Perinatal depression is related to poorer outcomes for women and their children. Measurement indices that categorize perinatal depression as present or absent are commonly used in clinical practice and research efforts. Categorization minimizes the health effects of potentially different symptom clusters and may confound understanding of health outcomes.

The objective of this investigation is to explore the symptom clusters resulting from administering two commonly used depression screening instruments during pregnancy and postpartum.

(1) Identify the depressive symptom clusters for perinatal depression; (2) Test whether symptom clusters predict maternal and newborn outcomes, and if so, whether these differ from categorization analytics.

A secondary analysis was conducted on data from a longitudinal study of 139 women. They participated from their 3rd trimester of pregnancy through 8 months after birth and completed surveys at five times using the center for epidemiologic studies Depressed Mood Scale (CES-D) and the Edinburgh Postnatal Depression Survey (EPDS). Analysis procedures included cluster analysis and hierarchical regression.

Individual symptoms were reported by 2.9–31.7% of the sample. Separate clusters (CES-D = 4; EPDS = 2) were identified and, of these, two clusters were primary predictors of maternal and newborn outcomes. Results differed from that obtained with cut-score analytics.

Examination of depression symptom clusters as related to health outcomes during childbearing has significance for clinical practice and research, particularly for women who would not score as depressed on established screening instruments.

The authors have not supplied their declaration of competing interest.

Depressive disorders are known to impair health-related quality of life (HRQoL) both in the short and long term. However, the determinants of long-term HRQoL outcomes in primary care patients with depressive disorders remain unclear.

In a primary care cohort study of patients with depressive disorders, 82% of 137 patients were prospectively followed up for five years. Psychiatric disorders were diagnosed with SCID-I/P and SCID-II interviews; clinical, psychosocial and socio-economic factors were investigated by rating scales and questionnaires plus medical and psychiatric records. HRQoL was measured with the generic 15D instrument at baseline and five years, and compared with an age-standardized general population sample (n = 3707) at five years.

Depression affected the 15D total score and almost all dimensions at both time points. At the end of follow-up, HRQoL of patients in major depressive episode (MDE) was particularly low, and the association between severity of depression (Beck Depression Inventory, BDI) and HRQoL was very strong (r = −0.804). The most significant predictors for change in HRQoL were changes in BDI and Beck Anxiety Inventory (BAI) scores. The mean 15D score of depressive primary care patients at five years was much worse than in the age-standardized general population, reaching normal range only among patients who were in clinical remission and had virtually no symptoms.

Among depressive primary care patients, presence of current depressive symptoms markedly reduces HRQoL, with symptoms of concurrent anxiety also having a marked impact. For HRQoL to normalize, current depressive and anxiety symptoms must be virtually absent.

The author has not supplied his/her declaration of competing interest.

Although rarely reported, antidepressant discontinuation may induce hypomania or mania even in the absence of bipolar disorder [1,2].

We report two cases of antidepressant withdrawal induced mania.

Clinical process consultation and PubMed search were performed in November 2016 using the search keywords antidepressant, mania and discontinuation.

Case report 1: a dysthymic 60 years old woman with 20 years of psychiatric following had been treated with venlafaxine 150 mg/daily the past year. She abruptly stopped taking this drug, developing heightened mood, irritability and racing thoughts five days later. She was admitted at our hospital, initiating then valproate and antipsychotics. Two weeks later, the hypomania clinical state remitted completely.

Case report 2: a 64 years old woman, with a 12-year-old diagnosis of unipolar depression was brought to our emergency service with complaints of disorganized behavior, paranoid delusional ideas, excessive speech, irritable mood and reduced need for sleep, 1 week after abrupt trazodone 150 mg/daily discontinuation. Valproic acid 1000 mg/daily and olanzapine 20 mg/daily were introduced, with gradual improvement of symptoms. Two weeks later she was completely asymptomatic.

Psychiatrists should be aware of the risk of antidepressant withdrawal induced mania. More studies should be conducted about this subject, aiming for the clarification of risk factors and the establishment of clinical criteria for this phenomenon.

The authors have not supplied their declaration of competing interest.

