Jerrold Rosenbaum
Harvard Medical School, Psychiatry, Faculty Member
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Research Interests: Psychology, Clinical Psychology, Psychiatry, Medicine, Comorbidity, and 15 moreAnxiety, Humans, Mania, Major Depressive Disorder, Female, Male, Panic Disorder, Clinical Sciences, Anxiety and Depression, Major Depression, Adult, ANXIETY, Case Control Studies, Socioeconomic Factors, and Referral and consultation
Background. To evaluate the longitudinal course of psychiatric disorders in children of parents with panic disorder (PD) and major depression (MD) as they transition through the period of risk from childhood into adolescence.Method. Over... more
Background. To evaluate the longitudinal course of psychiatric disorders in children of parents with panic disorder (PD) and major depression (MD) as they transition through the period of risk from childhood into adolescence.Method. Over a 5-year follow-up, we compared psychiatric disorders in four groups of children: (1) offspring of parents with PD plus MD (n=136); (2) offspring of parents with PD without MD (n=27); (3) offspring of parents with MD but without PD (n=53); and (4) offspring of non-PD non-MD parents (n=103).Results. Parental PD was significantly associated with increased risk for anxiety disorders, irrespective of parental MD. Parental MD was associated with increased risk for MD, disruptive behavior disorders, and deficits in psychosocial functioning, irrespective of parental PD.Conclusions. These longitudinal findings confirm and extend previous cross-sectional results documenting significant associations between PD and MD in parents and patterns of psychopathology and dysfunction in their offspring.
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Research Interests: Bipolar Disorder, Causality, Child Behavior, Humans, Child, and 15 moreMajor Depressive Disorder, Female, Male, American, Conduct Disorder, Major Depression, Age Factors, Disinhibition, Logistic Models, Child preschool, Attention deficit disorder with hyperactivity, Attention deficit hyperactivity disorder, High risk, Medical and Health Sciences, and Genetic predisposition to disease
Research Interests: Medicine, Comorbidity, Anxiety, Agoraphobia, Humans, and 15 moreGeneralized Anxiety Disorder, Major Depressive Disorder, Female, Male, Panic Disorder, Obsessive Compulsive Disorder, Life Cycle, Middle Aged, Major Depression, Panic, Observer Variation, Adult, ANXIETY, Anxiety Disorder, and Medical and Health Sciences
With the extensive media coverage on September 11, 2001, adults and children indirectly witnessed the terrorist attacks leading to the deaths of almost 3,000 people. An ongoing longitudinal study provided the opportunity to examine... more
With the extensive media coverage on September 11, 2001, adults and children indirectly witnessed the terrorist attacks leading to the deaths of almost 3,000 people. An ongoing longitudinal study provided the opportunity to examine pre-event characteristics and the impact of this media exposure. We assessed symptoms of PTSD in 166 children and 84 mothers who had no direct exposure to the 9/11 attacks. The sample included children who had parents with or without anxiety and mood disorders, and who had been assessed for the presence or absence of temperamental behavioral inhibition (BI). We found a 5.4 percent rate of symptomatic PTSD in response to 9/11 in children and 1.2 percent in their mothers. Children's identification with victims of the attack, and for younger children, the amount of television viewing predicted increased risk of PTSD symptoms. Parental depression was associated with higher symptoms, and pre-event levels of family support was associated with a lower risk for PTSD symptoms. BI in children was also linked to lower rates of PTSD symptoms, suggesting that a cautious and fearful approach to novelty may offer protection against exposure to media-based traumatic images. Media viewing of tragic events is sufficient to produce PTSD symptoms in vulnerable populations such as children. Given the links between PTSD symptoms and viewing habits, parental monitoring of media exposure may be important for younger children.
