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

Depression is associated with a risk of suicide 13 to 30 times greater than in the general population, and antidepressants are among the drugs most frequently implicated in fatal overdose, resulting in a dilemma for the clinician. Suicidal thoughts are a core symptom of depression, and there is evidence that the selective serotonin (5-hydroxytryptamine) reuptake inhibitors (SSRIs), including fluvoxamine, are of particular benefit in reducing their occurrence. Data from controlled studies indicate that the SSRIs do not exacerbate suicidal ideation; on the contrary, SSRIs protect against the emergence of suicidal thoughts, which reflect the natural history of the disease. The SSRIs also appear to be particularly effective in patients who are highly suicidal at treatment initiation, and to be more effective than the tricyclic antidepressants in treating severe depression and improving anxiety symptoms associated with depression. Thus, fluvoxamine, in common with other SSRIs, is of particular benefit in treating depression in patients with prominent suicidal thoughts or who are at increased risk of suicide.
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PMID:Suicide and antidepressants. 137 70

A review of the safety and tolerability of fluvoxamine in worldwide marketing studies involving 24,624 patients, predominantly receiving fluvoxamine treatment in uncontrolled studies in depression, has been conducted. There was a marked preponderance of female patients and patients aged between 30 and 50 years. The majority of patients were treated for 6 weeks, with the most frequent modal total daily dose being 100mg. The greatest proportion of adverse experiences occurring, by COSTART body system, affected the digestive system (24.1%), the nervous system (23.7%), and the body as a whole (15.3%). The only adverse experience with an incidence greater than 10% was nausea (15.7%), with somnolence (6.9%) and asthenia (6.2%) as the next most frequent experiences. Notably, the rates of agitation and anxiety were only 1.4 and 1.3%, respectively. The incidences of adverse experiences increased with age, and were slightly higher in females than males. 15.1% of patients discontinued treatment prematurely as a result of adverse experiences, principally nausea, dizziness, vomiting, somnolence, abdominal pain, and headache. The overall incidence of serious adverse events associated with fluvoxamine treatment was 2.5%, and the incidence of overall suicidality, including suicidal ideation, overdose, and intentional overdose as well as attempted and completed acts of suicide, was remarkably low at 0.8%.
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PMID:Review of fluvoxamine safety database. 137 74

Tianeptine is a new tricyclic compound whose principal action is to increase the reuptake of serotonin. In a multicentre trial in which 380 depressed patients were treated for one year, tianeptine produced a significant reduction in the MADRS scores from day 14, with a sustained reduction maintained for up to 12 months; other measures of efficacy (HRSA, HSCL, and CGI) also reflected the improvement. Only 11% of patients withdrew because of recurrence of depression and 2% because of side-effects, which were mainly drowsiness, irritability, and gastrointestinal disturbance. Apart from a minor reduction in heart rate, unaccompanied by any conduction changes, no clinically relevant changes in vital signs or laboratory tests were seen. Seven subjects who attempted suicide by tianeptine overdose had favourable outcomes, in spite of also taking other psychotropic drugs or alcohol. No evidence of tolerance or withdrawal symptoms was seen after treatment was stopped. These results suggest that tianeptine has the potential to provide safe antidepressant activity in both the acute and chronic phases of treatment.
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PMID:Long-term use of tianeptine in 380 depressed patients. 138 24

The purpose of this study was to explore the recognition and expression of anger in black high school adolescents. A total of 56 teens, aged 14-19 years, responded to questions about their recognition of anger, how and to whom they express anger, and to whom they refrain from expressing anger. They also stated their opinions about acceptable and unacceptable expressions of anger and its relationship to depression or suicide. Data were analyzed using frequency tabulations for all questions on the survey instrument. Specific variables of age, grade in school, gender, and family composition were analyzed by one-sample chi 2 tests (alpha set at 0.05). The study demonstrated 1) all the teens surveyed could recognize when they were angry; 2) most teens expressed anger to their friends, to their siblings, and to their mothers; 3) younger teens (ages 14-15 years) when compared to older teens (ages 18-19 years), identified mother as the one who made them angry; 4) females were more likely to feel like crying when angry; 5) females were more likely to feel like being silent when angry; 6) students from one- and two-parent homes did not differ in their expression of anger. Implications of this study include the recognition that anger is a natural, human emotion. Adolescents need to observe adults who can effectively manage behavior associated with anger. Problem solving skills, stress management techniques, and role play situations can be utilized as effective tools in the recognition and expression of anger in acceptable ways and in attempts at the prevention of dysfunctional anger.
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PMID:Self-reported anger in black high school adolescents. 139 Aug 10

