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Kendler KS, Justis V. Joseph Guislain's writings on melancholia from 1835 and 1852. J Affect Disord 2024; 351:278-284. [PMID: 38253135 DOI: 10.1016/j.jad.2024.01.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 01/16/2024] [Accepted: 01/19/2024] [Indexed: 01/24/2024]
Abstract
Over the course of the 19th century, the concept of melancholia morphed from a partial insanity defined by disorders of judgment to a disorder characterized primarily by mood disturbances. The francophone Belgian psychiatrist Joseph Guislain, whose work has not been previously translated into English, played an important role in this transition. We translate and comment upon two of his key descriptions of melancholia from 1835 and 1852, emphasizing the following 5 features. First, his concept of melancholia is quite "modern" meeting all DSM-5 criteria for major depression. Second, his clinical descriptions are vivid, often giving voice to his patients. Third, other aspects of his text reflect older concepts, including 17th century melancholic subtypes. Fourth, and of particular historical import, he was, in 1835, likely the first major European alienist to argue that nonpsychotic melancholia was an important form of the disorder and a legitimate mental illness. This represented key step in the transition of melancholia from a psychotic to a mood disorder and also helped expand the 18th century model of insanity which was as restricted solely to disturbances of judgment/imagination. Fifth, beginning with his 1835 writings, but more prominently in his 1852 text, Guislain emphasizes that melancholia is a form of phrenalgia - mental pain. In so doing, he played an important role in helping initiate this influential psychophysiological theory of melancholia that was championed by Wilhelm Griesinger and other important German and English psychiatrists later in the 19th century.
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Affiliation(s)
- Kenneth S Kendler
- Virginia Institute of Psychiatric and Behavioral Genetics, Departments of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
| | - Virginia Justis
- Virginia Institute of Psychiatric and Behavioral Genetics, Departments of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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Parker G, Tavella G, Spoelma MJ, Sazhin V. Does theta burst stimulation have differential benefit for those with melancholic or non-melancholic depression? J Affect Disord 2024; 350:847-853. [PMID: 38272362 DOI: 10.1016/j.jad.2024.01.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND To determine if theta burst stimulation (TBS) is of preferential benefit to those with melancholic or non-melancholic depression as an adjunctive treatment for treatment resistant depression (TRD). METHODS Fifty-two patients receiving TBS at a private psychiatric hospital participated in a naturalistic study. Four diagnostic strategies were used to assign melancholic versus non-melancholic depression subtype status. Depression symptoms were assessed at baseline, mid-treatment, and end of treatment using the Montgomery-Ǻsberg Depression Rating Scale - Self-Assessment (MADRS-S). Forty-one participants also completed the MADR-S at a six-week follow-up assessment. RESULTS We quantified poor correlations between the four study measures of melancholia; a finding suggesting that valid measurement of melancholia is likely to remain problematic. TBS led to significant reductions in depression symptoms from baseline to end of treatment, with this effect maintained at follow up. Response rates for the whole sample were 61.5 % at end of treatment and 53.7 % at follow-up, while remission rates were 34.6 % at end of treatment and 31.7 % at follow-up. Improvement rates as well as responder and remission rates were comparable for the melancholic and non-melancholic groups, irrespective of the diagnostic strategy used. LIMITATIONS The study was naturalistic (i.e., there being no control group, and concomitant medication changes were allowed), depression severity was assessed only by use of self-report measures, and the sample size was relatively small. CONCLUSION TBS appears to be non-specific, in that we failed to quantify any statistically significant differential benefit for those with melancholic compared to those with non-melancholic depression.
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Affiliation(s)
- Gordon Parker
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia; Gordon Private Hospital, Gordon, Sydney, Australia.
| | - Gabriela Tavella
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Michael J Spoelma
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia; Black Dog Institute, Sydney, Australia
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Martino DJ, Valerio MP. Revisiting the concept of bipolar depression: comparison of diagnostic validators between melancholic and non-melancholic episodes. Eur Arch Psychiatry Clin Neurosci 2024; 274:507-514. [PMID: 36583740 DOI: 10.1007/s00406-022-01546-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 12/19/2022] [Indexed: 12/31/2022]
Abstract
The current definition of bipolar disorder derives with minimal changes from one that emerged through expert consensus in the late 1970s, and the topic of its validity tended to be neglected in the literature. The aim of this exploratory study was to compare patients with bipolar disorder with a history of melancholic and non-melancholic depressive episodes in a series of external diagnostic validators. One hundred eight subjects were categorized as melancholic or non-melancholic in relation to their history of depressive episodes through the clinician-rated Sydney Melancholia Prototype Index (SMPI). The external validators used were clinical-demographic variables, family history of bipolar disorder, neurocognitive performance and functional outcome. There were 43.5% of the patients with a history of melancholia and 56.5% of non-melancholic depression. Non-melancholic depressions were overrepresented in females, while melancholic depressions had a female:male ratio closer to unity. Patients with melancholia had more history of BD in first-degree relatives and better functional outcome than those with non-melancholic depression. There were no differences between groups regarding neurocognitive performance. Results tended to be unchanged when controlled for confounders. Our preliminary results highlight the inherent heterogeneity in the current concept of bipolar depression, and suggest the need for further clinical research to elucidate its validity.
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Affiliation(s)
- Diego J Martino
- National Council of Scientific and Technical Research (CONICET), Godoy Cruz, 2290, Buenos Aires, Argentina.
- Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University. Pacheco de Melo 1854, Buenos Aires, Argentina.
| | - Marina P Valerio
- National Council of Scientific and Technical Research (CONICET), Godoy Cruz, 2290, Buenos Aires, Argentina
- Psychiatric Emergencies Hospital Torcuato de Alvear, Av. Warnes 2630, Buenos Aires, Argentina
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Szmulewicz A, Valerio MP, Lomastro J, Martino DJ. Melancholic features and treatment outcome to selective serotonin reuptake inhibitors in major depressive disorder: A re-analysis of the STAR*D trial. J Affect Disord 2024; 347:101-107. [PMID: 37981037 DOI: 10.1016/j.jad.2023.11.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/24/2023] [Accepted: 11/13/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Melancholia has been positioned as a qualitatively different form of Major Depressive Disorder (MDD). Some studies have suggested that melancholic MDD patients may show lower remission when receiving treatment with Selective Serotonin Reuptake Inhibitors, but this has not yet been explored in large, representative samples of MDD. METHODS We used data from the STAR*D, a multisite randomized controlled trial (n = 4041). We defined melancholia status through the BA Melancholia Empirical Index, constructed using items from the Inventory of Depressive Symptomatology (IDSC). The main outcome of interest was symptomatic remission defined as a Quick Inventory of Depressive Symptoms (Clinician version) (QIDS-C) below or equal to 5. Inverse probability weighting was used to control for confounding. RESULTS 3827 patients were eligible for this study. Melancholic patients were more likely to be unemployed, never married, to self-report an African American race, and to have a higher depressive severity. The adjusted 4-month probability of remission was 26.9 % (22.0, 45.5) for melancholic and 53.8 % (53.2, 58.5), for nonmelancholic patients. Compared with nonmelancholic, the difference in 4-month probability of remission was -26.9 % (-37.0, -15.6). Results were consistent across sensitivity analyses. LIMITATIONS Items from IDSC were used as a surrogate measure of the BA Melancholia Index, and extrapolation of the results to agents other than citalopram and to psychotic MDD patients requires caution. CONCLUSIONS Melancholic MDD patients showed lower probabilities of remission at 4-months receiving treatment with citalopram. The results of this study show how validly subtyping episodes could contribute to the personalized treatment of depression.
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Affiliation(s)
- Alejandro Szmulewicz
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, USA
| | | | | | - Diego J Martino
- Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Argentina; National Council of Scientific and Technical Research (CONICET), Argentina.
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Bayes A, Weickert TW, Parker G, Spoelma MJ, North HF, Lam-Po-Tang J, Weickert CS. Peripheral inflammatory markers in melancholic versus non-melancholic depression. Psychoneuroendocrinology 2024; 159:106418. [PMID: 37856925 DOI: 10.1016/j.psyneuen.2023.106418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/08/2023] [Accepted: 10/12/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Peripheral inflammation has been associated with major depression, however there is a paucity of studies examining whether inflammatory profiles differ across depressive subtypes. The current study sought to compare peripheral inflammatory markers in patients with melancholic versus non-melancholic depression and with healthy controls. METHOD Eighty outpatients with a current major depressive episode (MDE) were assigned as having a melancholic or a non-melancholic depressive subtype based on clinician diagnosis and the Sydney Melancholic Prototypic Index (SMPI). Participants provided peripheral venous blood from which plasma levels of cytokines and other inflammatory markers (C-reactive protein (CRP), neutrophil/lymphocyte ratio, plasma cytokines) were compared across the two patient groups and also to a group of 81 age-matched healthy controls. RESULTS Patients with melancholic and non-melancholic depression demonstrated increased CRP and decreased interferon-gamma (IFN-γ) levels compared to controls. Using clinician diagnosis of subtype, interleukin-12 (IL-12) and interleukin-10 (IL-10) levels were elevated in melancholic patients versus non-melancholic and control groups, with no differences found for the other measured markers of inflammation. CONCLUSION Study findings demonstrate shared inflammatory changes across certain inflammatory markers (CRP and IFN-γ) and increases in IL-12 and IL-10 levels specific to melancholic depression. While generally supportive of previous work, our peripheral inflammation findings in melancholic depression are relatively novel and suggest this subgroup may benefit from anti-inflammatory therapies. Further studies are required to replicate these findings.
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Affiliation(s)
- Adam Bayes
- Black Dog Institute, Sydney, Australia; Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW, Sydney, Australia; Red Tree Practice, Sydney, Australia.
| | - Thomas W Weickert
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW, Sydney, Australia; Department of Neuroscience & Physiology, State University of New York (SUNY), Upstate Medical University, Syracuse, NY, USA; Neuroscience Research Australia (NeuRA), Randwick, Australia
| | - Gordon Parker
- Black Dog Institute, Sydney, Australia; Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW, Sydney, Australia
| | - Michael J Spoelma
- Black Dog Institute, Sydney, Australia; Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW, Sydney, Australia
| | - Hayley F North
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW, Sydney, Australia; Neuroscience Research Australia (NeuRA), Randwick, Australia
| | | | - Cyndi Shannon Weickert
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW, Sydney, Australia; Department of Neuroscience & Physiology, State University of New York (SUNY), Upstate Medical University, Syracuse, NY, USA; Neuroscience Research Australia (NeuRA), Randwick, Australia
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Martini M, Arenhardt FK, Caldieraro MA, Fleck MP, Feiten JG, Marschner RA, Wajner SM. Chronic pain predicts a worse response to depression treatment, regardless of thyroid function or psychotropics prescribed. J Affect Disord 2023; 343:1-7. [PMID: 37734625 DOI: 10.1016/j.jad.2023.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/28/2023] [Accepted: 09/18/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Chronic pain (CP) and thyroid hormones' (TH) abnormalities are associated with depression, but the impact of pain and TH fluctuation on the response to depression treatment is uncertain. METHODS Eighty-eight patients with major depression were evaluated before and after 6 months of specific treatment, through scales of symptoms' severity (HAM-D-17), psychomotor disturbance (CORE), and quality of life (WHOQOL-Bref). We reviewed psychiatric medications and measured TSH, T3 and T4. We used Generalized Estimating Equations to assess the interaction effect between CP and treatment time on depression severity and TH levels, and Bonferroni to compare means. RESULTS 47.7 % of the patients had CP. Patients with and without CP did not differ at baseline. At follow-up, those with CP experienced a more modest decrease in symptoms' severity and no improvement in any domain of psychomotor disturbance, contrasting with a decrease of over 40 % from the baseline values of CORE in patients without CP (non-CP). Initial and final scores were respectively: HAM-D CP 24.06 and 19.3, Δ = -4.75; HAM-D non-CP 22.92 and 14.7, Δ = -8.21; CORE CP 5.36 and 5.24, Δ = -0.12; CORE non-CP 5.8 and 3.22, Δ = -2.57. There was no interaction with TH or life quality. Model adjustments for psychotropic drugs received and sensitivity analysis excluding somatic symptoms from severity scales did not impact the results. LIMITATIONS Findings may not replicate in mildly depressed patients from primary care. Pain scales were not applied. CONCLUSIONS Individuals with chronic pain showed a suboptimal response to depression treatment, regardless of the medications used or TH levels.
