Characteristics Associated with Depression Severity in 270 Juveniles in a Major Depressive Episode

Introduction: Severe depression is prevalent in young persons and can lead to disability and elevated suicidal risk. Objectives: To identify clinical and demographic factors associated with the severity of depression in juveniles diagnosed with a major mood disorder, as a contribution to improving clinical treatment and reducing risk of suicide. Methods: We analyzed factors associated with depression severity in 270 juveniles (aged 6–18 years) in a major depressive episode, evaluated and treated at the Bambino Gesù Children’s Hospital of Rome. Depressive symptoms were rated with the revised Children’s Depression Rating Scale (CDRS-R) and manic symptoms with the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) Mania Rating Scale (K-SADS-MRS). Bivariate comparisons were followed by multivariable linear regression modeling. Results: Depression severity was greater among females than males (55.0 vs. 47.2), with the diagnosis of a major depressive disorder (MDD) vs. bipolar disorder (BD; 53.8 vs. 49.3), and tended to increase with age (slope = 1.14). Some symptoms typical of mania were associated with greater depression severity, including mood lability, hallucinations, delusions, and irritability, whereas less likely symptoms were hyperactivity, pressured speech, grandiosity, high energy, and distractibility. Factors independently and significantly associated with greater depression severity in multivariable linear regression modeling were: MDD vs. BD diagnosis, female sex, higher anxiety ratings, mood lability, and irritability. Conclusions: Severe depression was significantly associated with female sex, the presence of some manic or psychotic symptoms, and with apparent unipolar MDD. Manic/psychotic symptoms should be assessed carefully when evaluating a juvenile depressive episode and considered in treatment planning in an effort to balance risks of antidepressants and the potential value of mood-stabilizing and antimanic agents to decrease the severity of acute episodes and reduce suicidal risk.

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Impact of gender, depression severity and type of depressive episode on efficacy and safety of escitalopram: an observational study on major depressive disorder patients in southern India

The Egyptian Journal of Neurology Psychiatry and Neurosurgery ◽

10.1186/s41983-021-00302-7 ◽

2021 ◽

Vol 57 (1) ◽

Author(s):

Tatiyana Mandal ◽

Laxminarayana Kurady Bairy ◽

Podila Satya Venkata Narasimha Sharma ◽

Vijaya Lakshmi Valaparla

Keyword(s):

Depressive Episode ◽

Rating Scale ◽

Severe Depression ◽

Depression Score ◽

Efficacy And Safety ◽

Depression Severity ◽

Drug Reactions ◽

Major Depressive ◽

South Indian ◽

Male Patients

Abstract Background Antidepressant response is a complex trait influenced by clinical, demographic and genetic factors. Objectives To explore the influences of baseline depression severity, gender and type of depressive episode on efficacy and safety of escitalopram (10–20 mg/day) in South Indian patients with major depressive disorder (MDD). Methods The study was conducted on 18–65-year-old patients (n = 151) suffering from a first or recurrent episode of MDD with a 17-item Hamilton Depression Rating Scale (HDRS-17) score of ≥ 18 at baseline. Efficacy assessments were done using HDRS-17, Montgomery-Asberg Depression Rating Scale (MADRS), and Clinical Global Impression (CGI) at baseline and weeks 4, 8 and 12. Patients were monitored for adverse drug reactions (ADRs). Clinical outcomes were compared among various groups based on gender, type of depressive episode (first or recurrent episode) and baseline HDRS-17 scores (moderate depression—score between 17 and 23; severe depression—score ≥ 24). Results Among the 148 subjects who completed the 12-week study, 43.9% and 42.6% achieved response and remission, respectively. The decline in HDRS-17 and MADRS scores from baseline was significant (p value < 0.05) at all follow-up visits and a similar pattern was seen with CGI. Efficacy outcomes were better in the moderate baseline depression group compared with severe depression. There were no associations of efficacy with gender and type of depressive episode. A total of 247 adverse drug reactions (ADR) were reported and 119 (80.41%) subjects experienced at least one ADR during the study period. No serious ADR was reported. Male patients experienced more ADRs compared with females. The safety profile of escitalopram was similar across various groups based on baseline depression severity and type of depressive episode. Conclusion The study revealed that escitalopram is efficacious in south Indian MDD patients with a favourable safety profile. The efficacy was influenced by baseline depression severity whereas more ADRs were reported by male patients.

