This pooled analysis evaluated efficacy of adjunct quetiapine XR (QTP-XR) in subgroups of patients with anxious depression and lower levels of anxiety.

Pooled data from two 6-week, double-blind, randomised, placebo-controlled trials (D1448C00006/D1448C00007) in patients with inadequate response to antidepressants were analysed. Patients received adjunct QTP-XR (150 or 300 mg/day) or placebo+antidepressant (SSRI or SNRI). Using criteria defined in the STAR*D study, analyses conducted in patients with anxious depression or lower baseline anxiety levels (HAM-D anxiety/somatic factor score >/ = 7 and < 7, respectively) included LSM change at Week 6 in: MADRS total (primary endpoint), HAM-A and CGI-S total scores.

For patients with anxious depression (n = 697; 76% patients), adjunct QTP-XR 150mg/day (-14.44, p < 0.01) and 300 mg/day (-15.09, p < 0.001) significantly improved MADRS total scores versus placebo+antidepressant (-11.78) at Week 6, with significant improvement demonstrated from Week 1 onwards. Significant improvements were seen in HAM-A (QTP-XR 150 mg/day: -9.05, p < 0.01; 300 mg/day -9.43, p < 0.01) and CGI-S total scores (QTP-XR 150 mg/day: -1.60, p< 0.001; 300 mg/day -1.63, p < 0.001) versus placebo+antidepressant (-7.40, -1.22, respectively) at Week 6.

A smaller subgroup (n = 222; 24% patients) had lower baseline anxiety levels. At Week 1, adjunct QTP-XR (150 mg/day -9.09; p < 0.01; 300 mg/day -8.60; p < 0.05) significantly improved MADRS total score versus placebo+antidepressant (-5.93). At Week 6 there were no significant changes (QTP-XR 150 mg/day -14.49; p = 0.243; 300 mg/day -14.01; p = 0.388) versus placebo+antidepressant (-12.78).

For patients with anxious depression, adjunct QTP-XR (150 and 300 mg/day) was effective at reducing symptoms of anxiety and depression, with symptom improvement observed from Week 1 onwards. AstraZeneca funded.

is a common side effect of IFN-alpha therapy. The current prospective study examines the effects of Interferon-alpha on the prevalence of depressive disorders, on cognitive functioning and on quality of life. Life Satisfaction before and the social support during the therapy were considered.

25 patients with chronic hepatitis C infection were investigated. One month and three months after the beginning of the treatment psychometric observer-rating and self-rating scales were administered to evaluate depressive symptoms (BDI; HAMD). The data on life satisfaction before therapy and health-related quality of life were obtained from the FLZ and the SF-36. Cognitive function was based on the SKT.

Three months after the initial Interferon-alpha administration in the whole sample significant impairments in health-related quality of life were found in the domains “physical functioning”, “role physical”, “role emotional”, “social functioning” and “vitality”. The whole sample showed cognitive impairements.

Three months after the first Interferon-alpha administration 48% (n = 12) suffered from moderate clinical depression.

Patients with Interferon-alpha induced clinical depression showed decreased life satisfaction before the initial antiviral therapy - especially in the domains “self-concept”, “employment” and “physical health&constitution”. Impairments in health-related quality of life (SF-36) were found in the clinical depressive sample in the domains “general health”, “social functioning”, “role emotional”,“vitality” and “mental health”.

Hepatitis C is associated with an increased prevalence of depression.

Interferon-alpha patients having low levels of life satisfaction in the domains “self concept”, “employment” and “physical health&constitution” seem to face a major risk of depression.

The data from previous studies suggested that folate serum level predicts outcome of treatment in patients who failed to respond to SSRI.

We examined the relationship of serum folate level and response to treatment with various antidepressant interventions (antidepressants, combinations of antidepressants and augmentations) in patients who had failed to respond to at least one previous antidepressant treatment.

