Major depression prevalence is very high, but the syndrome is a poor proxy for community populations' clinical treatment needs

Perceived Need for Mental Health Care in a Cohort of Persons With Inflammatory Bowel Disease

BACKGROUND

Psychiatric comorbidity is common in inflammatory bowel disease (IBD) and can negatively affect disease outcomes. We explored the perceived need for mental health care among persons with IBD.

STUDY

Persons with IBD completed self-report questionnaires, including the Hospital Anxiety and Depression Scale (HADS), and reported whether they wanted help with their mood. Each was also assessed using the Structured Clinical Interview for DSM-IV-TR Axis-I Disorders (SCIDs). We used logistic regression analyses to determine factors associated with the perceived need for mental health care.

RESULTS

Of 245 participants, 28% met the criteria for a past diagnosis of depression or anxiety disorder by SCID, and nearly 23% met the criteria for a current diagnosis of depression or anxiety disorder. One-third (n = 74) reported a perceived need for mental health care. Among those meeting criteria for a current SCID diagnosis of depression or anxiety, only 58% reported needing mental health care. Need for mental health care was reported by 79% of persons currently treated for either depression or 71% treated for anxiety. Persons with a perceived need for mental health care had higher mean HADS for depression and HADS for anxiety scores and also higher IBD symptom activity scores. Of those reporting no perceived need for mental health care, 13% had a current diagnosis of depression or anxiety disorder by SCID; even fewer had symptoms of depression or anxiety.

CONCLUSIONS

Symptoms of depression or anxiety are more important than a formal diagnosis of depression or anxiety in predicting which persons with IBD will perceive a need for mental health care.

Problematic features of episode-based definitions of depression and a preliminary proposal for their replacement

Episodes of depression are constructed by imposing temporal and symptom-severity thresholds onto symptom levels that vary over time, resulting in a loss of information. Consequently, it is widely acknowledged that binary categorization of depressive episodes is problematic. Binary classification can make similar symptom levels appear different and different symptom levels appear similar. Furthermore, symptom severity is only one of several thresholds that are applied in the construction of depressive episodes in DSM-5 and ICD-11, others being: a minimum duration of symptoms, the application of a “no significant symptoms” threshold for remission, and time requirements (e.g., 2  months) for remission. Application of each of these thresholds leads to a loss of information. The joint occurrence of these four thresholds creates a complex set of circumstances in which similar patterns of symptoms may be categorized differently and different patterns may be categorized as similar. The ICD-11 definition can be expected to lead to better classification than the DSM-5 approach since it does not require two symptom-free months for remission, eliminating one of four problematic thresholds. A more radical change would be to adopt a truly dimensional perspective which would need to incorporate new elements to reflect time spent at various levels of depression. Such an approach, however, seems feasible both in clinical practice and research.

DIP: Natural history model for major depression with incidence and prevalence

BACKGROUND

Major depression is a treatable disease, and untreated depression can lead to serious health complications. Therefore, prevention, early identification, and treatment efforts are essential. Natural history models can be utilized to make informed decisions about interventions and treatments of major depression.

METHODS

We propose a natural history model of major depression. We use steady-state analysis to study the discrete-time Markov chain model. For this purpose, we solved the system of linear equations and tested the parameter and transition probabilities empirically.

RESULTS

We showed that bias in parameters might collectively cause a significant mismatch in a model. If incidence is correct, then lifetime prevalence is 33.2% for females and 20.5% for males, which is higher than reported values. If prevalence is correct, then incidence is .0008 for females and .00065 for males, which is lower than reported values. The model can achieve feasibility if incidence is at low levels and recall bias of the lifetime prevalence is quantified to be 31.9% for females and 16.3% for males.

LIMITATIONS

This model is limited to major depression, and patients who have other types of depression are assumed healthy. We assume that transition probabilities (except incidence rates) are correct.

CONCLUSION

We constructed a preliminary model for the natural history of major depression. We determined the lifetime prevalences are underestimated and the average incidence rates may be underestimated for males. We conclude that recall bias needs to be accounted for in modeling or burden estimates, where the recall bias should increase with age.