Citalopram is a widely used antidepressant (AD), indicated for the treatment of Major Depressive Disorder (MDD), with a high and Selective Serotonin Reuptake Inhibitory action (SSRI), good efficacy and safety profile. Vortioxetine is a novel multimodal antidepressant compound, with a mixed action on Serotonin (both 5-HT agonism and antagonism). Its clinical efficacy has been established in several short and long term trials; furthermore it proved effective at mitigating cognitive dysfunction, which is addressed to as one of the main causes of social impairment in MMD patients.

To evaluate the relative efficacy and safety of Vortioxetine versus Citalopram, in patients suffering from MDD.

To assess whether Vortioxetine effectiveness and tolerability are comparable to those observed for previous antidepressants.

The main outcomes were efficacy (variance from baseline to 1 month) in the Montgomery-Åsberg Depression Rating Scale (MADRS) and Hamilton Rating Scale for Depression (HAM-D) and tolerability (adverse events). Changes in cognitive performance were assessed using the following specifics tools: Digit symbol substitution test (DSST), Trail Making Test A (TMT-A) and Hopkins Verbal Learning Test-Revised (HVLT-R).

Data collection is ongoing. According to Literature we expect to find a significant number of MDD patients on Vortioxetine to achieve a reduction in depressive symptoms from baseline, to report poor adverse events and to increase their cognitive performance.

As shown by recent literature, Vortioxetine might be an effective option in treating MMD with particular focus on cognitive dysfunction.

The authors have not supplied their declaration of competing interest.

Many students experience symptoms of loneliness, either as a result of the new academic situation or due to the lack of social skills, which results in an inability to actively participate in community activities and socialization. Depression is another common problem that impacts students’ ability to perform life activities. Further, while intuitively a negative association between loneliness, depression and academic achievement is assumed, consistent data are missing. Accordingly, the present study investigated the relationship between depression, and loneliness and academic achievement among undergraduate students.

This study was carried out on 240 university students (mean age: M = 23.42 years), who completed the Beck Depression Inventory and the UCLA Loneliness Scale, while for academic achievement the average marks were used.

Increased age was associated with lower scores in loneliness and depression, and higher achievements. Higher scores of depression and loneliness were associated. Achievement scores were unrelated to loneliness and depression.

Against intuitive expectations, academic achievement was unrelated to symptoms of depression and loneliness. Accordingly, we assume that academic achievement seemed to be related to further cognitive and emotional processes such as motivation, mental toughness, stress resistance, and goal oriented behavior.

The authors have not supplied their declaration of competing interest.

Hamilton Depression Rating Scale (HAMD) remains the most widely used outcome measure though many consider the scale to have many defects.

To use IRT analysis to identify HDRS items which are problematic in terms of IRT parameters, thus suggest changes to the scale.

Patients attending psychiatric OPD meeting DSM-5 criteria for unipolar depression were selected for the study. Patients were between 18-65 years of age, had no major medical problems and were not on any medicines at present. 17 item HDRS was administered using the anchors developed by William Guy as part of the ECDEU NIMH Collaborative Study To determine the relationship between scores on the individual HAMD items and overall depressive severity in an outpatient population Option Characteristic Curve (OCC) which is a graphical representation of the probability of endorsing the different options for a given item across the range of depressive severity) and Item Characteristic Curve (ICC) which is a graphical representation of the mean item score (expected value) and confidence interval as a function of depressive severity was used.

Results showed that Items Depressed Mood, Work and Activities show good relationship between item responses and overall depressive severity. Items Hypochondriasis, somatic symptoms general and retardation appeared to be more problematic with regard to their ability to discriminate over the full range of depression severity.

Further studies are needed to critically review one of the most commonly used scale for one of the commonest malady of humans.

The authors have not supplied their declaration of competing interest.

Depressive disorders are very common conditions, lifetime risk for experiencing major depression is approximately 15%.

Patients with major depression having an insufficient response to SSRI may benefit from addition of methylfolate and pyridoxine.

The aim of our study was to determine the effect of folate and pyridoxine augmentation to SSRI on emotional, physical and cognitive symptoms in major depression.

Eighteen patients with MDD were enrolled, were on citalopram 20 mg/day when folate/15 mg per day/and pyridoxine/40 mg per day/were added. They have been monitored for three months using standard scales for depression and assessment by interview.

