Mayor Depression affects 340 millions of people in the world 16.2% of risk of life prevalence, 2/3 are women. A refractary depression is the one that does not respond to a well found treatment in a period of time (usually around 8 weeks). It is associated to a higher rate of suicide, 15% higher rate of suicidal thoughts and actions, 33%, which means a worse prognosis. Higher costs; they visit the doctor three times as much as people who are not depressed.

we have analysed the main therapeutic reports on refractary depression.

ECT, may be effective if it is administrated acutely, but results tend to be poor if it is used for a long period of time. The STAR D report (Rush, 2006) showed that 25% of the patients improved as they were given a different antidepressant

The potentation of citalopram with bupropion or buspirone may also be useful (Madhulkar, 2006); combinations of antidepressants with some atypical antipsychotics have given good results (Nemeroff, 2004).

Fluoxetina, olanzapina or a combination of both were effective on a 60% of patients with a refractary depression (Shelton, 2001). Bolder I and II reports showed the effectiveness of using quetiapina. We introduce here the potential mechanisms of action of some atypical antipsychotics in refractary depression (improvement on the serotoninergic transmission, a blockade of the 5HT2 postsinaptic receptors, a release of dopamine in the prefrontal cortex).

The polyfarmacy is common. It is unknown which treatment or combination is better.

We evaluated depressive symptoms in individuals who reported overactive bladder (OAB) symptoms compared with those without OAB symptoms.

A cross-sectional population-based survey was conducted in 5 countries. Computer-assisted telephone interviews were conducted with a geographically stratified random sample of the population (N=19,165). Cases had OAB symptoms (n=1434); controls (n=1434) were randomly selected from participants without OAB within country, age, and gender categories. The Center for Epidemiologic Studies–Depression (CES-D) scale measured depressive symptoms (score range, 0–60). A CES-D score >=21 indicated major depressive symptoms. Participants reported whether they had ever been diagnosed with depression, hypertension, or diabetes. Prevalence odds ratios (PORs) and 95% confidence intervals (CIs) were calculated using conditional logistic regression models.

OAB cases reported significantly more depressive symptoms vs controls (Table 1). OAB cases were significantly more likely to have CES-D scores >=21 vs controls, after controlling for age, gender, country, and comorbidities (Table 2).

Significantly increased depressive symptoms were reported among individuals with OAB compared with individuals without OAB.

Table 1

CES-D and Self-Reported Depression Diagnosis in Controls and OAB Cases by Gender

Table 2

Conditional Logistic Regression Model∗ to Predict CES-D Score≥21

The Hypericum Perforatum or Saint John's wort is an antidepressant herb, known since ancient times. It has been studied and is widely known mostly in the USA and in Germany due to its antidepressant qualities.

Hypericum's pharmacodynamic and pharmacokinetic qualities as well as the investigation of its action mechanism.

The existing bibliography was studied, mostly from Medline with regard to the Hypericum's antidepressant action.

Comparative studies have been investigated with the use of questionnaires of the HAM-D, CGI and Von Zeersen of the action of Amitryptilline, Imipramine, Fluoxetine, fictitious medicine with the Hypericum.

The certain superiority of Hypericum to the fictitious medicine (Placebo) at its antidepressant action, as well as the action equality between the Hypericum and the known antidepressants Amitryptilline, Imipramine, Fluoxetine, and the certain superiority of Hypericum at its side-effects' low profile. In addition, it is verified that the Hypericum's effectiveness relates to its action at low or middle depression, since there are no pedantic studies for its effectiveness at heavy depression.

To ascertain the opinion of Lithuanian psychiatrists on depression treatment approach according to the type of depression.

An original questionnaire of 30 questions, which deals with reliance of antidepressants selection according to the peculiarity of the depression psychopathology.

Respondents for organic depression chose mostly mirtazapin (47.4%), for depression with obsession – 35.3% chose paroxetine. It is intresting that despite the controversial opinion about the TCA prescribing according to their side effects profile and safety to use, our respondent chose amitriptylinum for the melancholic depression with suicidal thoughts (42.1%) and for the anaesthetic depression (28%). The study results showed that in some cases there is no unanimous opinion among the psychiatrists – data scattering was received in antidepressants selection, the respondents chose different antidepressants from different groups in similar frequency. For instance, for treatment of the adynamic depression - 7.5% - amitriptyline, 12% - citalopram, 10.5 % - reboxetin, 10.5 % - venlafaxin, 4.5 % - mirtazapine, for the anxious depression - 15% - amitriptyline, 18.8% - citalopram, 15% - mirtazapine, for the anaesthetic depression – 14% - escitaloprami, 9% - sertraline, 8.5% - venlafaxine. There is no clear tendency nor prevailing antidepressant.