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Affiliation(s)
- Murilo Martini
- Postgraduate Program in Medical Sciences: Endocrinology, Federal University of Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2400 Porto Alegre, RS, Brazil; Endocrine Division, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2350 Porto Alegre, RS, Brazil; Department of Internal Medicine, Federal University of Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2350 Porto Alegre, RS, Brazil; Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350 Porto Alegre, RS, Brazil.
| | - Fernanda Klagenberg Arenhardt
- Postgraduate Program in Medical Sciences: Endocrinology, Federal University of Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2400 Porto Alegre, RS, Brazil; Endocrine Division, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2350 Porto Alegre, RS, Brazil; Department of Internal Medicine, Federal University of Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2350 Porto Alegre, RS, Brazil
| | - Marco Antonio Caldieraro
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350 Porto Alegre, RS, Brazil; Postgraduate Program in Psychiatry and Behavioral Sciences, Federal University of Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2400 Porto Alegre, RS, Brazil
| | - Marcelo P Fleck
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350 Porto Alegre, RS, Brazil; Postgraduate Program in Psychiatry and Behavioral Sciences, Federal University of Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2400 Porto Alegre, RS, Brazil
| | - Jacson Gabriel Feiten
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350 Porto Alegre, RS, Brazil; Postgraduate Program in Psychiatry and Behavioral Sciences, Federal University of Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2400 Porto Alegre, RS, Brazil
| | - Rafael Aguiar Marschner
- Postgraduate Program in Medical Sciences: Endocrinology, Federal University of Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2400 Porto Alegre, RS, Brazil; Endocrine Division, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2350 Porto Alegre, RS, Brazil; Department of Internal Medicine, Federal University of Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2350 Porto Alegre, RS, Brazil
| | - Simone Magagnin Wajner
- Postgraduate Program in Medical Sciences: Endocrinology, Federal University of Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2400 Porto Alegre, RS, Brazil; Endocrine Division, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2350 Porto Alegre, RS, Brazil; Department of Internal Medicine, Federal University of Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2350 Porto Alegre, RS, Brazil
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Buss JF, Watts AL, Lorenzo-Luaces L. Methods for quantifying the heterogeneity of psychopathology. BMC Psychiatry 2023; 23:897. [PMID: 38037069 PMCID: PMC10690966 DOI: 10.1186/s12888-023-05377-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 11/13/2023] [Indexed: 12/02/2023] Open
Abstract
OBJECTIVES Specifiers for a major depressive disorder (MDE) are supposed to reduce diagnostic heterogeneity. However, recent literature challenges the idea that the atypical and melancholic specifiers identify more homogenous or coherent subgroups. We introduce the usage of distance metrics to characterize symptom heterogeneity. We attempt to replicate prior findings and explore whether symptom heterogeneity is reduced using specifier subgroups. METHODS We used data derived from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC Wave I; N = 5,749) and the Sequenced Treatment Alternatives to Relieve Depression study (STAR*D; N = 2,498). We computed Hamming and Manhattan distances from study participants' unique symptom profiles. Distances were standardized from 0-1 and compared by their within- and between-group similarities to their non-specifier counterparts for the melancholic and atypical specifiers. RESULTS There was no evidence of statistically significant differences in heterogeneity for specifier (i.e., melancholic or atypical) vs. non-specifier designations (i.e., non-melancholic vs. non-atypical). CONCLUSION Replicating prior work, melancholic and atypical depression specifiers appear to have limited utility in reducing heterogeneity. The current study does not support the claim that specifiers create more coherent subgroups as operationalized by similarity in the number of symptoms and their severity. Distance metrics are useful for quantifying symptom heterogeneity.
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Affiliation(s)
- John F Buss
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN 47405, USA.
| | - Ashley L Watts
- Department of Psychology, Vanderbilt University, Nashville, TN 37420, USA
| | - Lorenzo Lorenzo-Luaces
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN 47405, USA
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Sharpley CF, Bitsika V, Shadli SM, Jesulola E, Agnew LL. Alpha wave asymmetry is associated with only one component of melancholia, and in different directions across brain regions. Psychiatry Res Neuroimaging 2023; 334:111687. [PMID: 37480706 DOI: 10.1016/j.pscychresns.2023.111687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/06/2023] [Accepted: 07/17/2023] [Indexed: 07/24/2023]
Abstract
Alpha wave asymmetry inconsistently correlates with Major Depressive Disorder (MDD). One possible reason for this inconsistency is the heterogeneity of MDD, leading to study of depressive 'subtypes', one of which is Melancholia. To investigate the correlation between Melancholia and alpha-wave asymmetry, 100 community participants (44 males, 56 females; aged at least 18 yr) completed the Zung self-rated Depression Scale, and underwent 3 min of eyes closed EEG recording from 24 scalp sites. There was no significant correlation between EEG data and Melancholia total score for the entire sample, but there was for those participants who had clinically significant depression (n = 33). When examined at the level of individual Melancholia scale items, significant EEG data correlations were found for some of the items but not for others. Factor analysis revealed a two-factor structure for the Melancholia scale, only one of which exhibited significant correlations with EEG AA data. Further exploration of those data identified two subcomponents of that Melancholia factor, one which was inversely correlated with frontal alpha asymmetry, and another which was directly correlated with parietal-occipital alpha wave asymmetry. These findings suggest that Melancholia may itself be heterogeneous, similarly to MDD, and rely upon different aspects of cognitive function.
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Affiliation(s)
- Christopher F Sharpley
- Brain-Behaviour Research Group, University of New England, Armidale, New South Wales, 2350, Australia; School of Science & Technology, University of New England, Queen Elizabeth Drive, Armidale, New South Wales, 2351, Australia.
| | - Vicki Bitsika
- Brain-Behaviour Research Group, University of New England, Armidale, New South Wales, 2350, Australia
| | - Shabah M Shadli
- Brain-Behaviour Research Group, University of New England, Armidale, New South Wales, 2350, Australia
| | - Emmanuel Jesulola
- Brain-Behaviour Research Group, University of New England, Armidale, New South Wales, 2350, Australia; Emmanuel Jesulola is now at Department of Neurosurgery, The Alfred Hospital, Melbourne, Australia
| | - Linda L Agnew
- Brain-Behaviour Research Group, University of New England, Armidale, New South Wales, 2350, Australia; Linda Agnew is now at Griffith University, Qld, Australia
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Nöbbelin L, Bogren M, Mattisson C, Brådvik L. Incidence of melancholic depression by age of onset and gender in the Lundby population, 1947-1997. Eur Arch Psychiatry Clin Neurosci 2022. [PMID: 36334129 DOI: 10.1007/s00406-022-01506-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Abstract
Whether melancholic depression is a distinct syndrome or not has long been debated. There are few studies providing information about the epidemiology of melancholic depression. In this study, we investigate the incidence rates, overall as well as by gender and age of onset of melancholic depression according to Taylor and Fink and corresponding DSM-IV disorders: major depressive disorder (MDD) with melancholic specifier, MDD with psychotic features, MDD with postpartum debut and bipolar depression in the Lundby population. Incidence rates with 95% confidence intervals were calculated. The incidence rate of melancholic depression was 0.48 (CI 0.36-0.61) per 1000 person-years under risk. The rates of the corresponding DSM-IV disorders were as follows: MDD with melancholic specifier 0.38 (CI 0.27-0.49), MDD with psychotic features 0.13 (CI 0.07-0.21), MDD with postpartum debut 0.02 (CI 0.00-0.06) and bipolar depression 0.04 (CI 0.01-0.10). Females had a significantly higher incidence rate, with a peak in age group 40-49, in melancholic depression according to Taylor and Fink and MDD with melancholic specifier. There was no gender difference in incidence rates of MDD with psychotic features or bipolar depression. The diagnoses were set in retrospect and the number of subjects with MDD with postpartum debut and bipolar depression was low. Incidence of melancholia was low in the Lundby Study. There was a female preponderance to become melancholically depressed in line with research on undifferentiated depression.
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Waite S, Tor PC, Mohan T, Davidson D, Hussain S, Dong V, Loo CK, Martin DM. The utility of the Sydney Melancholia Prototype Index (SMPI) for predicting response to electroconvulsive therapy in depression: A CARE Network study. J Psychiatr Res 2022; 155:180-185. [PMID: 36054966 DOI: 10.1016/j.jpsychires.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/03/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022]
Abstract
An enhanced understanding of clinical predictors of positive ECT outcome could assist with the decision to prescribe ECT for select patients. Reliable predictors of ECT response such as psychotic symptoms and age have been identified, however, studies of melancholia and ECT response have been inconsistent. The Sydney Melancholia Prototype Index (SMPI) is a clinical measure designed to differentiate melancholic and non-melancholic depression. This study aimed to investigate whether melancholic depression (as measured by the clinician rated version of the SMPI) predicted a better response to ECT than non-melancholic depression. The study included data collated from four participating sites in the Clinical Alliance for ECT and Related treatments (CARE) network. The primary outcome was response (>50% improvement) on the Montgomery Asberg Depression Rating Scale (MADRS) and the secondary outcome was raw change in MADRS score. Of the 329 depressed patients included in the study, 81% had melancholic features and 76% met criteria for clinical response. SMPI defined melancholia was associated with older age, higher pre-treatment mood scores and presence of psychosis. Melancholia as defined by the SMPI, however, did not significantly predict either clinical response or overall mood improvement with ECT in multivariate analyses. Instead, older age, greater pre-treatment depression severity and the use of bifrontal compared to right unilateral ultrabrief ECT were significant predictors of mood improvement. Path analysis showed that higher pre-treatment mood score and older age were independently associated with mood improvement with ECT.
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Affiliation(s)
- S Waite
- The Queen Elizabeth Hospital, South Australia, Australia
| | - P C Tor
- Institute of Mental Health, Singapore
| | - T Mohan
- Flinders Medical Centre, South Australia, Australia
| | - D Davidson
- Flinders Medical Centre, South Australia, Australia
| | - S Hussain
- Sir Charles Gairdner Hospital, North Metro Health Service, Western Australia, Australia; Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Australia; Section of ECT and Neurostimulation, Royal Australian and New Zealand College of Psychiatrists, Australia
| | - V Dong
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW, Australia; Black Dog Institute, Sydney, NSW, Australia
| | - C K Loo
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW, Australia; Black Dog Institute, Sydney, NSW, Australia
| | - D M Martin
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW, Australia; Black Dog Institute, Sydney, NSW, Australia.