Eighty-four inpatients (mean age = 46.2 ± 11.3 years, 69% woman) with major depression according to DSM IV and without gastrointestinal or other comorbidities that might influenced folate level were enrolled to the study. Clinical status was assessed using MADRS, CGI and BDI-SF at baseline and at the end of study (mean length of treatment- 5.2 ± 0.9 weeks) and response was defined as reduction of MADRS score≥50%. Folate serum levels were determined before start of treatment (normal level >2.5 ng/ml).

Low folate level was detected only in 3 patients (2 responders) in our sample. Responders (54%) and non-responders were not different in baseline folate level as well as in clinical a demographic parameters with exception of number of previous unsuccessful treatments of index episode. Furthermore we did not find any correlations between folate level and baseline or final MADRS score as well as reduction of MADRS respectively.

Despite encouraging data from previous studies, based on our data we did not suppose association of baseline serum folate level and outcome of treatment in resistant patients.

This study was supported by grants of Ministry of Health of Czech Republic NS 10368-3 and MZ0PCP2005.

Disrupted sleep is common in depression.

Investigate effects of adjunct extended release quetiapine fumarate (QTP-XR) on sleep disturbance and quality in patients with MDD and inadequate response to antidepressant (AD) therapy.

Data were pooled from two (D1448C00006/D1448C00007) 6-week, double-blind, randomised, placebo (placebo+AD)-controlled studies of adjunct QTP-XR (15 0 mg/day and 300 mg/day). Primary endpoint: MADRS total score change versus placebo+AD. Secondary endpoints (post hoc): change from randomisation in MADRS item 4 (reduced sleep), HAM-D items 4, 5 and 6 (early-, middle- and late-insomnia), sleep disturbance factor (HAM-D items 4+5+6) and sleep quality (PSQI global score). MADRS total score change in patients with baseline HAM-D sleep disturbance factor score > = 4 or < 4 (high and low sleep disturbance, respectively) was evaluated.

919 patients received adjunct QTP-XR: 150 mg/day (n = 309), 300 mg/day (n = 307), placebo+AD (n = 303). At Week 6, adjunct QTP-XR (both doses) reduced MADRS item 4, HAM-D sleep disturbance factor, HAM-D items 4, 5 and 6 and PSQI global scores from baseline versus placebo+AD (p < 0.001). In patients with baseline HAM-D>=4 (n = 226, 215 and 210, respectively) adjunct QTP-XR (both doses) improved (p< 0.01) MADRS total score versus placebo+AD from Week 1 onward. In patients with baseline HAM-D< 4 (n = 83, 92, 93, respectively) adjunct QTP-XR (both doses) improved (not statistically significantly) MADRS total score versus placebo+AD at Week 6.

Adjunct QTP-XR significantly restored sleep and improved sleep quality in patients with MDD and inadequate response to AD. Significant improvement in depressive symptoms was demonstrated with adjunct QTP-XR in patients with MDD and high baseline sleep disturbance. AstraZeneca funded.

The validity of the Seasonal Pattern Assessment Questionnaire (SPAQ) in diagnosing Seasonal Affective Disorder is questionable. In 2004 the Seasonal Health Questionnaire (SHQ) was proposed as a more appropriate screening instrument for depression with a seasonal pattern.

To compare the performance of the SPAQ, the most commonly used tool for assigning a diagnosis of SAD, with the SHQ, which uses the DSM-IV criteria for recurrent depression with seasonal pattern.

Two samples of approximately 200 medical students in Tromsø, Norway (69° north) and Ferrara, Italy (44° north), filled in both questionnaires. Prevalence of recurrent depression with seasonal pattern was calculated according to gender and latitude of living, with both instruments. Using SHQ diagnosis as the gold standard, sensitivity and specificity of the SPAQ as a diagnostic instrument was ascertained.