HS-GC-IMS-Based metabonomics study of Baihe Jizihuang Tang in a rat model of chronic unpredictable mild stress

The aim of this study was to investigate the differences in volatile organic compounds (VOCs) obtained from the feces of a Baihe Jizihuang Tang (BHT)-treated rat depression model. Rats were subjected to chronic unpredictable mild stress (CUMS), and the differences in VOCs were analyzed by headspace-gas chromatography-ion mobility spectrometry (HS-GC-IMS), NIST software, principal component analysis, and orthogonal partial least squares discriminant analysis. Eleven biomarkers were identified on the basis of VOC migration time, and their relative peak intensities were analyzed. A metabonomic model was established using multivariate statistical analysis. The study demonstrated the metabonomics of CUMS rats and the intervention effect of BHT and also highlighted the potential therapeutic effects of the traditional Chinese medicine (TCM) Jingfang for the clinical treatment of complex diseases, which was in line with the holistic and systemic approaches of TCM. This study augments the use of metabonomics based on HS-GC-IMS in research studies. Using this method, there is no need to pre-process samples by extraction or derivatization, and the VOC component of the sample can be detected directly and rapidly. In conclusion, this study establishes a simple, convenient, and fast technique, which can help identify clinical biomarkers for rapid medical diagnosis.

Depressive Symptoms in Adolescents

BACKGROUND

In this study, we determined the current prevalence of depressive symptoms in adolescents in Germany.

METHODS

A sample of 1001 adolescents aged 12 to 17 that was representative for Germany was surveyed in August and September 2017 through telephone interviews about depressive symptoms in the two weeks leading up to the interview and about the subjects' psychosocial features. The instrument that was used, called DesTeen, includes questions about depressed mood, loss of interest, loss of energy, feelings of worthlessness, guilt feelings, and cognitive symptoms.

RESULTS

Prevalences could be estimated and associated factors could be determined in a subset comprising 988 of the original 1001 subjects (mean age 14.58 years, 48.4% female). The estimated point prevalence of depressive symptoms (summated DesTeen score ≥ 14) in adolescents aged 12 to 17 was 8.2% (95% confidence interval [6.5; 9.9]). Girls (11.6% [95% CI 8.8; 14.4]) were more commonly affected than boys (5.0% [95% CI 3.1; 6.9]), and this difference was statistically significant (p<0.001). Depressive symptoms were more common with female sex, older age, poorer scholastic performance, lower interpersonal trust, more negative body image, more problematic use of social media or computer games, and lower family functioning. A multivariable regression model explained approximately one-third of the variation among groups (Nagelkerke's R2 = 0.35).

CONCLUSION

A substantial percentage of German adolescents suffers from depres - sive symptoms. This study was the first to show certain associations, such as that between depressive symptoms in adolescence and the problematic use of social media in German youth.

Effect of XingPiJieYu decoction on spatial learning and memory and cAMP-PKA-CREB-BDNF pathway in rat model of depression through chronic unpredictable stress

BACKGROUND

Depression is a mental disorder characterized by a pervasive low mood and loss of pleasure or interest in usual activities, and often results in cognitive dysfunction. The disturbance of cognitive processes associated with depression, especially the impairment of learning and memory, exacerbates illness and increases recurrence of depression. XingPiJieYu (XPJY) is one of the most widely clinical formulas of traditional Chinese medicine (TCM) and can improve the symptoms of depression, including learning and memory. However, its regulatory effects haven't been comprehensively studied so far. Recently, some animal tests have indicated that the cyclic adenosine monophosphate (cAMP)-protein kinase A (PKA)-cAMP response element-binding protein (CREB)-brain derived neurotrophic factor (BDNF) signaling pathway in hippocampus is closely related to depression and the pathogenesis of cognitive function impairments. The present study was performed to investigate the effect and mechanism of XPJY on depression and learning and memory in animal model.

MATERIALS

The rat model of depression was established by chronic unpredictable stress (CUS) for 21 days. The rats were randomly divided into six groups: control group, CUS group, CUS + XPJY (1.4 g/kg, 0.7 g/kg and 0.35 g/kg) groups, and CUS + sertraline (10 mg/kg) group. The sucrose preference, open field exploration and Morris water maze (MWM) were tested. The expression of cAMP, CREB, PKA and BDNF protein in hippocampus was examined with Elisa and Western Blot. The mRNA level of CREB and BDNF in hippocampus was measured with PCR.

