Major Depression: A Short Term Naturalistic Study in Outpatients.

Background: Surprisingly data regarding naturalistic or observational studies carried out in India to study Major Depressive Disorder in patients seeking outpatient treatment is almost non-existing. So this study was conducted to study the presentation and baseline characteristics of Major Depressive Disorder in Indian outpatients and the subsequent treatment and outcome after a three month follow up. Methodology: Patients seeking outpatient treatment were recruited after diagnosing an episode of Major Depressive Disorder through a clinical interview for DSM IV TR. Sociodemographic and clinical characteristics were recorded at the time of recruitment and follow up evaluations done for 3 months. All the patients were given outpatient treatment best suited to the patient profile. Results :.More than 90% patients reported one or more somatic symptoms spontaneously on presentation . Barely half of the patients out of 119 recruited completed three month follow up. 50 (81%) patients out of 62 who received adequate treatment met recovery criteria at the end of three months. Initial depression severity and receiving regular adequate antidepressant therapy was found to be associated with recovery. While sociodemographic variables were not found to significantly affect treatment outcome or compliance. Conclusion : Somatic presentation of depression is quite common in Indian patients .The high noncompliance indicate the need for strategies to be made to improve compliance and the good response to treatment found in naturalistic conditions in this study calls for more such studies to be done for better understanding of predictors of outcome in naturalistic conditions in India.

A Case Control Study to Assess the Comorbidity of Depression and Migraine.

Background — Migraine is a common neurological disorder affecting around 18% of females and 6% of males. The present study was undertaken to identify and assess the impact of coexisting depression in diagnosed cases of migraine. Material and Methods — A hospital based case control study was conducted on 450 patients suffering from migraine of all ages and both sexes attending psychiatry OPD at civil hospital, Gurdaspur in Punjab. International headache society criteria for the diagnosis of migraine and 21- item Hamilton rating scale for depression was used. Migraine with depression (MWD) cases were compared with migraine without depression as controls (MC). Duration and frequency of migraine, comorbidity with depression was measured. Results — Out of 450 patients, 200 were MWD and 200 were MC patients. Among MWD and MC, females were common: 73% (146) and 75% (150) respectively. Of the females having MWD, 50% (73) belonged to age group 31-40 years as compared to females with MC where 58% (87) were from age group 21-30 years. Among the males, maximum number of patients belonged to age group 20-30 years for MWD and MC i.e 48% ( 26 ) and 57% (29) respectively. 50% of MWD reported having migraine attacks for five years or more years, whereas only 16% of MC had the similar duration (P value<0.01). 80% of (n=160) of MWD reported maximum disability during the headache as compared to 64% (n=128) of MC. 70% (140) of MWD had an average frequency of 4 or more attacks per month compared to 45% (90) of MC having one episode per month or less. Conclusion — Patients suffering from migraine with long history and high frequency might benefit from psychiatric evaluation and addition of antidepressants for their treatment.