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Belanger HG, Lee C, Winsberg M. Symptom clustering of major depression in a national telehealth sample. J Affect Disord 2023; 338:129-134. [PMID: 37245550 DOI: 10.1016/j.jad.2023.05.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 03/30/2023] [Accepted: 05/11/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Major depressive disorder (MDD) is a heterogeneous disorder whose possible symptom combinations have not been well delineated. The aim of this study was to explore the heterogeneity of symptoms experienced by those with MDD to characterize phenotypic presentations. METHODS Cross-sectional data (N = 10,158) from a large telemental health platform were used to identify subtypes of MDD. Symptom data, gathered from both clinically-validated surveys and intake questions, were analyzed via polychoric correlations, principal component analysis, and cluster analysis. RESULTS Principal components analysis (PCA) of baseline symptom data revealed 5 components, including anxious distress, core emotional, agitation/irritability, insomnia, and anergic/apathy components. PCA-based cluster analysis resulted in four MDD phenotypes, the largest of which was characterized by a prominent elevation on the anergic/apathy component, but also core emotional. The four clusters differed on demographic and clinical characteristics. LIMITATIONS The primary limitation of this study is that the phenotypes uncovered are limited by the questions asked. These phenotypes will need to be cross validated with other samples, potentially expanded to include biological/genetic variables, and followed longitudinally. CONCLUSIONS The heterogeneity in MDD, as illustrated by the phenotypes in this sample, may explain the heterogeneity of treatment response in large-scale treatment trials. These phenotypes can be used to study varying rates of recovery following treatment and to develop clinical decision support tools and artificial intelligence algorithms. Strengths of this study include its size, breadth of included symptoms, and novel use of a telehealth platform.
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Affiliation(s)
- Heather G Belanger
- Brightside Health Inc., 5241F Diamond Heights Blvd #3422, San Francisco CA 94131, United States of America; University of South Florida, Department of Psychiatry and Behavioral Neurosciences, 3515 E Fletcher Ave, Tampa, FL 33613, United States of America.
| | - Christine Lee
- Brightside Health Inc., 5241F Diamond Heights Blvd #3422, San Francisco CA 94131, United States of America
| | - Mirène Winsberg
- Brightside Health Inc., 5241F Diamond Heights Blvd #3422, San Francisco CA 94131, United States of America
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Kim H, Yoo J, Han K, Jeon HJ. Physical activity and cardiovascular health in depression: Links between changes in physical activity and cardiovascular risk. Gen Hosp Psychiatry 2022; 78:35-41. [PMID: 35843062 DOI: 10.1016/j.genhosppsych.2022.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine the association between changes in physical activity before and after a diagnosis of depression and risks of cardiovascular diseases (CVDs) and all-cause mortality. METHOD A total of 1,282,160 patients with depression were included in the analyses. Subjects were divided into four groups (never, beginning, maintenance, and discontinuation) according to changes in physical activity before and after the diagnosis of depression. The occurrence of CVD including myocardial infarction (MI) and ischemic stroke and all-cause mortality were determined. RESULTS The beginning group showed decreased risks of MI (adjusted hazard ratio [aHR]: 0.85; 95% confidence interval [CI]: 0.81-0.89), ischemic stroke (aHR: 0.89; 95% CI: 0.85-0.93), and all-cause mortality (aHR: 0.80; 95% CI: 0.77-0.82) than the never group. Compared to the maintenance group, the discontinuation group showed increased risks of MI (aHR: 1.15; 95% CI: 1.08-1.23), ischemic stroke (aHR: 1.13; 95% CI: 1.06-1.21), and all-cause mortality (aHR: 1.29; 95% CI: 1.23-1.35). CONCLUSIONS Beginning regular physical activity after a diagnosis of depression was associated with a decreased cardiovascular risk. Discontinuing regular physical activity after a diagnosis of depression was associated with an increased cardiovascular risk.
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Affiliation(s)
- Hyewon Kim
- Department of Psychiatry, Hanyang University Hospital, Seoul, South Korea
| | - Juhwan Yoo
- Department of Biomedicine & Health Science, The Catholic University of Korea, Seoul, South Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, South Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Health Sciences & Technology, Department of Medical Device Management & Research, Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea.
