The previous studies reported that elevated serum cholesterol levels (≥ 200 mg/dl) were associated with poorer response to fluoxetine and nortiptyline treatment in patients with depression.

The aim of this study was to examine the relationship between pretreatment serum cholesterol levels and clinical response to treatment with different antidepresants among inpatients with depressive disorder.

One hundred and four inpatients with depressive disorder who did not respond to previous treatment were enrolled in a six-week open study. New treatment (different antidepressant monotherapies, combinations or augmentations) was chosen according to clinical judgment. Serum cholesterol levels were obtained before starting new treatment. Cholesterol levels were classified as either elevated (≥ 200 mg/dl) or nonelevated. Clinical response was defined as ≥ 50% decrease in the Montgomery Åsberg Depression Rating Scale (MADRS) score at endpoint compared to baseline.

Forty-six patient (44%) were classified as having elevated cholesterol levels at baseline. Patients with elevated cholesterol levels did not significantly differ in gender ratio, baseline MADRS score, duration of current episode and number of previous episodes but were significantly older than patients with nonelevated cholesterol levels. After adjusting for age, gender, and Body Mass Index (BMI), we did not find significant differences in response rate and as well as in the pretreatment-posttreatment change in MADRS between patients with elevated cholesterol and patients with nonelevated levels.

We did not demonstrate association between pretreatment cholesterol level and response to treatment in depressive disorder.

Study was supported by the grant NS10368 IGA MZ CR.

Research indicates that subjective tinnitus severity varies among tinnitus patients. One of the variables held responsible for these differences is depression. However the relationship between depression and tinnitus severity was never investigated more in depth.

If depression is responsible for differences in subjective tinnitus severity two conditions need to be fulfilled. First, there should be evidence for the presence of moderate to severe depressive symptomatology in a substantial group, and second, there should be evidence for a substantial relationship between depressive symptoms and tinnitus severity which can not be explained due to method and content overlap.

In this study we investigated whether tinnitus severity is a depression related problem.

136 consecutive help-seeking tinnitus patients were seen by a psychologist and an audiologist. All patients filled in the Beck Depression Inventory (BDI-II), the Tinnitus Handicap Inventory (THI), and underwent psychoacoustic measurement (pitch and loudness).

Mean scores indicate the presence of no or minimal depressive symptoms. There was only a positive correlation (p < .01) between the BDI-II and the THI. No correlations were found between psychoacoustic measures and the self-report questionnaires. Linear regression analysis revealed that only the somatic depression subscale significantly predicted tinnitus severity.

Tinnitus does not seem to be a depression-like problem. There is no substantial group of tinnitus patients with moderate to severe depressive symptoms. The relation between depressive symptoms and tinnitus severity seems to be an artefact due to content overlap between de THI and the somatic subscale of the BDI-II.

Late-onset depression (after age 60) has more frequently been reported to be associated with brain abnormalities compared to early-onset depression. Consistent with the hypothesized role of frontolimbic circuits in the etiology of depression, the preponderance of cross-sectional studies of late-life clinical depression have revealed structural and functional changes in the frontal lobes

NK was 70 years old female patient. She had a psychiatric history of five years with these symptoms. She had used several different antidepressants and benzodiazepines at adequate doses and some times low-dose atypical antipsychotics but she never had a full recovery. In this hospitalization, she was diagnosed as Major Depressive Disorder according to SCID-I. In MRI, we found generalized cortical atrophy especially in the frontal region. In neurocognitive tests, we realized that her minimental test score was 25. Wisconsin Card Sorting Test and Stroop test (main card reading time 54 seconds) showed disability in the executive functions such as cognitive flexibility, planning, decision making, overcoming of a strong habitual response or resisting temptation and in focused attention and working memory. The other cognitive domains evaluated with Rey Auditory learning test, Auditory trigram test, digit span test, trial making test, word association test were found to be normal. Conclusion: Treatment-resistant depression (TRD) is usually conceptualized as a failure to respond to several courses of adequate antidepressant treatment. Our findings can be suggested that cortical atrophy in especially frontal lobes can be consistent with a treatment resistance and neurocognitive impairment.

In the treatment of MDD, insufficient treatment outcome and the delayed onset of action still remain major problems.

Measuring plasma concentrations, i.e. TDM is a possible option to improve therapeutic outcomes.

