Showing papers on "Depression (differential diagnoses) published in 2009"

Depression in Older Adults

Abstract: Depression is less prevalent among older adults than among younger adults, but it can have serious consequences. More than half of cases represent a first onset in later life. Although suicide rates in the elderly are declining, they are still higher than in younger adults and are more closely associated with depression. Depressed older adults are less likely to endorse affective symptoms and more likely to display cognitive changes, somatic symptoms, and loss of interest than are depressed younger adults. Risk factors leading to the development of late-life depression likely comprise complex interactions among genetic vulnerabilities, cognitive diathesis, age-associated neurobiological changes, and stressful events. Insomnia is an often overlooked risk factor for late-life depression. We suggest that a common pathway to depression in older adults, regardless of which predisposing risks are most prominent, may be curtailment of daily activities. Accompanying self-critical thinking may exacerbate and maintain a depressed state. Offsetting the increasing prevalence of certain risk factors in late life are age-related increases in psychological resilience. Other protective factors include higher education and socioeconomic status, engagement in valued activities, and religious or spiritual involvement. Treatments including behavioral therapy, cognitive-behavioral therapy, cognitive bibliotherapy, problem-solving therapy, brief psychodynamic therapy, and life review/reminiscence therapy are effective but are too infrequently used with older adults. Preventive interventions including education for individuals with chronic illness, behavioral activation, cognitive restructuring, problem-solving skills training, group support, and life review have also received support.

Interaction Between the Serotonin Transporter Gene (5-HTTLPR), Stressful Life Events, and Risk of Depression: A Meta-analysis

Abstract: Context Substantial resources are being devoted to identify candidate genes for complex mental and behavioral disorders through inclusion of environmental exposures following the report of an interaction between the serotonin transporter linked polymorphic region (5-HTTLPR) and stressful life events on an increased risk of major depression. Objective To conduct a meta-analysis of the interaction between the serotonin transporter gene and stressful life events on depression using both published data and individual-level original data. Data Sources Search of PubMed, EMBASE, and PsycINFO databases through March 2009 yielded 26 studies of which 14 met criteria for the meta-analysis. Study Selection Criteria for studies for the meta-analyses included published data on the association between 5-HTTLPR genotype (SS, SL, or LL), number of stressful life events (0, 1, 2, ≥3) or equivalent, and a categorical measure of depression defined by the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) or the International Statistical Classification of Diseases, 10th Revision (ICD-10) or use of a cut point to define depression from standardized rating scales. To maximize our ability to use a common framework for variable definition, we also requested original data from all studies published prior to 2008 that met inclusion criteria. Of the 14 studies included in the meta-analysis, 10 were also included in a second sex-specific meta-analysis of original individual-level data. Data Extraction Logistic regression was used to estimate the effects of the number of short alleles at 5-HTTLPR, the number of stressful life events, and their interaction on depression. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated separately for each study and then weighted averages of the individual estimates were obtained using random-effects meta-analysis. Both sex-combined and sex-specific meta-analyses were conducted. Of a total of 14 250 participants, 1769 were classified as having depression; 12 481 as not having depression. Results In the meta-analysis of published data, the number of stressful life events was significantly associated with depression (OR, 1.41; 95% CI,1.25-1.57). No association was found between 5-HTTLPR genotype and depression in any of the individual studies nor in the weighted average (OR, 1.05; 95% CI, 0.98-1.13) and no interaction effect between genotype and stressful life events on depression was observed (OR, 1.01; 95% CI, 0.94-1.10). Comparable results were found in the sex-specific meta-analysis of individual-level data. Conclusion This meta-analysis yielded no evidence that the serotonin transporter genotype alone or in interaction with stressful life events is associated with an elevated risk of depression in men alone, women alone, or in both sexes combined.

Physical activity, exercise, depression and anxiety disorders

Abstract: There is a general belief that physical activity and exercise have positive effects on mood and anxiety and a great number of studies describe an association of physical activity and general well-being, mood and anxiety. In line, intervention studies describe an anxiolytic and antidepressive activity of exercise in healthy subjects and patients. However, the majority of published studies have substantial methodological shortcomings. The aim of this paper is to critically review the currently available literature with respect to (1) the association of physical activity, exercise and the prevalence and incidence of depression and anxiety disorders and (2) the potential therapeutic activity of exercise training in patients with depression or anxiety disorders. Although the association of physical activity and the prevalence of mental disorders, including depression and anxiety disorders have been repeatedly described, only few studies examined the association of physical activity and mental disorders prospectively. Reduced incidence rates of depression and (some) anxiety disorders in exercising subjects raise the question whether exercise may be used in the prevention of some mental disorders. Besides case series and small uncontrolled studies, recent well controlled studies suggest that exercise training may be clinically effective, at least in major depression and panic disorder. Although, the evidence for positive effects of exercise and exercise training on depression and anxiety is growing, the clinical use, at least as an adjunct to established treatment approaches like psychotherapy or pharmacotherapy, is still at the beginning. Further studies on the clinical effects of exercise, interaction with standard treatment approaches and details on the optimal type, intensity, frequency and duration may further support the clinical administration in patients. Furthermore, there is a lack of knowledge on how to best deal with depression and anxiety related symptoms which hinder patients to participate and benefit from exercise training.