One hundred fifteen consecutive patients in the Austin Hospital Comprehensive Epilepsy Program (Melbourne, Australia) were surveyed to document the psychosocial and rehabilitation difficulties after temporal lobectomy. During the follow-up period (mean 4 years) 3 patients died, 5 patients were lost to follow-up, and 107 patients with family and friends were interviewed. Eighty-four patients (78%) had been seizure-free for the year preceding the interview; 13 others had seizure reduction greater than 75%. Success in ablation or reduction in seizures correlated with the amount of postoperative gain, but in this series, analysis of work and dependency outcome did not emphasize areas of success. Although improvement in work and financial status, interpersonal relations and sexuality were all recorded, successful patients deemed that most advance had been made in the areas of newly acquired independence, enhanced career potential, and social freedom. Significant postoperative anxiety, especially after left temporal lobectomy, was noted, possibly explained by benzodiazepine antiepileptic drug (AED) discontinuation. Although 1 patient committed suicide, neither depression nor psychosis was common in the rehabilitation period, in contrast to results in previous series. Significant sociodomestic problems emerged from this survey, however: 35% of patients considered successes reported postoperative problems stemming from the necessity to restructure family dynamics; in 6%, this resulted in divorce. Moreover, 20% of patients and relatives reported significant behavioral problems in coping with the seizure-free lifestyle. Finally, the problems of the worsened situation after surgical failure indicated the counterproductive potential of ineffective lobectomy. These results indicate the necessity for a preoperative counseling program to prevent these problems.
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PMID:Psychosocial difficulties and outcome after temporal lobectomy. 139 33

Psychiatrists used a semi-structured Standardized Psychiatric Examination method to examine 810 adults drawn from a probability sample of eastern Baltimore residents in 1981. Of the population, 5.9% was found to be significantly depressed. DSM-III major depression (MD) had a prevalence of 1.1% and 'non-major depression' (nMD), our collective term for the other depressive disorder categories in DSM-III, had a prevalence of 3.4%. The two types of depression differed by sex ratio, age-specific prevalence, symptom severity, symptom profiles, and family history of suicide. Analyses using a multiple logistic regression model discerned that both types of depression were influenced by adverse life events, and that nMD was influenced strongly by gender, marital status, and lack of employment outside the home. Neither type of depression was influenced by income, education, or race. This study validates the concept of major depression as a clinical entity. Future studies of the aetiology, mechanism, and treatment of depression should distinguish between these two types of depression.
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PMID:The epidemiology of psychiatrist-ascertained depression and DSM-III depressive disorders. Results from the Eastern Baltimore Mental Health Survey Clinical Reappraisal. 141 89

Inadequate treatment of mood (affective) disorders is related to the mind/body dualism, desinformation about methods of treatment, the stigma of psychiatry, low funding of psychiatric research, low educational priority, and slow acquisition of new knowledge of psychiatry. The "respectable minority rule" has often been accepted without regard to the international expertise, and the consequences of undertreatment have not been weighed against the benefits of optimal treatment. The risk of chronicity increases with delayed treatment, and inadequately treated affective disorders are a leading cause of suicide. During the past 20 years the increase in suicide mortality in Norway has been the second largest in the world. Severe mood disorders are often misclassified as schizophrenia or other non-affective psychoses. Atypical mood disorders, notably rapid cycling and bipolar mixed states, are often diagnosed as personality, adjustment, conduct, attention deficit, or anxiety disorders, and even mental retardation. Neuroleptic drugs may suppress the most disturbing features of mood disorders, a fact often misinterpreted as supporting the diagnosis of a schizophrenia-like disorder. Treatment with neuroleptics is not sufficient, however, and serious side effects may often occur. The consequences are too often social break-down and post-depression syndrome.
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PMID:[Inadequate treatment of affective disorders]. 141 90

