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

Depressive signs and symptoms can change on a daily, monthly and annual scale (diurnal variation of mood, premenstrual dysphoric disorder, seasonal affective disorders). This can be understood as a coupling of psychopathology to pre-existing rhythmic processes (association hypothesis). Also early morning awakening, short REM-sleep-latencies and the antidepressive effects of sleep deprivation and of phase advance therapy bear no evidence of a particular chronopathology in depression. Correspondingly, most studies in depressives have not shown an abnormal phasing of circadian rhythms.
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PMID:[Chronobiology of depression]. 858 55

Research into the psychobiology of premenstrual dysphoric disorder (PDD) finds alterations in markers associated with serotonergic neurotransmission. Supporting this is work showing that patients with PDD respond to some agents that block the reuptake of serotonin. In this open trial, patients were treated for one cycle with placebo and then for three consecutive cycles with the serotonin reuptake inhibitor paroxetine. The study population was composed of 14 participants who met DSM-IV criteria for PDD with moderate to severe symptomatology and specifically endorsed anger and irritability as a central premenstrual complaint. Patients showed modest improvement over the course of the pretreatment evaluation, with significant improvement occurring for feelings of worthlessness, decreased interest, and low energy. The effects of active treatment were marked by the first active cycle with luteal phase 17-item Hamilton Rating Scale for Depression scores decreasing from 14.9 (+/- 5.3) to 8.2 (+/- 4.9) in the first, 7.8 (+/- 5.1) in the second, and 7.8 (+/- 6.8) in the third active treatment cycles (F[1,13] = 17.6; p < 0.0001). A group of items from daily ratings indicative of anger and irritability (mood swings, anger and irritability, behavioral dyscontrol, and interpersonal conflicts) also showed improvement (F[1,13] = 5.94; p < 0.03). Various definitions of response were applied to treatment completers. The most conservative measure, the Clinical Global Impression (CGI), revealed that 7 of 14 patients had a complete response (CGI = 1 or 2) whereas 4 patients had a partial response (CGI = 3). These open trial findings are consistent with the notion that paroxetine is effective in the acute phase for the treatment of PDD.
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PMID:Paroxetine as a treatment for premenstrual dysphoric disorder. 883 12

Premenstrual symptoms are common among young menstruating women, but the psychiatric disorder premenstrual dysphoric disorder (PMDD) is seen only in approximately 3% of this group. The symptom profile of PMDD has been empirically derived from a number of investigations including a large data base from five university centers. The most commonly reported symptoms are depression and mood swings, but a substantial number of women report tension and anxiety. Lifetime psychiatric illness is also common in women with PMDD, and although mood disorders predominate, past histories of anxiety disorders are also common, further suggesting an association between PMDD and anxiety disorders. The strongest data supporting such an association lie with challenge studies that have been used to provoke panic in panic patients and are effective in precipitating panic attacks in women with PMDD. Finally, treatments that are effective for anxiety disorders are also useful in the treatment of PMDD. In this paper, the above outlined relationship between anxiety disorders and PMDD is reviewed.
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PMID:Anxiety symptoms and anxiety disorders: how are they related to premenstrual disorders? 913 94

Serotonergic antidepressants have been shown to be effective treatments for premenstrual dysphoric disorder (PMDD). The efficacy of nonserotonergic antidepressants is less well studied. This study was a two-center, parallel design, placebo-controlled, randomized trial of fluoxetine, bupropion, and placebo in women with PMDD. Thirty-four women with PMDD completed 1 month of single-blind placebo and 2 months of fluoxetine 20 mg/day (N = 10), bupropion 100 mg three times daily (N = 12), or placebo (N = 12). Clinical Global Impressions (CGI) Scale, an expanded form of the Hamilton Rating Scale for Depression (HAM-D), and Global Assessment Scale (GAS) ratings were obtained premenstrually in each of the three treatment cycles. The three treatment groups differed significantly in efficacy by CGI ratings. Fluoxetine was superior to both bupropion and placebo. Comparison of posttreatment to pretreatment HAM and GAS scores demonstrated significant superior efficacy of fluoxetine compared with placebo. Posttreatment HAM and GAS scores for bupropion were intermediate between but not significantly different from fluoxetine or placebo. In summary, fluoxetine was significantly superior to bupropion and placebo as an effective treatment for PMDD. Although some improvement with bupropion was noted, and both medications were well tolerated, patient satisfaction was far greater with fluoxetine.
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PMID:Comparison of fluoxetine, bupropion, and placebo in the treatment of premenstrual dysphoric disorder. 924 Oct 4

