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Musil R, Seemüller F, Meyer S, Spellmann I, Adli M, Bauer M, Kronmüller KT, Brieger P, Laux G, Bender W, Heuser I, Fisher R, Gaebel W, Schennach R, Möller HJ, Riedel M. Subtypes of depression and their overlap in a naturalistic inpatient sample of major depressive disorder. Int J Methods Psychiatr Res 2018; 27:e1569. [PMID: 29498147 PMCID: PMC6877097 DOI: 10.1002/mpr.1569] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 03/31/2017] [Accepted: 04/10/2017] [Indexed: 12/18/2022] Open
Abstract
Subtyping depression is important in order to further delineate biological causes of depressive syndromes. The aim of this study was to evaluate clinical and outcome characteristics of distinct subtypes of depression and to assess proportion and features of patients fulfilling criteria for more than one subtype. Melancholic, atypical and anxious subtypes of depression were assessed in a naturalistic sample of 833 inpatients using DSM-IV specifiers based on operationalized criteria. Baseline characteristics and outcome criteria at discharge were compared between distinct subtypes and their overlap. A substantial proportion of patients (16%) were classified with more than one subtype of depression, 28% were of the distinct anxious, 7% of the distinct atypical and 5% of the distinct melancholic subtype. Distinct melancholic patients had shortest duration of episode, highest baseline depression severity, but were more often early improvers; distinct anxious patients had higher NEO-Five Factor Inventory (NEO-FFI) neuroticism scores compared with patients with unspecific subtype. Melancholic patients with overlap of anxious features had worse treatment outcome compared to distinct melancholic and distinct anxious subtype. Distinct subtypes differed in only few variables and patients with overlap of depression subtypes may have independent clinical and outcome characteristics. Studies investigating biological causes of subtypes of depression should take influence of features of other subtypes into account.
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Affiliation(s)
- Richard Musil
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Florian Seemüller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany.,Department of Psychiatry and Psychotherapy, kbo-Lech-Mangfall-Klinik, Garmisch-Partenkirchen, Garmisch-Partenkirchen, Germany
| | - Sebastian Meyer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany.,Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zürich, Switzerland.,Institute of Medical Informatics, Biometry, and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Ilja Spellmann
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany.,Bezirkskrankenhaus Kaufbeuren, Bezirkskliniken Schwaben, Kaufbeuren, Germany
| | - Mazda Adli
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte (CCM), Berlin, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Klaus-Thomas Kronmüller
- Department of Psychiatry and Psychotherapy, University of Heidelberg, Heidelberg, Germany.,LWL-Klinikum, Gütersloh, Germany
| | - Peter Brieger
- Department of Psychiatry and Psychotherapy, Martin-Luther University Halle-Wittenberg, Halle, Germany.,Department of Psychiatry and Psychotherapy, kbo-Isar-Amper-Klinikum Munich East, Haar, Gemany
| | - Gerd Laux
- kbo-Inn-Salzach-Klinikum, Department of Psychiatry and Psychotherapy, Wasserburg, Gemany
| | - Wolfram Bender
- Department of Psychiatry and Psychotherapy, kbo-Isar-Amper-Klinikum Munich East, Haar, Gemany
| | - Isabella Heuser
- Department of Psychiatry, Charité - Campus Benjamin Franklin (CBF), Berlin, Germany
| | - Robert Fisher
- Department of Psychiatry and Psychotherapy, Auguste-Viktoria-Krankenhaus, Berlin, Germany.,South Hackney CMHT, Donald WinniCott Centre, London, UK
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Rebecca Schennach
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany.,Schön Klinik Roseneck, Prien, Rosenheim, Prien am Chiemsee, Germany
| | - Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Michael Riedel
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany.,Klinik für Psychiatrie & Psychotherapie II, Zentrum für Psychiatrie Calw Klinikum Nordschwarzwald, Calw-Hirsau, Germany
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Bjølseth TM, Engedal K, Benth JŠ, Dybedal GS, Gaarden TL, Tanum L. Baseline cognitive function does not predict the treatment outcome of electroconvulsive therapy (ECT) in late-life depression. J Affect Disord 2015; 185:67-75. [PMID: 26143406 DOI: 10.1016/j.jad.2015.06.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 06/15/2015] [Accepted: 06/15/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND No prior study has investigated whether impairment of specific cognitive functions at baseline may predict the short-term treatment outcome of electroconvulsive therapy (ECT) in elderly non-demented patients with major depression (MD). METHODS This longitudinal cohort study included 65 elderly patients with unipolar or bipolar MD, aged 60-85 years, treated with formula-based ECT. Treatment outcome was assessed using the 17-item Hamilton Rating Scale for Depression (HRSD17). Cognitive function at baseline was assessed using nine neuropsychological tests or subtests measuring information processing speed, verbal learning and memory, and aspects of executive function. RESULTS A poorer performance on the word reading task of the Color Word Interference Test rendered higher odds of achieving remission during the ECT course (p=0.021). Remission was defined as an HRSD17 score of 7 or less. There were no other significant associations between the treatment outcome of ECT and cognitive performance parameters assessed at baseline. LIMITATIONS The limited number of subjects may have reduced the generalizability of the findings. Multiple statistical tests increase the risk for making a type I error. CONCLUSIONS How well patients perform on neuropsychological tests at baseline is most likely not a predictor of, or otherwise not significantly associated with the treatment outcome of formula-based ECT in elderly patients with MD.
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Affiliation(s)
- Tor Magne Bjølseth
- Department of Geriatric Psychiatry, Diakonhjemmet Hospital, Pastor Fangens vei 18, 0854 Oslo, Norway.
| | - Knut Engedal
- Norwegian Centre for Aging and Health, Vestfold Health Trust, Tønsberg, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Norway; HØKH, Research Centre, Akershus University Hospital, Norway
| | - Gro Strømnes Dybedal
- Department of Geriatric Psychiatry, Diakonhjemmet Hospital, Pastor Fangens vei 18, 0854 Oslo, Norway
| | - Torfinn Lødøen Gaarden
- Department of Geriatric Psychiatry, Diakonhjemmet Hospital, Pastor Fangens vei 18, 0854 Oslo, Norway
| | - Lars Tanum
- Department of Research and Development in Mental Health, Akershus University Hospital, Norway
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