Heterogeneity in major depression and its melancholic and atypical specifiers: a secondary analysis of STAR*D

Abstract Objectives The melancholic and atypical specifiers for a major depressive episode (MDE) are supposed to reduce heterogeneity in symptom presentation by requiring additional, specific features. Fried et al. (2020) recently showed that the melancholic specifier may increase the potential heterogeneity in presenting symptoms. In a large sample of outpatients with depression, our objective was to explore whether the melancholic and atypical specifiers reduced observed heterogeneity in symptoms. Methods We used baseline data from the Inventory of Depression Symptoms (IDS), which was available for 3,717 patients, from the Sequenced Alternatives to Relieve Depression (STAR*D) trial. A subsample met criteria for MDE on the IDS (“IDS-MDE”; N =2,496). For patients with IDS-MDE, we differentiated between those with melancholic, non-melancholic, non-melancholic, atypical, and non-atypical depression. We quantified the observed heterogeneity between groups by counting the number of unique symptom combinations pertaining to their given diagnostic group (e.g., counting the melancholic symptoms for melancholic and non-melancholic groups), as well as the profiles of DSM-MDE symptoms (i.e., ignoring the specifier symptoms). Results When considering the specifier and depressive symptoms, there was more observed heterogeneity within the melancholic and atypical subgroups than in the IDS-MDE sample (i.e., ignoring the specifier subgroups). The differences in number of profiles between the melancholic and non-melancholic groups were not statistically significant, irrespective of whether focusing on the specifier symptoms or only the DSM-MDE symptoms. The differences between the atypical and non-atypical subgroups were smaller than what would be expected by chance. We found no evidence that the specifier groups reduce heterogeneity, as can be quantified by unique symptom profiles. Most symptom profiles, even in the specifier subgroups, had five or fewer individuals. Conclusion We found no evidence that the atypical and melancholic specifiers create more symptomatically homogeneous groups. Indeed, the melancholic and atypical specifiers introduce heterogeneity by adding symptoms to the DSM diagnosis of MDE.

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Do melancholic and atypical specifiers reduce heterogeneity in major depressive disorder?: A secondary analysis of the STAR*D trial

10.31234/osf.io/ubndc ◽

2020 ◽

Cited By ~ 1

Author(s):

Lorenzo Lorenzo-Luaces ◽

John Buss ◽

Eiko I Fried

Keyword(s):

Major Depressive Disorder ◽

Depressive Disorder ◽

Secondary Analysis ◽

Large Degree ◽

Depression Symptoms ◽

Significant Heterogeneity ◽

Major Depressive ◽

Atypical Depression ◽

Presenting Symptoms ◽

Symptoms Of Depression

Objectives: Specifiers for the diagnosis of a major depressive disorder (MDD), like melancholic and atypical features, are supposed to reduce heterogeneity in symptom presentation. However, Fried et al. (2020) recently quantified how, at least the melancholic specifier, could increase heterogeneity in presenting symptoms. Methods: We analyzed baseline data from the Inventory of Depression Symptoms in the Sequenced Alternatives to Relieve Depression (STAR*D) trial. IDS data were available for 3, 724 patients, of which 2,498 reported five symptoms of depression on the IDS (“IDS-MDE”). For patients with IDS-MDE, we differentiated between those with melancholic, non-melancholic, atypical, and non-atypical depression as per the IDS. For each of these groups, we calculated the number of unique combinations of the symptom that allowed a patient to meet criteria for their given diagnostic group, as well as the number of unique combinations of depressive symptoms (i.e., ignoring the melancholic and atypical symptoms). Results: There was more heterogeneity within the specifiers than in the full sample. When considering only the symptoms of depression, there was somewhat less heterogeneity in the melancholic than non-melancholic groups. However, most symptom profiles, even in the specifier subgroups,had five or fewer individuals, suggesting the presence of significant heterogeneity. Conclusion: The DSM specifiers largely appear to reduce heterogeneity by creating smaller subgroups of patients with infrequent symptoms but there is a large degree of heterogeneity present even among those who meet the specifier criteria. Moreover, the specifier criteria themselves may add heterogeneity.

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Effects of a 6-week, whole-body vibration strength-training on depression symptoms, endocrinological and neurobiological parameters in adolescent inpatients experiencing a major depressive episode (the “Balancing Vibrations Study”): study protocol for a randomized placebo-controlled trial

Trials ◽

10.1186/s13063-018-2747-8 ◽

2018 ◽

Vol 19 (1) ◽

Cited By ~ 3

Author(s):

Max Oberste ◽

Nicola Großheinrich ◽

Heidrun-Lioba Wunram ◽

Johannes Levin Graf ◽

Alischa Ziemendorff ◽

...

Keyword(s):

Strength Training ◽

Depressive Episode ◽

Major Depressive Episode ◽

Controlled Trial ◽

Whole Body Vibration ◽

Whole Body ◽

Depression Symptoms ◽

Major Depressive ◽

Vibration Strength ◽

Adolescent Inpatients

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The Symptom Structure of Panic Attacks in Depressed and Anxious Patients

The Canadian Journal of Psychiatry ◽

10.1177/070674379303800305 ◽

1993 ◽

Vol 38 (3) ◽

pp. 181-184 ◽

Cited By ~ 4

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.

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Maladaptive mood repair, atypical respiratory sinus arrhythmia, and risk of a recurrent major depressive episode among adolescents with prior major depression

Psychological Medicine ◽

10.1017/s003329171600057x ◽

2016 ◽

Vol 46 (10) ◽

pp. 2109-2119 ◽

Cited By ~ 9

Author(s):

M. Kovacs ◽

I. Yaroslavsky ◽

J. Rottenberg ◽

C. J. George ◽

E. Kiss ◽

...

Keyword(s):

Risk Factors ◽

Respiratory Sinus Arrhythmia ◽

Depressive Episode ◽

Mood Induction ◽

Major Depressive Episode ◽

Depression Symptoms ◽

Major Depressive ◽

Sinus Arrhythmia ◽

Mood Repair ◽

Increased Risk

BackgroundBecause depressive illness is recurrent, recurrence prevention should be a mainstay for reducing its burden on society. One way to reach this goal is to identify malleable risk factors. The ability to attenuate sadness/dysphoria (mood repair) and parasympathetic nervous system functioning, indexed as respiratory sinus arrhythmia (RSA), are impaired during depression and after it has remitted. The present study therefore tested the hypothesis that these two constructs also may mirror risk factors for a recurrent major depressive episode (MDE).MethodAt time 1 (T1), 178 adolescents, whose last MDE had remitted, and their parents, reported on depression and mood repair; youths’ RSA at rest and in response to sad mood induction also were assessed. MDE recurrence was monitored until time 2 (T2) up to 2 years later. Mood repair at T1 (modeled as a latent construct), and resting RSA and RSA response to sadness induction (RSA profile), served to predict onset of first recurrent MDE by T2.ResultsConsistent with expectations, maladaptive mood repair predicted recurrent MDE, above and beyond T1 depression symptoms. Further, atypical RSA profiles at T1 were associated with high levels of maladaptive mood repair, which, in turn, predicted increased risk of recurrent MDE. Thus, maladaptive mood repair mediated the effects of atypical RSA on risk of MDE recurrence.ConclusionsThis study documented that a combination of behavioral and physiological risk factors predicted MDE recurrence in a previously clinically referred sample of adolescents with depression histories. Because mood repair and RSA are malleable, both could be targeted for modification to reduce the risk of recurrent depression in youths.

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