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There are now credible empirical data to support the conclusions that depressive disorders are among the most common diseases that human beings experience, with approximately 11.3% of all adults afflicted by these disorders during any one year. In comparison to common medical illnesses, such as diabetes, hypertension, lung diseases, etc., depression is associated with significantly greater physical limitations, more dysfunction in ability to perform one's social and occupational role and with increased bed days and poorer estimation of personal health. The disability associated with depression is compounded and extended by the fact that depressive disorders have a high tendency toward recurrence, relapse and chronicity. Thus, not only are patients acutely disabled from acute episodes of major depression or dysthymia, but they tend to be disabled for significant segments of their lifetimes by the lifelong nature of the clinical course of the mood disorders. Further, the scientific evidence now available indicates that even subsyndromal symptomatic and minor depressions are associated with significant disability and dysfunction as well. Finally, the accumulation of high prevalence, the significant disability and the lifelong nature of depressive disorders results in a palpable impact on all of the national economies throughout the world. It can be confidently concluded that depressive disorders are among the most common, disabling and costly of any of the diseases in the health care spectrum and represent significant, serious public health problems.
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PMID:Mood disorders in the general population represent an important and worldwide public health problem. 893 4

The course of depression in patients with comorbid medical illness is poorly understood. We report a 5-year follow-up study of 25 diabetic patients who had participated in an 8-week depression treatment trial. When a patient completed the trial, primary physicians were informed of patient outcomes and advised to monitor for relapse and treat those with ongoing depression. At the 5-year reevaluation depression was assessed using DSM-III-R criteria, and a depression severity scale was formed that reflected the presence, severity, frequency, and duration of depression episodes as well as a global assessment of functioning. Recurrence or persistence of depression occurred in 23 (92%) of the patients with an average of 4.8 depression episodes over the 5-year follow-up period. The duration of the longest episode averaged 16 +/- 4 months. Reversion to major depression occurred frequently and rapidly also in the subset that remitted during the treatment trial: 58.3% were depressed again within the first year. At the time of the follow-up interview, major depression was evident in 16 (64%) of the subjects, and glycemic control was significantly worse in this group compared with those without depression (gHb: 13.3% +/- 2.6% vs 11.1% +/- 1.9%, P = 0.03). Severity of depression over follow-up was related to the presence of neuropathy at entry and to incomplete remission during the initial treatment trial. Nineteen patients (82.6% of those who relapsed) received additional courses of antidepressant therapy, but none was treated continuously for depression prophylaxis. In this diabetic sample, depression was a recurrent condition in the vast majority of cases, and initial treatment response did not confer lasting euthymia. Whether maintenance antidepressant medication would be useful in preventing depression recurrence and promoting better glycemic control in diabetes remains to be studied.
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PMID:The course of major depression in diabetes. 909 68

The effect of streptozotocin (STZ)-induced diabetes and a combination of chronic treatment with haloperidol (HPD) on dopamine (DA)D2, serotonin (5-HT) 5-HT1A and 5-HT2A receptors was investigated in rat brain. Rats were randomly assigned to one of four groups: vehicle-vehicle, STZ-vehicle, vehicle-HPD, and STZ-HPD groups. Four weeks after single administration of STZ (65 mg/kg IV) or vehicle (citrate buffer), rats received depot HPD (4 mg/kg IM) or vehicle (sesame oil) once a week for 4 weeks. Sixteen days after the last injection of HPD or vehicle, rats were sacrificed, and the density of binding sites was determined using [3H]spiperone as ligand in the striatum (D2),[3H]8-hydroxy-2-(di-n-propyl)-aminotetraline in the hippocampus (5-HT1A), and [3H]ketanserin in the frontal cortex (5-HT2A). The density of D2 receptors was significantly increased in the vehicle-HPD compared to vehicle-vehicle controls. However, striatal D2 receptor density of the STZ-HPD and the STZ-vehicle were not significantly different from the vehicle-vehicle group. A significant increase in cortical 5-HT2A receptor density was observed only in the group of STZ-vehicle. Treatment with STZ, HPD, or the combination thereof, did not affect the density of 5-HT1A receptors. The affinity constants for D2, 5-HT1A, and 5-HT2A receptors were not affected by any treatment. These results suggest that diabetic state may affect brain serotonergic activity via an increase in the density of 5-HT2A receptors. This may indicate an increased vulnerability to major depression in patients with diabetes. The lack of an effect of the combined chronic treatment with STZ and HPD on the D2 receptor density may correspond to the increased risk to develop tardive dyskinesia in patients with diabetes.
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PMID:The effect of streptozotocin-induced diabetes on dopamine2, serotonin1A and serotonin2A receptors in the rat brain. 913 34

