Light visor treatment for seasonal affective disorder: a multicenter study

The effectiveness of light therapy in seasonal affective disorder (SAD) was evaluated in 105 subjects across five centers. Three intensities of light (60 lux, 600 lux, and 3500 lux) were used in a 2-week randomized, parallel design. There was no significant difference in antidepressant efficacy of the three intensities of light. All three intensities produced a similar frequency of antidepressant response to each other and to that reported in previous studies. There were site differences in the severity of depression during light treatment, but diagnosis and medication status did not affect antidepressant response. These findings suggest that light therapy has an antidepressant action by a nonspecific effect or that light is biologically active in the treatment of SAD across a wide range of intensities.

Clinical features of situational and nonsituational major depression

Clinical lore has long supported the subtype of situational or reactive depression. To date, however, there has been limited empirical research support for this subtype of major depression. We examined demographic, clinical and personality features of situational and nonsituational depression in 89 outpatients with unipolar nonpsychotic major depressive disorder. Situational depressives had a less recurrent course of illness and appeared to respond more completely to the antidepressant used for their current episode. Demographic and personality measures did not distinguish situational and nonsituational depression.

Folate, vitamin B12 and cognitive impairment in patients with Alzheimer's disease

This study examines the relationship between folate, vitamin B12 and severity of cognitive impairment in patients with Alzheimer's disease (AD) as compared with other disorders associated with cognitive impairment. The patients were 97 consecutive referrals to an AD clinic. Forty patients had either possible or probable AD, 31 had other dementias (OD) and 26 had mild cognitive impairment (cognitively impaired, not demented; CIND). Patients had blood drawn for serum, red cell folate and B12, as well as other biochemical indicators of nutrition, within 24 h of the Mini-Mental State Examination (MMSE). In the AD group, only B12 was significantly correlated with MMSE. Using regression analysis, B12 contributed significantly to variance in MMSE. There was no correlation between MMSE and serum, red cell folate or B12 in the OD or CIND group and no significant correlation between MMSE and other nutritional indices in any group. These findings suggest the possibility of a specific relationship between B12 levels and severity of cognitive impairment in patients with AD.

Diagnostic specificity of the dependent and self-critical personality dimensions in major depression

Validational studies of self-critical and dependent personality dimensions as vulnerability factors for depression have been tested primarily with depressed samples, employing research designs devised to address state vs. trait and trait-situational congruity issues. In this study we examined the diagnostic specificity to depression of these two personality dimensions, comparing Self-Criticism and Dependency scores as measured by the Depressive Experiences Questionnaire (DEQ) in two samples of outpatients: (1) panic disorder with agoraphobia; and (2) non-psychotic, unipolar major depression. As hypothesized, the two groups differed on Self-Criticism, with the depressed group scoring higher, but no differences were found for Dependency. These findings were similar even when depressed mood was partialed out. These results complement a growing body of research associating Self-Criticism, as specifically measured by the DEQ, with depression.

Major depression and subclinical (grade 2) hypothyroidism

Subclinical hypothyroidism (SCH) has been reported to occur in patients with a variety of affective syndromes. However, the clinical correlates of SCH in patients with major depression have received limited attention. We therefore examined demographic, clinical and treatment response variables in a cohort of patients with unipolar, nonpsychotic major depression with and without SCH. Of 139 subjects, 19 had SCH defined as an elevated basal TSH with normal circulating levels of T3 and T4. Major depression with SCH differed from that without SCH by the presence of a concurrent panic disorder and a poorer antidepressant response.

The thyroid and melancholia

Several studies that have examined heterogeneous groups of patients suggest that altered thyroid function may distinguish melancholic from nonmelancholic depression. We therefore measured basal thyroid hormone levels in 90 unipolar depressed patients who were divided into melancholic and nonmelancholic subgroups according to three definitions. Levels of thyroxine, triiodothyronine, and thyrotropin, obtained using an ultrasensitive assay, did not distinguish the subtypes of depression. However, severity of depression contributed significantly to the difference between these subtypes according to DSM-III and Research Diagnostic Criteria.

Coping styles, psychopathology and intellectual performance in patients with familial adenomatous polyposis

Thirty-eight patients with familial adenomatous polyposis (FAP) were compared with 19 patients with ulcerative colitis (UC) for differences in illness-related variables, coping styles, psychiatric symptomatology, and intellectual performance. Patients with FAP had significantly less education, longer time since recent surgery, less psychiatric illness, and evidence of less preoccupation with their illness, as compared with UC patients. FAP patients with a positive family history (N = 28) scored significantly lower on both verbal and performance intellectual tests, even when taking education into account, compared with FAP patients without a family history (N = 9). The relevance of these findings to the ongoing monitoring and surveillance of patients with FAP is discussed.

T3 augmentation of antidepressant treatment in T4-replaced thyroid patients

BACKGROUND

Clinicians may not consider using the thyroid hormone liothyronine sodium (levorotary isomer of triiodothyronine [T3]) for augmentation of antidepressant drugs in depressed patients who are also receiving the precursor hormone levothyroxine (levorotary isomer of thyroxine [T4]) for thyroid disease. We now report on the successful use of T3 augmentation therapy in seven of nine depressed patients who were also receiving T4 for thyroid disease.