The prevalence of depression with seasonal pattern measured by SPAQ was 12% in Norway and 14.5% in Italy, the difference was not significant. Prevalence was highest in females in both countries (Norway: males 4.2%, females 14.7%, Italy: males 2.3%, females 18.8%), but the difference was only significant in Italy (p = 0.007). According to SHQ, the corresponding figures in Norway 5.9% and 7.1% (p = 0.77) and in Italy 3.9% and 3% (p = 0.75). The specificity of the SPAQ was 88.8% and the sensitivity was 47.3%.

Compared to a DSM-IV diagnosis of depression with seasonal pattern as measured by the SHQ, the SPAQ seriously overestimates the prevalence of seasonal depression, especially in women, and the sensitivity is far too low.

The aim of this preliminary study is to assess, in a sample of patients with Coronary Heart Disease (CHD), the specific association between depressive symptoms and systemic inflammation.

Sixty-One inpatients with CHD, 31 Unstable Angina and 28 Myocardial Infarction, participated in the study. The plasma levels of C Reactive Protein were measured using Dade Behring’s High Sensitivity CRP assay (hs-CRP) at T0, T30 and T90.

At the same timings, they were tested by an examiner, unaware of their diagnosis, with a psychometric battery (SCL90-R, HDRS, MADRS, BDI, QlesQ).

The elevation of hs-CRP occurs during the whole observation period, with maximum significance at T90 (p = 0,031).

A multivariate analysis at T0 indicates a statistical correlation between SCL90-R scores and hs-CRP levels (p = 0.02).

The SCL90-R is also associated with the risk of further cardiac events (p = 0.013).

Also the BDI could be useful as a prognostic factor (p = 0.026).

We found a trend towards correlation between CRP values and depressive symptoms, but it never reaches statistical significance for the other scales.

The feelings of loss and the fear of death, related to the environmental and emotional situation of the hospitalization, may prevail in the acute phase of CHDs.

Some patients may overcome this reactive depression, while others may exhibit a biological depression, related to the high level of CRP and thus to an increased risk of re-infarction and other coronary events.

1. (I) Profound alterations of the hypothalamic-pituitary-adrenocortical (HPA) axis regulation were repeatedly shown in depressed patients. The most sensitive challenge test of the HPA axis, the combined dexamethasone/CRH test (DEX/CRH test), shows an overstimulation of ACTH and cortisol in depressed patients. Under tricyclic antidepressant treatment, a normalization of the HPA axis overdrive was found to precede the clinical improvement.

2. (II) Lithium is a well established drug for the treatment of affective disorders. Yet, its exact mode of action and its effects on the HPA axis are still unknown.

Three 4-week studies with each 30 acutely depressed patients (unipolar, SCID I confirmed) were conducted. In study 1, patients refractory to a treatment trial with an antidepressant of at least four weeks were treated with lithium augmentation. In study 2 and 3, drug free patients were treated with lithium monotherapy or citalopram monotherapy respectively. Weekly HAM-D ratings were performed. In each study, the DEX/CRH test was conducted right before and four weeks after initiation of the pharmacotherapy.

All three pharmacological strategies showed good antidepressive efficacy. Both lithium monotherapy and lithium augmentation led to a (for most parameters significant) increase in the HPA axis activity. In contrast, citalopram monotherapy resulted in a decrease of the hormone response to the DEX/CRH test.

Whilst it is important that we treat patients with depression in primary care if possible there are many patients with depression who will need the more expert support provided in secondary care.

An Anonymised Database held by the Bedford East Community Mental Health Team was studied to assess what factors were related to the use of Augmentation Strategies to treat resistant depression.

Of the total 282 patients 109 (38.7%) were on augmentation therapy. In the F32 and F33 group just over a third of the patients (35.8% and 37.1%) were on augmentation therapy and in the F41.2 group over a half of patients (56.7%) were on augmentation therapy.

There does seem to be a relationship between the number of risk factors a patient has and the likelihood that they are on augmentation. Particularly strong factors are another psychiatric diagnosis and ‘other suicide risk factors’.

Generally the patients coming to secondary care with more of the specified risk factors are more likely to need augmentation.

