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Zheng W, Yang XH, Gu LM, Tan JQ, Zhou YL, Wang CY, Ning YP. A comparison of the antianhedonic effects of repeated ketamine infusions in melancholic and non-melancholic depression. Front Psychiatry 2022; 13:1033019. [PMID: 36620669 PMCID: PMC9813595 DOI: 10.3389/fpsyt.2022.1033019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Melancholic depression may respond differently to certain treatments. The aim of this study was to compare the antianhedonic effects of six intravenous injections of 0.5 mg/kg ketamine in patients with melancholic and non-melancholic depression, which remain largely unknown. METHODS Individuals experiencing melancholic (n = 30) and non-melancholic (n = 105) depression were recruited and assessed for anhedonic symptoms using the Montgomery-Åsberg Depression Rating Scale (MADRS). The presence of melancholic depression was measured with the depression scale items at baseline based on DSM-5 criteria. RESULTS A total of 30 (22.2%) patients with depression fulfilled the DSM-5 criteria for melancholic depression. Patients with melancholic depression had a non-significant lower antianhedonic response (43.3 vs. 50.5%, t = 0.5, p > 0.05) and remission (20.0 vs. 21.0%, t = 0.01, p > 0.05) to repeated-dose ketamine infusions than those with non-melancholic depression. The melancholic group had significantly lower MADRS anhedonia subscale scores than the non-melancholic group at day 26 (p < 0.05). CONCLUSION After six ketamine infusions, the improvement of anhedonic symptoms was found in both patients with melancholic and non-melancholic depression, and the efficacy was similar in both groups.
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Affiliation(s)
- Wei Zheng
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xin-Hu Yang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Li-Mei Gu
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jian-Qiang Tan
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yan-Ling Zhou
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Cheng-Yu Wang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yu-Ping Ning
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.,The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
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Dold M, Bartova L, Fugger G, Kautzky A, Mitschek MMM, Fabbri C, Montgomery S, Zohar J, Souery D, Mendlewicz J, Serretti A, Kasper S. Melancholic features in major depression - a European multicenter study. Prog Neuropsychopharmacol Biol Psychiatry 2021; 110:110285. [PMID: 33609603 DOI: 10.1016/j.pnpbp.2021.110285] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 01/31/2021] [Accepted: 02/12/2021] [Indexed: 10/22/2022]
Abstract
There is still a debate, if melancholic symptoms can be seen rather as a more severe subtype of major depressive disorder (MDD) or as a separate diagnostic entity. The present European multicenter study comprising altogether 1410 MDD in- and outpatients sought to investigate the influence of the presence of melancholic features in MDD patients. Analyses of covariance, chi-squared tests, and binary logistic regression analyses were accomplished to determine differences in socio-demographic and clinical variables between MDD patients with and without melancholia. We found a prevalence rate of 60.71% for melancholic features in MDD. Compared to non-melancholic MDD patients, they were characterized by a significantly higher likelihood for higher weight, unemployment, psychotic features, suicide risk, inpatient treatment, severe depressive symptoms, receiving add-on medication strategies in general, and adjunctive treatment with antidepressants, antipsychotics, benzodiazepine (BZD)/BZD-like drugs, low-potency antipsychotics, and pregabalin in particular. With regard to the antidepressant pharmacotherapy, we found a less frequent prescription of selective serotonin reuptake inhibitors (SSRIs) in melancholic MDD. No significant between-group differences were found for treatment response, non-response, and resistance. In summary, we explored primarily variables to be associated with melancholia which can be regarded as parameters for the presence of severe/difficult-to treat MDD conditions. Even if there is no evidence to realize any specific treatment strategy in melancholic MDD patients, their prescribed medication strategies were different from those for patients without melancholia.
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Affiliation(s)
- Markus Dold
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Gernot Fugger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Alexander Kautzky
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Marleen M M Mitschek
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Chiara Fabbri
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | | | - Joseph Zohar
- Psychiatric Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Daniel Souery
- School of Medicine, Free University of Brussels, Brussels, Belgium; Psy Pluriel - European Centre of Psychological Medicine, Brussels, Belgium
| | | | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Center for Brain Research, Medical University of Vienna, Vienna, Austria.
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Santos-Casado M, Guisado-Gil AB, Santos-Ramos B. Systematic review of gender bias in vortioxetine clinical trials. Prog Neuropsychopharmacol Biol Psychiatry 2021; 108:110088. [PMID: 32890693 DOI: 10.1016/j.pnpbp.2020.110088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 01/12/2023]
Abstract
This paper evaluates gender bias in the published clinical trials of Vortioxetine. We conducted a systematic review of controlled clinical trials of Vortioxetine for the treatment of depression. The literature search was performed using MEDLINE and following the corresponding international recommendations. We identified 42 articles, of which 23 were included. The proportion of women ranged from 47%-75% and the percentage of women included in the 10,404 total patients sample was 65%. The separate analysis of the main variable between the subpopulations of men and women was only carried out in 3/23 publications included. In contrast, 6/23 trials analyzed secondary variables separated by sex. No trials discussed the results separately by sex. The proportion of women included was slightly higher than that in clinical trials of other antidepressants. However, the analysis of the main result or secondary variables by sex, as well as discussing the results separately by sex, are scarce. This gives rise to gender bias in these works.
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Imai H, Noma H, Furukawa TA. Melancholic features (DSM-IV) predict but do not moderate response to antidepressants in major depression: an individual participant data meta-analysis of 1219 patients. Eur Arch Psychiatry Clin Neurosci 2021; 271:521-526. [PMID: 32715345 DOI: 10.1007/s00406-020-01173-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 07/22/2020] [Indexed: 11/25/2022]
Abstract
It is sometimes clinically believed that major depression with melancholic features is more responsive to antidepressants than non-melancholic depression. Proper analysis and, therefore, valid evidence to support or refute this common clinical lore is lacking. The sample was taken from three placebo-controlled randomized trials of duloxetine, escitalopram and paroxetine (n = 1219). We conducted a two-step individual participant data meta-analysis to combine linear mixed-effects regressions modeling melancholic features as prognostic factor (variable that predicts overall response regardless of the treatments) and as effect modifier (variable that predict differential response to drug over placebo). Melancholic features represented a statistically significant prognostic factor for greater reduction in depression severity both on antidepressants and on placebo, especially after 4 weeks of treatment. However, they were not an effect modifier of the antidepressant treatment through the acute phase treatment: in other words. The superiority of antidepressants over placebo was not influenced by the melancholic features. The treatment decision-making as to the benefits of antidepressant treatment for patients with major depression should not be influenced by the presence or absence of melancholic features.
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Affiliation(s)
- Hissei Imai
- Department of Health Promotion and Human Behavior, Graduate School of Medicine/School of Public Health, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
| | - Hisashi Noma
- Department of Statistical Data Science, The Institute of Statistical Mathematics, Tachikawa, Tokyo, 190-8562, Japan
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Graduate School of Medicine/School of Public Health, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
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Flint AJ, Bingham KS, Neufeld NH, Alexopoulos GS, Mulsant BH, Rothschild AJ, Whyte EM, Voineskos AN, Marino P, Meyers BS. Association between psychomotor disturbance and treatment outcome in psychotic depression: a STOP-PD II report. Psychol Med 2021; 52:1-7. [PMID: 33766150 DOI: 10.1017/s0033291721000805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Little is known about the relationship between psychomotor disturbance (PMD) and treatment outcome of psychotic depression. This study examined the association between PMD and subsequent remission and relapse of treated psychotic depression. METHODS Two hundred and sixty-nine men and women aged 18-85 years with an episode of psychotic depression were treated with open-label sertraline plus olanzapine for up to 12 weeks. Participants who remained in remission or near-remission following an 8-week stabilization phase were eligible to participate in a 36-week randomized controlled trial (RCT) that compared the efficacy and tolerability of sertraline plus olanzapine (n = 64) with sertraline plus placebo (n = 62). PMD was measured with the psychiatrist-rated sign-based CORE at acute phase baseline and at RCT baseline. Spearman's correlations and logistic regression analyses were used to analyze the association between CORE total score at acute phase baseline and remission/near-remission and CORE total score at RCT baseline and relapse. RESULTS Higher CORE total score at acute phase baseline was associated with lower frequency of remission/near-remission. Higher CORE total score at RCT baseline was associated with higher frequency of relapse, in the RCT sample as a whole, as well as in each of the two randomized groups. CONCLUSIONS PMD is associated with poorer outcome of psychotic depression treated with sertraline plus olanzapine. Future research needs to examine the neurobiology of PMD in psychotic depression in relation to treatment outcome.
