Proposed DSM-5 mixed features are associated with greater likelihood of remission in out-patients with major depressive disorder

2012 ◽  
Vol 44 (7) ◽  
pp. 1361-1367 ◽  
Author(s):  
R. H. Perlis ◽  
C. Cusin ◽  
M. Fava
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Depressive Episode ◽  
Major Depressive Episode ◽  
Antidepressant Treatment ◽  
Adverse Outcomes ◽  
Self Report ◽  
Major Depressive ◽  
Dsm 5 ◽  
Mixed Features

BackgroundDraft DSM-5 criteria for a mixed major depressive episode have been proposed, but their predictive validity has not yet been established. We hypothesized that such symptoms would be associated with poorer antidepressant treatment outcomes.MethodWe examined outcomes among individuals with major depressive disorder participating in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, an effectiveness study conducted at primary and specialty care centers in the USA. Mixed features were derived from the six self-report items of the mania subscale of the Psychiatric Diagnosis Screening Questionnaire. Primary analyses examined the association between the presence of at least two of these in the 6 months before study entry, and remission across up to four sequential treatment trials, as well as adverse outcomes.ResultsOf the 2397 subjects with a major depressive episode of at least 6 months' duration, 449 (18.7%) reported at least two mixed symptoms. The presence of such symptoms was associated with a greater likelihood of remission across up to four sequential treatments, which persisted after adjustment for potential confounding clinical and demographic variables (adjusted hazard ratio 1.16, 95% confidence interval 1.03–1.28). Two individual items, expansive mood and cheerfulness, were strongly associated with a greater likelihood of remission.ConclusionsProposed DSM-5 mixed state features were associated with a greater rather than a lesser likelihood of remission. While unexpected, this result suggests the potential utility of further investigation of depressive mixed states in major depression.

A clinically useful self-report measure of the DSM-5 mixed features specifier of major depressive disorder

2014 ◽  
Vol 168 ◽  
pp. 357-362 ◽  
Author(s):  
Mark Zimmerman ◽  
Iwona Chelminski ◽  
Diane Young ◽  
Kristy Dalrymple ◽  
Jennifer H. Martinez
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Self Report ◽  
Major Depressive ◽  
Dsm 5 ◽  
Mixed Features ◽  
Report Measure

Lower plasma vascular endothelial growth factor A in major depressive disorder not normalized after antidepressant treatment: A case control study

2019 ◽  
Vol 54 (4) ◽  
pp. 402-408 ◽  
Author(s):  
Adrien Rigal ◽  
Romain Colle ◽  
Khalil El Asmar ◽  
Séverine Trabado ◽  
Emanuel Loeb ◽  
...  
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Major Depressive Disorder ◽  
Growth Factor ◽  
Depressive Disorder ◽  
Depressive Episode ◽  
Major Depressive Episode ◽  
Antidepressant Treatment ◽  
Vascular Endothelial ◽  
Major Depressive ◽  
Endothelial Growth Factor

Objective: Vascular endothelial growth factor A is a growth factor with pro-angiogenic and neurotrophic properties. Anti-vascular endothelial growth factor A treatments, used to treat cancers and opthalmic diseases, are known to induce depressive symptoms. Thus, we hypothesized that vascular endothelial growth factor A plasma levels are low in patients experiencing a major depressive episode in the context of major depressive disorder, which consequently increase after antidepressant treatment. The aim of this study was to compare plasma vascular endothelial growth factor A levels in patients with major depressive episode-major depressive disorder before and after antidepressant treatment. Methods: Vascular endothelial growth factor A fasting plasma levels of 469 major depressive episode-major depressive disorder patients were compared with healthy controls. Depressed patients were assessed for remission after 3 and 6 months of antidepressant treatment. Bivariate and multivariate analyses adjusted for sex, age, body mass index and tobacco use were performed. Results: As compared to healthy controls, major depressive episode patients had lower vascular endothelial growth factor A, 66.0 (38.3) pg/mL (standard deviation) vs 83.2 (49.2) pg/mL, p < 0.0001. Plasma vascular endothelial growth factor A levels did not change after antidepressant treatment, even in remitters, and remained lower than those of healthy controls, 64.9 (39.3) pg/mL vs 83.2 (49.2) pg/mL, p < 0.0001. Conclusion: Depressed patients with major depressive disorder have lower plasma vascular endothelial growth factor A levels than healthy controls during their major depressive episode and after remission following antidepressant treatment. New strategies targeting enhancement of plasma vascular endothelial growth factor A could be promising for the prevention and treatment of major depressive disorder.

