[Efficacy and acceptability of tianeptine and sertraline in the acute treatment phase of depression]. / Efficacité et tolérance de la tianeptine et de la sertraline dans le traitement d'attaque de la dépression.

Efficacy and acceptability of tianeptine were investigated in a multicenter, randomized, double blind, and sertraline-controlled study. As a total, 212 in- or outpatients with DSM IV major depression single episode, recurrent and bipolar depression, were treated for 42 days either with tianeptine (37.5 mg) or with sertraline (50 mg). At inclusion, sociodemographic, physical and psychological parameters showed no significant intergroup differences. MADRS responders (50% reduction of baseline score) were 66% and 67% with tianeptine and sertraline, respectively. No statistical interdrug differences were observed either in the number of withdrawals or in the efficacy and acceptability parameters.

Gender differences in major depressive disorder in a Hungarian community survey.

INTRODUCTION: The aim of this study was to investigate the characteristics of Major Depressive Disorder (MDD) in males and females in a sample of the Hungarian adult population. METHOD: 2953 randomly selected subjects between 18 and 64 years old were interviewed using the Hungarian version of the Diagnostic Interview Schedule (DIS), which generated DSM-III-R diagnoses. RESULTS: The lifetime and period prevalences of MDD were more than twice as high in women than in men. The gender difference appeared in early adolescence and continued up until the age of 50. An increased risk for anxiety disorders was found in patients with MDD, irrespective of gender, and in the majority of cases (65%) the anxiety symptoms preceded the onset of MDD. Depressed women tended to have more symptoms and a more marked tendency for recurrence than men. The preponderance of females was twice as high in MDD with comorbid anxiety than in MDD without it, in spite of the fact that the likelihood of the coexistence of MDD and anxiety disorders did not differ by gender. CONCLUSION: The higher MDD prevalence rate in women might be the consequence of a higher rate of pre-existing anxiety disorder(s).

Anxiety disorders comorbidity in bipolar I, bipolar II and unipolar major depression: results from a population-based study in Hungary.

BACKGROUND: The aim of this study was to analyze the lifetime comorbidity between DSM-III-R anxiety disorders in separate subgroups of patients with major depression, bipolar II and bipolar I disorder in a community sample of a Hungarian population. METHODS: Randomly selected subjects (aged between 18 and 64 years, N=2953) were interviewed by the Diagnostic Interview Schedule (DIS) which generated DSM-III-R diagnoses. RESULTS: The prevalence of generalized anxiety disorder, agoraphobia and simple phobia was the highest among bipolar II patients (20.8, 37.5 and 16.7%, respectively), social phobia was most prevalent in (nonbipolar) major depression (17.6%), while the rate of panic disorder was the same in the (nonbipolar) major depressive and bipolar II subgroups (12.4 and 12.5%, respectively). Bipolar I patients showed a relatively low rate of comorbidity. CONCLUSIONS: The findings support previous results on the particularly high rate of lifetime comorbidity between anxiety disorders and unipolar major depression and particularly bipolar II illness. LIMITATIONS: Underestimation of the prevalence of bipolar II disorder by the diagnostic methodology used, resulting in a small number of bipolar II cases, lack of analysis of data by gender, no data on obsessive-compulsive disorder.

Suicide attempts in the Hungarian adult population. Their relation with DIS/DSM-III-R affective and anxiety disorders.

Prevalence of suicide attempts and their relationship with DIS anxiety and affective disorder diagnoses were investigated in a Hungarian adult community sample. Despite the high suicide mortality rate, the rate of suicide attempts was similar to that reported in other studies using similar methods. Suicide attempts occurred more frequently among women and previously married persons. Although the presence of any lifetime anxiety and/or affective disorder increased the rate of reported suicide attempts, the effect of co-morbidity, recurrence and chronicity might be considered significant predictors. The highest odds of an attempt were related to the diagnoses of dysthymic or bipolar disorders. Agitation was the only depressive symptom, which increased the odds of a suicide attempt.

[Prevalence of mood and anxiety disorders in the Hungarian adult population]. / A hangulat- és szorongásos zavarok elöfordulása a felnött magyar lakosság körében.

