Showing papers on "Depression (differential diagnoses) published in 1994"
TL;DR: Three models for how gender differences in depression might develop in early adolescence are described and evaluated and it is concluded that Model 3 is best supported by the available data, although much more research is needed.
Abstract: There are no gender differences in depression rates in prepubescent children, but, after the age of 15, girls and women are about twice as likely to be depressed as boys and men. In this article, three models for how gender differences in depression might develop in early adolescence are described a
2,112 citations
01 Jan 1994
TL;DR: In this paper, the authors examined the prevalence and risk factor profile of both pure and comorbid major depression according to data from the National Comorbidity Survey and found significant differences between persons with pure and combined major depression.
Abstract: Objective: Major depression is a frequent and disabling psychiatric disorder in the United States. This report examines the prevalence and risk factor profile ofboth pure and comorbid major depression according to data from the National Comorbidity Survey. Method: To estimate the prevalence ofpsychiatric comorbidity in the United States, a nationalsample of 8,098 persons 15-54 years of age from the 48 conterminous states was surveyed with a modified version of the Composite International Diagnostic Interview. Results: From the survey data the prevalence ofcurrent (30-day) major depression was estimated to be 4.9%, with a relatively higher prevalence in females, young adults, and persons with less than a college education. The prevalence estimate for lifetime major depression was 1 7. 1 %, with a similar demographic distribution. Both 30-day and lifetime prevalence estimates were higher than estimates from the earlier Epidemiologic Catchment Area study. When pure major depression was compared with major depression co-occurring with other psychiatric disorders, the risk factor profiles exhibited clear differences. Conclusions: These findings suggest a greater burden of major depression in community-dwelling persons than has been estimated from previous community samples. The risk factor profile showed significant differences between persons with pure and combined major depression.
1,736 citations
TL;DR: A greater burden of major depression in community-dwelling persons than has been estimated from previous community samples is suggested and the risk factor profile showed significant differences between persons with pure and combined major depression.
Abstract: Objective Major depression is a frequent and disabling psychiatric disorder in the United States. This report examines the prevalence and risk factor profile of both pure and comorbid major depression according to data from the National Comorbidity Survey. Method To estimate the prevalence of psychiatric comorbidity in the United States, a national sample of 8,098 persons 15-54 years of age from the 48 conterminous states was surveyed with a modified version of the Composite International Diagnostic Interview. Results From the survey data the prevalence of current (30-day) major depression was estimated to be 4.9%, with a relatively higher prevalence in females, young adults, and persons with less than a college education. The prevalence estimate for lifetime major depression was 17.1%, with a similar demographic distribution. Both 30-day and lifetime prevalence estimates were higher than estimates from the earlier Epidemiologic Catchment Area study. When pure major depression was compared with major depression co-occurring with other psychiatric disorders, the risk factor profiles exhibited clear differences. Conclusions These findings suggest a greater burden of major depression in community-dwelling persons than has been estimated from previous community samples. The risk factor profile showed significant differences between persons with pure and combined major depression.
1,271 citations
1,208 citations
TL;DR: Findings support the hypothesis that alterations in 5-HT neurons play a role in the pathophysiology of depression.
Abstract: Considerable evidence has accrued in the last two decades to support the hypothesis that alterations in serotonergic neuronal function in the central nervous system occur in patients with major depression. These findings include the following: (a) reduced cerebrospinal fluid (CSF) concentrations of 5-hydroxyindoleacetic acid (5-HIAA), the major metabolite of serotonin (5-HT) in drug-free depressed patients; (b) reduced concentrations of 5-HT and 5-HIAA in postmortem brain tissue of depressed and (or) suicidal patients; (c) decreased plasma tryptophan concentrations in depressed patients and a profound relapse in remitted depressed patients who have responded to a serotonergic antidepressant when brain tryptophan availability is reduced; (d) in general, all clinically efficacious antidepressants augment 5-HT neurotransmission following chronic treatment; (e) clinically efficacious antidepressant action by all inhibitors of 5-HT uptake; (f) increases in the density of 5-HT2 binding sites in postmortem brain tissue of depressed patients and suicide victims, as well as in platelets of drug-free depressed patients; (g) decreased number of 5-HT transporter (determined with [3H]imipramine or [3H]paroxetine) binding sites in postmortem brain tissue of suicide victims and depressed patients and in platelets of drug-free depressed patients. In our studies, this reduction in platelet 5-HT transporter binding is not due to prior antidepressant treatment of hypercortisolemia and is not observed in mania, Alzheimer disease, schizophrenia, panic disorder, fibromyalgia, or atypical depression. In a pilot study, this deficit predicted treatment response to an experimental antidepressant. These findings support the hypothesis that alterations in 5-HT neurons play a role in the pathophysiology of depression.
