Depression - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

DEPRESSION A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R EFERENCES J AMES N. ...

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DEPRESSION A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R EFERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright ©2003 by ICON Group International, Inc. Copyright ©2003 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Depression: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-83618-3 1. Depression-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on depression. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON DEPRESSION .............................................................................................. 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Depression................................................................................... 18 E-Journals: PubMed Central ..................................................................................................... 173 The National Library of Medicine: PubMed .............................................................................. 182 CHAPTER 2. NUTRITION AND DEPRESSION .................................................................................. 309 Overview.................................................................................................................................... 309 Finding Nutrition Studies on Depression ................................................................................. 309 Federal Resources on Nutrition ................................................................................................. 315 Additional Web Resources ......................................................................................................... 316 CHAPTER 3. ALTERNATIVE MEDICINE AND DEPRESSION ............................................................ 323 Overview.................................................................................................................................... 323 The Combined Health Information Database............................................................................. 323 National Center for Complementary and Alternative Medicine................................................ 324 Additional Web Resources ......................................................................................................... 340 General References ..................................................................................................................... 368 CHAPTER 4. DISSERTATIONS ON DEPRESSION .............................................................................. 369 Overview.................................................................................................................................... 369 Dissertations on Depression ...................................................................................................... 369 Keeping Current ........................................................................................................................ 410 CHAPTER 5. CLINICAL TRIALS AND DEPRESSION ........................................................................ 411 Overview.................................................................................................................................... 411 Recent Trials on Depression ...................................................................................................... 411 Keeping Current on Clinical Trials ........................................................................................... 429 CHAPTER 6. PATENTS ON DEPRESSION ......................................................................................... 431 Overview.................................................................................................................................... 431 Patents on Depression................................................................................................................ 431 Patent Applications on Depression............................................................................................ 488 Keeping Current ........................................................................................................................ 505 CHAPTER 7. BOOKS ON DEPRESSION ............................................................................................ 507 Overview.................................................................................................................................... 507 Book Summaries: Federal Agencies............................................................................................ 507 Book Summaries: Online Booksellers......................................................................................... 510 The National Library of Medicine Book Index ........................................................................... 523 Chapters on Depression ............................................................................................................. 525 Directories.................................................................................................................................. 529 CHAPTER 8. MULTIMEDIA ON DEPRESSION.................................................................................. 531 Overview.................................................................................................................................... 531 Video Recordings ....................................................................................................................... 531 Audio Recordings....................................................................................................................... 532 Bibliography: Multimedia on Depression .................................................................................. 533 CHAPTER 9. PERIODICALS AND NEWS ON DEPRESSION............................................................... 535 Overview.................................................................................................................................... 535 News Services and Press Releases.............................................................................................. 535 Newsletters on Depression......................................................................................................... 540 Newsletter Articles .................................................................................................................... 541 Academic Periodicals covering Depression................................................................................ 543 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 547 Overview.................................................................................................................................... 547

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NIH Guidelines.......................................................................................................................... 547 NIH Databases........................................................................................................................... 549 Other Commercial Databases..................................................................................................... 553 The Genome Project and Depression ......................................................................................... 553 APPENDIX B. PATIENT RESOURCES ............................................................................................... 557 Overview.................................................................................................................................... 557 Patient Guideline Sources.......................................................................................................... 557 Associations and Depression...................................................................................................... 575 Finding Associations.................................................................................................................. 582 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 585 Overview.................................................................................................................................... 585 Preparation................................................................................................................................. 585 Finding a Local Medical Library................................................................................................ 585 Medical Libraries in the U.S. and Canada ................................................................................. 585 ONLINE GLOSSARIES................................................................................................................ 591 Online Dictionary Directories ................................................................................................... 594 DEPRESSION DICTIONARY..................................................................................................... 595 INDEX .............................................................................................................................................. 683

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with depression is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about depression, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to depression, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on depression. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to depression, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on depression. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON DEPRESSION Overview In this chapter, we will show you how to locate peer-reviewed references and studies on depression.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and depression, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “depression” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Depression and HIV Source: STEP Perspective; Vol. 5, No. 3. Contact: Seattle Treatment Education Project, 1123 E John St, Seattle, WA, 98102, (206) 329-4857, http://www.thebody.com/step/steppage.html. Summary: This journal article defines depression, remarks on the differences between symptoms resulting from HIV and those stemming from depression, and considers the relationship between HIV disease and depression. It states that the most important step in the treatment of depression is recognition and the most effective treatment is consistent counseling with or without the use of medications. The article identifies and describes four classes of anti-depressant medications: tricyclics, heterocyclics, selective serotonin inhibitors, and monoamine inhibitors.

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AD-venture Program: Therapeutic Biking for the Treatment of Depression in LongTerm Care Residents With Dementia Source: American Journal of Alzheimer's Disease and Other Dementias. 17 (2): 121-127. March/April 2002. Summary: This article describes the effects of AD-venture, a therapeutic biking program, on long-term care residents with dementia and depression. Forty-one residents of a skilled nursing facility and 29 residents of an assisted living facility were randomly assigned to intervention and control groups. The intervention group used a wheelchair bicycle in a recreation therapy protocol consisting of a 2- week period of intensive biking (one-on-one ride with staff member 5 days a week) followed by a 10week maintenance program (ride with staff, family member, or volunteer twice a week). Data were collected at baseline and following each intervention period. Depression levels, measured with the Geriatric Depression Scale, were significantly reduced after 2 weeks of intensive treatment and continued to improve during the 10-week maintenance period. Sleep and activity engagement levels also were improved. An educational videotape and training manual were developed as part of this project. 4 tables, 21 references.

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Early Detection and Differential Diagnosis of Alzheimer's Disease and Depression With Neuropsychological Tasks Source: Dementia and Geriatric Cognitive Disorders. 12(4): 265-280. 2001. Summary: This article examines the utility of neuropsychological tasks in the early detection and differential diagnosis of Alzheimer's disease (AD) and depression. Computerized and traditional tests of memory, attention, and executive function were administered to 26 patients with mild AD, 43 with questionable dementia (QD), 37 with major depression, and 39 healthy controls. Whereas several mnemonic tests were sensitive to QD, attentional and executive tests were more sensitive to depression. The paired associates learning (PAL) test accurately distinguished AD from the combined group of depressed patients and controls, and revealed an apparent subgroup of QD patients who performed like AD patients. Scores on tests from the mnemonic, attention, and executive function categories, but not the global cognitive function category, significantly correlated with the degree of subsequent cognitive decline. The authors suggest that elements of contextual and cued recall in the PAL may account for the task's sensitivity and specificity for AD. 2 figures, 5 tables, 75 references. (AA-M).

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Depression Among Alzheimer's Caregivers: Identifying Risk Factors Source: American Journal of Alzheimer's Disease and Other Dementias. 16 (6): 353-359. November/December 2001. Summary: This article examines risk factors for the development of depression among caregivers of patients with Alzheimer's disease (AD). Data were obtained from 77 pairs of AD patients and their caregivers seen at two primary care geriatric clinics (of 92 patient/caregiver pairs evaluated, 15 were excluded due to missing data and 77 were included in the analysis). The Yesavage Geriatric Depression Scale was used to assess depression in patients and caregivers. Cognitive, functional, and behavioral status also was assessed in patients only. Caregivers were mostly spouses (49.4 percent) and adult children (42.9 percent); their mean age was 63.1 years. Twenty-nine caregivers (38 percent) were found to be depressed. A multivariate logistic regression analysis indicated that patient depression, hallucinations, and poor functional status are significant and independent risk factors for depression in caregivers. The authors

Studies

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suggest that early recognition of these factors may help to identify caregivers at risk for depression. 5 tables, 39 references. •

Olfactory Dysfunction Discriminates Probable Alzheimer's Dementia from Major Depression: A Cross-Validation and Extension Source: Journal of Neuropsychiatry and Clinical Neurosciences. 12(1): 29-33. Winter 2000. Summary: This journal article concerns the loss of the sense of smell (olfactory dysfunction) as an indicator of brain pathology, and a way to discriminate between persons with Alzheimer's disease (AD) and those with major depression. The entorhinal cortex, a major component of the olfactory system, is the first brain area affected by neurofibrillary tangles, one of the markers of AD. Forty people, 20 diagnosed with AD and 20 with major depression, all over age 55, were assessed with the 3-item Pocket Smell Test (PST), and with the Mini-Mental State Examination. The AD group had significantly lower scores than the depressed group on the PST. Results indicate that assessment of olfactory functioning can provide information for the clinician in the differential diagnosis of AD versus major depression in elderly patients. 4 tables, 28 references.

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Controlled Clinical Trial of Sertraline in the Treatment of Depression in Nursing Home Patients With Late-Stage Alzheimer's Disease Source: American Journal of Geriatric Psychiatry. 8(1): 66-76. Winter 2000. Summary: This journal article describes a controlled trial of sertraline for the treatment of depression in nursing home residents with late stage Alzheimer's disease. Female residents with advanced dementia and depression were randomly assigned to sertraline or placebo for eight weeks. Two members of each group were discontinued due to adverse effects. Measures of depression included various objective scales and two measures of facial expressions of emotion. Analysis indicated that both the sertraline and placebo groups improved over time, with a significant time effect seen on three of six measures. Only the 'knit- brow' facial measure approached significance. Although sertraline had no significant effects over placebo in this trial, the authors suggest that further study may be warranted if, as hypothesized, the 'knit- brow' response is a more sensitive indicator of depression in late dementia. 5 tables, 38 references.

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Mental Status Change in Older Surgical Patients: Cognition, Depression, and Other Comorbidity Source: American Journal of Geriatric Psychiatry. 8(1): 40-46. Winter 2000. Summary: This journal article examines the effect of elective surgery on the mental status of older patients over the postoperative year. A sample of 251 patients scheduled for cataract, joint replacement, or general surgeries participated in assessment interviews conducted one week pre-surgery and one week, six weeks, six months, and one year post-surgery. Change in cognitive function was associated with age, physical disability, and depression. However, persistent cognitive decline was associated with identifiable factors related to the surgery in only three cases. The authors conclude that the risk of cognitive decline after elective surgery was minimal and should not obscure the possible benefits of surgery. 3 tables, 30 references.

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Is Depression a Risk Factor for Dementia or Cognitive Decline?: A Review Source: Gerontology. 46: 219-227. 2000. Summary: This journal article describes a research review that investigated whether depression earlier in life is a risk factor for subsequent dementia or cognitive decline. The author reviewed epidemiological evidence from prospective and case-control studies that showed a relationship between depression and later cognitive decline. The review examined evidence for six hypotheses that could explain this relationship. The author concluded that the following four hypotheses have limited support: depression is a prodrome of dementia, depression is an early reaction to dementia, depression affects the threshold for manifesting dementia, and depression is a causal factor in dementia. Further research is needed to explore these possible relationships between depression and subsequent dementia. 4 tables, 64 references.

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Distinction Between Preclinical Alzheimer's Disease and Depression Source: JAGS. Journal of the American Geriatrics Society. 48(5): 479- 484. May 2000. Summary: This article examines the prevalence of depression in preclinical Alzheimer's disease (AD) and the possibility of differentiating patients with preclinical AD and depression from those with depression- related cognitive impairment. Data on depression and cognitive function were collected for 111 older individuals with cognitive impairment but not dementia. The course of cognitive impairment and presence of dementia were assessed after 2 and 5 years. Twenty-five participants, defined as the preclinical AD group, were diagnosed with AD at follow-up; 15 (60 percent) of these individuals were depressed at baseline. Participants with depression and preclinical AD had poorer baseline performance on cognitive tasks and were older than those with depression-related cognitive impairment (those without dementia at follow-up). In logistic regression analyses, age and memory performance were identified as the best predictors of future AD in depressed participants; these predictors had a sensitivity of 90 percent and a specificity of 94 percent. 1 figure, 2 tables, 39 references.

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Dementia and Depression in Elderly Medical Inpatients Source: International Psychogeriatrics. 12(1): 67-75. March 2000. Summary: This article examines the prevalence and correlation of cognitive impairment, major depression, and depressive symptoms in elderly medical patients. It also compares cognitive impairment and depression in subgroups with possible Alzheimer's disease (AD) or vascular dementia (VD). One hundred patients aged 65 years and older were recruited from a department of internal medicine. The patients were assessed with the Modified Mini-Mental State Examination, Hachinski Ischemic Scale, and Hamilton Rating Scale for Depression. Forty-four patients were diagnosed with possible AD and 14 with possible VD. Eleven patients had major depression. Sixty-six patients were cognitively impaired; the degree of impairment was mild in 30 patients, moderate in 19, and severe in 17. Forty-six patients had mild depressive symptoms and 27 had severe symptoms. There was no association between the severity of cognitive impairment and depressive symptomatology. There was no difference in the prevalence or severity of depression or the severity of cognitive impairment in subgroups of patients with AD and VD. 4 tables, 46 references.

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Randomized, Placebo-Controlled, Double-Blind Clinical Trial of Sertraline in the Treatment of Depression Complicating Alzheimer's Disease: Initial Results from the Depression in Alzheimer's Disease Source: American Journal of Psychiatry. 157(10): 1686-1689. October 2000. Summary: This article describes a randomized, placebo controlled, double blind clinical trial of sertraline for the treatment of major depression in patients with Alzheimer's disease. Twenty-two patients received either sertraline (n=12) or placebo (n=10) for 12 weeks. The main outcome measure was response to treatment as rated by two psychiatrists. Another principal measure was the Cornell Scale for Depression in Dementia, given at baseline and at 3, 6, 9, and 12 weeks after treatment initiation. Secondary outcome measures were the Hamilton Depression Rating Scale, the activities of daily living subscale of the Psychogeriatric Dependency Rating Scales, and the MiniMental State Examination. At 12 weeks, nine of the patients given sertraline and two of those given placebo were rated as full or partial responders. Patients given sertraline had significantly greater improvements in mood than those given placebo. Sertraline also appeared to protect against the functional declines observed in placebo-treated patients, but it had no effect on cognition. Side effects were generally mild and did not differ between groups. 1 table, 13 references.

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Treating Depression in Alzheimer's Disease: Integration of Differing Guidelines Source: International Psychogeriatrics. 12(3): 353-358. September 2000. Summary: This article analyzes and integrates recommendations for the treatment of depression in Alzheimer's disease (AD). In May 1997, the American Psychiatric Association (APA) and the American Academy of Neurology (AAN) published in their respective official journals supplements devoted to the management of patients with AD. References used by these publications were extracted, and those relevant to the pharmacological treatment of depression were reviewed. Seven references were cited by the AAN and 11 by the APA; of these, 2 were used by both publications. The analyzed guidelines recommend selective serotonin reuptake inhibitors (SSRIs) as the treatment of choice for depression in AD patients. These drugs include fluoxetine, paroxetine, fluvoxamine, sertraline, and citalopram. Their side effect profile is more benign than that of the tricyclic antidepressants, and they do not have the cardiac adrenolytic and anticholinergic adverse effects. 37 references.

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Changes in Cognitive Functioning Following Treatment of Late-Life Depression Source: American Journal of Psychiatry. 157(12): 1949-1954. December 2000. Summary: This article examines the cognitive effects of treatment for depression in older patients. The sample consisted of 62 elderly patients with major depression, and 20 elderly controls were studied. Although some patients exhibited cognitive impairment at baseline, none met the diagnostic criteria for dementia. Of the 60 patients, 45 achieved remission of depressive symptoms after 12 weeks of treatment with the tricyclic agent nortriptyline or the selective serotonin reuptake inhibitor paroxetine. All participants completed a battery of clinical measures, including cognitive screening instruments, before and after treatment. Depressed patients with normal cognition at baseline showed no change in cognitive function after treatment, whereas those with cognitive impairment at baseline showed significant improvement in the domains of initiation/perseveration and conceptualization. Despite this improvement, however, patients with baseline cognitive impairment remained mildly impaired, especially in the memory and initiation/perseveration domains. This subgroup of elderly depressed

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patients may be at higher risk of developing progressive dementia. 3 tables, 29 references. •

Depression and Risk of Cognitive Decline and Alzheimer's Disease: Results of Two Prospective Community-Based Studies in the Netherlands Source: British Journal of Psychiatry. 176: 568-575. 2000. Summary: This article investigates whether depression is associated with increased risk of cognitive decline and Alzheimer's disease (AD) in elderly people with normal cognition. Two independent samples of older people with normal cognition were selected from the Amsterdam Study of the Elderly (AMSTEL; n=3,147) and the Longitudinal Aging Study Amsterdam (LASA; n=2,399). Data on incident AD were obtained in the AMSTEL using a two-step procedure. Data on cognitive decline were obtained in the LASA with the Mini-Mental State Examination. Depression was diagnosed with the Geriatric Mental State Schedule in the AMSTEL and with the Center for Epidemiological Studies Depression Scale in the LASA. Depression was associated with an increased risk of AD and cognitive decline in the AMSTEL and LASA samples, respectively, but only in people with higher levels of education. The findings suggest that depression may be an early manifestation of AD before cognitive symptoms become apparent. 2 figures, 7 tables, 35 references.

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Physical Aggression in Dementia Patients and its Relationship to Depression Source: American Journal of Psychiatry. 156(1): 66-71. January 1999. Summary: This article discusses a study that determined the frequency of physically aggressive behavior in community-residing patients with dementia and the relationship of physically aggressive behavior to depression. Researchers evaluated 541 patients with DSM-IV-defined dementia using the Cornell Scale for Depression in Dementia, the MiniMental State Examination, the Psychogeriatric Dependency Rating Scale, and the General Medical Health Rating. Data showed that 79 patients exhibited physically aggressive behavior in the 2 weeks before evaluation and this behavior was closely associated with moderate to severe depression, male gender, and greater impairment in activities of daily living after adjustment for delusions, hallucinations, sleep disturbance, and severity of cognitive impairment. The authors concluded that a substantial minority of patients with dementia exhibit physically aggressive behavior, and this aggression is linked strongly with the presence of depressive symptoms. They also describe the limitations of the study by saying they cannot be confident that treatment and resolution of depression would lead to resolution of the aggression. 1 table, 37 references.

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Health Care Utilization by Older Patients With Coexisting Dementia and Depression Source: American Journal of Psychiatry. 156(4): 550-556. April 1999. Summary: This journal article compared the use of medical services by older people with both depression and dementia to older people who had either disorder alone. The goal was to evaluate utilization of inpatient and outpatient services of a sample of 7,115 older veterans. Patients with coexisting depression and dementia had more psychiatric inpatient days and nursing home admissions than patients with only dementia or depression. However, they did not utilize more outpatient resources. The findings suggest that aggressive outpatient treatment approaches might decrease use of inpatient care for people with both depression and dementia. 24 references, 2 tables (AA-M).

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Late-Life Depression as a Possible Predictor of Dementia: Cross-Sectional and ShortTerm Follow-Up Results Source: American Journal of Geriatric Psychiatry. 7(2): 151-159. Spring 1999. Summary: This journal article reports on a study that explored cognitive functioning in a group of elderly subjects with depression. The group as a whole-and especially the lateonset group- demonstrated cognitive impairment on a dementia rating scale. Data showed that 47.5 percent of the late-onset group, compared to 31.5 percent of the earlyonset group, scored below the cutoff for a clinical diagnosis of dementia. Age-at-onset status in a logistical regression model predicted the rating scale category; treatment of depression had little effect on cognition. These results support the theory that late-life depression, especially in patients with late-onset dementia, is associated with cognitive impairment that may represent early Alzheimer's disease. 7 tables, 41 references. (AAM).

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Association Between Premorbid History of Depression and Current Depression in Alzheimer's Disease Source: Journal of Geriatric Psychiatry and Neurology. 12: 72-75. Summer 1999. Summary: This journal article presents a study of the association between a premorbid history of depression and current depression in patients with Alzheimer's disease (AD). The sample consisted of 243 AD outpatients evaluated consecutively at a universityaffiliated memory disorders center. Information about each patient's psychiatric history was obtained through semistructured interviews with the patient and caregiver. Current depressive symptoms were assessed with the Cornell Scale for Depression in Dementia. A positive history of depression was significantly more common among patients with current depression (23%) than among those without current depression (11%). This relationship remained significant after controlling for the effects of age, education, gender, ethnicity, and level of cognitive impairment. Neither gender nor the interaction of gender and history of depression was associated with risk of depression. 2 tables, 25 references.

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Predictors of Depression Among Chinese Family Caregivers of Alzheimer Patients Source: Alzheimer Disease and Associated Disorders. 13(3): 171-175. 1999. Summary: This article looks at predictors of depression among Chinese family caregivers of people with Alzheimer's disease (AD). Seventy-four AD patients and their caregivers were recruited for comprehensive assessment at a tertiary care teaching hospital in Taipei, Taiwan. The mean age of the patients was 72.2 years, and that of caregivers was 53.5 years. Patients were assessed with the Chinese version of the Cognitive Abilities Screening Instrument and the caregiver-rated Revised Memory and Behavior Problems Checklist. Caregivers also completed the short version of the Geriatric Depression Scale (GDS-S) and a scale assessing coping strategies. Twenty-six of the 74 caregivers (35.1 %) were classified as depressed. Caregivers' GDS-S scores were correlated positively with use of the management of stress coping strategy and frequency of patients' disruptive behaviors, and negatively with caregivers' educational level. 3 tables, 29 references.

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Early-Onset and Late-Onset Depression Are Independent of the Genetic Polymorphism of Apolipoprotein E Source: Dementia and Geriatric Cognitive Disorders. 10: 258-261. 1999.

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Summary: This journal article examines the association between apolipoprotein E (apoE) genotype and depressive illness in a large sample of Alzheimer's disease (AD) patients (n=102, mean age 74.4 years), depressed patients (n=160, mean age 68.0 years) recruited from the outpatient memory disorders clinic of the Psychiatric Department of the University of Bonn in Germany, and healthy controls (n=191, mean age 70.6 years). The depressed patients were divided into those with early-onset depression (EOD, n=129), defined as onset before age 60 years, or late-onset depression (LOD, n=31). AD patients were significantly more likely than the other groups to have at least one apoE4 allele. However, there was no significant difference in apoE4 allele frequency between the EOD, LOD, and control groups. Survival analysis was used to examine the cumulative incidence of depression depending on age-of-onset. There was no significant difference between depressed patients with at least one apoE4 allele and those with no apoE4 allele. In the authors' opinion, the results do not exclude the possibility that depression shares some pathophysiologic features with AD, but it is unlikely that apoE genotype will elucidate the assumed common mechanisms. 1 figure, 1 table, 22 references. •

History of Depression and Other Psychiatric Illness as Risk Factors for Alzheimer Disease in a Twin Sample Source: Alzheimer Disease and Associated Disorders. 13(1): 47-52. 1999. Summary: This journal article explores the association between history of depression and other psychiatric illness and the risk of developing Alzheimer's disease (AD). Putative psychiatric risk factors were examined in a registry-based sample of 65 Swedish twin pairs discordant for AD. Risk ratios were calculated both for psychiatric illness at any time and for episodes more than 10 years before the onset of dementia. Results revealed that prior episodes of depression or other psychiatric illness were significantly associated with elevated risk for AD. When analyses were restricted to twins whose mental illness occurred more than 10 years prior to AD, however, the magnitude of the odds ratio decreased markedly. The findings suggest that a history of psychiatric illness, including depression, may be associated with an elevated risk for AD. They further suggest that symptoms of depression and similar complaints may represent prodromal phases of dementia. 2 tables, 33 references. (AA-M).

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Longitudinal Patterns of Risk for Depression in Dementia Caregivers: Objective and Subjective Primary Stress as Predictors Source: Psychology and Aging. 14(1): 34-43. 1999. Summary: This journal article examines longitudinal patterns of risk for depression in caregivers of dementia patients. A sample of 188 dementia caregivers were followed for one year to determine whether patterns of risk for depression could be predicted by objective (patient behavior problems) and subjective (role captivity and overload) primary stress. The 20-item Center for Epidemiological Studies Depression Scale (CESD) was used to assess caregiver's risk for depression at baseline, 3 months, and 12 months. Results revealed that all primary stressors differentiated caregivers who remained at low levels of symptomatology over the course of one year from those who were at risk for experiencing a depressive disorder. In addition, caregivers' subjective experience of role captivity predicted the chronicity of risk. The findings extend previous research on patterns of depressive symptomatology among dementia caregivers by highlighting the relationship between subjective primary stressors and stability and change in caregivers' mental health. 1 figure, 5 tables, 54 references. (AAM).

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Neuropsychological Correlates of Apathy and Depression in Patients With Dementia Source: Neurology. 52: 1403-1407. 1999. Summary: This journal article describes a study of the neuropsychological correlates of apathy and depression in patients with Alzheimer's disease (AD). A comprehensive neuropsychological and psychiatric examination was carried out in 72 patients with AD and both apathy and depression, 29 patients with AD and apathy only, 31 patients with AD and depression only, and 52 patients with AD but no apathy or depression (control group). Patients with apathy had significantly lower scores on tests of verbal memory, naming, set shifting and verbal fluency than did those without apathy. The performance of patients with both apathy and depression was no worse than that of patients with apathy only except on a test of abstract thinking. Depression in the absence of apathy was not associated with greater cognitive impairment when compared with the AD control group. The findings suggest that apathy, but not depression, is associated with significantly more severe frontal lobe-related cognitive deficits in AD. 2 tables, 28 references. (AA-M).

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Cerebral Blood Flow and Metabolism in Late-Life Depression and Dementia Source: Journal of Geriatric Psychiatry and Neurology. 12: 118-127. 1999. Summary: This journal article reviews the literature on cerebral blood flow and metabolism in late-life depression (LLD) and dementia. LLD is characterized by abnormalities in cerebral blood flow (CBF) and cerebral metabolic rate (CMR) for glucose. Unlike younger adults with major depression, global cortical CBF and CMR reductions have been reported in LLD. Patients with LLD also are characterized by topographic abnormalities, most commonly involving selective prefrontal, superior temporal, and anterior parietal cortex regions. Characteristic profiles of CBF and CMR abnormalities also have been demonstrated in samples with Alzheimer's disease and other types of dementia. Functional imaging has shown sensitivity to disease severity and progression. However, there is limited information about the sensitivity and specificity of the functional imaging modalities in the differential diagnosis of the dementias. Available evidence does not support the use of functional imaging in isolation as a diagnostic tool, but rather as an adjunct to careful clinical assessment. 111 references. (AA-M).

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Depression Does Not Aggravate the Episodic Memory Deficits Associated With Alzheimer's Disease Source: Neuropsychology. 13(4): 532-538. 1999. Summary: This journal article examines the potential effects of depression on memory performance in people with Alzheimer's disease (AD). In a population-based study of people aged 75 years and older in the Kungsholmen parish of Stockholm, Sweden, 296 healthy older adults, 45 patients with AD, and 9 patients with AD and depression (ADD) were compared on free recall and recognition of slowly and rapidly presented words and digit span. The healthy older group outperformed the two AD groups across all tasks except forward digit span. In free recall, only the healthy group performed better with slowly presented than rapidly presented words. In recognition, however, all three groups showed similar gains from receiving more study time. This pattern of results suggests that both AD and AD-D patients have deficits in the ability to use more study time for remembering. The main finding was that the AD and AD-D groups were indistinguishable for all task variables, indicating that depression does not further

12 Depression

impair episodic memory performance in people with AD. 2 figures, 2 tables, 46 references. •

Interrelations Between Psychosis, Behavioral Disturbance, and Depression in Alzheimer Disease Source: Alzheimer Disease and Associated Disorders. 13(Supplement 2): S3-S8. 1999. Summary: This journal article reviews the literature on behavioral disturbances, psychosis, and depression in Alzheimer's disease (AD), using data from a recent study. Behavioral changes are common in AD, and heterogeneous in their presentation. Subtle personality changes such as apathy, irritability, and the inability to pay attention, tend to occur early. In later stages, agitation, aggression, and disinhibited behaviors may appear. In a recent study, the Columbia University Scale for Psychopathology in Alzheimer's Disease was used to monitor a number of behavioral symptoms in 235 patients with early probable AD. Markov analyses were conducted to predict the probability of developing or retaining a particular symptom at 6-month follow-up. Results show that the symptoms of psychopathology in AD fluctuate over time. Agitation was both the most frequent and persistent symptom, whereas paranoid delusions and hallucinations were less common and moderately persistent. Most behavioral disturbances, except paranoid delusions, were associated with greater cognitive impairment. There was no association between depressive features and either cognitive or functional impairment. 37 references.

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Characterization of Depression in Alzheimer's Disease by the CERAD Behavior Rating Scale for Dementia (BRSD) Source: American Journal of Geriatric Psychiatry. 6(1): 53-58. Winter 1998. Summary: This journal article describes a study funded by the National Institute on Aging to evaluate whether symptom clusters on the Behavior Rating Scale for Dementia (BRSD) differentiate between patients with Alzheimer's disease with and without depression. Participants were 69 patients with AD, who were recruited from the Research Registry at the Alzheimer Center of University Hospitals of Cleveland and Case Western Reserve University, Ohio. The patients were classified as depressed (n=29) or nondepressed (n=40) based on the Behavioral Symptoms Interview. A comparison of the two groups on the six content scales of the BRSD revealed that depressed patients had significantly higher scores than nondepressed patients on items related to depression and anxiety, but not on items related to psychosis, agitation, apathy, or vegetative symptoms. Using responses to the BRSD depression and anxiety items, 70 percent of the patients were correctly classified as depressed or nondepressed. The authors conclude that the BRSD may be useful for identifying patients for more intensive evaluation of depression in settings where resources for clinical evaluation are limited. 3 tables, 19 references.

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Depression Among African American Nursing Home Patients With Dementia Source: American Journal of Geriatric Psychiatry. 6(2): 162-175. Spring 1998. Summary: This journal article describes a study of the prevalence, recognition, and treatment of depression among 286 black and white nursing home residents with dementia. The participants were 218 black residents, mean age 80 years, and 68 white residents, mean age 85 years, from 3 nursing homes in Brooklyn, New York. Five scales were used to assess depressive symptoms, and the Core Research Center Modified Schedule for Affective Disorders and Schizophrenia was used to make a diagnosis of

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depression. Significantly more whites were diagnosed with possible depression, but there were no appreciable racial differences in the diagnoses of probable or definite depression, in depressive symptomatology, or in the clinical, social, or demographic factors associated with depression. There were no significant differences in depressive symptoms or diagnosis between American and Caribbean blacks. Depression was often unrecognized by staff in both racial groups, and was undertreated. Several of the depression scales developed for use in dementia had good reliability and validity among blacks. The authors suggest that factors related to nursing home admission criteria and residents' response to institutionalization may account for the absence of differences between racial groups. 6 tables, 46 references. •

Factors Associated With Symptoms of Depression Among Informal Caregivers of Demented Elders in the Community Source: Gerontologist. 38(2): 247-253. 1998. Summary: This journal article describes a study of the risk factors for depression among 321 informal caregivers of community-dwelling patients with dementia identified by a population-based Canadian national survey. The variables examined included caregiver and patient demographics, the caregiver's relationship to the patient, living arrangements, duration of dementia, and measures of the patient's functional, behavioral, and cognitive status. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale. Multiple regression analyses indicated that more severe depressive symptoms were associated with three caregiver variables (being a spouse or child of the patient, self-identified ethnicity other than English or French Canadian, and lower educational level) and two patient variables (greater behavioral disturbance and moderate to severe functional impairment). The authors conclude that physicians should be alert to depressive symptoms in informal caregivers of people with dementia, especially those at risk for more severe symptoms. 2 tables, 35 references. (AA-M).

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Frontal Lobe Hypometabolism and Depression in Alzheimer's Disease Source: Neurology. 50: 380-383. February 1998. Summary: This journal article describes a Japanese study of the association between focal brain metabolic abnormalities and depression in patients with Alzheimer's disease (AD). Regional cerebral glucose metabolism was determined by positron emission tomography in 53 patients with AD and mild to moderate levels of dementia. Depression and other psychiatric variables were assessed with the Neuropsychiatric Inventory (NPI), and the NPI scores were correlated with cerebral glucose metabolic rates for each brain region. Depression was present in 19 patients (35.9 percent). The NPI depression score was significantly correlated with normalized glucose metabolic rates in the bilateral superior frontal and left anterior cingulate cortices. Findings suggest an association between depression and decreased frontal lobe metabolic activity in AD. 2 tables, 28 references. (AA-M).

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Factor Structure of the Cornell Scale for Depression in Dementia Among Probable Alzheimer's Disease Patients Source: American Journal of Geriatric Psychiatry. 6(3):212-220. Summer 1998. Summary: This journal article describes the factor structure of the 19-item Cornell Scale for Depression in Dementia (CSDD) among 137 patients with probable Alzheimer's disease who were seen at an outpatient memory disorders clinic. The sample was 50.4

14 Depression

percent Hispanic and 49.6 percent white non-Hispanic; their mean age was 78.2 years, mean duration of illness was 4.1 years, and mean educational level was 10.4 years. Depressive symptoms were assessed with the CSDD as part of an extensive psychiatric clinical interview conducted by bilingual psychiatrists. A principal-factors analysis with varimax rotation resulted in a four-factor solution that accounted for 43.1 percent of the common variation. The four factors were general depression (lack of reactivity to pleasant events, poor self-esteem, pessimism, loss of interest, physical complaints, psychomotor retardation, sadness); rhythm disturbances (difficulty falling asleep, multiple night awakenings, early morning awakenings, weight loss, diurnal variation of mood); agitation/psychosis (agitation, mood-congruent delusions, suicide); and negative symptoms (appetite loss, weight loss, lack of energy, lack of reactivity to pleasant events). These factors showed moderate consistency with the five symptom clusters proposed in the original presentation of the CSDD. 4 tables, 43 references. •

Clinical Interface of Depression and Dementia Source: Journal of Clinical Psychiatry. 59(Supplement 10): 9-12. 1998. Summary: This article describes several aspects of the complex interface between depression and dementia. This area of clinical research has been studied primarily in Alzheimer's disease (AD). The author discusses depressive pseudodementia-depression as a prodrome and a risk factor for AD - and situations where depression complicates AD and presents treatment challenges for the clinician. Therapeutic efforts should be aimed at improving quality of life for patients and caregivers. A combination of behavioral treatment and judicious use of antidepressants should provide optimal management of depression in AD. 22 references.

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Diagnosis and Treatment of Depression in Patients With Alzheimer's Disease and Other Dementias Source: Journal of Clinical Psychiatry. 59(Supplement 9): 38-44. 1998. Summary: This article addresses the relationship of depression and dementia. Evidence is increasing that depression with reversible cognitive impairment may be a prodrome for dementia rather than a separate and distinct disorder. Questions have been raised about whether depression may be a risk factor for irreversible dementia. The author discusses the diagnosis of depression, rating depressive symptoms, potential confounding factors, clinical features of depression in dementia, treatment of depression in patients with dementia, and clinical guidelines. Randomized clinical trials have demonstrated that depression in patients with dementia responds to specific psychopharmacologic or psychosocial treatments. 86 references.

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Informant Interview for the Diagnosis of Dementia and Depression in Older Adults (IDD-GMS) Source: International Journal of Geriatric Psychiatry. 13(5): 298-309. May 1998. Summary: This study examined the development and validation of an informant interview for the diagnosis of dementia and depression in older adults (IDD-GMS). The IDD-GMS was based upon the Geriatric Mental State Schedule (GMS). Researchers identified 30 older adults with psychiatric illnesses and interviewed an informant/caregiver for each one. A total of 19 completed interviews using the GMS I, and 11 completed interviews using the IDD-GMS. Questions from the GMS were altered to reflect the informant nature of the interview. Researchers compared validity to ICD10 diagnoses agreed upon by two clinicians. They determined interrater reliability by

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one rater taping their interviews and the other making ratings according to the tape. Data analysis indicated that the validity and reliability of the IDD-GMS fell within acceptable limits. The researchers conclude that the IDD-GMS can be used as a diagnostic instrument for dementia and depression, and they note that it represents the first informant interview to achieve this. An appendix presents the IDD-GMS. 3 figures, 3 tables, 23 references. (AA-M). •

Clock Tests in Depression, Alzheimer's Disease, and Elderly Controls Source: International Journal of Psychiatry in Medicine. 28(4): 437-447. 1998. Summary: This study documents the clock-drawing, clock-copying, and clock-reading abilities of 33 older people with major depression and compares them to 42 people with Alzheimer's disease (AD) and 30 age-matched controls, to determine the test's usefulness in identifying depressed patients with underlying dementia. All patients with dementia met NINCDS-ADRDA criteria. Only those patients were selected who met the DSM-IV criteria for major depression within the past year. All subjects received detailed neurological, psychiatric, and mental status evaluations. Clock-task performance was analyzed with a repeated-measures analysis of covariance. The subject (AD, depression, older control) was the independent variable, and the dependent variables were the various clock task scores over multiple conditions. Education was included as a covariate. Linear regression assessed the effects of the Mini-Mental-State Examination, age, time post-onset of illness, education, and the Montgomery-Asberg Depression Rating Scale score on the clock tests within each group. Findings show that people with AD had significantly lower scores on all three clock tests than people with depression or the controls. Additionally, people with depression did not differ significantly from controls on quantitative scores or qualitative errors. These results indicate that clock tests may be useful for identifying depressed patients with underlying dementia. 2 tables, 26 references. (AA-M).

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Brief Measures of Depression and Cognitive Function Source: Generations. 21(1): 41-43. Spring 1997. Summary: This journal article reviews brief measures of depression and cognitive function that may be useful with older adults. The review of brief assessment instruments for depression focuses on the Center for Epidemiological Studies Depression Scale; and describes its structure, content, psychometric properties, strengths, and weaknesses. It also provides less detailed reviews of the Geriatric Depression Scale, Beck Depression Scale, Hamilton Depression Scale, and Cornell Scale for Depression. This article discusses general issues regarding the use of cognitive screening tests to identify symptoms that may be consistent with dementia. It describes one such test, the Mini-Mental Status Examination, and outlines its advantages and limitations. 18 references.

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Pleasant Events Schedule-AD: Psychometric Properties and Relationship to Depression and Cognition in Alzheimer's Disease Patients Source: Gerontologist. 37(1): 40-45. 1997. Summary: This article describes the psychometric properties of the Pleasant Events Schedule-Alzheimer's Disease (PES-AD) and the relationship among pleasant events, depression, and cognition in 42 outpatients with Alzheimer's disease (AD). Participants were recruited from the research roster of the Geriatrics and Family Services Clinic at the University of Washington Medical Center in Seattle, Washington. All AD patients

16 Depression

lived in the community with either a spouse or an adult child. None of the AD patients were taking antidepressants or other psychotropic medications; and none were suicidal, delusional, or hallucinating. Patients' participation in pleasant activities was measured with both the original, 53-item version of the PES-AD and a shortened, 20-item version. Overall cognitive functioning was assessed with the Mini-Mental State Examination (MMSE), and depression severity was measured with the Hamilton Depression Rating Scale (HDRS). The results suggest that both versions of the PES-AD had good reliability and were significantly correlated with each other and with the MMSE and HDRS. Both depression and decreased cognitive functioning were associated with reduced frequency of enjoyable activity. The loss of interest in pleasant activities was greater in depressed than in nondepressed patients, regardless of their cognitive level. The authors conclude that both the long and short forms of the PES-AD may be useful tools for identifying enjoyable activities for patients with AD. 5 tables, 27 references. •

Recognition and Psychopharmacologic Treatment of Geriatric Depression Source: Journal of the American Psychiatric Nurses Association. 3(2): 32-41. April 1997. Summary: This journal article discusses difficulties faced by nurses in the diagnosis and treatment of geriatric depression. It reviews the prevalence and risk factors of depression in older adults, and lists medical conditions and drug therapy associated with geriatric depression. Two major obstacles to diagnosing depression in older people are explored: distinguishing between physical and psychiatric causes, and between depression and dementia. Important elements to include in the medical evaluation of depressed older patients are noted. The article discusses antidepressant treatment issues, including pharmacokinetics in the elderly metabolism of antidepressants, and available antidepressants. Among the pharmacological treatment options for older people with depression are tricyclic antidepressants, newer agents such as buproprion, and selective serotonin reuptake inhibitors. The article concludes with a discussion of dosing strategies and factors affecting medication compliance in older patients. 4 tables, 34 references.

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Depression and Dementia in Relation to Apolipoprotein E Polymorphism in a Population Sample Age 75+ Source: Biological Psychiatry. 42: 898-903. 1997. Summary: This journal article describes a study of the co-occurrence of depression and dementia in relation to apolipoprotein E (apoE) gene status in a population-based sample of 806 people, aged 75 years and older, in Stockholm, Sweden. All participants completed an extensive clinical examination, including a psychiatric assessment, the Mini-Mental State Examination, and apoE genotyping. Of the 806 participants, 184 (22.8 percent) were diagnosed with dementia and 43 (5.3 percent) with major depression. Depression was present in 11.4 percent of the people with dementia compared with 3.5 percent of those without dementia. In people who were not depressed, the prevalence of dementia increased with the number of apoE4 alleles and tended to be lower when an apoE2 allele was present. However, depression was not strongly associated with apoE gene status, and the overrepresentation of depression in dementia was found to a similar extent in each of the common apoE gene status categories. Despite an association between apoE gene status and dementia, and between depression and dementia, the authors conclude that apoE gene status does not appear to be associated with depression in older people with or without dementia. 2 tables, 27 references.

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To Treat or Not To Treat: Issues in Decisions Not To Treat Older Persons With Cognitive Impairment, Depression, and Incontinence Source: Journal of the American Geriatrics Society. 45(9): 1094-1101. September 1997. Summary: This journal article describes a study of decisions not to treat problems of cognitive impairment, depression, and urinary incontinence in older people. The participants were 128 patients who were assessed at 1 of 4 outpatient geriatric assessment units in Allegheny County, Pennsylvania, and were identified as having cognitive impairment (55 percent), depression (50 percent), and/or incontinence (43 percent). More than 75 percent of the sample was female, 69 percent were white, and the mean age was 75.4 years. The patients' medical charts were reviewed to obtain information about presenting problems, diagnosis, and treatment recommendations. Although most of the identified problems received treatment recommendations, slightly more than a third of the cognitive impairment and depression problems and nearly half of the incontinence problems did not receive treatment recommendations. Six categories of reasons for decisions not to treat were identified: patient or family refused treatment, assessment not completed, intervention already in place, concurrent problems which might have interfered with treatment, no documented diagnosis, and no documented reason. 1 figure, 4 tables, 35 references.

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Case Study: Tetraaminotacrine Treatment and Depression Source: Alzheimer's Research. 3(3): 115-117. June 1997. Summary: This journal article describes two cases of depression associated with the use of tetrahydroaminotacrine (tacrine or Cognex) in patients with Alzheimer's disease (AD). One patient was a woman, age 82 years, who was admitted to the hospital with major melancholic depression. She had been diagnosed with AD 6 months earlier, and treatment with tacrine 40 mg/day was started 1 month after the diagnosis. The other patient was a woman, age 70 years, who was admitted to the hospital after attempting suicide by ingesting drugs. AD had been diagnosed 7 months earlier, and she had been treated with tacrine 40 mg/day for 9 months. In both cases, no other psychotropic or somatic drug was used. Depression regressed upon discontinuation of tacrine and administration of antidepressants or electroconvulsive therapy. Discussion of the cases focuses on possible explanations for induction of depression by tacrine. 15 references.

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Treatment of Depressive Disorders of Spousal Caregivers of Persons With Alzheimer's Disease: A Review Source: American Journal of Alzheimer's Disease. 14(5): 289-293. September-October 1999. Summary: This journal article reviews studies on the methods and efficacy of interventions for depressive disorders in spousal caregivers of people with Alzheimer's disease (AD). Support groups are one of the most popular forms of caregiver interventions; and research suggests that these groups are helpful for information sharing and peer support, but they do not adequately meet the affective needs of the participants. Psychoeducational intervention groups are more focused on helping caregivers develop a specific set of coping skills to deal with their depression while managing the problematic behaviors of the person with AD. These groups appear to be the most effective treatment for depression in AD caregivers. Although research on psychotherapy and counseling for caregivers is limited, one study suggests the efficacy of cognitive therapy. The author recommends further research on psychoeducational intervention groups and cognitive therapies. 31 references.

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Psychopathologic and Functional Outcome in the Treatment of Elderly Inpatients With Depressive Disorders, Dementia, Delirium, and Psychoses Source: International Psychogeriatrics. 10(1): 71-83. March 1998. Summary: This journal article describes a study of the psychopathologic and functional outcomes of 148 older patients with depressive disorders, dementia, delirium, and psychoses admitted for inpatient treatment at the psychogeriatric university clinic in Aarhus, Denmark. The sample consisted of 80 patients with major depression, 34 with dementia, 26 with delirium, and 8 with psychoses. The average ages were 79, 80, 83, and 76 years, and median lengths of stay were 53, 35, 24, and 24 days, respectively, in the four groups. The patients were assessed at admission and again at discharge for psychopathology, behavioral disorders, depression, cognitive function, activities of daily living, and gait. Treatment included physiotherapy, occupational therapy, and drug therapy. At the end of their stay, patients with depression and delirium improved significantly on all health measures, and patients with psychosis showed a trend toward improvement in psychopathology and gait. Patient with dementia improved in psychopathology, but the other measures remained unchanged. The authors conclude that some older patients with depression, delirium, and dementia may benefit from treatment in a psychogeriatric hospital setting. 9 tables, 19 references.

Federally Funded Research on Depression The U.S. Government supports a variety of research studies relating to depression. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to depression. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore depression. The following is typical of the type of information found when searching the CRISP database for depression: •

Project Title: 5-HT2A RECEPTOR IN DEPRESSION: MOLECULAR MECHANISMS Principal Investigator & Institution: Garlow, Steven J.; Psychiatry and Behavioral Scis; Emory University 1784 North Decatur Road Atlanta, GA 30322 Timing: Fiscal Year 2002; Project Start 15-JUL-2000; Project End 30-JUN-2004 Summary: (Adapted from applicant's abstract) Dysfunction of the serotonergic system is considered to play a central role in the genesis of major depression and schizophrenia. In particular, the 5-HT2A receptor has been implicated in the pathophysiology of depression and schizophrenia and as the site of action of various psychotherapeutic

Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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agents. The most important and consistent finding of serotonergic dysfunction in major depression is increased B of the S-HT2A receptor. This has been documented in the CNS and in the periphery of depressives. The molecular mechanisms that underlie the changes in receptor expression in depression are not understood. The objectives of this proposal are to identify and characterize the factors that regulate the expression of the 5HT2A receptor, and relate those mechanisms to the pathophysiology of depression. Three Specific Aims are proposed that examine the different levels of regulation of the receptor. The goal of the first Specific Aim is to map genes that control the level of expression of the 5-HT2A receptor in the brain, and begin to identify those genes. This will be accomplished through genetic analysis of Recombinant Inbred (RI) strains of mice, with QTL analysis. The final step in the genetic analysis will be to identify the relevant genes. The experiments in this Aim will also test whether the same genes control the expression of the receptor throughout the body. The goal of the second Specific Aim is to identify critical elements in the promoter for the S-HT2A gene that direct cell specific expression of the receptor. A series of transgenic animals will be produced that have different versions of the S-HT2A promoter driving expression of a reporter gene. The hypothesis tested is that the expression of the receptor is controlled by the interplay of positive and negative response elements in the receptor promoter. The goal of the third Specific Aim is to determine whether a number of growth factors control the expression of the S-HT2A receptor. These experiments will use a number of cells in culture that express the S-HT2A receptor. These cells have been derived from both the CNS and peripheral tissues. The factors that will be tested include glucocorticoids, and a series of immune regulators. These factors are known to be altered in depression and can exert powerful regulatory influences on the expression of a number of genes. As the factors are characterized in the in vitro systems, their relevance to the regulation of the S-HT2A receptor in the brain will be tested in experimental animals. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: A GROUNDED THEORY STUDY OF DEPRESSION IN ADULT LESBIANS Principal Investigator & Institution: Barnard, Amy G.; None; University of Arizona P O Box 3308 Tucson, AZ 857223308 Timing: Fiscal Year 2001; Project Start 15-SEP-2001 Summary: (provided by the applicant) Depression is a serious mental health issue. The World Health Organization has predicted that by the year 2010 depression will be the second leading cause of disability in the world. Women are diagnosed with depression at twice the rate of men. Within the population of women is a subgroup of lesbians. Lesbians? lives are considerably different from the lives of heterosexual women because their sexual orientation leads to marginalization and stigmatization. Though extensive research has been conducted investigating higher rates of depression in women, little research has been conducted on the psychological effects of living as a member of a sexual minority. The experience of depression in lesbians is even less studied. This proposed study will use grounded theory methodology to describe the experience of depression in adult lesbians. The findings of this study will establish a foundation for continued work in this area with the eventual goal of developing a community-based intervention to improve the mental health care of lesbians and other sexual minorities. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: A MOOD MANAGEMENT INTERVENTION FOR PREGNANT SMOKERS Principal Investigator & Institution: Cinciripini, Paul M.; Professor; Immunology; University of Texas Md Anderson Can Ctr Cancer Center Houston, TX 77030 Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 30-APR-2008 Summary: (provided by applicant): The majority of studies evaluating smoking cessation treatments for pregnant smokers have employed minimal intervention strategies that have achieved limited success. We believe a significant reason for this lack of efficacy is the failure of minimal treatment approaches to address symptoms of depression and stress among pregnant smokers who fail to quit on their own. Data from our recently completed trial of a videotape smoking cessation intervention for pregnant smokers indicated that significant levels of affective impairment were present in this group. Over 50 percent of the women met DSM-IV criteria for major depression on the Prime MD, or had CES-D scores > 16. Depressive symptoms were frequently chronic. In addition, research indicates that high levels of stress, poor coping resources, and low levels of social support satisfaction are predictive of depression and continued smoking during pregnancy. The proposed study will address these issues by evaluating the efficacy of an intervention designed to impact these risk factors. Approximately 375 women will be randomized to either a mood management (MM) intervention, health education (HE), or usual care (UC) control condition. The MM and HE interventions will be delivered in 7 60-minute counseling sessions that will incorporate 10 minutes of brief smoking cessation counseling based on the Clinical Practice Guidelines that will include a specific focus on smoking and pregnancy. Participants in the MM condition will receive an additional 50 minutes of counseling emphasizing the development of affect management skills. The MM protocol will be based on Cognitive Behavioral Analysis System of Psychotherapy (CBASP), a psychotherapy developed for the treatment of chronic depression that has been shown to be highly effective in reducing depression in this difficult-to-treat population. HE participants will receive an additional 50 minutes of standard pre/postnatal health education focused on non-smoking related issues relevant to maintaining a healthy pregnancy. The UC condition will receive 7 3 to 5minute Clinical Guidelines-based brief counseling sessions that will be similar in content to the smoking cessation counseling component of the MM and HE interventions. We hypothesize that cessation rates during pregnancy and at 3 and 6 months postpartum will be significantly greater for smokers in the MM versus the HE and UC control conditions. In addition, we hypothesize that smokers with significant levels of depression and/or positive histories of depression at the start of the intervention will quit significantly less often than nondepressed smokers and negative depression history smokers. We will also evaluate the role of coping, self-efficacy, social support, perceived counselor support, perceived stress, negative affect, and depression as mediators of treatment outcome. As secondary aims we will assess whether levels of depression are significantly reduced for smokers in the MM condition relative to those in the HE or UC conditions, and we will assess the role of neuroticism in the relationship between depression and nicotine dependence. We will also evaluate the extent of smoking reduction (cigarettes smoked/cotinine) among women who fail to quit, as a function of treatment, depression history, and current depression. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: A NOVEL THERAPY FOR DEPRESSION WITH CO-OCCURRING PANIC Principal Investigator & Institution: Frank, Ellen; Professor; Psychiatry; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, PA 15260 Timing: Fiscal Year 2001; Project Start 01-APR-2001; Project End 31-MAR-2004 Summary: Complication of major depression by the co-occurrence of panic attacks or panic disorder is both common and clinically significant. Patients with this condition show more severe symptom profiles, greater risk of suicidality, poorer psychosocial functioning, and a poorer response to traditional depression treatments. The primary aim of the current proposal is to develop an effective yet efficient psychotherapeutic intervention for patients with major depression complicated by panic symptoms. This new treatment, interpersonal psychotherapy for depression with panic symptoms (I PTPS), will adapt and integrate components of cognitive behavior therapy (CBT) for panic and anxiety (Barlow & Craske, 1989) into the therapeutic framework of interpersonal psychotherapy for depression (IPT, Kierman et al., 1984) to treat this clinically severe yet treatment-resistant condition. Conceptually, this integrated treatment approach will seek to promote active resolution of interpersonal problems while concurrently addressing symptoms of panic and anxiety that interfere with active interpersonal problem solving. In Phase I of the proposed study, 12 patients with major depression complicated by panic symptoms will be treated with a 16-session course of the newly developed treatment. Specific aims of Phase I include the development, elaboration, and iterative refinement of a treatment manual for IPT-PS; development of therapist training procedures; and the development of measures of treatment adherence, competence, and satisfaction. In Phase II, 24 patients with depression complicated by panic symptoms will be randomly assigned to treatment using IPT-PS, and will be compared with 12 patients randomly assigned to receive standard IPT. Specific aims of this pilot study include: finalizing the treatment manual and measures of treatment adherence, competence, and satisfaction; testing treatment satisfaction with IPT-PS; evaluating characteristics of treatment responders and non-responders; and generating treatment effect size estimates for use in planning a larger efficacy/effectiveness study of IPT-PS. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: A RANDOMIZED TRIAL OF LIAISON PSYCHIATRY IN PRIMARY CARE Principal Investigator & Institution: Katon, Wayne J.; Professor; Psychiatry and Behavioral Scis; University of Washington Seattle, WA 98195 Timing: Fiscal Year 2001; Project Start 01-JUL-1987; Project End 31-AUG-2005 Summary: (Applicant Abstract): Rationale - The overall goal is to integrate an organized program of improved care of depression into the management of other chronic diseases in primary care. Diabetes mellitus was selected for study because of its prevalence and its large impact on patients and society. If a Depression Care Program (DCP) improves disability and/or disease outcomes among diabetics, it would help establish the core importance of recognition and management of depression for chronic disease management in primary care. Research goals - (1) We will develop population-based data in a managed care setting concerning the effects of depression on the societal impacts of diabetes and on the quality of diabetes (self)-management. By (self)management we refer to both patients' and providers' roles in ongoing care of a chronic illness. (2) We will evaluate a generalizable and economically feasible Depression Care Program (DCP) for population-based management of depression among patients with

22 Depression

diabetes mellitus. These goals will be achieved by two related studies. Aims of Study 1: Study 1 will assess the impact and management of depressive illness among diabetic patients, in an epidemiologic study, which will include patients with and without depression. Study 1 will assess the effects of major depression on societal impacts of diabetes (health care costs and disability) and on the quality of diabetes (self) management. These analyses will control for medical co-morbidity and baseline severity of diabetes. Aims of Study 2: We will evaluate whether a Depression Care program (DCP) for major depression in adult patients with Type 2 diabetes mellitus improves depression outcomes, disability outcomes, and glycemic control (as measured by HemoglobinA1C). Secondary process and outcome measures will include adherence to antidepressant and to diabetic medications, severity of symptoms related to diabetes, self-efficacy in managing diabetes, adherence to diabetes (self) management regimens (diet, exercise, glucose monitoring and medications), and health care utilization and costs. We will assess the cost-effectiveness of the DCP relative to care as usual. Data collection: We will carry out these studies by assessing diabetes and depression status in 4500 diabetic patients. Among Type 2 diabetics with major depression, 290 eligible and willing patients will be randomly assigned to a Depression Care Program or to Usual Care, We will evaluate the effectiveness of the Depression Care Program using selfreport data collected at baseline, 3, 6, 12 and 24 months, and by HbA1C values assessed at baseline, 6, 12 and 24 months. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PREGNANCY

ACUPUNCTURE

TREATMENT

OF

DEPRESSION

DURING

Principal Investigator & Institution: Manber, Rachel; Associate Professor; Psychiatry and Behavioral Sci; Stanford University Stanford, CA 94305 Timing: Fiscal Year 2002; Project Start 30-SEP-1998; Project End 31-AUG-2007 Summary: (TAKEN FROM APPLICANT): Objective: The aim of the proposed randomized controlled study is to assess the efficacy and effectiveness of acupuncture treatment of depression during pregnancy. Significance: Depression is, unfortunately common during pregnancy and it has significant deleterious effects on mother and infant, including low birth weight, preterm delivery, and continued depression into postpartum. Few medically acceptable treatments are available for the treatment of depression during pregnancy. Our preliminary work provides evidence that acupuncture may be a safe and acceptable treatment option for depression. Specific aims: 1) to evaluate the efficacy of brief 8-week treatment with SPEC acupuncture for major depression during pregnancy relative to the two control treatments; 2) to evaluate the efficacy and clinical significance (pregnancy outcome) of continued treatment with SPEC acupuncture relative to the two control treatments; and 3) to evaluate the differential impact of treatment with SPEC acupuncture for major depression on the incidence of postpartum depression. Participants. Design: To test the efficacy of acupuncture designed specifically to address depressive symptomatology during pregnancy (SPEC) it will be compared, using random assignment, to the following 2 control conditions: 1) valid acupuncture that does not directly address depressive symptoms (NSPEC), thus controlling for the belief in the efficacy of the treatment; and 2) prenatal massage (MSSG), thus controlling for attention, physical contact, relaxation and respite from daily stress. The study includes three phases, acute, continuation and follows up. Participants: 180 participants meeting western diagnostic criteria for Major Depression with a score >: 14 on the first 17 items of the 24-item Hamilton Depression Rating Scale (HRSD) will be randomized. The ethnic distribution of the sample will be

Studies 23

representative of the ethnic distribution in the San Francisco Bay Area. Treatments: The acute phase of treatment consists of 16 half-hour treatment sessions delivered over 8 weeks. To consolidate treatment gains and to prevent post partum depression, participants who have full or partial response at the end of the acute phase will continue to receive the same, but less frequent, treatment until 10 weeks post partum, and will be followed up for 6 more months. Main Outcome Measure(s): The primary outcome measures are the HRSD and the depression portion of the SCID-IV, to be administered monthly during the treatment phases and at 3 and 6 months follow up. Other important measures include the Beck Depression Inventory (weekly), expectations (of the participants and the providers), and delivery and infant measures. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ADHERENCE TO DEPRESSION TREATMENT AMONG OLDER PATIENTS Principal Investigator & Institution: Bogner, Hillary R.; Family Practice and Cmty Med; University of Pennsylvania 3451 Walnut Street Philadelphia, PA 19104 Timing: Fiscal Year 2003; Project Start 20-FEB-2003; Project End 31-JAN-2008 Summary: This application for an NIMH Mentored Patient-Oriented Research Career Development Award (K23 Award) seeks support to develop a program of research related to the treatment of depression in older adults with cardiovascular disease (CVD). This application capitalizes on my background in family medicine and clinical epidemiology and proposes activities aimed at developing my ability to design, implement, and evaluate interventions directed at the treatment of depression in older primary care patients with CVD. An intervention for depression designed to address CVD comorbidity would provide a model for integration of depression treatment with care for other chronic medical conditions among older adults in the primary care setting. My knowledge of clinical family medicine, epidemiology, and biostatistics, as well as my experience of implementing a large primary care-based study provide an excellent background for development as an intervention researcher. The University of Pennsylvania offers an outstanding research environment to help accomplish the goals of this K23: (1) to study the patient characteristics that place older adults with depression and CVD at risk for nonadherence to depression treatment; (2) to obtain expertise in advanced statistical methods, e.g. structural equation models and new study designs, both of which are integral to my study of adherence in primary care settings; and, (3) to design interventions for depression among older primary care patients with CVD. In addition to educational activities, this application lays out a research plan unfolding in three phases. Phase I will examine factors associated with adherence to recommended depression therapy in older primary care patients with CVD in an NIMH-funded study designed to test the effectiveness of an intervention aimed at improving the recognition and treatment of depression (the PROSPECT study). The focus will be on how cardiovascular comorbidity, executive and cognitive functioning, beliefs about depression and its treatment, social support, and other patient-level factors are associated with adherence to depression treatment in older primary care patients. In Phase 2, semi-structured interviews of older primary care patients will explore patient concepts of depression in relation to CVD and its treatment and patient preferences for possible strategies aimed at improving adherence to depression treatment. Phase 3 will test the feasibility of a protocol for an intervention aimed at the treatment of older adults with CVD. The protocol will be based on the results from Phases 1 and 2. During Phase 4, the findings from Phases 1, 2, and 3 will guide the final development of an R01 intervention study, sketched out in the final

24 Depression

section of this K23. This project will set the stage for the development and implementation of interventions to improve depression treatment adherence among persons with co-existing CVD. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: AGMATINE, NEUROPROTECTION AND DEPRESSION Principal Investigator & Institution: Zhu, Meng-Yang; University of Mississippi Medical Center 2500 N State St Jackson, MS 39216 Timing: Fiscal Year 2002; Project Start 16-SEP-2002; Project End 31-AUG-2007 Summary: GRANT=6673599;P20RR Decreased hippocampal volume and reduced glial cell number in the cortex have been documented in major depression. Based largely on animal studies, stress-induced hypercortisolemia, leading to neurotoxicity and/or Active Cell Death (apoptosis) is the probable cause of the hippocampal volume loss in depression. Active Cell Death is known to involve NMDA glutamate receptor (NMDAR) activation and nitric oxide overproduction. Agmatine, an endogenous polyamine derived from decarboxylation of arginine and mainly stored in synaptic vesicles of neurons, has been found to antagonize both NMDA-R and Nitric Oxide synthase, and thereby to possess natural neuroprotective properties (i.e., shown against hypoxic ischemia). Hippocampal volume loss has been well-established to occur in animal models of chronic stress. Agmatine is normally abundant in the hippocampus where it may normally be co-released with glutamate to protect from excito-neurotoxicity through a polyamine site in the NMDA-R of normal rats. We hypothesize that in subjects suffering from major depression, agmatine becomes depleted as a consequence of long term release under prolonged stress, and therefore the hippocampal neurons become exposed to neuronal damage. The goal of my proposal is to examine the neuroprotective properties of agmatine against neurotoxicity induced by excitotoxins or higher concentrations of glucocorticoids as have been detected in patients with major depression. To address this goal, the neuroprotective effects of agmatine will be measured in 1) cultured fetal rat hippocampal neurons exposed to glutamate as well as related chemicals, or high concentrations of glucocorticoids in vitro which mimic conditions found in depressed patients in vivo, 2) the hippocampi of rats treated with excitotoxins, and 3) the hippocampi of rats after undergoing chronic mild stress. Concentrations of endogenous agmatine in hippocampi will be correlated with the extent of structural injury to neurons and glial cells in the hippocampal primary culture and in the hippocampus in vivo of treated rats and the rat chronic mild stress model. This research is designed to elucidate the functional significance of agmatine as an endogenous neuroprotective agent of relevance to the effects of chronic stress as occurs in depression. Clarification of structural and biochemical changes in the hippocampus of the chronic mild stress animal model will add to evidence of hippocampal neuron loss in depression, and hopefully suggest ways to augment agmatine's natural neuroprotective effects. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: AMERICAN MELANCHOLY: DEPRESSION IN THE TWENTIETH CENTURY Principal Investigator & Institution: Hirshbein, Laura D.; Psychiatry; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, MI 481091274 Timing: Fiscal Year 2003; Project Start 01-JUL-2003; Project End 30-JUN-2006

Studies 25

Summary: (provided by applicant): This project will examine depression in the United States between 1900 and 2000, particularly the social, cultural, political, economic, and professional forces that affected medical and popular ideas about this disease. For centuries, physicians have described an entity that today would be identified as melancholia or depression, but psychiatric diagnosis and treatment of depression have changed dramatically over the most recent century. Not only have medical ideas about depression changed in the last century, but also there have emerged popular ideas about depression that sometimes complement but also complicate professional ideas. The popular narratives about depression have grown in importance against a backdrop of expanding media sources, both visual and print. The proposed project will examine both medical and popular ideas about depression in the twentieth century. By using medical literature, this project will trace changes in the category of depression from involutional melancholia to the creation of specific diagnostic criteria with the third and subsequent editions of the Diagnostic and Statistical Manual (DSM). By rigorously analyzing magazine articles on mental illness and depression, it will be possible to understand cultural sources of information on this disease. Specific themes to be addressed throughout this study will be, 1) the role of gender in constructing categories; 2) the relationship between popular and psychiatric representations of depression and the role of culture in disease definitions; and 3) the shifting nature of psychiatric authority and professionalization. The product of this project will be a book length monograph, of interest to both historians and psychiatrists, to be published by a university press. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DEPRESSION

AMYGDALOSTRIATAL

CIRCUIT--AFFECTIVE

BEHAVIOR--

Principal Investigator & Institution: Taylor, Jane R.; Associate Professor; Yale University 47 College Street, Suite 203 New Haven, CT 065208047 Timing: Fiscal Year 2002; Project Start 16-JUL-2002; Project End 30-JUN-2006 Summary: Neurobiological studies of major depression have identified dysfunctional cognitive-affective-motor regions; however, the details of these altered physiological and structural changes, and the molecular basis for these alterations, remain to be elucidated. Recent imaging data suggest that depressed patients have increased blood flow/metabolism in the amygdala concomitant with decreased blood flow and volume in orbitofrontal cortex and ventromedial striatum. These effects may be relevant to the psychopathology of depression because cortico-limbic - striatal dysfunction may contribute to hypersensitive stress, fea4r, and anxiety responses, anhedonia, affective alterations, and changes in cognitive function. Thus, it is critical to understand the molecular basis of neuroplasticity in these brain regions implicated in depression and mood disorders and the resulting cellular and behavioral correlates. This project will thus focus on the role for the extended amygdala (notably the central nucleus of the amygdala, and nucleus accumbens shell) in depression and alterations in PKA/CREB signaling in these regions because the involvement of PKA/CREB in learning/plasticity is well established and because antidepressant treatment increases PKA/CREB activity. Specifically the functional and molecular correlates of plasticity in response to stress and antidepressant treatment will be investigated. We hypothesize that alterations in the extended amygdala results in abnormal processing of affective/emotional stimuli and behavioral regulation by appetitive and aversive events. Combined with alterations of neural signaling within the ventral striatum that contribute to anhedonia, negative stimuli may also exert heightened suppressive consequences on behavior in depression.

26 Depression

In addition, sustained increases PKA/CREB produced by anti-depressants would be predicted modify behavior by enhancing plasticity associated with learning and affective processes. Using direct pharmacological manipulations, transgenic murine models, vector-mediated over-expression of CREB and stress-induced animal models of depression, we will investigate the role of PKA/CREB signaling within the extended amygdala in reactivity to unconditioned aversive stimuli and/or anhedonia (sensitivity to appetitive rewards), and appropriate control procedures, as well as the mechanism of action of anti-depressant drugs in order to evaluate and validate the relevance of these processes to models of depression. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: AN EXPERT SYSTEM TO REDUCE DEPRESSION IN PRIMARY CARE Principal Investigator & Institution: Levesque, Deborah A.; Pro-Change Behavior Systems, Inc. 2 Chafee Rd Kingston, RI 02881 Timing: Fiscal Year 2001; Project Start 25-SEP-2001; Project End 31-DEC-2002 Summary: A variety of effective interventions exist for people who seek help for depression. However, there is a lack of effective interventions for individuals who do not seek help or follow through with treatment referrals. We propose to fill this gap in services by developing and testing a Transtheoretical Model-based intervention that will be delivered proactively, on a population basis, to primary care patients who are experiencing symptoms of depression but are not currently involved in treatment. It is the first intervention for depression that is appropriate for individuals in all stages of change-not merely the minority who are prepared to take action. In Phase I of this Fast Track Initiative, the aims are to norm TTM measures, develop the TTM interventions, and determine the feasibility of this approach by assessing study recruitment rates and reactions to the intervention materials. Primary care patients who screen positive for mild to moderate depression and are not involved in treatment will complete surveys for measurement norming (n=100) or participate in a pilot-test of the intervention materials (n=50). If feasibility conditions are met, we will conduct a randomized clinical trial in Phase II to assess the efficacy of the expert system intervention for depression. PROPOSED COMMERCIAL APPLICATIONS: Depression is a costly illness for health care organizations, disability insurers, and employers because of increased health service utilization, disability claims, and lost productively among depressed individuals. An effective, low-cost expert system that can reduce the prevalence of depression on a population basis has significant commercial potential. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ANIMAL DEPRESSION

MODELS OF

CHILDHOOD

AND

ADOLESCENT

Principal Investigator & Institution: Bylund, David B.; Professor and Chair; Pharmacology; University of Nebraska Medical Center Omaha, NE 681987835 Timing: Fiscal Year 2003; Project Start 14-AUG-2003; Project End 31-MAY-2006 Summary: (provided by applicant): Major Depressive Disorder (clinical depression) is a severe and potentially incapacitating mental illness that is common in children and adolescents, with an estimated lifetime prevalence of 15 -20 % in this population. An important difference between clinical depression in children and adolescents, as compared to adults, is its response to antidepressant drugs. Tricyclic antidepressants have not been shown to be effective in treatment of child and adolescent clinical depression. Although antidepressant drugs have numerous neurochemical actions, the

Studies 27

therapeutic mechanisms of action of antidepressant drugs in relieving depression remain unknown. In non-depressed persons antidepressant drugs are not euphoriant or stimulant. Therefore, investigations related to which of the many neurochemical effects of antidepressant drugs are functionally related to their therapeutic efficacy in relieving depression requires research using a behavioral animal model of clinical depression. To better understand the neurobiology underlying the differences between children and adolescents, and adults in the response to pharmacological treatment of clinical depression, animal models of childhood and adolescent depression are needed. Currently, there are no established juvenile animal models of clinical depression. Although the models developed in adult animals can serve as a starting point, they must be adapted and validated in juvenile animals due the many differences between juvenile and adult animals. The overall goal of this proposal is to assess the validity and usefulness of two well-established rat animal models of adult clinical depression as models of childhood and adolescent clinical depression. Specifically, we propose to assess the usefulness of the forced-swim test and of learned helplessness as animal models for clinical depression in juvenile rats. The key questions which are addressed by this proposal are: 1) Do juvenile rats respond to antidepressant drugs with decreased immobility in the forced swim? 2) Do juvenile rats develop learned helplessness after inescapable stress in both the acute and persistent paradigms, as demonstrated by shuttlebox testing? 3) Do juvenile rats respond to antidepressant drugs in the both acute and persistent learned helplessness paradigms with decreased escape latencies in shuttlebox testing? Ultimately, the models may facilitate a better understanding of the underlying neurobiology of clinical depression, and serve as predictive measures of antidepressant efficacy in children and adolescents. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SCLEROSIS

APATHY

AND

COGNITIVE

IMPAIRMENT

IN

MULTIPLE

Principal Investigator & Institution: Christodoulou, Christopher; Neurology; State University New York Stony Brook Stony Brook, NY 11794 Timing: Fiscal Year 2001; Project Start 28-AUG-2001; Project End 31-JUL-2003 Summary: (Adapted from Applicant's Description): While researchers have searched for a relationship between the cognitive deficits and depression that are both common in multiple sclerosis (MS), numerous investigations have failed to find an association. This failure may stem from the multifaceted nature of depression. Measures of depression tap a spectrum of symptoms (e.g., dysphoric/depressed mood, somatic complaints), and some may be more relevant to cognition than others in neurological disorders such as MS. While apathy has been historically associated with depression, recent evidence indicates that apathy represents an important and distinct neuropsychiatric phenomenon in its own right. Researchers recently found that apathy played a key role in predicting cognitive dysfunction in a variety of neurological disorders (e.g., Parkinson's disease, progressive supranuclear palsy). In contrast, no link was found between cognitive impairment and dysphoric mood, a core feature of depression. While a relationship between apathy and cognitive impairment has been identified in over half a dozen neurological populations, it has not been adequately examined in MS. Apathy has been associated with neuroanatomical damage to regions that are often affected by the MS disease process (e.g., prefrontal cortex). In addition, apathy has been linked to neuropsychological deficits commonly found in MS (e.g., in working memory, executive functions). The proposed study will demonstrate how apathy, when separated from other factors traditionally associated with depression, can serve as a key marker of

28 Depression

cognitive dysfunction in persons with MS. Subjects will consist of 80 MS patients. Apathy will be measured with the Apathy Evaluation Scale and the Apathy subscale of the Neuropsychiatric Inventory. Subjects will complete a battery of cognitive tasks focussed on executive functioning and working memory. It is hypothesized that apathy will correlate negatively with performance on tests of executive functioning and working memory, and that apathy will significantly add to the explanation of variance in such performance beyond that accounted for by other neuropsychiatric variables measuring depression, fatigue, pain, and sleep disturbance. Empirical support for the initial hypotheses will lay the foundation for further rehabilitative research designed to improve both apathy and cognitive functioning in persons with MS. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: APOE, DEPRESSION AND COGNITION IN LATE LIFE Principal Investigator & Institution: Gallo, Joseph J.; Associate Professor; Family Practice and Cmty Med; University of Pennsylvania 3451 Walnut Street Philadelphia, PA 19104 Timing: Fiscal Year 2001; Project Start 15-MAR-2000; Project End 29-FEB-2004 Summary: (Adapted from Applicant's Abstract): This study takes advantage of the primary care setting to consider whether we can identify presentations of depression in older adults that are characterized more by motivation disturbance (e.g., anhedonia, executive function disturbance and cognitive content related to physical illness (e.g., hopelessness, anxiety) rather than by mood disturbance (e.g. sadness). The specific aims of this proposal to be carried out in the primary care setting are: o to systematically describe and validate a depressive syndrome, apathetic depression, that does not meet standard criteria for Major Depression in older primary care patients; o to assess how physical illness, cognitive impairment, anxiety, and hopelessness among older primary care patients alters the course of depression and associated functional impairment over time; and, o to evaluate the clinical presentation of depression and associated symptoms in late life in relation to the assessment and treatment decisions of primary care physicians. An age-stratified sample of 3000 adults aged 65 years and older who have visited one of 30 participating primary care physicians will be interviewed with a revised version of the CES-D in the physician's office. Patients above a threshold will be asked to participate in a home assessment and follow-up study. Approximately 300 patients will have significant depressive symptoms and will be asked to participate in a longitudinal, observational study with a 10% random sample of persons without depression. The main study will include a baseline in-home assessment, a 3-monthly telephone follow-up, and a 12-month in-home follow-up evaluation of depression, function, and other factors. Information on assessment and treatment of depression will be obtained from participating physicians. We seek to identify, in primary care, an anhedonic depression syndrome which appears to be associated with physical illness and significant functional limitation and for which misidentification of depression could be avoided if the syndrome were better understood. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: BARRIERS TO MENTAL HEALTH TREATMENT IN PRIMARY CARE Principal Investigator & Institution: Sirey, Jo A.; Psychiatry; Weill Medical College of Cornell Univ New York, NY 10021 Timing: Fiscal Year 2001; Project Start 01-JAN-2001; Project End 31-DEC-2001 Summary: The proposed study of Barriers to Mental Health Treatment in Primary Care requests one year B/Start funding to investigate the prevalence and impact of

Studies 29

psychological barriers to mental health treatment, to treatment behaviors and to clinical outcome in older adults with depression in primary care. Inadequate treatment on major depression among older remains a significant public health concern, even though there is ample evidence that major depression can be effectively treated with pharmacotherapy in most elderly adults with depression (Hirschfeld et a., 1997 Schneider, 1996). Preliminary investigations suggest that psychological barriers, such as minimizing the need for treatment and perceived stigma, reported at the beginning of outpatient psychiatric treatment for depression can be important factors in predicting treatment behaviors such as medication recommendation, antidepressant adherence and treatment discontinuation (Sirey, et a., 1999, in press). The primary aims of this study are : 1) to assess the prevalence depression seen in primary care; 2) to examine the impact of psychological barriers on treatment initiation (either pharmacotherapy or nonpharmacologic interventions); and 3) to explore the relationship between psychological barriers and improvement in depressive symptoms. To address these aims the funding would be used to support the primary care (Prevention of Suicide in Primary Care Elderly: Collaborative Trial, PROSPECT; MH 59366; PI George S. Alexopoulos, M.D.). The proposed study would assess the psychological barriers reported by 60 Cornell site of the PROSPECT Study). A part of (PROSPECT) sample is re-interviewed four months later to assess: 1) treatment behaviors (e.g. initiation of treatment, services used); 2) depressive symptoms; and 3) review criteria for depression. Analyses examine the of barriers on treatment initiation, controlling for intervention status. Additional analyses will explore the impact of barriers on clinical status at follow-up. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BEHAVIORAL INTERVENTION FOR DEPRESSION IN NURSING HOMES Principal Investigator & Institution: Meeks, Suzanne; Associate Professor; Psychology; University of Louisville University of Louisville Louisville, KY 40292 Timing: Fiscal Year 2002; Project Start 01-APR-2002; Project End 31-MAR-2005 Summary: (provided by applicant): The risk for depression is nearly twice as great among nursing home residents as it is for community-residing elders, with up to 50 percent of nursing home residents affected by significant depressive symptoms. Although we now have a good understanding of the epidemiology and manifestations of depression in late life, and are beginning to apply effective treatments to some groups of elders, the benefits of the past decade of research have yet to reach the frailest elders living in nursing homes. Depression in long-term care is a significant public health issue. The health and cognitive multiple comorbidity of this population makes treatment, and treatment research, extremely challenging. The broad goal of this proposal is to adapt an efficacious psychosocial intervention for depression to the nursing home setting, using the public health model of intervention research and the exploratory/development mechanism provided by NIMH for implementing such work. There are 3 specific aims: (1) To use a collaborative treatment development process involving nursing home staff to adapt a behavioral intervention for treating depression in elders with cognitive impairment to nursing home residents with a range of physical and cognitive abilities; (2) to conduct a pilot effectiveness study on the adapted intervention, using a replicated, single-subject design, in 2-3 nursing homes other than the one in which the initial treatment development process took place, and (3) as a part of the effectiveness study, to collect data on staff outcomes and cost effectiveness. The treatment has a behavioral theoretical basis, and focuses on increasing opportunity for pleasant events to increase levels of activity and positive affect. Treatment is

30 Depression

implemented primarily by existing nursing facility staff, with supervision from a licensed psychologist, making ultimate dissemination of this treatment practical and affordable. Standardizing the treatment collaboratively with staff insures a high level of staff acceptance and maximizes feasibility in the nursing home setting. The treatment evaluation design employs a replicated, multiple-baselines-within-subjects design and Hierarchical Linear Modeling, optimizing features from single-case and group research. Each participant will be observed for a minimum of a two-week baseline, followed by six weeks of active intervention, four weeks of maintenance, and a three-month followup. Measures include comprehensive psychiatric evaluation and diagnosis, depression and mood rating scales, observed affect and activity participation, behavior problems, and staff burden. The end-product of the work will be a standardized treatment protocol ready for formal multi-site intervention trials. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BEHAVIORAL DEPENDENCE

THERAPY

FOR

DEPRESSION

IN

DRUG

Principal Investigator & Institution: Nunes, Edward V.; Associate Professor of Clinical Psychiat; New York State Psychiatric Institute 1051 Riverside Dr New York, NY 10032 Timing: Fiscal Year 2001; Project Start 25-SEP-1999; Project End 31-AUG-2003 Summary: Depression is the most common comorbid psychiatric disorder in opiate dependent patients along with antisocial personality disorder. Depression has been associated with both severity of addiction and poor treatment outcome. This suggests that effective treatment of depression would improve outcome for opiate addicts. However, standard antidepressant medication trials in depressed methadone maintenance patients have yielded mixed results indicating that antidepressant medication treatment by itself is limited in this population. Several reasons for poor treatment response include: 1) poor compliance; 2) ongoing substance abuse; 3) ongoing stresses with which patients do not cope effectively; and 4) the absence of pleasurable, satisfying activities in patients' lives. A high rate of aversive circumstances and a low frequency of positive reinforcement are classic components in a behavioral model of depression. This suggests that a behavioral therapy could be an alternative or a complement to antidepressant medication treatment in this population. We propose a Stage I development project to design and pilot test a Behavioral Therapy for Depression in Drug Dependence (BTDD) that is based on behavioral model of depression. The primary goals of BTDD are to decrease depressive symptomatology by increasing the frequency of response-contingent positive reinforcement and to build a base of behaviors that can compete with illicit substance use. Aspects of three operant conditioning based treatment programs demonstrated to be effective for treating depression or reducing illicit substance use in other drug using populations will be incorporated in BTDD. These programs include: the Coping with Depression Course, the Community Reinforcement Approach and Treatment-plan contingency management. The latter techniques will be adapted so that reduction in depression is the primary goal. The specific aims over the four years of proposal are: 1. To develop a preliminary BTDD treatment manual through the treatment of 20 depressed methadone maintained patients in an uncontrolled trial. 2. To explore the efficacy and acceptability of BTDD with a randomized controlled pilot trial. 3. To test the theory that an increase in response-contingent reinforcement will produce an improvement in depression and reduced drug use. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: BIOBEHAVIORAL MECHANISMS OF DEPRESSION IN WOMEN Principal Investigator & Institution: Cyranowski, Jill M.; Psychiatry; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, PA 15260 Timing: Fiscal Year 2001; Project Start 20-AUG-2001; Project End 31-JUL-2006 Summary: (provided by applicant): This Mentored Research Scientist Development Award (MRSDA) is designed to promote the Candidate's long-term goal of becoming a women's health researcher with expertise in the etiology and treatment of depression in women. The training and research activities described in this MRSDA will facilitate the Candidate's training in the methods of acute stress research and neurohormonal assessment techniques, and the integration of these techniques within her own background in depression intervention research. This interdisciplinary training will provide the Candidate with the skills and experience needed to pursue an independent program of research testing biobehavioral mechanisms of stress sensitivity, depression vulnerability, and ultimately, depression treatment outcomes in women. Post-pubertal females are twice as likely as males to experience a lifetime episode of major depression, and are particularly likely to become depressed when faced with stressful life events. This gender-linked health disparity persists throughout women's reproductive lives, carrying deleterious consequences for both the woman herself and the children under her care. We (Cyranowski et al., 2000) have theorized that women's sensitivity to interpersonal life stress is mediated, in part, by the hypothalamic neurohormone, oxytocin. Oxytocin is known to play a key role in female reproductive processes. A growing body of animal research indicates that oxytocin is critically regulated by female reproductive hormones, and that oxytocin serves to facilitate female affiliative behaviors and down-regulate the hypothalamic-pituitary-adrenal (HPA) stress axis. The proposed pilot study was designed to provide a preliminary examination of the role of oxytocin in women's stress sensitivity and depression vulnerability. Twenty-two normal cycling, depressed females aged 21-40 and 22 age-matched never-depressed controls will be recruited to participate in a 3-hour laboratory experiment designed to stimulate, measure and compare peripheral oxytocin release and basal oxytocin concentrations within and between groups, and to examine whether peripheral oxytocin release is associated with a down-regulation of the HPA stress axis following an acute stress task. Subjects will also complete self-report measures of depression, anxiety, interpersonal function, trauma history, and recent life stress. Subjects will then be retested with the laboratory paradigm at 18 weeks follow-up, or for depressed subjects, following a course of interpersonal psychotherapy (IPT). The skills, training, and pilot data obtained from this MRSDA will subsequently be used to support the Candidate's development of an R0l application in Years 03-05 of the award period. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: BRIEF ALCOHOL INTERVENTION WITH DEPRESSED PATIENTS Principal Investigator & Institution: Ramsey, Susan E.; Rhode Island Hospital (Providence, Ri) Providence, RI 02903 Timing: Fiscal Year 2003; Project Start 05-SEP-2003; Project End 31-MAY-2008 Summary: (provided by applicant): Heavy alcohol consumption is common among patients seeking treatment for depression. Heavy drinking is associated with a variety of medical and psychosocial problems. Heavy drinking is particularly problematic among depressed patients, increasing the likelihood of poor depression treatment outcomes. While methods for reducing alcohol use in this population have been unexplored to date, brief interventions to reduce heavy alcohol use have been well-

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validated in numerous patient populations and offer the promise to reduce heavy drinking among depressed patients and to improve depression treatment outcomes. We hypothesize that adding a brief alcohol intervention to standard psychiatric care, relative to standard psychiatric care alone, will reduce overall drinking volume and heavy drinking days among heavy-drinking depressed patients. Furthermore, we expect patients who receive the brief alcohol intervention to have better depression outcomes than patients receiving standard psychiatric care alone. We also expect that reduced alcohol consumption will mediate the effect of the brief alcohol intervention on depression outcomes. In addition, we will examine individual difference variables as predictors of change in alcohol use. The proposed study is a randomized, two-group design with repeated measures over time, comparing a brief, motivationally-focused alcohol intervention plus standard psychiatric care to standard psychiatric care alone. For this study, we will recruit a sample of 240 psychiatry clinic outpatients meeting structured diagnostic criteria for major depressive disorder who drink heavily but are not alcohol dependent. We expect that the results of this study will improve depression treatment outcomes for the significant sub-population of depressed patients who drink heavily and are likely to do poorly in depression treatment in the absence of a change in their drinking behavior. The intervention proposed in this study represents a novel approach to reducing heavy drinking among depressed patients that, if effective, can be readily integrated into depression treatment in a variety of treatment settings. In addition, this study will provide valuable information on the association between alcohol use and depression outcomes and on the mechanisms of change in alcohol use among heavy-drinking depressed patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BUPROPION IN ADOLESCENTS WITH COMORBID ADHD & DEPRESSION Principal Investigator & Institution: Daviss, William B.; Psychiatry; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, PA 15260 Timing: Fiscal Year 2003; Project Start 06-DEC-2002; Project End 30-NOV-2007 Summary: (provided by applicant): Attention deficit hyperactivity disorders (ADHD) in youth occur comorbidly with other psychiatric conditions approximately two thirds of the time. Major depressive disorder and dysthymic depression are common, occurring in as many as 40% of youth with ADHD. The comorbid occurrence of ADHD and depression (ADHD + Dep) may cause substantial long-term morbidity. While psychopharmacology is widely used to treat juvenile ADHD and/or depression, no research has established an efficacious treatment for ADHD + Dep, or for most other comorbid ADHD disorders. This five year Mentored Patient-Oriented Research Career Development Award (RCDA) will provide the candidate, a board certified child and adolescent psychiatrist, training to undertake pharmacological trials of youth with ADHD and comorbid disorders. The candidate has had extensive previous clinical experience and some research experience in the pharmacological treatment of juvenile ADHD + Dep. The RCDA will provide the candidate formal training in pharmacology, clinical trial design, and statistical analyses as well as the empirical assessment of juvenile ADHD, depression, and other comorbid psychopathology. The candidate will also receive training in ethical issues germane to juvenile psychopharmacology studies. Training will occur through a combination of formal coursework, guided readings, and consultation with mentors having relevant expertise. This training will be applied in a pharmacologic study of adolescents with ADHD and depression (major depression, dysthymia). The protocol will consist of a 2-week washout/observational period, then

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an 8-week randomized, placebo-controlled trial (RCT) to determine the efficacy of bupropion SR. Then a 24-week open label continuation phase will be used to determine if treatment response and tolerability persist. Exploratory analyses will assess correlations of initial treatment response with both pharmacological variables (plasma levels of bupropion and its metabolites; noradrenergic and dopaminergic effects as estimated by reuptake blockade of rat synaptosomes) and psychosocial variables (baseline psychopathology and psychosocial impairment). The candidate' s training and research experiences during the RCDA will enable him to pursue larger, more scientifically rigorous pharmacologic trials of youth with ADHD and depressive or other comorbid psychopathology. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CALCIUM FOR PREVENTION OF POSTPARTUM DEPRESSION Principal Investigator & Institution: Hatton, Daniel C.; Behavioral Neuroscience; Oregon Health & Science University Portland, OR 972393098 Timing: Fiscal Year 2002; Project Start 08-FEB-2002; Project End 31-JAN-2005 Summary: (provided by applicant): Post-partum depression causes maternal suffering and can have a lasting negative influence on the child's cognitive and emotional development. Interventions that prevent or reduce the incidence of post-partum depression would be of significant value to society. Preliminary studies indicate that dietary calcium supplementation during pregnancy may provide an inexpensive, safe, and effective protection against postpartum depression while at the same time providing a number of other health benefits for the mother and child. We will conduct a rigorous test of the hypothesis that supplemental calcium during pregnancy reduces the incidence of post-partum depression in a randomized, double-blind, placebo-controlled clinical trial of a 2 g/day oral calcium supplement in 238 women at risk for postpartum depression as a consequence of a positive history of depression. Supplementation will begin between weeks 16 and 20 of gestation and continue through 12-weeks post partum. Women will be recruited by newspaper advertisements and clinic referrals. Prior to randomization, a computerized version of the SCID followed by a psychiatric diagnostic interview will be used to determine baseline clinical status. Those currently suffering from major depression, active substance abuse, active psychosis, schizophrenia, bipolar disorder or are on antidepressant medication, will be referred for treatment and will not be included in the study. Prior history of postpartum depression and parity will be controlled for during randomization. The antenatal version of the Edinburgh Postnatal Depression Scale (EPDS) will be used to screen for depression at 26, 32 and 38 weeks of gestation and the postnatal version will be used at 6 and 12 weeks postpartum. Those with a positive change score of 30 percent or a score greater than 16 on the EPDS at any screening visit will be evaluated using a psychiatric interview. Those suffering from major depression will be referred for treatment. The proportion of women in the calcium supplemented group who experience a first episode of major depression since entry into the study in the postpartum period, either at 6 or 12 weeks, will be compared to the proportion in the placebo condition. A significantly smaller proportion in the calcium group will be taken as evidence in support of the hypothesis. Positive results from this trial will provide a strong foundation for a multicenter intervention trial. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CBASP AUGMENTATION FOR TREATMENT OF CHRONIC DEPRESSION Principal Investigator & Institution: Gelenberg, Alan J.; Professor and Head; Psychiatry; University of Arizona P O Box 3308 Tucson, AZ 857223308 Timing: Fiscal Year 2002; Project Start 24-SEP-2002; Project End 30-JUN-2006 Description (provided by applicant): Chronic depression affects approximately 5 percent of adults in the United States and is associated with significant functional impairment and high health care utilization. Recent work supports the efficacy of established antidepressant medications with chronic depression. However, only a minority of patients with chronic depression attain full remission in these trials: approximately 50 percent do not respond, and an additional 20 percent achieve only a partial response. A recent multi-site study demonstrated that the combination of medication and psychotherapy produced a significantly better response than either monotherapy. Unfortunately, combination treatment is expensive. It may be more efficient to employ a stepped approach, in which patients first receive medication, and only non-responders and partial responders receive adjunctive psychotherapy. We propose to conduct the first large-scale study of adjunctive psychotherapy in chronic depressives who fail to respond, or respond only partially, to an initial trial of medication. This multi-center trial will compare 12 weeks of adjunctive treatment with the Cognitive Behavioral Analysis System of Psychotherapy (CBASP), the form of psychotherapy with the best evidence for treating chronic depression, with adjunctive treatment with Supportive Psychotherapy (SP) and continued pharmacotherapy alone, in patients with chronic forms of major depression. Separate trials will be conducted in patients who fail to respond to an initial open trial of serotonin reuptake inhibitor (SSRI) and in patients who achieve only a partial response. In addition, we will conduct naturalistic follow-up assessments at 6- and 12-months post-treatment. The specific aims of the project include: (1) comparing the efficacy of adjunctive psychotherapy to continued SSRI alone; (2) determining whether adjunctive CBASP is specifically efficacious compared to adjunctive SP; (3) testing the hypothesized mechanism of action of CBASP, as well as exploring potential moderators of response, and (4) comparing the cost-effectiveness of the three treatment conditions for treatment resistant chronic depression. The outcomes examined will include both symptomatology and psychosocial functioning. In addition, we will conduct exploratory analyses comparing the effect of the three treatment conditions on relapse and post-treatment service utilization. This would be the first large-scale study ever to test the efficacy of any therapy for treatment resistant chronic depression, and to study the value of psychotherapy augmentation in medication non-responders with any form of depression. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CBT FOR HIV MEDICATION ADHERENCE AND DEPRESSION Principal Investigator & Institution: Safren, Steven A.; Assistant Professor, Harvard Medical Sch; Fenway Community Health Center 7 Haviland St Boston, MA 02115 Timing: Fiscal Year 2003; Project Start 01-DEC-2002; Project End 30-NOV-2005 Summary: (provided by applicant): Introduction: This is an amended application to develop a cognitive-behavioral therapy for HIV medication adherence and major depression. Depression is prevalent in HIV and is associated with poor self-care behaviors including poor adherence to antiretroviral medications. Patients with HIV and depression are at risk for poor health outcomes and possibly increased morbidity.

