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 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The 8 symptoms of Criterion B for major depressive disorder (MDE) in the third edition of the Diagnostic and Statistical Manual of Mental Disorders were studied in 107 cases and 57 noncases of MDE (all had depressed mood or pervasive anhedonia for more than 2 weeks). Sleep change, loss of energy, and appetite change were the most common symptoms, and psychomotor change and feelings of worthlessness the least common, in MDE. Loss of energy and sleep change were the best single symptoms and thoughts of death, feelings of worthlessness, and psychomotor change the worst for both diagnoses. Psychomotor change was the best and thoughts of death the worst indicator of MDE. Absence of sleep change and of loss of energy were the best and absence of thoughts of death, psychomotor change, and feelings of worthlessness the worst indicators of non-MDE. Results suggest that vegetative symptoms are more central to clinical depression than feelings of worthlessness, self-reproach, or guilt.
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PMID:The symptoms of major depression. 831 32

Disruptive changes in mood and low energy level are among the most common reasons women consult a physician. Usually no clear physiological explantation for these changes can be found. Many physicians feel uncomfortable dealing with patients with these complaints. The purpose of this paper is to discuss a practical approach to helping women with such conditions. A variety of terms have been utilized to refer to the situation in which a female patient has decreased energy or labile mood. Premenstrual Syndrome (PMS) and chronic fatigue syndrome (CFS) are currently popular terms. An association of low mood with menstrual cycle phase is undoubted, with the late luteal-early premenstrual phase most commonly associated with depression and irritability. It seems likely that women with PMS and those without it do not differ in circulating hormone levels during their cycles but rather in the brain response to these. Estrogen and progesterone receptors exist in the brain and change during the cycle. Elaborate diagnostic efforts are rarely rewarding in managing mood and energy disorders. Of more value is a careful history particularly concerned with the pattern of mood changes and with life stresses, accompanied by a thorough physical examination and laboratory tests. In most cases, changes in mood and energy are a variant of clinical depression. Changes in energy and sleep may be more evident than low affect. Treatment with an appropriate antidepressant, usually a selective serotonin re-uptake inhibitor (SSRI), benefits most of these patients. Allowing the patient to express concerns about stressful life situations is often of great value.
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PMID:Mood disorders in the female patient. 916 Feb 15

This paper investigates if the highly selective norepinephrine reuptake inhibitor reboxetine leads to a dose-dependent cortisol release and if this response depends on personality dimensions related to clinical depression in healthy volunteers. Twenty-four male subjects received placebo, 2 mg, or 4 mg reboxetine in a balanced, randomized cross-over study. Cortisol was measured in saliva at six different time-points according to the kinetics of the drug. Furthermore, several measurements of cardiovascular parameters, emotional states, and possible side-effects were obtained. Subjects were divided into two groups scoring above or below the median of a depressiveness questionnaire scale [n = 11, low (D-); n = 13, high (D+)]. Results clearly demonstrated, that reboxetine stimulates cortisol release. Whereas blood pressure was not affected, heart rate increased after 2 and 4 mg but not dose dependently. Subjects reported more non-specific arousal while the dimensions of tiredness-wakefulness and positive-negative emotional states were not affected by the drug. Somatic complaints were low and only non-specific complaints were statistically elevated but of negligible amount. Subjects classified as D+ can be characterized as high responders to the drug. This is especially true not only for cortisol increases but also for changes in heart rate and some ratings on physical complaints. Hot flushes, sweating and a throbbing sensation in blood vessels in the head were observed in D+ but only with the 4 mg dose. The results clearly demonstrate that reboxetine stimulates cortisol release and heart rate and that this is particularly pronounced in subjects scoring high on depression-related personality dimensions. Reboxetine, therefore, is a promising tool for investigating neuroendocrine response to noradrenergic challenge tests. The question whether increased responses in D+ are due to an up-regulation of receptor sensitivity as a consequence of low norepinephrine supply is discussed.
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PMID:Reboxetine in a neuroendocrine challenge paradigm: evidence for high cortisol responses in healthy volunteers scoring high on subclinical depression. 1134 96

A review of data on HIV and depression fails to show any direct cause-and-effect relationships between the two, despite the fact that clinical depression is the most commonly seen psychiatric disorder in patients with HIV infection. Most of the HIV-positive individuals with depressive disorders were found to have a history of depression antedating their infection. Contradicting early reports of unusually high rates of depression among HIV patients, more recent studies show that depression levels are not higher for the seropositive versus the seronegative, nor do the levels increase over time or at different stages of the infection. Persons with HIV may be misdiagnosed as depressed because the somatic symptoms of the illness--fatigue, lethargy, weight loss, loss of appetite, and low libido--are also symptoms of depressive disorders. Practitioners are urged to distinguish loss of interest, per se, from loss of interest in activities due to medical problems. When HIV-infected patients are diagnosed as clinically depressed, they respond as well as seronegative patients to antidepressant medications, such as tricyclic antidepressants, serotonin reuptake inhibitors (SRRI's), and psychostimulants. Brief, focused psychotherapy can prove helpful for assisting HIV-positive patients through times of particular vulnerability: the confirmation of HIV infection, adjusting to the seropositive status, onset of physical symptoms, and a sudden decline in T-cell counts.
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PMID:Depressive disorder and HIV disease: an uncommon association. 1136 50