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Valerio MP, Lomastro J, Igoa A, Martino DJ. Neurocognitive function of patients with melancholic and non-melancholic major depressive episodes: An exploratory study. Aust N Z J Psychiatry 2022:48674221133743. [PMID: 36314084 DOI: 10.1177/00048674221133743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this exploratory study was to compare the neurocognitive performance of patients undergoing melancholic and non-melancholic major depressive episodes. Considering potential limitations of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) specifier, we employed an additional tool that has proven useful in identifying melancholia (the Sydney Melancholia Prototype Index). METHODS One hundred forty-one depressed inpatients were classified as melancholic or non-melancholic according to the Sydney Melancholia Prototype Index and the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) criteria and compared on a neurocognitive battery selected to assess attention and processing speed, verbal memory, working memory and executive functions. Results were controlled for several potential confounders. RESULTS Patients diagnosed as melancholic by the two diagnostic systems displayed lower scores in executive measures, semantic verbal fluency and phonological verbal fluency. On attention and processing speed, patients with melancholia underperformed those with non-melancholic depression only when diagnosed by the Sydney Melancholia Prototype Index. After controlling for confounders, associations between melancholic status and executive dysfunction remained significant for the Sydney Melancholia Prototype Index but not for the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) diagnosis. CONCLUSION In this study, melancholia diagnosed by the Sydney Melancholia Prototype Index (but not by the Diagnostic and Statistical Manual of Mental Disorders [5th ed.] criteria) was characterized by a greater compromise of tests assessing executive functions than non-melancholic depressions, even after controlling for depressive severity. These preliminary results might contribute to generating hypotheses about differences in the cognitive profile and pathophysiological substrate between melancholic and non-melancholic depressions. Likewise, the pattern of findings supports the hypothesis that the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) melancholia specifier might identify more severe forms of depressive episodes rather than a qualitatively different subtype.
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Affiliation(s)
- Marina P Valerio
- National Council of Scientific and Technical Research (CONICET), Ciudad Autónoma de Buenos Aires, Argentina.,Psychiatric Emergencies Hospital Torcuato de Alvear, Ciudad Autónoma de Buenos Aires, Argentina
| | - Julieta Lomastro
- Psychiatric Emergencies Hospital Torcuato de Alvear, Ciudad Autónoma de Buenos Aires, Argentina
| | - Ana Igoa
- Psychiatric Emergencies Hospital Torcuato de Alvear, Ciudad Autónoma de Buenos Aires, Argentina
| | - Diego J Martino
- National Council of Scientific and Technical Research (CONICET), Ciudad Autónoma de Buenos Aires, Argentina.,Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Ciudad Autónoma de Buenos Aires, Argentina
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12
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Affiliation(s)
- Rajiv Tandon
- Department of Psychiatry, WMU Homer Stryker School of Medicine, Kalamazoo, MI, United States of America.
| | - John F Greden
- Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, MI, United States of America
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13
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Mertse N, Denier N, Walther S, Breit S, Grosskurth E, Federspiel A, Wiest R, Bracht T. Associations between anterior cingulate thickness, cingulum bundle microstructure, melancholia and depression severity in unipolar depression. J Affect Disord 2022; 301:437-444. [PMID: 35026360 DOI: 10.1016/j.jad.2022.01.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 01/04/2022] [Accepted: 01/08/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Structural and functional alterations of the anterior cingulate cortex (ACC) have been related to emotional, cognitive and behavioral domains of major depressive disorder. In this study, we investigate cortical thickness of rostral and caudal ACC. In addition, we explore white matter microstructure of the cingulum bundle (CB), a white matter pathway connecting multiple segments of the ACC. We hypothesized reduced cortical thickness and reduced white matter microstructure of the CB in MDD, in particular in the melancholic subtype. In addition, we expect an association between depression severity and CB microstructure. METHODS Fifty-four patients with a current depressive episode and 22 healthy controls matched for age, gender and handedness underwent structural and diffusion-weighted MRI-scans. Cortical thickness of rostral and caudal ACC were computed. The CB was reconstructed bilaterally using manual tractography. Cortical thickness and fractional anisotropy (FA) of bilateral CB were compared first between all patients and healthy controls and second between healthy controls, melancholic and non-melancholic patients. Correlations between FA and depression severity were calculated. RESULTS We found no group differences in rostral and caudal ACC cortical thickness or in FA of the CB comparing all patients with healthy controls. Melancholic patients had reduced cortical thickness of bilateral caudal ACC compared to non-melancholic patients and compared to healthy controls. Across all patients, depression severity was associated with reduced FA in bilateral CB. LIMITATIONS Impact of medication CONCLUSIONS: Cortical thickness of the caudal ACC is associated with the melancholic syndrome. CB microstructure may represent a marker of depression severity.
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Affiliation(s)
- Nicolas Mertse
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000 Bern 60, Bern, Switzerland
| | - Niklaus Denier
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000 Bern 60, Bern, Switzerland
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000 Bern 60, Bern, Switzerland
| | - Sigrid Breit
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000 Bern 60, Bern, Switzerland
| | - Elmar Grosskurth
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000 Bern 60, Bern, Switzerland
| | - Andrea Federspiel
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000 Bern 60, Bern, Switzerland
| | - Roland Wiest
- Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Bern, Switzerland
| | - Tobias Bracht
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000 Bern 60, Bern, Switzerland.
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14
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Lorenzo-Luaces L, Buss JF, Fried EI. Heterogeneity in major depression and its melancholic and atypical specifiers: a secondary analysis of STAR*D. BMC Psychiatry 2021; 21:454. [PMID: 34530785 PMCID: PMC8447832 DOI: 10.1186/s12888-021-03444-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 08/19/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The melancholic and atypical specifiers for a major depressive episode (MDE) are supposed to reduce heterogeneity in symptom presentation by requiring additional, specific features. Fried et al. (2020) recently showed that the melancholic specifier may increase the potential heterogeneity in presenting symptoms. In a large sample of outpatients with depression, our objective was to explore whether the melancholic and atypical specifiers reduced observed heterogeneity in symptoms. METHODS We used baseline data from the Inventory of Depression Symptoms (IDS), which was available for 3,717 patients, from the Sequenced Alternatives to Relieve Depression (STAR*D) trial. A subsample met criteria for MDE on the IDS ("IDS-MDE"; N =2,496). For patients with IDS-MDE, we differentiated between those with melancholic, non-melancholic, non-melancholic, atypical, and non-atypical depression. We quantified the observed heterogeneity between groups by counting the number of unique symptom combinations pertaining to their given diagnostic group (e.g., counting the melancholic symptoms for melancholic and non-melancholic groups), as well as the profiles of DSM-MDE symptoms (i.e., ignoring the specifier symptoms). RESULTS When considering the specifier and depressive symptoms, there was more observed heterogeneity within the melancholic and atypical subgroups than in the IDS-MDE sample (i.e., ignoring the specifier subgroups). The differences in number of profiles between the melancholic and non-melancholic groups were not statistically significant, irrespective of whether focusing on the specifier symptoms or only the DSM-MDE symptoms. The differences between the atypical and non-atypical subgroups were smaller than what would be expected by chance. We found no evidence that the specifier groups reduce heterogeneity, as can be quantified by unique symptom profiles. Most symptom profiles, even in the specifier subgroups, had five or fewer individuals. CONCLUSION We found no evidence that the atypical and melancholic specifiers create more symptomatically homogeneous groups. Indeed, the melancholic and atypical specifiers introduce heterogeneity by adding symptoms to the DSM diagnosis of MDE.
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Affiliation(s)
- Lorenzo Lorenzo-Luaces
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, 47405 IN USA
| | - John F. Buss
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, 47405 IN USA
| | - Eiko I. Fried
- Department of Psychology, Leiden University, Leiden, 2333 AK Netherlands
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15
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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16
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Abstract
BACKGROUND The status of melancholia as a categorical or dimensional condition remains unclear, and no measure of melancholia has achieved definitive status. This study aimed to use a machine learning approach to assess whether a pre-established cut-off score on the Sydney Melancholia Prototype Index (SMPI) provided clear differentiation of melancholic/non-melancholic depression, and to identify the items making the most distinct contribution. METHODS We analysed amalgamated data sets of 1513 clinically depressed patients assessed via the clinician-rated version of the SMPI (SMPI-CR). We also evaluated the self-report version of the SMPI (SMPI-SR) in a combined clinical/community sample of 2025 depressed patients and senior high school students. Rule ensembles were derived in which the outcome measure was the presence/absence of melancholia (defined as scoring at or above a SMPI cut-off score that had been established in previous studies) and the predictive variables were the individual SMPI items. RESULTS The pre-established SMPI cut-off score was confirmed as differentiating melancholic/non-melancholic with near perfect accuracy for the SMPI-CR, and with very high accuracy for the SMPI-SR. The relative importance of all SMPI items was quantified. LIMITATIONS It is difficult to validate SMPI-assigned diagnoses due to the lack of any similar measures. CONCLUSIONS The SMPI-CR was confirmed to be a highly precise instrument for differentiating melancholic and non-melancholic depression. Its use will advance clinical decision making and studies evaluating causes, mechanisms and treatments for the two depressive sub-types, as well as assist clarification as to whether melancholia is categorically or dimensionally distinct from non-melancholic depression.
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17
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Peters EM, Bowen R, Balbuena L. Melancholic depression and response to quetiapine: A pooled analysis of four randomized placebo-controlled trials. J Affect Disord 2020; 276:696-8. [PMID: 32871702 DOI: 10.1016/j.jad.2020.07.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 05/20/2020] [Accepted: 07/05/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Melancholic depression may preferentially respond to certain treatments. This study examined the efficacy of extended-release quetiapine monotherapy in patients with melancholic and nonmelancholic major depressive disorder. METHODS Data from four randomized placebo-controlled trials was pooled. Melancholic features were assessed with baseline depression scale items according to DSM criteria. The outcome measure was response on the Montgomery-Åsberg Depression Rating Scale. Cox regression models predicting response over time with interactions between treatment condition and melancholic status were used to test for treatment effect heterogeneity. RESULTS The 6-week response rate difference between quetiapine and placebo was roughly 10% greater in the melancholic subgroup, primarily due to a lower placebo response, although the subgroup-treatment interactions did not reach statistical significance. The main effect of quetiapine was significant in every model. LIMITATIONS The main limitations were the retrospective analysis and the post-hoc designation of melancholic depression based on scale items not designed for that purpose. Results should be considered preliminary and exploratory until replicated. CONCLUSIONS The lower placebo response rate in the melancholic subgroup is consistent with past research and reinforces the benefit of pharmacotherapy for these patients.