RESULTS

The results demonstrated that rats subjected to CUS exhibited decreases in sucrose preference, total ambulation, percentage of central ambulation, rearing in the open field test and spatial performance in the MWM. CUS reduced the expression of cAMP, PKA, CREB and BDNF in hippocampus of model rats. These effects could be reversed by XPJY.

CONCLUSION

The results indicated that XPJY can improve depression and related learning and memory and the effect of XPJY is partly exerted through the cAMP-PKA-CREB-BDNF signaling pathway.

Major Depression Prevalence Increases with Latitude in Canada

OBJECTIVE

To determine whether there is an association between latitude and annual major depressive episode (MDE) prevalence in Canada.

METHODS

Data from 2 national survey programs (the National Population Health Survey and the Canadian Community Health Survey) were used, providing 10 data sets collected between 1996 and 2013, together including 922,260 respondents, of whom 495,739 were assessed for MDE using 1 of 2 versions of the Composite International Diagnostic Interview, a short-form version (8 studies), and a Canadian adaptation of the World Mental Health version (2 studies). Approximate latitude was determined by linkage to postal code data. Data were analyzed using logistic regression and pooled across surveys using individual-level meta-analytic methods.

RESULTS

In models including latitude as a continuous variable, a statistically significant association was observed, with prevalence increasing with increasing latitude. This association persisted after adjustment for a set of known risk factors. The latitude gradient was modest in magnitude, a 1% to 2% increase in the prevalence odds of MDE per degree of latitude was observed. Due to sparse data, this gradient cannot be confidently generalized beyond major population centres, which tend to occur at less than 55° latitude in Canada.

CONCLUSION

A latitude gradient has not previously been reported. If replicated, the gradient may have implications for the planning of services and generation of aetiological hypotheses. However, this cross-sectional analysis cannot confirm aetiology and could not evaluate the potential contributions of variables such as light exposure, weather patterns, or social determinants.

Retracted: Umbelliferone reverses depression-like behavior in chronic unpredictable mild stress-induced mice via RIP140/NF-κB pathway

The above article from IUBMB Life, published online on October 5th, 2016 in Wiley Online Library (http://wileyonlinelibrary.com), has been retracted by agreement between the authors, the Journal Editors-in-Chief, Dr. Angelo Azzi and Dr. William Whelan, and Wiley Periodicals, Inc. The retraction has been agreed because the article was submitted and approved for publication by Chunhua Ma and Long Hongyan without consent in any form by the named Corresponding Author, Kong Lingdong.

REFERENCE

Chunhua, M., Lingdong, K., Hongyan, L. and Zhangqiang, M. (2016), Umbelliferone reverses depression-like behavior in chronic unpredictable mild stress-induced mice via RIP140/NF-κB pathway. IUBMB Life. doi:10.1002/iub.1570 © 2017 IUBMB Life, 69(9):767-767, 2017.

Structure-activity relationship of 39 analogs of laetispicine with antidepressant properties

The natural product Laetispicine ( N -isobutyl-(3,4-methylendioxyphenyl)-2E, 4E, 9E-undecatrienoamide), was isolated from the Piper laetispicum C. DC and screened, for its antidepressant activity and antinociceptive effects. Structure-functional activities of five natural products indicated that biological activity is dependent on double bonds present within the benzene ring and a conjugated double bond located at positions 2-3 and 4-5 in the molecular structure. To further understand the structural-activity relationship of Laetispicine as a new potent and safe antidepressant, the structural-activity relationship of 39 analogs of Laetispicine were synthetized and tested in forced swimming tests in mice whilst also in protective effects against glutamate or H 2 O 2 induced apoptosis in PC12 cells. The results show that the compound 30 - N -isobutyl-11-(4-chlorophenyl) undeca-2E,4E,9E-trienamide exhibited the same activity as the parental compound Laetispicine, and furthermore, the effective dose of this compound is lower than Laetispicine. Therefore, the compound 30 might be a potentially useful therapy in the treatment of depression. For structure, the conjugated double bonds located at 2-3, 4-5 and isolated double bonds from benzene ring are necessary for the antidepressant activities no matter the different length of carbon chain; the isobutyl connected with acylamino also are necessary; and the benzodioxole moiety is replaceable, the halogen atom in phenyl ring at the para-position could enhance this kind of activity.