There is little difference between LLPDD and PMDD. The names are different, and the criteria for PMDD include one more symptom (a subjective sense of being overwhelmed or out of control) than do those for LLPDD. Both diagnoses pertain to women with premenstrual complaints who suffer primarily from affective symptoms severe enough to interfere seriously with their lives. Recent controversies surrounding PMDD concern what meaning should be attributed to the clinical and research information that is now available on the condition. Some believe that there is abundant evidence to indicate that PMDD is a mood disorder; others argue that the meaning of the data is unclear. (See Gold and Severino for a comprehensive summary of the issues surrounding this diagnosis.) The nosological shift to categorize PMDD as a depression not otherwise specified implies that "enough information is available to indicate the class of disorder that is present." The validity of this assumption is questioned by some. Coding PMDD as a depression will encourage clinicians to view women with PMDD as depressed, will encourage women with the condition to view themselves as depressed, and will influence researchers' conceptualization of study designs in very complex and subtle ways that may go unquestioned.
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PMID:Premenstrual dysphoric disorder: controversies surrounding the diagnosis. 938 60

Even though premenstrual symptoms had been already described by Hippocrates, premenstrual dysphoric disorder (PMDD) was first mentioned as a special psychiatric diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) in 1994. In DSM-III-R-Appendix A is was called late luteal phase dysphoric disorder (LLPDD), Appendix A. Before this diagnosis was established based on operationalized criteria, the term premenstrual syndrome (PMS) was used for patients with severe premenstrual mood disturbances and physical symptoms. Many hypotheses about the pathophysiological mechanisms underlying PMS and PMDS led to different therapeutic strategies. While PMS was mainly treated by gynecologists, PMDD became of interest in psychiatric research. Several antidepressants, psychotherapy, sleep deprivation and light therapy have been investigated regarding their effectiveness in combatting premenstrual symptoms such as depression, tension, dysphoria and anxiety. Within the anti-depressants the best findings were for selective serotonin reuptake inhibitors (SSRIs).
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PMID:[Premenstrual dysphoric disorder. An overview of diagnosis, epidemiology and therapeutic approaches]. 941 Dec 73

Paroxetine is a potent and selective inhibitor of the neuronal reuptake of serotonin (5-hydroxytryptamine; 5-HT), which was previously reviewed as an antidepressant in Drugs in 1991. Since then, more comparative trials with other antidepressants have become available, and its use in the elderly and as long term maintenance therapy has been investigated. Paroxetine has also been studied in several other disorders with a presumed serotonergic component, primarily obsessive compulsive disorder (OCD) and panic disorder. In short term clinical trials in patients with depression, paroxetine produced clinical improvements that were significantly greater than those with placebo and similar to those achieved with other agents including tricyclic antidepressants (TCAs), maprotiline, nefazodone and the selective serotonin reuptake inhibitors (SSRIs) fluoxetine, fluvoxamine and sertraline. Long term data suggest that paroxetine is effective in preventing relapse or recurrence of depression in patients treated for up to 1 year. In the elderly, the overall efficacy of paroxetine was at least as good as that of comparator agents. In short term clinical trials involving patients with OCD or panic disorder, paroxetine was significantly more effective than placebo and of similar efficacy to clomipramine. Limited long term data show that paroxetine is effective in maintaining a therapeutic response over periods of 1 year (OCD) and up to 6 months (panic disorder). Preliminary data suggest that paroxetine has potential in the treatment of social phobia, premenstrual dysphoric disorder and chronic headache. Like the other SSRIs, paroxetine is better tolerated than the TCAs, causing few anticholinergic adverse effects. The most commonly reported adverse event associated with paroxetine treatment is nausea, although this is generally mild and subsides with continued use. Fewer withdrawals from treatment due to adverse effects occurred with paroxetine treatment than with TCAs. The adverse events profile of paroxetine appears to be broadly similar to that of other SSRIs, although data from comparative trials are limited. Serious adverse effects associated with paroxetine are very rare. In conclusion, paroxetine is effective and well tolerated, and suitable as first-line therapy for depression. It also appears to be a useful alternative to other available agents for the treatment of patients with OCD or panic disorder.
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PMID:Paroxetine. An update of its pharmacology and therapeutic use in depression and a review of its use in other disorders. 946 92

