Onset of Depression Inventory (ODI)--assessment of the speed of onset of depressive episodes

Transitions in depression: if, how, and when depressive symptoms return during and after discontinuing antidepressants

Purpose

The aim of the current study is to provide insight into if, how, and when meaningful changes occur in individual patients who discontinue antidepressant medication. Agreement between macro-level quantitative symptom data, qualitative ratings, and micro-level Ecological Momentary Assessments is examined.

Methods

During and shortly after antidepressant discontinuation, depressive symptoms and ‘feeling down’ were measured in 56 participants, using the SCL-90 depression subscale weekly (macro-level) for 6 months, and 5 Ecological Momentary Assessments daily (micro-level) for 4 months (30.404 quantitative measurements in total). Qualitative information was also obtained, providing additional information to verify that changes were clinically meaningful.

Results

At the macro-level, an increase in depressive symptoms was found in 58.9% of participants that (a) was statistically reliable, (b) persisted for 3 weeks and/or required intervention, and (c) was clinically meaningful to patients. Of these increases, 30.3% happened suddenly, 42.4% gradually, and for 27.3% criteria were inconclusive. Quantitative and qualitative criteria showed a very high agreement (Cohen’s κ = 0.85) regarding if a participant experienced a recurrence of depression, but a moderate agreement (Cohen’s κ = 0.49) regarding how that change occurred. At the micro-level, 41.1% of participants experienced only sudden increases in depressed mood, 12.5% only gradual, 30.4% experienced both types of increase, and 16.1% neither.

Conclusion

Meaningful change is common in patients discontinuing antidepressants, and there is substantial heterogeneity in how and when these changes occur. Depressive symptom change at the macro-level is not the same as depressive symptom change at the micro-level.

Prodromal Symptoms in Depression: A Systematic Review

INTRODUCTION

Appraisal of prodromal symptoms of unipolar depression may complement the traditional cross-sectional approach and provide a longitudinal perspective, according to a staging model of the illness.

OBJECTIVE

To provide an updated systematic review of clinical studies concerned with prodromal symptoms of unipolar depression, according to PRISMA guidelines.

METHODS

Keyword searches were conducted in PubMed, Scopus, and Web of Science. Longitudinal studies on prodromal symptoms and signs in adult patients primarily diagnosed with unipolar depression were selected. Findings were examined separately according to study design (i.e., retrospective or prospective).

RESULTS

Twenty-five studies met the criteria for inclusion in this systematic review. Findings indicate that a distinct prodromal symptomatology - commonly characterized by anxiety, tension, irritability, and somatic complaints - exists before the onset of unipolar depression. The duration of the prodromal phase was highly variable across studies, ranging from less than a month to several years. Prodromal symptoms profile and duration were consistent within individuals across depressive episodes. There was a close relationship between prodromal and residual symptoms of the same depressive episode.

CONCLUSIONS

The present systematic review addresses an important, and yet relatively neglected, clinical issue that deserves further investigation and may be of immediate practical value. The findings provide challenging insights into the pathogenesis and course of unipolar depression, which may result in more timely and effective treatment of recurrences. The definition of a prodromal phase in depression would benefit from the joint use of symptom identification, biomarkers, and neuroimaging.

When in doubt, Google it: distress-related information seeking in Italy during the COVID-19 pandemic

BACKGROUND

Psychological health has been one of the aspects affected by the recent COVID-19 pandemic. We aim to evaluate the patterns of Google search for mental distress symptoms of Italian citizens during the various phases of the COVID-19 pandemic.

METHODS

We assessed Google searches for psychological-health related words. We gathered and analyzed data on daily search queries on depression, anxiety, and insomnia from Google Trends, in a time ranging from the Pre-COVID phase (beginning 25th January 2020) up to the second wave phase (ending 17th October 2020). We performed three general linear models on search trends of the three words and tested whether and to what extent official data about new cases of COVID-19, information searching on new cases, and the government health measures impacted on these trends.

RESULTS

Average daily search queries were higher for anxiety, followed by depression and insomnia. General linear models performed to assess differences in daily search queries for anxiety, depression and insomnia were significant, respectively [F(13, 253) = 6.80, P < .001]; [F(13, 253) = 10.25, P < .001]; [F(13, 253) = 6.61, P < .001]. Specifically, daily search queries differed among different phases of managing the COVID-19 outbreak: anxiety [F(5, 253) = 10.35, P < .001, [Formula: see text] = .17]; depression [F(5, 253) = 13.59, P < .001, [Formula: see text] = .21]; insomnia [F(5, 253) = 3.52, P = .004, [Formula: see text] = .07].

CONCLUSIONS

Our study contributed to the investigation of online information-seeking behaviors of Italians regarding mental health throughout the entire phase of the pandemic and provides insights on the possible future trends of mental distress during upcoming pandemic phases.

Clinical features of differential diagnosis between unipolar and bipolar depression in a drug-free sample of young adults

INTRODUCTION

Subjects with bipolar disorder suffering of a depressive episode are frequently misdiagnosed as unipolar depression, being important studies assessing the differential diagnosis between bipolar and unipolar depression.

