Maternal postpartum depression is known to negatively affect parenting and the mother-child relationship. When compared with non-depressed mothers, depressed ones have more often negative perceptions about their child's characteristics. This cognitive distortion can be a mechanism that mediates mother-child relationship disorders. Postpartum depression in fathers and its effects on parenting are understudied and rarely recognised as relevant in clinical practice.

Aims: Our purpose with this work is to examine the association between paternal depression and the father's perceptions about his infant, namely the infant's temperament and the difficulty in dealing with the usual daily problems posed by the new baby.

50 families were recruited in primary care consultations. Data were collected at time points ranging from 3 months to 24 months postpartum. Paternal and maternal depression were measured using the Edinburgh Postnatal Depression Scale. The father's perceptions about the infant were measured using the Infant Characteristics Questionnaire and the Daily Hassles Scale.

The study is still ongoing.

Using a cross sectional study design 1366/1401 women in their 3rd trimester of pregnancy were screened for depression using the Self-Rating Questionnaire (SRQ) and the Edinburgh Postnatal Depression Scale (EPDS). These instruments are validated, available in Urdu and have been used in the pre and postnatal period in Pakistan. The life events checklist was used to measure social stress and the Brief Disability Questionnaire (BDQ) for disability.

342 women scored ≥ 12 on the EPDS giving an estimated AND prevalence of 25.6 %. The EPDS and SRQ scores showed a high positive correlation. A significantly higher percentage of depressed women experienced problems in marital relations, work, finances, housing and domestic violence. Depressed women had higher disability scores. 32% of the depressed and 14% of non depressed were unable to perform usual daily activities. 35% of depressed women stayed in bed due to illness as compared to only 16 % of non-depressed.

This study confirms a high prevalence of AND in less educated women, experiencing a large number of social difficulties.

One thousand and fourteen patients were recruited from a busy orthopaedic outpatient clinic at a general hospital in Karachi (90.5% response rate). Research assistants administered the Self Rating Questionnaire (SRQ) to measure psychological distress, the Oslo social support questionnaire, and the Brief Disability Questionnaire (BDQ). The surgeons documented the diagnosis and, if appropriate, rated symptoms as medically unexplained.

An SRQ score of 9 or more, which indicates probable depressive disorder, occurred in 45.6% of men & 76.1% of women. A high SRQ score was associated with female sex, divorced, separated or widowed status, little or no education, low income and little social support. Even after these were controlled for there was a significantly higher SRQ score in patients with arthritis, backache/prolapsed intervertebral disc, major fracture and other bone pathology. Overall there was no difference in SRQ score between patients with medically explained (by trauma or organic disease) or unexplained symptoms.

Depressive disorder appears to be very common in orthopaedic out patients in this low income country and both social circumstances and nature of bone pathology are associated with such depression. Treatment should address this extreme psychological distress.

The recognition of later late-onset (LLO) major depression (MD) is a matter of concern.

Cross-sectional study assessed MD with the MINI structured interview and the MADRS in a referred sample of 13 377 non-demented adult out-patients visiting their physicians. Among 6850 patients with a first episode of MD, 370 LLO (75 years of age and older) MD were compared with 814 late-onset (LO) (60-74 years old) MD and 5666 early-onset (EO) (18-59 years old) MD.

There are many similarities between the symptom patterns of EO, LO and LLO MDs. However, the symptom pattern of LLO MD includes more retardation/agitation, lassitude, reduced appetite and apparent sadness, and less sleep disturbances, guilt feelings, pessimism and inner tension than LO and EO MD.

The differences in symptom profiles are very modest and between-group differences may not be meaningful on an individual level.

Depression is the most frequent psychiatric disorder encountered in patients with Multiple Sclerosis (MS), with a life-time prevalence of approximately 50%. INF-beta (INF-β) shows beneficial effect on the course of MS. Although it has been suggested that interferons may be associated to depression, the validity and the nature of this relationship remain unclear regarding INF-β. The objective of this study is to review the scientific literature in order to elucidate the relationship between depression and INF-β therapy.