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

Canadian Journal of Physiology and Pharmacology ◽

10.1139/y11-063 ◽

2011 ◽

Vol 89 (9) ◽

pp. 647-653 ◽

Cited By ~ 3

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.

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Importance of retardation and fatigue/interest domains for the diagnosis of major depressive episode after stroke: a four months prospective study

Brazilian Journal of Psychiatry ◽

10.1590/s1516-44462009000300004 ◽

2009 ◽

Vol 31 (3) ◽

pp. 202-207 ◽

Cited By ~ 8

Author(s):

Luisa de Marillac Niro Terroni ◽

Renério Fráguas ◽

Mara de Lucia ◽

Gisela Tinone ◽

Patricia Mattos ◽

...

Keyword(s):

Depressive Symptoms ◽

Depressive Episode ◽

Major Depressive Episode ◽

Rating Scale ◽

University Hospital ◽

Regression Equations ◽

Stroke Patients ◽

Major Depressive ◽

Post Stroke ◽

Neurology Clinic

OBJECTIVE: Post-stroke major depressive episode is very frequent, but underdiagnosed. Researchers have investigated major depressive episode symptomatology, which may increase its detection. This study was developed to identify the depressive symptoms that better differentiate post-stroke patients with major depressive episode from those without major depressive episode. METHOD: We screened 260 consecutive ischemic stroke patients admitted to the neurology clinic of a university hospital. Seventy-three patients were eligible and prospectively evaluated. We assessed the diagnosis of major depressive episode using the Structured Clinical Interview for DSM-IV and the profile of depressive symptoms using the 31-item version of the Hamilton Depression Rating Scale. For data analysis we used cluster analyses and logistic regression equations. RESULTS: Twenty-one (28.8%) patients had a major depressive episode. The odds ratio of being diagnosed with major depressive episode was 3.86; (95% CI, 1.23-12.04) for an increase of one unit in the cluster composed by the domains of fatigue/interest and retardation, and 2.39 (95% CI, 1.21-4.71) for an increase of one unit in the cluster composed by the domains of cognitive, accessory and anxiety symptoms. The domains of eating/weight and insomnia did not contribute for the major depressive episode diagnosis. CONCLUSION: The domains of retardation and interest/fatigue are the most relevant for the diagnosis of major depressive episode after stroke.

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Psychomotor retardation in depression, a pilot study

Acta Neuropsychiatrica ◽

10.1017/s0924270800035018 ◽

1991 ◽

Vol 3 (2) ◽

pp. 22-25

Author(s):

J.J.M. van Hoof ◽

L.P. van Bavel ◽

A.J.M. van den Berg

Keyword(s):

Depressive Episode ◽

Major Depressive Episode ◽

Rating Scale ◽

Psychiatric Patients ◽

Depression Scale ◽

Psychomotor Retardation ◽

Point Of View ◽

Major Depressive ◽

Important Sign ◽

Depressive Patients

SummarySeveral studies have demonstrated that psychomotor retardation is an important sign of the major depressive episode, both from a diagnostic point of view and as a predictor of treatment outcome. However, it is uncertain to what extent psychomotor retardation is specific for the major depressive episode. A heterogeneous group of psychiatric patients (n=26) was studied using a rating scale developed specifically to assess psychomotor retardation (RRS). The 13 patients suffering from a major depressive episode had a significantly higher RRS score than patients with another diagnosis. Furthermore, in the depressive subjects the severity of the depression (measured by means of Hamilton's depression rating scale) appeared to correlate with the severity of the psychomotor retardation. Cognitive features of psychomotor retardation were mainly responsible for the more severe psychomotor retardation in the depressive patients. Surprisingly. Hamilton's depression scale which was used in this study does not pay much attention to these aspects.