Research Interests: Anxiety Disorders, Adolescent, Comorbidity, Anxiety, Humans, and 15 moreChild, Major Depressive Disorder, Female, Boston, Clinical Sciences, Longitudinal Studies, Longitudinal Study, Family Support, ANXIETY, EXPRESSED EMOTION, Anxiety Disorder, Family Conflict, Child preschool, Child behavior disorders, and Genetic predisposition to disease
BACKGROUND We have previously shown that subsyndromal scores on the Child Behavior Checklist (CBCL)-Anxiety/Depression (Anx/Dep) scale at baseline predicted the subsequent development of Major Depressive Disorder (MDD) in youth with ADHD.... more
BACKGROUND We have previously shown that subsyndromal scores on the Child Behavior Checklist (CBCL)-Anxiety/Depression (Anx/Dep) scale at baseline predicted the subsequent development of Major Depressive Disorder (MDD) in youth with ADHD. The present study aimed to replicate these findings in a separate, long-term, longitudinal sample of children at high- and low- risk for depression. METHODS 219 children of parents with and without depression and/or anxiety, ages 2-25, were stratified into 3 groups: 1) children with familial risk for depression (by presence of parental MDD) plus subsyndromal scores on the CBCL-Anx/Dep scale, 2) children with familial risk for depression without subsyndromal scores, and 3) children with neither familial risk for depression nor subsyndromal scores. Subjects were reassessed at both 5 and 10 year follow-ups. RESULTS Children with both subsyndromal scores on the CBCL-Anx/Dep plus a familial risk for depression were at greater risk for developing MDD at the 10 year follow-up when compared with all other groups. Those with familial risk but no subsyndromal scores had an intermediate risk that was greater than the controls, who had the lowest risk. LIMITATIONS The recruitment of the study included families with parental panic disorder, so the sample likely included more families with anxiety disorders than the general population. CONCLUSIONS Our results showed that subsyndromal scores of the CBCL-Anx/Dep scale increased the risk for the subsequent development of MDD, particularly in children at high risk for depression. These results confirm the CBCL-Anx/Dep scale's utility in identifying children at high risk for developing MDD.
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as having low «4) or high (::::4) insomnia. Baseline-to-<:ndpoint reduction in this score was used as a measure of improvement. The frequency of treatment-emergent insomnia (appeared or worsened during treatment) was also determined.... more
as having low «4) or high (::::4) insomnia. Baseline-to-<:ndpoint reduction in this score was used as a measure of improvement. The frequency of treatment-emergent insomnia (appeared or worsened during treatment) was also determined. Results: Fluoxetine-treated patients with high baseline insomnia experienced significant reductions in their HAMD-Sleep Disturbance Factor score compared with placebo-treated patients (f1uoxetine, -2.129; placebo, -1.616; p < .001). Patients with low baseline insomnia showed a slightly decreased (NS) Sleep Disturbance score in both treatment groups (fluoxetine, -Q.243; placebo, -Q.272). Improvement in mean HAMD total scores for f1uoxetinetreated patients (total, high, and low insomnia) was statistically significantly greater compared with placebo-treated patients. Frequency of treatment-emergent insomnia with f1uoxetine treatment was similar regardless of baseline Sleep Disturbance score (low insomnia, 15.7%; high insomnia, 16.0"10). Conclusion: These findings demonstrate that fluoxetine-treated patients with high baseline insomnia experience improvement in in. somnia symptoms as their overall depression imp=s. Treatmentemergent insomnia in t1uoxetine-treated patients cannot be predicted based on a patient's presenting sleep disturbance.