OBJECTIVE

To assess the sociodemographic and clinical features of drug-free young adults in a depressive episode of bipolar or unipolar disorder in order to identify factors that may differentiate these psychiatric conditions.

METHODS

This is a cross-sectional study with 241 young adults aged between 18 and 29 years who were evaluated using the Structured Clinical Interview for DSM-IV (SCID). The sample comprised patients with BD (n = 89) and major depressive disorder (n = 152), experiencing a depressive episode and not using psychoactive drugs or illicit psychoactive substances.

RESULTS

The characteristics associated with bipolar depression were being male (p < 0.001), with a family history of BD (p = 0.013), a higher frequency of childhood traumatic experiences (p = 0.001), younger age of onset of mood disorder (p = 0.004), many previous depressive episodes (p = 0.027), greater severity of depressive symptoms (p < 0.001) and day/night reversal (p = 0.013). Those with unipolar depression showed a higher frequency of biological rhythm disturbances (p < 0.001), and diurnal preference (p = 0.028).

LIMITATIONS

The sample has not included subjects with severe suicide risk, a possible important marker in differentiate unipolar from bipolar depression.

CONCLUSION

Some clinical aspects may contribute to an early differential diagnosis of both bipolar and unipolar depression even in the initial stages of the disease.

Association between acute critical life events and the speed of onset of depressive episodes in male and female depressed patients

BACKGROUND

A series of studies indicate that a fast onset of a depressive episode (within 7 days) is a clinical variable useful for indicating bipolarity even when no manic episode has occurred to date. The role of acute critical life events as an external trigger for a fast onset of the depression is unclear so far. Therefore, aim of this investigation was to analyse the effects of acute critical life events on the speed of onset of depressive episodes.

METHODS

Speed of onset of depression was assessed using the patient interview "Onset of Depression Inventory". Acute critical life events occurring within the last 6 months before the onset of first depressive symptoms were assessed using the Munich Interview for the Assessment of Life Events and Conditions.

RESULTS

96 of 100 (96.0%) patients had at least one acute critical life event within six months prior to first symptoms of a depressive episode. 22 patients (22.0%) had a fast onset of depression (≤ 7 days). Faster onset of the current depressive episode was significantly associated with a higher number of acute minor life events (β = - 0.23; p = 0.02), but overall fast onset of a depressive episode was not significantly associated with more acute critical life events in the six months before the onset of the depression. The association between the number of acute critical life events in the half-year period preceding the onset of unipolar depressive disorders and speed of onset for the current depressive episode was neither dependent from gender nor the presence of prior depressive episodes.

CONCLUSIONS

Speed of onset of depression is not strongly influenced by external trigger e.g. acute critical life events.

Aims and structure of the German Research Consortium BipoLife for the study of bipolar disorder

Background

Bipolar disorder is a severe and heterogeneous mental disorder. Despite great advances in neuroscience over the past decades, the precise causative mechanisms at the transmitter, cellular or network level have so far not been unraveled. As a result, individual treatment decisions cannot be tailor-made and the uncertain prognosis is based on clinical characteristics alone. Although a subpopulation of patients have an excellent response to pharmacological monotherapy, other subpopulations have been less well served by the medical system and therefore require more focused attention. In particular individuals at high risk of bipolar disorder, young patients in the early stages of bipolar disorder, patients with an unstable highly relapsing course and patients with acute suicidal ideation have been identified as those in need.

Structure

A research consortium of ten universities across Germany has therefore implemented a 4 year research agenda including three randomized controlled trials, one epidemiological trial and one cross-sectional trial to address these areas of unmet needs. The topics under investigation will be the improvement of early recognition, specific psychotherapy, and smartphones as an aid for early episode detection and biomarkers of lithium response. A subset of patients will be investigated utilizing neuroimaging (fMRI), neurophysiology (EEG), and biomaterials (genomics, transcriptomics).

Conclusions

This article aims to outline the rationale, design, and methods of these individual studies.

Major depressive disorder as a nonlinear dynamic system: bimodality in the frequency distribution of depressive symptoms over time

BACKGROUND

A defining characteristic of Major Depressive Disorder (MDD) is its episodic course, which might indicate that MDD is a nonlinear dynamic phenomenon with two discrete states. We investigated this hypothesis using the symptom time series of individual patients.

METHODS

In 178 primary care patients with MDD, the presence of the nine DSM-IV symptoms of depression was recorded weekly for two years. For each patient, the time-series plots as well as the frequency distributions of the symptoms over 104 weeks were inspected. Furthermore, two indicators of bimodality were obtained: the bimodality coefficient (BC) and the fit of a 1- and a 2-state Hidden Markov Model (HMM).

RESULTS

In 66% of the sample, high bimodality coefficients (BC>.55) were found. These corresponded to relatively sudden jumps in the symptom curves and to highly skewed or bimodal frequency distributions. The results of the HMM analyses classified 90% of the symptom distributions as bimodal.

