Alternative diagnostic criteria for major depressive disorder in patients with chronic pain

SummaryEleven drug free patients meeting Research Diagnostic Criteria for Major Depressive Disorder have been treated with desipramine and given a clonidine infusion after 0, 1 and 3 weeks of treatment. The sedative and hypotensive effects of clonidine were significantly inhibited after three weeks of treatment with desipramine: a similar interaction was seen after one week of treatment although this just failed to reach statistical significance. The growth hormone (GH) response to clonidine was initially impaired, but increased significantly after one week of treatment. A significant reduction in the GH response occurred during the second and third weeks of treatment with desipramine. This last finding is interpreted as evidence of adaptive change of α2 adrenoceptors: the other changes can be explained by the known ability of desipramine to block the re-uptake of noradrenaline.

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Genetic and Environmental Risk for Chronic Pain and the Contribution of Risk Variants for Major Depressive Disorder: A Family-Based Mixed-Model Analysis

PLoS Medicine ◽

10.1371/journal.pmed.1002090 ◽

2016 ◽

Vol 13 (8) ◽

pp. e1002090 ◽

Cited By ~ 33

Author(s):

Andrew M. McIntosh ◽

Lynsey S. Hall ◽

Yanni Zeng ◽

Mark J. Adams ◽

Jude Gibson ◽

...

Keyword(s):

Chronic Pain ◽

Major Depressive Disorder ◽

Depressive Disorder ◽

Environmental Risk ◽

Mixed Model ◽

Model Analysis ◽

Major Depressive ◽

Mixed Model Analysis ◽

Risk Variants ◽

Family Based

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Major Depressive Disorder and Sleep Disturbance in Patients with Chronic Pain

Pain Research and Management ◽

10.1155/2014/480859 ◽

2014 ◽

Vol 19 (1) ◽

pp. 35-41 ◽

Cited By ~ 27

Author(s):

Patricia C Emery ◽

Keith G Wilson ◽

John Kowal

Keyword(s):

Chronic Pain ◽

Major Depressive Disorder ◽

Depressive Disorder ◽

Sleep Hygiene ◽

Dysfunctional Beliefs ◽

Major Depressive ◽

Hygiene Practices ◽

Chronic Pain Patients ◽

Pain Patients ◽

Presleep Arousal

BACKGROUND: Disturbed sleep is a common problem in both chronic pain and major depressive disorder (MDD). Moreover, many patients with chronic pain are depressed.OBJECTIVES: To examine the effects of depression on the sleep behaviour of chronic pain patients by comparing patients who did or did not meet diagnostic criteria for MDD.METHODS: A total of 60 patients with chronic musculoskeletal pain underwent structured diagnostic interviews for MDD and insomnia, and completed questionnaires assessing pain severity, disability, sleep quality, beliefs and attitudes about sleep, and sleep hygiene. For four consecutive days, they also completed a sleep diary, and reported on sleep hygiene practices and presleep arousal.RESULTS: Thirty-three patients (55%) met diagnostic criteria for MDD, most of whom (n=32 [97%]) also fulfilled criteria for insomnia disorder. Insomnia was also common among patients without MDD (21 of 27 [78%]). Participants with MDD had higher self-reports of pain, disability, dysfunctional beliefs about sleep, and, on a prospective basis, greater presleep arousal and poorer sleep hygiene. However, diary assessments of specific sleep parameters (eg, sleep onset latency, total sleep time, sleep efficiency) did not differ between the groups.DISCUSSION: Chronic pain patients with comorbid MDD exhibited more dysfunctional beliefs about sleep, poorer sleep hygiene practices and greater presleep arousal; however, diary-recorded sleep characteristics may not differ from those of patients without MDD. Chronic pain itself may disturb sleep so extensively that MDD introduces little additive effect.CONCLUSION: MDD in chronic pain may be related to the cognitive and behavioural aspects of insomnia, rather than to an incremental disturbance in the initiation or maintenance of sleep.

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How many different ways do patients meet the diagnostic criteria for major depressive disorder?

Comprehensive Psychiatry ◽

10.1016/j.comppsych.2014.09.007 ◽

2015 ◽

Vol 56 ◽

pp. 29-34 ◽

Cited By ~ 71

Author(s):

Mark Zimmerman ◽

William Ellison ◽

Diane Young ◽

Iwona Chelminski ◽

Kristy Dalrymple

Keyword(s):

Major Depressive Disorder ◽

Depressive Disorder ◽

Diagnostic Criteria ◽

Major Depressive

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Identification of novel common variants associated with chronic pain using conditional false discovery rate analysis with major depressive disorder and assessment of pleiotropic effects of LRFN5

10.1101/495846 ◽

2018 ◽

Author(s):

Keira J.A. Johnston ◽

Mark J. Adams ◽

Barbara I. Nicholl ◽

Joey Ward ◽

Rona J Strawbridge ◽

...