Measures of the DSM–5 mixed-features specifier of major depressive disorder

CNS Spectrums ◽  
2017 ◽  
Vol 22 (2) ◽  
pp. 196-202 ◽  
Author(s):  
Mark Zimmerman
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Antidepressant Medication ◽  
Reliability And Validity ◽  
Mixed States ◽  
Major Depressive ◽  
Manic Symptoms ◽  
Dsm 5 ◽  
Depressed Patients ◽  
Mixed Features

During the past two decades, a number of studies have found that depressed patients frequently have manic symptoms intermixed with depressive symptoms. While the frequency of mixed syndromes are more common in bipolar than in unipolar depressives, mixed states are also common in patients with major depressive disorder. The admixture of symptoms may be evident when depressed patients present for treatment, or they may emerge during ongoing treatment. In some patients, treatment with antidepressant medication might precipitate the emergence of mixed states. It would therefore be useful to systematically inquire into the presence of manic/hypomanic symptoms in depressed patients. We can anticipate that increased attention will likely be given to mixed depression because of changes in the DSM–5. In the present article, I review instruments that have been utilized to assess the presence and severity of manic symptoms and therefore could be potentially used to identify the DSM–5 mixed-features specifier in depressed patients and to evaluate the course and outcome of treatment. In choosing which measure to use, clinicians and researchers should consider whether the measure assesses both depression and mania/hypomania, assesses all or only some of the DSM–5 criteria for the mixed-features specifier, or assesses manic/hypomanic symptoms that are not part of the DSM–5 definition. Feasibility, more so than reliability and validity, will likely determine whether these measures are incorporated into routine clinical practice.

Impairment of endothelial protection by ischemic postconditioning in patients with major depressive disorder

2011 ◽  
Vol 89 (9) ◽  
pp. 647-653 ◽  
Author(s):  
Chuanjun Zhuo ◽  
Ying Wang ◽  
Hongjun Tian ◽  
Xiaohui Wang ◽  
Yuhui Chen ◽  
...  
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Depressive Episode ◽  
Major Depressive Episode ◽  
Rating Scale ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Ischemic Postconditioning ◽  
Healthy Controls ◽  
Major Depressive

This study used a model of ischemia–reperfusion injury to the brachial artery endothelium to investigate whether the protective role of ischemic postconditioning (IPostC) is impaired in patients with major depressive episode. Flow-mediated dilation (FMD) was measured before and after ischemia–reperfusion in the absence or presence of IPostC in 24 patients with major depressive disorder and 20 healthy controls. In addition, the severity of the depression, as assessed by the Hamilton Depression Rating Scale (HDRS) and Beck Depression Inventory (BDI) scores, and plasma nitrogen dioxide (NOx) levels were also determined. Ischemia–reperfusion resulted in a significant decrease in FMD in both patients with a major depressive episode and healthy controls. IPostC effectively prevented this decrease in FMD in healthy controls, but not in patients with a major depressive episode. HDRS and BDI scores were markedly increased, but plasma NOx levels decreased, in patients with a major depressive episode compared with those in healthy controls. Correlation analysis showed that HDRS and BDI scores and plasma NOx levels were significantly associated with post-ischemia–reperfusion FMD. These results suggest that endothelial protection by IPostC is impaired in patients with major depressive disorder, which may be related to the decrease in endothelial nitric oxide production and the severity of the depression.

Sociodemographic Predictors of Response to Antidepressant Treatment

1997 ◽  
Vol 27 (2) ◽  
pp. 129-136 ◽  
Author(s):  
Maya Spillmann ◽  
Joseph S. Borus ◽  
Katharine G. Davidson ◽  
John J. Worthington ◽  
Joyce R. Tedlow ◽  
...  
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Marital Status ◽  
Employment Status ◽  
Antidepressant Treatment ◽  
Self Report ◽  
Study Entry ◽  
Major Depressive ◽  
Sociodemographic Variables ◽  
Level Of Education

Objective: Our goal was to assess whether sociodemographic variables such as gender, marital status, level of education, and employment status are related to the changes in social functioning that have been reported after drug treatment in outpatients with major depressive disorder. Method: Eligible subjects were 166 depressed outpatients participating in a study involving open treatment with fluoxetine 20 mg/day for eight weeks. Diagnosis of major depressive disorder was made with the use of the Structured Clinical Interview for DSM-III-R-Patient Edition (SCID-P), and patients were required to have a seventeen-item Hamilton Rating Scale for Depression (HAM-D-17) score ⩾ 16 at study entry. All subjects were administered the HAM-D-17 and the Social Adjustment Scale-Self-Report (SAS-SR) before and after treatment with fluoxetine. Results: We found that SAS-SR scores decreased significantly following treatment with fluoxetine from a mean score at baseline of 2.6 ± 0.7 to a mean score at endpoint of 2.3 ± 0.6. After adjusting for the degree of change in HAM-D-17 scores, we found a significant relationship between degree of change in SAS-SR and level of education. No statistically significant relationships were observed between SAS-SR change and age, gender, marital status, and employment status. Conclusion: The degree of improvement in psychosocial functioning observed in depressed outpatients following antidepressant treatment appears to be related to the level of education at study entry, but not to other sociodemographic variables. Further studies need to investigate the nature of this relationship.

