Depression as a disease of modern times is constantly growing and it is regarded as a global, medical, individual and economic problem. Special importance have major depressive episodes (first or recurrent) with resistance to pharmacotherapy with antidepressants.

Main goal of this paper is to demonstrate the realibility of using the antidepressant with dual mechanism of action (bupropion).

Case study of elderly female patient of CMHC Prijedor with recurrent major depressive episode from author's practice and using data from a patient's file, with follow up period of 28 weeks after the first visit at CMHC Prijedor.

After resistance on first-line pharmacotherapy (SSRI antidepressant) we achieved a positive development and progressive improvement of patient's condition with better involvement to other parts of the therapeutic process (psycho- and socio-therapy) after 4 weeks of use of bupropion in a single daily dose of 150 mg [1][2].

Bupropion is a drug of choice for the treatment of major depressive episode, especially for inhibited depression, and in a single daily dose of 150 mg is antidepressant of choice for the elderly with depression [3].

Stress and depression are among the most common complaints in primary healthcare settings.

To investigate stress and depression levels in chronic patients of a rural area.

118 chronic patients (53 males and 65 females, mean age 61 ± 4 years) that used primary healthcare services during the first three months of this study were interviewed. the Personal Disturbance Scale (DSSI/sAD), the Zung self-rating scale, and a structured demographic questionnaire were the tools used by the researchers. Statistical analysis was done with the SPSS 18.0 software.

The majority of our sample were living permanently in the area, 52% were married, and 73% had completed primary education. 76% complained of hypertension, 51% had dyslipidemia, and 28% suffered from stress and anxiety disorders under treatment. 61% had sleep problems, and 40% reported they had an undefined sense of unhappiness. Sexual dysfunction, eating disorders and pessimism about the future showed the worst Zung total scores. the analysis showed that coronary disease, hypertension and dyslipidemia seem to be independent prognostic factors for depression and anxiety disorders even after excluding age (r = 0,307, p = 0,001).

Early detection and management of mental disorders, as well as the identification of contributing factors to these disorders, seem to be key targets of primary health care.

A questionnaire is presented that is based on a new psychobiological model of depression (Mitterauer, 2009). We hypothesize that a patient suffering from a depressive disorder loses the ability to produce one or more modes of behavior at a given point in time and simultaneously has the urge to produce one or more other modes of behavior constantly. in addition, the patient is unable to interpret his behavioral disorder.

The object of this study was to validate the new questionnaire “Salzburg Subjective Behavioral Analysis” (SSBA) for the purpose of screening major depressive disorder (MDD) among primary care patients.

Participants were 30 adult inpatients meeting DSM-IV criteria for MDD. the participants were asked to complete the SSBA questionnaire together with the Hamilton Rating Scale for Depression (HAM-D17), the Beck Depression Inventory (BDI) and the State-Trait Anger Expression Inventory (STAXI). Furthermore the Clinical Global Impression (CGI) and the Global Assessment of Functioning (GAF) was assessed. the control group consisted of 32 students who did not meet criteria for MDD.

The discriminant function of the SSBA enables with a high probability the attribution of a person either to the MDD-group or to the symptomless group. It can also be shown that the SSBA significantly correlates with depression relevant criteria of other standard instruments for theassessment of depression.

The SSBA seem valid for detecting MDD among primary care patients.

This paper argues that “gifted” persons who suffer from depressive crises, should not be offered traditional therapeutic methods only. These methods may not be effective for these persons in the long run. Instead, these individuals should be provided with a treatment based on the Theory of Positive Disintegration (TPD), a theory of personality development devised by the Polish psychiatrist and psychologist Kazimierz Dabrowski (1902 – 1980). the TPD views neurotic depression not per se as an illness. Instead, it regards depressive symptoms as a necessary phase in which given socially/biologically determined mental structures disintegrate, so that a more conscious and autonomous personality structure can develop. in this context, “gifted” means that the respective person possesses

1. (1) An inner autonomous drive to develop one's own personality (called “third factor”) and

2. (2) Overexcitabilities (especially intellectual, imaginational and emotional).

To suggest an additional way to treat depressive crises in a subgroup of patients.

To propose how to identify persons who may profit from the TPD-approach.

The paper describes the TPD and therapeutic interventions which follow from the theory. in order to identify persons who may profit from the TPD-approach, application of a preliminary self-assessment questionnaire is suggested.

Using a questionnaire, depressive patients should be tested for overexcitabilities and the “third factor”. Patients displaying these characteristics should be offered therapeutic interventions based on the TPD. These include

1. (1) Assisting patients with reframing their neurotic symptoms as creative and developmental, and

2. (2) Providing “tools” for developmental autotherapy.