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Os autores examinaram a frequencia de eventos vitais significativos durante o ano que antecedeu o transtorno do pânico e sua relacao com historia de ansiedade na infância, historia familiar de ansiedade, comorbidades e curso da doenca.... more
Os autores examinaram a frequencia de eventos vitais significativos durante o ano que antecedeu o transtorno do pânico e sua relacao com historia de ansiedade na infância, historia familiar de ansiedade, comorbidades e curso da doenca. Foram acompanhados 223 pacientes em estudo naturalistico, longitudinal do transtorno do pânico. Embora 80 por cento dos pacientes com transtorno do pânico referisse a ocorrencia de fator estressante no ano anterior ao inicio da doenca, sua frequencia e mais elevada em pacientes com historia de ansiedade na infância e comorbidade com depressao na vida adulta. A presenca de eventos vitais significativos nao esta associada com a presenca de outros transtornos de ansiedade na vida adulta e nem com historia familiar de ansiedade. Apesarde sua associacao com historia de ansiedade na infância e depressao, a presenca de um fator estressor identificavel nao esta associado a severidade ou ao curso do transtorno do pânico (AU)
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The purpose of this study was to determine prospectively the optimal length of therapy in a long-term, placebo-controlled continuation study of patients who responded to acute fluoxetine treatment for major depression (defined by... more
The purpose of this study was to determine prospectively the optimal length of therapy in a long-term, placebo-controlled continuation study of patients who responded to acute fluoxetine treatment for major depression (defined by DSM-III-R). The study was conducted at five outpatient psychiatric clinics in the United States. Patients who met criteria for remission after 12 or 14 weeks of open-label acute fluoxetine therapy, 20 mg/day (N=395 of 839 patients), were randomly assigned to one of four arms of a double-blind treatment study (50 weeks of placebo, 14 weeks of fluoxetine and then 36 weeks of placebo, 38 weeks of fluoxetine and then 12 weeks of placebo, or 50 weeks of fluoxetine). Relapse rate was the primary outcome measure. Both Kaplan-Meier estimates and observed relapse rates were assessed in three fixed 12-week intervals after double-blind transfers from fluoxetine to placebo at the start of the double-blind period and after 14 and 38 weeks of continued fluoxetine treatment. Relapse rates (Kaplan-Meier estimates) were lower among the patients who continued to take fluoxetine compared with those transferred to placebo in both the first interval, after 24 total weeks of treatment (fluoxetine, 26.4%; placebo, 48.6%), and the second interval, after 38 total weeks of treatment (fluoxetine, 9.0%; placebo, 23.2%). In the third interval, after 62 total weeks of treatment, rates were not significantly different between the groups (fluoxetine, 10.7%; placebo, 16.2%). Patients treated with fluoxetine for 12 weeks whose depressive symptoms remit should continue treatment with fluoxetine for at least an additional 26 weeks to minimize the risk of relapse.
Research Interests: Psychology, Treatment Outcome, Medicine, Prospective studies, Humans, and 15 morePlacebo, Female, Male, American, Depressive Disorder, Placebos, Adult, Time Factors, FLUOXETINE, American J of Psychiatry, Continuation, SECONDARY PREVENTION, Ambulatory Care, Psychology and Cognitive Sciences, and Medical and Health Sciences
This study examined the use patterns and efficacy of the high potency benzodiazepine (HPB) clonazepam in panic patients who were treated and followed naturalistically in the Massachusetts General Hospital Longitudinal Study of Panic... more
This study examined the use patterns and efficacy of the high potency benzodiazepine (HPB) clonazepam in panic patients who were treated and followed naturalistically in the Massachusetts General Hospital Longitudinal Study of Panic Disorder. Of 204 patients followed over a 2-year period, 46 percent were receiving clonazepam alone or in combination with an antidepressant. Treatment was not controlled at initial evaluation or during the followup period. The main variables assessed in this analysis included global severity of the panic disorder and stability of clonazepam dose. All treatment groups tended to improve over time without significant differences in outcome between groups. Clonazepam doses remained stable over time. Results of this study suggest that treatment of panic disorder with the HPB clonazepam achieved and maintained a therapeutic benefit similar to that obtained with alternative pharmacologic treatments, without the development of tolerance as manifested by dose es...
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... 1988;24(1):189-94. An open-label pilot study of oral S-adenosyl-L-methionine in major depression: interim results. Rosenbaum JF, Fava M, Falk WE, Pollack MH, Cohen LS, Cohen BM, Zubenko GS. PMID: 3387521 [PubMed - indexed for... more
... 1988;24(1):189-94. An open-label pilot study of oral S-adenosyl-L-methionine in major depression: interim results. Rosenbaum JF, Fava M, Falk WE, Pollack MH, Cohen LS, Cohen BM, Zubenko GS. PMID: 3387521 [PubMed - indexed for MEDLINE]. MeSH Terms. ...