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18
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Powell A, Graham D, Portley R, Snowdon J, Hayes MW. Wearable technology to assess bradykinesia and immobility in patients with severe depression undergoing electroconvulsive therapy: A pilot study. J Psychiatr Res 2020; 130:75-81. [PMID: 32798772 DOI: 10.1016/j.jpsychires.2020.07.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 12/18/2022]
Abstract
The psychomotor retardation that may be seen in major depression represents an interesting parallel to bradykinesia, a core feature of Parkinson's disease. Psychomotor retardation has been correlated with the severity of depression and is a predictor of response to electroconvulsive therapy (ECT). Psychomotor retardation has typically been assessed by subjective clinical judgement including clinical rating scales. Gross activity levels have also been measured with actigraphy previously. The Parkinson's KinetiGraph (PKG) was developed to assess bradykinesia, dyskinesia and tremor in Parkinson's disease and allows for an objective assessment of motor symptoms over time. It has not been used previously to assess motor symptoms in depression. The aim of the current pilot study was to use the PKG to objectively measure both bradykinesia and immobility in depressed inpatients undergoing ECT before, during and at the end of therapy and review correlations with depressive symptomatology and treatment response. The majority of patients (9/12) had PKG defined bradykinesia at baseline and 7/9 of these improved with ECT. All patients with bradykinesia who remitted clinically demonstrated improvements in bradykinesia scores. PKG defined immobility was present at baseline in 11/12 total patients and improved in the majority of these patients (9/11) post ECT. Correlations between clinically assessed melancholia and PKG measures were significant (r = 0.701, p 0.011 at baseline to rs = 0.655, p 0.021 at end). A strong association between bradykinesia and immobility scores and depression severity was not seen. The PKG is a potentially useful wearable technology to objectively assess motor symptoms in depression.
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Affiliation(s)
- Alice Powell
- Department of Neurology, Concord Repatriation General Hospital, Sydney, NSW, Australia.
| | - David Graham
- Concord Centre for Mental Health, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Rosemarie Portley
- Department of Neurology, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - John Snowdon
- Concord Centre for Mental Health, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Michael W Hayes
- Department of Neurology, Concord Repatriation General Hospital, Sydney, NSW, Australia
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19
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Lorenzo-Luaces L, Rutter LA, Scalco MD. Carving depression at its joints? Psychometric properties of the Sydney Melancholia Prototype Index. Psychiatry Res 2020; 293:113410. [PMID: 32854032 DOI: 10.1016/j.psychres.2020.113410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 08/05/2020] [Accepted: 08/17/2020] [Indexed: 11/27/2022]
Abstract
Parker and colleagues developed the Sydney Melancholia Prototype Index (SMPI), a 24-item measure to assess a potential subtype of depression: melancholia. While research supports the validity of the measure, no study has assessed its psychometric properties. We recruited 1633 participants online, of whom 487 reported a lifetime period of depressed mood or anhedonia and were administered the SMPI. We conducted confirmatory factor analyses (CFA) of the SMPI, to assess the proposed fit of the measure. We also conducted exploratory factor analyses (EFA) to explore the structure implied by the current data. CFA did not support the hypothesized factor structure of the SMPI, no matter what structure we assumed as primary (i.e., a one factor, two factor, or bifactor model). An EFA suggested a five-factor solution wherein several items did not appear to co-vary reliably and other factors captured the severity of melancholic symptoms, negative mood reactivity, positive mood reactivity, emotionality and family relationships, and early life adversity. The SMPI may not measure a single construct. Future research should explore the longitudinal association between depression severity, contaminant symptoms, positive and negative mood reactivity, and early life experiences.
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Affiliation(s)
- Lorenzo Lorenzo-Luaces
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, United States.
| | - Lauren A Rutter
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, United States
| | - Matthew D Scalco
- Department of Psychology, The University of New Orleans, New Orleans, LA, United States
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van Diermen L, Vanmarcke S, Walther S, Moens H, Veltman E, Fransen E, Sabbe B, van der Mast R, Birkenhäger T, Schrijvers D. Can psychomotor disturbance predict ect outcome in depression? J Psychiatr Res 2019; 117:122-128. [PMID: 31382133 DOI: 10.1016/j.jpsychires.2019.07.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/18/2019] [Accepted: 07/29/2019] [Indexed: 10/26/2022]
Abstract
Psychomotor symptoms are core features of melancholic depression. This study investigates whether psychomotor disturbance predicts the outcome of electroconvulsive therapy (ECT) and how the treatment modulates psychomotor disturbance. In 73 adults suffering from major depressive disorder psychomotor functioning was evaluated before, during and after ECT using the observer-rated CORE measure and objective measures including accelerometry and a drawing task. Regression models were fitted to assess the predictive value of melancholic depression (CORE ≥ 8) and the psychomotor variables on ECT outcome, while effects on psychomotor functioning were evaluated through linear mixed models. Patients with CORE-defined melancholic depression (n = 41) had a 4.9 times greater chance of reaching response than those (n = 24) with non-melancholic depression (Chi-Square = 7.5, P = 0.006). At baseline, both higher total CORE scores (AUC = 0.76; P = 0.001) and needing more cognitive (AUC = 0.78; P = 0.001) and motor time (AUC = 0.76; P = 0.003) on the drawing task corresponded to superior ECT outcomes, as did lower daytime activity levels (AUC = 0.76) although not significantly so after Bonferroni correction for multiple testing. A greater CORE-score reduction in the first week of ECT was associated with higher ECT effectiveness. ECT reduced CORE-assessed psychomotor symptoms and improved activity levels only in those patients showing the severer baseline retardation. Although the sample was relatively small, psychomotor symptoms were clearly associated with beneficial outcome of ECT in patients with major depression, indicating that monitoring psychomotor deficits can help personalise treatment.
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Affiliation(s)
- Linda van Diermen
- University Department, Psychiatric Hospital Duffel, Duffel, Belgium; Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
| | - Simon Vanmarcke
- University Department, Psychiatric Hospital Duffel, Duffel, Belgium; Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Herman Moens
- University Department, Psychiatric Hospital Duffel, Duffel, Belgium
| | - Eveline Veltman
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
| | - Erik Fransen
- StatUa Center for Statistics, University of Antwerp, Antwerp, Belgium
| | - Bernard Sabbe
- University Department, Psychiatric Hospital Duffel, Duffel, Belgium; Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Roos van der Mast
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
| | - Tom Birkenhäger
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Psychiatry, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Didier Schrijvers
- University Department, Psychiatric Hospital Duffel, Duffel, Belgium; Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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21
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Parker G, Tavella G, Hadzi-Pavlovic D. Identifying and differentiating melancholic depression in a non-clinical sample. J Affect Disord 2019; 243:194-200. [PMID: 30245251 DOI: 10.1016/j.jad.2018.09.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 08/06/2018] [Accepted: 09/11/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Differentiating melancholic and non-melancholic depressive disorders and evaluating whether they differ categorically or dimensionally has had a lengthy history, but has not previously been evaluated in a non-clinical adolescent sample. METHODS We studied a sample of 1579 senior high school students and evaluated the capacity of the Sydney Melancholia Prototype Index (SMPI) to differentiate melancholic from non-melancholic depression, both using a 'top down' strategy of imposing a pre-established cut-off score and a 'bottom up' strategy of employing latent class analyses. RESULTS The two strategies respectively generated prevalence figures of 3.4% and 8.1% of the students having experienced a melancholic depressive episode and with the difference reflecting the LCA assigning some students who did not reach the pre-established cut-off score for the SMPI in the putative melancholic class. The principal latent class analysis failed to generate pristine melancholic and non-melancholic depressive classes, in that it also generated an 'intermediate' as well as a non-clinical depressive class. Both SMPI strategies identified similar symptoms-such as anhedonia and anergia-and several illness correlates that best differentiated those assigned melancholia status, and both strategies confirmed melancholia assignment being associated with factors indicative of more severe depressive disorders and of likely melancholic depression. LIMITATIONS Data were assessed by self-report only, only lifetime depression was assessed, and no other depressive diagnostic validating measure was administered. CONCLUSIONS The SMPI appears capable of identifying and differentiating melancholic from non-melancholic depression in a non-clinical adolescent sample.
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Affiliation(s)
- Gordon Parker
- School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Sydney, Australia.
| | - Gabriela Tavella
- School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Sydney, Australia
| | - Dusan Hadzi-Pavlovic
- School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Sydney, Australia
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22
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Coryell W. Impact, Diagnosis, Phenomenology, and Biology. Handb Exp Pharmacol 2019; 250:3-33. [PMID: 31004226 DOI: 10.1007/164_2018_156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This section provides summaries of the epidemiology, phenomenology, nosology, and the suspected biological substrates of the depressive disorders. It particularly emphasizes the historical evolution of the pertinent diagnostic constructs and the prognostic import both of the various diagnostic groupings and of the individual symptoms and symptom clusters.
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Affiliation(s)
- William Coryell
- Department of Psychiatry, Carver College of Medicine, University of Iowa Health Care, Iowa City, IA, USA.
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Mickey BJ, Ginsburg Y, Sitzmann AF, Grayhack C, Sen S, Kirschbaum C, Maixner DF, Abelson JL. Cortisol trajectory, melancholia, and response to electroconvulsive therapy. J Psychiatr Res 2018; 103:46-53. [PMID: 29775916 PMCID: PMC6457450 DOI: 10.1016/j.jpsychires.2018.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/19/2018] [Accepted: 05/07/2018] [Indexed: 12/26/2022]
Abstract
While biomarkers have been used to define pathophysiological types and to optimize treatment in many areas of medicine, in psychiatry such biomarkers remain elusive. Based on previously described abnormalities of hypothalamic-pituitary-adrenal (HPA) axis function in severe forms of depression, we hypothesized that the temporal trajectory of basal cortisol levels would vary among individuals with depression due to heterogeneity in pathophysiology, and that cortisol trajectories that reflect elevated or increasing HPA activity would predict better response to electroconvulsive therapy (ECT). To test that hypothesis, we sampled scalp hair from 39 subjects with treatment-resistant depression just before ECT. Cortisol trajectory over the 12 weeks preceding ECT was reconstructed from cortisol concentrations in sequential hair segments. Cortisol trajectories varied widely between individuals, and exploratory analyses of clinical features revealed associations with melancholia and global severity. ECT non-responders showed a decreasing trajectory (mean change -25%, 95%-CI = [-1%,-43%]) during the 8 weeks preceding ECT (group-by-time interaction, p = 0.004). The association between cortisol trajectory and subsequent ECT response was independent of clinical features. A classification algorithm showed that cortisol trajectory predicted ECT response with 80% accuracy, suggesting that this biomarker might be developed into a clinically useful test for ECT-responsive depression. In conclusion, cortisol trajectory mapped onto symptoms of melancholia and independently predicted response to ECT in this severely depressed sample. These findings deserve to be replicated in a larger sample. Cortisol trajectory holds promise as a reliable, noninvasive, inexpensive biomarker for psychiatric disorders.