The clinical variety of depression is posing serious task for practitioners – to choose adequate therapy and right antidepressant. Data scattering shows that in some cases guidelines for antidepressant selection would significantly relieve the work of practitioners.

because of the increasing rates of suicides, especially among young people, suicidal behavior becomes more and more actual problem in many countries. Lithuania is known as a country where suicides rate is the highest in Europe.

The goal is to find out and compare gender differences in teenagers suicidal behavior relations with depression, personal peculiarities.

two groups of teenagers from 14 to 17 were researched: cases (who tried to commit a suicide, N=109) and control group (without suicidal anamnesis, N=218). Aiming to establish teenagers' diagnoses in cases group, clinical psychiatric research was performed, in accordance with ICD- 10 classification of mental and behavioural disorders diagnostic reference requirements, diagnoses distribution was compared in relation to sex. Minnesota Multiphasic Personality Inventory (MMPI) was used to evaluate personalities in both groups, obtained profiles were compared among groups and sex.

depression diagnosis (F32) was established only to 22,9% of teenagers, more cases were established among boys than girls (p<0,001). Adjustment disorders (F43) and disorders of conduct and emotions (F91-92) diagnoses were more frequent among girls (p<0,001). Cases group boys in MMPI profile more often than girls had greater scales of depression, psychasteny and anxiety, girls, relatively, had greater scales of hysteric, psychopathic and mania (p<0,05).

Depression is less frequent than adjustment disorders and disorders of conduct and emotions among the teenagers who tried to commit a suicide. The researched boys proved to be more inclined to depression and girls implemented more hysteria and psychopathic personality attributes.

Anhedonia is the inability to experience physical or social pleasure. It may either represent a personality trait predisposing to depression and psychosis, or a neuropsychiatric symptom of endogenomorphic depression and schizophrenia. Its physical component is hypothesised to be due to dysfunction of a dopaminergic frontotemporalsubcortical circuit.

The aim of the present study is to investigate presence and severity of anhedonia in patients with depression who attended a Community Mental Health Center (CMHC) in Thessaloniki (Greece). Seventy-six (76) patients were screened with Beck Depression Inventory (BDI). Total BDI score as well as the questions of BDI which refer to anhedonia were studied.

The vast majority of the patients are women (88%), the mean age is 34.11±8.75 years, and the great percentage is married (43.4%), high educated (55.3%), with Personality Disorder on Axis-II (80%). The mean BDI score is 27.42±6.18, and the BDI score for anhedonia is 1.59±0.83. It is found that age and anhedonia are inversely related (r=-229, p<0.05). Furthermore, sex, educational level, comorbidity on Axis-I and diagnosis on Axis-II does not seem to affect anhedonia score in depression.

Findings from this study suggest that anhedonia is an endogenous characteristic of depression, although it seems to be an inversely ratio between age and anhedonia. Future studies with larger groups of depressed patients are warranted to further investigate anhedonia as component of depression.

According to the literature psychiatric illnesses decrease the quality of life (QL) of children and adolescents. There is no data, however, about the differential effect of psychiatric comorbidity on QL. We hypothesized that 1. any comorbidity would decrease the QL of depressed children and 2. attention deficit-hiperactivity disorder (ADHD) would have a more negative effect on the QL of depressed children than other illnesses.

The sample consisted of 483 children diagnosed with major depression (MDD) (247 boys, mean age: 11.88 years, sd: 2,47). We compared 3 groups: 1. MDD without comorbidity (N=147), 2. MDD with comorbidity (no ADHD) (N=249), 3. MDD with ADHD with/without other comorbidity (N=87). Diagnoses were determined by semi-structured interview, quality of life was measured by self-report and parental report. Groups were compared by ANOVA, post hoc comparisons were done in cases of significant differences.

The MDD with ADHD group differed from the others in gender distribution, younger age at onset of depression, more frequent hospitalization and/or outpatient treatment. Child reported QL was not different among the groups. Parent reported QL was the highest in the MDD without comorbidity group, somewhat decreased in the MDD with comorbidity group and lowest in the MDD and ADHD group.

ADHD worsens the course of MDD in children and adolescents. Quality of life of depressed children decreases further by additional comorbidity, but ADHD has the most negative effect in parents' opinion. It is important to ask both parent and child in examining QL of children.

Sleep studies in patients with major depression receiving the new selective norepinephrine and serotonin reuptake inhibitor (SNRI) duloxetine are lacking.

