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

This multicenter, open-label study with a duration of 85 days was performed to evaluate the antidepressant efficacy and safety of mirtazapine (dose range, 30-45 mg) in 12-18-year-old adolescents diagnosed with major depression. Twenty-four (24) patients (15 female patients and 9 male patients) meeting the DSM-IV criteria for major depression and the Hamilton Rating Scale for Depression (HAM-D-17) score of 18 at baseline were enrolled in the study. The primary outcome measures were HAM-D-17, Beck Depression Inventory (BDI), and Clinical Global Impression (CGI) scales. Any changes in symptoms of anxiety were measured using the Hamilton Anxiety Rating Scale (HAM-A). The average age of the 23 subjects, who were eligible for analysis, was 16.3 years (standard deviation (SD) 6.11, median 17.3). The mean daily dose of mirtazapine was 32.9 mg. Mirtazapine showed a marked efficacy on all rating scales and was well tolerated. Mirtazapine had a beneficial effect on sleep. A rapid onset of sleep and pattern of action was seen. No dropouts due to adverse events were recorded. The most common treatment-emergent adverse events were tiredness, increased appetite, and dizziness. The results of this study suggest that mirtazapine may be an effective treatment for major depression in adolescents.
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PMID:Mirtazapine in the treatment of adolescents with major depression: an open-label, multicenter pilot study. 1531 15

Fatigue is a common complaint in the community and medical care settings. Different studies show a high comorbidity between fatigue and depressive disorder. Furthermore, fatigue is an important somatic symptom of depressive disorder and one of the main depressive presentations in primary-care medicine. Fatigue shows a slow response to antidepressant treatment and psychotherapy. Improved work performance is strongly correlated to improvement in energy. However, the assessment and treatment of fatigue in depressive disorder remains understudied. Different definitions of fatigue in depressive disorder are applied in DSM-IV and ICD-10, and depression rating scales all show a different coverage of this core depressive symptom, thereby hampering scientific research. Serotonin, norepinephrine, dopamine and histamine mediate symptoms of fatigue in depressive disorder. Although few data address the effect of antidepressants or augmentation strategies on fatigue-related symptoms, there is a pharmacological rationale for using antidepressant monotherapies, such as venlafaxine, bupropion, sertraline, fluoxetine, or augmentation of first-line treatment with stimulants or modafinil.
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PMID:The many faces of fatigue in major depressive disorder. 1548 32

Anderson-Fabry disease (AFD) is an X-linked recessive disorder of glycosphingolipid metabolism. Most female carriers are clinically symptomatic; however, psychiatric diagnoses have not been reported in this population. We describe four female carriers of AFD disease who met DSM-IV criteria for major depression. All cases had a score above 26 on the Hamilton Rating Scale for Depression, indicating severe depression. This was independent of the severity or number of symptoms of AFD disease. Excessive guilt, fatigue, occupational difficulty, suicidal ideation and depressed mood were findings in all cases. In conclusion, the common presence of depression in carriers of AFD implies the need for a multidisciplinary approach, including psychiatry, in management of these patients. Further studies are recommended to establish the etiology of psychiatric complications, as well as the incidence and the response to pharmacotherapy and psychotherapy.
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PMID:Psychiatric findings in four female carriers of Fabry disease. 1556 93

Somatic symptoms are known to be a prominent characteristic in patients with depression. The aim of the present study was to investigate the major somatic and psychiatric symptoms associated with depression in each sex. Patients with a DSM-IV diagnosis of depressive disorders (n=335) and comparison patients without depression (n=423) among new outpatients in an urban hospital medical setting were eligible for study. The relationship between the the most distressing subjective symptoms at first visit, confirmed by the patient's description on a health questionnaire and the admitting physician's interview, and depression was investigated in each sex. Most (73.5%) of the complaints in patients with depression were somatic. In a simple logistic regression analysis, diarrhea, excessive sweating and psychomotor retardation in men and headache, depressed mood and grief in women were associated with depression. In multiple logistic regression analysis, diarrhea, excessive sweating and weight loss in men, and headache, dysesthesia and grief in women, as well as sleep disturbance, loss of appetite, general fatigue loss on interest and agitation in both sexes, were significantly associated with depression. Fever in men was also associated with depression by Fisher's exact test.
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PMID:Somatic symptoms most often associated with depression in an urban hospital medical setting in Japan. 1512 94