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Affiliation(s)
- Alastair J Flint
- The Department of Psychiatry, University of Toronto, Toronto, Canada
- Centre for Mental Health, University Health Network, Toronto, Canada
| | - Kathleen S Bingham
- The Department of Psychiatry, University of Toronto, Toronto, Canada
- Centre for Mental Health, University Health Network, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Nicholas H Neufeld
- The Department of Psychiatry, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - George S Alexopoulos
- Department of Psychiatry, Weill Cornell Medicine of Cornell University and New York Presbyterian Hospital, Westchester Division, New York, NY, USA
| | - Benoit H Mulsant
- The Department of Psychiatry, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Anthony J Rothschild
- University of Massachusetts Medical School and UMass Memorial Health Care, Worcester, MA, USA
| | - Ellen M Whyte
- Department of Psychiatry, University of Pittsburgh School of Medicine and UPMC Western Psychiatric Hospital, Pittsburgh, PA, USA
| | - Aristotle N Voineskos
- The Department of Psychiatry, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Patricia Marino
- Department of Psychiatry, Weill Cornell Medicine of Cornell University and New York Presbyterian Hospital, Westchester Division, New York, NY, USA
| | - Barnett S Meyers
- Department of Psychiatry, Weill Cornell Medicine of Cornell University and New York Presbyterian Hospital, Westchester Division, New York, NY, USA
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Messinger MF, Caldieraro MA, Mosqueiro BP, da Costa FBP, Possebon GMP, Santos PVDLN, Parker G, Fleck MP. Sydney Melancholia Prototype Index (SMPI): translation and cross-cultural adaptation to Brazilian Portuguese. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2020; 42:247-255. [PMID: 33084802 PMCID: PMC7879070 DOI: 10.1590/2237-6089-2019-0045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 12/26/2019] [Indexed: 11/22/2022]
Abstract
Introduction Depression is possibly not a single syndrome but rather comprises several subtypes. DSM-5 proposes a melancholia specifier with phenotypic characteristics that could be associated with clinical progression, biological markers or therapeutic response. The Sydney Melancholia Prototype Index (SMPI) is a prototypic scale aimed to improve the diagnosis of melancholia. So far, there is only an English version of the instrument available. The aim of this study is to describe the translation and adaptation of the English version of the SMPI into Brazilian Portuguese. Methods Translation and cross-cultural adaptation of the self-report (SMPI-SR) and clinician-rated (SMPI-CR) versions into Brazilian Portuguese were done following recommendations of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). This guideline includes the following steps: preparation, forward translation, reconciliation, back translation, back translation review, harmonization, cognitive debriefing, debriefing results review, proofreading and final report. Results The Brazilian Portuguese versions of the SMPI were well-accepted by respondents. Changes in about two-thirds of the items were considered necessary to obtain the final Brazilian Portuguese version of the SMPI. Conclusions Both versions of the SMPI are now available in Brazilian Portuguese. The instrument could become an important option to enhance studies on melancholia in Portuguese-speaking samples.
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Affiliation(s)
- Mateus Frizzo Messinger
- Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Serviço de Psiquiatria, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Marco Antonio Caldieraro
- Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Serviço de Psiquiatria, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Bruno Paz Mosqueiro
- Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Serviço de Psiquiatria, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Gabriela Maria Pereira Possebon
- Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Serviço de Psiquiatria, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.,Universidade do Vale do Rio dos Sinos (UNISINOS), São Leopoldo, RS, Brazil
| | - Pedro Victor de Lima Nascimento Santos
- Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Serviço de Psiquiatria, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Gordon Parker
- Black Dog Institute, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Marcelo P Fleck
- Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Serviço de Psiquiatria, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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Veltman EM, de Boer A, Dols A, van Exel E, Stek ML, Sienaert P, Bouckaert F, van der Mast R, Rhebergen D. Melancholia as Predictor of Electroconvulsive Therapy Outcome in Later Life. J ECT 2019; 35:231-237. [PMID: 31764445 DOI: 10.1097/yct.0000000000000579] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES In clinical practice, particularly melancholic depression benefits from electroconvulsive therapy (ECT), albeit research melancholia criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM) is not conclusive. We compared clinical characteristics and ECT outcome of melancholic and nonmelancholic depression, here defined by psychomotor symptoms. METHODS One hundred ten depressed older in-patients treated with ECT were included in the Mood Disorders in Elderly treated with ECT study. The CORE was used for the assessment of psychomotor symptoms, with a score of 8 or higher defining melancholic depression. Depression severity was measured before, during, and after ECT. Characteristics were compared across melancholic and nonmelancholic patients. Regression analysis was used to assess the relation between psychomotor symptoms and remission/response, and survival analysis was used to examine the difference in time. RESULTS Patients with melancholic depression had higher severity, lower cognitive and overall functioning, and lower prevalence of cardiovascular disease. However, no significant relations were found between CORE scores and remission/response. Because psychotic symptoms are a positive predictor of ECT response and remission, we examined whether CORE score was a predictor of response in the nonpsychotic group (n = 49). In nonpsychotic patients, remission was 62%, and the association between CORE scores and remission almost reached significance (P = 0.057). DISCUSSION Although melancholically and nonmelancholically depressed patients differed significantly on several clinical characteristics, ECT outcome did not differ. Analyses may be hampered by a high prevalence of psychotic features. In nonpsychotic patients, CORE scores neared significance as predictor of remission, suggesting that CORE scores might be a distinguishing characteristic of melancholia in nonpsychotic patients and a clinical useful predictor of ECT response.
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Affiliation(s)
| | | | - Annemiek Dols
- From the GGZ inGeest, Amsterdam
- Department of Psychiatry, EMGO+ Institute for Health and Care Research, and the Amsterdam Public Health Research Institute, VU University Medical Center Amsterdam, the Netherlands
| | - Eric van Exel
- From the GGZ inGeest, Amsterdam
- Department of Psychiatry, EMGO+ Institute for Health and Care Research, and the Amsterdam Public Health Research Institute, VU University Medical Center Amsterdam, the Netherlands
| | - Max L Stek
- From the GGZ inGeest, Amsterdam
- Department of Psychiatry, EMGO+ Institute for Health and Care Research, and the Amsterdam Public Health Research Institute, VU University Medical Center Amsterdam, the Netherlands
| | - Pascal Sienaert
- ECT Department, University Psychiatric Center- Catholic University Leuven, Campus Kortenberg, Kortenberg
| | - Filip Bouckaert
- ECT Department, University Psychiatric Center- Catholic University Leuven, Campus Kortenberg, Kortenberg
| | - Roos van der Mast
- Leiden University Medical Center, Leiden
- Department of Psychiatry, CAPRI-University of Antwerp, Antwerp, Belgium
| | - Didi Rhebergen
- From the GGZ inGeest, Amsterdam
- Department of Psychiatry, EMGO+ Institute for Health and Care Research, and the Amsterdam Public Health Research Institute, VU University Medical Center Amsterdam, the Netherlands
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Juruena MF, Bocharova M, Agustini B, Young AH. Atypical depression and non-atypical depression: Is HPA axis function a biomarker? A systematic review. J Affect Disord 2018; 233:45-67. [PMID: 29150144 DOI: 10.1016/j.jad.2017.09.052] [Citation(s) in RCA: 189] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 07/11/2017] [Accepted: 09/26/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND The link between the abnormalities of the Hypothalamic-pituitary-adrenal (HPA) axis and depression has been one of the most consistently reported findings in psychiatry. At the same time, multiple studies have demonstrated a stronger association between the increased activation of HPA-axis and melancholic, or endogenous depression subtype. This association has not been confirmed for the atypical subtype, and some researchers have suggested that as an antinomic depressive subtype, it may be associated with the opposite type, i.e. hypo-function, of the HPA-axis, similarly to PTSD. The purpose of this systematic review is to summarise existing studies addressing the abnormalities of the HPA-axis in melancholic and/or atypical depression. METHOD We conducted a systematic review in the literature by searching MEDLINE, PsycINFO, OvidSP and Embase databases until June 2017. The following search items were used: "hypothalamic-pituitary-adrenal" OR "HPA" OR "cortisol" OR "corticotropin releasing hormone" OR "corticotropin releasing factor" OR "glucocorticoid*" OR "adrenocorticotropic hormone" OR "ACTH" AND "atypical depression" OR "non-atypical depression" OR "melancholic depression" OR "non-melancholic depression" OR "endogenous depression" OR "endogenomorphic depression" OR "non-endogenous depression". Search limits were set to include papers in English or German language published in peer-reviewed journals at any period. All studies were scrutinized to determine the main methodological characteristics, and particularly possible sources of bias influencing the results reported. RESULTS We selected 48 relevant studies. Detailed analysis of the methodologies used in the studies revealed significant variability especially regarding the samples' definition comparing the HPA axis activity of melancholic patients to atypical depression, including healthy controls. The results were subdivided into 4 sections: (1) 27 studies which compared melancholic OR endogenous depression vs. non-melancholic or non-endogenous depression or controls; (2) 9 studies which compared atypical depression or atypical traits vs. non-atypical depression or controls; (3) 7 studies which compared melancholic or endogenous and atypical depression subtypes and (4) 5 studies which used a longitudinal design, comparing the measures of HPA-axis across two or more time points. While the majority of studies did confirm the association between melancholic depression and increased post-challenge cortisol levels, the association with increases in basal cortisol and basal ACTH were less consistent. Some studies, particularly those focusing on reversed vegetative symptoms, demonstrated a decrease in the activity of the HPA axis in atypical depression compared to controls, but the majority did not distinguish it from healthy controls. CONCLUSIONS In conclusion, our findings indicate that there is a difference in the activity of the HPA-axis between melancholic and atypical depressive subtypes. However, these are more likely explained by hypercortisolism in melancholia; and most often normal than decreased function in atypical depression. Further research should seek to distinguish a particular subtype of depression linked to HPA-axis abnormalities, based on symptom profile, with a focus on vegetative symptoms, neuroendocrine probes, and the history of adverse childhood events. New insights into the dichotomy addressed in this review might be obtained from genetic and epigenetic studies of HPA-axis related genes in both subtypes, with an emphasis on the presence of vegetative symptoms.
