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

Although they are likely to add their effects, physical and psychic traumata (or traumas) can provoke in different ways the appearance of depressive symptoms sometimes common. Post-traumatic depression, reactional depression, major depressive disorder and post-traumatic stress disorder represent different clinical and nosographic disorders in despite of their occasionally common symptomatic core. Historically, it is interesting to note during the XXth century the true semantic change of the terms of trauma from the somatic field to the psychic sphere. Physical traumatism is often represented by a material shock for the subject and by its organic consequences. It is defined as an event that leaves its mark which itself inflicts and handicaps the vital trajectory of the subject. It primarily comprises brain and rachis injuries, whose evolution is frequently characterized by the occurrence/appearance of a depressive disorder, whose genesis rests on psychological but also neurobiologic and physical arguments. Thus major depressive disorders are often present in the course of various physical traumatisms mainly related to nervous system. In accordance with several studies, the prevalence of major depressive disorders ranges from 25% to 50%. These mood disorders occur in the year which follows the accidental event. Their average time of revelation is estimated at four months and their average duration lies between three and six months. Lastly, although these depressive illnesses present clinical symptoms comparable with those observed in other contexts, some nuances can be raised. Nonetheless, they confine sometimes with true clinical forms depending on the intensity, the form, the circumstances or the consequences of the trauma. Psychic traumatism doesn't have the same profile and rests for much dedicated with the reexperiencing. Thus for some authors, depression illness represents a disorder that occurs after a traumatic event whereas others see a differential diagnosis which exludes or which represents a comorbidity with post-traumatic stress disorder. The review of the literature allows us to emphasize the complexity of the links as well as the clinical and epidemiologic differences between stress disorder and major depressive disorder. From the clinical point of view, the major features of PTSD are articulated around a triad of symptoms. They include the reexperiencing symptoms of the traumatic event such as intrusive memories and recurrent nightmares, the protective reactions such as avoidance of the stimuli associated with the trauma and emotional numbing, and the arousal symptoms such as the startled response and hypervigilance. The complexity of this syndrom is due to the frequent combination of these symptoms with other nonspecific ones. As far as the mood is concerned (the mood symptoms are concerned), the regrouping of some of these symptoms allows the clinician to sometimes releave a depressive symptomatology without being able to assess the DSM diagnosis of major depressive disorder. Epidemiologic studies dealing with the risk of installation of a PTSD after a traumatic event reveal differences in the prevalence depending on the nature of the traumatic events: ranging from 1% in general population to 80% following some situations of extreme and durable psychic suffering. Between both poles, one finds a prevalence ranging between 20 and 50% following other events such as serious accidents, natural disasters or criminal assaults. The clinical features of depressive episodes comorbid or associated with PTSD have some characteristics making it possible to individualize various clinical forms as a function of traumatic event type: asthenic, characterial or with somatic symptoms. According to the majority of authors, the co-occurrence of post-traumatic stress disorder and major depressive disorder is high although differential diagnosis is sometimes difficult. However, conceptual differences remain and two conceptions are distinguished. For some authors, like Bleich and Shalev, there would not be true chronological evolution from PTSD to MDD. Moreover the presence of symptoms considered as pertaining to the mood register within the criteria of PTSD would be clearly predictive of the occurrence and the severity of the diagnosis but not of the chronicity. For others, there would be a continuity between post-traumatic stress disorder and major depressive disorder. It is the case in many studies of veterans but also for civilian traumatic events. It is also the case for the American national study of comorbidity in which Kessler concludes that for 78% of the subjects who present a comorbidity PTSD/MDD (comorbidity raised for 48% of the 5,877 subjects included), the mood disorder is secondary to PTSD. (ABSTRACT TRUNCATED)
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PMID:[Post-traumatic stress, post-traumatic depression and major depressive episode: literature]. 1140 68