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Agüera-Ortiz L, Claver-Martín MD, Franco-Fernández MD, López-Álvarez J, Martín-Carrasco M, Ramos-García MI, Sánchez-Pérez M. Depression in the Elderly. Consensus Statement of the Spanish Psychogeriatric Association. Front Psychiatry 2020; 11:380. [PMID: 32508684 PMCID: PMC7251154 DOI: 10.3389/fpsyt.2020.00380] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 04/16/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Present knowledge about depression in the elderly is still scarce and often controversial, despite its high frequency and impact. This article reports the results and most relevant conclusions of a Delphi-based consensus on geriatric depression promoted by the Spanish Psychogeriatric Association. METHODS A 78-item questionnaire was developed by 7 highly specialized geriatric psychiatrists and was evaluated using the Modified Delphi technique in two rounds answered by 35 psychiatrists with an extensive expertise in geriatric depression. The topics and number of questions (in brackets) covered were: concepts, clinical aspects, and risk factors (12); screening and diagnosis (7); psychotic depression (17); depression and dementia (5); antidepressant drug treatment (18); non-pharmacological biological treatments (5); psychotherapeutic treatments (4); comorbidity and preventive aspects (6); professional training needed (4). In addition, the expert panel's opinion on the antidepressants of choice in 21 common comorbid conditions and on different strategies to approach treatment-resistant cases in terms of both efficacy and safety was assessed. RESULTS After the two rounds of the Delphi process, consensus was reached for 59 (75.6%) of the 78 items. Detailed recommendations are included in the text. Considering pharmacological treatments, agomelatine was the most widely mentioned drug to be recommended in terms of safety in comorbid conditions. Desvenlafaxine, sertraline, and vortioxetine, were the most frequently recommended antidepressants in comorbid conditions in general. Combining parameters of efficacy and safety, experts recommended the following steps to address cases of treatment resistance: 1. Escalation to the maximum tolerated dose; 2. Change of antidepressant; 3. Combination with another antidepressant; 4. Potentiation with an antipsychotic or with lamotrigine; 5. Potentiation with lithium; 6. Potentiation with dopamine agonists or methylphenidate. DISCUSSION AND CONCLUSIONS Consensus was reached for a high number of items as well as for the management of depression in the context of comorbid conditions and in resistant cases. In the current absence of sufficient evidence-based information, our results can be used to inform medical doctors about clinical recommendations that might reduce uncertainty in the diagnosis and treatment of elderly patients with depressive disorders.
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Affiliation(s)
- Luis Agüera-Ortiz
- Servicio de Psiquiatría, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | | | | | - Jorge López-Álvarez
- Servicio de Psiquiatría, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - María Isabel Ramos-García
- Instituto de Psiquiatría y Salud Mental, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Manuel Sánchez-Pérez
- Unidad de Psiquiatría Geriátrica, Hospital Sagrat Cor. Martorell, Barcelona, Spain
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Effects of age on depressive symptomatology and response to antidepressant treatment in patients with major depressive disorder aged 18 to 65 years. Compr Psychiatry 2020; 99:152170. [PMID: 32146314 DOI: 10.1016/j.comppsych.2020.152170] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/24/2020] [Accepted: 02/26/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND There is evidence that symptomatology in patients with major depressive disorder (MDD) changes with age. However, studies comparing depressive symptomatology between different age groups during antidepressant therapy are rare. We compared demographic and clinical characteristics in depressed patients of different age groups at baseline and during treatment. METHODS 889 MDD inpatients were divided into four age groups (18-29, 30-39, 40-49, 50-65 yrs.). Demographic and clinical characteristics including depressive symptomatology (assessed by the Inventory of Depressive Symptoms) were assessed at baseline and weekly during treatment. RESULTS At baseline, young patients (18-29 years) significantly more often reported cognitive symptoms like irritability, suicidality, negative self-concept and interpersonal sensitivity and more often suffered from drug abuse and comorbid personality disorders. Late middle aged patients (50-65 years) significantly more often suffered from neuro-vegetative symptoms such as reduced general interest, sexual interest and sleep disturbances and more often showed a recurrent MDD and comorbid physical disorders. During therapy, symptoms such as interpersonal sensitivity in young patients and low interest in sex in late middle aged patients persisted until the end of treatment while all other symptoms declined until day 56. LIMITATIONS The herein presented age differences in depressive symptomatology only hold true for the study medication and are not generalizable to other antidepressants agents. CONCLUSION There are substantial differences in the clinical presentation of depression between age groups. Whereas many of these differences disappear during treatment, some differences persisted until the end of treatment. These findings my help to more specifically tailor the treatment of depressed patients.
