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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

All patients suffering from affective psychoses (ICD 296) who were admitted to the Psychiatric University Clinic of Zurich between 1959 and 1963 were studied in a follow-up investigation until 1975. Of 254 affective psychoses, 95 were bipolar patients (37.4%) and 159 were monopolar (62.6%). The sample of bipolar patients was complemented with all patients who had been admitted in the period 1959--1963 because of manic or mixed manic-depressive syndromes. This paper describes the change of diagnosis in the two diagnostic groups. In 10% (N = 20) of monopolar depression cases there was a change of diagnosis to bipolar affective illness. An analysis shows that the diagnosis of patients with three or more depressive episodes (unipolar depressives) was especially prone to change. A mathematical correction of some diagnostic errors leads to the conclusion that the ratio of unipolar depression to bipolar illness may be about 1:1. A major source of diagnostic error lies in the change of affective to schizo-affective illness. Up to now, no clinical criterion exists that would exclude this error, which was found in 6% (n=12) of the monopolar but also in 7.5% (n = 3) of the bipolar index patients. It is recommended that studies of affective disorders should be based on truly representative samples of the illness, including patients with one or two episodes, and that the term 'unipolar depression' be used synonymously with the term 'monopolar depression,' originally created by Kleist (1947) and Leonhard (1957).
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PMID:The course of affective disorders. I. Change of diagnosis of monopolar, unipolar, and bipolar illness. 70 27

A representative sample of 95 hospitalized bipolar manic-depressive patients was followed up from 1959 to 1975. The mean age of the group at the time of this study was 61 years. It was observed that female bipolar patients demonstrate depression much more frequently than mania, while male patients show a symmetric distribution of both manic and depressive syndromes. The longitudinal occurrence of syndromes remains more or less constant; for instance, individual patients do not tend to go into depression with increasing age. The study shows that even after three episodes 29% of all bipolar patients would still have been misdiagnosed as unipolar depression. An attempt is made to classify bipolar patients into three subtypes, 'preponderantly manic,' 'preponderantly depressed,' and a 'nuclear' type. Male patients belong mainly to the latter with an equal proportion of the first and third subtype. In contrast, female patients belong mainly to the depressed subtype. The findings are discussed assuming either a heterogeneity of bipolar disorders or a threshold model of affective disorders suggested by Gershon et al. (1976).
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PMID:The course of affective disorders. II. Typology of bipolar manic-depressive illness. 70 28

Alpha 2 adrenergic receptors play an important role in regulating the neuronal release of norepinephrine through presynaptic feedback inhibition in the locus ceruleus. Therefore, alpha 2 adrenergic autoreceptors may underlie some aspects of the pathogenesis and symptomatic expression of depressive illness. We studied two brain-expressed alpha 2 adrenergic receptor genes as genetic markers in linkage analyses in 17 multiplex pedigrees of unipolar depression. Neither of the genes was supportive of linkage to depression. Lod scores of less than -2 were found in both familial pure depressive disease pedigrees and in depression spectrum disease pedigrees. Therefore, we conclude that depression in our pedigrees is not related to mutations in the two alpha 2 adrenergic receptor genes tested.
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PMID:Alpha 2 adrenergic receptor subtypes in depression: a candidate gene study. 132 69

Optimal treatment of mood disorders and prevention of suicide requires biological and psychosocial methods, therapeutic alliance and psycho-education. In moderate unipolar depression an antidepressant may be sufficient, if necessary potentiated by another antidepressant or triiodothyronine. In moderate bipolar depression lithium or carbamazepine are preferred. In severe unipolar and bipolar depression the combination of an antidepressant and lithium (or carbamazepine) or electroconvulsive therapy (ECT) is indicated, in psychotic depression neuroleptics, too. Non-selective monoamine oxidase inhibitors (MAOIs) are the most potent antidepressants. Moderate acute mania and mixed state may respond to lithium, carbamazepine or valproate only. In severe cases a neuroleptic and lithium are combined, or these drugs may be combined with carbamazepine or valproate. Electroconvulsive therapy is preferable in acute mixed states with marked confusion or depression. In chronic mixed state and rapid cycling, withdrawal of antidepressants and neuroleptics should be tried. Most patients will need a combination of lithium and carbamazepine or valproate. Added to these drugs, antidepressants are less risky. Adding thyroxin may stabilize rapid cycling. The combination of lithium and an antidepressant is the most potent prophylaxis in unipolar disorder and bipolar disorder dominated by depression.
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PMID:[Affective disorders. Drug treatment and electroconvulsive therapy]. 135 73

Total cellular polyadenylated RNA (poly(A)+ RNA, mRNA) was prepared after guanidinium thiocyanate extraction of frozen brain tissue from age-matched controls and patients suffering from schizophrenia and unipolar depression. These mRNA populations were analysed by in vitro translation followed by two-dimensional gel analysis. Data were obtained from fluorograms derived from 10 different schizophrenic patients, 10 different controls and 5 different depressive patients. The relative concentrations of mRNA species coding for 4 translation products (33 kDa, pI 5.8; 26 kDa, pI 5.8; 35 kDa, pI 7.1; 23 kDa, pI 6.1) were significantly reduced in schizophrenia compared to controls when determined by computerised image analysis of the fluorograms. In the case of depression, the relative concentrations of mRNA species coding for 6 translation products were significantly altered, 4 being increased (38 kDa, pI 6.2, 17 kDa, pI 5.7, 35 kDa, pI 7.1; 23 kDa, pI 6.1) and two decreased (34 kDa, pI 6.2; 33 kDa, pI 5.8). Three translation products were altered in both schizophrenia and depression, one (33 kDa, pI 5.8) being altered according to the same trend, a decrease relative to controls, but two (35 kDa, pI 7.1; 23 kDa, pI 6.1) being altered differently in schizophrenia (reduced) and depression (increased). The effects of post mortem delay, mode of death and drug treatment on mRNA composition were also examined and found not to affect the levels of these translation products significantly. The significance of these changes will be discussed in relation to their relevance of biological mechanisms in the psychoses.
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PMID:Changes in relative levels of specific brain mRNA species associated with schizophrenia and depression. 137 64