The mistreatment of major depressive disorder

OBJECTIVE

To examine the effects of classification on treatment in major depressive disorder (MDD).

METHOD

This is a narrative review.

RESULTS

MDD is a highly heterogeneous category, leading to problems in classification and in specificity of treatment. Current models classify all depressions within a single category. However, the construct of MDD obscures important differences between severe disorders that require pharmacotherapy, and mild-to-moderate disorders that can respond to psychotherapy or remit spontaneously. Patients with mild-to-moderate MDD are being treated with routine or overly aggressive pharmacotherapy.

CONCLUSIONS

The current classification fails to address the heterogeneity of depression, leading to mistreatment.

The point prevalence of depression and associated sociodemographic correlates in the general population of Latvia

AIM

To determine the point prevalence of depression in the general Latvian population and to explore the associated sociodemographic characteristics.

METHODS

The study was part of the cross-sectional survey on the general population on substance use in Latvia in 2011. It consisted of face-to-face interviews of a randomised stratified multi-stage probability sample. In total, 4493 persons were included, aged between 15 and 64. To assess depression, the participants were interviewed using the Patient Health Questionnaire-9; a score of ≥10 was defined as indicating the presence of a depressive episode. Socio-demographic, subjective health status and alcohol use were assessed using the structured interviews. Logistic regression models were applied to analyze data.

RESULTS

The point prevalence of depression was 6.7%. The odds of having depression were higher in females, in urban dwellers (though not in the capital city, Riga), in persons with non-Latvian ethnicity, with alcohol dependence, with poor subjective health status and having a dissatisfaction with life. Limitations. Cross-sectional nature of the sampling and the symptom scale used for the assessment of depression.

CONCLUSIONS

The point prevalence of depression in Latvia is within the European average. Certain socio-demographic and health related factors are associated with higher risk of morbidity with depression.

Demographic and clinical characteristics of consistent and inconsistent longitudinal reporters of lifetime suicide attempts in adolescence through young adulthood

BACKGROUND

Within the context of the recent release of the 2012 National Suicide Prevention Strategy, and as the third leading cause of death for individuals 10- to 24-years-old, suicide prevention is a national priority. A consistently reported and robust risk factor for suicide is a prior suicide attempt; however few studies have investigated the consistency of self-reported lifetime suicide attempts. The goal of this study is to describe the prevalence and characteristics of inconsistent reporting of suicide attempt in a longitudinal cohort of participants annually assessed in 12 waves of data collected from middle school (age 12) to early adulthood (age 22).

METHODS

Among this cohort (n = 678), we compared those who consistently, inconsistently, and never reported a suicide attempt according to demographic and clinical variables.

RESULTS

Almost 90% (88.5%) of our sample inconsistently reported a lifetime suicide attempt. Consistent and inconsistent reporters of lifetime suicide attempt did not differ on demographic or clinical variables with the exception of higher rates of lifetime suicidal ideation among consistent reporters (P < .001). Significant clinical differences were evident between inconsistent reporters and nonattempters.

CONCLUSIONS

Some level of inconsistent reporting of suicide attempt is inevitable when schools or health care systems systematically screen for suicide risk in adolescents. Inconsistent and consistent reporters of suicide attempt differ on few demographic or clinical variables; further prospective research should investigate the reasons for inconsistent reporting as well as the validity and stability of reporting in predicting future suicidal behavior.

Major depression epidemiology from a diathesis-stress conceptualization

BACKGROUND

Major depression is a widely used diagnostic category but there is increasing dissatisfaction with its performance. The diathesis-stress model is an alternative approach that does not require the (sometimes arbitrary) imposition of categories onto the spectrum of depressive morbidity. However, application of this model has not been well explored and its consistency with available epidemiologic data is uncertain.

METHODS

Simulation provides an opportunity to explore these issues. In this study, a simulation model based on an intuitive representation of diathesis-stress interaction was developed. Both diathesis and stress were represented using continuous distributions, without categorization. A diagnostic threshold was then applied to the simulation output to create nominal categories and to explore their consistency with available information.

RESULTS

An apparently complex epidemiologic pattern emerged from the diathesis-stress interaction when thresholds were applied: incidence was time dependent, recurrence depended on the number of past episodes, baseline symptoms were associated with an increased risk of subsequent episodes and the remission rate declined with increasing episode duration.