The aim of this prospective and naturalistic study was to evaluate the economic and clinical benefit of TDM for depressed inpatients treated with citalopram.

Inpatients with MDD according to ICD-10 were included and treated with citalopram. Psychopathology was assessed by the 17-item Hamilton Depression (HAMD-17) rating scale in weekly intervals for five weeks. In parallel, serum concentrations of citalopram were measured.

55 patients were included (27f). 84% of the patients with citalopram plasma concentrations below 50 ng/ml (n = 36) were non-responders in week five. Among patients who achieved plasma concentrations ≥50 ng/ml (n = 19) on day 7, 47% became responder at week five (p = 0.025). Patients with plasma levels ≥50 ng/ml had a significantly shorter duration of hospitalization (49 ± 20) than patients below 50 ng/ml (72 ± 37; p = 0.033).

Our results show that citalopram plasma levels above 50 ng/ml are predictive for later treatment outcome and that TDM is cost effective due to reduced duration of hospitalization.

Psychotic depression differs significantly from non-psychotic depression in many aspects. These differences comprise etiology, severity, treatment response and prognosis.

The aim of the study was to assess the diversity of the psychiatric morbidity preceding psychotic and non-psychotic depression.

Danish, register-based, nationwide cohort study. Subjects were all Danish residents assigned with an ICD-10 diagnosis of severe depression with- (F32.3 and F33.3) or without (F32.2 and F33.2) psychotic symptoms between January 1st 1994 and December 31st 2007. Psychiatric diagnoses preceding the severe depression were assessed through the Danish Psychiatric Central Research Register. It was investigated whether patients with psychotic depression had a history of more diverse/severe psychiatric morbidity and a different use of psychopharmacological drugs prior to index, compared to their non-psychotic counterparts.

The study included 29,254 subjects with severe depression. Of these, 9,768 patients (33%) were of the psychotic subtype while 19,576 (67%) were non-psychotic.

Patients with the psychotic depressive subtype had a psychiatric history involving more and longer admission, more diverse diagnoses and a different pattern of psychopharmacological treatment compared to their non-psychotic counterparts. The results indicate, that psychotic depression may be more related to the bipolar/schizophrenia/psychosis spectrum than to the depression/anxiety spectrum.

The results add to a growing body of literature proving fundamental differences between psychotic- and non-psychotic severe depression. This should be considered in the upcoming revisions of the current diagnostic classifications.

Depression is commonbut still ignored in general practice whereas it is a source of handicap, psychiatric and somatic morbidity.

To assess the punctual prevalence of major depression in primary healthcare centers in Tunisia.

A Transversal study during march 2007 was conducted in three primary healthcare centers in Hammamet city. All partients having sixteen years or older were evaluated by the Cluster A of the Mini International Neuropsychiatric Interview (MINI). Patients meeting criteria for major depressive disorder had subsequently been assessed by the MADRS depression scale. A score greater or equal to 20 was considered as the threshold score for the diagnosis of major depressive episode.

199 patients participated at the study (participation rate = 70%). The prevalence of major depression was 13% and half of the patients suffered from severe depression according to MADRS. Depression affected more patients with low socioeconomic level (p = 0.037), suffering from a chronic medical condition (p = 0.0013), unmarried, divorced or widowed (p = 0.022). There were no statistically significance according to age, gender, living environment, alcohol abuse, and tobacco or life events. The frequency of suicidal thoughts or behavior was 3% in the sample and 19% among depressed patients.

Need of further general practitioners training in systematic screening of depressive trouble is still requested.

The cognitive profile of the older depressed person includes impairments in executive functioning, episodic memory and processing speed. When in remission, executive functioning impairment may still remain. It is not known whether these impairments also exist in self-reported depression and if so, whether there are any performance differences between currently and remitted depression.

To examine differences in cognitive functioning between self-reported nondepressed, depressed, and remitted persons in young and older old.

Data were collected using interviews and cognitive testing (executive functioning, episodic memory, and processing speed) in the Swedish National study of Aging and Care in Kungsholmen (SNAC-K). All non-demented participants (n = 2727) were categorized according to age (60–77 years, n = 1626, and +78 years, n = 1101), and depression status, 1) never depressed (n = 2200), 2) current depression (n = 214), and 3) remitted depression (n = 313).

