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Michalak EE, Tam EM, Manjunath CV, Solomons K, Levitt AJ, Levitan R, Enns M, Morehouse R, Yatham LN, Lam RW. Generic and health-related quality of life in patients with seasonal and nonseasonal depression. Psychiatry Res 2004; 128:245-51. [PMID: 15541781 DOI: 10.1016/j.psychres.2004.01.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2003] [Accepted: 01/08/2004] [Indexed: 11/29/2022]
Abstract
Although a relatively large body of research has now accumulated concerning the relationship between quality of life (QoL) and nonseasonal depression, there is a dearth of information about QoL in seasonal affective disorder (SAD). The aim of this study was to compare perceived levels of broad ('generic') and health-related QoL in patients with seasonal and nonseasonal depression. Participants were 72 patients with SAD enrolled in an on-going multicentre study in Canada, and 72 patients with nonseasonal major depressive disorder (MDD) matched for severity of depression attending an outpatient psychiatric clinic in Vancouver, British Columbia. All participants completed two measures of QoL (the 20-item Medical Outcomes Study [MOS] Short-Form General Health Survey [SF-20] and the Quality of Life Enjoyment and Satisfaction Questionnaire [Q-LES-Q]) at baseline prior to treatment. The results of the study indicated that both generic and health-related QoL were compromised in patients with SAD compared with general population norms. For example, mean Q-LES-Q scores (range 0-100, where higher scores indicate better QoL) were 44%, compared with scores of 83% reported for the general population. Patients with nonseasonal depression showed significantly poorer functioning in several domains on the SF-20, but no significant differences in Q-LES-Q scores emerged. Perceived QoL is impaired in patients with SAD. Degree of impairment between seasonal and nonseasonal depressives is equivalent when assessed using the Q-LES-Q, but significant inter-group differences are apparent in SF-20 domain scores. Future research is required to determine whether perceived QoL is improved by treatment interventions for seasonal depression such as light therapy or antidepressant medication.
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Michalak EE, Tam EM, Manjunath CV, Yatham LN, Levitt AJ, Levitan RD, Lam RW. Hard times and good friends: negative life events and social support in patients with seasonal and nonseasonal depression. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2004; 49:408-11. [PMID: 15283538 DOI: 10.1177/070674370404900613] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Although a relatively large body of research has now accumulated concerning the relation between negative life events, social support, and major depressive disorder (MDD), little is known about the relation between seasonal affective disorder and these psychosocial variables. This study aimed to compare baseline levels of negative life events (NLEs) and perceived social support (SS) in patients with seasonal and nonseasonal depression. METHOD Canadian patients with winter seasonal affective disorder (SAD) (n = 26) and nonseasonal recurrent MDD (n = 66) completed measures of recent NLEs (the List of Threatening Experiences) and perceived SS (the Social Support Survey) prior to treatment. RESULTS No significant between-group differences were observed in mean number of NLEs experienced or in quality of SS. Perceived SS was impaired in both groups, compared with patients with chronic medical conditions. CONCLUSIONS The results of this study complement those of previous research reporting increased incidence of NLEs and decreased SS in primary care patients with high seasonality in the UK. Future research is required to determine the causal relation between these psychosocial risk factors and SAD and to assess whether they have an effect on, or are affected by, treatment interventions for SAD.
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Cheung AH, Levitt AJ, Szalai JP. Impact of antidepressant side effects on adolescent quality of life. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2003; 48:727-33. [PMID: 14733453 DOI: 10.1177/070674370304801104] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study examines the relative impact of antidepressant side effects on adolescents with a history of major depression. METHODS We used Q-sort methodology to capture the opinions of adolescents with a history of depression (n = 22), adults with a history of depression (n = 20), healthy adolescents (n = 20), and clinicians (n = 18) on the impact of 40 common antidepressant side effects. We asked subjects to force rank the side effects, judging each side effect on its relative impact on their daily lives. We also examined the impact of these side effects on health status and medication compliance. Primary analyses compared adolescents with depression with the other groups on their mean rankings for each of the 40 side effects. Secondary analyses included paired comparisons for ratings on health status and compliance. RESULTS Although all groups ranked syncope and vomiting among the worst 5 side effects, significant differences were found between the groups on other side effects, such as anxiety, sleepiness, and hair loss. Based on the side effect with the most negative impact, adolescents with depression judged their own compliance (mean = 22%) to be higher than predicted by clinicians (mean = 11%). There were no significant differences between the groups on the mean rating of health status. CONCLUSIONS Adolescents with depression, adults with depression, healthy adolescents, and clinicians agreed on the negative impact of 2 side effects: vomiting and syncope. Q-sort methodology provides valuable insight into the similarities and differences in opinion regarding the potential impact of side effects in patient groups.