CONCLUSIONS

A diathesis-stress conceptualization coupled with application of a threshold-based diagnostic definition may explain several of the apparent complexities of major depression epidemiology. Some of these complexities may be artifacts of the nominal diagnostic approach. These observations should encourage an empirical exploration of whether diathesis-stress interactions provide a more parsimonious framework for understanding depression than current approaches.

Psychometrics of the PHQ-9 as a measure of depressive symptoms in patients with heart failure

BACKGROUND

Depression in patients with heart failure commonly goes undiagnosed and untreated. The Patient Health Questionnaire-9 (PHQ-9) is a simple, valid measure of depressive symptoms that may facilitate clinical assessment. It has not been validated in patients with heart failure.

AIMS

To test the reliability, and concurrent and construct validity of the PHQ-9 in patients with heart failure.

METHODS

A total of 322 heart failure patients (32% female, 61 ± 12 years, 56% New York Heart Association class III/IV) completed the PHQ-9, the Beck Depression Inventory-II (BDI-II), and the Control Attitudes Scale (CAS).

RESULTS

Cronbach's alpha of .83 supported the internal consistency reliability of the PHQ-9 in this sample. Inter-item correlations (range .22-.66) and item-total correlation (except item 9) supported homogeneity of the PHQ-9. Spearman's rho of .80, (p < .001) between the PHQ-9 and the BDI-II supported the concurrent validity as did the agreement between the PHQ-9 and the BDI-II (Kappa = 0.64, p < .001). At cut-off score of 10, the PHQ-9 was 70% sensitive and 92% specific in identifying depressive symptoms, using the BDI-II scores as the criterion for comparison. Differences in PHQ-9 scores by level of perceived control measured by CAS (t(318) = -5.05, p < .001) supported construct validity.

CONCLUSION

The PHQ-9 is a reliable, valid measure of depressive symptoms in patients with heart failure.

[Health inequities in mood disorders based on material and social deprivation in dwelling sectors ]

OBJECTIVE

To compare mood disorder (MD) prevalence in Quebec in 2006, and compare health services and medication use, mortality and morbidity in patients with MD based on sex and the dwelling sector level of material and social deprivation. The objective was also to identify subgroups of individuals using health services in a larger proportion and having a higher risk of morbidity and mortality.

METHOD

We conducted a secondary analysis of the Régie de l’assurance maladie du Québec medico-administrative data. The cohort is composed of adults diagnosed with MD and living in Quebec in 2006. Variables include: physician consultation, medication demand, consultation for substance or alcohol abuse, emergency visit, hospitalization for a mental disorder, and death. Dwelling sector types are defined by crossing Pampalon material and social deprivation quintiles.

RESULTS

MD prevalence in 2006 was 3.06% (177 850 patients), with prevalence in women 1.7-fold with respect to men. Findings show a higher MD prevalence as well as a higher mortality and morbidity rate in materially and socially deprived dwelling sectors. Young men also represent a specifically vulnerable subgroup for many study variables.

CONCLUSION

Public policies aimed at improving material conditions (income, education, employment) and breaking out social isolation would have an important impact on the population mental health. Public health program development should pay close attention to young men population.

Depressive episode characteristics and subsequent recurrence risk

BACKGROUND

Clinical practice guidelines increasingly recognize the heterogeneity associated with major depressive episodes (MDE), e.g. through strategies such as watchful waiting. However, the implications of episode heterogeneity for long-term prognosis have not been adequately explored.

METHODS

In this project, we used data from a Canadian longitudinal study to evaluate recurrence risks for MDE after an initial episode in the mid-1990s. This study collected data from a community cohort between 1994/1995 and 2008/2009 using biannual interviews. Characteristics of the index episode: syndromal versus sub-syndromal, duration of symptoms, and indicators of seriousness (activity restriction, high distress or suicidal ideation) were recorded. The ability of these variables to predict MDE recurrence was explored using proportional hazards modeling. Additional analyses using generalized estimating equations were used to assess robustness.

RESULTS

Even brief, sub-syndromal episodes not characterized by indicators of seriousness were associated with an increased risk of subsequent MDE. However, episodes meeting diagnostic criteria for MDE, those lasting longer than four weeks and those associated with indicators of seriousness were associated with much higher recurrence risk. Sub-syndromal episodes associated with these characteristics generally predicted subsequent MDE as strongly as the occurrence of MDE itself.