This study examines the degree to which untreated anxiety disorders and major depressive disorder, occurring either singly or in combination, reduce functioning and well-being among primary care patients. Adult patients were screened using the SCL-52 to identify those with clinically significant anxiety symptoms. They also completed the Rand Short-Form (SF-36) to measure self-reported patient functioning and well-being. Patients with untreated disorders were identified using the Q-DIS-III-R to diagnose six DIS-anxiety disorders (generalized anxiety disorder, post-traumatic stress disorder (PTSD), simple phobia, social phobia, panic/agoraphobia, obsessive/compulsive disorder) and major depression. Of 319 patients identified, 137 (43%) had a single disorder and 182 (57%) had multiple disorders. Regression models estimated the relative effects of these disorders on health status (SF-36) by comparing patients with the disorders to patients screened as being not-anxious. Estimates of these effects were consistent with available national norms. The estimated effect of each single disorder on all subscales for physical, social and emotional functioning was negative, often as much as a 20-30 point reduction on this 100-point scale. Major depression had the greatest negative impact, followed by PTSD and panic/ agoraphobia. For patients with multiple disorders, the presence of major depression was associated with the greatest reduction in functioning status. The impact of untreated anxiety disorders and major depressive disorder on functioning was comparable to, or greater than, the effects of medical conditions such as low back pain, arthritis, diabetes and heart disease.
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PMID:The functioning and well-being of patients with unrecognized anxiety disorders and major depressive disorder. 916 80

As many as 25 percent of patients with diabetes mellitus may also have depressive symptoms. Tricyclic antidepressants (TCAs) may produce increased appetite and weight gain with adverse consequences for diabetes. The selective serotonin reuptake inhibitors (SSRIs), however, may improve fasting blood sugar in laboratory studies. In an initial application, sertraline was administered at a dose of 50 mg/day in a 10-week open study to 28 non-insulin-dependent diabetes mellitus (NIDDM) patients with DSM-III-R major depression after a 2-week single-blind placebo washout period with a minimum 17-Item Hamilton Rating Scale for Depression (HAM-D) score of 18. The patient group included 16 males and 12 females with a mean age of 54.2 +/- 8.8 years. Results indicated (1) significant improvement in mean HAM-D (22.6 +/- 3.4 to 4.9 +/- 5.9, p < .001) and in mean Beck Depression Inventory (BDI) scores (21.9 +/- 10.5 to 12.7 +/- 8.3, p < .001); (2) fall in platelet serotonin (5-HT) content (79.7 +/- 22.5 to 13.6 +/- 12.7 ng/10(8) platelets, p < .001); (3) correlation of baseline platelet 5-HT content with response to sertraline by BDI scores (r = 0.51, p < .05); (4) improved dietary compliance for those with baseline value below 70 percent (59.7% to 69.1%, p < .005); and (5) 13 of 17 patients with baseline glycosylated hemoglobin A (HbA1c) levels greater than 8.0, showed a reduction (p = .018). Sertraline may be an effective antidepressant in patients with diabetes mellitus and response may be predictable by higher baseline platelet 5-HT content, with the potential to improve dietary compliance and reduce HbA1c measures. As with all open studies, replication is essential.
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PMID:Sertraline in coexisting major depression and diabetes mellitus. 923 Jun 40

The topic of vascular depression has received increasing prominence as a putative etiology of depression in later life. The authors examined one aspect of this model by comparing the burden of systemic cerebrovascular risk factors (CVRFs) in 130 psychiatric inpatients with major depression and 64 normal control (NC) subjects, all age > or = 50 years. Depressed subjects did not differ statistically from NCs on cumulative CVRF scores. Diabetes mellitus and atrial fibrillation were both associated with depression, but only atrial fibrillation retained an independent association after medical disability was statistically controlled. Among the depressed subjects, CVRF scores were not significantly associated with overall symptom severity, psychiatric disability, age at onset of depression, melancholic subtype, or psychotic depression. These data did not support the notion that a linear model of small-vessel disease might apply to the great majority of older inpatients with major depression.
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PMID:Cerebrovascular risk factors and later-life major depression. Testing a small-vessel brain disease model. 946 9