Depression is a most common psychiatric complication of Parkinson's patients. Approximately 30% of Parkinson's patients show depressive mood changes. Loss of interest, feelings of hopelessness, marked loss of energy and psychomotor retardation are common depressive symptoms with parkinsonism. Suicidal ideations and delusions are less frequent in Parkinson's patients with depression in compared to endogenous depression. Somatic symptoms, like fatigue, constipation, headache, insomnia, loss of appetite, dizzinees and sweating are usually seen in Parkinson's patient with depression. Serotonin reuptake inhibitors and selegiline are recommended for the treatment of depression in parkinsonian patients.
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PMID:[Parkinson's disease]. 1151 61

Fatigue is a major complaint among cancer patients, yet it is unknown whether cancer-related fatigue experienced during the day relates to sleep/wake cycles or to the quality and quantity of sleep obtained at night. Although it is not well defined or well understood at present, cancer-related fatigue is generally regarded as a form of tiredness that does not improve following rest or sleep. Objectively recorded sleep and biological rhythms have not been well investigated in these patients, but it appears that most cancer patients may in fact not be getting a good night's sleep. Evidence is accumulating that sleep is often disturbed in cancer patients, probably owing to a variety of causes. We posit that some degree of cancer-related fatigue experienced during the day may relate to sleep/wake cycles or to the quality and quantity of sleep obtained at night. Different components or dimensions of fatigue (physical, attentional/cognitive, emotional/affective, etc.) are probably associated in some way with disrupted sleep and desynchronized sleep/wake rhythms. These associations may change in measurable ways prior to treatment, during treatment and after treatment completion. In cancer patients, as in other medically ill patients, sleep that is inadequate or unrefreshing may be important not only to the expression of fatigue, but to the patients' quality of life and their tolerance to treatment, and may influence the development of mood disorders and clinical depression. This review summarizes the state of the literature on fatigue, sleep and circadian rhythms.
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PMID:The relationship between fatigue and sleep in cancer patients: a review. 1180 75

Hardiness is defined as commitment to life, viewing change as challenge, and having control over one's life. Previous research suggests that hardiness is related to better outcomes in stressful situations. The effects of individual and family hardiness on depression and fatigue of caregivers of disabled older adults (DA) were examined using a descriptive, cross-sectional design. The sample was 67 caregivers of DA with high functional impairment. One-third of caregivers reported moderate to high fatigue, and 40% had scores indicating possible clinical depression. Memory and behavior problems of the DA were positively correlated with caregiver depression and fatigue. Family hardiness was negatively related to memory and behavior problems of the DA. Controlling for covariates, individual hardiness was negatively associated with depression and fatigue; coping strategies did not mediate the relationship. Caregivers with low individual and family hardiness had more depression than those high in both resources. Additional research is needed to determine the relevance of hardiness theory in caregiving research.
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PMID:Effects of individual and family hardiness on caregiver depression and fatigue. 1180 18

Abrupt onset of hot flashes poses a significant problem for women treated with chemotherapy for breast cancer. Alternatives to hormone replacement, such as the use of the selective serotonin re-uptake inhibitor (SSRI) paroxetine hydrochloride, are being explored as therapies for hot flashes in this patient population. The present study investigated the efficacy of paroxetine for the treatment of hot flashes and associated symptoms in women with breast cancer. This study included 13 patients who were seen in the Psychosocial Clinic at Moffitt Cancer Center. They were referred by their medical oncologist after reporting complaints of significant difficulty with hot flashes. Baseline questionnaires were completed and a structured diagnostic interview for clinical depression was conducted, all of which were repeated 5 weeks after the paroxetine 20 mg daily was started. Significant improvements were seen in the ratings of hot flash severity (P = 0.002). In addition, significant improvements were observed in general, emotional, and mental fatigue. Rates of clinically significant depressive symptomatology also decreased and sleep quality improved significantly as well. Finally, the incidence of clinical depression improved from 39% at baseline to 8% after treatment. These preliminary data suggest that the antidepressant paroxetine can be helpful in the treatment of hot flashes and associated fatigue, sleep disturbance, and depression in women with breast cancer treated with chemotherapy. Further controlled studies are needed to more fully evaluate the efficacy of the SSRIs for hot flashes in women with breast cancer.
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PMID:A pilot trial of paroxetine for the treatment of hot flashes and associated symptoms in women with breast cancer. 1199 3

The purpose of this study was to compare family caregivers of person with dementia and caregivers of stroke survivors with similar levels of caregiving responsibilities. The design was descriptive and included characteristics of care recipients, caregivers, and care situations. Caregivers of individuals with dementia reported care recipients were more impaired with independent activities of daily living and memory and behavior problems. There were no differences in caregiver depression and fatigue. Even with the benefit of respite care, a substantial number of caregivers had depression scores above the level indicating possible clinical depression. Consultation by advanced practice psychiatric nurses for caregivers and care recipients may be beneficial in detecting depression and making recommendations for appropriate treatment.
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PMID:Comparison of family caregivers. Stroke survivors vs. person with Alzheimer's disease. 1264 Aug 64

The purposes of this study were to examine shift-related differences in chronic fatigue and the contributions of sleep quality, anxiety, and depression to chronic fatigue among a random nationwide sample (N = 142) of female critical care nurses. Twenty-three percent of this sample met criteria for clinical depression. Day and night nurses did not differ in their reports of chronic fatigue. Night nurses reported more depression and poorer sleep quality than did day nurses. Regression analyses indicated that among the variables of global sleep quality, depression, and anxiety, depression and sleep quality were the most relevant to the explanation of chronic fatigue. These findings suggest the need for studies of strategies to promote sleep and improve mood in critical care nurses.
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PMID:Correlates of fatigue in critical care nurses. 1468 60


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