902 citations
TL;DR: The consistent relationship of psychopathology and disability indicates the compelling personal and socioeconomic impact of common mental illnesses across cultures and suggests the importance of impairments of higher-order human capacities as determinants of functional disability.
Abstract: Objective. —To examine the impact of common mental illness on functional disability and the cross-cultural consistency of this relationship while controlling for physical illness. A secondary objective was to determine the level of disability associated with specific psychiatric disorders. Design. —A cross-sectional sample selected by two-stage sampling. Setting. —Primary health care facilities in 14 countries covering most major cultures and languages. Patients. —A total of 25916 consecutive attenders of these facilities were screened for psychopathology using the General Health Questionnaire (96% response). Screened patients were sampled from the General Health Questionnaire score strata for the second-stage Composite International Diagnostic Interview administered to 5447 patients (62% response). Main Outcome Measures. —Patient-reported physical disability, number of disability days, and interviewer-rated occupational role functioning. Results. —After controlling for physical disease severity, psychopathology was consistently associated with increased disability. Physical disease severity was an independent, although weaker, contributor to disability. A dose-response relationship was found between severity of mental illness and disability. Disability was most prominent among patients with major depression, panic disorder, generalized anxiety, and neurasthenia; disorder-specific differences were modest after controlling for psychiatric comorbidity. Results were consistent across disability measures and across centers. Conclusions. —The consistent relationship of psychopathology and disability indicates the compelling personal and socioeconomic impact of common mental illnesses across cultures. This suggests the importance of impairments of higher-order human capacities (eg, emotion, motivation, and cognition) as determinants of functional disability. (JAMA. 1994;272:1741-1748)
859 citations
TL;DR: Risk of MDD is low in childhood, increasing substantially with adolescence, although the risk of recurrence is substantial, and the majority of episodes in community adolescents are relatively brief.
Abstract: Objective This paper presents retrospective and prospective data regarding time course parameters of major depressive disorder (MDD) in community adolescents (14 to 18 years old): time to onset and recovery and, among those who recovered, time to recurrence. Method Diagnostic interviews were conducted with 1,508 randomly selected high school students. Three hundred sixty-two had experienced at least one past or current episode of MDD. Results Mean age at onset of first episode was 14.9 (SD = 2.8). Early MDD onset was associated with female gender and suicidal ideation. MDD episode duration ranged from 2 to 520 weeks, with a mean of 26.4 weeks (SE = 3.3) and a median of 8.0 weeks. Longer episodes were observed in those whose depression occurred early (at or before age 15), whose depression had been accompanied by suicidal ideation, and for whom treatment was sought. Of the adolescents who recovered, 5% relapsed within 6 months, 12% within 1 year, and approximately 33% within 4 years. Shorter time to recurrence was associated with prior suicidal ideation and attempt and with later first onset. Conclusions Risk of MDD is low in childhood, increasing substantially with adolescence. The majority of episodes in community adolescents are relatively brief, although the risk of recurrence is substantial. Suicidal behaviors are important mediators of episode duration and of recurrence.
832 citations
TL;DR: Subjects who had experienced trauma reported higher levels of depression, anxiety, and PTSD symptomatology than nontraumatized subjects, and these symptoms were more intense in subjects who experienced multiple traumas.
Abstract: The lifetime prevalence of traumatic events and their psychological impact were assessed in 440 undergraduate students. Eighty-four percent of the subjects reported experiencing at least one event of sufficient intensity potentially to elicit Post-Traumatic Stress Disorder (PTSD). One-third of the sample had experienced four or more traumatic events. Subjects who had experienced trauma reported higher levels of depression, anxiety, and PTSD symptomatology than nontraumatized subjects, and these symptoms were more intense in subjects who experienced multiple traumas. Events that were particularly negative in their impact included unwanted sexual experiences and events that subjects reported were too traumatic to discuss openly. Males and females differed in their probability of experiencing some types of events and in the psychological response to certain events.
