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

In a prospective study, the authors compared 22 delusional and 36 non-delusional depressive patients with respect to demographic and clinical variables, personality, and response to treatment. Delusional depressives had a higher total score than non-delusional depressives on Hamilton's Rating Scale for Depression, as well as a higher score for depressed mood and psychomotor retardation. The type of treatment failed to differentiate the two groups as to outcome at discharge. However, six of the seven delusional depressives who did not respond to tricyclic antidepressants had a full recovery with ECT. The results indicate that delusional depression represents a more severe type of major depression.
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PMID:Delusional depression: phenomenology and response to treatment. A prospective study. 287 74

Thanks to progress in the diagnosis and treatment of depression it is now possible for most cases to be treated on an out-patient basis. Only 15-20% of patients require hospitalisation, most of them because their depression has proved resistant to therapy. To overcome therapy-resistance, the following methods of treatment are available: In therapy-resistant endogenous and psychogenic depressions, mono-infusion therapy is the treatment of choice; it can also be administered on an out-patient basis. In extremely intractable cases, it is advisable to resort to combined infusion therapy, preceded by five days of relaxation therapy with oral doses of a neuroleptic, and possibly reinforced by medication with 5-hydroxytryptophan (the precursor of serotonin) or by sleep deprival. In therapy-resistant cases of so-called masked depression, marked by overtones of anxiety and hypochondriasis, infusions of maprotiline are indicated, because this anti-depressant exerts a relaxing and mildly anxiolytic action, has a stabilising influence on the autonomic nervous system, and produces a mood-brightening effect. In patients who are apathetic and devoid of drive and suffering from involutional depression or depression of old age, infusion therapy plus administration of an MAO inhibitor can be recommended. Combination of an antidepressant with a neuroleptic agent also displaying certain antidepressive properties is really indicated only in the rare cases of schizo-affective psychosis. Electroconvulsive therapy should be employed only as a last resort in extremely retarded and apathetic patients with strong suicidal tendencies, and the indication for ECT should be established with the utmost reserve.
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PMID:Treatment for therapy-resistant depression. 288 99

A complete, unselected series of 68 patients who were seen during their first episode of an undoubtedly schizophrenic illness, and followed up one year later (for 56 patients) is described clinically. Depressive symptoms were common at onset, and 22% of patients could have been considered cases of depression from these symptoms alone. At follow-up, depressive symptoms had reduced in prevalence and only 7% of subjects were depressed cases. Only two cases of depression at follow-up had not been cases at onset. These changes could not be attributed to the use of antidepressants or ECT. Depressive syndromes could be distinguished from akinesia and the negative syndromes. The findings indicate that depression cannot be attributed solely to the administration of neuroleptics.
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PMID:Depressive syndromes in the year following onset of a first schizophrenic illness*. 290 85

The EEG has been a widely-used screening procedure before ECT. Previous studies have correlated seizures and post-ECT slowing with ECT efficacy. We investigated the utility of pre-ECT EEG in predicting therapeutic response and post-ECT confusion. EEGs were normal in 54 of 100 patients undergoing first courses of ECT for refractory depression. Patterns within the normal range, were present in 26/100 while 2/100 had paroxysmal discharges without clinical evidence of epilepsy. Focal and generalized EEG slowing were each present in 9/100 records. Full recovery occurred after ECT in 66.6 per cent of those with normal pre-ECT records, 61.5 per cent with borderline EEGs, 55.5 per cent of patients with diffuse EEG slowing, and 22.2 of cases with focal slow waves. Of those with EEG slowing 22.2 percent had little or no response to ECT as compared to 19.2 per cent with EEGs within normal limits and 9.3 per cent with normal EEGs. Four of 6 patients with prolonged confusion had normal EEGs, while 1 each had focal and generalized slowing. EEG slowing was related to incomplete ECT response, but not to therapeutic failure or post-ECT confusion. The limited predictive power of pre-ECT EEG may reflect the prevalence of normal or nonspecifically abnormal EEGs in psychiatric patients and the general efficacy of ECT. Other neurophysiologic methods may yield more definitive information about the mechanism and use of ECT.
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PMID:Predictive value of electroencephalography for electroconvulsive therapy. 292 28