Polysomnography in 10 patients with major depression (7 males, 39.9 ± 7.6 years, HAMD-21 score: 23.6 ± 5.6) was recorded twice, before and after 7-14 days of treatment with duloxetine.

A significant (p < 0.01) increase from baseline to endpoint was found for amount of stage 3 sleep (21.0 ± 10.7 to 37.4 ± 20.1 minutes) and REM latency (58.5 ± 31.1 to 193.6 ± 72.6 minutes). Amount of REM sleep significantly (p < 0.01) decreased from 94.8 ± 34.5 to 51.5 ± 42.5 minutes.

These results partly differ from those in healthy subjects receiving duloxetine.

Some researchers suppose that cortisol/DHEAS ratio is an important markers of anabolic balance.

The aim of the study was to investigate cortisol, DHEAS and cortisol/DHEAS ratio in depressed patients with antidepressant treatment.

There were examined 39 patients with depressive episode (F 32.2). Patients in the first group (n=25) had antidepressant treatment of tianeptine during three weeks in the average dose of 37,5 mg per day. Patients in the second group (n=14) had treatment of sertraline in the average dose of 50 mg per day. Depressive symptoms were evaluated by the Hamilton Depression Scale (HDS). Blood samples were drawn two times: before antidepressant treatment, and on 21 day of the treatment. Serum DHEAS and cortisol levels were measured using immune-enzyme method.

There was a negative correlation between DHEAS level and score by the HDS before treatment (rs = - 0,47, p=0,037). Cortisol/DHEAS ratio in patients after tianeptine treatment was significantly low than before treatment (accordingly 258 and 394, P = 0,002). In patients under sertraline treatment these differences were also significant (accordingly 339 and 419, p=0,04), but after tianeptine treatment cortisol/DHEAS ratio was significantly low than after sertraline treatment (accordingly 258 and 339, p=0,003). Decrease in the cortisol/DHEAS ratio was correlated with improvement of depressive symptoms, measured by HDS (rs = 0,42, p=0,045).

Our results demonstrate that antidepressants influence on anabolic balance in depression, decreasing cortisol/DHEAS ratio. The influence of the tianeptine on cortisol/DHEAS ratio is marked more than sertraline.

To assess the prevalence of depressive symptoms among college students and to find out whether sport activity have any influence on decreasing the depression score.

The authors screened all 664 first year college students. There were 466 females and 178 males. They answered The Beck Depression Inventory (BDI) and questionnaire about their sport activity (non active, recreational and active in sports). For the purpose of the analysis depressive symptoms were defined as a score > 11. We used Chi-square and Mann-Whitney test.

9,2% of the students have shown significant depressive symptoms. Statistically significant lower score on BDI have had the students who are active in sports compared with the recreational group and in correlation to the group of students not active in sports. In the group of the active ones in sports there are only 5,5% of them with depressive symptoms, while in the group of non active in sports there are 18% of them depressive. In separate analysis we have not found correlation of decreasing depressive symptoms and sport activity among males, but we have found that sport activity has a significant effect among females. Females are statistically more depressed (10, 5%) than males (5%).

Our results have shown moderate values of depression symptoms among college population. More females than males have experienced depressive symptoms. While sport activity have not shown significant influence on the depression among males, it has shown significant influence in reducing the depressive symptoms among females.

The goal of the present paper is to assess whether pallidotomy influences the degree of depression in Parkinson disease patients (PD). The prevalence of depression in PD patients has been reported to range from 45% to 50%. Deep depression is observed in 7% of patients. Previous data suggested that several factors can determine depression in PD patients. It is assumed that psychological factors, neurotransmitter dysfunctions (i.e. dopaminergic, serotoninergic and noradrenergic disease), and basal ganglia lesions may lead to depression.

The emotional state of 30 patients (16 women, 14 men) with PD was examined with depression tests: the Beck Depression Inventory and the Montgomery Asberg Depression Rating Scale twice - three days before and three days after pallidotomy. The age-matched control group was tested twice within a week.

The difference in the degree of depression before and after surgery was significant. Statistically significant difference in the degree of depression between healthy individuals and PD patients before pallidotomy was reported (p=0,07). Moreover, the results obtained after pallidotomy in the experimental group did not reveal any differences with the control group. It was noticed that sex has significantly influenced the degree of depression as measured before and after surgery with both tests.

The results obtained in the study showed that stereotactic pallidotomy reduced depression symptoms in PD patients. This finding is compatible with Lauerbach's model, according to which ablation or deep medial globus pallidus stimulation should inhibit thalamic and cortical activity, thus reducing depression symptoms.

The evaluation of depressive symptomatology and self-esteem in high school adolescent students in Greece and the assessment of their relation to demographic variables, school performance and adolescents' activities.