628 citations
TL;DR: In this paper, a prospective study of adolescent depression, adolescents were assessed at Time 1 and after 1 year (Time 2) on psychosocial variables hypothesized to be associated with depression.
Abstract: In a prospective study of adolescent depression, adolescents (N = 1,508) were assessed at Time 1 and after 1 year (Time 2) on psychosocial variables hypothesized to be associated with depression. Most psychosocial variables were associated with current (n = 45) depression. Formerly depressed adolescents (n = 217) continued to differ from never depressed controls on many of the psychosocial variables. Many of the depression-related measures also acted as risk factors for future depression (n = 112), especially past depression, current other mental disorders, past suicide attempt, internalizing behavior problems, and physical symptoms. Young women were more likely to be, to become, and to have been depressed. Controlling for the psychosocial variables eliminated the gender difference for current and future but not for past depression.
508 citations
Patent•
28 Sep 1994
TL;DR: The treatment, control or prevention of medical, psychiatric or neurological disorders may be accomplished by application of modulating electric signals to one or both of a patient's trigeminal and glossopharyngeal nerves.
Abstract: The treatment, control or prevention of medical, psychiatric or neurological disorders may be accomplished by application of modulating electric signals to one or both of a patient's trigeminal and glossopharyngeal nerves. The disorders treatable, controllable or preventable by such nerve stimulation include voluntary and involuntary disorders, migraine, epileptic seizure, motor disorders, Parkinson's disease, cerebral palsy, spasticity, chronic nervous illnesses and involuntary movement; pancreatic endocrine disorders including diabetes and hypoglycemia; dementia including cortical, subcortical, multi-infarct, Alzheimer's disease and Pick's disease; sleep disorders including central sleep apnea, insomnia and hypersomnia; eating disorders including anorexia nervosa, bulimia and compulsive overeating; and neuropsychiatric disorders including schizophrenia, depression and borderline personality disorder.
507 citations
TL;DR: The evidence supports both the views that depression promotes pain and pain promotes depression, and chronic pain was the most powerful variable.
Abstract: Chronic pain and depression often coexist, but there is still uncertainty about the nature of this relationship. Virtually all the available data are cross-sectional and therefore do not clarify the causal relationship between the two variables. In epidemiological studies, chronic pain has often been defined fairly liberally in terms of the actual duration. In this study, the definition of chronic pain was based upon self-reports of pain present for most of the days in at least 1 month of the 12 months preceding the interview. We tested the hypotheses that depression causes pain and that pain causes depression in a sample of 2324 subjects who were assessed for the presence of musculo-skeletal pain and the presence of depression, using for the latter a standardized published instrument called the Center for Epidemiologic Studies Depression scale (CES-D). The subjects were first examined using the National Health and Nutrition Survey (NHANES 1) of the United States National Center for Health Statistics from 1974 to 1975, and were followed-up from 1981 to 1984. Those with data on both occasions represent 76% of an initial population of 3059 persons. On logistic regression analysis depressive symptoms at year 1 significantly predicted the development of chronic musculo-skeletal pain at year 8 with an odds ratio of 2.14 for the depressed subjects compared with the non-depressed subjects. In patients in whom pain was present at baseline no socio-demographic variable alone predicted its persistence; however, male sex and white race together with 2 items of the CES-D did predict the persistence of existing pain.(ABSTRACT TRUNCATED AT 250 WORDS)
TL;DR: Among Harvard alumni aged 35-74 in 1962 or 1966, incidence rates of physician-diagnosed depression, together with suicide rates, were examined during a 23-27-year follow-up period, by antecedent physical activity habits and other personal characteristics.
Abstract: Among Harvard alumni aged 35-74 in 1962 or 1966, incidence rates of physician-diagnosed depression, together with suicide rates, were examined during a 23-27-year follow-up period, by antecedent physical activity habits and other personal characteristics. A total of 387 first attacks of depression developed among 10,201 alumni who survived through 1988; 129 suicides occurred among 21,569 alumni during follow-up through 1988. Depression rates were lower among the physically active and sports players, higher among cigarette smokers, unrelated to alcohol consumption, and higher among alumni reporting such personality traits as insomnia, exhaustion, cyclothymia, and self-consciousness. Suicide rates were largely unrelated to antecedent physical activity and alcohol consumption, higher among smokers, and substantially higher among men reporting the personality traits that predicted increased rates of depression.
