Superimposition of acute depressive episode on chronic neurotic symptoms: one of the reasons for refractoriness of depression

1994 ◽  
Vol 9 (6) ◽  
pp. 307-308
Author(s):  
F Okada ◽  
M Daiguji
Keyword(s):  
Mental Health ◽  
Major Depression ◽  
Panic Disorder ◽  
Personality Disorders ◽  
Depressive Episode ◽  
Major Depressive Episode ◽  
Minor Depression ◽  
Major Depressive ◽  
Collaborative Program ◽  
Double Depression

Keller and Shapiro (1982) reported that 26% of the first 101 patients who entered the National Institute of Mental Health (NIMH)-Clinical Research Branch Collaborative Program on the Psychobiology of Depression (Katz and Klerman, 1979; Katz et al, 1979) with a major depressive episode were found to have a pre-existing chronic minor depression of at least 2 years’ duration. They labeled this Phenomenon “double depression„ (Keller and Shapiro, 1982). Furthermore, patients with panic disorder almost universally suffer from major depression at some time in the course of their disorder (Coryell et al, 1988; Stein and Uhde, 1988; Vollrath et al, 1990). “Double diagnosis„, or identification of psychotic or related syndromes, co-existing with personality disorders, have received much attention in the literature in recent years (Sanderson et al, 1990; Torgersen, 1990; Barsky et al, 1992). Much of the research on comorbidity between depressive and anxiety disorders has been summarized in two edited volumes (Kendall and Watson, 1989; Maser and Cloninger, 1990).

Work stress as a risk factor for major depressive episode(s)

2004 ◽  
Vol 35 (6) ◽  
pp. 865-871 ◽  
Author(s):  
JIANLI WANG
Keyword(s):  
Multivariate Analysis ◽  
Risk Factor ◽  
Major Depression ◽  
Work Stress ◽  
Depressive Episode ◽  
Major Depressive Episode ◽  
Working Population ◽  
Major Depressive ◽  
Major Depressive Episodes ◽  
Depressive Episodes

Background. Major depression is a prevalent mental disorder in the general population, with a multi-factorial etiology. However, work stress as a risk factor for major depression has not been well studied.Method. Using a longitudinal study design, this analysis investigated the association between the levels of work stress and major depressive episode(s) in the Canadian working population, aged 18 to 64 years. Data from the longitudinal cohort of the Canadian National Population Health Survey (NPHS) were used (n=6663). The NPHS participants who did not have major depressive episodes (MDE) at baseline (1994–1995 NPHS) were classified into four groups by the quartile values of the baseline work stress scores. The proportion of MDE of each group was calculated using the 1996–1997 NPHS data.Results. The first three quartile groups had a similar risk of MDE. Those who had a work stress score above the 75th percentile had an elevated risk of MDE (7·1%). Using the 75th percentile as a cut-off, work stress was significantly associated with the risk of MDE in multivariate analysis (odds ratio=2·35, 95% confidence interval 1·54–3·77). Other factors associated with MDE in multivariate analysis included educational level, number of chronic medical illnesses and child and adulthood traumatic events. There was no evidence of effect modification between work stress and selected sociodemographic, clinical and psychosocial variables.Conclusions. Work stress is an independent risk factor for the development of MDE in the working population. Strategies to improve working environment are needed to keep workers mentally healthy and productive.

The Symptom Structure of Panic Attacks in Depressed and Anxious Patients

1993 ◽  
Vol 38 (3) ◽  
pp. 181-184 ◽  
Author(s):  
Brian J. Cox ◽  
Gary Hasey ◽  
Richard P. Swinson ◽  
Klaus Kuch ◽  
Robert Cooke ◽  
...  
Keyword(s):  
Major Depression ◽  
Panic Disorder ◽  
Major Depressive Episode ◽  
Structured Interview ◽  
Panic Attacks ◽  
Major Depressive ◽  
Symptom Profiles ◽  
History Of ◽  
Depressive Episodes ◽  
Panic Symptom

This study examined the panic symptom profiles of three diagnostic groups: those with panic disorder and no history of major depression; those with panic disorder with a history of major depressive episode but no current depression; and those current major depression with panic disorder. Patients were compared on the frequency of specific panic attack symptoms based on structured interview responses. The symptom profiles of all three groups were significantly correlated. The patients with past and current depressive episodes had the most similar symptom structure.

