone or as adjuncts should be considered in the treatment of resistant postpartum depression in patients with a bipolar diathesis. [source] | |||||||||||||