Among inpatients treated without ECT, those with primary unipolar depression had significantly better outcomes at discharge than did those with secondary depression. This difference grew more striking during a 6-month follow-up; patients with secondary depression were clearly less likely to recover from the index depressive episode and had substantially higher symptom levels at the time of follow-up. In contrast, patients with DSM-III melancholia resembled depressed patients without melancholia on all outcome measures.
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PMID:Short-term prognosis in primary and secondary major depression. 293 60

To summarise, depression in the elderly is often a relapsing, serious illness in which physical treatments by drugs and ECT are the only specific anti-depressant measures we have. Once depressed, patients are likely to suffer further adverse events and are at risk of losing their close emotional supports as a result of the depression itself. The evidence suggests that it is unlikely that a pre-existing close intimate relationship can protect against relapse in the face of further adversity and furthermore it is unlikely that professional social support, as provided by day hospitals and outpatient clinics, is an effective antidote to the adverse effects of continuing problematic social circumstances. We need to learn a great deal more about how to manipulate the social milieu effectively and how to help distressed family carers cope better with the stress of a depressed elderly relative. Admission to an old people's home is rarely the right answer. Finally, let us look more objectively at the ward treatment offered to our seriously depressed patients and not impose a 'therapeutic' regime which is inflexible to individual patient's needs.
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PMID:General management of depression in late life. 293 86

Platelet alpha 2-and lymphocyte beta 2-adrenoceptor densities, plasma noradrenaline and serum cortisol were measured before, during and one week after a course of EEG-monitored electroconvulsive therapy, in nine depressed patients. A 50% fall in Hamilton Depression Rating scores occurred after a fairly consistent total seizure time, regardless of the amount of ECT given. Platelet alpha 2-adrenoceptor densities showed a statistically significant fall after three ECTs, but were unchanged after the full course of ECT and were independent of clinical change. Lymphocyte beta 2-adrenoceptor densities were unaltered. Plasma noradrenaline concentrations were initially high, and fell with ECT in a manner paralleling clinical recovery. Plasma noradrenaline may be a more useful index of central changes during antidepressant treatment than peripheral blood cell receptor densities.
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PMID:Adrenergic receptors in depression. Effects of electroconvulsive therapy. 299 28

Five patients suffering with delusional depression, and who were resistant to tricyclic antidepressants, were successfully treated with lithium carbonate. Delusional depression does not usually respond to tricyclic antidepressants, and ECT has been considered the treatment of choice. Such patients often refuse to acknowledge that they are ill. They, therefore, understandably often refuse to accept ECT. In order to treat, the Mental Health Act 1983 must be invoked. Treatment with lithium carbonate is more acceptable to most patients, and in the cases described, patients agreed to take this drug whereas they had refused to accept ECT.
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PMID:Lithium augmentation in the treatment of delusional depression. 309 14

Recent work has demonstrated the coexistence of depressive illness in some patients with dementing disorders. Two cases of mixed depression and dementia showed behavioural and mood improvement after treatment with ECT, but without improvement in cognition. The role of ECT in the treatment of affective symptoms in dementia is discussed.
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PMID:ECT in the treatment of mixed depression and dementia. 316 52

The study tests the hypothesis that delusional and non-delusional depressive illnesses are distinct entities in late life. Two groups of 24 patients with late-onset depression, one with and one without delusions, were compared retrospectively. At the index admission, deluded patients were significantly more depressed, were in hospital for longer, responded poorly to antidepressants alone and required more physical treatments, especially ECT and major tranquillisers. Although illness severity was a major factor accounting for these differences, the finding that only the deluded group experienced delusional relapses suggests an underlying intrinsic susceptibility. The discharge status was similar for both groups, as were relapse rates over 48 months and the clinical course of depressive symptoms over 42-104 months. The findings are consistent with studies of younger patients which point to a distinction between these two types of depression, but not with recent work suggesting a very poor prognosis for delusional depression in late life.
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PMID:Delusional and non-delusional depression in late life. Evidence for distinct subtypes. 316 75


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