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Cognitive-behavioral therapy is the most widely studied and efficacious psychosocial intervention for depression. Overview of project goals and conceptual model of intervention: The main goal of this project is to complete NIH-defined stage 1 activities in developing a cognitive behavioral intervention for depression and ART medication adherence. We propose to estimate the effect size of the intervention on improved depression, improved adherence to medications, and improved health status as defined by a clinically significant reduction in HIV viral load. Following the goals of the R21 mechanism, this will allow for the collection of the necessary pilot data to conduct a fullscale intervention study. We hypothesize that the psychosocial intervention will achieve improved health status in two ways: by directly increasing adherence to antiretroviral medications using the adherence skills training, and by treating the depression which otherwise makes it difficult for patients to acquire or use these adherence skills. Overview of research plan: Patients with a detectable viral load who have a diagnosis of major depressive disorder will be randomized into either: (1) "CBT," the combination of CBT for depression and HIV medication adherence or (2)"Enhanced Clinical Management," a single-session adherence intervention (Safren et al., 1999, 2001). Those who are assigned to Enhanced Clinical Management will be re-assigned to CBT after the acute phase of the study (4 months) if they have not improved on key outcome variables. Eligibility requirements at this stage of treatment development were selected to maximize the chances of finding an effect with a circumscribed sample (and minimizing the possibility of a type-II error). This will allow for an adequate power analysis for a full-scale intervention trial. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CHILDHOOD DEPRESSION--PHYSIOLOGICAL CORRELATES Principal Investigator & Institution: Armitage, Roseanne; Professor; Psychiatry; University of Texas Sw Med Ctr/Dallas Dallas, TX 753909105 Timing: Fiscal Year 2001; Project Start 15-JUN-1999; Project End 31-MAY-2004 Summary: This study will establish whether sleep EEG dysregulation (low inter- and intrahemispheric coherence) is a reliable feature of childhood and adolescent depression, contrasting symptomatic and remitted children and adolescents with ageand gender-matched normal controls. The long range objective of identifying reliable biological features of depression is to improve on differential diagnosis, prognostication, and treatment selection. Of particular relevance to this application is the additional potential to identify patients prior to the clinical expression of the illness in order to ultimately intervene to prevent the onset of illness. The specific aims are: 1) To establish which sleep EEG coherence measures are significantly lower in those with childhood depression (n=50) compared to age- and gender-matched health controls (n=50). 2) To establish which sleep EEG coherence measures are significantly lower in those with adolescent depression (n=50) compared to age- and gender-matched healthy controls (n=50). 3) To fully explore gender differences in sleep EEG coherence measures in the total sample of depressed (n=100) and control (n=100) and control (n=100) subjects. Equal numbers of males and females will be included in the total sample. We expect that gender differences will be evidence in adolescents with MDD. 4) To explore state-train characteristics of low-inter and intrahemispheric coherence in depressed children and adolescents. 5) A sub-aim is to evaluate the developmental time course of sleep EEG coherence in the 100 healthy controls as a means of determining how high inter- and intrahemispheric coherence measures are influenced by brain maturation. 6) To establish the relationship between sleep micro- and macro- architecture in childhood and adolescent MDD.

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Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CHILDREN AT HIGH AND AT LOW RISK FOR DEPRESSION Principal Investigator & Institution: Weissman, Myrna M.; Professor; Psychiatry; Columbia University Health Sciences New York, NY 10032 Timing: Fiscal Year 2003; Project Start 01-JUL-1987; Project End 31-DEC-2007 Summary: (provided by applicant): The overall aim of this study has been to understand the long term temporal sequence and familial patterns of mood and other disorders from childhood to adulthood in offspring at high and low risk for depression. This study has had 4 waves of assessments. The last wave began in 12/98, 17 years after the initial assessment. This application is for Wave 5. The sample now includes 3 generations (grandparents, parents, and grandchildren). The basic design is one of families at high and low risk for depression based on the depression status of the original sample (1st generation -- the grandparents). Our previous findings in the offspring (2nd generation -- now the parents) showed both cross-sectionally and longitudinally that the offspring of depressed grandparents were at high risk (3-fold increase) for major depression. Their depression began early, often at puberty, and was preceded by prepubertal onset anxiety. The results for the 3rd generation (the grandchildren) again shows that the grandchildren in the high risk group (i.e., at least one depressed grandparent) are at increased risk of mood and anxiety disorders. These consistent findings across the generations lead directly to this new application which focuses on understanding the brain based correlates of familial depression. These results support the use of the original high and low risk classification which guide this renewal and its hypotheses. A new aim of the current application is to define the neural correlates of familial risk for depression in subjects in the 2nd and 3rd generations of this cohort using anatomical and functional MRI. This sample is uniquely valuable for identifying the neural correlates of familial risk because the study of high-risk populations prior to the onset of illness is likely to be the best way to distinguish cause from compensatory effect in neurobiological studies, and because psychiatric diagnoses established prospectively and across generations will provide the greatest possible confidence in the assessment of multi-generational familial risk. In addition, the availability of MRI data will provide us with the opportunity to understand better the underlying basis, in terms of brain structure and function, of the electrophysiological abnormalities identified in the last cyclic of funding. Our specific aims for this renewal are (1) to complete data analyses of the 4th wave assessment; (2) to acquire and analyze both anatomical and functional MRI in 214 subjects (118 second and 96 third generation) of this cohort; and (3) to conduct data analysis integrating findings of the clinical, psychophysiologic and neuroimaging studies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CHRONIC DRUG USE, DEPRESSION, AND LABOR SUPPLY Principal Investigator & Institution: Alexandre, Pierre K.; Epidemiology and Public Health; University of Miami Box 016159 Miami, FL 33101 Timing: Fiscal Year 2001; Project Start 30-SEP-2000; Project End 31-AUG-2003 Summary: (Applicant's Abstract) The University of Miami Health Services Research Center recently collected extensive community-based information on chronic drug users (CDUs) and non-drug users (NDUs) to examine differences in health services utilization, access, and cost. The survey instrument contains information on demographics, health status, lifestyle behaviors, and labor market activities. It also includes the 20-item Zung

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Self-Rating Depression Scale (SDS). The primary objective of the proposed small grant application is to use this unique set of data to analyze the relationships between drug use and depression among CDUs and NDUs, and the effects of these conditions on labor market decisions. Some researchers have examined the relationships between drug use labor market problems, but no study has used community-based data to investigate the co-occurring and confounding effects of depression and drug use on labor market behavior. This research project will pursue the following specific aims: 1. Examine the prevalence of CDU, depression, and the comorbid conditions of CDU and depression in a community-based sample of individuals. 2. Estimate the main and interaction effects of CDU and depression on the probability of employment. 3. Conditional on being employed, estimate the main and interaction effects of CDU and depression on the number of weeks worked during the past 12 months. The proposed study will provide support for the investigators (including Dr. Alexandre, an African American health economist who qualifies as a newer, less experienced investigator) to use a unique set of data to examine the relationships between drug use, depression, and labor supply. Since employers and policymakers are not well informed about the co-occurring and confounding effects of drug use and depression on the labor market, the research and policy importance of this application is immediate and widespread. CDUs as a group have been singled out for intervention and extended study by the Office of National Drug Control Policy. Moreover, mental health problems in the United States have become a challenge to communities, health and social service agencies, managed care organizations, employers, and families. The resulting findings will help policy makers and employers make decisions regarding the allocation of scarce resources between workplace drug control programs and other alternatives such as improving employees' mental health. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CLINICAL IMPLICATIONS OF DEPRESSION-BASED STIGMA Principal Investigator & Institution: Miranda, Martha J.; Research Professor; Psychiatry & Biobehav Sciences; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, CA 90024 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-AUG-2006 Summary: (provided by applicant): This grant examines stigma as it relates to depressive illness. Depressive disorders are among the most significant contributors to disability and reduced quality of life worldwide, but most patients don't receive appropriate care. This is particularly true of ethnic minorities and the poor. In this grant, we examine the extent to which stigma related concerns explain failure to receive appropriate care for depression. Specifically, we examine the extent to which concerns about depression-related stigma, such as fears about losing a job, insurance, or friends due to other people's awareness of illness or treatment, explain unmet need for depression care. We will also investigate if efforts to provide treatments or improve rates of treatment predict outcomes for both persons with and without stigma concerns. We use two existing data sets: (1) Partners in Care, a randomized, controlled trial of improving quality care for depression in primary health care settings and (2) We Care, a randomized controlled trial of providing access to guideline care (either CBT or paroxetine) for disadvantaged, young minority women. These studies allow us to examine the impact of stigma related concerns on acceptance and outcomes of depression care and include large samples of poor and ethnic minorities. Finally, we include stigma items in a nationally representative community study, Healthcare for Communities, funded by the Robert Wood Johnson Foundation that will allow us to

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estimate rates of depression-related stigma in a nationally representative sample. The specific aims of this grant are: 1) to assess rates of concerns about depression-related stigma in a nationally representative community sample; 2) to determine the impact of concerns about depression-related stigma on use of mental health services, controlling for need, predisposing, and enabling factors known to affect access to care; 3) to examine whether interventions to increase the use of guideline-concordant primary care treatments for depression are effective at improving the quality of care for both persons with high and low levels of concern about depression-related stigma; 4) to examine whether use of guideline-concordant treatments for depression (as opposed to quality improvement programs that promote access to those treatments) improve outcomes for both persons with high and low concerns about depression related stigma. Within each of the aims, we will explore the extent to which the findings vary by ethnicity. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CLINICIAN MANAGED INTERPERSONAL PSYCHOTHERAPY Principal Investigator & Institution: Stuart, Scott P.; Associate Professor; Psychiatry; University of Iowa Iowa City, IA 52242 Timing: Fiscal Year 2001; Project Start 28-SEP-2001; Project End 31-AUG-2006 Summary: (Adapted from the Applicant's Abstract): Empirical studies evaluating the effects of acute psychotherapeutic treatment have provided invaluable data demonstrating the efficacy of such treatments for major depression. Under controlled conditions, time-limited manual-based psychotherapies are efficacious in bringing about remission of depressive symptoms. Such efficacy studies, however, have several limitations. First, though the treatments are efficacious in laboratory settings, the effectiveness of such treatments, efficacy studies are limited by their lack of external validity. Second, though the acute effects of time-limited treatments for depression are impressive, the improvement is often not maintained, and recurrence of symptoms is common. Our proposed research project is an empirical investigation of the effectiveness of Clinician-Managed Interpersonal Psychotherapy (CM-IPT) for postpartum depression, a treatment based on the manual of Klerman et al (1) and refined for a community setting. Timing and frequency of sessions will be determined collaboratively by the therapist and patient rather than arbitrarily specified by manualized directives. We will evaluate the effectiveness of 12 sessions of CM-IPT delivered over the course of a year compared to "standard" IPT for postpartum depression, a treatment which we have previously demonstrated to be efficacious compared to a waiting list control condition. Standard IPT will require that 2 sessions of IPT be delivered in the first 12 weeks after treatment assignment. The first major aim of this research application is to evaluate the longitudinal effectiveness of CM-IPT for postpartum depression compared to standard IPT. We predict that CM-IPT will be associated with lower cumulative levels of depressive symptoms and lower rates of depression over the first year than standard IPT. The second major aim of this research application is to demonstrate the acute effectiveness of CM-IPT for postpartum depression. We will compare CM-IPT and standard IPT at 12 weeks after treatment assignment (the conclusion of standard IPT treatment), at which time we expect the two treatments to be clinically equivalent. Our study, which uniquely combines the best elements of both efficacy and effectiveness research, will lead to more effective treatment for depressed postpartum women in the community. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: COGNITIVE AND AFFECTIVE NEUROSCIENCES OF DEPRESSION Principal Investigator & Institution: Siegle, Greg J.; Assistant Professor; Psychiatry; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, PA 15260 Timing: Fiscal Year 2002; Project Start 15-MAY-2002; Project End 30-APR-2007 Summary: (provided by applicant) Disruptions of emotional information processing (e.g., attention to, memory for, and interpretation of emotional information) have been implicated in depression. The emerging field of affective neuroscience suggests there are distinct physiological correlates of emotional information processing styles. The proposed research integrates basic research on affective neuroscience with conclusions from cognitive-clinical research regarding depressive information processing to understand brain mechanisms associated with disruptions of emotional information processing in depression. The applicant, Dr. Greg Siegle, Ph.D., has examined information processing in depressive disorders for eight years, and has developed a computational neural network model that suggests a convergence of specific cognitive, environmental, and biological factors are associated with depression. Further training is necessary for the next step in this research, which involves clearly linking observed cognitive phenomena and model behaviors to underlying biological mechanisms. Shortterm goals include using cognitive, physiological, and neuroimaging assessment to test predictions, generated using the model, regarding interactions of factors that could lead to distinct profiles of depressive emotional information processing. Long-term goals involve using this research to direct depressed individuals to focused treatments that target their particular cognitive and physiological profiles, thus improving speed and efficacy of depression interventions. The proposed research involves assessing depressed individuals' pupil dilation and brain activity (via functional magnetic resonance imaging; fMRI) during emotional information processing tasks to create profiles of emotional information processing disruptions in depression. Computational neural network modeling of interactions between relevant brain structures will be used to generate and refme hypotheses and experimental design throughout the study. This research will allow development and refinement of a formal theory of psychobiological mechanisms underlying individual differences in depressive information processing biases. It will lead to an R01 proposal involving understanding changes in brain activity associated with treatment for depression. Research will be conducted at the Western Psychiatric Institute and Clinic, a world center for research on the psychobiology of depression. Researchers who are expert in depression as well as the proposed assessment technologies will serve as mentors and preceptors. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: COMMUNITY LTC SERVICE AND OUTCOMES--BURDEN OF DEPRESSION Principal Investigator & Institution: Morrow-Howell, Nancy L.; None; Washington University Lindell and Skinker Blvd St. Louis, MO 63130 Timing: Fiscal Year 2001; Project Start 15-JUN-2000; Project End 31-MAY-2004 Summary: (Applicant's Abstract): This study addresses fundamental concerns in community long-term care: ensuring appropriate service in response to a broad range of client needs and understanding factors associated with service outcomes. It is expected that a disproportionate number of public CLTC clients have mental health service needs due to depression, given that depression is associated with both physical dependency and low income. Yet virtually no research has addressed the extent of depression among elders in CLTC nor the impact of depression on CLTC service use and outcomes.

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Further, little is known about the attitudes of CLTC clients regarding mental health services nor the potential role of CLTC in meeting mental health needs. Study aims are to 1) estimate the extent of depression among elders first entering public CLTC and identify factors associated with depression; 2) determine the service demand in CLTC attributable to depression; 3) determine whether depressed elders experience less benefit from CLTC than do non-depressed elders; 4) examine how CLTC responds to the mental health needs of its clients. The proposed research will survey elders at entry to and through one year of service in Missouri's publicly funded, community long-term care system. Study participants will be 60 years of age or older and eligible for public CLTC services because of low income and functional disabilities. Through a telephonescreening interview, we will assess 1,500 new CLTC clients, documenting the extent and type of depression. We will follow 300 depressed elders as well as a random sample of 300 non-depressed elders though one year of CLTC service use. Subjects will be interviewed and service records will be abstracted to determine the service demand attributable to depression and the extent to which CLTC serves as a gateway to mental health services. Outcomes of CLTC (maintenance in community care, quality of life, life satisfaction, and consumer satisfaction with home care) at six months and one year will be compared for depressed and non-depressed clients to determine the extent to which depression affects the outcomes of CLTC services. Community long-term care is a rapidly growing service sector, and the expansion of home and community care is a priority in the development of long-term care policy. This project has the potential to influence program and policy developments in CLTC. Findings will inform the next step testing interventions that integrate CLTC and mental health services. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: COMMUNITY SOCIOECONOMIC CONTEXT, DEPRESSION AND ANXIETY Principal Investigator & Institution: Muntaner, Carles; Professor; None; University of Maryland Balt Prof School Baltimore, MD 21201 Timing: Fiscal Year 2002; Project Start 12-MAR-2002; Project End 28-FEB-2004 Summary: (provided by applicant): Socioeconomic position is a key determinant of individual mental health, including depression and anxiety disorders. Depression and anxiety disorders inflict major social and economic burden on families and communities. Recent studies suggest that the community socioeconomic context, in particular its degree of income inequality, contribute to a person's morbidity and mortality, even after individual socioeconomic position has been taken into account; a disturbing finding as income inequality has grown in the US during the last three decades. The proposed analyses will expand this research program on socioeconomic context to include psychiatric disorders. We will examine the relationship between socioeconomic residential context and the prevalence of major depression and anxiety disorders in Baltimore neighborhoods using the Epidemiologic Catchment Area- Follow Up survey sample, and in US counties, using the National Comorbidity Survey sample. In addition to income inequality, we will examine the relationship between alternative contextual socioeconomic indicators at the county and neighborhood levels (i.e., absolute income, poverty and social capital) and major depression and anxiety disorders. This will be the first population-based analysis to examine the association between residential socioeconomic context in relation to the prevalence of depression and anxiety disorders in the US. Our analysis will also make important methodological contributions to the field of psychiatric epidemiology. Socioeconomic context will be measured at the individual, neighborhood (FCA-F) and county (NCS) levels, and we

Studies 41

will apply innovative statistical methods that are appropriate for the simultaneous analysis of two levels of data and interactions between contextual and individual-level variables. Testing hypothetical mechanisms that may relate contextual and individual socioeconomic attributes (e.g., age, gender, race/ethnicity, socioeconomic position) will be an area of concentration of this analysis, as it has been overlooked in most multilevel studies to date. The results of these analyses will have implications for local health policy in urban neighborhoods and counties across the US that have the potential to reduce the social costs associated with depression and anxiety disorders. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CONSUMER INFLUENCES OF TREATMENT OF DEPRESSION Principal Investigator & Institution: Kravitz, Richard L.; Professor and Director; Medicine; University of California Davis Sponsored Programs, 118 Everson Hall Davis, CA 95616 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2005 Summary: (provided by applicant): By 2005, the pharmaceutical industry will spend $7.5 billion annually on direct-to-consumer advertising (DTCA) of prescription drugs. Proponents of DTCA say it encourages productive discussions between patients and physicians, while critics charge that it increases unnecessary prescribing, raises costs, and strains the patient-clinician relationship. Empirical evidence for policymaking in this area is lacking. This study will examine the clinical impact of DTCA by conducting an experiment using standardized patients (SPs) who present with depressive symptoms (representing either major depression or adjustment disorder) and make either: 1) an ad-driven request for a brand-name antidepressant, 2) a generic request for treatment, or 3) no request. Our focus on depression is justified by the high prevalence and costs of this condition, its relevance to general medical practice, the ubiquity of depression-related DTC ads in both broadcast and print media, and the broadening indications for the use of antidepressant medications. The application has 3 specific aims: 1) to estimate the effects of DTC ad-driven requests on physicians' prescribing of antidepressants for patients with depressive symptoms; 2) to determine whether DTC ad-driven requests are associated with better or worse quality of care in primary care settings; and 3) to describe differences in physicians' communication behaviors when they are confronted by patients making ad-driven requests, generic requests, and no specific requests. In this randomized trial, 144 primary care physicians in 3 U.S. cities will each see 2 unannounced SPs. The SPs will be trained to portray 6 different roles, generated by crossing 2 clinical presentations (major depression and adjustment disorder) with 3 request conditions (DTCA activated, generically activated, and no request). Visits will be audio-recorded, and SPs will record physicians' clinical behaviors. Using multi-level mixed effects models, data will be analyzed to assess the influence of DTCA on antidepressant prescribing and the clinical process of care. These analyses will be supplemented by qualitative and quantitative analyses of physician communication behaviors across experimental conditions. The results will address a pressing policy question (i.e., should DTCA be further regulated?) while also contributing to our understanding of the social influences on diagnosis and treatment of depression in primary care settings. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

42 Depression

•


CONTROLLED

TRIAL

OF

HYPERICUM

FOR

JUVENILE

Principal Investigator & Institution: Weber, Wendy J.; None; Bastyr University 14500 Juanita Dr Ne Kenmore, WA 98028 Timing: Fiscal Year 2002; Project Start 01-APR-2002; Project End 31-MAR-2007 Summary: The candidate, Wendy J. Weber, seeks funding for a Mentored PatientOriented Research Career Development Award to obtain the skills of an independent clinical researcher. During the five year training period, Ms. Weber will conduct an eight-week double blind placebo controlled clinical trial of Hypericum perforatum (St. John's Wort) for the treatment of depression in children and adolescents aged 6 to 17. Childhood and adolescent depression is a major public health concern affecting 2 to 8% of this population and is a significant cause of morbidity and mortality. Numerous clinical trials of Hypericum for the treatment of adult depression have found that it is superior to placebo and nearly equivalent to pharmaceutical anti-depressants. The side effects of Hypericum are adolescent depression, and therefore a placebo- controlled trial is warranted. The proposed trial will determine the efficacy, safety, and response pattern of Hypericum for the treatment of mild-to-moderate depression in children and adolescents. The response to treatment will be determined by th Hamilton Depression Rating-Scale, safety will be determined by measuring adverse event rates, and response pattern will be evaluated by collecting and examining data at weeks one, two, four, six and eight of the clinical trial. Her proposal includes completion of a MPH Degree from the University of Washington School of Public Health's Epidemiology Department. This didactic training will give Ms. Weber the knowledge to design and conduct epidemiological studies in neuropathic medicine. In addition, the research skills we will develop by completing the research plan will give her the expertise to conduct clinical trials that evaluate efficacy of naturopathic therapies individually and in combination for juvenile mental health problems. Ms. Weber has assembled a highly qualified, interdisciplinary team of co- sponsors to ensure the success of her training. These mentors include: Joseph Biederman, MD, Professor of Psychiatry at Harvard Medial School and Chief of the Joint Program in Pediatric Psychopharmacology, who will provide expertise in pediatric psychopharmacology research; Leanna J. Standish, ND, PhD, Director of the Bastyr University Research Institute, who will provide guidance in the development of Ms. Weber's academic career; and Jon McClellan, MD, Associate Professor in the Department of Psychiatry and Behavioral Science at the University of Washington, who will provide guidance in the field of child psychiatry and psychiatric services in western Washington. At the end of the grant period, Ms. Weber will have obtained a MPH degree in epidemiology, conducted the first placebo controlled trial of Hypericum in childhood and adolescent depression, and become a well-trained naturopathic, clinical researcher, which is of critical importance to the field of complementary and alternative medicine. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CONTROLLED TRIAL OF SERTRALINE FOR DEPRESSION AFTER TBI Principal Investigator & Institution: Bombardier, Charles H.; Rehabilitation Medicine; University of Washington Seattle, WA 98195 Timing: Fiscal Year 2001; Project Start 20-SEP-2000; Project End 31-MAY-2005 Summary: Persons with traumatic brain injury (TBI) experience high rates of depression, especially during the first six months following their injuries. Neurological

Studies 43

and psychosocial factors appear to contribute to depression in this population. Depression following TBI is associated with poor cognitive, behavioral, and functional outcomes. Preliminary studies suggest that people with TBI and major depression may not respond to antidepressant treatment in the same way as depressed persons without TBI, post TBI depression may respond well to selective serotonin reuptake inhibitor (SSRI) antidepressants, that and effective antidepressant treatment is associated with improvements in health status, neuropsychological function, and post-concussive symptoms. No large randomized placebo-controlled studies have been conducted and basic questions remain about the treatment and outcomes of major depression among persons with traumatic injury. As a consequence, depression is not usually assessed after traumatic brain injury, and optimal rehabilitation guidelines for identifying and treating depression have not been established. To address this gap, the proposed study would follow a large consecutive sample of persons hospitalized for moderate to severe TBI to identify those who develop major depression. With those who develop major depression, a 12-week, randomized, double-blind, controlled trial of sertraline would be conducted. The trial would test the hypothesis that sertraline reduces depression related symptoms, as measured by the Hamilton Rating Scale for Depression. Secondary hypotheses to be tested include whether sertraline leads to greater improvement in neuropsychological test performance, post-concussive symptoms and self-reported health status as measured by the SF 36. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •


CONVENIENT,

AUTOMATED,

OBJECTIVE

MEASURE

OF

Principal Investigator & Institution: Mundt, James C.; Healthcare Technology Systems, Llc 7617 Mineral Point Rd Madison, WI 53713 Timing: Fiscal Year 2003; Project Start 15-SEP-2003; Project End 31-AUG-2004 Summary: (provided by applicant): This research is aimed at demonstrating the feasibility of obtaining measures of depression severity using interactive voice response (IVR) technology that are equivalent or superior to clinician-administered Hamilton Depression Rating Scale (HAMD) interviews. Physicians will refer forty patients beginning treatment for a new episode of depression to the naturalistic, open-label study. Clinician HAMDs will be obtained at baseline and Weeks 2, 4 and 6. Beginning at baseline, subjects will call an IVR system daily to provide severity ratings of eight symptoms frequently associated with depression and a rating of clinical change since their last call. Beginning at baseline, and weekly thereafter, subjects will complete a validated IVR version of the HAMD, an IVR implementation of the Quick Inventory of Depressive Symptomatology (QIDS), provide a rating of clinical change since baseline enhanced by personalized recording of their experiences at baseline, and will provide speech samples elicited by a standardized protocol for subsequent acoustical analysis by Dr. Peter Snyder. Principal axis factoring will be used to define a statistically constrained, theoretically interpretable multivariate factor of depressive severity. Derived factor scores will be analyzed for between- and within-subjects variance related to clinician HAMD assessments and compared to depression metrics derived from the Daily Questions on Depression (DQD), the Memory Enhanced Retrospective Evaluation of Treatment (MERET), the IVR HAMD and QIDS, and speech characteristics extracted from the speech samples collected by IVR and analyzed in Dr. Snyder's laboratory. Improving the quality of assessment instruments used in depression treatment research might reverse the currently increasing rates of placebo response in randomized clinical trials, reduce the number of failed trials, provide more accurate measurement of

44 Depression

therapeutic onset, and provide a more level playing field for comparing efficacy between compounds. Ultimately such efforts may decrease the drug development cycle at lower developmental costs. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CORE--MEDICAL Principal Investigator & Institution: Williams-Russo, Pamela; Weill Medical College of Cornell Univ New York, NY 10021 Timing: Fiscal Year 2001 Summary: Geriatric depression is rarely found without at least some medical comorbidity and/or impatient in physical functioning. Not only do these conditions complicate the study of geriatric depression, but evidence from the Developing CRC suggests that they are important indicators of heterogeneity in late life mood disorders and contribute to their outcomes; for example in depressed CRC subjects, medical burden predicts chronicity of depression and delayed recovery is associated with increased mortality. The Medical Core is newly added to the CRC and developed from collaborative relationships between investigators in the Departments of Psychiatry and Internal Medicine at Cornell. Addition of the Medical Core uniquely contributes to the CRC's investigation of heterogeneity of late life mood disorders by rigorous and extensive study of medical illness, functional impairment and depression course and outcome. The Medical Core expands the CRC's resource by providing: 1. funded medical investigators with extensive experience conducting longitudinal studies of comorbidity in medical setting patients and having central roles in the CRC; 2. access to a large population of elderly medical patients accustomed to receiving care in a research environment; 3. training and supervision in the administration of carefully selected instruments to assess longitudinal variation in medical morbidity and functional performance; (4) investigations of depression in post-operative depression in subjects enrolled in funded longitudinal studies of coronary bypass surgery and hip fracture repair. The Medical Core will work with the Clinical Core in screening and recruiting elderly patients from primary care settings for assessments and longitudinal follow-up, including subjects with major depression (N=50), minor depression (N=50) and nondepressed. These patients will contribute to the overall CRC database, yielding a sample of depressed elderly subjects ranging widely in severity and type of medical comorbidity and functional status, and followed longitudinally with extensive clinical, neuropsychological and psychosocial ratings. As part of its mission, the Medical Core will take advantage of these data to test cross-core hypotheses concerning the reciprocal relationships of depression and medical illness over time. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: COUPLE THERAPY AND PHARMACOTHERAPY FOR MAJOR DEPRESSION Principal Investigator & Institution: Denton, Wayne H.; Psychiatry and Behavioral Med; Wake Forest University Health Sciences Winston-Salem, NC 27157 Timing: Fiscal Year 2003; Project Start 22-JUL-2003; Project End 30-JUN-2008 Summary: (provided by applicant): Depression is a serious public health problem facing our society. Although there is a variety of generally effective treatments non-response, partial response, and relapse continue to be problems and there is a need for improved treatments. There are reasons to believe that couple therapy might be a beneficial treatment of depression for some people. The purpose of this K23 Award application is

Studies 45

to prepare the candidate to become an independent investigator in psychiatric clinical trials and to conduct a research study on the combination of pharmacotherapy and couple psychotherapy. On-site mentorship at the Wake Forest University School of Medicine will be provided by Dr. David Goldston (Sponsor), Dr. Curt Furberg (Mentor), Dr. Vaughn McCall (Consultant), Dr. Beverly Melton (Biostatistician) and through coursework that is part of an NIH K30 Clinical Research Curriculum Award. Off-site mentorship will be provided by Drs. Donald Baucom and Robert Golden (both at the nearby University of North Carolina at Chapel Hill). Additional guidance will be provided by Dr. Susan Johnson, Dr. Steven Beach, and Dr. David Miklowitz (External Consultants). Short term goals will include: 1) development of a treatment manual for a couple therapy of depression based on emotion focused therapy for couples (EFT), 2) development of a therapist adherence and competence rating for the new intervention, and 3) collection of pilot feasibility data on the new intervention through a small clinical trial of sertraline plus couple therapy to sertraline plus an attention control. The primary hypotheses of this clinical trial will be that depressed individuals treated with the combination of sertraine and couples therapy will have 1) more improvement in levels of depression (and better maintenance of gains) and 2) more improvement in relationship adjustment scores (and better maintenance of gains) than individuals treated with sertraline and an attention control condition. Long term goals include: 1) becoming an independent investigator in psychiatric clinical trials, with skills in couple therapy, pharmacotherapy, and comparative trials, 2) successfully preparing a funded R01 grant application by the conclusion of this award that will consist of a larger clinical trial using pilot feasibility data and other materials developed from the present research, 3) developing a program of research on the role of couples interventions in the treatment of depression to eventually include effectiveness studies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •


CULTURALLY

RELEVANT

PSYCHOTHERAPY--PERINATAL

Principal Investigator & Institution: Grote, Nancy K.; Social Work; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, PA 15260 Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 31-JAN-2008 Summary: (provided by applicant): Depression during the perinatal period has adverse effects on the mother, on the development of her newborn infant, and on her family relationships. The purpose of this proposed mentored Patient-Oriented Research Career Development (K23) Award is to promote the Candidate's long-term goal of conducting clinical trials of culturally relevant, psychosocial interventions for perinatal depression in low-income, African American and White Ob/Gyn patients to ameliorate their depression during pregnancy and prevent postpartum depression. The training and research activities described in this application will take place in the cross-disciplinary environment of the School of Social Work and the Department of Psychiatry, University of Pittsburgh. Training will enable the Candidate to assess perinatal mood disorders, develop culturally relevant strategies to effectively engage and retain Ob/Gyn patients in multi-session psychosocial interventions, conduct randomized clinical trials of psychosocial treatments, and collaborate with health services researchers to enhance the public health value of the intervention. Interpersonal psychotherapy (IPT) addresses both depressive symptoms and problematic interpersonal relationships and is an efficacious treatment for depression in general (Weissman, Markowitz, & Klerman, 2000), as well as for depressed African American and White primary care patients (Brown et al, 1999). The first phase of this research plan consists of employing an 8-

46 Depression

session form of IPT 0PT-B; Swartz, Frank, & Shear, 2002) and modifying it to be more culturally relevant to poor, African American and White Ob/Gyn patients by incorporating a number of engagement strategies to minimize practical and psychological practical barriers to care. The second phase of the research plan consists of a small, randomized pilot trial comparing treatment as usual to culturally relevant IPT-B (followed by monthly maintenance IPT up to 6 months postpartum) in a sample of depressed, pregnant, low-income African American and White patients in a public care Ob/Gyn clinic. Participants will be assessed at baseline, posttreatment, and 2 months and 6 months postpartum. The skills, training, and pilot data obtained from this award will support the development of an RO1 application in Years 03-05 of the award period. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CULTURALLY SENSITIVE TREATMENT FOR DEPRESSED ASIANS Principal Investigator & Institution: Yeung, Albert S.; Staff Psychiatrist; Massachusetts General Hospital 55 Fruit St Boston, MA 02114 Timing: Fiscal Year 2003; Project Start 15-JUL-2003; Project End 30-JUN-2008 Summary: (provided by applicant): This is a resubmission of an application for a mentored patient-oriented K-23 award, designed to enhance clinical training and research expertise in the area of treatment of depression among Asian Americans. This application differs from the original one in that face to face interviews will be used for screening of depression in primary care clinic instead of using telephone interviewers; hypotheses are added to assess if degree of acculturation and illness beliefs predict treatment outcomes; and involvement of patients' family members for psychoeducation and family counseling will be provided if necessary. Preliminary studies from the candidate and the Depression Clinical and Research Program at the Massachusetts General Hospital have shown that depression is prevalent among Asian Americans and many of these patients are unfamiliar with the concept of depression. Depressed Asian Americans frequently do not complain about their mood symptoms leading to underrecognition of their illness. Recognition of depressed Asian Americans in primary care alone does not result in adequate treatment by primary care physicians. We are proposing a comprehensive approach: Culturally Sensitive Collaborative Treatment (CSCT) for treating depressed Asian Americans in primary care. CSCT includes Cultural Consultation to depressed patients by a psychiatrist trained in cultural sensitivity to introduce the concept of depression, treatment of depression by primary care physicians based on established guidelines, and Care Management by a bilingual and bicultural Care Manager under the supervision of a psychiatrist. The goal of this project is to evaluate the effectiveness of this innovative approach compared to usual care. The proposed study will be based at the Massachusetts General Hospital in the Depression Clinical and Research Program, under the mentorship of Dr. Maurizio Fava, MD, and will include consultation from experts in this research area. There will also be a didactic component to the project, include coursework in the cultural aspects of mental illness, methodology of health service research, cost-effectiveness analysis, and ethics. The development of a larger scale R01 project involving different sites and different groups of Asian Americans will be started during the last 2 years of the award period. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: CYTOKINE INDUCED DEPRESSION Principal Investigator & Institution: Miller, Andrew H.; Professor; Emory University 1784 North Decatur Road Atlanta, GA 30322

Studies 47

Timing: Fiscal Year 2003; Project Start 11-AUG-2003; Project End 30-JUN-2008 Summary: Depression in the medically ill occurs 5-10 times more often than depression in the general population and has a significant impact on treatment adherence, quality of life, and morbidity and mortality. New developments in the conceptualization of depression in the medically ill have focused on the potential role of immune activation/inflammation and the associated release of proinflammatory cytokines. Proinflammatory cytokines have been found to influence neurobiologic function and induce a depressive syndrome that has overlapping features with major depression. The long term objective of the proposed work is to further understand the pathophysiology and treatment of this cytokine-induced depression as it relates to depression in the medically ill. To accomplish this goal, we plan to develop an animal model of cytokineinduced depression using rhesus monkeys administered the cytokine, interferon (IFN) alpha. IFN alpha is a potent inducer of proinflammatory cytokines (especially interleukin 6) and leads to depressive symptoms in 30-50% of patients depending on dose. In addition, IFN alpha activates corticotropin releasing factor (CRF) pathways and has been shown to lead to monoamine depletion in laboratory animals (including rhesus monkeys). In addition, IFN alpha has been shown to alter fronto-striatal neurocircuitry in humans and induce REM sleep changes (decreased REM latency, increased REM percentage) consistent with depression in both humans and rhesus animals. Thus, IFN alpha treatment provides a unique model system to further understand the pathophysiology and treatment of cytokine-induced mood disorders. The specific aims of the proposed work are 1) to characterize neuroendocrine, monoamine, immune and behavioral responses of rhesus monkeys to IFN alpha and 2) to examine the therapeutic efficacy (capacity to reverse IFN alpha-induced neuroendocrine, monoamine, immune and behavioral changes) of pharmacologic compounds that antagonize activation of the cytokine network (NK-1 antagonists), antagonize CRF, or increase the activity of neurotransmission in monoamine neurocircuits. Relevant techniques to be used to accomplish these aims will include repeated blood and CSF sampling, telemetric polysomnography, microPET, and behavioral analysis of fear potentiated startle and social interactions. Results from these studies will identify novel targets as well as pharmacologic strategies for treatment of mood disorders in the medically ill. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DEPRESSION & MORTALITY FOLLOWING MYOCARDIAL INFARCTION Principal Investigator & Institution: Carney, Robert M.; Professor of Medical Psychology; Psychiatry; Washington University Lindell and Skinker Blvd St. Louis, MO 63130 Timing: Fiscal Year 2003; Project Start 01-SEP-1997; Project End 30-APR-2006 Summary: (provided by applicant): This is a competitive renewal application for a study of cardiovascular autonomic dysregulation as a mechanism linking depression to mortality after acute myocardial infarction (MI). Pinpointing the mechanism is an important goal because it is one of the key steps in developing a treatment for post-MI depression that improves the chances for cardiac event-free survival. During the first 4 years of the study, a cohort of 356 depressed and 411 non-depressed post-MI patients were recruited and followed for up to 30 (mean = 24) months, during which time 47 deaths and 57 recurrent non-fatal MIs were documented. This cohort includes far more depressed patients than any other study of depression and mortality after MI, is highly diverse (40% women, 25% minorities), and very well characterized medically, with 100% follow-up. The original hypotheses were that both depression and low HRV predict

48 Depression

mortality in post-MI patients, depressed post-MI patients have lower HRV than do nondepressed patients, and low HRV mediates the relationship between depression and mortality. The findings provide robust support for the first two hypotheses and partial support for the third. The proposed renewal will extend the follow-up of this unique cohort in order to increase the number of endpoints and derive new, state-of-the-art measures from the existing Holter monitor tapes, including QT interval measures and nonlinear and wavelet indices of HRV. These variables have recently been shown to be highly sensitive to specific components of cardiac autonomic modulation, and there is growing evidence that they are better predictors of mortality and other cardiac events than the traditional HRV indices. The specific aims of the study are (1) to determine whether novel nonlinear and wavelet indices of HRV and QT interval variability are associated with depression and with mortality after acute myocardial infarction, (2) to determine whether they mediate the effect of depression on mortality after acute MI, and (3) to determine whether nighttime cardiovascular autonomic dysregulation in depressed post-MI patients is a stronger predictor of mortality than is daytime dysregulation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TREATMENTS

DEPRESSION

AND

ANXIETY--REFINING

EFFICACIOUS

Principal Investigator & Institution: Moras, Karla K.; Assistant Professor; Psychiatry; University of Pennsylvania 3451 Walnut Street Philadelphia, PA 19104 Timing: Fiscal Year 2001; Project Start 15-JUL-1997; Project End 30-JUN-2002 Summary: An Independent Scientist Award is sought to enable the applicant to devote major effort to mental health treatment research, specifically to the identification, development, and refinement of efficacious and efficient treatments for the most common presenting problems of adult outpatients (e.g, depression, comorbid anxiety and depression, interpersonal problems). The award also is sought to augment the applicant's expertise in treatment research with training in mental health services research, cost-effectiveness evaluation, and advanced statistical techniques. The specific research aim f the award is to conduct two treatment development projects, each on a patient group that is poorly or incompletely responsive to existing treatments that have been found to be efficacious for patients with similar disorders and symptoms. One group is referred to as having "drug resistant depression" (DRD), the other group has a specific pattern of DSM-IV Anxiety and Mood Disorder comorbidity. The ultimate aim of the DRD work is to develop an effective combined cognitive therapy (CT) + drug treatment for DRD. Three immediate aims are to: (1) Extend CT to the treatment of DRD by integrating three existing forms of CT: CT for depression, CT for personality disorders, and CT for anxiety disorders; (2) develop a treatment manual for conducting CT + drug treatment that will optimize the efficacy of combined treatment for DRD, and (3) obtain outpatient pilot outcome data on the combined CT + drug treatment to determine if it merits further investigation in a controlled clinical trial. The second project extends the applicant's prior developmental research on a psychotherapy that integrates cognitive-behavioral anxiety control techniques (ACT) with Interpersonal Psychotherapy for Depression (IPT) for patients with DSM-IV Generalized Anxiety Disorder (GAD) and an independent Major Depressive Episode (MDE). Two central aims are to: (1) Evaluate the effects of two alternative strategies for sequencing the components of ACT + IPT on symptoms of anxiety and depression, and (2) obtain pilot data on ACT + IPT to compare with outcomes of diagnostically and symptomatically matched patients who receive CT at the University of Pennsylvania Center for Cognitive

Studies 49

Therapy to evaluate the treatment's potential to have enhanced benefit for GAD + MDE, compared to existing standard treatments. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DEPRESSION AND AUTONOMIC CONTROL IN POST-MI PATIENTS Principal Investigator & Institution: Watkins, Lana L.; Duke University Durham, NC 27706 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-AUG-2007 Summary: (provided by applicant): Approximately one out of four medically ill patients have depression, and the prevalence is projected to increase during the twenty-first century. Depression independently predicts mortality and considerable evidence suggests that depression may increase risk through lowering parasympathetic (PSNS) control of the heart and increasing sympathetic nervous system (SNS) activity. Depression may be especially harmful following an acute myocardial infarction (MI), where clinical depression is associated with a 2- to 4-fold increase in mortality. In the acute phase following an MI, there is a transient denervation of the PSNS and a marked increase in SNS activity. During this period, low PSNS control and high SNS activity are strongly predictive of subsequent fatal cardiac events. Because depression itself is associated with reduced PSNS and increased SNS activity, the presence of depression may exacerbate the impaired PSNS control and increased SNS activity observed after an MI. The purpose of this study is twofold: (1) to examine the effects of depression on PSNS control and SNS activity after MI; and (2) to examine the biobehavioral pathways involved in the altered PSNS and SNS control associated with depression by evaluating the contribution of anxiety, physical activity, and medical comorbidity to this relationship. The effects of depression, anxiety, physical activity, and medical comorbidity on PSNS and SNS control and recovery will be determined in 360 post-MI patients, assessed at two weeks, six weeks, and thirteen weeks post-MI. At the time of each assessment, depression will be measured using a diagnostic interview and anxiety will be measured using the Spielberger state-trait anxiety inventory. SNS activity will be determined by the excretion of urinary catecholamines over 24-hours, and PSNS control will be measured from baroreflex sensitivity and 24-hour heart rate variability; each of these measures are prognostic of mortality. Physical activity will be estimated using 24hour wrist actigraphy. We believe that the study findings will further our understanding of the biobehavioral pathways that link depression to altered autonomic nervous system control, and provide the basis for developing evidence-based treatment programs to improve prognosis in depressed patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: DEPRESSION AND BRAIN STRUCTURE IN TYPE 1 DIABETES Principal Investigator & Institution: Jacobson, Alan M.; Senior Vice President; Joslin Diabetes Center Boston, MA 02215 Timing: Fiscal Year 2002; Project Start 15-AUG-2002; Project End 31-JUL-2006 Summary: (provided by applicant): There is growing evidence that type 1 diabetes leads to an increased prevalence of depressive disorders and preliminary data suggesting that the metabolic disturbances associated with diabetes, both severe hypoglycemia and persistent hyperglycemia, lead to changes in brain structure and cognition. These findings, together with research on structural changes in the brain among depressed patients without diabetes, suggest that diabetes could cause structural changes in the

50 Depression

brain that lead to depression. No studies have evaluated mechanisms underlying the etiology of depression among patients with type 1 diabetes. Using a cross sectional research design, we propose to study six groups of subjects: All subjects (N = 180) will be ages 30-40, right-handed and matched according to age, gender and SES. Diabetic patients will have between a 15-25 year history of types of diabetes. There will be three groups of diabetic subjects without psychiatric history: 1. Well controlled (0-1 episodes of severe hypoglycemia; mean HbA1c over history of diabetes equal to or 3 episodes of severe hypoglycemia; mean HbA1c over time equal to or 9.0%; 0-1 hypoglycemic episodes). A fourth group of diabetic subjects with a history of unipolar major depression and who equally represent the glycemic control characteristics of the other three diabetic groups will also be studied. In addition, two non-diabetic control groups (history of depression; no psychiatric history) will also be studied. We will assess these patients as to brain structure, using Magnetic Resonance Imaging (MRI); depression, using the Structured Clinical Interview for DMS IV (SCID); and cognition using the Wechsler Adult Intelligence Scale III (WAIS III) and other neuropsychological tests of memory, psychomotor speed and mental efficiency. We will also evaluate medical factors (e.g., glycemic control-HbA1c; and history of severe hypoglycemia). We will examine whether: 1) structural abnormalities are more common in diabetic subjects compared to the matched community controls; 2) there is a relationship between diabetes specific medical variables, such as long-term glycemic control, and brain structure abnormalities; 3) structural abnormalities are more common in diabetic patients with a history of unipolar major depression than diabetic patients without a history of depression; and 4) the frequency of structural abnormalities in the brain among diabetic patients with a lifetime history of unipolar depression differs from the depression control group. The proposed research will, for the first time, provide evidence regarding the linkage between structural changes in the brain and depressive disorder in diabetes, and evidence about the relationship of type I diabetes and its attendant metabolic disturbances to structural changes in the brain. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DEPRESSION AND CHILD ASTHMA: EFFECTS OF FAMILY RELATIONS Principal Investigator & Institution: Wood, Beatrice L.; Associate Professor of Psychiatry; Psychiatry; State University of New York at Buffalo 402 Crofts Hall Buffalo, NY 14260 Timing: Fiscal Year 2003; Project Start 01-DEC-2002; Project End 30-NOV-2007 Summary: (provided by applicant): Depression and family dysfunction have been implicated as factors complicating childhood asthma. Direct psychobiologic links have been proposed, but previous studies were limited by lack of integrative models and research methods capable of investigating specific pathways and mechanisms. Wood's 3iobehavioral Family Model (BBFM) proposes specific family relational patterns and child psychological "processes which interact so as to influence physiological processes affecting physical disease in the child. Miller's Autonomic Nervous System (ANS) Dysregulation Model of Emotional Influence in Asthma proposes vagal bias as mediating the effect of depression on airway function. A hypothalamic-pituitaryadrenal (HPA)-immune mechanism is also postulated. The proposed project integrates these two conceptual models to test a family-depression-airway pathway. A controlled laboratory protocol will be used to elicit family interaction in synchrony with physiological measures. Structural Equation Modeling will assess the primary hypotheses: 1)Negative family emotional climate, parental conflict, triangulation of child

Studies 51

in conflict predict depression/hopelessness in the child; 2) The family-depression effect is moderated by parent-child relationship security; 3) Depression predicts airway compromise, which is mediated by vagal bias and/or hypo-HPA function. Children with asthma (N= 320, age 7-12; about 60% boys) and their families will be recruited from the Emergency Department at Children's Hospital of Buffalo. Four weeks later they will have a clinical asthma evaluation and participate in Wood's Family Problem Solving Interaction Tasks (FPSIT). Throughout the protocol, cardio-impedance methods will be used to measure sympathetic and vagal branches of ANS function to index vagal bias in the child. Salivary cortisol response will examine a possible (HPA) pathway. Pulmonary function tests will assess airway compromise. Family interactions will be rated using a reliable and valid instrument (SCIFF). Questionnaires and interview will provide convergent data. This work will lay the foundation for controlled intervention studies, ultimately leading to the reduction of morbidity and mortality in childhood asthma. It will also fill a gap in understanding relationships between family patterns of relationship and the co-morbid conditions of emotional disorder and physical disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DEPRESSION AND CHRONIC PAIN IN MARRIAGE Principal Investigator & Institution: Cano, Annmarie; Psychology; Wayne State University 656 W. Kirby Detroit, MI 48202 Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 31-JUL-2008 Summary: (provided by applicant): The principal investigator (PI) is requesting five years of funding through the Scientist Development Award for New Minority Faculty (K01). The career development goals described in this application include testing an integrative model of depression and chronic pain developed by the applicant and training in theoretical and conceptual issues, advanced longitudinal statistical methods, objective interview assessment of life events, observational research methods with couples, and the responsible conduct of research with ethnic minorities. These activities are expected to build on the Pl's strong research and clinical background in marriage and enhance her ability to produce sophisticated scholarly work. Major depression and chronic pain are costly public health problems in the United States that are highly comorbid with each other. Although research suggests that marital variables may contribute to depression, researchers have yet to integrate existing theory and empirical findings into a comprehensive model that accounts for the interrelationships between marital functioning, chronic pain, and depression. Building on the career development activities described in the application, the PI will test an integrative model of the comorbidity of chronic pain and depression in which marital functioning plays a key role. The long-term objective of the study is to develop marital treatments for individuals experiencing both depression and chronic pain. The specific aims of the study include examining how changes in general marital functioning (e.g., marital satisfaction, affect expressed in a marital interaction, marital stressors), pain-specific marital functioning (e.g., spouse responses to pain, affect expressed in a marital interaction related to the impact of pain on the couple), and pain factors (e.g., pain severity, disability) relate to changes in depression over time. Participants will be 160 married couples in the community in which one spouse has a chronic musculoskeletal pain problem. Participant couples will complete surveys, a diagnostic interview for major depression, a life events interview, and two videotaped marital interactions. Participants will also take part in 6- and 12-month follow-ups in which they will complete the same instruments. Participants will be paid upon completion of each phase of the study.

52 Depression


Project Title: DEPRESSION AND DISABILITY IN PATIENTS WITH HEART FAILURE Principal Investigator & Institution: Turvey, Carolyn L.; Psychiatry; University of Iowa Iowa City, IA 52242 Timing: Fiscal Year 2001; Project Start 01-SEP-2000; Project End 31-AUG-2005 Summary: Description (adapted from investigator's abstract): In this application for a Mentored Research Scientist Development Award, Carolyn L. Turvey will obtain expertise in the relation between physical disability and depression in late-life. Dr. Turvey will study the relationship between physical disability and depression in elder patients with congestive heart failure (CHF). Heart failure is a major source of disability in the elderly because patients experience fatigue and breathlessness when performing even minor activities of daily living. Accordingly, there are high rates of depression in heart failure patients, ranging from 17-26 percent. Disability is strongly associated with depression for this group. Dr. Turvey aims to identify how patients with CHF can cope successfully with their illness and with physical disability. She will compare CHF patients with and without depression on their level of disability, how they cope with the illness and disability, and the degree and quality of social support they receive. She will then determine which of these factors predicts time to remission of a depressive episode. She will use the information gathered in this study to develop interventions designed to reduce depression in CHF patients. She will develop a brief intervention that teaches CHF patients cognitive and behavioral skills for coping with their illness and the most effective ways of engaging social support. Dr. Turvey proposes a training and research program making use of the diverse resources at the University of Iowa the Departments of Psychiatry, Psychology, Epidemiology and the Aging Studies Program. Dr. Turvey seeks training in gerontology and the design and implementation of outcomes research. As part of this training, she has arranged visits to other sites that specialize in the treatment of late-life depression and the relation between depression and disability in the elderly. Her long-term career goal is to develop interventions that promote healthy aging amongst elders faced with functional decline. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: DEPRESSION AND HEALTH BEHAVIOR IN LATE LIFE Principal Investigator & Institution: Kaplan, Mark S.; School of Community Health; Portland State University Box 751 Portland, OR 97207 Timing: Fiscal Year 2001; Project Start 01-DEC-1999; Project End 30-NOV-2002 Summary: (Adapted from the Applicant's Abstract): The overall purpose of this study is to expand the health behavior-health status model to include depressive symptoms and related psychosocial factors as components, thus capturing a more comprehensive conceptualization of the role behavioral factors play in the health of older adults. An understanding of these interactive and dynamic relationships between psychosocial resources, depression, and health behavior may lay the foundation for developing more effective public health interventions. The specific goals of this research are (1) to assess the effects of depression and psychological distress on health behaviors among older adults. (2) To examine the role of depression and depressive symptoms (including their psychosocial antecedents) among older men and women who engage in behaviors which are harmful to their health, and (3) to initiate a longitudinal study to identify and assess the directionality of the causal relationships between general risk factors

Studies 53

(including deficits in psychological and social resources and life event-related stress), depression, and health behaviors. The proposed study will utilize cross-sectional and panel data derived from the Canadian National Population Health Survey (NPHS). The NPHS data are especially attractive for the analyses of depression and health in late life. The survey contains data on a myriad of factors for analytic studies that will assist in understanding the determinants of physical and mental well being. Also, with regard to forecasting the impact on U.S. health policy formulation and analysis, the NPHS has several attractive features. First, the sample is representative of the entire population [From which it is drawn. Studies also suggest that health behaviors among older adults in Canada can be generalized to the U.S.] Second, the survey is longitudinal. Third, the interview data (including standardized psychiatric instruments) will be linked in the near future with health care utilization information obtained from automated record keeping systems. Fourth, the survey information is recent. Fifth, older adults are well represented. Because recent epidemiologic studies suggest that health-promoting habits appear to augment biologic vitality/host resistance in late adulthood, it is critical to understand the psychosocial factors that affect health behaviors. Although numerous researchers have examined the psychosocial factors associated with late life depression, little evidence has accrued regarding how depressive symptoms and their psychosocial antecedents affect health behavior which in turn might exert a negative impact on longevity and disability in older populations. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DEPRESSION AND HEALTH OUTCOMES IN REFRACTORY EPILEPSY Principal Investigator & Institution: Gilliam, Frank G.; Neurology; Washington University Lindell and Skinker Blvd St. Louis, MO 63130 Timing: Fiscal Year 2001; Project Start 24-AUG-2001; Project End 31-JUL-2006 Summary: (provided by applicant): Epilepsy is the most prevalent disabling neurologic illness, and depression is the most frequent comorbid condition associated with epilepsy. The prevalence of depression is 20-50 percent in patients with uncontrolled seizures. This combination affects between 250,000 and 450,000 people in the United States. Our recent clinical studies have shown that depression is a strong predictor of function and health outcomes in epilepsy. Despite the marked adverse effects and high prevalence of depression in epilepsy, most affected patients are not treated. This complacency toward treatment may result from insufficient use of diagnostic screening, the widespread belief that antidepressants lower the seizure threshold, or lack of demonstrated efficacy in the only controlled trial of antidepressant medications in epilepsy. The broad aims of this study are to define the benefits of antidepressant treatment on mood, compliance, and health outcomes in epilepsy patients with comorbid major depression. Based on our prior clinical and research experience, we hypothesize that 1) pharmacotherapy or psychotherapy will reduce depression and improve health-related quality of life in patients with refractory epilepsy, 2) antiepileptic medication compliance will improve after reduction of depression, 3) seizure frequency will not significantly increase during treatment with a selective seratonin reuptake inhibitor compared to psychotherapy, and 4) depression and antiepileptic medication toxicity are stronger predictors of health-related quality of life than seizure frequency or severity in patients with refractory epilepsy. The hypotheses will be tested through a randomized trial comparing the efficacy of sertraline (n=127) to cognitive behavior therapy (n=127) for mood and health outcomes in patients with refractory epilepsy and depression. Reliable and valid measures will be used to assess depression and health-

54 Depression

related quality of life. Electronic, computer-assisted monitoring will determine compliance. Multivariate repeated-measures analyses will be used to determine the interrelationships of treatment, mood, antiepileptic medication toxicity, seizure frequency and severity, compliance and health-related quality of life. We anticipate that dissemination of the results of a positive study will support the modification of the current model of intervention for epilepsy from predominantly seizure reduction to a more comprehensive approach that includes assessment and treatment of depression Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DEPRESSION AND CARDIOVASCULAR PATHOLOGY

HEART

FAILURE

ASSOCIATED

Principal Investigator & Institution: Johnson, Alan K.; Associate Professor; University of Iowa Iowa City, IA 52242 Timing: Fiscal Year 2003; Project Start 21-JAN-2003; Project End 31-DEC-2007 Summary: Depression is both a debilitating psychological disorder and a condition that affects an individual's physical well-being. Depression is a recognized risk factor for heart disease. Research has demonstrated that depression predisposes an individual to myocardial infarction, sudden death, atherosclerosis, thrombosis and arrhythmias. While the behavioral and cognitive aspects of depression have been studied extensively, there has been much less research investigating the mechanisms responsible for the physiological consequences of mood disorders. Exposure of rodents to a series of chronic mild stressors (CMS) generates key behavioral characteristics of human depression that are observable and quantifiable. The CMS model of experimentallyinduced depression (ID) mimics the reduced responsiveness to pleasurable stimuli (anhedonia)which is a pivotal diagnostic criterion seen in depression. In the CMSdD model, anhedonia is induced by presenting mild unpredictable stressors (e.g., paired housing, stroboscopic illumination, white noise) of varying durations. In rats,anhedonia is operationally defined as a decrease in responding for a previously demonstrated reinforcer (reward). Recently, we have begun to characterize cardiovascular function in rats with CMS-ID. We have found that rats exposed to CMS for 4 weeks showed anhedonia along with cardiovascular alterations. Similar to patients with depression and with heart failure,CMSgD rats had elevated resting heart rates and reduced heart rate variability. In addition, rats exposed to CMS have increased susceptibility to experimentally-induced premature ventricular contractions. In other studies investigating the behavioral consequences of heart failure, we have found evidence of anhedonia (i.e., experimental depression) in rats with experimental myocardial infarction. The proposed research program will extend our characterization of the cardiovascular changes that accompany experimentally-induced depression and investigate the role of brain serotonergic mechanisms that are hypothesized to be common in the mediation of cardiovascular alterations that accompany both experimental depression and experimental heart failure. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DEPRESSION AND HIV RISK BEHAVIOR IN AN STD CLINIC Principal Investigator & Institution: Erbelding, Emily J.; Assistant Professor of Medicine; Medicine; Johns Hopkins University 3400 N Charles St Baltimore, MD 21218 Timing: Fiscal Year 2001; Project Start 15-JAN-2000; Project End 31-DEC-2003 Summary: There is a high prevalence of depression in HIV-infected populations, as well as in some HIV-uninfected populations at risk for HIV. Depressive symptoms

Studies 55

themselves have been associated with behaviors that transmit HIV infection. The aim of the proposed cross-sectional study to define the epidemiology of depression, as well as any substance use disorders that may interact with depression in those attending an inner city STD clinic who are known to be at high risk for acquiring HIV. Those who present with symptoms of a new STD or as an STD contact will be eligible for enrollment. They will undergo (1) screening for depression using the Beck Depression Inventory and General Health Questionnaire; (2) behavioral assessment for HIV transmitting behaviors by confidential computer-based survey; and (3) clinical and laboratory evaluation for STDs. Of the 700 enrolled participants, 200 will additionally undergo a structured clinical interview in order to establish a specific DSM-IV diagnosis. The data generated will allow us to describe (1) the prevalence of major depression and substance use disorders in an STD clinic population at high risk for HIV; (2) the independent association of depression with behaviors that transmit HIV infection; (3) the independent association between depression and biologic measure of risk, an STD diagnosis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DEPRESSION AND PRODUCTIVE WORK ACTIVITY Principal Investigator & Institution: Lerner, Debra J.; New England Medical Center Hospitals 750 Washington St Boston, MA 021111533 Timing: Fiscal Year 2001; Project Start 08-SEP-2000; Project End 31-AUG-2004 Summary: (Applicant's abstract): While depression is a leading cause of work disability in this nation, disability reduction efforts remain hampered by a lack of research. This study's long-term goal is to prevent work disability due to depression. A longitudinal study is proposed that addresses on-the-job work disability among employed primary care patients with depression. The sample will include 350 patients who have Major Depressive Disorder (MDD) and/or dysthymia and are employed at baseline, and two comparison groups: 1)) 200 workers with rheumatoid arthritis (PA), a physically limiting condition with one of the highest work disability rates; and 2) 100 "healthy" controls. The study has 3 specific aims: 1) to prospectively assess and compare the rates at which four types of work disabilities (job loss, work time loss, reduced work hours and on-the-job limitations) occur among the groups; 2) to identify variables that contribute to successful and unsuccessful work outcomes among patients with depression; 3) to determine whether the variables that contribute to work disability are the same for depression and RA. The project's health-relatedness is its focus on a major public health problem (work disability due to depression) within an increasingly important segment of the mental health care delivery system (primary care). Subjects will be recruited from primary care practices, 18-62 years of age, employed at baseline and not planning to stop working for at least 2 years. Data will be collected from patient surveys (baseline and months 3, 6, 12 and 18), patient charts and clinic pharmacy records. We will also administer a new validated survey instrument; The Work Limitations Questionnaire, which assesses on-the-job performance and productivity and, thus, captures aspects of work disability not reflected in job loss and absenteeism data. The statistical analysis will: 1) establish the magnitude of the four types of work disability and work productivity costs within the depression sample); 2) identify variables that predict work disability or a sustained ability to work; and 3) determine the differential impact of a mental and a physical illness on work disability rates, the predictors of work disability and productivity costs. Study results will contribute to the design of disability prevention and productivity improvement programs and policies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

56 Depression

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Project Title: DEPRESSION IN ADAPTATION TO OPEN-HEART SURGERY Principal Investigator & Institution: Goyal, Tanya M.; Psychology; Rutgers the St Univ of Nj New Brunswick Asb Iii New Brunswick, NJ 08901 Timing: Fiscal Year 2001; Project Start 01-JUN-2001 Summary: Applicant?s The proposed study will examine the effects of depressive symptomatology on physical and psychological adaptation to open-heart surgery. There is growing evidence suggesting that depression may influence the development and progression of coronary heart disease as well as recovery following cardiac events. While several physiological and behavioral pathways have been proposed to explain these associations, potential psychological mechanisms have rarely been considered. In addition to evaluating effects of depression on adaptation to cardiac surgery, this study will examine the role of social cognitive variables as mediators of these effects. The specific aims of this study are to test the following hypotheses: (1) Lower levels of preoperative depression will predict shorter hospitalizations following surgery; (2) Lower levels of preoperative depression will predict less angina and better physical functioning six months after surgery; (3) Lower levels of preoperative depression will predict less anxiety six months after surgery; and (4) These effects will be partially mediated by outcome expectancies and efficacy expectancies regarding behavioral and social activities associated with recovery. This project seeks to advance theoretical understanding of the relationship between psychosocial factors and physical illness. Additional long-term goals of this research include improving pre-surgical identification of cardiac patients at risk for poor outcomes, the development of psychosocial interventions for this population, and ultimately, the enhancement of surgical outcomes and long-term adaptation to chronic disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: DEPRESSION IN ALZHEIMER'S DISEASE STUDY 2 (DIADS-2) Principal Investigator & Institution: Porsteinsson, Anton P.; Psychiatry; University of Rochester Orpa - Rc Box 270140 Rochester, NY 14627 Timing: Fiscal Year 2003; Project Start 10-JUN-2003; Project End 29-FEB-2008 Summary: (provided by applicant): Depression in the context of Alzheimer's disease (AD) is a significant public health problem with serious adverse consequences for patients and their caregivers. There has been little research into the course or treatment of depression associated with AD. This is in part due to the absence of validated operational criteria for defining depression in AD. Recently, NIMH convened an expert consensus panel to develop draft criteria for depression of Alzheimer's disease (dAD) and to establish research priorities in this area. These criteria are intended to facilitate further studies of the course and treatment of depression in AD. The first aim of the proposed multicenter study is to determine whether individuals with dAD respond to antidepressant treatment using the medication sertraline in a 12-week randomized, controlled, double blind trial. The second aim is to establish whether earlier treatment of depression in AD affects critical non-mood outcomes such as cognition, quality of life, activities of daily living and caregiver variables, over 24 weeks. The third aim is to validate the dAD syndrome by evaluating its course and response to treatment in comparison to other diagnostic conceptualizations of depression in AD, over six months. These aims are consistent with priorities articulated by the NIMH expert consensus panel. 130 patients meeting criteria for dAD, and their caregivers, will be recruited into the study at five clinical centers: Johns Hopkins, University of Southern California, University of Rochester, University of Pennsylvania, and Medical University

Studies 57

of South Carolina. The study will be coordinated by the Johns Hopkins Center for Clinical Trials. After detailed baseline characterization participants will be randomized to treatment with sertraline or placebo for at least twelve weeks and followed for up to 24 weeks. All patients and caregivers will receive psychosocial interventions for Alzheimer's and depression. Patient outcomes will include: global improvement of the depressive disturbance, ratings on a depression scale, quality of life, cognitive functioning, activities of daily living, behavioral disturbance, and adverse events. Caregiver outcomes will include: depression, quality of life, and care giving burden. Regarding the first study aim, analyses will compare the two treatment groups on patient mood outcomes in the first twelve weeks. Regarding the second study aim, analyses will compare the two treatment groups on the trajectories of patient critical AD patient outcomes (cognition, functioning, quality of life, behavior) and of caregiver outcomes over 24 weeks. Regarding the third aim, analyses will examine the longitudinal course of depressive symptoms and of depressive syndromes in the context of Alzheimer's using three different syndromic definitions: dAD, DSM-IV, and "Alzheimer's Associated Affective disorder" derived empirically. The predictive validity of defining depression in AD using a symptom scale or each of these syndromes will be assessed longitudinally against the various study outcomes, and against efficacy of response to antidepressant treatment. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DEPRESSION IN ALZHEIMER'S DISEASE STUDY-2(DIADS-2) Principal Investigator & Institution: Katz, Ira R.; Professor; Psychiatry; University of Pennsylvania 3451 Walnut Street Philadelphia, PA 19104 Timing: Fiscal Year 2003; Project Start 18-AUG-2003; Project End 29-FEB-2008 Summary: (provided by applicant): Depression in the context of Alzheimer's disease (AD) is a significant public health problem with serious adverse consequences for patients and their caregivers. There has been little research into the course or treatment of depression associated with AD. This is in part due to the absence of validated operational criteria for defining depression in AD. Recently, NIMH convened an expert consensus panel to develop draft criteria for depression of Alzheimer's disease (dAD) and to establish research priorities in this area. These criteria are intended to facilitate further studies of the course and treatment of depression in AD. The first aim of the proposed multicenter study is to determine whether individuals with dAD respond to antidepressant treatment using the medication sertraline in a 12-week randomized, controlled, double blind trial. The second aim is to establish whether earlier treatment of depression in AD affects critical non-mood outcomes such as cognition, quality of life, activities of daily living and caregiver variables, over 24 weeks. The third aim is to validate the dAD syndrome by evaluating its course and response to treatment in comparison to other diagnostic conceptualizations of depression in AD, over six months. These aims are consistent with priorities articulated by the NIMH expert consensus panel. 130 patients meeting criteria for dAD, and their caregivers, will be recruited into the study at five clinical centers: Johns Hopkins, University of Southern California, University of Rochester, University of Pennsylvania, and Medical University of South Carolina. The study will be coordinated by the Johns Hopkins Center for Clinical Trials. After detailed baseline characterization participants will be randomized to treatment with sertraline or placebo for at least twelve weeks and followed for up to 24 weeks. All patients and caregivers will receive psychosocial interventions for Alzheimer's and depression. Patient outcomes will include: global improvement of the depressive disturbance, ratings on a depression scale, quality of life, cognitive

58 Depression

functioning, activities of daily living, behavioral disturbance, and adverse events. Caregiver outcomes will include: depression, quality of life, and care giving burden. Regarding the first study aim, analyses will compare the two treatment groups on patient mood outcomes in the first twelve weeks. Regarding the second study aim, analyses will compare the two treatment groups on the trajectories of patient critical AD patient outcomes (cognition, functioning, quality of life, behavior) and of caregiver outcomes over 24 weeks. Regarding the third aim, analyses will examine the longitudinal course of depressive symptoms and of depressive syndromes in the context of Alzheimer's using three different syndromic definitions: dAD, DSM-IV, and "Alzheimer's Associated Affective disorder" derived empirically. The predictive validity of defining depression in AD using a symptom scale or each of these syndromes will be assessed longitudinally against the various study outcomes, and against efficacy of response to antidepressant treatment. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DEPRESSION IN ALZHEIMER'S DISEASE-II Principal Investigator & Institution: Martin, Barbara K.; Epidemiology; Johns Hopkins University 3400 N Charles St Baltimore, MD 21218 Timing: Fiscal Year 2003; Project Start 05-JUN-2003; Project End 29-FEB-2008 Summary: (provided by applicant): Depression in the context of Alzheimer's disease (AD) is a significant public health problem with serious adverse consequences for patients and their caregivers. There has been little research into the course or treatment of depression associated with AD. This is in part due to the absence of validated operational criteria for defining depression in AD. Recently, NIMH convened an expert consensus panel to develop draft criteria for depression of Alzheimer's disease (dAD) and to establish research priorities in this area. These criteria are intended to facilitate further studies of the course and treatment of depression in AD. The first aim of the proposed multicenter study is to determine whether individuals with dAD respond to antidepressant treatment using the medication sertraline in a 12-week randomized, controlled, double blind trial. The second aim is to establish whether earlier treatment of depression in AD affects critical non-mood outcomes such as cognition, quality of life, activities of daily living and caregiver variables, over 24 weeks. The third aim is to validate the dAD syndrome by evaluating its course and response to treatment in comparison to other diagnostic conceptualizations of depression in AD, over six months. These aims are consistent with priorities articulated by the NIMH expert consensus panel. 130 patients meeting criteria for dAD, and their caregivers, will be recruited into the study at five clinical centers: Johns Hopkins, University of Southern California, University of Rochester, University of Pennsylvania, and Medical University of South Carolina. The study will be coordinated by the Johns Hopkins Center for Clinical Trials. After detailed baseline characterization participants will be randomized to treatment with sertraline or placebo for at least twelve weeks and followed for up to 24 weeks. All patients and caregivers will receive psychosocial interventions for Alzheimer's and depression. Patient outcomes will include: global improvement of the depressive disturbance, ratings on a depression scale, quality of life, cognitive functioning, activities of daily living, behavioral disturbance, and adverse events. Caregiver outcomes will include: depression, quality of life, and care giving burden. Regarding the first study aim, analyses will compare the two treatment groups on patient mood outcomes in the first twelve weeks. Regarding the second study aim, analyses will compare the two treatment groups on the trajectories of patient critical AD patient outcomes (cognition, functioning, quality of life, behavior) and of caregiver