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Affiliation(s)
- Mario F Juruena
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust (SLaM) and King's College London, UK; Department of Neuroscience and Behavior, School of Medicine of Ribeirao Preto, University of Sao Paulo, Sao Paulo, Brazil.
| | - Mariia Bocharova
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust (SLaM) and King's College London, UK
| | - Bruno Agustini
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust (SLaM) and King's College London, UK
| | - Allan H Young
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust (SLaM) and King's College London, UK
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9
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Parker G, McCraw S. The properties and utility of the CORE measure of melancholia. J Affect Disord 2017; 207:128-135. [PMID: 27721186 DOI: 10.1016/j.jad.2016.09.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 09/20/2016] [Accepted: 09/24/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND The CORE measure was designed to assess a central feature of melancholia - signs of psychomotor disturbance (PMD) - and so provide an alternate non-symptom based measure of melancholia or of its probability. This review evaluates development and application studies undertaken over the last 25 years to consider how well it has met its original objectives. METHODS All studies published using the CORE measure as either the only or an adjunctive measure of melancholia were obtained and are considered in this review. RESULTS Findings suggest high reliability in quantifying CORE scores can be achieved and that it has construct validity as a measure of PMD. A number of application studies assessing socio-demographic factors, cognitive and motor impairment, dexamethasone suppression and thyrotropin-releasing hormone, response to psychotherapy and to electroconvulsive therapy support its validity as a measure of melancholia, while functional brain imaging studies suggest that the measure identifies regions of decreased connectivity. LIMITATIONS Use of the CORE benefits from rater training and for subjects to be assessed at or near nadir of their depressive episode. There have been insufficient studies evaluating genetic factors, and the treatment response of CORE-defined melancholic patients to antidepressant drugs of differing classes. CONCLUSIONS The CORE, either as a proxy or direct measure of melancholia, provides a strategy for assigning depressed subjects a diagnosis or melancholic or non-melancholic depression or for estimating the probability of melancholia.
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Affiliation(s)
- Gordon Parker
- School of Psychiatry, the University of New South Wales, Sydney, NSW, Australia; The Black Dog Institute, Sydney, NSW, Australia.
| | - Stacey McCraw
- School of Psychiatry, the University of New South Wales, Sydney, NSW, Australia; The Black Dog Institute, Sydney, NSW, Australia
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10
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Liu H, Sarapas C, Shankman SA. Anticipatory reward deficits in melancholia. JOURNAL OF ABNORMAL PSYCHOLOGY 2016; 125:631-40. [PMID: 27175986 DOI: 10.1037/abn0000172] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Dysfunctional reward processing has long been considered an important feature of major depressive disorder (MDD). However, depression is a heterogeneous construct and the nature of this heterogeneity may contribute to some of the inconsistent empirical findings on reward dysfunction in MDD. The current study examined 1 source of heterogeneity, melancholic symptoms, and its association with reward processing. In individuals with MDD (N = 141) and MDD-free controls (N = 113), electroencephalogram (EEG) alpha asymmetry was measured during a behavioral reward task that probed reward anticipation. Melancholic depression was measured both categorically (Diagnostic and Statistical Manual of Mental Disorders [DSM] diagnosis) and dimensionally (Hamilton Endogenomorphy Scale [HES]). Results showed that a dimensional (and not categorical) definition of melancholia predicted reward processing, with higher melancholic symptoms predicting reduced reward anticipation. Importantly, the effects of melancholic symptoms on reduced reward anticipation remained above and beyond overall depression severity. These results suggest that dysfunctional reward processing may only be associated with melancholic symptoms, not depression in general. (PsycINFO Database Record
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Affiliation(s)
- Huiting Liu
- Department of Psychology, University of Illinois at Chicago
| | - Casey Sarapas
- Department of Psychology, University of Illinois at Chicago
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11
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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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Association between core-assigned melancholia and the melancholia subscale of the HAM-D. J Affect Disord 2015; 172:175-8. [PMID: 25451414 DOI: 10.1016/j.jad.2014.09.050] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 09/20/2014] [Accepted: 09/30/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Clinical observation and research data suggest that major depression (MD) is a heterogeneous disorder, possibly representing a group of different clinical entities. The identification of more homogeneous subtypes of depression could enhance research and enable development of more specific treatments. A melancholic subtype of MD, defined by the presence of observable psychomotor disturbance (PMD), is proposed to be more homogeneous and associated with biological determinants. The aim of this study was to investigate the homogeneity of this melancholic subtype in terms of symptoms by searching for an association between melancholia and a unidimensional subscale of the Hamilton Depression Rating Scale (HAM-D) proposed to have biological validity (HAM-D6). METHODS A cross-sectional assessment of 385 outpatients presenting with a unipolar major depressive episode was carried out to evaluate depressive symptoms using the HAM-D and melancholic or nonmelancholic subtype, according to the CORE measure of PMD. RESULTS Melancholic patients exhibited more severe depressive symptoms, mainly associated with the HAM-D6. The items of this melancholia subscale represent 42.3% of the total HAM-D and were responsible for 59.4% of between-group differences. Correlation analysis showed similar results. LIMITATIONS Most patients received previous treatment, and some were not at the nadir of the episode when assessed. This could have lowered the CORE measure sensibility. CONCLUSION Melancholic depression, as assigned by the CORE measure, represents a more severe and homogeneous subtype of MD. This observation may allow identification of proper biomarkers and development of more specific treatments.
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Spanemberg L, Caldieraro MA, Vares EA, Wollenhaupt-Aguiar B, Kauer-Sant'Anna M, Kawamoto SY, Galvão E, Parker G, Fleck MP. Biological differences between melancholic and nonmelancholic depression subtyped by the CORE measure. Neuropsychiatr Dis Treat 2014; 10:1523-31. [PMID: 25187716 PMCID: PMC4149384 DOI: 10.2147/ndt.s66504] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The purpose of this study was to compare melancholic patients rated by the CORE measure of observable psychomotor disturbance with nonmelancholic and control subjects across a set of biomarkers. METHODS Depressed patients were classified as melancholic or nonmelancholic by using the CORE measure. Both groups of patients, as well as control subjects, were compared for a set of clinical and laboratory measures. Serum levels of brain-derived neurotrophic factor, of two markers of oxidative stress (protein carbonyl content [PCC] and thiobarbituric acid reactive substances [TBARS]), and of several immunity markers (interleukin [IL]-2, IL-4, IL-6, IL-10, IL-17, tumor necrosis factor-alpha, and interferon-gamma) were analyzed. RESULTS Thirty-three depressed patients and 54 healthy controls were studied. Depressive patients showed higher IL-4, IL-6, and PCC values than healthy controls. Thirteen (39%) of the depressed patients were assigned as melancholic by the CORE measure. They generated lower interferon-gamma (compared with nonmelancholic depressed patients) and TBARS (compared with both the nonmelancholic subset and controls) and returned higher IL-6 levels than controls. Both depressive groups generated higher PCC scores than controls, with no difference between melancholic and nonmelancholic subsets. CONCLUSION A sign-based measure to rate melancholia was able to replicate and extend biological findings discriminating melancholic depression. Signs of psychomotor disturbance may be a useful diagnostic measure of melancholia.