LIMITATIONS

The data source did not include assessment of all potentially relevant covariates. The assessment of MDE used an abbreviated instrument.

CONCLUSIONS

Brief sub-syndromal episodes of depression are not usually targets of acute treatment, but such episodes have implications for subsequent MDE risk. Episode characteristics identify a range of outcomes that have potential implications for long-term management.

Is mental health in the Canadian population changing over time?

OBJECTIVE

Mental health in populations may be deteriorating, or it may be improving, but there is little direct evidence to support either possibility. Our objective was to examine secular trends in mental health indicators from national data sources.

METHODS

We used data (1994-2008) from the National Population Health Survey and from a series of cross-sectional studies (Canadian Community Health Survey) conducted in 2001, 2003, 2005, and 2007. We calculated population-weighted proportions and also generated sex-specific, age-standardized estimates of major depressive episode prevalence, distress, professionally diagnosed mood disorders, antidepressant use, self-rated perceived mental health, and self-rated stress.

RESULTS

Major depression prevalence did not change over time. No changes in the frequency of severe distress were seen. However, there were increases in reported diagnoses of mood disorders and an increasing proportion of the population reported that they were taking antidepressants. The proportion of the population reporting that their life was extremely stressful decreased, but the proportion reporting poor mental health did not change.

CONCLUSIONS

Measures based on assessment of symptoms showed no evidence of change over time. However, the frequency of diagnosis and treatment appears to be increasing and perceptions of extreme stress are decreasing. These changes probably reflect changes in diagnostic practice, mental health literacy, or willingness to report mental health concerns. However, no direct evidence of changing mental health status was found.

Predictors of 1-year outcomes of major depressive disorder among individuals with a lifetime diagnosis: a population-based study

BACKGROUND

Examining predictors of the outcomes of major depressive disorder (MDD) is important for clinical practice and population health. There are few population-based longitudinal studies on this topic. The objectives of this study were to (1) estimate the proportions of persistent and recurrent MDD among those with MDD over 1 year, and (2) identify demographic, socio-economic, workplace psychosocial and clinical factors associated with the outcomes.

METHOD

From a population-based longitudinal study of the working population, participants with a lifetime diagnosis of MDD were selected (n=834). They were classified into two groups: those with and those without current MDD. The proportions of 1-year persistence and recurrence of MDD were estimated. MDD was assessed by the World Health Organization (WHO) Composite International Diagnostic Interview, CIDI-Auto 2.1, by telephone.

RESULTS

The proportions of persistent and recurrent MDD in 1 year were 38.5% [95% confidence interval (CI) 31.1-46.5] and 13.3% (95% CI 10.2-17.1) respectively. Long working hours, negative thinking and having co-morbid social phobia were predictive of persistence of MDD. Perceived work-family conflict, the severity of a major depressive episode and symptoms of depressed mood were significantly associated with the recurrence of MDD.

CONCLUSIONS

Clinical and psychosocial factors are important in the prognosis of MDD. The factors associated with persistence and recurrence of MDD may be different. More large longitudinal studies on this topic are needed so that clinicians may predict potential outcomes based on the clinical profile and provide interventions accordingly. They may also take clinical action to change relevant psychosocial factors to minimize the chance of persistence and/or recurrence of MDD.

Antidepressant-like effect of the extracted of Kai Xin San, a traditional Chinese herbal prescription, is explained by modulation of the central monoaminergic neurotransmitter system in mouse

ETHNOPHARMACOLOGICAL RELEVANCE

Kai Xin San (KXS) is a traditional Chinese herbal prescription for the treatment of depression-like disorders, anxiety, and impairment in learning and memory, however, there is very little scientific data concerning the efficacy of this.

AIM OF THE STUDY

The present study aimed to investigate the antidepressant potential of Kai Xin San and its possible mechanisms.

MATERIALS AND METHODS

Mouse models of depression including the tail suspension test (TST) and the forced swim test (FST) were used to evaluate the effects of KXS. A possible mechanism was explored in the tests of antagonism of reserpine-induced ptosis, akinesia and hypothermia and 5-HTP induced head-twitch response in mice. The contents of monoamine neurotransmitters including epinephrine (NE), 5-hydroxytryptamine (5-HT) and dopamine (DA) in mice brain were determined by Elisa. Spontaneous motor activities of mice and rotarod test were performed to find whether KXS has excitatory or inhibitory actions on the central nervous system.