The prevalence rates of affective and anxiety disorders in the Hungarian adult population were assessed with a well-structured questionnaire which has been successfully applied in several multinational epidemiological studies. The Hungary material showed significantly higher lifetime and period prevalence rates of bipolar disorders than is found in most of related literature. However, the frequency of other affective disorders and the anxiety states strongly corresponded with international findings.

The prevalence of major depressive and bipolar disorders in Hungary. Results from a national epidemiologic survey.

In order to estimate the prevalence of affective disorders in Hungary a sample of the Hungarian adult population (18-64 years) selected at random was interviewed using the Diagnostic Interview Schedule (DIS) which generated DSM-III-R diagnoses. The lifetime rate for Major Depressive Disorder (MDD) was 15.1%, and for Bipolar Disorders (BD) 5.1%. The female-to-male ratio was 2.7 for MDD and nearly equal for BD. The 1-year and 1-month period prevalence rates were 7.1% and 2.6% for MDD and 0.9% and 0.5% for manic episodes. A higher rate of divorced or separated persons was found among individuals with a lifetime diagnosis of MDD. Besides these, the lifetime diagnosis of BD coexisted with higher rates of the never-married state. The highest hazard rate for the development of BD or MDD was in the range 15-19 years but in MDD another peak was also found in the range 45-50 years. The first peak was characteristic of the recurrent, and the other one of the single form of MDD. Insomnia, loss of energy, decreased interest, concentration problems were the most common symptoms during the depressive episode, independent of polarity. Higher rates of lifetime diagnosis of dysthymia and all kinds of anxiety disorder were revealed among persons with MDD. BD was associated with GAD (Generalized Anxiety Disorder), and panic disorder more often than chance.

The prevalence of affective and anxiety disorders in primary care practice in Hungary.

The lifetime and point prevalence of affective and anxiety disorders were investigated with the aid of the DIS questionnaire in 15 primary care practices among patients aged 18 to 60. According to the DSM-III-R criteria, 43% of the eligible 301 patients had had some kind of affective or anxiety disorder till the time of the assessment. Major depression was found to be the most common lifetime diagnosis (18%). At the time of the investigation 15% of the patients were suffering from affective or anxiety disorder (point prevalence) calling for clinical therapy. Females had significantly higher numbers of lifetime and point diagnoses of affective and anxiety disorders. Sixty percent of patients failed to report psychiatric complaints to their doctor, and in social phobia this figure was as high as 87%. Our results are in accordance with international findings and underline the need to diagnose and treat psychiatric patients already at the stage of the primary care service.

The role of psychosocial and biological variables in separating chronic and non-chronic major depression and early-late-onset dysthymia.

Psychosocial (sociodemographic characteristics, loss and separation and family atmosphere in childhood, recent life events) and biological (family history, DST, TRH-test) variables were investigated in 180 patients with Major Depression (MD) and Dysthymic Disorder (DD). The aim of the study was to reveal certain differences between the chronic and non-chronic course of MD and the early- and late-onset subtypes of dysthymia. When comparing the two course patterns of MD, a higher rate of malignant tumours among first-degree relatives, a greater number of long-lasting stress situations before the index depressive episode, longer duration of the previous episodes, less frequent DST nonsuppression, and a blunted TSH response to TRH were found in patients with a chronic course of MD. Several factors seem to influence the course pattern of MD, or else the chronic form represents a subgroup within MD. The late-onset dysthymics were mainly women with a low level of education, a lower suicidal tendency, normal suppression in DST, and a lack of blunted TSH responses to TRH administration during the period of double depression. The early-onset dysthymics showed a higher number of persons who had never married, who presented a more traumatic and frustrating childhood background, and who had a higher rate of DST non-suppressors and blunted TSH responses after TRH administration during the period of their double depression. Our data suggest that late-onset dysthymia might be a biologically distinct subgroup of chronic depression.

Dexamethasone suppression test and TRH-TSH test in subaffective dysthymia and character-spectrum disorder.

Based on Akiskal's criteria of subaffective dysthymia (SDT) and character-spectrum disorder (CSD) as the two, etiologically distinct forms of early-onset primary dysthymia, the authors investigated the dexamethasone suppression test (DST) in 18 patients with SDT and in 30 patients with CSD. TRH-TSH test was also investigated in smaller subsamples of the patients (n = 8, and n = 7, respectively). Fifty percent of the patients with SDT showed abnormal DST and TRH-TSH test results respectively, while the figures in the CSD patients were 7% and 0%. These findings suggest that SDT is a clinically diagnosable and biologically distinct subgroup within the broader category of early-onset primary dysthymia, which represents a symptomatically milder version of primary affective disorder.

