ABSTRACT
Mixed anxiety-depressive disorder (MADD) is a new diagnostic category defining patients who suffer from both anxiety and depressive symptoms of limited and equal intensity accompanied by at least some autonomic features. Patients do not meet the criteria for specific anxiety or depressive disorders. The emergence of the symptoms is independent of stressful life events. There are many issues presently under investigation about the validity of this clinical entity. In this study, a group of 29 patients with MADD was compared with a group of 31 patients with major depressive disorder (MDD) to assess the differences and similarities between these two disease categories in terms of severity measures and biological variables. The dexamethasone suppression test (DST) was employed, and thyroid hormones and thyrotropin (TSH) levels were measured for the evaluation of hypothalamic-pituitary-adrenal (HPA) and hypothalamic-pituitary-thyroid (HPT) axes, respectively. The patients with MADD were found to be less depressive and more anxious compared to those with MDD. DST responses and thyroid functions were found to be similar in the two groups. When severity of depression was controlled, k(max) and 2300-h cortisol values were found to be significantly higher in the MADD group. Although the patients with MDD and MADD presented with relatively different clinical features, there is not enough biological evidence indicating that MADD represents a discrete diagnostic category. However, there may be relatively higher HPA activity in MADD patients.
Subject(s)
Anxiety/diagnosis , Depressive Disorder, Major/diagnosis , Adult , Anti-Inflammatory Agents , Anxiety/complications , Anxiety/metabolism , Cross-Sectional Studies , Depressive Disorder/complications , Depressive Disorder/diagnosis , Depressive Disorder/metabolism , Depressive Disorder, Major/metabolism , Dexamethasone , Female , Humans , Hydrocortisone/blood , Hypothalamo-Hypophyseal System/metabolism , Life Change Events , Male , Pituitary-Adrenal System/metabolism , Sensitivity and Specificity , Severity of Illness Index , Stress, Psychological/psychology , Thyroid Hormones/metabolism , Thyrotropin/metabolismABSTRACT
Regional cerebral blood flow was investigated in 14 patients with major depression diagnosed according to the DSM-III-R criteria (six patients with single and eight patients with recurrent episodes) and in ten healthy volunteers. The mean ages of the patients and the controls were 33.5 +/- 2.7 and 31.6 +/- 2.6 years, respectively. The severity of the depression was assessed using the 17-item Hamilton Depression Scale (mean: 23.2 +/- 1.5). None of the patients was under medication. After administration of 500 MBq technetium-99m hexamethylpropylene amine oxime, a single photon emission tomography study was performed and then transaxial, sagittal and coronal slices were obtained. For the semiquantitative analysis of the data, the ratios of the mean counts/pixel to the whole slice were calculated for 24 regions on three consecutive transaxial slices in the orbitomeatal plane. Additionally, left/right and frontal/occipital ratios were calculated. Both sides of the temporal region had a significantly decreased cerebral blood flow (CBF) when compared to the controls. The left/right ratio of the prefrontal region was also significantly lower in the patients than in the controls. The Hamilton score had a negative correlation with blood flow in the anterofrontal and left prefrontal regions. According to our results, regional CBF seems to be decreased in the left prefrontal and in both temporal regions in major depression. The severity of depression is correlated with the reduction in CBF in the regions of the anterofrontal and left prefrontal cortex.
Subject(s)
Brain/diagnostic imaging , Cerebrovascular Circulation/physiology , Depressive Disorder/diagnostic imaging , Organotechnetium Compounds , Oximes , Tomography, Emission-Computed, Single-Photon , Adult , Depressive Disorder/diagnosis , Depressive Disorder/physiopathology , Female , Humans , Male , Psychiatric Status Rating Scales , Technetium Tc 99m ExametazimeABSTRACT
A review is presented of knowledge about the following issues in Turkey: prevalence of depression, suicidal attempts and suicide, clinical picture of depression, and etiological factors responsible for causing depression. Epidemiological studies of depression are reviewed and their results are discussed in detail, with special emphasis on conclusions with valid generalizations. As in almost all countries, depression, though exhibiting some differences clinically, is a major public health problem in Turkey. The point prevalence rate for depressive symptoms is nearly 20% and clinical depression has a rate of approximately 10%. Besides, about one-third of depressive patients are chronically ill. Specific risk groups for depression by various sociodemographic characteristics include women, widowed persons aged 40 years and over, close relatives of depressive persons, and members of lower socio-economic classes. An increase in the prevalence rates of depression in Turkey is expected due to changes in public attitudes, which do not consider depression a medical disorder at present; increase in life expectancy; rapid changes in socio-economic, cultural environments; and in family structures and lifestyles.