Studies 59

outcomes over 24 weeks. Regarding the third aim, analyses will examine the longitudinal course of depressive symptoms and of depressive syndromes in the context of Alzheimer's using three different syndromic definitions: dAD, DSM-IV, and "Alzheimer's Associated Affective disorder" derived empirically. The predictive validity of defining depression in AD using a symptom scale or each of these syndromes will be assessed longitudinally against the various study outcomes, and against efficacy of response to antidepressant treatment. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DEPRESSION IN BLACK AND WHITE ADOLESCENT GIRLS Principal Investigator & Institution: Franko, Debra L.; Psychology; Wesleyan University Middletown, CT 06459 Timing: Fiscal Year 2001; Project Start 01-SEP-2001; Project End 31-AUG-2003 Summary: (provided by applicant): The broad, long-term goal of this research is the development of effective preventive interventions to reduce the prevalence of common mental disorders among adolescent and young adult women. Specifically, the aims of this project are to clarify the risk factors for and consequences of depression and related psychopathology in female Black and White adolescents and young adults. By increasing our understanding of the vulnerabilities for and outcomes of depression, more specific and effective prevention strategies can be developed. The three major aims of this project are: 1) To determine ethnicity-specific prevalence rates of depressive symptoms and syndromes of depression in Black and White females during adolescence and early adulthood; 2) To test a bio-psycho-social model of risk for depression in Black and White girls, by exploring the relationship between risk factors (e.g., coping style, body image, pubertal timing, and stressful life events) and the emergence of depressive symptoms during adolescence; 3) To examine the outcomes of adolescent depression for Black and White women. The following outcome variables will be investigated: obesity and health services utilization, psychosocial factors, and psychiatric comorbidity. Capitalizing upon the availability of extensive data collected prospectively among an exceptionally well-maintained cohort of 2,3 79 Black and White females over a 12-year period (from ages 9-10 to ages 2 1-23), we propose to apply innovative analytic procedures to further the scientific understanding of risk factors, course, and outcomes of depressive symptoms in adolescence. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: DEPRESSION IN ELDERLY CARDIAC PATIENTS Principal Investigator & Institution: Krishnan, Ranga R.; Chairman and Professor; Psychiatry; Duke University Durham, NC 27706 Timing: Fiscal Year 2001; Project Start 01-APR-1994; Project End 30-NOV-2003 Summary: High rates of depression have been reported in patients with neurological disorder, endocrinologic/metabolic disorder, post- myocardial infarction, malignancy, and chronic obstructive pulmonary disease. Studies have documented a clear excess of cardiovascular disorders among older compared with younger depressed patients. Rates of persistent depressive disorder in middle-aged and elderly persons following myocardial infarction have been especially high. Despite numerous studies in the population of patients with coronary artery disease (CAD) and post myocardial infarction, few studies have focused specifically on the prevalence of depression other psychiatric problems and its prognostic effects in patients with chronic heart failure (CHF). CHF is a major public health problem in the United States. Currently, it is

60 Depression

estimated by the National Heart, Lung, and Blood Institute that over 3 million Americans suffer from CHF, and about 400,000 new cases are diagnosed each year. A large number of factors have been found to correlate with mortality in patents with CHF. Clinically, the presence of CAD as the etiology of CHF, an audible S3, low pulse and systolic blood pressure, a high NYHA functional class (greater than 11), and reduced exercise capacity have been shown to be associated with increased risk of death. There is evidence which suggests that the rate of depression may be high in the CHF population, maybe even higher than the rate in CAD patients. With the evidence of higher mortality and morbidity which occur in CAD patients with depression, it is speculated that CHF patients with depression bear higher mortality and morbidity as well. Provided that depression is modifiable and therefore results in a better outcome, studies to learn the prevalence of depression and its association with prognosis in the CHF population are promptly needed and, if the results are similar to what is observed in the CAD population, trials to evaluate therapeutic interventions will be undertaken consequently. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DEPRESSION INTERVENTION FOR POOR PREGNANT WOMEN Principal Investigator & Institution: Zlotnick, Caron; Associate Professor; Women and Infants Hospital-Rhode Island 101 Dudley St Providence, RI 02905 Timing: Fiscal Year 2001; Project Start 27-AUG-2001; Project End 31-JUL-2004 Summary: (provided by applicant): In the postpartum period, approximately 10 to 16 percent of women will become clinically depressed. The impact of major depression in the postpartum period is profound with considerable emotional pain for the new mother as well as disturbances in infant development. Unfortunately, few preventive interventions have been developed or systematically tested to reduce the risk of postpartum depression. An area of even greater neglect is the development of such an intervention for financially disadvantaged women who are at high risk for postpartum depression and for the disturbances associated with postpartum depression. This treatment development application proposes to develop a psychosocial intervention for financially disadvantaged, pregnant women at risk for postpartum depression. and to collect preliminary data on the efficacy of this intervention in reducing the likelihood of postpartum depression. The intervention, "Life at Home with a New Baby," is an interpersonal-oriented intervention that targets those factors that may play a significant role in the development of postpartum depression (i.e., poor social support, role transitions, and life stressors). More specifically, the aims of this project are to: (i) develop the manual for the intervention, "Life at Home with a New Baby" (ii) develop, implement, and evaluate a therapist training program, (iii) develop and test the reliability and validity of competence and adherence rating scales that evaluate the training therapists' ability to perform the intervention and assess the reliable delivery of the intervention, and (iv) conduct a randomized controlled pilot study to evaluate the initial efficacy of the proposed intervention compared to a care as usual condition in a sample of financially disadvantaged, pregnant women at risk for postpartum depression. and to provide an estimate of effect size in comparison to the care as usual condition. This pilot study will lay the groundwork for a larger clinical trial evaluating the efficacy of this new group intervention. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: DEPRESSION ADOLESCENTS

PREVENTION

FOR

AFRICAN-AMERICAN

Principal Investigator & Institution: Robinson, W L.; Professor; Psychology; De Paul University 1 E Jackson Blvd Chicago, IL 60604 Timing: Fiscal Year 2001; Project Start 01-SEP-2001; Project End 30-JUN-2003 Summary: (adapted from Investigator's abstract) Low income, inner-city, AfricanAmerican adolescents are at high risk for depression, due to the many stressors associated with being adolescent, poor, and minority. This is an exploratory project that will use a controlled randomized design to examine the impact of a 15-session, groupbased, cognitive-behavioral depression preventive intervention adapted for low income, inner-city African-American adolescents. This study will lay the groundwork for a future effectiveness study. Participants will be 1029 freshmen and 765 sophomore African-American students, attending three inner-city high schools located in lowincome Chicago neighborhoods. They will be administered the Center for Epidemiologic Studies-Depression Scale (CES-D) and the Adolescent Health Assessment-2000, a collection of psychometrically sound instruments which assess the various study variables of interest. Those students who are determined to be at-risk for depression, based on elevated CES-D scores (i.e., _24), will be interviewed using the DISCIV. Variables of interest include stress, coping, aggression, socio-ecological factors, and other indicators of emotional/physical well-being and adjustment. Students who are at-risk for depression but who do not have a current Depressive, Bipolar, Dysthymic, Cyclothymic and/or Conduct Disorder will be randomized to either the culturally adapted 15-session, group-based, cognitive-behavioral depression preventive intervention or the "usual care" control condition. Upon completion of the preventive intervention, students in both conditions will be reassessed using the CESD, the DISCIV, and the AHA-2000 and will be tracked for follow-up assessments at 6 months. Students who meet DSM.-IV criteria for the above mentioned disorders will either be treated by on-site school based health center staff or referred for community-based service. The study will employ multiple data sources including: teachers' reports, school archival data and primary health care records. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DEPRESSION PRONE SMOKERS AND CIGARETTE CRAVING Principal Investigator & Institution: Mcchargue, Dennis E.; Psychology; University of Illinois at Chicago 1737 West Polk Street Chicago, IL 60612 Timing: Fiscal Year 2001; Project Start 10-SEP-2000; Project End 31-AUG-2005 Summary: Dr. McChargue's short-term goals are to enhance the theoretical, methodological, and statistical skills that he needs to study the determinants of nicotine self-administration in smokers with comorbid psycohpathology. His long-term goals are to develop an independent laboratory, as well as a network of research collaborators devoted to advancing our understanding of nicotine dependence and training fixture clinical researchers. The proposed studies will evaluate two premises about smokers with a history of depression that have been assumed but not directly tested. The first proposition is that depression-prone smokers experience greater than normal cigarette cravings when exposed to negative affect cues. The second proposition is that the dysphoria-reducing effects of self-administering nicotine are more potent for depression-prone than non-prone smokers. Study 1 aims to compare the reactivity of smokers with and without history of depression to cues involving smoking paraphernalia and negative mood. Reactivity will be measured via self-report,

62 Depression

behavioral and physiological indices of craving. The hypothesis is that depression-prone smokers will show heightened cue reactivity in general, but will be especially reactive to dysphoric mood cues. The aim of Study 2 is to compare the degree to which smoking a nicotinized versus a denicotinized cigarette alleviates experimentally induced dysphoria in smokers with versus without a history of depression. The hypothesis is that nicotine's potency as a negative reinforcer (i.e., its ability dispel dysphoric mood) will be enhanced for smokers who have a history of depression, as compared to those who lack such a history. These studies will be the first to systematically examine craving responses in depression-prone smokers and to quantify the dysphoria-reducing effects of nicotine administration for this population. Results should increase understanding of mechanisms that mediate the high prevalence and persistence of smoking among depression-prone individuals, and may contribute to the development of novel treatments for this recalcitrant group of smokers. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DEPRESSION SCREENING & TREATMENT IN OVARIAN CANCER Principal Investigator & Institution: Shinn, Eileen H.; Behavioral Science; University of Texas Md Anderson Can Ctr Cancer Center Houston, TX 77030 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-AUG-2008 Summary: (provided by applicant): Dr. Eileen Shinn earned her Ph.D. in Clinical Psychology from Ohio University and is a postdoctoral fellow in the Department of Behavioral Science at M.D. Anderson Cancer Center. Dr. Shinn will use the K07 award to train with a mentoring team comprised of medical and psychosocial experts at M. D. Anderson and four national experts in depression and primary care research (Drs. James Coyne, Lynn Rehm, John Williams, James Bray). This project has a longitudinal design with an embedded feasibility study to evaluate an innovative intervention for depression. The revised prospective screening plan has been expanded to include a hierarchical screening strategy for depression, as well as additional questions about timing of screening, quality of care received, and basic psychological processes which may affect depression. On the other hand, the pilot intervention has been scaled down and now offers patients a choice of treatment, reflecting the reality of depression treatment in managed-care settings. The training plan now includes formal coursework and workshops suggested by the 4 co-mentors, as well as annual training trips to Dr. James Coyne at U. Penn, and regularly scheduled face-to-face meetings with Drs. Lynn Rehm and James Bray, and to a lesser extent, Dr. John Williams. Formal agreements and specific roles with the mentoring team have been documented and are presented. The research and training plan will be conducted at M.D. Anderson, which has a commitment to research and training with numerous didactic and collaborative opportunities. The Gynecologic Cancer Center at M.D. Anderson treats 250-300 different ovarian cancer patients per year. Major depression is the most prevalent psychiatric disorder in cancer patients and severely disables patients' quality of life. Yet depression is underdiagnosed and inadequately treated when recognized. The research plan proposes to address many of the barriers that hinder the detection and treatment of major depression in busy oncology practice settings. The screening plan now features a brief 2-phase screening method which may demonstrate positive predictive value well above other screening instruments. The pilot intervention will test the feasibility and acceptability among depressed ovarian cancer patients. It will be delivered in the patient's home by telephone and a structured cognitive-behavioral therapy (CBT) journal. The pilot intervention will last 10 sessions over 3 months and cover a range of cognitive-behavioral skills. Each skill will suggest a choice of applications ranging from

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side-effect management and pain reduction, to concerns about losses in functioning. Drs. Rehm and Taylor will co-supervise Dr. Shinn in the CBT administration. This intervention is innovative and has not been done before with any group of cancer patients, including ovarian cancer patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DEPRESSION DISABILITIES

SELF-MANAGEMENT

AND

WOMEN

WITH

Principal Investigator & Institution: Hughes, Rosemary B.; Phys Med and Rehabilitation; Baylor College of Medicine 1 Baylor Plaza Houston, TX 77030 Timing: Fiscal Year 2001; Project Start 18-SEP-2001; Project End 31-AUG-2004 Summary: (provided by applicant): Depression is a common secondary condition associated with a primary disability. Disproportionately high among women compared to men, depression appears to be even more prevalent among women with disabilities. Although the risk for depression among all persons with disabilities appears to be higher than that among people in general, women with disabilities may be at even greater risk comparied to their male counterparts, yet the literature fails to report on a therapeutic modality that is responsive to the unique needs of depressed women with functional limitations. The purpose of this project is to develop and test an innovative, targeted, and theory-driven group intervention designed to ameliorate depression in women with physical disabilities. It is hypothesized that (a) women with disabilities who participate in a depression self-management group intervention will report lower levels of depression and higher levels of self- management of depression, self-efficacy, and social connectedness after the intervention and at a three-month follow-up, compared to those who participate in a depression education-only intervention; and, (b) self-management of depression, self-efficacy, and social connectedness will mediate the relation of disability to depression outcomes among women with physical disabilities. This study uses a randomized with-groups and between-groups pre/post-test design with a three-month follow-up. The intervention will be implemented at local public and private chronic care clinics with 154 women with physical disabilities who will randomly be assigned to participate in either the self- management intervention or education-only comparison workshop. The scores of the two groups on measures of selfmanagement of depression, self-efficacy, social connectedness, and depression will be compared. These assessments will be conducted at three time points, before and after the intervention period and at a three-month follow-up. Formative and summative evaluations, using qualitative and quantitative methodologies, will be conducted. This study is designed to be generalizable for clinical practice in physical medicine and rehabilititation, for mental health services for women with disabilities, and for public health policy governing the delivery of mental health services to people with disabilities. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DEPRESSION TREATMENT IN MEDICALLY REHABILITATING ELDERLY Principal Investigator & Institution: Lenze, Eric J.; Psychiatry; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, PA 15260 Timing: Fiscal Year 2001; Project Start 01-SEP-2001; Project End 31-AUG-2006 Summary: (provided by applicant): This application requests a Mentored PatientOriented Research Career Development Award (K23). The candidate is a geriatric

64 Depression

psychiatrist and postdoctoral research fellow at the University of Pittsburgh who proposes to develop research skills for geriatric psychiatry research in medical rehabilitation settings. Funding of this award would provide time and resources necessary for him to develop into an independent investigator capable of conducting depression intervention studies in elderly patients undergoing rehabilitation after disabling medical events such as hip fracture. Studies of elders undergoing rehabilitation suggest that depression is associated with poorer outcomes and an increased likelihood of permanent disability and institutionalization. Therefore, it would be of tremendous public health benefit to determine the most efficacious interventions for late-life depression in the medical rehabilitation setting. However, little such intervention research has been done, in part because not enough is known about depression in this setting, and in part due the difficulty of carrying out psychiatric Intervention studies in this setting. To perform such research, the candidate will develop skills in the areas of psychiatric assessment of patients in medical settings, design of intervention trials, measurement of rehabilitation outcomes, and data management and biostatistical analysis. Proposed research consists of a longitudinal descriptive study characterizing late-life depression in medical rehabilitation settings, leading to a pilot intervention study assessing effects of depression treatment on rehabilitation outcomes. The proposed activities will take place in the NIMH-funded Intervention Research Center for Late Life Mood Disorders, directed by the candidate's sponsor, in the Department of Psychiatry at the University of Pittsburgh. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DEPRESSION, DISABILITY & REHAB IN VISION IMPAIRED ELDERS Principal Investigator & Institution: Horowitz, Amy; Senior Vice President for Research; Lighthouse International 111 E 59Th St New York, NY 10022 Timing: Fiscal Year 2001; Project Start 30-SEP-1998; Project End 29-SEP-2003 Summary: The proposed study builds upon current research addressing the interrelationships among chronic impairment, disability and depression in later life and will make several unique contributions. The study's focus is on subgroup of elders experiencing an extremely common age- related disability, vision impairment, in which the rates of both functional disability and depression are particularly high, but which has received relatively little systematic research attention. The longitudinal design will permit an in-depth examination of the course of depression over time, utilizing a stress and coping conceptual model which incorporates key personal and social resources as mediators of the relationship between disability and depression. Most importantly, the focus on a sample seeking rehabilitation permits us to empirically challenge the assumption of inevitable, reciprocal decline in functional and depressive status. By following the natural course of both depression and rehabilitation service use, a primary long-term goal is to examine the extent to which, and mechanisms by which, this nonpsychiatric intervention may influence depression status among disabled elders. This knowledge will provide a foundation for future intervention studies. The specific study aims are: 1. to document the prevalence, course, and severity of depression among visually impaired elders over time. 2. to examine the influence of depression on utilization of vision rehabilitation services. 3. to examine the mechanisms by which vision rehabilitation services may affect the severity and course of depression. 4. to test a longitudinal model explicating the interrelationships among vision impairment severity, comorbid health conditions, functional disability, rehabilitation service utilization and depression, and how such relationships are mediated by

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personal and social resources. 5. to examine gender differences relative to aims 1-4 above. 600 elders (300 of each gender) will be sampled from applicants, age 65+, of a vision rehabilitation agency. Subjects will be assessed 4 times (at baseline, 6, 12 and 18 months) in order to examine both short and long-term causal relationships among key variables. Analyses address concurrent associations (cross-sectional) and prospective relationships (longitudinal) using regression and structural equation modeling (SEM) techniques. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DEPRESSION, DUAL DIAGNOSIS AND ANTIRETROVIRAL ADHERENCE Principal Investigator & Institution: Bova, Carol A.; None; Yale University 47 College Street, Suite 203 New Haven, CT 065208047 Timing: Fiscal Year 2001; Project Start 16-NOV-2000 Summary: The long-term objective of this project is to examine the relationship between depression, dual diagnosis and medication adherence in HIV infected individuals. Understanding adherence behaviors in vulnerable populations is essential to maximizing the clinical effectiveness of highly active antiretroviral therapy (HAART) among all HIV seropositive populations. The specific aims of this study are (1) to describe the prevalence of depression and dual diagnosis (depression and substance abuse) in a cohort of 200 HIV infected individuals currently treated with HAART, (2) to describe the relationship between depression, dual diagnosis and antiretroviral adherence, (3) to examine the relationship between depression, dual diagnosis and response to a home-based nursing intervention to improve adherence to HAART. This is a prospective, descriptive study nested in a randomized clinical trial of a home-based nursing intervention to improve adherence to HAART (Williams, A.). Subjects will be 200 HIV infected individuals enrolled in the parent study. Measures of depression (selfreport, Beck Depression Inventory, 5-item mental health subscale of the MOS Short Form) and substance abuse (self-report) will be added to the parent study data collection instrument and measured at baseline in face to face interviews. Adherence data (measured by self report, unannounced pill counts and MEMS cap data) will be collected at baseline, monthly for 3 months then every 3 months for 18 months. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: DEPRESSION, HPA AXIS ACTIVITY, AND NEONATAL OUTCOME Principal Investigator & Institution: Suri, Rita; Psychiatry; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, CA 90024 Timing: Fiscal Year 2001; Project Start 01-JUL-2000; Project End 30-JUN-2005 Summary: (Adapted from applicant's description) This revised application proposes Rita Suri, M.D. for a K23 Mentored Patient-Oriented Research Career Development Award for the study of depressive disorders during pregnancy. A limited body of knowledge regarding the impact of mood state on the fetus complicates the management of major depression during pregnancy. The purpose of this prospective study is to examine the effects of maternal depression on the hypothalamic-pituitaryadrenal (HPA) axis during pregnancy and its impact on variables related to neonatal outcome. This will be achieved by studying mood, plasma corticotropin releasing hormone (CRH), salivary cortisol, and neonatal outcome in the following groups of pregnant women: 1) 50 women with major depression who are depressed and not on antidepressants; 2) 50 women with a history of major depression who are treated with

66 Depression

an SSRI and are euthymic; 3) 50 women without a history of major depression who are euthymic and not on antidepressants. Maternal mood state and anxiety will be assessed across each month of pregnancy; an assessment of HPA axis activity will be made in each trimester with measurements of plasma CRH and salivary cortisol. Neonatal outcome measures will include infant birth weight, gestational age, and performance on the Brazelton Neonatal Behavioral Assessment Scale. Information gained from this study will help clinicians and patients better understand the impact of untreated maternal depression versus treatment with antidepressants on HPA axis activity and the neonate and better assess the risks and benefits of treatment versus no medication during pregnancy. During the Award period, Dr. Suri will follow an organized program of interdisciplinary training and supervised research under the sponsorship of Dr. Lori Altshuler. She will undergo coursework in endocrinology, physiology, embryology, neuroscience, biostatistics, and research design. She will complete a methodologically sound study of mood and endocrinology across pregnancy and effects on neonatal outcome. This research and career development plan will provide a foundation for future independent investigation regarding the management of psychiatric disorders during pregnancy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DIABETES

DEPRESSION,

SELF-MANAGEMENT

AND

ETHNICITY

IN

Principal Investigator & Institution: Fisher, Lawrence L.; Professor in Residence; Family and Community Medicine; University of California San Francisco 500 Parnassus Ave San Francisco, CA 94122 Timing: Fiscal Year 2003; Project Start 01-JUL-2003; Project End 30-JUN-2007 Summary: (provided by applicant): Diabetes affects between 6.5 and 13 million Americans and is associated with an expenditure of over $44 billion in direct health care costs per year. Prevalence rates for Latinos, America's fastest growing minority, are approximately twice that of European-Americans (EAs). Depression occurs as a comorbid condition in 23% of EAs with diabetes, but the rate of depression among Latinos with diabetes is almost 30%. Depression is associated with decreased selfmanagement behavior, poor metabolic control, and increased risk for complications. Explanatory models, based almost exclusively on cross-sectional research, suggest that depression has both direct and indirect effects on metabolic control through selfmanagement. Disease severity, impairment, complications, life stress, personal resources, and social support also affect these relationships. Given the pervasiveness of depressive affect, the variability in self-management among EA and Latino patients with diabetes, and the increased behavioral and biological risk that depression poses for these patients, longitudinal studies with implications for intervention are needed to describe the forms that depression and self-management can take in these patients over time. The proposed 3-wave, 18-month longitudinal project seek to: (1) describe the variation, and sub group patterning of depression and self-management over time in EA and Latino patients with type 2 diabetes; (2) identify the linkages among depression, self-management, and metabolic control, over time, along with factors that moderate these linkages; and (3) determine variations in these relationships based on patient ethnicity (EAs, Latinos). The proposed longitudinal research has major implications for intervention: it will provide a more complete description of the natural course of the full range of major and minor depression and self-management over time, it will identify sub group variations that may warrant specific interventions, it will identify at what point along the continuum of depressive affect linkages with disease self-management

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and metabolic control become evident, and it will highlight differences in these relationships based on patient ethnicity. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DEPRESSION, STRESS & HEALTH: ROLE OF ANABOLIC HORMONES Principal Investigator & Institution: Epel, Elissa S.; Langley Porter Psychiatric Institute; University of California San Francisco 500 Parnassus Ave San Francisco, CA 94122 Timing: Fiscal Year 2002; Project Start 05-SEP-2002; Project End 31-AUG-2007 Summary: (provided by applicant): The objective of the proposed Mentored Clinical Scientist Development Award (K08) is to promote the candidate's development as an independent behavioral science researcher, with a focus on neuroendocrine responses to stress, and their effects on mental and physical health. During the five-year career development period, the candidate will engage in formal and informal training in psychoneuroendocrinology and stress and coping, complete three research projects, build collaborations, and address basic questions about relationships between stress, hormones, and risk for depression and cardiovascular disease. Chronic psychological stress contributes strongly to depression and cardiovascular disease, but the mechanisms are unclear. Most research in this area has focused on the deleterious effects of catabolic stress hormones like cortisol. Although hypercortisolemia turned out to be a weak biological marker of depression, it may be more revealing when examined in combination with anabolic hormones, such as dehydroepiandrosterone (DHEA) and growth hormone (GH), which can buffer the damaging effects of cortisol. The long-term goal of the current research program is to examine whether anabolic and catabolic hormones, as well as their levels relative to each other (anabolic balance) serve as a mediating pathway from stress to depression and to risk factors for cardiovascular disease (insulin resistance, visceral fat, and atherosclerosis). Studies 1 and 2 will examine whether history of chronic stress predicts low anabolic balance, depression, and risk for disease in longitudinal cohorts of younger adults (N = 1000) and older adults (N = 1000). Study 3 will assess whether chronic stress alone and with major depression is related to basal and reactive measures of anabolic balance and disease risk in caregivers, who serve as a unique model of chronic stress. If warranted, future research will compare effects of stress reduction and hormonal supplementation on mood and disease risk. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: DEPRESSION/DESIRE FOR DEATH IN TERMINAL CANCER PATIENTS Principal Investigator & Institution: Breitbart, William; Professor and Chief; SloanKettering Institute for Cancer Res New York, NY 10021 Timing: Fiscal Year 2001; Project Start 01-SEP-2000; Project End 31-MAY-2004 Summary: A clinically important mental health issue in palliative care concerns desire for death and its relationship to depression. Research focused on desire for death provides a link to understanding why patients might want to end their lives or request physician-assisted suicide (PAS) in the face of terminal illness. There have been several recent studies of patients with cancer or AIDS, demonstrating the central role of depression in desire for death and hypothetical interest in PAS. With one exception, these studies have not directly assessed desire for death among terminally ill patients, and no research has attempted to answer the question of whether treatment for

68 Depression

depression has a significant impact on desire for death. This project aims to describe desire for death among patients with end-stage cancer, determine its correlates, and assess the impact of treatment for major depression on desire for death. Specifically, the research would assess the prevalence, severity, stability, and medical/psychosocial correlates of desire for death among terminally ill cancer patients hospitalized in a palliative care facility. It will examine the relationship between desire for death and a clinical diagnosis of Major Depressive Episode. Desire for death will then be monitored in a group of patients who receive a standardized pharmacological treatment for depression, as well as in patients who do not receive any intervention. This study is expected to provide a direct evaluation of desire for death in terminally ill cancer patients, and to ascertain whether a pharmacological treatment for depression influences desire for death. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: AMERICANS

DEPRESSION-DIABETES

MECHANISMS:

URBAN

AFRICAN

Principal Investigator & Institution: Musselman, Dominique L.; Assistant Professor; Psychiatry and Behavioral Scis; Emory University 1784 North Decatur Road Atlanta, GA 30322 Timing: Fiscal Year 2003; Project Start 18-JUL-2003; Project End 30-APR-2008 Summary: (provided by applicant): African-Americans have increased prevalence of both diabetes and diabetes complications, reflecting combined psychobehavioral and metabolic dysfunction. Depression may contribute to both the genesis of Type 2 diabetes, and difficulties in management; we find that many African-Americans with diabetes also have depression, that depression is a factor in nonadherence, and that nonadherence leads to poor glycemic control- a major cause of complications. (1) To establish the prevalence, socioecoloqic associates, and. qlycemic impact of depression, we will study patients presenting to the Grady Diabetes Clinic; evaluate socioeconomic status, literacy, and access to care; and relate depression to these factors and to metabolic control both at presentation and after one year of care. (2) To define the pathways through which depression contributes to metabolic imbalance, we will study patients exposed to progressive psychobehavioral challenge (depression and/or early life stress), and assess (a) hypothalamic-pituitary-adrenal activation; (b) counterregulatory hormones; and (c) immunoinflammatory cytokines; in relation to (d) insulin resistance. (3) To determine the psychobehavioral and neurohormonal mechanisms of treatment, we will conduct a randomized, placebo-controlled, double-blind trial: patients with depression will receive stress management videotapes and either placebo or the selective serotonin reuptake inhibitor (SSRI) citalopram, and we will assess (a) overall glycemic control (HbAlc levels), and (b) patient adherence -to a prescribed diet/exercise program, to use of medications, and to scheduled return appointments; in relation to (c) depressive symptoms and (d) neurometabolic function as defined in Aim #2. These questions will be addressed by a multidisciplinary team with experience in both neuroendocrine analysis, clinical psychiatry, and diabetes management. The goal of this proposal is to use state-of-the-art psychobiological techniques to define the neurobehavioral and neurometabolic abnormalities and their response to treatment in urban African-Americans with type 2 diabetes and depression, as needed to improve basic understanding of disordered metabolism in this patient population and to help relieve their disparity in health. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: DEPRESSION--LOCUS COERULEUS AFFECTS DOPAMINE VIA GALANIN Principal Investigator & Institution: Weiss, Jay M.; Professor; Psychiatry and Behavioral Scis; Emory University 1784 North Decatur Road Atlanta, GA 30322 Timing: Fiscal Year 2001; Project Start 01-AUG-1997; Project End 31-JUL-2003 Summary: (Adapted From The Applicant's Abstract): The research proposed here investigates a possible mechanism by which noradrenergic neurons in the brain influence dopaminergic neurons to produce behavioral changes seen in depression. These studies address an important issue related to the neurobiology of depression; namely, that while much evidence shows brain norepinephrine (NE) is important in both the pathogenesis and therapy of depression, basic research implicates dopamine (DA) in depression-related responses (motor activity changes, hedonic responses) much more so than NE. The proposed research derives from, and will continue to use, an animal (rat) model of depression that reproduces characteristics of clinical depression by exposing animals to uncontrollable stressful conditions (called "stress-induced behavioral depression"). Behavioral depression in this model has been traced to heightened "burst" firing of locus coeruleus (LC) neurons. The proposed hypothesis, based on recent electrophysiological data, is that the rapid firing of LC neurons releases galanin (GAL) from LC-NE terminals in the VTA, which inhibits activity of DA cells that project to forebrain. Because VTA DA neurons mediate motor activity and reward processes, their inhibition causes changes seen in depression (i.e., psychomotor retardation and anhedonia). In testing this hypothesis, previous work has shown that microinjection of GAL into VTA mimics behavioral depression. Studies proposed here will determine if (1) conversely, blockade of GAL receptors in VTA can reverse behavioral depression, and (2) commensurate changes in extracellular DA (measured by microdialysis) in forebrain also occur. All microdialysis studies use a recently-developed methodology that permits continuous microdialysis sampling for several days, and also sampling from multiple brain regions simultaneously. Next, using an animal model that shows long-lasting behavioral depression, studies are proposed to (1) measure changes in monoamines and metabolites (DA, HVA, NE, MHPG, 5-HT, 5-HIAA) in various brain regions thought to be important in depression, and (2) determine whether therapy for the long-lasting behavioral depression occurs if one blocks GAL receptors in VTA. Finally, studies are proposed to measure the consequences of effective antidepressant treatment (i.e., chronic administration of antidepressant drugs or a series of electroconvulsive shocks) on (i) electrophysiological activity of LC neurons (since GAL is released at high rates of depolarization), and (ii) estimates of GAL synthesis in LC (i.e., by measuring GAL mRNA and GAL concentration in LC cell bodies) and GAL levels in VTA. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: DEPRESSIVE DISORDERS IN PRIMARY CARE AND WORK SETTINGS Principal Investigator & Institution: Druss, Benjamin G.; Assistant Professor; Psychiatry; Yale University 47 College Street, Suite 203 New Haven, CT 065208047 Timing: Fiscal Year 2001; Project Start 01-JAN-1999; Project End 31-DEC-2003 Summary: The proposed K08 Mentored Clinical Scientist Development Award outlines a program of training and health services research studying the impact of depressive disorders outside of the specialty mental health sector. The candidate is an Assistant Professor of Psychiatry and Public Health at Yale University with a clinical background

70 Depression

in psychiatry and primary care internal medicine, as well as postdoctoral health services research training. The career award will allow the candidate to successfully conduct the proposed studies and develop a career as an independent researcher through classes in research design, statistics, economics, and organizational theory at Yale, and via off-site training with experts in the field. Yale University offers a rich source of resources and faculty and a growing breadth of experience in health services research. The career award mentor, Robert A. Rosenheck MD, is a nationally known health services researcher and director of the Health Services Research and Treatment Outcomes Division for the Yale Department of Psychiatry; the candidate and Dr. Rosenheck have developed a close collaborative relationship. The growing importance of purchasers and primary care providers in determining benefits and delivering care for depression has made it an increasing priority to understand the costs of depression in the workplace and general medical settings. The research program seeks to fill gaps in the previous literature studying the impact of depression in these two areas. The first project will seek to provide a better understanding of the causal mechanisms underlying the association between depression and increased use of general medical services. It will examine the role of health beliefs--a person's perception of his or her medical condition, and of the benefits and barriers to treatment--in mediating the relationship between depression and medical utilization. The second project will use a longitudinal database combining work and health claims data for employees of a major US corporation. This project will compare the impact of depression and three chronic medical illnesses on health costs, absenteeism and job performance ratings both cross-sectionally and over time. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DEPRESSOIN IN ALZHEIMER'S DISEASE STUDY-2 (DIADS-2) Principal Investigator & Institution: Mintzer, Jacobo E.; Professor; Psychiatry and Behavioral Scis; Medical University of South Carolina 171 Ashley Ave Charleston, SC 29425 Timing: Fiscal Year 2003; Project Start 01-JUL-2003; Project End 29-FEB-2008 Summary: (provided by applicant): Depression in the context of Alzheimer's disease (AD) is a significant public health problem with serious adverse consequences for patients and their caregivers. There has been little research into the course or treatment of depression associated with AD. This is in part due to the absence of validated operational criteria for defining depression in AD. Recently, NIMH convened an expert consensus panel to develop draft criteria for depression of Alzheimer's disease (dAD) and to establish research priorities in this area. These criteria are intended to facilitate further studies of the course and treatment of depression in AD. The first aim of the proposed multicenter study is to determine whether individuals with dAD respond to antidepressant treatment using the medication sertraline in a 12-week randomized, controlled, double blind trial. The second aim is to establish whether earlier treatment of depression in AD affects critical non-mood outcomes such as cognition, quality of life, activities of daily living and caregiver variables, over 24 weeks. The third aim is to validate the dAD syndrome by evaluating its course and response to treatment in comparison to other diagnostic conceptualizations of depression in AD, over six months. These aims are consistent with priorities articulated by the NIMH expert consensus panel. 130 patients meeting criteria for dAD, and their caregivers, will be recruited into the study at five clinical centers: Johns Hopkins, University of Southern California, University of Rochester, University of Pennsylvania, and Medical University of South Carolina. The study will be coordinated by the Johns Hopkins Center for

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Clinical Trials. After detailed baseline characterization participants will be randomized to treatment with sertraline or placebo for at least twelve weeks and followed for up to 24 weeks. All patients and caregivers will receive psychosocial interventions for Alzheimer's and depression. Patient outcomes will include: global improvement of the depressive disturbance, ratings on a depression scale, quality of life, cognitive functioning, activities of daily living, behavioral disturbance, and adverse events. Caregiver outcomes will include: depression, quality of life, and care giving burden. Regarding the first study aim, analyses will compare the two treatment groups on patient mood outcomes in the first twelve weeks. Regarding the second study aim, analyses will compare the two treatment groups on the trajectories of patient critical AD patient outcomes (cognition, functioning, quality of life, behavior) and of caregiver outcomes over 24 weeks. Regarding the third aim, analyses will examine the longitudinal course of depressive symptoms and of depressive syndromes in the context of Alzheimer's using three different syndromic definitions: dAD, DSM-IV, and "Alzheimer's Associated Affective disorder" derived empirically. The predictive validity of defining depression in AD using a symptom scale or each of these syndromes will be assessed longitudinally against the various study outcomes, and against efficacy of response to anti-depressant treatment. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DETECTING DEPRESSIVE SYMPTOMS IN OLDER ADULTS Principal Investigator & Institution: Duberstein, Paul R.; Associate Professor; Psychiatry; University of Rochester Orpa - Rc Box 270140 Rochester, NY 14627 Timing: Fiscal Year 2002; Project Start 15-AUG-2002; Project End 31-JUL-2005 Summary: (provided by applicant): One consistent and disturbing finding in the suicide literature compels this investigation. Most older adults who take their own lives have an affective disorder, but the potential risk for suicide was unrecognized by family members and health professionals. The central thrust of our symptom detection model is that specific factors deter the detection, diagnosis, and treatment of depression in older adults. ROl funding is sought to test aspects of this model in a demographically and clinically heterogeneous sample of 1000 primary care patients 65 years of age and older. Beginning in August 2001, these patients were recruited into a naturalistic study, "Depression Outcome in Primary Care Elderly" (DPC) (NIMH ROl MH61429-O1A1, J. Lyness, M.D., P.I.). For this proposed ROl, we will collect data from informants who are members of the social networks of participants in the DPC study in order to examine informant detection of depressive disorders and symptoms of depression and anxiety. We will strive to recruit one informant for each subject in that study, and plan to collect data from more than 628 informants. We will ask the informants questions about themselves and the DPC participants' psychiatric symptoms. Specifically, we will examine informant detection of depression as a function of: the severity and history of patients' psychiatric disorders (Aim 1), patients' psychosocial (personality and social support) characteristics and physical health parameters (Aim 2), patients' demographic characteristics (Aim 3), and informants' psychiatric history and self-reported health (Aim 4). We will explore the role of informants' personality traits and attitudes toward mental illness, and differences between African-Americans and Whites will be explored. We hypothesize the detection will be poorer for: disorders that are less severe and first episode (Aim1); patients with certain personality traits (e.g., low extraversion; low openness to experience) or poor physical health (Aim 2); and men and unmarried participants (Aim 3). Detection will also be poorer when informants have no prior history of depression or are in poor physical health (Aim 4). For Aim 2, the mediating

72 Depression

effect of social support will be examined. Confirmation of these hypotheses will indicate needed revisions in current approaches to late-life depression and suicide. Findings will help guide the development of screening instruments, educational and clinical interventions, and surveillance strategies to lessen the public health impact of unrecognized and untreated depression. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DEVELOPMENT OF DEPRESSION DURING ADOLESCENCE Principal Investigator & Institution: Hankin, Benjamin L.; Psychology; University of Illinois at Chicago 1737 West Polk Street Chicago, IL 60612 Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 31-JUL-2004 Summary: (provided by applicant): Rates of depression rise dramatically during adolescence (from 3-17%). Twice as many girls as boys will experience depression starting in early adolescence. Many individuals experience depression first during adolescence, and half of them may have a recurrence of depression later in adulthood. Thus, adolescence is a crucial time to study risk factors and mechanisms for developing depression, especially with girls, so that improved treatment/prevention programs may be created for this public health concern. This study aims to examine particular vulnerability factors and processes based on 3 different cognitive vulnerability- stress models of depression. Cognitive vulnerability to depression--the way in which individuals interpret negative information about the self and explain why negative events happen is an important risk factor that predicts the prospective development of depression. Cognitive vulnerability is actively operating by early adolescence, and negative life events increase throughout adolescence. Thus, the interaction of cognitive vulnerability with more negative events may be a potent explanation for the rise in depression observed during adolescence. This prospective study will test the hypothesis that the dramatic increase in depression during middle adolescence can be explained by a rising number of negative events interacting with higher levels of cognitive vulnerability. Also, cognitive vulnerability, negative events, and their interaction will be examined as an explanation for the emergence of the gender difference in depression among early adolescents. Last, the precise form of the cognitive vulnerability X stress interaction will be examined to see what combination of cognitive vulnerability and stress best predicts prospective changes in depression. Adolescents from 7th and 10th grade (200 in each grade for a total of 400; half girls) will be assessed initially and then at 4-month intervals for a total of 3 waves of data. The adolescents will be assessed for demographics, 3 forms of cognitive vulnerability, negative events, depressive symptoms, and pubertal status. Parents will provide collateral information on their children's symptoms and negative events. Multilevel growth curve analyses will be used to test the hypotheses. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: DEVELOPMENT SYMPTOMATOLOGY

OF

INVENTORY

OF

DEPRESSIVE

Principal Investigator & Institution: Bernstein, Ira H.; Psychology; University of Texas Arlington 301 South Center Street Arlington, TX 76019 Timing: Fiscal Year 2003; Project Start 03-JUL-2003; Project End 30-JUN-2006 Summary: (provided by applicant): This proposal is a collaborative R01 submitted by Duke University, the University of Texas Southwestern Medical Center, and the University of Texas at Arlington. We plan to further develop and evaluate the 30-item

Studies 73

Inventory of Depressive Symptomatology, which is available in clinician-rated (IDS30) and self-reported (IDS-SR30) forms, and to further develop and evaluate a shortened version (the Quick IDS), which is available in a 16-item self-report (QIDS-SR16) and a clinician-rated (QIDS-C16) format. The properties of each of these four instruments as both screens for depression in general medical and psychiatric populations, and as measures of symptomatic change will be evaluated. We will analyze data that have been or that are now being collected from "ongoing" studies. We will also acquire and analyze new data from "prospective" studies to be conducted at Duke and at UT Southwestern. These studies will evaluate the performance of each measure to screen for major and minor depression, defined by a structured interview to render DSM-IV diagnoses - DIS (elderly), by SCID (adults), or by the K-SADS-PL (children/adolescents). We will evaluate concurrent validity with the Montgomery Asberg Depression Rating Scale (MADRS), the 17-item Hamilton Depression Rating Scale (HRSD17), or Children's Depression Rating Scale (CDRS) as outcome measures in adolescent, adult, and older/elderly populations. Classic psychometric properties (e.g., factor analyses, Cronbach's alpha, concurrent validity) will be established for each of these four measures (IDS-SR30, IDS-C30, QIDS-SR16, QIDS-C16). We will determine whether an anxiety subscale of the IDS-C or IDS-SR can be identified and compare the potential items against the Spielberger State Anxiety Inventory. We will create equivalence tables using Item Response Theory analysis to translate total scores on the IDS or QIDS to total scores on the HRSD17, MADRS, and CDRS. We will provide benchmark scores for depressive symptom severity by IDS/QIDS ratings to identify minimal, mild, moderate, and severe levels of impaired daily function, as measured by the Sheehan Disability Scale (DIS), SF-12, SF-36, or Social Adjustment Scale-Self-Report (SAS-SR). The result will be a matched self-report and clinician rating scale to assess only the core criterion symptoms of major depression (i.e., the QIDS-C and SR), and more expanded scales capable of assessing both core and associated symptoms (e.g., anxiety, irritability) (IDSC and SR) that are in the public domain for use with patients across the age spans seen in practice and in research. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DEVELOPMENT OF NEGATIVE ATTRIBUTIONAL STYLES Principal Investigator & Institution: Gibb, Brandon E.; Psychology; Temple University 406 Usb, 083-45 Philadelphia, PA 19122 Timing: Fiscal Year 2001; Project Start 28-SEP-2001; Project End 30-JUN-2002 Summary: (provided by applicant): The primary goal of the current study is to better understand the development of depression by examining factors that may contribute to the development of a cognitive vulnerability to depression. Understanding the development of depression is important given that depression is the second most common psychological disorder, with lifetime prevalence estimates as high as 17.1 percent , and estimates that the economic burden of depression in the United States is $43.7 billion annually. Thus, understanding how vulnerability to depression develops is an important step in targeting interventions to buffer against the development of that vulnerability, thereby reducing the risk of depression onset. In the current study, therefore , the independent, unique, and combined influences of a number of factors hypothesized to contribute to the development of negative attributional styles in children will be examined over a 6-month longitudinal follow-up. These factors will include variables previously identified in longitudinal studies as contributing to the development of children?s and adolescents? attributional styles as well as factors demonstrating cross-sectional relationships with attributional styles but not yet

74 Depression

examined longitudinally. In this way, the current study will seek to both integrate and extend previous findings. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: AMERICANS

DIABETES

AND

DEPRESSION

IN

ELDERLY

MEXICAN-

Principal Investigator & Institution: Black, Sandra A.; Associate Professor & Associate Director; Epidemiology and Prev Medicine; University of Maryland Balt Prof School Baltimore, MD 21201 Timing: Fiscal Year 2001; Project Start 22-SEP-1996; Project End 31-AUG-2004 Summary: The proposed research is a study of the relationship between diabetes, functional disability, and depression in the elderly. Examining the correlates and consequences of a specific disease (diabetes) that is strongly associated with both functional impairment ad high levels of depressive symptomatology, in a specific population (older Mexican- Americans) will provide a unique contribution to our understanding of these relationships. This approach will help to eliminate much of the confounding effects introduced by examining these relationships concomitantly in several chronic diseases and in heterogenous populations. It will also add to our understanding of the more general relationship between compromised health and depression in the Mexican-American elderly. In particular, the study is significant in that it will (1) conduct an extensive examination of the epidemiology of diabetes and its functional and emotional consequences in older Mexican-Americans; (2) compare different profiles of comorbidity of diabetes and other chronic conditions in terms of their association with functional disability, pain, and depression; (3) examine differences in the utilization of health care services associated with depression in this group; and (4) make use of a longitudinal design to identify probable causal paths between diabetes and depressive status, while controlling for the possible moderating effects of personal factors such as sociodemographic characteristics, health-related factors, and cultural factors. These aims will be accomplished by examining data from a population-based longitudinal panel study of Mexican -American elderly, in which a sample of 3050 older adults are administered extensive interviews. Cross-sectional analyses will examine associations between diabetes and other chronic physical health conditions, activity limitations, functional capacity, pain, medication use, depression and moderating factors. Longitudinal analyses will identify the influences of change in disease status, functional disability, and pain on depression, and characterize the mechanisms by which chronic conditions influence the development, chronicity, and exacerbation of depression in the elderly. Findings from this study will provide a unique contribution to our understanding of the functional and emotional consequences of compromised physical health, not only in older diabetic Mexican-Americans, but among older adults in general. These findings will also help to improve the health care of all older adults by enhancing our understanding of the risk factors for depression in the elderly. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DIFFERENTIAL RESPONSE TO CBT IN TYPE 1 & TYPE 2 DIABETES Principal Investigator & Institution: Surwit, Richard S.; Professor; Psychiatry; Duke University Durham, NC 27706 Timing: Fiscal Year 2001; Project Start 01-JUL-2000; Project End 30-JUN-2004

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Summary: (adapted from investigator's abstract): Extensive literature documents increased incidence of depression in patients with diabetes mellitus. However, the degree to which the treatment of depression impacts on diabetes control is not clear. Some investigators have found a strong association between depression and diabetes control, while others have found a weak association. A review of existing literature as well as preliminary data from our laboratory suggest that this discrepancy may be due, in part, from failure of many studies to clearly differentiate type 1 and type 2 diabetes in their patient samples. The strongest association between depression and diabetes control has been reported in studies of patients with type 1 diabetes. Preliminary data from our group suggests that the Beck Depression Inventory (BDI) scores may be more significantly related to hemoglobin A1C (HbA1c) in type 1, than in type 2, diabetes mellitus. Studies assessing the effects of pharmacologic antidepressant therapy on diabetes have been confounded by the combined use of both diagnostic categories as well as by the direct metabolic effects of most antidepressant drugs. An emerging literature on the use of Cognitive Behavior Therapy (CBT) suggests that improving affect through behavioral intervention can improve diabetes control, particularly in type 1 patients. The overall aim of this proposal is to determine if CBT differentially improves glucose control in type 1 and type 2 diabetes patients. We hypothesize that CBT will produce a greater reduction in HbA1c in type 1 diabetes than in type 2 diabetes and that CBT-induced improvement in HbA1c is mediated by an improvement in depression. We will measure the effects of CBT on changes in HbA1c and daily blood glucose in a sample of 150 depressed patients with type 1 and type 2 diabetes over one year. To evaluate the mechanism by which CBT-induced changes in depression affect blood glucose, we will determine the role of cortisol and the role of diabetes self-care behaviors as mediating variables. Changes in cortisol and self-care are predicted to impact blood glucose levels to a greater extent in type 1 diabetes because these individuals are metabolically more sensitive to any variation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DYADIC SOCIAL SUPPORT FOR MEN WITH PROSTATE CANCER Principal Investigator & Institution: Weber, Bryan A.; Adult and Elderly Nursing; University of Florida Gainesville, FL 32611 Timing: Fiscal Year 2001; Project Start 01-SEP-2001; Project End 31-AUG-2003 Summary: (Applicant's Description) This 2 year study, "Dyadic Social Support For Men with Prostate Cancer," will investigate the effects of dyadic social support on selfefficacy, social support, and depression for men with prostate cancer, which is the leading form of cancer for American men. Improvements in screening and medical management of prostate cancer have prolonged life expectancy for the 180,000 men to be diagnosed this year. The diagnosis and treatment side effects, particularly urinary and erectile dysfunction from radical prostatectomy, are known to lead to depression. Although support groups have been found to reduce depression for cancer patients, few men participate in such groups. One-to-one support with another man as in the proposed dyadic intervention may be more acceptable than support groups to these men. The purpose of the study is to test the effects of a dyadic intervention based on Bandura's Self-Efficacy Theory (vicarious experience, performance and attribute similarity) that links men who are newly diagnosed with prostate cancer with those who are long-term survivors (> 5 years). One hundred men (50 years and older) with prostate cancer and having a radical prostatectomy will be recruited within 100 days of the diagnosis. Excluded will be those with prior history of cancer and death of a loved one within 1 year. Subjects will be randomized to control or experimental groups.

76 Depression

Experimental subjects will be matched according to race with a long-term survivor volunteer who had a prostatectomy for prostate cancer. After training in the study protocol, long-term survivors will meet with subjects 8 times during a 60-day period to discuss feelings, thoughts, and concerns associated with prostate cancer. The investigator will monitor the intervention through weekly telephone calls and weekly logs recorded by the long-term survivors that will be used to assess the quality of the interaction, the number and duration of sessions, and topics discussed. Baseline and post-test measures of self-efficacy (Stanford Inventory of Cancer Patient Adjustment), social support (Modified Inventory of Socially Supportive Behaviors), and depression (Geriatric Depression Scale ) will be used to determine if the dyadic intervention decreases depression and increases self-efficacy and social support. Comorbidity (Charlson Index), and urinary and sexual dysfunction (UCLA Prostate Cancer Index) are expected to influence depression, hence data will be collected and these factors will be controlled. If dyadic interventions are shown to enhance survival and/or reduce depression among this group, results may be extended to others with cancer. Hence, this may be integrated in the treatment of cancer survivors in the future. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DYNAMIC COMORBIDITY AND PREVENTION IN HIGH-RISK YOUTH Principal Investigator & Institution: Aber, J L.; Nat'l Ctr/Children in Poverty; Columbia University Health Sciences New York, NY 10032 Timing: Fiscal Year 2001; Project Start 20-AUG-2001; Project End 31-JUL-2004 Summary: (provided by applicant): The proposed study proposes to examine longitudinally the dynamic patterns of comorbidity between depression and conduct disorder throughout middle childhood and adolescence. The study capitalizes on an existing unique data set by proposing a follow-up of an evaluation, conducted by the PI, of one of the largest school-based violence prevention programs in the country, the Resolving Conflict Creatively Program (RCCP). The RCCP curriculum targeted socialcognitive and interpersonal processes known to predict later antisocial behavior and psychopathology; the 1994-1996 RCCP evaluation included assessments of children's depressive symptoms, conduct disordered behaviors, ineffective social-cognitive processes, aggressive tendencies, and socially competent behavior. Aim I of the proposed study is to characterize the dynamic nature of comorbidity between depression and conduct disorder across middle childhood and into adolescence. Aim II is to examine whether comorbidity status in middle childhood as well as developmental trajectories of depression, conduct disorder, social-cognitive processes, and competence predict key outcomes in adolescence. Outcomes of academic achievement will be obtained from New York City Board of Education records for the full sample of 2260 students who completed reports of depression and conduct disorder in the original study; of this sample, 48 percent are female, 38 percent are Hispanic, 42 percent are Black, and 15 percent are White. Outcomes of depression, conduct disorder/delinquency, substance use, social-cognitive processes, and social-emotional competence will be assessed through individual interviews with a selected subsample of the original RCCP sample (N = 600), half of which will be strategically selected based on their initial comorbidity status (100 high comorbid, 100 high depression only, 100 high conduct disorder only) and half of which will be non-disordered children matched on demographic characteristics. The proposed study will provide a greater understanding of the role dynamic comorbidity in middle childhood in predicting adolescents'

Studies 77

psychological and social adjustment as well as an evaluation of the effectiveness of a universal intervention in both preventing and mitigating the occurrence of comorbidity. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EFFECTS ACTIVATION

OF

DEPRESSION

TREATMENT

ON

PLATELET

Principal Investigator & Institution: Markovitz, Jerome H.; Medicine; University of Alabama at Birmingham Uab Station Birmingham, AL 35294 Timing: Fiscal Year 2001; Project Start 15-SEP-1999; Project End 31-AUG-2003 Summary: (adapted from investigator's abstract): The primary objective of this study is to assess the effects of standard pharmacologic treatments of the clinical depression on platelet activation PA). Increased PA is present in clinical depression, and has been implicated as one mechanism that may explain the link between depression and coronary heart disease (CHD) events. The investigators' preliminary work indicates that platelet secretion in increased in clinical depression, and that pharmacologic treatment with the selective serotonin reuptake inhibitor sertraline attenuates this increase. They also found evidence that depressed patients with a family history of CHD have increased PA. In the present application, the investigators seek to extend these findings by (a) performing a double-blind, placebo-controlled trial of sertraline and (b) assessing the effects of another pharmacologic treatment for depression (bupropion) on PA. As in previous studies, PA will be assessed by state-of-the-art flow cytometric detection, using methods developed and standardized in our laboratory. After initial PA testing, a total of 180 patients will be randomized to receive either sertraline or placebo for 8 weeks, with retesting at the end of this time period. A control group of 70 nondepressed individuals of similar age and gender composition will also be tested twice over 8 weeks. After follow-up measures for PA are taken, the blind will be broken and patients previously on placebo will be given 8 weeks of treatment with bupropion (an antidepressant medication that affects dopamine and norepinephrine pathways without affecting serotonin pathways). A final PA measure will be performed at the end of this 8-week treatment, in order to a) assess the stability of the response to sertraline and b) assess the open-label effects of bupropion. The investigators anticipate that 144 subjects will complete the entire protocol. The hypotheses for the study are: (1) PA is increased in depressed patients relative to controls, with the highest levels found among depressed patients with a family history of CHD; (2) Sertraline decreases PA in depressed patients relative to placebo; and (3) Bupropion, an antidepressant with nonserotonergic mechanisms of action, also decreases PA. This work will contribute to the understanding of mechanisms and treatment for depression so as to diminish CHD risk, particularly among those with a family history of CHD. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EFFECTS ON CHILDREN OF TREATING MATERNAL DEPRESSION Principal Investigator & Institution: Riley, Anne W.; Associate Professor; Health Policy and Management; Johns Hopkins University 3400 N Charles St Baltimore, MD 21218 Timing: Fiscal Year 2001; Project Start 15-APR-1998; Project End 28-FEB-2003 Summary: (Applicants Abstract): Maternal depression has devastating effects on the mental and physical health of children. An obvious first step to solving this social and public health problem is to determine the effects of treatment of maternal depression on children. This proposal captures a unique opportunity to study the influence of treating maternal depression on children ages 5-11 by studying children of women taking part

78 Depression

in an NIMH-funded randomized treatment of a depression trial led by the Co-Principal Investigator. Furthermore, this study fills gaps in the literature on the impact of maternal depression in three ways, by studying: 1) children of women screened while obtaining public sector family planning care, a sample more representative of depressed women than previous studies in psychiatric settings; 2) poor women; and 3) equal numbers of Latina, African American and White women so that cultural differences can be examined. Based on a comprehensive model of the mechanisms by which maternal depression may influence child outcomes, we will study 150 elementary-school aged children whose mothers are depressed (50 Latina, 50 African American, and 50 White) and 50 comparable children whose mothers are not depressed. Their mental health and functioning will be assessed by natural raters in their environments over a two-year time period, with five face-to-face interviews, two mother-child interaction assessments, and bi-monthly phone assessments that will link child functioning, symptomatology, and psychiatric disorders to mothers' symptomatology, parenting behavior, and family environment. Mothers, the children, fathers/other caregivers, teachers, and interviewers will contribute to these assessments in a time-series design. This design will enable us to develop sensitive longitudinal models of the way in which changes in aspects of the mother's depression affect the outcomes of the child over time. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ELECTROACUPUNCTURE FOR MAJOR DEPRESSION: A PILOT STUDY Principal Investigator & Institution: Mulsant, Benoit H.; Psychiatry; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, PA 15260 Timing: Fiscal Year 2003; Project Start 08-SEP-2003; Project End 31-MAY-2005 Summary: (provided by applicant): Major depression is a common and serious mental illness. It is associated with a markedly lower quality of life, significant functional impairment, and premature death due to suicide or comorbid physical illness. Over the past 50 years, effective and safe treatments for major depression have been developed, including antidepressant pharmacotherapy, psychotherapy, and electroconvulsive therapy. However, many Americans who suffer from a depressive disorder either do not accept to receive one of these conventional treatments or do not complete an adequate course of treatment. A growing number of Americans with depression are choosing to be treated with complementary and alternative therapies. Acupuncture, in particular, is increasingly being used to treat depression even though only limited data support its safety and efficacy. The proposed pilot study builds upon the complementary expertise of a group of investigators of conventional antidepressant treatments and a group of practitioners of alternative medicine. It will use a randomized parallel-group design to compare the safety, efficacy, and tolerability of electroacupuncture (EA) and sham electroacupuncture (SA) for the treatment of major depression. Over a 15-month period, 60 adult outpatients with a major depressive disorder of mild or moderate severity (as defined by the DSM-IV) will be randomized to either 12 sessions of EA or SA to be provided over 6 weeks. Safety and symptomatic improvement (as measured with the Hamilton Rating Scale for Depression) will constitute the primary outcome measures. Tolerability and functional improvement will constitute secondary outcome measures. The data generated by this pilot project will be used to support the feasibility of conducting, and inform the design of, a large multicenter study comparing the efficacy of two forms of acupuncture with a conventional treatment for depression. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: EMORY CONTE CENTER FOR NEUROSCIENCE OF MENTAL DISORDERS Principal Investigator & Institution: Nemeroff, Charles B.; Reunette W. Harris Professor and Chair; Psychiatry and Behavioral Scis; Emory University 1784 North Decatur Road Atlanta, GA 30322 Timing: Fiscal Year 2001; Project Start 30-SEP-1999; Project End 31-AUG-2004 Summary: This revised application seeks support for the Emory Center for the Neuroscience of Mental Disorders (ECNMD) in the Department of Psychiatry and Behavioral Sciences at the Emory University School of Medicine. The major goal of this five year research plan is to characterize the persistent neurobiological consequences of adverse events early in life and to determine the relationship of such long-lived central nervous system (CNS) alterations to the development of affective disorders, particularly depression, in adulthood. Two animal models of early adverse experience, for which pilot data on persistent neurobiological alterations exist, will comprise the bulk of the proposed work. These two models include a particularly well documented rodent model of maternal separation and a non-human primate variable foraging demand model of early stress. Gender-specific effects of early life stress will also be evaluated in these models. All of the preclinical projects will receive CNS tissue and biological fluids from each of these animal models. Neural circuits that have been implicated in both the neurobiology of stress and anxiety as well as the neurobiology of depression-like syndrome will be scrutinized, including corticotropin-releasing factor (Proj l; PI: Plotsky), serotonin (Proj 2; PLC Owens), dopamine and norepinephrine (Proj 3; PI: Kuhar), and signal transduction systems (Proj 4; PI: Nestler), hippocampal neurogenesis and remodeling (Proj 5; PI: Gould) and acoustic startle plasticity (Proj 6; PI: Davis) will be characterized in these models. In addition two clinical research projects will be included. Project 7, conducted both at Emory University (PI: Nemeroff) and Yale University (PI: Bremner), will examine the neurobiological consequences of child abuse by studying women with a past history of child abuse who are currently suffering from an episode of major depression versus a group of women who are currently depressed without a history of child abuse and a group of women with a history of child abuse without major depression. Finally, Project 8 will seek to determine the neurobiological and behavioral consequences of maternal depression during pregnancy or in the postpartum period on their children (PI: S.Goodman, Stowe). These research projects will be supported by an administrative core led by the Center Director, a rodent animal core (PI: Plotsky, Weiss), a primate animal core (PI: Insel, Winslow), an assay core (PI: Bonsall, Ritchie), and an integrated functional brain imaging core (PI: M. Goodman, Kilts). We postulate a model in which genetic vulnerability coupled with early trauma in a critical plastic period of development results in sensitization of neural systems which when exposed to even mild stressors in adulthood responds in a heightened manner, resulting in the neurobiological alterations that underlie the syndrome of depression. These studies have important implications not only for the neurobiology of depression but the development of novel treatment strategies for both depression and child abuse. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: EMOTION PROCESSES IN ADOLESCENT DEPRESSION Principal Investigator & Institution: Burwell, Rebecca A.; Psychology; University of Denver Box 101562 Denver, CO 80208 Timing: Fiscal Year 2002; Project Start 01-SEP-2002

80 Depression

Summary: (provided by candidate): Theories of depression have been conceptualized primarily using cognitive, interpersonal, and behavioral frameworks. However, the role of emotion regulation processes in the development of depression has not been adequately addressed despite their association with mental health. Study 1 of the application utilizes a prospective longitudinal design and developmentally sensitive and reliable measures to examine the relative contributions o cognitive versus emotional vulnerability to depression among a community sample of adolescents. Comparing three models (a cognitive vulnerability model, an emotion regulation deficit model and a cognitive-emotional vulnerability model) will allow for a greater understanding of processes associated with depressive symptoms Study 2 will experimentally assess the role of emotion expression in depressive symptoms by assigning adolescents to expression, inhibition, and control conditions and examining resulting declarative (selfreport) and procedural (color naming negative and positive words) negative mood. The proposed project will utilize multiple informants for depressive symptoms, varied methodology, and complementary experimental design, providing an increased understanding of the relative contributions of cognitive and emotional processes to depression. Finally gaining knowledge into the mechanisms by which cognitive and emotion vulnerabilities are linked with depression may inform research and interventions by identifying proximal emotion factors that may be targeted clinically. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ENVIRONMENTAL MODIFIERS OF FAMILIAL RISK FOR MDD Principal Investigator & Institution: Williamson, Douglas E.; Psychiatry; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, PA 15260 Timing: Fiscal Year 2002; Project Start 01-MAY-2002; Project End 30-APR-2007 Summary: (provided by applicant): The career development and research plans outlined in this Mentored Research Scientist Development Award (K0l) proposal are designed to enable the candidate to independently design and conduct studies that examine the combined importance of genetic and environmental risk factors for the development of depression in children and adolescents. Depression is a chronic condition that often begins early in life and appears to be the result of both genetic and environmental risk factors. Recent studies have suggested that the phenotypic expression of genetic risk for depression emerges during adolescence and appears to be moderated by the presence of behavior-dependent stressful life events. Understanding the pathway(s) by which various stressful environments interact with genetic risk factors to contribute to the onset of depression is crucial for understanding how to successfully treat and/or prevent this debilitating disease. The proposed study will prospectively examine whether the frequency of environmental stressors, particularly behavior-dependent stressors, increases during adolescence and continue to increase thereafter. An important aim of the research plan is to determine whether exposure to specific environmental stressors modifies the familial risk for depression in adolescents at highand low-familial risk for depression. The candidate is formally trained in psychiatric epidemiology and has research experience in the study of familial and environmental risk factors for depression in children and adolescents. Neal D. Ryan, M.D. and Bernie Devlin, Ph.D. will serve as co-mentors. Coursework and didactic readings in genetic epidemiologic methods, quantitative genetics, molecular genetic techniques, and clinical interviewing techniques are designed to complement the candidates research training and prepare him to become an independent investigator. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: EPIDEMIOLOGY AND CARE OF COMORBID OBESITY AND DEPRESSION Principal Investigator & Institution: Simon, Gregory E.; Associate Clinical Investigator; Center for Health Studies 1730 Minor Ave, Ste 1600 Seattle, WA 98101 Timing: Fiscal Year 2002; Project Start 20-SEP-2002; Project End 31-AUG-2007 Summary: (provided by applicant): This application proposes two related studies: A population-based epidemiologic study of obesity and depression among women and a longitudinal study of obesity treatment among two cohorts (one with comorbid obesity and depression, one with obesity only) identified by the epidemiologic study. Study 1 Epidemiologic Study: A population-based sample of approximately 6000 women aged 40-65 will be complete structured telephone assessment of weight, nutrient intake, physical activity, depression, functional impairment, and disability. Women with Body Mass Index (BMI) >30 will be oversampled. Insurance claims data will be used to measure health care costs. Aims of the epidemiologic study include: 1) Examine the association between obesity and depression among middle-aged women 2) Examine the specific contributions of obesity and depression to disability and health care costs. Study 2 - Treatment study: A cohort of approximately 100 women with obesity (BMI > 30) and no current depressive disorder will be enrolled in a 6-month state-of-the-art group weight loss treatment. Approximately 200 women with comorbid obesity and depression will be randomly assigned to either the identical weight loss treatment or to a combined cognitive-behavior group therapy program focused on both depression and weight loss. Aims of the treatment study will include: 1) Examine the effect of depression on success in weight loss treatment by comparing weight loss, diet, and exercise in depressed and non-depressed women enrolled in the identical weight loss program 2) Examine the benefits of a combined weight loss/depression intervention above those of weight loss treatment alone by comparing weight loss, nutrient intake, physical activity, depressive symptoms, functional impairment and disability in the two groups of women with comorbid obesity and depression randomly assigned to the two different intervention programs Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ETHNOGRAPHY OF SELF-CARE AND ALCOHOL USE FOR DEPRESSION Principal Investigator & Institution: Han, Clara Y.; Social Medicine & Hlth Policy; Harvard University (Medical School) Medical School Campus Boston, MA 02115 Timing: Fiscal Year 2001; Project Start 25-SEP-2001 Summary: The long term objective of this research is to investigate how people's understanding of conditions medically defined as depression influence self-care patterns for depression. This study of self-care behaviors will explore: 1) the primary factors involved in the evident treatment gap between a disease model of depression and the practices and knowledge that inform people's attempts at care for their depressive symptoms, and 2) the proposed understanding of alcohol use as a form of self-care rather than only a provoking factor of depression. This research will take place in a poor, urban setting of Santiago, Chile. The overall research design is a case-based, 18-month longitudinal, ethnographic study of the development and utilization of careseeking behaviors for depressive symptoms by community and hospital-based samples of people meeting DSM-IV-R criteria for minor depression, major depression and comorbid depression and alcohol abuse/dependency. It will rely on screening and diagnostic tools for depression and substance use, bi-monthly open-ended interviews

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with subjects, and a general ethnographic study of the social and economic context of mental health care. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EXERCISE TRAINING AND DEPRESSION IN OLDER ADULTS Principal Investigator & Institution: Blumenthal, James A.; Professor; Psychiatry; Duke University Durham, NC 27706 Timing: Fiscal Year 2001; Project Start 01-APR-1994; Project End 30-JUN-2005 Summary: Aging of the population and the increased prevalence of chronic diseases among the elderly are major challenges facing our society and medical community. More than 20% of Americans will experience an episode of depression serious enough to warrant diagnosis and treatment. Treatment of major depressive disorder (MDD) has focused on reduction of symptoms and restoration of functioning. Although antidepressant medication has been particularly effective in this regard, many patients either fail to respond to medication or suffer from significant side effects. Thus, there continues to be a need to identify alternative approaches for treating depression, particularly in the elderly. There is now good reason to believe that exercise may be one such approach. The study proposed in the application will build upon the applicant's previous work in which they demonstrated the feasibility and efficacy of exercise as a treatment for MDD in older men and women. The major aim of this project will be to test the hypothesis that a program of home exercise is as effective as supervised exercise and medication in reducing depression relative to placebo controls. As a further extension of past work, the Principal Investigator proposes to examine the differential effectiveness of exercise for a significant subgroup of patients identified by Magnetic Resonance Imaging of the brain as having "vascular depression." Two hundred sixteen men and women, aged > 55 years, with MDD will be randomly assigned to supervised exercise, home exercise, drug (sertraline), or placebo. Before and after treatment patients will undergo evaluation of depression and exercise testing, assessment of vascular functioning including endothelial dysfunction and baroreceptor control, and psychometric testing to assess cognitive function and other measures of quality of life. Six month follow-up will assess relapse rates. The data generated from this study will have important practical implications by determining the extent to which exercise may benefit older men and women with MDD. The study also will provide information regarding the relationship between vascular depression and various indices of vascular and neurocognitive function, and the extent to which these indices may be modifiable by treatment. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: EXPLORING DIABETES AND DEPRESSION IN YOUTH Principal Investigator & Institution: Mckeown, Robert E.; Graduate Director for Epidemiology; Epidemiology and Biostatistics; University of South Carolina at Columbia Byrnes Bldg., Room 501 Columbia, SC 29208 Timing: Fiscal Year 2002; Project Start 24-SEP-2002; Project End 31-AUG-2006 Summary: (provided by applicant): Exploring Diabetes and Depression in Youth (EDDY) is a response to RFA-DK-02-009: Depression and Mental Disorders in Diabetes, Renal Disease, and Obesity / Eating Disorders. EDDY will focus on depression and diabetes in 10 to 19 year old youth at two ethnically diverse sites: South Carolina and Colorado. EDDY is an ancillary study to SEARCH for Diabetes in Youth, a CDC- and NIDDK-funded, multisite investigation for population-based case ascertainment and

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classification of both prevalent and incident cases of diabetes in youth. This case-cohort will allow investigation of the complex association between diabetes and depression in three major ethnic groups, African American, Hispanic, and Non-Hispanic Whites. Diabetes mellitus (DM) is the third most prevalent severe chronic disease of childhood, and a major cause of morbidity, mortality, and compromised quality of life. Childhood DM is now acknowledged to be a complex and heterogeneous disorder, with increasing rates of type 2 DM. A few smaller studies have found that children with DM are at higher risk for depression and that depressed children with DM may be at increased risk of poor management and complications. Existing studies have been small, and restricted to type 1 diabetes. The overall aim of this application is to explore the complex associations of depression and diabetes, which may differ for type 1 and type 2, in the SEARCH case cohort in SC and CO. We will examine the mutual impact of depression on diabetes management, glucose control, quality of life, and complications, as well as the impact of DM disease burden on the risk for depression. Specifically, we will estimate the prevalence and incidence of depression and related affective and anxiety disorders among youth with DM, and explore the correlates and predictors for depression among children and teens with DM, including parenting, self-efficacy, body image, and self-esteem. We will also investigate the impact of depression on diabetes management, clinical course, and complications in both type 1 and type 2 DM, and examine the extent of effective treatment for depression, and the impact of treatment on DM outcomes. Finally, we will explore the pathways involved in the association between DM and co-morbid depression and recurrent depression, with particular attention to disease burden, self-concept, obesity, and parenting. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FAMILIAL RISKS FOR MOOD DISORDERS IN ADULT OFFSPRING Principal Investigator & Institution: Giles, Donna E.; Professor; Psychiatry; University of Rochester Orpa - Rc Box 270140 Rochester, NY 14627 Timing: Fiscal Year 2001; Project Start 01-SEP-2000; Project End 31-AUG-2003 Summary: (Verbatim from the Applicant's Abstract) The proposed project is a revised new R01 project, MH 60350. We propose to: 1) determine whether EEG sleep abnormalities and early onset independently predict lifetime affective morbidity in the offspring of families identified by depressed probands; 2) estimate the additive effects of early onset and abnormal EEG sleep in lifetime risk for depression; 3) establish cohort of offspring at risk for depression for prospective assessment of predictors of affective morbidity. We have compelling evidence that EEG sleep abnormalities cosegregate in families, are associated with increased lifetime risk for major depression, and double the risk of new-onset depression in at-risk relatives. Early onset of depression in the proband independently conferred increased familial risk for depression. These findings hold for two generations of relatives ascertained through unipolar depressed proband identified as part of MH39531 to the PI. By extending our well-characterized twogeneration pedigrees to include the third generation we will specify, in a definitive and cost-effective manner, independent sources of familial risk for depression and morbidity associated with early onset and with abnormal sleep physiology. Young adult offspring are an ideal resource to evaluate the cumulative or interactive influence of these distinct sources of risk. Lifetime psychiatric disorders and EEG sleep have been studied in parent and grandparent generations. Offspring targeted for this proposal have not been studies as part of MH39531. Unipolar depressed probands who defined our families had onset of depression before age 45 and 63 percent had their first episode by age 25 (early onset). Data on EEG sleep and clinical history in these offspring can be

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critically informative in describing physiological characteristics that cosegregate with the disorder and build on observations from two well-characterized generations to identify pathophysiologically important characteristics in adult offspring. Effects of age, sex, illness and medication will be controlled to generate information that is relevant across generations and across time. The proposed study creates a cohort that spans three generations, provides the framework for longitudinal, prospective predictions and identifies maximally informative families who can then be studied using molecular and/or genetic techniques. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FUNCTIONAL STATUS OF 5HT IN AGING & LATE LIFE DEPRESSION Principal Investigator & Institution: Meltzer, Carolyn C.; Associate Professor; Radiology; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, PA 15260 Timing: Fiscal Year 2001; Project Start 05-AUG-2000; Project End 31-JUL-2005 Summary: (Adapted from application's abstract) Depression in late life, which carries an increased risk of dementia and brittle response to treatment, is a significant public health care concern. Extensive evidence supports a key role of serotonergic dysfunction in the development of major depression. The well-characterized serotonin type 2A receptors (5HT2A) have been among the sites of prime interest in postmortem human studies and animal models of depression, and an effect of age on the density of this receptor subtype has been observed. We recently used a position emission tomography (PET) to demonstrate a marked reduction in 5-HT2A receptor binding with normal aging in vivo in humans, which is consistent with our hypothesis that age-related changes in serotonergic function may predispose the elderly to depression. However, we have found no effect of depression on the 5HT2a receptor in the elderly. This finding suggests that, although the loss of 5HT2A receptors may contribute to changes in mood and 5HT mediated behaviors, it does not directly account for the development of depression in late life. These observations have prompted investigations of other important components of the 5HT system that are strongly implicated in depression and mechanisms of antidepressant pharmacotherapy. The development of several selective markers of aging, including partial volume correction, have made it possible to image two important targets of action for antidepressant medication: the 5HT1A receptors and the 5HT transporter. This proposal will evaluate the interaction of aging and depression on 5HT1A and 5HTT binding. The interpretation of PET data will be addressed by an MR-based method for Late-Life Mood Disorders at the University of Pittsburgh. Subjects will be longitudinally followed to determine the potential predictive value of serotonergic markers identified by the PET study on treatment resistance and dementia risk. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: GENDER AND DEPRESSION; TREATMENT, QI, AND OUTCOMES Principal Investigator & Institution: Sherbourne, Cathy D.; Senior Health Policy Analyst; Rand Corporation 1700 Main St Santa Monica, CA 90401 Timing: Fiscal Year 2002; Project Start 10-JUL-2002; Project End 30-JUN-2004 Summary: Little is known about the clinical aspects of depression care received by females, relative to males, in primary care settings. In particular, few studies have addressed whether depressed men and women respond similarly to treatment for depression within usual care primary care settings. Recently, a number of studies have

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examined the efficacy and cost- effectiveness of models designed to improve depression treatment for primary care patients by increasing the number of patients who receive guideline-concordant care. Yet, we do not know whether these quality improvement (QI) efforts have been equally effective for men and women. It is important for policy makers to know whether existing QI programs successfully reduce gender disparities or inadvertently create new disparities. The proposed study will contribute to research knowledge of these issues using a unique, common data base from four quality improvement studies for depression, called QID. This data base includes 1498 primary care patients with major depression plus an additional 500 depressed patients who did not meet QID exclusion criteria from Partners in Care (PIC), an AHRQ-funded PORT II for depression. The proposed study will 1) determine if there are differences in quality of care received, compliance and health outcomes for depressed men and women in usual care; 2) determine whether QI programs for depression reduce existing disparities in quality of care and outcomes for men and women; 3) determine (for PIC only) whether costs and cost-effectiveness of QI programs differ for men and women; and 4) determine whether the effect of appropriate treatment on outcomes differ for men and women. Multiple factors that explain possible gender differences will be explored. Estimates of treatment effectiveness under QID's more naturalistic conditions are the type of data needed to inform policy debates over mental health care coverage. Results from the proposed study will enable policy makers to refine treatment and services interventions to ensure gender-equitable care for this prevalent and disabling condition. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GENETIC DISTRUPTION IMPLICATION FOR DEPRESSION

OF

MONOAMINE

SYSTEMS:

Principal Investigator & Institution: Caron, Marc G.; Professor and Hhmi Invesitgator; Duke University Durham, NC 27706 Timing: Fiscal Year 2001; Project Start 01-SEP-2001; Project End 31-JUL-2006 Summary: (provided by applicant): Depression is a psychiatric disorder where a disturbance of mood is the prominent feature. Although the etiology of depression is unknown, alterations in serotonergic and noradrenergic function have been clearly implicated in the disorder. The present Center Grant proposes to examine depression from the perspectives of functional imaging, morphometrics, and pharmacological interventions in humans, as well as through the use of a variety of animal models of depression. The overall objective of the mouse studies is to show how the serotonin (5HT) and norepinephrine (NE) systems are interdependent in the development and amelioration of symptoms of depression and to reveal the neural mechanisms that contribute to this reaction. In Aim I, the role of the monoamines will be investigated in the heterozygous vesicular monoamine transporter 2 (VMAT2) animals. Studies will be performed to determine whether antidepressants influence monoamine levels in selected brain regions and whether these alterations are related to responses in several different behavioral models of depression. An inducible VMAT2 knockout (KO) mouse will be developed so that the role of this gene and subsequent alterations in neurochemical and behavioral responses can be readily assessed. In Aim II, the role of the norepinephrine transporter (NET) in depression will be evaluated. Experiments will be conducted in NET-KO mice to examine the effects of antidepressants on brain monoamines and behavior. An inducible NET-KO mouse line will be developed such that the role of this gene in the prevention of depression can be evaluated at any time. In Aim III, effects of 5-HT dysfunction will be studied in mice by selectively restoring VMAT-2 function to catecholaminergic neurons in the VMAT2-KO line. In this case, 5-

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HT and histamine function should be defective. We have generated these mice and plan to create an inducible mouse line for additional studies where disruption of VMAT2 function in 5-HT neurons can occur at the discretion of the investigator. The results from the studies in Project 4 will complement the aims of the other Center projects and they will be coordinated with the clinical Projects to better understand the mechanisms that may underlie depression. Additionally, results from the clinical Projects will be integrated into the mouse Project such that, an attempt will be made to examine some of these same phenomena in mice. From these perspectives, the findings from the mouse studies should be helpful revealing some of the molecular, cellular, and biochemical changes that accompany depressive-like behaviors. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GERIATRIC DEPRESSION AND ANTIDEPRESSANT USE Principal Investigator & Institution: Crystal, Stephen; Research Professor; None; Rutgers the St Univ of Nj New Brunswick Asb Iii New Brunswick, NJ 08901 Timing: Fiscal Year 2001; Project Start 01-JAN-2000; Project End 31-DEC-2002 Summary: Among the elderly, few conditions are more consequential than depression. Rapid evolution in health care systems, new treatment technologies, changing prescription patterns and wider social acceptance of the biomedical basis of depression have created a new context for diagnosis and treatment of depression among the elderly. Such changes make it essential to examine national patterns and trends in the diagnosis and treatment of geriatric depression. In this study, nationally representative data from the Medicare Current Beneficiary Survey, including detailed longitudinal information on use of pharmaceuticals and mental health services, will be used to examine patterns of diagnosis of geriatric depression; analyze trends in and predictors of antidepressant treatment among the elderly; analyze use of specialty mental health services among elderly diagnosed with depression; investigate the extent and predictors of early discontinuation of antidepressant use; model amounts received and duration of mental health services use; and compare observed treatment patterns to those recommended by treatment guidelines. Variations in these patterns by care sector (mental health specialty versus general medical care), payer system (managed care versus fee-for-service), sociodemographic subgroup, insurance coverage, medical comorbidities, and other factors will be evaluated. We will also use data from the National Ambulatory Medical Care Survey, which link physician specialty, assigned diagnoses and medications prescribed during physician visits, to explore the evolving roles of the specialty and general medical care sectors in treatment of geriatric depression, and analyze the relationship between diagnoses assigned and psychotropic treatments prescribed at medical visits. Data from both sources will also be used to study the diffusion of selective serotonin reuptake inhibitors (SSRIs) among the elderly. These analyses will contribute to a better understanding of the process of diagnosis and treatment of depression in the elderly population, so that barriers to optimal care can be identified and addressed. They will also provide important information on trends in treatment patterns and shed light on the impact of health care system changes on the treatment of depression. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: GERIATRIC DEPRESSION: RISK FACTORS FOR ADVERSE OUTCOMES Principal Investigator & Institution: Steffens, David C.; Associate Professor; Psychiatry; Duke University Durham, NC 27706

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Timing: Fiscal Year 2002; Project Start 01-JUL-1995; Project End 30-NOV-2006 Summary: This is a renewal of a project in which 375 depressed patients aged 60 years and over will be followed for two to ten years, with a focus on cognition as a primary outcome. 250 patients from the current funding period will continue to be followed, and 125 new patients will be added in the first 30 months of the study. Detailed psychosocial, functional, functional, clinical, psychiatric, medical, neurological, and cognitive assessments will occur at intake and defined points during follow-up. Brain MRI studies will be performed at intake and once again two years later. The principal outcome measures are cognitive decline and dementia. The investigators will continue to examine depression outcomes. The analysis plan focuses on examination of risk for cognitive decline and later dementia using the following independent variables: change in fronto-striatal lesion burden, change in hippocampal volume, APOE genotype, and depression course. The project will preserve past methodological advances by combining and psychiatric assessments with psychosocial and psychobiological perspectives. In a study design that employs carefully defined treatment protocols, we will test specific hypothesis regarding cognitive decline and dementia in depression. While several studies have noted an increased risk of later dementia among depressed elderly, how one may predict incident dementia in older depressed adults is unclear. This application will focus on clinical variables (course of depression), neuroimaging variables (changes in fronto-striatal lesions) and genetics (APOE genotype) as predictors of cognitive decline and dementia in a group of older depressives and a group of elderly controls. Psychosocial factors will be used as co-variates. It is expected that the results from this study will clarify the relationship between depression and dementia in the elderly. It will also add to the literature on the long-term outcome of depression in a clinical setting. Ultimately it should aid in the clinical management of geriatric depression, shedding light on the prognosis for cognitive outcomes of depression in the elderly, as well as for long-term recovery and remission of depression symptoms. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GERIATRIC DEPRESSION--NEUROBIOLOGY OF TREATMENT Principal Investigator & Institution: Reynolds, Charles F.; Professor; Psychiatry; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, PA 15260 Timing: Fiscal Year 2001; Project Start 01-APR-1983; Project End 30-NOV-2003 Summary: In this revised competing renewal of MH37869-16, we propose a randomized, double-blind, placebo-controlled study to test a method for the rapid treatment of geriatric major depression and for probing treatment response variability. We hypothesize that therapeutic sleep deprivation (TSD) will accelerate response to paroxetine (PX), as compared with TSD (+ placebo) or with PX alone. In open pilot studies, we have observed a rapid response rate of 69 percent (9/13 subjects), with Hamilton depression ratings of 10 or less by 14 days, in elderly depressed patients treated with the combination of TSD (one night) and paroxetine (20 mg QHS). By contrast, in other studies of bereavement- related or recurrent major depression, we have observed rapid response rates to placebo of 15 percent, to nortriptyline of 25-32 percent, and to paroxetine alone of 26 percent, suggesting that the use of combined (TSD + medication) may double or triple the rate of rapid response as compared with placebo or drug monotherapy, respectively. With respect to treatment response variability in geriatric major depression, we hypothesize that metabolic activity in cortical areas (prefrontal cortex and ventral anterior cingulate gyrus) will decrease to normal levels in patients showing an antidepressant response to TSD and will remain decreased after recovery sleep in patients responding rapidly to antidepressant treatment. (Data from

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non-depressed control subjects will be collected for comparison.) By contrast, we predict that glucose metabolism will remain elevated in non-responders and unchanged in nonresponders who may be hypometabolic at baseline. Our pilot data show a reduction in cingulate metabolism after TSD in patients but not controls; the reduction persists after successful treatment with paroxetine. We will recruit 108 elderly depressed outpatients with current major depression into a 14-day randomized, placebo-controlled, doubleblind, parallel-group study of TSD + PX, TSD + Placebo, and PX without TSD. All subjects will have pre-treatment MRI scans and twenty of 36 subjects in each treatment condition will also participate in PET studies of treatment response variability, together with 20 normal elderly control subjects. The percentage of patients meeting criteria for rapid response after 14 days of treatment in each of the three conditions will be contrasted in the intent-to-treat sample using contingency table analysis. Measures of subject expectancy, vascular risk factors, cerebral atrophy and white-matter hyperintensity, and cognitive status will be used as covariates in survival analyses of treatment response variability. Correlational analyses will be used to determine the association between changes in depression severity and alterations in regional glucose metabolic rates. Thus, this study aims to develop strategies to accelerate treatment response in geriatric major depression, to improve the early discrimination of nonresponders, to model the functional neuroanatomy of treatment response variability, and ultimately to reduce heterogeneity of treatment response in geriatric depression. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GERIATRIC DEPRESSION--TREATMENT RESPONSE VARIABILITY Principal Investigator & Institution: Little, John T.; Assistant Professor; Psychiatry and Behavioral Scis; Johns Hopkins University 3400 N Charles St Baltimore, MD 21218 Timing: Fiscal Year 2001; Project Start 01-SEP-1999; Project End 31-AUG-2004 Summary: This is an application for a Mentored Patient-Oriented Research Career Development Award (K23). The candidate is a geriatric psychiatrist who proposes to acquire the specific skills and knowledge necessary to become an independent investigator and leader in geriatric depression treatment research. Among the aged, major depression is a common problem which causes significant morbidity and mortality. While effective treatments exist for major depression, the speed, extent, and permanence of treatment response are unpredictable and vary widely, thus leaving considerable residual symptoms and disability. The candidate proposes to use the tools of functional neuroimaging to examine the underlying biology of treatment response variability in geriatric depression in order to predict and optimize antidepressant treatment response. Career development activities emphasize an integrative approach and focus on treatment research methodology, functional neuroimaging, and geriatric psychopharmacology. The research plan involves a treatment trial for elders with major depression combined with fluorine-18 deoxyglucose positron emission tomography before and after 10 weeks of acute treatment with paroxetine. Reduction in the Hamilton Depression Scale score will be correlated with cerebral metabolism in neuroanatomical regions of interest. It is hypothesized that pretreatment anterior cingulate hypermetabolism will correlate positively with extent of antidepressant response to acute treatment. Possible sources of variance accounting for treatment response heterogeneity (e.g., cerebrovascular disease reflected as white matter hyperintensities on brain magnetic resonance imaging, age of illness onset, and serum paroxetine concentration) will also be examined. As continuation and maintenance treatment will be offered through the Mental Health Clinical Research Center for the Study of Late-Life

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Mood Disorders, regional cerebral glucose metabolism before and after acute treatment will also be examined with respect to long-term clinical outcome. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GLIAL CELL GLYCOGEN AND STRESS-INDUCED DEPRESSION Principal Investigator & Institution: Bonsall, Robert W.; Associate Professor; Psychiatry and Behavioral Scis; Emory University 1784 North Decatur Road Atlanta, GA 30322 Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 31-MAR-2005 Summary: (provided by applicant): In this exploratory project, we propose to test a new hypothesis that deficiencies in the brain's reserves of energy make it vulnerable to stress and constitute a risk factor in the development of depression. Normal brain function is dependent on the expenditure of large amounts of energy (up to 20 percent of all energy needs in the human) and most of this energy is consumed in maintaining electrical potentials and ionic gradients across neuronal cell membranes. Exposure to stressful conditions induces greatly increased energy consumption in specific areas of the brain, and the ability of a neuron to respond normally to stressors and to survive the excited state that stressors produce is dependent on surrounding glial cells providing energy in the form of glucose and glucose metabolites. The glial cell's ability to provide energy sources to neurons is not only dependent on the transport of glucose from the blood but also on the mobilization of its own glycogen energy reserves. In response to excitatory neurotransmitters, glial cells break down glycogen into glucose and lactic acid and export them to neurons. We will determine if depression results when the brain is exposed to stressful conditions of sufficient intensity and duration as to deplete the glial glycogen reserve in specific regions of the brain. Depleted glial cells would then be unable to provide nearby neurons with sufficient glucose and lactic acid, and neuroprotective responses to the energy deficit would reduce local neural activity and cause symptoms of depression. We present new data using a well-established animal model of depression that support the glycogen hypothesis. These data indicate that stressful conditions sufficient to cause behavioral depression not only deplete cerebral glycogen but also cause a profound metabolic deficit. In the planned experiments, we shall (a) examine the effects of depression-inducing stressors on levels of glycogen in different brain areas, (b) monitor brain glucose and lactic acid release during exposure to the stressor and during the development and recovery from behavioral depression, and (c) examine the neurochemical and behavioral effects of manipulating brain glycogen levels. Results will provide entirely new insights into the mechanisms of stress induced depression and should suggest new approaches to the treatment and prevention of this devastating disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: GLUCOCORTICOID RECEPTORS IN STRESS AND DEPRESSION Principal Investigator & Institution: Boyle, Maureen P.; Anatomy and Neurobiology; Washington University Lindell and Skinker Blvd St. Louis, MO 63130 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-AUG-2005 Summary: (provided by applicant): Dysregulation of the hypothalamic-pituitaryadrenal axis (HPA), which controls the endocrine stress response, has been implicated in the pathogenesis of stress-related disorders including depression and anxiety. It is believed that at least part of the dysfunction is related to a lack of glucocorticoidmediated negative feedback to the hypothalamus. It has been hypothesized that glucocorticoid receptors (GRs) within the hippocampus (HPC) are important mediators

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of this inhibition. In order to investigate this hypothesis we will take advantage of recent advances in transgenic technology. We have generated mice with a conditional knockout of the GR in area CA1 of the HPC. In addition, we are in the process of generating mice with inducible expression of GRs in the HPC. Analysis of these two lines of mice will allow us to discretely address the role of GRs within the HPC in regulation of the HPA axis. We will examine these mice for changes in basal and/or stress-induced activation of the HPA axis. These mice will also be analyzed for changes in stress/depression related behaviors. Decreased hippocampal GR has been associated with a number of animal models of depression, while increased hippocampal GR is correlated with a decreased susceptibility to depression. We will therefore examine how changes in GR expression in the HPC influence depression related behaviors including anxiety, despair, anhedonia, and learning. We will further examine whether these mutations influence susceptibility to two established models of depression: chronic mild stress and social defeat. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GROUP CBT FOR DEPRESSION IN PUERTO RICAN YOUTH WITH IDDM Principal Investigator & Institution: Rossello, Jeannette M.; Psychology; University of Puerto Rico Rio Piedras Rio Piedras Sta San Juan, PR 00931 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-AUG-2005 Summary: (provided by applicant): Insulin dependent diabetes mellitus (IDDM) is a serious and complicated medical condition that requires a strict and burdensome regimen for its control. Statistical data suggests that IDDM is more prevalent in Latino populations, particularly in Puerto Ricans. Also, higher rates of complications, hospitalizations and mortality have been registered for Latinos. This population has been traditionally underrepresented in medical and psychological research. Depression symptomatology has been identified in approximately 32.4% of diabetic patients making it a frequent co-morbid condition. Although several studies have demonstrated good outcomes in the treatment of depression in adult diabetes, this has not been tested for youth with IDDM, much less for Latino youth. The main objective of this proposal is to develop and test a culturally appropriate group CBT intervention for depression in Puerto Rican youth with IDDM. The specific aims are to: (1) Develop, adapt, manualize, and refine an empirically based CBT group intervention for the treatment of depression in Puerto Rican adolescents with IDDM and depressive symptoms; (2) To pilot test the CBT for adolescents with IDDM (CBT-IDDM) to assess primary (depression, adherence, and metabolic control) and secondary (cognitions, self-esteem, coping strategies, quality of life, social support, and functionality) outcomes; (3) To evaluate the feasibility and acceptability of the procedures for implementation of CBT-G-IDDM and measures. Data will be collected to estimate intervention parameters such as effect size, attrition and response rate; recruitment of participants and therapists; sample definitions; outcome measures; protocol adherence; therapist competency; and patient acceptance of treatment and measures. Forty Puerto Rican adolescents with IDDM and depression symptomatology will be randomly assigned to one of two conditions: CBT-G-IDDM or a minimal contact (MC) group with close monitoring of symptoms. Multiple measures will be completed by multiple raters (adolescent, parent, and interviewer) at pre, midline and post. The impact of the intervention will be evaluated on primary and secondary outcome targets. Results from this study will permit a large randomized controlled clinical trial to further study efficacy and effectiveness issues. The treatment manual and procedures could benefit other Latino and minority youth with IDDM.

