Temperament and character traits in major depressive disorder: a case control study.

BACKGROUND: Patients with major depressive disorder (MDD) have distinct personality traits, compared with control subjects, although the role of anxiety and positive and negative affects in this finding is unclear. DESIGN AND SETTING: A case-control study enrolling 103 antidepressant-free depressed patients and 103 age and gender-matched controls was conducted at the University Hospital, University of São Paulo. METHODS: The self-reported scales of the Positive and Negative Affect Schedule (PANAS), State-Trait Anxiety Inventory (STAI) and Cloninger's Temperament and Character Inventory (TCI) were applied. Temperament and character traits were compared between groups using multivariate and bivariate analyses of variance (MANOVA and ANOVA). The influence of anxiety and affect was further investigated using ANOVA and mediation analyses. RESULTS: Depressed patients presented higher harm avoidance and lower self-directedness scores than controls. After adjustment for anxiety trait, harm avoidance was no longer significantly different between groups. Mediation analysis revealed that the anxiety trait, but not state-anxiety or affect, fully mediated the influence of group (depressed versus control subjects) on harm avoidance. CONCLUSIONS: Our findings confirm that depressed patients present personality traits distinct from those of controls and suggest that MDD is not directly associated with harm avoidance, but that this effect is fully mediated through the anxiety trait.

Temperament and character traits in major depressive disorder: a case control study

ABSTRACT BACKGROUND: Patients with major depressive disorder (MDD) have distinct personality traits, compared with control subjects, although the role of anxiety and positive and negative affects in this finding is unclear. DESIGN AND SETTING: A case-control study enrolling 103 antidepressant-free depressed patients and 103 age and gender-matched controls was conducted at the University Hospital, University of São Paulo. METHODS: The self-reported scales of the Positive and Negative Affect Schedule (PANAS), State-Trait Anxiety Inventory (STAI) and Cloninger's Temperament and Character Inventory (TCI) were applied. Temperament and character traits were compared between groups using multivariate and bivariate analyses of variance (MANOVA and ANOVA). The influence of anxiety and affect was further investigated using ANOVA and mediation analyses. RESULTS: Depressed patients presented higher harm avoidance and lower self-directedness scores than controls. After adjustment for anxiety trait, harm avoidance was no longer significantly different between groups. Mediation analysis revealed that the anxiety trait, but not state-anxiety or affect, fully mediated the influence of group (depressed versus control subjects) on harm avoidance. CONCLUSIONS: Our findings confirm that depressed patients present personality traits distinct from those of controls and suggest that MDD is not directly associated with harm avoidance, but that this effect is fully mediated through the anxiety trait.

Características de temperamento e caráter no transtorno depressivo maior: um estudo transversal com grupo controle / Temperament and character traits in major depressive disorder a cross-sectional study with a control group

A Depressão é um transtorno mental grave e com alta prevalência, de difícil tratamento e fator de risco para inúmeras outras doenças e disfuncionalidades. Seus principais sintomas são o humor deprimido e a anedonia. Considera-se que a personalidade afeta a vulnerabilidade individual para a depressão além de influenciar os tipos de sintomas e complicações experimentadas pelo paciente. O presente trabalho aborda o tema do Transtorno Depressivo Maior em relação a características de temperamento e caráter, baseado no modelo psicobiológico de Cloninger. Questiona-se quais estariam associadas à Depressão Maior e ainda, quais outras se revelam protetoras da saúde e do bem estar físico, mental e social. Foi realizado um estudo transversal cujo objetivo foi comparar características de temperamento e caráter entre sujeitos com Transtorno Depressivo Maior moderado a grave e um grupo controle de sujeitos saudáveis, sem transtornos neuropsiquiátricos. Os pacientes deprimidos estavam sem uso de antidepressivos há pelo menos três semanas no momento da avaliação. Participaram 103 sujeitos (69 mulheres e 34 homens) em cada grupo, pareados por sexo e idade. Os mesmos preencheram o Inventário de Temperamento e Caráter (ITC), um teste autoaplicável e que avalia quatro dimensões de temperamento (Busca de Novidades, Evitação de Danos, Dependência de Recompensa e Persistência) e três de caráter (Autodirecionamento, Cooperatividade e Autotranscendência), cada qual com suas subdimensões. Foi realizada a comparação de dados sociodemográficos entre os grupos e a correlação entre as 7 dimensões de temperamento e caráter com escalas que avaliam afeto e humor no grupo de deprimidos e outras características do Transtorno Depressivo Maior, como tipo, idade de início da Depressão e número de episódios depressivos. Foi realizada a comparação das médias com o teste-t e das frequências com o chi-quadrado. Correlações foram realizadas para analisar as diferentes variáveis com... (AU)

