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East Asian Archives of Psychiatry :... Mar 2020The binarian model views melancholia as a distinct depressive class, whereas the unitarian model views it as a more severe expression of depression. This study aims to... (Comparative Study)
Comparative Study Observational Study
BACKGROUND
The binarian model views melancholia as a distinct depressive class, whereas the unitarian model views it as a more severe expression of depression. This study aims to investigate the sociodemographic, clinical, and course differences between melancholic and non-melancholic depression.
METHODS
This prospective observational study was carried out at Kasturba Hospital, Manipal, India from November 2010 to September 2011. We recruited consecutive inpatients aged 18 to 60 years who have a diagnosis of depressive disorder (based on ICD-10), with or without any psychiatric or physical comorbidities. Patients were categorised into melancholia and non-melancholia using the CORE questionnaire, with scores of ≥8 indicating the presence of melancholic depression. In addition, patients were evaluated using the Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Somatoform Symptom Checklist, Columbia Suicide Severity Rating Scale, Clinical Global Impression, and Presumptive Stressful Life Events Scale at baseline and at 1, 3, and 6 months.
RESULTS
Of 87 inpatients with a diagnosis of depression, 50 met the inclusion criteria and 37 were excluded. Compared with patients with non-melancholic depression, patients with melancholic depression had higher depression score (30.8 vs 23.8, p < 0.001), had higher number of patients with psychotic depression (39.1% vs 7.4%, p = 0.007), had higher overall illness severity score (5.9 vs 4.8, p < 0.001), and had higher number of patients with suicidal ideation and suicidal behaviour. Regarding the course of melancholia, the number of melancholic patients decreased from 23 at baseline to eight at 1 month, three at 3 months, and three at 6 months. Scores of non-interactiveness, retardation, and agitation decrease significantly over 3 months.
CONCLUSIONS
The construct and course of melancholia may be viewed as a part of depression, more in line with severe depression. Melancholia increases the risk for suicidal ideation and suicidal behaviour.
Topics: Adolescent; Adult; Depressive Disorder; Female; Humans; India; Inpatients; Male; Middle Aged; Prospective Studies; Severity of Illness Index; Socioeconomic Factors; Surveys and Questionnaires; Young Adult
PubMed: 32229643
DOI: 10.12809/eaap1852 -
Australasian Psychiatry : Bulletin of... Jun 2018
Topics: Aged, 80 and over; Depressive Disorder; Female; Humans
PubMed: 29873548
DOI: 10.1177/1039856215620027 -
The World Journal of Biological... Nov 2023Melancholia is a severe form of depression that is typified by greater genetic and biological influence, distinct symptomatology, and preferential response to physical... (Review)
Review
OBJECTIVES
Melancholia is a severe form of depression that is typified by greater genetic and biological influence, distinct symptomatology, and preferential response to physical treatment. This paper sought to broadly overview potential biomarkers of melancholia to benefit differential diagnosis, clinical responses and treatment outcomes. Given nuances in distinguishing melancholia as its own condition from other depressive disorder, we emphasised studies directly comparing melancholic to non-melancholic depression.
METHODS
A comprehensive literature search was conducted. Key studies were identified and summarised qualitatively.
RESULTS
105 studies in total were identified. These studies covered a wide variety of biomarkers, and largely fell into three domains: endocrinological (especially cortisol levels, particularly in response to the dexamethasone suppression test), neurological, and immunological (particularly inflammatory markers). Less extensive evidence also exists for metabolic, genetic, and cardiovascular markers.
CONCLUSIONS
Definitive conclusions were predominantly limited due to substantial heterogeneity in how included studies defined melancholia. Furthermore, this heterogeneity could be responsible for the between- and within-group variability observed in the candidate biomarkers that were examined. Therefore, clarifying these definitional parameters may help identify underlying patterns in biomarker expression to improve diagnostic and therapeutic precision for the depressive disorders.
Topics: Humans; Depression; Depressive Disorder; Diagnosis, Differential; Biomarkers
PubMed: 37259772
DOI: 10.1080/15622975.2023.2219725 -
L'Encephale Feb 2016In the treatment of unipolar depression, treatment response is a key issue in terms of evolution and prognosis. Within this concept, the inadequate response includes the... (Review)
Review
In the treatment of unipolar depression, treatment response is a key issue in terms of evolution and prognosis. Within this concept, the inadequate response includes the worsening, the lack of response, partial response and poor tolerance. This lack of response may be related to intrinsic factors to the individual, but also to more extrinsic environmental factors. In this review, we explore this concept through its links with adherence and treatment duration. In this field, the concept of early response can be a powerful indicator of therapeutic response, which conditions the prescription of antidepressants beyond the strict framework of the sufficient period of 4 to 6 weeks. In addition to its impact on prognosis, the literature data show that the insufficient response is a significant burden in terms of medical and economic cost, and somatic comorbidity; and justifies a systematic identification of this dimension. Therefore self-reports (QIDS; BDI) will be preferred to the clinician-rated depression symptom rating scales (MADRS, HAMD) that require a specific training. Identifying predictors of non-response would be an attractive target for prescribers but the results to date are not operative.