Resolution of episode of major depressive disorder with emergence of Ganser syndrome symptoms

1997 ◽  
Vol 14 (1) ◽  
pp. 35-37 ◽  
Author(s):  
Dinesh K Arya
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Depressive Episode ◽  
Major Depressive Episode ◽  
Spontaneous Resolution ◽  
Major Depressive ◽  
Symptoms Of Depression ◽  
Intrapsychic Conflict

AbstractA 48 year old housewife, admitted with a diagnosis of major depressive episode suddenly developed Ganser syndrome during the course of her illness. This resulted in spontaneous resolution of symptoms of depression. The resolution of intrapsychic conflict as a result of development of Ganser syndrome which led to sudden remission of major depressive episode is discussed.

scholarly journals Diagnosis Accuracy of Baptista Depression Scale: Adult and Screening Versions

2021 ◽  
Vol 37 ◽  
Author(s):  
André Pereira Gonçalves ◽  
Makilim Nunes Baptista ◽  
Anna Elisa de Villemor-Amaral ◽  
Lucas de Francisco Carvalho
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Diagnostic Accuracy ◽  
Depressive Episode ◽  
Major Depressive Episode ◽  
Depression Scale ◽  
Major Depressive ◽  
Diagnosis Accuracy

Abstract This study aimed to investigate the diagnostic accuracy of the Baptista Depression Scale adult and screening versions (EBADEP-A and EBADEP-screening) for discrimination of people with a major depressive episode (MDE) or major depressive disorder (MDD) and to compare discriminative capacities. Participants were 187 people, 52 patients, and 135 non-clinical individuals. Results indicated sensitivity equal to 0.92 and specificity equal to 0.88 for EBADEP-A (cut-off = 54), and 0.96 and 0.82, respectively, for EBADEP-screening (cut-off = 17). Findings suggest equivalence between the two versions of EBADEP to discriminate people with MDE or MDD. Results indicate that the two versions can provide a correct diagnostic indicative for MDE and MDD.

scholarly journals What patients with bipolar disorder and major depressive disorder perceive as adverse life events precipitating a current major depressive episode

2015 ◽  
Vol 21 (2) ◽  
pp. 4 ◽  
Author(s):  
Robyn Anne Van Schoor ◽  
Pierre M Joubert
Keyword(s):  
Bipolar Disorder ◽  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Life Events ◽  
Depressive Episode ◽  
Major Depressive Episode ◽  
Assessment Instrument ◽  
Adverse Life Events ◽  
Major Depressive ◽  
A Current

<p><strong>Background.</strong> Adverse life events (ALEs) as precipitants of a major depressive episode (MDE) have been the subject of many studies. These studies indicate an increase in ALEs in the 6 months preceding an MDE.</p><p><strong>Objectives. </strong>The study examined what participants, suffering from major depressive disorder (MDD) or bipolar disorder (BD), perceived as the precipitating ALE of a current MDE. The severity and categories of ALEs were compared between these two patient groups.</p><p><span><strong>Methods. </strong>Consenting, adult inpatients were sourced from Weskoppies Hospital, Steve Biko Academic Hospital, Tshwane District Hospital, Denmar Psychiatric Hospital and Vista Clinic in the Pretoria area. A semi-structured questionnaire was used to obtain demographic data and the diagnosis. Information regarding the course of the disorder, including the number of previous MDEs and the age at which the first MDE occurred, was also obtained. The perceived precipitating ALE was detailed for each participant. A severity value referred to as a Life Change Unit Score (LCU score), based on the Recent Life Changes Questionnaire (RLCQ) by Miller and Rahe, was then assigned to each participant’s perceived precipitant.</span></p><p><span><strong>Results.</strong> Of the 64 participants, 12.7 % were experiencing a first MDE. In those participants who had experienced prior episodes the average number (standard deviation (SD)) of previous episodes was 3.86 (2.46). The mean approximate age (SD) at first onset of an MDE was 24.81 (10.9) years. The BD group had significantly more previous MDEs than the MDD group. Although the average LCU scores were higher in the BD group than the MDD group this did not reach statistical significance. Therefore, this study could not find a difference in the severity of the perceived precipitants between the BD group and MDD group. However, when the LCU scores were analysed within subcategories of the RLCQ, it was found that participants with BD perceived significantly more problems associated with the workplace as precipitants of a current MDE than individuals with MDD.</span></p><p><strong>Conclusion.</strong> Most participants could link an ALE to the onset of a current MDE. The study did not find a differential response to ALEs between patients with BD and MDD. The severity of the social precipitants did not differ significantly between the two groups. The notion of a ‘kindling effect’ could not be supported by the outcome of this study. Because some study participants experienced ALEs not accounted for by the RLCQ, a more comprehensive assessment instrument may be more appropriate for similar studies.</p>

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