This systematic review was based on Medline, Embase and, PsycLIT literature searches (through January 2005), supplemented by bibliographical citations in identified papers.

The majority of studies ruled out a correlation between INF-β1a/1b and depression in MS patients. However, patients with a recent history of depression may be at higher risk for depression particularly in the early phase of treatment (first 6 months), even if they are not depressed at the initiation of medication. There is an association between depressive symptoms and discontinuation of INF therapy but INF-β does not seem to be associated with suicide attempts. Treating patient-reported depression increases adherence to treatment.

Clinicians should not refrain from including patients with MS in INF-β treatment programs, even those with depression in the past or at the present time. Screening, monitoring, and early antidepressant treatment is necessary to optimize IFN therapy for the majority of patients with MS.

This prospective clinical study included 95 patients diagnosed by ICD-10 criteria for MDD, who are randomly divided into control (30 patients) and experimental group (65 patients). Patients were observed for 6 months in hospital and outpatients conditions, according to specially designed protocol, which included Hamilton Depression Rating Scale (HAMD) and Leeds Sleeping Evaluation Questionnaire (LSEQ). Control group was treated with maprotiline (75-150 mg/24h) and experimental group with escitalopram (10-20 mg/24h).

Escitalopram therapy influenced on HAMD score with high statistical significance vs. maprotiline, p=0.000. Escitalopram therapy improves LSEQ score after 6 months in comparison to maprotiline therapy with high statistical significance p=0.000. Percentage of adverse effects is significantly lower in escitalopram (10.76%) than in maprotiline (26.67%) group.

Escitalopram has significantly better efficacy and lower adverse effects rate in treatment of depressive symptoms and sleep disturbances in MDD patients comparing to maprotiline.

This longitudinal study examined anxiety (Child Manifest Anxiety Scale; CMAS) and depression (Moods and Feelings Questionnaire; MFQ) during the critical period when adolescents finish compulsory education and then embark upon their chosen course of study or employment.

Eighty-nine adolescents with SLI and 90 typically developing (TD) peers were assessed during their final year of compulsory schooling (16 years) and one year later.

At 16 years, there is a greater risk of both anxiety and depression in adolescents with SLI compared to their peers. Group scores for adolescents with SLI were significantly higher on both the CMAS (p< .001) and the MFQ (p< .01). However, while this finding is replicated at 17 years for anxiety symptoms (p< .01), there is a significant decrease in depressive symptoms for adolescents with SLI across time such that risk of depression is comparable to TD peers at 17 years. Scores for TD adolescents remain remarkably stable across this period. Poor mental health symptoms were not related to measures of nonverbal IQ, language, literacy or sociability but were associated with higher levels of shyness.

Notwithstanding a sustained, elevated risk of anxiety symptoms, there is an encouraging trend for a decrease in depressive symptoms as adolescents with SLI complete compulsory education. The findings are interpreted within a developmental psychopathology framework, focusing on the changing structure of intrapersonal and environmental processes that influence internalizing symptoms during mid-adolescence.

To evaluate quetiapine XR as adjunct to ongoing antidepressant therapy in patients with MDD showing inadequate response to antidepressant treatment.

Data were analysed from two 6-week, multicentre, double-blind, randomised, placebo-controlled studies (D1448C00006; D1448C00007), prospectively designed to be pooled. Outpatients received adjunctive quetiapine XR 150mg/day (n=309), 300mg/day (n=307), placebo (n=303). Primary endpoint: change at Week 6 in MADRS total score. Other assessments included: MADRS individual item scores, HAM-A total scores, MADRS response and remission; AE reporting.