There is increasing recognition that pain often coexists with depression. the current survey was undertaken to ascertain patients’ and clinicians’ perceptions of pain as a physical symptom associated with depression.

Web-based surveys were undertaken for patients with depression, and for physicians treating patients with depression (psychiatrists, psychosomatic physicians, general internists).

848 patients aged 20–59 years entered the main survey, of whom 663 returned the completed survey (78.2%). of the respondents, 424 (64.0%) experienced at least one painful symptom, with almost three-quarters (72.1%) reporting that the pain affected mental symptoms and 68.6% indicating that it prevented recovery from depression itself. Among 337 patients who discussed their painful symptoms with their physician, 52.5% initiated the discussion.

456 physicians completed the physician survey. When asked about the influence of pain associated with depression, 61.7% of physicians indicated that they ask their patients about pain during a consultation, and 79.9% considered that painful symptoms might disturb the patients’ daily life and 52.8% felt that they would delay recovery from depression.

The survey provides further evidence of the association between depression and pain, highlighting the fact that pain is prevalent in this patient population. Increased patient and physician awareness of pain in association with depression and improved doctor-patient communication, enabling patients to discuss painful symptoms with their physicians, and vice-versa, should lead to better overall management and treatment strategies.

To identify correlation between personal characteristics and scale of Edinburgh postnatal depression.

In this cross-sectional study, 597 volunteer postnatal women, whom had been visited in 6 primary health clinics of Iran University of Medical Sciences in Tehran during fourth months after delivery, by consecutive sampling selected. After they filled in informed consent, were interviewed by valid and reliable questioner. (Year 2009) Questioner had two main parts of personal characteristics and self-reporting scale of Edinburgh postnatal depression (EPDS). All ethical points were considered.

Average of age was 27.01 ± 4.94 there were significant correlation between scores of Edinburgh postnatal depression scale and Planned pregnancy of women and their couples, the history of Intra Uterine Fetal Death, women's occupation and their couple's too, family economical status, women's' educational status and their couples' too, and smoking habits. Regarding to the cutoff point of EPDS for screening of depression, which 22.65 had it (313) there were significant correlation just between two characteristics of unplanned pregnancy and unwanted pregnancy by Spouse.

Since there were significantly associated between postpartum depression and spouse unwanted pregnancy, it is better to have more guiding and counseling for the high risk group during pregnancy and postpartum time. It is better to screen all women during postpartum period by Edinburgh postnatal depression scale in health centers for prevention of postpartum morbidity.

Depression is frequent in people with diabetes mellitus, particularly in those with microvascular complications, as diabetic nephropathy is.

To realise a two years prospective study in T2DM patients with diabetic nephropathy, in order to explore the impact of depression in them.

A prospective, observational study was realised at a hospital and two diagnostic centers in Tirana. 110 patients (55 males and 55 females) with T2DM, aged ≥ 20 years were enrolled in 2008. Exclusion criteria were personal and familial history for mental illness. for each patient were prescribed: gender, age, duration of diabetes, oldness of diabetic nephropathy, blood glucose level, HbA1c level, UAE level, education and nature of work. the evaluation of depression was done according to Hamilton Depression Scale, by psychiatrists.

83% of the studied cases with diabetic nephropathy resulted with a level of depression. 39% of them result with mild depression, 31% with moderate depression, 21% with severe depression and 9% with very severe depression.

Depression was strongly associated with age, male gender, HbA1c levels, UAE rate, duration of diabetic nephropathy, the presence of diabetic retinopathy and diabetic foot disease, education level and mental work. However, the likelihood of depression was not significant with duration of diabetes and insulin use.

This study showed high prevalence of depression in type 2 diabetic patients with diabetic nephropathy. So, the management of chronic complications of diabetes is important for the depression prevention in type 2 DM patients.

The degree to which depressive disorders, as the most frequent psychiatric comorbidity in epilepsy, influence the quality of life (QOL) of the patients is a research issue of interest in recent years.

Purpose of the study is to assess simultaneously the influence of some sociodemographic, seizure-related variables and comorbid depression in determining QOL of people with epilepsy (PWE).

The study included 126 patients aged 18–60 with a determined diagnosis of idiopathic epilepsy. Comorbid depressive disorder was diagnosed according to ICD-10 diagnostic criteria followed by an evaluation on Hamilton Depression Rating Scale (HAMD-17). QOL was assessed by the Quality of Life in Epilepsy Inventory - 31(QOLIE-31). Seizure severity was measured by Seizure Severity Questionnaire (SSQ). Univariate and multivariate regression analyses were performed to explore the association between possible prognostic variables (independent variables) and QOLIE-31 overall and subscale scores (dependent variables).