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Project Title: GROUP TREATMENT FOR DEPRESSION IN HEART FAILURE Principal Investigator & Institution: Friedman, Michael A.; Psychology; Rutgers the St Univ of Nj New Brunswick Asb Iii New Brunswick, NJ 08901 Timing: Fiscal Year 2003; Project Start 14-FEB-2003; Project End 31-JAN-2006 Summary: (provided by applicant): The overall aim of this research is to develop an efficacious group psychotherapy for the treatment of major depression among individuals with congestive heart failure. Both major depression and heart failure are associated with severe loss of functioning and increased mortality, and this co-morbid condition is particularly debilitating. While treating depression among heart failure patients has the potential to improve functioning and prolong life in this population, there are currently no empirically-supported treatments for depression among heart failure patients. Among the several well-validated psychosocial treatments, group cognitive-behavioral therapy (CBT) has been proposed as efficacious, and has established feasibility among heart failure patients. Group CBT may be particularly efficacious among CHF patients with depression due to the potential for increasing patient social support. Initial research suggests that there are several ways in which current group CBT could be improved to treat major depression among CHF patients, including: (1) the use of an "open" group format that allows for immediate patient care, (2) integration of individual interventions to individually tailor treatment goals and improve adherence to treatment, and (3) family-based interventions within the group CBT format to mobilize patient social support. The proposed integrated cognitivebehavioral therapy program includes group, individual, and family treatment (GIFT) for depression among individuals with CHF (GIFT-CHF). The current proposal is designed to develop the GIFT-CHF program. The proposal consists of three phases: a Development, Pilot, and Revision Phase. During the Development phase of the GIFTCHF, the goal of the research will be to: (a) develop an integrative group therapy program for depressed patients with heart failure (GIFT-CHF); (b) develop a therapist training program; and (c) develop and test the reliability and validity of competence and adherence rating scales. During the Pilot phase of the GIFT-CHF program, the goal will be to conduct a small pilot trial investigating the short-term efficacy of the GIFT-CHF program in comparison to a Standard Medical Care/Wait-List control group, and determine effect size. Finally, during the Revision phase of the GIFT-CHF program, the goal of the research will be based on the results of the Development and Pilot phases, to revise the GIFT-CHF program and treatment manual. This treatment development grant will lay the groundwork for a large-scale treatment outcome study of the GIFT-CHF program for depressed individuals with congestive heart failure. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: HIV IN WOMEN: DEPRESSION AND IMMUNITY Principal Investigator & Institution: Evans, Dwight L.; Professor and Chair; Psychiatry; University of Pennsylvania 3451 Walnut Street Philadelphia, PA 19104 Timing: Fiscal Year 2003; Project Start 25-JUL-2003; Project End 31-MAY-2007 Summary: (provided by applicant): Psychiatric morbidity has been associated with HIV disease since the beginning of the AIDS epidemic. Most of the clinical literature to date has focused on psychiatric issues in men who are HIV seropositive. There has been little data regarding the prevalence of psychiatric disorders in HIV infected women, despite the fact that HIV remains among the leading causes of death for US women between the

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ages of 25 and 44. HIV also is the leading cause of death among African American women in this age group. We found that the proportion of women with current major depression was four times higher in HIV positive women compared to HIV seronegative women. This high rate of major depression coupled with the recent and largest epidemiology study to date indicating that depression is associated with increased mortality in HIV-infected women, underscores the need for studies to ascertain the relationship of major depression, immunity, and HIV disease progression in HIV infected women. The potential immune mechanisms by which depression may influence HIV disease progression and mortality remain to be understood. In our studies of HIV infected men, we have found depression associated alterations of immune cytotoxic cells suggesting that killer lymphocytes might mediate the effects of depression on HIV disease progression. Although previous studies have focused almost exclusively on HIV infected men, we have recently found that women with depression exhibit significant reductions in natural killer cell activity as well as increases in activated CD8 lymphocytes and viral load. The proposed study of HIV seropositive women, largely of minority representation, is designed to provide important information on 1) the underlying immune mechanisms by which depression my influence HIV-1 replication and thereby HIV disease progression; and 2) three potential mechanisms of action whereby depression my influence immunity and HIV disease progression. The present study may also help determine whether conventional antidepressants (SSRIs) as well as novel antidepressant pharmacotherapies (substance P antagonists and glucocorticoid antagonists) might benefit HIV-infected individuals and extend survival with HIV infection. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HMO TREATMENT OF DEPRESSION & SUBSTANCE ABUSE Principal Investigator & Institution: Clarke, Gregory N.; Senior Investigator; Kaiser Foundation Research Institute 1800 Harrison St, 16Th Fl Oakland, CA 94612 Timing: Fiscal Year 2001; Project Start 01-JUL-1999; Project End 31-MAR-2003 Summary: Previous research has shown that depression is frequently comorbid with alcohol abuse and/or dependence, and that it is predictive of poorer short- and longterm drinking outcomes. Efficacy studies suggest that alcohol and other drug (AOD) treatment outcomes improve when comorbid depression is successfully treated. However, these efficacy studies are limited in their generalizability to real-world clinical settings, and their results require replication in effectiveness trials. Further, little is known regarding the cost- effectiveness of the treatment of depression comorbid with AOD problems. This randomized, controlled trial will test whether concurrent treatment for depression and AOD disorders improves drinking outcomes (percent days abstinent from alcohol, and mean standard drinks per possible drinking day) and depression. Adult HMO members entering an intensive, 5-week outpatient AOD treatment program will be administered a depression screening scale (the Beck Depression Inventory; BDI) as part of their standard intake assessment. Members scoring 16 or greater on the BDI will be contacted and invited to participate in the study. Consenting members will be administered an intensive intake battery, assessing drug, alcohol and psychiatric history, life functioning, and other psychosocial constructs of interest. Two hundred and twelve (212) subjects will be randomized to either: (a) "usual care" AOD treatment, or (b) usual care AOD treatment plus 8 individual sessions of cognitive-behavioral treatment for depression (CBT-D). All subjects will be re-assessed for AOD and depression outcomes at post-treatment, and at 3,6 and 12- months follow-up points. HMO databases will be employed to examine health services utilization and costs outcomes.

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Principal outcomes analyses will examine whether (a) AOD outcomes are better in the CBT-D condition; (b) depression outcomes are better in the CBT-D condition; (c) better AOD outcomes are mediated by improved depression outcomes: and (d) CBT-D is a cost effective adjunctive treatment for AOD with comorbid depression. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •


HORMONE

RHYTHMS:

METABOLIC

SIGNIFICANCE

IN

Principal Investigator & Institution: Rubin, Robert T.; Professor; Allegheny-Singer Research Institute 320 E North Ave Pittsburgh, PA 15212 Timing: Fiscal Year 2001; Project Start 01-DEC-1985; Project End 31-JUL-2006 Summary: (adapted from applicant's abstract) This renewal application, for years 23-27, is to continue studies of the neuroendocrinology of major depression. The studies planned herein build upon more than 20 years of systematic exploration of the HPA axis in major depression, supported by this grant. In previous years, we conducted several large studies of patients with major depression vs normal controls, the results of which have led to our current focus on the hypothalamo-pituitary-adrenal cortical (HPA) axis. This axis is mildly to moderately hyperactive in 30-50 percent of depressed patients, most likely on the basis of increased corticotropin releasing hormone (CRH) and arginine vasopressin (AVP) secretion from the hypothalamus. Our most recent studies have revealed an unexpected and very interesting finding, the HPA axis responds differently to cholinergic challenge not only in depressed patients vs normal controls but also in women vsmen. Our extension of this to the study of laboratory rats has revealed similar findings between female and male animals. This is an emerging area of CNS neuropharmacology, with only a few prior studies that have considered neuroendocrine responses, other than the hypothalamo-pituitary-gonadal axis, by sex. Specific aims include: 1) Continued analysis of data from earlier studies. 2) Continued detailed study of sex differences in cholinergic regulation of the HPA axis in patients with major depression vs normal controls, in depressed patients during illness vsafter successful treatment, and in women us men. This specific aim forms the major thrust of this renewal application. 3) Completion of HPA axis studies at the adrenal and pituitary levels. 4) Continuation of animal studies of sexual diergism of cholinergic regulation of the HPA axis in female and male rats. The human studies will be used to inform planning of the studies in laboratory animals, and vice versa. The significance of the planned studies lies in their furthering our understanding of HPA axis regulation by CNS cholinergic mechanisms in major depression, as well as what we hypothesize to be adaptive changes to increased CNS stimulation of the axis at the pituitary and adrenal levels. In particular, understanding sex differences in cholinergic regulation of the HPA axis may help elucidate biological mechanisms underlying the greater incidence of major depression in women vsmen. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HPA AXIS IN DEPRESSION AND ANXIETY Principal Investigator & Institution: Young, Elizabeth Ann.; Professor; Psychiatry; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, MI 481091274 Timing: Fiscal Year 2001; Project Start 01-MAY-2001; Project End 30-APR-2006 Summary: (Applicant's abstract) This is a Research Scientist Award Application. I have received 15 years of salary support through the RSDA program and have become a

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leader in the area of HPA axis regulation in depression. Future studies proposed in this application will continue to explore hormonal abnormalities in depression and also in related anxiety disorders, panic disorder and PTSD. Current research indicates that depression is accompanied by abnormalities of the HPA axis, while anxiety disorders, particularly Panic Disorder, is accompanied by abnormalities of the central noradrenergic system, as reflected by a blunted growth hormone response to clonidine. Specific research aims in this proposal are I) to determine if abnormalities of central noradrenergic system are present in both pure depression, pure panic disorder and depression plus panic disorder. We will study a group of well characterized pure depressed, pure panic and mixed panic and depressed patients with the clonidine/growth hormone challenge to determine if all depressed patients manifest abnormalities in clonidine stimulated growth hormone release or if only those with comorbid panic symptoms manifest this abnormality. 2) To determine if abnormal activation of HPA axis secretion occurs in Panic Disorder patients. We will examine 24 hr urinary cortisol excretion, collected in 8 hrs segments in pure depressed, pure panic and and mixed panic and depressed patients. 3) To evaluate noradrenergic and HPA axis 'reactivity' to two simple challenges in pure depression, depression plus anxiety, panic disorder patients and normal controls. These challenges include orthostatic challenge and the Trier Social Stress Test (TSST). We hypothesize that panic disorder patients and depressed patients with co-morbid anxiety will demonstrate exaggerated catecholamine response to orthostatic challenge i.e increased reactivity. We hypothesize that depressed patients will have altered HPA axis responses to stress response while Panic Disorder patients will have normal HPA axis response to the TSST. 4 ) To determine if the abnormalities in basal HPA axis dysregulation, exaggerated responses to stress and blunted response to clonidine-growth hormone challenge studies occur in the same individuals and if the results of these biological studies support the nosological distinction between Panic Disorder, pure Major Depression and Major Depression with co-morbid Panic Disorder. Finally we will examine whether HPA axis and noradrenergic dysfunction reflect a common factor, degree of impairment, more than a specific mood and anxiety disorder. With regards to PTSD, we will explore whether decreases in urinary free cortisol and increases in urinary catecholamines are present in epidemiological sample of subjects exposed to trauma both with and without PTSD and normal subjects not exposed to trauma who are free of Psychiatric disorders. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •


HPA

REACTIVITY,

PUBERTY,

&

SEX

DIFFERENCES

IN

Principal Investigator & Institution: Stroud, Laura R.; Miriam Hospital Providence, RI 02906 Timing: Fiscal Year 2002; Project Start 01-JUN-2002; Project End 31-MAY-2007 Summary: (provided by applicant): The goal of this Mentored Patient-Oriented Research Career Development Award (K23) is to allow me to become an independent, transdisciplinary researcher examining sex differences in stress responses and depression over puberty. I am a new Assistant Professor at the Brown University Center for Behavioral and Preventive Medicine with previous research focusing on sex differences in stress responses and depression in adults. Training from this K23 proposal will allow me to re-focus on adolescents and to develop a program of research examining: a) How do HPA responses to stress change across puberty in boys and girls? and b) Do changes in HPA responses to stress over puberty influence the emergence of sex differences in depression? My Career Development Plan includes training in social

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and biological influences on adolescent development, nosology and measurement of adolescent depression, statistical methods and ethics. My research goals include carrying out the K23 study, building a base of publications in adolescent stress responses and depression, and the submission of an R01. Guiding my training and research will be four transdisciplinary Mentors: Raymond Niaura, Ph.D. (sex differences in stress responses); Ronald Seifer, Ph.D. (high-risk children, statistics, ethics); Ronald Dahl, M.D. (puberty, depression, brain stress systems) and Adrian Angold, MRCPsych (sex differences in depression, nosology, statistics). The Research Plan involves a crosssectional investigation of sex differences in stress responses across stages of puberty in adolescents at risk for depression (offspring of depressed mothers). I hypothesize that in the early stages of puberty there will be no sex differences in HPA responses to interpersonal and instrumental stress. In advanced puberty, however, paralleling the emergence of sex differences in depression, girls will show greater responses to interpersonal compared to achievement stress, but boys will show greater responses to achievement compared to interpersonal stress. The K23 study will represent pilot data for a longitudinal study of stress responses and depression over puberty (R01 submission). This work has implications for targeted intervention and prevention efforts to diminish sex differences in adolescent depression. It should also elucidate basic interactions between the gonadal and stress axes over puberty. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HUMAN NEUROENDOCRINE STUDIES Principal Investigator & Institution: Akil, Huda; Gardner Quarton Distinguished University; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, MI 481091274 Timing: Fiscal Year 2001 Summary: This proposal attempts to address the question: is the dysregulation of the Limbic-Hypothalamo-Pituitary-Adrenal (LHPA) Axis observed in depression a result of the stress which either precipitated the depression and/or resulted from it, or does the LHPA axis play a more fundamental role in the biology of depression? If the latter is correct, we would hypothesize that individuals who are prone to depression may respond to psychological stressors differently as monitored by endocrine correlates, and that they may do so not only when in episode, but also when out of episode. It would suggest that information which is laden with negative affect may be remembered differently by depressive individuals, as compared to normal controls. We propose to test these ideas by subjecting depressed patients, in and out of episode, to a social stressor and testing how they respond to it endocrinologically, how rapidly they terminate this response, and how well they habituate to its repeated presentation. We shall also use a newly devised memory test which contrast the ability to remember neutral vs. negative material, and ask whether depressed subjects, be they in or out of episode, show differences from controls in the way they handle emotional material. In addition, we shall test subjects out of episode at the purely neuroendocrine level using some sensitive challenges which we have devised and validated, and which we believe are reflective of the neuronal rather than the peripheral elements of the LHPA axis-these will include a metyrapone test in the evening at the nadir of the rhythm where we observe substantial dysregulation in drive level, and a test of fast feedback in the morning, at the peak of the rhythm, where we have shown a disturbance in glucocorticoid feedback. A complementary approach to addressing this central question is to study a group of subjects undergoing a very stressful life situation ( genetic test for a familial Breast Cancer Gene-BRCA1, to determine whether or not they carry a

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mutation which gives them an almost 90% chance of developing breast and/or ovarian cancer); evaluating their neuroendocrine profile at that point; and determining whether it resembles that of individuals with major depression. We shall then ask whether an abnormal neuroendocrine profile is correlated with a personal or a family history of major depression, or with the subsequent occurrence of depression or mood disorders, as determined with a 6 month follow-up. Together, this series of studies should shed light on the extent of the relationship between major depression and the dysregulation of stress responsiveness. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: IMAGING OF SEROTONERGIC AND CHOLINERGIC MARKERS IN SMOKERS Principal Investigator & Institution: Innis, Robert P.; Yale University 47 College Street, Suite 203 New Haven, CT 065208047 Timing: Fiscal Year 2001 Summary: Prospective studies have shown that smokers whoa re vulnerable to depression are less successful at quitting and have a higher relapse rate than euthymic smokers. Seventy-five percent of smokers with a history of depression develop depression during smoking cessation, even if they are not depressed prior to quitting Nicotine, a principal component of cigarette smoke, has been suggested to have rapidacting antidepressant effects in non-smokers. These effects of nicotine are mediated through its initial actions on a central nicotinic acetylcholine receptor (nAChR) and the downstream enhancement of serotonin (5-HT) neurotransmission. In addition, a unknown byproduct of tobacco smoke is a potent monoamine oxidase inhibitor which further enhances 5-HT function. Since cigarette smoke has potent effectors on 5-HT, synaptic markers for this transmitter may by differentially regulated in smokers versus non-smokers. Also, the emergence of depression during smoking cessation in vulnerable smokers may be a consequence of adaptive changes in 5-HT markers. In vivo imaging using radiotracers regionally selective for the 5-HT transporter and 5-HT2A receptor have demonstrated reduced numbers of these pre- and post-synaptic 5-HT markers in living depressed patients. We hypothesize that heavy cigarette smoking will induce adaptive changes in 5-HT markers in living depressed patients. We demonstrated reduced numbers of these pre- and postsynaptic 5-HT markers in living depressed patients. We hypothesize that heavy cigarette smoking will induce adaptive changes in 5-HT transporter and 5-HT2A receptor number in smokers, and that these 5HT markers will down-regulate during smoking cessation in the subset of smokers vulnerable to depression. To test this hypothesis, we propose the following specific aims: 1) to determine the effects of smoking on 5-HT transporters and 5-HT2A receptors in euthymic smokers and non-smokers between genders 2) to determine if 5- HTtransporters and 5-HT2A receptors undergo adaptive changes during smoking cessation in smokers that develop depression; and 3) to develop a radiotracer for in vivo imaging of the nAChR, so that its potential role in nicotine dependence and depression may be studied in living smokers. The results from these studies will determine if there is a difference in pre- and postsynaptic 5-HT in smokers and if adaptations in key 5-HT markers during withdrawal are correlated with the emergence of depressive symptoms in vulnerable smokers. Furthermore, these studies may elucidate a neurochemical marker which will identify a subgroup of smokers who would benefit from antidepressant treatment during smoking cessation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: IMAGING OF SEROTONIN TRANSPORTERS IN DEPRESSION Principal Investigator & Institution: Parsey, Ramin V.; Assistant Professor; Psychiatry; Columbia University Health Sciences New York, NY 10032 Timing: Fiscal Year 2001; Project Start 29-MAY-2001; Project End 30-APR-2006 Summary: (Provided by Applicant): Structural and functional imaging studies have suggested a neurocircuitry of mood disorders that involves a limbicthalamic-cortical circuit (amygdala, thalamus, prefrontal cortex) and a limbic-striatal-pallidal-thalamiccortical circuit. Abnormalities in a component of these circuits may affect the regulation of mood. Serotonin has been implicated in the pathophysiology of depression. Reports of fewer platelet serotonin transporters in major depression have rarely been extended to postmortem brain studies and neuroreceptor imaging studies in vivo. Serotonin transporter binding in the brainstem of depressed patients measured by SPECT is reportedly lower. ["C]McN5652 is a PET radioligand with high affinity for the serotonin transporter. Our group has developed kinetic modeling methods with this ligand that allow quantification of the serotonin transporter in subcortical and to a lesser extent in some cortical structures. We propose an in vivo study of the neurocircuitry of the serotonergic system in major depression. We predict that transporter binding will be decreased in depressed subjects in the midbrain, thalamus, putamen, hippocampus, and amygdala. Symptoms of depression have been correlated to serotonergic measures, including suicidal ideation, psychomotor retardation, and anxiety. We will correlate these measures of psychopathology with ["C]McN5652 binding. Correlations will help refine the neurocircuitry model of depression. Several lines of evidence suggest that serotonin dysfunction in depression may be a trait marker. Consequently, we will study both currently depressed (n=40) and remitted depressed subjects (N=20) while off medication, and compare both groups to healthy volunteers (N=20). We predict remitted depressed will not differ from currently depressed subjects. These results will greatly enhance our knowledge of the pathophysiology of major depression and help in our diagnosis, treatment, and design of future studies. This application for a Mentored Clinical Scientist Development Award has been submitted with the goal of supporting the development of the applicant's career as a psychiatric researcher. This research plan is intended to build on the candidate's prior work with neuroreceptor imaging in mood disorders. This application delineates plans for training and mentoring in the areas of the neurobiology of depression, cell and molecular physiology, pharmacology, neuroanatomy, statistical analysis, clinical diagnosis and ratings, teaching, brain imaging, and mathematical modeling necessary to enable the applicant to pursue an independent career of scientific inquiry in psychiatry. These goals will be met by a combination of didactic I course work and supervision. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: IMIDAZOLINE RECEPTORS IN DEPRESSION--CLINICAL STUDIES Principal Investigator & Institution: Halaris, Angelos E.; Psychiatry and Human Behavior; University of Mississippi Medical Center 2500 N State St Jackson, MS 39216 Timing: Fiscal Year 2001; Project Start 01-MAR-1998; Project End 28-FEB-2003 Summary: (Adapted from applicant's abstract): For the last twelve years the investigator's laboratory has attempted to identify a specific and readily obtainable biological marker for depression. Platelet a2-adrenergic receptors (a2AR) were of theoretical interest because brain a2AR modulate monoamine output. In the wake of over 60 studies or the platelet a2AR in depression, the investigator noted a high degree of consistency only with an elevation in radioligand binding amongst those studies

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which utilized imidazolines (principally 3H-clonidine) in their "a2 assays". After thoroughly characterizing the imidazoline-receptive sites on human platelets, the investigator concluded that platelets possess a nonadrenergic imidazoline receptor (IR1) binding site, in addition to an a2AR. In four studies of depression, and one of dysphoric PMS, the investigator has consistently observed an elevation of IR1 on platelet plasma membranes of depressed patients compared to matched controls, suggesting that the earlier literature might be explained by IR1 sites. The investigator also found that treatment of patients with either desipramine (DMI) or fluoxetine for 6 weeks leads to normalization (i.e., down regulation) of platelet IR1, suggesting that the platelet IR1 site might be a state marker for depression. These alterations were not correlated with changes in catecholamines. After transferring the grant from Case Western Reserve University the investigator replicated his findings in depressed patients with a demographically different population. Furthermore, he has developed a selective antibody assay for the IR1 protein, which is 100-fold more sensitive than the older IR1 radioligand binding assay. Using IR1-selective antiserum, depressed patients continue to display a marked elevation in the platelet IR1 density. The density of this single band (33 kDa), as detected on Western blots, is linearly correlated with the IR1 Bmax values of platelet samples. Recently the investigator has also observed an increase in 33 kDa/IR1 in hippocampi of depressed victims of suicide. Thus, in our search for an a2AR marker, he uncovered a novel nonadrenergic receptive protein which in five pre-treatment and 3 post-treatment studies of depression (and as assayed by two independent techniques) appears to be a marker for depression. The investigator's specific aims will determine: a) the extent to which IR1 elevation is observed throughout brain regions of depressed suicide victims, b) whether depressed patients also exhibit a functional IR1 alteration in hypothalamic growth hormone (GH) and prolactin responses to moxonidine infusions (as assessed under an a2AR mask), c) whether the potential platelet IR1 marker is sensitive to the severity of depressive illness, and d) whether the IR1 neurotransmitter candidate, agmatine, is also altered in depression. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: IMMUNOLOGICAL ASPECTS OF HEMORRHAGE Principal Investigator & Institution: Chaudry, Irshad H.; Professor, Vice Chairman & Director; Surgery; University of Alabama at Birmingham Uab Station Birmingham, AL 35294 Timing: Fiscal Year 2003; Project Start 01-APR-1988; Project End 31-MAR-2007 Summary: (provided by applicant): A major feature of trauma is immune depression. Studies demonstrate immune depression is severe in aged and ovariectomized (OVX) females and adult males, as opposed to maintained immune functions in proestrus females, after trauma-hemorrhage and resuscitation (T-H). Administration of 17betaestradiol (E2) in OVX females and males, or prolactin or steroid enzyme activity modulators (SEAM) in males after T-H restores immune functions. Moreover, survival rate of proestrus females subjected to sepsis after T-H is significantly higher than agematched males or OVX females. Studies also show that increased 5alphadihydrotestosterone synthesis in T cells is the likely cause for immune depression in males, while continued E2 synthesis maintains immune functions in proestrus females, following T-H. Similarly, hypoxemia also causes immune depression in mice. Recent studies show that in males, (a) pattern recognition receptors TREM 1, 2 and 3 are expressed in CD11b+ macrophages from bone marrow, PBMC, spleen and liver, in the absence of LPS stimulation, and their expressions are enhanced following T-H, and (b) there is a Th1 to Th2 shift in T cell cytokine release following T-H, implying that the

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depression in immune function may be due phenotypic changes in MPh and T cells. Since immune response following T-H is gender-dimorphic, phenotypic changes occurring in the immune cells early following T-H may be different in males and proestrus females. Therefore, the hypothesis is that the sex steroid hormonal milieu prevailing at the time of injury induces phenotypic changes in macrophages and T cells whose altered functions, evidenced in the release of mediators, lead to either depression or maintenance of immune functions after T-H. Since macrophages and T cells express receptors for sex steroids, and T cells synthesize active steroids in situ, it is also hypothesized that modulation of immune functions early following T-H with sex steroid receptor-specific antagonists/agonists or SEAM will lead to restoration and maintenance of immune functions and decrease mortality from subsequent sepsis in both genders. The specific aims are to: characterize phenotypic changes in macrophages and dendritic and T cells in the inflammatory microenvironment early following T-H; delineate the mechanism(s) for the release of inflammatory mediators by immune and endothelial cells; determine the contribution of hypophysis-pituitary-adrenal-gonad axis to immune depression; and evaluate the effects of steroidogenic enzyme and sex steroid receptor-specific modulators for restoring immune functions in males and estrus cyclespecific females after T-H or hypoxemia. Detailed analysis of phenotypic changes in immune cells and understanding their functions in T-H induced milieu, using recent cellular/molecular biological techniques, delineating sex steroid immune functions and assessing how they can be modulated by exogenous steroidal/ nonsteroidal modulators to improve immune responses should lead to innovative approaches for preventing immune depression and reducing mortality from sepsis in trauma victims with low E2 levels. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: IMPACT OF DEPRESSION & FUNCTION ON HEALTHCARE USE & COST Principal Investigator & Institution: Friedman, Bruce; Community and Prev Medicine; University of Rochester Orpa - Rc Box 270140 Rochester, NY 14627 Timing: Fiscal Year 2002; Project Start 01-FEB-2002; Project End 31-JAN-2007 Summary: (provided by applicant): The purpose of this Mentored Research Scientist Career Development Award (KO1) is to become an independent researcher prepared to make a unique and significant contribution to our understanding of the impact of depression and functional impairment on health services use and expenditures among older adults (age 65+). Three themes characterize my background: (a) work-related positions with an exclusive or major focus on the aged; (b) exposure to and involvement with late life mental health; and (c) expertise in crosssectional analysis of healthcare use and expenditures. My past scientific history has focused on innovative intervention studies of elderly patients. I will receive the needed training and conduct mentored research at the University of Rochester, with additional study at the University of Michigan and training and mentored research at Cornell University. Presently little is known about the impact of depression and functional impairment on healthcare use and expenditures among most categories of elderly patients (e.g., primary care patients, home care patients, and community-dwelling high users of medical care). The Training Objectives of my Research Career Development Plan are to: (1) Improve my knowledge base in relation to affective illness, cognitive dysfunction, and chronic illness comorbidity and disability in elderly persons; (2) Increase my knowledge of mental health oriented community-based interventions and public health models; (3) Add to my knowledge and skills in longitudinal data analysis; (4) Become more familiar with

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the requirements for responsible conduct of research involving human subjects; and (5) Plan, organize, and carrying out a systematic research program adding knowledge of geriatric mental health and function to my expertise and skills in Health Services Research and community-based geriatric interventions. The Specific Aims of the Research Plan are: (Aim 1) To better understand the impact of major and subsyndronml depression on certain specific types of healthcare use and expenditures; (Aim 2) To better understand the effect of functional impairment (deficits in activities of daily living, instrumental activities of daily living, and ambulation/-mobility) on certain specific types of healthcare use and expenditures; and (Aim 3) To study the role of depression as a mediator between functional impairment and use/expenditures, and functional impairment as a mediator between depression and use/expenditures. The Analytic Plan consists of (a) bivariate associations, (b) regression analyses, (c) an examination of direct and indirect effects, and (d) longitudinal analyses applied to data from 3 studies: (1) the Medicare Primary and Consumer-Directed Care Demonstration (2) the Depression Outcome in Primary Care Elderly study, and (3) the Depression in Elderly Medical Homecare Patients study. Given the expected continuing rise in healthcare costs and the high prevalence of depression and functional impairment among the chronically ill aged, understanding the impact of depression and functional impairment on healthcare use and expenditures is of particular public health importance. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: IMPROVING ANTIDEPRESSANT ADHERENCE IN OLDER ADULTS Principal Investigator & Institution: Sirey, Joanne; Associate Professor; Psychiatry; Weill Medical College of Cornell Univ New York, NY 10021 Timing: Fiscal Year 2002; Project Start 23-SEP-2002; Project End 31-MAY-2007 Summary: (provided by applicant): This proposal is for a K23 Mentored PatientOriented Research Scientist Award. The applicant is a clinical psychologist and a developing investigator in the Cornell Intervention Research Center for Geriatric Mood Disorders. The goal of this application is to provide further interdisciplinary training and research opportunities to transition the applicant to become an independent investigator in interventions research. The career goal of the applicant is to develop interventions to improve adherence to antidepressant treatment among depressed older adults in primary care. The career development objectives of this application are to learn: 1) the theories underlying behavioral change interventions: 2) the design and evaluation of interventions in late-life depression; 3) assessment of older adults' attitudes and beliefs; and 4) factors that affect treatment adherence across illnesses. This training will provide the knowledge and skills to assess and to address negative attitudes and beliefs about: 1) depression and the usefulness of treatment efficacy, 2) stigma, and 3) treatment self-efficacy. The research proposed will pilot the usefulness of a brief, individualized intervention to improve adherence to SSRI antidepressant therapy by older adults prescribed by Primary Care Physicians. The intervention is designed to improve adherence by addressing the negative attitudes and beliefs that are obstacles to adherence for adults with late-life depression. Although the intervention is not a therapy to reduce depression; but because depression itself can contribute to negative attitudes and beliefs, one of the goals of the intervention is to buffer the effect of depression on adherence. The intervention targets obstacles to adherence and if proven useful, would be a manualized and feasible way to reduce the personal and public health costs of under treatment of late-life depression in older adults seen in primary care.

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Project Title: OUTCOMES

IMPROVING

DEPRESSION

TREATMENT

ADHERENCE

&

Principal Investigator & Institution: Flynn, Heather A.; Psychiatry; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, MI 481091274 Timing: Fiscal Year 2001; Project Start 31-AUG-2001; Project End 31-JUL-2006 Summary: (provided by applicant): This application seeks support for a Mentored Patient-Oriented Research Career Development Award (K23). The award would provide me the opportunity to transition to a successful independent research career focused on improving treatment adherence and outcomes for women with depression. I have had a thematic clinical and investigational interest in identifying factors that maintain depression, determining effective prevention and treatment strategies to overcome them. I have followed a career trajectory to develop a research focus in this area. The K23 mechanism will continue this trajectory, allowing me to: 1) obtain additional knowledge and skills in targeted areas pertaining to treatment adherence and transition to an independent research career in this area, 2) expand research methodology and grant-writing skills sufficiently so as to become competitive for extramural funding in this adherence/outcome arena, and 3) obtain support to pursue these academic and research goals under the mentorship of successful researcheracademicians in a multidisciplinary academic environment. Specifically, the educational and research endeavors for the proposed career development period will focus on developing incremental skills in 3 areas: I) theoretical/conceptual models (and associated methodological skills) of etiology, maintenance and treatment of depression in women, 2) exploration of how to incorporate selected psychological theoretical/conceptual models to improve treatment adherence, and 3) clinical and health services projects to objectively assess changes in treatment adherence and effectiveness of treatments for depression in women in naturalistic settings. To achieve these goals, I propose specific mentoring, coursework, didactic training, visits to national consultants, and participation in national meetings. The research plan aims to examine the underlying mechanisms and processes of psychotherapeutic approaches (Interpersonal Psychotherapy; IPT) and other psychological and interpersonal factors that might enhance treatment adherence and improve outcomes in women with depression. The first study proposed will examine the effectiveness of IPT in improving adherence and depression outcomes in pregnant women with depression. A second proposed project will examine the role of a number of factors hypothesized to affect treatment adherence in a more heterogeneous group of women (i.e. pregnant and nonpregnant) with depression in primary care. At the later stages of the proposed career development period, I will have achieved the training, mentoring and research experiences to permit independent formulation and execution of competitive ROl applications. This research has potential to meaningfully improve medication adherence, enhance outcomes and quality of life, and minimize the terrible morbidity burden experienced among women with depression. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: IMPROVING DEPRESSION TREATMENT/OUTCOMES IN PRIMARY CARE Principal Investigator & Institution: Adler, David A.; New England Medical Center Hospitals 750 Washington St Boston, MA 021111533 Timing: Fiscal Year 2001; Project Start 15-SEP-1997; Project End 30-APR-2003

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Summary: (Adapted from applicant's abstract): This randomized clinical effectiveness trial will test the ability of a pharmacist intervention to improve the outcomes of treatment of depressive disorders in primary care. Numerous treatments are available; however, all require compliance to be effective. Approximately 30% of depressed primary care patients stop using antidepressant medications within the first month of treatment, while only 40% reach the recommended therapeutic dosage of antidepressant medication. Participation in care by clinical pharmacists has been proposed as a way to ensure the safe and effective use of drugs and to improve compliance. However, their specific clinical and economic contributions to the care of patients with depressive disorders are unknown. This study will evaluate the impact of standardized pharmacist interventions on the clinical, therapeutic, health status and financial outcomes of care, and on patient satisfaction with care. Specifically, we aim to (1) Compare, between the intervention and control group: a) the optimality of drug therapy for depressive disorders as defined by AHCPR guidelines; b) patient compliance with and knowledge of antidepressant medications; c) the number of drug-related problems; d) the resolution of clinical symptoms of depression and health status outcomes; and e) patient satisfaction; (2) Estimate the economic consequences (e.g., utilization of health resources, work functioning) and cost-effectiveness of the intervention. Consecutive patients (n=27,000) from 3 primary care practice settings will be screened. Patients meeting DSMIV criteria for major depression or dysthymia (n=710), based on a validated two-stage screening process, will be randomized to either an intervention or control group. Four pharmacists will participate in the primary care physicians' (PCP) care of each patient in the intervention group by: conducting an initial evaluation; following a standardized protocol to monitor drug therapy; assessing compliance and recommending strategies to correct non-compliant behavior, and educating and counseling patients about drug use. Patients in the control group will receive usual care from their PCP. All groups will be assessed at 3, 6, 12, and 18 months. By doing this study, we hope to elucidate whether participation of a clinical pharmacist in primary care treatment of depression improves the process of patient care, improves health outcomes and patient satisfaction, and decreases the economic costs of depression. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: INCREASING THE DETECTION OF MAJOR DEPRESSION--VIDAS Principal Investigator & Institution: Gonzalez, Gerardo M.; Professor; California State University San Marcos 820 W Los Vallecitos Blvd San Marcos, CA 92069 Timing: Fiscal Year 2001 Summary: The specific aims of this project are: 1. To develop a innovative computerassisted voice-interactive screener for accurately detecting major depression in English and Spanish- speakers. 2. To enhance culturally-sensitive depression assessment which provides access to mental health services. 3. To provide a reliable and valid depression screening tool that promotes the prevention of depression. The investigators seek to develop a reliable, valid, and culturally-sensitive computer-assisted voice-interactive screening tool for accurately detecting major depression in English and Spanishspeakers. The investigators intend to design and evaluate an innovative application called the Voice- interactive Depression Assessment System (VIDAS). VIDAS will integrate state-of-the-art speech recognition digital voice analysis, and natural spoken language understanding to overcome the limitations of self-report screening. Computerized speech recognition can conduct a structured clinical interview by verbally presenting each item and recognizing the patient's spoken responses. Digital voice analysis can quantitatively measure the patient's voice characteristics (e.g. speech

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rate, loudness, and tone) to objectively assess the intensity of current depressive mood. Natural spoken language understanding can evaluate depression symptoms through analyses derived from patient speech patterns (e.g. reaction time and pauses). The investigators propose to enhance the early and accurate identification of depression by evaluating the verbal content, speech patterns, and voice characteristics of English and Spanish-speakers. The investigators also seek to broaden the research on culturallysensitive depression because of invalid English language assessment methods. Furthermore, VIDAS is not intended to replace mental health professionals, but will extend mental health services by providing a tool for assessing individuals who would otherwise continue to suffer or develop debilitating depressive disorders. Early detection will also promote access to English or Spanish language services for the prevention of major depression. Ultimately, the investigators' broad long- term objectives are to contribute to the reduction of inappropriate health care practices, undue costs associated with the misdiagnoses of depression, and the incidence and occurrence of depression. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: INFORMATION PROCESSING BIASES IN DEPRESSION Principal Investigator & Institution: Gotlib, Ian H.; Professor; Psychology; Stanford University Stanford, CA 94305 Timing: Fiscal Year 2001; Project Start 01-JAN-1999; Project End 31-DEC-2002 Summary: Depression is among the most prevalent of all psychiatric disorders, accounting for over 20 percent of economic costs for all mental illness. A great deal of theoretical attention has focused on the possibility that negative thinking might represent not only a feature of depression, but a vulnerability factor for this disorder as well. A recent influential research paradigm has operationalized depressotypic cognitions in terms of selective attention to, and memory for, negative emotional stimuli. The overall goal of the proposed investigations is to utilize this paradigm to investigate the role of cognitive biases in onset and course of depression, and to examine neurobiological foundations of cognitive biases in depression. Specific aims include (1) examining the utility of cognitive biases to predict the course of depressive symptoms and diagnostic status over a two-year period; (2) localizing the neurobiological underpinnings of these biases; and (3) examining the breadth of these biases and their specificity to depression. To achieve these aims, standardized cognitive informationprocessing tasks will be used to identify 30 "high-bias" and 30 "low- bias" depressed patients in psychiatric outpatient clinics. The nature and breadth of these biases in the depressed patients will be compared to cognitive biases among 30 patients diagnoses with generalized anxiety disorder, 30 patients diagnosed with social phobia, and 30 non-patient controls. Each depressed patient will be followed for one year, and the degree of cognitive biases will be reassessed when the patient achieves clinical remission. Hypotheses concerning the neurobiological underpinnings of depressotypic cognitive biases will be tested by conducting functional magnetic resonance imaging (MRI) of depressed (and later, remitted) patients while they are performing informationprocessing tasks. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: INSURANCE EFFECTS ON PRIMARY CARE FOR DEPRESSED PATIENTS Principal Investigator & Institution: Post, Edward P.; Medicine; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, PA 15260

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Timing: Fiscal Year 2001; Project Start 01-JUL-2001; Project End 30-JUN-2006 Summary: (Provided by applicant): This application's primary purpose is to provide the candidate with the means and mentorship to achieve the following goals: 1) Immediate goal: to characterize the effect of healthcare financing structure on utilization and quality of primary care services for patients with depression. 2) Long-term goals: to become an independent health services researcher, investigating policy-relevant questions about the effects of insurance structure on care for the chronically ill. The candidate will further develop and utilize research skills in health economics and psychiatric outcomes assessment; develop facility in techniques to analyze the effects of financial and organizational incentives; and acquire advanced training in quality of care measurement. He will master disease-specific skills in mental health services research by working on a multidisciplinary team studying a patient-oriented mental health intervention in a primary care setting. The career development program will incorporate formal coursework; tutorials and workshops with experts in specific methodological issues; site visits to major venues studying mental health services; and attendance and research presentations at local and national conferences. The major goal of the proposed research program is to characterize the effect of insurance structure on utilization and quality of primary care services for patients with depression. This goal will be accomplished through the planning, conduct, and analysis of a research project using data from a study that focuses on treatment for geriatric patients with depression. This study, a five-year multi-site NIMH-funded clinical intervention trial (Charles F. Reynolds, III, P.I., Prevention of Suicide in Older Primary Care: Patients [PROSPECT], is investigating strategies to improve depression treatment in primary care settings. The proposed K23 research will describe the effects of insurance structure on: individual patients' ambulatory service utilization, and the quality of care for depression. In addition, the research will assess the effect of insurance on the intervention to improve depression treatment in a primary care setting. Furthermore, this study will implement, collect, and predictably validate quality of care performance measures for several domains of depression management. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: INTERPERSONAL CONTEXT OF ADOLESCENT DEPRESSION Principal Investigator & Institution: Rudolph, Karen D.; Assistant Professor; Psychology; University of Illinois Urbana-Champaign Henry Administration Bldg Champaign, IL 61820 Timing: Fiscal Year 2001; Project Start 01-JUN-1999; Project End 31-MAY-2003 Summary: Despite recent widespread recognition of child depression as a valid and potentially debilitating clinical phenomenon, controversy remains as to the etiology, significance, and prognostic power of depression in childhood. The primary goal of the proposed research is to identify the antecedents and sequelae of depression during the early course of disorder. A particular focus is placed on understanding the rise in depression during adolescence, especially in girls. The model guiding the research posits that family dysfunction in the form of parental depression and lifetime family disruptions fosters the development of maladaptive conceptions of interpersonal relationships and ineffective coping, which create a vulnerability to depression. Stressful circumstances, including the negotiation of normative developmental transitions, are hypothesized to activate this vulnerability, leading to depression during transition periods. Girls are expected to be most sensitive to these processes due to personal characteristics as well as the experience of unique challenges during adolescence. Finally, depression is expected to induce further psychosocial disruption,

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which increases the likelihood of persistence or recurrence of disorder across adolescence. This proposed multivariate model will be examined using a prospective, multi-informant, multi-method design. Subgroups of depressed, externalizing, and comparison children selected from a community sample will be followed over a period of 2 1/2 years to explore the social-cognitive, affective, interpersonal, and contextual processes underlying onset and recurrence of depression during the early course of disorder. Ultimately, it is anticipated that knowledge from such research can inform the creation of empirically based intervention programs designed to treat childhood-onset depression. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: LATE-LIFE DEPRESSION MASKED BY LOW SADNESS Principal Investigator & Institution: Francoeur, Richard B.; None; Columbia Univ New York Morningside 1210 Amsterdam Ave, Mc 2205 New York, NY 10027 Timing: Fiscal Year 2002; Project Start 01-JAN-2002; Project End 31-DEC-2003 Summary: (provided by applicant): Only ten percent of older adults with depression are estimated to receive treatment, in part due to low levels of detection by primary care clinicians. There is a growing body of evidence that depression among older adults may present in atypical ways, involving low levels of dysphoric mood, especially sadness. However, there has been little research to identify correlates or risk factors for these conditions of masked presentation. The compelling need for such research is suggested by recent findings that subclinical, intermediate-level symptoms of dysphoria which fail to meet DSMIV diagnostic criteria may be an important risk factor for future stroke episodes. The literature provides evidence that certain physiological conditions that occur with advancing age (vascular diseases, hypotension) are associated with three broad categories of "depression with low sadness": vascular depression, depression related to systolic hypotension, and depression related to diastolic hypotension. Psychosocial factors (chronic life stress, social isolation) are believed to influence expression of depressive symptoms, although it appears that the proposed study would be the first to investigate this. The proposed study is based upon a conceptual model of co-occurrence, or comorbidity, of different forms of "depression with low sadness" associated with underlying physiological conditions. The purpose of the proposed study is to investigate the etiology of these masked forms of depression with the aims of: 1) clarifying distinct patterns of items for depressed affect, low positive affect, and other depressive symptoms; and 2) identifying age-related and depression-specific correlates of these different patterns. A methodologically innovative use of latent trait analysis (MIMIC) will involve interactions between multiple covariates to model the endorsement of specific symptoms by well-focused subgroups, while simultaneously adjusting for the level of overall depression. The proposed study is based on secondary analysis of the first wave from the New Haven site of the EPESE community survey. The empirical model will be replicated on targeted sub-samples (i.e., blacks, white females, white males). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: LIFE STRESS AND COGNITIVE BIASES IN MAJOR DEPRESSION. Principal Investigator & Institution: Monroe, Scott M.; Professor; Psychology; University of Oregon Eugene, OR 97403 Timing: Fiscal Year 2001; Project Start 01-APR-2001; Project End 31-MAR-2005

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Summary: Depressed individuals have been found consistently to report a higher incidence of recent severe stress than nondepressed people. Further, compared with patients without a recent severe life event, depressed patients with severe stress may have more severe symptoms, a different clinical course, and different rates of remission. Collectively, these findings suggest that the presence of recent severe stress represents a marker of potentially important individual differences in depression. Because not all people who encounter severe stress develop depression, however, information on other risk factors is required to understand individual differences in vulnerability to depression in the face of life stress. The construct of cognitive biases has been prominent in major theories of depression, and has been postulated to be important in relation to life stress and depression. Despite the obvious relevance of research that integrates information across social (life stress) and psychological (cognitive) domains, such inquiry has proven difficult to undertake. The methodological intricacies within each domain present a number of practical and logistic obstacles. Moreover, there are conceptual difficulties that have hindered this integration. Longitudinal empirical work, guided by theoretical insights and based on state-of-the-art methods from each domain, is required to advance understanding of multifactorial, integrative research. The primary goal of the present project is to investigate life stress and cognitive information processing biases for depression within the conceptual scheme afforded by diathesisstress theory. The present research has three specific aims. First, we test the relationship between life stress and cognitive bias within a well-differentiated conceptual scheme afforded by diathesis-stress theory and informed by attention to the issue of etiologic heterogeneity of depression; state-of-the-art methods will be used to assess life stress and cognitive vulnerability. Second, we test the predictive utility of stress, cognitive bias, and their interaction for clinical features and treatment course of depression. Third, we test differential activation of cognitive biases in remitted depressives as a function of preonset life stress with a laboratory mood priming paradigm to address questions of cognitive vulnerability. Secondary aims include testing: (1) other forms of life stress in relation to cognitive vulnerability; (2) life stress measurement issues; and (3) associations between stress-cognition interactions and other clinically relevant (e.g., attrition, treatment-seeking, post-recovery course) phenomena. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: LIMBIC DOPAMINERGIC SYSTEM IN MAJOR DEPRESSION Principal Investigator & Institution: Ordway, Gregory A.; Associate Professor; Psychiatry and Human Behavior; University of Mississippi Medical Center 2500 N State St Jackson, MS 39216 Timing: Fiscal Year 2002; Project Start 14-DEC-2001; Project End 30-NOV-2005 Summary: A vast amount of research reveals that central dopamine (DA) containing systems are neuronal substrates of a broad spectrum of behaviors related to rewardseeking, motivation, and environmental responsivity. Disruption of these behaviors leads to anhedonia, social isolation, and psychomotor retardation that form core symptoms of depression. While there is little debate for a critical role of limbic structures, e.g. amygdala, in the regulation of mood and affect, the role of limbic DA in the pathobiology of depressive illness is not known. Functional imaging studies report involvement of limbic structures in depression, but few have focused on dopaminergic indices. Furthermore, there is a paucity of neurochemical studies of depression that have utilized postmortem brain tissue. Studies using postmortem brain tissue offer much higher anatomical resolution than it is offered by functional imaging. In preliminary studies, we have found lower dopamine transporter (DAT) and up-

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regulation of D2 receptors in the basal and central nuclei of the amygdala, but not in the other nuclei of this complex region, in major depression as compared to psychiatrically normal controls. These and other findings compel us to examine the possibility that there is diminished DA neurotransmission in subjects diagnosed with major depression (who died of suicide or natural causes). The central hypothesis of this proposal is that subjects with major depression have diminished mesolimbic DA activity that can be revealed by neurochemical abnormalities in discrete regions of the mesolimbic dopaminergic system. These neurochemical measures will be performed in discrete regions of the amygdala, (Aim 1), in the nucleus accumbens (Aim 2), and in the ventral tegmental area (VTA, Aim 3), core limbic regions of the brain. We also hypothesize that a distinct constellation of neurochemical abnormalities within limbic structures is specific for major depression (Aim 4), and will differentiate the pathobiology of major depression from that of suicide or schizophrenia. Groups of subjects to be studied will be: a) subjects with major depression who committed suicide, b) subjects with major depression not dying by suicide, c) sudden death non-psychiatric controls, and d) schizophrenics not dying by suicide. The proposed research will be the first focused investigation of potential abnormalities of limbic DA in major depression utilizing psychiatrically characterized subjects. The research will establish the specificity of neurochemical findings with respect to major depression and with respect to regional brain anatomy. Uncovering the potential role of DA in the pathobiology of depression may lead to advancements in the pharmacological, and possibly genetic, intervention of major depression. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MAJOR DEPRESSION FOLLOWING MINOR INJURY Principal Investigator & Institution: Richmond, Therese S.; None; University of Pennsylvania 3451 Walnut Street Philadelphia, PA 19104 Timing: Fiscal Year 2002; Project Start 01-APR-2002; Project End 31-MAR-2007 Summary: (provided by applicant): The cost of injury is considerable, estimated at $260 billion for fiscal year 1995. The primary costs are morbidity costs -- the value of goods and services not produced because of injury. Preliminary findings indicate that psychological distress is a significant predictor of post-injury disability and that symptoms of depression often accompany injury, appearing out of proportion to the severity of physical injury. The purpose of this study is to follow up on these findings, and in particular, to examine the public health impact of the development of major depression following minor injury. The majority of all injuries are minor, defined as injuries of sufficient import that individuals seek urgent medical care in an emergency department, but which do not threaten loss of life or limb. The primary aims of this study are to: determine the frequency of major depression (& related mood disorders) following minor physical injury; and determine the extent to which developing major depression (& related mood disorders) contribute to increased disability and reduced quality of life following minor physical injury. The secondary aims are to: compare the effect of developing depression and related psychiatric disorders (anxiety & stressrelated disorders) on outcomes following minor physical injury; and describe the onset and course of developing depression and related psychiatric disorders in the year following minor physical injury. 250 patients presenting to the emergency department at the Hospital of the University of Pennsylvania with minor injury will be enrolled. Minor injury will be defined by the Injury Severity Score for anatomic severity and the triageRevised Trauma Score for physiologic severity. Intake information includes injury data, pre-injury disability and quality of life. A comprehensive, structured psychiatric

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diagnostic evaluation will be conducted 72 hours after the minor injury has occurred, documenting psychiatric baseline (excluding patients with existing depression at time of injury or major DSM IV Axis I psychotic disorders). Participants will be followed by systematic, longitudinal follow-up evaluations (3, 6, & 12 months) to determine the development of major depression and its effect on post-injury disability and quality of life. The quasi-experimental design, in which each participant serves as his/her own control, will enable an accurate and comprehensive profile of developing major depression (and related mood disorders) following minor injury. Further, this design, using comprehensive psychiatric evaluation, will allow a critical analysis of the influence of major depression and related psychiatric disorders on outcomes following minor injury. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MARITAL ADJUSTMENT, DEPRESSION AND MYOCARDIAL INFARCTION Principal Investigator & Institution: Gallo, Linda C.; Psychology; San Diego State University 5250 Campanile Dr San Diego, CA 92182 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2004 Summary: (provided by applicant): Depression and Coronary Heart Disease (CHD) are each prevalent disorders, which frequently co-occur. Approximately 15-23% of individuals recovering from a heart attack (e.g., myocardial infarction; MI) will meet criteria for major depression and up to 65% will experience elevations in depressive symptoms. Yet, history of depression and disease severity are only moderately predictive of this co-morbidity. Importantly, depression is embedded within social context and, in particular, depression is strongly associated with marital adjustment. The primary goal of the current research is to examine if individuals with worse marital adjustment experience higher levels and a more persistent course of depressive symptoms following MI, in a 6-mo, 3-wave, prospective study of 150 men and women. Some research suggests that marital distress and depressive symptoms are more closely linked in women than in men. Therefore, the current research will examine if gender moderates the associations between marital adjustment and level and course of depression, with the hypothesis that associations will be stronger for women than for men. Previous research suggests that depression and possibly marital adjustment represent risk factors for negative physical health outcomes following MI. Further, when psychosocial risk factors occur in combination, the probability of negative outcomes is likely to increase substantially due to additive or synergistic effects. A secondary goal of the study will therefore be to examine the joint and independent effects of depression and marital adjustment on quality of life, functional status, and the probability of recurrent events following Ml. Women may experience worse outcomes following MI, and psychosocial factors could contribute to this trend. The proposed research will therefore examine if gender moderates the relationships between depression, marital adjustment, and health outcomes following CHD, with the hypothesis that effects will be stronger for women than for men. The broader goal of the proposed research is to identify aspects of social functioning that could represent potent, modifiable risk factors for CHD and depression co-morbidity, in the hopes of informing more effective prevention and intervention efforts. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MATERNAL DEPRESSION: AN ADVERSE EVENT FOR INFANTS Principal Investigator & Institution: Goodman, Mark M.; Professor of Radiology; Emory University 1784 North Decatur Road Atlanta, GA 30322 Timing: Fiscal Year 2001 Summary: It is now well established that the children of depressed mothers are at increased risk for depression and other psychiatric disorders. The present proposal, the second of the two clinical projects on the CCNMD proposal, takes advantage of these previous clinical observations and scrutinizes the children of mothers who suffer depression during pregnancy or in the puerpurium. We propose to conduct the first longitudinal study of children whose mothers experienced at least one episode of major depression prior to pregnancy, thus placing the children at risk for exposure to depression in pregnancy or during the postpartum period. We propose to obtain behavioral, neurophysiological, neuroendocrine, and neuroimaging measures. Specifically we will test whether fetal exposure to maternal neuroendocrine dysregulation associated with depression, e.g., elevated cortisol, alters infant behavioral and/or endocrine responsiveness. Maternal blood samples will be obtained throughout pregnancy and maternal and umbilical cord blood will be obtained at birth. Subsequent infant measures including salivary cortisol, EEG, heart rate variability, as well as measures of maternal-infant interaction will permit us to test the potential contribution of maternal depressed affect on infant development. The data collected will allow for testing of hypotheses related to maternal depression during pregnancy as an early prenatal stressor and depression postpartum as a neonatal stressor with the resultant novel data on critical periods, severity of maternal depression and its impact on the fetus, as well as the role of genetic factors (family history and genetic analyses). In addition, potential ethnic differences between African-Americans and European Americans will be assessed. Taken together, this study will provide novel behavioral and neuroendocrinological information of the impact of maternal depression in children from birth to one year of age. This project is complementary to the other clinical project (Project 7) on the effects of early life stress on psychiatric and HPA function in adult women, has specific links to the basic science aspects of the proposed Center- through Project 2 and the Functional Brain Imaging Core, and utilizes multiple resources available in the CCNMD. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MECHANISMS LINKING DEPRESSION TO CARDIOVASCULAR RISK Principal Investigator & Institution: Vaccarino, Viola V.; Assistant Professor; Medicine; Emory University 1784 North Decatur Road Atlanta, GA 30322 Timing: Fiscal Year 2001; Project Start 01-JUN-2001; Project End 31-MAY-2006 Summary: (adapted from Investigator's abstract) Although several epidemiological studies pointed out an association between depression and increased risk for cardiovascular (CVD) events, little is known about the mechanisms for this effect. The broad objective of this project is to clarify the role of depression on CVD risk by studying the effects of depression on the cardiovascular system. Using a co-twin study design, 150 monozygotic and dizygotic twin pairs discordant for lifetime diagnosis of major depression drawn from a large national twin registery, the Vietnam Era Twin (VET) Registry will be enrolled. Twin pairs will be compared for 2 indices of altered cardiac function: a) decreased coronary flow reserve, a sensitive indicator of early coronary artery disease, assessed by Positron Emission Tomography (PET) myocardial

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perfusion imaging; and b) decreased heart rate variability, a risk factor for coronary arrhythmias and sudden death, assessed by means of ambulatory electrocardiographic (Holter) monitoring. Since twins share genetic makeup (which is identical if they are monozygotic) and rearing environment while growing up, they are matched on numerous known and unknown potentially confounding factors. Another aim of this project is to determine the relative contributions of genetic and environmental factors (such as life stressors) in the association between depression and abnormal cardiac function, by comparing the size of the intra-pair difference in cardiac parameters between depression-discordant twins. Twin pairs who are free of CVD and discordant for lifetime depression in previous surveys of the VET registry, will be invited to participate. Participants will travel to our institution in order to undergo confirmation of depression diagnosis by means of the Structured Clinical Interview for DSM-IV (SCID), PET myocardial imaging, and 24-hour Holter monitoring. Blood will also be drawn in order to investigate the role of biological mediators such as increase in hypothalamicpituitary-adrenocortical and sympathomedullary activity. Besides extending our knowledge of the mechanisms linking depression to CVD risk, the findings of this project will help in the design of more effective approaches to the primary prevention of CVD. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MECHANISMS OF DEPRESSION AND CARDIOVASCULAR PATHOLOGY Principal Investigator & Institution: Grippo, Angela J.; Psychology; University of Iowa Iowa City, IA 52242 Timing: Fiscal Year 2002; Project Start 01-APR-2002 Summary: (provided by applicant): This research proposal addresses physiological mechanisms and processes underlying the association between depression and cardiovascular disease. Human studies demonstrate a strong link between depression and coronary artery disease but have not progressed beyond correlational methods. The current proposal will examine the underlying mechanisms in depression and cardiovascular pathology by using a rodent model of depression (chronic mild stress) and a combination of behavioral, physiological, and pharmacological techniques. Rats will be exposed to chronic mild stress to induce the depression-associated sign of anhedonia (a reduced capacity to experience pleasure), and tested for cardiovascular impairments (Aim 1). Autonomic nervous system imbalance will be examined as a mechanism for the cardiovascular dysfunction (e.g., elevated heart rate and reduced heart rate variability) associated with the chronic mild stress model (Aim 2). In addition, central serotonin activity will be examined as a common pathophysiological factor underlying both depression and cardiovascular/autonomic dysfunction (Aim 3). This research will extend our knowledge of the interactions between psychological and physiological conditions, and possibly prompt the development of new treatments for patients with depression and/or cardiovascular disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MEN AND DEPRESSION Principal Investigator & Institution: Watts, H G.; Vice President; State of the Art, Inc. 4455 Connecticut Ave Nw, Ste B-2 Washington, DC 20008 Timing: Fiscal Year 2002; Project Start 13-SEP-2002; Project End 31-AUG-2003

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Summary: (provided by applicant): The proposed is a multi-media campaign for men with depression, using documentary video, print, and Internet. Campaign targets men with diagnosed or undiagnosed depression, and their significant referents. The project aims to: increase knowledge about depression in men; destigmatize depression; and promote professional diagnosis and treatment. There is a special emphasis on depression in men of color. In Phase I, we interview experts (including our Advisors), men with depression, and referents. We analyze interview content and generate creative plans for a video and companion booklet, and a web module prototype. Advisors review creative plans and prototype, which are revised, then qualitatively and quantitatively tested. Focus groups test validity of content in creative plans and prototype. Testing ensures materials meet the informational, motivational, and supportive needs of men with/at risk for depression, and their significant referents. In Phase II, we will fully produce the video, booklet, and interactive web module based on concepts validated in Phase I. This package is unique in that it examines men's experience of depression with modeling and interactive content. Documentary profiles model seeking professional diagnosis and treatment, web module engages user for education and motivation. The completed documentary video, booklet, and interactive web module will be distributed through counselors, physicians, therapists, clinic, other health professional, and organizations that serve people with depression, as well as Internet health website, and corporate Intranets. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MENTORED DEVELOPMENT AW

PATIENT

ORIENTED

RESEARCH

CAREER

Principal Investigator & Institution: Garlow, Stepheng J.; Psychiatry and Behavioral Scis; Emory University 1784 North Decatur Road Atlanta, GA 30322 Timing: Fiscal Year 2001; Project Start 01-MAY-2000; Project End 30-APR-2005 Summary: PROPOSAL (Adapted from the applicant's abstract): Major depression is a significant independent risk factor for the development of ischemic heart disease and is a potentially lethal comorbid condition in post-myocardial infarction patients. The pathophysiology that links major depression to the occurrence of heart disease is not known. Preliminary observations indicate that platelet reactivity is increased in depression, which implies that depressed patients may be prone to thrombus formation, hence at increased risk for catastrophic cardiac events. There are considerable data indicating that the serotonergic system is altered in depression, both in the central nervous system (CNS) and in the platelets. In the periphery, the most notable and consistently replicated observation of serotonergic alteration is an increased B max for the serotonin-2A (5-HT2A) receptor on the platelets of depressed individuals. The platelet 5-HT2A receptor plays a central role in platelet reactivity and thrombus formation, and may be involved in regulating the expression of platelet specific genes in megakaryocytes, the cells from which platelets are derived. While not tested directly, the overarching hypothesis for this proposal is that major depression adversely increases platelet reactivity, which leads to increased risk of developing heart disease. The principal hypotheses that will be tested are that: 1) Platelets from depressed patients are produced in a "upregulated" state, with increased amounts of a number of transcripts that encode platelet specific genes, the result being the platelets are more reactive and prone to thrombus formation. 2) The platelet serotonergic system, in particular the 5-HT2A receptor, is altered in depression which in turn contributes to the increased platelet reactivity observed in depression, and the relevant alteration may occur in the megakaryocytes. 3) Alterations in the concentration of one or more humoral

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factors (interleukins, cytokines, stress hormones) orchestrate the alterations in platelet reactivity and serotonergic functioning observed in depression. Patients suffering from major depression will be recruited and their condition treated. Their platelets will be sampled before and after treatment and the amounts of transcripts that encode platelet reactivity molecules will be measured. The circulating concentration of three hormones, cortisol, interleukin-1 and interleukin-6 will be measured before and after treatment, and correlated to platelet reactivity. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MORPHOLOGIC/NEUROCHEMICAL DEPRESSION IN AD

CORRELATES

OF

Principal Investigator & Institution: Zubenko, George S.; Professor; Psychiatry; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, PA 15260 Timing: Fiscal Year 2001; Project Start 30-SEP-1992; Project End 31-JUL-2003 Summary: (applicant's abstract): Emerging clinicopathological studies of major depression in Alzheimer's disease (AD+D) suggest that the development of this behavioral complication of AD is associated with degeneration of the brainstem aminergic nuclei and the relative preservation of the cholinergic bnM. The neuropathologic and related neurochemical correlates of AD+D appear to be relatively specific for this condition, and may explain aspects of the course and treatment responsiveness of major depression in this context. Family histories of major depression may also be more common for AD+D patients, suggesting an interaction between a preexisting familial vulnerability and key neurodegenerative events in the pathogenesis of AD+D. The Lewy body variant (ADLBV) has been reported to be accompanied by more aggressive degeneration of the brainstem aminergic nuclei and a higher prevalence of major depression than AD alone. If confirmed, the latter observations would strengthen the relationship of degeneration of the brainstem aminergic nuclei to the development of AD+D. We propose to continue our clinicopathologic studies of these relationships and to evaluate their generalizability using autopsy-confirmed AD/ADLBV cases and controls who were prospectively characterized by a consortium of four NIA-funded ADCs/ADRCs. Moreover. we will test the hypothesis that the severity/ chronicity of major depression in AD is correlated with the extent of degeneration of the brainstem aminergic nuclei. To assess the specificity of these findings for depression, we will also explore the morphologic and neurochemical correlates of psychosis and other behavioral abnormalities in AD. In addition to family history studies we will determine whether the emergence of AD+D is influenced by the APOE genotype of AD patients. We will also continue our investigation of the role of apoptosis in neuronal loss from the brainstem aminergic nuclei in AD. Our data suggest that AD+D patients have increased susceptibility to neuronal loss in the LC (and possibly the DR and SN) due to increased vulnerability of these cells to apoptosis. We hypothesize that this enhanced vulnerability to apoptotic cell death results from a reduction in cellular protective mechanisms as reflected by a reduced proportion of neurons that manifest the upregulation of Bcl-2. The long-term goals of the proposed research plan are to better define the biological substrates of AD+D, to facilitate the development of more effective treatments, and to provide additional insight into the clinical biology of depression in the elderly. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: NEGATIVE COGNITION DEPRESSION: ETIOLOGY AND COURSE Principal Investigator & Institution: Abramson, Lyn Y.; Professor; Psychology; University of Wisconsin Madison 750 University Ave Madison, WI 53706 Timing: Fiscal Year 2002; Project Start 01-AUG-1990; Project End 31-DEC-2003 Summary: (provided by applicant): This competing continuation is part of a 2-site collaborative research grant with an identical application submitted concurrently by Dr. Lauren B. Alloy at Temple University. Prior research did not provide an adequate test of the hopelessness theory (HT) and Beck's theory (BT) of depression and may have been misleading about those cognitive theories' validity. Thus, the overarching goal of this project is to provide a more powerful test of HT's and BT's predictions about the etiology of depression and a validation of the Hopelessness Depression subtype. To this end, a large scale, 5.5-year prospective study was conducted at both sites. Initially nondepressed, non-psychopathological Ss (n=349) who were at either high or low cognitive risk for depression were followed prospectively with independent and blind self-report and interview assessments of stressful life events, cognitions, social support, coping, and psychiatric status/symptoms in order to predict onsets and subsequent recurrences of depression. Familial and developmental origins of cognitive vulnerability to depression also were examined, including assessment of the parents (n=335) of highrisk and low-risk Ss. In this renewal, differential predictors of first onsets vs. recurrences of depression, factors that increase resilience among high-risk Ss and promote depression among low-risk Ss, factors that contribute to and moderate change in cognitive vulnerability, and different models of cognitive vulnerability-stress relations also were investigated. This project contributes to: 1) the scientific understanding of the etiology and course of a subset of the mood disorders; 2) a more valid nosologv of the depressive disorders; 3) an understanding of the origins and continuity/change of cognitive vulnerability to depression; 4) an understanding of factors that promote resilience to depression; and 5) the development of interventions for treating and preventing depression. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: NEGATIVE COGNITION DEPRESSION: ETIOLOGY AND COURSE Principal Investigator & Institution: Alloy, Lauren B.; Professor; Psychology; Temple University 406 Usb, 083-45 Philadelphia, PA 19122 Timing: Fiscal Year 2002; Project Start 01-SEP-1990; Project End 31-DEC-2003 Summary: This competing continuation is part of a 2-site collaborative research grant with an identical application submitted concurrently by Dr. Lyn Y. Abramson at the University of Wisconsin. Prior research did not provide an adequate test of the hopelessness theory (HT) and Beck's theory (BT) of depression and may have been misleading about those cognitive theories' validity. Thus, the overarching goal of this project is to provide a more powerful test of HT's and BT's predictions about the etiology of depression and a validation of the Hopelessness Depression subtype. To this end, a large scale, 5.5-year prospective study was conducted at both sites. Initially nondepressed, non-psychopathological Ss (n=349) who were at either high or low cognitive risk for depression were followed prospectively with independent and blind self-report and interview assessments of stressful life events, cognitions, social support, coping, and psychiatric status/symptoms in order to predict onsets and subsequent recurrences of depression. Familial and developmental origins of cognitive vulnerability to depression were also examined, including assessment of the parents(n=335) of highrisk and low-risk Ss. In this renewal, differential predictors of first onsets vs. recurrences

114 Depression

of depression, factors that increase resilience among high-risk Ss and promote depression among low-risk Ss, factors that mediate and moderate change in cognitive vulnerability, and different models of cognitive vulnerability-stress relations are also investigated. This project contributes to: 1) the scientific understanding of the etiology and course of a subset of the mood disorders; 2) a more valid nosology of the depressive disorders; 3) an understanding of the origins and continuity/change of cognitive vulnerability to depression; 4) an understanding of factors that promote resilience to depression; and 5) the development of interventions for treating and preventing depression. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NET - SELECTIVE LIGANDS FOR THE TREATMENT OF DEPRESSION Principal Investigator & Institution: Johnson, Kenneth M.; Professor; Acenta Discovery, Inc. 9030 S Rita Rd, Ste 300 Tucson, AZ 85717 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-AUG-2005 Summary: (provided by applicant): World-wide public health surveys point to an increased global health burden for serious psychiatric disorders, particularly depression. Indeed, by 2020 it is expected that depression may be the second most serious medical condition with respect to global disease burden. It is clear that more effective pharmacotherapies are needed in treating depressive illness. Selective ligands for the norepinephrine transporter (NET) such as desipramine are quite effective in some patient populations, but their use is often limited by side effects, particularly those thought to be mediated by their anticholinergic properties. More selective NET ligands may have considerable application in the treatment of depression. However, currently there are very few NET-selective ligands available. The studies described in this research proposal involve the synthesis and pharmacological evaluation of novel conformationally constrained tricyclic tropane analogues that are designed to be potent NET-selective inhibitors. For the best NET inhibitors identified, we will then screen them in animal models of depression. Additionally, it is reasonable that such ligands could be utilized with positron emission tomography (PET) imaging to assess changes in noradrenergic terminal fields in a variety of human conditions including depression. Thus, these ligands could be a significant addition to the clinical armamentarium available to treat and diagnose psychiatric disease. Within the context of this grant, it is our intention to follow up on our exciting preliminary findings of potent NET-selective compounds by conducting the following studies: 1. Further elaborate the biaryl and thienyl series of conformationally constrained tricyclic tropane analogues based on the SAR information already in hand; 2. Investigate certain phenylacetylene analogues that are derived from our biaryl analogues by the replacement of Ar1 with a triple bond as an aromatic ring bioisostere.; 3. Assay the inhibitory activity of all new ligands at the NET, SERT, DAT and the muscarinic receptor; 4. Scale up the synthesis of the most drug-like NET-inhibitors and study these in animal models of depression. Key words: depression, norepinephrine transporter (NET) inhibitors, conformationally constrained tricyclic tropanes, pharmacotherapy, PET imaging, chemical synthesis, behavioral testing. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: NEUROANATOMY PROCESSING IN DEPRESSION

OF

COGNITIVE

AND

EMOTIONAL

Principal Investigator & Institution: Mccarthy, Gregory; Professor and Director; Duke University Durham, NC 27706 Timing: Fiscal Year 2001; Project Start 01-SEP-2001; Project End 31-JUL-2006 Summary: (provided by applicant): The goal of this project is to investigate the functional neuroanatomy of cognitive and emotional processing in humans as it relates to late life depression. This Center has proposed a cerebrovascular lesion model in which small vascular lesions within prefrontal cortex, basal ganglia, and related structures lead to the development of late life depression [1,2]. Here we propose to use functional magnetic resonance imaging (fMRI) supplemented by psychophysiological recording to investigate prefrontal cortical function in emotional regulation during depression. We have adopted as our framework Mayberg?s model delineating the role of prefrontal cortex in depression [3]. Mayberg proposed that three brain systems comprise the neurological substrate of depression: (1) a dorsal attention-cognitive system composed of dorsolateral prefrontal cortex (PFC) (Brodmann areas, BA 9/46,44), the anterior cingulate (BA 24), and inferior parietal cortex (BA 40), (2) a ventral vegetative-somatic system composed of ventral frontal (BA 47) cortex, the amygdala, hippocampus, subgenual cingulate (BA 25), and ventral insula and (3) a rostral cingulate region (BA 24) that integrates the dorsal and ventral systems. A reciprocal relationship between the dorsal and ventral system is believed to regulate mood. Sadness and depression are associated with decreased activity in the dorsal system and increased activity in the ventral system. Remission of depression reverses these relationships. We will test this model in the context of the vascular lesion model proposed above. There are four specific aims: (1) we will investigate the interplay between dorsal and ventral brain systems in-patients with late life depression and MRI-verified prefrontal lesions, and in age-matched controls with no lesions or depression. We will use a target detection task to engage dorsolateral prefrontal cortex with embedded task-irrelevant neutral and emotional distracters to engage ventral prefrontal cortex and the amygdala. (2) We will compare the pattern of functional activation found in patients with late life depression and prefrontal lesions with age-matched controls who have had a sad mood induced by an experimental Relived Emotion procedure. (3) We will compare the pattern of functional activation found in patients with late life depression and prefrontal lesions after treatment. (4) We will investigate the time course of habituation for stimuli with emotional valence and the salience for conditioned emotional stimuli using fMRI supplemented by psychophysiological measurement. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NEUROBIOLOGICAL BASIS OF DEPRESSION AFTER BRAIN DAMAGE Principal Investigator & Institution: Solodkin, Ana; Neurology; University of Chicago 5801 S Ellis Ave Chicago, IL 60637 Timing: Fiscal Year 2001; Project Start 15-SEP-1999; Project End 31-AUG-2004 Summary: Depression is a serious complication of structural brain injury, and can severely impair physical and cognitive recovery. Of the three million stroke survivors living in the US, more than 65 percent of them will suffer clinical symptoms of depression. Many of these cases can be directly attributable to the stroke, making poststroke depression a serious health problem. The specific aim of this proposal is to study the biological bases of depression as revealed through patients recovering from