After three months of using folate and pyridoxine to SSRI there was a significant improvement in depression as measured by the scales. In 8 patients were recorded improvements of 30–50%. The most prominent changes were in cognitive sphere of depression such as attention, reasoning and problem solving, working memory and speed of processing.

Low levels of folate and pyridoxine have been associated with the presence of depression and residual poor cognitive function. Our study confirms that folate and pyridoxine as adjunctive therapy to SSRI-partially refractory major depression is useful in particular to issues of residual cognitive interference conditions such as impaired concentration and memory, slow mentation, attention/vigilance, problem solving, working memory and speed of processing.

The authors have not supplied their declaration of competing interest.

Treatment resistant depression (TRD) is a disabling condition associated with a relevant psychosocial impairment worldwide.

This exploratory study is aimed to evaluate the main clinical and neurocognitive characteristics in a sample of 21 subjects admitted to the Psychiatric Clinic of University of Genoa as inpatients between 2015 and 2016 and diagnosed with TRD according to Thase and Rush staging method.

Patients have been assessed using the Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale, and Clinical Global Impression (CGI). The Continuous Performance Test (CPT), Trial Making Test (TMT-A/B), Stroop Color Word Interference Test, Verbal Fluency Test, and Rey auditory-verbal learning test (RAVLT) have been administered as well.

Subjects with early-onset (< 50 years) depression had a longer illness duration, higher depressive episodes and more impaired performance at RAVLT while individuals with late-onset (> 50 years) depression showed a higher severity of depressive symptoms and more anxiety symptoms. Depressive symptoms were positively associated with anxiety (r = 0.82; P = 0.00) and negatively with TMT-A/B (r = −0.56, P = 0.01), Stroop Color Word Interference Test (r = −0.72, P = 0.005 and r = −0.616, P = 0.008), and RAVLT (r = −0.60; P = 0.02) performances. According to regression analyses, anxiety symptoms were the only significant predictor of depression severity (P = 0.02).

Early-onset depression is associated with more disability and worse neurocognitive performance whereas late-onset depression is linked to more anxiety symptoms and more depressive symptoms severity. Clinicians should closely monitor patients with TRD for the presence of anxiety symptoms that may represent a significant risk factor of poorer long-term outcome.

The authors have not supplied their declaration of competing interest.

To identify predictive variables of chronic benzodiazepine use among elderly patients with depressive disorder.

This was a cross-sectional, descriptive and analytical study, including 41 patients suffering from depressive disorders, aged 65 years or more, treated with benzodiazepine (BZD) and followed-up in outpatient psychiatry unit at Hedi Chaker university hospital in Sfax in Tunisia. We used a standardized questionnaire including socio-demographic and clinical data. Chronic BZD use was defined as BZD availability at least 50% of the days between day 181 and day 365 following initiation.

The average age of patients was 69.29 ± 5.7 years. The sex ratio (M/F) was 0.5. The majority of them were married (78%), unemployed (82.9%) and living in urban area (61%). They had at most a primary degree (90.2%) and a low socioeconomic level (63.4%). The average time of BZD consumption was 4 years and 5 months.

The prevalence of chronic BZD use in our sample was 56.1%. Duration of benzodiazepine use was greater than 1 year for all chronic BZD users. The mean dose of Benzodiazepine (Lorazepam) consumed was 3.87 ± 2.8 mg per day. Chronic BZD use was correlated with low socioeconomic level (86.3% vs 36.8%; P = 0.000), psychiatric comorbidity (72.7% vs 26.3%; P = 0.004) and recent hospitalization (59% vs 15.7%; P = 0.023).

There is a high prevalence of chronic BZD use in our study. For the 65 years and older patients with depressive disorder, significant predictors of chronic BZD use were low socioeconomic level, psychiatric comorbidity and recent hospitalization.

The authors have not supplied their declaration of competing interest.

Major depressive episode is having highest lifetime prevalence almost about 18% of all psychiatric disorder. W.H.O has ranked depression the 4th leading cause of disability worldwide and projects that it will be 2nd leading cause of disability by 2020. a number of consistent socio demographic correlates have also been found across countries. Here I am going to give a glimpse of MDD i.e. Depression excluding Bipolar Depression. Although It is the commonest psychiatric disorder, but attitude views about disease is very unscientific and biased.