Following the univariate analysis gender, age, education and employment as sociodemographic factors and seizure severity, seizure frequency, duration of epilepsy and antiepileptic medication intake as seizure-related factors and comorbid depressive disorder were the variables strongly associated with QOLIE-31 scores. Multiple regressions examined the contribution of these independent variables to QOLIE-31 overall score and subscales’ scores. A three variable model accounted for 68.9% of the variance for QOLIE-31 overall score including seizure severity, comorbid depression and seizure frequency.

Clinical factors are the strongest predictors of QOL of PWE in our study. Seizure severity and comorbid depression are found to be the main variables affecting QOLIE-31 scores.

Major depressive disorder is a prevalent mental disorder. Although several interventions are effective, treatment response (TR) remains difficult to predict.

This study aimed a) to investigate whether cognitive functioning improved after treatment with escitalopram, b) to evaluate if baseline cognitive functioning predicted TR and c) to detect the biological processes underlying TR.

Thirty-seven patients and 32 healthy controls were included. Patients were treated with escitalopram flexible dose regime. Patients were assessed before treatment, 2 and 8 weeks after the start of escitalopram. Cognitive functioning was investigated using the STROOP colour word test, the verbal fluency test, future thinking task and the emotional STROOP test. Depressive symptoms were assessed using the BDI-II. Metabolism PET (18F-FDG) was performed at baseline and week 8.

All patients significantly differed from controls on cognitive (p < 0.01) and depressive (p < 0.001) measures at baseline, which further improved after treatment. in contrast to responders, significant differences were found between controls and non- responders before treatment on all cognitive measures. These differences disappeared after treatment except for the future-thinking task. in association, non-responders compared to responders showed a lower metabolism in the bilateral prefrontal cortex (p < 0.001), which normalized after treatment. Subcortical decrease in the frontal-striatal thalamic tract after treatment further differentiated responders from non-responder (p < 0.001).

Escitalopram improved depressive symptoms and cognitive functioning in depression. Poor treatment response of escitalopram may be associated with pre-treatment worse cognitive functioning and lower activity in the prefrontal cortex.

Extended-release formulations of antidepressants have been marketed as a strategy to increase patient adherence. Changes in the formulation of drugs, however, could be related to changes in efficacy and tolerability. Among second-generation antidepressants bupropion, fluoxetine, mirtazapine, paroxetine, and venlafaxine are available in immediate- and extended-release formulations.

To compare the efficacy, tolerability, and adherence of immediate- versus extended-release formulations of second-generation antidepressants for the treatment of major depressive disorder (MDD) in adults.

To provide an evidence base for clinicians when choosing immediate- or extended-release formulations for the treatment of MDD.

We conducted a comparative effectiveness review for the U.S. Agency for Healthcare Research and Quality searching PubMed, EMBASE, the Cochrane Library, PsycINFO, and International Pharmaceutical Abstracts up to January 2011. Two persons independently reviewed the literature, abstracted data, and rated the risk of bias.

Six RCTs and one retrospective cohort study provided evidence about the comparative efficacy, tolerability, and adherence of bupropion XL (extended release) versus bupropion SR (sustained release), fluoxetine daily versus fluoxetine weekly, paroxetine IR (immediate release) versus paroxetine CR (continuous release), and venlafaxine IR versus venlafaxine XR (extended release). Overall, no substantial differences in efficacy and safety could be detected. Open-label and observational evidence indicated better adherence for bupropion XL and fluoxetine weekly than for immediate-release medications. No differences in adherence could be detected between paroxetine IR and paroxetine CR.

Our findings indicate similar efficacy and tolerability between immediate- and extended-release formulations. Whether extended-release formulations lead to better adherence remains unclear.

To evaluate the comparative medium-term efficacy of dual antidepressants in patients with dysthymic disorder and major depressive disorder who also met criteria for alcohol dependence.

A group of 16 patients, mean age 43.2, diagnosed with dysthymic disorder and major depressive disorder, according to DSM IV TR criteria, were screened positive for alcohol dependence during the initial interview. Antidepressants used were dual agents- venlafaxine mean daily dose 225 mg (n = 7), milnacipran 100 mg (n = 5) and duloxetine 75.6 mg (n = 4). Other drugs were used in the treatment of alcohol related pathology, like naltrexone 50 mg/day and anxiolytics. Patients were monitored every 4 weeks for 6 months using Hamilton Depression Rating Scale (HAMD)-17 items, Clinical Global Impressions- Severity/Improvement (CGI-S/I), Global Assessment of Functioning (GAF), Inventory of Drug Taking Situations- alcohol focused version (IDTS).