The 17-item Hamilton Rating Scale for Depression (HAMD-17) Anxiety/Somatization factor includes six items: Anxiety (psychic), Anxiety (somatic), Somatic Symptoms (gastrointestinal), Somatic Symptoms (general), Hypochondriasis and Insight. This study examines the relationship between early changes (defined as those observed between baseline and week 1) in these HAMD-17 Anxiety/Somatization Factor items and treatment outcome among major depressive disorder (MDD) patients who participated in a study comparing the antidepressant efficacy of a standardized extract of hypericum with both placebo and fluoxetine. Following a 1-week, single-blind washout, patients with MDD diagnosed by the Structured Clinical Interview for DSM-IV (SCID) were randomized to 12 weeks of double-blind treatment with hypericum extract (900 mg/day), fluoxetine (20 mg/day) or placebo. The relationship between early changes in HAMD-17 anxiety/somatization factor items and treatment outcome was assessed separately for patients who received study treatment (hypericum or fluoxetine) versus placebo with a logistic regression method. One hundred and thirty-five patients (female 57%, mean age=37.3+/-11.0 years; mean baseline HAMD-17=19.7+/-3.2 years) were randomized to double-blind treatment and were included in the intent-to-treat (ITT) analyses. After adjusting for baseline HAMD-17 scores and for multiple comparisons with the Bonferroni correction, patients who remitted (HAMD-17 score <8) after study treatment had significantly greater early improvement in Somatic Symptoms (General) scores than non-remitters. No other significant differences in early changes were noted for the remaining items between remitters versus non-remitters who received active treatment. For patients treated with placebo, early change was not predictive of remission for any of the items after Bonferroni correction. In conclusion, the presence of early improvement on the HAMD-17 item concerning fatigue and general somatic symptoms is significantly predictive of achieving remission at endpoint with active study treatment but not with placebo.
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PMID:The relationship between early changes in the HAMD-17 anxiety/somatization factor items and treatment outcome among depressed outpatients. 1572 83

Preclinical and clinical studies suggest that individual drug withdrawal symptoms may have differential effects on addictive behaviors. The goals of this study were (1) to explore the dimensions of DSM-IV cocaine withdrawal symptoms and (2) to examine the association of these dimension and individual withdrawal symptoms with problems related to drug dependence in male and female cocaine users. The results of the principal components analyses of withdrawal symptoms supported a two factor model. The first one is labeled the depressive symptoms factor and included symptoms of depressed mood, psychomotor agitation, psychomotor retardation, craving for cocaine, insomnia, and vivid, unpleasant dreams. The second factor labeled the somatic symptoms factor included symptoms of increased appetite, hypersomnia, and fatigue. The depressive symptoms factor, in comparison to the somatic symptoms factor, was associated with more frequent reporting of having chemical dependency treatment, having depressed mood for longer than 2 weeks, and trading cocaine for sex. When the individual withdrawal symptoms were examined, depressed mood, psychomotor agitation, vivid, unpleasant dreams, and fatigue were associated with more frequent reporting of some of these outcomes. Our findings support two dimensions in cocaine withdrawal symptoms with differential effects on cocaine dependence outcomes.
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PMID:The effect of individual cocaine withdrawal symptoms on outcomes in cocaine users. 1592 22

Mild to severe cognitive impairment and depression are common among patients with Parkinson's disease (PD) and play a significant role in disability. Effective treatment planning requires a holistic assessment of cognitive and emotional difficulties. A brief neuropsychological protocol was developed to examine the pattern of cognitive and emotional functioning of patients with idiopathic PD. Data was retrospectively analyzed for the first 61 male veterans who were evaluated at an interdisciplinary movement disorders clinic. The most frequently observed cognitive impairments were in the areas of auditory learning, delayed recall memory, and visual motor functioning that required alternating tracking and sequencing. Executive dysfunction was marked by the inability of 60% of the sample to complete the Wisconsin Card Sorting Test, a measure of non-verbal reasoning with a cognitive flexibility component. Clinical interviews revealed that 28% of the sample met DSM-IV Criterion A for a Major Depressive Episode. The findings suggested that this brief neuropsychological protocol established cognitive and emotional profiles of patients with PD, consistent with other samples of patients with Parkinson's Disease. Clinical uses of the brief neuropsychological protocol are detailed. Selection of an alternative executive function measure with a lower "floor" that minimizes patient fatigue and frustration is recommended.
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PMID:A brief neuropsychological protocol for assessing patients with Parkinson's disease. 1634 Jan