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Schaffer A, Levitt AJ, Boyle M. Influence of season and latitude in a community sample of subjects with bipolar disorder. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2003; 48:277-80. [PMID: 12776396 DOI: 10.1177/070674370304800413] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To report on the prevalence of seasonal bipolar disorder (BD) and the impact of latitude in a community sample in the province of Ontario. METHOD This study used the telephone-administered Depression and Seasonality Interview. Exact latitude was determined for each participant. RESULTS Overall, 14 of 62 (22.6%) subjects with BD had the seasonal subtype of BD. Latitude did not appear to influence the proportion of subjects with the seasonal subtype. CONCLUSIONS We identified a seasonal pattern of illness in a proportion of subjects with BD.
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Levitt AJ, Lam RW, Levitan R. A comparison of open treatment of seasonal major and minor depression with light therapy. J Affect Disord 2002; 71:243-8. [PMID: 12167524 DOI: 10.1016/s0165-0327(01)00397-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Although several investigators have described a milder form of seasonal affective disorder (SAD), called subsyndromal SAD, little is known about the effect of light therapy in this group. The current study evaluates 3 weeks of open treatment with light therapy in SAD and subsyndromal SAD patients. METHODS Subjects with major or minor depression according to DSM-IV with a seasonal pattern were recruited during the winter of 1998-1999 from clinic patients and media advertising. Subjects were commenced on open treatment of morning light therapy, for 30 min daily using a new fluorescent light therapy unit that produced approximately 5,000 lux at a distance of 12 inches. The treatment lasted 3 weeks and at the end of the first and second week of treatment the duration of exposure could be increased to a maximum of 60 min at the discretion of the clinician. The Structured Interview Guide for the Hamilton Depression Rating Scale-SAD version (SIGH-SAD) was administered weekly to evaluate outcome. Response was defined in a variety of ways to reflect the fact that subsyndromal SAD subjects had milder symptoms. RESULTS Forty-six subjects entered treatment and 44 (SAD, n = 29, subsyndromal SAD, n = 15) completed at least 2 weeks. Response rates were generally similar in SAD subjects (64-69%) and subsyndromal SAD (40-67%) patients. There was a trend for longer exposure to be associated with better outcome. CONCLUSIONS Light therapy may be an effective treatment for subjects with both major and minor depression with a seasonal pattern. Optimal duration, for the light therapy unit used in this study, is likely 45-60 min daily.
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Schaffer A, Levitt AJ, Hershkop SK, Oh P, MacDonald C, Lanctot K. Utility scores of symptom profiles in major depression. Psychiatry Res 2002; 110:189-97. [PMID: 12057830 DOI: 10.1016/s0165-1781(02)00097-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Utility is a measure of undesirability for a specific health state. This study determines the utility scores for the individual symptoms of depression, and examines the impact that personal experience with depression has on these scores. Seventy-five subjects (19 with current depression, 21 with past depression, and 35 healthy controls) assigned utility scores to each of 10 individual symptoms of depression, and three depression severity profiles. Utility scores were measured using the standard gamble technique. Mean utility scores were used to list the symptoms of depression from most to least undesirable. The three diagnostic groups were compared with respect to the magnitude of undesirability of the depressive symptoms. The results of this study found that individuals assigned different utility scores to different symptoms of depression. The psychological symptoms of depression such as suicidal ideation, guilt and depressed mood were ranked as more undesirable than the somatic symptoms of depression. Each diagnostic group ranked the symptoms of depression in a similar manner. Patients with a current depression were willing to accept a greater risk of death to avoid suffering from lifelong depressive symptoms as compared to patients with a past depression or healthy controls.