Little is known about which factors may adversely affect response to psychotherapy in diabetic patients with major depression. We studied the relationship of various demographic, diabetes, and depression characteristics to change in depression in 42 patients with type 2 diabetes who completed a randomized clinical trial of cognitive behavior therapy (CBT). Depression remitted in a significantly greater percentage of the patients treated with CBT than with the control intervention (85.0% vs 27.3%, p < 0.001). In the sample as a whole, nonremission of depression was associated with lower compliance with blood glucose monitoring, higher glycated hemoglobin (GHb) levels, higher weight, and a history of previous treatment for depression. In the group treated with CBT, the presence of diabetes complications and lower compliance with blood glucose monitoring were significant independent predictors of diminished response. These findings show that factors related to the medical illness, such as the presence of diabetes complications, may negatively influence the prognosis for recovery from depression. Specific coverage of these issues during psychotherapy may optimize the likelihood of treatment success in patients with diabetes.
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PMID:Predicting response to cognitive behavior therapy of depression in type 2 diabetes. 978 30

Non-insulin dependent diabetes mellitus (NIDDM) extracts a heavy toll on the Native American community in the United States. Evidence indicates that patients with NIDDM are three times more likely to have a co-existing diagnosis of depression. Untreated major depression unfavorably impacts the complication rates of NIDDM. Thus, Native Americans who are at increased risk for NIDDM are likely to be at increased risk for major depression. Physicians in Oklahoma should be aware of important treatment issues when selecting an antidepressant medication to treat major depression in Native Americans with NIDDM. Treatment options for major depression in the context of diabetes are discussed. Evidence currently indicates that the serotonin reuptake inhibitors (SSRIs) have significant advantages and a more favorable side effect profile for the treatment of depression in patients with diabetes mellitus.
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PMID:Diabetes mellitus and major depression: considerations for treatment of Native Americans. 986 55

Major depressive disorder is present in 15%-20% of patients with diabetes and impairs functioning and quality of life. It has unique importance in diabetes because of its association with poor compliance with diabetes treatment, poor glycemic control, and an increased risk for micro- and macrovascular disease complications. These observations have inspired several recent clinical trials to determine whether these associations may be favorably influenced by depression treatment. The outcome data are scant but promising and suggest that psychotherapy and pharmacotherapy can have important positive effects on both mood and glycemic control. Unfortunately, even after successful treatment, recurrence of depression is the norm. Afflicted subjects are seldom asymptomatic for an entire year at a time. Factors related to the medical illness (eg, presence of diabetes complications, hyperglycemia) are associated with a poorer prognosis for recovery from depression, a finding that suggests that optimal relief of depression in diabetes may require vigorous, simultaneous management of the medical and psychiatric conditions. Whether maintenance antidepressant treatment is useful in preventing depression recurrence and promoting better glycemic control in diabetes is unknown, but this question is the focus of an ongoing clinical trial.
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PMID:Management of Major Depression in Adults With Diabetes: Implications of Recent Clinical Trials. 1008 97

With the increasing concern about job stress, there is a growing body of literature addressing psychosocial job stress and its adverse effects on health in Japan. This paper reviews research findings over the past 15 years concerning the assessment of job stress, the relationship of job stress to mental and physical health, and the effects of worksite stress reduction activities in Japan. Although studies were conducted in the past using ad-hoc job stress questionnaires, well-established job stressor scales have since been translated into Japanese, their psychometric properties tested and these scales extensively used in recent epidemiologic studies. While the impact of overtime and quantitative job overload on mental health seems moderate, job control, skill use and worksite support, as well as qualitative job demands, had greater effects on psychological distress and drinking problems in cross-sectional and prospective studies. These job stressors also indicated a strong association with psychiatric disorders, including major depression, even with a prospective study design. Long working hours were associated with a higher risk of myocardial infarction, diabetes mellitus and hypertension. There is evidence that the job demands-control model, as well as the use of new technology at work, is associated with higher levels of blood pressure and serum lipids among Japanese working populations. Fibrinolytic activity, blood glucose levels, immune functions and medical consultation rates were also affected by job stressors. It is further suggested that Japanese workers tend to suppress expression of positive feelings, which results in apparently higher psychological distress and lower job satisfaction among Japanese workers compared with workers in the U.S. Future epidemiologic studies in Japan should focus more on a prospective study design, theoretical models of job stress, job stress among women, and cultural difference and well-designed intervention studies of various types of worksite stress reduction.
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PMID:Epidemiology of job stress and health in Japan: review of current evidence and future direction. 1031 66


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