RESULTS

The results showed that intragastric administration of KXS at 175, 350, 700, 1400 mg/kg/day or fluoxetine at 28 mg/kg/day for 3 days significantly reduced the duration of immobility in TST and FST, while it showed no effect on the spontaneous motor activity and rotarod performance in mice. However, the effect was not dose-dependent. The pre-treatment with KXS or fluoxetine for 3 days could elevate the contents of NE, 5-HT and DA in mice brain significantly. When the mice were treated with KXS (350 mg/kg, p.o) or desipramine (30 mg/kg, p.o) for 7 days, both of them could antagonize reserpine-induced ptosis, akinesia and hypothermia. The KXS (350 mg/kg) also increased the accumulative number of the 5-HTP-induced head twitch response in mice in 20 min when KXS at dosages of 175, 350, 700 and 1400 mg/kg/day were performed per os (p.o.) during a 1-day, 3-day or 7-day period.

CONCLUSIONS

Our results suggested that KXS exerts antidepressant-like effect. A possible mechanism, at least in part, is via the central monoaminergic neurotransmitter system and 5-HT plays a major role.

Mood instability in women with premenstrual syndrome

OBJECTIVE

Most women of reproductive age experience premenstrual symptoms. Mood swings within a day and from day to day are a common complaint of people with mood problems (mood instability). We investigated whether mood instability was higher in women with premenstrual syndrome (PMS) than in a control group with no PMS.

METHODS

We prospectively studied mood and physical symptoms over two menstrual periods in 29 women with self-identified PMS and 31 women without PMS. We excluded women on hormonal birth control or with a history of past or current diagnoses of depression. We used the mean square successive difference derived from twice daily visual analogue scale ratings of mood as the measure of mood instability.

RESULTS

The women with PMS showed more irritable and depressed mood instability than the women without PMS. These differences were present whether or not the late luteal phase (seven days before the start of menstruation) was included in the data. On visual inspection of mood ratings, typically irritable and depressed moods increased in the late luteal phase. However, women with self-identified PMS showed a variety of mood patterns throughout the cycle.

CONCLUSION

Women with PMS have increased mood instability within the seven day premenstrual phase and at other times as well. This supports the premise that PMS may represent a manifestation of an underlying problem of mood dysregulation in common with other mood disorders.

Vaccinium myrtillus ameliorates unpredictable chronic mild stress induced depression: possible involvement of nitric oxide pathway

Chronic unpredictable stressors can produce a situation similar to clinical depression and such animal models can be used for the preclinical evaluation of antidepressants. Nitric oxide, a secondary messenger molecule, has been implicated in neurotransmission, synaptic plasticity, learning, aggression and depression. Vaccinium myrtillus (bilberry) extract is a potent inhibitor of reactive oxygen/nitrogen species and cytokine production. The present study investigated the role of nitric oxide in the antidepressant action of Vaccinium myrtillus in unpredictable chronic mild stress-induced depression in mice. Animals were subjected to different stress paradigms daily for a period of 21 days to induce depressive-like behavior. Pretreatment with L-arginine significantly reversed the protective effect of bilberry (500 mg/kg) on chronic stress-induced behavioral (immobility period, sucrose preference) and biochemical (lipid peroxidation and nitrite levels; endogenous antioxidant activities) in stressed mice. Furthermore, L-NAME (10 mg/kg) pretreatment with a sub-effective dose of bilberry (250 mg/kg) significantly potentiated the protective effect of bilberry extract. The study revealed that modulation of the nitric oxide pathway might be involved in antidepressant-like effects of Vaccinium myrtillus in stressed mice.

Subjective distress predicts treatment seeking for depression, bipolar, anxiety, panic, neurasthenia and insomnia severity spectra

OBJECTIVE

To examine correlates of mental health treatment seeking such as gender, diagnosis, impairment, distress and mastery.

METHOD

Longitudinal epidemiological data from the Zurich Study of common psychiatric syndromes, including unipolar and bipolar depression, panic, anxiety, neurasthenia and insomnia, were utilized. In longitudinal Generalized Estimating Equations, treatment seeking was regressed on measures of subjective distress and impairment, childhood family problems, mastery and number of comorbid diagnoses.