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Levitt AJ, Boyle MH. The impact of latitude on the prevalence of seasonal depression. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2002; 47:361-7. [PMID: 12025435 DOI: 10.1177/070674370204700407] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study sought to determine whether the prevalence of the seasonal subtype of major depression (SAD) in the community varied as a function of latitude. METHODS Random telephone numbers were generated across 8 degrees of latitude (41.5 degrees N to 49.5 degrees N) for the province of Ontario. Eight strata of 1 degree each were sampled equally throughout a 12-month period. Using a validated and structured diagnostic interview, we interviewed by telephone respondents over 20 years of age who had lived in the region for 3 years or more. We evaluated patterns of symptom change across seasons to establish a diagnosis of SAD according to DSM-IV criteria. RESULTS Of the 2078 households that were assessed for eligibility, 1605 (77%) completed the interview. The crude prevalence of lifetime SAD was 2.6% (95% CI, 1.9 to 3.5). There was no impact of latitude on prevalence of either major depression or the seasonal subtype across the 8 strata, although the global measure of the severity of seasonal change in mood was significantly negatively correlated with latitude. CONCLUSIONS SAD is a common subtype of major depression in Ontario, but there is no evidence to support an increase in prevalence with increasing latitude.
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Schaffer A, Levitt AJ, Bagby RM, Kennedy SH, Levitan RD, Joffe RT. Suicidal ideation in major depression: sex differences and impact of comorbid anxiety. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2000; 45:822-6. [PMID: 11143832 DOI: 10.1177/070674370004500906] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Being female and having comorbid anxiety are both thought to increase suicidality in patients with major depression. Whether these effects are independent or related to severity of depression is not known. METHOD We conducted a retrospective review of 533 patients (190 men, 343 women) with major depression at the time of assessment. RESULTS Suicidal ideation was present in 57.8% of all patients, and 43.2% of all patients had a lifetime anxiety disorder. Significantly more women than men experienced suicidal ideation, and both men and women with a lifetime anxiety disorder were more likely to be suicidal. Age and severity of depression did not account for these results. CONCLUSIONS In patients with a current major depression, being female and having a lifetime anxiety disorder increase suicidality independently of one another and independently of severity of depression.
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Levitt AJ, Boyle MH, Joffe RT, Baumal Z. Estimated prevalence of the seasonal subtype of major depression in a Canadian community sample. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2000; 45:650-4. [PMID: 11056828 DOI: 10.1177/070674370004500708] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine estimates of lifetime prevalence of seasonal affective disorder (SAD) in Toronto, Ontario. METHOD Random telephone numbers were generated for the city of Toronto, and 781 respondents completed a telephone interview. Trained nonphysician interviewers conducted all interviews, which involved structured questions for diagnosing major depression. Patterns of symptom change across seasons were evaluated to establish a diagnosis of SAD according to DSM-III-R criteria. RESULTS Correcting for sex and age, the prevalence of SAD defined by DSM-III-R criteria was 2.9% (95% CI, 1.7% to 4.0%), and the overall lifetime prevalence of major depression in the sample was 26.4% (95% CI, 23.3% to 29.4%). Some subjects were contacted for a follow-up interview conducted in person; the positive predictive value for the diagnosis of major depression for the telephone interview was 100%, and the negative predictive value was 93%. CONCLUSIONS The seasonal subtype of depression represents 11% of all subjects with major depression, suggesting that SAD is a significant public health concern. The telephone interview demonstrated adequate reliability, indicating that it is appropriate for epidemiological surveys of this nature.
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MacQueen GM, Tipper SP, Young LT, Joffe RT, Levitt AJ. Impaired distractor inhibition on a selective attention task in unmedicated, depressed subjects. Psychol Med 2000; 30:557-564. [PMID: 10883711 DOI: 10.1017/s0033291799001981] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Impaired distractor inhibition may contribute to the selective attention deficits observed in depressed patients, but studies to date have not tested the distractor inhibition theory against the possibility that processes such as transient memory review processes may account for the observed deficits. A negative priming paradigm can dissociate inhibition from such a potentially confounding process called object review. The negative priming task also isolates features of the distractor such as colour and location for independent examination. METHOD A computerized negative priming task was used in which colour, identification and location features of a stimulus and distractor were systematically manipulated across successive prime and probe trials. Thirty-two unmedicated subjects with DSM-IV diagnoses of non-psychotic unipolar depression were compared with 32 age, sex and IQ matched controls. RESULTS Depressed subjects had reduced levels of negative priming for conditions where the colour feature of the stimulus was repeated across prime and probe trials but not when identity or location was the repeated feature. When both the colour and location feature were the repeated feature across trials, facilitation in response was apparent. CONCLUSIONS The pattern of results supports studies that found reduced distractor inhibition in depressed subjects, and suggests that object review is intact in these subjects. Greater impairment in negative priming for colour versus location suggests that subjects may have greater impairment in the visual stream associated with processing colour features.