Depressive symptoms responded well to all three antidepressants, with a slow trend in favor of venlafaxine (HAMD score −15.6 vs.−13.3 duloxetine and −12.2 milnacipran), but without statistical significance (p = 0.122). CGI-I showed also a significant improvement at endpoint (3.2 mean decrease, p < 0.01) for all three antidepressants. GAF increased accordingly, to a mean value of 82.3 at week 24, compared to baseline. the severity of alcohol dependence fluctuated, but mean values of IDTS at endpoint improved with 56.5% for venlafaxine, 52.2% for milnacipran and 50.1% for duloxetine. A number of 4 patients relapsed into alcohol abuse during the trial.

Serotonergic and dopaminergic reuptake inhibitors are useful in the treatment of double depression associated with alcohol dependence.

Major Depressive Disorder (MDD) with psychotic features is common and it is associated with worse symptoms and outcomes. But should it represent a severe MDD or should it constitute a different syndrome? One of the answers to that question may live in a long term follow up of these patients.

To assess the diagnostic consistency of MDD with psychotic features over 5 years.

The sample included 47 income patients from the Departamento de Psiquiatria e Saúde Mental do Centro Hospitalar Barreiro-Montijo, hospitalized between 1998 and 2006, to whom was diagnosed MDD with psychotic symptoms. there clinical processes were consulted and those with at least 5 years of follow up were assessed and the most updated diagnosis was registered applying DSM-IV.

31 of 47 participants had a diagnosis of MDD with psychotic symptoms with five years of evolution. about 74% (23), had a Mood Disorder (Recurrent MDD; MDD - Single episode; Bipolar Disorder) comparing to 19% (6) with a Psychotic Disorder (Schizophrenia and Schizoafective Disorder). from those with a Mood Disorder, Recurrent Depressive Disorder was the most frequent, with 32% (10), but it was close to those who switched to a Bipolar Disorder, about 26% (8). Only 2 patients still had the same diagnosis of MDD with psychotic symptoms - Single Episode, the same as those with dementia.

The diagnosis of MDD with psychotic features among inpatients demonstrated poor long term consistency and when it is based on a single assessment should be provisional.

In patients with MDD, empirical evidence supports the existence of moderate but significant neuropsychological deficits as compared to non-depressed controls. with respect to cognitive domains, impairment has been reported for executive functioning in particular, whereas less significant deficits have been found for psychomotor speed, attention and memory. Additionally, studies reported a substantial improvement in neuropsychological functioning during the course of an antidepressant treatment in patients with MDD. Nevertheless, the effect size of executive dysfunctions in unipolar, non-psychotic MDD as well as their relationship to antidepressant treatment is ambiguous.

Meta-analytic methods were used to assess the severity of executive dysfunctions in unipolar, non-psychotic MDD as compared to healthy controls and to investigate their course during antidepressant treatment.

15 studies comparing the executive functions of 375 patients with DSM-IV MDD and 481 healthy controls were analysed. Furthermore, in 3 studies including 122 MDD patients the Stroop test performance was examined before and after antidepressant treatment. MDD patients performed 0.439 up to 1.18 (p < 0.0001) standard mean differences worse than healthy controls. the Stroop performance improved during the course of treatment (p = 0.0001).

We revealed significant executive dysfunctions in unipolar, non-psychotic MDD patients compared to healthy controls and an improvement of the Stroop performance during the course of treatment. However, the results of our longitudinal analysis are not transferable to other components of executive functioning. Future studies with different test procedures are needed to further investigate the influence of antidepressant treatment on executive functions.

Narcolepsy is a rare sleep disorder characterized by excessive daytime sleepiness (EDS), cataplexy, sleep paralysis, hallucinations and disturbed nighttime sleep. Diagnosis is confirmed by polysomnography, MSLT and HLA DQ-B1 06*02 typing. Depressive symptoms are often associated. Neverthless, pseudo-narcolepsy is also reported in major depressive disorder (MDD).

We provide arguments to differentiate pseudo-narcolepsy associated to MDD and narcolepsy in young man with some complains of narcolepsy (EDS, muscular tonus inhibition, hallucinations) without amelioration by derived-amphetaminic treatment.

A better cognition of confounding symptoms in MDD and narcolepsy would help to better treatment.

A 26-year-old man was hospitalized during three successive night at Sleep Laboratory. Psychiatric interview, polysomnography, MSLT, 24 h-recording, HLA-typing, projective test (Rorschach), Hamilton Depressive Scale, familial history were performed. Patient was treated by venlafaxine and support therapy during 6 months and then, evaluated by the same psychiatrist.