Objective of this study was to know the views of relatives and friends about Depression, and acceptance of scientific view about depression.

As various survey reports are projecting that Depression will be the 2nd commonest cause of disability by 2020. So to create an awareness about depression and its modalities of successful treatments.

In this study, 96 patients were selected who had first episode of MDD without any discrimination of male and female. Their relatives and friends were categorized by their socioeconomic status. All of them were put on open questions regarding the disease.

Amongst them 10% were from upper socioeconomic status, 68% were from middle socioeconomic status and 22% were from lower socioeconomic status. Only 36% accepted depression as a disease, 45.8% suggested to change behavior and thought to get rid off disease; 8.2%believed the disease is due to devils spirit; 20.1% had no comments.

After explaining the disease psycho and pharmacopathology and showing the results of medicines 91.3% accepted it as a disease entity, 4.2% still in favor of devils spirit and 4.5% had no comments.

The author has not supplied his/her declaration of competing interest.

For a long time, cognitive deficits were considered as part of depressive episodes and were expected to improve as other affective symptoms diminished with treatment. Because of this, cognitive impairment was rarely assessed for Major depressive disorder, but in the present time this has changed.

The study included 35 patients (age between 18 and 70) diagnosed with recurrent major depressive disorder (according to ICD-10 and DSM-V) which were evaluated during an acute depressive episode. The severity of depression was quantified clinically and with the help of Hamilton Depression Rating Scale -17 items- whereas cognitive functions were evaluated with standard cognitive tests.

Out of the 35 patients included, 25 were female patients, the rest of 10 being represented by male participants. A median score of 81,5 seconds on the Trail Making Test part A showed attention focusing deficits when compared with standard scores. For semantic fluency, ten words represented the mean score; whereas for phonemic fluency the mean score was lower (seven words). A median score of 5 words resulted from the assessment of the verbal learning and memory, these are considered to be associated with memorization and retention of a list of words given.

These results sustain what the majority of studies revealed, that cognitive deficits are present in all cognitive domains, mostly in attention, verbal fluency and memory.

The authors have not supplied their declaration of competing interest.

The occurrence of chronic diseases, motor limitation, cognitive impairment and social isolation could be related to late life depression.

To describe the pathologies related to elderly patients with depression. To study possible relationship between depression and others pathologies in elderly patients.

This retrospective study included 124 geriatric patients enrolled in a private long-term care institution with mean age of 86.2 ± 6.5 years old, mean weight of 60.28 ± 2.00 kg and mean period of hospitalisation of 4.4 ± 2.3 years. For data analysis, double-entry tables and tests of proportion Qui-square were used.

Cardiovascular, respiratory, endocrine metabolic, skeletal muscle, sense organs, hematological, digestive tract; neuropsychological and genitourinary, diseases were analyzed.

We observed a significant correlation between depression and endocrine-metabolic (P value of 0.0003), sense organs (P value of 9.298 E-5) and skeletal muscle pathologies (P value of 6.843 E-6)

We observed in that population that depression could be prevalent in elderly patients with endocrine-metabolic, sense organs and skeletal muscle pathologies.

The authors have not supplied their declaration of competing interest.

Accelerated aging is associated with major depressive disorder (MDD) and studies of yoga and meditation based lifestyle intervention (YMLI) on biomarkers of cellular aging are lacking.

To investigate the peripheral blood biomarkers of cellular aging in MDD patients after short term YMLI. Biomarkers include DNA damage, oxidative stress (OS), telomere attrition, and nutrition sensing assessed respectively by 8-hydroxy 2’- deoxyguanosine (8-OHdG); reactive oxygen species (ROS) and total antioxidant capacity (TAC); telomere length and telomerase activity; and sirtuin-1.

We consecutively enrolled 33 MDD patients and 40 healthy subjects; 30 MDD patients were followed up with 12- week YMLI. Biomarkers of cellular aging in peripheral blood were measured with assay kits. All patients were evaluated by examining the correlation between cellular aging markers and Montgomery–Asberg Depression Rating Scale (MADRS) scores.

The levels of DNA damage, OS, and telomere attrition in MDD patients were significantly higher than healthy subjects (all P = 0.005). The MADRS scores had a significantly positive association with 8-OHdG and ROS levels and negative association with TAC, telomerase and sirtuin-1 levels (all P < 0.01).