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Cox BJ, Rector NA, Bagby RM, Swinson RP, Levitt AJ, Joffe RT. Is self-criticism unique for depression? A comparison with social phobia. J Affect Disord 2000; 57:223-8. [PMID: 10708835 DOI: 10.1016/s0165-0327(99)00043-9] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND This study further examined the diagnostic specificity of the self-critical personality dimension, as measured by the Depressive Experiences Questionnaire (DEQ; Blatt et al., 1976. The Depressive Experiences Questionnaire. Yale University Press, New Haven). METHODS Patients with major depression (n=26) were compared to social phobia patients (n=32). RESULTS Depressed patients scored significantly higher on the DEQ Self-Criticism dimension. However, when current level of depressed mood was controlled for, self-criticism was not a significant predictor of diagnostic status. Further, the level of DEQ self-criticism reported by patients with social phobia was almost three times greater than the level reported in an earlier diagnostic specificity study with panic disorder patients [Bagby et al., 1992. Diagnostic specificity of the dependent and self-critical personality dimensions in major depression. J. Affect. Disord. 26, 59-64]. LIMITATIONS Only one measure of self-criticism was used in this study, and the research design was cross-sectional rather than prospective. CONCLUSIONS Self-criticism is not unique to major depression, and this personality dimension may be implicated in other forms of psychopathology [Blatt, 1991. A cognitive morphology of psychopathology. J. Nerv. Ment. Dis. 179, 449-458]. Some cognitive features believed to play an important role in depression may also be salient in persons with social phobia.
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Abstract
BACKGROUND The purpose of this study was to evaluate the efficacy and safety of mexiletine, a medication with antiarrhythmic, anticonvulsant and analgesic properties, in treatment-resistant bipolar disorder patients. METHODS Twenty subjects with rapid-cycling bipolar disorder who had failed to respond or were intolerant to lithium, valproic acid and carbamazepine were entered into the 6-week, open label study. Subjects were followed on a weekly basis for dosing of mexiletine, blood levels, and completion of the Hamilton Depression Rating Scale (HAM-D) and the Manic State Rating Scale (MSRS). "Burden of Mood Symptoms" (BMS) was calculated by combining scores for the HAM-D and MSRS. RESULTS Thirteen subjects (10 female, 3 male), mean age 41 years (S.D.=7.6), and mean duration of illness 20 years (S.D.=7.7) completed the study. The dose range of mexiletine was 200-1200 mg/day. Full response (>/=50% reduction in BMS) was seen in 46% of the subjects, and a partial response (25-49% reduction in BMS) in 15%. Of note, 5/5 subjects with a mixed or manic state demonstrated a full or partial response. LIMITATIONS This study has an open label design, and a small number of subjects. CONCLUSIONS Mexiletine may be effective and safe in patients with highly treatment-resistant, chronic bipolar disorder. Randomized, controlled trials are required to confirm the current results.
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Bagby R, Costa PT, McCrae RR, Livesley W, Kennedy SH, Levitan RD, Levitt AJ, Joffe RT, Young L. Replicating the five factor model of personality in a psychiatric sample. PERSONALITY AND INDIVIDUAL DIFFERENCES 1999. [DOI: 10.1016/s0191-8869(99)00055-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bagby RM, Rector NA, Segal ZV, Joffe RT, Levitt AJ, Kennedy SH, Levitan RD. Rumination and distraction in major depression: assessing response to pharmacological treatment. J Affect Disord 1999; 55:225-9. [PMID: 10628892 DOI: 10.1016/s0165-0327(99)00015-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Response style theory of depression (RST) predicts that individuals who ruminate in response to their depressed mood will suffer an amplification and prolongation of that mood, whereas individuals who engage in distraction responses will alleviate and attenuate their depressed mood. RST has been shown to predict prolonged depression in samples of non-clinical, untreated individuals with mild to moderate depression but has not been tested in samples of depressed patients undergoing treatment. OBJECTIVE In this preliminary investigation we examined: (1) whether RST predicts non-response to pharmacotherapy with outpatients suffering from major depression, and (2) whether distractive and ruminative responses are associated with clinical variables hypothesized to be associated with them. METHODS Eighty-nine depressed outpatients being treated with standard antidepressant pharmacotherapy were administered the Response Style Questionnaire, a scale designed to measure rumination and distraction, prior to treatment. RESULTS Distraction, but not rumination, predicted change in depression severity over the course of treatment and overall treatment outcome. Neither rumination nor distraction was associated with previous number of depressive episodes or duration of current depressive episode. DISCUSSION These results provide only partial support for RST as a predictor of treatment response. Future investigations are needed to determine if rumination and distraction are predictive of recurrent depressive episodes in recovered depressed patients. LIMITATIONS As the data in this study was retrieved from a clinical database, the conclusions of this report must be viewed tentatively. Replication with other clinical samples is needed.