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We hypothesized that the dehydroepiandrosterone-sulfate (DHEA-S)/cortisol ratio, which has been used as an index of adrenocortical function, would be altered in panic disorder patients and would change after treatment. We evaluated 10... more
We hypothesized that the dehydroepiandrosterone-sulfate (DHEA-S)/cortisol ratio, which has been used as an index of adrenocortical function, would be altered in panic disorder patients and would change after treatment. We evaluated 10 male and 14 female outpatients meeting DSM-III-R criteria for panic disorder. Of these 24 subjects, 13 were treated with clonazepam, 8 were treated with alprazolam, and 3 were treated with placebo as part of a double-blind study. The DHEA-S/cortisol ratio values in the 24 patients with panic disorder (mean = 20.5, SD = 11.6) were significantly higher than those of a group of 60 normal controls (mean = 11.5, SD = 6.01) and were also significantly higher than those of a group of 22 depressed patients (mean = 10.6, SD = 6.33). Although there was no significant difference in the pretreatment DHEA-S/cortisol ratio values between male (mean = 23.6, SD = 11.8) and female (mean = 18.2, SD = 11.3) panic disorder patients, the effects of treatment on this ratio differed between the two sexes. In fact, in the female patients there was a significant decrease in the DHEA-S/cortisol ratio at the end of the study (mean = 15.1, SD = 7.9), while in the male patients there was no significant change in this ratio at the end of the study (mean = 30.2, SD = 21.4). No significant differences were noted between pretreatment and posttreatment DHEA-S/cortisol ratio values in patients treated with alprazolam (n = 8), in patients treated with clonazepam (n = 13), or in patients treated with placebo (n = 3).(ABSTRACT TRUNCATED AT 250 WORDS)
Research Interests: Endocrinology, Fear, Medicine, Agoraphobia, Cortisol, and 15 moreHumans, Internal Medicine, Female, Male, Panic Disorder, Panic, Adult, Dehydroepiandrosterone, Alprazolam, Clinical Trials as Topic, clonazepam, Phobic disorders, hydrocortisone, Medical and Health Sciences, and dehydroepiandrosterone sulfate
Research Interests: Endocrinology, Psychology, Medicine, Dopamine, Brain, and 15 moreHumans, Prolactin, Internal Medicine, Antidepressant, Female, Male, Depressive Disorder, Middle Aged, Adult, Psychiatric, Psychiatric Status Rating Scales, dopaminergic, Psychology and Cognitive Sciences, Medical and Health Sciences, and Antidepressive agents
Research Interests: Clinical Psychology, Cognitive Science, Personality, Personality Disorders, Adolescent, and 15 moreMedicine, Comorbidity, Humans, Female, Personality Disorder, Male, Depressive Disorder, Clinical Sciences, Aged, Middle Aged, Adult, Age Factors, Ambulatory Care, Personality Inventory, and Age distribution
Research Interests: Clinical Psychology, Anxiety Disorders, Medicine, Comorbidity, Anxiety, and 15 moreHumans, Child, Female, Male, Mental Disorders, Adult, Clinical Psychiatry, Age Factors, ANXIETY, Anxiety Disorder, Cross Sectional Studies, Age of Onset, Cohort Studies, Attention deficit disorder with hyperactivity, and Medical and Health Sciences
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Research Interests: Psychology, Medicine, Biological Sciences, Biological Psychiatry, Dexamethasone, and 15 moreCortisol, Humans, Placebo, Female, Male, Depressive Disorder, Dichotic Listening, Adult, Prognosis, Ambulatory Care, Psychology and Cognitive Sciences, hydrocortisone, Dichotic Listening tests, Medical and Health Sciences, and Antidepressive agents
This study provides norms for depressed subjects for a widely used test of verbal memory, the California Verbal Learning Test (CVLT). Subjects were 156 outpatients with major depression tested during a drug washout period. Mean CVLT... more
This study provides norms for depressed subjects for a widely used test of verbal memory, the California Verbal Learning Test (CVLT). Subjects were 156 outpatients with major depression tested during a drug washout period. Mean CVLT memory scores for these patients were generally between one-half and one standard deviation below age- and sex-corrected norms for nondepressed populations. Severity of depression in the patients was not associated with memory performance, but was associated with self-report of cognitive difficulties. A table of age-, sex-, and education-specific norms for the CVLT is provided.