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ischemic focal brain injury. These studies of depression will focus on its effects on motor system plasticity after middle cerebral artery infarction. We will test the following hypotheses: Motor cortices in clinically depressed subjects will present neurochemical changes in monoaminergic systems (Serotonin, dopamine and noradrenaline). Recovery of motor skills after frontal ischemic stroke depends on the anatomical reorganization of ipsilateral frontal regions adjacent to the infarcted area, and these anatomical changes will be more pronounced in individuals without depression when compared to cases with post-stroke depression. Functional neuroimaging will corroborate the anatomical findings, demonstrating poorer anatomical recovery in depressed patients than in those without depression. Areas underlying functional recovery as seen with fMRI will show the greatest degree of anatomical reorganization when assessed with direct anatomical methods in non-depressed cases compared to depressed ones. The overriding goal of this research is to investigate the neuroanatomical and neuropharmacological differences between depressed and non-depressed patients following focal ishemic brain damage, and to correlate the findings from studies of autopsy tissue with neuroimaging studies using functional magnetic resonance imaging (fMRI). Since combining both methods will limit the number of cases, in parallel, we will perform the same neuroantomical studies in post-mortem tissue with damage in the equivalent areas (but without fMRI assessment). The detection of the changes in cellular circuitry during recovery in groups with and without post-stroke depression will allow us to understand better the neurobiological substrate of this disorder. In the long run, this information may lead to novel pharmacological treatments in both depression and stroke, but most importantly, in those cases where depression is a concomitant of structural brain injury. At the same time, the current research aims to give the principal investigator necessary mentored experience to achieve independence in biological psychiatry research. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DISORDERS

NEUROBIOLOGICAL

PREDICTORS

OF

STRESS-RELATED

Principal Investigator & Institution: Liberzon, Israel; Associate Professor; Psychiatry; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, MI 481091274 Timing: Fiscal Year 2002; Project Start 05-JUL-2002; Project End 30-JUN-2007 Summary: (provided by applicant): Stress-related psychiatric disorders in general, and post-operative depression in particular, constitute a major challenge. Depression, anxiety and post-traumatic stress disorder (PTSD) often develop after various stressors like surgery, serious illnesses, motor vehicle accidents, and natural disasters, and vulnerability factors are likely shared by these disorders. Distinct profiles of hypothalamo-pituitary - adrenal (HPA) abnormalities, are well-established in depression and PTSD, but those alterations which are pre-existing, those which are a response to stress/trauma, and those which are a component of the active illness, remain to be identified. Only prospective study of markers prior to a predictable stressful event will be able to address this question effectively and clarify the role of a neuroendocrine response to stress in the this process prospectively. Studying candidate markers of susceptibility in subjects who undergo a predictable stressful event, such as major surgery, will be important not only for study of post-operative depression but also for study of stress-related disorders in general. Our hypothesis is that postoperative depression develops in patients with pre-stress alteration of neuroendocrine function in concert with specific premorbid risk factors. Our pilot findings suggest that major

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abdominal surgery constitutes a predictable stressful event leading to a de novo depression in a subgroup of postoperative patients. Therefore, we will test the hypothesis that pre-stress markers of HPA axis and catecholaminergic system will predict the development of depressive disorder following predictable stress of abdominal surgery. We predict that hypercortisolemia and DST non-suppression will predict depression. A cohort of 2lO patients undergoing elective endovascular or abdominal aortic operation for aneurysmal or occlusive disease and 70 "control" patients with aortic disease treated conservatively will be studied (4 groups). Surgical patients will be assessed preoperatively, and at three times postoperatively (3, 9, and 18 mo.) to document preoperative and postoperative neuroendocrine function and psychiatric morbidity. Control patients will be assessed to determine frequency of spontaneous onset of psychiatric abnormalities. Using mixed model regression, we will examine the role of psychological and neuroendocrine abnormalities in post-operative depression and determine the stability of specific factors (neuroendocrine measures, psychiatric symptoms and diagnoses) and whether they reliably predict the development of comorbid disorders postoperatively. We will also determine if the ability to terminate neuroendocrine stress response after surgery or in response to dexamethasone predicts outcome, and if this is linked to pre-stress abnormalities. Identification of pre-stress markers of vulnerability clearly has profound implications for our understanding of stress-related dysfunction, the pathophysiology of psychiatric disorders. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NEUROIMAGING IN DEPRESSION TREATMENT STUDIES Principal Investigator & Institution: Sheline, Yvette I.; Associate Professor; Psychiatry; Washington University Lindell and Skinker Blvd St. Louis, MO 63130 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2007 Description (provided by applicant): This K24 Midcareer Investigator Award in PatientOriented Research will provide five years of support to enhance a program of research and mentoring for the applicant in Neuroimaging in Depression Treatment Studies. The treatment of major depression in late life is an important health problem with a large and growing number of affected individuals. Many investigators have found that patients with late-onset depression, particularly those with cerebrovascular disease risk factors (VRF), are likely to have a slower and less complete response to antidepressant treatment. It has been proposed VRF may predispose to occult cerebrovascular disease in the form of frontal cortex deep white matter hyperintensities (FDWMH) and subcortical gray matter hyperintensities (SCGMH), collectively referred to as T2H. This may contribute to the development of late life depression by interrupting pathways involved in mood regulation. The overall goals of the applicant's research are 1) to continue the transition from cross-sectional studies to treatment outcome studies investigating brain pathophysiological factors that predict treatment outcome and 2) to train junior investigators from a range of clinical backgrounds in the design and conduct of neuroimaging studies in assessing treatment outcome of depression. The proposal describes the applicant's current research program and the career development and mentoring activities planned for the 5-year duration of the K24. Two NIH grants are ongoing: one will determine if severity of T2H and frontal executive dysfunction predict less antidepressant treatment response; the other will determine if late life depression is associated with abnormalities in 5-HT2A receptor regulation by antidepressants. Career development activities for the PI in MRI diffusion tensor imaging are described to further delineate the prognostic value of T2H and their ischemic nature and a third project is described to use these measures in longitudinal studies of white matter

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ischemic changes. Trainees will engage in these projects, take coursework in neuroimaging and clinical investigation and complete a research proposal over the 2year training period. K24 support will provide the applicant with protected time to carry out depression treatment outcome studies in late life depression and to increase the mentoring of beginning clinical investigators in neuroimaging studies in depression. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NICOTINE, BIOGENIC AMINES AND DEPRESSION Principal Investigator & Institution: Tizabi, Yousef; Howard University 2400 6Th St Nw Washington, DC 20059 Timing: Fiscal Year 2002; Project Start 01-JUN-1977; Project End 31-JUL-2006 Summary: Because of high incidence of cigarette smoking among depressed individuals, it has been postulated that smoking may reflect an attempt at self-medication with nicotine by these individuals. We have observed anti-depressant effects of nicotine in an animal model of depression. Moreover, the effects of nicotine can be blocked by preadministration of the nicotine antagonist, mecamylamine. There is also a differential expression of nicotinic receptors in depressed rat lines compared to their controls. These findings suggest a role for nicotinic receptors in depressed rat lines compared to their controls. These findings suggest a role for nicotinic receptors in depressive characteristics of animals. Nicotinic receptors are potent modulators of a variety of neurotransmitters including biogenic amines which have been directly implicated in human depression.. Although nicotinic manipulation may constitute a novel intervention in depressive disorders, a clearer understanding of the role of specific nicotinic receptors in depression is critical in developing pharmacotherapies for this devastating mental disorder. Here, we hypothesize that depression is associated with inherent changes in specific nicotinic and/or biogenic amine pathways. Furthermore, we postulate that nicotine would tend to normalize these neurotransmitter systems. These hypotheses will be tested in two rat models of depression by examining the role of nicotinic receptor subtypes as well as the contribution of selective dopaminergic noradrenergic and serotonergic pathways to depressive characteristics in these animals. Specifically, we will: 1) determine the effects of selective noradrenergic and serotonergic neurons in selective pathways implicated in mood regulation; 3) determine the basal function of biogenic amines in selective pathways; 4) determine the effects of nicotine functionality of these pathways; 5) determine central and peripheral bioavailability of nicotine. Behavioral analysis will include measurements of several parameters in the forced swim test as well as locomotor activity. Neuronal densities will be assessed by stereological technique. In-vivo microdialysis will be used to determine the functionality of the neurotransmitter systems. Plasma and brain nicotine and cotinine levels will be measured by gas chromatograph-mass spectrometry. The information provided by these studies will significantly advanced our understanding of biological substrates of depression and can lead to novel pharmacotherapies for this disorder. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ONCOLOGY DEPRESSION PROGRAM--LATINAS WITH CANCER Principal Investigator & Institution: Ell, Kathleen R.; None; University of Southern California 2250 Alcazar Street, Csc-219 Los Angeles, CA 90033 Timing: Fiscal Year 2001; Project Start 01-MAY-2001; Project End 30-APR-2003 Summary: (Provided by applicant): Despite the high incidence of depression among patients with cancer, detection and treatment of depression in oncology care is

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inadequate with negative effects on patient's functioning, symptoms, quality of life, and even survival. Hispanics under-utilize mental health services and have been underrepresented in depression treatment studies. We propose to conduct a phased developmental pilot study of a socioculturally compatible Multifaceted Oncology Depression Program (MODP). MODP is aimed at reducing symptoms and improving outcomes among Latinas with breast or cervical cancer, reducing demands on family caregivers, and assisting oncologists in caring for their patients. Thus, we aim to: 1) Adapt an existing collaborative care model used in primary care, implement the model, evaluate and further refine the model based on the pilot experience, and produce a detailed manual for use in a randomized trial; 2) determine what treatment is given and what outcomes are obtained with usual care for recognized depression in a separate open trial; 3) evaluate the MODP in an open trial to determine its acceptance by patients and oncologists, adherence, and the size and variability of change from baseline in the primary outcome measures: depressive symptoms, quality of life, and caregiver distress at 4 and 8 months follow-up; 4) estimate the proportion of oncology outpatients having major depression who would meet eligibility criteria for a randomized study; 5) evaluate the use of assessment and outcome measures including direct cost measures; and (6) determine what additional cultural adaptations are needed to optimize acceptance and outcomes of treatment for a low-income Hispanic patient population. The proposed study will address the following specific questions: (i) Can a collaborative model of depression care known to be effective in primary care be effectively adapted and implemented in specialty oncology care, and specifically among low-income Hispanic patients? (ii) What modifications in the intervention model are acceptable, feasible, and appropriate for oncology practice and for Hispanic women? (iii) By implementing enhanced depression management with socioculturally compatible interventions to reduce known barriers to Latinas' access to depression treatment, will recruitment, retention, follow-up, and outcomes of minority women be favorably affected versus modestly augmented usual care? (iv) What would be likely recruitment, necessary sample size and best measures for a randomized trial to compare the effectiveness of the MODP and usual care for patients with identified major depression? Two open trials (of usual care and MODP) will be carried out sequentially on 40 women (a total of 80 women). Women will be screened using the SCL-20 and diagnostically assessed using the PRIME-MD PHQ-9. In addition to screening and physician didactics, MODP intervention enhancements are: onsite case management services to reduce barriers to care; patient and family education on depression treatment; psychiatric consultation; and patient-oncologist shared decision-making in selecting medication treatment or cognitive-behavioral Problem-Solving Treatment. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ONLINE DEPRESSION EDUCATION FOR PRIMARY CARE PROVIDERS Principal Investigator & Institution: Tanner, T Bradley.; President; Clinical Tools, Inc. 431 W Franklin St, #30 Chapel Hill, NC 27516 Timing: Fiscal Year 2001; Project Start 22-SEP-1998; Project End 31-AUG-2003 Summary: Nineteen million adults suffer from depression and it is the leading cause of disability in the United States and a leading cause of suicide. Yet there is clear evidence that primary care physicians --those who treat the majority of depression cases are undertreating depression. During Phase I we developed and implemented a successful Internet based CME course on diagnosing depression. During Phase II we will create a complete continuing education program of 6 Internet-based courses on the topic of

120 Depression

depression diagnosis and treatment in the primary care setting. Courses will be approved by the University of Pittsburgh for CE credit and/or by the American Academy of Family Physicians. The Principal Investigator, Co-PI, and an esteemed group of depression and education consultants will apply an approach used in the development of other CE projects to expand upon the work done in Phase I. The Webbased courses will emphasize learning via a case-based approach. In addition, courses will be enhanced to include unique features possible with web-based courses including support for user control and feedback, discussion/communication, an accompanying news/resource area, patient education materials, and links to other information resources. A standard rapid-prototyping formative analysis technique will utilize consultation with and review by our consultant experts as well as input from potential end-users to produce successively improved versions of each course. If successful, this project will affect improved knowledge, attitude, depression clinical skills, self-efficacy, and awareness of resources. We will evaluate the benefits of the educational experience offered by the courses by using a two-group, pre-post testing design. Over a six-month period, the study group will be required to view all of the web-based courses. The control group will view courses of the same format that are on other clinical topics and do not include any information on depression. We will also assess overall user satisfaction with the online learning experience in terms of course elements, comparison to other learning experiences, and perceived impact. If the courses are successful, this project will produce a new means to educate physicians in depression diagnosis and treatment techniques. The methodology used in this research will serve as a template to guide other Investigators interested in developing other mental health continuing education materials. PROPOSED COMMERCIAL APPLICATION: NOT AVAILABLE Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ONTOGENY OF DEPRESSIVE SUBSTRATES Principal Investigator & Institution: Feng, Pingfu; Assistant Professor; Psychiatry and Behavioral Scis; Emory University 1784 North Decatur Road Atlanta, GA 30322 Timing: Fiscal Year 2001; Project Start 01-JUL-1998; Project End 30-JUN-2003 Summary: (Adapted from applicant's abstract): The long-term goal of the proposed work is to determine brain processes involved in the pathogenesis of endogenous depression (ED). In past work investigator found that if neonatal rats were treated with clomipramine (CLI) and other antidepressant drugs they developed signs of depression when they became adults. The investigator's current work concerns the brain substrates of the adult rat depression. The work proposed in this application concerns the processes between neonatal CLI administration and the adult depression. The investigator's question is: what neonatal effect of CLI leads to the adult depression? Evidence suggests that neonatal RSD by CLI (and other antidepressant drugs) produces the adult depression. The investigator has recently developed the first successful technique to produce long-term, instrumental REM sleep deprivation (IRSD). Using this technique, his main aim is to test the hypothesis that in rats neonatal RSD causes adult depression (RSD hypothesis). An unambiguous test of the RSD hypothesis requires that IRSD be administered to neonatal rats over the precise age period (critical period) of depressogenic CLI administration to other rats. The precise critical age period of CLI administration has not been determined. Thus, preliminary to the IRSD study, the investigator's first aim is to determine the precise critical neonatal age period of depressive CLI administration. Also an unambiguous test of the RSD hypothesis requires that IRSD achieve the same RSD as neonatal CLI. The level of RSD by CLI has not been precisely determined. Thus, preliminary to the IRSD study, the investigator's

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second aim is to determine the precise level of daily RSD produced by neonatal CLI during the prior established precise critical period of CLI administration. Using these 2 results, he will administer IRSD to test the RSD hypothesis. Several adult behavior and RS measures related to depression will be the outcome measures. Although it is known from brief (1-3 hour) samples that RS time decreases in the first postnatal month, very little is known about the ontogeny of other RS variables and the interrelationships of their developmental changes. The investigator has recently developed the first successful technique for continuous (24 hour/ day), long-term (weeks) polysomnographic (PSG) recording of sleep/wake states in neonatal rats. With this technique the investigator's preliminary evidence suggests that 7 different RS variables follow parallel developmental courses over postnatal weeks 2-4. Confirmation of this preliminary finding can: a) yield the first systematic data on the ontogeny of several different RS parameters; b) identify the RS markers of the critical period of depressive CLI administration; c) suggest by these RS markers and their known neurophysiology and neurochemistry testable hypotheses about the underlying processes involved in the ontogeny of depressive disposition. The significance of the proposed work is that it may shed light on early developmental processes that contribute to later depression and depressive temperament. In doing so, the proposed work may help in the search for early prevention of ED, and in more precisely targeted treatments of ED. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: OPIOID DEPRESSION OF RESPIRATORY NEURONS Principal Investigator & Institution: Lalley, Peter M.; Associate Professor; Physiology; University of Wisconsin Madison 750 University Ave Madison, WI 53706 Timing: Fiscal Year 2001; Project Start 15-JAN-2000; Project End 31-DEC-2003 Summary: (Adapted from the applicant's abstract): Opioid drugs are key adjuncts in the management of acute and chronic pain. However, they depress respiration in therapeutic doses, limiting their effectiveness, and cause fatal respiratory arrest in overdose. At present there is very little information about the cellular and neural network disturbances which underlie opioid respiratory depression. This in vivo investigation will identify mechanisms through which opioids disturb excitability and rhythm in several types of medullary respiratory neurons that control depth and rate of respiration. In adult decerebrate cats of either sex (1), Receptor-selective opioids will be pressure-microinjected into regions of the medulla which are known to influence depth and rate of respiration, and their effects on motor discharges in hypoglossal (HGN), recurrent laryngeal (RLN) and phrenic (PN) nerves will be measured. The results will reveal how these sites contribute to opioid depression of respiratory depth and rate, how they influence upper airway resistance in the presence of opioids, and the functional significance of different subtypes of opioid receptors. (2), Effects of opioids applied by microiontophoresis to medullary Inspiratory, Post-Inspiratory and Expiratory neurons will be measured and analyzed with intra- and extracellular recording methods. Responses related to specific subtypes of opioid receptor will be identified by applying receptor-selective agonists and antagonists to each type of neuron. This research will reveal how opioids and their receptors alter excitability in functionally important cell types and thus contribute to reductions in depth and rate of breathing. (3), A novel approach for reversing opioid-induced depression of the respiratory network based on activating D1-dopamine receptors on respiratory neurons to increase intracellular cyclic AMP will be investigated. In some experiments, A D1dopamine receptor agonist will be applied by microiontophoresis to respiratory neurons to determine whether it reverses opioid-evoked depression of cell excitability. In others,

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receptors on respiratory neurons and network interneurons will be activated by administering the D1-agonist intravenously, and its effectiveness will be judged from its ability to reverse depression of HGN, RLN and PN discharges produced by i.v. injections of opioids. This project will thus identify sites, cells and receptors in the medulla where endogenous opioids modulate respiration and where opiate drugs depress breathing. It will also test a new method that may alleviate opioid-induced depression of respiration without affecting analgesia, and counteract respiratory depression by overdose of opioids. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ORGANIZED SELF-MANAGEMENT SUPPORT FOR CHRONIC DEPRESSION Principal Investigator & Institution: Ludman, Evette J.; Center for Health Studies 1730 Minor Ave, Ste 1600 Seattle, WA 98101 Timing: Fiscal Year 2003; Project Start 01-JUL-2003; Project End 31-DEC-2005 Summary: (provided by applicant): Randomized effectiveness trials demonstrate that organized care programs can significantly improve the process and outcomes of acutephase depression treatment. This application aims to adapt and pilot test two Core elements of an organized care program (systematic telephone outreach and monitoring to improve quality and continuity of pharmacotherapy, and structured psychoeducational group programs focused on patient activation and self-management) in a population-based sample of patients with chronic or recurrent depression. Two forms of group self-management training will be evaluated: a Peer-Led Chronic Disease Self-Management Group (after that developed by Lorig and colleagues) and a TherapistLed Cognitive-Behavioral Therapy Group. Approximately 120 patients with chronic or recurrent depression will be randomly assigned to one of four conditions: 1) usual care; 2) phone care management; 3) phone care management plus peer-led self-management group; or 4) phone care management plus therapist-led CBT group. Blinded assessments will examine clinical outcomes (SCL depression score, depression diagnosis by SCID), functional outcomes (SF-36 Questionnaire, illness intrusiveness, disability/lost productivity), and process variables (self-efficacy for managing depression, use of coping strategies) over 12 months. If patients choose not to participate in treatment, reasons for dropout will be assessed. Computerized data systems and intervention time logs will assess quality of treatment received (prescriptions filled, visits made) as well as direct program costs. The data collected will provide: 1) an evaluation of the feasibility and acceptability (including recruitment, intervention uptake and continued participation) of the intervention programs; 2) preliminary evaluation of effectiveness, i.e., the effects of each intervention on patient outcomes and process of care; and 3) information to inform the design and implementation of a full-scale effectiveness trial (refinement of intervention programs and measurement strategy, necessary sample size). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: PARENTAL DEPRESSION AND INFANT DEVELOPMENT Principal Investigator & Institution: Lewinsohn, Peter M.; Research Scientist; Oregon Research Institute 1715 Franklin Blvd Eugene, OR 97403 Timing: Fiscal Year 2001; Project Start 10-APR-1997; Project End 31-MAR-2004 Summary: (Adapted from applicant's abstract): Research has demonstrated specific impairments in infants of depressed mothers, and in the interactions between these

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infants and their mothers. These impairments include developmental delay, deficits in infant affective and cognitive behavior, poor mother-child attunement, and psychophysiological abnormalities. The participants for this project will be drawn from males and females enrolled in the Oregon Adolescent Depression Project. Females from the sample who become pregnant during a three year recruitment period (n-126). These participants, their partners, and their infants will be assessed on four occasions over the first two years of the child's life. Assessments will include current and past psychopathology amongst the mothers and fathers, marital functioning and familial context, parenting behaviors, parental perceptions of the infant, and observational data pertaining to infant development. The infant will also be observed interacting with each parent in order to examine both parental and infant affect and responsiveness. The three specific aims are to examine: (1) the effect of different aspects of parental depression, including family and personal history of depression on the developmental of infants, (2) the specificity of the abovementioned impairments in infant development of depression, and (3) the role of fathers and the marital relationship in the development of impairments in infants. The results of this study will allow assessment of how history of depression (including family history) influences the development of infants, either through its influence on parental depression in the post-partum period, or as a trait marker that adversely affects parenting independent of current psychopathology. The second aim will be addressed by the inclusion of mothers and fathers with histories of psychiatric disorders other than depression, and the assessment of a wide variety of psychopathology in both. The third aim will be addressed by examination of levels of depression and other psychopathology in fathers, the marital relationship, and observation of their interactions with their child. The public health benefits of this study include knowledge about risk factors that can be used to identify children who are at especially elevated risk, and about specific parental behaviors which are involved in the transmission of risks. This information is important for the design of preventative interventions intended to reduce the deleterious effects of parental depression on children. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PARENTAL POSTPARTUM DEPRESSION & THE FAMILY SYSTEM Principal Investigator & Institution: Goodman, Janice H.; None; Boston College 140 Commonwealth Ave Newton, MA 02467 Timing: Fiscal Year 2001; Project Start 13-SEP-2001 Summary: (provided by applicant) Postpartum depression affects between 8 and 28 percent or new mothers, with up to 68 percent of new mothers experiencing some degree of depressive symptoms. New fathers also experience depression, especially if their partner is depressed, and postpartum depression is correlated with decreased marital satisfaction. Parent-infant interaction and attachment are major indicators of the quality of the infant?s nurturing environment. Postpartum depression has significant negative effects on mother-infant interaction and on child development. Little is known about how the infant is affected when a new father is depressed or when both parents are experiencing depressive symptoms. Also unknown is whether or not a nondepressed father may buffer the negative effects of a mother?s postpartum depression on the infant. Using a family systems framework, this study aims to explore the influences of maternal depressive symptoms, paternal depressive symptoms, quality of the couple relationship and parental dyad functioning on the parent-infant interaction and each parent?s attachment to the infant. A mixed-method triangulated design involving quantitative measures at 2 to 3 months postpartum, followed by in-depth

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qualitative interviews and quantitative measurements at 6 to 12 months with a purposive subset of study families will be used. Findings will be interpreted to increase understanding of how postpartum depressive symptoms impact the family, and a family systems model of postpartum depression will be generated. Knowledge gained from this study may be useful in developing nursing interventions that will promote optimal parent-infant relationships in the early postpartum months. This may be especially crucial to child development in families where early parenting is compromised by depression. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PARTNER PSYCHOPATHOLOGY

VIOLENCE

PREVENTION

&

ADOLESCENT

Principal Investigator & Institution: Ehrensaft, Miriam K.; Psychiatry; Columbia University Health Sciences New York, NY 10032 Timing: Fiscal Year 2001; Project Start 01-JUN-2000; Project End 31-MAY-2005 Summary: (adapted from candidate's abstract): This is a request for a Mentored Clinical Scientist Development Award (K08). The purpose of this application is to acquire training and prevention of partner violence in urban adolescents with conduct disorder and depression. Current research suggests that early antisocial behavior, and possibly depression may make unique and substantial contribution to the development of violence between adult romantic partners. Yet, questions remain regarding mechanisms by which these disorders may influence partner violence, especially in urban adolescents. Understanding these mechanisms can inform strategies to prevent partner violence in youth with conduct disorder or depression. The candidate is a clinical psychologist with expertise in adult partner violence and recent postdoctoral training in child psychiatry, especially the study of conduct disorder and depression. This proposal aims to acquire additional training needed for the comprehensive study of the prevention of partner violence in youth with conduct disorder and depression, including: 1) Longitudinal methodology and data analysis used to examine mechanisms mediating the association of conduct disorder, depression and partner violence; 2) Conducting clinical trials of violence prevention programs to target partner violence in conduct disordered and, possibly, mood disordered urban adolescents. Training will be provided via coursework at Columbia, formal tutorials, consultation with a panel of experts, work on longitudinal, epidemiological samples of adolescents, and a Phase I clinical trial of a multiphase prevention program for conduct disordered youth. This Phase I trial will be modified based on results of the longitudinal studies. Training obtained via this award will be used to apply for independent funding to design a controlled clinical trial of partner violence in youth with conduct problems and/or depression. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PATHOBIOLOGY OF HOPELESSNESS, DEPRESSION, SES AND CVD Principal Investigator & Institution: Everson, Susan A.; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, MI 481091274 Timing: Fiscal Year 2001 Summary: (adapted from investigator's abstract): High levels of depression and hopelessness increase risk of cardiovascular disease (CVD) morbidity and mortality. Likewise, CVD prevalence and incidence are inversely related to socioeconomic status

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(SES). Mechanisms by which depression, hopelessness, and low SES increase risk for CVD are not well understood; however, research shows that traditional coronary risk factors cannot account for much of the observed associations. Several studies indicate that depression and hopelessness are associated with abnormalities in serotonin (5HT) function and dysregulation of the hypothalamic-pituitary-adrenal axis, resulting in excess secretion of cortisol, an important stress hormone. Chronic stress exposure and higher levels of psychological stress associated with living in poor conditions also are thought to adversely influence 5HT and cortisol levels. Both 5HT and cortisol have cardiovascular effects and are involved in pathogenesis of CVD. However, to our knowledge, no prior population-based epidemiologic studies have examined whether serotonergic and glucocorticoid mechanisms mediate the well-documented associations between depression, hopelessness, low SES and atherosclerosis. The proposed study takes advantage of a unique opportunity to test these hypotheses within the context of the Kuopio Ischemic Heart Disease (KIHD) Risk Factor Study, the most comprehensive study of biopsychosocial risk factors for atherosclerosis and related morbidity and mortality ever to be conducted. The KIHD study is conducted in Kuopio, Finland, and has been at the forefront of research into psychosocial determinants of CVD. The proposed study will utilize existing data to examine plasma cortisol concentrations and whole blood 5HT and platelet 5HT receptor and transporter binding in relation to depression, hopelessness, SES and athersclerosis. Participants include a populationbased cohort of 800 men and 800 women aged 53-71. The investigators argue that depression, hopelessness, and low SES will be related to decreased levels of 5HT and elevated plasma cortisol; that both 5HT and cortisol will mediate the effects of depression, hopelessness, and low SES on carotid atherosclerosis; that these mediating effects will be evident after taking into account traditional risk factors (although the effects of cortisol also may operate through some of these risk factors); and that 5HT function will be lower in women compared to men. Depression and CVD are expected to be the two leading causes of disability in the next 20-25 years. Moreover, widespread economic disparities and associated health consequences are evident throughout the world. Thus, understanding mechanisms by which psychological states and SES are related to the development and progression of CVD is a critical task and one that will shed light on treatment and prevention strategies for patients with atherosclerotic vascular disease and for patients suffering from depression or hopelessness. Importantly, delineating the mechanisms by which psychosocial attributes influence atherosclerosis also will advance understanding of important mind-body interactions in cardiac disease processes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PATIENT CENTERED DEPRESSION CARE FOR AFRICANAMERICANS Principal Investigator & Institution: Cooper, Lisa A.; Medicine; Johns Hopkins University 3400 N Charles St Baltimore, MD 21218 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 29-SEP-2008 Summary: (Provided by the Applicant) Several studies document underutilization of outpatient specialty mental health services by African Americans. However, African Americans with depression are just as likely as whites to receive care in primary care settings. Despite their use of primary care services, African American patients are less likely than whites to be recognized as depressed, offered pharmacotherapy, and to initiate or complete pharmacotherapy or psychotherapy for depression. Compared to whites, African American patients express stronger preferences for counseling and more

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negative attitudes toward antidepressant medication, the most common form of treatment of depression used by primary care physicians. African Americans are also more likely to see depression and its treatment through a spiritual framework. Studies show that African Americans receive less optimal technical and interpersonal health care than whites for many conditions, including depression. Depression is a common chronic condition that results in substantial morbidity, functional disability, and resource use. Despite the proven efficacy of pharmacotherapy and psychotherapy for treatment of depression, many depressed primary care patients of all races and ethnicities still do not receive adequate treatment. Recent quality improvement trials for depression in primary care have shown improvements in outcomes; however, there is room for improvement, particularly for ethnic minority patients. Interventions focusing on patient-centeredness have documented benefits on patient adherence, patient satisfaction, and health outcomes. Yet, only a few recent quality improvement strategies for depression include patient-centered accommodations. We have created a patientcentered adaptation that includes many of the components of recent successful quality improvement interventions for depression in primary care. The proposed study compares a standard depression intervention for patients (delivered by a depression case manager) and physicians (review of guidelines and structured mental health consultation) to a patient-centered intervention for patients (incorporates patient activation, individual preferences, and cultural sensitivity) and physicians (incorporates participatory communication skills training with individualized feedback on interactive CD-ROM). Thirty physicians and 250 patients will be randomized to either the standard interventions or the culturally tailored interventions. The main hypothesis is that patients in the patient-centered, culturally tailored intervention group will have higher remission rates from depression and lower levels of depressive symptoms at 12 months than patients in the standard intervention care group. Secondary outcomes will include patient receipt of guideline concordant care, patient and physician satisfaction with care, patient-physician communication behaviors, patient and physician attitudes toward depression, and self-efficacy in managing depression. This study will add to knowledge about how to effectively engage African American patients in care of depression and serve as a prototype of how to incorporate patient-centeredness in programs to reduce racial and ethnic disparities in health care for common conditions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PATIENT DECISION MAKING ABOUT ANTIDEPRESSANT MEDICATION Principal Investigator & Institution: Wills, Celia E.; Associate Professor; None; Michigan State University 301 Administration Bldg East Lansing, MI 48824 Timing: Fiscal Year 2001; Project Start 15-JUN-2000; Project End 31-MAY-2005 Summary: (Applicant's abstract): The purpose of this application is to prepare the PI for an independent research career focused on primary care mental health services for depression. Depression is a highly prevalent primary care health problem with impact comparable to the burden of major medical illness, and is associated with high morbidity, mortality, diminished quality of life, and health services costs ($44 billion in 1990). Although effective depression treatments including medication are available, a majority of primary care patients who are prescribed antidepressant medication decide to either decline or discontinue medication soon after starting it. Little is known about how people make depression treatment decisions, including key influences on decision making and appropriateness of decision making as related to health status and health system outcomes. Research on patient decision making can provide information that is

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needed to develop patient-focused interventions to improve depression treatment outcomes. The aims of the proposed award are for the PI to: 1) develop knowledge of health services research concepts and methods for primary care and mental health services research; 2) develop and test measurement and analytic strategies for examining relationships between primary care patient decision making, antidepressant medication use, and health services outcomes; and 3) conduct two pilot studies as the basis for a R01 application to test a nurse-implemented patient decision support intervention for depression treatment in primary care. The PI will gain needed health services research skills to carry out these aims through a program of formal course work, directed study, and supervised research field experiences. The goal of research Project #1, a patient decision support intervention for primary care depression treatment will be pilot-tested for feasibility in research Project #2. The PI's long-term goal is to improve the quality of primary care services for depression through implementation of decision support interventions for diverse populations of patients undergoing depression treatment. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PATIENT FACTORS IN THE OUTCOME OF DEPRESSION IN PRIMARY Principal Investigator & Institution: Coyne, James C.; Professor; Psychiatry; University of Pennsylvania 3451 Walnut Street Philadelphia, PA 19104 Timing: Fiscal Year 2001; Project Start 01-AUG-2001; Project End 31-JUL-2005 Summary: This project examines the role of patient factors and treatment alliance (TA) in the outcome of depression in primary care. The overarching hypothesis is that patients' attitudes about depression, help-seeking, and antidepressant medication, and the quality of their social support influence the TA, treatment adherence, and ultimately the outcome of care for depression. The project involves a mixed method triangulation design in which patients newly identified as depressed are followed for a year with either a quantitative or qualitative methodology. Participating physicians will record all patients they detect as depressed. Following the index visit, patients will be given an initial telephone screening for eligibility. Patients who are deemed incident cases, i.e., who have not received treatment for depression in the previous 6 months, will be scheduled for a comprehensive telephone interview within 2 weeks. A smaller number of subjects will be selected for the qualitative component of the study via purposeful sampling. For the patients assigned to the quantitative arm of the study, this interview will include modules of the SCID and a standardized assessment of attitudes and experiences relevant to depression and its treatment. They will also be provided with a mailback questionnaire and will receive brief assessments at 6 weeks, and 3, 6, and 9 months. A final comprehensive interview and questionnaire at 12 months will reassess symptoms and diagnosis; attitudes, beliefs, and social support; the intervening experience of depression, its treatment and the TA. Relevant physician attitudes and treatment practices will be assessed before patient recruitment commences and at the completion of the study. Patients selected for the qualitative component will participate in unstructured interviews concerning the index encounter, relevant past experiences, and views of their physician, depression and the treatment being offered them, with reassessment at 6 and 12 months. At the end of the 12-month interview clinical diagnosis will be ascertained. Qualitative data analysis will be based on grounded theory methodology. This theoretical model will be compared (triangulated) with the longitudinal structural model developed in the quantitative phase of study. In this way, both quantitative and qualitative results and interpretations will inform an

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understanding of patient depression, adherence, and therapeutic alliance. Results of the project will highlight the need for continued efforts to change lay beliefs concerning the nature and treatment of depression. They will also demonstrate that primary care may not be the optimal setting for treating all patients, and explain why this is so. For the many patients who are treated in primary care, the project will contribute to the development of more collaborative, and, thus, more effective disease management by specifying the themes and barriers that should be addressed in tailored messaging, education, and other patient-oriented treatment strategies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PET MAPPING DEPRESSION/SUICIDE

OF

5HT

RECEPTOR

IN

MAJOR

Principal Investigator & Institution: Mann, J John.; Chief; New York State Psychiatric Institute 1051 Riverside Dr New York, NY 10032 Timing: Fiscal Year 2001 Summary: Project 3 will test with PET neuroreceptor imaging techniques one of the central theme of this center, i.e. that alterations in serotonin (5-HT) transmission in key brain regions confers vulnerability to suicidal attempts. Postmortem studies from our group suggest that decreased 5-HT transporters (SERT) and increased 5-HT1A receptor densities in the amygdala and the ventro-lateral portion of the orbitofrontal cortex might be associated with a vulnerability to suicide. The results are consistent with the role of the amygdala and the orbitofrontal cortex in the modulation of aggressivity and impulsivity, respectively. These hypotheses will be tested over five years by studying in vivo the distribution of SERT with [11C]McN 5652 and 5-HT/1A receptors with [11C]WAY 100635 in three groups of subjects. Group 1 will include patients with major depression and a history of a severe suicide attempt. Group 2 will include subjects with major depression, but without any history of suicide attempts. Group 3 will include healthy controls. Each group will include 30 subjects studied over 5 years. Groups will be matched on age, gender, race, socioeconomic background and nicotine smoking. In addition, groups 1 and 2 will be matched for severity of depression (both in terms of the current episode, and in terms of previous history of depression). Alterations associated with vulnerability to major depression are expected to be found in both groups 1 and 2, while alterations associated with suicide vulnerability are expected to be found only in group 1. Thus, this design will test one of the central hypotheses of this Center, i.e. that alterations of 5-HT function confer a vulnerability to suicide attempts per se, over and above alterations of 5-HT function that underlie vulnerability to suicide attempts per se, over and above alterations of 5-HT function that underlie vulnerability to major depression. A similar hypotheses will also be tested in a group of schizophrenic subjects studied in project 4C. Thus, patients with schizophrenia with and without a history of suicidal attempts will be compared, to test if neurochemical abnormalities associated with vulnerability to suicide detected in this study (depressed subjects) are also present in another diagnosis group associated with high suicidal risk. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PHYSICIANS' DECISIONS FOR THE DEPRESSED MEDICALLY ILL Principal Investigator & Institution: Epstein, Steven A.; Professor and Chair; Psychiatry; Georgetown University Washington, DC 20057 Timing: Fiscal Year 2001; Project Start 01-JUL-2001; Project End 30-JUN-2004

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Summary: (Applicant's abstract): Depression among primary care patients has been shown to be underrecognized and undertreated. However, previous research has not determined which physicians do not reliably diagnose or treat depression and why they make such errors. Thus, it is critical to address the main objective of this proposal: to determine patient and physician factors that are associated with physicians' quality of care for depression. The specific aims for this project are: 1) To describe primary care physicians' decision-making for depression care in the medically ill; 2) To determine the relationship of patient variables (medical illness comorbidity, attributional style, attitudes toward depression treatment, and demographics) with physicians' decisions for the care of depression; and 3) To determine the relationship of physician characteristics (e.g. specialty, experience with patients with depression, age, and gender) with physicians' decisions for the care of depression. The overall design of the study is the presentation of one videotaped case of a patient with major depression and physical complaints to each physician subject. The study has a 2x2x2x2x2 factorial design with two main effects: medical illness comorbidity (recent myocardial infarction vs. good health); and attributional style (somatic vs. non-somatic). The vignettes will also vary by treatment preference (prefer no mental health treatment vs. accepting of treatment), race (African-American vs. White), and gender. Thus, there will be 32 vignettes, each of which represents one distinct combination of levels. Subjects will be 500 physicians, half general internists and half family physicians. Each physician will complete a semi-structured interview assessing diagnostic, evaluation and treatment decisions for the case vignette. This interview will be followed by a structured interview assessing covariates including physician experience with patients with depression, demographic variables, practice characteristics, and attitudes regarding the care of patients with depression. The direct benefit of this study would be enhanced understanding of patient and physician characteristics that determine whether depression is appropriately treated. The results from this study can guide continuing medical education efforts and be used to improve future intervention studies designed to enhance quality of care. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PILOT--DEPRESSION HYPERTENSIVES

&

TREATMENT

ADHERENCE

IN

Principal Investigator & Institution: Rojas, Mary; Mount Sinai School of Medicine of Nyu of New York University New York, NY 10029 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-AUG-2007 Summary: Hypertension is a prevalent disorder. Treatment for hypertension usually requires a patient to take daily medications, reduce sodium intake and lose weight, adhere to routine follow-up visits, and undergo routine monitoring tests. Adherence to such regimens requires a great degree of patient motivation and perseverance, convictions that often require strong feelings of self-efficacy. Hypertensive patients who are also depressed may be less likely to summon the necessary self-discipline to follow such a complex health routine. Depression is also a prevalent disorder; approximately 9.5% of U.S. adults ages >=18 suffer from a depressive disorder in any given year. The relatively high prevalence of these 2 conditions suggest that it is likely that both hypertension and depression will occur concomitantly. Current research is lacking on the extent to which depression complicates hypertension and adherence to antihypertensive treatment regimens. Specific Aims: 1) To describe the prevalence of depression among controlled and uncontrolled hypertensive minority patients; 2) To describe the prevalence of treatment adherence among depressed and nondepressed

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hypertensive patients; 3) To explore associations between depression, treatment adherence, and blood pressure control; 4) To assess the feasibility of recruiting minority hypertensive patients to undergo screening for depression. We will take advantage of an ongoing AHRQ-EXCEED-funded randomized trial among minority patients with uncontrolled hypertension and utilize the recruitment procedures and tools to identify minority patients with diagnosed and treated hypertension. We will assess patients for depression, anti-hypertensive treatment adherence and perceived self-efficacy. We will survey 30 controlled and 30 uncontrolled hypertensive minority patients recruited from the waiting rooms of clinics in East and Central Harlem. This pilot study is an exploration of the relationship of depression, attitudes toward treatment of depression, hypertension treatment adherence, self-efficacy and blood pressure control. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •


PILOT--PREVENTIVE

INTERVENTION

FOR

MATERNAL

Principal Investigator & Institution: Lagomasino, Isabel; Charles R. Drew University of Med & Sci 1621 E 120Th St Los Angeles, CA 90059 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-AUG-2007 Summary: Elevated rates of depressive symptoms have been well-documented among low-income mothers, including Latinas who are at high risk for living in poverty. However, Latinos have consistently been found to underutilize mental health services when these services are needed for such disorders as depression. Despite maternal depression in this group representing a disparity in health and functioning for both Latino mothers and their children, there is a lack of effective intervention strategies to decrease this health disparity. One way to address this disparity is by delivering services through Promotoras, lay health workers who are familiar with the neighborhood, culture, language and social status of immigrant Latinas. This proposal will examine the effectiveness of a preventive intervention for postpartum Latina women in decreasing symptoms of minor depression and will explore how treatment of these mothers may affect their parenting of and attachment to their infants. Teh Promotoras who regularly conduct home visits for postpartum Latinas will be trained in administering a screening instrument for detection of minor depression, the PrimeMD. Four Promotoras will then be trained and supervised in delivering a standardized 12session cognitive behavioral therapy intervention developed to prevent depression in pregnant women and new mothers. 100 postpartum Mexican American immigrant women recently discharged from the hospital following childbirth, will be identified as having minor depression and will be consented to participate in the study. The participants will be randomized to either the intervention group or a control condition. The main outcome variable will be maternal depression symptoms as measured by a structured interview for the Hamilton Rating Scale. Data will also be collected on appropriateness of parenting, attachment, and developmental outcome measures to estimate effect sizes and sample size needed (through power calculations) for a full-scale trial of the preventive intervention. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PILOT--PROVIDE AHRQ GUIDELINES TO AFRICAN AMERICANS WITH DIABETES & DEPRESSION Principal Investigator & Institution: Egede, Leonard E.; Assistant Professor; Medical University of South Carolina 171 Ashley Ave Charleston, SC 29425

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Timing: Fiscal Year 2001 Summary: TITLE: A Pilot Program To Provide AHRQ Guidelines Concordant Care to African-Americans With Type 2 Diabetes Mellitus And Depression ABSTRACT: Despite improved rates of depression recognition in primary care settings, outcomes following treatment of depression in this setting are generally poor. AHRQ guidelines describe the elements of effective depression treatment. Unfortunately, the fast paced nature of primary care interactions makes it difficult for primary care providers to meet these expectations The Diabetes Nurse Educator (DNE) model of diabetes care was designed to address similar problems in the provision of American Diabetes Association minimum levels of diabetes care. We proposed to train the DNA to collaborate with primary care providers to provide AHRQ guidelines concordant depression treatment for African- Americans (AA) with both diabetes and depression. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: POSTRECEPTOR DYSREGULATION IN DEPRESSION Principal Investigator & Institution: Dwivedi, Yogesh; Psychiatry; University of Illinois at Chicago 1737 West Polk Street Chicago, IL 60612 Timing: Fiscal Year 2001; Project Start 01-SEP-2000; Project End 31-AUG-2005 Summary: This proposal for a Mentored Scientist Development Award focuses on elucidating the role of beta adrenergic receptors (ARs) and the adenylyl cyclase-cyclic cAMP (AC-cAMP) pathway in the pathophysiology of depression and suicide. Several studies suggest that betaAR number is increased in the postmortem brain of suicide subjects; however, the precise mechanism, significance and the cellular/molecular nature of events associated with this increase have not been elucidated. The goals of this study are to examine: 1) if upregulation of betaARs is due to increased rnRNA and/or protein expression of beta1 and/or beta2 ARs; 2) whether this increase is associated with increase transcription rate and/or dysregulated HPA axis; 3) functional consequences of increased betaARs in the AC-cAMP signaling pathway at the level of catalytic and regulatory activities of protein kinase A (PKA) and gene transcription of their specific subunits; 4) functional significance of altered PKA by examining functional characteristics and gene expression of transcription factors and target genes; 5) the localization of these changes at the cellular level in discrete brain areas; and 5) whether these changes are specific to depression.To achieve these goals we propose a series of related human postmortem brain and animal studies. We will study mRNA and protein expression of beta1 and beta2ARs by quantitative RT-PCR, in-situ hybridization and gold-immunolabeling. To examine whether changes in betaARs are associated with alterations in components of the AC- cAMP signaling pathway, we will study [3H]cAMP binding to PKA; total, endogenous and betaAR-mediated PKA activity; mRNA and protein expression of PKA (regulatory and catalytic subunits), CREB, BDNF and phospho-CREB; CREB-DNA binding activity in BAs 8, 9, 10 and hippocampus of suicide victims and age-, postmortem interval-, and gender-matched nonpsychiatric control subjects. We will examine changes in mRNA and protein expression in discrete areas of the brain (layers I-VI of prefrontal cortex and areas CA1-4, dentate gyrus subiculum and area entorhinalis of the hippocampal formation). Further, to examine if the changes in the proposed measures are specific to depression, we will examine the effects of major depression on the proposed measures. To consolidate our human postmortem brain findings, we will study the proposed measures in prefrontal cortex and hippocampus of behaviorally depressed rats. Finally, to examine if these changes are associated with abnormal HPA function we will study the proposed measures in prefrontal cortex and hippocampus of corticosterone-treated rats with and without

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adrenalectomy. With this proposal the candidate seeks training in 1) Clinical and psychological aspects of mental disorders and suicide, 2) molecular biology, 3) neuroanatomy, 4) animal behavior, and 5) specialized statistical analyses. The rigorous training plan, which integrates strong didactics and multidisciplinary expertise, and the research plan will advance the knowledge of molecular mechanisms associated with depression and suicide and will provide the candidate with the skills needed to achieve independence in this highly complex field. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PREDICTING DEPRESSION OUTCOMES IN MEDICALLY ILL ELDERS Principal Investigator & Institution: Koenig, Harold G.; Associate Professor; Psychiatry; Duke University Durham, NC 27706 Timing: Fiscal Year 2001; Project Start 15-AUG-1999; Project End 31-JUL-2004 Summary: Older adults with congestive heart failure (CHF) and chronic pulmonary disease (CPD) are increasing in number. Their lives and ability to function are greatly affected by these illnesses, which frequently lead to recurrent hospital admissions to manage exacerbations. We have found that 26 percent of older persons with CHF or CPD fulfill criteria for major depressive disorder when hospitalized. Depression is often prolonged, affects recovery, and increases use of health services. About one-third of these depressed patients, however, will go into full remission within three months of hospital discharge, often without specific treatment for depression. Many of these patients improve because their physical illness improves. The other two-thirds of depressed patients will have persistent depression, whether or not their health improves. Minor depression is even more common than major depression, being present in 32 percent of such patients, and while it may have a better prognosis than major depression, it is nevertheless associated with considerable disability and poorer quality of life. Research Questions: We are interested in studying four conjoint trajectories of depression-physical health outcome in the first six months after hospital discharge: depression and health both improve, depression improves but health does not, health improves but depression does not, and neither depression nor health improves. What proportion of patients follow each trajectory? What psychosocial and health characteristics predict which trajectory they will follow? What are the barriers to effective treatment, how is depression currently treated in these patients, and what are predictors of treatment intensity? Methods: 1000 older patients with CHF or CPD and major (n=500) or minor depression (n=500) will be recruited from the inpatient services of Duke Hospital and two community hospitals and followed for six months after discharge. Detailed assessments of depression and severity of medical illness will be conducted by a research nurse during telephone and in-person evaluations. Significance: Such information is necessary to determine which of the many patients with major or minor depression need specific treatment, and which patients will improve on their own after discharge as their medical illness improves or fails to improve. It will also provide important information to both guide future clinical trials and identify barriers to effective treatment of depression in these patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PREDICTORS OF ANTENATAL AND POSTPARTUM DEPRESSION Principal Investigator & Institution: Rich-Edwards, Janet W.; Harvard Pilgrim Health Care, Inc. 93 Worcester St Wellesley, MA 02481

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Timing: Fiscal Year 2003; Project Start 01-JUL-2003; Project End 30-JUN-2006 Summary: (provided by applicant): Antenatal and postpartum depression together affect roughly 15% of mothers, and may have serious consequences for the health and well-being of the entire family. Despite significant advances in understanding major depression, the specific causes of antenatal and postpartum depression remain less understood. Like major depression, antenatal and postpartum depression appear to arise from interacting environmental and biological factors. A large volume of work implicates poverty and lack of social support as environmental determinants of major depression and postpartum depression. However, there has been little investigation into the impact of experiences of personal threat, such as violent abuse or racial discrimination, on the incidence of antenatal or postpartum depression. Among biological factors, disorders of the hypothalamic-pituitary-adrenal stress response have been implicated in depression. During normal pregnancy, cortisol levels are elevated, and the placenta contributes large quantities of corticotropin-releasing hormone (CRH) to matemal circulation. The implications of these high levels of stress hormones for onset of depression during and immediately following pregnancy are poorly understood. We predict that antenatal and postpartum depression are influenced by these endocrine factors as well as by the psychosocial environment. We hypothesize that: 1) Physical and/or sexual abuse in childhood, in adulthood, and/or during pregnancy are associated with antenatal and postpartum depression. 2) Experience of racial discrimination is associated with antenatal and postpamam depression among women of color. 3) Levels of CRH during pregnancy are associated with a history of depression, are correlated with antenatal depression, and predict postpartum depression; 4) Elevated morning cortisol and/or depressed evening cortisol levels in the first three postpartum months are associated with postpartum depression. Few studies have had the size or the data needed to investigate both biologic and environmental predictors of depression before, during, and after pregnancy. Project Viva and Project Access are two ongoing cohort studies of pregnant women and their children in Boston, supported by the National Institutes of Health and the March of Dimes to assess psychosocial and hormonal predictors of pregnancy outcome and child health. To date, they have enrolled over 2800 women; by the end of the project, the proposed project will include 3,500 participants. These ongoing longitudinal cohort studies will provide a cost-effective and unique resource with which to determine factors predicting depression during pregnancy and the postpartum. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PREFRONTAL CELL PATHOLOGY IN VASCULAR DEPRESSION Principal Investigator & Institution: Rajkowska, Grazyna; Duke University Durham, NC 27706 Timing: Fiscal Year 2001; Project Start 01-SEP-2001; Project End 31-JUL-2006 Summary: (provided by applicant): The project is a direct extension of project 1. The present project will evaluate in the brains of elderly depressed subjects with and without vascular deficits the cellular pathology of cortical prefrontal areas that have been found to be involved in depression. The specific aim of the project is to estimate quantitatively the changes in the morphology and distribution of neurons and glial cells in dorsolateral area 9, lateral orbitofrontal area 47 and medial prefrontal area 12 in postmortem brains from matched depressive subjects with vascular deficits, depressives without vascular disease, and elderly controls. To achieve this objective we will measure morphological features of neurons, glia and blood vessels using Cresyl Violet (Nissl staining) for the study of the general cellular cytoarchitecture and immunohistochemical

134 Depression

methods modified for labeling of cytoskeletal and calcium-binding proteins in neurons and glial fibrillary acid protein in glial cells in celloidin-embedded human brain sections. In addition, similar morphometric parameters will be measured in the homological regions of the prefrontal cortex in the VMAT2 and NET knockout mouse representing an animal model of depression. The measurements will be carried out using a computer-assisted stereological counting method. To understand whether specific pathology is associated with depression in old age with or without vascular diseases is important, because it will contribute to establish specific therapeutic basis for a differential treatment of depression in the elderly with vascular disorders. Alternatively, it may turn out that idiopathic and vascular depression share many pathological characteristics, which will suggest that a common treatment for both would be possible. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PREVENTION OF DEPRESSION IN AT-RISK ADOLESCENTS Principal Investigator & Institution: Beardslee, William R.; Psychiatrist-In-Chief; Judge Baker Children's Center 3 Blackfan Cir Boston, MA 02115 Timing: Fiscal Year 2003; Project Start 03-FEB-2003; Project End 31-JAN-2008 Summary: (provided by applicant): This application is one of four interlocking R01's to assess the impact of a group cognitive behavioral program (CBP) on the prevention of depression in adolescents at risk for depression. Eligible teens must have a parent with active depression; teens themselves must have either a past depressive episode or current subsyndromal depressive symptoms. In this 5-year study, 320 at-risk adolescents (80 at each site) drawn from managed care organizations will be randomized to either CBP or usual care (UC) and followed for 32 months post intake to determine the impact of CBP vs. UC on onset of depressive disorders and symptoms, level of functioning, and medical and mental health care utilization. We hypothesize that participants in the CBP intervention will have a significantly lower prospective incidence of first and repeated episodes of depressive disorders and symptoms compared to adolescents in the usual care group. In addition, we will explore whether participants in CBP have a reduced prospective incidence of non-affective symptoms and disorders, and will show improved global functioning relative to the comparison group. Analyses also will focus on the incremental cost-effectiveness of providing the CBP over usual care from the health care perspective. This study builds on previous work by the Portland site (Clarke et al., 2001) showing a nearly six-fold reduction in the incidence of depression in CBP vs. UC, and extends this work in two ways - first, by testing whether the program can be replicated at several different sites, thereby greatly increasing the generalizability of the original findings; and second, by changing the timing and spacing of the intervention to provide continuation sessions to prolong the duration of the effect of CBP. This program of research is significant for several reasons: (1) depression is a chronic, prevalent, and impairing condition in adolescence that is often undetected, and which is more difficult to treat as chronicity increases; (2) there have been no large-scale studies of the prevention of depression in adolescence; and (3) by basing this study in managed care organizations, it will be possible to ascertain the costs and benefits of incorporating this intervention into "best practice" in real world settings. This application is based in Nashville (Judy Garber, PI), and interlocks with applications from Boston (William Beardslee, PI), Pittsburgh (David Brent, PI), and Portland (Greg Clarke, PI). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PREVENTION OF DEPRESSION IN LATINO PARENTS Principal Investigator & Institution: Cardemil, Esteban V.; Psychology; Clark University (Worcester, Ma) 950 Main Street Worcester, MA 01610 Timing: Fiscal Year 2002; Project Start 01-AUG-2002; Project End 31-JUL-2007 Description (provided by applicant): This application is a request for a Scientist Development Award for New Minority Faculty (K01) that will enable Dr. Cardemil to continue to develop his programmatic line of research in the prevention of depression in Latinos. Depression is among the most prevalent of the major psychiatric disorders in the general population, and emerging evidence suggests that members of low-income racial/ethnic minorities may be particularly at-risk for its development. Research that develops and evaluates programs designed to prevent the development of depression in low-income racial/ethnic minorities may prove especially beneficial. Dr. Cardemil's training goals are to (1) broaden his conceptual knowledge in researching the prevention and treatment of depression, (2) enhance his experience with family- and child assessments and interventions for depression, (4) improve his methodological skills in order to effectively conduct large-scale randomized prevention trials, (5) acquire experience developing and evaluating a therapist-training program, (6) improve his statistical skills in order to more effectively evaluate longitudinal outcome data, and (7) improve his grant- and publication-writing skills. These training goals will be achieved through (1) the resources available at the Brown University Medical School, (2) the high quality of mentorship provided by Dr. Ivan Miller, Dr. Ricardo Mufioz, and Dr. Ronald Seifer, and the expertise of the assembled consultant team, (3) focused coursework and clinical experiences, and (4) the proposed research project. The proposed research project extends the natural progression of Dr. Cardemil's current depression prevention work under the auspices of a NRSA F32 fellowship. The F32 project is a cognitivebehavioral depression prevention program for low-income Latino parents that integrates 6 group-based interventions with 2 family-based interventions: the Family Coping Skills Program (FCSP). The specific research aims of this application are to (1) implement a randomized clinical trial to evaluate the efficacy of the FCSP on Latino parents using both interviewer and self-report measures, (2) in an exploratory fashion, evaluate the effects of the FCSP on the family-level functioning in a subsample of the participants using both interviewer and self-report measures, (3) in an exploratory fashion, evaluate the effects of the FCSP on the children of a subsample of participants using both interviewer and self-report measures, and (4) develop and evaluate a therapist-training program for the efficacious delivery of the FCSP. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PREVENTION OF DEPRESSION IN LOW-INCOME SINGLE MOTHERS Principal Investigator & Institution: Peden, Ann R.; Associate Professor; None; University of Kentucky 109 Kinkead Hall Lexington, KY 40506 Timing: Fiscal Year 2001; Project Start 01-APR-2000; Project End 31-MAR-2003 Summary: The ultimate goal of this program of research is to decrease the incidence of clinical depression in high risk individuals through prevention intervention. Lowincome, single mothers are at high risk for depression which may have negative effects on their children. The specific aim of this randomized controlled prevention trial is to test the effects of a cognitive-behavioral intervention designed to reduce negative thoughts, chronic stress, and depressive symptoms and increase self-esteem of low income single mothers experiencing subclinical depressive symptoms. In addition, the

136 Depression

effects of the intervention on mothers' reports of behavioral problems of their 2- to 6year old children will be tested. While cognitive-behavioral interventions with depressed individuals have been used extensively, the effects of affirmations and thought stopping techniques in reducing the risk of depression have not been tested empirically. A sample of 550 single mothers at least 18 years of age will be recruited for the cross-sectional phase of this study. Inclusion and exclusion criteria are: (1) no prior treatment for psychiatric care; (2) not now or ever on antidepressants; (3) never diagnosed with clinical depression; (4) not suicidal; (5) never married, separated at least 6 months, or divorced; (6) at least one child 2 to 6 years of age living with the mother; (7) no child under the age of 2; (8) not pregnant by self-report; (9) not currently in counseling; (10) at or below 185% of Federal poverty level guidelines by family size. Baseline data on depressive symptoms, negative thoughts, self-esteem, chronic stressors, and mothers' report of child behavior will be collected from all women. Recruitment will continue until 160 women with a Beck Depression Inventory score between 9 and 35 and/or a Center for Epidemiologic Studies--Depression Scale score between 16 and 40 are identified and agree to participate in the clinical trial. As women are recruited for the intervention phase, each will be randomly assigned to the control or experimental condition. The intervention consists of six one-hour per week group sessions that target identification and management of negative thinking as it effects depressive symptoms. Though stopping and the use of affirmations (positive self-talk) are the primary techniques that are taught. Experimental and control subjects will be re-interviewed at one-month, six-months and twelve-month post-intervention to assess their negative thinking, depressive symptoms, self-esteem, and chronic stressors and to obtain reports of their children's behavior. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SUPPLEMENT

PREVENTION

OF

DEPRESSION

WITH

A

WEB-BASED

Principal Investigator & Institution: Seligman, Martin E.; Professor; Psychology; University of Pennsylvania 3451 Walnut Street Philadelphia, PA 19104 Timing: Fiscal Year 2001; Project Start 22-SEP-2001; Project End 31-AUG-2006 Summary: (provided by investigator): Our aim is to create and validate robust prevention of depression and anxiety among young adults at risk for depression, using a classroom-based cognitive-behavioral intervention in combination with Web-based ancillary material. We propose a targeted intervention with a population of 260 college students - 130 in the intervention group and 130 in a no-intervention control group. At risk is defined as those who score in the worst quartile of depressive symptoms but excluding those with severe depressive symptoms. We will track all participants for three years following the intervention, assessing depressive episodes and symptoms, anxiety episodes and symptoms, physical health, grades, and cognitive mediators. We hypothesize that the intervention group will have fewer episodes of depression and anxiety, fewer symptoms of depression and anxiety, better physical health, and higher grades than the control group. We propose that our replicated classroom-based intervention will, when supplemented by Web-based resources, one-on-one boosters, and ongoing Web-based boosters, produce robust prevention of depression and anxiety, as well as maintain durable cost-effective prevention effects. Our ultimate goal is to provide school settings, such as universities, colleges, and high schools with easily implemented prevention programs against depression and anxiety. If this intervention can prevent depression and anxiety robustly, it is possible that such programs can be widely disseminated, producing nationally measurable mental health benefits.

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Project Title: PREVENTION OF POST-STROKE DEPRESSION-TREATMENT STRATEGY Principal Investigator & Institution: Robinson, Robert G.; Professor and Head; Psychiatry; University of Iowa Iowa City, IA 52242 Timing: Fiscal Year 2002; Project Start 16-SEP-2002; Project End 31-JUL-2007 Summary: (provided by applicant): Previous studies have shown that about 35% of all depression occurring in the 2 years following stroke begin after the acute in-hospital period. We have shown that both acute and delayed onset depression influence cognitive and ADL recovery throughout the 1st year following stroke. A recent treatment study aimed at preventing the development of post-stroke depression found that nortriptyline (NT) and fluoxetine were effective in preventive depression (i.e., 1 of 13 patients given NT and 1 of 13 given fluoxetine became depressed compared with 5 of 15 patients given placebo; p=.03). During the next 6 mos. after treatment, a significantly greater number of active treatment patients developed depression compared with patients given fluoxetine or placebo. This increased rate of depression among the treated patients raises the question of whether a longer period of treatment would continue to prevent depression. Furthermore, a 7-year follow-up of the 37 nondepressed patients who were given fluoxetine, nortriptyline or placebo found that those given antidepressants were more likely to survive than those given placebo (Kaplan Meier Log Rank, x(2)=4.3, df=1, p=0.4)(i.e., 65% treated survived vs 29% of placebo). This grant will examine these questions by treating consenting non-depressed stroke patients who are within the first 3 mos. post-stroke. Patients will be given problemsolving therapy (PST) over 12 mos. or 12 mos. of double blind treatment with NT, citalopram or placebo. Patients who develop depressing meeting criterion for major or minor depression of at least 2 weeks duration will be given all of the tests intended to be given at 12 mos. and then will be terminated so that their depression can be treated. After 1 year of treatment, all patients will be followed without treatment of another 6 mos. We will determine whether psychosocial or pharmacological treatment provides extended protection from depression and thereby enhances post-stroke recovery. We will also determine whether abnormalities in startle response either before or after treatment or atrophy of specific rain regions are correlated with the development of depression. The significance of this study is that it will answer the most important question with remains in the therapeutics of post-stroke depression and that is whether prophylactic antidepressant treatment of this population should be given to all stroke patients because it will enhance their recovery from stroke by decreasing their likelihood of suffering the emotional, physical, cognitive and mortality consequences of depression. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: TREATMENT

PRISM--COMORBIDITY

DIAGNOSIS

FOR

DRUG

ABUSE

Principal Investigator & Institution: Hasin, Deborah S.; Associate Professor; New York State Psychiatric Institute 1051 Riverside Dr New York, NY 10032 Timing: Fiscal Year 2001; Project Start 15-MAR-1998; Project End 28-FEB-2003 Summary: (Applicant's Abstract): Psychiatric comorbidity, particularly depression, occurs often in substance abusers, and is associated with poor outcome. However, previous diagnostic instruments have been unreliable, controversy has surrounded the concepts of comorbidity diagnosis, and results of treatment studies have been

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inconsistent. In particular, questions persist on whether a treatment-responsive depressive disorder exists in non-abstinent substance abusers. For treatment research to begin to accumulate meaningful results on substance abuse comorbidity, concepts and diagnoses must be clear and reliable. To begin to address this problem, we developed the DSM-111-R Psychiatric Research Interview for Substance and Mental Disorders (PRISM), which showed very good test-retest reliability for primary major depression and other DSM-111-R mental disorders in substance abuse and psychiatric patients. To address the problem of current DSM-IV diagnosis of depression and other disorders in non-abstinent substance abusers, we developed a new version of the PRISM. This version uses phenomenologically-oriented methods for differentiating between primary disorders, substance-induced disorders, and the expected effects of intoxication/withdrawal. These PRISM methods were carefully designed to be consistent with DSM-IV. A reliability and validity test of the new PRISM is needed, with special focus on the differentiation between current primary depression, substanceinduced depression and expected intoxication/withdrawal effects. We propose such a study in 510 methadone maintenance and dual diagnosis psychiatric patients. Interviews will be conducted by clinicians. The sample will allow for separate reliability coefficients for each site. Subjects will be sampled to ensure stable reliability estimates for African-American as well as white patients. The data will also allow tests of the effects of demographic, clinical and process factors on reliability. An initial validity study will also be conducted, focused on the PRISM differentiation between primary major depression, substance-induced major depression, and the expected effects of intoxication/withdrawal. For the validity study, we will use family history and inperson expert psychiatrist evaluation of the need for antidepressant treatment as validators. If the PRISM shows good reliability and validity, it will offer a significant methodological advance for treatment research in substance abusers with psychiatric comorbidity. The study results will provide empirical evidence that is likely to be useful in formulating DSM-V. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •


PROBLEM-SOLVING

TREATMENT

FOR

PRIMARY

CARE

Principal Investigator & Institution: Oxman, Thomas E.; Professor; Psychiatry; Dartmouth College 11 Rope Ferry Rd. #6210 Hanover, NH 03755 Timing: Fiscal Year 2002; Project Start 01-APR-2002; Project End 31-MAR-2007 Summary: Minor depression is one of the most common types of depressive disorders in primary care. It is not clear that antidepressants are indicated for minor depression, and even if they are, a substantial proportion of patients cannot or will not take them. Alternative treatment approaches are indicated. The purpose of this project is to use a four-week watchful waiting period to identify patients with persistent minor depression, potentially most in need of depression specific treatment, and then test the therapeutic effect of Problem- Solving Treatment for Primary Care (PST-PC), a manual driven, six-session, behavioral treatment for depression in primary care. In this project, 300 primary care, minor depression patients will be identified and followed. The relationship of patient predictors to remission will be examined. After four weeks, patients who do not demonstrate symptomatic remission (approximately 50 percent or 150 patients) will be entered into a randomized nine-week clinical trial comparing PSTPC with Usual Care. Subjects will be followed for six months after completing the trial. The primary aim of this project is to test the therapeutic effect of PST-PC versus Usual Care for persistent minor depression in primary care. As a subsidiary aim the project

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will examine the relationship of characteristics of the patient (social support, adverse life events, personality traits, comorbidity) to early remission of minor depression. Patient and therapy characteristics will also be examined as predictors of recovery six months after the trial. The broader, long-term goal of this line of investigation is to disseminate practical, non-pharmacologic mental health treatments for use by non-physician practitioners (e.g. psychologists, nurses, social workers, counselors) who will increasingly be working in primary care. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PST DYSFUNCTION

IN

GERIATRIC

DEPRESSION

WITH

EXECUTIVE

Principal Investigator & Institution: Alexopoulos, George S.; Professor and Vice Chair; Psychiatry; Weill Medical College of Cornell Univ New York, NY 10021 Timing: Fiscal Year 2002; Project Start 15-SEP-2002; Project End 31-MAY-2007 Summary: (provided by applicant): This study proposes to compare the efficacy of Problem Solving Therapy (PST) to that of Supportive Therapy (ST) in non-demented elderly patients with major depression and cognitive impairment. Among them, we will focus on patients with major depression and executive dysfunction because this combination of symptoms (as defined in our preliminary studies) is prevalent, debilitating, and responds poorly to treatment with antidepressant agents. Therefore, we find it compelling to identify an effective treatment for these patients, who would otherwise remain depressed, debilitated, and demoralized during the last years of their lives. We selected PST because it can address depression as well as deficits in problem solving skills that impact on the patients' ability to negotiate their environment and contribute to their depression and disability. Moreover we now have empirical evidence suggesting that PST can reduce depressive symptoms and disability in cognitively unimpaired depressed elderly patients as well as elderly patients with major depression and executive dysfunction. The subjects will be 240 (120 from each Center) elderly (>64 years) patients with non-psychotic, unipolar major depression and executive dysfunction and will be randomly assigned to receive 12 sessions of PST or ST. The study is designed to test the hypotheses that the PST is more effective than ST in reducing depressive symptoms and disability. Furthermore, we hypothesize that these effects are mediated by improvement in generation of alternative solutions, decision making, and solution implementation. While we are aware of the methodological problems and confounds posed by studying a "sick and old population", we bring to this project two groups with complementary expertise in treatment studies and psychotherapy research, and experience in directing multicenter studies. Moreover, the project will be supported by the structures of the Cornell Intervention Research Center (IRC), whose principal objective is to develop treatment interventions targeting specific clinical and biological characteristics of geriatric depression. Accordingly, we are well positioned to meet the challenges inherent in this difficult but important area of research. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PSYCHIATRIC DISORDERS IN ADULTS WITH DIABETES MELLITUS Principal Investigator & Institution: Lustman, Patrick J.; Professor of Psychiatry; Psychiatry; Washington University Lindell and Skinker Blvd St. Louis, MO 63130 Timing: Fiscal Year 2001; Project Start 01-JUL-1985; Project End 31-MAR-2004

140 Depression

Summary: Diabetes increases the risks of maternal, fetal, and neonatal complications from pregnancy. Tight glycemic control during pregnancy reduces these risks but is difficult to achieve. Major depression is present in approximately 25 percent of diabetic women and is associated with significant deterioration in glycemic control. There has been no study in diabetic or nondiabetic subjects of depression treatment during pregnancy, and the effects of depression treatment on obstetric outcomes remain unknown. Recently, we showed that cognitive behavior therapy (CBT) was an effective nonpharmacologic treatment for depression in diabetes that produced durable improvements in glycemic control. In this study we plan to treat major depression in pregnant diabetic women with CBT and determine its effects on depression, glycemic control, and maternal and neonatal outcomes. We also plan to assess the relationship of diabetes during pregnancy and postpartum depression to neuropsychological development of the infants. 150 pregnant diabetic women will be recruited for study: 100 with and 50 without major depression. The nondepressed subjects function only as a comparison group in some of the statistical analyses. All subjects will be assessed serially during the 2nd and 3rd trimesters and the 1 year postpartum period while receiving the usual degree of intensive medical care for the diabetic pregnancy. Depressed patients will be assigned randomly to treatment with individual CBT (n =50) or supportive counseling (n =50). The pregnancy care team is informed of the depression status of all subjects and advised to give usual care for depression. The design blinds the pregnancy care team to treatment assignment, controls for nonspecific effects of attention and the influence of enhanced diabetes control on mood, provides a comparison group likely to remain depression free during gestation and the postpartum period, and is sensitive to human subject issues. We hypothesize that CBT will be superior to supportive counseling in terms of improving depression and glycemic control, and that the treatment-related improvements in glycemic control will reduce the adverse effects of diabetes in pregnancy, including c-section, macrosomia, neonatal hypoglycemia, and fetal hyperinsulinemia. We also expect that by improving glycemic control during pregnancy and reducing the risk of postpartum depression CBT will improve neuropsychological development in the offspring. The findings should demonstrate the relevance of depression treatment to maternal and neonatal outcomes of diabetic pregnancies and translate directly to the management of patients living with diabetes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PSYCHOSOCIAL TREATMENT OF DEPRESSION IN DELINQUENTS Principal Investigator & Institution: Rohde, Paul D.; Research Scientist; Oregon Research Institute 1715 Franklin Blvd Eugene, OR 97403 Timing: Fiscal Year 2001; Project Start 15-SEP-1997; Project End 30-APR-2004 Summary: (Adapted from applicant's abstract): Given the high rate of psychiatric comorbidity with depression in adolescents, treatment interventions that have been shown to be effective with "pure" samples of depressed adolescents need to be evaluated with youth who have comorbid conditions. The goal of this proposal is to evaluate the efficacy of a cognitive-behavioral group treatment intervention for adolescents whose depression is comorbid with conduct disorder. Adolescents, ages 1317, who have been charged with at least two criminal violations but are not in juvenile detention in the Lane Country Department of Youth Services (DSY) will be referred to participation in the study. Adolescents meeting initial inclusion criteria will be recruited to participate in a diagnostic interview (K-SADS for DSM-IV) assessing all major psychiatric disorders, including depression (major depression and dysthymia) and

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conduct disorder. Over a four-year period, 200 adolescents with comorbid depression/conduct disorder will be randomly assigned to one of two interventions conditions: (1) the Adolescent Coping With Depression (CWD-A) course, or (2) academic tutoring. Adolescents will be assessed pre- and post-treatment (estimated n=150) and at 6 and 12 months post-treatment (estimated n=120). In addition, academic and criminal arrest records will be monitored for 12 months pre- and post-treatment (a total of 24 months). Analyses will focus on 3 primary issues: (1) Group differences in treatment outcome (depression and conduct disorder). The main hypotheses are that the CWD-A intervention will be superior to academic tutoring in reducing depression and conduct disorder, both of which will be evaluated as numerical and categorical (diagnosis vs. no diagnosis) measures. The intervention is predicted to impact depression more significantly than conduct disorder. (2) Group differences in additional outcome measures (e.g., future suicidal behavior, criminal recidivism, and academic performance). (3) Predictors of participation vs. attrition, improvement vs. nonrecovery, and maintenance of gains vs. relapse. Predictors will include pre-treatment patient variables, in-session variables, and interventionist variables. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PUFA AUGMENTATION IN TREATMENT OF MAJOR DEPRESSION Principal Investigator & Institution: Gertsik, Lev G.; Cedars-Sinai Medical Center Box 48750, 8700 Beverly Blvd Los Angeles, CA 90048 Timing: Fiscal Year 2003; Project Start 15-JUL-2003; Project End 31-MAR-2005 Summary: (provided by applicant): This is a second revision of an Investigator-Initiated Exploratory/Developmental Research (R21) grant application to the National Center for Complementary and Alternative Medicine to explore the use of polyunsaturated fatty acids (PUFAs) as an augmentation strategy for the treatment of unipolar major depression. Major depression is a common mental disorder, and is associated with serious functional impairment, morbidity and mortality. Moreover, it also produces a significant financial burden on our society. Despite the availability of numerous pharmacologic and psychotherapeutic interventions, the current treatment of depression is not optimal. Even in patients who do respond to treatment, remission is rarely complete. In addition, the onset of action of antidepressants is delayed; the drugs usually must be taken for three weeks or more before improvement is clinically discernible. Accordingly, a number of augmentation strategies to hasten the onset of activity and increase the efficacy of traditional antidepressants have been proposed and tested, but many of these produce significant side-effects, and some patients still do not respond. PUFAs are found in high concentrations in the central nervous system, and they appear to be involved in many aspects of signal transduction. Recently, evidence has surfaced suggesting that the dietary intake of PUFAs might be related to depression, and the administration of PUFAs might reduce depressive symptomatology. In this application, we propose testing the hypothesis that administration of one of the PUFAs, eicosapentanoic acid (EPA), in combination with a selective serotonin reuptake inhibitor (SSRI) antidepressant will improve treatment outcome in unipolar major depression. In addition, we will determine whether the onset of antidepressant activity occurs more rapidly when EPA supplementation is combined with selective serotonin uptake inhibitor. The results of the proposed study might provide a new, economical, safe, and potentially important alternative approach to the treatment of unipolar major depression. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: QALYS FOR DEPRESSION: WHOSE VALUATIONS TO USE FOR CEA Principal Investigator & Institution: Pyne, Jeffrey M.; Psychiatry and Behavioral Scis; University of Arkansas Med Scis Ltl Rock 4301 W Markham St Little Rock, AR 72205 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2004 Summary: (provided by applicant): Recent evidence suggests that health status may strongly influence an individual's valuation of depression outcomes. This proposal will explore the health policy implications of obtaining depression outcome valuations for use in cost-effectiveness analyses from persons with varying levels of depression severity and the general public. This proposal is motivated by the concern that cost effectiveness analyses based on outcome valuations from persons without experience with depression may discriminate against treatments for persons with depression. The general public's continued misunderstanding of mental disorders in general and its undervaluation of depression outcomes in particular, could bias cost-effectiveness analyses (CEAs) against depression treatments (e.g. they will appear to be less costeffective) and ultimately result in inequitable healthcare resource allocation decisions. The specific aims are (1) examine differences in incremental depression outcome and prevention valuations across four groups: i) general population, ii) previous history of depression but not currently depressed, iii) less severe current depression, iv) more severe current depression; (2) examine the extent to which specific depression severity characteristics of the respondent (e.g. symptom severity, episode frequency, chronicity, past history of depression treatment, recent changes in depression severity, and health status) are associated with incremental depression outcome and prevention valuations; (3) examine CERs for hypothetical treatment and prevention interventions using depression outcome valuations obtained from the populations defined above and explore the health policy implications. Depression outcome valuations will be collected from 400 subjects: 100 subjects from the general population, 200 primary care patients (100 with a history of depression but not currently depressed, 75 with mild to moderate depression, and 25 with moderately severe to severe depression), and 100 mental health clinic patients (75 with moderately severe to severe depression and 25 with mild to moderate depression). We will examine two common methods for eliciting outcome valuations, rating scale and standard gamble, using an interactive computer-based program. The depression outcome descriptions will be based on the Patient Health Questionnaire (PHQ) nine-item depression module and the Medical Outcomes Study SF-12. We will also explore the equity implications of using depressed patient versus general public depression outcome and prevention valuations. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: QUALITY IMPROVEMENT FOR DEPRESSION Principal Investigator & Institution: Ford, Daniel E.; Professor; Medicine; Johns Hopkins University 3400 N Charles St Baltimore, MD 21218 Timing: Fiscal Year 2001; Project Start 30-SEP-1994; Project End 31-MAY-2003 Summary: Policy makers do not know how to alter the structure and process of primary care to provide treatment which will improve and sustain improvement in the functional impairment associated with major depression, the fourth leading cause of disability worldwide. To address this problem, we propose an R-10 to fund Quality Improvement for Depression (QID). The specific aims of QID are: (1) to provide integrated analyses of the long term impact of four distinct but related primary care interventions to improve depression treatment during the acute, continuation, and

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maintenance phase of care; and (2) to estimate the effects of high quality primary care depression treatment on long term disability. In the early stages of QID collaboration, funded investigators of four separately conceived quality improvement interventions planned and implemented a coordinated strategy for recruitment, intervention, and data collection in 108 primary care clinics in network and staff model HMOs, IPAs, PPOs, and mixed model settings. In addition to common baseline organizational and provider data, QID investigators are collecting over 80 common variables from 1,980 patients with major depression at each of three waves across the first year. This application seeks support to conduct effectiveness analyses in the combined database after standardizing patient follow-up during the second year across the four projects. This effort is needed to understand the "big picture" of how four dissemination interventions which are feasible to integrate across a variety of practice settings and populations, impact the quality and outcome of care, with sufficient power to determine whether they improve outcomes over a duration meaningful to policy makers. The analyses will inform policy debates about effective mental health treatment by providing generalizable estimates of the effect of antidepressant medication and psychotherapy on disability over the long term. To address these policy questions through the QID is more efficient than funding another large new project and more scientifically rigorous than drawing conclusions from heterogeneous studies whose differing methodologies complicate meta- analytic methods and conclusions. In addition to serving as a competing continuation for the Depression Guidelines Cooperative Agreement, QID serves as an important model of how mental health effectiveness research can be efficiently conducted by intensive collaboration of independently funded projects. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: REGULATION OF SYNAPTIC AMINO ACID RECEPTORS Principal Investigator & Institution: Trussell, Laurence O.; Professor; Otolaryngology Head & Neck Surgery; Oregon Health & Science University Portland, OR 972393098 Timing: Fiscal Year 2001; Project Start 01-MAY-1991; Project End 30-APR-2004 Summary: The control of the strength of individual synapses is essential to fine- tuning the performance of neural circuits. Synaptic strength may be regulated in the short term by trains of high frequency pre-synaptic action potential which at many synapses leads to short-term synaptic depression. Using the large calyceal synapses of the chick cochlear nucleus (nucleus magnocellularis, or nMAG), we will carry out experiments which are based upon the following hypothesis: We propose that there are multiple forms of short-term depression, each with distinctive properties, and that these become recruited at specific frequencies of neural activity. By the independent regulation of these forms of depression, neurons may produce changes in synaptic strength at specific ranges of frequencies and not at others. This concept, which we term complex depression, would provide a powerful and sophisticated means for control of neural circuits, and will be comprehensively tested in the proposed studies. These will employ patch clamp recordings and the direct measurement of pre- and postsynaptic signals during the course of depression, testing specific hypotheses about the types, origins and function of depression. Specifically, we will first document that there are different components to depression and how each contributes to the control of synaptic strength at specific frequencies of synaptic activity. Then, we will identify the probable cellular mechanisms that underlie different forms of depression. Moreover, we will examine how depression can be regulated by transmitter uptake systems and by patterns of activity. Finally, we will determine the functional consequences of depression when synapses converse onto a single target cell. The results of the analyses will give new