High, normal or low plasma magnesium (Mg) levels have been observed in depressed patients. The aim of our study was to investigate the relationship of plasma Mg levels with depression severity, specific psychopathological dimensions and treatment outcome.

123 outpatients (M/F 60/63; mean age = 48 ± 15) during a Major Depressive Episode (MDE) were recruited. Most of them were affected by “difficult to treat” depression, that includes patients with history of at least two MDE, risk of chronicization and who did not achieve remission in previous treatments.

The psychopathological status was assessed using HAM-D, HAM-A, DRRS for psychomotor retardation and SHAPS for anhedonia. HAM-D was repeated at 3 months. A blood sample was collected to determine total plasma Mg levels.

We observed an association between Mg levels and psychomotor retardation scores (p = 0.045). Moreover, subjects with residual symptoms after treatment (HAM-D at 3 months > 15) have lower starting Mg values compared to treatment-responsive individuals (2.14 ± 0.2 vs. 2.25 ± 0.21, p = 0,039).

Conflicting data on plasma Mg levels in depression could be due to the isolation of brain Mg compartments from blood Mg compartments. As in a previous study, the association between high Mg levels and psychomotor retardation found in this larger sample strengthens the notion that high Mg levels play a part in the hypoactivity so often observed in depressed patients. Also, low Mg values in patients with poor treatment outcome suggest Mg could have a therapeutic potential in “difficult-to-treat” patients.

High-sensitive C-reactive protein (hs-CRP) has been used to assess low-grade immune system activation. In a population-based cohort hs-CRP was associated with functional somatic symptoms (SS), particularly with general and musculoskeletal functional SS clusters.

Immune system dysregulation has also been reported in depression that is frequently associated to a high burden of SS.

We investigated the correlation between hs-PCR and SS in depressed patients.

123 outpatients (M/F = 58/65; mean age 48,6 ± 14,8) during a Major Depressive Episode were recruited at the Institute of Psychiatry of the Catholic University in Rome. Severity of depression was assessed with the HAM-D scale. The somatization factor of the HAM-D (somatic anxiety, gastrointestinal symptoms, general somatic symptoms, hypochondria, weight loss) measured SS burden. A blood sample was collected to determine hs-CRP.

Hs-CRP and depression severity were not correlated, while hs-CRP and SS were (r = -0,27; p = 0,001). Patients with higher (> 3) somatizazion factor had significantly lower hs-PCR values compared to patients with lower (≤3) somatization factor (2,47 mg/L ± 4.77 vs. 3.20 mg/L ± 4.44; p = 0,026).

In contrast with the hypothesized cytokine involvement in somatic features of sickness behavior, higher somatic burden correlates with lower immune activation.

The role of sickness behavior in experiencing SS and hs-CRP's use as valid indicator of cytokine production remain uncertain. Further studies are necessary, also to explore the relationship between HPA axis dysregulation and immune activation, possibly relevant to the interpretation of our results.

Due to the high prevalence of depressive symptoms in PC (Ayuso, 2001) is relevant to know the impact of the psychoeducation in the management of these symptoms to decrease the prevalence in the PC population.

To compare the effectiveness of a psychoeducational group intervention in patients with mild/moderate depression in PC.

242 participants older than 20 years with ICD-10 mild/moderate depression were recruited through nurse/general practice in 12 urban primary health care centers in Barcelona city. Randomization was realised by means of a computer program. Exclusion criteria: severe mental disorder, major depressive disorder, use of secondary mental health services and acute medical illness. The intervention group (IG) received a psycoeducational group program (12 weekly 1,5h sessions) leads by two nurses. The program was an adaptation of Coping With Depression (CWD) (Lewinsohn, 1989). The control group (CG) received TAU. Outcome measures: Sociodemographic, BDI and EuroQol-5D questionnaires pre-post intervention.