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Research Interests: Psychology, Depression, Personality Assessment, Drug interactions, Medicine, and 15 moreProspective studies, Humans, Antidepressant, Major Depressive Disorder, Female, Male, Clinical Sciences, Anxiety and Depression, Middle Aged, Adult, Serotonin Uptake Inhibitors, Tolerability, Personality Inventory, discontinuation, and Substance Withdrawal Syndrome
Research Interests: Anxiety Disorders, Medicine, Comorbidity, Anxiety, Agoraphobia, and 15 moreHumans, Generalized Anxiety Disorder, Major Depressive Disorder, Female, Male, Depressive Disorder, Clinical Sciences, Major Depression, Comprehensive, Adult, ANXIETY, Indexation, Anxiety Disorder, Age of Onset, and Age distribution
Research Interests: Depression, Evolution, Comparative Study, Medicine, Comorbidity, and 15 moreProspective studies, Humans, Internal Medicine, Antidepressant, Major Depressive Disorder, Female, Drug Resistance, Male, Depressive Disorder, Health Status, Clinical Sciences, Adult, FLUOXETINE, desipramine, and discontinuation
The relationship between hypochondriacal concerns, as assessed by the Illness Attitude Scales, and depressive symptoms was examined in a sample of 100 drug-free outpatients with major depressive disorder. These patients were treated with... more
The relationship between hypochondriacal concerns, as assessed by the Illness Attitude Scales, and depressive symptoms was examined in a sample of 100 drug-free outpatients with major depressive disorder. These patients were treated with fluoxetine for 8 weeks, and the effect of treatment on hypochondriacal symptoms was examined. All patients were administered the Structured Clinical Interview for DSM-III-R, the Hamilton Depression Rating Scale, the Symptom Questionnaire, and the Personality Disorders Questionnaire-Revised. We found little relationship between severity of depressive symptoms and hypochondriacal concerns. Measures of anxiety, somatic symptoms, and psychological distress were more consistently related to these concerns. Similarly, patients with either histrionic personality disorder or a lifetime history of panic disorder had greater hypochondriacal concerns than patients without these diagnoses. After open treatment with fluoxetine, the degree of hypochondriacal concerns showed statistically significant decreases, which were only partly related to the degree of change in depression and anxiety severity. Our findings suggest that the presence of hypochondriacal concerns among depressed outpatients is more closely related to the presence of anxiety than depressive symptoms. The relatively small impact of an acute course of antidepressant treatment on hypochondriacal concerns in our sample suggests that these concerns may be enduring characteristics modulated only to a limited extent by short term pharmacological alterations of affective state.
Research Interests: Clinical Psychology, Psychiatry, Anxiety Disorders, Medicine, Comorbidity, and 15 moreDistress, Anxiety, Humans, Female, Male, Panic Disorder, Depressive Disorder, Middle Aged, Adult, FLUOXETINE, ANXIETY, Histrionic Personality Disorder, Hypochondriasis, Personality Inventory, and Medical and Health Sciences
Atypical depression is the most common form of depression in outpatients, but compared with melancholia, little is known about its comorbidity, course, and treatment. Beyond the well-characterized constellation of symptoms that define... more
Atypical depression is the most common form of depression in outpatients, but compared with melancholia, little is known about its comorbidity, course, and treatment. Beyond the well-characterized constellation of symptoms that define atypical depression (mood reactivity, hypersomnia, leaden paralysis, hyperphagia, and rejection sensitivity), specific Axis I and II comorbid conditions may differentiate atypical from other depressed patients. Similarly, age at onset, duration of episodes, frequency of relapses and recurrences, and frequency of complete remission in atypical depression may be different. It has not even been established if atypical depression is a stable subtype or if it is just one of several forms of depression that an individual may express during a lifetime of recurrent depressions. Monoamine oxidase inhibitors (MAOIs) are superior to tricyclic antidepressants (TCAs) for the treatment of atypical depression, but few studies have compared MAOIs to the newer generation of antidepressants (SSRIs, bupropion, venlafaxine, nefazodone, and mirtazapine). Because of the favorable benefit/risk ratio, clinicians tend to use these newer antidepressants for all outpatients, including those with atypical depression, even though the literature is limited. A review and critique of the relevant literature on atypical depression will be presented.