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Cabanel N, Schmidt AM, Fockenberg S, Brückmann KF, Haag A, Müller MJ, Kundermann B. Evening preference and poor sleep independently affect attentional-executive functions in patients with depression. Psychiatry Res 2019; 281:112533. [PMID: 31521842 DOI: 10.1016/j.psychres.2019.112533] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 07/31/2019] [Accepted: 08/25/2019] [Indexed: 11/16/2022]
Abstract
Cognitive impairments are well documented in major depressive disorder (MDD), however, they cannot be fully explained by depressive symptom severity. We investigated how diurnal preference and sleep quality affect cognitive function in MDD. In 34 inpatients with current MDD and 29 healthy controls (HC), we obtained diurnal preference (Morningness-Eveningness Questionnaire, MEQ) and subjective sleep quality (Pittsburgh Sleep Quality Index, PSQI). Further, current mood and neuropsychological performance (Trail Making Test, TMT, part A and B) were assessed in the evening and in the following morning. Patients with MDD performed worse than HC on the TMT-B (particularly requiring executive function), but not on the TMT-A (assessing foremost visuomotor processing speed). In general, participants with evening preference (MEQ-score median split) performed poorer on the TMT than participants with morning preference. Subgroup analyses within MDD confirmed the negative effect of evening preference on the TMT. In addition, patients with severely impaired sleep quality (PSQI > 10) performed cognitively worse than patients with normal to moderately impaired sleep quality (PSQI ≤ 10). The results were largely independent of current mood state. Our findings suggest that evening preference and severely impaired sleep quality independently contribute to cognitive impairment in MDD.
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Affiliation(s)
- Nicole Cabanel
- Vitos Clinic for Psychiatry and Psychotherapy Giessen, Germany; Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Germany.
| | | | | | | | - Anja Haag
- Vitos Clinic for Psychiatry and Psychotherapy Marburg, Germany
| | - Matthias J Müller
- Oberberg Group, Berlin, Germany; Justus-Liebig University Giessen, Germany
| | - Bernd Kundermann
- Vitos Clinic for Psychiatry and Psychotherapy Giessen, Germany; Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Germany
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Lamers F, Cui L, Hickie IB, Roca C, Machado-Vieira R, Zarate CA, Merikangas KR. Familial aggregation and heritability of the melancholic and atypical subtypes of depression. J Affect Disord 2016; 204:241-6. [PMID: 27450632 DOI: 10.1016/j.jad.2016.06.040] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 05/18/2016] [Accepted: 06/11/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND The heterogeneity of mood disorders has been a challenge to our understanding of their underlying biologic and genetic pathways. This report examines the specificity of the familial aggregation of atypical and melancholic subtypes of depression and their clinical correlates in a large community based family study of affective spectrum disorders. METHODS The sample includes 457 probands and their directly interviewed adult first degree relatives from the National Institute of Mental Health (NIMH) Family Study of Affective Spectrum Disorder. Depression subtypes were based on best estimate diagnoses using information from semi-structured diagnostic interviews by experienced clinical interviews and multiple family history reports. RESULTS Atypical depression in probands was significantly associated with the atypical subtype of depression in relatives (OR 1.75 [95%CI 1.02-3.02], p=0.04), independent of proband and relative comorbid disorders. Melancholic depression in probands was not associated with melancholic depression in relatives (OR 1.25 [95%CI 0.62-2.55], p=.53). The familial heritability of the atypical subtype was 0.46 (95%CI 0.21-0.71), whereas that of the melancholic subtype was 0.33 (95%CI 0.21-0.45). Melancholic depression was associated with greater severity in terms of treatment, global functioning, suicide attempts, comorbid disorders, and an earlier age at onset of depression. LIMITATIONS The subsample of interviewed relatives necessary to assess specific subtypes of depression reduced the power to detect the specificity of mood disorder subtypes. CONCLUSION The results indicate that the atypical subtype should be incorporated in future treatment, genetic and other etiologic studies of major depression. Findings further suggest that melancholic subtype may be an indicator of clinical severity of depression.