This 6-month open-label study evaluated the efficacy, tolerability, and safety of sertraline in 21 adolescent psychiatric outpatients, ages 12 to 18 years, diagnosed with major depressive disorder (MDD, n = 13) or dysthymic disorder (DD, n = 8). Both groups showed clinically significant improvements on the Hamilton Depression Scale (HAM-D), Hamilton Anxiety Scale, and the Clinical Global Impression Scale-Severity (CGI-S). The MDD group showed maximal clinical response (based on the method of last observation carried forward) on the HAM-D and CGI at weeks 12 (76.9%) and 20 (76.9%), respectively. Response rates were maintained at week 24 with all six MDD study completers (100%) responding to treatment. The DD group achieved maximal response on the HAM-D (100%) and the CGI (75%) at week 6. Response rates in this group did not remain as elevated over time with two out of three (66.7%) DD study completers responding to treatment at week 24. Generally, sertraline was safe and well tolerated. Most adverse events were mild to moderate in severity and resolved with no action taken. Results suggest that sertraline may be efficacious in acute and continuation treatment of MDD in adolescents. DD patients showed evidence of clinical response and improvement, particularly in the acute treatment phase. Incorporating a longer evaluation period in the study of antidepressant therapy for adolescents with MDD and/or DD is emphasized.
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PMID:Sertraline effects in adolescent major depression and dysthymia: a six-month open trial. 1143 52

We describe the successful treatment of five patients with treatment-resistant major depressive disorder (TR-MDD) with a combination pharmacotherapy of pindolol, tryptophan and nefazodone. Five TR-MDD outpatients who had previously not responded to at least four different antidepressant medication trials were initiated on 300 mg/day of nefazodone, 7.5 mg/day of pindolol and 1 g/day of tryptophan. Pindolol doses remained the same throughout the 20 weeks, while tryptophan and nefazodone dosages were gradually increased to 8 g/day and 450 mg/day, respectively. The Hamilton Depression Rating Scale (HAM-D) was used to evaluate outcome. By week 4, all cases demonstrated at least 50% decrease in HAM-D scores. At the end of the trial, the group mean HAM-D score had significantly decreased from 26.8 (+/- 1.9) to 1.8 (+/- 0.8) (p < 0.001). No significant adverse effects were reported. These results suggest that if serotonin availability and release is further enhanced by tryptophan in the presence of nefazodone and pindolol, an antidepressant effect may be produced in patients who are otherwise treatment-resistant. Due to limited sample size, an open design and an 'unusually' high successful efficacy rate of this preliminary study, controlled studies are required to confirm the efficacy of this treatment strategy.
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PMID:The 'dalhousie serotonin cocktail' for treatment-resistant major depressive disorder. 1144 87

Depersonalisation disorder may occur during severe anxiety or following a traumatic event, suggesting a possible role of stress hormones. This study investigated basal activity of the hypothalamic-pituitary-adrenal (HPA) axis in patients with depersonalisation disorder. Salivary cortisol levels were measured at four time points over 12 h in patients with depersonalisation disorder (N=13), major depressive disorder (MDD, N=14) and healthy controls (N=13). Beck Depression Inventory scores were significantly higher in depersonalised subjects than controls, while MDD subjects demonstrated higher scores than both groups. Basal cortisol levels of depersonalised subjects were significantly lower than those of MDD subjects but not healthy controls. These results point to reduced basal activity of the HPA axis in depersonalisation disorder. This pilot study supports the distinction between depersonalisation disorder and major depressive disorder which should be examined in a larger sample.
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PMID:Basal activity of the hypothalamic-pituitary-adrenal axis in patients with depersonalization disorder. 1160 Jan 92