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Affiliation(s)
- Lucas Spanemberg
- Mood Disorders Program, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil ; Department of Psychiatry, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Marco Antonio Caldieraro
- Mood Disorders Program, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Edgar Arrua Vares
- Mood Disorders Program, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Bianca Wollenhaupt-Aguiar
- INCT Translational Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil ; Bipolar Disorders Program and Laboratory of Molecular Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Márcia Kauer-Sant'Anna
- INCT Translational Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil ; Bipolar Disorders Program and Laboratory of Molecular Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Sheila Yuri Kawamoto
- Mood Disorders Program, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Emily Galvão
- INCT Translational Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil ; Bipolar Disorders Program and Laboratory of Molecular Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil ; Centro Universitário Metodista, Porto Alegre, Brazil
| | - Gordon Parker
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia ; Black Dog Institute, Sydney, NSW, Australia
| | - Marcelo P Fleck
- Mood Disorders Program, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil ; Neuromodulation Research Clinic, Douglas Mental Health University Institute, Montréal, ON, Canada
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Abstract
The best classification of depressive disorders is still to be established. A melancholic subtype has a lengthy history, and recent research demonstrates its relevance. This study compares the prevalence of psychotic symptoms in nonmelancholic and melancholic depression and assesses whether there is a dimensional pattern in the severity of symptoms among the subtypes. Patients with unipolar depression were assessed for melancholic status, psychotic symptoms, and severity of depression. The diagnosis of melancholia was made by both Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), criteria and CORE measure. The DSM criteria assigned a much higher percentage of patients as melancholics (67.4%) than did the CORE (24.9%). Prevalence of psychosis was distinctly higher in the melancholics. Symptoms severity was higher among the melancholics when compared with the nonmelancholics. The presence of psychotic symptoms was not associated with an increase in the intensity of depressive symptoms. Psychotic symptoms are more frequently associated with the melancholic subtype of depression. This suggests clinical contiguity between the melancholic and psychotic subtypes and the clinical relevance of identifying melancholia.
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Abstract
Data on the specific effects of sex on pharmacokinetics, as well as tolerability, safety, and efficacy of psychotropic medications are still meager, mainly because only recently sex-related issues have attracted a certain degree of interest within the pharmacological domain. Therefore, with the present study, we aimed to provide a comprehensive review of the literature on this topic, through careful MEDLINE and PubMed searches of the years 1990-2012. Generally, data on pharmacokinetics are more consistent and numerous than those on pharmacodynamics. Sex-related differences have been reported for several parameters that influence pharmacokinetics, such as gastric acidity, intestinal motility, body weight and composition, blood volume, liver enzymes (mainly the cytochrome P450), or renal excretion, which may alter plasma drug levels. Sex-related peculiarities may also account for a different sensitivity of men and women to side effects and toxicity of psychotropic drugs. Further, some differences in drug response, mainly to antipsychotics and antidepressants, have been described. Further studies are, however, necessary to explore more thoroughly the impact of sex on the pharmacokinetics and pharmacodynamics of psychotropic drugs, in order to reach the most appropriate and tailored prescription for each patient.
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Snowdon J. Should psychomotor disturbance be an essential criterion for a DSM-5 diagnosis of melancholia? BMC Psychiatry 2013; 13:160. [PMID: 23724792 PMCID: PMC3679799 DOI: 10.1186/1471-244x-13-160] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 05/13/2013] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The CORE measure has proved useful in rating observed psychomotor disturbance (PMD), which has been held to be a key feature of melancholic depression. However, studies have shown a substantial percentage of subjects fulfilling DSM criteria for melancholia do not have observable PMD. METHODS A semi-structured interview schedule was used in assessing and diagnosing depressed older patients. DSM-IV diagnoses were made, and the CORE measure was used to rate PMD. Comparisons were made between melancholia inpatients who scored low and those scoring high on the CORE in relation to presentation and pattern of symptoms. RESULTS Of 32 inpatients with melancholia, 10 scored 0-7, 8 scored 8-10, and 14 scored 15 or more on the CORE. Thirty-two inpatients with psychotic depression scored 13 or more. High-CORE participants manifested unvarying depression more often than did low-CORE participants, and were less likely to state that stress precipitated their depressive episode. CONCLUSIONS High-CORE melancholia cases appear to have more in common with psychotic depression than do low-CORE cases. Designation of observable PMD as an essential criterion in making a diagnosis of melancholia could increase the utility of the DSM classification in relation to treatment planning.
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Affiliation(s)
- John Snowdon
- Discipline of Psychological Medicine, University of Sydney, Concord Hospital, Sydeny, NSW 2139, Australia.
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Caldieraro MAK, Baeza FLC, Pinheiro DO, Ribeiro MR, Parker G, Fleck MP. Clinical differences between melancholic and nonmelancholic depression as defined by the CORE system. Compr Psychiatry 2013; 54:11-5. [PMID: 22770717 DOI: 10.1016/j.comppsych.2012.05.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 05/20/2012] [Accepted: 05/24/2012] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The definition and delineation of melancholia have remained elusive for an extended period. A longstanding signal of psychomotor disturbance has been operationalized via the observer-rated CORE measure and with CORE-assigned melancholic and nonmelancholic compared in several Australian studies. Replication studies in other regions have not previously been reported. This study compares Brazilian patients with melancholic and nonmelancholic depression according to the CORE measure of psychomotor disturbance in terms of clinical characteristics, suicide ideation, stressful life events, quality of life, parental care, and personality styles. METHODS A total of 181 patients with unipolar major depression attending a tertiary care outpatient service in Brazil were evaluated in relation to melancholic status and study variables. RESULTS The CORE-assigned melancholic patients presented higher symptom severity, greater prevalence of suicide ideation, and Axis I comorbidities than nonmelancholics. Scores of dysfunctional personality styles and dysfunctional parental care measures were also higher among melancholics. Quality-of-life scores were low in both groups. LIMITATIONS The absence of a criterion standard for the diagnosis of melancholia and the use of medication can be potential limitations of the study. CONCLUSION Differences suggest that CORE-assigned melancholia defines a distinct group of patients and probably a disorder distinct from nonmelancholic depression not only in quantitative but also in qualitative aspects.
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Affiliation(s)
- Marco Antonio Knob Caldieraro
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-003, Brazil.
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Flint J, Chen Y, Shi S, Kendler KS. Epilogue: Lessons from the CONVERGE study of major depressive disorder in China. J Affect Disord 2012; 140:1-5. [PMID: 21955396 PMCID: PMC3387371 DOI: 10.1016/j.jad.2011.09.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Revised: 06/29/2011] [Accepted: 09/06/2011] [Indexed: 01/11/2023]
Abstract
This review summarizes the first clinical reports from the CONVERGE consortium: China, Oxford and VCU Experimental Research on Genetic Epidemiology. CONVERGE sets out to investigate the nature and mode of action of the genetic and environmental risk factors for major depressive disorder (MDD). CONVERGE aims to collect 6000 cases of recurrent MDD and 6000 controls. The consortium includes hospitals in 30 cities, all with populations exceeding 5million, and has collected over 2000 cases and controls. High quality phenotype data on MDD collected in China is now available to determine the source and nature of this highly heterogeneous condition. Analyses reported in a series of papers indicate that the clinical features and risk factors of MDD are sufficiently similar to those in the West that we can confidently predict that the results of subsequent analyses will be widely applicable.
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Affiliation(s)
- Jonathan Flint
- Wellcome Trust Centre for Human Genetics, Oxford OX3 7BN, UK.
| | - Yiping Chen
- Clinical Trial Service Unit, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford OX3 7LF, UK
| | - Shenxun Shi
- Fudan University affiliated Huashan Hospital, No. 12 Wulumuqi Zhong Road, Shanghai 200040, PR China,Shanghai Jiao Tong University School of Medicine affiliated Shanghai Mental Health Centre, No. 600 Wan Ping Nan Road, Shanghai 200030, PR China
| | - Kenneth S. Kendler
- Virginia Commonwealth University, Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Richmond, VA 23298-0126, United States
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Xiang YT, Wang G, Hu C, Guo T, Ungvari GS, Kilbourne AM, Lai KYC, Si TM, Zheng QW, Chen DF, Fang YR, Lu Z, Yang HC, Hu J, Chen ZY, Huang Y, Sun J, Wang XP, Li HC, Zhang JB, Chiu HFK. Demographic and clinical features and prescribing patterns of psychotropic medications in patients with the melancholic subtype of major depressive disorder in China. PLoS One 2012; 7:e39840. [PMID: 22768140 PMCID: PMC3386985 DOI: 10.1371/journal.pone.0039840] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 05/28/2012] [Indexed: 11/29/2022] Open
Abstract
Background Little has been known about the demographic and clinical features of the melancholic subtype of major depressive disorder (MDD) in Chinese patients. This study examined the frequency of melancholia in Chinese MDD patients and explored its demographic and clinical correlates and prescribing patterns of psychotropic drugs. Methods A consecutively collected sample of 1,178 patients with MDD were examined in 13 psychiatric hospitals or psychiatric units of general hospitals in China nationwide. The cross-sectional data of patients’ demographic and clinical characteristics and prescriptions of psychotropic drugs were recorded using a standardized protocol and data collection procedure. The diagnosis of the melancholic subtype was established using the Mini International Neuropsychiatric Interview (MINI). Medications ascertained included antidepressants, mood stabilizers, antipsychotics and benzodiazepines. Results Six hundred and twenty nine (53.4%) of the 1,178 patients fulfilled criteria for melancholia. In multiple logistic regression analyses, compared to non-melancholic counterparts, melancholic MDD patients were more likely to be male and receive benzodiazepines, had more frequent suicide ideations and attempts and seasonal depressive episodes, while they were less likely to be employed and receive antidepressants and had less family history of psychiatric disorders and lifetime depressive episodes. Conclusions The demographic and clinical features of melancholic MDD in Chinese patients were not entirely consistent with those found in Western populations. Compared to non-melancholic MDD patients, melancholic patients presented with different demographic and clinical features, which have implications for treatment decisions.
