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Progress in Neuro-psychopharmacology &... Aug 2011In humans almost all physiological and behavioural functions occur on a rhythmic basis. Therefore the possibility that delays, advances or desynchronizations of... (Review)
Review
In humans almost all physiological and behavioural functions occur on a rhythmic basis. Therefore the possibility that delays, advances or desynchronizations of circadian rhythms may play a role in the pathophysiology of psychiatric disorders is an interesting field of research. In particular mood disorders such as seasonal affective disorder and major depression have been linked to circadian rhythms alterations. Furthermore, the antidepressant efficacy of both pharmacological and non-pharmacological strategies affecting endogenous circadian rhythms, such as new antidepressant medications, light-therapy and sleep deprivation, is consistent with the idea that circadian alterations may represent a core component of depression, at least in a subgroup of depressed patients. This paper briefly describes the molecular and genetic mechanisms regulating the endogenous clock system, and reviews the literature supporting the relationships between depression, antidepressant treatments and changes in circadian rhythms.
Topics: Antidepressive Agents; Circadian Rhythm; Depression; Depressive Disorder; Depressive Disorder, Major; Humans
PubMed: 20691746
DOI: 10.1016/j.pnpbp.2010.07.028 -
Minerva Medica Feb 2009While the most serious of depressive illnesses in the elderly is major depressive disorder, patients' quality of life can be significantly impacted by dysthmic disorder,...
While the most serious of depressive illnesses in the elderly is major depressive disorder, patients' quality of life can be significantly impacted by dysthmic disorder, sub-threshold depression (minor depression), or a depressive disorder due to a general medical condition, all of which have been shown to be more prevalent than major depression in the community dwelling population of older adults. Older adults are also more likely to develop grief reaction and frequently deal with issues of bereavement. This review will discuss the diagnoses of all relevant depressive diagnoses that primary care physicians are likely to encounter. Among the many different assessment tools that screen for depression the briefest instruments are a two-question screening tool recommended by the U.S. Preventive Services Task Force and, specifically developed for older adults, the Geriatric Depression Scale (GDS) that is available in a short 15- Yes/No-question version. Many medical illnesses are associated with depressive symptoms. The focus in this review is on dementing illnesses/cerebrovascular disease, dementia of the Alzheimer's type, and Parkinson disease. First-line pharmacological therapy of depression includes selective serotonin inhibitors (SSRIs), and serotonin-norepinephrine reuptake inhibitors (SNRIs). Side effects of particular drugs can often be geared towards achieving additional benefits, e.g. weight gain associated with the use of some SSRISs may be helpful for patients with dementia.
Topics: Aged; Depression; Depressive Disorder; Depressive Disorder, Major; Dysthymic Disorder; Geriatric Assessment; Grief; Humans; Surveys and Questionnaires
PubMed: 19277008
DOI: No ID Found -
Canadian Family Physician Medecin de... Jan 1994Depressed patients are often undiagnosed, misdiagnosed, or underdiagnosed. Is this because family physicians are trained mainly to treat somatic complaints? Are patients... (Review)
Review
Depressed patients are often undiagnosed, misdiagnosed, or underdiagnosed. Is this because family physicians are trained mainly to treat somatic complaints? Are patients reluctant to accept psychological causes for their physical symptoms? High volume of patients and short visits make it difficult for doctors to recognize depression. We propose strategies for identifying depressed patients in primary care.
Topics: Depression; Depressive Disorder; Family Practice; Humans; Primary Health Care
PubMed: 8312746
DOI: No ID Found -
Clinical Cornerstone 1999In recent years, clinicians and epidemiologists have examined the differences between depressed patients in primary care and psychiatric settings. Although evidence to... (Review)
Review
In recent years, clinicians and epidemiologists have examined the differences between depressed patients in primary care and psychiatric settings. Although evidence to support antidepressant efficacy is largely derived from studies of major depression, many patients in primary care settings fall into "nonmajor" depression diagnostic categories. In deciding when to initiate treatment, functional change may be even more important than discrete symptom profiles. Recognizing and treating depression as a comorbid condition in patients with other medical illnesses represents an additional challenge for the primary care physician. Variations in the clinical presentation of depression based on gender, age, culture, or personality must also be considered.
Topics: Adult; Age Factors; Anxiety; Child; Cost of Illness; Cultural Characteristics; Depression; Depressive Disorder; Diagnosis, Differential; Female; Humans; Male; Pregnancy; Primary Health Care; Severity of Illness Index; Sex Factors; Surveys and Questionnaires
PubMed: 10682174
DOI: 10.1016/s1098-3597(99)90021-2 -
Psychological Medicine Feb 2022Inflammation and metabolic dysregulation are age-related physiological changes and are associated with depressive disorder. We tried to identify subgroups of depressed...
