Unipolar depression is daily encountered in psychiatry.

To describe the socio-demographic and clinical characteristics of patients with unipolar depression.

This is a cross-sectional, descriptive study carried out at the psychiatric department of the University Hospital of Mahdia. We have included patients with unipolar depression. The data were collected from patients’ medical files using a pre-established 37-item questionnaire.

We have collected 53 patients. The mean age was 44 years. The majority of patients were female (56.6%) and unemployed (70%). 47.2% of patients were married. 72% of patients had a low socio-economic level. They were smokers in 45.3% of cases. Alcohol consumption was found in 24.5% of cases. A family history of mood disorder and suicide or attempted suicide were present in 7% and 13.2% of the cases respectively. 7% of the patients had a history of a postpartum thymic episode. The mean number of depressive episodes was 2.5. Personal history of suicide attempts was found in 40% of cases. The mean age of the first thymic episode was 35 years. At the psychiatric examination, psychomotor retardation was present in 64% of cases, anxiety distress in 58.5% of cases, psychotic, melancholic and atypical characteristics in 30%, 13.2% and 5.7% of cases respectively. 81% of patients were treated with anxiolytic drugs in combination with an antidepressant. Antipsychotic treatment was combined in 45% of cases and electro-convulsive therapy in 9.4% of cases.

Our patients presented predictive criteria of bipolarity. Therefore, vigilance is necessary in their medical management.

As psychotic agitated depression is now a well-described form of mixed state during the course of bipolar I disorder, we sought to investigate the diagnostic validity of a new definition for agitated (mixed) depression in bipolar II (BP-II) and major depressive disorder (MDD).

Three hundred and thirty six consecutive outpatients presenting with major depressive episodes (MDE) but without history of mania were evaluated with the Structured Clinical Interview for DSM-IV when presenting for the treatment of MDE. On the basis of history of hypomania they were assigned to BP-II (n = 206) vs. MDD (n = 130). All patients were also examined for hypomania during the current MDE. Mixed depression was operationally defined by the coexistence of a MDE and at least two of the following excitatory signs and symptoms as described by Koukopoulos and Koukopoulos (Koukopoulos A, Koukopoulos A. Agitated depression as a mixed state and the problem of melancholia. In: Akiskal HS, editor. Bipolarity: beyond classic mania. Psychiatr Clin North Am 1999;22:547–64): inner psychic tension (irritability), psychomotor agitation, and racing/crowded thoughts. The validity of mixed depression was investigated by documenting its association with BP-II disorder and with external variables distinguishing it from unipolar MDD (i.e., younger age at onset, greater recurrence, and family history of bipolar disorders). We analyzed the data with multivariate regression (STATA 7).

MDE plus psychic tension (irritability) and agitation accounted for 15.4%, and MDE plus agitation and crowded thoughts for 15.1%. The highest rate of mixed depression (38.6%) was achieved with a definition combining MDE with psychic tension (irritability) and crowded thoughts: 23.0% of these belonged to MDD and 76.9% to BP-II. Moreover, any of these permutations of signs and symptoms defining mixed depression was significantly and strongly associated with external validators for bipolarity. The mixed irritable-agitated syndrome depression with racing-crowded thoughts was further characterized by distractibility (74–82%) and increased talkativeness (25–42%); of expansive behaviors from the criteria B list for hypomania, only risk taking occurred with some frequency (15–17%).

These findings support the inclusion of outpatient-agitated depressions within the bipolar spectrum. Agitated depression is validated herein as a dysphorically excited form of melancholia, which should tip clinicians to think of such a patient belonging to or arising from a bipolar substrate. Our data support the Kraepelinian position on this matter, but regrettably this is contrary to current ICD-10 and DSM-IV conventions. Cross-sectional symptomatologic hints to bipolarity in this mixed/agitated depressive syndrome are virtually absent in that such patients do not appear to display the typical euphoric/expansive characteristics of hypomania—even though history of such behavior may be elicited by skillful interviewing for BP-II. We submit that the application of this diagnostic entity in outpatient practice would be of considerable clinical value, given the frequency with which these patients are encountered in such practice and the extent to which their misdiagnosis as unipolar MDD could lead to antidepressant monotherapy, thereby aggravating it in the absence of more appropriate treatment with mood stabilizers and/or atypical antipsychotics.

Age and sex-related patterns of association between medical conditions and major depressive episodes (MDE) are important for understanding disease burden, anticipating clinical needs and for formulating etiological hypotheses. General population estimates are especially valuable because they are not distorted by help-seeking behaviours. However, even large population surveys often deliver inadequate precision to adequately describe such patterns. In this study, data from a set of national surveys were pooled to increase precision, supporting more precise characterisation of these associations.