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Affiliation(s)
- Femke Lamers
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA
| | - Lihong Cui
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA
| | - Ian B Hickie
- Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, Camperdown, NSW, Australia
| | - Catherine Roca
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA
| | - Rodrigo Machado-Vieira
- Experimental Therapeutics and Pathophysiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA
| | - Carlos A Zarate
- Experimental Therapeutics and Pathophysiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA
| | - Kathleen R Merikangas
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA.
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Lin CH, Huang CJ, Liu SK. Melancholic features in inpatients with major depressive disorder associate with differential clinical characteristics and treatment outcomes. Psychiatry Res 2016; 238:368-373. [PMID: 26899817 DOI: 10.1016/j.psychres.2015.11.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 11/01/2015] [Accepted: 11/07/2015] [Indexed: 11/17/2022]
Abstract
To determine whether the presence of melancholic features in hospitalized patients with major depressive disorder (MDD) was associated with specific clinical characteristics and treatment outcomes, supporting melancholic depression as a distinct subtype within MDD. 126 acutely ill inpatients with MDD were enrolled in an open, 6-week trial with fixed-dose fluoxetine 20mg daily. Symptom severity was assessed regularly, using the 17-item Hamilton Depression Rating Scale (HAMD-17) and Clinical Global Impression of Severity (CGI-S). Melancholic features were defined according to the DSM-IV criteria. Clinical variables were compared between patients with and without melancholic features. Generalized estimating equations method was used to explore the differences in HAMD-17 and CGI-S scores between the 2 groups over time. Clinical response was defined as having a 50% or greater reduction in HAMD-17 scores. 96 (76.2%) of the 126 patients with at least one post-baseline assessment met the criteria for melancholic depression. Melancholic depression differed from non-melancholic depression in clinical characteristics and predicted a better response to fluoxetine treatment. The differentiation between melancholic and non-melancholic depression within MDD hence is clinically significant and valid.
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Affiliation(s)
- Ching-Hua Lin
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan; Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Jen Huang
- Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Psychiatry, Kaohsiung Medical University Hospital, Taiwan
| | - Shi-Kai Liu
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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Rimay T, Benak I, Kiss E, Baji I, Feher A, Juhasz A, Strauss J, Kennedy J, Barr C, Kovacs M, Vetro A, Kapornai K. BDNF Val66Met polymorphism and stressful life events in melancholic childhood-onset depression. Psychiatr Genet 2015; 25:249-55. [PMID: 26462036 PMCID: PMC4714603 DOI: 10.1097/ypg.0000000000000107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Brain-derived neurotrophic factor (BDNF) polymorphisms have been examined for their contribution toward depression with equivocal results. More homogeneous phenotypes might be used to improve our understanding of genetic liability to depression. The aim of our study was to (a) test for an association between the BDNF Val66Met polymorphism and childhood-onset melancholic depression and (b) to examine the interactive effects of stressful life events (SLE) and the Val66Met polymorphism on the risk of childhood-onset melancholic depression. MATERIALS AND METHODS A total of 583 depressed probands were involved in this study (162 of the melancholic subtype). Diagnoses were derived through the Interview Schedule for Children and Adolescents - Diagnostic Version and life event data were collected using an Intake General Information Sheet. RESULTS Overall, 27.8% of the participants fulfilled the criteria for melancholy. In the melancholic group, the proportion of females was higher (53.1%), although there were more males in the overall depressed sample. We detected no significant differences in genotype or allele frequency between the melancholic and the nonmelancholic depressed group. The BDNF Val66Met polymorphism and SLE interaction was not significantly associated with the melancholy outcome. CONCLUSION In our study, females were more prone to developing the early-onset melancholic phenotype. To our knowledge, this is the first study to investigate the differentiating effect of the genotype and the G×E interaction on the melancholic phenotype in a large sample of depressed young patients. We did not find an association between the melancholic subtype of major depression and the BDNF genotype and SLE interaction in this sample, which is representative of the Hungarian clinic-referred population of depressed youths.