The CES-D Scale (depressive symptomatology) and the Rosenberg scale (self-esteem) were administered to 713 students (396 girls and 317 boys, age 15-18), of the Athens Metropolitan Area, Senior's High School Grades 1-3. Personal data such as age, sex, school records, family's conditions and time spent per week in school-related (e.g. tutorials) and extracurricular (e.g. sports) activities were collected.

Considering CES-D cut-off score >28, 26.2% of the students (33.7% of females and 16.1% of males) could be considered as having depression. CES-D score was found to be associated to sex and school record (being less for students with a better record). Male students were having higher depression scores as they grew older, while respective scores for females were decreasing; at third grade boys had slightly higher CES-D mean score than girls.

Self-esteem and depressive symptoms were negatively correlated among both boys and girls.

A relatively high number of adolescent students in Greek schools can be considered as having significant depressive symptomatology and low self-esteem. The higher depression score in girls is consistent with the existing literature. The fact that boys have higher depression scores in the last grade of high school may be an indication of the higher pressure for academic achievement imposed by the family on them.

In 2 drug approval studies lamotrigine has been shown to possess prophylactic potentials comparable with lithium in bipolar disorder. However, the generalisabilty of these results are limited. In 2001, an investigator-driven study was initiated comparing lamotrigine and lithium for prophylaxis aiming at mimicking routine clinical conditions. Data collection is not completed (until end 2006) albeit recruitment is accomplished. Based on preliminary findings, the focus will be on methodological implications.

This is an open, multicenter, randomised trial conducted within the Danish University Antidepressant Group Subjects suffered from bipolar disorder indicating prophylaxis. Exclusion criteria were kept to a minimum. Randomisation took place when clinically appropriate The primary end-point was the need for additional medication or hospitalization, conditionally that patients were stabilized on monotherapy 6 months after randomisation. Patients were followed up to 6 years after randomisation.

Of the 155 randomised patients, 123 (79%) were recruited at the main center. So far, 25% of the patients were prematurely withdrawn within the first 6 months after randomisation, 25% were withdrawn at 6 months since they were not in monotherapy at this point, 25% have reached the primary end-point and the remaining 25% are still in trial.

The large proportion of patients that needed additional medications even after 6 months indicates that previous long-term studies randomising patients on monotherapies may have limited generalisability. The uneven contribution from the main center and the other centers indicates that multicenter studies may include patients that are selected beyond the selection criteria.

To investigate whether the depressive tendency of adolescents are associated with certain personality traits in a stratified sample in eastern Taiwan.

Students who were sampled from 6 junior high and 25 primary schools in a multi-stratified manner were invited to join the study and asked to complete the Center for Epidemiologic Studies Depression Scale (CES-D) and the Junior Eysenck Personality Questionnaire (JEPQ) administrated together with other measurements of behavioral problems and life events. Effects of gender and grades on the score of the CES-D and the JEPQ and all its four subscales (N, E, P, and L) were analyzed. Correlation between the CES-D and the JEPQ's subscales were explored.

Data from 3222 participants was analysed. Scores of CES-D and all four subscales (N, E, P, and L) of JEPQ were not influenced by gender. Scores of CES-D of participants from junior high school (grade 7-9) were significantly higher than those from primary schools (grade 4-6) but not similar finding in JEPQ scores. Gender difference was not noted in the low depressive tendency group, but there's more girls (59.2%) than boys (41.8%) in the high depressive group. Participants in the high depressive tendency group had significantly higher scores of N and P subscale, but not E subscale of JEPQ than those in the low depressive tendency group.

Different aspects of personality might be correlated differently to the tendency of depression among adolescents. Whether there's developmental causation warrants further analyses and explorations.

The intensity dependent amplitude change (IDAP) of auditory evoked Event Related Potential (ERP) components has been found to correlate with the level of central serotonergic neurotransmission and to be associated with response to certain antidepressants. However, it is currently unknown whether there is a general abnormality of the IDAP in patients with major depression. Therefore, the purpose of the present study was to compare the IDAP in unmedicated depressive individuals with that of healthy control subjects.

We report the results of a study evaluating the change of auditory evoked P1, N1, P2 as well as P1/N1 and N1/P2 peak to peak amplitudes in 40 in-patients with major depressive episode prior to antidepressant treatment, and 44 healthy control subjects. Clinical symptoms of depression were assessed by means of standardized psychiatric rating scales (CGI, HDRS, HAMA and BDI).

In multivariate analyses of variance we found no group differences in the intensity dependent increase neither of the P1, N1, and P2 nor of the P1/N1 and N1/P2 peak to peak amplitudes between patients and controls.