The aim of this study was to measure the effectiveness of ECT in-patients who had failed to respond to a course of repetitive transcranial magnetic stimulation (rTMS) treatment. Seventeen patients with severe MDD who had not responded to a course of rTMS were switched to receive ECT treatments. All the patients were assessed with the Hamilton Rating Scale for Depression, the Global Assessment Functioning Scale, the Global Depression Scale, and the Pittsburgh Sleep Quality Index. Response to the treatment was defined as a 50% decrease in HDRS final score and a final GAS higher than 60. Seven out of 17 patients responded to ECT. Three out of 5 non-psychotics and 4 out of 12 psychotic patients responded. ECT seems to be an effective treatment for 40% of patients who failed to respond to rTMS treatment. Whether this is a result of reduced responsiveness to ECT in rTMS-resistant patients or a consequence of small sample size requires further study.
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PMID:Effect of electroconvulsive therapy in repetitive transcranial magnetic stimulation non-responder MDD patients: a preliminary study. 1160 32

The authors examined patterns of improvement in quality of life (QOL) in elderly patients with recurrent major depression (MDD) after acute treatment. One hundred elderly (age 60-88 years) patients with recurrent MDD were randomized to receive either bupropion sustained-release (100 mg-300 mg/day) or paroxetine (10 mg-40 mg/day) for 6 weeks. Treatment with both paroxetine and bupropion was associated with improvements in QOL. Lower perceived Physical- and Social-Functioning QOL ratings at baseline were associated with lower treatment response. Improvement in depression symptom ratings correlated significantly with improvement in QOL on many domains, but accounted for less than one-quarter of the total variance. Remitters showed significantly (P<0.001) greater improvement than both Partial Responders and Nonresponders on various measures. Findings support the importance of treating elderly depressed patients to full remission to maximize impact on both emotional and physical QOL domains.
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PMID:Quality of life in geriatric depression: a comparison of remitters, partial responders, and nonresponders. 1173 69

Many studies have reported the effectiveness of antidepressants in patients with so-called "anxious depression". This is the first report aimed at studying the beneficial therapeutic effects of fluoxetine alone on anxiety dimension in first episode drug naive patients suffering from DSM-IV major depression (MDD) and double depression (DD). Twenty-two outpatients (11 women and 11 men) were recruited in a University clinic for the treatment of a first episode pure MDD (n = 13) or DD (n = 9). All of the patients were drug naive, had Hamilton Rating Scale for Depression (HRSD) and Anxiety (HRSA) scores > or = 15, and were interviewed using the Structured Clinical Interview for DSM-IV-Patient edition. Fluoxetine alone (20 mg daily) was used in an attempt to treat depression with comorbid anxiety symptoms. A series of clinical- and self-rating scales (i.e., HRSD, HRSA, Beck Depression Inventory, and Stait Trait Anxiety Inventory) were used to measure the psychopathology at day 0, and every 10 days until day 50. In the whole group, there were statistically significant changes, starting from the baseline, in depression and anxiety symptoms after 10 days of treatment. Self evaluated anxiety, however, improved after 20 days. Furthermore, at day 50, the patients with comorbid DD experienced a major improvement (diminished anxiety symptoms) compared to pure MDD patients. This open study suggests that depression and anxiety symptoms in first-episode drug-naive patients with anxious depression diminished very quickly with fluoxetine.
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PMID:Fluoxetine alone in the treatment of first episode anxious-depression: an open clinical trial. 1200 96

Causes of cognitive impairment after stroke are not yet clear because a large number of sociodemographic and clinical variables complicate the understanding of the phenomenon. We aim to evaluate sociodemographic and clinical predictors of cognitive level and depression in subjects with different lesion laterality. We assessed 153 right (n = 87) and left (n = 66) unilateral first-ever stroke patients within the first year of illness with the Structured Clinical Interview for DSM-IV-Patient Edition, the Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale, the State Trait Anger Expression Inventory, the Barthel Index, and the Mini Mental State Examination (MMSE). Sociodemographic variables were also measured. Sixty-two (41 %) patients suffered from Major Depression (MDD), and 26 (17 %) suffered from Minor Depression (MIND). An univariate analysis of variance showed that MMSE scores were different throughout the groups of left and right stroke patients with MDD, MIND and without depression. Left stroke patients with MDD were more cognitively impaired than all the other groups. This result was valid after controlling for the effect of lesion location on cognitive level difference between the groups. A series of stepwise multiple regression analyses indicated that depression severity was a predictor of cognitive level and vice-versa in left hemispheric stroke patients only. Moreover, educational level in right hemispheric stroke patients and state-anger and number of regions affected in left hemispheric stroke patients were other predictors of cognitive level. The study confirms the hypothesis that predictors of cognitive level and depression severity are different in subjects with different laterality of lesion and that MDD is associated with cognitive impairment in left stroke patients.
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PMID:Predictors of cognitive level and depression severity are different in patients with left and right hemispheric stroke within the first year of illness. 1242 95