Psychiatric Comorbidities and Schizophrenia

Abstract: Psychiatric comorbidities are common among patients with schizophrenia. Substance abuse comorbidity predominates. Anxiety and depressive symptoms are also very common throughout the course of illness, with an estimated prevalence of 15% for panic disorder, 29% for posttraumatic stress disorder, and 23% for obsessive-compulsive disorder. It is estimated that comorbid depression occurs in 50% of patients, and perhaps (conservatively) 47% of patients also have a lifetime diagnosis of comorbid substance abuse. This article chronicles these associations, examining whether these comorbidities are "more than chance" and might represent (distinct) phenotypes of schizophrenia. Among the anxiety disorders, the evidence at present is most abundant for an association with obsessive-compulsive disorder. Additional studies in newly diagnosed antipsychotic-naive patients and their first-degree relatives and searches for genetic and environmental risk factors are needed to replicate preliminary findings and further investigate these associations.

Depression as a predictor of disease progression and mortality in cancer patients: a meta-analysis.

Abstract: BACKGROUND: Cancer patients and oncologists believe that psychological variables influence the course of cancer, but the evidence remains inconclusive. This meta-analysis assessed the extent to which depressive symptoms and major depressive disorder predict disease progression and mortality in cancer patients. METHODS: Using the MEDLINE, PsycINFO, CINAHL, and EMBASE online databases, the authors identified prospective studies that examined the association between depressive symptoms or major/minor depression and risk of disease progression or mortality in cancer patients. Two raters independently extracted effect sizes using a random effects model. RESULTS: Based on 3 available studies, depressive symptoms were not shown to significantly predict cancer progression (risk ratio [RR] unadjusted = 1.23; 95% confidence interval [CI], 0.85-1.77; P = .28). Based on data from 25 independent studies, mortality rates were up to 25% higher in patients experiencing depressive symptoms (RR unadjusted = 1.25; 95% CI, 1.12-1.40; P < .001), and up to 39% higher in patients diagnosed with major or minor depression (RR unadjusted = 1.39; 95% CI, 1.10-1.89; P = .03). In support of a causal interpretation of results, there was no evidence that adjusting for known clinical prognostic factors diminished the effect of depression on mortality in cancer patients. CONCLUSIONS: This meta-analysis presented reasonable evidence that depression predicts mortality, but not progression, in cancer patients. The associated risk was statistically significant but relatively small. The effect of depression remains after adjustment for clinical prognosticators, suggesting that depression may play a causal role. Recommendations were made for future research to more clearly examine the effect of depression on cancer outcomes. Cancer 2009. © 2009 American Cancer Society.

The epidemiology of trauma, PTSD, and other posttrauma disorders.

Abstract: Epidemiologic studies have reported that the majority of community residents in the United States have experienced posttraumatic stress disorder (PTSD)-level traumatic events, as defined in the DSM-IV. Only a small subset of trauma victims develops PTSD (<10%). Increased incidence of other disorders following trauma exposure occurs primarily among trauma victims with PTSD. Female victims of traumatic events are at higher risk for PTSD than male victims are. Direct evidence on the causes of the sex difference in the conditional risk of PTSD is unavailable. The available evidence suggests that the sex difference is not due to (a) the higher occurrence of sexual assault among females, (b) prior traumatic experiences, (c) preexisting depression or anxiety disorder, or (d) sex-related bias in reporting. Observed sex differences in anxiety, neuroticism, and depression, inducing effects of stressful experiences, might provide a theoretical context for further inquiry into the greater vulnerability of females to PTSD.

Depression and anxiety in inflammatory bowel disease: a review of comorbidity and management.

Abstract: While there has been a great deal of speculation over the years on the importance of emotional factors in inflammatory bowel disease (IBD), it is only in the last decade or so that studies with stronger designs have been available to clarify the nature of this relationship This review considers recent evidence on the prevalence of anxiety and depressive disorders in IBD, the role of these disorders as a risk factor for IBD onset, the degree to which they affect the course of the IBD, and the contribution of corticosteroid treatment to psychiatric symptom onset There is evidence that anxiety and depression are more common in patients with IBD and that the symptoms of these conditions are more severe during periods of active disease The few studies that address the issue of anxiety and depression as risk factors for IBD do not yet provide enough information to support definite conclusions There is evidence, however, that the course of the disease is worse in depressed patients Treatment with corticosteroids can induce mood disorders or other psychiatric symptoms The second part of the review focuses on patient management issues for those with comorbid anxiety or depression Practical approaches to screening are discussed, and are recommended for routine use in the IBD clinic, especially during periods of active disease We review evidence-based pharmacological and psychological treatments for anxiety and depression and discuss practical considerations in treating these conditions in the context of IBD to facilitate overall management of the IBD patient

Associations of C-reactive protein and interleukin-6 with cognitive symptoms of depression: 12-year follow-up of the Whitehall II study.