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Affiliation(s)
- Yu-Tao Xiang
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China.
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Sun N, Li Y, Cai Y, Chen J, Shen Y, Sun J, Zhang Z, Zhang J, Wang L, Guo L, Yang L, Qiang L, Yang Y, Wang G, Du B, Xia J, Rong H, Gan Z, Hu B, Pan J, Li C, Sun S, Han W, Xiao X, Dai L, Jin G, Zhang Y, Sun L, Chen Y, Zhao H, Dang Y, Shi S, Kendler KS, Flint J, Zhang K. A comparison of melancholic and nonmelancholic recurrent major depression in Han Chinese women. Depress Anxiety 2012; 29:4-9. [PMID: 22065498 PMCID: PMC3429859 DOI: 10.1002/da.20875] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 06/27/2011] [Accepted: 07/05/2011] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Although the diagnosis of melancholia has had a long history, the validity of the current DSM-IV definition remains contentious. We report here the first detailed comparison of melancholic and nonmelancholic major depression (MD) in a Chinese population examining in particular whether these two forms of MD differ quantitatively or qualitatively. METHODS DSM-IV criteria for melancholia were applied to 1,970 Han Chinese women with recurrent MD recruited from 53 provincial mental health centers and psychiatric departments of general medical hospitals in 41 cities. Statistical analyses, utilizing Student's t-tests and Pearson's χ(2) , were calculated using SPSS 13.0. RESULTS Melancholic patients with MD were distinguished from nonmelancholic by being older, having a later age at onset, more episodes of illness and meeting more A criteria. They also had higher levels of neuroticism and rates of lifetime generalized anxiety disorder, panic disorder, and social and agoraphobia. They had significantly lower rates of childhood sexual abuse but did not differ on other stressful life events or rates of MD in their families. DISCUSSION Consistent with most prior findings in European and US populations, we find that melancholia is a more clinically severe syndrome than nonmelancholic depression with higher rates of comorbidity. The evidence that it is a more "biological" or qualitatively distinct syndrome, however, is mixed.
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Affiliation(s)
- Ning Sun
- No.1 Hospital of Shanxi Medical UniversityTaiyuan, Shanxi, People's Republic of China
| | - Yihan Li
- Wellcome Trust Centre for Human GeneticsOxford, United Kingdom
| | - Yiyun Cai
- Fudan University affiliated Huashan HospitalShanghai, People's Republic of China
| | - Jing Chen
- Shanghai Jiao Tong University School of Medicine affiliated Shanghai Mental Health CentreShanghai, People's Republic of China
| | - Yuan Shen
- Shanghai Tongji University affiliated Tongji HospitalShanghai, People's Republic of China
| | - Jing Sun
- Nanjing Brain HospitalNanjing, Jiang Su, People's Republic of China
| | - Zheng Zhang
- No. 4 Affiliated Hospital of Jiangsu UniversityZhenjiang, Jiang Su, People's Republic of China
| | - Jiulong Zhang
- Tianjin Anding HospitalHexi District, Tianjin, People's Republic of China
| | - Lina Wang
- Shandong Mental Health CenterJinan, Shan Dong, People's Republic of China
| | - Liyang Guo
- No. 1 Hospital of Medical College of Xian Jiaotong UniversityXian, Shan Xi, People's Republic of China
| | - Lei Yang
- No.1 Hospital of Zhengzhou UniversityZhengzhou, He Nan, People's Republic of China
| | - Li Qiang
- No. 1 Mental Health Center Affiliated Harbin Medical UniversityNangang District, Haerbin, Heilongjiang, People's Republic of China
| | - Yanchun Yang
- Mental Health Center of West China Hospital of Sichuan UniversityWu Hou District, Chengdu, Si Chuan, People's Republic of China
| | - Gang Wang
- Beijing Anding Hospital, Capital Medical UniversityXicheng District, Beijing, People's Republic of China
| | - Bo Du
- Hebei Mental Health CenterBaoding, Hebei, People's Republic of China
| | - Jing Xia
- ShengJing Hospital of China Medical UniversityHeping District Shenyang, Liaoning, People's Republic of China
| | - Han Rong
- Shenzhen Kangning HospitalLuo Hu, Shenzhen, People's Republic of China
| | - Zhaoyu Gan
- No. 3 Affiliated Hospital of Zhongshan UniversityTian He District, Guangzhou, Guangdong, People's Republic of China
| | - Bin Hu
- Mental Hospital of Jiangxi ProvinceNanchang, Jiangxi, People's Republic of China
| | - Jiyang Pan
- The First Affiliated Hospital of Jinan UniversityTian He District, Guangzhou, People's Republic of China
| | - Chang Li
- Wuhan Mental Health CenterWuhan, People's Republic of China
| | - Shufan Sun
- No.3 Hospital of Heilongjiang ProvinceBeian, Heilongjiang, People's Republic of China
| | - Wei Han
- Jilin Brain HospitalSiping, Jilin, People's Republic of China
| | - Xue Xiao
- The First Hospital of China Medical UniversityHe Ping District, Shenyang, People's Republic of China
| | - Lei Dai
- Dalian No. 7 People's Hospital & Dalian Mental Health CenterGan Jing Zi District, Dalian, People's Republic of China
| | - Guixing Jin
- The First Hospital of Hebei Medical UniversityShijiazhuang, People's Republic of China
| | - Yutang Zhang
- Lanzhou University Second Hospital, Second Clinical Medical College of Lanzhou UniversityLanzhou, Gansu Province, People's Republic of China
| | - Lixin Sun
- Psychiatric Hospital of Henan ProvinceXin Xiang, Henan, People's Republic of China
| | - Yunchun Chen
- The Fourth Military Medical University affiliated Xijing HospitalXi'an, Shaanxi, People's Republic of China
| | - Haiying Zhao
- No. 4 People's Hospital of LiaochengLiaocheng, Shandong, People's Republic of China
| | - Yamei Dang
- Guangzhou Brain Hospital/Guangzhou Psychiatric HospitalFang Cun Da Dao, Li Wan District, Guangzhou, People's Republic of China
| | - Shenxun Shi
- Fudan University affiliated Huashan HospitalShanghai, People's Republic of China,Shanghai Jiao Tong University School of Medicine affiliated Shanghai Mental Health CentreShanghai, People's Republic of China
| | - Kenneth S Kendler
- Virginia Commonwealth University, Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral GeneticsRichmond, Virginia
| | - Jonathan Flint
- Wellcome Trust Centre for Human GeneticsOxford, United Kingdom,*Correspondence to: Jonathan Flint, Wellcome Trust Centre for Human Genetics, Roosevelt Drive, Oxford OX3 7BN, United Kingdom. E-mail: and Kerang Zhang, No.1 Hospital of Shanxi Medical University, No. 85 Jiefang South Road, Taiyuan, Shanxi 030001, People's Republic of China. E-mail:
| | - Kerang Zhang
- No.1 Hospital of Shanxi Medical UniversityTaiyuan, Shanxi, People's Republic of China,*Correspondence to: Jonathan Flint, Wellcome Trust Centre for Human Genetics, Roosevelt Drive, Oxford OX3 7BN, United Kingdom. E-mail: and Kerang Zhang, No.1 Hospital of Shanxi Medical University, No. 85 Jiefang South Road, Taiyuan, Shanxi 030001, People's Republic of China. E-mail:
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Buyukdura JS, McClintock SM, Croarkin PE. Psychomotor retardation in depression: biological underpinnings, measurement, and treatment. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:395-409. [PMID: 21044654 PMCID: PMC3646325 DOI: 10.1016/j.pnpbp.2010.10.019] [Citation(s) in RCA: 217] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 10/05/2010] [Accepted: 10/25/2010] [Indexed: 01/09/2023]
Abstract
Psychomotor retardation is a long established component of depression that can have significant clinical and therapeutic implications for treatment. Due to its negative impact on overall function in depressed patients, we review its biological correlates, optimal methods of measurement, and relevance in the context of therapeutic interventions. The aim of the paper is to provide a synthesis of the literature on psychomotor retardation in depression with the goal of enhanced awareness for clinicians and researchers. Increased knowledge and understanding of psychomotor retardation in major depressive disorder may lead to further research and better informed diagnosis in regards to psychomotor retardation. Manifestations of psychomotor retardation include slowed speech, decreased movement, and impaired cognitive function. It is common in patients with melancholic depression and those with psychotic features. Biological correlates may include abnormalities in the basal ganglia and dopaminergic pathways. Neurophysiologic tools such as neuroimaging and transcranial magnetic stimulation may play a role in the study of this symptom in the future. At present, there are three objective scales to evaluate psychomotor retardation severity. Studies examining the impact of psychomotor retardation on clinical outcome have found differential results. However, available evidence suggests that depressed patients with psychomotor retardation may respond well to electroconvulsive therapy (ECT). Current literature regarding antidepressants is inconclusive, though tricyclic antidepressants may be considered for treatment of patients with psychomotor retardation. Future work examining this objective aspect of major depressive disorder (MDD) is essential. This could further elucidate the biological underpinnings of depression and optimize its treatment.