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Levitt AJ, Joffe RT, Kamil R, McIntyre R. Do depressed subjects who have failed both fluoxetine and a tricyclic antidepressant respond to the combination? J Clin Psychiatry 1999; 60:613-6. [PMID: 10520980 DOI: 10.4088/jcp.v60n0908] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Recent evidence suggests that the combination of fluoxetine and desipramine may provide a rapid and effective treatment for depression. METHOD The current study evaluated 13 subjects with DSM-III-R nonpsychotic major depression who had previously failed either desipramine or imipramine and who were currently unsuccessfully treated with fluoxetine. Desipramine or imipramine was added to fluoxetine and Hamilton Rating Scale for Depression (HAM-D) scores, Beck Depression Inventory (BDI) scores, and plasma tricyclic levels were monitored for 3 weeks. RESULTS Of the 13 subjects, 7 (54%) had a greater than 40% decline in HAM-D scores and 4 of these (31%) had 50% or greater decline in HAM-D. At week 3, responders (767 +/- 282 nmol/L) had a significantly higher mean tricyclic level as compared with nonresponders (515 +/- 95 nmol/L, F = 25.1, p < .0001), and change in BDI scores was significantly correlated with tricyclic level (r = -0.60, p < .05). CONCLUSION These findings suggest that in some subjects the positive clinical effect of combining fluoxetine and a tricyclic antidepressant may be related to the plasma levels of the tricyclic compound.
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Bagby RM, Levitan RD, Kennedy SH, Levitt AJ, Joffe RT. Selective alteration of personality in response to noradrenergic and serotonergic antidepressant medication in depressed sample: evidence of non-specificity. Psychiatry Res 1999; 86:211-6. [PMID: 10482340 DOI: 10.1016/s0165-1781(99)00041-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Recent investigations suggest that serotonergic mechanisms modulate dimensions of personality, in particular decreases in Anger-Hostility and increases in Affiliation. None of these studies, however, demonstrated a specific serotonergic effect on personality, as other neurotransmitter systems have not been assessed for their impact on these personality dimensions. In this study, 76 depressed outpatients were treated with either the noradrenergic antidepressant desipramine (n = 38) or a selective serotonin re-uptake inhibitor (paroxetine or sertraline) (n = 38) over a period of 8-14 weeks. Personality scores were measured pre- and post-treatment using the revised NEO Personality Inventory, which measures five basic dimensions of personality, with subscales assessing Anger-Hostility and Affiliation (Gregariousness). There was a significant decrease in Neuroticism and Anger-Hostility, and a significant increase in Extraversion and Gregariousness following antidepressant treatment. Although changes in neuroticism and extraversion were significantly correlated with change in depression severity, Anger-Hostility and Gregariousness personality scores were not. Therefore, changes in these personality traits were not attributable to a non-specific effect of medication on changes in depression severity. There were no significant differences in personality change scores between the antidepressant treatment groups. Thus, while antidepressants may have a direct effect on neurochemical pathways relevant to personality, independent of changes in depression severity, these effects cannot be directly or specifically attributed to a serotonergic mechanism.