A 2 (age) × 3 (depression) MANOVA showed significant main effects of age, depression and a significant interaction effect. Younger outperformed older on all tests. Depression showed an effect on Trail Making Test B, where nondepressed outperformed currently depressed, and the remitted outperformed the currently depressed on free recall. Furthermore, an interaction effect was found for recognition, suggesting that decline in episodic memory is more pronounced in persons with self-reported depression when aging.

Self-reported depression in an older population affects executive functioning and episodic memory, but not processing speed. For persons in remission, we found remaining deficits in episodic memory, rather than executive functioning.

There is a bidirectional relationship between depression and insomnia, the latter being both a risk factor for the development of depression and a consequence of depression itself. Since depressive patients with residual symptoms of insomnia are at higher risk for disease recurrence, dealing successfully with sleep disorders during antidepressive treatment is of great importance.

The aim of the current study was to evaluate the effectiveness and tolerability of escitalopram on both depressive symptoms and sleep problems of depressive patients.

An observational, open-label, 3-month study was conducted in Greece.

Effectiveness was assessed using the CGI-S and AIS (Athens Insomnia Scale) scales. Tolerability was evaluated by spontaneously reported adverse events and treatment discontinuation rates.

The study included 2,103 patients (mean age 51 ± 15 years, 64.0% women).

Patients showed significant improvement during the treatment period for both depressive symptoms and sleep problems. Mean CGI-S scores decreased from 4.2 ± 0.8 to 2.2 ± 1.0 and total AIS score decreased from 13.6 ± 4.9 to 3.5 ± 3.8 (repeated measures analysis of variance Hotelling's test, p < 0.001). The positive effect of escitalopram treatment was significant both on “night sleep” and “behaviour on the following days”. Moreover, the percentage of patients suffering from insomnia (AIS score >=6) decreased from 89.1% to 22.1% (Cochran's Q test p < 0.001). Escitalopram was also well tolerated, as 1909 (90.8%) patients successfully completed the study and 39 patients (1.85%) discontinued due to adverse events.

Escitalopram combines significant effectiveness on both depressive symptoms and sleep problems with good tolerability.

Seasonal Affective Disorder (SAD) is thought to be related to a lack of serotonin, or according to other theories, the primary cause is melatonin produced in the pineal gland, since there are direct connections between the retina and the pineal gland.

To demonstrate cases of SAD treated in the CMHC of Katerini(northern Greece), in 2009.

Archives of the adult-clinic of the CMHC in 2009.

The CMHC accepted 3294 people (1517:males/1777:females) in 2009. 280 were diagnosed with depression (48:males/232:females). 96 were newcomers (22: males/74:females) seeking for session the fall-spring period, complaining about mood swings as daylight hours began to dwindle.

In September: 72 depression cases were reported (63:women/9:men). In December: 92 (73:women/19:men). The references were amazingly high: 84 (71:females/13:males) in March. More than ¾ of all sufferers were women,most in their 40s, correlating with international literature. The majority complained about decreased levels of energy/difficulty concentrating/fatigue/increased desire to be alone/increased need for sleep (unlike typical depression). They also mentioned interference with their relationships and work productivity. 1/3 of them received antidepressant medication, whereas Cognitive Behavior Therapy (CBT) was applied to the total of them. Although light therapy is widely recommended, there aren’t the means to be applied in the CMHC.

Though SAD is prevalent in most of the Nordic countries and mid-latitude places, our patients followed the SAD pattern with an onset of depressive symptoms in the fall, continuation of symptoms throughout winter and remission of them in the spring according to other international references.

ECT is a save and one of the most effective treatments of depression and other severe mental diseases.

Despite these facts rates of ECT use are highly variable in different regions. In Villach there has been a continous use of ECT for many years.

We investigate the agreement of the rate of ECT between our clinical practice and and international recommendations.

Additionally we want to show our data about indications, frequency and outcome in the use of ECT.

Data will be reported and discussed.

Differentiation between Severe major depression and schizophrenia is oftenly a problematic issue, whether due to resemblance between negative symptoms of schizophrenia and depressive symptoms or due to presence of psychotic features with psychiatrists subjective assessment of the volume of psychotic features in relation to the whole illness. Our aim is to assess the utility of polysomnography as a differentiating tool that may add diagnostic value.

Patients were recruited randomly from the outpatient service at Alexandria University Hospital, 20 patients with severe major depression with or without psychotic features and 20 patients with schizophrenia. Diagnosis done in accordance with criteria of DSM IV-TR. Only patients scoring above 4 on the Clinical Global Impression scale for severity were recruited. Polysomnography was done to all patients while at least 1 week off medication.