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Affiliation(s)
- Jeylan S. Buyukdura
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Shawn M. McClintock
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Division of Brain Stimulation and Therapeutic Modulation, Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, New York, USA
| | - Paul E. Croarkin
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Fostick L, Silberman A, Beckman M, Spivak B, Amital D. The economic impact of depression: resistance or severity? Eur Neuropsychopharmacol 2010; 20:671-5. [PMID: 20624674 DOI: 10.1016/j.euroneuro.2010.06.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2010] [Revised: 06/03/2010] [Accepted: 06/09/2010] [Indexed: 11/27/2022]
Abstract
Treatment-Resistant Depression (TRD) affects 60 to 70% of patients with Major Depressive Disorder (MDD). The economic impact of depression in general, and of TRD specifically, was found to be relatively high. As the course of depression can be defined both by the severity of the disease and by the resistance to treatment, the question of the unique contribution of MDD severity vs. resistance to the economic burden of depression is being raised. One hundred and seven unipolar MDD patients, all treated for at least 4weeks, were enrolled in the study. Patients were assessed for their current MDD severity using the Hamilton Depression Rating Scale (HDRS) and past treatments, and for medical-related costs (number of blood and imaging tests, visits paid to physicians, psychiatric hospitalizations) and incapacity-related costs (number of working days lost) during the last episode. TRD and non-TRD patients were, respectively, 39.3% and 60.7% of the patients recruited for the study. TRD patients had more severe depression, and higher costs for imaging tests, physician visits, psychiatric hospitalizations, and number of working days lost. In addition, higher MDD severity was found to be associated with higher costs. Finally, when controlling for the shared variance of TRD and MDD severity, by using residual scores, TRD was associated with higher costs, but MDD severity was no longer related to costs. While both resistance and severity are associated with higher direct and indirect costs, our findings suggest that TRD may be the main factor in determining the economic burden of depression.
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Affiliation(s)
- L Fostick
- Ariel University Center of Samaria, Israel.
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Monzón S, Gili M, Vives M, Serrano MJ, Bauza N, Molina R, García-Toro M, Salvà J, Llobera J, Roca M. Melancholic versus non-melancholic depression: differences on cognitive function. A longitudinal study protocol. BMC Psychiatry 2010; 10:48. [PMID: 20565743 PMCID: PMC2896936 DOI: 10.1186/1471-244x-10-48] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Accepted: 06/17/2010] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Cognitive dysfunction is common among depressed patients. However, the pattern and magnitude of impairment during episodes of major depressive disorder (MDD) through to clinical remission remains unclear. Heterogeneity of depressive patients and the lack of longitudinal studies may account for contradictory results in previous research. METHODS/DESIGN This longitudinal study will analyze cognitive differences between CORE-defined melancholic depressed patients (n = 60) and non-melancholic depressed patients (n = 60). A comprehensive clinical and cognitive assessment will be performed at admission and after 6 months. Cognitive dysfunction in both groups will be longitudinally compared, and the persistence of cognitive impairment after clinical remission will be determined. DISCUSSION The study of neuropsychological dysfunction and the cognitive changes through the different phases of depression arise a wide variety of difficulties. Several confounding variables must be controlled to determine if the presence of depression could be considered the only factor accounting for group differences.
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Affiliation(s)
- Saray Monzón
- Institut Universitari d'Investigacions en Ciències de la Salut, University of Balearic Islands, 07122 Palma de Mallorca, Balearic Islands, Spain.
| | - Margalida Gili
- Institut Universitari d'Investigacions en Ciències de la Salut (IUNICS), University of Balearic Islands (UIB), Ctra, Valldemossa km 7.5, 07122 Palma de Mallorca, Balearic Islands, Spain,Unitat de Psiquiatria i Psicologia Clinica, Hospital Joan March, University of Balearic Islands, Ctra, Sóller s/n, 07110, Bunyola, Balearic Islands, Spain
| | - Margalida Vives
- Institut Universitari d'Investigacions en Ciències de la Salut (IUNICS), University of Balearic Islands (UIB), Ctra, Valldemossa km 7.5, 07122 Palma de Mallorca, Balearic Islands, Spain,Unitat de Psiquiatria i Psicologia Clinica, Hospital Joan March, University of Balearic Islands, Ctra, Sóller s/n, 07110, Bunyola, Balearic Islands, Spain
| | - Maria Jesus Serrano
- Institut Universitari d'Investigacions en Ciències de la Salut (IUNICS), University of Balearic Islands (UIB), Ctra, Valldemossa km 7.5, 07122 Palma de Mallorca, Balearic Islands, Spain,Unitat de Psiquiatria i Psicologia Clinica, Hospital Joan March, University of Balearic Islands, Ctra, Sóller s/n, 07110, Bunyola, Balearic Islands, Spain
| | - Natalia Bauza
- Institut Universitari d'Investigacions en Ciències de la Salut (IUNICS), University of Balearic Islands (UIB), Ctra, Valldemossa km 7.5, 07122 Palma de Mallorca, Balearic Islands, Spain,Unitat de Psiquiatria i Psicologia Clinica, Hospital Joan March, University of Balearic Islands, Ctra, Sóller s/n, 07110, Bunyola, Balearic Islands, Spain
| | - Rosa Molina
- Institut Universitari d'Investigacions en Ciències de la Salut (IUNICS), University of Balearic Islands (UIB), Ctra, Valldemossa km 7.5, 07122 Palma de Mallorca, Balearic Islands, Spain,Servei de Psiquiatria, Hospital de Manacor, Ctra, Manacor-Alcudia s/n, 07500 Manacor, Balearic Islands, Spain
| | - Mauro García-Toro
- Institut Universitari d'Investigacions en Ciències de la Salut (IUNICS), University of Balearic Islands (UIB), Ctra, Valldemossa km 7.5, 07122 Palma de Mallorca, Balearic Islands, Spain
| | - Joan Salvà
- Institut Universitari d'Investigacions en Ciències de la Salut (IUNICS), University of Balearic Islands (UIB), Ctra, Valldemossa km 7.5, 07122 Palma de Mallorca, Balearic Islands, Spain
| | - Joan Llobera
- Institut Universitari d'Investigacions en Ciències de la Salut (IUNICS), University of Balearic Islands (UIB), Ctra, Valldemossa km 7.5, 07122 Palma de Mallorca, Balearic Islands, Spain,Direcció General d'Avaluació i Acreditació, Conselleria Salut i Consum, Govern de les Illes Balears, C/de Carles I, 6, 07003 Palma de Mallorca, Balearic Islands, Spain
| | - Miquel Roca
- Institut Universitari d'Investigacions en Ciències de la Salut (IUNICS), University of Balearic Islands (UIB), Ctra, Valldemossa km 7.5, 07122 Palma de Mallorca, Balearic Islands, Spain,Unitat de Psiquiatria i Psicologia Clinica, Hospital Joan March, University of Balearic Islands, Ctra, Sóller s/n, 07110, Bunyola, Balearic Islands, Spain
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Schrijvers D, Hulstijn W, Sabbe BGC. Psychomotor symptoms in depression: a diagnostic, pathophysiological and therapeutic tool. J Affect Disord 2008; 109:1-20. [PMID: 18082896 DOI: 10.1016/j.jad.2007.10.019] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2007] [Revised: 09/12/2007] [Accepted: 10/25/2007] [Indexed: 11/17/2022]
Abstract
BACKGROUND Psychomotor disturbances have been described repeatedly over many centuries. More recently, Sobin and Sackeim [Sobin, C., Sackeim, H.A., 1997. Psychomotor symptoms of depression. Am. J. Psychiatry. 154, 4-17.] discussed the relevance of psychomotor symptoms in depression in an extensive review. Since their report, new pathophysiological, diagnostic and therapeutic findings have been published. In the current review of the recent literature, we aim to argue the importance of psychomotor symptoms in depression and propose directions for future research. METHOD A review of all the relevant reports on this topic, published between 1996 and 2006, was conducted. RESULTS Several assessment methods demonstrate the diagnostic and pathophysiological significance of psychomotor symptoms. Antidepressants show differential effects on psychomotor performance and findings concerning the symptoms' predictive capacity for clinical response are contradictory. Numerous imaging studies as well as studies on the neurotransmitter systems and the HPA-axis contribute to the elucidation of the neurobiological processes underlying impaired psychomotor functioning in depression. CONCLUSIONS Psychomotor disturbances are of great diagnostic significance for the depressive subtype of melancholia. To enhance the conceptualisation of the construct 'psychomotor' a standardised battery for their assessment is recommended. As to the symptoms' predictive therapeutic power, to date research into functional outcome and studies applying objective experimental assessment methods are lacking. Moreover, the reported pathophysiological importance of dopamine for 'retarded depression' still warrants translation to the daily practice.