BACKGROUND
Inflammation and metabolic dysregulation are age-related physiological changes and are associated with depressive disorder. We tried to identify subgroups of depressed older patients based on their metabolic-inflammatory profile and examined the course of depression for these subgroups.
METHODS
This clinical cohort study was conducted in a sample of 364 depressed older (⩾60 years) patients according to DSM-IV criteria. Severity of depressive symptoms was monitored every 6 months and a formal diagnostic interview repeated at 2-year follow-up. Latent class analyses based on baseline metabolic and inflammatory biomarkers were performed. Adjusted for confounders, we compared remission of depression at 2-year follow-up between the metabolic-inflammatory subgroups with logistic regression and the course of depression severity over 2-years by linear mixed models.
RESULTS
We identified a 'healthy' subgroup (n = 181, 49.7%) and five subgroups characterized by different profiles of metabolic-inflammatory dysregulation. Compared to the healthy subgroup, patients in the subgroup with mild 'metabolic and inflammatory dysregulation' (n = 137, 37.6%) had higher depressive symptom scores, a lower rate of improvement in the first year, and were less likely to be remitted after 2-years [OR 0.49 (95% CI 0.26-0.91)]. The four smaller subgroups characterized by a more specific immune-inflammatory dysregulation profile did not differ from the two main subgroups regarding the course of depression.
CONCLUSIONS
Nearly half of the patients with late-life depressions suffer from metabolic-inflammatory dysregulation, which is also associated with more severe depression and a worse prognosis. Future studies should examine whether these depressed older patients benefit from a metabolic-inflammatory targeted treatment.
Topics: Cohort Studies; Depression; Depressive Disorder; Diagnostic and Statistical Manual of Mental Disorders; Humans; Prospective Studies
PubMed: 32618234
DOI: 10.1017/S0033291720002159 -
The American Journal of Medicine Dec 1994Depression is a common, but treatable, source of suffering, excess disability, and caregiver strain in late life. It is important to take a long-term view of the... (Review)
Review
Depression is a common, but treatable, source of suffering, excess disability, and caregiver strain in late life. It is important to take a long-term view of the treatment of late-life depression because of the high risk for relapse, recurrence, and chronic illness. Elderly patients with medical and neurological illness or bereavement-related depressions also merit greater attention. Recent data highlight several important caveats: (a) the role of medical and psychosocial factors in the course of major depression; (b) variability in etiology, clinical presentation, and treatment response; (c) need for additional studies of syndromal and subsyndromal depression in primary and long-term care facilities, particularly in patients > 75 years of age; and (d) importance of continuation and maintenance treatment to maintain quality of life and to lower the risk for chronic illness. Nortriptyline, desipramine, and the newer selective serotonin reuptake inhibitors (SSRIs), paroxetine and sertraline, are preferred pharmacotherapy for short-term and long-term treatment. The newer SSRIs should be further studied in controlled trials of elderly depressed patients, including those > 75 years and those with medical or neurological illness. Psychotherapy also appears to be of major importance in successful outcome but, as does pharmacotherapy, merits further controlled investigation in both short- and long-term clinical trials.
Topics: Age Factors; Aged; Antidepressive Agents; Depression; Depressive Disorder; Humans; Psychology; Psychotherapy
PubMed: 7992826
DOI: 10.1016/0002-9343(94)90362-x -
Clinical Advances in Hematology &... Jun 2009Head and neck cancer patients experience among the highest rates of major depressive disorder of all oncology patients with an incidence of 15-50%. Correct diagnosis is... (Review)
Review
Head and neck cancer patients experience among the highest rates of major depressive disorder of all oncology patients with an incidence of 15-50%. Correct diagnosis is critical to expeditious management. Oncologists are not always adept at making the diagnosis as medical and treatment side effects can mimic the signs and symptoms of depression. Treatment can be successful and typically involves medical, social, and psychologic interventions. Causes of depression, obtaining an accurate diagnosis, and treatment options are all discussed in this review.