RESULTS

Approximately half of all treated participants across all six syndromes suffered from subthreshold disorders. Meeting full or subthreshold diagnostic criteria was associated with treatment seeking for insomnia. Being female was associated with treatment seeking for depression. The only variable highly and consistently associated with treatment seeking, across all syndromes, was subjective distress. Treated participants reported high levels of distress, work and social impairment in both diagnostic and subthreshold groups.

CONCLUSION

Subjective distress may be a better indicator of treatment seeking than symptom count.

Predictors of the longitudinal course of major depression in a Canadian population sample

OBJECTIVE

Most psychiatric epidemiologic studies have used cross-sectional methods, resulting in a lack of information about the longitudinal course of depressive disorders. The objective of our study was to describe the longitudinal epidemiology of major depressive episodes (MDEs) in a Canadian sample using data from the National Population Health Survey (NPHS).

METHODS

The NPHS started data collection in 1994 and has evaluated past-year MDE using repeat interviews of the same cohort every 2 years since then. In our study, we examined the number of weeks depressed during years when MDEs occurred, the proportion of respondents having MDEs at consecutive cycles, and MDE counts during follow-up.

RESULTS

A sizable proportion of MDEs were brief: about one-half of respondents with past-year MDE reported 8 or fewer weeks of depression during that year. Less than 10% reported that they were depressed for the entire year. However, a larger proportion (19.1%) fulfilled criteria for MDE on consecutive interview cycles, suggesting either persistence or rapid recurrence. The mean number of detected MDEs among those with at least 1 detected MDE up to 2006 was 2. Positive family history, evidence of comorbidity, negative cognitive style, stress, pain, and smoking were associated with a more negative course.

CONCLUSIONS

The longitudinal course of MDE in the general population is heterogeneous, including a mixture of brief and more protracted MDEs. Many risk factors for MDE are also associated with a negative course, exceptions being (younger) age and sex. These epidemiologic observations may assist with identification of patients requiring more intensive management in clinical practice.

Sustainable effects on suicidality were found for the Nuremberg alliance against depression

During an intense four-level community-based intervention program conducted in Nuremberg (490,000 inhabitants) in 2001 and 2002 [Nuremberg Alliance Against Depression (NAD)], the number of suicidal acts (main outcome completed + attempted suicides) had dropped significantly (-21.7%), a significant effect compared with the baseline year and the control region (Wuerzburg, about 290,000 inhabitants). To assess the sustainability of the intervention effects the number of suicidal acts was assessed in the follow-up year (2003), after the termination of the 2-year intervention. Also, in the follow-up year (2003), the reduction in suicidal acts compared with the baseline year in Nuremberg (2000 vs. 2003: -32.4%) was significantly larger than that in the control region (P = 0.0065). The reduction was even numerically larger than that of the intervention years (2001, 2002). Thus, 1 year after the end of the main intervention, preventive effects on suicidality of the NAD remain at least stable. The four-level intervention concept appears to be cost-effective and is presently implemented in many European regions.

Antidepressant effects of ginseng total saponins in the forced swimming test and chronic mild stress models of depression

Ginseng total saponins (GTS) are the major active components of Panax ginseng C.A. Meyer, which has been used as a popular tonic herb for 2000 years in Far East countries. In the present study, two classic animal models: the forced swimming test (FST) and the chronic mild stress (CMS) model were used to evaluate the antidepressant-like activities of GTS. It was observed that GTS at doses of 50 and 100 mg/kg significantly reduced the immobility time in the FST in mice after 7-day treatment. GTS also reversed the reduction in the sucrose preference index, decrease in locomotor activity as well as prolongation of latency of feeding in the novelty environment displayed by CMS rats. In addition, HPLC-ECD and immunohistochemical staining analysis indicated that the CMS-induced decrease in monoamine neurotransmitter concentration and brain-derived neurotrophic factor (BDNF) expression in the hippocampus were almost completely reversed by GTS. In conclusion, GTS exerts antidepressant-like effects in two highly specific and predictive animal models of depression. The activity of GTS in antidepression may be mediated partly through enhancing the monoamine neurotransmitter concentration and BDNF expression in the hippocampus.