The diagnostic criteria for depression were developed on the basis of clinical experience rather than empirical study. Although they have been available and widely used for many years, few studies have examined the psychometric properties of the DSM criteria for major depression. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services project, we examined whether criteria such as insomnia, fatigue, and impaired concentration that are also diagnostic criteria for other disorders are less specific than the other DSM-IV depression symptom criteria. We also conducted a regression analysis to determine whether all criteria are independently associated with the diagnosis of major depressive disorder. A total of 1538 psychiatric outpatients were administered a semistructured diagnostic interview. We inquired about all of the symptoms of depression for all patients. All of the DSM-IV symptom criteria for major depressive disorder were significantly associated with the diagnosis. Contrary to our prediction, symptoms such as insomnia, fatigue, and impaired concentration, which are also criteria of other disorders, generally performed as well as the criteria that are unique to depression such as suicidality, worthlessness, and guilt. The results of the regression analysis, which controlled for symptom covariation, indicated that five symptoms (increased weight, decreased weight, psychomotor retardation, indecisiveness, and suicidal thoughts) were not independently associated with the diagnosis of depression. The implications of these results for revising the diagnostic criteria for major depression are discussed.
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PMID:Diagnosing major depressive disorder I: A psychometric evaluation of the DSM-IV symptom criteria. 1653 31

In an experiment with 33 first-litter sows from day 90 of pregnancy to day 28 of lactation, the influence of a probiotic supplementation on weight performance, feed intake, litter sizes, litter weights, health status and microbiological profile was tested. Enterococcus faecium DSM 7134 was supplemented in a concentration of 5 x 10(8) CFU/kg feed to the gestation and lactation diets of gilts. The supplemented sows showed a significant higher improvement of feed intake (4.16 vs. 3.71 kg/day), litter size (9.2 vs. 7.7 piglets) and weight performance. The average live weight of the probiotic sows at day 28 of lactation was 11 kg higher than of the controls. The bacterial counts/g faeces (lactobacilli, Gram-positive anaerobes, Gram-negative anaerobes, Escherichia coli and enterococci) and the incidence of adhesive and haemolytic E. coli organisms revealed no significant differences between the sows of the two groups or their piglets. While the litter size cannot necessarily be assumed as a primary effect of the probiotic supplementation, the significantly better feed intake and weight performance might be partly due to the probiotic use and can prevent "starvation sterility" of young sows after their first litter caused by reduced feed intake during lactation with high mobilization of body tissue accompanied with lack of energy.
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PMID:Dietary probiotic supplementation and resulting effects on performance, health status, and microbial characteristics of primiparous sows. 1686 76

Serotonin reuptake inhibitors (SRIs) do not have to be administered continuously to be effective for premenstrual dysphoric disorder (PMDD), but can be given during luteal phases only. This is of practical importance, but also of theoretical interest since it suggests that the onset of action of SRIs is shorter in PMDD than in, for example depression. In this study, both continuous and intermittent SRI administration was compared with placebo, with the special purpose of analyzing if different PMDD symptoms respond differently depending on the treatment regimen. To this end, women meeting slightly modified DSM-IV criteria for PMDD (mean+/-SD age, 37+/-6.3 years) were treated for three menstrual cycles with paroxetine continuously, paroxetine during the luteal phase only, or placebo, the population completing at least one treatment cycle comprising 55-56 subjects per group. Continuous treatment with paroxetine reduced premenstrual symptoms effectively with a response rate of 85%. The effect size was highest for irritability (1.4) and lowest for lack of energy (0.5). Intermittent treatment was as effective as continuous treatment in reducing irritability, affect lability, and mood swings, but had a somewhat weaker effect on depressed mood and somatic symptoms. The study indicates that the response rate when treating PMDD with SRIs is high, and that irritability is a key target symptom. Symptoms such as irritability, affect lability, and mood swings appear to be more inclined to respond rapidly to SRIs, enabling intermittent treatment, than are, for example, the somatic symptoms.
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PMID:Placebo-controlled trial comparing intermittent and continuous paroxetine in premenstrual dysphoric disorder. 1703 33


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