To evaluate quetiapine XR as adjunct to ongoing antidepressant therapy in patients with MDD showing inadequate response to antidepressant treatment.

Data were analysed from two 6-week, multicentre, double-blind, randomised, placebo-controlled studies (D1448C00006; D1448C00007), prospectively designed to be pooled. Outpatients received adjunctive quetiapine XR 150mg/day (n=309), 300mg/day (n=307), placebo (n=303). Primary endpoint: change at Week 6 in MADRS total score. Other assessments included: MADRS individual item scores, HAM-A total scores, MADRS response and remission; AE reporting.

Quetiapine XR 150mg/day and 300mg/day (p< 0.001) reduced MADRS total scores versus placebo at Week 6 (-14.5, -14.8, -12.0) and Week 1 (-7.8, -7.3, -5.1). Subgroup analyses showed the therapeutic effect of quetiapine XR was neither limited to nor driven by factors such as gender or antidepressant class (SSRI/SNRI). Quetiapine XR demonstrated consistent improvements in individual MADRS items: 150mg/day and 300mg/day significantly improved 4/10 and 7/10 items at Week 6 versus placebo. At Week 6, MADRS response (≥50% decrease in total score) was 53.7% (p=0.063), 58.3% (p< 0.01) versus 46.2%; MADRS remission (total score ≤8) was 35.6% (p< 0.01), 36.5% (p< 0.001) versus 24.1% for quetiapine XR 150mg/day and 300mg/day and placebo, respectively. Quetiapine XR 150mg/day and 300mg/day improved HAM-A total scores versus placebo at Week 1 (-4.8 [p< 0.001], -4.2 [p< 0.01], -3.0) and Week 6 (-8.9 [p< 0.01], -9.1 [p< 0.001], -7.3). AEs (≥10%) were dry mouth, somnolence, sedation, dizziness, fatigue, constipation and headache with quetiapine XR.

In patients with MDD and an inadequate response to antidepressant therapy adjunctive quetiapine XR is effective and generally well tolerated.

Our main purpose was to examine the clinical and socio-demographical influencing factors that play a significant role to medical co-morbidity occurrences in unipolar depressives.

We performed two types of clinical studies, one longitudinal retrospective study on 248 unipolar depressives admitted in our Clinic during 2001 - 2005 and second represented by a cross-sectional study on 45 inpatients and outpatients that had meet diagnostic criteria of unipolar depression according to ICD-10 and DSM-IV.

Socio-demographical factors that concurring to medical co-morbidity in unipolar depressives were represented by advanced current age and low educational level. Interestingly, the total duration of unipolar depression was not significant correlated with medical co-morbidity. A positive familial history of depression was correlated with a significant higher risk for coronary hearth diseases (depressives - average=0.443, S.D. =0.652; bipolars+delusionals - average=0.252, S.D.=0.499; t=2,665, p=0.008). Cluster C personality traits have had higher risk of cardiovasculare diseases (p=0.024). Inversely, in cross-sectional research those who met diagnostic criteria for cluster A and/or B personality disorders have had significant higher risk to develop medical co-morbidity. The higher level of co-existing anxiety, both as a trait as well as a state, was correlated with medical co-morbidity of unipolar depression. Surprisingly, in both type of studies, the severity of depression was not significant correlated with the extension of medical co-morbidity. Unipolar depressives were more prone to use dysfunctional copings as psychoactive substance use.

Both clinical and socio-demographical data profiles could give us some valuable informations in predicting medical co-morbidity in unipolar depressives.

Fatigue in patients with major depression is understudied, although highly prominent. The objective of this study was to investigate the independent correlation of various depressive symptoms with the severity of fatigue in major depression.

Eighty-one patients (70 female/11 male, 40 inpatients/41 outpatients), aged 23-65 years (mean 48.6±10.6), with a DSM-IV main diagnosis of Major Depressive Disorder (М.Ι.Ν.Ι. 5.0.0.) and currently in a Major Depressive Episode [17-item Hamilton Depression Rating Scale (HDRS) score ≥15], were studied. Patients with physical diseases or other fatigue-related conditions were excluded. The 14-item Fatigue Questionnaire (FQ) was used for the assessment of reported fatigue. Factor analysis of all HDRS items was performed. Pearson's correlations between the derived regression factor scores and the FQ score were calculated. Age, gender, and factor scores that significantly correlated with the FQ score entered a multiple regression analysis, with the FQ score as the dependent variable.

Factor analysis of HDRS items indicated a 6-factor structure (F1 ‘depressed mood’, F2 ‘middle/late insomnia and somatic anxiety’, F3 ‘anorexia/ weight loss’, F4 ‘general somatic symptoms’, F5 ‘anxiety/hypochondriasis’, F6 ‘early insomnia’). Only factors F1 (items 1,3,7,8), F2 (items 5,6,11) and F4 (items 13,14,17) were significantly correlated with the FQ score (p< 0.05). F1, F2 and F4 turned out to be significant predictors of FQ in the multiple regression, with standardised beta coefficients of 0.291, 0.290 and 0.278 (p< 0.05), respectively.