Abstract: BackgroundA lack of longitudinal studies has made it difficult to establish the direction of associations between circulating concentrations of low-grade chronic inflammatory markers, such as C-reactive protein and interleukin-6, and cognitive symptoms of depression. The present study sought to assess whether C-reactive protein and interleukin-6 predict cognitive symptoms of depression or whether these symptoms predict inflammatory markers.MethodIn a prospective occupational cohort study of British white-collar civil servants (the Whitehall II study), serum C-reactive protein, interleukin-6 and cognitive symptoms of depression were measured at baseline in 1991–1993 and at follow-up in 2002–2004, an average follow-up of 11.8 years. Symptoms of depression were measured with four items describing cognitive symptoms of depression from the General Health Questionnaire. The number of participants varied between 3339 and 3070 (mean age 50 years, 30% women) depending on the analysis.ResultsBaseline C-reactive protein (β=0.046, p=0.004) and interleukin-6 (β=0.046, p=0.005) predicted cognitive symptoms of depression at follow-up, while baseline symptoms of depression did not predict inflammatory markers at follow-up. After full adjustment for sociodemographic, behavioural and biological risk factors, health conditions, medication use and baseline cognitive systems of depression, baseline C-reactive protein (β=0.038, p=0.036) and interleukin-6 (β=0.041, p=0.018) remained predictive of cognitive symptoms of depression at follow-up.ConclusionsThese findings suggest that inflammation precedes depression at least with regard to the cognitive symptoms of depression.

Prevention of depression in at-risk adolescents: a randomized controlled trial.

Abstract: Context Adolescent offspring of depressed parents are at markedly increased risk of developing depressive disorders. Although some smaller targeted prevention trials have found that depression risk can be reduced, these results have yet to be replicated and extended to large-scale, at-risk populations in different settings. Objective To determine the effects of a group cognitive behavioral (CB) prevention program compared with usual care in preventing the onset of depression. Design, Setting, and Participants A multicenter randomized controlled trial conducted in 4 US cities in which 316 adolescent (aged 13-17 years) offspring of parents with current or prior depressive disorders were recruited from August 2003 through February 2006. Adolescents had a past history of depression, current elevated but subdiagnostic depressive symptoms, or both. Assessments were conducted at baseline, after the 8-week intervention, and after the 6-month continuation phase. Intervention Adolescents were randomly assigned to the CB prevention program consisting of 8 weekly, 90-minute group sessions followed by 6 monthly continuation sessions or assigned to receive usual care alone. Main Outcome Measure Rate and hazard ratio (HR) of a probable or definite depressive episode (ie, depressive symptom rating score of ≥4) for at least 2 weeks as diagnosed by clinical interviewers. Results Through the postcontinuation session follow-up, the rate and HR of incident depressive episodes were lower for those in the CB prevention program than for those in usual care (21.4% vs 32.7%; HR, 0.63; 95% confidence interval [CI], 0.40-0.98). Adolescents in the CB prevention program also showed significantly greater improvement in self-reported depressive symptoms than those in usual care (coefficient, −1.1; z = −2.2; P = .03). Current parental depression at baseline moderated intervention effects (HR, 5.98; 95% CI, 2.29-15.58; P = .001). Among adolescents whose parents were not depressed at baseline, the CB prevention program was more effective in preventing onset of depression than usual care (11.7% vs 40.5%; HR, 0.24; 95% CI, 0.11-0.50), whereas for adolescents with a currently depressed parent, the CB prevention program was not more effective than usual care in preventing incident depression (31.2% vs 24.3%; HR, 1.43; 95% CI, 0.76-2.67). Conclusion The CB prevention program had a significant prevention effect through the 9-month follow-up period based on both clinical diagnoses and self-reported depressive symptoms, but this effect was not evident for adolescents with a currently depressed parent. Trial Registration clinicaltrials.gov Identifier: NCT00073671

Depression, anxiety and their relationship with chronic diseases: a review of the epidemiology, risk and treatment evidence.

Abstract: Objective: To review the evidence for an association between depression and anxiety and the National Health Priority Area conditions — heart disease, stroke, diabetes mellitus, asthma, cancer, arthritis and osteoporosis — and for the effectiveness of treatments for depression and anxiety in these settings. Data sources: Systematic literature search of systematic reviews, meta-analyses and evidence-based clinical practice guidelines published between 1995 and 2007, inclusive. Data extraction: Each review was examined and summarised by two people before compilation. Data synthesis: Depression is more common in all disease groups than in the general population; anxiety is more common in people with heart disease, stroke and cancer than in the general population. Heterogeneity of studies makes determination of risk and the direction of causal relationships difficult to determine, but there is consistent evidence that depression is a risk factor for heart disease, stroke and diabetes mellitus. Antidepressants appear to be effective for treating depression and/or anxiety in patients with heart disease, stroke, cancer and arthritis, although the number of studies in this area is small. A range of psychological and behavioural treatments are also effective in improving mood in patients with cancer and arthritis but, again, the number of studies is small. Conclusion: The evidence for the association of physical illness and depression and anxiety, and their effects on outcome, is very strong. Further research to establish the effectiveness of interventions is required. Despite the limits of current research, policy and practice still lags significantly behind best evidence-based practice. Models of