TL;DR: Results show that prior depression is the variable most predictive of subsequent depression, as measured by the Center for Epidemiologic Studies-Depression (CES-D) scale.
TL;DR: Vredenburg, Flett, and Krames's (1993) conclusion that self-reported distress in college students is an appropriate analog for diagnosable depression is examined in light of a broader literature.
Abstract: Vredenburg, Flett, and Krames's (1993) conclusion that self-reported distress in college students is an appropriate analog for diagnosable depression is examined in light of a broader literature. Self-reported distress is conceptually and empirically distinct from depression and depressive symptoms. Distress has stronger correlates with common psychological and social factors. Distress in college students tends to be mild and transient, and most distressed college students are not depressed. Some other features of college life also make generalizations to clinical and community samples of adults problematic. Overall, ubiquitous misunderstandings in the literature have limited recognition of the pitfalls of studying distress as an analog for diagnosable depression. It is undesirable for reasons of science, social responsibility, and the credibility of psychological models of depression.
Journal Article•
TL;DR: There is good evidence to conclude that SSD is an unrecognized clinical condition of considerable public health importance that is deserving of further characterization and study.
Abstract: Secondary analyses in a subsample (N = 9160) of the National Institute of Mental Health Epidemiologic Catchment Area Program data base revealed that 19.6% of the general population reported one or more depressive symptoms in the previous month. One-year prevalence of two or more depressive symptoms in the general population was 11.8%, a prevalence figure exceeding the 9.5% 1-year prevalence for all the DSM-III mood disorders combined. We have labeled this potential clinical condition as subsyndromal symptomatic depression (SSD), defining it as any two or more simultaneous symptoms of depression, present for most or all of the time, at least 2 weeks in duration, associated with evidence of social dysfunction, occurring in individuals who do not meet criteria for diagnoses of minor depression, major depression, and/or dysthymia. SSD has a 1-year prevalence in the general population of 8.4%, two thirds of whom are women (63.4%). The most common SSD symptoms reported are insomnia (44.7%), feeling tired out all the time (42.1%), recurrent thoughts of death (31.0%), trouble concentrating (22.7%), significant weight gain (18.5%), slowed thinking (15.1%), and hypersomnia (15.1%). Increased prevalence of disability and welfare benefits was found in SSD as compared with respondents with no depressive symptoms. SSD represents a significant clinical population not covered by any DSM-III, DSM-III-R, or DSM-IV mood disorder diagnosis. Since SSD is also associated with significant increases in social dysfunction and disability, we feel there is good evidence to conclude that SSD is an unrecognized clinical condition of considerable public health importance that is deserving of further characterization and study.
TL;DR: Both stress-response and anxiety/depression symptoms differed in children as a function of age, sex of child, and sex of patient, and adolescent girls whose mothers had cancer were the most significantly distressed.
Abstract: This study assessed anxiety/depression and stress response symptoms in adult cancer patients (n = 117), spouses (n = 76), and their children (n = 110, ages 6 to 30 years old) near the patients' diagnoses to identify family members at risk for psychological maladjustment. Patients' and family members' distress was related to appraisals of the seriousness and stressfulness of the cancer but not related to objective characteristics of the disease. Patients and spouses did not differ in anxiety/depression or in stress-response symptoms. Both stress-response and anxiety/depression symptoms differed in children as a function of age, sex of child, and sex of patient. Adolescent girls whose mothers had cancer were the most significantly distressed. Implications for understanding the impact of cancer on the family are highlighted.
TL;DR: It is indicated that older adults are less likely than younger adults to acknowledge dysphoria or anhedonia even at the same level of depression, and bias against older adults may account in part for the low rates of Major Depression reported for older persons from epidemiologic studies employing the standard diagnostic criteria.