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Affiliation(s)
- Brian J. Mickey
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, USA,Department of Psychiatry, University of Michigan Medical School, Ann Arbor, USA
| | - Yarden Ginsburg
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, USA
| | - Adam F. Sitzmann
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, USA
| | - Clara Grayhack
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, USA
| | - Srijan Sen
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, USA
| | - Clemens Kirschbaum
- Department of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Daniel F. Maixner
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, USA
| | - James L. Abelson
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, USA
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Heu U, Bogren M, Wang AG, Brådvik L. Aspects of Additional Psychiatric Disorders in Severe Depression/ Melancholia: A Comparison between Suicides and Controls and General Pattern. Int J Environ Res Public Health 2018; 15:E1299. [PMID: 29933593 DOI: 10.3390/ijerph15071299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 06/06/2018] [Accepted: 06/19/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Additional and comorbid diagnoses are common among suicide victims with major depressive disorder (MDD) and have been shown to increase the suicide risk. The aim of the present study was first, to investigate whether patients with severe depression/melancholia who had died by suicide showed more additional psychiatric disorders than a matched control group. Second, general rates of comorbid and additional diagnoses in the total group of patients were estimated and compared with literature on MDD. METHOD A blind record evaluation was performed on 100 suicide victims with severe depression/melancholia (MDD with melancholic and/or psychotic features: MDD-M/P) and matched controls admitted to the Department of Psychiatry, Lund, Sweden between 1956 and 1969 and monitored to 2010. Diagnoses in addition to severe depression were noted. RESULTS Less than half of both the suicides and controls had just one psychiatric disorder (47% in the suicide and 46% in the control group). The average number of diagnoses was 1.80 and 1.82, respectively. Additional diagnoses were not related to an increased suicide risk. Anxiety was the most common diagnosis. Occurrence of suspected schizophrenia/schizotypal or additional obsessive-compulsive symptoms were more common than expected, but alcohol use disorders did not appear very frequent. CONCLUSIONS The known increased risk of suicide in MDD with comorbid/additional diagnoses does not seem to apply to persons with MDD-M/P (major depressive disorder-depression/Melancholia). Some diagnoses, such as schizophrenia/schizotypal disorders, were more frequent than expected, which is discussed, and a genetic overlap with MDD-M/P is proposed.
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Abraham R. Revisiting The Depleted Self. J Relig Health 2018; 57:561-574. [PMID: 29442218 DOI: 10.1007/s10943-018-0561-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This article revisits Donald Capps's book The Depleted Self (The depleted self: sin in a narcissistic age. Fortress Press, Minneapolis, 1993), which grew out of his 1990 Schaff Lectures at Pittsburgh Theological Seminary. In these lectures Capps proposed that the theology of guilt had dominated much of post-Reformation discourse. But with the growing prevalence of the narcissistic personality in the late twentieth century, the theology of guilt no longer adequately expressed humanity's sense of "wrongness" before God. Late twentieth-century persons sense this disjunction between God and self through shame dynamics. Narcissists are not "full" of themselves, as popular perspectives might indicate. Instead, they are empty, depleted selves. Psychologists suggest this stems from lack of emotional stimulation and the absence of mirroring in the early stages of life. The narcissist's search for attention and affirmation takes craving, paranoid, manipulative, or phallic forms and is essentially a desperate attempt to fill the internal emptiness. Capps suggests that two narratives from the Gospels are helpful here: the story of the woman with the alabaster jar and the story of Jesus's dialogue with Mary and John at Calvary. These stories provide us with clues as to how depleted selves experienced mirroring and the potential for internal peace in community with Jesus.
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Affiliation(s)
- Reggie Abraham
- Princeton Theological Seminary, P.O. Box 821, Princeton, NJ, 08542, USA.
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Borrione L, Brunoni AR, Sampaio-Junior B, Aparicio LM, Kemp AH, Benseñor I, Lotufo PA, Fraguas R. Associations between symptoms of depression and heart rate variability: An exploratory study. Psychiatry Res 2018; 262:482-7. [PMID: 28958456 DOI: 10.1016/j.psychres.2017.09.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 06/27/2017] [Accepted: 09/11/2017] [Indexed: 12/11/2022]
Abstract
Major depressive disorder (MDD) is associated with decreased heart rate variability (HRV), a predictor of cardiovascular morbidity by many, but not all studies. This inconsistency could be due to the association of HRV with specific depressive symptoms. Here, we investigated the association of HRV parameters with components of depressive symptoms from 120 MDD patients, at baseline of a published trial comparing the effect of sertraline to transcranial direct current stimulation. We used Principal Component Analysis to extract components of the Hamilton Rating Scale for Depression (HAM-D-17), the Montgomery Asberg Depression Rating Scale (MADRS) and the Beck Inventory for Depressive Symptomatology (BDI). We constructed one equation of multiple linear regression for each HRV parameter as the dependent variable, and the components of depressive symptoms of the three scales as the independent ones, adjusted for age and gender. A component of HAM-D-17 predicted LF/HF (low frequency/high frequency) and a component of MADRS predicted LF (low frequency). "Guilt" and "loss of interest/pleasure in activities" were present in the components of both scales, and the MADRS component also included "psychomotor retardation". These results suggest that melancholic features might be relevant for the association between MDD and HRV. Considering multiple comparisons, these results are preliminary.
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Nöbbelin L, Bogren M, Mattisson C, Brådvik L. Risk factors for recurrence in depression in the Lundby population, 1947-1997. J Affect Disord 2018; 228:125-31. [PMID: 29247900 DOI: 10.1016/j.jad.2017.11.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 09/13/2017] [Accepted: 11/11/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Depression is a common disorder in both men and women, and the recurrence rate is high. The aim of this study was to identify risk factors for recurrence in depression in the Lundby Study. METHODS The Lundby Study is a community-based longitudinal study with focus on mental health. The study started in 1947 and three follow-ups have been carried out since, the last one in 1997. The population consists of 3563 subjects. Data from 508 subjects afflicted by depression was gathered. Premorbid factors (gender, socioeconomic status, marital status, personality and heredity) and factors related to the first depressive episode (age, degree of impairment and melancholic depression) were investigated regarding their influence on the risk for recurrence in depression. Multiple logistic regression was used in the calculations. RESULTS Risk factors associated with recurrent depression were melancholic depression at first onset (OR 3.52 [95% CI 1.62-7.66, p < 0.001]), young age as compared to old age at first onset (OR 0.51 [95% CI 0.28-0.92, p = 0.03]) and a premorbid nervous/tense personality (OR 1.77 [95% CI 1.22-2.56, p < 0.01]). Demographic factors, including gender, had no effect on the odds of recurrence. LIMITATIONS The Lundby Study spans over 50 years, making the results vulnerable to changes in diagnostic regimes and recall bias. CONCLUSION Melancholia at onset, regardless of severity of symptoms, had the greatest impact on the risk of recurrence in depression in the Lundby Study. Information about risk factors for recurrence in depression are useful in offering effective preventive measures in the form of psychotropic drugs and psychotherapy, and deciding the length of follow-up.
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Sowa-Kućma M, Styczeń K, Siwek M, Misztak P, Nowak RJ, Dudek D, Rybakowski JK, Nowak G, Maes M. Are there differences in lipid peroxidation and immune biomarkers between major depression and bipolar disorder: Effects of melancholia, atypical depression, severity of illness, episode number, suicidal ideation and prior suicide attempts. Prog Neuropsychopharmacol Biol Psychiatry 2018; 81:372-383. [PMID: 28867391 DOI: 10.1016/j.pnpbp.2017.08.024] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 08/09/2017] [Accepted: 08/30/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is evidence that major depression (MDD) and bipolar disorder (BD) are accompanied by activated immune & oxidative (I&O) pathways. METHODS To compare I&O biomarkers between MDD and BD we assessed serum levels of thiobarbituric acid reactive substances (TBARS; a lipid peroxidation marker), soluble interleukin-2 receptor (sIL-2R), sIL-6R, IL-α, sIL-1R antagonist (sIL-1RA), tumor necrosis factor receptor 60kDa/80kDa (sTNFR60/R80) in 114 MDD and 133 BD patients, and 50 healthy controls. We computed z-unit weighted indices reflecting the 5 cytokine receptor levels (zCytR), cell-mediated immunity (zCMI) and I&O pathways (zCMI+TBARS). RESULTS There are no significant differences in biomarkers between MDD and BD. BD/MDD with atypical features is characterized by increased sIL-6R and TBARS, whereas melancholia is associated with higher TBARS and lower sTNFR60 levels. Severity of illness, as measured with the Hamilton Depression Rating Scale, is correlated with increased sIL-6R, sTNFR80, TBARS, zCytR and zCMI+TBARS. The number of episodes the year prior to blood sampling is positively associated with sTNFR80, TBARS, zCMI, zCMI+TBARS, while number of hospitalizations is positively associated with sIL-1RA. Prior suicidal attempts are associated with increased sIL-1RA, IL-1α, zCMI, TBARS and zCMI+TBARS, while TBARS is associated with current suicidal ideation. CONCLUSIONS There are no I&O biomarker differences between MDD and BD. Atypical depression is associated with increased IL-6 trans-signaling and lipid peroxidation. Severity of depression, number of episodes and suicidal attempts are associated with activated I&O pathways. Increased TBARS is the single best predictor of BD/MDD, atypical depression, melancholia and current suicidal ideation.
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Affiliation(s)
- Magdalena Sowa-Kućma
- Institute of Pharmacology, Polish Academy of Sciences, Laboratory of Trace Elements Neurobiology, Department of Neurobiology, Smetna Street 12, 31-343 Krakow, Poland; Department of Human Physiology, Institute of Clinical and Experimental Medicine, Medical Faculty, University of Rzeszow, Al. Kopisto Street 2a, 35-959 Rzeszów, Poland.
| | - Krzysztof Styczeń
- Department of Affective Disorders, Chair of Psychiatry, Jagiellonian University Medical College, Kopernika 21a, 31-501 Krakow, Poland
| | - Marcin Siwek
- Department of Affective Disorders, Chair of Psychiatry, Jagiellonian University Medical College, Kopernika 21a, 31-501 Krakow, Poland
| | - Paulina Misztak
- Institute of Pharmacology, Polish Academy of Sciences, Laboratory of Trace Elements Neurobiology, Department of Neurobiology, Smetna Street 12, 31-343 Krakow, Poland; Department of Pharmacobiology, Jagiellonian University Medical College, Medyczna 9, 30-688 Krakow, Poland
| | - Rafał J Nowak
- Department of Drug Management, Jagiellonian University Medical College, Grzegórzecka 20, 31-531 Krakow, Poland
| | - Dominika Dudek
- Department of Affective Disorders, Chair of Psychiatry, Jagiellonian University Medical College, Kopernika 21a, 31-501 Krakow, Poland
| | - Janusz K Rybakowski
- Department of Adult Psychiatry, Poznań University of Medical Sciences, Szpitalna 27/33, 60-572 Poznań, Poland
| | - Gabriel Nowak
- Institute of Pharmacology, Polish Academy of Sciences, Laboratory of Trace Elements Neurobiology, Department of Neurobiology, Smetna Street 12, 31-343 Krakow, Poland; Department of Pharmacobiology, Jagiellonian University Medical College, Medyczna 9, 30-688 Krakow, Poland.
| | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; IMPACT Strategic Research Centre, Deakin University, School of Medicine and Barwon Health, Geelong, VIC, Australia; Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria; Revitalis, Waalre, The Netherlands
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Bogren M, Brådvik L, Holmstrand C, Nöbbelin L, Mattisson C. Gender differences in subtypes of depression by first incidence and age of onset: a follow-up of the Lundby population. Eur Arch Psychiatry Clin Neurosci 2018; 268:179-189. [PMID: 28315937 PMCID: PMC5809533 DOI: 10.1007/s00406-017-0778-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 03/06/2017] [Indexed: 12/24/2022]
Abstract
The Lundby Study is a prospective mental health survey in a community population (N = 3563), in which data were collected in 4 waves of field-work between 1947 and 1997. We investigated gender differences during the follow-up in overall first incidence rates, ages of onset, and incidence by age of onset patterns, in different subtypes of depression. The overall incidence rate in females was higher than males for most subtypes of depression. However, for depression with melancholic and/or psychotic features, the overall first incidence rate did not differ significantly between the genders. The mean age of onset did not differ significantly between females and males in any of the depressive subtypes. Nevertheless, females and males had different first incidence rates by age of onset patterns for unipolar non-melancholic DSM-IV mood disorder and major depressive disorder (MDD), with a consistent gender incidence gap across all ages, but with the most conspicuous gender gap in middle age. The first incidence rates by age of onset patterns for DSM-IV MDD with melancholic and/or psychotic features did not differ significantly between the genders. The findings support that females are more prone than males to develop depression with medium severity, but no gender differences were found in melancholic and/or psychotic depression. The findings may support that unipolar non-melancholic depression and melancholic and/or psychotic depression represents different disorders. Tentative explanations for this are discussed.