Depressed mood, somatic anxiety, middle and late insomnia correlate independently with the severity of fatigue reported by patients with major depression.

Young individuals with Type 1 Diabetes have an increased risk for psychological and emotional problems. However, little is known of the factors which encounter for depression among young individuals with Type 1 Diabetes.

The present study aimed first to examine differences on psychological variables between disease and non-disease groups and second to determine the developmental, psychosocial and health predictors of depression in young individuals with Type 1 Diabetes.

The sample consisted of 123 participants with Type 1 Diabetes and 123 healthy controls, aged from 12 to 26 years, 32.9 % males, recruited from different states of Australia and completed a battery of self report questionnaires for development, anxiety, depression, coping, health behaviours, social support and psychological adjustment to diabetes.

Young adults with Type 1 diabetes (n=62) reported significantly higher depression scores and lower levels of problem focused coping than their controls, p< .05. Adolescents with Type 1 diabetes (n=61) reported more health behaviors than those without, p< .01. Using regression analysis findings showed that significant predictors of depression for participants with Type 1 Diabetes were development, independent living, social support (degree of satisfaction), health behaviours and problem focused coping.

Psychological interventions specifically designed for the enhancement of positive coping, independent living skills and social satisfaction could be important for the prevention and/or management of depressive symptoms among individuals with Type 1 Diabetes.

Although depressive disorders are common conditions in primary health care service, and many depressed patients consult their general practitioners, GPs have some difficulties in the detection and correct diagnosis of depression. Unrecognized and untreated depression causes great health and economic burden and also contributes to significant suffering, therefore the correct recognition of affective disorder in GP settings is an important healthcare target. The aim of our study was to assess the prevalence of depressive disorders in general practices in Hungary and also to assess the sensitivity and specificity of different depression screening instruments.

In the present study the current prevalence of DSM-IV depressive disorders were surveyed among 984 primary care attendees in 6 GP practices in Hungary, using the Beck Depression Inventory and the PRIME-MD screening instrument.

The current prevalence rate of any PRIME-MD DSM-IV depressive disorders, including symptomatic major depressive episode, were 18.5% and 7.3% respectively. Beck Depression Inventory identified any current depressive disorders with 95% sensitivity and 56% specificity and the same figures for current symptomatic major depressive episode were 83% and 23%, respectively.

Our results are similar to those reported previously from Hungary and from other countries. The findings also indicate that the Beck Depression Inventory and PRIME-MD can help in detecting depressive disorders in primary care.

Affective temperaments as measured by the TEMPS-A are known to be associated with 5-HTTLPR, however, this association is valid in case of all scales within the depressive superfactor (depressive, cyclothymic, irritable, anxious). Less attention was paid to the association of items composing these affective temperament scales with the 5-HTTLPR polymorphism. The aim of our study was to investigate the association of TEMPS-A items with the s allele of the 5-HTTLPR.

138 psychiatrically healthy women completed the TEMPS-A questionnaire and were genotyped for 5-HTTLPR. Scores of subjects on the temperament scales, subscales and items were compared in subjects carrying and not carrying the s allele (dominant model) using ANOVA. We selected items with significantly different mean scores between two groups and performed item analysis.

Subjects in the two groups had significantly different scores on the depressive, cyclothymic, irritable and anxious temperament scales. Subjects carrying and not carrying the s allele had significantly different scores on 12 items, 9 of which were retained in a derived 5-HTTLPR phenotype scale after item analysis.

Our data provide further support for the association of affective temperaments with the s allele. Although the cyclothymic temperament shows the strongest association, all temperaments within the depressive superfactor have a similar share in this association. The newly derived 5-HTTLPR Phenotype Scale shows strong association with 5-HTTLPR genotype and phenotype, therefore this scale should be further investigated in relation to psychiatric disorders, pharmacological response, and suicide, as well as psychological traits and temperaments.

The present study attempted to investigate the clinically important broader dimensions of clinical characteristics of delusions, through multivariate analysis, in a pure sample of elderly unipolar delusional depressives as well as to test their external validity against a set of demographic, anamnestic and psychopathological validators.

Fifty inpatients suffering from psychotic major depression (PMD) in the context of major depressive disorder, 60 years old or older, were assessed on the basis of SCID IV, HRSD, MMSE and by three - point ordinal scales of twelve clinical, intrinsic or relational characteristics of delusions tested for their interrater reliability.

Principal Component Analysis resulted in the extraction of five factors, jointly accounting for 69.7% of the total variance. The five factors were interpreted as representing the dimensions of delusional strength, acute upsetting, delusional organization, incomprehensibility and incitation to actions. Most of the factors were differentially associated with patients’ demographic, anamnestic and clinical variables.