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insight into the factors that determine the optical transmission of signals in the brain, and will contribute to an understanding of sensory or cognitive deficits. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RELATIONAL GROUP INTERVENTION FOR POSTPARTUM DEPRESSION Principal Investigator & Institution: Clark, Roseanne; Associate Professor; Psychiatry; University of Wisconsin Madison 750 University Ave Madison, WI 53706 Timing: Fiscal Year 2001; Project Start 18-SEP-2001; Project End 31-JUL-2006 Summary: (provided by applicant): Major and minor depression in the postpartum period occurs in 10-15 percent of all new mothers, representing a significant public health problem. One of the major mechanisms by which PPD may influence infant outcomes is through its impact on the quality of the mother's affective and behavioral interactions during infancy, a critical time when physiological and emotional regulation and the capacity for human attachments are developing. Risk for disturbances in the mother-infant relationship as well as developmental delays and psychopathology in their infants represent significant areas of morbidity associated with postpartum depression and have not been addressed adequately by current intervention approaches. Therefore, the investigation of the efficacy of mother-infant relational treatment approaches for major depression during the postpartum period is warranted. The proposed study, representing a revision of the first R01 application by the principal investigator has four major aims: (1) To compare the efficacy of a manualized, relationally focused group treatment approach (M-ITG) for women with major depression in the postpartum period and their infants with a standard individual treatment (IPT) to ameliorate depressive symptoms and reduce recurrent episodes; (2) To compare the efficacy of M-ITG and IPT in improving the quality of mother-infant interactions; (3) To determine whether improvements in the mother-infant interaction mediate the impact of maternal depression on infant emotional, behavioral, and attention regulation; and (4) To examine the unique effects of depression severity and chronicity, comorbid anxiety and personality pathology on mother-infant interaction quality, and infant outcomes. Two hundred and eight women meeting criteria for major depression will be randomly assigned to one of two treatments for depression (1) MITG for mothers and their infants or (2) IPT. Assessments of mother, infant and motherinfant dyadic functioning, as well as parenting stress and marital conflict will be conducted at pre and post-treatment and at two follow-up points(l2 months posttreatment and when the infant is 24 months of age). Measures include diagnostic interviews, self and other report instruments and observational coding methods. The long-range objectives addressed by this research are to identify an effective intervention for postpartum depression that also reduces recurrences of depressive episodes in mothers, prevents subsequent psychopathology in their young children, and identifies key relational mechanisms that may inform the development of specifically targeted preventive interventions for high-risk dyads. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: REWARD SENSITIVITY IN DEPRESSION: A BIOBEHAVIORAL STUDY Principal Investigator & Institution: Shankman, Stewart A.; Psychology; State University New York Stony Brook Stony Brook, NY 11794 Timing: Fiscal Year 2002; Project Start 12-SEP-2002; Project End 31-AUG-2004

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Summary: (provided by applicant): In recent years, many researchers have been interested in discovering a neuropsychological basis of emotion and emotional disorders. One of the more widely studied of these models has been Davidson's approach-withdrawal model (Davidson, 1998), which posits two separate neural systems of motivation and emotion and hypothesizes that these systems are responsible for individual differences in reactivity to emotional stimuli, or "affective styles." The model also proposes that abnormalities in these systems play an etiological role in emotional disorders: depression is characterized by a deficit in reward seeking behavior (i.e., approach motivation) and anxiety is characterized by a tendency to withdraw from aversive stimuli (i.e., withdrawal motivation). These abnormalities are also hypothesized to be associated with specific asymmetries in frontal activation (depression = decrease in left frontal; anxiety = increase in right frontal). While several researchers have found support for this model, no study has directly tested whether the hypothesized frontal asymmetry reflects this "low approach style" in depression. This project will be able to test this hypothesis by comparing the EEG activation of depressed and non-depressed individuals during tasks that manipulate approach and withdrawal motivation. This study will also be able to explore whether the relationship between motivation and EEG asymmetry is different for individuals with particular clinical characteristics (e.g., a comorbid anxiety disorder, chronic depression). This project will not only be able to address the relationship between motivation and depression but will also further the understanding of the heterogeneity of depression by teasing apart its biological correlates. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RISK AND PREDICTORS OF POSTPARTUM DEPRESSION Principal Investigator & Institution: Altshuler, Lori L.; None; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, CA 90024 Timing: Fiscal Year 2003; Project Start 11-APR-2003; Project End 31-MAR-2008 Summary: (provided by applicant): The postpartum period is a time of heightened risk for the emergence of psychiatric illness, particularly in women who already have a history of mood disorder. Given the prevalence of depressive disorders during the childbearing years, it is crucial to identify women who are at highest risk for new onset or recurrence of depression during the postpartum period. Identification of those women at greatest risk for postpartum depression may allow for interventions that would limit maternal morbidity associated with untreated postpartum depression. This proposal outlines a multi-institutional collaborative research project (R01) in response to PA-00-074, in which risk for postpartum depression will be evaluated in women with histories of major depressive disorder. Subjects who have had at least one episode of DSM-IV major depression will be followed prospectively from late pregnancy (32-36 weeks gestation) up to six months after delivery using a series of standardized instruments. The primary aims of this investigation are (1) to identify clinical and psychosocial predictors of postpartum depression and functional impairment and (2) to determine the extent to which treatment (pharmacologic, nonpharmacologic or a combination) proximate to delivery modulates risk for postpartum relapse. How clinical and psychosocial variables including history of postpartum depression, severity of past depression, number of previous episodes, age at illness onset, depression during pregnancy, and social support affect risk for postpartum depression, as well as psychosocial functioning, will be investigated. The current submission is a natural extension of an ongoing academically productive collaboration in which risk for depressive relapse is evaluated in pregnant women with histories of major depression

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who either discontinue or maintain antidepressant treatment. This proposal provides an opportunity to study a rigorously followed population into a period of risk -- the postpartum period -- and to investigate the factors that confer or modulate risk for depression at this time. The three participating sites for this investigation include the Perinatal and Reproductive Psychiatry Clinical Research Program at the Massachusetts General Hospital, Harvard Medical School (Drs. Cohen, Nonacs and Otto), the Women's Life Center and Mood Disorders Research Program at UCLA (Dr. AItshuler, Dr. Hendrick), and the Emory Women's Mental Health Program at Emory University School of Medicine (Dr. Stowe). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RISK AND PREVENTION OF DEPRESSION IN YOUTH Principal Investigator & Institution: Garber, Judy; Professor; Psychology & Human Development; Vanderbilt University 3319 West End Ave. Nashville, TN 372036917 Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 31-MAR-2008 Summary: (provided by applicant): This is a request for an NIH Independent Scientist Award (K02) to enhance the Pl's ability to contribute to the understanding of the processes underlying the development of depressive disorders in children and adolescents and to develop and test interventions aimed at preventing depression in youth. The Pl's research program has evolved from studying psychosocial risk factors that predict depression in children and adolescents, to examining the role of these risk factors as mediators of the link between parent and child psychopathology, to testing a prevention program that targets several of the risk factors identified in the earlier studies. This proposal describes three research programs involving five different but related studies. The first program includes two separate longitudinal studies that examine the contribution of varbus psychosocial factors (e.g., family dysfunction, social feedback, stress) to the development of negative cognitions and depressive disorders in children and adolescents. The second program is comprised of two different investigations of whether decreases in parents' depression as a result of treatment (cognitive-behavioral and/or pharmacotherapy) are associated with changes in their children's psychopathology and functioning, and whether these changes are mediated by improvements in parent-child relationships, negative cognitions, and/or decreases in stressful life events. The last project uses knowledge about risk factors learned from the first two research programs to test a cognitive-behavioral intervention for preventing depression in adolescents at risk for mood disorders due to their having a parent in treatment for depression, and themselves having either a past depressive ecandidatesode or current subsyndromal depressive symptoms. The goal of the career development plan is to expand the candidate's skills in two areas: quantitative methods and prevention science. Because most of the candidate's research is longitudinal, learning state-of-the-art statistical methods (e.g. latent growth curve, linear and nonlinear mixed effects models, survival analysis, structural equations modeling) will broaden the kinds of research questions that can be addressed with both existing and new data. In addition, she will update and expand her knowledge of preventive interventions, particularly cognitive-behavioral approaches, with the aim of further developing and testing the efficacy of programs for preventing depression in high-risk adolescents. This K award will allow the candidate to bridge emcandidaterical research with practice by using basic knowledge about etiology to address the practical problem of preventing the onset and recurrence of the serious public health condition of depression, particularly among those at greatest risk for the disorder. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ROLE OF NUCLEUS ACCUMBENS CREB IN DEPRESSION Principal Investigator & Institution: Carlezon, William A.; Mc Lean Hospital (Belmont, Ma) Belmont, MA 02478 Timing: Fiscal Year 2001; Project Start 01-JUL-2001; Project End 30-JUN-2006 Summary: From applicant's abstract): The proposed studies are designed to examine if the transcription factor CREB (cAMP response element binding protein) in the nucleus accumbens shell (NASh) plays a role in depression. Although the NASh is involved in the hedonic (pleasurable) effects of food, sex, and addictive drugs, little is known about its involvement in mood disorders. We found previously that blockade of CREB function in the NASh increases cocaine reward in rats, whereas elevated CREB function in this region eliminates cocaine reward. Because anhedonia (a diminished ability to experience pleasure) is a hallmark symptom of depression, these data suggest that CREB (and genes regulated by CREB) in the NASh may be involved in depressive syndromes. To address this question, we have examined relationships between CREB function in the NASh and behavior in the Porsolt forced swim test (FST), a model of depression. In preliminary studies, we find that exposure to the FST causes immediate increases in phospho-CREB (P-CREB, an activated form of CREB) in the NASh. To examine the significance of this effect, we elevated CREB expression in the NASh by viral-mediated gene transfer. This treatment increases immobility in the FST (suggesting increased depression), whereas blockade of CREB function in the NASh (by overexpression of a dominant negative CREB) decreases immobility (suggesting an antidepressant effect). Together, our work suggests that CREB in the NASh is a molecular regulator of at least some symptoms of depression (anhedonia, despair). We propose to further examine the interaction of CREB (and CREB-regulated genes) in the NASh with two antidepressants (desipramine, fluoxetine) in the FST. First, we will determine if antidepressants block CREB-induced increases in immobility. Second, we will examine the time course of FST-induced P-CREB elevations in the NASh, and determine if they are blocked by antidepressants. Third, we will determine if the FST increases expression of dynorphin, a target gene of CREB. Fourth, we will determine if blockade of the brain receptors for dynorphin (k opioid receptors) has antidepressant actions. Finally, we will use intracranial self-stimulation (ICSS) to examine if elevated CREB expression in the NASh produces symptoms of depression in a second behavioral assay. These studies may establish that elevated CREB expression in the NASh is a "molecular trigger" for depression, and identify novel targets for pharmacotherapies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: SERTRALINE FOR ALCOHOL DEPENDENCE AND DEPRESSION Principal Investigator & Institution: Pettinati, Helen M.; Director; Psychiatry; University of Pennsylvania 3451 Walnut Street Philadelphia, PA 19104 Timing: Fiscal Year 2001; Project Start 30-SEP-1992; Project End 31-MAR-2004 Summary: This is a competing continuation proposal to extend results from a 5- year NIAAA-funded project on sertraline for depressed alcoholics. Comorbidity in substance abusers traditionally has been associated with a more severe clinical picture and a poorer prognosis for drinking outcome, compared to cases of uncomplicated alcoholism. In clinical populations, one-third to one-half of patients seeking alcohol treatment have a lifetime major depressive disorder. Persistent depression in abstinent alcoholics is both disabling and a risk factor for relapse to drinking, and further clinical deterioration that may result in suicide. Because we have effective, FDA-approved pharmacotherapy for alleviating depressive symptoms, it is important that we are fully informed about the

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advantages (or disadvantages) of treating primary or secondary depression in alcoholics with antidepressant medications. Results from our initial, project suggested that comorbidly depressed alcoholics appeared to have reduced antidepressant effects from sertraline and sertraline did not reduce their drinking (more than placebo). To address these results, we propose a study that will examine if we can achieve a more optimal outcome in comorbidly depressed alcoholics by directly treating the alcoholism with naltrexone, and combining this pharmacotherapy with the use of sertraline for treating depression. Thus, the primary aim of this proposal is to examine in depressed alcoholic outpatients whether combining naltrexone (an FDA-approved pharmacological intervention to reduce drinking) with sertraline (an FDA-approved pharmacological intervention to treat depression) will result in greater reductions in both drinking and depression over either medication alone or placebo. A secondary aim is to examine whether certain patient features, e.g., extent of pre-treatment drinking or severity of depression, will predict response to sertraline, naltrexone, or the combination. Patients who present to the University of Pennsylvania Treatment Research Center will be recruited for participation in this study over a 5-year period. There will be 160 males and females with a current DSM-IV diagnosis of alcohol dependence and also of major depression (via PRISM) who will be randomized to one of four treatment groups (40 per group): 1) the combination of 100mg/day naltrexone and 200mg/day sertraline, 2) 100mg/day naltrexone, 3) 200mg/day sertraline, or 4) placebo. Subjects will also receive once- weekly sessions of Cognitive Behavioral Therapy that has been adapted to include a medication compliance enhancement component. The treatment phase will last 16 weeks (includes a week of baseline, and a week of single-blind, placebo lead-in, and 14 weeks of double-blind pharmacotherapy). The follow-up phase includes two visits at 6 and 9 months post-treatment entry. Overall, this project will determine if combining pharmacotherapies results in a better response in comorbidly depressed alcoholics than either medication alone or placebo. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SEVERE DEPRESSION IN WOMEN AFTER CARDIAC SURGERY Principal Investigator & Institution: Doering, Lynn V.; None; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, CA 90024 Timing: Fiscal Year 2001; Project Start 01-FEB-2000; Project End 31-JAN-2003 Summary: Women account for 27% of the estimated 573,000 coronary artery bypass (CABG) graft surgeries performed annually and suffer greater perioperative mortality and post-operative morbidity, including depression, than men. Depression is a predictor of both mortality and morbidity in other cardiac patients. It has been associated with decreased cell-mediated immunity. While depression after CABG is common, little is known about its severity or its association with post-operative outcomes, such as immune function, infectious complications, functional status, psychosocial adjustment, and quality of life. A structured cognitive behavioral intervention designed specifically to relieve depression has not been tested during early postoperative recovery of CABG patients, even though it is the therapy of choice for mild to moderate depression. The proposed research plan has two overall objectives. The first objective is to obtain evidence regarding the risk of postoperative complications associated with compromised immune function in depressed women compared to non-depressed women undergoing CABG. The second objective is to describe the application of cognitive behavioral therapy in depressed women early after CABG. The overall objective of the proposed award is to increase the applicant's knowledge in immunology and in the delivery of cognitive behavioral therapy, so that

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she is better equipped to pursue a research career in biobehavioral science. A 3-year training plan is proposed. The plan incorporates formal classes in immunology and cognitive behavioral therapy with laboratory training, under the direction of scientists and clinical experts, in each field. The research proposed as part of the award is designed to completed the applicant's formal and laboratory training. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SEXUAL ABUSE, SUBSTANCE ABUSE AND DEPRESSION Principal Investigator & Institution: Lewis-Jack, Ometha; Howard University 2400 6Th St Nw Washington, DC 20059 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2005 Summary: Clinicians that treat female substance abusers consistently report having to treat other pathologies besides substance abuse. It is typical for a female substance abuser to enter treatment because of drug use, yet, during the process of achieving abstinence, other issues such as depression and sexual abuse emerge and become major treatment concerns. Both depression and sexual abuse seem to be more inherent among the female substance abusing population than the male substance abusing population. Also, males tend to use alcohol for social reasons whereas women report using alcohol to escape from distress rather than for social reasons. Thus, women may tend to use alcohol and drugs more often to mediate distressful feelings. If this is the case, issues that are related to depression, such as sexual abuse, and the depression itself must be identified and then addressed therapeutically to maximize recovery. Additionally, substance-abusing women who have experienced childhood abuse may have children who will also encounter childhood abuse. Sedlak and Broadhurst cited reports from the National Clearinghouse on Child Abuse and Neglect indicating that illicit drug abuse probably contributed significantly to increased rates of suspected child maltreatment and documented injuries. Thus, needs of the mothers and children for which they are responsible. Subsequently, treatment should result in family preservation and prevention of further childhood abuse. The present study has two specific aims (1) to examine the relationship between childhood sexual abuse, depression, and substance abuse among women, and (2) to examine the relationship between substance abusing women who have experienced childhood abuse and the incidence of abuse among their children. The goal of the study is to gain a better understanding of substance abusing women's issues and their impact on recovery and family preservation. The present study also has two long-term objectives (1) to advanced a more comprehensive model of recovery that addresses the specific needs of African American women who have experienced childhood sexual and/or physical abuse and (2) to reduce the incidence of subsequent substance abuse and other mental illness resulting from childhood abuse by developing a more comprehensive model of treatment designed to detect, prevention, and treat abuse among children of substance abusing women. Utilizing factorial ANOVA's, MANOVA's, Pearson Correlation's and Multiple Regressions, the current research intends to examine the relationship childhood sexual abuse, depression, substance abuse and the incidence of sexual abuse among children of substance abusers. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: SLEEP IMAGING STUDIES IN DEPRESSION Principal Investigator & Institution: Nofzinger, Eric A.; Associate Professor of Psychiatry; Psychiatry; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, PA 15260

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Timing: Fiscal Year 2002; Project Start 25-SEP-2002; Project End 31-AUG-2007 Summary: (provided by applicant): Reliable changes in EEG sleep characterize depression although the neurobiology of these changes remain unknown. Preliminary findings from our lab suggest that depressed patients suffer from two related behavioral state changes: deficits in the generation and maintenance of slow wave sleep, and increases in measures related to behavioral arousal including sleep continuity and REM sleep disturbances. We propose that these changes are related to functional alterations in two related brain systems: 1) an anterior paralimbic and prefrontal cortex system (anterior cingulate, basal forebrain, hypothalamus and prefrontal cortex); and 2) a generalized arousal system (pontine reticular formation, thalamus and amygdala). Career development activities to further this line of investigation focus on three areas: 1) the application o neurobiological studies to longitudinal clinical trials; 2) the cognitive neuroscience of limbic/prefrontal cortex interactions and their applications to the functional neuroanatomy of sleep in depression; and 3) the pharmacologic modulation of limbic/prefrontal cortex interactions across behavioral states in depression. The research plan of the K24 award will test a functional neuroanatomic model of behavioral state (sleep/wake) changes in depression that are proposed to be central to the pathophysiology of depression. We will recruit 27 depressed outpatients and 27 healthy controls into a five-day sleep brain imaging study. Measures of behavioral state include EEG sleep and regional quantitative EEG. Measures of brain function include -FDG PET relative regional glucose metabolism during waking, NREM and REM sleep. Repeated measures multivariate analyses of covariance and multivariate multiple regressions will test the above hypotheses. This plan has previously been funded as the R01 "Sleepguided PET studies in depression" (EA Nofzinger, P1, MH61 566). Findings from this study are expected to significantly advance our understanding of the pathophysiology of depression. The goals of mentoring activities are to recruit and mentor at least one new trainee per year from the ranks of medical students, residents, or post-doctoral fellows. Success in mentoring will be measured by trainee's productivity in peerreviewed publications, presentations of research at scientific meetings, and pursuit of independent career development awards and funding proposals. The principal investigator will mentor trainees in conducting patient* oriented research, including the development of IRB approved protocols, implementing a research plan, and interpreting and presenting data. Content areas for mentoring young investigators include functional neuroimaging methods for use during sleep, the neuroscience of behavioral state regulation, and in the ethical conduct of research. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SMOKING AND METABOLIC COMPLICATIONS IN ADOLESCENT GIRLS Principal Investigator & Institution: Dorn, Lorah D.; Associate Professor of Nursing & Psychia; Health Promotion & Development; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, PA 15260 Timing: Fiscal Year 2003; Project Start 15-APR-2003; Project End 31-MAR-2008 Summary: (provided by applicant): Adolescence is a time of vulnerability for youth where depression rates increase, particularly in girls, and smoking behaviors are also initiated. Increased morbidity and mortality in women who are smokers has been highlighted by recent statistics showing that women now have an increased rate of smoking over the last several decades. Morbidity and mortality is usually defined by cardiovascular and respiratory disorders. Less attention has been paid to the effect of smoking on aspects of health such as the relationship between smoking and depression

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and anxiety, and in turn, their combined effects on reproductive and bone health. No studies have examined such issues in puberty. The aims of this study are to examine: (1) baseline relationships between puberty, smoking status, depression anxiety, reproductive and bone health, (2) causal direction between smoking status and depression and anxiety across 3 years, (3) characteristics of individual differences in developmental trajectories of: (a) reproductive and (b) bone health (accrual of bone mineral content; BMC) across a 3 year period, (4) the systematic effects of timing of puberty, smoking status and depression and anxiety on individual differences in developmental trajectories of reproductive and bone health (accrual of BMC) across a 3 year period, (5) the relationship of individual differences in developmental trajectories of adolescent reproductive health with individual differences in developmental trajectories of bone health across a 3 year period, and (6) whether baseline levels of smoking status, depression, and pubertal timing predict the simultaneous developmental trajectories of reproductive and bone health. The study will include 252 girls, ages 11-17 years enrolled in a cross-sequential design for three annual visits. Measures include smoking status, depression and anxiety, pubertal timing, gonadal and adrenal hormones, menstrual cycle information, and accrual of BMC. Examining the combined impact of smoking, depression and anxiety, on timing of puberty has import for future intervention and prevention strategies. Any negative influence during this critical period, such as smoking or depression, may have significant long-term consequences for bone (i.e. increased risk of osteoporotic fracture) or reproductive health (i.e. menstrual irregularity & endocrine disruption, infertility, dysmenorrhea). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SOCIAL CHANGE, HEART DISEASE, AND DEPRESSION Principal Investigator & Institution: Fechner, Mary J.; Anthropology; University of Oregon Eugene, OR 97403 Timing: Fiscal Year 2001; Project Start 01-SEP-2001 Summary: INVESTIGATOR'S The research is part of a larger goal to understand the role of culture on the experience of heart disease, depression, and their co-morbidity. The research begins with a cultural investigation of post-socialism in eastern Germany, but will culminate in an understanding of illness as a meaningful experience in a context of rapid social change. Research suggests that heart disease (and heart disease co-morbid with depression) is sensitive to biologic and psychosocial variables, but few studies have investigated the role of culture in heart disease, or its co-morbid state. This work builds on research into culture and hypertension, and culture and depression, to fill a gap in our understanding of the cultural processes at work in the expression of heart disease, but adds a new dimension by exploring co-morbidity. The research will take place in eastern Germany, where individuals are at increased risk to both conditions since 1989. Research aims include: 1) a community-based cultural study of the political-economic transition; 2) a community-based cultural study of cardiac and mental health; and 3) a clinic- or hospital based appraisal of cultural factors among patients expressing: a) heart disease; or, b) co-morbid heart disease and depression. Data sources will include: ethnographic interviews of post-socialism; idioms of distress, explanatory models, illness narratives, and semantic illness networks for heart disease and depression; a cultural consonance measure; measures for depression; demographics; and, local health statistics. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: LIFECOURSE

SOCIAL

INEQUALITIES

IN

DEPRESSION

ACROSS

THE

Principal Investigator & Institution: Buka, Stephen L.; Associate Professor; Maternal and Child Health; Harvard University (Sch of Public Hlth) Public Health Campus Boston, MA 02460 Timing: Fiscal Year 2001; Project Start 01-APR-2001; Project End 31-MAR-2003 Summary: This application addresses two major current themes in the epidemiology and prevention of adult mental disorders: a) social and economic disparities in health status: and b) early origins of adult health status. Where most of the current work in these areas has focused on physical health conditions (e.g., cardiovascular illness. diabetes) there is mounting evidence of the relevance of these lines of inquiry to psychiatric disorders. Furthermore, while socioeconomic disparities in depression in adulthood have been documented consistently, the mechanisms generating these disparities have yet to be fully elucidated. Accordingly, we seek to conduct new data analyses examining socioeconomic disparities in major depressive disorder in relation to adult and childhood socioeconomic status, and to examine the role of other childhood environmental factors in the development of depression. These investigations will be based on the Providence follow-up National Collaborative Perinatal Project, a thirtyyear, longitudinal study of 1,263 individuals who were enrolled at birth and systematically followed for an average of 27.8 years. Comprehensive prospective assessment of childhood environmental conditions have been obtained at multiple points in time and adult psychiatric diagnoses obtained using structured diagnostic interviews. We will employ a range of analytic strategies including discrete-time survival analyses. The specific aims of this study are to examine the effects of childhood socioeconomic status on the occurrence and severity of major depressive disorder in adulthood. Furthermore, we will assess the direct role of childhood environmental factors in the occurrence of depression as well as their potential to mediate the association between early-life socioeconomic conditions and subsequent depression. Finally, we will study the risk that substance abuse disorders pose on the incidence of depression and examine whether this risk is modified by childhood conditions. The prospective nature of this study, the comprehensive assessment of parental and childhood variables, and the rigorous measurement of psychiatric disorders in adulthood make this sample uniquely suited to addressing these aims. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SOCIAL SUPPORT AND DEPRESSION AMONG DIALYSIS PATIENTS Principal Investigator & Institution: Brown, Stephanie L.; Survey Research Center; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, MI 481091274 Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 31-JUL-2006 Summary: (provided by applicant): The proposed three-year research and training plan is designed to foster the academic development of the candidate in preparation for her career as a translation research scientist. Specifically, the plan is intended to (a) foster the candidate's transition from conducting experimental research on interpersonal relationships to conducting pre-intervention research on depression in chronically ill populations and (b) enable the candidate to design an intervention for depression that is informed by her program of research. The research plan is described below. The purpose of the proposed research project is to identify malleable factors that influence

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depression among patients undergoing dialysis therapy for renal failure. We direct special focus on the exchange of emotional and practical support between dialysis patients and their caregivers in order to isolate the unique effects of giving and receiving. We intend to examine whether giving has beneficial effects for the giver, and whether receiving has adverse effects for recipients who feel like a burden. These possibilities have typically been overlooked. Instead, investigations have focused on the benefits of receiving support from relationship partners (House, Landis, & Umberson, 1988). A longitudinal study consisting of two waves of data collection--baseline and an eight-month follow-up-is proposed to examine the unique effects of giving and receiving social support, feeling like a burden, and a number of other personality and relationship measures on depression, health, and well-being. 160 dialysis patients within the University of Michigan Health Care System will be invited to participate in two 1-hour interviews over the course of eight months. Participants will be asked to respond to questions about their current mental health status (e.g., depression, anxiety), and about their relationship to a caregiver (e.g., social bonds, the exchange of social support). In addition, caregiver reports and medical records indicating patient health and compliance will be correlated with interpersonal relationship measures. The results of this project will be used to develop and test a mental health intervention for dialysis patients that takes into consideration the potential risks and benefits of social support. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SPIRAL OF DEPRESSION AND DISABILITY IN LATE LIFE Principal Investigator & Institution: Bruce, Martha L.; Professor; Psychiatry; Weill Medical College of Cornell Univ New York, NY 10021 Timing: Fiscal Year 2001; Project Start 05-AUG-1998; Project End 31-JUL-2003 Summary: (Adapted from applicant's abstract): This application for a NIMH Independent Scientist Award(K02) requests support for the candidate's career goal of identifying strategies which can effectively intervene on the potential spiral of depression and functional disability in older adults. The K02 career development aims are: a) to foster collaborative study of these issues with an interdisciplinary set of scientists with clinical, biological, and psychosocial orientations, and b) to develop personal expertise in: i) theory and assessment of functional disability, and ii) methodology for assessing the feasibility and effectiveness of intervention strategies for reducing the causal effects of disability and depression on each other. The specific K02 research aims are to further the understanding of the relationship between depression and functional disability in elderly adults by testing hypotheses in data from both naturalistically treated and controlled treatment samples of elderly adults about: a) specific attributes of depression and disability that contribute to the risk of each condition over time, and b) the effect of systematic treatment interventions for depression on changes in functional disability in relationship to changes in depressive status. Depression and disability are both highly prevalent in advanced age and both associated with immense personal suffering, burden on family and expensive health care. Longitudinal population-based and clinical-based studies demonstrate that depression and disability affect each other's onset and course. The K02 award offers an opportunity to introduce the concept of heterogeneity to this research, both in terms of the severity and other clinical features of depression but also in terms of the assessment of functional disability. Disaggregating these phenomena and specifying attributes of depression and disability associated with the downward course of both promises two sets of scientific contributions. First, this research will identify specific mechanisms relating depression to functional disability in older adults. Second, it will identify

154 Depression

potential avenues for effective intervention into these relationships in high risk populations. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: STRESS RESILIENCE IN AN ANIMAL MODEL OF DEPRESSION Principal Investigator & Institution: Kohen, Ruth; Psychiatry and Behavioral Scis; University of Washington Seattle, WA 98195 Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 31-MAR-2005 Summary: (provided by applicant): Major depression is the most common psychiatric disorder, affecting over 17% of individuals over the course of their lifetime. Genetic and environmental factors working in concert determine an individual's vulnerability to depression by affecting the use of genetic information in the brain. This use of genetic information can be measured as the amount of messenger RNA (mRNA) that is produced from a single gene, a process described as 'gene expression analysis'. In the proposed study we will use an animal model of depression, the forced swim test, to investigate the influence of environmental stress and chronic antidepressant treatment on gene expression in rat hippocampus. We hypothesize that resilience to depression occurs as a result of adaptive changes in the brain. We will observe these adaptive changes by large-scale gene expression analysis, using oligonucleotide microarrays and quantitative reverse transcription polymerase chain reaction (RT-PCR). We further hypothesize that animals show behavioral depression if and when these adaptive changes in gene expression fail to occur. We will also test the hypothesis that chronic treatment with antidepressant drugs works by facilitating this adaptive pattern of gene expression changes. This is a departure from the traditional way of thinking about depressive illness. The traditional view suggests that depressive illness occurs as a result of a change of metabolism or neuronal circuitry in the brain of affected subjects. We propose just the opposite: that stress resilience is accompanied by an adaptive change in brain neurochemistry that is missing in depressed individuals. Hence, depressed subjects resemble controls that have not been challenged with environmental stress. Our approach is novel because it focuses on investigating factors that protect the individual from depression, rather than on changes that occur as a result of the disease. If our hypothesis is true, it would mean a paradigm shift in our understanding of affective illness that could alter the focus of treatment from the current management of symptoms to their prevention Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: STRESS RESPONSE DIFFERENCES IN FEMALES: ESTRADIOL'S ROLE Principal Investigator & Institution: Faraday, Martha M.; Henry M. Jackson Fdn for the Adv Mil/Med Rockville, MD 20852 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-AUG-2004 Summary: (provided by applicant): In response to stress, pre-menopausal women are more likely to become depressed than are men, suggesting that being female and exposure to cycling female sex hormones may constitute part of depression vulnerability. Only some women develop depressive illness, however, indicating that women differ in stress sensitivity and depression vulnerability. Rodent models of depression that examine responses of stress-vulnerable vs. stress-resistant females would be valuable to understand the biologic basis of differential stress and depression vulnerability in women but models of depression generally have used male rats as

Studies 155

subjects. Preliminary data indicate that Sprague-Dawley female rats are markedly more sensitive to stress than are Long-Evans female rats across several behaviors and biologic indices, including a behavioral model of depression and hypothalamo-pituitaryadrenocortical (HPA) axis responses. These differences in response to stress could be the result of many factors, including actions of estradiol on brains that are different and line differences in how stress affects estradiol levels or estrus cycling. Estradiol is the major sex hormone with behavioral and biologic actions in females. Estradiol interacts with stress-sensitive brain systems (i.e., serotonergic, dopaminergic) that control the behaviors under study. Estradiol also interacts with the HPA axis. Therefore, examining estradiol's role in stress responding of stress-sensitive female rats (Sprague-Dawley) and stress-resistant female rats (Long-Evans) is a critical step toward understanding why some females are more vulnerable to stress and depression than others. Behavioral and corticosterone responses of Sprague-Dawley and Long-Evans females that are intact, ovariectomized, or ovariectomized with estradiol replacement will be evaluated in response to daily restraint stress. Responses also will be compared with intact male rats. To determine whether female line differences in response to stress are the result of changes in estrus cycling or line differences in estradiol levels, estrus cycle and estradiol levels of intact females also will be assessed. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: STRUCTURE AND ASSESSMENT OF SYMPTOMS OF DEPRESSION Principal Investigator & Institution: Watson, David B.; Professor; Psychology; University of Iowa Iowa City, IA 52242 Timing: Fiscal Year 2003; Project Start 01-JUL-2003; Project End 30-APR-2008 Summary: (provided by applicant): Many of the most frequently used depression instruments were created more than 40 years ago, without the benefit of rigorous psychometric development and testing. Most of these measures were designed to provide only a single overall index of depression, so that they do not yield reliable and valid subscales assessing specific types of depressive symptoms. Furthermore, progress in this area is hampered by our limited understanding of the internal structure of depressive symptoms. The proposed work will result in a multi-dimensional measure of depression that will include a wide range of depression symptoms, as well as symptoms of related anxiety disorders such as generalized anxiety disorder, social phobia, and panic disorder. The scales comprising the final measure will be suitable for use in clinical outcome research as well as other studies of the etiology and consequences of depression. The process will begin with the creation of a comprehensive item pool; our review of the literature indicates that this pool should multiple groups of items assessing prominent symptoms of depression, another group of items measuring positive emotionality, and several clusters of anxiety-related items. These items will undergo extensive testing with diverse samples of both clinical and non-clinical adult populations. The goal of the initial phases of the proposed research is to determine the factor structure of depression and related symptoms so that appropriate subscales are modeled in the final measure. Further studies will assess the construct validity of the resulting factor-based measures through analyses of their (a) sensitivity to change and (b) convergence with other self-report and clinician-rated measures of depression and anxiety. The next group of proposed studies will use advanced psychometric methods (including confirmatory factor analysis and item response theory) to assess the suitability of the measure--at both the subscale and item level--in different populations (e.g., adolescents, pregnant and postpartum women, and older adults) and to modify the instrument as necessary for use with these populations.

156 Depression


Project Title: SUBCORTICAL MICROVASCULAR DISEASE IN DEPRESSION Principal Investigator & Institution: Salloway, Stephen P.; Associate Professor; Rhode Island Hospital (Providence, Ri) Providence, RI 02903 Timing: Fiscal Year 2001; Project Start 01-JAN-1999; Project End 31-DEC-2003 Summary: The objective of this five year Mentored Clinical Scientist Development Award is to become an independent investigator in the pathogenesis, prevention, and treatment of subcortical microvascular disease in geriatric depression. The award will help the nominee develop skills in the following areas: clinical research methodology and statistics, quantitative magnetic resonance imaging (MRI) analysis, pathogenesis of cerebral small artery disease, and assessment of cognitive function and clinical manifestations of geriatric depression. These skills will be utilized to conduct a pilot study of the role of subcortical microvascular disease in geriatric depression. The study will use a case control design to compare two groups of geriatric depressed inpatients with and without high levels of subcortical microvascular disease. The specific aim is to look for differences in hypertensive burden, cognitive function, phenomenology of depression, and rate of decline in cognition and activities of daily living (ADLs). Subsidiary analyses will correlate the regional distribution of MRI hyperintensities with the pattern of cognitive dysfunction, and will evaluate the presence of apolipoprotein E4 alleles as a marker for the development of microvascular disease. The findings from this study should have important implications for prevention, prognosis, and treatment of geriatric depression associated with microvascular disease. The nominee plans to submit an RO1 level grant on subcortical microvascular disease in geriatric depression based on results obtained in the pilot study prior to the completion of the award. The nominee plans to develop a high quality morphometric imaging laboratory which will be used as a resource for a number of clinical studies in the departments of psychiatry and clinical neurosciences at Brown. The nominee further plans on assuming a leadership role in developing a post-doctoral clinical research training program in geriatric neuropsychiatry at Brown University. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: SUBMISSIVE BEHAVIOR AS A MODEL OF DEPRESSION Principal Investigator & Institution: Tunnicliff, Godfrey; Pharmacology and Toxicology; Indiana Univ-Purdue Univ at Indianapolis 620 Union Drive, Room 618 Indianapolis, IN 462025167 Timing: Fiscal Year 2001; Project Start 01-JUL-2001; Project End 30-JUN-2003 Summary: (provided by applicant): Depression is one of the most prevalent mental disorders in the United States and is associated with high levels of morbidity and mortality. It is estimated that costs associated with depression (from absenteeism, lost productivity, lost earnings, treatment and rehabilitation) exceed $40 billion in the United States alone. Our work is focused on the investigation of the mechanism of depression and antidepressant drug action. We developed a new animal model of depression, reduction of submissive behavior (RSBM) that differs from existing behavioral tests by not subjecting animals to pain or artificially stressful conditions. Instead, pairs of rats compete during a daily 5-minute trial period for a limited amount of food. Half of the rats tested under this condition develop a dominant/submissive relationship that is a characteristic feature of normal animal social behavior. The submissive behavior observed can be objectively measured as the amount of time spent on the feeder relative

Studies 157

to that by the paired dominant animal. We have shown that this submissive behavior has qualities of human depression and can be greatly reduced or eliminated by treatment with a wide variety of antidepressant drugs. We want to adopt the RSBM to mice for testing mouse mutants for candidate gene related to depression. The extension of the dominance-submissive model to mice is of particular importance because of the development of many genetically distinct mouse strains and the availability of mice with specific genetic modifications (i.e. knockout strains). The studies in this proposal are designed to test the hypothesis that mice, like rats, will form dominant-submissive behavior and to demonstrate the activity of antidepressant drugs in mice using the model as described above. We will also determine whether selected mouse strains are more prone to submissiveness than others. Furthermore we will study whether specific knockout mice showing depressive-like behaviors in other models of depression will be submissive as compared with the wild type animals. Human depression shows an inheritance pattern consistent with a genetic component. The identification of genetic elements in mice associated with depression-like behavior can be tested for homology in human patients that could ultimately lead to an understanding of genetic defects underlying depression in humans. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SUBSTANCE DEPENDENT TEENS--IMPACT OF TREATING DEPRESSION Principal Investigator & Institution: Riggs, Paula D.; Associate Professor of Psychiatry; Psychiatry; University of Colorado Hlth Sciences Ctr Uchsc at Fitzsimons Aurora, CO 800450508 Timing: Fiscal Year 2001; Project Start 30-SEP-2000; Project End 31-JUL-2005 Summary: (Applicant's Abstract) Adolescents with substance use disorders (SUD) and conduct disorder (CD) have high rates of comorbid depression. Despite the high prevalence of depression in such youth, little is known about effective treatment of such depressions. Moreover, the effects of treating depression on substance use and other problem behaviors in such youth are not known. Only serotonergic agents, fluoxetine (FLX) and paroxetine, with most support for FLX, have empirical support in the treatment of depression in adolescents without serious comorbidity. It is not known whether FLX (or paroxetine) are effective in treating the depressions of adolescents with SUD and CD. The proposed study is a randomized, placebo-controlled trial comparing placebo to fluoxetine for major depressive disorder (MDD) in 120 adolescents with SUD and CD. Adolescents with DSM-1V SUD, CD, and MDD assessed both clinically and with structured assessment instruments, will be randomized to one of these two treatment cells for 16 weeks. All subjects will also receive standardized, manual-driven cognitive behavior treatment for adolescent SUD for the duration of the trial as the background "treatment as usual" Medication compliance will be electronically monitored. Adverse side effects will be monitored weekly. The specific aims of this study are to test the following hypotheses: 1. Fidoxeline + CBT will be more effective in treating unipolar depression in adolescents with SUD and CD than placebo + CBT. 2. The treatment of depression with RX + CBT, in depressed adolescents with SUD and CD will be more effective than placebo + CBT in reducing substance use and improving conduct symptoms. 3. The treatment of depression with RX will result in greater retention in, and compliance with substance treatment (CBT) and reduction in both substance use and conduct problems than treatment with placebo. This research will contribute important knowledge regarding effective treatment of depression in

158 Depression

conduct-disordered adolescents with SUD and provide information about the effects of treating depression on substance and other behavioral outcomes as well. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TELECOM ANTIDEPRESSANTS

SYSTEM

TO

IMPROVE

ADHERENCE

TO

Principal Investigator & Institution: Friedman, Robert H.; Director, Ambulatory Medicine; Boston Medical Center Gambro Bldg, 2Nd Fl, 660 Harrison Ave, Ste a Boston, MA 02118 Timing: Fiscal Year 2001; Project Start 21-SEP-2001; Project End 31-AUG-2004 Summary: (provided by applicant): The purpose of this pilot study is the development and preliminary evaluation of an automated telecommunications system to help adult patients with unipolar depression improve adherence to their antidepressant medication regimens and scheduled office visits with their mental health care providers. Based on Social Cognitive Theory (SCT), particularly its self-efficacy construct, the Telephone-Linked Care for Adherence to Treatment Regimen in Depression (TLCDepression) will automatically monitor adherence to treatment regimens as well as disease symptoms and functional status of patients and will give information, advice and counseling to patients to reinforce adherence. TLC-Depression will also generate reports from the information obtained from the patients and will communicate it to their mental health caregivers in order to assist the responsible physician in better monitoring of the patients medication-taking behavior, their depression symptoms and their functioning. The study will entail 2 components: 1) A qualitative evaluation of TLCDepression that will be carried out with a maximum of 20 patients with the purpose of modification and refinement of the system. These patients will be screened for a period of 1 month to determine eligibility (medication adherence as measured by MEMS track caps less than 80 percent, and pill count audit). In-Depth interviews will be conducted twice a month with eligible subjects who will use TLC-Depression for 2 months. The results of the interviews will be utilized to improve and refine the intervention. 2) A quantitative pilot study to test TLC-Depression in order to utilize the system in a future randomized clinical trial with sufficient power to evaluate its efficacy. Sixty eligible patients will be randomized to the intervention (TLC) and usual care (UC) groups for a period of 4 months. All patients will be screened for a 1-month period to determine adherence eligibility (medication adherence as measured by MEMS track caps less than 80 percent, and pill count audit). Patients will call TLC-Depression and will converse with the system through the touch-tone keypad on their telephones. Patients will call TLC-Depression once a week at a scheduled time. The analysis will compare TLC and UC patients between baseline and follow-up 4 months later. Patients' self-efficacy, psychological and physical health status will be measured at baseline and at the end of the study. We hypothesize that TLC Depression will improve adherence, self-efficacy and psychological and physical health status among patients in the intervention group over a 4-month period in comparison with those in the control group. And that TLCDepression will be acceptable and usable by the patients Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TELEPHONE PSYCHOTHERAPY--TREATMENT OF DEPRESSION IN MS Principal Investigator & Institution: Mohr, David C.; Northern California Institute Res & Educ San Francisco, CA 941211545

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Timing: Fiscal Year 2001; Project Start 08-SEP-2000; Project End 31-JUL-2005 Summary: (Adapted from the Applicant's Abstract): Rates of depression in multiple sclerosis (MS) have been estimated at between 14% and 54%, and have been shown to be higher than rates in the general population or in other chronic illnesses. While untreated depression in MS is likely to worsen over time, it has been shown to respond well to treatment with cognitive behavioral therapy (CBT). Nevertheless, many patients with MS remain untreated. This may be due in part to common symptoms of MS, which can interfere with regular office visits. We are proposing to test a model of CBT, administered over the telephone, designed to treat depression in MS. While the use of telephone counseling and support services is increasing, empirical evidence on the efficacy of such services for the treatment of depression is scant at best. A patient workbook and therapist CBT treatment manual were developed by the PI and tested in an uncontrolled pilot study. In the 8-week pilot, 32 MS patients were randomly assigned to either telephone CBT or standard care (SC) in an HMO. Patients receiving telephone CBT showed improvement, as compared to patients receiving SC as measured by the Profile of Mood States Depression-Dejection scale (p=.01). This study proposed to enroll 128 patients in a randomized treatment study. Patients will be selected from the diverse population of patients in the Northern California Kaiser Permanente Medical Care Group (KPMC). Patients who meet inclusion criteria, including definite MS, activity limitation (disability) criteria, and DSM-IV diagnosis of Major Depressive Disorder (MDD), will be randomized into one of two treatment groups: 1) Coping with MS (CMS) telephone psychotherapy, which is a 16 week, 18 session, manualized form of telephone CBT that focuses on depression and adjustment to illness; or 2) a non-directive (ND) therapy contrast condition that controls for the nonspecific effects of psychotherapy. Outcomes include dichotomous and continuous measures of MDD, Quality of Life, and activity limitations. Patients will be followed for one year after the end of treatment. If the treatment proves efficacious, it will result in a validated form of telephone CBT for the treatment of depression that can be provided to MS patients independent of their mobility status or geographic location. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TESTING CAREGIVERS

THE

DIATHESIS

STRESS

MODEL

WITH

LAY

Principal Investigator & Institution: Clark, Michele C.; None; University of Texas Medical Br Galveston 301 University Blvd Galveston, TX 77555 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 29-SEP-2004 Summary: (Provided by the Applicant) Caregivers providing direct and indirect care often experience depression, which impairs their health and compromises their ability to provide care. Using the Diathesis-Stress Model developed from cognitive theory (Beck, 1983; Clark & Beck, 1999), this study will evaluate whether researchers and clinicians can differentiate between lay caregivers susceptible to clinical depression and those who are not. The Diathesis-Stress Model examines sociotropy, autonomy, and negative assumptions. Sociotropy is defined as the beliefs and attitudes that lead an individual to depend on others for personal satisfaction. Sociotropic individuals tend to place high value on approval, intimacy, affection, guidance, and help. Autonomy represents self-evaluation about one's abilities in mastery, control, and achievement. Negative assumptions are the rules individuals develop to support beliefs about their own characteristics of sociotropy and autonomy. Specifically, this study aims to (1) evaluate the influence of caregiver burden on depression; (2) explore the influence of caregiver burden on caregiver's individual levels of sociotropy, autonomy, and negative

160 Depression

assumptions; (3) measure the influence of sociotropy, autonomy, and negative assumptions on depression; and (4) compare the magnitude of the direct influence of caregiver burden on depression with three indirect influences of sociotropy, autonomy, and negative assumptions. A causal model will be tested to achieve the study aims. Participants will consist of 109 caregivers providing a minimum of 10 hours per week of instrumental or personal care to a community dwelling elderly (60 +) family member. To test the overall Diathesis-Stress Model for Caregivers, a structural model will be constructed. Caregiver burden is hypothesized to have a direct influence on depression. Additionally, caregiver burden is also expected to influence depression through the mediating variables of sociotropy, autonomy, and negative assumptions. Differentiating between lay caregivers susceptible to clinical depression and those who are not is important. Identifying depression-prone caregivers can accelerate researchers' abilities to design programs that prevent or reduce depression among individuals and communities. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: THE BEHAVIORAL TREATMENT OF DEPRESSED CANCER PATIENTS Principal Investigator & Institution: Hopko, Derek R.; Psychology; University of Tennessee Knoxville Knoxville, TN 37996 Timing: Fiscal Year 2003; Project Start 01-JAN-2003; Project End 31-DEC-2003 Summary: (provided by applicant): Among cancer patients, major depression is the most common psychiatric disorder, with as many as 50-85% of patients considered clinically depressed, the majority of which present to a primary care environment for treatment (ct. Stevens, et al., 1995). Among primary care patients with depression, treatment satisfaction is moderate to low and response rates are lower than those anticipated based on the Agency for Health Care Policy and Research Guidelines (Wells et al., 1999). Accordingly, the need to focus on quality improvement has been highlighted (Coyne, 2000). The primary objective of the study is to explore the effectiveness and feasibility of a brief behavioral activation treatment for depression (BA TD; Lejuez, Hopko, & Hopko, 2001) for clinically depressed cancer patients within primary care. The BATD protocol may be a viable means to improve quality of care and quality of life for cancer patients in that the treatment addresses primary symptoms often associated with cancer and depression and may reduce practical problems associated with mainstream psychosocial treatments for depression in primary care (Coyne, 2000). This research is important considering the paucity of psychosocial treatment outcome work focused on depressed cancer patients, methodological limitations of studies, lack of effectiveness research in "real-world" (primary care) settings where most patients present with depressive symptoms, and limitations of existing psychosocial treatments in this context. The design involves the collection of pilot data within a small open trial (N = 12). Using a heterogenous sample, the effects of BATD at post-treatment will be evaluated using clinical, functional, satisfaction, and service utilization outcome measures. Clinical outcomes include measurement of target symptoms (depression) and potentially coexistent clinical conditions (i.e., anxiety, substance use). Functional outcomes will assess functional status and quality of life. Satisfaction outcome will assess patient satisfaction with BATD. Longer-term effects of BATD will be assessed on these variables at 3-month follow- up. The project is an important first step toward developing a large-scale, multi-site, randomized hybrid efficacy-effectiveness study that will assess the clinical utility of BA TD in treating depressed cancer patients within primary care, and the efficacy of this treatment

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compared with alternative (psychosocial and pharmacological) interventions for depression. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •


THE

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Principal Investigator & Institution: Conti, Rena M.; Health Care Policy; Harvard University (Medical School) Medical School Campus Boston, MA 02115 Timing: Fiscal Year 2003; Project Start 15-JUN-2004 Summary: (provided by applicant): Depression is a prevalent chronic condition nationally and is associated with high levels of impairment. Extraordinary advances have been achieved in the last two decades in the pharmacological treatment of depression. The introduction of these agents has altered the way in which depression is treated in the US and may have a large impact on individuals and their well being. New treatments are also more expensive than older medications and are associated with remarkable increases in spending. The principal goal of this research is to develop practical, aggregate measures of the economic values of new methods for treating depression. I propose to measure the economic welfare generated by innovation in depression treatment by estimating a demand system that explicitly accounts for some unique features of the delivery of mental health care. From the demand estimates, several types of commonly used measures of welfare gain for the treatment of depression will be constructed. There are several competing approaches to measuring welfare change from innovation, of which the demand side approach is one. Welfare gains using the demand side approach will be compared to alternative measures. The specific aims of the research application are: 1. To review the literature on the nature of clinical decision making for depression treatment. To perform a careful review of the economics and health policy literature regarding demand estimation and consumer price index (CPI) construction. Discussions with established researchers and practitioners in the field will also be pursued; 2. To perform a series of descriptive analyses regarding the composition of depression treatment, illness characteristics, patient demographics and institutional determinants of treatment over time; 3. To estimate a model of economic welfare based on the demand for depression treatment before and after new treatment introduction. From the demand estimates, several types of welfare measures will be constructed; 4. To compare demand side estimates of welfare gain from innovation to other measures reported in the literature. Alternative measures will also be constructed and compared. The proposed research would be the first attempt to develop a comprehensive measure of the value of depression treatment innovation using the demand approach. It will also be among the first projects to extend and compare alternative empirical methodologies for valuing consumer welfare in the mental health context. The derivation of accurate measures of economic welfare from treatment innovation has important policy implications. Specifically, the results of this research may be useful to policy makers who must interpret and make judgments about the benefits associated with mental health spending. Progress on this issue will also be useful for government agencies charged with constructing accurate measures of medical sector productivity. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: TRANSITION TO ADULTHOOD IN YOUTH AT RISK FOR DEPRESSION Principal Investigator & Institution: Brennan, Patricia A.; Psychology; Emory University 1784 North Decatur Road Atlanta, GA 30322 Timing: Fiscal Year 2001; Project Start 30-SEP-1995; Project End 31-AUG-2005 Summary: (adapted from the investigator's abstract): The proposed study examines the effect of maternal depression on young adult outcomes in a unique community sample of Australian youth who have previously been studied by the investigators at age 15. The youth and their families are a high-risk sample from a birth cohort study in Queensland, Australia. The original birth cohort study by Australian investigators included interviews of mothers at pregnancy, birth, and six-months post-partum, with evaluations at children's ages 5 and 14 to assess socio-demographic predictors of health and child development. The 15-year-old follow-up by the present investigators focused intensively on maternal depression and child mental health and adjustment. The present proposal is for a follow-up at age 20 with these youth, their peers, and their mothers in order to address a number of gaps in the field concerning the transition to adulthood for high-risk youth. The proposed follow-up period marks the challenging developmental transition, and it is expected that during this period the youth in the sample will encounter significant stress, and will be particularly susceptible to depressive outcomes. The two primary aims of the study are (1) to examine the diagnostic outcomes, as well as functional impairments in high-risk youth from the ages of 15 to 20 years as well as the role of paternal psychopathology, co-morbidity, protective factors and gender in this process; and (2) to examine interpersonal models of intergenerational transmission of depression, and models of the stress-depression relationship as relevant to the period of early adulthood. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: TRANSLATING DEPRESSION GUIDELINES IN SUBSTANCE ABUSE TX Principal Investigator & Institution: Curran, Geoffrey M.; Psychiatry and Behavioral Scis; University of Arkansas Med Scis Ltl Rock 4301 W Markham St Little Rock, AR 72205 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 30-JUN-2008 Summary: (provided by applicant): The applicant is requesting five years of funding though the Mentored Career Development Award (K01) program to enhance his knowledge base and methodological skills for diffusion of renovation research-specifically, to translate evidence-based care for depression into community substance use treatment settings. The applicant's strong background in medical sociology, the developmental course of substance use disorders, and health services/outcomes research is an ideal foundation for developing expertise in technology transfer in these settings. The proposed career development plan supports this goal by providing specific training in five areas: 1) organizational change theory and methods; 2) clinical provision of care for substance abuse and depression 3) the current organizational/policy structure of substance abuse and mental healthcare services, focusing on continuity of care within and across systems; 4) quantitative and qualitative methods pertinent to the proposed research plan; and 5) the ethical conduct of research. The research plan seeks to develop, implement, and test an organizational intervention in community substance abuse treatment settings to establish guideline-concordant treatment of comorbid depression. The intervention will assist programs in their own implementation of a

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guidelines-based treatment algorithm to improve the recognition of depression and initiation of pharmacotherapy. The algorithm will involve two assessment-to-treatment steps-- 1) early post-detoxification assessment of depressive symptoms plus a patient history of depression, with initiation of pharmacotherapy if the patient reports both current symptoms and a history of major depression during periods of sobriety; 2) assessment of depression symptoms at least 4 weeks post-detoxification, with initiation of pharmacotherapy if an independent diagnosis of depression is indicated. We know from previous guideline implementation research that the simple dissemination of guidelines does little to influence provider/system behavior. Rather, a multi-component diffusion of innovation intervention is necessary to maximize the adoption of guideline concordant behavior. Study 1 analyzes the barriers and facilitators to technology transfer of depression management in participating facilities. These data will inform the development of the technology transfer intervention, its implementation tools, and the depression algorithm. Study 2 implements and tests the intervention. The evaluation will examine program- and provider-level outcomes. Program level outcomes will include feasibility, extent of adoption of the algorithm, and provider/organizational attitudes and beliefs about the intervention's design and effectiveness. Patient-level outcomes will include depressive symptoms, substance use outcomes, medication adherence quality of life, and services use. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TRANSLATIONAL STUDIES OF DEPRESSION, PLATELETS, & CAD Principal Investigator & Institution: Badimon, Juan Jose.; Professor of Medicine; Medicine; Mount Sinai School of Medicine of Nyu of New York University New York, NY 10029 Timing: Fiscal Year 2002; Project Start 10-SEP-2002; Project End 31-AUG-2007 Summary: (provided by applicant): Depressive symptoms significantly increase the risk of acute coronary syndromes recurrence (ACS). Platelet-thrombus formation over a disrupted atherosclerotic plaque is fundamental for ACS recurrence.Serotonin (5-HT) is an important stimulant of platelet reactivity. Increased 5-HT-mediated platelet reactivity due to upregulation of the platelet 5-HT2A receptor, increases thrombosis formation and has been postulated to a major mechanism linking depression to ACS recurrence. It is not known at this time if depression interventions reverse the increased risk of ACS events in depressed patients. The selective serotonin reuptake inhibitors (SSRIs) and the 5-HT2A receptor antidepressants improve depressive symptoms at equal rates. Both types of antidepressants may attenuate platelet reactivity by improving depressive symptoms (CNS mediated indirect effects). However, the SSRIs and the 5-HT2A receptor antagonists may have additional but divergent pharmacologic effects on platelet reactivity (direct platelet effects). Given the relationship between depression, platelet-thrombus formation, and the ACS, those antidepressants capable not only of improving depression symptoms but also of inhibiting platelet reactivity directly, may have the greatest net (direct + indirect) impact in inhibiting platelet-thrombus formation and preventing ACS events. A cross-sectional, case-control study will be conducted to compare 5-NT-mediated platelet reactivity and thrombosis between depressed and nondepressed patients with coronary artery disease (CAD) history. The direct in vitro effects of the SSRIs and 5-HT2A receptor antagonists will also be assessed. A randomized, 3 active arm, 1 control arm, depression intervention trial will be conducted to compare the in vivo net effects of pharmacologic (the SSRIs and 5-HT2A receptor antagonists) treatment and the indirect effects of a non-pharmacologic (cognitive behavioral therapy) treatment on platelet reactivity and thrombosis in depressed CAD

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patients. By defining differences in direct-platelet, CNS-mediated indirect, and net effects on platelet reactivity and thrombus formation, depression interventions that are best at inhibiting platelet reactivity and thrombogenicity can then be tested for reducing cardiovascular morbidity and mortality. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TREATING DEPRESSED MOTHERS IN A COMMUNITY CLINIC Principal Investigator & Institution: Swartz, Holly A.; Assistant Professor; Psychiatry; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, PA 15260 Timing: Fiscal Year 2002; Project Start 01-FEB-2002; Project End 31-JAN-2007 Summary: (provided by applicant): When mothers suffer from depression, the effects of their illness are borne not only by mothers but also by their dependent offspring. The converse may also be true: that is, effective treatments for mothers with depression may also improve outcomes for their children. The purpose of this proposed Mentored Patient-Oriented Research Career Development (K23) Award is to promote the Candidate's long-term goal of conducting clinical trials of psychosocial interventions for mothers with depression in community settings and to study the impact of these treatments on mothers and their dependent children. The activities described in this application will enable the Candidate to assess the reciprocal relationship between maternal depression and child illness, successfully engage and retain mothers in multisession psychosocial treatments, and collaborate with health services researchers in order to enhance the public health value of the intervention. Interpersonal psychotherapy (IPT), an efficacious treatment for depression, addresses both depressive symptoms and problematic interpersonal relationships. For mothers whose struggles caring for ill children contribute to her psychiatric illness, IPT provides the opportunity to resolve both the depression itself and depression-engendering conflicts with a child or partner. The first phase of the research plan consists of modifying an 8-session form of IPT (IPT-B) for depressed mothers with ill children by incorporating an engagement strategy and minimizing practical barriers to care. The second phase of the research plan consists of a small, preliminary, randomized trial comparing enhanced IPT-B to a referral for usual care in a sample of depressed mothers who bring their school-age children for treatment in a community mental health clinic. Mothers and children will be assessed at baseline, post-treatment, and 6-month follow-up. The skills, training, and pilot data obtained from this award will subsequently support the Candidate's development of an R01 application in Years 03-05 of the award period. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: TREATING FAMILY CAREGIVERS TO LATE-LIFE DEPRSSION PTS Principal Investigator & Institution: Martire, Lynn M.; Psychiatry; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, PA 15260 Timing: Fiscal Year 2003; Project Start 18-DEC-2002; Project End 30-NOV-2007 Summary: (provided by candidate): This is a revised application for a Mentored Research Scientist Development Award (K01). The candidate is a social psychologist who proposes to acquire the knowledge and skills to design and implement psychosocial interventions for family caregivers to clinically-depressed older adults. Depression in late life is associated with increased health care utilization, amplification of physical disability, cognitive impairment, and increased risk for suicide. Although remission of late-life depression can be achieved with pharmacotherapy and psychotherapy, the long-term prognosis for patients is mixed. Family members who

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provide support and physical assistance to depressed older patients are at high risk for psychiatric and physical morbidity of their own, and may play a critical role in patient treatment adherence and response. The candidate's proposed career development activities focus on acquiring knowledge of the pharmacologic and psychotherapeutic treatment of late-life depression, as a platform for additional training and research activities focused on the assessment and psychosocial treatment of family caregivers to late-life depression patients. In addition, the candidate aims to master advanced statistical techniques for analyzing treatment outcomes for older depressed patients and their family caregivers. The Research Plan of this application includes a study that will examine the prospective relationships between caregiver factors (knowledge, attitudes, burden, and psychiatric symptomatology) and patient treatment adherence and response. A second study will evaluate a pilot psychosocial treatment for adult children of older adults receiving psychiatric treatment for major depression that is designed to provide these caregivers with information and support. Treatment benefits experienced by caregivers may extend to older patients by increasing the likelihood that they will recover from depression and stay well. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TREATMENT OF DEPRESSION AFTER CORONARY BYPASS SURGERY Principal Investigator & Institution: Freedland, Kenneth E.; Professor of Medical Psychology; Psychiatry; Washington University Lindell and Skinker Blvd St. Louis, MO 63130 Timing: Fiscal Year 2001; Project Start 29-JUN-2001; Project End 31-MAY-2005 Summary: (Adapted from investigator's abstract): Depression is a common and persistent problem after coronary artery bypass graft (CABG) surgery that complicates recovery, increases the risk of cardiac events, and may exacerbate the neurocognitive deficits that are often observed in post-CABG patients. Although CABG is one of the most frequently performed operations in the United States, there have not been any randomized, controlled trials of treatments for depression in this population. The aims of this study are (1) to compare the efficacy of cognitive behavior therapy (CBT), stress management (SM), and usual care (UC) for major depression following CABG surgery; (2) to determine the effects of CBT on neurocognitive performance, psychosocial adjustment, functional status, employment status, and health-related quality of life; and (3) to collect pilot data on the relationship between the treatment of depression and the 12-month incidence of cardiac and cerebrovascular events following CABG. Consenting patients will be screened for depression 4 to 6 weeks after surgery. Those who screen positive will return for a psycho-diagnostic evaluation and additional testing approximately 1 week later. A sample of 165 patients with major depression who meet all other eligibility criteria will be randomized to 12 weeks of CBT, SM, or UC with no restriction on non-study antidepressants. Participants in all 3 arms will be monitored for worsening depression and will be referred for additional care if needed. Depression outcomes will be assessed 12 weeks post-randomization and 6 months after surgery (2 months after termination of CBT or SM.) The primary hypothesis is that the posttreatment severity of depression is lower in patients treated with CBT than with SM or UC, with baseline depression severity and non-study treatment as planned covariates. Secondary analyses will test the effects of treatment on remission, neurocognitive and functional recovery, quality of life, and examine the relationships between treatment process and outcome variables. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: TREATMENT OF DEPRESSION FOLLOWING BYPASS SURGERY Principal Investigator & Institution: Rollman, Bruce L.; Associate Professor of Medicine; Medicine; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, PA 15260 Timing: Fiscal Year 2003; Project Start 24-AUG-2003; Project End 30-JUN-2008 Summary: (provided by applicant): Depression is highly prevalent among patients following coronary artery bypass graft (CABG) surgery and is associated with reduced health-related quality of life (HRQoL) and increased cardiovascular morbidity and mortality. Since depression is a treatable determinant of HRQoL, evidence-based treatment for post-CABG depression provided in a primary care setting and using proven effective dissemination methods is a novel approach to improve outcomes and potentially reduce health care costs. We will recruit 300 patients who endorse elevated levels of depressive symptoms at both 3-5 days following CABG surgery and when reassessed 2-weeks after hospital discharge. We will randomize these patients to receive either: (1) their physicians' "usual care" for depression; or (2) a stepped collaborative care program involving a telephone based nurse care manager who will contact patients at regular intervals to assess treatment preferences for depression (counseling, selfmanagement workbook, pharmacotherapy, or specialty referral); promote adherence with care; and monitor the therapeutic response in concert with patients' POPs and under the supervision of a study clinician. We will also randomly select 150 nondepressed post-CABG patients to serve as a control cohort to facilitate comparisons with our depressed patients on various baseline and follow-up measures, and to better understand the benefits derived from depression treatment (total N=450). We will conduct blinded telephone assessments at 2-, 4-, 8-, and 12-months post-CABG and then every six months until the Last study patient completes his/her 8-month assessment (range: 8-44 months follow-up). We will use intent-to-treat analyses to test our primary hypothesis that our intervention will produce at least a clinically meaningful 0.5 effect size improvement in HRQoL at 8-months post-CABG, as measured by the SF-36 Mental Component Summary score, compared to patients who receive their POPs' "usual care" for depression. Our secondary hypotheses are that compared to "usual care" patients, intervention patients will: (1) experience higher levels of functional status, and lower levels of depressive symptoms, risk for future cardiovascular events, and health services costs; and (2) report similar levels of HRQoL as non-depressed post-CABG patients. Providing evidence-based stepped collaborative care treatment for post-CABG depression may be an ideal method for organized health care delivery systems to improve outcomes. Our focus on HRQoL and on health services costs will facilitate comparisons of the benefits derived from our intervention to that of other established treatments of cardiovascular risk factors and care for other chronic conditions. This study will enhance our understanding of the impact and course of post-CABG depression. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: TREATMENT OF DEPRESSION IN ALZHEIMERS DISEASE Principal Investigator & Institution: Lyketsos, Constantine G.; Professor; Psychiatry and Behavioral Scis; Johns Hopkins University 3400 N Charles St Baltimore, MD 21218 Timing: Fiscal Year 2001; Project Start 20-JUL-1997; Project End 30-JUN-2003 Summary: Major depression afflicts approximately 25% of patients with Alzheimer's disease (AD). In addition to mental suffering, it is associated with a series of "non-mood" consequences: behavioral disturbance (such as aggression), poor cognition, poor self

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care, caregiver depression, caregiver burden, and early entry into the nursing home. Since major depression is treatable, the excess disability it brings to the Alzheimer patient is potentially avoidable. The use of antidepressants to treat major depression in Alzheimer's is supported by two placebo controlled trials, although a third trial does not show a benefit for antidepressants over plaebo. No published study has assessed whether antidepressant treatment reduces the non- mood consequences of depression. An improvement of the latter would imply a reversal of the accelerated nursing home entry of depressed AD patients. Finally, the safety of antidepressant treatment in depressed AD patients is poorly studied. A conclusive demonstration that depression reduction in AD can be accomplished safely with antidepressant medications, and that depression reduction is associated with improvements in activities of daily living, nonmood behavioral disturbances, caregiver burden, and caregiver depression would have major clinical and cost implications for the care of the Alzheimer patient. This grant request proposes a 12- week, double blind, flexible dose, placebo controlled trial of sertraline in the treatment of outpatients with AD and co-morbid major depression. The hypothesis is that antidepressant treatment is superior to placebo in improving mood, in improving cognition, in reducing physical dependency, in reducing caregiver depression, and in reducing caregiver burden. It is also hypothesized that the degree of depression reductio is correlated with these improvements. It is further hypothesized that the 12 week safety profile of sertraline when compared to placebo is acceptable, especially with regard to risk of falls, sleep disturbance and delirium. One hundred community residing outpatients with probable Alzheimer's disease who also meet DSMIV criteria for major depressive episode will be recruited into the study. They will be randomized to sertraline or placebo and followed through weekly telephone contact by an experienced clinical trials team. Outcomes will be assessed every three weeks, for a total of four follow-up data points. Scales assessing the following domains will be used: depression, cognition, behavioral disturbance, physical dependency, delirium, falls, sleep, other side-effects, caregiver depression, caregiver burden, caregiver functioning, and caregiver health. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TREATMENT OF DEPRESSION IN HOMECARE PATIENTS Principal Investigator & Institution: Brown, Ellen L.; Psychiatry; Weill Medical College of Cornell Univ New York, NY 10021 Timing: Fiscal Year 2001; Project Start 01-JAN-2001; Project End 31-DEC-2001 Summary: This proposed study of A Physician's Decision: Treatment of Depression Homecare Patients requests 1 year of funding to conduct a pilot investigation into the primary care physicians' perspectives on antidepressant treatment for t6heir older patient receiving homecare nursing for medical or surgical problems. Depression is highly prevalent in home care patients but usually unrecognized and rarely treated. This pilot will augment the Cornell-Visiting Nurse Services of New York (VNSNY) Depression Treatment Study of the effectiveness of nurse initiated and managed antidepressant treatment for geriatric depression. The primary aims of this study are to (1) describe the knowledge and attitudes of physicians toward antidepressant treatment for older homecare patients, (2) identify both physician-specific and patient-specific factors associated with the physician's willingness to initiate antidepressant treatment in the older depressed home health patient, and (3) describe the interaction between the Advanced Practice Psychiatric Nurse and the treating physician in initiating and managing depression in older adults. The proposed study will contact and attempt to interview the 80 primary care physicians whose patients were enrolled in the Cornell-

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VNSNY Depression Treatment Study. These data as well as information collected by the study's Advanced Practice Psychiatric Nurse about her interaction with each primary care physician, the patient medical record and the patient interview will be used to address the study aims. Funds are being requested to collect additional data to build on and extend ongoing research with the overall goal of improving recognition and treatment of late-life depression in older health care patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TREATMENT OF DEPRESSION IN PARKINSON'S DISEASE Principal Investigator & Institution: Menza, Matthew A.; Psychiatry; Univ of Med/Dent Nj-R W Johnson Med Sch Robert Wood Johnson Medical Sch Piscataway, NJ 08854 Timing: Fiscal Year 2003; Project Start 01-JUN-2003; Project End 31-MAY-2006 Summary: (provided by the applicant): Depression is the most common neuropsychiatric disorder found in patients with Parkinson's Disease (PD). It causes immense personal suffering, and is associated with increased disability and caregiver burden. Despite the adverse consequences of depression in patients with PD, there are virtually no empirical data to guide clinical treatment. In the absence of data, the SSRIs are apparently used as the first-line treatment, despite concerns about efficacy, safety, and tolerability in this population. This proposal is for a pilot study to establish the feasibility of, and generate sufficient data to plan, a larger clinical trial that will be able to inform clinical treatment of these patients. This pilot trial will (AIM 1) examine the feasibility of a larger trial, and establish (AIM 2) the effect size for short-term efficacy of anti-depressants, compared to placebo, in this population. It will also (AIM 3) evaluate the effect of long-term depression treatment on quality-of-life. This will be done in the context of a placebo-controlled, double-blind, parallel group, flexible dose trial of an SSRI (Paroxetine), a tri-cyclic (Nortriptyline) and placebo in acute (8 weeks) and longterm treatment (6 months). A total of 75 patients with PD (without significant motor fluctuations or Dementia) and depression (major depression or Dysthymia) will be randomized to each of the three arms in a balanced design. The feasibility issues that will be explored include recruitment, retention, drug tolerability, and the ability to maintain the blind. The outcomes that will be explored for the acute phase include changes in the Hamilton Depression Rating Scale (HAM-D) score, and the percent of patients who are responders (>50% improvement in the HAM-D, or < 10 on the HAMD). The outcome variables explored for the long-term phase include the Parkinson's Disease Questionnaire and the Medical Outcome Study Short Form. Secondary analyses will involve the exploration of anxiety, motor disability, sleep, cognition, and individual or clusters of symptoms that are responsive to treatment in order to facilitate planning a subsequent, full-scale clinical trial. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: TREATMENT OF DEPRESSION WITH MASSAGE IN END OF LIFE AIDS Principal Investigator & Institution: Poland, Russell E.; Professor and Director of Research; Cedars-Sinai Medical Center Box 48750, 8700 Beverly Blvd Los Angeles, CA 90048 Timing: Fiscal Year 2001; Project Start 27-SEP-2001; Project End 31-AUG-2003 Summary: (provided by applicant): This is an Exploratory/Developmental Research (R21) grant application to the National Center for Complementary and Alternative Medicine in response to RFA AT-O1-002 to assess the usefulness of massage therapy for

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treatment of depression and improvement in the quality of life in patients with end of life AIDS. This study will define the clinical and biologic response to massage therapy in patients with AIDS and depression who are clinically stable and on a fixed medical regimen. Depression is a co-morbid condition in individuals with advanced HIV disease and has a negative impact on quality of life. Depression in HIV-infected patients also has been associated with a decrease in adherence to medications and progression of clinical disease. While pharmacologic therapy for depression have resulted in variable success in managing this problem, it is associated with an increase in the number of medications that these patients are required to take, potential for additional drug-drug interactions, and many adverse events. In patients with advanced stage HIV disease, palliative care is often a priority and identifying new treatment modalities that do not require additional medications while improve clinical symptoms and overall quality of life is of the utmost importance. Pilot studies with massage therapy have been performed in HIV-infected and uninfected individuals. These studies have shown a reduction in depression scores in HIV-uninfected subjects. In HIV-infected patients, massage therapy has been shown to improve quality of life measures and decrease plasma cortisol levels. The specific aims of this proposal are 1) to determine the effect of massage therapy on depression in subjects with advanced HIV disease, 2) to investigate the effect of massage therapy on quality of life in subjects with advanced HIV disease, and 3) to investigate the effect of massage therapy on plasma cortisol levels in subjects with advanced HIV disease. This study will randomize advanced stage HIV-infected subjects with depression in a 1:1:1 manner to massage therapy, "sham massage" or no physical intervention. The massage and "sham massage" groups will be treated for one hour, twice per week, for 8 weeks. All enrolled subjects will have depression measured (Hamilton Depression Scale) at baseline, weeks 1, 2, 4, 6 and 8, and quality of life (SF36), and pain assessments (Gracely Pain Scale) at baseline, weeks 4 and 8. In addition, 24-hour urine free cortisol, lymphocyte subsets and HIV RNA measurements will be assessed at baseline and weeks 4 and 8. This will be a rigorously controlled clinical trial using validated measures to assess the clinical (depression and quality of life), and biologic (cortisol levels) effect of massage therapy on subjects with advanced stage HIV disease and clinical depression. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TREATMENT OF LATE LIFE DEPRESSION COMPLICATED BY ALCOHOL Principal Investigator & Institution: Oslin, David W.; Professor; Psychiatry; University of Pennsylvania 3451 Walnut Street Philadelphia, PA 19104 Timing: Fiscal Year 2001; Project Start 01-JUN-1999; Project End 31-MAY-2004 Summary: The focus of this Mentored Clinical Scientist Development Award (MCSDA) is to enable David Oslin, MD to acquire academic and research expertise for the treatment of late life mental disorders including major depression and comorbid alcoholism. Dr. Oslin is currently an Assistant Professor of Psychiatry at the University of Pennsylvania with appointments in the Section of Geriatric Psychiatry and the Center for Studies on Addiction. His career goals include: 1) gaining expertise in study design and methodology for intervention research, 2) establishing independent research projects on the treatment of comorbid mental health disorders, 3) enhancing his clinical expertise in the prevention, recognition and treatment of late life mental illness, and 4) being a resource for the university community on the research and clinical care of older adults, especially those with comorbid mental health problems. The proposal for this application includes both formal and informal instruction in research design and

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methodology as well as an intervention development project that will have both educational and scientific significance. The research plan for this award includes an intervention development study for older adults with primary major depression complicated by alcohol dependence. The aim of the project is to evaluate the tolerability and efficacy of naltrexone compared to placebo as a treatment for alcoholism in combination with sertraline as a treatment for primary major depression. Focusing on older adults enhances the goal of examining primary depression and comorbid alcoholism as the literature suggests that alcoholism is more often secondary to major depression in older adults compared to younger adults. This research plan is seen as a step toward the design of future studies of comorbidity in late life major depression. A growing awareness of a strong association between depression and alcohol abuse/dependence, the need for safe and effective treatments for comorbidity, and everpresent problem of gaining patient compliance with treatment regimens all appear to be fertile ground for study in an older population. The MCSDA would provide an important vehicle via course work and mentoring to enable Dr. Oslin to advance his knowledge and experience in these areas, which in turn, may advance the field of psychiatry's understanding of these complex issues. Dr. Oslin's training in geriatric psychiatry and addictions also makes him a good candidate to conduct the proposed intervention study. Finally, proposed plans for this MCSDA are well coordinated with the research activities of the Section of Geriatric Psychiatry and the Center for Studies on Addiction. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •


TREATMENT

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EXERCISE

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Principal Investigator & Institution: Trivedi, Madhukar H.; Associate Professor; University of Texas Sw Med Ctr/Dallas Dallas, TX 753909105 Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 31-MAR-2007 Summary: (provided by applicant): This study proposes to examine the efficacy of a public health dose (PHD) of exercise as an augmentation strategy in the treatment of Major Depressive Disorder (MDD). We will assess patients on SSRI treatment who still have significant residual symptoms of depression, defined by a Hamilton Rating Scale for Depression (17-item; HRSD17) score >14. Incomplete response with significant residual symptoms is common in MDD and is associated with an increased likelihood of relapse and poorer quality of life and function. Augmentation strategies are often implemented to alleviate residual symptoms. However, limitations of pharmacological augmentation, such as lack of overwhelming evidence for efficacy for most agents and increased risks of adverse side effects, often render this strategy undesirable. Exercise may be a viable augmenting strategy for the treatment of residual symptoms of depression since it is associated with a reduced risk of side effects, as well as many associated benefits, including increased longevity and reduced risks of many common medical conditions. Our recently completed randomized controlled trial, DOSE (Depression Outcomes Study of Exercise), revealed that a public health dose of exercise significantly reduced symptoms of depression, measured by the HRSD17, compared to a low dose of exercise or flexibility exercise control group. A logical next step in our investigation of the use of exercise in the treatment of depression is to assess its viability as an augmenting strategy in persons who responded to SSRI therapy, but still endorse significant residual depressive symptoms. The goal of our exercise intervention will be remission, defined as an HRSD17 score of 7 or less. Patients meeting DSM-IV criteria for Major Depressive Disorder, who have been taking an SSRI at an adequate dose for 8-12

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weeks, will be randomized to a PHD or low dose of exercise for 12 weeks. The HRSD17 will serve as the primary outcome measure. In addition, the 30-item versions of the Inventory for Depressive Symptomatology, Clinician-Rated (IDS-C30) and Self-Report (IDS-SR30) will be assessed. Quality of life and satisfaction will also be evaluated. The primary aims of the study are to: 1) compare the effectiveness of PHD exercise augmentation to low dose augmentation in eliciting remission in responders to SSRI treatment who have significant residual symptoms of depression; 2) to compare functioning and quality of life between treatment groups; 3) to examine the extent to which symptom reduction mediates improvement in social function; and 4) to explore the pattern of symptom reduction that occurs over the course of exercise augmentation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: USING BEHAVIORAL SCIENCE TO EXPLAIN PCP DEPRESSION CARE Principal Investigator & Institution: Meredith, Lisa S.; Staff Scientist; Rand Corporation 1700 Main St Santa Monica, CA 90401 Timing: Fiscal Year 2001; Project Start 01-APR-2001; Project End 31-MAR-2003 Summary: (provided by applicant): Improving care for depression is a fundamental goal of mental health services research. The need to improve care within primary care is particularly relevant because most patients receive care solely within that setting. Primary care provider (PCP) behavior is a key vehicle for achieving improvement. This application (responding to PAR99-073) aims to enhance the understanding of underlying relationships among provider attitudes, intentions, and PCP treatment behavior to improve care for depression. The multidisciplinary research team will examine and compare selected theories from the social and behavioral sciences to gain new insights into PCP depression treatment behavior. This work will ask old questions about improving mental health care in new ways by applying and integrating models traditionally used to study personal health behavior to study PCP depression treatment behavior. Lessons from application of these frameworks could inform future interventions for changing provider behavior to improve depression care. These objectives will be addressed through secondary analyses of data from a sample of 414 PCPs and 2,030 patients (5-15 per provider) with major depression participating in the four Quality Improvement for Depression consortium studies. These PCPs are from 80 different clinics in 11 different managed care organizations across the U.S. Few databases contain the breadth of constructs necessary for broad theoretical testing with a relatively large sample of providers. Regression and structural equation analyses will elucidate the degree to which the selected expectancy-value frameworks from social and health psychology, and agency theory from behavioral economics explain provider depression treatment behavior. The relative efficacy of these adapted theories will be compared (using indicators of variance explained and relative goodness of fit) to identify the most useful combination of PCP attitudes, behavioral intentions, and treatment choices in modeling PCP depression treatment behavior. We will also outline the strengths and weaknesses of the models from the different disciplines. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: VALIDATION OF PRESCHOOL DEPRESSIVE SYNDROME Principal Investigator & Institution: Luby, Joan L.; Psychiatry; Washington University Lindell and Skinker Blvd St. Louis, MO 63130 Timing: Fiscal Year 2003; Project Start 01-DEC-2002; Project End 30-NOV-2007

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Summary: (provided by applicant): Numerous developmental studies have detected very early behavioral and biological changes in infants and toddlers at high-risk for depression. Despite these highly suggestive findings, prior to the investigator's preliminary study, there was insufficient data to address the question of whether children younger than six could manifest clinically significant depression. The need to identify depression at the earliest developmental point is underscored by the known chronic and relapsing course, and relative treatment resistance of the disorder when identified after six years of age. The investigator and colleagues are completing a federally funded study of the nosology of preschool depression. Findings from this study are the first to demonstrate that a valid depressive syndrome can be identified in preschool children using DSM-IV MDD criteria when the assessment is modified for age adjusted symptom manifestations. Preliminary validation of this syndrome has been established based on the association with numerous markers including a specific and stable symptom constellation, increased family history of related disorders, significant depression severity compared to controls and social impairment. Study findings raised questions about the duration of an episode of clinical depression and the criteria that distinguish syndromal from sub-syndromal states. This application proposes to utilize the sensitive and specific criteria derived from this study to ascertain a community based sample of depressed preschoolers (and appropriate controls) for a field trial and longitudinal follow-up. To address questions raised by the preliminary study, this investigation proposes to define the clinical characteristics of preschool depression using a new comprehensive and age appropriate diagnostic measure, in addition to assessing impairment in multiple domains. The need to validate diagnostic criteria for preschool depression is heightened by the alarming national increase in the off-label prescription of antidepressants to these young children, representing a serious public health crisis. While treatment unsupported by data is an obvious danger, the potential for earlier intervention in depression is a compelling possibility that must be aggressively explored. Valid diagnostic criteria are necessary for these future treatment studies and to facilitate investigations of the developmental neurobiology of this disorder. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: VULNERABILITY TO DEPRESSION--GENETIC EPIDEMIOLOGY Principal Investigator & Institution: Rende, Richard; Miriam Hospital Providence, RI 02906 Timing: Fiscal Year 2001; Project Start 01-JAN-1999; Project End 31-DEC-2003 Summary: This application is a request for a Mentored Research Scientist Developmental Award to develop necessary skills to conduct genetic epidemiological studies of depression in childhood and adolescence. Although recent advances in genetic research hold promise for the identification of genetic markers of potential relevance to the effective disorders, the successful application of such techniques will depend on clear and valid definitions of the phenotype which reflects genetic vulnerability. This proposal is designed to provide the applicant with necessary skills to conduct informative genetic epidemiological studies of depression geared toward the identification of homogeneous subtypes. The guiding hypothesis is that a critical indicator of a potentially homogeneous subtype is depression with an initial onset prior to adulthood, as suggested by recent family-genetic studies. This hypothesis will be tested through a refinement of the family study/high risk design by focusing on siblings of depressed youth as an informative family member matched for age and cohort. Within this framework, a pilot study has been designed to address two aims: (1) to

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determine the feasibility of longitudinal high-risk sibling studies; and (2) to sharpen diagnostic boundaries of phenotypic indicators of familial vulnerability for depression. In conjunction with the research goals, two primary training goals will be pursued: (1) training in the evaluation of depression, and related psychopathology, in children and adolescents; (2) training in the application of novel biostatistical techniques used to help sharpen diagnostic boundaries for genetic studies. The overall purpose of research and training is to acquire requisite skills to examine transactions between genetic and environmental risk factors specific to depression, and their interplay during sensitive developmental periods, as such a focus may eventually carry implications for future preventative efforts. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “depression” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for depression in the PubMed Central database: •

[gamma]-Aminobutyric acid type A receptors modulate cAMP-mediated long-term potentiation and long-term depression at monosynaptic CA3 --CA1 synapses. by Yu TP, McKinney S, Lester HA, Davidson N. 2001 Apr 24; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=33198

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A cross-sectional study of early identification of postpartum depression: Implications for primary care providers from The Ontario Mother & Infant Survey. by Watt S, Sword W, Krueger P, Sheehan D. 2002; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=107838

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Accuracy of a single question in screening for depression in a cohort of patients after stroke: comparative study. by Watkins C, Daniels L, Jack C, Dickinson H, van den Broek M. 2001 Nov 17; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=59850

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Admission for depression among men in Scotland, 1980-95: retrospective study. by Shajahan PM, Cavanagh JT. 1998 May 16; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28549

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Age-Specific Inbreeding Depression and Components of Genetic Variance in Relation to the Evolution of Senescence. by Charlesworth B, Hughes KA. 1996 Jun 11; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=39203

3 4

Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print.

