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Query: UMLS:C0015672 (fatigue)
 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The goal of treatment of major depression should be full remission. Many patients, however, fail to achieve or maintain symptom-free status. Residual depressive symptoms are common, even where there has been a robust response to antidepressant therapy. In clinical studies, approximately one-third of patients achieve a full remission, one-third experience a response and one-third are nonresponders. Partial remission is characterized by the presence of poorly defined residual symptoms. These symptoms typically include depressed mood, psychic anxiety, sleep disturbance, fatigue and diminished interest or pleasure. It is currently unclear which factors predict partial remission. However, it is clear that residual symptoms are powerful predictors of relapse, with relapse rates 3-6 times higher in patients with residual symptoms than in those who experience full remission. Residual symptoms are also associated with more medical and psychiatric visits, increased public assistance, disability benefits, thoughts of and attempts at suicide and chronicity. The risk of stroke and coronary events is also higher in patients with residual depressive symptoms. The substantial proportion of patients who achieve only partial remission has traditionally been neglected in antidepressant trials. Given that residual symptoms may relate, in part, to an incompatibility between patient and treatment, further research is needed to predict a better match. These symptoms are a clinically relevant state of illness, and the correct choice of initial antidepressant treatment should offer the greatest chance of achieving full remission.
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PMID:Prevalence and outcome of partial remission in depression. 1217 33

Approximately 70% of adolescents with major depression are not receiving adequate assessment and treatment due, in part, to an incomplete picture of the disorder. Current conceptualizations of depression in adolescence have not adequately addressed integration of developmental principles, salient contextual events, and the adolescent viewpoint of precipitators, symptoms, and treatments. The purpose of this study was to describe the experience of major depression from the adolescent's perspective to provide a more comprehensive description of the disorder. Using a phenomenologic approach, in-depth interviews were conducted with five depressed adolescents, ages 13-17. Data analysis, using an adaptation of Colaizzi's method, resulted in eight theme categories. The essential structure of the experience was formulated from all data. Adolescents focused on anger, fatigue, and interpersonal difficulties as characteristic of depression. The results call for increased awareness of the unique aspects of adolescents, an examination of adolescent-accessible services, and further clarification of the roles of friends and siblings in the disorder.
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PMID:The experience of major depression: adolescents' perspectives. 1221 22

In contrast to women, men do not experience a sudden cessation of gonadal function comparable to menopause. However, there is a progressive reduction in hypothalamic-pituitary-gonadal (HPG) function in aging men: testosterone (T) levels decline through both central (pituitary) and peripheral (testicular) mechanisms and there is a loss of the circadian rhythm of T secretion. In cohorts of men 75 years of age, mean plasma T levels are 35% lower than comparable young men, and more than 25% of men over 75 appear to be T-deficient. Such age-associated T deficiency, which has been termed 'andropause', is thought to be responsible for a variety of symptoms experienced by elderly men, such as weakness, fatigue, reduced muscle and bone mass, impaired haematopoiesis, oligospermia, sexual dysfunction, depression, anxiety, irritability, insomnia and memory impairment. However, it has been difficult to establish correlations between these symptoms and plasma T levels. Nevertheless, there is some evidence that T replacement leads to symptom relief, particularly with respect to muscle strength, bone mineral density, and haematopoiesis. Studies to date on the specific association between psychiatric symptoms, such as depressed mood, and T levels have been methodologically flawed. Overall, data suggest that although hypogonadism is not central to major depressive disorder (MDD), HPG hypofunction may have aetiological importance in mild depressive conditions, such as dysthymia.
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PMID:Testosterone deficiency and mood in aging men: pathogenic and therapeutic interactions. 1258 72

The aim of our open clinical trial was to determine the efficacy and the tolerance of a blue coloured placebo in moderated anxious patients (Hamilton score below 15) and a red one for tired patients without DSM IV criteria of major depressive disorder. All the patients knew that treatment was a placebo and so, had no pharmacological effect. The trial run over seven days. All patients were considered as responders if their initial symptoms were reduced more than 50%. At the end of the week, the final clinical evaluation showed that 18 patients about 34 were in good condition (10 anxious patients, 7 women and 3 men, and 8 tired patients, 4 women and 4 men). The anxious score of Hamilton scale was reduced of 63%; 16 of the 18 responders were absolutely sure that the treatment was usefull. Four patients were obliged to stop their treatment because side effects: insomnia, tiredness and sleepiness, gastric pain and itching of fore arm.
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PMID:[Efficacy of a non blind placebo prescription]. 1264 Mar 29

Primary care patients with a major depressive disorder and 17-item Hamilton Rating Scale for Depression (17-HAM-D) score >18 were randomized to 24 weeks of treatment with mirtazapine 30-45 mg/day (n=99) or paroxetine 20-30 mg/day (n=98). Both treatments were efficacious in improving depressive symptomatology, as assessed by group mean 17-HAM-D scores, percentages of HAM-D responders and remitters and Clinical Global Improvement responders. The mirtazapine group showed statistically significantly larger decreases from baseline in group mean 17-HAM-D scores at weeks 1, 2 and 4, and the difference with the paroxetine group reached the level of clinical relevance at weeks 2 and 4. Antidepressant efficacy was maintained throughout both the acute and continuation phase of treatment. Both treatments were well tolerated. The only adverse event with a statistically significantly higher incidence in the mirtazapine group was fatigue. Statistically significantly more paroxetine-treated patients complained of increased sweating, headache and nausea. The results demonstrate that both mirtazapine and paroxetine were efficacious and well tolerated when used for 24 weeks in depressed patients treated in primary care. An observed difference in efficacy favouring mirtazapine between weeks 1 and 4 indicates that mirtazapine patients had improved earlier compared to those on paroxetine, and corroborates similar findings in other comparisons of mirtazapine versus selective serotonin reuptake inhibitors.
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PMID:A randomized, double-blind, 24-week study comparing the efficacy and tolerability of mirtazapine and paroxetine in depressed patients in primary care. 1270 91