Topics: Alcohol Drinking; Antidepressive Agents; Attitude to Death; Attitude to Health; Depression; Depressive Disorder; Female; Head and Neck Neoplasms; Humans; Interpersonal Relations; Male; Pain; Psychotherapy; Quality of Life; Risk; Smoking; Social Support; Suicide
PubMed: 19606075
DOI: No ID Found -
Neuroscience and Biobehavioral Reviews 2005It has recently been postulated that cytokines may cause depressive illness in man. This hypothesis is based on the following observations: 1. Treatment of patients with... (Review)
Review
It has recently been postulated that cytokines may cause depressive illness in man. This hypothesis is based on the following observations: 1. Treatment of patients with cytokines can produce symptoms of depression; 2. Activation of the immune system is observed in many depressed patients; 3. Depression occurs more frequently in those with medical disorders associated with immune dysfunction; 4. Activation of the immune system, and administration of endotoxin (LPS) or interleukin-1 (IL-1) to animals induces sickness behavior, which resembles depression, and chronic treatment with antidepressants has been shown to inhibit sickness behavior induced by LPS; 5. Several cytokines can activate the hypothalamo-pituitary-adrenocortical axis (HPAA), which is commonly activated in depressed patients; 6. Some cytokines activates cerebral noradrenergic systems, also commonly observed in depressed patients; 7. Some cytokines activate brain serotonergic systems, which have been implicated in major depressive illness and its treatment. The evidence for each of these tenets is reviewed and evaluated along with the effects of cytokines in classical animal tests of depression. Although certain sickness behaviors resemble the symptoms of depression, they are not identical and each has distinct features. Thus the value of sickness behavior as an animal model of major depressive disorder is limited, so that care should be taken in extrapolating results from the model to the human disorder. Nevertheless, the model may provide insight into the etiology and the mechanisms underlying some symptoms of major depressive disorder. It is concluded that immune activation and cytokines may be involved in depressive symptoms in some patients. However, cytokines do not appear to be essential mediators of depressive illness.
Topics: Animals; Antidepressive Agents; Behavior, Animal; Brain Chemistry; Cytokines; Depression; Depressive Disorder; Disease Models, Animal; Humans; Immune System Diseases; Models, Immunological; Psychoneuroimmunology; Serotonin
PubMed: 15885777
DOI: 10.1016/j.neubiorev.2005.03.023 -
The British Journal of Psychiatry.... Dec 1994The separation of persistent depression into meaningful and useful subcategories, including major depression, dysthymia, recurrent brief depression, and depressive... (Review)
Review
The separation of persistent depression into meaningful and useful subcategories, including major depression, dysthymia, recurrent brief depression, and depressive personality disorder, is the subject of much debate. Depressions can be grouped on the basis of their type and severity of symptoms, aetiology, clinical course, or their association with other psychiatric illnesses. Several investigators have conducted epidemiologic and family studies to evaluate the prevalence of depressive disorders, their diagnostic stability over time, and the amount of overlap among the disorders. Although progress has been made toward a better understanding of the different disorders, insufficient evidence exists to support the hypothesis that these disorders are separate and distinct from one another. However, preliminary data suggest that depressive personality disorder is separate from the other disorders. Additionally, several questions have been raised, particularly the extent to which differentiation between the depressive disorders, specifically major depression and dysthymia, has an impact on treatment decisions.
Topics: Adolescent; Adult; Aged; Depression; Depressive Disorder; Family Health; Humans; Manuals as Topic; Middle Aged; Personality Disorders; Prevalence; Switzerland; United States
PubMed: 7873134
DOI: No ID Found -
Psychological Bulletin Sep 1993Research on depressive phenomena during adolescence has focused on 3 separate constructs: depressed mood, depressive syndromes, and depressive disorders. Approaches to... (Review)
Review
Research on depressive phenomena during adolescence has focused on 3 separate constructs: depressed mood, depressive syndromes, and depressive disorders. Approaches to the assessment, taxonomy, and diagnosis of these 3 conceptualizations are reviewed. Each of the approaches is represented by different assessment tools measuring related but distinct aspects of depressive phenomena. The constructs share a common set of symptoms reflecting negative affectivity but differ in their inclusion of symptoms of anxiety, somatic problems, and disrupted concentration and in the duration and severity of the symptoms they include. Depressed mood, syndromes, and disorders are integrated as 3 levels of depressive phenomena in a hierarchical and sequential model, and moderating factors are hypothesized to account for the relationships among the 3 levels. The need for a stronger developmental focus to understand depressive phenomena during adolescence is emphasized.
Topics: Adolescent; Anxiety Disorders; Depression; Depressive Disorder; Female; Humans; Male; Personality Inventory; Syndrome
PubMed: 8416035
DOI: 10.1037/0033-2909.114.2.323