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Affiliation(s)
- Timea Rimay
- Department of Pediatrics, Child and Adolescent Psychiatry Unit, University of Szeged, Szeged, Hungary
| | - Istvan Benak
- Department of Pediatrics, Child and Adolescent Psychiatry Unit, University of Szeged, Szeged, Hungary
| | - Eniko Kiss
- Department of Pediatrics, Child and Adolescent Psychiatry Unit, University of Szeged, Szeged, Hungary
| | - Ildiko Baji
- Department of Pediatrics, Child and Adolescent Psychiatry Unit, University of Szeged, Szeged, Hungary
| | - Agnes Feher
- Department of Psychiatry, University of Szeged, Szeged, Hungary
| | - Anna Juhasz
- Department of Psychiatry, University of Szeged, Szeged, Hungary
| | - John Strauss
- Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - James Kennedy
- Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Cathy Barr
- University Health Network, Toronto Western Research Institute, Toronto, ON, Canada
| | - Maria Kovacs
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Agnes Vetro
- Department of Pediatrics, Child and Adolescent Psychiatry Unit, University of Szeged, Szeged, Hungary
| | - Krisztina Kapornai
- Department of Pediatrics, Child and Adolescent Psychiatry Unit, University of Szeged, Szeged, Hungary
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Fletcher K, Parker G, Paterson A, Fava M, Iosifescu D, Pizzagalli DA. Anhedonia in melancholic and non-melancholic depressive disorders. J Affect Disord 2015; 184:81-8. [PMID: 26074016 PMCID: PMC4519400 DOI: 10.1016/j.jad.2015.05.028] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 05/11/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Anhedonia represents a core symptom of major depression and may be a potential marker for melancholia. However, current understanding of this construct in depressive sub-types is limited. METHOD Participants were recruited from the Black Dog Institute (Sydney) and Massachusetts General Hospital (Boston). Diagnostic groups were derived on the basis of agreement between clinician and DSM-IV diagnosis from structured interviews. Currently depressed unipolar melancholic, non-melancholic and healthy control participants were administered a probabilistic reward task (PRT) to assess a behavioural correlate of anhedonia-blunted reward-based learning. Self-reported measures of anhedonia, approach and avoidance motivation were completed by the Sydney sample. RESULTS Relative to healthy controls and non-melancholic participants, melancholic depressed participants had reduced response bias, highlighting blunted reward learning. Moreover, although non-melancholic participants were characterized by a delayed response bias, melancholic depressed participants failed to develop a bias throughout blocks. Response bias showed no associations with self-report measures of hedonic tone in depressed participants. Positive associations were observed between response bias, approach and avoidance motivation in non-melancholic participants only. LIMITATIONS Possible medication, fatigue and anxiety effects were not controlled; small sample sizes; inclusion criteria may have excluded those with severe melancholia and led to underestimation of group differences. CONCLUSIONS Melancholia is characterised by a reduced ability to modulate behaviour as a function of reward, and the motivational salience of rewarding stimuli may differ across depressive sub-types. Results support the view that melancholia is a distinct sub-type. Further exploration of reward system functioning in depressive sub-types is warranted.
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Affiliation(s)
- Kathryn Fletcher
- School of Psychiatry, University of New South Wales, NSW, Australia; Black Dog Institute, NSW, Australia; Centre for Psychological and Relationship Counselling, VIC, Australia.
