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The New England Journal of Medicine Dec 2023
Review
Topics: Humans; Depressive Disorder; Technology; Wearable Electronic Devices
PubMed: 38157501
DOI: 10.1056/NEJMra2215898 -
Journal of Affective Disorders Mar 2021The status of melancholia as a categorical or dimensional condition remains unclear, and no measure of melancholia has achieved definitive status. This study aimed to...
BACKGROUND
The status of melancholia as a categorical or dimensional condition remains unclear, and no measure of melancholia has achieved definitive status. This study aimed to use a machine learning approach to assess whether a pre-established cut-off score on the Sydney Melancholia Prototype Index (SMPI) provided clear differentiation of melancholic/non-melancholic depression, and to identify the items making the most distinct contribution.
METHODS
We analysed amalgamated data sets of 1513 clinically depressed patients assessed via the clinician-rated version of the SMPI (SMPI-CR). We also evaluated the self-report version of the SMPI (SMPI-SR) in a combined clinical/community sample of 2025 depressed patients and senior high school students. Rule ensembles were derived in which the outcome measure was the presence/absence of melancholia (defined as scoring at or above a SMPI cut-off score that had been established in previous studies) and the predictive variables were the individual SMPI items.
RESULTS
The pre-established SMPI cut-off score was confirmed as differentiating melancholic/non-melancholic with near perfect accuracy for the SMPI-CR, and with very high accuracy for the SMPI-SR. The relative importance of all SMPI items was quantified.
LIMITATIONS
It is difficult to validate SMPI-assigned diagnoses due to the lack of any similar measures.
CONCLUSIONS
The SMPI-CR was confirmed to be a highly precise instrument for differentiating melancholic and non-melancholic depression. Its use will advance clinical decision making and studies evaluating causes, mechanisms and treatments for the two depressive sub-types, as well as assist clarification as to whether melancholia is categorically or dimensionally distinct from non-melancholic depression.
Topics: Depressive Disorder; Humans; Outcome Assessment, Health Care; Self Report
PubMed: 33401125
DOI: 10.1016/j.jad.2020.12.112 -
Molecular Psychiatry Aug 2019Maternal mental illness can have a devastating effect during the perinatal period, and has a profound impact on the care that the baby receives and on the relationships... (Review)
Review
Maternal mental illness can have a devastating effect during the perinatal period, and has a profound impact on the care that the baby receives and on the relationships that the baby forms. This review summarises clinical evidence showing the effects of perinatal depression on offspring physical and behavioural development, and on the transmission of psychopathology between generations. We then evaluate a number of factors which influence this relationship, such as genetic factors, the use of psychotropic medications during pregnancy, the timing within the perinatal period, the sex of the foetus, and exposure to maltreatment in childhood. Finally, we examine recent findings regarding the molecular mechanisms underpinning these clinical observations, and identify relevant epigenetic and biomarker changes in the glucocorticoid, oxytocin, oestrogen and immune systems, as key biological mediators of these clinical findings. By understanding these molecular mechanisms in more detail, we will be able to improve outcomes for both mothers and their offspring for generations.
Topics: Child; Child Abuse; Depression; Depressive Disorder; Family; Female; Humans; Infant; Male; Mental Disorders; Mothers; Pregnancy; Prenatal Exposure Delayed Effects
PubMed: 30283036
DOI: 10.1038/s41380-018-0265-4 -
Ugeskrift For Laeger Apr 2022This narrative review addresses the challenges of how to identify and treat bipolar depression. Bipolar depression, i.e. depressive episode(s) as part of bipolar... (Review)
Review
This narrative review addresses the challenges of how to identify and treat bipolar depression. Bipolar depression, i.e. depressive episode(s) as part of bipolar disorder, can be differentiated from unipolar depression only through the previous course of illness. A correct diagnosis therefore may be delayed. The pharmacotherapy of bipolar depression differs from that of unipolar depression due to a high risk of recurrence of either hypomanic/manic or depressive episodes or mood instability. Therefore, long periods of specialized treatment will often be required. Both bipolar and unipolar depression will often benefit from adjunctive social and psychological interventions.
Topics: Bipolar Disorder; Depressive Disorder; Diagnostic and Statistical Manual of Mental Disorders; Humans
PubMed: 35410656
DOI: No ID Found -
Psychopharmacology Bulletin Aug 2023The first monoamine oxidase inhibitors (MAOIs) used for the treatment of depression in the 1950-60s were credited with treating severe melancholic depression (MeD)... (Review)
Review
The first monoamine oxidase inhibitors (MAOIs) used for the treatment of depression in the 1950-60s were credited with treating severe melancholic depression (MeD) successfully and greatly reducing the need for electroconvulsive therapy (ECT). Following the hiatus caused by the then ill-understood cheese reaction, MAOI use was relegated to atypical and treatment-resistant depressions only, based on data from insufficiently probing research studies suggesting their comparatively lesser effectiveness in MeD. The siren attraction of new 'better' drugs with different mechanisms amplified this trend. Following a re-evaluation of the data, we suggest that MAOIs are effective in MeD. Additionally, the broad unitary conceptualisation of major depressive disorder (MDD) in the DSM model diminished the chance of demonstrating distinctive responses to different antidepressant drugs (ADs) such as SSRIs, TCAs, and MAOIs, thereby further reducing the interest in MAOIs. More reliable categorical distinction of MeD, disentangling it from MDD, may be possible if more sensitive measuring instruments (CORE, SMPI) are used. We suggest these issues will benefit from re-appraisement via an inductive reasoning process within a binary (rather than a unitary) model for defining the different depressive disorders, allowing for the use of more reliable diagnostic criteria for MeD in particular. We conclude that MAOIs remain essential for, , TCA-resistant MeD, and should typically be used prior to ECT; additionally, they have a role in maintaining remission in cases treated with ECT (and ketamine/esketamine). We suggest that MAOIs should be utilized earlier in treatment algorithms and with greater regularity than is presently the case.