Our results overlap in part with those of another similar study in delusional depressives of all age-ranges, differing, however in respects possibly attributable to peculiarities of elderly depressives. Overall, the findings of the present study contribute to the further elucidation of major clinical dimensions of delusions in PMD in the elderly and the testing of their external validity.

Changes in mood and anxiety constantly follow nearly all clinical categories which we encounter in working with adolescents. While recent studies that followed the therapeautic effects of antidepressants on children and adolescents report results which argue against the use of antidepressants on children and adolescents, our experiences show that within the therapeutic process it is often necessary to include medication, keeping in mind their developmental processes as well as the risks and protection i factors in potential psychopathological phenomena. The study is directed towards the confirmation of the therapeutic effects of Tianeptine in the treatment of adolescents.

60 adolescents (ages 15 - 23) took Tianeptine in a daily dosage of 37,5mg and were followed for the duration of 3-6 months. Tianeptine monotherapy was applied for 31,8% of adolescents, while we involved 68,2% of adolescents in some form of pscyhotherapeutic work. Clinical monitoring was conducted with the HRDA scale. Psychological testing (MMPI, PIE) was done at the beginning of therapy and after three months.

Statistically, a less significant depression and anxiety resulted in both clinical and pyschological tests following the utilisation of Tianeptine in both monotherapeutic as well as combined psychotherapeutic techniques.

Our results confirm the therapeutic effects of Tianeptine on symptoms of depression and anxiety in adolescents. We want to point out the efficacy of a rational application of antidepressants for adolescents, especially when the same is utilised as part of a complex medical psychotherapy treatment of adolescents.

University student became a target population for number of research studies due to increased number and types of mental and psychosocial problems that they suffer from.

To examine the relationship between depression, hostility and substance use among university students in Jordan.

Descriptive correlation study. Data collected on demographics, depression, hostility, and substance use from 572 university students in Jordan.

Almost 75% of the university students had mild to severe depression. Tobacco, pain killers, stimulants, tranquilizers, inhalants, and alcohol respectively were the most used substances. Depression was negatively correlated with hostility(r = .10, p= .04) and tobacco use (r =.19, p < .001). Depression level has positive correlation with frequency of using pain killers, inhalants, stimulants, tranquilizers, and heroine (p < .05). Male and female university students were not different in their depression scores, hostility, and frequency of substance use.

Depression, hostility and substance use were correlated. Mental health care providers have to understand the impact of depression among university students in Jordan.

To determine association of religious moral beliefs and depressiveness of war veterans twelve years after Bosnia-Herzegovina war 1992-95, finished.

The sample consists of 99 male war veterans aged 41.7±6.8 years, who were inpatients (n=50) in Department of Psychiatry in Tuzla with clinically presented depression and those who were observed as healthy regarding results of previous psychological testing (n=49). Groups were equalized by educational level (secondary school), behavioral characteristics, family structure, and level of exposure to war trauma. Subjects were assessed with regard to the level of belief in some basic ethical principles that arise from religious moral values. The score of religious moral belief index was used to compare two groups of subjects. For sample selection the measuring instruments were used to assess the religious, moral and social profile of subject. We applied the Bosnia-Herzegovina versions of Hopkins Symptom Checklist - 25 (HSCL-25) for measuring of depression symptoms and Harvard Trauma Questionnaire (HTQ) for measuring of trauma experiences.

The score of the religious moral belief index was significantly negatively correlated to the score of depressiveness (Pearson's r=-0.289, P=0.004).

A higher index of religious moral beliefs amongst war veterans was associated with lower level of depressiveness. In this way, it helps protection, development and socialization of the war veterans after surviving severe war traumatization, leading to the mental health stability.

Perinatal depression (PND) has adverse effects on the well being of the mother-infant dyad. Women with PND often show different patterns of help seeking behaviour.

We aimed to examine the association between PND and the reporting of health events and healthcare use in a cohort of British women of Pakistani origin.

Participants were recruited from antenatal clinics in the North West of England and followed up 6 months postnatal. Sixty-seven women diagnosed with depression using the Schedule for Clinical Assessment in Neuropsychiatry (SCAN) were compared with 156 non depressed controls in terms of reporting of health events elicited using the Life Events and Difficulties Schedule (LEDS). Health events included any condition that involved attending primary or secondary care.

Depressed mothers were 1.5 times more likely to report a health event within the perinatal period (p=0.005) and 1.8 times more likely to report a health event (0.031) outside the perinatal period. Depressed mothers were more likely to attend secondary care services for their children (p=0.001) but there was no significant difference in terms of attendance at primary care.