232 patients were included, IG (n = 121) and CG (n = 112), of whom 86 patients had mild depression (BDI≤ 18) and 146 moderate depression (BDI≥ 19). The sample characteristics were as follow: 90% women with mean age of 53,27 (SD = 12,72)The intervention was associated with significant improvements in BDI (t(230) =-2.25; p = 0.025). Separately analyze the sample: Patients with mild depression: (t(83) =-2.52; p = 0.014).Patients with moderate depression: (t(141) =-2.62; p = 0.010). Posttest results show that this intervention has statistically significant effect on depressive symptoms in overall sample and in mild/moderate depression separately.

The psychoeducational intervention is effective treatment in both mild and moderate depressive symptoms in primary care.

Cushing's patients demonstrate major depression more than any other medical condition. Major depression is a common, complication of Cushing’s syndrome, with no significant differences between pituitary -dependent and -independent forms. The aims of the study is to estimate the prevalence of depression in patients with Cushing’s syndrome.

23 patients with Cushing’s syndrome (14 with pituitary-dependent and 9 with pititary-independent forms) were recruited for this study. The subjects were between 52 and 67 years. Patients were screened initially with a questionnaire detailing their age, medical history, concomitant medications. The Zung self-rating depression scale was used to assess depressive symptomatology. It contains 20 items: index scores below 50 reflect no depression, 50–59 reflect mild depression, 60–69 reflect marked to moderate depression and scores of ≥ 70 reflect severe to extreme depression. Results were compared with measurements in 21 subjects without Cushing’s syndrome.

The prevalence of depression in patients with Cushing’s syndrome was 52.17% (12 patients). 2 patients (2 women) present mild depression and 10 patients (9 women and 1 men) present moderate or severe depression. Moderate or severe depression was significantly associated with older age, female sex, relatively more severe clinical condition. The prevalence of depression in 21 subjects without Cushing’s syndrome was 4.76% (1 women with mild depression).

This study showed that patients with Cushing’s syndrome have a greater a risk of depression than people without Cushing’s syndrome. Patients with Cushing’s syndrome should be routinely screened and adequately treated for depression.

At resent 3desaides management of chronic mental disorders at psychiatric health association tobe high attention.

Determining effect of psychodrama on depression among women with chronic mental disorder.

This study was a quasi-experimental study that done in RAZI comprehensive psychiatric center. Community of this research consists of chronic mental patients bedridden at RAZI comprehensive psychiatric center that among them 30 women with chronic mental disease possess entrains criterions selected and with randomized permuted blokes’ allocation to two control and intervention groups. Then them depression examined with beck depression inventory (BDI). Then 12sessions hours long of psychodrama, 2ice per week, 6 weeks for intervention group enactment but control group received routine treatments. When the program ended depression of ills reexamined whit study instrument and analyzed with independent T test, paired T test kolmogroph smernophand Leven and covariance analyzes tests.

Main of depression before and after intervention at control group was not significant but at Intervention group was significant (P = 0.000).

At two groups after Intervention depression differences revolve significant (P = 0.000).

Comparison between main of depression after psychodrama even after modification of age and before intervention depression effect by covariance analyzes at two groups showed significant deferens.

Psychodrama leads to decrease of depression at intervention group.

The well-known huge global burden of unipolar depression is, at least in part, due to the higher prevalence of medical co-morbidities in affected subjects. We purpose to evaluate, in what extent, the increased medical co-morbidity is due to the genetic factors shared, both, by unipolar depression and some of the chronic medical diseases.

We performed a longitudinal retrospective research on data records of 248 subjects admitted in our psychiatric clinic during 2001 – 2005. Two control samples were done. First control sample consisted in 44 bipolar patients and the second control sample was represented by 59 persistent delusional subjects admitted in our clinic during the same period.

