Prediction of response to electroconvulsive therapy: preliminary validation of a sign-based typology of depression

Article Abstract:

As the debate continues over the classification of depression into endogenous versus neurotic categories, it would be useful, from a clinical point of view, to have a reliable system for determining outcomes of depression and predicting responses to particular treatments (especially electroconvulsive, or ''shock'' therapy, ECT). Previous studies have emphasized the value of measurable psychomotor disturbances, such as (psychomotor) retardation, and psychotic features for predicting responses to somatic therapies. To assess the validity of a system of ranking signs (which are more objective, as opposed to symptoms, which are self-reported) to differentiate between psychotic/endogenous and nonendogenous depressives, 14 men and 21 women were evaluated by means of scores on a core set of 15 symptoms. The core items, described in an article by Parker et al. in the July 1990 issue of The British Journal of Psychiatry, measure such observable features as slumped posture, facial immobility, reduced speech, and observable anxiety. In addition, degrees of psychomotor retardation or agitation were noted. All patients were subjected to ECT, and then changes in their state were rated from no change to complete recovery. ECT was associated with reduced severity of depressive symptoms and psychomotor disturbance. Subdivision of core scores by agitation or retardation did not lead to any useful correlation with predicting response to ECT. The authors conclude that the core diagnostic system has clinical validity in predicting responses to ECT, and that psychotic features are not useful predictors of treatment response. One primary advantage of the core system used here is that it relies solely upon clinical observation as opposed to self-reported symptoms. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Care and treatment, Methods, Identification and classification, Electroconvulsive therapy, Electroshock, Symptomatology, Signs and symptoms

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Hormonal responses to fenfluramine in depressive subtypes

Article Abstract:

Fenfluramine is an appetite suppressant which enhances serotonin activity, reduces central nervous system activity, and tends to have some antidepressant effects. Effects of fenfluramine on cortisol and prolactin levels were studied among 30 patients with major depression, in order to investigate central neurotransmitter differences among different depressive subtypes. The patients were classified according to The Diagnostic and Statistical Manual of Mental Disorder, third edition (DSM-III), Research Diagnostic Criteria (RDC), and World Health Organization (ICD-9) criteria. After being assigned to diagnostic groups, patients were subdivided into endogenous (biological) and nonendogenous subtypes. None of the patients were taking antidepressants or any other medications. Blood samples were taken before the administration of fenfluramine (baseline samples), and drawn every hour for five hours after administration. Baseline cortisol and prolactin levels did not differ between subgroups of patients, and could not define depressive subtypes. After administration of fenfluramine, no differences in cortisol levels were found among the different subgroups of patients. However, patients who had been diagnosed with endogenous depression exhibited lower levels of prolactin than nonendogenous depressives. Differences in prolactin response were more highly significant when criteria from the ICD-9 classification system was used to define endogenous versus nonendogenous depression. Although results suggest that the prolactin response to fenfluramine may be different in endogenous and nonendogenous patients, further evaluation of larger groups of patients is required. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Adrenocortical hormones, Antidepressants, Fenfluramine

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Personality as a vulnerability factor to depression

Article Abstract:

Several personality traits are believed to make one more susceptible to depression, including dependence, neuroticism, orality (a general term referring to oral components of sexuality), obsessive behavior, and a dysfunctional cognitive style. However, methodological problems, (e.g., depression may itself alter the results of a personality assessment), have hampered investigation of the hypothesis that there are specific personality traits that predispose one to depression. In the present study, 150 women who were in their first pregnancy were assessed using two personality measures, the EPI and the Interpersonal Sensitivity Measure (IPSM). The EPI is a personality inventory that includes a neuroticism scale. The women were assessed during pregnancy and several times after childbirth. This population was chosen because childbirth is a relatively standardized stressor. The results of the assessment were compared with results obtained on measures of depression. It was proposed that certain personality features, such as neuroticism and sensitivity, predispose an individual to become depressed when faced with a stressor. Six months after childbirth, during the period that subjects were adapting to motherhood, women who scored high on interpersonal sensitivity were up to 10 times more likely to become depressed than women who were less sensitive. Women who were assessed as highly neurotic were up to three times more likely to become depressed than women who were not. This trend held even when women with a history of depression were excluded from the analysis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Risk factors, Postpartum depression, Emotions, Personality and emotions, Personality (Psychology)

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