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Antidepressant drugs and generic counselling for treatment of major depression in primary care: randomised trial with patient preference arms. by Chilvers C, Dewey M, Fielding K, Gretton V, Miller P, Palmer B, Weller D, Churchill R, Williams I, Bedi N, Duggan C, Lee A, Harrison G. 2001 Mar 31; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=30555

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Antidepressants in bipolar depression: when less is more. by Ruzickova M, Alda M. 2002 Jul; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=161665

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Asynchronous Pre- and Postsynaptic Activity Induces Associative Long-Term Depression in Area CA1 of the Rat Hippocampus in vitro. by Debanne D, Gahwiler BH, Thompson SM. 1994 Feb 1; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=43111

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Brief Dendritic Calcium Signals Initiate Long-Lasting Synaptic Depression in Cerebellar Purkinje Cells. by Konnerth A, Dreessen J, Augustine GJ. 1992 Aug 1; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=49643

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Bullying in schools: self reported anxiety, depression, and self esteem in secondary school children. by Salmon G, James A, Smith DM. 1998 Oct 3; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28678

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Bullying, depression, and suicidal ideation in Finnish adolescents: school survey. by Kaltiala-Heino R, Rimpela M, Marttunen M, Rimpela A, Rantanen P. 1999 Aug 7; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28187

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Calcium is an Intracellular Mediator of the Climbing Fiber in Induction of Cerebellar Long-Term Depression. by Sakurai M. 1990 May 1; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=53904

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Capture of a protein synthesis-dependent component of long-term depression. by Kauderer BS, Kandel ER. 2000 Nov 21; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=27226

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Comparison of St John's wort and imipramine for treating depression: randomised controlled trial. by Woelk H. 2000 Sep 2; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=27467

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Cooperative Interactions Among Afferents Govern the Induction of Homosynaptic Long-Term Depression in the Hippocampus. by Kerr DS, Abraham WC. 1995 Dec 5; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=40457

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Cooperative Interactions in the Induction of Long-Term Potentiation and Depression of Synaptic Excitation between Hippocampal CA3-CA1 Cell Pairs in vitro. by Debanne D, Gahwiler BH, Thompson SM. 1996 Oct 1; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=38312

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Coordinate Depression of Bradykinin Receptor Recycling and MicrotubuleDependent Transport by Taxol. by Hamm-Alvarez SF, Alayof BE, Himmel HM, Kim PY, Crews AL, Strauss HC, Sheetz MP. 1994 Aug 2; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=44492

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Cross sectional study of symptom attribution and recognition of depression and anxiety in primary care. by Kessler D, Lloyd K, Lewis G, Gray DP. 1999 Feb 13; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=27737

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Decreased probability of neurotransmitter release underlies striatal long-term depression and postnatal development of corticostriatal synapses. by Choi S, Lovinger DM. 1997 Mar 18; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=20146

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Dependence of Long-Term Depression on Postsynaptic Metabotropic Glutamate Receptors in Visual Cortex. by Kato N. 1993 Apr 15; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=46359

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Depression and coronary artery disease: time to move from observation to trials. by Lesperance F, Frasure-Smith N. 2003 Mar 4; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=149252

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Depression and prognosis following hospital admission because of acute myocardial infarction. by Lauzon C, Beck CA, Huynh T, Dion D, Racine N, Carignan S, Diodati JG, Charbonneau F, Dupuis R, Pilote L. 2003 Mar 4; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=149246

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Depression and unintended pregnancy in the National Longitudinal Survey of Youth: a cohort study. by Reardon DC, Cougle JR. 2002 Jan 19; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=64517

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Depression as a risk factor for ischaemic heart disease in men: population based casecontrol study. by Hippisley-Cox J, Fielding K, Pringle M. 1998 Jun 6; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28573

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Depression, antidepressants, and the shrinking hippocampus. by Sapolsky RM. 2001 Oct 23; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=60045

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Detection of depression and anxiety in primary care: follow up study. by Kessler D, Bennewith O, Lewis G, Sharp D. 2002 Nov 2; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=131021

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Diagnosis and management of depression in primary care: a clinical update and review. by Remick RA. 2002 Nov 26; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=134138

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Effectiveness of teaching general practitioners skills in brief cognitive behaviour therapy to treat patients with depression: randomised controlled trial. by King M, Davidson O, Taylor F, Haines A, Sharp D, Turner R. 2002 Apr 20; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=102328

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Efficacy and tolerability of selective serotonin reuptake inhibitors compared with tricyclic antidepressants in depression treated in primary care: systematic review and

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meta-analysis. by MacGillivray S, Arroll B, Hatcher S, Ogston S, Reid I, Sullivan F, Williams B, Crombie I. 2003 May 10; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=154760 •

Efficacy of combined, sequentialand crossover psychotherapy and pharmacotherapy in improving outcomes in depression. by Segal Z, Vincent P, Levitt A. 2002 Jul; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=161662

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Endogenous cannabinoids mediate long-term synaptic depression in the nucleus accumbens. by Robbe D, Kopf M, Remaury A, Bockaert J, Manzoni OJ. 2002 Jun 11; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=123076

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Evidence of a role for cyclic ADP-ribose in long-term synaptic depression in hippocampus. by Reyes-Harde M, Empson R, Potter BV, Galione A, Stanton PK. 1999 Mar 30; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=22420

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Experience-dependent plasticity without long-term depression by type 2 metabotropic glutamate receptors in developing visual cortex. by Renger JJ, Hartman KN, Tsuchimoto Y, Yokoi M, Nakanishi S, Hensch TK. 2002 Jan 22; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=117426

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Factors Associated with Depression of Photosynthetic Quantum Efficiency in Maize at Low Growth Temperature.. by Fryer MJ, Oxborough K, Martin B, Ort DR, Baker NR. 1995 Jun; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=157398

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Follow up study of longstanding depression as predictor of mortality in elderly people living in the community. by Pulska T, Pahkala K, Laippala P, Kivela SL. 1999 Feb 13; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=27733

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Glutamate and [gamma]-aminobutyric acid mediate a heterosynaptic depression at mossy fiber synapses in the hippocampus. by Vogt KE, Nicoll RA. 1999 Feb 2; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=15360

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Growth Depression in Mycorrhizal Citrus at High-Phosphorus Supply (Analysis of Carbon Costs).. by Peng S, Eissenstat DM, Graham JH, Williams K, Hodge NC. 1993 Mar; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=158726

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Hippocampal Atrophy in Recurrent Major Depression. by Sheline YI, Wang PW, Gado MH, Csernansky JG, Vannier MW. 1996 Apr 30; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=39458

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Hippocampal Long-Term Depression and Depotentiation are Defective in Mice Carrying a Targeted Disruption of the Gene Encoding the RI[beta] Subunit of cAMPDependent Protein Kinase. by Brandon EP, Zhuo M, Huang Y, Qi M, Gerhold KA, Burton KA, Kandel ER, McKnight GS, Idzerda RL. 1995 Sep 12; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=41065

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Homosynaptic Long-Term Depression in Area CA1 of Hippocampus and Effects of NMethyl-D-Aspartate Receptor Blockade. by Dudek SM, Bear MF. 1992 May 15; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=49082

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Homosynaptic long-term depression: A mechanism for memory? by Bear MF. 1999 Aug 17; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=33710

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Hypericum extract versus imipramine or placebo in patients with moderate depression: randomised multicentre study of treatment for eight weeks. by Philipp M, Kohnen R, Hiller KO. 1999 Dec 11; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28296

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Hypothalamic-pituitary-thyroid system activity during lithium augmentation therapy in patients with unipolar major depression. by Bschor T, Baethge C, Adli M, Lewitzka U, Eichmann U, Bauer M. 2003 May; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=161745

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Identifying depression in primary care: a comparison of different methods in a prospective cohort study. by Henkel V, Mergl R, Kohnen R, Maier W, Moller HJ, Hegerl U. 2003 Jan 25; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=140277

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Immediate Early Gene Expression Associated with the Persistence of Heterosynaptic Long-Term Depression in the Hippocampus. by Abraham WC, Christie BR, Logan B, Lawlor P, Dragunow M. 1994 Oct 11; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=44955

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Incidence of major depression in Canada. by Patten SB. 2000 Sep 19; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=80167

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Increase in the cerebrospinal fluid content of neurosteroids in patients with unipolar major depression who are receiving fluoxetine or fluvoxamine. by Uzunova V, Sheline Y, Davis JM, Rasmusson A, Uzunov DP, Costa E, Guidotti A. 1998 Mar 17; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=19726

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Induction of long-term depression and rebound potentiation by inositol trisphosphate in cerebellar Purkinje neurons. by Khodakhah K, Armstrong CM. 1997 Dec 9; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28423

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Influence of symptoms of anxiety on treatment of depression in later life in primary care: questionnaire survey. by Kirby M, Denihan A, Bruce I, Radic A, Coakley D, Lawlor BA. 1999 Feb 27; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=27763

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Interaction of the AMPA receptor subunit GluR2 /3 with PDZ domains regulates hippocampal long-term depression. by Kim CH, Chung HJ, Lee HK, Huganir RL. 2001 Sep 25; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=58797

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Intracellular Injection of Ca2+ Chelators Blocks Induction of Long- Term Depression in Rat Visual Cortex. by Brocher S, Artola A, Singer W. 1992 Jan 1; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=48188

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Late-onset minor and major depression: early evidence for common neuroanatomical substrates detected by using MRI. by Kumar A, Jin Z, Bilker W, Udupa J, Gottlieb G. 1998 Jun 23; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=22713

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Longitudinal comparison of depression, coping, and turnover among NHS and private sector staff caring for people with dementia. by Margallo-Lana M, Reichelt K, Hayes P, Lee L, Fossey J, O'Brien J, Ballard C. 2001 Mar 31; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=30553

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Long-Term Depression of Glutamate-Induced [gamma]-Aminobutyric Acid Release in Cerebellum by Insulin-Like Growth Factor I. by Castro-Alamancos MA, TorresAleman I. 1993 Aug 1; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=47142

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Long-Term Depression: Not So Depressing After All. by Malenka RC. 1993 Apr 15; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=file&artid=46250&blobname=[PNASPDFPath]/1993/90-08/pdf/pq003121.pdf

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Low-dose dexamethasone challenge in women with atypical major depression: pilot study. by Levitan RD, Vaccarino FJ, Brown GM, Kennedy SH. 2002 Jan; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=149795

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Male --male competition magnifies inbreeding depression in wild house mice. by Meagher S, Penn DJ, Potts WK. 2000 Mar 28; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=16238

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Managing depression as a chronic disease: a randomised trial of ongoing treatment in primary care. by Rost K, Nutting P, Smith JL, Elliott CE, Dickinson M. 2002 Oct 26; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=130058

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Meta-analysis of effects and side effects of low dosage tricyclic antidepressants in depression: systematic review. by Furukawa TA, McGuire H, Barbui C. 2002 Nov 2; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=131022

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Mirtazapine for treatment-resistant depression: a preliminary report. by Wan DD, Kundhur D, Solomons K, Yatham LN, Lam RW. 2003 Jan; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=161726

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Multifaceted shared care intervention for late life depression in residential care: randomised controlled trial. by Llewellyn-Jones RH, Baikie KA, Smithers H, Cohen J, Snowdon J, Tennant CC. 1999 Sep 11; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28220

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Muscarinic and [beta]-Adrenergic Depression of the Slow Ca2+- Activated Potassium Conductance in Hippocampal CA3 Pyramidal Cells is not Mediated by a Reduction of Depolarization-Induced Cytosolic Ca2+ Transients. by Knopfel T, Vranesic I, Gahwiler BH, Brown DA. 1990 Jun 1; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=54051

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Novelty acquisition is associated with induction of hippocampal long-term depression. by Manahan-Vaughan D, Braunewell KH. 1999 Jul 20; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=17586

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Patients' perceptions of entitlement to time in general practice consultations for depression: qualitative study. by Pollock K, Grime J. 2002 Sep 28; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=126657

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Phagocytosis and killing of Staphylococcus aureus: effects of stress and depression in children.. by Bartlett JA, Demetrikopoulos MK, Schleifer SJ, Keller SE. 1997 May; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=170533

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Phantom pain, anxiety, depression, and their relation in consecutive patients with amputated limbs: case reports. by Fisher K, Hanspal RS. 1998 Mar 21; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28494

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Prevalence and outcome of partial remissionin depression. by Tranter R, O'Donovan C, Chandarana P, Kennedy S. 2002 Jul; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=161658

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Problem solving treatment and group psychoeducation for depression: multicentre randomised controlled trial. by Dowrick C, Dunn G, Ayuso-Mateos JL, Dalgard OS, Page H, Lehtinen V, Casey P, Wilkinson C, Vazquez-Barquero JL, Wilkinson G. 2000 Dec 9; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=27549

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Pronounced and sustained central hypernoradrenergic function in major depression with melancholic features: Relation to hypercortisolism and corticotropin-releasing hormone. by Wong ML, Kling MA, Munson PJ, Listwak S, Licinio J, Prolo P, Karp B, McCutcheon IE, Geracioti TD Jr, DeBellis MD, Rice KC, Goldstein DS, Veldhuis JD, Chrousos GP, Oldfield EH, McCann SM, Gold PW. 2000 Jan 4; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=26662

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Psychosocial and clinical predictorsof response to pharmacotherapy for depression. by Bagby RM, Ryder AG, Cristi C. 2002 Jul; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=161659

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Quality of web based information on treatment of depression: cross sectional survey. by Griffiths KM, Christensen H. 2000 Dec 16; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=27555

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Quantification of spread of cerebellar long-term depression with chemical twophoton uncaging of glutamate. by Wang SS, Khiroug L, Augustine GJ. 2000 Jul 18; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=27000

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Quantitative EEG amplitude across REM sleep periods in depression: preliminary report. by Liscombe MP, Hoffmann RF, Trivedi MH, Parker MK, Rush AJ, Armitage R. 2002 Jan; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=149794

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Randomised controlled trial of midwife led debriefing to reduce maternal depression after operative childbirth. by Small R, Lumley J, Donohue L, Potter A, Waldenstrom U. 2000 Oct 28; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=27510

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Randomised controlled trial of non-directive counselling, cognitive-behaviour therapy, and usual general practitioner care for patients with depression. I: Clinical effectiveness. by Ward E, King M, Lloyd M, Bower P, Sibbald B, Farrelly S, Gabbay M, Tarrier N, Addington-Hall J. 2000 Dec 2; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=27542

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Randomised controlled trial of non-directive counselling, cognitive-behaviour therapy, and usual general practitioner care for patients with depression. II: Cost effectiveness. by Bower P, Byford S, Sibbald B, Ward E, King M, Lloyd M, Gabbay M. 2000 Dec 2; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=27543

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Randomised controlled trial of problem solving treatment, antidepressant medication, and combined treatment for major depression in primary care. by Mynors-Wallis LM, Gath DH, Day A, Baker F. 2000 Jan 1; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=27250

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Randomised trial of monitoring, feedback, and management of care by telephone to improve treatment of depression in primary care. by Simon GE, VonKorff M, Rutter C, Wagner E. 2000 Feb 26; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=27299

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Readily releasable pool size changes associated with long term depression. by Goda Y, Stevens CF. 1998 Feb 3; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=18746

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Regional Cerebral Glucose Metabolism in Late-Life Depression and Alzheimer Disease: A Preliminary Positron Emission Tomography Study. by Kumar A, Newberg A, Alavi A, Berlin J, Smith R, Reivich M. 1993 Aug 1; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=47067

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Reliability, Validity and Psychometric Properties of the Greek Translation of the Center for Epidemiological Studies-Depression (CES-D) Scale. by Fountoulakis K, Iacovides A, Kleanthous S, Samolis S, Kaprinis SG, Sitzoglou K, Kaprinis GS, Bech P. 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=34551

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Reliability, validity and psychometric properties of the Greek translation of the Major Depression Inventory. by Fountoulakis KN, Iacovides A, Kleanthous S, Samolis S, Gougoulias K, Tsiptsios I, Kaprinis GS, Bech P. 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=149454

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Reliability, validity and psychometric properties of the Greek translation of the zung depression rating scale. by Fountoulakis KN, lacovides A, Samolis S, Kleanthous S, Kaprinis SG, Kaprinis GS, Bech P. 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=64635

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Reversal of Synaptic Depression by Serotonin at Aplysia Sensory Neuron Synapses Involves Activation of Adenylyl Cyclase. by Goldsmith BA, Abrams TW. 1991 Oct 15; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=52643

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Routinely administered questionnaires for depression and anxiety: systematic review. by Gilbody SM, House AO, Sheldon TA. 2001 Feb 17; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=26571

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Severe deep white matter lesions and outcome in elderly patients with major depressive disorder: follow up study. by O'Brien J, Ames D, Chiu E, Schweitzer I, Desmond P, Tress B. 1998 Oct 10; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28682

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Should thyroid replacement therapy be considered for patients with treatmentrefractory depression? by Joffe RT. 2002 Jan; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=149799

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Spreading depression and focal brain ischemia induce cyclooxygenase-2 in cortical neurons through N-methyl-d-aspartic acid-receptors and phospholipase A2. by Miettinen S, Fusco FR, Yrjanheikki J, Keinanen R, Hirvonen T, Roivainen R, Narhi M, Hokfelt T, Koistinaho J. 1997 Jun 10; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=21079

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Stillbirth as risk factor for depression and anxiety in the subsequent pregnancy: cohort study. by Hughes PM, Turton P, Evans CD. 1999 Jun 26; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=31099

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Synaptic depression creates a switch that controls the frequency of an oscillatory circuit. by Nadim F, Manor Y, Kopell N, Marder E. 1999 Jul 6; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=22213

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Synaptic Inhibition Regulates Associative Interactions Between Afferents During the Induction of Long-Term Potentiation and Depression. by Tomasulo RA, Ramirez JJ, Steward O. 1993 Dec 15; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=48027

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Systematic review of efficacy of cognitive behaviour therapies in childhood and adolescent depressive disorder. by Harrington R, Whittaker J, Shoebridge P, Campbell F. 1998 May 23; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28555

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The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials. by Lawlor DA, Hopker SW. 2001 Mar 31; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=30551

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The Hospital Anxiety and Depression Scale (HADS): translation and validation study of the Iranian version. by Montazeri A, Vahdaninia M, Ebrahimi M, Jarvandi S. 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=161819

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The Hospital Anxiety And Depression Scale. by Snaith RP. 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=183845

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The influence of age on the female/male ratio of treated incidence rates in depression. by Gutierrez-Lobos K, Scherer M, Anderer P, Katschnig H. 2002; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=65549

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The Norwegian naturalistic treatment study of depression in general practice (NORDEP) ---I: randomised double blind study. by Malt UF, Robak OH, Madsbu HP, Bakke O, Loeb M. 1999 May 1; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=34546

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The Use of Spreading Depression Waves for Acute and Long-Term Monitoring of the Penumbra Zone of Focal Ischemic Damage in Rats. by Koroleva VI, Bures J. 1996 Apr 16; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=39677

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Transient Protein Kinase C Activation Primes Long-Term Depression and Suppresses Long-Term Potentiation of Synaptic Transmission in Hippocampus. by Stanton PK. 1995 Feb 28; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=42592

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Treatment for chronic depression: cognitive behavioral analysis system of psychotherapy (CBASP). by Bland RC. 2001 Sep; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=167192

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Treatment Plans and Interventions for Depression and Anxiety Disorders. by Antony MM. 2001 Nov; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=167202

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Two distinct forms of long-term depression coexist at the mossy fiber-CA3 synapse in the hippocampus during development. by Domenici MR, Berretta N, Cherubini E. 1998 Jul 7; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=20972

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Why treat depression differently from other medical problems? by Blier P. 2002 Jul; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=161655

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with depression, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “depression” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for depression (hyperlinks lead to article summaries):

6 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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A Clinical Practice Guideline approach to treating depression in long-term care. Author(s): Kaldyand J, Tarnove L. Source: Journal of the American Medical Directors Association. 2003 March-April; 4(2 Suppl): S60-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12807572&dopt=Abstract

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A comparative study into the one year cumulative incidence of depression after stroke and myocardial infarction. Author(s): Aben I, Verhey F, Strik J, Lousberg R, Lodder J, Honig A. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 2003 May; 74(5): 581-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12700297&dopt=Abstract

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A computer algorithm for calculating the adequacy of antidepressant treatment in unipolar and bipolar depression. Author(s): Oquendo MA, Baca-Garcia E, Kartachov A, Khait V, Campbell CE, Richards M, Sackeim HA, Prudic J, Mann JJ. Source: The Journal of Clinical Psychiatry. 2003 July; 64(7): 825-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12934985&dopt=Abstract

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A confirmatory study on the mechanisms behind reduced P300 waves in depression. Author(s): Roschke J, Wagner P. Source: Neuropsychopharmacology : Official Publication of the American College of Neuropsychopharmacology. 2003 July; 28 Suppl 1: S9-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12827138&dopt=Abstract

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A double-blind, placebo-controlled study of sertraline in the prevention of depression in stroke patients. Author(s): Rasmussen A, Lunde M, Poulsen DL, Sorensen K, Qvitzau S, Bech P. Source: Psychosomatics. 2003 May-June; 44(3): 216-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12724503&dopt=Abstract

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A hidden problem: identifying depression in older people. Author(s): Hope K. Source: British Journal of Community Nursing. 2003 July; 8(7): 314-20. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12920466&dopt=Abstract

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A history of depression and smoking cessation outcomes among women concerned about post-cessation weight gain. Author(s): Levine MD, Marcus MD, Perkins KA. Source: Nicotine & Tobacco Research : Official Journal of the Society for Research on Nicotine and Tobacco. 2003 February; 5(1): 69-76. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12745508&dopt=Abstract

184 Depression

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A longitudinal evaluation of adolescent depression and adult obesity. Author(s): Richardson LP, Davis R, Poulton R, McCauley E, Moffitt TE, Caspi A, Connell F. Source: Archives of Pediatrics & Adolescent Medicine. 2003 August; 157(8): 739-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12912778&dopt=Abstract

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A pilot study of a parent-education group for families affected by depression. Author(s): Sanford M, Byrne C, Williams S, Atley S, Miller J, Allin H. Source: Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie. 2003 March; 48(2): 78-86. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12655904&dopt=Abstract

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A prospectively studied clinicopathological case of 'vascular depression'. Author(s): O'Brien JT, Thomas A, English P, Perry R, Jaros E. Source: International Journal of Geriatric Psychiatry. 2003 July; 18(7): 656-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12833311&dopt=Abstract

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A psychopathological study into the relationship between attention deficit hyperactivity disorder in adult patients and recurrent brief depression. Author(s): Hesslinger B, Tebartz van Elst L, Mochan F, Ebert D. Source: Acta Psychiatrica Scandinavica. 2003 May; 107(5): 385-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12752035&dopt=Abstract

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A qualitative study of clinical nurse specialists' views on depression in palliative care patients. Author(s): Lloyd Williams M, Payne S. Source: Palliative Medicine. 2003 June; 17(4): 334-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12822850&dopt=Abstract

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A randomized controlled trial of the effect of psychotherapy on anxiety and depression in chronic obstructive pulmonary disease. Author(s): de Godoy DV, de Godoy RF. Source: Archives of Physical Medicine and Rehabilitation. 2003 August; 84(8): 1154-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12917854&dopt=Abstract

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A screening program for depression. Author(s): American College of Occupational and Environmental Medicine. Source: Journal of Occupational and Environmental Medicine / American College of Occupational and Environmental Medicine. 2003 April; 45(4): 346-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12708137&dopt=Abstract

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A sib-pair study of the Temperament and Character Inventory scales in major depression. Author(s): Farmer A, Mahmood A, Redman K, Harris T, Sadler S, McGuffin P. Source: Archives of General Psychiatry. 2003 May; 60(5): 490-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12742870&dopt=Abstract

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A simplified predictive index for the detection of women at risk for postnatal depression. Author(s): Webster J, Pritchard MA, Creedy D, East C. Source: Birth (Berkeley, Calif.). 2003 June; 30(2): 101-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12752167&dopt=Abstract

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A study comparing patients with amyotrophic lateral sclerosis and their caregivers on measures of quality of life, depression, and their attitudes toward treatment options. Author(s): Trail M, Nelson ND, Van JN, Appel SH, Lai EC. Source: Journal of the Neurological Sciences. 2003 May 15; 209(1-2): 79-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12686407&dopt=Abstract

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A survey of prescribing preferences in the treatment of refractory depression: recent trends. Author(s): Kornbluh R, Papakostas GI, Petersen T, Neault NB, Nierenberg AA, Rosenbaum JF, Fava M. Source: Psychopharmacology Bulletin. 2001 Summer; 35(3): 150-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12397884&dopt=Abstract

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A tripartite of HIV-risk for African American women: the intersection of drug use, violence, and depression. Author(s): Johnson SD, Cunningham-Williams RM, Cottler LB. Source: Drug and Alcohol Dependence. 2003 May 21; 70(2): 169-75. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12732410&dopt=Abstract

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Abnormal nocturnal blood pressure fall in senile-onset depression with subcortical silent cerebral infarction. Author(s): Hamada T, Murata T, Omori M, Takahashi T, Kosaka H, Wada Y, Yoshida H. Source: Neuropsychobiology. 2003; 47(4): 187-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12824741&dopt=Abstract

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Acceleration and augmentation strategies for treating bipolar depression. Author(s): Altshuler LL, Frye MA, Gitlin MJ. Source: Biological Psychiatry. 2003 April 15; 53(8): 691-700. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12706955&dopt=Abstract

186 Depression

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ADA: isolated bouts of depression do not qualify as a disability. Author(s): Prieto-Gonzalez M. Source: The Journal of Law, Medicine & Ethics : a Journal of the American Society of Law, Medicine & Ethics. 2003 Spring; 31(1): 165-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12762116&dopt=Abstract

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Addressing depression in obstetrics/gynecology practice. Author(s): Scholle SH, Haskett RF, Hanusa BH, Pincus HA, Kupfer DJ. Source: General Hospital Psychiatry. 2003 March-April; 25(2): 83-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12676420&dopt=Abstract

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Adolescent depression, cortisol and DHEA. Author(s): Angold A. Source: Psychological Medicine. 2003 May; 33(4): 573-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12785459&dopt=Abstract

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Adult brain neurogenesis and depression. Author(s): Jacobs BL. Source: Brain, Behavior, and Immunity. 2002 October; 16(5): 602-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12401475&dopt=Abstract

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Adult oncology and chronically ill patients: comparison of depression, anxiety and caregivers' quality of life. Author(s): Sherif T, Jehani T, Saadani M, Andejani AW. Source: East Mediterr Health J. 2001 May; 7(3): 502-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12690772&dopt=Abstract

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Advances in the pharmacologic treatment of bipolar depression. Author(s): Keck PE Jr, Nelson EB, McElroy SL. Source: Biological Psychiatry. 2003 April 15; 53(8): 671-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12706953&dopt=Abstract

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Age and major depression after mild traumatic brain injury. Author(s): Rapoport MJ, McCullagh S, Streiner D, Feinstein A. Source: The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry. 2003 May-June; 11(3): 365-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12724117&dopt=Abstract

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Age differences in symptoms of depression and anxiety: examining behavioral medicine outpatients. Author(s): Goldberg JH, Breckenridge JN, Sheikh JI. Source: Journal of Behavioral Medicine. 2003 April; 26(2): 119-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12776382&dopt=Abstract

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Age-specific norms and determinants of anxiety and depression in 731 women with breast cancer recruited through a population-based cancer registry. Author(s): Osborne RH, Elsworth GR, Hopper JL. Source: European Journal of Cancer (Oxford, England : 1990). 2003 April; 39(6): 755-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12651200&dopt=Abstract

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Alterations in pattern of rapid eye movement activity during REM sleep in depression. Author(s): Wichniak A, Antczak J, Wierzbicka A, Jernajczyk W. Source: Acta Neurobiol Exp (Wars). 2002; 62(4): 243-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12659290&dopt=Abstract

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Amitriptyline versus other types of pharmacotherapy for depression. Author(s): Guaiana G, Barbui C, Hotopf M. Source: Cochrane Database Syst Rev. 2003; (2): Cd004186. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12804503&dopt=Abstract

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An 8-week multicenter, parallel-group, double-blind, placebo-controlled study of sertraline in elderly outpatients with major depression. Author(s): Schneider LS, Nelson JC, Clary CM, Newhouse P, Krishnan KR, Shiovitz T, Weihs K; Sertraline Elderly Depression Study Group. Source: The American Journal of Psychiatry. 2003 July; 160(7): 1277-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12832242&dopt=Abstract

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An examination of the response styles theory of depression in third- and seventhgrade children: a short-term longitudinal study. Author(s): Abela JR, Brozina K, Haigh EP. Source: Journal of Abnormal Child Psychology. 2002 October; 30(5): 515-27. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12403154&dopt=Abstract

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Analyses of nursing home residents with multiple sclerosis and depression using the Minimum Data Set. Author(s): Buchanan RJ, Wang S, Tai-Seale M, Ju H. Source: Multiple Sclerosis (Houndmills, Basingstoke, England). 2003 March; 9(2): 171-88. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12708813&dopt=Abstract

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Analysis of structural polymorphisms and C-1018G promoter variant of the 5-HT(1A) receptor gene as putative risk factors in major depression. Author(s): Arias B, Arranz MJ, Gasto C, Catalan R, Pintor L, Gutierrez B, Kerwin RW, Fananas L. Source: Molecular Psychiatry. 2002; 7(9): 930-2. Erratum In: Mol Psychiatry. 2003 February; 8(2): 246. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12399944&dopt=Abstract

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Analysis of the concept of aloneness. As applied to older women being treated for depression. Author(s): Pierce LL, Wilkinson LK, Anderson J. Source: Journal of Gerontological Nursing. 2003 July; 29(7): 20-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12874936&dopt=Abstract

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Anger in bipolar depression. Author(s): Benazzi F. Source: The Journal of Clinical Psychiatry. 2003 April; 64(4): 480-1; Author Reply 481. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12716253&dopt=Abstract

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Antidepressants for the treatment of depression in people with schizophrenia: a systematic review. Author(s): Whitehead C, Moss S, Cardno A, Lewis G. Source: Psychological Medicine. 2003 May; 33(4): 589-99. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12785461&dopt=Abstract

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Antihistamines and potentiation of opioid induced sedation and respiratory depression. Author(s): Anwari JS, Iqbal S. Source: Anaesthesia. 2003 May; 58(5): 494-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12694022&dopt=Abstract

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Antisaccade performance of 1,273 men: effects of schizotypy, anxiety, and depression. Author(s): Smyrnis N, Evdokimidis I, Stefanis NC, Avramopoulos D, Constantinidis TS, Stavropoulos A, Stefanis CN. Source: Journal of Abnormal Psychology. 2003 August; 112(3): 403-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12943019&dopt=Abstract

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Anxiety and depression are related to autonomic nervous system function in women with irritable bowel syndrome. Author(s): Jarrett ME, Burr RL, Cain KC, Hertig V, Weisman P, Heitkemper MM. Source: Digestive Diseases and Sciences. 2003 February; 48(2): 386-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12643620&dopt=Abstract

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Anxiety and depression influence the relation between disability status and quality of life in multiple sclerosis. Author(s): Janssens AC, van Doorn PA, de Boer JB, Kalkers NF, van der Meche FG, Passchier J, Hintzen RQ. Source: Multiple Sclerosis (Houndmills, Basingstoke, England). 2003 August; 9(4): 397403. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12926846&dopt=Abstract

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Anxiety, depression and anger suppression in infertile couples: a controlled study. Author(s): Fassino S, Piero A, Boggio S, Piccioni V, Garzaro L. Source: Human Reproduction (Oxford, England). 2002 November; 17(11): 2986-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12407062&dopt=Abstract

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Anxiety, depression and informed consent in patients referred to a radiotherapy department. Author(s): Cazzaniga LF, Maroni D, Bianchi E, Bossi A, Cagna E, Cosentino D, Palmieri L, Scandolaro L, Valli MC. Source: Tumori. 2003 March-April; 89(2): 176-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12841667&dopt=Abstract

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Apathy and cognitive performance in older adults with depression. Author(s): Feil D, Razani J, Boone K, Lesser I. Source: International Journal of Geriatric Psychiatry. 2003 June; 18(6): 479-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12789667&dopt=Abstract

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Apolipoprotein E genotype and major depression in a community of older adults. The Cache County Study. Author(s): Steffens DC, Norton MC, Hart AD, Skoog I, Corcoran C, Breitner JC; Cache County Study Group. Source: Psychological Medicine. 2003 April; 33(3): 541-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12701674&dopt=Abstract

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Applicability of the Spanish Translation of the Zung Self-Rating Depression Scale in a general Puerto Rican population. Author(s): Martinez KG, Guiot HM, Casas-Dolz I, Gonzalez-Tejera G, Colon de Marti LN. Source: P R Health Sci J. 2003 June; 22(2): 179-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12866143&dopt=Abstract

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Aspects of quality of life in persons with pre-lingual deafness using sign language: subjective wellbeing, ill-health symptoms, depression and insomnia. Author(s): Werngren-Elgstrom M, Dehlin O, Iwarsson S. Source: Archives of Gerontology and Geriatrics. 2003 July-August; 37(1): 13-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12849069&dopt=Abstract

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Assessing risk for major depression on patients selected for percutaneous transluminal coronary angioplasty: is it a worthwhile venture? Author(s): Burton HJ, Kline SA, Cooper BS, Rabinowitz A, Dodek A. Source: General Hospital Psychiatry. 2003 May-June; 25(3): 200-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12748033&dopt=Abstract

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Assessment and prevalence of depression in women 45-55 years of age visiting gynecological clinics in Poland: screening for depression among midlife gynecologic patients. Author(s): Wojnar M, Drod W, Araszkiewicz A, Szymanski W, Nawacka-Pawlaczyk D, Urbanski R, Hegedus AM. Source: Archives of Women's Mental Health. 2003 August; 6(3): 193-201. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12920617&dopt=Abstract

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Association analysis for neuronal nitric oxide synthase gene polymorphism with major depression and fluoxetine response. Author(s): Yu YW, Chen TJ, Wang YC, Liou YJ, Hong CJ, Tsai SJ. Source: Neuropsychobiology. 2003; 47(3): 137-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12759556&dopt=Abstract

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Association between dorsolateral prefrontal N-acetyl aspartate and depression in chronic back pain: an in vivo proton magnetic resonance spectroscopy study. Author(s): Grachev ID, Ramachandran TS, Thomas PS, Szeverenyi NM, Fredrickson BE. Source: Journal of Neural Transmission (Vienna, Austria : 1996). 2003 March; 110(3): 287312. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12658377&dopt=Abstract

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Association between visual impairment and depression in the elderly. Author(s): Tsai SY, Cheng CY, Hsu WM, Su TP, Liu JH, Chou P. Source: J Formos Med Assoc. 2003 February; 102(2): 86-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12709736&dopt=Abstract

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Association of depression and rheumatoid arthritis. Author(s): Dickens C, Jackson J, Tomenson B, Hay E, Creed F. Source: Psychosomatics. 2003 May-June; 44(3): 209-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12724502&dopt=Abstract

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Association of depression with agitation in elderly nursing home residents. Author(s): Heeren O, Borin L, Raskin A, Gruber-Baldini AL, Menon AS, Kaup B, Loreck D, Ruskin PE, Zimmerman S, Magaziner J. Source: Journal of Geriatric Psychiatry and Neurology. 2003 March; 16(1): 4-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12641365&dopt=Abstract

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Association of exaggerated HPA axis response to the initial injection of interferonalpha with development of depression during interferon-alpha therapy. Author(s): Capuron L, Raison CL, Musselman DL, Lawson DH, Nemeroff CB, Miller AH. Source: The American Journal of Psychiatry. 2003 July; 160(7): 1342-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12832253&dopt=Abstract

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Association of exercise-induced, silent ST-segment depression with the risk of stroke and cardiovascular diseases in men. Author(s): Kurl S, Laukkanen JA, Tuomainen TP, Rauramaa R, Lakka TA, Salonen R, Eranen J, Sivenius J, Salonen JT. Source: Stroke; a Journal of Cerebral Circulation. 2003 July; 34(7): 1760-5. Epub 2003 June 26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12829872&dopt=Abstract

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Association of life events and psychosocial factors with early but not late onset depression in the elderly: implications for possible differences in aetiology. Author(s): Grace J, O'Brien JT. Source: International Journal of Geriatric Psychiatry. 2003 June; 18(6): 473-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12789666&dopt=Abstract

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Associations between ST depression, four year mortality, and in-hospital revascularisation in unselected patients with non-ST elevation acute coronary syndromes. Author(s): Hyde TA, French JK, Wong CK, Edwards C, Whitlock RM, White HD. Source: Heart (British Cardiac Society). 2003 May; 89(5): 490-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12695448&dopt=Abstract

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Associations of blood glucose control with self-efficacy and rated anxiety/depression in type II diabetes mellitus patients. Author(s): Ikeda K, Aoki H, Saito K, Muramatsu Y, Suzuki T. Source: Psychological Reports. 2003 April; 92(2): 540-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12785638&dopt=Abstract

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Asthma symptoms associated with depression and lower quality of life: a population survey. Author(s): Goldney RD, Ruffin R, Fisher LJ, Wilson DH. Source: The Medical Journal of Australia. 2003 May 5; 178(9): 437-41. Erratum In: Med J Aust. 2003 July 7; 179(1): 17. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12720509&dopt=Abstract

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Attachment and dysthymia: the contributions of preoccupied attachment and agency of self to depression in women. Author(s): West M, George C. Source: Attachment & Human Development. 2002 December; 4(3): 278-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12537847&dopt=Abstract

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Attentional and executive dysfunctions in schizophrenia and depression: evidence from dichotic listening performance. Author(s): Hugdahl K, Rund BR, Lund A, Asbjornsen A, Egeland J, Landro NI, Roness A, Stordal KI, Sundet K. Source: Biological Psychiatry. 2003 April 1; 53(7): 609-16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12679239&dopt=Abstract

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Attitudes accentuate attributes in social judgment: the combined effects of substance use, depression, and technical incompetence on judgments of professional impairment. Author(s): Beckstead JW. Source: The Journal of Social Psychology. 2003 April; 143(2): 185-201. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12735517&dopt=Abstract

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Avoiding drug-induced switching in patients with bipolar depression. Author(s): Henry C, Demotes-Mainard J. Source: Drug Safety : an International Journal of Medical Toxicology and Drug Experience. 2003; 26(5): 337-51. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12650634&dopt=Abstract

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Awareness about depression: important for all physicians. Author(s): Glass RM. Source: Jama : the Journal of the American Medical Association. 2003 June 18; 289(23): 3169-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12813124&dopt=Abstract

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Background and rationale for the sequenced treatment alternatives to relieve depression (STAR*D) study. Author(s): Fava M, Rush AJ, Trivedi MH, Nierenberg AA, Thase ME, Sackeim HA, Quitkin FM, Wisniewski S, Lavori PW, Rosenbaum JF, Kupfer DJ. Source: The Psychiatric Clinics of North America. 2003 June; 26(2): 457-94, X. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12778843&dopt=Abstract

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Back-neck pain and symptoms of anxiety and depression: a population-based twin study. Author(s): Reichborn-Kjennerud T, Stoltenberg C, Tambs K, Roysamb E, Kringlen E, Torgersen S, Harris JR. Source: Psychological Medicine. 2002 August; 32(6): 1009-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12214782&dopt=Abstract

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Barriers to postpartum depression prevention and treatment: a policy analysis. Author(s): Sobey WS. Source: Journal of Midwifery & Women's Health. 2002 September-October; 47(5): 331-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12361344&dopt=Abstract

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Baseline prolactin and L-tryptophan availability predict response to antidepressant treatment in major depression. Author(s): Porter RJ, Mulder RT, Joyce PR. Source: Psychopharmacology. 2003 January; 165(3): 216-21. Epub 2002 November 19. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12439628&dopt=Abstract

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Beck Depression Inventory-II items associated with self-reported symptoms of ADHD in adult psychiatric outpatients. Author(s): Steer RA, Ranieri WF, Kumar G, Beck AT. Source: Journal of Personality Assessment. 2003 February; 80(1): 58-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12584068&dopt=Abstract

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Behavioral activation and inhibition systems and the severity and course of depression. Author(s): Kasch KL, Rottenberg J, Arnow BA, Gotlib IH. Source: Journal of Abnormal Psychology. 2002 November; 111(4): 589-97. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12428772&dopt=Abstract

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Behavioural inhibition and symptoms of anxiety and depression: is there a specific relationship with social phobia? Author(s): Neal JA, Edelmann RJ, Glachan M. Source: The British Journal of Clinical Psychology / the British Psychological Society. 2002 November; 41(Pt 4): 361-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12437791&dopt=Abstract

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Beliefs about alcohol among UK Jews and Protestants: do they fit the alcoholdepression hypothesis? Author(s): Loewenthal KM, MacLeod AK, Cook S, Lee M, Goldblatt V. Source: Social Psychiatry and Psychiatric Epidemiology. 2003 March; 38(3): 122-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12616309&dopt=Abstract

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Benefits and risks to mother and infant of drug treatment for postnatal depression. Author(s): Misri S, Kostaras X. Source: Drug Safety : an International Journal of Medical Toxicology and Drug Experience. 2002; 25(13): 903-11. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12381212&dopt=Abstract

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Beta-blocker therapy and depression. Author(s): Messerli FH, Grossman E. Source: Jama : the Journal of the American Medical Association. 2002 October 16; 288(15): 1845-6; Author Reply 1846. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12377075&dopt=Abstract

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Beta-blocker therapy and depression. Author(s): Terao T. Source: Jama : the Journal of the American Medical Association. 2002 October 16; 288(15): 1845; Author Reply 1846. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12377074&dopt=Abstract

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Bibliotherapy as an adjunct to psychotherapy for depression in older adults. Author(s): Floyd M. Source: Journal of Clinical Psychology. 2003 February; 59(2): 187-95. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12552627&dopt=Abstract

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Biological markers of atypical depression. Author(s): Posternak MA. Source: Harvard Review of Psychiatry. 2003 January-February; 11(1): 1-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12866736&dopt=Abstract

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Biological mechanisms in the relationship between depression and heart disease. Author(s): Grippo AJ, Johnson AK. Source: Neuroscience and Biobehavioral Reviews. 2002 December; 26(8): 941-62. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12667498&dopt=Abstract

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Biological risk factors for late life depression. Author(s): Tiemeier H. Source: European Journal of Epidemiology. 2003; 18(8): 745-50. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12974548&dopt=Abstract

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Bipolar depression and melancholia. Comments on Parker et al. 'The nature of bipolar depression: implications for the definition of melancholia'. J. Affect. Disord. 59 (2000) 217-224. Author(s): Benazzi F. Source: Journal of Affective Disorders. 2002 November; 72(2): 201-2; Author Reply 203-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12200211&dopt=Abstract

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Bipolar depression: criteria for treatment selection, definition of refractoriness, and treatment options. Author(s): Yatham LN, Calabrese JR, Kusumakar V. Source: Bipolar Disorders. 2003 April; 5(2): 85-97. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12680897&dopt=Abstract

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Bipolar depression: management options. Author(s): Malhi GS, Mitchell PB, Salim S. Source: Cns Drugs. 2003; 17(1): 9-25. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12467490&dopt=Abstract

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Bipolar depression: relationship between episode length and antidepressant treatment. Author(s): Frankle WG, Perlis RH, Deckersbach T, Grandin LD, Gray SM, Sachs GS, Nierenberg AA. Source: Psychological Medicine. 2002 November; 32(8): 1417-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12455940&dopt=Abstract

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Blunted prolactin response to fentanyl in depression. Normalizing effect of partial sleep deprivation. Author(s): Frecska E, Perenyi A, Arato M. Source: Psychiatry Research. 2003 May 30; 118(2): 155-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12798980&dopt=Abstract

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Borderline personality disorder in major depression: symptomatology, temperament, character, differential drug response, and 6-month outcome. Author(s): Joyce PR, Mulder RT, Luty SE, McKenzie JM, Sullivan PF, Cloninger RC. Source: Comprehensive Psychiatry. 2003 January-February; 44(1): 35-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12524634&dopt=Abstract

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Boundary maintenance as a barrier to mental health help-seeking for depression among the Old Order Amish. Author(s): Reiling DM. Source: The Journal of Rural Health : Official Journal of the American Rural Health Association and the National Rural Health Care Association. 2002 Summer; 18(3): 42836. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12186317&dopt=Abstract

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Breaking the myths: new treatment approaches for chronic depression. Author(s): Michalak EE, Lam RW. Source: Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie. 2002 September; 47(7): 635-43. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12355675&dopt=Abstract

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Bringing depression out of the shadows. Author(s): Linnell AL. Source: Nursing. 2003 June; 33(6): 10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12799579&dopt=Abstract

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Burden of illness and suicide in elderly people. Physical disease and depression are prevalent in elderly Finnish suicide victims. Author(s): Timonen M, Viilo K, Vaisanen E, Rasanen P, Hakko H, Sarkioja T. Source: Bmj (Clinical Research Ed.). 2002 August 24; 325(7361): 441. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12193366&dopt=Abstract

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By the way doctor. Last fall, my mother went into a deep depression. The same thing happened about five years ago, but she took an antidepressant for a few weeks and it went away. This time she's been depressed for nearly a year. No medication has helped. Now her doctors want her to try electroshock therapy, but that scares her--and me. Author(s): Lee TH. Source: Harvard Health Letter / from Harvard Medical School. 2002 August; 27(10): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12217840&dopt=Abstract

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Can long-term treatment with antidepressant drugs worsen the course of depression? Author(s): Fava GA. Source: The Journal of Clinical Psychiatry. 2003 February; 64(2): 123-33. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12633120&dopt=Abstract

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Can only reversed vegetative symptoms define atypical depression? Author(s): Benazzi F. Source: European Archives of Psychiatry and Clinical Neuroscience. 2002 December; 252(6): 288-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12563537&dopt=Abstract

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Can routine information improve case finding of depression among 65 to 74 year olds in primary care? Author(s): Freudenstein U, Arthur A, Matthews R, Jagger C. Source: Family Practice. 2002 October; 19(5): 520-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12356706&dopt=Abstract

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Can we prevent postnatal depression? A randomized controlled trial to assess the effect of continuity of midwifery care on rates of postnatal depression in high-risk women. Author(s): Marks MN, Siddle K, Warwick C. Source: J Matern Fetal Neonatal Med. 2003 February;13(2):119-27. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12735413&dopt=Abstract

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Cancer pain and depression: management of the dual-diagnosed patient. Author(s): Valentine AD. Source: Current Pain and Headache Reports. 2003 August; 7(4): 262-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12828875&dopt=Abstract

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Case histories for understanding depression in primary care. Author(s): Baron DA. Source: J Am Osteopath Assoc. 2003 August; 103(8 Suppl 4): S16-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12956253&dopt=Abstract

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Catecholamine and HPA axis dysfunction in depression: relationship with suicidal behavior. Author(s): Pitchot W, Reggers J, Pinto E, Hansenne M, Ansseau M. Source: Neuropsychobiology. 2003; 47(3): 152-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12759559&dopt=Abstract

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Cathartic effect of suicide attempts not limited to depression: a short-term prospective study after deliberate self-poisoning. Author(s): Sarfati Y, Bouchaud B, Hardy-Bayle MC. Source: Crisis. 2003; 24(2): 73-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12880225&dopt=Abstract

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Cervical vagus nerve stimulation for treatment-resistant depression. Author(s): Carpenter LL, Friehs GM, Price LH. Source: Neurosurg Clin N Am. 2003 April; 14(2): 275-82. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12856494&dopt=Abstract

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Challenges in the treatment of depression with psychotic features. Author(s): Rothschild AJ. Source: Biological Psychiatry. 2003 April 15; 53(8): 680-90. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12706954&dopt=Abstract

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Child and adolescent depression: short-term treatment effectiveness and long-term opportunities. Author(s): Ryan ND. Source: Int J Methods Psychiatr Res. 2003; 12(1): 44-53. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12830309&dopt=Abstract

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Childhood adversities associated with major depression and/or anxiety disorders in a community sample of Ontario: issues of co-morbidity and specificity. Author(s): Levitan RD, Rector NA, Sheldon T, Goering P. Source: Depression and Anxiety. 2003; 17(1): 34-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12577276&dopt=Abstract

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Childhood depression: Be on the alert. Author(s): Nelms BC. Source: Journal of Pediatric Health Care : Official Publication of National Association of Pediatric Nurse Associates & Practitioners. 2003 July-August; 17(4): 161-2. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12847424&dopt=Abstract

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Childhood parental separation experiences and depressive symptomatology in acute major depression. Author(s): Takeuchi H, Hiroe T, Kanai T, Morinobu S, Kitamura T, Takahashi K, Furukawa TA. Source: Psychiatry and Clinical Neurosciences. 2003 April; 57(2): 215-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12667169&dopt=Abstract

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Childhood trauma and depression. Author(s): Levitan RD, Parikh SV. Source: The American Journal of Psychiatry. 2003 June; 160(6): 1188; Author Reply 11889. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12777288&dopt=Abstract

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Chronic complex depression. Author(s): Staller JA. Source: Psychiatric Services (Washington, D.C.). 2003 June; 54(6): 771. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12773588&dopt=Abstract

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Chronic depression and comorbid personality disorders: response to sertraline versus imipramine. Author(s): Russell JM, Kornstein SG, Shea MT, McCullough JP, Harrison WM, Hirschfeld RM, Keller MB. Source: The Journal of Clinical Psychiatry. 2003 May; 64(5): 554-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12755659&dopt=Abstract

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Citalopram in children and adolescents with depression or anxiety. Author(s): Baumgartner JL, Emslie GJ, Crismon ML. Source: The Annals of Pharmacotherapy. 2002 November; 36(11): 1692-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12398561&dopt=Abstract

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Clinical and health services relationships between major depression, depressive symptoms, and general medical illness. Author(s): Katon WJ. Source: Biological Psychiatry. 2003 August 1; 54(3): 216-26. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12893098&dopt=Abstract

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Clinical and neurobiological effects of tianeptine and paroxetine in major depression. Author(s): Nickel T, Sonntag A, Schill J, Zobel AW, Ackl N, Brunnauer A, Murck H, Ising M, Yassouridis A, Steiger A, Zihl J, Holsboer F. Source: Journal of Clinical Psychopharmacology. 2003 April; 23(2): 155-68. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12640217&dopt=Abstract

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Clinical and personality correlates of a new measure of depression: a general practice study. Author(s): Parker G, Hilton T, Hadzi-Pavlovic D, Irvine P. Source: The Australian and New Zealand Journal of Psychiatry. 2003 February; 37(1): 104-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12534665&dopt=Abstract

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Clinical and phenomenological comparisons of delusional and non-delusional major depression in the Chinese elderly. Author(s): Lee TW, Tsai SJ, Yang CH, Hwang JP. Source: International Journal of Geriatric Psychiatry. 2003 June; 18(6): 486-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12789668&dopt=Abstract

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Clinical differences between bipolar II depression and unipolar major depressive disorder: lack of an effect of age. Author(s): Benazzi F. Source: Journal of Affective Disorders. 2003 July; 75(2): 191-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12798259&dopt=Abstract

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Clinical outcome after trimipramine in patients with delusional depression - a pilot study. Author(s): Frieboes RM, Sonntag A, Yassouridis A, Eap CB, Baumann P, Steiger A. Source: Pharmacopsychiatry. 2003 January; 36(1): 12-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12649769&dopt=Abstract

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Clinical practice guidelines for depression in young people. Author(s): Jureidini JN, Tonkin AL. Source: The Medical Journal of Australia. 2003 March 17; 178(6): 300; Author Reply 3002. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12633493&dopt=Abstract

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Clinical trial of interactive and videotaped educational interventions reduce infection, reactive depression, and rehospitalizations for sepsis in patients on home parenteral nutrition. Author(s): Smith CE, Curtas S, Kleinbeck SV, Werkowitch M, Mosier M, Seidner DL, Steiger E. Source: Jpen. Journal of Parenteral and Enteral Nutrition. 2003 March-April; 27(2): 13745. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12665170&dopt=Abstract

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Clinical utility of ST-segment depression in lead AVR in acute myocardial infarction. Author(s): Senaratne MP, Weerasinghe C, Smith G, Mooney D. Source: Journal of Electrocardiology. 2003 January; 36(1): 11-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12607191&dopt=Abstract

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Clonazepam in the long-term treatment of patients with unipolar depression, bipolar and schizoaffective disorder. Author(s): Winkler D, Willeit M, Wolf R, Stamenkovic M, Tauscher J, Pjrek E, Konstantinidis A, Schindler S, Barnas C, Kasper S. Source: European Neuropsychopharmacology : the Journal of the European College of Neuropsychopharmacology. 2003 March; 13(2): 129-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12650958&dopt=Abstract

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Cognitive and somatic symptoms of depression are associated with medical comorbidity in patients after acute myocardial infarction. Author(s): Watkins LL, Schneiderman N, Blumenthal JA, Sheps DS, Catellier D, Taylor CB, Freedland KE; ENRICHD Investigators. Source: American Heart Journal. 2003 July; 146(1): 48-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12851607&dopt=Abstract

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Cognitive aspects of chronic depression. Author(s): Riso LP, du Toit PL, Blandino JA, Penna S, Dacey S, Duin JS, Pacoe EM, Grant MM, Ulmer CS. Source: Journal of Abnormal Psychology. 2003 February; 112(1): 72-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12653415&dopt=Abstract

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Cognitive behavior therapy for depression? Choose horses for courses. Author(s): Parker G, Roy K, Eyers K. Source: The American Journal of Psychiatry. 2003 May; 160(5): 825-34. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12727682&dopt=Abstract

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Cognitive behavioural therapy skills training for adolescent depression. Author(s): Rowe L, Tonge B. Source: Aust Fam Physician. 2003 May; 32(5): 364-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12772372&dopt=Abstract

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Cognitive functions and depression as predictors of poor outcome 15 months after stroke. Author(s): Pohjasvaara T, Vataja R, Leppavuori A, Kaste M, Erkinjuntti T. Source: Cerebrovascular Diseases (Basel, Switzerland). 2002; 14(3-4): 228-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12403956&dopt=Abstract

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Cognitive predictors of symptom return following depression treatment. Author(s): Beevers CG, Keitner GI, Ryan CE, Miller IW. Source: Journal of Abnormal Psychology. 2003 August; 112(3): 488-96. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12943027&dopt=Abstract

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Cognitive, interpersonal, and behavioral predictors of patients' and spouses' depression. Author(s): Teichman Y, Bar-El Z, Shor H, Elizur A. Source: Journal of Affective Disorders. 2003 May; 74(3): 247-56. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12738043&dopt=Abstract

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Comorbid personality disorder predicts suicide after major depression: a 10-year follow-up. Author(s): Hansen PE, Wang AG, Stage KB, Kragh-Sorensen P; Danish University Antidepressant Group. Source: Acta Psychiatrica Scandinavica. 2003 June; 107(6): 436-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12752020&dopt=Abstract

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Comorbidity and depression treatment. Author(s): Krishnan KR. Source: Biological Psychiatry. 2003 April 15; 53(8): 701-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12706956&dopt=Abstract

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Comorbidity of depression with other medical diseases in the elderly. Author(s): Krishnan KR, Delong M, Kraemer H, Carney R, Spiegel D, Gordon C, McDonald W, Dew M, Alexopoulos G, Buckwalter K, Cohen PD, Evans D, Kaufmann PG, Olin J, Otey E, Wainscott C. Source: Biological Psychiatry. 2002 September 15; 52(6): 559-88. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12361669&dopt=Abstract

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Comorbidity of late life depression: an opportunity for research on mechanisms and treatment. Author(s): Alexopoulos GS, Buckwalter K, Olin J, Martinez R, Wainscott C, Krishnan KR. Source: Biological Psychiatry. 2002 September 15; 52(6): 543-58. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12361668&dopt=Abstract

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Co-morbidity of migraine and major depression in the Turkish population. Author(s): Kececi H, Dener S, Analan E. Source: Cephalalgia : an International Journal of Headache. 2003 May; 23(4): 271-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12716344&dopt=Abstract

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Comparative study of anxiety, depression, somatization, functional disability, and illness attribution in adolescents with chronic fatigue or migraine. Author(s): Smith MS, Martin-Herz SP, Womack WM, Marsigan JL. Source: Pediatrics. 2003 April; 111(4 Pt 1): E376-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12671155&dopt=Abstract

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Comparing anxiety disorders and anxiety-related traits in bipolar disorder and unipolar depression. Author(s): Simon NM, Smoller JW, Fava M, Sachs G, Racette SR, Perlis R, Sonawalla S, Rosenbaum JF. Source: Journal of Psychiatric Research. 2003 May-June; 37(3): 187-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12650739&dopt=Abstract

Studies 203

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Comparing depression treatments. Author(s): Rifkin A. Source: The American Journal of Psychiatry. 2003 June; 160(6): 1186-7; Author Reply 1187. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12777284&dopt=Abstract

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Comparing the effectiveness of process-experiential with cognitive-behavioral psychotherapy in the treatment of depression. Author(s): Watson JC, Gordon LB, Stermac L, Kalogerakos F, Steckley P. Source: Journal of Consulting and Clinical Psychology. 2003 August; 71(4): 773-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12924682&dopt=Abstract

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Comparing various short-form Geriatric Depression Scales leads to the GDS-5/15. Author(s): Weeks SK, McGann PE, Michaels TK, Penninx BW. Source: Journal of Nursing Scholarship : an Official Publication of Sigma Theta Tau International Honor Society of Nursing / Sigma Theta Tau. 2003; 35(2): 133-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12854293&dopt=Abstract

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Comparison of immunological and endocrinological markers associated with major depression. Author(s): Jozuka H, Jozuka E, Takeuchi S, Nishikaze O. Source: J Int Med Res. 2003 January-February; 31(1): 36-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12635532&dopt=Abstract

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Complications associated with surveying medical student depression: the importance of anonymity. Author(s): Levine RE, Breitkopf CR, Sierles FS, Camp G. Source: Academic Psychiatry : the Journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry. 2003 Spring; 27(1): 12-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12824115&dopt=Abstract

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Computerized, interactive, multimedia cognitive-behavioural program for anxiety and depression in general practice. Author(s): Proudfoot J, Goldberg D, Mann A, Everitt B, Marks I, Gray JA. Source: Psychological Medicine. 2003 February; 33(2): 217-27. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12622301&dopt=Abstract

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Confronting depression and suicide in physicians: a consensus statement. Author(s): Center C, Davis M, Detre T, Ford DE, Hansbrough W, Hendin H, Laszlo J, Litts DA, Mann J, Mansky PA, Michels R, Miles SH, Proujansky R, Reynolds CF 3rd, Silverman MM. Source: Jama : the Journal of the American Medical Association. 2003 June 18; 289(23): 3161-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12813122&dopt=Abstract

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Consequences and correlates of adolescent depression. Author(s): Glied S, Pine DS. Source: Archives of Pediatrics & Adolescent Medicine. 2002 October; 156(10): 1009-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12361447&dopt=Abstract

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Considerations in the management of the patient with comorbid depression and anxiety. Author(s): Sekula LK, DeSantis J, Gianetti V. Source: Journal of the American Academy of Nurse Practitioners. 2003 January; 15(1): 23-33. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12613410&dopt=Abstract

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Construct validity of the 15-item geriatric depression scale in older medical inpatients. Author(s): Incalzi RA, Cesari M, Pedone C, Carbonin PU. Source: Journal of Geriatric Psychiatry and Neurology. 2003 March; 16(1): 23-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12641369&dopt=Abstract

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Contingency-competence-control-related beliefs and symptoms of anxiety and depression in a young adolescent sample. Author(s): Muris P, Schouten E, Meesters C, Gijsbers H. Source: Child Psychiatry and Human Development. 2003 Summer; 33(4): 325-39. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12723904&dopt=Abstract

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Controlled trial of the short- and long-term effect of psychological treatment of postpartum depression. I. Impact on maternal mood. Author(s): Cooper PJ, Murray L, Wilson A, Romaniuk H. Source: The British Journal of Psychiatry; the Journal of Mental Science. 2003 May; 182: 412-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12724244&dopt=Abstract

Studies 205

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Controlled trial of the short- and long-term effect of psychological treatment of postpartum depression: 2. Impact on the mother-child relationship and child outcome. Author(s): Murray L, Cooper PJ, Wilson A, Romaniuk H. Source: The British Journal of Psychiatry; the Journal of Mental Science. 2003 May; 182: 420-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12724245&dopt=Abstract

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Conventional antipsychotic prescription in unipolar depression, I: an audit and recommendations for practice. Author(s): Wheeler Vega JA, Mortimer AM, Tyson PJ. Source: The Journal of Clinical Psychiatry. 2003 May; 64(5): 568-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12755661&dopt=Abstract

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Conventional antipsychotic prescription in unipolar depression, II: withdrawing conventional antipsychotics in unipolar, nonpsychotic patients. Author(s): Mortimer AM, Martin M, Wheeler Vega JA, Tyson PJ. Source: The Journal of Clinical Psychiatry. 2003 June; 64(6): 668-72; Quiz 738-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12823081&dopt=Abstract

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Convergent and divergent effects of odors and emotions in depression. Author(s): Pause BM, Raack N, Sojka B, Goder R, Aldenhoff JB, Ferstl R. Source: Psychophysiology. 2003 March; 40(2): 209-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12820862&dopt=Abstract

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Coping effectiveness training reduces depression and anxiety following traumatic spinal cord injuries. Author(s): Kennedy P, Duff J, Evans M, Beedie A. Source: The British Journal of Clinical Psychology / the British Psychological Society. 2003 March; 42(Pt 1): 41-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12675978&dopt=Abstract

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Coping strategies and its effects on depression among caregivers of impaired elders in Japan. Author(s): Abe K, Kashiwagi T, Tsuneto S. Source: Aging & Mental Health. 2003 May; 7(3): 207-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12775402&dopt=Abstract

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Coping strategies, illness perception, anxiety and depression of patients with idiopathic constipation: a population-based study. Author(s): Cheng C, Chan AO, Hui WM, Lam SK. Source: Alimentary Pharmacology & Therapeutics. 2003 August 1; 18(3): 319-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12895216&dopt=Abstract

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Coping with postnatal depression: a personal perspective. Author(s): Bishop LM. Source: The Medical Journal of Australia. 2002 October 7; 177 Suppl: S106. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12358567&dopt=Abstract

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Correlation between cortisol level and serotonin uptake in patients with chronic stress and depression. Author(s): Tafet GE, Idoyaga-Vargas VP, Abulafia DP, Calandria JM, Roffman SS, Chiovetta A, Shinitzky M. Source: Cognitive, Affective & Behavioral Neuroscience. 2001 December; 1(4): 388-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12467090&dopt=Abstract

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Corticotropin-releasing hormone modulators and depression. Author(s): Holsboer F. Source: Curr Opin Investig Drugs. 2003 January; 4(1): 46-50. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12625028&dopt=Abstract

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Cost of lost productive work time among US workers with depression. Author(s): Stewart WF, Ricci JA, Chee E, Hahn SR, Morganstein D. Source: Jama : the Journal of the American Medical Association. 2003 June 18; 289(23): 3135-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12813119&dopt=Abstract

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Counseling versus antidepressant therapy for the treatment of mild to moderate depression in primary care: economic analysis. Author(s): Miller P, Chilvers C, Dewey M, Fielding K, Gretton V, Palmer B, Weller D, Churchill R, Williams I, Bedi N, Duggan C, Lee A, Harrison G. Source: International Journal of Technology Assessment in Health Care. 2003 Winter; 19(1): 80-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12701941&dopt=Abstract

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Cross-cultural aspects of depression in general practice. Author(s): Ellis CG. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 2003 May; 93(5): 342-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12830594&dopt=Abstract

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Cytokines and depression: an update. Author(s): Dantzer R, Wollman EE, Yirmiya R. Source: Brain, Behavior, and Immunity. 2002 October; 16(5): 501-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12401463&dopt=Abstract

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Cytokines and depression: the need for a new paradigm. Author(s): Capuron L, Dantzer R. Source: Brain, Behavior, and Immunity. 2003 February; 17 Suppl 1: S119-24. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12615197&dopt=Abstract

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Decreasing pain and depression in a health promotion program for people with rheumatoid arthritis. Author(s): Oh H, Seo W. Source: Journal of Nursing Scholarship : an Official Publication of Sigma Theta Tau International Honor Society of Nursing / Sigma Theta Tau. 2003; 35(2): 127-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12854292&dopt=Abstract

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Defeat depression. Author(s): Sharma S, Sharma V. Source: The Nursing Journal of India. 2002 December; 93(12): 274-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12718117&dopt=Abstract

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Delirium, depression often overlooked. Author(s): Naylor M. Source: The American Journal of Nursing. 2003 May; 103(5): 116. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12762330&dopt=Abstract

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Depression and antisocial personality disorder: two contrasting disorders of 5HT function. Author(s): Deakin JF. Source: Journal of Neural Transmission. Supplementum. 2003; (64): 79-93. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12830930&dopt=Abstract

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Depression and anxiety in chronic hepatitis B: effect of hepatitis B virus infection on psychological state in childhood. Author(s): Arslan N, Buyukgebiz B, Ozturk Y, Akay AP. Source: Turk J Pediatr. 2003 January-March; 45(1): 26-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12718367&dopt=Abstract

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Depression and assisted suicide in the terminally ill. Author(s): Angelo EJ. Source: Natl Cathol Bioeth Q. 2001 Autumn; 1(3): 307-12. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12866518&dopt=Abstract

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Depression and Bipolar Support Alliance consensus statement on the unmet needs in diagnosis and treatment of mood disorders in late life. Author(s): Charney DS, Reynolds CF 3rd, Lewis L, Lebowitz BD, Sunderland T, Alexopoulos GS, Blazer DG, Katz IR, Meyers BS, Arean PA, Borson S, Brown C, Bruce ML, Callahan CM, Charlson ME, Conwell Y, Cuthbert BN, Devanand DP, Gibson MJ, Gottlieb GL, Krishnan KR, Laden SK, Lyketsos CG, Mulsant BH, Niederehe G, Olin JT, Oslin DW, Pearson J, Persky T, Pollock BG, Raetzman S, Reynolds M, Salzman C, Schulz R, Schwenk TL, Scolnick E, Unutzer J, Weissman MM, Young RC; Depression and Bipolar Support Alliance. Source: Archives of General Psychiatry. 2003 July; 60(7): 664-72. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12860770&dopt=Abstract

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Depression and cancer: mechanisms and disease progression. Author(s): Spiegel D, Giese-Davis J. Source: Biological Psychiatry. 2003 August 1; 54(3): 269-82. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12893103&dopt=Abstract

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Depression and cardiovascular disease: mechanisms of interaction. Author(s): Joynt KE, Whellan DJ, O'Connor CM. Source: Biological Psychiatry. 2003 August 1; 54(3): 248-61. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12893101&dopt=Abstract

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Depression and cognitive impairment in disability-free early multiple sclerosis. Author(s): Haase CG, Tinnefeld M, Lienemann M, Ganz RE, Faustmann PM. Source: Behavioural Neurology. 2003; 14(1-2): 39-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12719637&dopt=Abstract

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Depression and comorbid medical illness: the National Institute of Mental Health perspective. Author(s): Stover E, Fenton W, Rosenfeld A, Insel TR. Source: Biological Psychiatry. 2003 August 1; 54(3): 184-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12893092&dopt=Abstract

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Depression and congestive heart failure. Author(s): Guck TP, Elsasser GN, Kavan MG, Barone EJ. Source: Congestive Heart Failure (Greenwich, Conn.). 2003 May-June; 9(3): 163-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12826775&dopt=Abstract

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Depression and increased myocardial ischemic activity in patients with ischemic heart disease. Author(s): Jiang W, Babyak MA, Rozanski A, Sherwood A, O'Connor CM, Waugh RA, Coleman RE, Hanson MW, Morris JJ, Blumenthal JA. Source: American Heart Journal. 2003 July; 146(1): 55-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12851608&dopt=Abstract

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Depression and neurocognitive functioning in mild traumatic brain injury patients referred for assessment. Author(s): Ruttan LA, Heinrichs RW. Source: J Clin Exp Neuropsychol. 2003 May; 25(3): 407-19. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12916653&dopt=Abstract

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Depression and obesity. Author(s): Stunkard AJ, Faith MS, Allison KC. Source: Biological Psychiatry. 2003 August 1; 54(3): 330-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12893108&dopt=Abstract

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Depression and other psychological risks following myocardial infarction. Author(s): Frasure-Smith N, Lesperance F. Source: Archives of General Psychiatry. 2003 June; 60(6): 627-36. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12796226&dopt=Abstract

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Depression and satisfaction with health coverage and medical care in the 1998 NRC Healthcare Market Guide survey. Author(s): Haviland MG, Pincus HA, Morales LS. Source: Administration and Policy in Mental Health. 2003 July; 30(6): 511-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=13677457&dopt=Abstract

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Depression and suicidal behavior in adolescent inpatients with obsessive compulsive disorder. Author(s): Apter A, Horesh N, Gothelf D, Zalsman G, Erlich Z, Soreni N, Weizman A. Source: Journal of Affective Disorders. 2003 July; 75(2): 181-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12798258&dopt=Abstract

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Depression and suicidal behavior: the real estate analogy. Author(s): Goldney RD. Source: Crisis. 2003; 24(2): 87-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12880228&dopt=Abstract

210 Depression

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Depression and tinnitus. Author(s): Dobie RA. Source: Otolaryngologic Clinics of North America. 2003 April; 36(2): 383-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12856305&dopt=Abstract

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Depression and trail making test scores in a sample of cocaine abusers. Author(s): Horton AM Jr, Roberts C. Source: The International Journal of Neuroscience. 2003 April; 113(4): 595-604. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12856485&dopt=Abstract

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Depression as a risk factor for Alzheimer disease: the MIRAGE Study. Author(s): Green RC, Cupples LA, Kurz A, Auerbach S, Go R, Sadovnick D, Duara R, Kukull WA, Chui H, Edeki T, Griffith PA, Friedland RP, Bachman D, Farrer L. Source: Archives of Neurology. 2003 May; 60(5): 753-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12756140&dopt=Abstract

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Depression as a risk factor for mortality after coronary artery bypass surgery. Author(s): Blumenthal JA, Lett HS, Babyak MA, White W, Smith PK, Mark DB, Jones R, Mathew JP, Newman MF; NORG Investigators. Source: Lancet. 2003 August 23; 362(9384): 604-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12944059&dopt=Abstract

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Depression associated with abortion and childbirth: a long-term analysis of the NLSY cohort. Author(s): Cougle JR, Reardon DC, Coleman PK. Source: Medical Science Monitor : International Medical Journal of Experimental and Clinical Research. 2003 April; 9(4): Cr105-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12709667&dopt=Abstract

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Depression care attitudes and practices of newer obstetrician-gynecologists: a national survey. Author(s): Dietrich AJ, Williams JW Jr, Ciotti MC, Schulkin J, Stotland N, Rost K, Baram D, Cornell J. Source: American Journal of Obstetrics and Gynecology. 2003 July; 189(1): 267-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12861173&dopt=Abstract

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Depression during early recovery from heart surgery among early middle-age, midlife, and elderly women. Author(s): Plach SK, Napholz L, Kelber ST. Source: Health Care for Women International. 2003 April; 24(4): 327-39. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12746004&dopt=Abstract

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Depression in adolescents with diabetes. Author(s): Kanner S, Hamrin V, Grey M. Source: Journal of Child and Adolescent Psychiatric Nursing : Official Publication of the Association of Child and Adolescent Psychiatric Nurses, Inc. 2003 January-March; 16(1): 15-24. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12790304&dopt=Abstract

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Depression in Alzheimer's disease: heterogeneity and related issues. Author(s): Lee HB, Lyketsos CG. Source: Biological Psychiatry. 2003 August 1; 54(3): 353-62. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12893110&dopt=Abstract

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Depression in cardiovascular disease: can the risk be reduced? Author(s): Kaufmann PG. Source: Biological Psychiatry. 2003 August 1; 54(3): 187-90. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12893093&dopt=Abstract

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Depression in epilepsy: prevalence, clinical semiology, pathogenic mechanisms, and treatment. Author(s): Kanner AM. Source: Biological Psychiatry. 2003 August 1; 54(3): 388-98. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12893113&dopt=Abstract

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Depression in inpatients: bipolar vs unipolar. Author(s): Dorz S, Borgherini G, Conforti D, Scarso C, Magni G. Source: Psychological Reports. 2003 June; 92(3 Pt 1): 1031-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12841481&dopt=Abstract

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Depression in medical ill: improving the care. Author(s): Wahid ZU. Source: Journal of the National Medical Association. 2003 April; 95(4): A17-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12749612&dopt=Abstract

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Depression in mothers of children presenting for emergency and primary care: impact on mothers' perceptions of caring for their children. Author(s): Grupp-Phelan J, Whitaker RC, Naish AB. Source: Ambulatory Pediatrics : the Official Journal of the Ambulatory Pediatric Association. 2003 May-June; 3(3): 142-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12708891&dopt=Abstract

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Depression in patients with advanced cancer. Author(s): Bowers L, Boyle DA. Source: Clinical Journal of Oncology Nursing. 2003 May-June; 7(3): 281-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12793334&dopt=Abstract

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Depression in premenopausal women: gonadal hormones and serotonergic system assessed by D-fenfluramine challenge test. Author(s): Rajewska J, Rybakowski JK. Source: Progress in Neuro-Psychopharmacology & Biological Psychiatry. 2003 June; 27(4): 705-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12787860&dopt=Abstract

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Depression in sickle cell disease. Author(s): Hasan SP, Hashmi S, Alhassen M, Lawson W, Castro O. Source: Journal of the National Medical Association. 2003 July; 95(7): 533-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12911250&dopt=Abstract

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Depression in the elderly: the RN can make a difference. Author(s): Hicks J. Source: Okla Nurse. 2003 June-August; 48(2): 23. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12856453&dopt=Abstract

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Depression in women with polycystic ovary syndrome: clinical and biochemical correlates. Author(s): Rasgon NL, Rao RC, Hwang S, Altshuler LL, Elman S, Zuckerbrow-Miller J, Korenman SG. Source: Journal of Affective Disorders. 2003 May; 74(3): 299-304. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12738050&dopt=Abstract

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Depression influences the EDI scores in anorexia nervosa patients. Author(s): Bizeul C, Brun JM, Rigaud D. Source: European Psychiatry : the Journal of the Association of European Psychiatrists. 2003 May; 18(3): 119-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12763297&dopt=Abstract

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Depression of activity in the corticospinal pathway during human motor behavior after strong voluntary contractions. Author(s): Petersen NT, Taylor JL, Butler JE, Gandevia SC. Source: The Journal of Neuroscience : the Official Journal of the Society for Neuroscience. 2003 September 3; 23(22): 7974-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12954858&dopt=Abstract

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Depression screening attitudes and practices among obstetrician-gynecologists. Author(s): LaRocco-Cockburn A, Melville J, Bell M, Katon W. Source: Obstetrics and Gynecology. 2003 May; 101(5 Pt 1): 892-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12738146&dopt=Abstract

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Depression screening. Author(s): Kessler R. Source: The Journal of Family Practice. 2003 June; 52(6): 466; Author Reply 467. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12836648&dopt=Abstract

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Depression status, medical comorbidity and resource costs. Evidence from an international study of major depression in primary care (LIDO). Author(s): Chisholm D, Diehr P, Knapp M, Patrick D, Treglia M, Simon G; LIDO Group. Source: The British Journal of Psychiatry; the Journal of Mental Science. 2003 August; 183: 121-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12893665&dopt=Abstract

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Depression with atypical features in the National Comorbidity Survey: classification, description, and consequences. Author(s): Matza LS, Revicki DA, Davidson JR, Stewart JW. Source: Archives of General Psychiatry. 2003 August; 60(8): 817-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12912765&dopt=Abstract

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Depression with late onset is associated with right frontal lobe atrophy. Author(s): Almeida OP, Burton EJ, Ferrier N, McKeith IG, O'Brien JT. Source: Psychological Medicine. 2003 May; 33(4): 675-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12785469&dopt=Abstract

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Depression with physical symptoms: treating to remission. Author(s): Fava M. Source: The Journal of Clinical Psychiatry. 2003; 64 Suppl 7: 24-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12755649&dopt=Abstract

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Depression, anxiety, and associated health status in low-income Chinese patients. Author(s): Lubetkin EI, Jia H, Gold MR. Source: American Journal of Preventive Medicine. 2003 May; 24(4): 354-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12726874&dopt=Abstract

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Depression, anxiety, and relevant cognitions in persons with mental retardation. Author(s): Glenn E, Bihm EM, Lammers WJ. Source: Journal of Autism and Developmental Disorders. 2003 February; 33(1): 69-76. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12708581&dopt=Abstract

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Depression, fatigue, and health-related quality of life among people with advanced multiple sclerosis: results from an exploratory telerehabilitation study. Author(s): Egner A, Phillips VL, Vora R, Wiggers E. Source: Neurorehabilitation. 2003; 18(2): 125-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12867675&dopt=Abstract

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Depression, homicide and diminished responsibility: new Scottish directions. Author(s): Collins P, White T. Source: Med Sci Law. 2003 July; 43(3): 195-202. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12899423&dopt=Abstract

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Depression, mortality, and medical morbidity in patients with coronary heart disease. Author(s): Carney RM, Freedland KE. Source: Biological Psychiatry. 2003 August 1; 54(3): 241-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12893100&dopt=Abstract

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Depression. Coping with a spouse's death. Author(s): Schneider J. Source: U.S. News & World Report. 2003 June 2; 134(19): 58,60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12800332&dopt=Abstract

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Depression. Interview by Helen Crane. Author(s): Crane H. Source: Bmj (Clinical Research Ed.). 2003 June 14; 326(7402): 1324. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12805179&dopt=Abstract

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Depression: emerging research and treatment approaches. 16-17 January 2003, Paris, France. Author(s): Moret C. Source: Idrugs. 2003 March; 6(3): 183-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12838974&dopt=Abstract

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Depression--a cardiac risk factor in search of a treatment. Author(s): Frasure-Smith N, Lesperance F. Source: Jama : the Journal of the American Medical Association. 2003 June 18; 289(23): 3171-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12813125&dopt=Abstract

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Depression-free days as a summary measure of the temporal pattern of response and remission in the treatment of major depression: a comparison of venlafaxine, selective serotonin reuptake inhibitors, and placebo. Author(s): Mallick R, Chen J, Entsuah AR, Schatzberg AF. Source: The Journal of Clinical Psychiatry. 2003 March; 64(3): 321-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12716275&dopt=Abstract

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Depression-like changes of the sleep-EEG during high dose corticosteroid treatment in patients with multiple sclerosis. Author(s): Antonijevic IA, Steiger A. Source: Psychoneuroendocrinology. 2003 August; 28(6): 780-95. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12812864&dopt=Abstract

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Dexamethasone suppression test findings in subjects with personality disorders: associations with posttraumatic stress disorder and major depression. Author(s): Grossman R, Yehuda R, New A, Schmeidler J, Silverman J, Mitropoulou V, Sta Maria N, Golier J, Siever L. Source: The American Journal of Psychiatry. 2003 July; 160(7): 1291-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12832244&dopt=Abstract

