Depression: a need for new directions in practice and research

Anhedonia in depressed patients on treatment with selective serotonin reuptake inhibitor anti-depressant--A two-centered study in Malaysia

OBJECTIVE

Anhedonia is the reduced ability to experience pleasure. It is a core symptom of depression and is particularly difficult to treat. This study aims to compare the level of anhedonia between depressed patients on anti-depressants and healthy subjects.

METHOD

A total of 111 depressed patients on selective serotonin reuptake inhibitor (SSRI) and 82 healthy subjects were recruited from the outpatient psychiatric services at two major general hospitals in a cross-sectional study. Subjects were assessed using the Mini International Neuropsychiatric Interview 5.0.0 or MINI, Beck's Depression Index (BDI), and Snaith-Hamilton Pleasure Scale (SHAPS). Relevant personal and sociodemographic information were also collected.

RESULTS

There was a significant association between educational level and SHAPS-M scores (P < 0.01) among the participants. Most items in the SHAPS scores were significantly different (P < 0.01) in the depressed subjects treated with anti-depressant compared with the healthy subjects, after adjusting the confounding factors, BDI score, and educational level.

CONCLUSION

Anhedonia often persists in depressed patients despite on SSRI anti-depressant treatment.

Screening for depression in women with metastatic breast cancer: a comparison of the Beck Depression Inventory Short Form and the Hospital Anxiety and Depression Scale

OBJECTIVE

To compare two self-report questionnaires for identifying possible depression in women with metastatic breast cancer.

METHOD

We conducted structured psychiatric interviews and administered the Beck Depression Inventory Short Form (BDI-SF) and Hospital Anxiety and Depression Scale (HADS) to 227 women with stage IV breast cancer. The accuracy for identifying DSM-IV-defined major and minor depression was examined. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were calculated and receiver operating characteristic curves plotted.

RESULTS

Seventy-four (32.6%) patients satisfied DSM-IV criteria for a depressive disorder. With a cut-off of 4, the BDI-SF had a sensitivity of 0.84, specificity of 0.63, and PPV of 0.52. A cut-off of 11 on the HADS-Depression scale (HADS-D) resulted in sensitivity, specificity, and PPV of 0.16, 0.97, and 0.75, respectively. For major depression alone, the BDI-SF with a cut-off of 5 had excellent sensitivity but poor PPV; the HADS, with a cut-off of 7, had weak sensitivity and PPV.

CONCLUSIONS

Overall, the two scales perform similarly in identifying major depression, while the BDI-SF is the more useful in screening for DSM-IV major or minor depression categories in this clinical group.

Relationship of anhedonia and anxiety to social rank, defeat and entrapment

There is good evidence to suggest that depression is highly correlated with perceptions of low rank and subordinate status (i.e. feeling inferior, low-self esteem, feeling that others look down on the self, and submissive behaviour). However, it is possible for people to feel inferior and anxious, and behave submissively but not necessarily be depressed. More recently two other processes, defeat and entrapment, have attracted attention as possible processes linked specifically to depression and anhedonia. This research explored the relationship of these variables (social rank variables and defeat and entrapment) to two measures of hedonic tone (low positive affectivity and anhedonia) and anxiety in both a clinical and student population. All variables were strongly associated with lowered hedonic tone and anxiety. However, partial correlations, and a structural equation model fitted to the data from combined groups, suggests that perceptions of defeat play a specifically important role in anhedonia as measured by low positive affect. Framed within an evolutionary model the data suggest that the mechanisms which evolved to help animals accommodate and respond to defeats may have important regulatory effects over positive affect, reducing exploration of and engagement with the environment.

Psychological distress in patients awaiting heart transplantation

Heart transplantation has become an established procedure for the treatment of terminal heart failure. However, due to a shortage of donor organs, the waiting period for a donor organ is increasing. Cross-sectional and retrospective studies have indicated that there is tremendous psychological distress during this waiting period. The aim of this study was to assess this phase systematically and longitudinally. At the beginning of their waiting period, 62 patients at the Heidelberg Transplantation Centre were examined with regard to their physical complaints, quality of life, and level of depression. Four months later the remaining 42 patients were re-examined. The sample showed a significant increase (p<0.001) in subjective physical symptoms and an impairment in social activities (p<0.05) and everyday life (p<0.05), and a significant increase in depression (p<0.001), despite the relatively short time period. These results show the necessity of supportive psychotherapy for patients undergoing heart transplantation.