Topics: Antidepressive Agents; Depressive Disorder; Depressive Disorder, Major; Humans; Psychiatric Status Rating Scales; Self Report; Treatment Failure
PubMed: 26879255
DOI: 10.1016/S0013-7006(16)30017-3 -
L'Encephale Feb 2016
Topics: Antidepressive Agents; Depressive Disorder; History, 20th Century; History, Ancient; Humans; Pain
PubMed: 26879251
DOI: 10.1016/S0013-7006(16)30013-6 -
Actas Espanolas de Psiquiatria Sep 2015Cognitive impairments are core symptoms of depressive disorders. We assess the systematic reviews and meta-analysis studies published over the last 10 years (2004-2014)... (Review)
Review
Cognitive impairments are core symptoms of depressive disorders. We assess the systematic reviews and meta-analysis studies published over the last 10 years (2004-2014) that address cognitive performance of depressed patients and taking into account age; clinical and demographic features; symptom severity; number of previous episodes; clinical remission; depressive subtypes and pharmacological treatment. Twelve (12) papers were included after search in international databases. In first episode depression the cognitive domains affected were psychomotor speed, attention, visual learning and memory as well as executive functions. Depressive patients in remission phase improved their performance in attention tasks although they did not achieve similar performance levels as healthy controls. Melancholic patients seem to have a different pattern of cognitive impairment compared with non-melancholic depressive patients. Patients treated with the current antidepressants perform worse in inhibition tasks, verbal fluency, and working memory scores as well as on composite scores of visual and verbal working memory. Future research should study longitudinal outcome and clinical relevance of cognitive symptoms, determine their underlying etiopathogenesis and how they impact on clinical functioning. Specifically, it would be important to analyze the ability of the new antidepressant drugs to improve affective symptoms as well as cognitive dysfunctions.
Topics: Cognitive Dysfunction; Depressive Disorder; Humans; Meta-Analysis as Topic; Review Literature as Topic
PubMed: 26320897
DOI: No ID Found -
American Journal of Psychotherapy Mar 2020Family-based interpersonal psychotherapy (FB-IPT) is an evidence-based psychosocial intervention for depression in preadolescents (ages 8-12 years). Adapted from... (Review)
Review
Family-based interpersonal psychotherapy (FB-IPT) is an evidence-based psychosocial intervention for depression in preadolescents (ages 8-12 years). Adapted from interpersonal psychotherapy for adolescents with depression and modified for younger children, this therapy includes structured dyadic sessions with preadolescents and their parents, guidance for parents in supporting their children and decreasing negative parent-child interactions, and a focus on preadolescents' comorbid anxiety and peer relationships. This article reviews the conceptual foundations and risk factors related to preadolescent depression and the rationale for focusing on improving preadolescents' interpersonal relationships to decrease depressive symptoms and risk for depression during adolescence. The structure and goals for the initial, middle, and termination phases of FB-IPT are described, as well as the specific communication and problem-solving strategies presented to preadolescents and parents. Last, research on the efficacy of FB-IPT is summarized, as are future directions for implementing this promising psychosocial intervention for preadolescent depression in community settings.
Topics: Anxiety; Child; Depression; Depressive Disorder; Family Therapy; Humans; Interpersonal Psychotherapy; Interpersonal Relations; Peer Group
PubMed: 32050785
DOI: 10.1176/appi.psychotherapy.20190028 -
History of Psychiatry Mar 2022My book charts how melancholia was reconceptualized in the nineteenth century as a modern mood disorder and a precursor to clinical depression. The book shows how this...
My book charts how melancholia was reconceptualized in the nineteenth century as a modern mood disorder and a precursor to clinical depression. The book shows how this occurred chiefly in two ways. First, the idea of disordered mood as a medical concept was created through the appropriation of language from experimental physiology into the realm of psychopathology. Second, the interplay of statistical and diagnostic practices formed the basis for modern psychiatric classification and facilitated the standardization of melancholia as a psychiatric diagnosis. These developments were key to the reconceptualization of melancholia and the subsequent emergence of clinical depression, and were foundational to modern psychiatric theory and practice.
Topics: Depression; Depressive Disorder; Humans; Mood Disorders; Psychiatry
PubMed: 35090349
DOI: 10.1177/0957154X211062539 -
The Journal of Nervous and Mental... Sep 2016
Topics: Depressive Disorder; Humans; Mental Health; Psychiatry; Running
PubMed: 27570897
DOI: 10.1097/NMD.0000000000000578 -
Neuropsychopharmacology : Official... Jan 2017Suicidal behavior is complex and manifests because of a confluence of diverse factors. One such factor involves dysregulation of the immune system, which has been linked... (Review)
Review
Suicidal behavior is complex and manifests because of a confluence of diverse factors. One such factor involves dysregulation of the immune system, which has been linked to the pathophysiology of suicidal behavior. This review will provide a brief description of suicidality and discuss the contribution of upstream and downstream factors in the etiology of suicidal behavior, within the contextual framework of inflammation. The contribution of inflammatory conditions such as traumatic brain injury, autoimmune disorders, and infections to neuropsychiatric symptoms and suicidality is only beginning to be explored. We will summarize studies of inflammation in the etiology of suicide, and provide a neurobiological basis for different mechanisms by which inflammation might contribute to the pathophysiology. Finally, we will review treatments that affect upstream and downstream pathways related to inflammation in suicidality.
Topics: Depressive Disorder; Humans; Inflammation; Suicide
PubMed: 27377015
DOI: 10.1038/npp.2016.116