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Depressive Symptoms Versus Depression in Older Adults in a Rural Community

European Journal of Investigation in Health, Psychology and Education ◽

10.3390/ejihpe4030030 ◽

2014 ◽

Vol 4 (3) ◽

pp. 321-327

Author(s):

Clemente Cordero Sánchez ◽

Guillermina García Madrid ◽

Marcela Flores Merlo ◽

Francisco Javier Báez Hernández ◽

Alejandro Torres Reyes ◽

...

Keyword(s):

Older Adults ◽

Depressive Symptoms ◽

Rural Community ◽

Depressive Episode ◽

Major Depressive Episode ◽

Severe Depression ◽

Female Gender ◽

Geriatric Syndrome ◽

Mild Depression ◽

Major Depressive

Depression is a mood disorder characterized by loss of interest or pleasure in activities of daily living. Frequent and disabling geriatric syndrome that often goes unnoticed, which generates physical and functional. The objective was to know the depressive symptoms in older adults in a rural community in the state of Puebla, Mexico. Study was descriptive, correlational, cross, made of 155 seniors was an applied to Scale Center for Epidemiologic Studies Depression CES-D and the Scale of Yesavage. The age range of older adults was 60 to 90 years, with a predominance of female gender in 65.2%, the CES-D reported 18.7% were found no clinical y significant symptoms, 70.3% in symptoms of sub- threshold depression, 9% in possible major depressive episode, 1.9% in probable major depressive episode. Similar results to those of Scale of Yesavage 43.2% found no evidence of depression, 32.9% with mild depression, 17.4% with moderate depression and 6.5% with severe depression. Noticing a difference by gender (Women=8482.00, Male=3608.00, p=.023). Knowing depressive symptoms in older adults can implement care interventions based on scientific evidence.

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Depressive Symptoms Versus Depression in Older Adults in a Rural Community

European Journal of Investigation in Health, Psychology and Education ◽

10.1989/ejihpe.v4i3.79 ◽

2014 ◽

Vol 4 (3) ◽

pp. 321-327

Author(s):

Clemente Cordero Sánchez ◽

Guillermina García Madrid ◽

Marcela Flores Merlo ◽

Francisco Javier Báez Hernández ◽

Alejandro Torres Reyes ◽

...

Keyword(s):

Older Adults ◽

Depressive Symptoms ◽

Rural Community ◽

Depressive Episode ◽

Major Depressive Episode ◽

Severe Depression ◽

Female Gender ◽

Geriatric Syndrome ◽

Mild Depression ◽

Major Depressive

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A Comparison of the QIDS-C16, QIDS-SR16, and the MADRS in an Adult Outpatient Clinical Sample

CNS Spectrums ◽

10.1017/s1092852900000389 ◽

2010 ◽

Vol 15 (7) ◽

pp. 458-468 ◽

Cited By ~ 15

Author(s):

Ira H. Bernstein ◽

A. John Rush ◽

Diane Stegman ◽

Laurie Macleod ◽

Bradley Witte ◽

...

Keyword(s):

Depressive Episode ◽

Major Depressive Episode ◽

Rating Scale ◽

Depressive Symptomatology ◽

Clinical Sample ◽

Classical Test Theory ◽

Test Theory ◽

Self Report ◽

Screening Tools ◽

Major Depressive

ABSTRACTBackground: This study compared the 16-item Clinician and Self-Report versions of the Quick Inventory of Depressive Symptomatology (QIDS-C16 and QIDS-SR16) and the 10-item Montgomery-Asberg Depression Rating Scale (MADRS) in adult outpatients. The comparison was based on psychometric features and their performance in identifying those in a major depressive episode as defined by the Mini-International Neuropsychiatric Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.Methods: Of 278 consecutive outpatients, 181 were depressed. Classical test theory, factor analysis, and item response theory were used to evaluate the psychometric features and receiver operating characteristic (ROC) analyses.Results: All three measures were unidimensional. All had acceptable reliability (coefficient α=.87 for MADRS10, .82 for QIDS-C16, and .80 for QIDS-SR16). Test information function was higher for the MADRS (ie, it was most sensitive to individual differences in levels of depression). The MADRS and QIDS-C16 slightly but consistently outperformed the QIDS-SR16 in differentiating between depressed versus non-depressed patients.Conclusion: All three measures have satisfactory psychometric properties and are valid screening tools for a major depressive episode.