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Affiliation(s)
- Mats Bogren
- Division of Psychiatry, Department of Clinical Sciences, Lund University Hospital, 221 85, Lund, Sweden.
| | - L. Brådvik
- grid.411843.bDivision of Psychiatry, Department of Clinical Sciences, Lund University Hospital, 221 85 Lund, Sweden
| | - C. Holmstrand
- grid.411843.bDivision of Psychiatry, Department of Clinical Sciences, Lund University Hospital, 221 85 Lund, Sweden
| | - L. Nöbbelin
- grid.411843.bDivision of Psychiatry, Department of Clinical Sciences, Lund University Hospital, 221 85 Lund, Sweden
| | - C. Mattisson
- grid.411843.bDivision of Psychiatry, Department of Clinical Sciences, Lund University Hospital, 221 85 Lund, Sweden
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30
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Messas G, Garcia Tamelini M, Cutting J. A meta-analysis of the core essence of psychopathological entities: an historical exercise in phenomenological psychiatry. Hist Psychiatry 2017; 28:473-481. [PMID: 28675309 DOI: 10.1177/0957154x17715414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Two fundamentally different approaches among phenomenological psychopathologists can be discerned. One is what we call fixed essentialism, where the pathognomonic element of, say, schizophrenia is conceived of as a single, enduring and intrinsically morbid way of grasping all entities in the world, including self and body. The other, which we call dialectical essentialism, accounts for the same manifestations of, say, schizophrenia, but through a process which is not life-enduring, and, most critically vis-à-vis the former formulation, is not in itself a single morbid defect: a morbid pattern of world, self and body is achieved by an imbalance between two or more otherwise healthy constituents of the 'normal' human being, whose imbalance and attempts to resolve this - the dialectic - induce the 'morbidity'.
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Sowa-Kućma M, Styczeń K, Siwek M, Misztak P, Nowak RJ, Dudek D, Rybakowski JK, Nowak G, Maes M. Lipid Peroxidation and Immune Biomarkers Are Associated with Major Depression and Its Phenotypes, Including Treatment-Resistant Depression and Melancholia. Neurotox Res 2017; 33:448-460. [PMID: 29103192 PMCID: PMC5766730 DOI: 10.1007/s12640-017-9835-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 09/14/2017] [Accepted: 10/19/2017] [Indexed: 12/21/2022]
Abstract
To examine immune-inflammatory and oxidative (I&O) biomarkers in major depression (MDD) and its related phenotypes, we recruited 114 well-phenotyped depressed patients and 50 healthy controls and measured serum levels of interleukin (IL)-1α, soluble IL-1 receptor antagonist (sIL-1RA), soluble IL-2 receptor (sIL-2R), soluble IL-6 receptor (sIL-6R), soluble tumor necrosis factor receptor 60 and 80 kDa (sTNF-R1/R2), and thiobarbituric acid reactive substances (TBARS). Obtained results indicate that MDD is characterized by increased sIL-1RA, sTNF-R1, and TBARS concentrations. Melancholic depression is associated with increased sIL-6R but lowered IL-1α levels. A current episode of depression is accompanied by significantly increased sIL-6R compared to the remitted state. Treatment-resistant depression (TRD) is accompanied by increased sIL-6R and TBARS but lowered sTNF-R2 levels compared to non-TRD patients. These immune markers are not significantly correlated with Hamilton Depression Rating Scale (HDRS), Montgomery-Asberg Depression Scale (MADRS), number episodes, or age at onset. Our findings show that increased sIL-1RA, sTNF-R1, and TBARS levels may be trait markers of depression, while increased sIL-6R levels may be a state marker of melancholia and an acute phase of depression. MDD is accompanied by increased lipid peroxidation and simultaneous activation of immune pathways, and the compensatory anti-inflammatory reflex system (CIRS). TRD is characterized by highly increased oxidative stress and probably increased TNFα and IL-6 trans-signalling. Novel treatments for major depression should target oxidative stress pathways, while new treatments for TRD should primary target lipid peroxidation and also activated immune-inflammatory pathways.
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Affiliation(s)
- Magdalena Sowa-Kućma
- Institute of Pharmacology, Polish Academy of Sciences, Department of Neurobiology, Laboratory of Trace Elements Neurobiology, Smetna Street 12, 31-343, Krakow, Poland. .,Department of Human Physiology, Institute of Clinical and Experimental Medicine, Medical Faculty, University of Rzeszow, Al. Kopisto Street 2a, 35-959, Rzeszow, Poland.
| | - Krzysztof Styczeń
- Department of Affective Disorders, Chair of Psychiatry, Jagiellonian University Medical College, Kopernika 21a, 31-501, Krakow, Poland
| | - Marcin Siwek
- Department of Affective Disorders, Chair of Psychiatry, Jagiellonian University Medical College, Kopernika 21a, 31-501, Krakow, Poland
| | - Paulina Misztak
- Institute of Pharmacology, Polish Academy of Sciences, Department of Neurobiology, Laboratory of Trace Elements Neurobiology, Smetna Street 12, 31-343, Krakow, Poland.,Chair of Pharmacobiology, Jagiellonian University Medical College, Medyczna 9, 30-688, Krakow, Poland
| | - Rafał J Nowak
- Department of Drug Management, Jagiellonian University Medical College, Grzegórzecka 20, 31-531, Krakow, Poland
| | - Dominika Dudek
- Department of Affective Disorders, Chair of Psychiatry, Jagiellonian University Medical College, Kopernika 21a, 31-501, Krakow, Poland
| | - Janusz K Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Szpitalna 27/33, 60-572, Poznan, Poland
| | - Gabriel Nowak
- Institute of Pharmacology, Polish Academy of Sciences, Department of Neurobiology, Laboratory of Trace Elements Neurobiology, Smetna Street 12, 31-343, Krakow, Poland.,Chair of Pharmacobiology, Jagiellonian University Medical College, Medyczna 9, 30-688, Krakow, Poland
| | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. .,IMPACT Strategic Research Centre, Deakin University, School of Medicine and Barwon Health, Geelong, VIC, Australia. .,Health Sciences Postgraduate Program, State University of Londrina, Londrina, Paraná, Brazil. .,Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria. .,Revitalis, Waalre, the Netherlands.
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Veras AB, Cougo S, Meira F, Peixoto C, Barros JA, Nardi AE, Malaspina D, Poyurovsky M, Kahn JP. Schizophrenia dissection by five anxiety and depressive subtype comorbidities: Clinical implications and evolutionary perspective. Psychiatry Res 2017; 257:172-178. [PMID: 28763736 DOI: 10.1016/j.psychres.2017.07.048] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 06/07/2017] [Accepted: 07/25/2017] [Indexed: 10/19/2022]
Abstract
Twenty patients with DSM5 schizophrenia were comprehensively and formally assessed by an experienced psychiatrist. All subjects were assessed for: positive and negative psychotic symptoms; social anxiety; panic anxiety; obsessive compulsive disorder, atypical depression; major depression; suicide risk; and global assessment of functioning. Different profiles of clinical presentation and symptom evolution emerged for patients with schizophrenia who had co-morbid depression (15%), OCD (15%), panic or limited symptom attacks (55%) and social anxiety (5%). At least eighty percent of the sample had one or more of these co-morbidities. Summing up, the data support our previous finding that panic is highly prevalent in Schizophrenia with Auditory Hallucinations (>73% here, versus 100% before), and panic was paroxysmally concurrent with voice onset. Moreover, characteristic clinical findings may help point clinicians to five specific co-morbidity psychosis subtypes. Moreover, co-morbidity dissection of psychotic diagnoses recalls and parallels the historical psychopharmacologic dissection of non-psychotic anxiety and depressive subtypes diagnoses. Larger studies should further test and explore these preliminary findings.
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Affiliation(s)
- André B Veras
- Laboratory of Panic and Respiration, Federal University of Rio de Janeiro (LabPR/UFRJ), Rio de Janeiro, Brazil; Translational Research Group on Mental Health (GPTranSMe), Dom Bosco Catholic University, Campo Grande, Brazil; Department of Psychiatry and Environmental Medicine, New York University Medical Center, New York, NY, USA.
| | - Simone Cougo
- Translational Research Group on Mental Health (GPTranSMe), Dom Bosco Catholic University, Campo Grande, Brazil
| | - Fernanda Meira
- Translational Research Group on Mental Health (GPTranSMe), Dom Bosco Catholic University, Campo Grande, Brazil
| | - Clayton Peixoto
- Laboratory of Panic and Respiration, Federal University of Rio de Janeiro (LabPR/UFRJ), Rio de Janeiro, Brazil; Translational Research Group on Mental Health (GPTranSMe), Dom Bosco Catholic University, Campo Grande, Brazil
| | - Jorge A Barros
- Translational Research Group on Mental Health (GPTranSMe), Dom Bosco Catholic University, Campo Grande, Brazil
| | - Antonio E Nardi
- Laboratory of Panic and Respiration, Federal University of Rio de Janeiro (LabPR/UFRJ), Rio de Janeiro, Brazil
| | - Dolores Malaspina
- Department of Psychiatry and Environmental Medicine, New York University Medical Center, New York, NY, USA
| | - Michael Poyurovsky
- Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Jeffrey P Kahn
- Department of Psychiatry, Weill-Cornell Medical College, New York, NY, USA
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Roberts JA, Friston KJ, Breakspear M. Clinical Applications of Stochastic Dynamic Models of the Brain, Part I: A Primer. Biol Psychiatry Cogn Neurosci Neuroimaging 2017; 2:216-24. [PMID: 29528293 DOI: 10.1016/j.bpsc.2017.01.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Biological phenomena arise through interactions between an organism's intrinsic dynamics and stochastic forces-random fluctuations due to external inputs, thermal energy, or other exogenous influences. Dynamic processes in the brain derive from neurophysiology and anatomical connectivity; stochastic effects arise through sensory fluctuations, brainstem discharges, and random microscopic states such as thermal noise. The dynamic evolution of systems composed of both dynamic and random effects can be studied with stochastic dynamic models (SDMs). This article, Part I of a two-part series, offers a primer of SDMs and their application to large-scale neural systems in health and disease. The companion article, Part II, reviews the application of SDMs to brain disorders. SDMs generate a distribution of dynamic states, which (we argue) represent ideal candidates for modeling how the brain represents states of the world. When augmented with variational methods for model inversion, SDMs represent a powerful means of inferring neuronal dynamics from functional neuroimaging data in health and disease. Together with deeper theoretical considerations, this work suggests that SDMs will play a unique and influential role in computational psychiatry, unifying empirical observations with models of perception and behavior.