During all nights, polysomnography showed altered REM latency, largely decreased sleep efficiency and deep sleep while awake and stage 1 durations were increased. MSLT and HLA-typing were typical of narcolepsy but daytime sleeping was shortened. Psychiatric interview and Hamilton scale confirmed MDD. Somatisation and post-traumatic depression elements were pointed by Rorschach evaluation. Familial history reported physical abuse during childhood. Each symptom disappeared after 6 months.

In the absence of a clear history of narcolepsy, MDD would be excluded by extensive complementary evaluation.

Relationship between depression and myocardial infarction (MI) is established. Depression post MI is frequent and it worsens the course of CAD causing higher mortality.

One of suggested mechanisms connecting depression and MI is disturbed function of hypothalamic-pituitary-adrenal axis (HPA).

To verify if depression influences cortisol levels in patients with depression after the MI.

Analyzing morning and afternoon levels of cortisol on the 3rd and 5th day after MI in three subgroups:

1. 1- Patients with major or minor depression recognized immediately after the MI;

2. 2- Patients who developed depression during six months observation;

3. 3- Patients without depression.

44 patients of Cardiology Department of Medical University in Gdansk were included. Patients were 30 to 65, had first MI with ST elevation, EF was at least 40%, had no significant somatic diseases.

The diagnosis of major depressive disorder (MDD) or minor depressive disorder (mdd) was set based on the DSM-IV-TR criteria at three time-points: on the 3rd day of the MI, after 3 and 6 months.

Obtained results confirm diurnal changes in cortisol levels in all three subgroups. in subgroups with depression differences are less evident compared to the subgroup without depression but with no statistical significance.

In subgroups with depression, on the 5th day after the MI, morning levels of cortisol were significantly higher. Interestingly morning levels of cortisol in those subgroups on the 3rd day after the MI were lower compared to patients without depression.

Presence of post MI depression probably influences functioning of HPA axis.

To study the relationship between insulin-like growth factor 1 receptor (IGF1R)and subsyndromal symptomatic depression (SSD).

In this case-control study, real-time quantitative reverse transcriptase polymerase chain reaction (RT-qPCR) with TaqMan MGB was used to analyzing the differences of IGF1R gene mRNA expression in peripheral leukocytes between subsyndromal symptomatic depression group(n = 47) and healthy controls(n = 52). At the same time Hamilton Depression Rating Scale -17(HAMD17) were assessed.

IGF1R gene mRNA expression was 0.21 ± 0.11 in SSD group, 0.56 ± 0.37 in healthy group, and there was significant difference between both groups on IGF1R expression(z = 39.54, P < 0.001). the expression levels of IGF1R in SSD patients was not correlated with Hamilton score(r = −0.292, p = 0.275).

This study suggested that the decreased expression of IGF1R were related with the pathophysiology of SSD.

Studies have convinced that the rodents' exposure to prenatal stress (PNS) may induce depression and anxiety to their offspring. We focused on the glutamatergic system to explore the mechanisms.

By examining EAAT2,EAAT3 (Excitatory Amino Acid Transporter 2,3), which are the only substances to inactivate glutamate in nervous system, we explored the effect of PNS on glutamatergic system.

Pregnant rats were assigned to Control group (CON), Middle period of PNS group (MPS) and Late period of PNS group (LPS). MPS and LPS rats were exposed to restraint stress on days 7–13, 14–20 of pregnancy three times daily for 45 min. EAAT2 and EAAT3 mRNA expression in the hippocampus, frontal cortex, and striatum of one month rat offspring were checked by RT-PCR.

For the female offspring, EAAT2 mRNA expression of hippocampus in LPS and MPS was significantly lower compared to CON(P = 0.008,p = 0.003); EAAT2 and EAAT3 mRNA expression of frontal cortex in LPS were significantly lower than CON (p = 0.003,p = 0.013). for the male offspring, EAAT2 and EAAT3 mRNA expression of hippocampus in LPS and MPS were significantly lower (p = 0.005, p = 0.05); EAAT2 mRNA expression of frontal cortex was significantly lower in LPS (p = 0.022); EAAT2 mRNA in LPS group and MPS were significantly lower (p = 0.009, p = 0.014), and EAAT3 mRNA expression of striatum in MPS was significantly lower (p = 0.049).

Decreased EAAT2 and EAAT3 of PNS may explain the increase of glutamate in synaptic cleft and its downstream excitotoxicity. (Supported by National Natural Science Foundation of China, No: 30970952)