Targeted electrode-based modulation of neural circuits for depression

Abstract: Depression affects at least 10% of the world population and is a leading cause of worldwide disability (1). Major depressive disorder (MDD) is clinically defined as a multidimensional syndrome, involving disruption of mood, cognition, sensorimotor functions, and homeostatic/drive functions (including those that control sleep, appetite, and libido). While depression can be treated in many cases with either medication or an evidence-based psychotherapy, remission rates in controlled trials using currently available treatments rarely exceed 30%, and relapse is the rule rather than the exception (2). For many patients, combinations of multiple medications and electroconvulsive therapy (ECT) are required. For those who remain severely depressed despite these aggressive approaches, new strategies are needed (3). This Review describes the development and testing of a new interventional strategy, deep brain stimulation (DBS), directed at this group of patients who are otherwise resistant to treatment. Critical to the development of DBS as a new treatment for intractable MDD has been the evolving understanding of the brain circuits that mediate normal and abnormal mood states and the systematic characterization of changes in these circuits that accompany successful and unsuccessful response to various treatments, measured using functional imaging (reviewed in refs. 4–8). Based on brain circuit models of depression derived primarily from PET scan measures of glucose metabolism and blood flow, the first region of the brain to be targeted with DBS in patients with treatment-resistant depression (TRD) was the subcallosal cingulate (SCC), the ventral-most segment of the cingulate gyrus (Figure ​(Figure1).1). As detailed in the following sections, this region of the brain was considered a critical node within a putative mood regulatory circuit, as it showed the most consistent changes in metabolism and blood flow with clinical recovery, using various well-established antidepressant interventions (9). As such, it was hypothesized that direct stimulation of the SCC and adjacent white matter would produce modulatory or normalizing changes within this otherwise unresponsive mood circuit, resulting in antidepressant effects (10). The first clinical results of DBS of the SCC were encouraging, leading to the initiation of additional clinical studies (11, 12). This initial clinical success further motivated continued refinement of this depression circuit model, with goals to optimize surgical targeting, define biomarkers that might effectively guide patient selection, and increase understanding of DBS mechanisms of action. Figure 1 Anatomical locations of key brain regions implicated in MDD.

Optimized antidepressant therapy and pain self-management in primary care patients with depression and musculoskeletal pain: a randomized controlled trial.

Abstract: Context Pain and depression are the most common physical and psychological symptoms in primary care, respectively. Moreover, they co-occur 30% to 50% of the time and have adverse effects on quality of life, disability, and health care costs. Objective To determine if a combined pharmacological and behavioral intervention improves both depression and pain in primary care patients with musculoskeletal pain and comorbid depression. Design, setting, and patients Randomized controlled trial (Stepped Care for Affective Disorders and Musculoskeletal Pain [SCAMP]) conducted at 6 community-based clinics and 5 Veterans Affairs general medicine clinics in Indianapolis, Indiana. Recruitment occurred from January 2005 to June 2007 and follow-up concluded in June 2008. The 250 patients had low back, hip, or knee pain for 3 months or longer and at least moderate depression severity (Patient Health Questionnaire 9 score > or = 10). Intervention Patients were randomly assigned to the intervention (n = 123) or to usual care (n = 127). The intervention consisted of 12 weeks of optimized antidepressant therapy (step 1) followed by 6 sessions of a pain self-management program over 12 weeks (step 2), and a continuation phase of therapy for 6 months (step 3). Main outcome measures Depression (20-item Hopkins Symptom Checklist), pain severity and interference (Brief Pain Inventory), and global improvement in pain at 12 months. Results At 12 months, 46 of the 123 intervention patients (37.4%) had a 50% or greater reduction in depression severity from baseline compared with 21 of 127 usual care patients (16.5%) (relative risk [RR], 2.3; 95% confidence interval [CI], 1.5-3.2), corresponding to a much lower number of patients with major depression (50 [40.7%] vs 87 [68.5%], respectively; RR, 0.6 [95% CI, 0.4-0.8]). Also, a clinically significant (> or = 30%) reduction in pain was much more likely in intervention patients (51 intervention patients [41.5%] vs 22 usual care patients [17.3%]; RR, 2.4 [95% CI, 1.6-3.2]), as was global improvement in pain (58 [47.2%] vs 16 [12.6%], respectively; RR, 3.7 [95% CI, 2.3-6.1]). More intervention patients also experienced benefits in terms of the primary outcome, which was a combined improvement in both depression and pain (32 intervention patients [26.0%] vs 10 usual care patients [7.9%]; RR, 3.3 [95% CI, 1.8-5.4]). Conclusion Optimized antidepressant therapy followed by a pain self-management program resulted in substantial improvement in depression as well as moderate reductions in pain severity and disability. Trial registration clinicaltrials.gov Identifier: NCT00118430.

Incidence and risk factors of insomnia in a population-based sample.