Keyword(s):

Chronic Pain ◽

Major Depressive Disorder ◽

Depressive Disorder ◽

False Discovery Rate ◽

Complex Traits ◽

Pleiotropic Effects ◽

Chromosome 1 ◽

Chromosome 14 ◽

Major Depressive ◽

False Discovery

AbstractChronic pain is highly prevalent worldwide, with a significant socioeconomic burden, and also contributes to excess mortality. Chronic pain is a complex trait that is moderately heritable and genetically, as well as phenotypically, correlated with major depressive disorder (MDD). Use of the Conditional False Discovery Rate (cFDR) approach, which leverages pleiotropy identified from existing GWAS outputs, has been successful in discovering novel associated variants in related phenotypes. Here, genome-wide association study outputs for both von Korff chronic pain grade as a quasi-quantitative trait and for MDD were used to identify variants meeting a cFDR threshold for each outcome phenotype separately, as well as a conjunctional cFDR (ccFDR) threshold for both phenotypes together. Using a moderately conservative threshold, we identified a total of 11 novel single nucleotide polymorphisms (SNPs), six of which were associated with chronic pain grade and nine of which were associated with MDD. Four SNPs on chromosome 14 were associated with both chronic pain grade and MDD. SNPs associated only with chronic pain grade were located within SLC16A7 on chromosome 12. SNPs associated only with MDD were located either in a gene-dense region on chromosome 1 harbouring LINC01360, LRRIQ3, FPGT and FPGT-TNNI3K, or within/close to LRFN5 on chromosome 14. The SNPs associated with both outcomes were also located within LRFN5. Several of the SNPs on chromosomes 1 and 14 were identified as being associated with expression levels of nearby genes in the brain and central nervous system. Overall, using the cFDR approach, we identified several novel genetic loci associated with chronic pain and we describe likely pleiotropic effects of a recently identified MDD locus on chronic pain.Author SummaryGenetic variants explaining variation in complex traits can often be associated with more than one trait at once (‘pleiotropy’). Taking account of this pleiotropy in genetic studies can increase power to find sites in the genome harbouring trait-associated variants. In this study we used the suspected underlying pleiotropy between chronic pain and major depressive disorder to discover novel variants associated with chronic pain, and to investigate genetic variation that may be shared between the two disorders.

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Diagnosing Depression in Chronic Pain Patients: DSM-IV Major Depressive Disorder vs. Beck Depression Inventory (BDI)

PLoS ONE ◽

10.1371/journal.pone.0151982 ◽

2016 ◽

Vol 11 (3) ◽

pp. e0151982 ◽

Cited By ~ 15

Author(s):

Peter Knaster ◽

Ann-Mari Estlander ◽

Hasse Karlsson ◽

Jaakko Kaprio ◽

Eija Kalso

Keyword(s):

Chronic Pain ◽

Major Depressive Disorder ◽

Depressive Disorder ◽

Beck Depression Inventory ◽

Major Depressive ◽

Chronic Pain Patients ◽

Dsm Iv ◽

Pain Patients

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Questionable Agreement: The Experience of Depression and DSM-5 Major Depressive Disorder Criteria

The Journal of Medicine and Philosophy A Forum for Bioethics and Philosophy of Medicine ◽

10.1093/jmp/jhaa025 ◽

2020 ◽

Vol 45 (6) ◽

pp. 623-643

Author(s):

Abraham M Nussbaum

Keyword(s):

Major Depressive Disorder ◽

Depressive Disorder ◽

Diagnostic Criteria ◽

Field Tests ◽

Mental Health Practitioners ◽

Major Depressive ◽

Dsm 5 ◽

Health Practitioners ◽

Classic Essay ◽

Depressive Episodes

Abstract Immediately before the release of DSM-5, a group of psychiatric thought leaders published the results of field tests of DSM-5 diagnostic criteria. They characterized the interrater reliability for diagnosing major depressive disorder by two trained mental health practitioners as of “questionable agreement.” These field tests confirmed an open secret among psychiatrists that our current diagnostic criteria for diagnosing major depressive disorder are unreliable and neglect essential experiences of persons in depressive episodes. Alternative diagnostic criteria exist, but psychiatrists rarely encounter them, forestalling the discipline’s epistemological crisis. In Alsadair MacIntyre’s classic essay, such crises occur in science when a person encounters a rival schemata that is incompatible with their current schemata and subsequently constructs a narrative that allows them to reconstruct their own tradition. In search of rival schemata that are in conversation with their own tradition, psychiatric practitioners can utilize alternative diagnostic criteria like the Cultural Formulation Interview, embrace an epistemologically humble psychiatry, and attend to the narrative experience of a person experiencing a depressive episode.

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