METHOD

Following an earlier single case report, we prescribed T3 augmentation therapy for eight depressed patients who had not responded to an adequate antidepressant drug trial and who were receiving T4 therapy for thyroid disease. T3 was prescribed in open-label fashion, and response was judged by the clinician, whose assessment was supplemented by the use of standardized rating scales.

RESULTS

Seven of the nine patients were judged to respond to T3 augmentation.

CONCLUSION

These results are consistent with a report of differential effects for T3 versus T4 augmentation in depressed patients free of thyroid disease. The results have implications for the treatment of depression in the presence of thyroid disease and for the mechanism of thyroid hormone potentiation of antidepressants.

Life course of depressive illness and characteristics of current episode in patients with double depression

It has been suggested recently that major depression and concurrent chronic minor depression, or "double depression" (DD), may have a different course and presentation from major depression alone (MDA). The present study compares 41 patients with DD and 60 patients with MDA for differences in life course of depressive illness and characteristics of the current depressive episode. Patients with DD, as compared with patients with MDA, had an earlier age of onset of mood disturbance, more episodes of major depression, and more frequent concurrent anxiety disorders. However, patients with DD were not significantly different from patients with MDA who had greater than a 6-month history of mood disturbance, with regard to life course of illness variable. The characteristics of current depression in patients with DD and MDA were not significantly different. The clinical and theoretical implications of these findings are discussed.

Seasonal variation of peripheral thyroid hormone levels in major depression

The seasonal variation in thyroid function tests was examined in 138 patients with major depression. No alterations in thyroxine, free thyroxine index, triiodothyronine, T3 resin uptake and thyrotropin were observed across the four seasons. This applied to both male and female subgroups. These data suggest that seasonality does not account for the wide variability in abnormalities of thyroid function reported in depression.

Bright light augmentation in antidepressant nonresponders

BACKGROUND

This study was designed to examine the potential benefit of the addition of bright lights to antidepressant treatment in depressed subjects.

METHOD

Ten patients who presented during the winter months with major depression and who had failed an adequate trial of antidepressants or who had relapsed following a successful course of antidepressants underwent a 2-week course of bright light therapy.

RESULTS

Augmentation with bright lights resulted in substantial improvement in 7 of the 10 patients.

CONCLUSION

Bright light augmentation may provide a useful treatment alternative for patients with treatment-resistant depression.

Acute psychostimulant challenge in primary obsessive-compulsive disorder

The effects of acute oral administration of methylphenidate 40 mg versus dextroamphetamine 30 mg versus matched placebo were compared in 11 patients with primary obsessive-compulsive disorder. Dextroamphetamine but not methylphenidate had a significantly greater antiobsessive-compulsive effect as measured by the Comprehensive Psychiatric Rating Scale--Obsessive-Compulsive Subscale, as compared with placebo. This effect appeared unrelated to their effect on depression although a differential effect of the two psychostimulants on anxiety was observed. Although both these stimulants affect serotonin, the differences noted between dextroamphetamine and methylphenidate suggest that catecholamines may be implicated in the pathophysiology of obsessive-compulsive disorder.

The prevalence of cyclothymia in borderline personality disorder

Sixty patients with personality disorders were evaluated by several different diagnostic instruments to determine the prevalence of cyclothymia in borderline personality disorder (BPD) and in other personality disorders (OPD). Cyclothymia occurred more frequently in BPD than in OPD, regardless of which diagnostic system was used. In contrast, the prevalence of major, minor, and intermittent depression, hypomania, and bipolar disorder was not significantly different in BPD as compared with OPD. Cyclothymic borderlines and noncyclothymic borderlines could not be distinguished on behavioral or functional measures. These results have implications for the diagnostic validity of both BPD and cyclothymia.

Quality of life in chronically mentally ill patients in day treatment

A structured assessment instrument, the Quality of Life Interview, was used to explain the quality of life of seventy patients with chronic psychiatric illness attending a day treatment programme. The interview was found to have acceptable psychometric properties. Factors that best predicted the quality of life of these patients included the number of re-admissions in the last year, frequency of family contacts, satisfaction with social life, psychiatric health and adult education. The theoretical implications and potential clinical benefits of these findings for chronic psychiatric patients are discussed.

Folate, B12, and life course of depressive illness

Forty-four consecutive, unmedicated outpatients with a major depressive disorder were evaluated to determine the relationships in life course, severity of depressive illness, and serum folate and B12 levels. Duration of current episode was significantly inversely correlated with folate levels. Age at onset of illness was significantly correlated with B12. In a subgroup of recurrent depressives, current age and age at onset of depressive illness were positively correlated with folate. The findings are discussed in light of the current hypotheses regarding the association of folate and mood.

Total and free testosterone in depressed men

Total and free testosterone, estradiol and cortisol were measured in 12 depressed males and 12 age-matched normal volunteers. There was no significant difference in any of the hormone levels between the patient and control group. Total testosterone was negatively correlated with age in the depressed group, but not with severity of depression.

Effect of cigarette smoking on thyroid function in depressed patients

The effect of cigarette smoking on thyroid function tests was evaluated in 82 patients with major depression. Smokers had significantly lower measures of thyroxine than non-smokers. The implications of these findings are discussed.