Abstract: INSOMNIA IS AMONG THE MOST PREVALENT HEALTH COMPLAINTS. APPROXIMATELY 9% OF THE GENERAL POPULATION REGULARLY SUFFER FROM INSOMNIA, and about 30% do so occasionally.1–3 Incidence rates reported in longitudinal studies vary extensively (from 3% to 20%), depending on the population studied, the time interval (e.g., 1 year versus 10 years), and the definition of insomnia used (i.e., insomnia syndrome versus symptoms). For instance, it is estimated that over a period of one year, approximately 6% of the general population develop an insomnia syndrome,4 and approximately 20% develop insomnia symptoms, with the latter figures being based on samples of older adults5 and individuals with chronic health problems.6 Furthermore, new onset of insomnia is generally more frequent among women and individuals with medical conditions, psychiatric disorders, and a perceived stressful life.4,7–9 Based on a tripartite conceptual framework widely used to explain the development of insomnia,10–12 3 types of factors are involved at different times during the course of insomnia. First, everyone is, to some degree, predisposed to develop insomnia. Second, a precipitating event is usually associated with the onset of insomnia. Third, insomnia is perpetuated over time by psychological and behavioral factors, even after precipitating factors have been controlled or eliminated. The most commonly hypothesized predisposing factors include demographic factors (e.g., aging, female gender, living alone),1,3,13 familial/hereditary conditions (a personal or family history of insomnia),14–16 psychological factors (e.g., anxiety, depression, personality traits),4,17–19 and physiological and lifestyle factors (e.g., arousability and smoking).20,21 Precipitating factors include stressful life events (e.g., divorce),9,22 as well as psychological and health-related factors (e.g., pain, mental health problems).10,23 Finally, maintaining factors include maladaptive sleep habits (e.g., excessive amounts of time spent in bed, napping, chronic medication use) and dysfunctional cognitions about sleep loss and its impact on life (e.g., worry over sleep loss).10 Most studies investigating insomnia risk factors have been either retrospective or cross-sectional, precluding unequivocal inference about the relationship between these factors and the development of insomnia. The extent to which depression and anxiety trigger insomnia or represent consequences of insomnia remains ambiguous. The few longitudinal studies of insomnia have provided informative data about incidence and risk factors, although most of those studies have focused predominantly on selected samples such as young adults,7,28 elderly adults,8,24,25 or patients attending medical practices.6,26,27 Only one longitudinal study evaluating the relation between sleep problem symptoms (i.e., insomnia and hypersomnia) and psychiatric disorders sampled the population at large.4 Few studies have used standard diagnostic criteria to define insomnia. Moreover, previous studies have used various time frames and most have not adequately operationalized their measure of incidence. For instance, most studies have not differentiated between incident cases of first episode of insomnia (no prior history of insomnia) and cases of recurrence (with past history of insomnia). Furthermore, the majority of studies included only individuals experiencing insomnia at the time of the second assessment in their incidence estimates5,6,8,29 rather than all cases emerging during the interval between baseline and follow-up assessment.7 Since insomnia may prove transient or episodic, incidence rates may have been underestimated in previous studies. The National Institutes of Health30 called for additional longitudinal studies using well-operationalized and stringent diagnostic criteria to estimate insomnia incidence and identify risk factors within the general population. The objectives of this study were to estimate the incidence of insomnia symptoms and syndrome and to identify associated risk factors in a cohort of good sleepers sampled from the general population and followed over a one-year period.

Childhood Bullying Behaviors as a Risk for Suicide Attempts and Completed Suicides: A Population-Based Birth Cohort Study

Abstract: Objective There are no previous studies about the association of childhood bullying behavior with later suicide attempts and completed suicides among both sexes. The aim was to study associations between childhood bullying behaviors at age 8 years and suicide attempts and completed suicides up to age 25 years in a large representative population-based birth cohort. Method The sample includes 5,302 Finnish children born in 1981. Information about bullying was gathered at age 8 years from self-report, as well as parent and teacher reports. Information about suicide attempts requiring hospital admission and completed suicides was gathered from three different Finnish registries until the study participants were 25 years old. Regression analyses were conducted to determine whether children who experience childhood bullying behaviors are at risk for later suicide attempts and completed suicides after controlling for baseline conduct and depression symptoms. Results The association between bullying behavior at age 8 years and later suicide attempts and completed suicides varies by sex. Among boys, frequent bullying and victimization are associated with later suicide attempts and completed suicides but not after controlling for conduct and depression symptoms; frequent victimization among girls is associated with later suicide attempts and completed suicides, even after controlling for conduct and depression symptoms. Conclusions When examining childhood bullying behavior as a risk factor for later suicide attempts and completed suicides, each sex has a different risk profile.

Four-year longitudinal course of children and adolescents with bipolar spectrum disorders: the Course and Outcome of Bipolar Youth (COBY) study.

Abstract: Objective: The authors sought to assess the longitudinal course of youths with bipolar spectrum disorders over a 4-year period. Method: At total of 413 youths (ages 7–17 years) with bipolar I disorder (N=244), bipolar II disorder (N=28), and bipolar disorder not otherwise specified (N=141) were enrolled in the study. Symptoms were ascertained retrospectively on average every 9.4 months for 4 years using the Longitudinal Interval Follow-Up Evaluation. Rates and time to recovery and recurrence and week-by-week symptomatic status were analyzed. Results: Approximately 2.5 years after onset of their index episode, 81.5% of the participants had fully recovered, but 1.5 years later 62.5% had a syndromal recurrence, particularly depression. One-third of the participants had one syndromal recurrence, and 30% had two or more. The polarity of the index episode predicted that of subsequent episodes. Participants were symptomatic during 60% of the follow-up period, particularly with subsyndromal symptoms of depression...