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Longitudinal Association Between Smoking Abstinence and Depression Severity in Those With Baseline Current, Past, and No History of Major Depressive Episode in an International Online Tobacco Cessation Study

Nicotine & Tobacco Research ◽

10.1093/ntr/ntaa036 ◽

2020 ◽

Cited By ~ 1

Author(s):

Nancy H Liu ◽

Chaorong Wu ◽

Eliseo J Pérez-Stable ◽

Ricardo F Muñoz

Keyword(s):

Depressive Symptoms ◽

Depressive Episode ◽

Tobacco Cessation ◽

Major Depressive Episode ◽

Smoking Abstinence ◽

Time Varying ◽

Depression Severity ◽

Major Depressive ◽

History Of ◽

Over Time

Abstract Introduction We use multilevel modeling to parse out the effects of time-varying smoking abstinence and baseline depression (history and severity) on depression severity over 1 year. Aims and Methods Participants were 1000 smokers recruited worldwide for an online randomized controlled tobacco cessation trial. We examined whether changes in depression severity over time were associated with self-reported 7-day point prevalence smoking status assessed at 1-, 3-, 6-, and 12-month follow-up (FU) using baseline major depressive episode (MDE) history and baseline depression severity as time-invariant covariates. We present depression severity means and smoking abstinence at each FU. Results Regardless of concurrent abstinence status, baseline MDE history was significantly related to depression severity over time: those reporting a past MDE had worse depressive symptoms over time compared with those reporting no MDE history. Baseline depression severity interacted significantly with time-varying abstinence status: for every 1-unit increase in baseline scores on the Center for Epidemiological Studies—Depression Scale (CES-D), individuals who were smoking at FU reported CES-D scores that were 0.17 points higher than those who were abstinent. In this context, nicotine dependence, gender, age, or marital status did not affect depression severity. Conclusions In the context of cessation, having an MDE history plays a significant role in the trajectory of depression severity over the course of 1 year, regardless of abstinence status. Abstinence is related to lower depressive symptoms at each FU, and this effect was stronger at higher levels of baseline depression severity. Implications This study indicates that depressive symptoms are not exacerbated among individuals who are quitting smoking at 1-, 3-, 6-, and 12-month FUs. Depression severity is worse with a baseline history of MDE. Further, those with high baseline depression severity who continue smoking have worse depressive symptoms throughout a 1-year period compared with their abstinent counterparts.

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Salivary Cortisol Awakening Response as a Predictor for Depression Severity in Adult Patients with a Major Depressive Episode Performing a Daily Exercise Program

Neuropsychobiology ◽

10.1159/000521234 ◽

2022 ◽

pp. 1-10

Author(s):

Else Refsgaard ◽

Anne Vibeke Schmedes ◽

Klaus Martiny

Keyword(s):