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Affiliation(s)
- Didier Schrijvers
- Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Universiteitsplein 1 B-2610 Antwerp, Belgium.
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25
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The development of valid subtypes for depression in primary care settings: a preliminary study using an explanatory model approach. J Nerv Ment Dis 2008; 196:289-96. [PMID: 18414123 PMCID: PMC2774710 DOI: 10.1097/nmd.0b013e31816a496e] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A persistent theme in the debate on the classification of depressive disorders is the distinction between biological and environmental depressions. Despite decades of research, there remains little consensus on how to distinguish between depressive subtypes. This preliminary study describes a method that could be useful, if implemented on a larger scale, in the development of valid subtypes of depression in primary care settings, using explanatory models of depressive illness. Seventeen depressed Hispanic patients at an inner city general practice participated in explanatory model interviews. Participants generated illness narratives, which included details about symptoms, cause, course, impact, health seeking, and anticipated outcome. Two distinct subtypes emerged from the analysis. The internal model subtype was characterized by internal attributions, specifically the notion of an "injured self." The external model subtype conceptualized depression as a reaction to life situations. Each subtype was associated with a distinct constellation of clinical features and health seeking experiences. Future directions for research using explanatory models to establish depressive subtypes are explored.
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26
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Taylor MA, Fink M. Restoring melancholia in the classification of mood disorders. J Affect Disord 2008; 105:1-14. [PMID: 17659352 DOI: 10.1016/j.jad.2007.05.023] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2007] [Revised: 05/21/2007] [Accepted: 05/29/2007] [Indexed: 11/27/2022]
Abstract
The present DSM criteria for major depression poorly identify samples for treatment selection, prognosis, and assessments of pathophysiology. Melancholia, in contrast, is a disorder with definable clinical signs that can be verified by laboratory tests and treatment response. It identifies more specific populations than the present system and deserves individual identification in psychiatric classification. Its re-introduction will refine diagnosis, prognosis, treatment selection, and studies of pathophysiology of a large segment of the psychiatrically ill.
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Affiliation(s)
- Michael Alan Taylor
- Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, United States
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27
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Abstract
OBJECTIVE To examine the evidence that dopamine (DA) dysfunction contributes to melancholic depression. METHOD Database (EMBASE, PsychLit and MEDLINE) searches using relevant key words were conducted and citations were scrutinized. RESULTS In this paper, we assume that the definition of melancholia is contingent upon the presence of psychomotor disturbance (PMD). In melancholic depression PMD comprises both a cognitive and motor component and DA is found to be important in both. DA neurotransmission modulates cognition in particular in attention, adaptation and motivational processes and has a pivotal role in motor function. CONCLUSION DA is a credible aetiological candidate for the PMD in melancholic depression. However, melancholia needs first to be characterized both clinically and in terms of its pathophysiology. In this regard, illnesses such as bipolar depression and Parkinson's disease warrant consideration as they provide suitable models of both the cognitive and motor aspects of PMD, and hold the necessary markers to better define melancholia.
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Affiliation(s)
- G S Malhi
- Psychological Medicine, Northern Clinical School, University of Sydney, NSW, Australia.
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Joyce PR, Williamson SAH, McKenzie JM, Frampton CMA, Luty SE, Porter RJ, Mulder RT. Effects of childhood experiences on cortisol levels in depressed adults. Aust N Z J Psychiatry 2007; 41:62-5. [PMID: 17464682 DOI: 10.1080/00048670601050473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the impact of childhood abuse and parental bonding on cortisol levels in depressed adults. METHODS Mean afternoon cortisol levels were measured in 192 depressed adult patients at the beginning of a treatment trial. Childhood experiences of physical and sexual abuse were ascertained by interview, and perceived parenting by self-report. RESULTS Maternal affectionless control, childhood sexual and physical abuse were all associated with cortisol levels. CONCLUSION Childhood experiences, especially maternal affectionless control, appear to be related to hypothalamic pituitary adrenal axis function in depressed adults.
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Affiliation(s)
- Peter R Joyce
- Department of Psychological Medicine, Christchurch School of Medicine & Health Sciences, PO Box 4345, Christchurch, New Zealand.
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29
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Winograd-Gurvich C, Georgiou-Karistianis N, Fitzgerald PB, Millist L, White OB. Self-paced and reprogrammed saccades: Differences between melancholic and non-melancholic depression. Neurosci Res 2006; 56:253-60. [DOI: 10.1016/j.neures.2006.07.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2006] [Revised: 07/04/2006] [Accepted: 07/07/2006] [Indexed: 11/26/2022]
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30
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Winograd-Gurvich C, Fitzgerald PB, Georgiou-Karistianis N, Bradshaw JL, White OB. Negative symptoms: A review of schizophrenia, melancholic depression and Parkinson's disease. Brain Res Bull 2006; 70:312-21. [PMID: 17027767 DOI: 10.1016/j.brainresbull.2006.06.007] [Citation(s) in RCA: 112] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2005] [Revised: 06/08/2006] [Accepted: 06/12/2006] [Indexed: 11/23/2022]
Abstract
Negative symptoms generally refer to a reduction in normal functioning. In schizophrenia they encompass apathy, anhedonia, flat affect, avolition, social withdrawal and, on some accounts, psychomotor retardation. Negative symptoms have been identified in other psychiatric disorders, including melancholic depression, and also in neurological disorders, such Parkinson's disease. Achieving a better understanding of negative symptoms constitutes a priority in mental health. Primarily, negative symptoms represent an unrelenting, intractable and disabling feature for patients, often amounting to a severe burden on families, carers and the patients themselves. Identifying and understanding subgroups within disorders may also contribute to the clinical care and scientific understanding of the pathophysiology of these disorders. The purpose of this paper is to review the current literature on negative symptoms in schizophrenia and explore the idea that negative symptoms may play an important role not only in other psychiatric disorders such as melancholic depression, but also in neurological disorders, such as Parkinson's disease. In each disorder negative symptoms manifest with similar motor and cognitive impairments and are associated with comparable neuropathological and biochemical findings, possibly reflecting analogous impairments in the functioning of frontostriatal-limbic circuits.
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Affiliation(s)
- C Winograd-Gurvich
- Experimental Neuropsychology Research Unit, Psychology Department, Monash University, Melbourne, Victoria 3800, Australia.
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Winograd-Gurvich C, Georgiou-Karistianis N, Fitzgerald PB, Millist L, White OB. Ocular motor differences between melancholic and non-melancholic depression. J Affect Disord 2006; 93:193-203. [PMID: 16678910 DOI: 10.1016/j.jad.2006.03.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2005] [Revised: 03/23/2006] [Accepted: 03/24/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND Major depressive disorder may be a heterogeneous disorder, yet melancholic depression is the most consistently described subtype, regarded as qualitatively different to non-melancholic depression in terms of cognitive and motor impairments. Eye movement studies in depression are infrequent and findings are inconclusive. METHODS This study employed a battery of saccadic eye movement tasks to explore reflexive saccades, as well as higher order cognitive aspects of saccades including inhibitory control and spatial working memory. Nineteen patients with major depressive disorder (9 melancholic; 10 non-melancholic) and 15 healthy controls participated. RESULTS Differences were revealed between melancholic and non-melancholic patients. Melancholia was associated with longer latencies, difficulty increasing peak velocities as target amplitudes increased, and hypometric primary saccades during the predictable protocol. In contrast, the non-melancholic depression group performed similarly to controls on most tasks, but saccadic peak velocity was increased for reflexive saccades at larger amplitudes. LIMITATIONS Most patients were taking antidepressant medication. CONCLUSIONS The latency increases, reduced peak velocity and primary saccade hypometria with more severe melancholia may be explained by functional changes in the fronto-striatal-collicular networks, related to dopamine dysfunction. In contrast, the serotonergic system plays a greater role in non-melancholic symptoms and this may underpin the observed increases in saccadic peak velocity. These findings provide neurophysiological support for functional differences between depression subgroups that are consistent with previous motor and cognitive findings.