Depressed group showed a significantly shorter REM latency (26 ± 6.9min) and higher REM intensity (34 ± 14%) compared to schizophrenic group with REM latency (43.9 ± 16.9 min) and REM Intensity (21.4 ± 4.5). On the other hand deep sleep phases 3 and 4 constituted 12 ± 3.8% and 17.8 ± 9.2% of sleep in schizophrenic group compared to 16.4 ± 5% and 9 ± 7.9% in depressed group respectively with significant difference.

Polysomnography may be of benefit as a diagnostic differentiating tool between schizophrenia and severe Major depression.

To determine the frequency of Depressive Disorder among patients with breast cancer in an outpatient department of a tertiary care hospital in Pakistan.

Cancer not only affects body physically but can also affect the mind in the form of psychiatric disorder. Proper identification and treatment of these conditions can be beneficial and cost-effective.

This cross-sectional descriptive study was conducted on patients of breast cancer attending OPD of oncology department of Civil Hospital Karachi. The sample consisted of ninety three diagnosed patients of breast cancer who were screened for psychiatric morbidity through Hospital Anxiety and Depression Scale (HAD Scale). Screened patients were interviewed and diagnosed as depressive disorder according to ICD criteria. The level of depression in these diagnosed patients was quantified through ZUNG'S Depression Rating Scale.

Eighty two percent (n = 76) of the sample (n = 93) were found to have psychiatric morbidity on HAD scale. Out of these screened sample sixty percent (n = 46) were found to be depressed on Zung self rating depression scale. Majority of these patients were suffering from mild to moderate depression. Half of the female in this sample were undergone mastectomy that was not found to have any statistically significant impact on psychiatric morbidity of the patient.

This study shows high prevalence of depression in patients with breast cancer. The health professional involve in care of breast cancer should screen routinely their patients for symptoms of depression.

Mental disorders are of diseases that modern societies encounter with and among them depression is one of the most common disorder especially in young people as prayer and blessing has positive effects on different aspects of life, this study was done to determine relationship between attitude and practice toward prayer and depression in students of Kurdistan university of medical sciences.

This was a descriptive - analytic study. The study population consisted of 400 students of Kurdistan university of medical sciences that were selected though stratified random sampling method. The data were collected by 2 questionnaires, one that contained questions related to attitude and practice toward prayer and another was beck test.

37.5% has depression (mild to severe). 71% had positive attitude and 29.5% had good practice toward prayer. There was significant relations ship between attitude toward prayer and depression (p = 0/03). So that depression average ranking was lower in those who had positive attitude toward prayer.

With higher mean scores of practice toward prayer depression rates were lower but these. Differences were not significant.

As depression rate is high in these students and because of positive effect of prayer on decreasing prevalence and severity of depression so not only exploring for risk factors of depression in university students is necessary but also reinforcing and promoting doing prayer and religious duties: it is recommended to pay more attention to student's mental health.

The presence of macro vascular diseases is common among patients with diabetes mellitus, with result the increase of danger for depression appearance.The attack of greater vessels (macro vascular disease) conducts to the appearance of coronary disease, vascular brain episodes(strokes) and peripheral vasculopathy.

of this study was the examination of the relation between depression and the existence of macro vascular diseases at patients with diabetes mellitus type II.

164 diabetics were examined (72 male and 92 female, medieval age 66,9 ± 11,53 years), at diabetological clinics. The tools that were used at this study was the scale of depression self evaluation of Zung and a structured questionnaire about the existence of macro vascular diseases. The analysis was done with the statistic package SPSS 18.0.

64,6% of diabetics reported hypertension and 61% dyslipidemia, 30,5% suffered from coronary disease and 26.2% of vascular brain episode (stroke), while 13,4% suffered from heart attack and 19,5% from other diseases. 50% of diabetics had depression at mild levels and another 20% at medium levels.

The majority of the sample appeared mild or medium degree depression and relation was observed between accompanying macro vascular diseases. The coronary disease, hypertension and dyslipidemia seemed to be independent prognostic factors of depression even after the abstraction of age effect and diseases duration effect, while the depressive effect of heart attack or stroke seemed to be effected mainly by age.