Research Interests: Adolescent, Medicine, Comorbidity, Humans, Female, and 15 moreDepressive Disorder, Mental Disorders, Melancholia, Aged, Middle Aged, Adult, Clinical Psychiatry, Atypical Depression, Ambulatory Care, Age of Onset, Clinical Trials as Topic, bupropion, Medical and Health Sciences, Antidepressive agents, and Monoamine oxidase inhibitors
Tolcapone is a catechol-O-methyltransferase (COMT) inhibitor that has shown efficacy in the treatment of Parkinson&amp;amp;#39;s disease. The authors undertook the first study on the efficacy of this COMT inhibitor in the treatment of... more
Tolcapone is a catechol-O-methyltransferase (COMT) inhibitor that has shown efficacy in the treatment of Parkinson&amp;amp;#39;s disease. The authors undertook the first study on the efficacy of this COMT inhibitor in the treatment of major depressive disorder (MDD). The authors also wanted to assess the effects of tolcapone on the choline and myoinositol resonances in the left caudate and dorsolateral frontal lobe through proton magnetic resonance spectroscopy and on whole blood levels of S-adenosyl-L-methionine (SAMe). The study enrolled 21 adults (10 men and 11 women; mean age, 42.6 +/- 9.6 years) with MDD, which was diagnosed using the Structured Clinical Interview for DSM-IV, and an initial score of &amp;amp;gt; or = 16 on the 17-item Hamilton Rating Scale for Depression (HAM-D-17). Patients were then treated openly for 8 weeks with tolcapone 400 mg twice daily. Treatment efficacy was assessed with the HAM-D-17, the Clinical Global Impressions Severity (CGI-S) scale, and the Beck Depression Inventory (BDI). Among all subjects (N = 21), there were significant (p &amp;amp;lt; .0001) decreases at endpoint in HAM-D-17 scores (from 19.4 +/- 2.9 to 10.7 +/- 5.5), CGI-S scores (from 3.9 +/- 0.6 to 2.4 +/- 1.1), and BDI scores (from 21.6 +/- 8.1 to 12.3 +/- 8.6). Eight patients (38%) dropped out before completing the 8-week open study because of diarrhea, elevated liver function tests, increased anxiety, and noncompliance. No significant effects were noted on choline and myoinositol resonance or on SAMe levels in whole blood before and after 2 weeks of tolcapone treatment. The preliminary results suggest that tolcapone may be a promising agent in the treatment of MDD. Furthermore, double-blind, placebo-controlled studies are necessary to confirm this impression.
Research Interests: Gastroenterology, Magnetic Resonance Spectroscopy, Medicine, Humans, Internal Medicine, and 15 moreCaudate Nucleus, Personality Assessment Inventory, Major Depressive Disorder, Female, Clinical, Male, Inositol, Benzophenones, Beck Depression Inventory, Middle Aged, Adult, Choline, Frontal Lobe, Clinical Psychopharmacology, and Medical and Health Sciences
Research Interests: Psychology, Psychiatry, Health Care, Medicine, Clinical Practice, and 15 moreHumans, Antidepressant, Depressive Disorder, Massachusetts, Questionnaires, Empirical evidence, FLUOXETINE, Reproducibility of Results, Monoamine oxidase, Psychology and Cognitive Sciences, discontinuation, Medical and Health Sciences, Antidepressive agents, Monoamine oxidase inhibitors, and Drug prescriptions
Research Interests: Psychology, Depression, Personality Assessment, Medicine, Humans, and 15 moreInternal Medicine, Personality Assessment Inventory, Major Depressive Disorder, Female, Drug Resistance, Male, Middle Aged, Adult, Clinical Psychiatry, Combination drug therapy, Antipsychotic, Personality Inventory, Antipsychotic agents, Psychology and Cognitive Sciences, and Medical and Health Sciences
STAR* D is a multisite, prospective, randomized, multistep clinical trial of outpatients with nonpsychotic major depressive disorder. The study compares various treatment options for those who do not attain a satisfactory response with... more
STAR* D is a multisite, prospective, randomized, multistep clinical trial of outpatients with nonpsychotic major depressive disorder. The study compares various treatment options for those who do not attain a satisfactory response with citalopram, a selective serotonin ...
