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

The study of depression, drinking and suicidality has long preoccupied students of American Indian life, in part because of the assumed connection between these specific forms of psychiatric distress and generalized demoralization. Given the significant variation in suicidal behavior and prevalence rates intertribally, this assumption deserves closer attention. Recently, researchers working with Western populations have sought to clarify the relationships among depression, alcohol abuse and suicidality through an explicit investigation of their comorbidity. Using data collected at the Flathead Reservation, this paper explores the degree to which the investigation of the comorbidity of these three disorders can validly reveal the relevant contours of psychopathological distress in a cross-cultural setting. The data show that while the comorbidity of problem drinking and depression can sometimes indicate severe psychopathological distress, measured in this case by suicidality, comorbidity cannot account for another group at high risk for suicide. The discrepancy is explicable with reference to the cultural construction of depression, drinking and suicidality in relation to the creation, maintenance and disruption of social bonds, rather than in relation to an internal state of demoralization.
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PMID:"Feeling worthless": an ethnographic investigation of depression and problem drinking at the Flathead reservation. 130 26

Recurrent brief depression, characterised by frequently occurring brief depressive episodes, lasting less than two weeks, is now recognised as a common and disabling illness with a chronic relapsing course and a significant suicide risk. The episodes have a mean duration of 3 days, but otherwise fulfill the symptomatic criteria for DSM III-R major depression. Some two thirds of episodes satisfy severity criteria for at least moderate depression and about a third for severe depression. They recur erratically with a mean period of 18 days between the start of one episode and the next. Because of the frequency of the episodes patients may report longer continuous periods of depression than was the case and may be mistakenly perceived as dysthymia as major depression. It is important to identify these patients as treatment response appears to differ. The episodes are too short to be able to assume efficacy with conventional antidepressants; it is necessary to adopt a prophylactic strategy for treatment aiming to reduce the severity, the frequency, or the duration of episodes.
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PMID:Features of recurrent brief depression. 130 49

In this longitudinal study of 9,904 clients who were treated at methadone, outpatient drug-free (OPDF), and residential treatment facilities, at intake more than half of all clients reported symptoms of depression or suicide. Females and multiple nonnarcotics users were at highest risk for suicide attempts. Despite a dramatic drop in the level of symptomatology by 4 weeks in treatment, many clients remained suicidal throughout the study period. Suicidal tendencies at both intake and 4 weeks were strongly related to suicidal tendencies at 12 months post-treatment; even more strongly related was the return to weekly or more frequent use of narcotics or nonnarcotics for residential and OPDF clients.
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PMID:Effects of drug misuse treatment on symptoms of depression and suicide. 132 75

Antibodies against tyrosine hydroxylase (TH, the rate-limiting enzyme in norepinephrine synthesis) and dopamine beta-hydroxylase (DBH, the last enzyme in the synthesis) were used for immunohistochemical staining of human brain locus coeruleus sections, obtained postmortem from suicide victims and matched controls. Stain density over individual cells was quantified by a computerized, video-camera-based image analysis system. Mean stain density for TH was significantly lower (by about 30%) in the locus coeruleus of suicide victims. There was no difference between suicides and controls in DBH immunoreactivity or in the number of TH immunoreactive cells. Reduced TH availability, either genetically or environmentally determined, may contribute to the noradrenergic insufficiency postulated to occur in depression and the increased beta-adrenergic receptor concentrations observed in prefrontal cortex of suicide victims.
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PMID:Reduced tyrosine hydroxylase immunoreactivity in locus coeruleus of suicide victims. 134 45

Prevention or reduction of suicide remains a serious challenge for the medical community. Psychotherapeutic and psychosocial interventions have not been shown to reduce the incidence of suicide attempts and analytic psychotherapy has been shown to increase suicidal behavior. The efficacy of pharmacotherapy in reducing suicide attempts in patients with a history of repeated suicidal behavior has been shown with low doses of the neuroleptic agent flupenthixol compared with placebo. Supporting findings have been reported with trifluoperazine. There is evidence to suggest that some antidepressants may not be neutral in their effect on suicidal behavior. Maprotiline, for example, was associated with an increase in suicide attempts compared with placebo in a large long-term treatment study despite its significant efficacy in preventing relapse of depression. Differential lethality indices taken from large community studies support the notion that noradrenergic drugs such as maprotiline, desipramine, and nortriptyline are associated with a higher than expected incidence of death from overdose, and the suicide-provoking potential may relate to some noradrenergic property. The studies of serotonergic antidepressants do not suggest that they are suicide-provoking agents; rather they appear to be neutral or protective. Prospective prophylactic studies are needed to test the ability of potential treatments for the reduction of suicidal behavior.
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PMID:Pharmacotherapy in the prevention of suicidal behavior. 846 51