| | - Gordon Parker
- School of Psychiatry, University of New South Wales, NSW, Australia,Black Dog Institute, NSW, Australia
| | - Amelia Paterson
- School of Psychiatry, University of New South Wales, NSW, Australia,Black Dog Institute, NSW, Australia
| | - Maurizio Fava
- Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | | | - Diego A. Pizzagalli
- Massachusetts General Hospital, Boston, MA, USA, McLean Hospital, Belmont, MA, USA
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Terroni L, Amaro E, Iosifescu DV, Mattos P, Yamamoto FI, Tinone G, Conforto AB, Sobreiro MF, Guajardo VD, De Lucia MCS, Moreira AC, Scaff M, Leite CC, Fraguas R. The association of post-stroke anhedonia with salivary cortisol levels and stroke lesion in hippocampal/parahippocampal region. Neuropsychiatr Dis Treat 2015; 11:233-42. [PMID: 25678790 PMCID: PMC4322890 DOI: 10.2147/ndt.s73722] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Anhedonia constitutes a coherent construct, with neural correlates and negative clinical impact, independent of depression. However, little is known about the neural correlates of anhedonia in stroke patients. In this study, we investigated the association of post-stroke anhedonia with salivary cortisol levels and stroke location and volume. PATIENTS AND METHODS A psychiatrist administered the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition to identify anhedonia in 36 inpatients, without previous depression, consecutively admitted in a neurology clinic in the first month after a first-ever ischemic stroke. Salivary cortisol levels were assessed in the morning, evening, and after a dexamethasone suppression test. We used magnetic resonance imaging and a semi-automated brain morphometry method to assess stroke location, and the MRIcro program according to the Brodmann Map to calculate the lesion volume. RESULTS Patients with anhedonia had significantly larger diurnal variation (P-value =0.017) and higher morning levels of salivary cortisol (1,671.9±604.0 ng/dL versus 1,103.9±821.9 ng/dL; P-value =0.022), and greater stroke lesions in the parahippocampal gyrus (Brodmann area 36) compared to those without anhedonia (10.14 voxels; standard deviation ±17.72 versus 0.86 voxels; standard deviation ±4.64; P-value =0.027). The volume of lesion in the parahippocampal gyrus (Brodmann area 36) was associated with diurnal variation of salivary cortisol levels (rho=0.845; P-value =0.034) only in anhedonic patients. CONCLUSION Our findings suggest that anhedonia in stroke patients is associated with the volume of stroke lesion in the parahippocampal gyrus and with dysfunction of the hypothalamic-pituitary-adrenal axis.
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Affiliation(s)
- Luisa Terroni
- Consultation-Liaison Psychiatry Group, Department and Institute of Psychiatry, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Edson Amaro
- Department of Radiology, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Dan V Iosifescu
- Mood and Anxiety Disorders Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Patricia Mattos
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Fabio I Yamamoto
- Department of Neurology, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Gisela Tinone
- Department of Neurology, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Adriana B Conforto
- Department of Neurology, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Matildes Fm Sobreiro
- Consultation-Liaison Psychiatry Group, Department and Institute of Psychiatry, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Valeri D Guajardo
- Consultation-Liaison Psychiatry Group, Department and Institute of Psychiatry, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Mara Cristina S De Lucia
- Division of Psychology, Central Institute, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Ayrton C Moreira
- Department of Medicine, University of São Paulo, School of Medicine, Ribeirão Preto, Brazil
| | - Milberto Scaff
- Department of Neurology, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Claudia C Leite
- Department of Radiology, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Renerio Fraguas
- Consultation-Liaison Psychiatry Group, Department and Institute of Psychiatry, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil
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11
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Parker G, Hyett MP, Friend P, Hadzi-Pavlovic D. Does age impact on rating melancholic and non-melancholic depressive symptoms? J Affect Disord 2013; 147:318-24. [PMID: 23411026 DOI: 10.1016/j.jad.2012.11.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 11/07/2012] [Accepted: 11/15/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND Melancholic depression has long evaded attempts at accurate definition. A range of factors may influence symptom reporting and so compromise definitional attempts. One possible factor is age, and its possible influence led to the current study examining the impact of age on the reporting of melancholic and non-melancholic depressive symptoms. METHODS A set of 32 self-rated depression items from the SDS depression measure and weighted to both melancholic and non-melancholic depressions were analysed for any impact of age in clinically diagnosed melancholic and non-melancholic depressed patients. RESULTS Melancholic and non-melancholic patients did not differ by gender, severity of depression or duration of current episode. None of the melancholic items from the SDS showed a linear increase with age. Analyses of factor analytic derived constructs identified one factor as evidencing a linear decrease (rather than increase) in scores with age in the melancholic patients. Differential item functioning was only found for melancholic patients' scores on the 'non-melancholic scale', with a decrease across age. Simulated data revealed, for the same scale, a decrease in both melancholic and non-melancholic patients. LIMITATIONS Our assessment strategies effectively excluded those with severe melancholia and who were unable to complete self-report measures, and may have contributed to study findings. As we had few patients over the age of 70, age effects in elderly patients may have missed identification. CONCLUSIONS We found no evidence for melancholic symptoms to increase in severity with age. To the contrary, some items decreased in severity with age in both melancholic and non-melancholic patients. Overall study results are reassuring in indicating that age is unlikely to distort analyses seeking to differentiate those with melancholic and non-melancholic depressive conditions.