Depressed mothers were more likely to report personal health events and more likely to access secondary care rather than primary care services for health events affecting their children. This highlights the hidden costs of this condition and the need for adequate diagnosis and management of this treatable but under recognised illness.

Aim of this study is to review recent studies and examine the physiology of glutamate and its receptors, pathophysiology of NMDA, effects of stress on glial cells and glutamate neurotransmission and explore the antidepressant properties of NMDA antagonists.

Review of recent pharmacological, imaging and genetic studies.

Increasing evidence supports a tight relationship between stress, the glutamatergic system and depression. Extracellular glutamate concentrations are increased in several brain regions including prefrontal cortex and hippocampus after exposure to stress. Interactions between glutamate and other neurotransmitters are discussed, as are possible mechanisms by which such altered receptor activity might result in the clinical expression of depression.

A variety of NMDA antagonists, group I metabotropic glutamate receptor antagonists, as well as positive modulators of AMPA receptors, demonstrate efficacy in various preclinical models

It seems that a breakthrough in the therapy of depression will require going beyond monoamine-based theory of depression. Evidence indicates that the glutaminergic system might be a promising target fir novel antidepressant therapy.

Baccharis ilimita. Forced swimming test. Depression. Mice.

Daytime sleepiness and disturbed sleep quality are core symptoms of sleep disorders. In addition, depressive symptoms are often reported. In the present study, we examined the possible relationships of daytime sleepiness, sleep quality and objective and subjective rated depressive symptoms in three major sleep disorders: obstructive sleep apnea (OSA; n = 25), restless legs syndrome (RLS; n = 18) and psychophysiological insomnia (n = 21), compared to healthy controls (n = 33).

Otherwise healthy subjects without a history of psychiatric disorder or psychotropic medication use were included. The Epworth Sleepiness Scale (ESS) for daytime sleepiness assessment and the Pittsburg Sleep Quality Inventory (PSQI) for subjective sleep quality were administered. Participants filled in the Beck Depression Inventory (BDI) as indicator of subjective rated depression and underwent a standard psychiatric interview; observer ratings comprised the Hamilton Depression Scale (HAMD) and the Hamilton Anxiety Scale (HAMA).

As expected daytime sleepiness was highest in OSA, whereas insomnia patients showed the highest depression and anxiety scores and the worst subjective sleep assessment. In contrast to the HAMD, the BDI was unable to differentiate among patient groups. Objective (HAMD) and subjective (BDI) rated depression correlated significantly in insomnia, RLS and healthy controls, but surprisingly not in OSA. Subjective rated depression (BDI) correlated significantly with subjective sleep quality (PSQI) in these patients. This correlation was not present in insomnia, RLS or controls. Therefore, increased BDI levels in OSA are possibly related to disturbed sleep (PSQI) rather than to depression.

Assesing family functionality in families with a member diagnosed according to DSM IV TR with depressive disorder; depression intensity was assesed with HDRS.

A sample of 3o families (71 members); FFS assesses the most important and consistent five functioning areas: positive affect, comunication, conflicts, worries and rituals.

Values obtained in each of the 40 questions of the scale can give information on variables affecting the increase or decrease in subscales values. Positive affect 35,07, communication 37, conflicts 15,11, worries 40,77, rituals 45,03. The reuslts were compared to those obtained by assessin normal families from a control group of 132 families (323 members).

Differences were noticed. Values obtained in our study represent the standard of functioning of families with a depressed member.

The data of various studies indicates, that stressful life events having a strong influence to the development of depression in adolescence.

To study the correlation between psychosocial stress and depression among adolescents.

The subjects of the study were 1026 schoolchildren (519 boys and 507 girls) of secondary schools (ninth form pupils) of one administrative region of Lithuania. Average age of adolescents was 14,8±1,12 years. The 57-item Depression scale of Minnesota Multiphasic Personality Inventory for Adolescents (MMPI-A D) and 7-item Reeder scale were used.

The first four factors of depression (pessimism, hostility, somatic health, tension-anxiety) after MMPI-A D scale orthogonal varimax rotation were used in data analysis. Correlative analysis was show statistically meaning correlations between depression, the pessimism factor and the all items of psychosocial stress for the girls. The boys’ tension-anxiety factor correlated statistically meaning with all items of psychosocial stress. Comparing depressive and not depressive adolescents according Reeder scale, determined that both: depressive boys (p=0,043), and depressive girls (p< 0,0001) experienced more psychosocial stress comparing with not depressive adolescents. The stepwise regression analyses differed an importance of the items “nervous tension” (p=0,011), “stress because of communication” (p=0,014) for the girls’ depression and the items “nervous tension” (p=0,011), “physical and mental exhaustion at the end of a day” (p=0,003) for the boys’ depression.

1. 1. Depressive boys and girls experienced more psychosocial stress comparing with not depressive adolescents.

2. 2. Psychosocial stress is important for prognosis of depression in adolescence.