The data were from a series of Canadian national surveys. These surveys used comparable sampling strategies and assessment methods for MDE. Chronic medical conditions were assessed using items asking about professionally diagnosed medical conditions. Individual-level meta-analysis methods were used to generate unadjusted, stratified and adjusted prevalence odds ratios for 11 chronic medical conditions. Random effects models were used in the meta-analysis. A procedure incorporating rescaled replicate bootstrap weights was used to produce 95% confidence intervals.

Overall, conditions characterised by pain and inflammation tended to show stronger associations with MDE. The meta-analysis uncovered two previously undescribed patterns of association. Effect modification by age was observed in varying degrees for most conditions. This effect was most prominent for high blood pressure and cancer. Stronger associations were found in younger age categories. Migraine was an exception: the strength of association increased with age, especially in men. Second, especially for conditions predominantly affecting older age groups (arthritis, diabetes, back pain, cataracts, effects of stroke and heart disease) confounding by age was evident. For each condition, age adjustment resulted in strengthening of the associations. In addition to migraine, two conditions displayed distinctive patterns of association. Age adjusted odds ratios for thyroid disease reflected a weak association that was only significant in women. In epilepsy, a similar strength of association was found irrespective of age or sex.

The prevalence of MDE is elevated in association with most chronic conditions, but especially those characterised by inflammation and pain. Effect modification by age may reflect greater challenges or difficulties encountered by young people attempting to cope with these conditions. This pattern, however, does not apply to migraine or epilepsy. Neurobiological changes associated with these conditions may offset coping-related effects, such that the association does not weaken with age. Prominent confounding by age for several conditions suggests that age adjustments are necessary in order to avoid underestimating the strength of these associations.

There is substantial variability in the degree of cognitive impairment among older depressed persons. Inconsistencies in previous findings may be due to differences in clinical and demographic characteristics across study samples. We assessed the influence of unipolar depression and severity of depression on cognitive performance in a population-based sample of elderly persons aged ⩾60 years.

Eighty-nine persons fulfilled ICD-10 criteria for unipolar depression (mild, n = 48; moderate, n = 38; severe, n = 3) after thorough screening for dementia (DSM-IV criteria), psychiatric co-morbidities and antidepressant pharmacotherapy. Participants (n = 2486) were administered an extensive cognitive test battery.

Moderate/severe unipolar depression was associated with poorer performance on tasks assessing processing speed, attention, executive function, verbal fluency, episodic memory and vocabulary. Mild depression was associated with poorer performance in processing speed, and few differences between mild and moderate/severe depression were observed. No association between depression and short-term memory, general knowledge or spatial ability was observed. Increasing age did not exacerbate the depression-related cognitive deficits, and the deficits remained largely unchanged after excluding persons in a preclinical phase of dementia. Furthermore, depression-related cognitive deficits were not associated with other pharmacological treatments that may affect cognitive performance.

Cognitive deficits in unipolar old-age depression involve a range of domains and the cognitive deficits seem to follow the spectrum of depression severity. The finding that mild depression was also associated with poorer cognitive functioning underscores the importance of detecting mild depression in elderly persons.

We sought to ascertain the strength of evidence for association between the 5-HTTLPR polymorphism and unipolar depression.

We applied meta-analytic techniques to data from relevant published studies, and obtained an estimate of the likely magnitude of effect of any association. We also tested for possible publication bias, and explored the impact of various study design characteristics on the magnitude of the observed effect size.

Meta-analysis indicated evidence of a small but statistically significant association between the 5-HTTLPR polymorphism and unipolar depression [odds ratio (OR) 1.08, 95% confidence interval (CI) 1.03–1.12]. This remained significant when data from samples of European and East Asian ancestry were analyzed separately. In all cases there was evidence of significant between-study heterogeneity, although the observed associations were robust to the application of a random-effects framework.

Our results support the presence of a small effect of a polymorphism in the serotonin transporter promoter on susceptibility to depression. However, we caution that it is possible that the effect has an artifactual basis, rather than a biological origin.

Neurocognitive impairment is a well-recognized feature of depression that has been reported in younger and older adults. Similar deficits occur with ageing and it is unclear whether the greater deficits in late-life depression are an ageing-related phenomenon or due to a difference in the nature of late-life depression itself. We hypothesized that ageing alone would not fully explain the increased neurocognitive impairment in late-life depression but that differences in the illness explain the greater decrements in memory and executive function.

