Personality and response to tricyclic antidepressants in depressed patients

Article Abstract:

Patients suffering from depression are sometimes treated with antidepressant medications, but not all patients respond to the drug therapy. It has been suggested that certain aspects of personality may be predictive of a depressed patient's response. Some studies have reported that patients with a personality disorder (a type of psychiatric illness) often do not benefit as much from antidepressant treatment as other depressed patients. However, these conclusions have been called into question because they were not based on the currently accepted definitions of personality traits and personality disorders, as described in the Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III). The current study utilized the Millon Clinical Multiaxial Inventory, a self-report questionnaire based upon the DSM-III definitions, to assess personality. Forty-two outpatients with major depressive disorder were evaluated for response to antidepressant therapy (with either desipramine or imipramine) in relation to their personality scores on the Millon Inventory. Nineteen patients did not respond, but 23 patients did respond to the drug therapy. The researchers investigated whether the responders differed from the nonresponders on personality measures. There was no difference between the two groups during the remission phase, but the responder group had a greater degree of antisocial and paranoid personality traits while taking medication for depression. However, the groups did not differ on the number of patients diagnosed with personality disorders. Some of the aspects of the antisocial and paranoid traits are assertiveness, independence, self-determination and competitiveness, which may be associated with a good response to the antidepressants; other aspects of these traits are considered less useful, such as isolation and inability to maintain relationships. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Diagnosis, Personality disorders, Personality assessment

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Life course of depressive illness and characteristics of current episode in patients with double depression

Article Abstract:

Double depression (DD) is a phenomenon experienced by 25 percent to 51 percent of patients with major depression; these individuals also have concurrent chronic minor depression. Researchers have suggested that the course of the major depression in patients with DD differs from that of those who suffer major depression alone. Patients with DD have been observed to have more previous episodes of major depression than patients with major depression alone; a nonsignificant, but consistent, finding has been that those with DD have an earlier onset of the first episode of depression than those with major depression alone. Therefore, DD may be more chronic and may have more relapse potential than major depression alone. Reports of differences between specific characteristics of the current depression in patients with DD and those with major depression only are less consistent. In the present study, 41 patients with DD and 60 patients with major depression only were investigated for differences in life course of illness and characteristics of the current depressive episode. Compared with those with major depression only, DD patients in this sample had an earlier initial age of onset of depression, more episodes of major depression, and more frequent anxiety disorders during depressive episodes. There were no differences between groups with regard to life course of illness measures, and the characteristics of the present episode of depression did not differ significantly between groups, making it impossible to distinguish between the major depressive illness in the two groups. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Dose-related paranoid reaction associated with fluoxetine

Article Abstract:

Mental depression is thought to arise from an imbalance of brain chemicals called neurotransmitters that include serotonin and norepinephrine. A new antidepressant drug called fluoxetine affects brain serotonin metabolism two to four weeks after the start of treatment and is used to effectively treat depression. Fluoxetine may produce a heightened sense of excitability in some patients. A recent case study described a 58-year-old man who was hospitalized with depression following a series of job losses. He had a depressed mood, felt worthless, could not experience pleasure, had recent weight loss, and withdrew from his family and friends. His history revealed no prior mental illness, but did reveal the presence of diabetes mellitus and a heart attack four years prior to admission. He was currently taking medications to help him sleep at night and for chest pain. Prior to admission, he was treated with an antidepressant, but treatment was stopped due to side effects. Therapy was then begun with fluoxetine 20 milligrams (mg) per day and after three weeks, the dosage was increased to 40 mg. Two weeks after this increase the depression subsided, but the patient suddenly became paranoid and agitated. The dose was then reduced to 20 mg per day and his paranoia subsided. He was discharged four weeks later without symptoms of depression or paranoia and continued to do well two months after his discharge. It is concluded that fluoxetine is capable of eliciting psychotic symptoms in susceptible patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Fluoxetine

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