Abstract: Our hypothesis was that older adults are less likely than younger adults to acknowledge dysphoria or anhedonia even at the same level of depression. Study subjects were 3,141 participants in Baltimore, Maryland, and 3,469 participants in the Durham-Piedmont region of North Carolina who had complete data on symptoms of depression active in the one month prior to interview, as well as several covariates thought to be related to depression. The effect of age on the endorsement of the dysphoria/anhedonia stem question from the section on Major Depression in the Diagnostic Interview Schedule was estimated in the two independently gathered samples employing structural equations with a measurement model. The results indicate that, even accounting for differences due to overall level of depressive symptoms, as well as gender, minority status, educational attainment, marital status, employment status, and cognitive impairment, dysphoria was less likely to be endorsed by persons 65 years of age and older. This bias against older adults may account in part for the low rates of Major Depression reported for older persons from epidemiologic studies employing the standard diagnostic criteria.
TL;DR: In this paper, the associations between depression and cardiovascular diseases (CVDs) were examined in the nationally representative Mini-Finland Health Survey, which covers 8,000 persons, and the strongest associations were observed in the case of severe CVDs.
Abstract: We first review the associations between depression and cardiovascular diseases (CVDs). Then we examine them in the nationally representative Mini-Finland Health Survey, which covers 8,000 persons. Chronic somatic diseases and mental disorders were diagnosed using standardized methods. Cross-sectionally, CVDs and neurotic depression were associated both before and after adjustment for covariates. The strongest associations were observed in the case of severe CVDs. During a 6.6 year follow-up, the risk of CVD death and coronary death was elevated in depressed persons both with and without CVDs at entry. Much of the cross-sectional association is probably due to depression caused by CVDs. The outcome of CVD may be poorer in depressed persons. The hypothesis that depression is a cause of CVDs requires further study.
TL;DR: In young men, completed suicide is linked to specific mental disorders, namely, major depression, borderline personality disorder, and substance abuse, which is frequently associated with completed suicide.
Abstract: Objective By means of the psychological autopsy method and a case-control design, the authors examined the association of specific mental disorders and comorbidity with suicide among young men. Method Seventy-five men aged 18-35 years whose deaths were adjudicated as completed suicides by coroners of greater Montreal and Quebec City were matched to 75 living young men for age, neighborhood, marital status, and occupation. For each subject in both groups a key respondent best acquainted with the subject was interviewed by clinicians using standardized schedules. Information from the coroner and medical records was also collected. Two experienced psychiatrists, blind to outcome, established best-estimate DSM-III-R diagnoses. Results Six-month prevalence rates for all axis I diagnoses for the suicide and comparison groups were 88.0% and 37.3%, respectively; major depression was present in 38.7% and 5.3%, alcohol dependence in 24.0% and 5.3%, psychoactive substance dependence in 22.7% and 2.7%. Borderline personality disorder was identified in 28.0% and 4.0%, respectively. Of the suicide subjects, 28.0% had at least two of the following disorders: major depression, borderline personality disorder, and alcohol or drug dependence; the rate was 0.0% among the comparison subjects. Conclusions In young men, completed suicide is linked to specific mental disorders, namely, major depression, borderline personality disorder, and substance abuse. Comorbidity involving any of these disorders is frequently associated with completed suicide.
TL;DR: Better self-ratings of health had an incremental association with survival for women, but only men with poor ratings had significantly worse survival than others, and Australian findings show gender differences relative to North American results.
Abstract: OBJECTIVES. This study tested the hypothesis, from North American findings, that global self-ratings of health predict survival for older Australians. METHODS. A stratified sample of Australians 60 years of age and older surveyed in 1981 was resurveyed in 1988. Cox proportional hazard general linear models were constructed separately for men and women to predict survival over 7 years. RESULTS. Better self-ratings of health had an incremental association with survival for women, but only men with poor ratings had significantly worse survival than others. After major illnesses, comorbidities, disability, depression, and social support were controlled for, poor ratings of health for both men and women were not significantly different from excellent ratings in predicting survival. Only women's good and fair health ratings remained significant predictors. CONCLUSIONS. People rate their health as poor on the objective basis of illness and disability. Australian findings show gender differences relative to North...
TL;DR: The relevance of the CMS procedure as a potential animal model of depression is supported, as it confirmed the effect of CMS on sucrose drinking, in both male and female rats.
TL;DR: Examination of suicide victims with current unipolar DSM-III-R major depression in Finland found there were significant sex differences in current and previous treatment and suicide methods, and it would seem crucial to improve treatment and follow-up, for males with major depression, in particular.