Treatment resistance in bipolar disorder

2011 ◽  
Vol 26 (S2) ◽  
pp. 2025-2025
Author(s):  
Z. Rihmer
Keyword(s):  
Bipolar Disorder ◽  
Major Depression ◽  
Depressive Episode ◽  
Depressive Disorders ◽  
Major Depressive Episode ◽  
Treatment Resistance ◽  
Mood Stabilizers ◽  
Common Source ◽  
Major Depressive ◽  
Unipolar Major Depression

Antidepressant-resistant major depression (AD-RD) is a great challenge for the treating clinician. The most widely accepted definition of AD-RD refers that the depressed patient does not show a clinically significant response after at least two adequate trials of different classes of antidepressants. In spite of the fact that there are several causes of AD-RD in general, there is increasing evidence that one of the most common sources of it is the unrecognized bipolar nature of the “unipolar” major depressive episode, when the patients receive antidepressant monotherapy - unprotected by mood stabilizers/atypical antipsychotics. While it is well documented that the optimal clinical response to antidepressants is much rare in bipolar I and II than in unipolar major depression, only the most recent clinical studies have focused on the boundaries between treatment-resistant unipolar major depressive disorder and bipolar disorder. The most widely noted conclusion of the prior studies on AD-RD is that if noncompliance, hypothyreosis, use of “depressiogenic” drugs and pharmacokinetic causes etc, can be excluded, antidepressant-resistance reflects the heterogeneity of depressive disorders and different subgroups of depressed patients respond (or do not respond) to different drugs. However, current psychopathological research on the complex relationship between unipolar depression and bipolar disorders show that the most common source of antidepressant-resistance in DSM-IV diagnosed unipolar major depression is the result of the subthreshold or unrecognized bipolar nature of the depressive episode and antidepressant-induced (hypo)manic switches, antidepressant-resistance and “suicide-inducing” potential of antidepressants seem to be related to the underlying bipolarity of the major depressive episode.

Enhancing Outcomes from Major Depression: Using Antidepressant Combination Therapies with Multifunctional Pharmacologic Mechanisms from the Initiation of Treatment

CNS Spectrums ◽  
2010 ◽  
Vol 15 (2) ◽  
pp. 79-94 ◽  
Author(s):  
Stephen M. Stahl
Keyword(s):  
Major Depression ◽  
Depressive Episode ◽  
Major Depressive Episode ◽  
Antidepressant Treatment ◽  
Symptomatic Improvement ◽  
Good News ◽  
Sustained Remission ◽  
Major Depressive ◽  
Remission Rates ◽  
Antidepressant Combination

Traditional guidelines call for treatment of major depression with a sequence of single antidepressants. Augmentation with a second agent generally only occurs when the first agent is well tolerated and when it also provides at least some symptomatic improvement on its own. Since this standard approach leads to low rates of attaining and sustaining remission by the first agent, with diminishing returns for each subsequent agent, there is growing dissatisfaction with this approach to the treatment of major depression. One new trend is to attempt to enhance the rates of sustained remission from a major depressive episode by combining two therapeutic agents from the very initiation of treatment of a major depressive episode.Traditional treatment of major depression begins with a single “first line” antidepressant, and if it does not work or is not tolerated, trying another and then another. Unfortunately, this strategy results in disappointing remission rates for the first antidepressant (Figure 1), and disappointing rates of maintaining any improvement that is attained by this first agent because of high relapse rates over the next year despite continuing treatment with the first antidepressant (Figure 2A). And that is the good news. The bad news is that with each subsequent antidepressant treatment administered remission rates are progressively reduced (Figure 1). For those patients who do improve, they are progressively less likely to sustain their therapeutic gains despite continuing to take the drug that led to their initial improvement (Figure 2).

Depression in Self-Harm Patients

1989 ◽  
Vol 154 (1) ◽  
pp. 41-47 ◽  
Author(s):  
Jon Ennis ◽  
Rosemary A. Barnes ◽  
Sidney Kennedy ◽  
Dvora D. Trachtenberg
Keyword(s):  
Personality Disorders ◽  
Beck Depression Inventory ◽  
Depressive Episode ◽  
Major Depressive Episode ◽  
Depressive Illness ◽  
The Self ◽  
Subjective Distress ◽  
Major Depressive ◽  
High Prevalence ◽  
Self Harm

DSM-III diagnoses and responses to the Beck Depression Inventory (BDI) were examined in 71 consecutive admissions to an inpatient psychiatric crisis service following deliberate self-harm. Although 80% of the admitted patients were moderately or severely depressed according to BDI scores, only 31 % were diagnosed with a major depressive episode. While all of the self-harm patients may be viewed as experiencing severe subjective distress, only a minority were shown to suffer from DSM-III depressive illness. The high depression scores on the BDI may be related to the patients' extreme distress preceding a crisis admission and to the high prevalence of personality disorders in this group of patients.

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