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Joffe RT, Young LT, Levitt AJ, MacQueen G, Marriott MJ, Robb J. Number of episodes and antidepressant response in major depression. Int J Neuropsychopharmacol 1999; 2:111-113. [PMID: 11281978 DOI: 10.1017/s1461145799001443] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Current series of depression suggests that episodes of major depression sensitize a patient to further episodes so that the illness adopts a recurrent course. This suggested pathophysiological process may also lead to increased risk of treatment resistance and a chronic course of illness. This hypothesis has received little empirical support and, if correct, would suggest that greater number of episodes would lead to a decreased response to antidepressants. We examined this in a cohort of outpatients with major depressive disorder. We observed that initial severity of depression and duration of treatment, but not number of previous episodes, was related to treatment outcome. Our findings are discussed in relation to prevailing theories of the pathophysiology of depression and suggestions for further studies are made.
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Joffe RT, Levitt AJ. Relationship between antidepressant partial and nonresponse and subsequent response to antidepressant augmentation. J Affect Disord 1999; 52:257-9. [PMID: 10357043 DOI: 10.1016/s0165-0327(97)00178-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the relationship between the degree of antidepressant nonresponse and subsequent response to lithium and triiodothyronine (T3) augmentation. METHOD This is a retrospective analysis of data combined from two previous controlled studies of lithium and triiodothyronine augmentation of tricyclic antidepressants. RESULTS There was no difference in the rate of augmentation response between partial and nonresponders to tricyclic antidepressant treatment. CONCLUSIONS Augmentation response does not appear to be related to the degree of nonresponse to the preceding antidepressant trial.
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Levitt AJ, Wesson VA, Joffe RT. Impact of suppression of thyroxine on folate status during acute antidepressant therapy. Psychiatry Res 1998; 79:123-9. [PMID: 9705050 DOI: 10.1016/s0165-1781(98)00033-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Antidepressant response is associated with a rise in red cell folate (RCF) and a reduction in thyroxine (T4). Since T4 levels may directly influence folate status, it is possible that the increase in folate with recovery results from the decline in T4. To examine the possible role of thyroid hormones in the observed change in folate status during antidepressant therapy, T4, tri-iodothyronine (T3) or placebo was given in a double-blind fashion to 25 depressed subjects at the initiation of standard antidepressant treatment. Folate levels and mood [using the Hamilton Rating Scale for Depression (HAMD), Montgomery-Asberg Depression Rating Scale (MADRS) and Beck Depression Inventory (BDI)] were measured at baseline and following 4 weeks of therapy. Using MANOVA for repeated measures, there was a significant interaction between response status and time for vitamin and hormone levels. Univariate analysis confirmed that response was associated with a significant change in red cell folate, but not a significant change in T4 or T3. The mean change in RCF across the 4-week trial was significantly greater in the 14 responders than the 11 non-responders. Change in RCF, and not change in T4 or T3, was significantly correlated with change in HAMD and contributed significantly to the variance in change in HAMD. These results suggest that change in RCF is closely tied to response to antidepressant treatment, and this effect is not inhibited by exogenous administration of thyroid hormones or the changes in T4 that the exogenous hormones produce. These findings support the possible role of folate, independent of thyroid function, in the modulation of mood.
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Levitan RD, Kaplan AS, Brown GM, Vaccarino FJ, Kennedy SH, Levitt AJ, Joffe RT. Hormonal and subjective responses to intravenous m-chlorophenylpiperazine in women with seasonal affective disorder. ARCHIVES OF GENERAL PSYCHIATRY 1998; 55:244-9. [PMID: 9510218 DOI: 10.1001/archpsyc.55.3.244] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND There is emerging evidence of serotonergic dysfunction in patients with seasonal affective disorder (SAD). We examined central serotonergic function in female patients with SAD (fall-winter pattern) by means of neuroendocrine and subjective responses to the postsynaptic serotonin receptor agonist m-chlorophenylpiperazine. METHODS Using a double-blind, randomized, placebo-controlled design, we assessed neuroendocrine and subjective responses to m-chlorophenylpiperazine (0.1 mg/kg intravenously) and placebo in 14 unmedicated female patients with SAD in the depressed state and 15 female normal controls. All testing was done in the fall-winter months and during the follicular phase of the menstrual cycle. Plasma prolactin and cortisol levels were used as neuroendocrine measures, while subjective responses were assessed by means of visual analog scales of 10 mood states. RESULTS On the basis of net responses to m-chlorophenylpiperazine (placebo effects subtracted from drug effects), patients with SAD exhibited blunted prolactin responses and less sadness than normal controls in response to the drug. When order of presentation of drug and placebo was taken into consideration, altered "calm" and "high" responses were also found in the patient group. CONCLUSION Evidence of dysfunction at or downstream to central serotonergic receptors in female patients with SAD confirms and extends findings from previous research.