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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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Simões do Couto F, Lunet N, Ginó S, Chester C, Freitas V, Maruta C, Figueira ML, de Mendonça A. Depression with melancholic features is associated with higher long-term risk for dementia. J Affect Disord 2016; 202:220-9. [PMID: 27267294 DOI: 10.1016/j.jad.2016.05.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 04/30/2016] [Accepted: 05/17/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Depression has been reported to increase the risk of subsequently developing dementia, but the nature of this relation remains to be elucidated. Depression can be a prodrome/manifestation of dementia or an early risk factor, and the effect may differ according to depression subtypes. Our aim was to study the association between early-onset depression and different depression subtypes, and the later occurrence of dementia. METHODS We conducted a cohort study including 322 subjects with depression, recruited between 1977 and 1984. A comparison cohort (non-exposed) was recruited retrospectively, to include 322 subjects admitted at the same hospital for routine surgery (appendicectomy or cholecystectomy), at the same period as the depressed cohort. Subjects were contacted again between 2009 and 2014, to assess their dementia status. We computed the risk for dementia in subjects with early onset depression and quantified the association between different depression subtypes (namely melancholic, anxious, and psychotic) and dementia. RESULTS The odds of dementia were increased by 2.90 times (95% C.I. 1.61-5.21; p<0.0001) for the depressed cohort when compared to the surgical cohort. When the analysis was restricted to patients younger than 45 years old at baseline, the odds for dementia in the depressed cohort were also significantly higher when compared to the surgical cohort (8.53; 95% C.I. 2.40-30.16). In the multivariate Cox analysis, subjects having depression with melancholic features had an increased risk for developing dementia compared to those without melancholic features (HR=3.64; 95% C.I. 1.78-11.26; p=0.025). LIMITATIONS About 59% of the participants with depression and 53% of those non-exposed were lost during follow up. The inclusion of biological biomarkers would strengthen the results. The sample included a low number of bipolar patients. CONCLUSIONS These results support depression as an early risk factor for dementia. Depression with melancholic features was found as an important risk factor for dementia, playing a main role in the relation between these disorders.
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Affiliation(s)
- Frederico Simões do Couto
- Dementia Study Group, Institute of Molecular Medicine, Faculdade de Medicina, Universidade de Lisboa, Portugal; Psychiatry and Psychology Department, Faculdade de Medicina, Universidade de Lisboa, Portugal.
| | - Nuno Lunet
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, Faculty of Medicine, University of Porto, Porto, Portugal; EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal
| | - Sandra Ginó
- Dementia Study Group, Institute of Molecular Medicine, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Catarina Chester
- Dementia Study Group, Institute of Molecular Medicine, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Vanda Freitas
- Dementia Study Group, Institute of Molecular Medicine, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Carolina Maruta
- Dementia Study Group, Institute of Molecular Medicine, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Maria Luísa Figueira
- Psychiatry and Psychology Department, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Alexandre de Mendonça
- Dementia Study Group, Institute of Molecular Medicine, Faculdade de Medicina, Universidade de Lisboa, Portugal
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Abstract
This essay analyses six case studies of theories of exhaustion-related conditions from the early eighteenth century to the present day. It explores the ways in which George Cheyne, George Beard, Richard von Krafft-Ebing, Sigmund Freud, Alain Ehrenberg and Jonathan Crary use medical ideas about exhaustion as a starting point for more wide-ranging cultural critiques related to specific social and technological transformations. In these accounts, physical and psychological symptoms are associated with particular external developments, which are thus not just construed as pathology-generators but also pathologized. The essay challenges some of the persistently repeated claims about exhaustion and its unhappy relationship with modernity.
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Soria V, Vives M, Martínez-Amorós È, Gálvez V, Monzón S, Crespo JM, Gili M, Menchón JM, Roca M, Parker G, Urretavizcaya M. The CORE system for sub-typing melancholic depression: Adaptation and psychometric properties of the Spanish version. Psychiatry Res 2016; 239:179-83. [PMID: 27010187 DOI: 10.1016/j.psychres.2016.03.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 03/02/2016] [Accepted: 03/09/2016] [Indexed: 11/18/2022]
Abstract
We report the development procedure for a Spanish version of the CORE measure for subtyping melancholic depression and its psychometric properties. The sample comprised two subsets of depressive patients: 117 in-patients clinically assessed after admission and before discharge; and 34 in- and out-patients who were video-recorded, with each recording being rated by independent raters and re-rated six months later. The internal consistency of the Spanish version of the CORE was high, with Cronbach's alpha coefficient of 0.93 for the total CORE score. High intra-class correlation coefficient for the total score (0.96) and the three subscales (around 0.8) indicate high inter-rater reliability. Baseline and six-month ratings of video-recordings showed high test-retest reliability. Regarding construct validity, the correlation between the CORE and the Newcastle endogeneity scale scores was 0.64. A ROC curve generated an optimal cut-off of 10 to predict the definition of endogeneity/melancholia based on the Newcastle score >=6 and the DSM-IV-TR definition of melancholia. The comparison between the CORE scores at admission and at discharge revealed large differences, indicating demonstrable sensitivity to change. The Spanish version of the CORE system is a reliable and valid instrument for sub-typing depression in terms of melancholic versus non-melancholic sub-types.
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Affiliation(s)
- Virginia Soria
- Department of Psychiatry, Bellvitge University Hospital, IDIBELL, CIBERSAM, Department of Clinical Sciences, University of Barcelona, Barcelona, Spain.
| | - Margalida Vives
- Institut Universitari d' Investigació en Ciències de la Salut (IUNICS), Red de Actividades Preventivas y de Promoción de la Salud (Rediapp), Hospital Joan March, Universitat de les Illes Balears, Palma de Mallorca, Spain
| | - Èrika Martínez-Amorós
- Department of Psychiatry, Corporació Sanitària Parc Taulí, Institut Universitari Parc Taulí- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Verònica Gálvez
- School of Psychiatry, University of New South Wales, Black Dog Institute, Sydney, Australia
| | - Saray Monzón
- Institut Universitari d' Investigació en Ciències de la Salut (IUNICS), Red de Actividades Preventivas y de Promoción de la Salud (Rediapp), Hospital Joan March, Universitat de les Illes Balears, Palma de Mallorca, Spain
| | - José M Crespo
- Department of Psychiatry, Bellvitge University Hospital, IDIBELL, CIBERSAM, Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
| | - Margalida Gili
- Institut Universitari d' Investigació en Ciències de la Salut (IUNICS), Red de Actividades Preventivas y de Promoción de la Salud (Rediapp), Hospital Joan March, Universitat de les Illes Balears, Palma de Mallorca, Spain
| | - José M Menchón
- Department of Psychiatry, Bellvitge University Hospital, IDIBELL, CIBERSAM, Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
| | - Miquel Roca
- Institut Universitari d' Investigació en Ciències de la Salut (IUNICS), Red de Actividades Preventivas y de Promoción de la Salud (Rediapp), Hospital Joan March, Universitat de les Illes Balears, Palma de Mallorca, Spain
| | - Gordon Parker
- School of Psychiatry, University of New South Wales, Black Dog Institute, Sydney, Australia
| | - Mikel Urretavizcaya
- Department of Psychiatry, Bellvitge University Hospital, IDIBELL, CIBERSAM, Department of Clinical Sciences, University of Barcelona, Barcelona, Spain.
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Weinberg A, Liu H, Shankman SA. Blunted neural response to errors as a trait marker of melancholic depression. Biol Psychol 2015; 113:100-7. [PMID: 26638761 DOI: 10.1016/j.biopsycho.2015.11.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 10/21/2015] [Accepted: 11/24/2015] [Indexed: 01/18/2023]
Abstract
Identification of biomarkers of vulnerability for Major Depressive Disorder is a high priority, but heterogeneity of the diagnosis can hinder research. Biomarkers of vulnerability should also be present in the absence of the diagnosis. The present study examined the magnitude of the error-related negativity (ERN), an event-related potential component following errors in a sample with remitted melancholic depression (N=17), remitted non-melancholic depression (N=33), and healthy controls (N=55). Remitted melancholic depression was uniquely characterized by a blunted ERN relative to the other two groups. Individuals with remitted non-melancholic depression did not differ from controls in the magnitude of the ERN. This was the case despite the fact that the melancholic and non-melancholic groups did not differ in course or severity of their past illnesses, or in their current functioning. Results suggest that the blunted ERN may be a viable vulnerability marker for melancholia.
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Affiliation(s)
| | - Huiting Liu
- University of Illinois at Chicago, United States
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Parker G, McCraw S, Hadzi-Pavlovic D. The utility of a classificatory decision tree approach to assist clinical differentiation of melancholic and non-melancholic depression. J Affect Disord 2015; 180:148-53. [PMID: 25911130 DOI: 10.1016/j.jad.2015.03.057] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 03/27/2015] [Accepted: 03/27/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Studies suggest that differentiating melancholic from non-melancholic depressive disorders is advanced by use of illness course as well as symptom variables but, in practice, potentially differentiating variables are generally positioned as having equal value. Judging that differentiating features are more likely to vary in their signal intensity, we sought to determine the number of features required to effect differentiation and their hierarchical order. METHODS The 24-item clinician-rated Sydney Melancholia Prototype Index (SMPI-CR) was completed for 364 unipolar depressed patients. The sample was divided into two cohorts according to the recruitment period. An RPART classification tree analysis identified the most discriminating SMPI items in the development sample of 197 patients, and examined the sensitivity and specificity of the diagnostic decisions, then sought to replicate findings in a validation sample of 169 patients. RESULTS Independent analyses of putative SMPI items identified only seven items as required to discriminate those with clinically-diagnosed melancholic or non-melancholic depression when the conditions were examined separately. An RPART analysis considering differentiation of melancholic and non-melancholic depression in the total samples retained five of those items in the classification tree, three of which were non-symptom items, and with 92% sensitivity and 80% specificity in the development sample. This reduced item set showed 93% sensitivity and 82% specificity in the validation sample. LIMITATIONS Our clinical judgment of melancholic or non-melancholic depression may not correspond with the clinical logic employed by other clinicians. CONCLUSION Only five SMPI items were required to derive a succinct and efficient decision tree, comprising high sensitivity and specificity in differentiating melancholic and non-melancholic depression. Current study findings provide an empirical model that could enrich clinicians׳ approach to differentiating melancholic and non-melancholic depression.