Peripheral blood biomarker levels in our results suggest significant cellular aging in MDD patients compared to healthy subjects. There was strong correlation between the changes in biomarkers of cellular aging and clinical improvement in MDD. Our study is the first to show significant increase in sirtuin-1 levels in MDD patients after yoga and meditation. Therefore, biomarkers of cellular aging might be indicators of MDD severity and clinical remission after YMLI.

The authors have not supplied their declaration of competing interest.

Depression is a common mental disorder that can be associated with more functional disability than most chronic medical illnesses and the increased reporting of medically unexplained somatic symptoms.

To assess the prevalence of depression in a Tunisian population, as well as the associated factors.

We conducted a cross-sectional, descriptive and analytic study, among 707 subjects consulting in 20 primary care units in Sfax and Tunis, Tunisia. These participants, randomly chosen, were asked to answer a questionnaire after their consent. Depressive symptoms were evaluated using the “Beck Depression Inventory” (BDI).

The mean age of participants was 39.84 years. Among them, 38.6% had a low educational level (illiterate or primary school level); 45.3% were professionally inactive and 92.9% had a low to medium socio economic level. Medical, psychiatric and suicide attempt histories were reported respectively in 51.2%, 7.6% and 1.8% of cases. According to BDI, a mild depression was noted in 22.9%; moderate 16.1%; severe 4.1%. Among those presenting a moderate to severe depression (MSD), only 16.8% were followed up in psychiatry, 4.2% were receiving antidepressant and 9.8% benzodiazepine. MSD was associated with low educational level (P < 0.001); low to medium socio economic level (P < 0.001); psychiatric histories (P < 0.001); suicide attempt histories (P < 0.001); somatic histories (P < 0.001).

Our study highlighted a high prevalence of depression that is still under diagnosed and therefore poorly managed. General practitioners should be made aware of the importance of screening for depression in medical patients because it not only complicates their overall medical treatments, but also impedes their physical and social functioning.

The authors have not supplied their declaration of competing interest.

Depression is one of the most well-known psychological issues and is among the most severe ones. World Health Organisation's (WHO) report on health identifies 1.9% lifetime prevalence of depressive episode for males and almost twice as high–3.2% for females.

This study aimed to map the depressive symptoms among working population in Czech Republic.

Analysis of covariance showed that there is significant effect of age F(52) = 6.58, P = 0.010 and gender F(52) = 12.53, P < .001 and t-tests showed the means of BDI II scores were significantly different for genders with females having higher mean (11.91) than males (9.80), t(1025) = −3.42, P < .001.

The clinical burden of depression is still an increasing one in today's society and this research helped to identify the potentially most vulnerable individuals. These seem to be working women aged 35–44.

The authors have not supplied their declaration of competing interest.

Caregivers of Alzheimer Disease (AD) patients suffer from chronic stress and psychophysical burden, which often lead to depression symptoms. It seems that core self-evaluation (CSE), coping with stress and social support might be modifying factors in coping with situation of caregiving.

The aims of the study were to examine: (1) level of depression; (2) relationships between CSE, style of coping with stress, social functioning and depression severity among caregivers.

The study involved 60 caregivers of AD patients who were children of the sick and have been caring for at least one year. It was cross-sectional and assessed by questionnaires. Following tools were used: Core Self-Evaluation, Beck Depression Inventory, Coping Inventory for Stress Situations, Distress Thermometer and an original questionnaire assessing the situation of caregiving.

A total of 51.7% of responders demonstrated severity of depression symptoms, associated to at least one mild clinical depression episode. The factors introduced to the model explained 65% variance of depression symptoms. Predictors of greater depression symptoms proved to be: low CSE (ΔR2 = 0.32; β = −0.12), low social support (ΔR2 = 0.08; β = −0.27), low life satisfaction (ΔR2 = 0.02, β = −0.26), high levels of distress (ΔR2 = 0.12, β = 0.31), coping style focused on emotions (ΔR2 = 0.12, β = 0.17).