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Levitt AJ, Joffe RT, Sokolov ST. Does the chronological relationship between the onset of dysthymia and major depression influence subsequent response to antidepressants? J Affect Disord 1998; 47:169-75. [PMID: 9476757 DOI: 10.1016/s0165-0327(97)00085-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine whether the chronological relationship between the onset of dysthymia and the onset of the first major depression influences treatment outcome in patients with double depression (DD). METHOD Clinical and outcome measures previously collected in 77 consecutive outpatients who presented with major depression and who had pre-existing dysthymia (i.e. DD) were reviewed for the current retrospective analysis. Subjects had been administered the Schedule for Affective Disorders and Schizophrenia, Lifetime Version (SADS-LV), and the Hamilton Rating Scale for Depression (HAM-D) prior to open antidepressant treatment and after 5 and 12 weeks of therapy. Response was defined as a 50% decline in HAM-D to score +/-8. Subjects were divided into those with the onset of dysthymia before the first major depression (DysB; n = 47), onset of dysthymia after major depression (DysA; n = 12) and those with onset of both condition within 2 years of each other (INDIST; n = 18). RESULTS There were no significant differences between these three groups in baseline HAM-D. However, DysA subjects had significantly higher mean HAM-D scores than the DysB subjects at week 5 and the INDIST subjects at week 12. Response rates at week 12 were lower in subjects with DysA (33%) as compared with DysB (57%; Fisher's exact test, P = 0.06) and INDIST (78%; Fisher's Exact test P = 0.02). CONCLUSIONS These findings suggest that the onset of the first episode of dysthymia after the first major depressive episode (i.e. DysA) may adversely affect response to subsequent treatments in patients with DD.
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Levitan RD, Kaplan AS, Joffe RT, Levitt AJ, Brown GM. Hormonal and subjective responses to intravenous meta-chlorophenylpiperazine in bulimia nervosa. ARCHIVES OF GENERAL PSYCHIATRY 1997; 54:521-7. [PMID: 9193192 DOI: 10.1001/archpsyc.1997.01830180027004] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Several lines of evidence point to serotonergic abnormalities in patients with bulimia nervosa (BN). Our goal was to further examine central serotonergic function in bulimic patients using neuroendocrine and subjective responses to the postsynaptic serotonin receptor agonist meta-chlorophenylpiperazine (mCPP). METHOD Using a double-blind, randomized, placebo-controlled design, we assessed neuroendocrine and subjective responses to intravenous mCPP (0.1 mg/kg) and placebo in 16 patients with BN, free of medication, and 14 normal control subjects. Plasma prolactin and cortisol levels were used as neuroendocrine measures, whereas subjective responses were measured using a visual analog scale of 10 different mood states. RESULTS Compared with controls, the BN group exhibited blunted prolactin and net cortisol responses following mCPP challenge. Subjective responses, while preliminary, also differed between groups on items related to anxiety, calmness, and altered self-awareness. CONCLUSION Evidence of dysfunction at or downstream of central serotonergic receptors in BN confirms and extends findings of prior research.
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Sokolov ST, Levitt AJ, Joffe RT. Thyroid hormone levels before unsuccessful antidepressant therapy are associated with later response to T3 augmentation. Psychiatry Res 1997; 69:203-6. [PMID: 9109188 DOI: 10.1016/s0165-1781(96)02941-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Thyroid function was measured in 24 patients before antidepressant treatment, and following failure of acute desipramine treatment but before triiodothyronine (T3) augmentation. While all measures of thyroid function were within the euthyroid range, eventual T3 augmentation responders were found to have, prior to any antidepressant treatment, lower levels of TSH and higher levels of thyroxine (T4) and free thyroxine index (FTI) than non-responders. This suggests that T3 augmentation may be of particular importance in subjects with comparatively elevated levels of serum FTI.
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Levitan RD, Kaplan AS, Brown GM, Joffe RT, Levitt AJ, Vaccarino FJ, Kennedy SH. Low plasma cortisol in bulimia nervosa patients with reversed neurovegetative symptoms of depression. Biol Psychiatry 1997; 41:366-8. [PMID: 9024959 DOI: 10.1016/s0006-3223(96)00432-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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