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Affiliation(s)
- Gordon Parker
- School of Psychiatry, University of New South Wales, Prince of Wales Hospital, Hospital Road, Randwick, NSW 2031, Australia.
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Hegeman JM, Kok RM, van der Mast RC, Giltay EJ. Phenomenology of depression in older compared with younger adults: meta-analysis. Br J Psychiatry 2012; 200:275-81. [PMID: 22474233 DOI: 10.1192/bjp.bp.111.095950] [Citation(s) in RCA: 168] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Late-life depression may differ from early-life depression in its phenomenology. AIMS To investigate the effect of age on the phenomenology of major depression. METHOD A systematic search was conducted in PubMed, Embase and PsycINFO for all studies examining the relation between age and phenomenology of major depression according to RDC, DSM and ICD criteria. Studies were included only if the age groups were compared at the single-item level using the 17-, 21- or 24-item versions of the Hamilton Rating Scale for Depression; a meta-analysis was done for each item of the 17-item scale. RESULTS Eleven papers met the inclusion criteria. Older depressed adults, compared with younger depressed adults, demonstrated more agitation, hypochondriasis and general as well as gastrointestinal somatic symptoms, but less guilt and loss of sexual interest. CONCLUSIONS The phenomenology of late-life depression differs only in part from that of early-life depression. Major depression in older people may have a more somatic presentation, whereas feelings of guilt and loss of sexual function may be more prevalent in younger people.
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Affiliation(s)
- J M Hegeman
- Department of Psychiatry, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
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Abstract
OBJECTIVE We examine the depressive symptom profile of bipolar II disorder patients compared with a comparator (composite) group of those with unipolar depression, with stratification by melancholic and non-melancholic subtypes. METHOD Out-patients (n = 394) attending a specialist depression clinic comprised the sample. Data on severity and prototypic status of depressive symptoms were analysed. RESULTS Age-matched analyses revealed minimal differentiation between bipolar II and composite unipolar groups. Stratified analyses suggested that 'bipolar II depression' more closely approximated melancholic depression in terms of psychomotor and cognitive slowing. Severity-based analyses and prototypic symptom patterns yielded differing results, suggesting that definition of bipolar II depression is influenced by rating strategies, and age. CONCLUSION We found limited differentiation of bipolar II depression from unipolar, melancholic and non-melancholic depression. Differences suggested previously may reflect age, gender and severity differences, highlighting the need for appropriately matched groups in defining bipolar II depression.
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Affiliation(s)
- G B Parker
- School of Psychiatry, University of New South Wales and Black Dog Institute, Prince of Wales Hospital, Randwick 2031, Sydney, Australia.
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Kennedy SH. Core symptoms of major depressive disorder: relevance to diagnosis and treatment. DIALOGUES IN CLINICAL NEUROSCIENCE 2008. [PMID: 18979940 PMCID: PMC3181882 DOI: 10.31887/dcns.2008.10.3/shkennedy] [Citation(s) in RCA: 195] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The construct of major depressive disorder makes no etiological assumptions about populations with diverse symptom clusters. "Depressed mood" and "loss of interest or pleasure in nearly all activities" are core features of major depressive episode, though a strong case can be made to pay increasing attention to symptoms of fatigue, sleep disturbance, anxiety, and neurocognitive and sexual dysfunction in the diagnosis and evaluation of treatment outcome. Mood, guilt, work, and interest, as well as psychic anxiety, are consistently identified across validated subscales of the Hamilton Depression Rating Scale as prevalent and sensitive to change with existing treatments. A major limitation of these antidepressant therapies is their narrow spectrum of action. While the core "mood and interest" symptoms have been the main focus of attention, the associated symptoms listed above are often unaffected or exacerbated by current treatments. Careful clinical evaluation should address all of these dimensions, recognizing that improvement may occur sooner in some symptoms (eg, mood) compared with others (eg, sleep disturbance).
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Affiliation(s)
- Sidney H Kennedy
- Department of Psychiatry, University Health Network, University of Toronto, Ontario, Canada.
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