Abstract: OBJECTIVE: The purpose of this study was to examine a sample representing all suicide victims with current DSM-III-R major depression in Finland within 1 year in aspects relevant to suicide prevention, including comorbidity, clinical history, current treatment, suicide methods, and communication of suicide intent. METHOD: Using the psychological autopsy method, the authors examined all 71 suicide victims with current unipolar DSM-III-R major depression, taken from a random sample of 229 subjects representing 16.4% of all suicide victims in Finland in 1 year. RESULTS: The majority (85%) were complicated cases with comorbid diagnoses, and comorbidity varied according to the subjects' sex and age. Three-quarters had a history of psychiatric treatment, but only 45% were receiving psychiatric treatment at the time of death. Most suicide victims had received no treatment for depression. Only 3% had received antidepressants in adequate doses, 7% weekly psychotherapy, and 3% ECT. None of the 24 psychotic subjects had received adequate psychopharmacological treatment. Few (8%) had used an antidepressant overdose as a suicide method. Men had received less treatment for depression and had more commonly used violent suicide methods. CONCLUSIONS: Although about half of the suicide victims with major depression were receiving psychiatric care at the time of death, few were receiving adequate treatment for depression. There were significant sex differences in current and previous treatment and suicide methods. For suicide prevention in major depression, it would seem crucial to improve treatment and follow-up, for males with major depression, in particular. Language: en
TL;DR: In this paper, the authors examined the association between migraine and major depression in a sample of young adults, using longitudinal data, and provided the first body of evidence that the previously observed cross-sectional association between major depression and migraine can result from bidirectional influences, with each disorder increasing the risk for first onset of the other.
Abstract: SYNOPSIS
Recent epidemiologic studies have reported an association between migraine and major depression. Little is known about the mechanisms that link the two disorders, or the natural history of their co-occurrence. We examined the association between migraine and major depression in a sample of young adults, using longitudinal data.
Method: A random sample of 1,007 young adults (21–30 years of age) members of a large HMO in Southeast Michigan was interviewed in 1989; 97% of the sample were reinter-viewed 3.5 years later, in 1992. A structured diagnostic interview was used to elicit information on DSM-III-R major depression and IHS migraine in lifetime (in the 1989 interview) and during the 3.5 year follow-up interval (in the 1992 interview). Using Cox-proportional hazards models with time-dependent covariates, we estimated the relative risk for major depression associated with prior migraine and the relative risk for migraine associated with prior major depression.
Results: In this sample of young adults, the incidence of migraine per 1,000 person years, based on the prospectively gathered data, was 5.0 in males and 22.0 in females. The estimated relative risk for major depression associated with prior migraine, adjusted for sex and education, was 3.2 (95% CI 2.3–4.6). The adjusted relative risk for migraine associated with prior major depression was 3.1 (95% CI 2.0–5.0).
Conclusions: The study provides the first body of evidence that the previously observed cross-sectional association between migraine and major depression can result from bidirectional influences, with each disorder increasing the risk for first onset of the other. The explanation that major depression in persons with migraine represents a psychologic response to migraine attacks would have been more plausible had we found an influence only from migraine to depression. By diminishing the plausibility of a simple causal explanation for the migraine-depression comorbidity, the findings favor the shared mechanisms explanation.
TL;DR: Analysis of Epidemiologic Catchment Area panel data revealed that of employed respondents not diagnosed with major depression at first interview, those who became unemployed had over twice the risk of increased depressive symptoms and of becoming clinically depressed as those who continued employed.
Abstract: Studies that have found an association between unemployment and psychological depression often fail to establish the direction of causal influence. Analyses of Epidemiologic Catchment Area panel data revealed that of employed respondents not diagnosed with major depression at first interview, those who became unemployed had over twice the risk of increased depressive symptoms and of becoming clinically depressed as those who continued employed. Although the increase in symptoms was statistically significant, the effect on clinical depression was not, possibly because of the low power of the test. The reverse causal path from clinical depression at Time 1 to becoming unemployed by Time 2 was not supported. The unemployment rate in the respondent's community at time of interview was not related directly to psychological depression but appeared associated indirectly with depression via its impact on the risk of becoming unemployed. Implications for policy and further research were discussed.