A total of 60 patients aged 65 years and over who were suffering from unipolar depression were entered into a double-blind 6-week comparative study of paroxetine and mianserin. Assessments of efficacy of treatment included the Hamilton Depression Rating Scale, Clinical Global Impression, and the Leeds Sleep Evaluation Questionnaire. The results showed that the two drugs had equal and acceptable clinical efficacy. There was a similar overall incidence of spontaneously reported adverse events, but with clearly different profiles and a suggestion that mianserin was associated with more anticholinergic effects. In terms of sleep, the study provided evidence of a more beneficial effect from paroxetine.
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PMID:Sleep and paroxetine: a comparison with mianserin in elderly depressed patients. 143 Oct 12

Pattern recognition methods were carried out on a sample of 80 depressed men, assessed by means of 14 items relevant to depressive symptomatology of the Structured Clinical Interview for DSM-III-R. 1985 edition (SCID). A cluster analysis generated two classes, which were described as a vital (n = 35) and a nonvital cluster (n = 45). Vital depressives were characterized by psychomotor disorders, loss of energy, cognitive disturbances, a distinct quality of mood, early morning awakening and nonreactivity (the "vital" symptoms). Our findings support the descriptive validity of the DSM-III melancholia diagnostic category, although the DSM-III criteria are too conservative and include nonrelevant symptoms (e.g., diurnal variation, anorexia-weight loss) whilst excluding some important items (e.g., loss of energy, cognitive disorders). Vital depressed men were significantly older, more severely depressed and they exhibited biological disturbances (abnormal dexamethasone suppression test, lower basal thyroid secreting hormone) as opposed to nonvital depressives. There are several arguments to support the possibility that both clusters constitute relevant stages in the overall severity of illness continuum, whilst showing qualitative differences with regard to the vital symptoms. In other words, both clusters are continuous categories within the overall severity of illness continuum and form discrete categories with regard to the vital symptoms. By merging the dimensional and categorical hypotheses, we were able to construct a new integrated threshold model: unipolar depression in men is probably a homogeneous disease with reference to overall severity of illness, but--as severity increases--vital symptoms emerge, grouping together into a distinct profile, i.e., vital depression.
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PMID:A clinical and biological validation of the DSM-III melancholia diagnosis in men: results of pattern recognition methods. 143 45

Major depressive disorder using Feighner et al. (Arch. Gen. Psychiatry 26, 57-63, 1972) and DSM-III or DSM-III-R criteria has proven to be a heterogeneous diagnosis. It apparently includes a wide variety of clinical conditions. This report, based upon the results of a multi-year blind follow-up of 500 randomly selected psychiatric outpatients focuses on certain problems associated with the diagnosis of primary unipolar affective disorders. At index, 141 patients received diagnoses of primary unipolar depression. At follow-up, only 62 (44%) of these received the same diagnosis, with an additional 14 (10%) receiving a diagnosis of undiagnosed: questionable primary unipolar depression, and 5 (4%) a diagnosis of bipolar disorder. Thus, about 43% received other diagnoses at follow-up: 35 (25%) diagnoses of secondary depression and 25 (18%) other diagnoses without indication of an affective component. Bipolar patients' stability was significantly better for those who were manic at intake.
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PMID:Unipolar depression: diagnostic inconsistency and its implications. 144 28

Recurrent brief depression (RBD) has recently been proposed as a new subtype of affective disorder characterized by episodes of major depression which last less than two weeks. The aim of this study was to further evaluate the validity of this putative subtype by means of clinical and biological data. DST, TSH response to TRH and sleep EEG variables were compared in 25 RBD patients sex- and age-matched to 25 major depressed (MD) and 25 healthy subjects. Family history, age at onset, and psychiatric comorbidity did not discriminate RBD from MD. Recurrent unipolar depression was found to be more prevalent in MD. Although less severely depressed during the biological tests, patients with RBD did not significantly differ from those with MDD on basis of DST non-suppression, blunted TSH response and shortening of REM latency. Compared to controls, a greater sleep onset latency was observed both in RBD and MD and a lower total sleep time in MD patients only. These results suggest that RBD could be viewed as a subtype of affective disorder sharing many characteristics with MDD.
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PMID:Biological and clinical features of recurrent brief depression: a comparison with major depressed and healthy subjects. 147 36

Currently it is not clear whether minor forms of unipolar depression not matching the criteria of "major depression" should be considered as a separate diagnostic category. A controlled family study examined the familial aggregation of minor depression among probands with unipolar major depression. In the families of these probands the relative risk for minor depression was elevated by a similar magnitude to the risk for major depression. Therefore, the diagnostic category "minor depression" would not increase diagnostic sensitivity at the expense of diagnostic specificity as far as familiality is the criterion. In agreement with recent epidemiological studies, minor depression did not reveal a similar excess prevalence in females compared with males as major depression does. The variation of the sex ratio for any subtype of unipolar depression was not associated with the familiality of this disorder.
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PMID:The risk of minor depression in families of probands with major depression: sex differences and familiality. 148 13


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