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Affiliation(s)
- C Winograd-Gurvich
- Experimental Neuropsychology Research Unit, School of Psychology, Psychiatry and Psychological Medicine, Monash University, Melbourne 3800, Australia.
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Mallinckrodt CH, Watkin JG, Liu C, Wohlreich MM, Raskin J. Duloxetine in the treatment of Major Depressive Disorder: a comparison of efficacy in patients with and without melancholic features. BMC Psychiatry 2005; 5:1. [PMID: 15631624 PMCID: PMC546184 DOI: 10.1186/1471-244x-5-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2004] [Accepted: 01/04/2005] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND The most prominent feature of melancholic depression is a near-total loss of the capacity to derive pleasure from activities or other positive stimuli. Additional symptoms can include psychomotor disturbances, anorexia, excessive guilt, and early awakening from sleep. Melancholic patients may exhibit treatment responses and outcomes that differ from those of non-melancholic patients. Pooled data from double-blind, placebo-controlled studies were utilized to compare the efficacy of duloxetine in depressed patients with and without melancholic features. METHODS Efficacy data were pooled from 8 double-blind, placebo-controlled clinical trials of duloxetine. The presence of melancholic features (DSM-IV criteria) was determined using results from the Mini International Neuropsychiatric Interview (MINI). Patients (aged >or= 18 years) meeting DSM-IV criteria for major depressive disorder (MDD) received duloxetine (40-120 mg/d; melancholic, N = 759; non-melancholic, N = 379) or placebo (melancholic, N = 519; non-melancholic, N = 256) for up to 9 weeks. Efficacy measures included the 17-item Hamilton Rating Scale for Depression (HAMD17) total score, HAMD17 subscales (Maier, anxiety, retardation, sleep), the Clinical Global Impression of Severity (CGI-S) and Patient Global Impression of Improvement (PGI-I) scales, and Visual Analog Scales (VAS) for pain. RESULTS In data from all 8 studies, duloxetine's advantage over placebo did not differ significantly between melancholic and non-melancholic patients (treatment-by-melancholic status interactions were not statistically significant). Duloxetine demonstrated significantly greater improvement in depressive symptom severity, compared with placebo, within both melancholic and non-melancholic cohorts (p <or= .001 for HAMD17 total score, CGI-S and PGI-I). When analyzed by gender, the magnitude of improvement in efficacy outcomes did not differ significantly between duloxetine-treated male and female melancholic patients. In the two studies that assessed duloxetine 60 mg once-daily dosing, duloxetine-treated melancholic patients had significantly greater improvement compared with placebo on HAMD17 total score, CGI-S, PGI-I, 3 of 4 subscales of the HAMD17, and VAS overall pain severity (p < .01). Estimated probabilities of response and remission were significantly greater for melancholic patients receiving duloxetine 60 mg QD compared with placebo (response 74.7% vs. 42.2%, respectively, p < .001; remission 44.4% vs. 24.7%, respectively, p = .002. CONCLUSIONS In this analysis of pooled data, the efficacy of duloxetine in patients with melancholic features did not differ significantly from that observed in non-melancholic patients.
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Affiliation(s)
| | - John G Watkin
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN 46285
| | - Chaofeng Liu
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN 46285
| | | | - Joel Raskin
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN 46285
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Joyce PR, Luty SE, McKenzie JM, Mulder RT, McIntosh VV, Carter FA, Bulik CM, Sullivan PF. Bipolar II disorder: personality and outcome in two clinical samples. Aust N Z J Psychiatry 2004; 38:433-8. [PMID: 15209835 DOI: 10.1080/j.1440-1614.2004.01380.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To compare the personality traits and disorders of patients with bipolar II disorder and major depression and to examine the impact on treatment outcome of a bipolar II diagnosis. METHOD Patients from two clinical trials, a depressive sample (n = 195, 10% bipolar II) and a bulimic sample (n = 135, 16% bipolar II), were assessed for personality traits using DSM-IV criteria. Patients were randomised to treatments (fluoxetine or nortriptyline for depressive sample; cognitive behaviour therapy for bulimic sample) and followed for 3 years (depressive sample) or 5 years (bulimic sample) to assess the impact on outcome of a bipolar II diagnosis. RESULTS Bipolar II patients were assessed as having more borderline, histrionic and schizotypal personality traits than patients with major depression. A baseline bipolar II diagnosis did not impact negatively on treatment outcome, and less than 5% of bipolar II patients developed bipolar I disorder during follow up. CONCLUSIONS The low rate of conversion of bipolar II to bipolar I disorder and the lack of adverse impact of the diagnosis on outcome, questions the need for antimanic or mood stabiliser medication in most bipolar II patients.
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Affiliation(s)
- Peter R Joyce
- Department of Psychological Medicine, Christchurch School of Medicine and Health Sciences, Christchurch, New Zealand.
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Abstract
Modern antidepressant drugs have response rates in the 65% range. Considerable effort has been made to predict which patients would be more likely to respond to antidepressant treatment. Some progress has been made, more in finding psychological predictors than biological predictors of antidepressant response. In spite of slow progress, these findings have made a valuable contribution towards the understanding of antidepressant response. In future it may be possible for psychiatrists to use a more broad-based approach, tailoring therapies to the clinical profile of individuals.
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Affiliation(s)
- Seetal Dodd
- Department of Clinical and Biomedical Sciences, University of Melbourne and Community and Mental, Health, Barwon Health, P.O. Box 281, Geelong, Victoria, 3220, Australia
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Joyce PR, McKenzie JM, Luty SE, Mulder RT, Carter JD, Sullivan PF, Cloninger CR. Temperament, childhood environment and psychopathology as risk factors for avoidant and borderline personality disorders. Aust N Z J Psychiatry 2003; 37:756-64. [PMID: 14636393 DOI: 10.1080/j.1440-1614.2003.01263.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate childhood experiences (neglect and abuse), temperament and childhood and adolescent psychopathology as risk factors for avoidant and borderline personality disorders in depressed outpatients. METHOD One hundred and eighty depressed outpatients were evaluated for personality disorders. Risk factors of childhood abuse, parental care, temperament, conduct disorder symptoms, childhood and adolescent anxiety disorders, depressive episodes, hypomania and alcohol and drug dependence were obtained by questionnaires and interviews. RESULTS Avoidant personality disorder can be conceptualized as arising from a combination of high harm avoidance (shy, anxious), childhood and adolescent anxiety disorders and parental neglect. Borderline personality disorder can be formulated as arising from a combination of childhood abuse and/or neglect, a borderline temperament (high novelty seeking and high harm avoidance), and childhood and adolescent depression, hypomania, conduct disorder and alcohol and drug dependence. CONCLUSIONS Combinations of risk factors from the three domains of temperament, childhood experiences and childhood and adolescent psychopathology make major contributions to the development of avoidant and borderline personality disorders.
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Affiliation(s)
- Peter R Joyce
- Department of Psychological Medicine, Christchurch School of Medicine and Health Sciences, New Zealand.
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36
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Joyce PR, Mulder RT, Luty SE, McKenzie JM, Rae AM. A differential response to nortriptyline and fluoxetine in melancholic depression: the importance of age and gender. Acta Psychiatr Scand 2003; 108:20-3. [PMID: 12807373 DOI: 10.1034/j.1600-0447.2003.00120.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To consider the impact of age and gender on the antidepressant response to nortriptyline and fluoxetine in melancholic depression. METHOD Of 191 depressed patients, 113 met study criteria for melancholia. All patients were randomized to receive either fluoxetine or nortriptyline. Response rates, defined as an improvement of 60% or more on the Montgomery Asberg Depression Rating Scale over 6 weeks of antidepressant treatment on an intention to treat basis, were examined by age, and by age and gender. RESULTS Melancholic depressed patients 40 years or older, especially men, had a markedly superior response to nortriptyline compared with fluoxetine. Conversely, melancholic depressed patients, age 18-24 years, especially women, had a markedly superior response to fluoxetine. CONCLUSION Age and gender appear to be critical variables in understanding differential antidepressant responses to tricyclic antidepressants and selective serotonin reuptake inhibitors in melancholic depression.
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Affiliation(s)
- P R Joyce
- Department of Psychological Medicine, Christchurch School of Medicine & Health Sciences, PO Box 4345, Christchurch, New Zealand.
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