TL;DR: Investigation of the prevalence, nature, and comorbidity of depressive disorders using DSM-III-R criteria among patients recruited from the waiting rooms of family physicians finds that gender and other demographic variables failed to distinguish depressed patients, but a variety of self-ratings did.
TL;DR: The evidence indicates that ECT is associated with remission or marked clinical improvement in 80% of manic patients and that it is an effective treatment for patients whose manic episodes have responded poorly to pharmacotherapy.
Abstract: Objective: The most common indication for electroconvulsive therapy (ECT) is major depression. It is less recognized that ECT is effective also in the treatment ofacute mania. This article aims to provide a comprehensive and critical review ofthe literature on the use of ECT for manic patients. Method: All published papers in the English language on the use of ECT in acute mania that could be found were reviewed with regard to efficacy, frequency and number of treatments, bilateral versus unilateral electrode placement, predictors of antimanic response, stability of therapeutic response, cognitive consequences, and other relevant issues. Results: The evidence indicates that ECT is associated with remission or marked clinical improvement in 80% of manic patients and that it is an effective treatment for patients whose manic episodes have responded poorly to pharmacotherapy. Manic patients do not require a high frequency or prolonged course of treatments to respond to ECT. The seizure threshold appears to be lower in manic patients than in depressed patients. The issues ofrelapse following response to E CT, cognitive consequences of E CT, and the relative merits of unilateral versus bilateral ECT in manic patients require further study. Conclusions: ECT is an effective and safe treatment for acute mania. Remission ofmania following ECT reflects a primary therapeutic effect rather than a secondary consequence ofan ECT-induced organic brain syndrome.
TL;DR: A meta-analysis of 17 studies examined the efficacy of psychosocial treatments for depression among older adults and indicated that treatments were reliably more effective than no-treatment on self-rated and clinician-rated measures of depression.
Abstract: A meta-analysis of 17 studies examined the efficacy of psychosocial treatments for depression among older adults. Studies were included only if a comparison was made to a control condition (no-, delayed-, or placebo-treatment) or another psychosocial intervention. Results indicated that treatments were reliably more effective than no-treatment on self-rated and clinician-rated measures of depression. Effect sizes for studies involving participants with major depression disorder were also reliably different from zero, as were effect sizes from studies involving participants with less severe levels of depression. These findings compare favorably with several other quantitative reviews of treatments for depression. Results suggest more balanced presentations of the potential benefits of psychosocial interventions are warranted.
TL;DR: The prevalence and 9‐month incidence of depressive symptoms among a cohort of elderly primary care patients are described and whether different patterns of depression are associated withDifferent patterns of health services use are determined.
Abstract: The objective of this study was to describe the prevalence and 9-month incidence of depressive symptoms among a cohort of elderly primary care patients and to determine whether different patterns of depression are associated with different patterns of health services use.
TL;DR: Viewing clinical depression as a disease involving dysfunction of the prefrontal cortex and connected brain regions may prove helpful in both the clinical management of depression and in clarifying future avenues for research.
Abstract: The role of specific brain regions in the pathophysiology of clinical depression is poorly understood. However, one brain area, the prefrontal cortex, is emerging as likely being directly involved in clinical depression. The authors review accepted clinical diagnostic criteria for depression and show how these relate to the behavioral changes seen after prefrontal cortex damage in man and other animals. Information from structural (MRI, CT) and functional imaging (SPECT, PET) is then examined for direct evidence of prefrontal cortex abnormalities in clinically depressed subjects. Functional imaging studies, with few exceptions, demonstrate prefrontal lobe hypometabolism in primary and secondary depression, with severity of depression often correlating with the degree of frontal inactivity. These studies imply that dysfunction of the prefrontal cortex, particularly with respect to its role in modulating limbic activity, could conceivably produce many of the symptoms seen in clinical depression. Viewing clinical depression as a disease involving dysfunction of the prefrontal cortex and connected brain regions may prove helpful in both the clinical management of depression and in clarifying future avenues for research. Depression 2:59–72 (1994). © 1994 Wiley-Liss, Inc.
TL;DR: The results support the predictive validity of the CES-D and suggest that a cut-offs score of 19 should be used for diagnosing depression in chronic pain patients rather than the standard cut-off point of 16.