Research Interests: Clinical Trial, Adolescent, Prospective studies, Humans, Major Depressive Disorder, and 15 moreChronic Disease, Cognitive Therapy, Aged, Middle Aged, Adult, Health Care Utilization, Citalopram, Depressive Symptoms, Clinical Protocols, Level, Psychiatric Status Rating Scales, bupropion, Medical and Health Sciences, Antidepressive agents, and Major Depressive Episode
Research Interests: Psychology, Demography, Lithium, Medicine, Logistic Regression, and 15 moreHumans, Major Depressive Disorder, Female, Male, Psychological Intervention, Depressive Disorder, Adult, FLUOXETINE, Combination drug therapy, Serotonin Uptake Inhibitors, Socioeconomic Factors, desipramine, Psychology and Cognitive Sciences, Medical and Health Sciences, and Major Depressive Episode
Studies have revealed a relationship between serum cholesterol levels and serotonergic (5HT) function in healthy young adults. Patients with major depressive disorder (MDD) may have significant differences in cholesterol levels compared... more
Studies have revealed a relationship between serum cholesterol levels and serotonergic (5HT) function in healthy young adults. Patients with major depressive disorder (MDD) may have significant differences in cholesterol levels compared with healthy adults, while MDD patients with elevated cholesterol have a poorer prognosis for treatment response. The goal of the present study is to examine (1) the relationship between serum cholesterol levels and central 5HT function by way of the cortisol and prolactin response to the 5HT-selective agonist DL-fenfluramine in MDD patients and (2) differences in 5HT-function between MDD patients who present with and without elevated cholesterol. Fasting serum cholesterol levels were measured in 21 outpatients with MDD. After oral administration of 60 mg of DL-fenfluramine in these patients, cortisol and prolactin responses were measured to test whether cholesterol levels predicted the degree of cortisol or prolactin response. Cortisol and prolactin responses were compared between patients with and without elevated cholesterol levels, defined as &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;/=200 mg/dl. MDD patients with elevated cholesterol levels were more likely to demonstrate an attenuated cortisol response. There was no relationship between cholesterol levels and cortisol or prolactin response. Excess cholesterol may adversely affect the function of membrane-bound serotonergic structures, and this may explain why MDD patients with elevated cholesterol are more likely to exhibit attenuated neuroendocrine responses, less likely to respond to treatment and more likely to relapse.
Research Interests: Endocrinology, Psychiatry, Medicine, Serotonin, Cortisol, and 15 moreHumans, Prolactin, Internal Medicine, Major Depressive Disorder, Cholesterol, Female, Male, Middle Aged, Adult, Serum Cholesterol, Fenfluramine, Serotonin Uptake Inhibitors, Psychology and Cognitive Sciences, hydrocortisone, and Medical and Health Sciences
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Differences between depressed patients with and without suicidal ideation were examined, focusing on anger, aggression, and hostility. The Adult Suicide Ideation Questionnaire was used to compare 42 outpatients with major depression in... more
Differences between depressed patients with and without suicidal ideation were examined, focusing on anger, aggression, and hostility. The Adult Suicide Ideation Questionnaire was used to compare 42 outpatients with major depression in relationship to measures of anger, aggression, hostility, cynicism, life events, and depression. There were no differences on measures of anger, aggression, hostility, and on most measures of severity of depression, but the suicidal group demonstrated more evidence of cynicism. Suicidal ideation is associated with cynicism but is unrelated to measures of hostility, anger, or aggression or to severity of depression in outpatients.