In the area of caregivers’ psychological assistance and depression therapy, interventions leading to increase of CSE and providing adequate social support that contributes to better care provision and maintaining proper self-image, should be taken into consideration.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The application of scientific evidence in clinical practice management of Major Depressive Disorder (MDD) is complex. Generally, the usual dissemination process and implementation of Clinical Practice Guidelines (CPG) induce modest changes. A computerized version of a Clinical Practice Guideline for Major Depression (e-CPG-MD) has been integrated in Electronic Clinical Records of Primary Care in Catalonia (Spain). It offers an opportunity to improve clinical results. The design allows access to precise help in the visit itself, improving diagnosis, treatment and follow-up.

To evaluate the effects of a multifaceted implementation process of e-CPG-MD, analysing their use and changes in MDD diagnosis.

A cluster randomized clinical trial was performed in 10 primary care centers (PCC) in Barcelona. In five of ten centers, a multifaceted implementation process of the e-CPG-MD was developed during 6 month. The active process includes: interactive training program, regular feedback audit, educational outreach visits and periodic reminders.

The multifaceted implementation of e-CPG-MD was associated with a significant increase in use during the first 6 months (4.1% + 3.1% vs. 52.7% + 7.3%, P < 0.001). In the active centers, the MD diagnosis increased significantly (rate quotient = 1.56, P < 0.001) and the proportion of moderate and severe MD increased (13.6% vs 41.1%, P = 0.002).

A multifaceted implementation method of e-CPG-MD increased significantly its use in active centers at 6 months. Diagnosis of MDD and the proportion of moderate and severe cases also increased significantly.

The authors have not supplied their declaration of competing interest.

Digital mood-monitoring technology, such as mood-monitoring applications, is increasingly advocated within clinical research and is a potentially effective method to engage and empower youth. However, limited evidence is available on this type of technology.

(1) To assess the evidence for the use of mobile mood-monitoring applications in youth; (2) to explore what available smartphone application would be most suitable to monitor mood from the perspective of young people; (3) to examine whether mood-monitoring applications are useful for investigating mood instability in youth; (4) to explore the utility and acceptability of using the mood-monitoring application from young people's and clinicians’ perspectives.

To investigate how mood-monitoring applications can be used to support the assessment, engagement and empowerment of young people presenting to mental health services with a range of diagnoses in which mood instability forms a key component.

A systematic review using a Cochrane methodology was conducted. After obtaining ethical approval, this study will also employ a mixed methods approach, through which quantitative findings (e.g., digital mood-monitoring data) will be furnished with an in-depth understanding of young people's views on digital mood-monitoring technology.

Findings from a systematic review focusing on the evidence for the psychometric properties, usability and clinical impacts of applications in youth will be presented. Preliminary results from consultations groups and plans for future research will also be discussed.

Evidence acquired through this research can potentially influence mental health policies and result in more innovative (adjunct) interventions and improved outcomes for young people with mood instability.

The authors have not supplied their declaration of competing interest.

With an increasingly growing population in Europe, cognitive impairment is a major social and health issue. According to the World Alzheimer Report (WHO, 2014), dementia, including Alzheimer's disease is one of the biggest global public health challenges our generation is facing. There are many efforts at European level to promote active and healthy ageing. This three-year project has the ambition to provide new services for integrated care with breakthrough research and radical innovation by employing user-friendly Information and Communication Technology (ICT) tools, ultimately increasing patients’ quality-of-life and autonomy at home.

ICT4Life proposes an innovative platform for integrated care by the use of sensor-based analytics for human behaviour. Novel ICT services are used to determine the relation between cognitive decline, related psychopathological symptoms and the quality-of-life of the patients, and to assess how these affect patients’ and caregivers’ daily living. ICT4Life platform uses advanced sensor-based analytics; to maximize elderly empowerment and self-care abilities thanks to a properly designed and reconfigurable recommendation system that will be able to exploit user-generated data; and to improve decision-making processes in care professionals’ daily activities. All solutions are developed following a user-centred methodology and tested in real-life scenarios.

The study design and the preliminary results of the ICT4Life project are presented on the poster.

ICT4Life programme develops a solution for individuals with early stage cognitive impairment that will permit doctors and caregivers to extract useful information about patients, while contributing in a user-friendly way to extending their independence.

COI: This project has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement N° 690090. Tamas Tenyi and Sandor Fekete are supported by the National Brain Research Program Grant N° NAP KTIA NAP-A-II/12.