To examine directly in the brain the status of the alpha 2-adrenoceptor in major depression, the specific binding of the agonists [3H]clonidine and [3H]UK 14304 was quantitated in various brain regions of suicide victims with a retrospective diagnosis of depression or other psychiatric disorders. In depressed suicides, the binding capacity of [3H]clonidine was found to be increased in the hypothalamus (Bmax 35%-55% greater), and to a lesser extent in the frontal cortex, as compared with that in matched controls, schizophrenic suicides, or suicides with various diagnosis. The binding capacity of [3H]UK 14304 also was found increased in the frontal cortex (Bmax 30% greater), and to a lesser extent in the hypothalamus, of depressed suicides. In other brain regions such as the amygdala, hippocampus, and cerebellum there also was a tendency for an increased receptor density associated with suicide. Moreover, in the frontal cortex of suicides, the potency of norepinephrine in displacing the binding of the antagonist [3H]idazoxan also was found increased (Ki decreased eight-fold). The results indicate that the density and affinity of alpha 2A-adrenoceptors in the high-affinity state are increased in the brain of depressed suicides.
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PMID:Alpha 2-adrenoceptors in the brain of suicide victims: increased receptor density associated with major depression. 134 30

The majority of schizophrenic patients receive neuroleptics (NL) and a relatively high number of them commit suicide. Is there a relationship between the two variables? Long-term observations failed to demonstrate an interdependence between a large-scale introduction of NL in the therapeutic practice and suicide rates. There is a relationship between depression and suicide and depressive syndroms are frequent in schizophrenic patients. Depressions due to an exclusive use of NL probably do occur, but quite seldom so. Also, possible relationships between other NL side effects (akathisia, dysphoric reaction to NL) and suicidal behavior are not sufficiently supported by the clinical data. Direct comparisons in controlled studies (the own study included) between NL therapy of suicide and control subjects yielded no consistent results. Suicide promoting effect of NL cannot be postulated on the basis of the available data, however, it also cannot be fully excluded in individual cases.
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PMID:[Neuroleptic therapy and suicide--review of the literature and personal results]. 135 Oct 27

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

Suicidal behavior is the result of a combination of factors that span the domains of psychopathology, genetics, early life experience, family interactions, social stress, physical illness, and neurobiology. To develop predictive and explanatory models of suicidal behavior it is necessary to consider all of these domains. A stress-diathesis model is proposed that classifies risk factors for suicidal behavior into those that are trait-dependent and those that are state-dependent. The timing of suicidal behavior is determined by state-dependent factors. The relationship of psychopathologic factors such as severity of depression or anxiety to suicide will be discussed. Biologic changes that correlate with suicide may be either state- or trait-dependent. Particular emphasis will be given to changes in the serotonin system and how these may represent a constitutional risk factor as opposed to a state-dependent risk factor for suicidal behavior.
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PMID:Integration of neurobiology and psychopathology in a unified model of suicidal behavior. 137 33

Cerebrospinal fluid studies have reported that low concentrations of the dopamine metabolite homovanillic acid are associated with suicidal behavior in depression. Although only a small proportion of homovanillic acid in the urine derives from the brain, we decided to examine 24-hour urinary outputs of homovanillic acid in relation to suicidal behavior in depression. Patients with depression who had attempted suicide had significantly smaller urinary outputs of homovanillic acid, dihydroxyphenylacetic acid, and total body output of dopamine (sum dopamine) than did patients with depression who had not attempted suicide. Patients with depression who reattempted suicide during 5-year follow-up had significantly smaller urinary outputs of homovanillic acid and sum dopamine than did patients who did not reattempt suicide, patients who never attempted suicide, and normal control subjects, and had significantly smaller outputs of dihydroxyphenylacetic acid than patients who never attempted suicide or control subjects. These data suggest that urinary outputs of homovanillic acid may be peripheral correlates of suicidality in depression. These data add to data on the low levels of homovanillic acid in cerebrospinal fluid in suggesting that diminished dopaminergic neurotransmission may play a part in suicidal behavior in depression.
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PMID:Marked reduction in indexes of dopamine metabolism among patients with depression who attempt suicide. 137 7


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