Research Interests: Clinical Psychology, Cognitive Science, Psychiatry, Anger, Medicine, and 15 moreHumans, Aggression, Female, Male, Cynicism, Depressive Disorder, Differential Diagnosis, Clinical Sciences, Adult, Hostility, Poison Control, Life Change Events, Ambulatory Care, Psychiatric Status Rating Scales, and Personality Inventory
Research Interests: Psychology, Anxiety Disorders, Adolescent, Medicine, Comorbidity, and 15 moreAnxiety, Psychological Medicine, Humans, Antidepressant, Major Depressive Disorder, Female, Male, Aged, Middle Aged, Adult, Public health systems and services research, ANXIETY, Neurosciences, Psychiatric Status Rating Scales, and Antidepressive agents
Research Interests: Psychology, Research Design, Treatment Outcome, Medicine, Probability, and 15 morePhytotherapy, Humans, Placebo, Major Depressive Disorder, Female, Male, Antidepressants, Middle Aged, Adult, Hypericum, Clinical Psychopharmacology, Randomized Controlled Trials as Topic, Psychology and Cognitive Sciences, Medical and Health Sciences, and Antidepressive agents
Research Interests: Psychology, Clinical Psychology, Cognitive Science, Medicine, Humans, and 15 moreAggression, Female, Male, Gender Difference, Lung Diseases, Depressive Disorder, Clinical Sciences, Adult, Sex Factors, Hostility, Irritability, Ambulatory Care, Severity of Illness Index, Psychiatric Status Rating Scales, and Personality Inventory
Research Interests: Depression, Prediction, Medicine, Prospective studies, Humans, and 15 moreInternal Medicine, Affective Disorders, Placebo, Antidepressant, Female, Male, Depressive Disorder, Placebos, Middle Aged, Major Depression, Affective, Adult, FLUOXETINE, Hamilton Depression Rating Scale, and Medical and Health Sciences
Although the newer antidepressants are widely used, little is known about how long it takes to see their full effect. The authors sought to determine how many weeks a fluoxetine trial with no improvement should continue before treatment... more
Although the newer antidepressants are widely used, little is known about how long it takes to see their full effect. The authors sought to determine how many weeks a fluoxetine trial with no improvement should continue before treatment is changed. The data involved 840 patients in a 12-week open trial of fluoxetine, 20 mg/day, followed by a blinded, placebo-controlled discontinuation study. Outcomes at 4, 6, 8, 10, and 12 weeks were classified as nonresponse, partial response, response, and remission and were based on Hamilton Depression Rating Scale scores. The rate of remission at week 12 was calculated for each group of patients without remission at the earlier time points. The time to relapse during weeks 13-26 of the discontinuation study was examined in patients taking placebo and fluoxetine in relation to status at week 6. Patients unimproved at week 6 had a remission rate at week 12 of 31%-41%. For patients with remission at week 12, level of improvement at week 6 did not affect prognosis in weeks 13-26. Of the unimproved patients at week 8, 23% had remissions by week 12. The week 12 remission rate for unimproved patients at week 4 was clearly high enough to justify continued treatment; the rate for unimproved patients at week 10 was too low. These data suggest that nonresponse to fluoxetine should not be declared until 8 weeks of treatment have elapsed. Practitioners should discuss trial length with patients at the beginning of treatment.
Research Interests: Mental Health, Depression, Adolescent, Comparative Study, Medicine, and 15 moreHumans, Placebo, American, Depressive Disorder, Placebos, Aged, Middle Aged, Major Depression, Adult, FLUOXETINE, Prognosis, Disease Progression, Proportional Hazards Models, discontinuation, and Medical and Health Sciences
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The relationship between depression and comorbid personality disorders is still poorly understood. The aims of this study were to examine differences in depression severity between depressed outpatients with and without comorbid... more
The relationship between depression and comorbid personality disorders is still poorly understood. The aims of this study were to examine differences in depression severity between depressed outpatients with and without comorbid personality disorders, to determine the effect of a fixed dose of fluoxetine on personality disorders, and to assess the predictive value of personality disorder diagnoses at baseline with regard to response to fluoxetine. Eighty-three outpatients with major depressive disorder (MDD) were assessed with a self-rating scale, the Personality Diagnostic Questionnaire-Revised (PDQ-R), before and after 8 weeks of treatment with fluoxetine 20 mg/day. The presence of a cluster B diagnosis before treatment predicted positive outcome as measured by the change in score on the modified 17-item Hamilton Rating Scale for Depression (HAM-D-17*). Following treatment, we found significant reductions in the frequency of most individual personality disorder diagnoses and total PDQ-R score. While patients no longer meeting criteria for cluster B personality disorders after treatment had similar reductions in depressive symptoms compared to those maintaining the diagnoses, subjects no longer meeting criteria for cluster A and cluster C diagnoses after treatment exhibited significantly greater decreases in depression severity than those who maintained the diagnoses. Overall, these results suggest that fluoxetine may be beneficial in the treatment of certain personality disorder traits in patients with MDD.