A systematic review of longitudinal studies on the association between depression and smoking in adolescents

Abstract: It is well-established that smoking and depression are associated in adolescents, but the temporal ordering of the association is subject to debate. Longitudinal studies in English language which reported the onset of smoking on depression in non clinical populations (age 13-19) published between January 1990 and July 2008 were selected from PubMed, OVID, and PsychInfo databases. Study characteristics were extracted. Meta-analytic pooling procedures with random effects were used. Fifteen studies were retained for analysis. The pooled estimate for smoking predicting depression in 6 studies was 1.73 (95% CI: 1.32, 2.40; p < 0.001). The pooled estimate for depression predicting smoking in 12 studies was 1.41 (95% CI: 1.21, 1.63; p < 0.001). Studies that used clinical measures of depression were more likely to report a bidirectional effect, with a stronger effect of depression predicting smoking. Evidence from longitudinal studies suggests that the association between smoking and depression is bidirectional. To better estimate these effects, future research should consider the potential utility of: (a) shorter intervals between surveys with longer follow-up time, (b) more accurate measurement of depression, and (c) adequate control of confounding.

Mitochondrial Dysfunction and Psychiatric Disorders

Abstract: Mitochondrial oxidative phosphorylation is the major ATP-producing pathway, which supplies more than 95% of the total energy requirement in the cells. Damage to the mitochondrial electron transport chain has been suggested to be an important factor in the pathogenesis of a range of psychiatric disorders. Tissues with high energy demands, such as the brain, contain a large number of mitochondria, being therefore more susceptible to reduction of the aerobic metabolism. Mitochondrial dysfunction results from alterations in biochemical cascade and the damage to the mitochondrial electron transport chain has been suggested to be an important factor in the pathogenesis of a range of neuropsychiatric disorders, such as bipolar disorder, depression and schizophrenia. Bipolar disorder is a prevalent psychiatric disorder characterized by alternating episodes of mania and depression. Recent studies have demonstrated that important enzymes involved in brain energy are altered in bipolar disorder patients and after amphetamine administration, an animal model of mania. Depressive disorders, including major depression, are serious and disabling. However, the exact pathophysiology of depression is not clearly understood. Several works have demonstrated that metabolism is impaired in some animal models of depression, induced by chronic stress, especially the activities of the complexes of mitochondrial respiratory chain. Schizophrenia is a devastating mental disorder characterized by disturbed thoughts and perception, alongside cognitive and emotional decline associated with a severe reduction in occupational and social functioning, and in coping abilities. Alterations of mitochondrial oxidative phosphorylation in schizophrenia have been reported in several brain regions and also in platelets. Abnormal mitochondrial morphology, size and density have all been reported in the brains of schizophrenic individuals. Considering that several studies link energy impairment to neuronal death, neurodegeneration and disease, this review article discusses energy impairment as a mechanism underlying the pathophysiology of some psychiatric disorders, like bipolar disorder, depression and schizophrenia.

Symptom Burden, Depression, and Quality of Life in Chronic and End-Stage Kidney Disease

Abstract: Background and objectives: While many patients with end-stage renal disease (ESRD) have impaired physical and psychologic well-being, less is known about these health domains in patients with advanced chronic kidney disease (CKD). The authors sought to compare symptoms, depression, and quality of life in patients with ESRD and those with CKD. Design, setting, participants, & measurements: Patients with ESRD and subjects with advanced CKD were enrolled. Patients’ symptoms, depression, and quality of life were assessed using the Dialysis Symptom Index (DSI), Patient Health Questionnaire-9 (PHQ-9), and Short Form 36 (SF-36), respectively, and these health domains were compared between patient groups. Results: Ninety patients with ESRD and 87 with CKD were enrolled. There were no differences in the overall number of symptoms or in the total DSI symptom-severity score. Median scores on the PHQ-9 were similar, as was the proportion of patients with PHQ-9 scores >9. SF-36 Physical Component Summary scores were comparable, as were SF-36 Mental Component Summary scores. Conclusions: The burden of symptoms, prevalence of depression, and low quality of life are comparable in patients with ESRD and advanced CKD. Given the widely recognized impairments in these domains in ESRD, findings of this study underscore the substantial decrements in the physical and psychologic well-being of patients with CKD.

Anxiety and depression symptoms in patients with diabetes.

Abstract: Aims To identify the prevalence and major determinants of anxiety and depression symptoms in patients with diabetes. Methods A cross-sectional study of 2049 people with Types 1 and 2 diabetes, selected from patients experiencing three different models of care in Ireland: (i) traditional mixed care; (ii) hospital/general practitioner (GP) shared care; (iii) structured GP care. Anxiety and depression symptoms were assessed with the Hospital Anxiety and Depression Scale (HADS). Analyses were conducted primarily using logistic regression with adjustment for relevant confounders. Results The overall response rate was 71% ( n = 1456). Based on the HADS, there was evidence of high levels of anxiety and depression symptoms in patients with diabetes; 32.0% (95% confidence interval = 29.5–34.6%) exceeded the HADS cut-off score of ‘mild to severe’ anxiety and 22.4% (95% confidence interval = 20.2–24.7%) exceeded the HADS cut-off score of ‘mild to severe’ depression. Diabetes complications, smoking, uncertainty about glycaemic control and being an ex-drinker or a heavy drinker were risk factors for both higher anxiety and depression scores in multivariate analysis. Female gender and poor glycaemic control were risks factors associated only with higher anxiety scores. Higher socio-economic status and older age were protective factors for lower anxiety and depression scores. Type of diabetes, insulin use, marital status and models of care were not significant predictors of anxiety and depression scores. Conclusions The prevalence of anxiety and depression symptoms in patients with diabetes is considerably higher than in general population samples. These data serve as a benchmark for the prevalence of anxiety and depression symptoms in patients with diabetes.