Depressive Episode ◽

Major Depressive Episode ◽

Regression Coefficient ◽

Psychiatric Inpatient ◽

Exercise Program ◽

Cortisol Awakening Response ◽

Depression Severity ◽

Major Depressive ◽

Saliva Cortisol ◽

Daily Exercise

Introduction: The hypothalamic-pituitary-adrenal axis function in depression has been the subject of considerable interest, and its function has been tested with a variety of methods. We investigated associations between saliva cortisol at awakening and the 24-h urine cortisol output, both measured at study baseline, with endpoint depression scores. Methods: Patients were admitted to a psychiatric inpatient ward with a major depressive episode and were started on fixed duloxetine treatment. They delivered saliva samples at awakening and 15, 30, and 60 min post-awakening and sampled urine for 24 h. Subsequently, they started a daily exercise program maintained for a 9-week period. Clinician-rated depression severity was blindly assessed with the Hamilton Depression Rating 6-item subscale (HAM-D6). The cortisol awakening response was quantified by the area under the curve with respect to the ground (AUCG) and with respect to the rise (AUCI) using saliva cortisol levels in the 1-h period after awakening. Analysis of expected associations between depression severity, AUCG, AUCI, exercise, and 24-h cortisol output was performed in a general linear model. Results: In all, 35 participants delivered saliva or 24-h urine samples. The mean age was 49.0 years (SD = 11.0) with 48.6% females with a mean baseline HAM-D6 score of 12.2 (SD = 2.3). In a statistical model investigating the association between HAM-D6 at week 9 as a dependent variable and AUCI, concurrent HAM-D6, gender, smoking, and exercise volume as covariates, we found a significant effect of AUCI, concurrent HAM-D6, and exercise. The following statistics were found: AUCI (regression coefficient 0.008; F value = 9.1; p = 0.007), concurrent HAM-D6 (regression coefficient 0.70; F value = 8.0; p = 0.01), and exercise (regression coefficient −0.005; F value = 5.7; p = 0.03). The model had an R2 of 0.43. The association between HAM-D6 endpoint scores and the AUCI showed that higher AUCI values predicted higher HAM-D6 endpoint values. The association between HAM-D6 endpoint scores and the exercise level showed that a high exercise level was associated with lower HAM-D6 endpoint values. Conclusion: The results thus showed that high AUCI values predicted less improvement of depression and high exercise levels predicted more improvement of depression. These findings need to be confirmed in larger samples to test if more covariates can improve prediction of depression severity.

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Factors Associated with Depression Severity in Adolescence

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.2219 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S224-S224

Author(s):

G. Serra ◽

M.P. Casini ◽

V. Maggiore ◽

R.J. Baldessarini ◽

S. Vicari

Keyword(s):

Suicidal Ideation ◽

Mood Disorder ◽

Rating Scale ◽

Severe Depression ◽

Suicidal Behaviors ◽

Depression Severity ◽

Major Depressive ◽

Factors Associated ◽

Manic Symptoms ◽

Children’S Depression

IntroductionSevere depression is greatly impairing during adolescence and involves a high risk for suicidal behaviors.Objectives and aimsIdentify clinical and demographic factors associated with severity of depression in adolescents diagnosed with a major mood disorder so as to improve clinical treatment and prevent suicidal behaviors.MethodsWe analyzed factors associated with depression severity in 145 severely ill adolescents diagnosed with a major affective disorder using the K-SADS (Kiddie-Schedule for Affective Disorders and Schizophrenia) at the Mood Disorder Outpatient Program of Bambino Gesù Children's Hospital (Rome). Depressive and manic symptoms were rated with the CDRS-R (Children's Depression Rating Scale-Revised) and K-SADS-MRS (Mania Rating Scale), respectively. Bivariate comparisons were followed by multivariable linear regression modeling.ResultsDepression severity was greater among females than males (mean CDRS scores: 53.0 vs. 42.8; P < 0.0001) and with major depressive versus bipolar disorder diagnosis (50.4 vs. 45.4; P = 0.001). Manic symptoms, including irritability, mood lability, crowded thoughts, delusions, and insomnia, were more likely with more severe depression; their number and severity correlated with CDRS-R total score (respectively, β = 1.53 and 5.44;both P < 0.0001). Factors independently and significantly associated with CDRS-R depression score in multivariate modeling were:– presence of suicidal ideation;– absence of ADHD;– female sex;– greater number of manic symptoms.ConclusionsSevere depression was associated with manic symptoms and with suicidal ideation among adolescents diagnosed with either bipolar or major depressive disorders. This relationship should be considered in treatment planning and suicide prevention, including consideration of mood-stabilizing and antimanic agents in the treatment of severe adolescent depression.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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