Lung cytochrome P-450 has been suggested to play a role in hypoxic pulmonary vasoconstriction. We reexamined this hypothesis using specific suicide substrate inhibitors of cytochrome P-450, 1-aminobenzotriazole (1-ABT), and chloramphenicol. In isolated, blood-perfused rat lungs, 1-ABT (0.5 mg/ml) and chloramphenicol (1 mg/ml) inhibited lung microsomal cytochrome P-450 (ethoxycoumarin O-deethylase) activity to 24 and 44% of control, respectively, and blunted hypoxia and angiotensin II-induced vasoconstriction. The depression of vascular contraction by 1-ABT was not due to an effect on calcium channels, since similar concentrations of 1-ABT had no inhibitory activity on electrical field-stimulated contractile response in rabbit papillary muscle strips. However, when 1-ABT was washed out of the lung after preincubation, the vascular reactivity to hypoxia and angiotensin II was restored despite persistent depression of lung cytochrome P-450 activity to 26% of control values. In isolated rat aortic and pulmonary arterial rings, addition of 1-ABT or metyrapone to the organ bath acutely reversed norepinephrine-induced contraction but preincubation with 1-ABT, metyrapone, or chloramphenicol had no effect on subsequent norepinephrine contractions. We conclude that 1-ABT inhibited lung vascular reactivity by a mechanism independent of cytochrome P-450 inhibition or calcium channel blockade and that an intact lung cytochrome P-450 system is not required for hypoxic pulmonary vasoconstriction in rat lungs.
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PMID:Intact lung cytochrome P-450 is not required for hypoxic pulmonary vasoconstriction. 141 22

Comparisons are made of the impact of a suicide death on the surviving spouse (55 years and older) with that of a natural death on spouse survivors and a married nonbereaved control group over a bereavement period of 2 1/2 years after death. Regardless of mode of death, the loss of a loved one is a difficult psychological trauma, accompanied by depression, confusion, and pervasive feelings of emptiness. Few differences in the impact of the deaths in the early months of bereavement were reported, but changes appeared over the course of the 2 1/2-year measurement period. Compared with natural death survivors, the process of bereavement was found to be more difficult for the survivors of a suicide death, whose severe depressive feelings do not seem to lessen significantly and whose feelings of mental health do not seem to improve until after the first year. Women, in general, report greater feelings than men of anxiety, tension, and apprehension, especially within the first 6 months. By the end of the observation period, most of the differences between the two bereaved groups have disappeared, and both report functioning adequately despite continuing feelings of sadness and loss.
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PMID:Changes in grief and mental health of bereaved spouses of older suicides. 143 Aug 57

A relationship of urinary catecholamines and of urinary free cortisol with violent suicide attempts has been reported. We have reexamined this issue in patients within 24 hours of hospital admission. Suicide attempters had significantly higher norepinephrine (NE: mean +/- SD = 58.3 +/- 27.0 micrograms/24 hours; n = 27) than did control patients with suicidal ideation (mean +/- SD = 37.1 +/- 21.3; n = 10). Among suicide attempters, those who used physical means had the highest NE levels (mean +/- SD = 69.7 +/- 21.3) and those who took overdoses of antidepressants (mean +/- SD = 51.9 +/- 17.3; n = 6), benzodiazepines (mean +/- SD = 65.1 +/- 29.7; n = 5), or miscellaneous drugs (mean +/- SD = 59.1 +/- 36.5; n = 11) had lower NE values. In contrast to NE, urinary dopamine (mean +/- SD = 402.6 +/- 392 micrograms/24 hours, epinephrine (EPI: mean +/- SD = 14.3 +/- 4.0 micrograms/24 hours), the NE/EPI ratio (mean +/- SD = 8.3 +/- 0.9), urinary free cortisol (mean +/- SD = 157.9 +/- 11.5 micrograms/24 hours) and serum cortisol (mean +/- SD = 35.0 +/- 13.1 nM/l) did not differ between groups. There were no group differences in age (mean +/- SD = 36.3 +/- 16.5 years), Beck Depression Inventory score (mean +/- SD = 26.3 +/- 12.9), Beck Hopelessness Scale score (mean +/- SD = 10.0 +/- 5.6), Beck Scale for Suicidal Ideation score (mean +/- SD = 13.6 +/- 9.3), or Hamilton Rating Scale for Depression score (mean +/- SD = 19.5 +/- 9.8). In the four parasuicide groups, there was no difference in suicide intent (mean +/- SD = 13.3 +/- 7.9). These findings indicate that there is increased NE output shortly after suicide attempts. Previous reports of a low NE/EPI ratio in suicidal patients may reflect adaptive changes rather than the acute state of the patient at the time of the attempt.
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PMID:Urinary catecholamines and cortisol in parasuicide. 143 15


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