Depression and quality of life in patients with diabetes: a systematic review from the European depression in diabetes (EDID) research consortium.

Abstract: Diabetes patients are known to have a worse quality of life than individuals without diabetes. They also have an increased risk for depressive symptoms, which may have an additional negative effect on their quality of life. This systematic review summarizes the current knowledge on the association between depressive symptoms and quality of life in individuals with diabetes. A systematic literature search using MEDLINE, Psychinfo, Social SciSearch, SciSearch and EMBASE was conducted from January 1990 until September 2007. We identified studies that compared quality of life between diabetic individuals with and without depressive symptoms. Twenty studies were identified, including eighteen cross-sectional and two longitudinal studies. Quality of life was measured as generic, diabetes specific and domain specific quality of life. All studies reported a negative association between depressive symptoms and at least one aspect of quality of life in people with diabetes. Diabetic individuals with depressive symptoms also had a severely lower diabetes specific quality of life. Generic and domain specific quality of life were found to be mild to moderately lower in the presence of depressive symptoms. Therefore, increased awareness and monitoring for depression is needed within different diabetes care settings.

Depression and anxiety among US adults: associations with body mass index.

Abstract: Obesity is associated with an increased risk of developing a variety of chronic diseases, most of which are associated with psychiatric disorders. We examined the associations of depression and anxiety with body mass index (BMI) after taking into consideration the obesity-related comorbidities (ORCs) and other psychosocial or lifestyle factors. We analyzed the data collected from 177 047 participants (aged⩾18 years) in the 2006 Behavioral Risk Factor Surveillance System. Current depression was assessed by the Patient Health Questionnaire-8 diagnostic algorithm. Lifetime diagnoses of depression, anxiety and ORCs were self-reported. The prevalence of the three psychiatric disorders was age standardized to the 2000 US population. Multivariate-adjusted prevalence ratios were computed to test associations of depression and anxiety with BMI using SUDAAN software. The age-adjusted prevalence of current depression, lifetime diagnosed depression and anxiety varied significantly by gender. Within each gender, the prevalence of the three psychiatric disorders was significantly higher in both men and women who were underweight (BMI<18.5 kg/m2), in women who were overweight (BMI: 25–<30 kg/m2) or obese (BMI⩾30 kg/m2), and in men who had class III obesity (BMI⩾40 kg/m2) than in those with a normal BMI (18.5−<25 kg/m2). After adjusting for demographics, ORCs, lifestyle or psychosocial factors, compared with men with a normal BMI, men with a BMI⩾40 kg/m2 were significantly more likely to have current depression or lifetime diagnosed depression and anxiety; men with a BMI<18.5 kg/m2 were also significantly more likely to have lifetime diagnosed depression. Women who were either overweight or obese were significantly more likely than women with a normal BMI to have all the three psychiatric disorders. Our results demonstrate that disparities in the prevalence of depression and anxiety exist among people with different BMI levels independent of their disease status or other psychosocial or lifestyle factors.

Childhood life events and childhood trauma in adult patients with depressive, anxiety and comorbid disorders vs. controls

Abstract: Hovens JGFM, Wiersma JE, Giltay EJ, van Oppen P, Spinhoven P, Penninx BWJH, Zitman FG. Childhood life events and childhood trauma in adult patients with depressive, anxiety and comorbid disorders vs. controls. Objective: To investigate the association between childhood life events, childhood trauma and the presence of anxiety, depressive or comorbid anxiety and depressive disorders in adulthood. Method: Data are from 1931 adult participants in the Netherlands Study of Depression and Anxiety (NESDA). Childhood life events included divorce of parents, early parental loss and ‘placed in care’, whereas childhood trauma was assessed as experienced emotional neglect, psychological, physical and sexual abuse prior to age 16. Results: Childhood life events were not associated with psychopathology, except for ‘placed in care’ in the comorbid group. All types of childhood trauma were increasingly prevalent in the following order: controls, anxiety, depression, and comorbid group (P P Conclusion: Childhood trauma rather than childhood life events are related to anxiety and depressive disorders. The strong associations with the comorbid group suggest that childhood trauma contributes to the severity of psychopathology. Our study underscores the importance of heightened awareness of the possible presence of childhood trauma, especially in adult patients with comorbid anxiety and depressive disorders.

