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

The authors analyze a series of 20 patients seen over the past 4 years who have shown a dramatic improvement following the introduction of lithium carbonate to their therapy. The results indicate that these patients showed a consistent syndrome with the following features: a) anergic endogenous depression; b) positive family history in first degree probands; c) obsessional personality traits and symptoms; d) hypochondriasis and somatic symptoms; e) failure to respond to previous antidepressant therapy with tricyclic and MAOI compounds as well as ECT. A previous study by Gittleson showed that one third of a series of psychotic depressives admitted to the Maudsley Hospital, London, also displayed obsessional symptoms and hypochondriasis. These patients, however, seemed to do as well with standard antidepressant treatment as a control group of psychotic depressives without obsessional features. However, in this series, there was a 7 per cent residue whose obsessional symptoms worsened, even after recovery from their depression. The authors' group of patients represented approximately 3 per cent of all psychotic depressives seen over the 4-year period and could, therefore, coincide with Gittleson's residue. The mean age of onset of illness in the authors' depressive group was 45.5 years, and this finding, coupled with the high incidence of psychotic depression in first degree relatives, indicates that these patients were suffering from a psychotic depression modified by personality traits, rather than an atypical obsessional neurosis. The consistency of clinical features and specificity of response to lithium therapy appear to indicate that this is a clearly definable clinical syndrome worthy of further investigation.
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PMID:A depressive syndrome responsive to lithium. An analysis of 20 cases. 97 30

The depressive character is characterized by perpetual and unsuccessful efforts to maintain self-esteem and to avoid a sense of helplessness. Such individuals suffer from chronic depression which may or may not be masked, but which permeates their character. Although the condition is among the commonest seen in many of our clinics and practices, it remains without a generally accepted diagnostic form. It is suggested that the essential, clinical, dynamic, and structural features of the depressive character are: (1) consistently low self-esteem and a sense of helplessness, dependent object relations and chronic guilt; (2) self-directed aggression and masochism are frequent but not invariable; (3) extensive use of the mechanism of denial is as common as the previously described obsessional defenses seen in patients subject to psychotic depression; (4) often the depressive character suffers from intense oral envy; (5) depressive character traits may help to ward off any of the basic anxieties, namely, object loss, loss of love, castration anxiety, and superego anxiety (guilt) (6) the depressive character may be similar to a number of related disorders, namely, the obsessional character, hysterical characters with a large oral component, and depressive borderline states; (7) sensitivity to loss, sadness, and fragility of self-esteem makes the depressive character especially vulnerable to regression into overt depression; (8) the persistence of oral incorporative mechanisms, ambivalent, dependent object relations, ego versus superego tension with depressive affect, and sensitivity to loss are characteristic of the ego of the depressive character.
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PMID:The depressive character. 123 40

It has been mentioned that herpes simplex antibodies are increased in depressed patients. In the present study, serums from 21 patients with reactive depressions, nine with psychotic depression, 33 schizophrenic and 15 normal controls were studied, and herpes simplex antibodies were measured. Neither was statistically significant difference found between any of the groups nor could antibody titres be correlated with severity of depression measured by a psychiatric rating scale. The authors review the pertinent literature, and state that although antibody tires do not correlated with psychiatric diagnosis, there still exists the possibility that latent brain viral infections might trigger depressive episodes in some cases.
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PMID:[Depression and Herpex simplex infections]. 125 8

Whilst tricyclic antidepressants are efficacious in all depressive syndromes, classical MAO-inhibitors differ substantially from them in their action. They are considered less effective in general and not very effective in endogenous depression, but recommended for the treatment of 'atypical' depression. A new class of RIMA (Reversible Inhibitors of MAO-A) represented by moclobemide requires a change in clinical thinking on antidepressants. Moclobemide shows the same efficacy in depression as tricyclics: its effects are similar in unipolar and bipolar affective disorders, and in patients with major depressive episode superimposed on dysthymia (double depression). As with classical antidepressants, the response rate tends to be lower, but is still present in psychotic depression. Agitated depressives do not respond less well than non-agitated patients to moclobemide. Patients meeting DSM-III-R criteria for major depression with melancholia tend to respond better than non-melancholics, but this may be associated with the significantly higher baseline severity observed in melancholics. A slightly higher response rate in patients without concomitant benzodiazepine treatment, compared to those with benzodiazepine comedication, may also be related to baseline differences in the severity of depression. Elderly depressives respond less well than younger patients to classical antidepressants, but with moclobemide, elderly patients do as well as younger ones.
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PMID:Efficacy of moclobemide in different patient groups: a meta-analysis of studies. 134 58

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

Urinary excretion of neopterins and biopterins was measured in 23 patients with severe depression before and after receiving electroconvulsive therapy (ECT) and 26 healthy control subjects. Patients with psychotic depression and those responding to ECT had neopterin:biopterin (N:B) ratio significantly higher than controls before commencing ECT and positive therapeutic response was associated with reduction of N:B ratio towards control values. As a raised N:B ratio implies failure to convert neopterin to biopterin it is possible that reduced availability of tetrahydrobiopterin, the essential cofactor for the formation of noradrenaline, serotonin and dopamine, may exert rate limiting control over the synthesis of monoamines implicated in the pathogenesis of depressive disorders. The N:B ratio may be a marker for certain depressive subtypes and response to ECT.
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PMID:Pterin metabolism in depression: an extension of the amine hypothesis and possible marker of response to ECT. 148 84