Our data revealed no general abnormality of the IDAP in patients with major depression in comparison to healthy control subjects.

Most suicide victims contact a primary care physician within a month before their death. Over 90% of suicide victims have a diagnosable psychiatric illness, most commonly a mood disorder.

To compare demographic and clinical characteristics of depressed patients with and without a comorbid psychiatric disorder, and subjects without depressive disorders (DD). We hypothesized that depressed patients with a comorbid disorder would be the most impaired group and would have the greatest suicidality.

195 patients were evaluated in three primary care centers in Madrid (Spain) using systematic sampling. Patients were assessed using the Spanish version of Prime-PHQ and a Recent Life Changes Checklist. Demographic data and previous psychiatric history were also collected.

22.1% of all patients had a DD according to PHQ. 46.5% were not previously diagnosed as having a DD. 81.4% of depressed patients had a comorbid psychiatric disorder. Comorbid patients contacted more frequently their primary care physicians and spent more days absent from work compared to the other two groups (p<0.001; p=0.005, respectively). Comorbid subjects had more depressive symptoms and experienced more recent life events compared to the other two groups (p<0.001; p=0.001, respectively). Suicidal ideation was reported by 48.6% of comorbid subjects (p<0.001). Severe suicidal ideation was reported only by the comorbid patients.

Patients with DD are frequently seen in primary care practice. All patients with depression should be screened for suicidal ideation. Primary care physicians should concentrate their prevention efforts for suicidal behavior on depressed patients with comorbid psychiatric disorders.

Yet, little is known about the role neuroticism and life adversity play in the development of depressive symptoms.

A total of 184 subjects aged 20-80 years were examined in the cross-sectional study. The whole group consists of 4 subgroups, namely: inpatients with haematologic malignances, inpatients with various internal illnesses like the cardiovascular disease or diabetes, outpatients infected with HCV (before antiviral treatment), and healthy subjects. The Eysenck's neuroticism questionnaire (EPQ) and the Present State Examination (PSE from SCAN 2.0) were used in the study

Mean neuroticism scores in groups were similar (11.3, 12.6, 11.3, 10.0 respectively) differences were not statistically significant (ANOVA, F = 1.44, p = 0.23). Mean depression scores were different (6.33, 4.57, 3.93, 1.93 respectively), differences were statistically significant (ANOVA, F = 6.34, p < 0.001). Slopes of regression line between depression and neuroticism scores (0.73, 0.39, 0.5, 0.05 respectively) were not homogenous (F = 7.16, p < 0.001). Results revealed strong interaction between group variable and neuroticism in terms of their influence on depression mean scores (F = 22.9, p < 0.001). Residual effect of the group variable was weaker (F = 0.54, p = 0.21).

Differences in mean depression score among groups resulted mainly from symmetric interactions between group variable (adversity caused by an illness and treatment) and neuroticism. Slope of regression line between depression and neuroticism scores among subjects undergoing similar life adversity could be treated as a potential of this adversity to provoke emotional stress, and consequently depressive symptoms.

To examine the efficacy of lithium and valproate in Bipolar I patients suffering from a manic episode with previous EEG abnormalities.

Fifteen patients of both sexes were included in four weeks, prospective, observational, open-label treatment trial. They met criteria: Bipolar I affective disorder (manic episode) according to ICD-10 and EEG abnormalities (high voltage, 10-13 cps alpha, “iritative”, sharp activity). Patients were divided into two groups: Group I – seven patients (4 male and 3 female) treated with lithium 900 mg/day, haloperidol 10 mg/day and chlorpromazine 150 mg/day and Group II – eight patients (4 male and 4 female) treated with valproate 1000 mg/day, haloperidol 10 ma/day and 150 mg/day. Severity of illness and treatment efficacy were measured with Young Mania Rating Scale (YMRS) at the start point, after 2 and 4 weeks, along with conventional EEG registration.

Throughout observational period, lithium treated patients (Group I) did not expressed any improvement in EEG (continuously showing high voltage, sharp alpha activity). Meanwhile, Group II (valproate) patients, after 2 weeks of treatment expressed clear EEG stabilisation. In addition, after 4 week of lithium appliance (Group I) there is no significant reduction in YMRS-score. Group II (valproate) patients after 2 weeks achieved significant clinical improvement (significance level p<0,05) and after 4 weeks highly significant YMRS-score reduction (p<0,01).

Conventional EEG may be useful in therapeutic prediction in a manner that patients with EEG abnormalities had better respond to anticonvulsant mood stabilizers than lithium.