Effect of phototherapy on 3H-imipramine binding sites in patients with SAD, non-SAD and in healthy controls.

The effect of incandescent light treatment on the density of 3H-imipramine binding sites (Bmax) was investigated in 17 patients with seasonal affective disorder, in eight patients with non-seasonal depression and in six healthy volunteers. A significant increase in mean Bmax value parallel to a marked improvement of the depressive symptoms was found only in patients with SAD. No effect was observed either on mean Bmax value or on clinical symptoms in patients with non-SAD and on mean Bmax value in healthy volunteers.

Phototherapy increases platelet 3H-imipramine binding in patients with winter depression.

The density of platelet 3H-imipramine binding sites (Bmax) was investigated in seven inpatients with winter depression before and after incandescent light treatment and in seven healthy volunteers within a 7-day interval without light exposure. A significantly lower mean Bmax value was found in the depressed patients compared to the controls. After light treatment, parallel to a marked clinical improvement, Bmax increased in each patient and reached or even exceeded the mean values of the controls. These results indicate that in patients with winter depression the decreased Bmax value is state-dependent. The incandescent light treatment has beneficial effect in winter depressives and can influence Bmax values.

Platelet MAO activity and the dexamethasone suppression test in bipolar depression.

The correlation between postdexamethasone cortisol levels after the dexamethasone suppression test (DST) and platelet monoamine oxidase (MAO) activity was studied in 31 depressed female inpatients with Research Diagnostic Criteria primary, endogenous, bipolar depression (12 bipolar 1 and 19 bipolar 11). Out of the 31 patients, 25 showed abnormal DST results. Platelet MAO activity did not differ significantly from the matched control group. There was a trend that patients with higher MAO activity had lower postdexamethasone cortisol levels, but it was significant only for the 0800 hr cortisol levels.

The dexamethasone suppression test in psychotic versus non-psychotic endogenous depression.

The authors investigated the dexamethasone suppression test (DST) in 93 female patients with primary (endogenous) major depression; in 20 female paranoid schizophrenics, and in 17 healthy females. Depressed patients had a significantly higher rate of abnormal DST response and significantly higher post-dexamethasone serum cortisol levels than schizophrenics and normal controls. The unipolar and bipolar depressives showed a similar profile of DST abnormalities. Depressed patients with psychotic features had a significantly higher rate of positive DST results than non-psychotic patients.

Dexamethasone suppression test as a predictor of drug treatment response.

The possible predictive value of cortisol non-suppression by dexamethasone for therapeutic response to antidepressants was investigated both in "endogenous" and "neurotic" depression. Seventy-four female patients who fulfilled the RDC of Major Depressive Disorder (Study 1) and 44 female patients with the diagnosis of "Neurotic Depression" of ICD-9 (Study 2) were given DST and then treated with antidepressants, their clinical response being assessed after four weeks of drug treatment. Forty-three out of the 74 patients with Primary Major Depression were non-suppressor. The DST non-suppressors showed a significantly more frequent therapeutic response to maprotiline than to amitriptyline. DST suppressors, on the other hand, responded better to amitriptyline treatment than non-suppressors. In the neurotic depression group 23 patients were subclassified as Primary Minor Depression, and 52% of them showed non-suppressor response to DST. Twenty-one patients were diagnosed as Secondary Depression, with a history of chronic neurosis. One patient only (5%) was the non-suppressor. Patients with Primary Minor Depression showed good therapeutic response to antidepressants more frequently, than patients with Secondary Depression.

Dexamethasone suppression test in masked depression.

The dexamethasone suppression test (DST), family history, response to antidepressant medication and short-term course were investigated in 16 female patients with masked depression. Twelve patients showed abnormal DST results, 3 patients had positive family history of affective illness in first-degree relatives, 11 responded well to antidepressant drug treatment and 3 showed definite hypomanic episodes during follow-up. The results suggest that masked depression is a special form of primary (endogenous) depressive illness, and that the DST is a good diagnostic aid not only in the 'classical' but also in masked forms of depressive disorders.