To review data supporting or not supporting the designation of unipolar psychotic major depression as a distinct syndrome in DSM-IV, the authors used computerized literature searches to identify reports of studies that have directly compared the characteristics, biology, familial transmission, course/outcome, and response to treatment of psychotic and nonpsychotic major depression. The review showed that statistically significant differences between the two types of depression have been found on each of these dimensions. There are greater guilt feelings and psychomotor disturbance, among other features, in psychotic depression. Studies have found significant differences between patients with psychotic and nonpsychotic depression in glucocorticoid activity, dopamine beta-hydroxylase activity, levels of dopamine and serotonin metabolites, sleep measures, and ventricle-to-brain ratios. Family studies show higher rates of bipolar disorder in first-degree relatives of probands with psychotic major depression than of probands with nonpsychotic major depression. Greater morbidity and residual impairment have also been reported in patients with psychotic major depression, and they respond more poorly to placebo and to tricyclic antidepressants. Differences between patients with psychotic and nonpsychotic major depression on many of these measures were not due to differences in severity or endogenicity. Since the data indicate that psychotic and nonpsychotic major depression can be separated, the frequency with which the diagnosis of psychotic major depression is missed and its unique course and response to treatment point to the practical importance of a separate diagnosis for this disorder. However, further studies are needed to resolve important methodological issues and to develop an optimal set of operational criteria.
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PMID:Psychotic (delusional) major depression: should it be included as a distinct syndrome in DSM-IV? 831 97

Psychiatrists at Emory University Hospital in Atlanta, Georgia examined a 37-year old divorced woman suffering from refractory depression. She reported her 1st bout of depression to be at 9-10 years old (onset of menses). She tried to kill herself at ages 11 and 17. The only time she remembered not being depressed was when she was using oral contraceptives (OCs). She 1st took them for oligomenorrhea at age 14. She suffered from oligomenorrhea off and on ever since then. The next time she took OCs was in her early 20s while she was married. She stopped taking them after she had her son. An outpatient psychiatrist had been treating her for the last 10 years. 3 years before this visit to Emory, psychotic depression and a suicide attempt sent her to a hospital. 5 years before coming to Emory, she gained 40 lbs and developed hirsutism, acne, and a low-pitched voice. 8 months before coming to Emory, a physician diagnosed acanthosis nigricans which is dark hyperpigmentation of the epidermis in body fold areas. 6 months prior to coming to Emory, an endocrinologist evaluated her for oligomenorrhea, obesity, and hirsutism and prescribed 0.25 mg dexamethasone/day to inhibit androgen production, regulate menses, and reduce facial hair. 3 months before admission, she experience severe depression. Her psychiatrist treated her with bupropion, amitriptyline, buspirone, and lithium and continued the same dexamethasone treatment. At Emory, her glucose tolerance tests were abnormal and her insulin levels were elevated. Emory psychiatrist stopped all psychotropic medications and dexamethasone. They and some endocrinologists diagnosed HAIR-AN syndrome (hyperandrogenism, insulin resistance, and acanthosis nigricans). They prescribed OCs and within several weeks her mood improved. 2 months later she was fine and had lost 25 lbs. The primary disturbances of HAIR-AN syndrome are insulin resistance and hyperandrogenism. These 2 disturbances together cause acanthosis nigricans.
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PMID:Organic mood disorder associated with the HAIR-AN syndrome. 855 59

1. Twenty-one schizophrenic or schizoaffective patients with histories of cannabis abuse and operationally-defined syndromes of post-psychotic depression completed a double-blind trial of adjunctive imipramine added to their on-going medication regimen of fluphenazine decanoate and benztropine. 2. The imipramine-treated patients had superior global outcome. 3. Subscales suggested that specific improvement occurred in imipramine-treated patients in the domain of depression-like features. 4. Psychotic symptomatology was not found to be exacerbated by the imipramine.
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PMID:Adjunctive imipramine for dysphoric schizophrenic patients with past histories of cannabis abuse. 164 97

In subtypes of schizophrenia and unipolar depression, both increased and decreased levels of platelet serotonin were found. Hyperserotonemia was usually observed in patients with psychotic features (i.e., in paranoid schizophrenia and psychotic depression). Hyposerotonemia, although less common than hyperserotonemia, was present in nonparanoid schizophrenia and nonpsychotic depression (i.e., in patients without psychotic symptoms). A sex difference in platelet monoamine oxidase activity was observed among healthy subjects, but not among schizophrenic patients. The activity of platelet monoamine oxidase in paranoid and nonparanoid schizophrenic patients did not differ from that in healthy subjects. The findings in this study suggest that biological differences between subtypes of unipolar depression or schizophrenia might depend upon the presence of psychotic symptoms.
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PMID:Platelet serotonin in subtypes of schizophrenia and unipolar depression. 175 25


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