Lower frequency of antidepressant use in patients on renin-angiotensin-aldosterone system modifying medications.

Both hypertension and depression are common disorders which may both involve components of the hypothalamic-pituitary-adrenal axis system and the Renin-Angiotensin-Aldosterone System (RAAS). These observations, coupled with growing evidence that RAAS-active drugs may have anti-depressant properties prompted us to study the frequency of anti-depressant medication usage in the patients receiving RAAS-active agents. A chart review was performed on 378 patients who were seen during a 3-month period in a primary care clinic and who were diagnosed with hypertension. Demographic information and data on the rates of co-administration of antihypertensive and anti-depressant medications was collected. Overall, 23.7% of the sample was on an antidepressant. 20% of the patients taking a RAAS-modifying medication were on an antidepressant, compared to 34% of those not taking a RAAS-modifying medication (Χ(2) = 8.88, P = 0.003). The patients taking a beta-blocker alone had the highest rate of antidepressant usage (40%). The use of RAAS-modifying medications was associated with an even lower rate of anti-depressant usage in males compared with females. It was also observed that the patients taking an additional diuretic had a significantly lower rate of antidepressant use (17.6%, Χ(2) = 5.81, P = 0.016) compared with the patients not taking a diuretic. The patients being treated with an ACE inhibitor or ARB showed significantly lower rates of antidepressant usage. The data is supportive of the hypothesis that these agents may possess anti-depressant effects.

Screening for major depression in private practice.

BACKGROUND: Several studies have compared the 16-item self-report version of the Quick Inventory of Depressive Symptomatology (QIDS-SR16) with other depression scales, but none has used a sample of patients from a single, large, private psychiatric practice. This study compared ratings from 175 outpatients on the QIDS-SR16, the 17-item Carroll Depression Rating Scale (CDRS-SR17, a self-report modification of the Hamilton Rating Scale for Depression), and the thirteen depression items from the Symptom Check List-90 (SCL-D13). The Mini version of the Structured Clinical Interview for DSM-IV (MiniSCID) served as a "gold standard" for assessing depression. METHODS: Basic item and scale statistics were obtained using classical test theory. Dimensionalities were obtained using factor analysis. Test information functions obtained from the Samejima item response theory model provided additional reliability-like results. This model was also used to compare patients classified as depressed versus nondepressed on the basis of the MiniSCID. Additional validity information was assessed comparing: (a) ANOVA effect sizes, (b) receiver operating characteristic curves, (c) univariate logistic regression, (d) the MANOVA, and (e) multivariate logistic regression. RESULTS: The QIDS-SR16 was found to be related most strongly to the MiniSCID diagnoses. The SCL-D13, however, was the most reliable of the three scales (alpha=0.91). It was the most sensitive to differences in depression for all but the most depressed patients, for whom the CDRS-SR17 was the most sensitive. The QIDS-SR16 was the most valid based on four different analyses (effect size/ANOVA, univariate logistic regression/ROC analysis, MANOVA, and multivariate logistic regression), although only slightly more so. The QIDS-SR16 was found to be unidimensional; its items cover only the nine diagnostic symptom domains used to characterize a DSM-IV-TR major depressive episode. CONCLUSIONS: All three measures performed satisfactorily, but there are clearly defined advantages to using the QIDS-SR16, as, by its very design, it assesses the core symptoms of depression and does not require a clinician.