Quetiapine XR 150mg/day and 300mg/day (p< 0.001) reduced MADRS total scores versus placebo at Week 6 (-14.5, -14.8, -12.0) and Week 1 (-7.8, -7.3, -5.1). Subgroup analyses showed the therapeutic effect of quetiapine XR was neither limited to nor driven by factors such as gender or antidepressant class (SSRI/SNRI). Quetiapine XR demonstrated consistent improvements in individual MADRS items: 150mg/day and 300mg/day significantly improved 4/10 and 7/10 items at Week 6 versus placebo. At Week 6, MADRS response (≥50% decrease in total score) was 53.7% (p=0.063), 58.3% (p< 0.01) versus 46.2%; MADRS remission (total score ≤8) was 35.6% (p< 0.01), 36.5% (p< 0.001) versus 24.1% for quetiapine XR 150mg/day and 300mg/day and placebo, respectively. Quetiapine XR 150mg/day and 300mg/day improved HAM-A total scores versus placebo at Week 1 (-4.8 [p< 0.001], -4.2 [p< 0.01], -3.0) and Week 6 (-8.9 [p< 0.01], -9.1 [p< 0.001], -7.3). AEs (≥10%) were dry mouth, somnolence, sedation, dizziness, fatigue, constipation and headache with quetiapine XR.

In patients with MDD and an inadequate response to antidepressant therapy adjunctive quetiapine XR is effective and generally well tolerated.

Our main purpose was to examine the clinical and socio-demographical influencing factors that play a significant role to medical co-morbidity occurrences in unipolar depressives.

We performed two types of clinical studies, one longitudinal retrospective study on 248 unipolar depressives admitted in our Clinic during 2001 - 2005 and second represented by a cross-sectional study on 45 inpatients and outpatients that had meet diagnostic criteria of unipolar depression according to ICD-10 and DSM-IV.

Socio-demographical factors that concurring to medical co-morbidity in unipolar depressives were represented by advanced current age and low educational level. Interestingly, the total duration of unipolar depression was not significant correlated with medical co-morbidity. A positive familial history of depression was correlated with a significant higher risk for coronary hearth diseases (depressives - average=0.443, S.D. =0.652; bipolars+delusionals - average=0.252, S.D.=0.499; t=2,665, p=0.008). Cluster C personality traits have had higher risk of cardiovasculare diseases (p=0.024). Inversely, in cross-sectional research those who met diagnostic criteria for cluster A and/or B personality disorders have had significant higher risk to develop medical co-morbidity. The higher level of co-existing anxiety, both as a trait as well as a state, was correlated with medical co-morbidity of unipolar depression. Surprisingly, in both type of studies, the severity of depression was not significant correlated with the extension of medical co-morbidity. Unipolar depressives were more prone to use dysfunctional copings as psychoactive substance use.

Both clinical and socio-demographical data profiles could give us some valuable informations in predicting medical co-morbidity in unipolar depressives.

Fatigue in patients with major depression is understudied, although highly prominent. The objective of this study was to investigate the independent correlation of various depressive symptoms with the severity of fatigue in major depression.

Eighty-one patients (70 female/11 male, 40 inpatients/41 outpatients), aged 23-65 years (mean 48.6±10.6), with a DSM-IV main diagnosis of Major Depressive Disorder (М.Ι.Ν.Ι. 5.0.0.) and currently in a Major Depressive Episode [17-item Hamilton Depression Rating Scale (HDRS) score ≥15], were studied. Patients with physical diseases or other fatigue-related conditions were excluded. The 14-item Fatigue Questionnaire (FQ) was used for the assessment of reported fatigue. Factor analysis of all HDRS items was performed. Pearson's correlations between the derived regression factor scores and the FQ score were calculated. Age, gender, and factor scores that significantly correlated with the FQ score entered a multiple regression analysis, with the FQ score as the dependent variable.

Factor analysis of HDRS items indicated a 6-factor structure (F1 ‘depressed mood’, F2 ‘middle/late insomnia and somatic anxiety’, F3 ‘anorexia/ weight loss’, F4 ‘general somatic symptoms’, F5 ‘anxiety/hypochondriasis’, F6 ‘early insomnia’). Only factors F1 (items 1,3,7,8), F2 (items 5,6,11) and F4 (items 13,14,17) were significantly correlated with the FQ score (p< 0.05). F1, F2 and F4 turned out to be significant predictors of FQ in the multiple regression, with standardised beta coefficients of 0.291, 0.290 and 0.278 (p< 0.05), respectively.

Depressed mood, somatic anxiety, middle and late insomnia correlate independently with the severity of fatigue reported by patients with major depression.