Diagnosing depression in cancer patients has been challenging because the diagnostic criteria include somatic symptoms frequently attributed to the cancer itself or its treatment. However, few studies have explored how to appropriately deal with individual somatic symptoms. The authors used data from 220 cancer patients with major depression to examine the intercorrelations among the DSM-IV somatic and nonsomatic symptom criteria as well as whether the presence of an individual somatic symptom could discriminate the severity of major depression. Appetite changes and a diminished ability to think were positively associated with anhedonia. Sleep disturbance and fatigue were not significantly associated with nonsomatic symptoms. These associations were consistent after adjusting for physical functioning and pain. Only patients with appetite changes showed a higher severity of depression. These results suggest that individual somatic symptoms differ in nature and that appetite-related symptoms and a diminished ability to think may be useful for diagnosing depression in cancer patients, whereas sleep disturbances and fatigue may not be as useful.
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PMID:Somatic symptoms for diagnosing major depression in cancer patients. 1272 6

>55% were observed in two of the studies, while in a third study the probability of remission with duloxetine treatment was nearly three times that observed with placebo (44% versus 16%). Duloxetine also produced significant improvement in painful physical symptoms compared with placebo, in many cases after only 2 weeks of treatment. The discontinuation rate due to adverse events (14.6%) was similar to those observed with selective serotonin reuptake inhibitors. The most frequently reported adverse events were nausea, dry mouth, fatigue, and insomnia. Conclusion. Duloxetine was demonstrated to be safe and effective in the treatment of MDD. The starting dose with the best balance of efficacy and tolerability is 60 mg QD.
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PMID:Duloxetine for the treatment of major depressive disorder. 1285 50

A Japanese woman developed prolonged fatigue, neck and shoulder pain, headache, pyrexia, insomnia, anorexia, lymphadenopathy, and diarrhea for two months. She had experienced various stressors before these symptoms developed. Serological test demonstrated that she had acute parvovirus B19 infection. Major depressive disorder was also diagnosed by a psychiatrist. Her symptoms disappeared after administration of selective serotonin reuptake inhibitors and oriental herbs, although human parvovirus B19 viral genome has been present in her serum for nine months. These findings suggest that parvovirus B19 causes clinical features similar to those of chronic fatigue syndrome in cases who have prior life stressors.
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PMID:Acute parvovirus B19 infection mimicking chronic fatigue syndrome. 1451 87

Principal component (PC) analysis is a statistical technique that has been used to identify core depression symptoms on the Hamilton Rating Scale for Depression (HAM-D). PC analysis is also a useful method to identify unidimensional scales of the HAM-D that are more sensitive to change following antidepressant treatment. Although there have been previous PC investigations of various versions of the HAM-D, there have been no investigations of the 31-item HAM-D scale or investigations that include subjects administered bupropion SR. We performed a PC analysis on data from 910 outpatients who participated in randomized, double-blind trials evaluating bupropion SR versus placebo for major depression. The goal of our analysis was to 1) identify components (domains) of the 31-item HAM-D and 2) determine patient response to bupropion SR using the domains identified. PC analysis produced a solution comprised of 7 domains of the HAM-D that accounted for approximately 49% of the total variance. Bupropion SR demonstrated a significant reduction (p<.01, least square mean change) in symptoms over placebo on 4 domains (cognitive, retardation, fatigue/interest, and anxiety items).
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PMID:Effect of bupropion SR on specific symptom clusters of depression: analysis of the 31-item Hamilton Rating Scale for depression. 1456 16

In seeking to learn more about the etiology and treatment of fatigue in patients with cancer, clinicians and researchers have been challenged to understand how fatigue can be distinguished from depression. Approaches currently used to study fatigue and depression in patients with cancer appear to be of limited usefulness in distinguishing these phenomena. This conclusion is supported by a review of studies in which the single-symptom and symptom-cluster approaches were used to measure fatigue and depression concurrently in patients with cancer. The review yielded consistent evidence of high positive correlations between fatigue and depression, even when attempts were made to eliminate overlapping item content. A consideration of causal mechanisms suggests why it remains difficult to distinguish between fatigue and depression. In addition to fatigue being a possible cause of depression and depression being a possible cause of fatigue, both fatigue and depression can share a common cause. That is, certain forms of cancer and cancer treatment can cause both fatigue and depression. These different mechanisms have implications for efforts to distinguish fatigue and depression and to identify appropriate treatments. For example, recently developed diagnostic criteria for a clinical syndrome of cancer-related fatigue might be useful in identifying fatigue that is caused by a major depressive disorder for which antidepressant therapy is generally indicated.
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PMID:Distinguishing fatigue and depression in patients with cancer. 1461 50


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