Depression is a severe mental disorder of high prevalence, difficult treatment and risk factor for several other diseases and disorders. Its main symptoms are depressed mood and the anhedonia or loss of interest. There is evidence that personality affects the individual vulnerability for depression, as well as influences the types of symptoms and complications experimented by the patient. This work investigated the relationship between Major Depressive Disorder and temperament and character traits, based on Cloninger`s psychobiological model. We investigated which traits may be associated to Major Depression; furthermore, which others may reveal themselves protective of health and physical, mental and social welfare. A cross-sectional study was performed with the objective of comparing temperament and character traits between subjects with moderate to severe Major Depressive Disorder and a control group composed of healthy subjects without neuropsychiatric disorders. The depressed patients were antidepressant-free for at least three weeks at the time of the assessment. One hundred and three subjects (69 women and 34 men) participated in each group, matched by gender and age. These individuals filled out the Temperament and Character Inventory (TCI), a self-administered test which evaluates four dimensions of temperament (Novelty Seeking, Harm Avoidance, Reward Dependence and Persistence) and three of character (Self-Directedness, Cooperativeness and Self- Transcendence), each one with their own subscales. A comparison of sociodemographic data between the groups and the correlation between the seven dimensions of temperament and character was performed. Scales were used to assess affect and mood in the group of depressed individuals, as well as other characteristics of the Major Depressive Disorder, such as type, age... (AU)

The Escitalopram versus Electric Current Therapy for Treating Depression Clinical Study (ELECT-TDCS): rationale and study design of a non-inferiority, triple-arm, placebo-controlled clinical trial.

CONTEXT AND OBJECTIVE: Major depressive disorder (MDD) is a common psychiatric condition, mostly treated with antidepressant drugs, which are limited due to refractoriness and adverse effects. We describe the study rationale and design of ELECT-TDCS (Escitalopram versus Electric Current Therapy for Treating Depression Clinical Study), which is investigating a non-pharmacological treatment known as transcranial direct current stimulation (tDCS). DESIGN AND SETTING: Phase-III, randomized, non-inferiority, triple-arm, placebo-controlled study, ongoing in São Paulo, Brazil. METHODS: ELECT-TDCS compares the efficacy of active tDCS/placebo pill, sham tDCS/escitalopram 20 mg/day and sham tDCS/placebo pill, for ten weeks, randomizing 240 patients in a 3:3:2 ratio, respectively. Our primary aim is to show that tDCS is not inferior to escitalopram with a non-inferiority margin of at least 50% of the escitalopram effect, in relation to placebo. As secondary aims, we investigate several biomarkers such as genetic polymorphisms, neurotrophin serum markers, motor cortical excitability, heart rate variability and neuroimaging. RESULTS: Proving that tDCS is similarly effective to antidepressants would have a tremendous impact on clinical psychiatry, since tDCS is virtually devoid of adverse effects. Its ease of use, portability and low price are further compelling characteristics for its use in primary and secondary healthcare. Multimodal investigation of biomarkers will also contribute towards understanding the antidepressant mechanisms of action of tDCS. CONCLUSION: Our results have the potential to introduce a novel technique to the therapeutic arsenal of treatments for depression.