Topics: Humans; Monoamine Oxidase Inhibitors; Depressive Disorder, Major; Depression; Depressive Disorder, Treatment-Resistant; Electroconvulsive Therapy
PubMed: 37601082
DOI: No ID Found -
International Review of Psychiatry... 2020Dysthymia is a psychopathological construct historically described and often reconsidered through the centuries. Its first description is dated back to 400 b.C., when... (Review)
Review
Dysthymia is a psychopathological construct historically described and often reconsidered through the centuries. Its first description is dated back to 400 b.C., when Hippocrates proposed his theory about the 'black bile' and the melancholic temperament. The concept of dysthymia (-, 'ill', -, 'emotions') has been largely elaborated in the XIX and XX centuries by Burton, Cullen, Schneider, Kretschmer, Akiskal and other authors, and recently re-formulated in the various editions of the modern Diagnostic and Statistical Manual of Mental Disorders under different diagnostic labels: neurotic depression, dysthymic disorder, persistent depressive disorder. Beyond the nosology, dysthymia issues some other challenges, including the need for further research to characterise the peculiar pathophysiological framework of this syndrome (compared with major depressive disorder) and to better define evidences about tailored-treatment options and their effectiveness.
Topics: Depression; Depressive Disorder, Major; Depressive Disorder, Treatment-Resistant; Diagnostic and Statistical Manual of Mental Disorders; Dysthymic Disorder; Humans
PubMed: 32436408
DOI: 10.1080/09540261.2020.1765517 -
Drug Discovery Today Sep 2023Current treatments modalities for major depressive disorder (MDD) mainly target the monoaminergic neurotransmission. However, the therapeutic inadequacy and adverse... (Review)
Review
Current treatments modalities for major depressive disorder (MDD) mainly target the monoaminergic neurotransmission. However, the therapeutic inadequacy and adverse effects confine the use of these conventional antidepressants to a limited subset of MDD patients. The classical antidepressants are increasingly proving unsatisfactory in tackling the treatment-resistant depression (TRD). Hence, the focus of treatment is shifting to alternative pathogenic pathways involved in depression. Preclinical and clinical evidences accumulated across the last decades have unequivocally affirmed the causative role of immuno-inflammatory pathways in the progression of depression. There is an upsurge in the clinical evaluations of the drugs having anti-inflammatory effects as antidepressants. This review highlights the molecular mechanisms connecting the inflammatory pathways to the MDD and current clinical status of inflammation modulating drugs in the treatment of MDD.
Topics: Humans; Depressive Disorder, Major; Antidepressive Agents; Depressive Disorder, Treatment-Resistant; Inflammation
PubMed: 37422168
DOI: 10.1016/j.drudis.2023.103697 -
Zhurnal Nevrologii I Psikhiatrii Imeni... 2021To compare socio-demographic and clinical characteristics in men and women with depression.
OBJECTIVE
To compare socio-demographic and clinical characteristics in men and women with depression.
MATERIAL AND METHODS
We studied 388 patients with unipolar depression, 74 men and 314 women. The survey was carried out using the clinical-psychopathological method and psychometric scales for depression.
RESULTS AND CONCLUSION
Gender differences are identified for several parameters. Women are older, more often had comorbid somatic and organic disorders; men have personality disorders and chronic depression. The severity of depression in women was higher due to symptoms such as reported sadness, anxiety, reduced sleep and appetite, concentration difficulties, and suicidal thoughts. Apparent sadness did not significantly differ in men and women. Anhedonia was more pronounced in men.
Topics: Anhedonia; Anxiety; Anxiety Disorders; Depression; Depressive Disorder; Female; Humans; Male
PubMed: 34481430
DOI: 10.17116/jnevro202112108113 -
Journal of Affective Disorders Apr 2020The concept of melancholia has been associated with psychiatric nosology for centuries. Nevertheless, its definition, relationship to the contemporary concept of Major...
BACKGROUND
The concept of melancholia has been associated with psychiatric nosology for centuries. Nevertheless, its definition, relationship to the contemporary concept of Major Depressive Disorder, and clinical implications remain uncertain.
METHODS
In a total sample of 3211 closely evaluated patient-subjects diagnosed with DSM-5 Major Depressive or Bipolar Disorder and meeting DSM-5 criteria for major depression with melancholic features or not at a European mood disorder center, we matched 1833 for depression severity (baseline HDRS score ≥18) and compared rates and ratings of characteristics of interest between the subgroups, using bivariate and multivariate methods.
RESULTS
Observed prevalence of melancholic features was 35.2% in the 1833 subjects matched for severity, and 21.0% among all 3211 subjects. Diagnosis was highly dependent on depression-severity measured three ways. Very few clinical characteristics differed between melancholic and nonmelancholic subjects matched for illness-severity; more suicidal ideation with melancholic features was a notable exception.
CONCLUSIONS
Study findings leave the distinction of melancholic features from depression-severity unclear and the potential clinical value of diagnosing melancholic features uncertain.
Topics: Bipolar Disorder; Depression; Depressive Disorder, Major; Diagnostic and Statistical Manual of Mental Disorders; Humans; Severity of Illness Index
PubMed: 32217259
DOI: 10.1016/j.jad.2020.01.139 -
European Archives of Psychiatry and... Apr 2021
Topics: Antidepressive Agents; Depressive Disorder, Major; Humans; Ketamine; Precision Medicine
PubMed: 33666694
DOI: 10.1007/s00406-021-01249-9