Many women experience psychological and physical symptoms associated with the menstrual cycle, commonly referred to as premenstrual syndrome (PMS). For the 3% to 5% of women who meet Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for premenstrual dysphoric disorder (PMDD), symptoms are severe and impair social and occupational functioning. Although the etiology of PMDD is unknown, symptoms of dysphoria, including depression and anxiety, predominate and indicate a link to serotonergic neurotransmission. Pharmacotherapy trials have shown greater efficacy with serotonergic versus nonserotonergic compounds. We reviewed the published literature and found 7 controlled and 4 open-label clinical trials of fluoxetine, a selective serotonin reuptake inhibitor, in the treatment of PMDD. These trials demonstrate that PMDD symptoms decreased during treatment with fluoxetine. Preliminary findings suggest that intermittent luteal-phase fluoxetine dosing may also be a suitable treatment strategy for selected patients with PMDD. At 20 mg/d, adverse events were usually transient, rarely caused discontinuation, and were consistent with fluoxetine's known safety profile. Fluoxetine 20 mg/d is an effective and well-tolerated treatment for women with PMDD, a severe variant of PMS.
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PMID:The role of fluoxetine in the treatment of premenstrual dysphoric disorder. 1036 29

Women experience depression twice as often as men. The diagnostic criteria for depression are the same for both sexes, but women with depression more frequently experience guilt, anxiety, increased appetite and sleep, weight gain and comorbid eating disorders. Women may achieve higher plasma concentrations of antidepressants and thus may require lower dosages of these medications. Depending on the patient's age, the potential effects of antidepressants on a fetus or neonate may need to be considered. Research indicates no increased teratogenic risk from in utero exposure to selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants. SSRIs are effective in treating premenstrual dysphoric disorder and many comorbid conditions associated with depression in women. Psychotherapy may be used alone in women with mild to moderate depression, or it may be used adjunctively with antidepressant drug therapy. Women who have severe depression accompanied by active suicidal thoughts or plans should usually be managed in conjunction with a psychiatrist.
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PMID:Depression in women: diagnostic and treatment considerations. 1041 40

During the last decade, it became evident that antidepressants may represent a useful treatment option for a variety of primary psychiatric disorders other than depression. Improved understanding of both underlying etiology of these disorders and pharmacologic modes of action of available treatments has led to an improvement in conditions such as panic disorder, generalized anxiety disorder, obsessive-compulsive disorder, posttraumatic stress disorder, and premenstrual dysphoric disorder. In addition, evidence is accumulating that some new antidepressants may be of therapeutic value in treatment of some subtypes of depressive disorder previously unresponsive to treatment or difficult to treat, such as seasonal affective disorder, depression with atypical features, and recurrent brief depression. Mirtazapine is an antidepressant with mode of action different from other currently available antidepressants. A review of currently available data of mirtazapine's use in indications other than depression and in some types of depressive disorder is presented.
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PMID:Mirtazapine: other indications. 1044 41


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