The Escitalopram versus Electric Current Therapy for Treating Depression Clinical Study (ELECT-TDCS): rationale and study design of a non-inferiority, triple-arm, placebo-controlled clinical trial / Estudo clínico Escitalopram versus Eletroterapia no Tratamento da Depressão (ELECT-TDCS): racional e desenho de estudo de um ensaio de não inferioridade, de três braços, placebo-controlado

CONTEXT AND OBJECTIVE: Major depressive disorder (MDD) is a common psychiatric condition, mostly treated with antidepressant drugs, which are limited due to refractoriness and adverse effects. We describe the study rationale and design of ELECT-TDCS (Escitalopram versus Electric Current Therapy for Treating Depression Clinical Study), which is investigating a non-pharmacological treatment known as transcranial direct current stimulation (tDCS). DESIGN AND SETTING: Phase-III, randomized, non-inferiority, triple-arm, placebo-controlled study, ongoing in São Paulo, Brazil. METHODS: ELECT-TDCS compares the efficacy of active tDCS/placebo pill, sham tDCS/escitalopram 20 mg/day and sham tDCS/placebo pill, for ten weeks, randomizing 240 patients in a 3:3:2 ratio, respectively. Our primary aim is to show that tDCS is not inferior to escitalopram with a non-inferiority margin of at least 50% of the escitalopram effect, in relation to placebo. As secondary aims, we investigate several biomarkers such as genetic polymorphisms, neurotrophin serum markers, motor cortical excitability, heart rate variability and neuroimaging. RESULTS: Proving that tDCS is similarly effective to antidepressants would have a tremendous impact on clinical psychiatry, since tDCS is virtually devoid of adverse effects. Its ease of use, portability and low price are further compelling characteristics for its use in primary and secondary healthcare. Multimodal investigation of biomarkers will also contribute towards understanding the antidepressant mechanisms of action of tDCS. CONCLUSION: Our results have the potential to introduce a novel technique to the therapeutic arsenal of treatments for depression. .

CONTEXTO E OBJETIVO: O transtorno depressivo maior (TDM) é uma condição psiquiátrica comum, tratada com medicamentos antidepressivos, os quais são limitados devido à refratariedade e efeitos adversos. Descrevemos o racional e o desenho do Estudo Clínico Escitalopram versus Eletroterapia no Tratamento da Depressão (ELECT-TDCS), que investiga um tratamento não farmacológico, conhecido como estimulação transcraniana por corrente contínua (ETCC). DESENHO E LOCAL: Ensaio de fase III, randomizado, de não inferioridade, de três braços, placebo-controlado, em execução em São Paulo, Brasil. MÉTODOS: O estudo compara a eficácia da ETCC ativa/pílula placebo, ETCC simulada/escitalopram 20 mg/dia e ETCC simulada/pílula placebo durante 10 semanas, randomizando 240 pacientes em uma proporção 3:3:2, respectivamente. O objetivo principal é demostrar que a ETCC não é inferior ao escitalopram com uma margem de não inferioridade de pelo menos 50% do efeito de escitalopram em relação ao placebo. Como objetivos secundários, investigamos biomarcadores como polimorfismos genéticos, marcadores séricos, excitabilidade cortical motora, variabilidade da frequência cardíaca e neuroimagem. RESULTADOS: Provar que ETCC é igualmente eficaz a antidepressivos teria um tremendo impacto na psiquiatria clínica, uma vez que a ETCC é praticamente isenta de efeitos adversos. Sua facilidade de uso, portabilidade e preço baixo são outras características atraentes para uso na atenção primária e secundária de saúde. A investigação multimodal de biomarcadores também contribuirá para a compreensão dos mecanismos de ação antidepressivos da ETCC. CONCLUSÃO: Os nossos resultados podem introduzir uma nova técnica no arsenal terapêutico do tratamento da depressão. .