Depression is a dysfunction with great range of demonstrations and according to researches appears at person with diabetes mellitus two or three times more than in general population. The knowledge although about the reasons and the way that depression affects the management of diabetes are limited.

Of this study was the examination of existence of possible depression at patients with diabetes mellitus.

164 diabetics were studied (72 male and 92 female, medieval age 66,9 ± 11,53 years) at diabetic clinics. We used the self evaluation scale of Zung (ZDRS) and structured questionnaire about demographical and body measure data.

The statistic analysis was done with the statistic package SPSS 18.0.

57,3% of diabetics were overweight, and 30,5% obese, with high rates of central obesity (83,3% at males and 92,4% at females), while the big Index of Body Maze [r = 0,309, p = 0,001] and central obesity [t(162)=4,773, p = 0,001] were related significantly with depression. 50% of diabetics appeared depression symptoms at mild levels and 20% at medium levels, with the females [t(162)=3,26, p = 0,001] and elder to be related statistically significant with depression.

The majority of the sample appeared a level of mild or medium depression and correlation was observed between bad glycemic examinations. The daily and for many years effort of diabetes control can create the suitable situation for depressive symptomatology appearance. The examination and evaluation of the causative factors can help at the adaptation of diabetic and the solution of his problems.

Evaluation of concepts and reactions on a public online forum concerning depression.

Revision of 100 consecutive entries posted using an adapted Collazzi method.

Comments were divided according to their content and the main subjects found were symptomatology, suicide, therapeutic advice and concerns about medication, psychotherapy and alternative therapies. The effect of a support group was found to be present based on the comments to each individual post by diminishing loneliness and deconstructing desperation. Non-therapeutic opinions were expressed and there were high levels os expressed emotion.

The absence of a ealth professional as group moderator may lead to conflict and misleading remarks.

Though rater drift in clinical trials has long been understood to negatively impact trial results, few studies have systematically quantified this. We examined training data for the HAM-D (Hamilton Depression Scale, 17-item version) at two time points to measure the impact.

Raters participating in a standardized training scored the HAM-D based on two videotaped interviews of depressed patients. To assess drift, data from an initial, post-online training session was compared to data obtained 12 months later. Intra-class correlation coefficients (Shrout & Fliess, 1979) and concordance with expert ratings were compared.

Intra-class correlation coefficients (ICC) for raters (n = 167) following initial training were good to excellent for individual raters (.695–.976, p < .0001) and good for the overall cohort (.752, p < .0001). Concordance with expert ratings was excellent at 99.3%. The overall ICC fell to .730 at the second assessment and although the upper bound of individual performance remained in the good to excellent range, the frequency of scores in the poor to fair range (< .65) increased. Concordance also fell slightly to 87%.

Rater drift occurred over 12 months, as gauged by the metrics of reliability and concordance. Drift was apparent in a limited portion of the cohort but resulted in a lower overall ICC at the second time point. Because studies are generally powered assuming that the ICC remains stable, there are implications for both this power calculation and the required sample size.

Maximal serotonin transporter (5-HTT) densities have been found in the cingulate cortex, a cortical region that has been critically implicated in emotion processing and the pathophysiology of Major Depressive Disorder. Furthermore, serotonin (5-HT) re-uptake inhibition is the first line strategy in the treatment of depression.

Since 5-HTTs are not restricted to neuronal cells, 5-HT uptake velocity (Vmax) can be easily measured on blood platelets subserving as peripheral model of neuronal 5-HTT function and related measures of neural activation.

To determine whether peripheral 5-HTT uptake velocity is related to neural activation in the cingulate cortex during emotion processing.

48 healthy subjects underwent an fMRI paradigm comprising emotional (angry/fearful faces and scenes) and neutral stimuli (simple shapes). 5-HT Vmax was determined in platelets. Subjects were genotyped for a common triallelic polymorphism in the promoter region of the 5-HTT gene (5-HTTLPR).

Significant negative correlations between Vmax and BOLD-signal in the anterior and posterior portion of the cingulate cortex have been found. Cluster maxima within both regions were detected in the subgenual anterior cortex (−1.5, 28.5, −3.5, t = −3.77) and the ventral posterior cingulate cortex (−4.5, −49.5,14.5, t = −3.06). Genotype did not impact on this relationship.

Our results indicate a clear dependency between a peripheral marker, platelet 5-HT uptake velocity, and neural activity in portions of the cingulate cortex for the first time.