The positive family history of chronic medical disease was more consistent in unipolar depressions comparatively with controls, regarding several medical chronic diseases. More exactly, high blood pressure, coronary heart disease and neoplastic diseases were most prevalent among the grade 1 relatives of unipolar depressions comparatively with that existing among the grade 1 relatives of controls. Just in the case of coronary heart disease, the difference has reached statistical significance (depressives - m = 0.443, S.D. = \0.652; bipolars + delusionals - m = 0.252, S.D. = 0.499; t = 2,665, p = 0.008).

The higher prevalence of some of medical diseases among unipolar depressives comparatively with other categories of psychiatric patients could be explained by genetic perspective. For example, according with our research, unipolar depression and coronary heart disease could be viewed as two distinct phenotypes of two genotypes that shares somewhat similar alterations.

The purpose of this study was to investigated the prevalence child depression in primary schools.

3685 students from Grade 3 to Grade 5 were selected from 7 primary schools of Pudong district in Shanghai by random and cluster sampling. The study design consisted of a screening stage in which the Center for Epidemiological Studies Depression Scale for Children(CES-DC) were used, and a clinical interview stage in which the K-SADS-present state version (K-SADS) and DSM-IV were used. The diagnoses of depressive disorder were made according the DSM-IV criteria.

The prevalence of children depression was 1.60% (95%CI = 1.19%∼2.00%). The prevalence rate of male(2.08%) was significant higher than that of female (1.09%)(X2=5.40, P = 0.02). The rate of depressive disorder increased with age from 0.57% (8 years old) to 2.47% (12 years old). The prevalence of depression was no significant difference between ages from 8 to 12 years old (X2 = 4.49, P = 0.34).

The prevalence rate of children depression in Shanghai is low. The prevalence of depression among boys is much higher than that of girls.It shows the prevalence of depression is no significant difference between ages from 8 to 12 years old.

Medical plants have been used for centuries as a medicinal agent in treatment of depression and anxiety. The purpose of this study was to explore the effects of the lavendula officinalis on depression in patients using citalopram.

This clinical trial study was performed in Hajar hospital, Shahrekord, Iran. In this study eighty patients randomly allocated into two groups (40 patients in each group). Patients who complained from depression were studied during a two-month double-blind study. In control group, patients were given 20 mg citalopram twice daily plus placebo and case group were treated with 5 g arial part of dried Lavendula officinalis and citaloperam (20 mg, twice per day). After 4 and 8 weeks, patients were followed for evaluations of their depression and complications. Depression severity was scored using standard Hamilton’s depression questionnaire. Data were analyzed using Chi square and Paired-t test.

After 1 month treatment, mean depression score in case and control groups were 15.2 ± 3.6 and 17.5 ± 3.5, respectively (P < 0.05). After 2 months the mean score of depression in case and control groups was 14.8 ± 4 and 16.8 ± 4.6, respectively (P < 0.01). The most common side effects in two groups were confusion and dry mouth, which were not significantly different between two groups.

Lavendula officinalis has a positive effect on depressed patients and may be useful to decrease the severity of depression in patients using other antidepressants.

Family burden, defined as the consequences for those in close contact with a severely disturbed psychiatric patient, is now well-documented in schizophrenia research, whereas very few data are available in affective disorders.

To explore:

1. 1) the levels of family burden in a sample of key-relatives of patients with major depression;

2. 2) the professional and social support for relatives of patients with major depression disorder.

324 patients with major depression and their key-relatives were randomly recruited in 30 Italian mental health centres, randomly selected and stratified by geographical area and population density. Family burden was explored in relation to:

1. a) patient's clinical status and disability;

2. b) relatives’ social and professional support.

Reduction of leisure (53% of the sample) and social activities (44%) were the most frequently reported sources of practical burden, whereas psychological burden was mainly due to sense of loss (75%) and worries for the future (61%). Family burden is higher in key-relatives with a lower education level (p < .05), and when patients’ symptomatology and social functioning are more severe. Key-relatives who can rely on a stronger support from social network and from mental health professionals have lower levels of family burden (p < .05).

These results highlight the need to provide supportive interventions for patients with major depression and their key-relatives.