CONCLUSIONS

A two-state pattern can be used to describe the course of depression symptoms in many patients. The BC seems useful in differentiating between subgroups of MDD patients based on their life course data.

What Does the Speed of Onset of a Depressive Episode Tell Us?

BACKGROUND

In patients with affective disorders, the full-blown symptomatology of a depressive episode can develop very fast (e.g., within 1 d) or slowly over weeks or months. These differences in the speed of onset of depression are likely to reflect stable intraindividual differences in neurobiological pathomechanisms. This article presents available data on this issue from published studies and from a recently unpublished study and discusses the relevance of these data for diagnostic, therapeutic, and research purposes.

METHODS

On the basis a database search, we reviewed the literature on speed of onset of depressive episodes. Results of a study for which only some of the data have previously been published involving 205 patients with unipolar or bipolar depression were also considered.

RESULTS

Five older studies produced data concerning the speed of onset of depressive episodes. In addition, our research group has conducted 2 other more recent studies that used the Onset of Depression Inventory to assess the speed of onset of depressive episodes. The major findings of the studies we examined were that depression developed within 1 week in 50% to 58% of patients with a bipolar disorder, whereas only in 7.4% to 21.4% of those with unipolar depression. Different depressive episodes appeared to develop at a similar speed within individual subjects (correlation coefficients: 0.46 to 0.66).

CONCLUSIONS

Consistent evidence from 2 studies that used the Onset of Depression Inventory revealed that rapid onset of a depressive episode is more common in patients with bipolar disorder than in those with unipolar major depressive disorder and may be an indication of a latent, not yet expressed, bipolar disorder. The neurobiology of the speed of onset of depressive episodes is a topic for future research.

"Onset of Depression Inventory"--comparison between the data of depressed patients and their relatives

BACKGROUND

The "Onset of Depression Inventory" (ODI) represents a patient interview which aims to register the speed of onset of depression systematically. The purpose of this study was to evaluate the patient-relative agreement regarding the speed of onset of depression in the patients.

METHODS

The ODI was investigated in 31 patients with a depressive episode. Moreover, 31 patients' relatives participated in an interview for which a modified version of the ODI (for relatives of depressed patients; ODI-A) was applied.

RESULTS

There was a significant association between patients' estimation of the speed of onset of the depressive episode and relatives' estimation of this parameter in the case of patients and relatives living in a common household (rho = 0.68; p = 0.006).

CONCLUSIONS

There was an agreement between patients and their relatives regarding the speed of onset of the current depressive episodes, however only if they lived in a common household.

Association of speed of onset and speed of recovery of depressive episodes in patients with major depression

BACKGROUND

Depressive episodes show large interindividual differences concerning their speed of onset and speed of recovery, which might suggest differences in underlying pathophysiological processes. The aim of the present study was to assess whether there is a relationship between the speed of onset and the speed of recovery from depressive episodes.

METHODS

The speed of onset and the speed of recovery from depression were assessed using a structured patient interview, the Onset of Depression Inventory (ODI). In total, 28 patients with bipolar depression and 91 patients with unipolar depression were included.

RESULTS

The mean speed of onset of depression was significantly faster than the mean speed of recovery from depression (35.25, range 0-360 days vs. 59.60, range 0.13-720 days; Z = -3.40; p = 0.001). The correlation between these variables was positive, but numerically low (ρ = 0.22; p = 0.016). The speed of onset of the previous episode and that of the present episode were significantly correlated (ρ = 0.45; p < 0.001).

LIMITATIONS

Data are based on retrospective patient reports within a naturalistic study.

CONCLUSIONS

While the speed of onset of depressive episodes has been found to show large interindividual variability and some intraindividual stability, the data of this study do not indicate that the neurobiological processes involved in the onset of and in the recovery from depressive episodes are closely linked.

Test-retest stability of the Onset of Depression Inventory

BACKGROUND

The 'Onset of Depression Inventory' (ODI) is a patient interview developed for systematically registering the speed of onset of depression. The ODI might contribute to the detection of hidden bipolarity because in previous studies a more rapid depression onset was found in patients with bipolar compared to unipolar depression. The aim of this study was to evaluate the test-retest stability of the ODI. Patients were asked concerning the speed of onset at the time of hospitalization and again before discharge.

SAMPLING AND METHODS

Test-retest stability of the ODI was investigated in 37 patients with a depressive episode. Each patient was interviewed concerning his present depressive episode by the same person at two different time points. Severity of depression at the different time points was assessed using the Hamilton Depression Rating Scale (HAMD-17) and the Inventory of Depressive Symptomatology (IDS-C).

RESULTS

The speed of onset as assessed with the ODI showed good test-retest stability (rho = 0.83, p < 0.001). This parameter was not influenced by changes in depression severity.

CONCLUSIONS

The ODI allows reliable assessment of the speed of onset of depressive episodes. The instrument might be useful for the detection of hidden bipolarity.