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Affiliation(s)
- G Parker
- School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Prince of Wales Hospital, Randwick 2031, Sydney, Australia.
| | - S McCraw
- School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Prince of Wales Hospital, Randwick 2031, Sydney, Australia
| | - D Hadzi-Pavlovic
- School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Prince of Wales Hospital, Randwick 2031, Sydney, Australia
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Caldieraro MA, Vares EA, Spanemberg L, Radtke Becker F, Fleck MP. 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] [What about the content of this article? (0)] [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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Baeken C, Desmyter S, Duprat R, De Raedt R, Van Denabbeele D, Tandt H, Lemmens GMD, Vervaet M, van Heeringen K. Self-directedness: an indicator for clinical response to the HF-rTMS treatment in refractory melancholic depression. Psychiatry Res 2014; 220:269-74. [PMID: 25175912 DOI: 10.1016/j.psychres.2014.07.084] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 07/27/2014] [Accepted: 07/31/2014] [Indexed: 12/26/2022]
Abstract
Although well-defined predictors of response are still unclear, clinicians refer a variety of depressed patients for a repetitive Transcranial Magnetic Stimulation (rTMS) treatment. It has been suggested that personality features such as Harm Avoidance (HA) and self-directedness (SD) might provide some guidance for a classical antidepressant treatment outcome. However, to date no such research has been performed in rTMS treatment paradigms. In this open study, we wanted to examine whether these temperament and character scores in particular would predict clinical outcome in refractory unipolar depressed patients when a typical high-frequency (HF)-rTMS treatment protocol is applied. Thirty six unipolar right-handed antidepressant-free treatment resistant depressed (TRD) patients, all of the melancholic subtype, received 10 HF-rTMS sessions applied to the left dorsolateral prefrontal cortex (DLPFC). All patients were classified as at least stage III TRD and were assessed with the Temperament and Character Inventory (TCI) before a HF-rTMS treatment. Only the individual scores on SD predicted clinical outcome. No other personality scales were found to be a predictor of this kind of application. Our results suggest that refractory MDD patients who score higher on the character scale SD may be more responsive to the HF-rTMS treatment.
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Affiliation(s)
- Chris Baeken
- Department of Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium; Department of Psychiatry University Hospital (UZBrussel), Brussels, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium.
| | - Stefanie Desmyter
- Department of Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium
| | - Romain Duprat
- Department of Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium
| | - Rudi De Raedt
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Dirk Van Denabbeele
- Department of Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Hannelore Tandt
- Department of Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Gilbert M D Lemmens
- Department of Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Myriam Vervaet
- Department of Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Kees van Heeringen
- Department of Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium
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Abstract
BACKGROUND Negative hallucinations are characterized by a defect in perception of an object or a person, or a denial of the existence of their perception. Negative hallucinations create blank spaces, due to both an impossible representation and an incapability of investment in reality. They have a close relationship with Cotard's syndrome, delusional theme of organ denial observed in melancholic syndromes in the elderly. METHODS Phenomenological approach. The phenomenology of negative hallucinations provides quite an amount of information on the origin of the psychotic symptoms when one is rather old. RESULTS The connections between hallucinations, mood disorders and negative symptoms are often difficult to live with for the nearest and dearest. Negative hallucinations require a strict approach to identify their expression that is crucial because a wide heterogeneity exists within the pathological pictures, as in Cotard's syndrome. Although the negative hallucination has an anti traumatic function in elderly people fighting against mental pain, it still represents a deficiency in symbolization. The prevalence of this symptom is without doubt underestimated, although its presence often underlines thymic suffering that is more striking. These hallucinatory symptoms have an important impact on the patients' daily life, and they appear to be prisoners of a suffering, which cannot be revealed. CONCLUSIONS We propose in this article to review the clinical symptoms of negative hallucinations in the elderly and the way to manage them. The medicinal approaches are not always effective. A greater place must be given to what is in connection with the body, aiming at a strong impact and thus to offer non-pharmacological approaches, such as somatic ones, which can be either invasive (electroconvulsive therapy) or not (transcranial magnetic stimulation).
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Affiliation(s)
- C Hazif-Thomas
- Service de l'intersecteur de psychiatrie du sujet âgé, hôpital de Bohars, CHU de Brest, route de Ploudalmézeau, 29820 Bohars, France; EA éthique professionnalisme et santé, EA 4486, université UBO, 29820 Bohars, France.
| | - F Stephan
- Service hospitalo-universitaire de psychiatrie adulte, hôpital de Bohars, CHRU de Brest, 29820 Bohars, France; EA laboratoire de neurosciences de Brest (EA 4685), UFR de médecine, université de Bretagne Occidentale, 22, avenue Camille-Desmoulins, CS 93837, 29230 Brest cedex 3, France
| | - M Walter
- EA éthique professionnalisme et santé, EA 4486, université UBO, 29820 Bohars, France; Service hospitalo-universitaire de psychiatrie adulte, hôpital de Bohars, CHRU de Brest, 29820 Bohars, France; EA laboratoire de neurosciences de Brest (EA 4685), UFR de médecine, université de Bretagne Occidentale, 22, avenue Camille-Desmoulins, CS 93837, 29230 Brest cedex 3, France
| | - P Thomas
- Centre Jean-Marie-Léger, CHU de Limoges, 87025 Limoges, France
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Dalfardi B, Yarmohammadi H, Ghanizadeh A. Melancholia in medieval Persian literature: The view of Hidayat of Al-Akhawayni. World J Psychiatry 2014; 4:37-41. [PMID: 25019055 PMCID: PMC4087154 DOI: 10.5498/wjp.v4.i2.37] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 02/27/2014] [Accepted: 05/19/2014] [Indexed: 02/05/2023] Open
Abstract
“Melancholia” seems to be the oldest term used to describe the manifestations of depression. Throughout the history of medicine, melancholia has been the focus of consideration of many scholars who have provided varying definitions of this disorder and its manifestations. This continual process has resulted in the gradual development of the concept of melancholia over time. Persian scholars were among the scientists who have studied the melancholia and contributed to its concept. One figure, Al-Akhawayni Bukhari (?-983 AD), a Persian physician whose reputation was based on the treatment of patients with mental problems, investigated this disorder. He described Melancholia and explained its clinical manifestations and treatment methods. Al-Akhawayni provided an early classification of the patients suffering from this disorder. Since the medieval Persian concept of melancholia is not well-known, this paper aims to review Al-Akhawayni’s 10th century knowledge on melancholia which can represent the early concept of this disorder in the Near East.
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Steinberg H, Hegerl U. Johann Christian August Heinroth on sleep deprivation as a therapeutic option for depressive disorders. Sleep Med 2014; 15:1159-64. [PMID: 24994565 DOI: 10.1016/j.sleep.2014.03.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 03/05/2014] [Accepted: 03/25/2014] [Indexed: 11/28/2022]
Abstract
Partial or total therapeutic sleep deprivation leads to an immediate and far-reaching release of depressive symptoms in about 60% of patients with depressive disturbances. It is for that reason that this therapeutic option is offered and studied in many psychiatric clinics. Several papers have acclaimed the German psychiatrist Johann Christian August Heinroth (1773-1843) - the first university professor of psychiatry--as a pioneer of this therapeutic approach. However, no reference has been made specifying where in his comprehensive oeuvre he promoted this notion, nor has any analysis of the texts or passages in question been delivered. This study demonstrates that Heinroth indeed understood the existence of numerous close bidirectional relationships between mental disorders and sleep, above all, disorders of the latter. Consequently, he explicitly recommended sleep deprivation as a therapy for "melancholia," the contemporary name for depressive disorders. This finding is of apparent relevance to the history of psychiatry and sleep medicine. One should nonetheless bear in mind that the passages summarized below are scattered throughout Heinroth's famous Textbook of Psychiatry of 1818 and other works, and that Heinroth never elaborated on this issue systematically. Moreover, his statements promote the impression that they were the result of vague impressions and thoughts, and that Heinroth did not benefit from extensive experience. Yet what is important to note is that he regarded sleep deprivation as a feasible treatment option only for patients whose depression had recently been diagnosed.
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Affiliation(s)
- Holger Steinberg
- Archives for the History of Psychiatry in Leipzig, Department of Psychiatry and Psychotherapy, Leipzig University, Leipzig, Germany.
| | - Ulrich Hegerl
- Department of Psychiatry and Psychotherapy, Leipzig University, Leipzig, Germany
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Quinn CR, Rennie CJ, Harris AWF, Kemp AH. The impact of melancholia versus non-melancholia on resting-state, EEG alpha asymmetry: electrophysiological evidence for depression heterogeneity. Psychiatry Res 2014; 215:614-7. [PMID: 24467874 DOI: 10.1016/j.psychres.2013.12.049] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 12/21/2013] [Accepted: 12/29/2013] [Indexed: 11/17/2022]
Abstract
While depression has been associated with relatively greater right than left frontal cortical activity - a neurophysiological marker reflecting greater activation of the withdrawal system - contradictory findings have been reported. It was hypothesised that melancholia would be associated with relative right frontal activation, in comparison to non-melancholia and controls. We collected 2-min of resting-state, eyes closed, electroencephalographic activity from a total of 237 participants including 117 patients with major depressive disorder (57 with melancholia, 60 with non-melancholia) and 120 healthy controls. In contrast to hypotheses, patients with non-melancholia displayed relative left frontal activation in comparison to controls and those with melancholia. These findings were associated with a small to moderate effect size (Cohen's d=0.30-0.34). Critically, patients with melancholic subtype did not differ from controls despite increased severity - relative to those with non-melancholia - on clinical measures. These results may reflect an increase in approach tendencies in patients with non-melancholia including reassurance seeking, anger or irritable aggression. Findings highlight the need for further research on the heterogeneity MDD.
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Affiliation(s)
- Candice R Quinn
- Discipline of Psychiatry, Sydney Medical School, University of Sydney, Australia
| | - Chris J Rennie
- School of Physics, University of Sydney, Sydney, New South Wales, Australia; Brain Dynamics Centre, University of Sydney, Westmead Hospital, Australia
| | - Anthony W F Harris
- Discipline of Psychiatry, Sydney Medical School, University of Sydney, Australia; Brain Dynamics Centre, University of Sydney, Westmead Hospital, Australia
| | - Andrew H Kemp
- Discipline of Psychiatry, Sydney Medical School, University of Sydney, Australia; University of Sydney Cognitive and Affective Neuroscience (SCAN) Research and Teaching Unit, School of Psychology, University of Sydney, Australia; University Hospital and Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
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Abstract
Despite the increasingly widespread availability of psychotropics believed to restore biochemical equilibrium in the brains of persons diagnosed with mood disorders, the number of people suffering from such medical conditions appears to be increasing. According to The Royal College of Psychiatrists, ‘by 2020 it is estimated that depression will be the second most common disabling condition in the world’, a figure it derives from the World Health Organization. Depression is, it seems, rapidly becoming a global threat. In a trend that is mirrored in much of the West, the number of prescriptions dispensed for antidepressants in the UK has doubled in the last decade and is continuing to rise. The need for a critical perspective on mood disorders is growing.
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Affiliation(s)
- Åsa Jansson
- Centre for the History of the Emotions, School of History, Queen Mary, University of London, Mile End Road, London E1 4NS, UK.
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47
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Rao AV. Depression - the proteus of medicine. Indian J Psychiatry 2004; 46:169-73. [PMID: 21408045 PMCID: PMC2949934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Depression is discussed as a disease of antiquity with suitable contemporary references also. The prevalence of this disorder, which at a given time constitutes 121 millions world-wide is mentioned. Among the types of depression, comorbid depression forms an important one. Classical depression forms the visible part of the depression iceberg while somatic and other life contextual situation forms the submerged part. Somatic manifestations per se do not carry diagnostic weightage unless the core features of depression are elicited. Non-recognition of somatic manifestations result in under-diagnosis and under treatment of the disorder.
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Affiliation(s)
- A Venkoba Rao
- Emeritus Professor of Psychiatry, Madurai Medical College, Madurai
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