Comparison of the neuropsychological performance of younger (<60 years) and older (⩾60 years) adults with major depressive disorder (MDD) and healthy comparison subjects. Scores for each depression group were normalized against their respective age-matched control group and the primary comparisons were on four neurocognitive domains: (i) attention and executive function; (ii) verbal learning and memory; (iii) visuospatial learning and memory; and (iv) motor speed.

We recruited 75 subjects with MDD [<60 years (n=44), ⩾60 years (n=31)] and 82 psychiatrically healthy comparison subjects [<60 years (n=42), ⩾60 years (n=40)]. The late-life depression group had greater impairment in verbal learning and memory and motor speed but not in executive function. The two depressed groups did not differ in depression severity, global cognitive function, intelligence or education.

Late-life depression is associated with more severe impairment in verbal learning and memory and motor speed than depression in earlier adult life and this is not due to ageing alone.

– Como la depresión agitada psicótica es ahora una forma bien descrita de estado mixto durante el curso del trastorno bipolar I, intentamos investigar la validez diagnóstica de una nueva definición para la depresión (mixta) agitada en el trastorno bipolar II (TB II) y el trastorno depresivo mayor (TDM).

– Se evaluó a 336 pacientes ambulatorios consecutivos que acudieron con episodio depresivo mayor (EDM) pero sin antecedentes de manía con la Entrevista Clínica Estructurada para el DSM-IV cuando asistían para el tratamiento del EDM. Según los antecedentes de hipomanía se les asignó a TB II (n = 206) frente a TDM (n = 130). Se examinó también a todos los pacientes para hipo manía durante el EDM actual. La depresión mixta se definió operacionalmente por la coexistencia de un EDM y al menos dos de los sig- nos y si'ntomas excitatorios siguientes descritos por Koukopoulos y Koukopoulos (Koukopoulos, A. y Koukopoulos, A., "Agitated depression as a mixed State and the problem of melancolía". En: Akiskal H. S., compilador. "Bipolarity: Beyond classic mania". Psychiatr. Clin.North Am., 1999, 22: 547-564): tensión psíquica interna (irritabilidad), agitación psicomotriz y aceleración/agolpamiento de los pensa-mientos. La validez de la depresión mixta se investigó documentando su asociación con el TB II y con las variables externas que la dis- tinguían del TDM unipolar (es decir, edad menor en el comienzo, mayor recurrencia y antecedentes familiares de trastornos bipolares). Analizamos los datos con regresión multivariable (STATA 7).

– El EDM m ás la tensión psíquica (irritabilidad) y la agitación explicaban el 15,4%, y el EDM más la agitación y el agol- pamiento de los pensamientos, el 15,1%. La tasa más alta de depresión mixta (38,6%) se logró con una definición que combinaba el EDM con la tensión psíquica (irritabilidad) y el agolpamiento de los pensamientos: el 23,0% de estos pertenecía al TDM y el 76,9% al TB II. Además, cualquiera de estas permutaciones de los signos y si'ntomas que definían la depresión mixta se asociaba significativamente y con fuerza con validadores externos para la bipolaridad. El síndrome depresivo irritable-agitado mixto con aceleración-agolpamiento de los pensamientos se caracterizaba además por la distraibilidad (74-82%) y el aumento de la locuacidad (25-42%); de las conductas expansi- vas de la lista B de criterios para hipomanía, sólo la adopción de riesgos se produjo con alguna frecuencia (15-17%).

– Estos hallazgos apoyan la inclusión de las depresiones ambulatorias agitadas dentro del espectro bipolar. La depresión agitada se valida aquí como una forma disfóricamente excitada de la melancolía, lo que debería inclinar a los profesionales clínicos a pen- sar que un paciente de esta índole pertenece a un sustrato bipolar o deriva de él. Nuestros datos apoyan la posición de Kraepelin sobre este asunto, pero lamentablemente esto es contrario a las convenciones actuales de la CIE-10 y el DSM-IV. Las indicaciones sintomato- lógicas transversales hacia la bipolaridad en este síndrome depresivo mixto/agitado están casi ausentes, ya que estos pacientes no pare- cen mostrar las características eufóricas/expansivas típicas de la hipomanía, aun cuando una entrevista hábil para el TB II pueda obtener antecedentes de esta conducta. Reconocemos que la aplicación de esta entidad diagnóstica en la consulta ambulatoria sería de valor clí-nico considerable, dada la frecuencia con la que se encuentra a estos pacientes en ella y el grado en el que su diagnóstico erróneo como TDM unipolar podría llevar a monoterapia antidepresiva, agravándola así en ausencia de tratamiento más apropiado con estabilizadores del estado de ánimo, antipsicóticos atípicos, o ambos.