Maternal Depression: A Global Threat to Children’s Health, Development, and Behavior and to Human Rights

Abstract: Depressive disorders are a common source of disability among women. In addition to the economic and human costs of maternal depression, children of depressed mothers are at risk for health, developmental, and behavioral problems. Although most of the research examining the evidence and inter-generational aspects of maternal depression has been conducted in high-income countries, recent evidence suggests that rates of maternal depression may be higher in low- and middle-income countries, where nearly 90% of the world's children live. This review examines the evidence from low- and middle-income countries that links maternal depression with children's health, development, and behavior. We present recommendations for future policies and intervention programs related to maternal depression and examine how maternal depression affects the rights of millions of children living in these countries.

Health and disease in 85 year olds: baseline findings from the Newcastle 85+ cohort study

Abstract: Objectives The Newcastle 85+ Study aims to systematically study the clinical, biological, and psychosocial attributes of an unselected cohort of 85 year olds and to examine subsequent health trajectories as the cohort ages; health at baseline is reported. Design Cross sectional analysis of baseline data from a cohort study. Setting Newcastle upon Tyne and North Tyneside primary care trusts, United Kingdom. Participants 1042 people born in 1921 and registered with the participating general practices. Main outcome measures Detailed health assessment and review of general practice records (disease, medication, and use of general practice services); participants could decline elements of the protocol. Results Of the 1453 eligible people, 851 (58.6%) were recruited to health assessment plus record review, 188 (12.9%) to record review only, and 3 (0.2%) to health assessment only. Data from record review are reported on a maximum of 1030 and from health assessment on a maximum of 853; individual denominators differ owing to withdrawal and missing values. Of the health assessment sample (n=853), 62.1% (n=530) were women and 10.4% (n=89) were in institutional care. The most prevalent diseases were hypertension (57.5%, 592/1030) and osteoarthritis (51.8%, 534/1030). Moderate or severe cognitive impairment was present in 11.7% (96/824) of participants, severe or profound urinary incontinence in 21.3% (173/813), hearing impairment in 59.6% (505/848), and visual impairment in 37.2% (309/831). Health assessment identified participants with possible disease but without a previous diagnosis in their medical record for hypertension (25.1%, 206/821), ischaemic heart disease (12.6%, 99/788), depression (6.9%, 53/772), dementia (6.7%, 56/840), and atrial fibrillation (3.8%, 30/788). Undiagnosed diabetes mellitus and thyroid disease were rare (1%, 7/717 and 6/762, respectively). A median of 3 (interquartile range 1-8) activities of daily living were undertaken with difficulty. Overall, 77.6% (646/832) of participants rated their health compared with others of the same age as good, very good, or excellent. High contact rates in the previous year with general practitioners (93.8%, 960/1024) were recorded. Women had significantly higher disease counts (medians: women 5, men 4; P=0.033) and disability scores (medians: women 4, men 2; P=0.0006) than men, but were less likely to have attended outpatient clinics in the previous three months (women 29% (150/524), men 37% (118/320), odds ratio 0.7, 95% confidence interval 0.5 to 0.9). Conclusions This large cohort of 85 year olds showed good levels of both self rated health and functional ability despite significant levels of disease and impairment. Hypertension, ischaemic heart disease, atrial fibrillation, depression, and dementia may be underdiagnosed. Notable differences were found between the sexes: women outnumbered men and had more disease and disability.

A controlled trial of antidepressants in patients with Parkinson disease and depression

Abstract: Background: Parkinson disease (PD) is a common neurodegenerative disease affecting up to 1 million individuals in the United States. Depression affects up to 50% of these patients and is associated with a variety of poor outcomes for patients and their families. Despite this, there are few evidence-based data to guide clinical care. Methods: An NIH-funded, randomized, controlled trial of paroxetine CR, nortriptyline, and placebo in 52 patients with PD and depression. The primary outcomes were the change in the Hamilton Depression Rating Scale (HAM-D) and the percentage of depression responders at 8 weeks. Results: Nortriptyline was superior to placebo for the change in HAM-D ( p p p = 0.024): nortriptyline 53%, paroxetine CR 11%, placebo 24%. In planned contrasts of response rates, nortriptyline was superior to paroxetine CR ( p = 0.034). Nortriptyline was also superior to placebo in many of the secondary outcomes, including sleep, anxiety, and social functioning, while paroxetine CR was not. Both active drug treatments were well tolerated. Conclusions: Though relatively modest in size, this is the largest placebo-controlled trial done to date in patients with Parkinson disease (PD) and depression. Nortriptyline was efficacious in the treatment of depression and paroxetine CR was not. When compared directly, nortriptyline produced significantly more responders than did paroxetine CR. The trial suggests that depression in patients with PD is responsive to treatment and raises questions about the relative efficacy of dual reuptake inhibitors and selective serotonin reuptake inhibitors. ARR = absolute risk reduction; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th edition; HAM-A = Hamilton Anxiety Scale; HAM-D = Hamilton Depression Rating Scale; MMSE = Mini-Mental State Examination; NNT = number needed to treat; PD = Parkinson disease; PDQ = Parkinson’s Disease Questionnaire; PSQI = Pittsburgh Sleep Quality Index; SCID = Structured Clinical Interview; SSRI = selective serotonin reuptake inhibitor; TCA = tricyclic antidepressant; UPDRS = Unified Parkinson’s Disease Rating Scale.