Scientific evidence has accumulated during the last 15 years establishing that SD symptoms have a high prevalence in the general population and in clinically depressed patient cohorts studied cross-sectionally or followed longitudinally. The clinical relevance and public health importance of SD symptoms were confirmed when various investigators, including the authors' group at University of California, San Diego, found that SD symptoms are associated with a significant and pervasive impairment of psychosocial function when compared to no depressive symptoms. There is strong evidence that all levels of depressive symptom severity of unipolar MDD are associated with significant psychosocial impairment, which increases significantly and linearly with each increment in level of symptom severity. It is only when MDD patients are completely symptom free that psychosocial function returns to good or very good levels. The disability associated with depression is state dependent, and disability returns to good or normal levels only when all of the depressed patients' symptoms abate, because disability is present when even a few symptoms (i.e., SD symptoms) are detected. There is strong evidence during the long-term course of illness that major, minor, dysthymic, and subsyndromal symptoms wax and wane within the same patient and that these symptomatic periods are interspersed in the overall course with times when patients are remitted and symptom free. The modal longitudinal symptom status of MDD patients involves primarily subthreshold depressive symptoms, which are much more common than symptoms at the syndromal MDE level. The longitudinal systematic examination of the clinical relevance and high prevalence of SD symptoms helped establish the fact that the long-term symptomatic expression of MDD is dimensional, not categorical, in nature. Abatement of SD symptoms is of fundamental importance in defining full remission or recovery of MDEs. Ongoing residual SD symptoms during the recovery periods after an MDE are associated with psychosocial disability, more rapid MDE relapse, and a more severe chronic future course of illness, all of which indicate that when residual SD symptoms are present the MDE has not fully remitted and the disease is still active. When all depressive symptoms of an MDE abate for a minimum of 8 weeks, then full remission has been achieved. MDE remission defined in this way is associated with significant delay or even prevention of future episode relapse and a less severe, relapsing, and chronic future course. The authors submit that the research reviewed in this article heralds a new paradigm in understanding the progression of clinical depression through various overlapping stages of severity, which begin at the seemingly "subclinical" level of depressive symptoms. This conceptualization in turn dictates a public health approach, which emphasizes that treatment of MDD even at the deceptively mild levels of symptoms should be initiated or maintained.
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PMID:The prevalence, clinical relevance, and public health significance of subthreshold depressions. 1246 55

This study prospectively examined predicting factors and depressive antecedents of depression in early adulthood and determined differences by sex. 199 adolescents aged 11-12 from the general community were followed up annually for 4 years and reassessed at 18 years of age. Sociodemographic data, depressive symptomatology, anxiety level, personality dimensions, self-esteem, academic aptitude and pubertal development were reported throughout this period and tested as possible risk variables of depression. At 18, depression was diagnosed using ICD-10 criteria. Of the cases of major depression (MDD) at eighteen, 30% had been diagnosed as MDD between 12 and 14 years of age. Of the cases of MDD at eighteen, 80% had had depressive symptomatology between the ages of 11 and 14. Subclinical scores in the Children's Depression Inventory (CDI) were early indicators of long-term risk. Gender differences were found in the risk pattern; depressive symptoms were more significant in girls than in boys. In boys, early anxious symptomatology was a significant predictor. This study reports cross-cultural data that support a continuity of depression from adolescence to young adulthood.
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PMID:Predictors of depression at eighteen. A 7-year follow-up study in a Spanish nonclinical population. 1246 40


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