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Differences in anger expression between individuals with and without headache after controlling for depression and anxiety. Author(s): Nicholson RA, Gramling SE, Ong JC, Buenevar L. Source: Headache. 2003 June; 43(6): 651-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12786926&dopt=Abstract

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Different long-term course between chest pain and exercise-induced ST depression in syndrome X. Author(s): Shintani S, Nishiyama Y, Yamamoto K, Koga Y. Source: Japanese Heart Journal. 2003 July; 44(4): 471-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12906029&dopt=Abstract

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Differential sensitivity to induction of spreading depression by partial disinhibition in chronically epileptic human and rat as compared to native rat neocortical tissue. Author(s): Kohling R, Koch UR, Hagemann G, Redecker C, Straub H, Speckmann EJ. Source: Brain Research. 2003 June 13; 975(1-2): 129-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12763600&dopt=Abstract

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Differentiate depression from dementia. Author(s): Maynard CK. Source: The Nurse Practitioner. 2003 March; 28(3): 18-9, 23-7; Quiz 27-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12800692&dopt=Abstract

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Differentiating anxiety and depression in older adults with generalized anxiety disorder. Author(s): Beck JG, Novy DM, Diefenbach GJ, Stanley MA, Averill PM, Swann AC. Source: Psychological Assessment. 2003 June; 15(2): 184-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12847778&dopt=Abstract

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Disability in depression and back pain: evaluation of the World Health Organization Disability Assessment Schedule (WHO DAS II) in a primary care setting. Author(s): Chwastiak LA, Von Korff M. Source: Journal of Clinical Epidemiology. 2003 June; 56(6): 507-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12873644&dopt=Abstract

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Discrepancy between subjective and objective sleep in patients with depression. Author(s): Tsuchiyama K, Nagayama H, Kudo K, Kojima K, Yamada K. Source: Psychiatry and Clinical Neurosciences. 2003 June; 57(3): 259-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12753564&dopt=Abstract

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Do age of onset and course of illness define biologically distinct groups within atypical depression? Author(s): Stewart JW, Bruder GE, McGrath PJ, Quitkin FM. Source: Journal of Abnormal Psychology. 2003 May; 112(2): 253-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12784835&dopt=Abstract

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Does age play a role in the structure of anxiety and depression in children and youths? An investigation of the tripartite model in three age cohorts. Author(s): Turner CM, Barrett PM. Source: Journal of Consulting and Clinical Psychology. 2003 August; 71(4): 826-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12924688&dopt=Abstract

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Does cognitive recovery after treatment of poststroke depression last? A 2-year follow-up of cognitive function associated with poststroke depression. Author(s): Narushima K, Chan KL, Kosier JT, Robinson RG. Source: The American Journal of Psychiatry. 2003 June; 160(6): 1157-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12777275&dopt=Abstract

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Dopamine and adenosine mediate substance P-induced depression of evoked IPSCs in the rat nucleus accumbens in vitro. Author(s): Kombian SB, Ananthalakshmi KV, Parvathy SS, Matowe WC. Source: The European Journal of Neuroscience. 2003 July; 18(2): 303-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12887412&dopt=Abstract

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Early fluoxetine treatment of post-stroke depression--a three-month double-blind placebo-controlled study with an open-label long-term follow up. Author(s): Fruehwald S, Gatterbauer E, Rehak P, Baumhackl U. Source: Journal of Neurology. 2003 March; 250(3): 347-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12638027&dopt=Abstract

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Early improvement under mirtazapine and paroxetine predicts later stable response and remission with high sensitivity in patients with major depression. Author(s): Szegedi A, Muller MJ, Anghelescu I, Klawe C, Kohnen R, Benkert O. Source: The Journal of Clinical Psychiatry. 2003 April; 64(4): 413-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12716243&dopt=Abstract

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Economic costs of post-natal depression in a high-risk British cohort. Author(s): Petrou S, Cooper P, Murray L, Davidson LL. Source: The British Journal of Psychiatry; the Journal of Mental Science. 2002 December; 181: 505-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12456521&dopt=Abstract

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Educational and organizational interventions to improve the management of depression in primary care: a systematic review. Author(s): Gilbody S, Whitty P, Grimshaw J, Thomas R. Source: Jama : the Journal of the American Medical Association. 2003 June 18; 289(23): 3145-51. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12813120&dopt=Abstract

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Effect of depression on stroke morbidity and mortality. Author(s): Ramasubbu R, Patten SB. Source: Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie. 2003 May; 48(4): 250-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12776392&dopt=Abstract

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Effect of neuroticism, response style and information processing on depression severity in a clinically depressed sample. Author(s): Lam D, Smith N, Checkley S, Rijsdijk F, Sham P. Source: Psychological Medicine. 2003 April; 33(3): 469-79. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12701667&dopt=Abstract

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Effect of reminiscence therapy on depression in older adults: a systematic review. Author(s): Hsieh HF, Wang JJ. Source: International Journal of Nursing Studies. 2003 May; 40(4): 335-45. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12667510&dopt=Abstract

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Effect of serotonin 1A agonist tandospirone on depression symptoms in senile patients with dementia. Author(s): Masuda Y, Akagawa Y, Hishikawa Y. Source: Human Psychopharmacology. 2002 June; 17(4): 191-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12404687&dopt=Abstract

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Effect of the Teaching Kids to Cope (TKC) program on outcomes of depression and coping among rural adolescents. Author(s): Puskar K, Sereika S, Tusaie-Mumford K. Source: Journal of Child and Adolescent Psychiatric Nursing : Official Publication of the Association of Child and Adolescent Psychiatric Nurses, Inc. 2003 April-June; 16(2): 7180. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12873069&dopt=Abstract

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Effective use of electroconvulsive therapy in late-life depression. Author(s): Flint AJ, Gagnon N. Source: Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie. 2002 October; 47(8): 734-41. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12420651&dopt=Abstract

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Effectiveness of chromium in atypical depression: a placebo-controlled trial. Author(s): Davidson JR, Abraham K, Connor KM, McLeod MN. Source: Biological Psychiatry. 2003 February 1; 53(3): 261-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12559660&dopt=Abstract

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Effectiveness of cognitive therapy for depression in a community mental health center: a benchmarking study. Author(s): Merrill KA, Tolbert VE, Wade WA. Source: Journal of Consulting and Clinical Psychology. 2003 April; 71(2): 404-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12699035&dopt=Abstract

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Effectiveness of collaborative care depression treatment in Veterans' Affairs primary care. Author(s): Hedrick SC, Chaney EF, Felker B, Liu CF, Hasenberg N, Heagerty P, Buchanan J, Bagala R, Greenberg D, Paden G, Fihn SD, Katon W. Source: Journal of General Internal Medicine : Official Journal of the Society for Research and Education in Primary Care Internal Medicine. 2003 January; 18(1): 9-16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12534758&dopt=Abstract

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Effectiveness of informational support in reducing the severity of postnatal depression in Taiwan. Author(s): Heh SS, Fu YY. Source: Journal of Advanced Nursing. 2003 April; 42(1): 30-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12641809&dopt=Abstract

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Effects of a depression education program on residents' knowledge, attitudes, and clinical skills. Author(s): Learman LA, Gerrity MS, Field DR, van Blaricom A, Romm J, Choe J. Source: Obstetrics and Gynecology. 2003 January; 101(1): 167-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12517663&dopt=Abstract

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Effects of exercise on depression in old age. Author(s): Jagadheesan K, Chakraborty S, Sinha VK, Nizamie SH. Source: The British Journal of Psychiatry; the Journal of Mental Science. 2002 December; 181: 532; Author Reply 532. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12456527&dopt=Abstract

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Effects of maternal depression on breast-feeding. Author(s): Taj R, Sikander KS. Source: J Pak Med Assoc. 2003 January; 53(1): 8-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12666844&dopt=Abstract

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Effects of mirtazapine on sleep polygraphic variables in major depression. Author(s): Schittecatte M, Dumont F, Machowski R, Cornil C, Lavergne F, Wilmotte J. Source: Neuropsychobiology. 2002; 46(4): 197-201. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12566938&dopt=Abstract

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Effects of perceived self-efficacy and functional status on depression in patients with chronic heart failure. Author(s): Tsay SL, Chao YF. Source: The Journal of Nursing Research : Jnr. 2002 December; 10(4): 271-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12522740&dopt=Abstract

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Effects of rapid tryptophan depletion on sleep electroencephalogram and mood in subjects with partially remitted depression on bupropion. Author(s): Evans L, Golshan S, Kelsoe J, Rapaport M, Resovsky K, Sutton L, Gillin JC. Source: Neuropsychopharmacology : Official Publication of the American College of Neuropsychopharmacology. 2002 December; 27(6): 1016-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12464458&dopt=Abstract

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Effects of treating depression and low perceived social support on clinical events after myocardial infarction: the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Randomized Trial. Author(s): Berkman LF, Blumenthal J, Burg M, Carney RM, Catellier D, Cowan MJ, Czajkowski SM, DeBusk R, Hosking J, Jaffe A, Kaufmann PG, Mitchell P, Norman J, Powell LH, Raczynski JM, Schneiderman N; Enhancing Recovery in Coronary Heart Disease Patients Investigators (ENRICHD). Source: Jama : the Journal of the American Medical Association. 2003 June 18; 289(23): 3106-16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12813116&dopt=Abstract

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Efficacy and tolerability of oral and intramuscular S-adenosyl-L-methionine 1,4butanedisulfonate (SAMe) in the treatment of major depression: comparison with imipramine in 2 multicenter studies. Author(s): Delle Chiaie R, Pancheri P, Scapicchio P. Source: The American Journal of Clinical Nutrition. 2002 November; 76(5): 1172S-6S. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12418499&dopt=Abstract

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Efficacy and tolerability of Paroxetine 20 mg daily in the treatment of depression and depression associated anxiety. Author(s): Chaudhry HR, Qureshi Z, Tareen IA, Yazdani I. Source: J Pak Med Assoc. 2002 November; 52(11): 518-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12585372&dopt=Abstract

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Efficacy and tolerability of selective serotonin reuptake inhibitors compared with tricyclic antidepressants in depression treated in primary care: systematic review and meta-analysis. Author(s): MacGillivray S, Arroll B, Hatcher S, Ogston S, Reid I, Sullivan F, Williams B, Crombie I. Source: Bmj (Clinical Research Ed.). 2003 May 10; 326(7397): 1014. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12742924&dopt=Abstract

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Efficacy of citalopram as a monotherapy or as an adjunctive treatment to estrogen therapy for perimenopausal and postmenopausal women with depression and vasomotor symptoms. Author(s): Soares CN, Poitras JR, Prouty J, Alexander AB, Shifren JL, Cohen LS. Source: The Journal of Clinical Psychiatry. 2003 April; 64(4): 473-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12716252&dopt=Abstract

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Efficacy of venlafaxine in major depression resistant to selective serotonin reuptake inhibitors. Author(s): Saiz-Ruiz J, Ibanez A, Diaz-Marsa M, Arias F, Padin J, Martin-Carrasco M, Montes JM, Ferrando L, Carrasco JL, Martin-Ballesteros E, Jorda L, Chamorro L. Source: Progress in Neuro-Psychopharmacology & Biological Psychiatry. 2002 October; 26(6): 1129-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12452535&dopt=Abstract

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Electro convulsive therapy in a pre-pubertal child with severe depression. Author(s): Russell PS, Tharyan P, Arun Kumar K, Cherian A. Source: Journal of Postgraduate Medicine. 2002 October-December; 48(4): 290-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12571387&dopt=Abstract

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Electroconvulsive therapy for patients with major depression and probable Lewy body dementia. Author(s): Rasmussen KG Jr, Russell JC, Kung S, Rummans TA, Rae-Stuart E, O'Connor MK. Source: The Journal of Ect. 2003 June; 19(2): 103-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12792460&dopt=Abstract

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Electroconvulsive therapy update: recognizing and treating psychotic depression. Author(s): Fink M. Source: The Journal of Clinical Psychiatry. 2003 March; 64(3): 232-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12716262&dopt=Abstract

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Elevated agonist binding to alpha2-adrenoceptors in the locus coeruleus in major depression. Author(s): Ordway GA, Schenk J, Stockmeier CA, May W, Klimek V. Source: Biological Psychiatry. 2003 February 15; 53(4): 315-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12586450&dopt=Abstract

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Elevated plasma interleukin-6 (IL-6) and soluble IL-6 receptor concentrations in menopausal women with and without depression. Author(s): Ushiroyama T, Ikeda A, Ueki M. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2002 October; 79(1): 51-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12399096&dopt=Abstract

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Elevated platelet vesicular monoamine transporter density in untreated patients diagnosed with major depression. Author(s): Zucker M, Aviv A, Shelef A, Weizman A, Rehavi M. Source: Psychiatry Research. 2002 November 15; 112(3): 251-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12450634&dopt=Abstract

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Emerging evidence for a central epinephrine-innervated alpha 1-adrenergic system that regulates behavioral activation and is impaired in depression. Author(s): Stone EA, Lin Y, Rosengarten H, Kramer HK, Quartermain D. Source: Neuropsychopharmacology : Official Publication of the American College of Neuropsychopharmacology. 2003 August; 28(8): 1387-99. Epub 2003 June 18. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12813473&dopt=Abstract

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Emerging models of depression care: multi-level ('6 P') strategies. Author(s): Pincus HA, Hough L, Houtsinger JK, Rollman BL, Frank RG. Source: Int J Methods Psychiatr Res. 2003; 12(1): 54-63. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12830310&dopt=Abstract

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Endocrine factors and postpartum depression. A selected review. Author(s): McCoy SJ, Beal JM, Watson GH. Source: J Reprod Med. 2003 June; 48(6): 402-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12856509&dopt=Abstract

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Endotoxemic myocardial depression: a novel inducible nitric oxide synthase suppressant effect of albumin. Author(s): Kumar A, Kumar A. Source: Critical Care Medicine. 2003 January; 31(1): 324-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12545046&dopt=Abstract

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Energetic depression caused by mitochondrial dysfunction. Author(s): Gellerich FN, Trumbeckaite S, Chen Y, Deschauer M, M ller T, Zierz S. Source: Eur Cytokine Netw. 2002 October-December; 13(4): 395-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12517722&dopt=Abstract

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Enhancement of serotonin uptake by cortisol: a possible link between stress and depression. Author(s): Tafet GE, Toister-Achituv M, Shinitzky M. Source: Cognitive, Affective & Behavioral Neuroscience. 2001 March; 1(1): 96-104. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12467107&dopt=Abstract

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Enhancing neuronal plasticity and cellular resilience to develop novel, improved therapeutics for difficult-to-treat depression. Author(s): Manji HK, Quiroz JA, Sporn J, Payne JL, Denicoff K, A Gray N, Zarate CA Jr, Charney DS. Source: Biological Psychiatry. 2003 April 15; 53(8): 707-42. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12706957&dopt=Abstract

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Entrapment and arrested fight and flight in depression: an exploration using focus groups. Author(s): Gilbert P, Gilbert J. Source: Psychology and Psychotherapy. 2003 June; 76(Pt 2): 173-88. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12855063&dopt=Abstract

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Epidemiologic evidence on the comorbidity of depression and diabetes. Author(s): Eaton WW. Source: Journal of Psychosomatic Research. 2002 October; 53(4): 903-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12377301&dopt=Abstract

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Epidemiology of comorbid coronary artery disease and depression. Author(s): Rudisch B, Nemeroff CB. Source: Biological Psychiatry. 2003 August 1; 54(3): 227-40. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12893099&dopt=Abstract

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Epidemiology of major depression in a predominantly rural health region. Author(s): Patten SB, Stuart HL, Russell ML, Maxwell CJ, Arboleda-Florez J. Source: Social Psychiatry and Psychiatric Epidemiology. 2003 July; 38(7): 360-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12861441&dopt=Abstract

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Epidemiology of women and depression. Author(s): Kessler RC. Source: Journal of Affective Disorders. 2003 March; 74(1): 5-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12646294&dopt=Abstract

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Epidural opioid analgesia and neonatal respiratory depression. Author(s): Kumar M, Paes B. Source: Journal of Perinatology : Official Journal of the California Perinatal Association. 2003 July-August; 23(5): 425-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12847541&dopt=Abstract

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Erectile dysfunction: prevalence and relationship to depression, alcohol abuse and panic disorder. Author(s): Okulate G, Olayinka O, Dogunro AS. Source: General Hospital Psychiatry. 2003 May-June; 25(3): 209-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12748034&dopt=Abstract

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Escitalopram: efficacy and tolerability in the treatment of depression. Author(s): Baldwin DS. Source: Hosp Med. 2002 November; 63(11): 668-71. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12474611&dopt=Abstract

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Essentialist thinking about depression: evidence for polarized beliefs. Author(s): Haslam N. Source: Psychological Reports. 2002 December; 91(3 Pt 2): 1253-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12585546&dopt=Abstract

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Estrogen-mediated effects on depression and memory formation in females. Author(s): Shors TJ, Leuner B. Source: Journal of Affective Disorders. 2003 March; 74(1): 85-96. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12646301&dopt=Abstract

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Ethical concerns associated with childhood depression. Author(s): Nelson EL. Source: Bioethics Forum. 2002; 18(3-4): 55-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12744271&dopt=Abstract

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Ethnicity, depression, and suicide. Author(s): Munson MR. Source: The American Journal of Psychiatry. 2002 October; 159(10): 1794-5; Author Reply 1795. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12359695&dopt=Abstract

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Etiology and treatment of postpartum depression. Author(s): Flores DL, Hendrick VC. Source: Current Psychiatry Reports. 2002 December; 4(6): 461-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12441026&dopt=Abstract

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Evaluation of a depression health management program to improve outcomes in first or recurrent episode depression. Author(s): Aubert RE, Fulop G, Xia F, Thiel M, Maldonato D, Woo C. Source: Am J Manag Care. 2003 May; 9(5): 374-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12744299&dopt=Abstract

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Evaluation of dexamethasone suppression test in fibromyalgia patients with or without depression. Author(s): Ataoglu S, Ozcetin A, Yildiz O, Ataoglu A. Source: Swiss Medical Weekly : Official Journal of the Swiss Society of Infectious Diseases, the Swiss Society of Internal Medicine, the Swiss Society of Pneumology. 2003 April 19; 133(15-16): 241-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12811674&dopt=Abstract

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Evaluation of freezing point depression osmolality for classifying random urine specimens defined as substituted under HHS/DOT criteria. Author(s): Cook JD, Hannon MW Sr, Vo T, Caplan YH. Source: Journal of Analytical Toxicology. 2002 October; 26(7): 424-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12422996&dopt=Abstract

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Evaluation of the psychometric characteristics of the Spanish version of the Hospital Anxiety and Depression Scale. Author(s): Quintana JM, Padierna A, Esteban C, Arostegui I, Bilbao A, Ruiz I. Source: Acta Psychiatrica Scandinavica. 2003 March; 107(3): 216-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12580829&dopt=Abstract

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Everyday memory and laboratory memory tests: general function predictors in schizophrenia and remitted depression. Author(s): Fennig S, Mottes A, Ricter-Levin G, Treves I, Levkovitz Y. Source: The Journal of Nervous and Mental Disease. 2002 October; 190(10): 677-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12409861&dopt=Abstract

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Evidence that the SSRI dose response in treating major depression should be reassessed: a meta-analysis. Author(s): Baker CB, Tweedie R, Duval S, Woods SW. Source: Depression and Anxiety. 2003; 17(1): 1-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12577272&dopt=Abstract

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Evidence-based care for depression in Maine: dissemination of the Kaiser Permanente Nurse Telecare Program. Author(s): Pearson B, Katz SE, Soucie V, Hunkeler E, Meresman J, Rooney T, Amick BC 3rd. Source: The Psychiatric Quarterly. 2003 Spring; 74(1): 91-102. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12602791&dopt=Abstract

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Evolved mechanisms in depression: the role and interaction of attachment and social rank in depression. Author(s): Sloman L, Gilbert P, Hasey G. Source: Journal of Affective Disorders. 2003 April; 74(2): 107-21. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12706512&dopt=Abstract

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Excess mortality in depression: a meta-analysis of community studies. Author(s): Cuijpers P, Smit F. Source: Journal of Affective Disorders. 2002 December; 72(3): 227-36. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12450639&dopt=Abstract

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Executive control deficit in depression: event-related potentials in a Go/Nogo task. Author(s): Kaiser S, Unger J, Kiefer M, Markela J, Mundt C, Weisbrod M. Source: Psychiatry Research. 2003 April 1; 122(3): 169-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12694891&dopt=Abstract

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Exercise interventions for smokers with a history of alcoholism: exercise adherence rates and effect of depression on adherence. Author(s): Patten CA, Vickers KS, Martin JE, Williams CD. Source: Addictive Behaviors. 2003 June; 28(4): 657-67. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12726782&dopt=Abstract

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Exercise therapy for depression in middle-aged and older adults: predictors of early dropout and treatment failure. Author(s): Herman S, Blumenthal JA, Babyak M, Khatri P, Craighead WE, Krishnan KR, Doraiswamy PM. Source: Health Psychology : Official Journal of the Division of Health Psychology, American Psychological Association. 2002 November; 21(6): 553-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12433007&dopt=Abstract

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Experimental autoimmune encephalomyelitis-associated behavioral syndrome as a model of 'depression due to multiple sclerosis'. Author(s): Pollak Y, Orion E, Goshen I, Ovadia H, Yirmiya R. Source: Brain, Behavior, and Immunity. 2002 October; 16(5): 533-43. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12401467&dopt=Abstract

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Exploring psychological abuse in childhood: II. Association with other abuse and adult clinical depression. Author(s): Bifulco A, Moran PM, Baines R, Bunn A, Stanford K. Source: Bulletin of the Menninger Clinic. 2002 Summer; 66(3): 241-58. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12448629&dopt=Abstract

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Expressed emotion, attributions and depression in mothers of children with problem behaviour. Author(s): Bolton C, Calam R, Barrowclough C, Peters S, Roberts J, Wearden A, Morris J. Source: Journal of Child Psychology and Psychiatry, and Allied Disciplines. 2003 February; 44(2): 242-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12587860&dopt=Abstract

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Facial pain, depression and stress - connections and directions. Author(s): Korszun A. Source: Journal of Oral Pathology & Medicine : Official Publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology. 2002 November; 31(10): 615-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12406308&dopt=Abstract

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Factor analysis of the Hospital Anxiety and Depression Scale from a large cancer population. Author(s): Smith AB, Selby PJ, Velikova G, Stark D, Wright EP, Gould A, Cull A. Source: Psychology and Psychotherapy. 2002 June; 75(Pt 2): 165-76. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12396762&dopt=Abstract

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Factor structure of the Beck Depression Inventory in a university sample. Author(s): Helm HW Jr, Boward MD. Source: Psychological Reports. 2003 February; 92(1): 53-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12674257&dopt=Abstract

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Factor structure of the Cornell Scale for Depression in Dementia among Japanese poststroke patients. Author(s): Schreiner AS, Morimoto T. Source: International Journal of Geriatric Psychiatry. 2002 August; 17(8): 715-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12211120&dopt=Abstract

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Factorial validity of the center for epidemiologic studies-depression (CES-D) scale in military peacekeepers. Author(s): Boisvert JA, McCreary DR, Wright KD, Asmundson GJ. Source: Depression and Anxiety. 2003; 17(1): 19-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12577274&dopt=Abstract

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Factors associated with depression in a representative sample of 14 217 people aged 75 and over in the United Kingdom: results from the MRC trial of assessment and management of older people in the community. Author(s): Osborn DP, Fletcher AE, Smeeth L, Stirling S, Bulpitt CJ, Breeze E, Ng ES, Nunes M, Jones D, Tulloch A. Source: International Journal of Geriatric Psychiatry. 2003 July; 18(7): 623-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12833307&dopt=Abstract

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Failed depression CQI project yields important lessons. Author(s): Levenson D. Source: Rep Med Guidel Outcomes Res. 2002 January 11; 13(1): 9-10, 12. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12416511&dopt=Abstract

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Failure of tibolone to potentiate the pharmacological effect of fluoxetine in postmenopausal major depression. Author(s): Berlanga C, Mendieta D, Alva G, del Carmen Lara M. Source: Journal of Women's Health (2002). 2003 January-February; 12(1): 33-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12639367&dopt=Abstract

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Family caregivers' sleep loss and depression over time. Author(s): Carter PA. Source: Cancer Nursing. 2003 August; 26(4): 253-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12886115&dopt=Abstract

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Family disruption in childhood and risk of adult depression. Author(s): Gilman SE, Kawachi I, Fitzmaurice GM, Buka SL. Source: The American Journal of Psychiatry. 2003 May; 160(5): 939-46. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12727699&dopt=Abstract

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Family history, life events and the factorial structure of depression in a Nigerian sample of inpatients. Author(s): Ohaeri JU, Otote DI. Source: Psychopathology. 2002 July-August; 35(4): 210-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12239437&dopt=Abstract

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Fatigue and depression are associated with poor quality of life in ALS. Author(s): Lou JS, Reeves A, Benice T, Sexton G. Source: Neurology. 2003 January 14; 60(1): 122-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12525733&dopt=Abstract

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Fatigue and sleep disturbance in patients with cancer, patients with clinical depression, and community-dwelling adults. Author(s): Anderson KO, Getto CJ, Mendoza TR, Palmer SN, Wang XS, Reyes-Gibby CC, Cleeland CS. Source: Journal of Pain and Symptom Management. 2003 April; 25(4): 307-18. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12691682&dopt=Abstract

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Fatigue in HIV/AIDS is associated with depression and subjective neurocognitive complaints but not neuropsychological functioning. Author(s): Millikin CP, Rourke SB, Halman MH, Power C. Source: J Clin Exp Neuropsychol. 2003 April; 25(2): 201-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12754678&dopt=Abstract

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Fatigue in multiple sclerosis: reciprocal relationships with physical disabilities and depression. Author(s): Schreurs KM, de Ridder DT, Bensing JM. Source: Journal of Psychosomatic Research. 2002 September; 53(3): 775-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12217451&dopt=Abstract

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Fatigue, anxiety, and depression in long-term survivors of testicular cancer. Author(s): Fossa SD, Dahl AA, Loge JH. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 2003 April 1; 21(7): 1249-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12663711&dopt=Abstract

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Favorable effect of milnacipran on depression induced by interferon-alpha. Author(s): Yoshida K, Higuchi H, Takahashi H, Shimizu T. Source: The Journal of Neuropsychiatry and Clinical Neurosciences. 2003 Spring; 15(2): 242-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12724470&dopt=Abstract

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Feedback seeking in children and adolescents: associations with self-perceptions, attachment representations, and depression. Author(s): Cassidy J, Ziv Y, Mehta TG, Feeney BC. Source: Child Development. 2003 March-April; 74(2): 612-28. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12705576&dopt=Abstract

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Fewer beta-endorphin expressing arcuate nucleus neurons and reduced betaendorphinergic innervation of paraventricular neurons in schizophrenics and patients with depression. Author(s): Bernstein HG, Krell D, Emrich HM, Baumann B, Danos P, Diekmann S, Bogerts B. Source: Cell Mol Biol (Noisy-Le-Grand). 2002; 48 Online Pub: Ol259-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12643442&dopt=Abstract

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Fluoxetine augmentation with olanzapine for treatment of chronic resistant depression in an elderly patient: a case report. Author(s): Detweiler MB, Trinkle DB. Source: The Journal of Clinical Psychiatry. 2003 July; 64(7): 851-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12934994&dopt=Abstract

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Fluoxetine for acute treatment of depression in children and adolescents: a placebocontrolled, randomized clinical trial. Author(s): Emslie GJ, Heiligenstein JH, Wagner KD, Hoog SL, Ernest DE, Brown E, Nilsson M, Jacobson JG. Source: Journal of the American Academy of Child and Adolescent Psychiatry. 2002 October; 41(10): 1205-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12364842&dopt=Abstract

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Fluvoxamine as effective as clomipramine against symptoms of severe depression: results from a multicentre, double-blind study. Author(s): Zohar J, Keegstra H, Barrelet L. Source: Human Psychopharmacology. 2003 March; 18(2): 113-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12590404&dopt=Abstract

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Folate and depression. Author(s): Bjelland I, Ueland PM, Vollset SE. Source: Psychotherapy and Psychosomatics. 2003 March-April; 72(2): 59-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12601222&dopt=Abstract

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Folate, vitamin B12, homocysteine, and the MTHFR 677C->T polymorphism in anxiety and depression: the Hordaland Homocysteine Study. Author(s): Bjelland I, Tell GS, Vollset SE, Refsum H, Ueland PM. Source: Archives of General Psychiatry. 2003 June; 60(6): 618-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12796225&dopt=Abstract

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Frequency and heritability of depression symptomatology in the second half of life: evidence from Danish twins over 45. Author(s): Johnson W, McGue M, Gaist D, Vaupel JW, Christensen K. Source: Psychological Medicine. 2002 October; 32(7): 1175-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12420887&dopt=Abstract

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From damaged nerves to masked depression: inevitability and hope in Latvian psychiatric narratives. Author(s): Skultans V. Source: Social Science & Medicine (1982). 2003 June; 56(12): 2421-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12742605&dopt=Abstract

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From the editor--enhancing family coping with depression. Author(s): Thomas SP. Source: Issues in Mental Health Nursing. 2003 March; 24(2): 107. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12554422&dopt=Abstract

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Frontal white matter microstructure and treatment response of late-life depression: a preliminary study. Author(s): Alexopoulos GS, Kiosses DN, Choi SJ, Murphy CF, Lim KO. Source: The American Journal of Psychiatry. 2002 November; 159(11): 1929-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12411231&dopt=Abstract

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Frontostriatal and limbic dysfunction in late-life depression. Author(s): Alexopoulos GS. Source: The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry. 2002 November-December; 10(6): 687-95. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12427577&dopt=Abstract

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Functional neuroimaging studies of the amygdala in depression. Author(s): Whalen PJ, Shin LM, Somerville LH, McLean AA, Kim H. Source: Semin Clin Neuropsychiatry. 2002 October; 7(4): 234-42. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12382206&dopt=Abstract

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Functioning and interpersonal relationships as predictors of response in treatmentresistant depression. Author(s): Papakostas GI, Petersen T, Mischoulon D, Hughes ME, Spector AR, Alpert JE, Fava M, Nierenberg AA. Source: Comprehensive Psychiatry. 2003 January-February; 44(1): 44-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12524635&dopt=Abstract

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G protein beta3 subunit 825T allele is associated with depression in young, healthy subjects. Author(s): Exton MS, Artz M, Siffert W, Schedlowski M. Source: Neuroreport. 2003 March 3; 14(3): 531-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12634518&dopt=Abstract

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Gabapentin augmentation therapy in bipolar depression. Author(s): Wang PW, Santosa C, Schumacher M, Winsberg ME, Strong C, Ketter TA. Source: Bipolar Disorders. 2002 October; 4(5): 296-301. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12479661&dopt=Abstract

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Gender and depression: a study of severity and symptomatology of depressive disorders (ICD-10) in general practice. Author(s): Hildebrandt MG, Stage KB, Kragh-Soerensen P. Source: Acta Psychiatrica Scandinavica. 2003 March; 107(3): 197-202. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12580826&dopt=Abstract

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Gender differences in depression. Epidemiological findings from the European DEPRES I and II studies. Author(s): Angst J, Gamma A, Gastpar M, Lepine JP, Mendlewicz J, Tylee A; Depression Research in European Society Study. Source: European Archives of Psychiatry and Clinical Neuroscience. 2002 October; 252(5): 201-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12451460&dopt=Abstract

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Gender differences in rates of depression among undergraduates: measurement matters. Author(s): Grant K, Marsh P, Syniar G, Williams M, Addlesperger E, Kinzler MH, Cowman S. Source: Journal of Adolescence. 2002 December; 25(6): 613-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12490179&dopt=Abstract

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Gender, ethnicity, and physician-patient communication about depression and anxiety in primary care. Author(s): Sleath B, Rubin RH. Source: Patient Education and Counseling. 2002 December; 48(3): 243-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12477609&dopt=Abstract

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Generalized anxiety disorder in patients with major depression: is DSM-IV's hierarchy correct? Author(s): Zimmerman M, Chelminski I. Source: The American Journal of Psychiatry. 2003 March; 160(3): 504-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12611832&dopt=Abstract

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Genetic linkage of region containing the CREB1 gene to depressive disorders in women from families with recurrent, early-onset, major depression. Author(s): Zubenko GS, Hughes HB 3rd, Maher BS, Stiffler JS, Zubenko WN, Marazita ML. Source: American Journal of Medical Genetics. 2002 December 8; 114(8): 980-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12457397&dopt=Abstract

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Genetic segregation analysis of alcohol and other substance-use disorders in families with recurrent, early-onset major depression. Author(s): Maher BS, Marazita ML, Zubenko WN, Kaplan BB, Zubenko GS. Source: The American Journal of Drug and Alcohol Abuse. 2002 November; 28(4): 71131. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12492266&dopt=Abstract

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Genetics of early-onset depression. Author(s): Smith D, Muir W, Blackwood D. Source: The British Journal of Psychiatry; the Journal of Mental Science. 2003 April; 182: 363; Author Reply 364. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12668415&dopt=Abstract

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Geriatric depression in Nigerian primary care attendees. Author(s): Sokoya OO, Baiyewu O. Source: International Journal of Geriatric Psychiatry. 2003 June; 18(6): 506-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12789671&dopt=Abstract

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Geriatric nurse practitioner care guidelines: depression in older adults. Author(s): Gerstenlauer CJ, Maguire SR, Wooldridge L. Source: Geriatric Nursing (New York, N.Y.). 2003 May-June; 24(3): 185-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12813438&dopt=Abstract

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Getting what you ask for: on the selectivity of depression rating scales. Author(s): Demyttenaere K, De Fruyt J. Source: Psychotherapy and Psychosomatics. 2003 March-April; 72(2): 61-70. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12601223&dopt=Abstract

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Global burden of depression: the intersection of culture and medicine. Author(s): Scott J, Dickey B. Source: The British Journal of Psychiatry; the Journal of Mental Science. 2003 August; 183: 92-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12893658&dopt=Abstract

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GPs' perspectives on managing time in consultations with patients suffering from depression: a qualitative study. Author(s): Pollock K, Grime J. Source: Family Practice. 2003 June; 20(3): 262-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12738694&dopt=Abstract

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Greater depression severity associated with less improvement in depressionassociated cognitive deficits in older subjects. Author(s): Taylor WD, Wagner HR, Steffens DC. Source: The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry. 2002 September-October; 10(5): 632-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12213698&dopt=Abstract

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Grief counselling and depression. Author(s): Campion-Smith C. Source: The British Journal of General Practice : the Journal of the Royal College of General Practitioners. 2003 January; 53(486): 61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12564284&dopt=Abstract

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Group interpersonal psychotherapy for depression in rural Uganda: a randomized controlled trial. Author(s): Bolton P, Bass J, Neugebauer R, Verdeli H, Clougherty KF, Wickramaratne P, Speelman L, Ndogoni L, Weissman M. Source: Jama : the Journal of the American Medical Association. 2003 June 18; 289(23): 3117-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12813117&dopt=Abstract

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Guideline adherence rates and interprofessional variation in a vignette study of depression. Author(s): Tiemeier H, de Vries WJ, van het Loo M, Kahan JP, Klazinga N, Grol R, Rigter H. Source: Quality & Safety in Health Care. 2002 September; 11(3): 214-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12486983&dopt=Abstract

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Guidelines recommend universal adult depression screening. Author(s): Rollins G. Source: Rep Med Guidel Outcomes Res. 2002 June 28; 13(12): 1-2, 5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12506927&dopt=Abstract

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Health-related quality of life among patients with major depression. Author(s): Saarijarvi S, Salminen JK, Toikka T, Raitasalo R. Source: Nordic Journal of Psychiatry. 2002; 56(4): 261-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12470316&dopt=Abstract

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Health-related quality of life and depression in an Italian sample of multiple sclerosis patients. Author(s): Patti F, Cacopardo M, Palermo F, Ciancio MR, Lopes R, Restivo D, Reggio A. Source: Journal of the Neurological Sciences. 2003 July 15; 211(1-2): 55-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12767498&dopt=Abstract

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Health-related quality of life and depression in patients with chronic hepatitis C. Author(s): Gallegos-Orozco JF, Fuentes AP, Gerardo Argueta J, Perez-Pruna C, Hinojosa-Becerril C, Sixtos-Alonso MS, Cruz-Castellanos S, Gutierrez-Reyes G, OliveraMartinez MA, Gutierrez-Ruiz MC, Kershenobich D. Source: Archives of Medical Research. 2003 March-April; 34(2): 124-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12700008&dopt=Abstract

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Helpless attributions and depression in adolescents: the roles of anxiety, event valence, and demographics. Author(s): Waschbusch DA, Sellers DP, LeBlanc M, Kelley ML. Source: Journal of Adolescence. 2003 April; 26(2): 169-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12581725&dopt=Abstract

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Hemispheric asymmetry in the processing of emotional content in word meanings: the effect of current and past depression. Author(s): Atchley RA, Ilardi SS, Enloe A. Source: Brain and Language. 2003 January; 84(1): 105-19. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12537954&dopt=Abstract

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High incidence of depression in the primary care setting. Author(s): Emanuel SF, Holland JC, Bedno SA, Earles JE. Source: Military Medicine. 2002 October; 167(10): Iii-Iv. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12392241&dopt=Abstract

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High serum TSH levels are associated with depression in the elderly. Author(s): Chueire VB, Silva ET, Perotta E, Romaldini JH, Ward LS. Source: Archives of Gerontology and Geriatrics. 2003 May-June; 36(3): 281-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12849083&dopt=Abstract

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High-dimensional mapping of the hippocampus in depression. Author(s): Posener JA, Wang L, Price JL, Gado MH, Province MA, Miller MI, Babb CM, Csernansky JG. Source: The American Journal of Psychiatry. 2003 January; 160(1): 83-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12505805&dopt=Abstract

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Higher incidence of depression preceding the onset of Parkinson's disease: a register study. Author(s): Leentjens AF, Van den Akker M, Metsemakers JF, Lousberg R, Verhey FR. Source: Movement Disorders : Official Journal of the Movement Disorder Society. 2003 April; 18(4): 414-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12671948&dopt=Abstract

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Historical generations and psychology. The case of the Great Depression and World War II. Author(s): Rogler LH. Source: The American Psychologist. 2002 December; 57(12): 1013-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12613154&dopt=Abstract

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History of depression and smoking cessation outcome: a meta-analysis. Author(s): Hitsman B, Borrelli B, McChargue DE, Spring B, Niaura R. Source: Journal of Consulting and Clinical Psychology. 2003 August; 71(4): 657-63. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12924670&dopt=Abstract

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History of depression, angina, and quality of life after acute coronary syndromes. Author(s): Rumsfeld JS, Magid DJ, Plomondon ME, Sales AE, Grunwald GK, Every NR, Spertus JA. Source: American Heart Journal. 2003 March; 145(3): 493-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12660673&dopt=Abstract

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HIV disease progression: depression, stress, and possible mechanisms. Author(s): Leserman J. Source: Biological Psychiatry. 2003 August 1; 54(3): 295-306. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12893105&dopt=Abstract

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Home care nursing and detection of depression. Author(s): Blank MB, Kane CF. Source: Psychiatric Services (Washington, D.C.). 2003 June; 54(6): 909; Author Reply 90910. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12773611&dopt=Abstract

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Hopelessness and suicidal ideation in outpatients with treatment-resistant depression: prevalence and impact on treatment outcome. Author(s): Papakostas GI, Petersen T, Pava J, Masson E, Worthington JJ 3rd, Alpert JE, Fava M, Nierenberg AA. Source: The Journal of Nervous and Mental Disease. 2003 July; 191(7): 444-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12891091&dopt=Abstract

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How could antidepressants worsen unipolar depression? Author(s): Benazzi F. Source: Psychotherapy and Psychosomatics. 2003 March-April; 72(2): 107-8; Author Reply 109. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12601229&dopt=Abstract

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How does the Hospital and Anxiety and Depression Scale measure anxiety and depression in healthy subjects? Author(s): Caci H, Bayle FJ, Mattei V, Dossios C, Robert P, Boyer P. Source: Psychiatry Research. 2003 May 1; 118(1): 89-99. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12759165&dopt=Abstract

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How long should drug treatment of depression last? Author(s): Fava GA, Ruini C, Tossani E. Source: The Medical Journal of Australia. 2003 May 19; 178(10): 526; Author Reply 526-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12741948&dopt=Abstract

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How long should patients with psychotic depression stay on the antipsychotic medication? Author(s): Rothschild AJ, Duval SE. Source: The Journal of Clinical Psychiatry. 2003 April; 64(4): 390-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12716238&dopt=Abstract

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How to diagnose and treat depression. Author(s): Solnek BL, Seiter T. Source: The Nurse Practitioner. 2002 October; 27(10): 12-5, 19-23; Quiz 24. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12394584&dopt=Abstract

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How useful is the concept of somatization in cross-cultural studies of maternal depression? A contribution from the Mothers in a New Country (MINC) study. Author(s): Small R, Lumley J, Yelland J. Source: Journal of Psychosomatic Obstetrics and Gynaecology. 2003 March; 24(1): 45-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12685339&dopt=Abstract

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How well do automated performance measures assess guideline implementation for new-onset depression in the Veterans Health Administration? Author(s): Kramer TL, Owen RR, Cannon D, Sloan KL, Thrush CR, Williams DK, Austen MA. Source: Jt Comm J Qual Saf. 2003 September; 29(9): 479-89. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14513671&dopt=Abstract

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Hypergraphia, verbal aspontaneity and post-stroke depression secondary to right cyngulate and corpus callosum infarction. Author(s): Carota A, Annoni JM, Combremont P, Clarke S, Bogousslavsky J. Source: Journal of Neurology. 2003 April; 250(4): 508-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12760393&dopt=Abstract

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Hypomanic traits and response styles to depression. Author(s): Thomas J, Bentall RP. Source: The British Journal of Clinical Psychology / the British Psychological Society. 2002 September; 41(Pt 3): 309-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12396257&dopt=Abstract

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Hypothalamic-pituitary-adrenal axis function in patients with chronic depression. Author(s): Watson S, Gallagher P, Del-Estal D, Hearn A, Ferrier IN, Young AH. Source: Psychological Medicine. 2002 August; 32(6): 1021-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12214783&dopt=Abstract

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Hypothalamic-pituitary-thyroid system activity during lithium augmentation therapy in patients with unipolar major depression. Author(s): Bschor T, Baethge C, Adli M, Lewitzka U, Eichmann U, Bauer M. Source: Journal of Psychiatry & Neuroscience : Jpn. 2003 May; 28(3): 210-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12790161&dopt=Abstract

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Iatrogenic depression in the elderly. Results from a community-based study in the Netherlands. Author(s): Dhondt TD, Beekman AT, Deeg DJ, Van Tilburg W. Source: Social Psychiatry and Psychiatric Epidemiology. 2002 August; 37(8): 393-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12195547&dopt=Abstract

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Identification of a claims data "signature" and economic consequences for treatment-resistant depression. Author(s): Corey-Lisle PK, Birnbaum HG, Greenberg PE, Marynchenko MB, Claxton AJ. Source: The Journal of Clinical Psychiatry. 2002 August; 63(8): 717-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12197453&dopt=Abstract

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IDentify, Educate and Alert (IDEA) trial: an intervention to reduce postnatal depression. Author(s): Webster J, Linnane J, Roberts J, Starrenburg S, Hinson J, Dibley L. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2003 September; 110(9): 842-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14511967&dopt=Abstract

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Identifying depression in primary care: a comparison of different methods in a prospective cohort study. Author(s): Henkel V, Mergl R, Kohnen R, Maier W, Moller HJ, Hegerl U. Source: Bmj (Clinical Research Ed.). 2003 January 25; 326(7382): 200-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12543837&dopt=Abstract

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Identifying physician-recognized depression from administrative data: consequences for quality measurement. Author(s): Spettell CM, Wall TC, Allison J, Calhoun J, Kobylinski R, Fargason R, Kiefe CI. Source: Health Services Research. 2003 August; 38(4): 1081-102. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12968818&dopt=Abstract

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Identifying possible depression in clinical research: ethical and outcome considerations for the investigator/clinician. Author(s): Clark PC, Deaton C, Dunbar SB. Source: Applied Nursing Research : Anr. 2003 February; 16(1): 53-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12624863&dopt=Abstract

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Immunity in adolescents with major depression. Author(s): Schleifer SJ, Bartlett JA, Keller SE, Eckholdt HM, Shiflett SC, Delaney BR. Source: Journal of the American Academy of Child and Adolescent Psychiatry. 2002 September; 41(9): 1054-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12218426&dopt=Abstract

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Impact of a primary care quality improvement intervention on use of psychotherapy for depression. Author(s): Jaycox LH, Miranda J, Meredith LS, Duan N, Benjamin B, Wells K. Source: Mental Health Services Research. 2003 June; 5(2): 109-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12801074&dopt=Abstract

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Impact of antidepressant discontinuation after acute bipolar depression remission on rates of depressive relapse at 1-year follow-up. Author(s): Altshuler L, Suppes T, Black D, Nolen WA, Keck PE Jr, Frye MA, McElroy S, Kupka R, Grunze H, Walden J, Leverich G, Denicoff K, Luckenbaugh D, Post R. Source: The American Journal of Psychiatry. 2003 July; 160(7): 1252-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12832239&dopt=Abstract

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Impact of major depression on chronic medical illness. Author(s): Katon W, Ciechanowski P. Source: Journal of Psychosomatic Research. 2002 October; 53(4): 859-63. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12377294&dopt=Abstract

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Impact of ongoing primary care intervention on long term outcomes in uninsured and insured patients with depression. Author(s): Smith JL, Rost KM, Nutting PA, Elliott CE, Dickinson LM. Source: Medical Care. 2002 December; 40(12): 1210-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12458303&dopt=Abstract

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Impact of primary care depression intervention on employment and workplace conflict outcomes: is value added? Author(s): Smith JL, Rost KM, Nutting PA, Libby AM, Elliott CE, Pyne JM. Source: The Journal of Mental Health Policy and Economics. 2002 March; 5(1): 43-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12529569&dopt=Abstract

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Impact of religious activity on depression and quality of life of chronic peritoneal dialysis patients in Taiwan. Author(s): Kao TW, Tsai DM, Wu KD, Shiah CJ, Hsieh BS, Chen WY. Source: J Formos Med Assoc. 2003 February; 102(2): 127-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12709745&dopt=Abstract

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Impacting late life depression: integrating a depression intervention into primary care. Author(s): Oishi SM, Shoai R, Katon W, Callahan C, Unutzer J, Arean P, Callahan C, Della Penna R, Harpole L, Hegel M, Noel PH, Hoffing M, Hunkeler EM, Katon W, Levine S, Lin EH, Oddone E, Oishi S, Unutzer J, Williams J; Improving Mood: Promoting Access to Collaborative Treatment Investigators. Source: The Psychiatric Quarterly. 2003 Spring; 74(1): 75-89. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12602790&dopt=Abstract

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Impaired repression at a 5-hydroxytryptamine 1A receptor gene polymorphism associated with major depression and suicide. Author(s): Lemonde S, Turecki G, Bakish D, Du L, Hrdina PD, Bown CD, Sequeira A, Kushwaha N, Morris SJ, Basak A, Ou XM, Albert PR. Source: The Journal of Neuroscience : the Official Journal of the Society for Neuroscience. 2003 September 24; 23(25): 8788-99. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14507979&dopt=Abstract

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Implementing an office system to improve primary care management of depression. Author(s): Korsen N, Scott P, Dietrich AJ, Oxman T. Source: The Psychiatric Quarterly. 2003 Spring; 74(1): 45-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12602788&dopt=Abstract

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Improved detection of depression in primary care through severity evaluation. Author(s): Nease DE, Klinkman MS, Volk RJ. Source: The Journal of Family Practice. 2002 December; 51(12): 1065-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12540333&dopt=Abstract

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Improving Australians' depression literacy. Author(s): Parslow RA, Jorm AF. Source: The Medical Journal of Australia. 2002 October 7; 177 Suppl: S117-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12358570&dopt=Abstract

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Improving primary care treatment of depression among patients with diabetes mellitus: the design of the pathways study. Author(s): Katon W, Von Korff M, Lin E, Simon G, Ludman E, Bush T, Walker E, Ciechanowski P, Rutter C. Source: General Hospital Psychiatry. 2003 May-June; 25(3): 158-68. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12748028&dopt=Abstract

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Improving the care for depression in patients with comorbid medical illness. Author(s): Koike AK, Unutzer J, Wells KB. Source: The American Journal of Psychiatry. 2002 October; 159(10): 1738-45. Erratum In: Am J Psychiatry 2003 January; 160(1): 204. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12359681&dopt=Abstract

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Improving the detection and management of depression in primary care. Author(s): Gilbody SM, Whitty PM, Grimshaw JM, Thomas RE. Source: Quality & Safety in Health Care. 2003 April; 12(2): 149-55. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12679514&dopt=Abstract

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Improving the detection of drug abuse, alcohol abuse, and depression in community health centers. Author(s): Olfson M, Tobin JN, Cassells A, Weissman M. Source: Journal of Health Care for the Poor and Underserved. 2003 August; 14(3): 386402. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12955918&dopt=Abstract

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Inadequate treatment of depression after myocardial infarction. Author(s): Luutonen S, Holm H, Salminen JK, Risla A, Salokangas RK. Source: Acta Psychiatrica Scandinavica. 2002 December; 106(6): 434-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12392486&dopt=Abstract

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Incidence and clinical course of major depression in patients with chronic hepatitis type C undergoing interferon-alpha therapy: a prospective study. Author(s): Horikawa N, Yamazaki T, Izumi N, Uchihara M. Source: General Hospital Psychiatry. 2003 January-February; 25(1): 34-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12583926&dopt=Abstract

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Incidence of senile dementia and depression in elderly population in Xicheng District, Beijing, an epidemiologic study. Author(s): Yan F, Li S, Liu J, Zhang W, Chen C, Liu M, Xu L, Li S, Shao J, Wu H, Wang Y, Liang K, Zhao C, Lei X. Source: Zhonghua Yi Xue Za Zhi. 2002 August 10; 82(15): 1025-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12194791&dopt=Abstract

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Increased amygdala: hippocampal volume ratios associated with severity of anxiety in pediatric major depression. Author(s): MacMillan S, Szeszko PR, Moore GJ, Madden R, Lorch E, Ivey J, Banerjee SP, Rosenberg DR. Source: Journal of Child and Adolescent Psychopharmacology. 2003 Spring; 13(1): 65-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12804127&dopt=Abstract

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Increased postoperative pain scores in chronic depression patients who take antidepressants. Author(s): Kudoh A, Katagai H, Takazawa T. Source: Journal of Clinical Anesthesia. 2002 September; 14(6): 421-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12393109&dopt=Abstract

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Infection, treatment and immune response in patients with bipolar disorder versus patients with major depression, schizophrenia or healthy controls. Author(s): Hinze-Selch D. Source: Bipolar Disorders. 2002; 4 Suppl 1: 81-3. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12479687&dopt=Abstract

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Inflammatory proteins and depression in the elderly. Author(s): Tiemeier H, Hofman A, van Tuijl HR, Kiliaan AJ, Meijer J, Breteler MM. Source: Epidemiology (Cambridge, Mass.). 2003 January; 14(1): 103-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12500057&dopt=Abstract

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Influence of a functional polymorphism within the angiotensin I-converting enzyme gene on partial sleep deprivation in patients with major depression. Author(s): Baghai TC, Schule C, Zwanzger P, Zill P, Ella R, Eser D, Deiml T, Minov C, Rupprecht R, Bondy B. Source: Neuroscience Letters. 2003 March 27; 339(3): 223-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12633893&dopt=Abstract

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Influence of cognitive impairment, illness, gender, and African-American status on psychiatric ratings and staff recognition of depression. Author(s): Teresi JA, Abrams R, Holmes D, Ramirez M, Shapiro C, Eimicke JP. Source: The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry. 2002 September-October; 10(5): 506-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12213684&dopt=Abstract

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Influence of depression on patients satisfaction with the outcome of microsurgical "key-hole" vs classical discectomy: prospective matched-cohort study. Author(s): Ljubicic Bistrovic I, Ljubicic D, Ekl D, Penezic L, Mocenic D, Stancic MF. Source: Croatian Medical Journal. 2002 December; 43(6): 702-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12476480&dopt=Abstract

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Influence of gender and hemispheric lateralization on heat pain perception in major depression. Author(s): Bar KJ, Greiner W, Letsch A, Kobele R, Sauer H. Source: Journal of Psychiatric Research. 2003 July-August; 37(4): 345-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12765857&dopt=Abstract

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Influence of life stress on depression: moderation by a polymorphism in the 5-HTT gene. Author(s): Caspi A, Sugden K, Moffitt TE, Taylor A, Craig IW, Harrington H, McClay J, Mill J, Martin J, Braithwaite A, Poulton R. Source: Science. 2003 July 18; 301(5631): 386-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12869766&dopt=Abstract

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Influence of sleep deprivation on neuroactive steroids in major depression. Author(s): Schule C, di Michele F, Baghai T, Romeo E, Bernardi G, Zwanzger P, Padberg F, Pasini A, Rupprecht R. Source: Neuropsychopharmacology : Official Publication of the American College of Neuropsychopharmacology. 2003 March; 28(3): 577-81. Epub 2002 October 10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12629540&dopt=Abstract

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Inhibition of norepinephrine uptake in patients with major depression treated with paroxetine. Author(s): Gilmor ML, Owens MJ, Nemeroff CB. Source: The American Journal of Psychiatry. 2002 October; 159(10): 1702-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12359676&dopt=Abstract

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In-hospital symptoms of depression do not predict mortality 3 years after myocardial infarction. Author(s): Lane D, Carroll D, Ring C, Beevers DG, Lip GY. Source: International Journal of Epidemiology. 2002 December; 31(6): 1179-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12540719&dopt=Abstract

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Insight into illness in patients with mania, mixed mania, bipolar depression and major depression with psychotic features. Author(s): Dell'Osso L, Pini S, Cassano GB, Mastrocinque C, Seckinger RA, Saettoni M, Papasogli A, Yale SA, Amador XF. Source: Bipolar Disorders. 2002 October; 4(5): 315-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12479664&dopt=Abstract

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Integrating mental health into primary health care in Nigeria: management of depression in a local government (district) area as a paradigm. Author(s): Odejide AO, Morakinyo JJ, Oshiname FO, Omigbodun O, Ajuwon AJ, Kola L. Source: Seishin Shinkeigaku Zasshi. 2002; 104(10): 802-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12607921&dopt=Abstract

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Interaction between mother's and father's affection as a risk factor for anxiety and depression symptoms--evidence for increased risk in adults who rate their father as having been more affectionate than their mother. Author(s): Jorm AF, Dear KB, Rodgers B, Christensen H. Source: Social Psychiatry and Psychiatric Epidemiology. 2003 April; 38(4): 173-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12664227&dopt=Abstract

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Interferon beta1a and depression in secondary progressive MS: data from the SPECTRIMS Trial. Author(s): Patten SB, Metz LM; SPECTRIMS Study Group. Source: Neurology. 2002 September 10; 59(5): 744-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12221168&dopt=Abstract

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Interferon beta-1a-induced depression and suicidal ideation in multiple sclerosis. Author(s): Lana-Peixoto MA, Teixeira AL Jr, Haase VG. Source: Arquivos De Neuro-Psiquiatria. 2002 September; 60(3-B): 721-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12364937&dopt=Abstract

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Interleukin-18 and CD30 serum levels in patients with moderate-severe depression. Author(s): Merendino RA, Di Rosa AE, Di Pasquale G, Minciullo PL, Mangraviti C, Costantino A, Ruello A, Gangemi S. Source: Mediators of Inflammation. 2002 August; 11(4): 265-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12396479&dopt=Abstract

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Intermittent burst-firing weak (1 microTesla) magnetic fields reduce psychometric depression in patients who sustained closed head injuries: a replication and electroencephalographic validation. Author(s): Baker-Price L, Persinger MA. Source: Percept Mot Skills. 2003 June; 96(3 Pt 1): 965-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12831278&dopt=Abstract

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Interpersonal problems, personality pathology, and social adjustment after cognitive therapy for depression. Author(s): Vittengl JR, Clark LA, Jarrett RB. Source: Psychological Assessment. 2003 March; 15(1): 29-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12674722&dopt=Abstract

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Interpersonal stress and depression in women. Author(s): Hammen C. Source: Journal of Affective Disorders. 2003 March; 74(1): 49-57. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12646298&dopt=Abstract

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Is case-finding an inefficient way of addressing depression as a public health problem? Author(s): Coyne JC, Palmer SC, Sullivan PA. Source: Pharmacoepidemiology and Drug Safety. 2002 October-November; 11(7): 545-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12462130&dopt=Abstract

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Is depression normal in human beings? A critique of the evolutionary perspective. Author(s): McLoughlin G. Source: International Journal of Mental Health Nursing. 2002 September; 11(3): 170-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12510594&dopt=Abstract

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Is depression taxonic, dimensional, or both? Author(s): Beach SR, Amir N. Source: Journal of Abnormal Psychology. 2003 May; 112(2): 228-36. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12784832&dopt=Abstract

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Is exercise a good treatment for depression? Author(s): Miller MC. Source: The Harvard Mental Health Letter / from Harvard Medical School. 2003 June; 19(12): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12835136&dopt=Abstract

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Is late onset depression a prodrome to dementia? Author(s): Schweitzer I, Tuckwell V, O'Brien J, Ames D. Source: International Journal of Geriatric Psychiatry. 2002 November; 17(11): 997-1005. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12404648&dopt=Abstract

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Is recurrent brief depression an expression of mood spectrum disorders in young people? Results of a large community sample. Author(s): Carta MG, Altamura AC, Hardoy MC, Pinna F, Medda S, Dell'Osso L, Carpiniello B, Angst J. Source: European Archives of Psychiatry and Clinical Neuroscience. 2003 June; 253(3): 149-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12904979&dopt=Abstract

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Is there a genetic relationship between alcoholism and depression? Author(s): Nurnberger JI Jr, Foroud T, Flury L, Meyer ET, Wiegand R. Source: Alcohol Research & Health : the Journal of the National Institute on Alcohol Abuse and Alcoholism. 2002; 26(3): 233-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12875052&dopt=Abstract

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Is there a link between atypical and early-onset "unipolar" depression and bipolar II disorder? Author(s): Benazzi F. Source: Comprehensive Psychiatry. 2003 March-April; 44(2): 102-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12658618&dopt=Abstract

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Is there a role for 5-HT1A agonists in the treatment of depression? Author(s): Blier P, Ward NM. Source: Biological Psychiatry. 2003 February 1; 53(3): 193-203. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12559651&dopt=Abstract

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Is there a SSRI dose response in treating major depression? The case for re-analysis of current data and for enhancing future study design. Author(s): Baker CB, Woods SW. Source: Depression and Anxiety. 2003; 17(1): 10-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12577273&dopt=Abstract

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Is there an association between life events, postnatal depression and thyroid dysfunction in thyroid antibody positive women? Author(s): Oretti RG, Harris B, Lazarus JH, Parkes AB, Crownshaw T. Source: The International Journal of Social Psychiatry. 2003 March; 49(1): 70-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12793517&dopt=Abstract

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Is there an increased risk of dying after depression? Author(s): Ensinck KT, Schuurman AG, van den Akker M, Metsemakers JF, Kester AD, Knottnerus JA, Buntinx F. Source: American Journal of Epidemiology. 2002 December 1; 156(11): 1043-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12446261&dopt=Abstract

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Is treatment-resistant depression a unique subtype of depression? Author(s): Fagiolini A, Kupfer DJ. Source: Biological Psychiatry. 2003 April 15; 53(8): 640-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12706950&dopt=Abstract

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Ischemic basis for deep white matter hyperintensities in major depression: a neuropathological study. Author(s): Thomas AJ, O'Brien JT, Davis S, Ballard C, Barber R, Kalaria RN, Perry RH. Source: Archives of General Psychiatry. 2002 September; 59(9): 785-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12215077&dopt=Abstract

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Ischemic stroke and depression. Author(s): Desmond DW, Remien RH, Moroney JT, Stern Y, Sano M, Williams JB. Source: Journal of the International Neuropsychological Society : Jins. 2003 March; 9(3): 429-39. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12666767&dopt=Abstract

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It's just different in the country: postnatal depression and group therapy in a rural setting. Author(s): Lane B, Roufeil LM, Williams S, Tweedie R. Source: Soc Work Health Care. 2001; 34(3-4): 333-48. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12243432&dopt=Abstract

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JAMA patient page. Depression. Author(s): Torpy JM, Lynm C, Glass RM. Source: Jama : the Journal of the American Medical Association. 2003 June 18; 289(23): 3198. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12813126&dopt=Abstract

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Kinematic analysis of handwriting movements in patients with Alzheimer's disease, mild cognitive impairment, depression and healthy subjects. Author(s): Schroter A, Mergl R, Burger K, Hampel H, Moller HJ, Hegerl U. Source: Dementia and Geriatric Cognitive Disorders. 2003; 15(3): 132-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12584428&dopt=Abstract

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Knowledge about postpartum depression is family's responsibility. Author(s): Henderson BJ. Source: Pediatric Nursing. 2002 September-October; 28(5): 542. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12424995&dopt=Abstract

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Lack of age differences in the Beck Depression Inventory-II scores of clinically depressed adolescent outpatients. Author(s): Krefetz DG, Steer RA, Kumar G. Source: Psychological Reports. 2003 April; 92(2): 489-97. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12785631&dopt=Abstract

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Lack of association between suicidal ideation and enhanced platelet 5-HT2A receptormediated calcium mobilization in cancer patients with depression. Author(s): Uchitomi Y, Kugaya A, Akechi T, Nakano T, Inagaki M, Matsuoka Y, Kagaya A, Yamawaki S. Source: Biological Psychiatry. 2002 December 15; 52(12): 1159-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12488061&dopt=Abstract

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Lamotrigine as an augmentation agent in treatment-resistant depression. Author(s): Barbee JG, Jamhour NJ. Source: The Journal of Clinical Psychiatry. 2002 August; 63(8): 737-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12197456&dopt=Abstract

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Lamotrigine augmentation in unipolar depression. Author(s): Rocha FL, Hara C. Source: International Clinical Psychopharmacology. 2003 March; 18(2): 97-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12598821&dopt=Abstract

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Lamotrigine use in geriatric patients with bipolar depression. Author(s): Robillard M, Conn DK. Source: Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie. 2002 October; 47(8): 767-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12420655&dopt=Abstract

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Larger amygdala volumes in first depressive episode as compared to recurrent major depression and healthy control subjects. Author(s): Frodl T, Meisenzahl EM, Zetzsche T, Born C, Jager M, Groll C, Bottlender R, Leinsinger G, Moller HJ. Source: Biological Psychiatry. 2003 February 15; 53(4): 338-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12586453&dopt=Abstract

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Late-life depression and mental health services in primary care. Author(s): Wagenaar DB, Mickus MA, Gaumer KA, Colenda CC. Source: Journal of Geriatric Psychiatry and Neurology. 2002 Fall; 15(3): 134-40. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12230083&dopt=Abstract

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Late-life depression is associated with arterial stiffness: a population-based study. Author(s): Tiemeier H, Breteler MM, van Popele NM, Hofman A, Witteman JC. Source: Journal of the American Geriatrics Society. 2003 August; 51(8): 1105-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12890073&dopt=Abstract

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Late-life depression: its oral health significance. Author(s): Friedlander AH, Friedlander IK, Gallas M, Velasco E. Source: Int Dent J. 2003 February; 53(1): 41-50. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12653339&dopt=Abstract

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Late-life depression: psychopathology, medical interventions, and dental implications. Author(s): Friedlander AH, Norman DC. Source: Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics. 2002 October; 94(4): 404-12. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12374911&dopt=Abstract

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Late-life depression: rationalizing pharmacological treatment options. Author(s): Montgomery SA. Source: Gerontology. 2002 November-December; 48(6): 392-400. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12393956&dopt=Abstract

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Lateral asymmetries in the frontal brain: effects of depression and a family history of alcoholism in female adolescents. Author(s): Bauer LO, Hesselbrock VM. Source: Alcoholism, Clinical and Experimental Research. 2002 November; 26(11): 1662-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12436054&dopt=Abstract

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Life after primary care depression quality improvement intervention. Author(s): Rost K. Source: Journal of General Internal Medicine : Official Journal of the Society for Research and Education in Primary Care Internal Medicine. 2002 October; 17(10): 811. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12390558&dopt=Abstract

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Life event dimensions of loss, humiliation, entrapment, and danger in the prediction of onsets of major depression and generalized anxiety. Author(s): Kendler KS, Hettema JM, Butera F, Gardner CO, Prescott CA. Source: Archives of General Psychiatry. 2003 August; 60(8): 789-96. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12912762&dopt=Abstract

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Life events and changes in the course of depression in young adults. Author(s): Friis RH, Wittchen HU, Pfister H, Lieb R. Source: European Psychiatry : the Journal of the Association of European Psychiatrists. 2002 September; 17(5): 241-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12381493&dopt=Abstract

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Life events, number of social relationships, and twelve-month naturalistic course of major depression in a community sample of women. Author(s): Wildes JE, Harkness KL, Simons AD. Source: Depression and Anxiety. 2002; 16(3): 104-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12415534&dopt=Abstract

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Lifetime depressive and somatic symptoms as preclinical markers of late-onset depression. Author(s): Hein S, Bonsignore M, Barkow K, Jessen F, Ptok U, Heun R. Source: European Archives of Psychiatry and Clinical Neuroscience. 2003 February; 253(1): 16-21. Erratum In: Eur Arch Psychiatry Clin Neurosci. 2003 April; 253(2): 110. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12664308&dopt=Abstract

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Lifetime history of depression and carotid atherosclerosis in middle-aged women. Author(s): Jones DJ, Bromberger JT, Sutton-Tyrrell K, Matthews KA. Source: Archives of General Psychiatry. 2003 February; 60(2): 153-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12578432&dopt=Abstract

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Lifetime physical and sexual abuse, substance abuse, depression, and suicide attempts among Native American women. Author(s): Bohn DK. Source: Issues in Mental Health Nursing. 2003 April-May; 24(3): 333-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12623689&dopt=Abstract

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Lifetime symptoms of depression in Alzheimer's disease. Author(s): Heun R, Kockler M, Ptok U. Source: European Psychiatry : the Journal of the Association of European Psychiatrists. 2003 March; 18(2): 63-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12711401&dopt=Abstract

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Links in the chain of adversity following job loss: how financial strain and loss of personal control lead to depression, impaired functioning, and poor health. Author(s): Price RH, Choi JN, Vinokur AD. Source: Journal of Occupational Health Psychology. 2002 October; 7(4): 302-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12396064&dopt=Abstract

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Literacy and comprehension of Beck Depression Inventory response alternatives. Author(s): Sentell TL, Ratcliff-Baird B. Source: Community Mental Health Journal. 2003 August; 39(4): 323-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12908646&dopt=Abstract

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Lithium augmentation in treatment-refractory unipolar depression. Author(s): Lee W, Cleare A. Source: The British Journal of Psychiatry; the Journal of Mental Science. 2003 May; 182: 456; Author Reply 456-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12724254&dopt=Abstract

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Lithium augmentation increases post-dexamethasone cortisol in the dexamethasone suppression test in unipolar major depression. Author(s): Bschor T, Baethge C, Adli M, Eichmann U, Ising M, Uhr M, MullerOerlinghausen B, Bauer M. Source: Depression and Anxiety. 2003; 17(1): 43-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12577277&dopt=Abstract

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Lithium augmentation increases the ACTH and cortisol response in the combined DEX/CRH test in unipolar major depression. Author(s): Bschor T, Adli M, Baethge C, Eichmann U, Ising M, Uhr M, Modell S, Kunzel H, Muller-Oerlinghausen B, Bauer M. Source: Neuropsychopharmacology : Official Publication of the American College of Neuropsychopharmacology. 2002 September; 27(3): 470-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12225704&dopt=Abstract

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Lithium augmentation therapy in refractory depression-update 2002. Author(s): Bauer M, Forsthoff A, Baethge C, Adli M, Berghofer A, Dopfmer S, Bschor T. Source: European Archives of Psychiatry and Clinical Neuroscience. 2003 June; 253(3): 132-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12904977&dopt=Abstract

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Lithium combinations in acute and maintenance treatment of unipolar and bipolar depression. Author(s): Fawcett JA. Source: The Journal of Clinical Psychiatry. 2003; 64 Suppl 5: 32-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12720482&dopt=Abstract

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Living with heart failure: depression and quality of life in patients and spouses. Author(s): Martensson J, Dracup K, Canary C, Fridlund B. Source: The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation. 2003 April; 22(4): 460-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12681424&dopt=Abstract

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Localization of age-associated white matter hyperintensities in late-life depression. Author(s): Taylor WD, MacFall JR, Steffens DC, Payne ME, Provenzale JM, Krishnan KR. Source: Progress in Neuro-Psychopharmacology & Biological Psychiatry. 2003 May; 27(3): 539-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12691791&dopt=Abstract

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Lone mothers, social exclusion and depression. Author(s): Targosz S, Bebbington P, Lewis G, Brugha T, Jenkins R, Farrell M, Meltzer H. Source: Psychological Medicine. 2003 May; 33(4): 715-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12785473&dopt=Abstract

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Loneliness and depression in spousal caregivers of those with Alzheimer's disease versus non-caregiving spouses. Author(s): Beeson RA. Source: Archives of Psychiatric Nursing. 2003 June; 17(3): 135-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12840806&dopt=Abstract

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Loneliness, health and depression in older males. Author(s): Alpass FM, Neville S. Source: Aging & Mental Health. 2003 May; 7(3): 212-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12775403&dopt=Abstract

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Long-lasting cognitive impairment in unipolar major depression: a 6-month followup study. Author(s): Hammar A, Lund A, Hugdahl K. Source: Psychiatry Research. 2003 May 30; 118(2): 189-96. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12798984&dopt=Abstract

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Long-term depression of the human blink reflex. Author(s): Schorr A, Ellrich J. Source: Experimental Brain Research. Experimentelle Hirnforschung. Experimentation Cerebrale. 2002 December; 147(4): 549-53. Epub 2002 October 09. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12444487&dopt=Abstract

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Low dosage tricyclic antidepressants for depression. Author(s): Furukawa T, McGuire H, Barbui C. Source: Cochrane Database Syst Rev. 2003; (3): Cd003197. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12917952&dopt=Abstract

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Low dosage tricyclic antidepressants in depression. Evidence to change current guidelines is insufficient. Author(s): Ali IM. Source: Bmj (Clinical Research Ed.). 2003 March 1; 326(7387): 499; Author Reply 499. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12617073&dopt=Abstract

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Low dosage tricyclic antidepressants in depression. Giving low dose tricyclics is not justified by evidence. Author(s): Jones HM. Source: Bmj (Clinical Research Ed.). 2003 March 1; 326(7387): 499; Author Reply 499. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12609953&dopt=Abstract

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Low dosage tricyclic antidepressants in depression. Non-superiority does not equal equivalence. Author(s): Martin JE. Source: Bmj (Clinical Research Ed.). 2003 March 1; 326(7387): 499; Author Reply 499. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12617074&dopt=Abstract

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Low-density lipoprotein cholesterol and post-myocardial infarction depression. Author(s): Ziegelstein RC. Source: The American Journal of Cardiology. 2003 June 15; 91(12): 1532. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12804755&dopt=Abstract

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Maintenance efficacy of divalproex in the prevention of bipolar depression. Author(s): Gyulai L, Bowden CL, McElroy SL, Calabrese JR, Petty F, Swann AC, Chou JC, Wassef A, Risch CS, Hirschfeld RM, Nemeroff CB, Keck PE Jr, Evans DL, Wozniak PJ. Source: Neuropsychopharmacology : Official Publication of the American College of Neuropsychopharmacology. 2003 July; 28(7): 1374-82. Epub 2003 May 28. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12784116&dopt=Abstract

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Major depression and conduct disorder in a twin sample: gender, functioning, and risk for future psychopathology. Author(s): Marmorstein NR, Iacono WG. Source: Journal of the American Academy of Child and Adolescent Psychiatry. 2003 February; 42(2): 225-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12544183&dopt=Abstract

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Major depression in 6050 former drinkers: association with past alcohol dependence. Author(s): Hasin DS, Grant BF. Source: Archives of General Psychiatry. 2002 September; 59(9): 794-800. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12215078&dopt=Abstract

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Major depression with ischemic heart disease: effects of paroxetine and nortriptyline on long-term heart rate variability measures. Author(s): Yeragani VK, Pesce V, Jayaraman A, Roose S. Source: Biological Psychiatry. 2002 September 1; 52(5): 418-29. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12242058&dopt=Abstract

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Major depression with ischemic heart disease: effects of paroxetine and nortriptyline on measures of nonlinearity and chaos of heart rate. Author(s): Yeragani VK, Roose S, Mallavarapu M, Radhakrishna RK, Pesce V. Source: Neuropsychobiology. 2002; 46(3): 125-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12422059&dopt=Abstract

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Management of cancer symptoms: pain, depression, and fatigue. Author(s): Prog Neuropsychopharmacol Biol Psychiatry. 2002 Jun;26(5):1011-8 Source: Evid Rep Technol Assess (Summ). 2002 July; (61): 1-5. No Abstract Available. /entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12369251

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Management of major depression during pregnancy. Author(s): Hendrick V, Altshuler L. Source: The American Journal of Psychiatry. 2002 October; 159(10): 1667-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12359670&dopt=Abstract

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Management of recurrent depression in primary care. Author(s): Fava GA, Ruini C, Sonino N. Source: Psychotherapy and Psychosomatics. 2003 January-February; 72(1): 3-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12466632&dopt=Abstract

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Managing depression as a chronic disease: a randomised trial of ongoing treatment in primary care. Author(s): Rost K, Nutting P, Smith JL, Elliott CE, Dickinson M. Source: Bmj (Clinical Research Ed.). 2002 October 26; 325(7370): 934. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12399343&dopt=Abstract

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Managing depression in primary care: another example of the inverse care law? Author(s): Chew-Graham CA, Mullin S, May CR, Hedley S, Cole H. Source: Family Practice. 2002 December; 19(6): 632-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12429666&dopt=Abstract

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Managing treatment-resistant major depression. Author(s): Nelson JC. Source: The Journal of Clinical Psychiatry. 2003; 64 Suppl 1: 5-12. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12625799&dopt=Abstract

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Marital distress, co-occurring depression, and marital therapy: a review. Author(s): Mead DE. Source: J Marital Fam Ther. 2002 July; 28(3): 299-314. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12197153&dopt=Abstract

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Markers for depression in Parkinson's disease. Author(s): Leentjens AF, Lousberg R, Verhey FR. Source: Acta Psychiatrica Scandinavica. 2002 September; 106(3): 196-201. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12197857&dopt=Abstract

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Maternal depression, paternal psychopathology, and adolescent diagnostic outcomes. Author(s): Brennan PA, Hammen C, Katz AR, Le Brocque RM. Source: Journal of Consulting and Clinical Psychology. 2002 October; 70(5): 1075-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12362958&dopt=Abstract

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Measurement issues in postpartum depression part 1: anxiety as a feature of postpartum depression. Author(s): Ross LE, Gilbert Evans SE, Sellers EM, Romach MK. Source: Archives of Women's Mental Health. 2003 February; 6(1): 51-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12715264&dopt=Abstract

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Measurement issues in postpartum depression part 2: assessment of somatic symptoms using the Hamilton Rating Scale for Depression. Author(s): Ross LE, Gilbert Evans SE, Sellers EM, Romach MK. Source: Archives of Women's Mental Health. 2003 February; 6(1): 59-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12715265&dopt=Abstract

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Measuring cognitive vulnerability to depression in adolescence: reliability, validity, and gender differences. Author(s): Hankin BL, Abramson LY. Source: Journal of Clinical Child and Adolescent Psychology : the Official Journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53. 2002 December; 31(4): 491-504. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12402568&dopt=Abstract

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Measuring depression of elderly Chinese Americans: a replication study. Author(s): Lai DW. Source: Home Health Care Serv Q. 2003; 22(2): 69-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12870713&dopt=Abstract

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Measuring outcomes in patients with depression or anxiety: an essential part of clinical practice. Author(s): Andersen-Dalheim H. Source: The Medical Journal of Australia. 2003 March 17; 178(6): 302-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12776735&dopt=Abstract

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Measuring outcomes in patients with depression or anxiety: an essential part of clinical practice. Author(s): Boettcher BM. Source: The Medical Journal of Australia. 2003 March 17; 178(6): 302. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12633494&dopt=Abstract

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Measuring outcomes in patients with depression or anxiety: an essential part of clinical practice. Author(s): Dinnen A. Source: The Medical Journal of Australia. 2003 January 6; 178(1): 48; Author Reply 48. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12492398&dopt=Abstract

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Measuring the quality of depression care in a large integrated health system. Author(s): Charbonneau A, Rosen AK, Ash AS, Owen RR, Kader B, Spiro A 3rd, Hankin C, Herz LR, Jo V Pugh M, Kazis L, Miller DR, Berlowitz DR. Source: Medical Care. 2003 May; 41(5): 669-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12719691&dopt=Abstract

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Medical comorbidity and receipt of medical care by older homeless people with schizophrenia or depression. Author(s): Folsom DP, McCahill M, Bartels SJ, Lindamer LA, Ganiats TG, Jeste DV. Source: Psychiatric Services (Washington, D.C.). 2002 November; 53(11): 1456-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12407275&dopt=Abstract

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Medication treatment for depression in children and adolescents. Author(s): Ryan ND. Source: Cns Spectr. 2003 April; 8(4): 283-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12679743&dopt=Abstract

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Mefloquine-induced paranoid psychosis and subsequent major depression in a 25year-old student. Author(s): Dietz A, Frolich L. Source: Pharmacopsychiatry. 2002 September; 35(5): 200-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12237793&dopt=Abstract

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Melatonin response to atenolol administration in depression: indication of betaadrenoceptor dysfunction in a subtype of depression. Author(s): Paparrigopoulos T. Source: Acta Psychiatrica Scandinavica. 2002 December; 106(6): 440-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12392487&dopt=Abstract

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Mental health and welfare transitions: depression and alcohol abuse in AFDC women. Author(s): Dooley D, Prause J. Source: American Journal of Community Psychology. 2002 December; 30(6): 787-813. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12385483&dopt=Abstract

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Mental health literacy of those with major depression and suicidal ideation: an impediment to help seeking. Author(s): Goldney RD, Fisher LJ, Wilson DH, Cheok F. Source: Suicide & Life-Threatening Behavior. 2002 Winter; 32(4): 394-403. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12501964&dopt=Abstract

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Meta-analysis of effects and side effects of low dosage tricyclic antidepressants in depression: systematic review. Author(s): Furukawa TA, McGuire H, Barbui C. Source: Bmj (Clinical Research Ed.). 2002 November 2; 325(7371): 991. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12411354&dopt=Abstract

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Migraine, major depression, panic disorder, and personality traits in women aged 4074 years: a population-based study. Author(s): Mattsson P, Ekselius L. Source: Cephalalgia : an International Journal of Headache. 2002 September; 22(7): 54351. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12230596&dopt=Abstract

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Mineralocorticoid receptor function in major depression. Author(s): Young EA, Lopez JF, Murphy-Weinberg V, Watson SJ, Akil H. Source: Archives of General Psychiatry. 2003 January; 60(1): 24-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12511169&dopt=Abstract

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Mirtazapine for treatment-resistant depression: a preliminary report. Author(s): Wan DD, Kundhur D, Solomons K, Yatham LN, Lam RW. Source: Journal of Psychiatry & Neuroscience : Jpn. 2003 January; 28(1): 55-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12587851&dopt=Abstract

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Modafinil in the treatment of depression with severe comorbid medical illness. Author(s): Schwartz TL, Leso L, Beale M, Ahmed R, Naprawa S. Source: Psychosomatics. 2002 July-August; 43(4): 336-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12189262&dopt=Abstract

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Modeling the spreading cortical depression wavefront. Author(s): Baysal U, Haueisen J. Source: Annals of the New York Academy of Sciences. 2002 October; 972: 127-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12496007&dopt=Abstract

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Modulating limbic-cortical circuits in depression: targets of antidepressant treatments. Author(s): Mayberg HS. Source: Semin Clin Neuropsychiatry. 2002 October; 7(4): 255-68. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12382208&dopt=Abstract

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Monitoring the response to rTMS in depression with visual analog scales. Author(s): Grunhaus L, Dolberg OT, Polak D, Dannon PN. Source: Human Psychopharmacology. 2002 October; 17(7): 349-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12415554&dopt=Abstract

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Motherhood as a vulnerability factor in major depression: the role of negative pregnancy experiences. Author(s): Bernazzani O, Bifulco A. Source: Social Science & Medicine (1982). 2003 March; 56(6): 1249-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12600362&dopt=Abstract

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Mounting student depression taxing campus mental health services. Author(s): Voelker R. Source: Jama : the Journal of the American Medical Association. 2003 April 23-30; 289(16): 2055-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12709447&dopt=Abstract

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MRI subcortical hyperintensities in old and very old depressed outpatients: the important role of age in late-life depression. Author(s): Salloway S, Correia S, Boyle P, Malloy P, Schneider L, Lavretsky H, Sackheim H, Roose S, Krishnan KR. Source: Journal of the Neurological Sciences. 2002 November 15; 203-204: 227-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12417389&dopt=Abstract

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Multiple sclerosis, depression, and the risk of suicide. Author(s): Caine ED, Schwid SR. Source: Neurology. 2002 September 10; 59(5): 662-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12221154&dopt=Abstract

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Mutuality as background music in women's lived experience of mental health and depression. Author(s): Hedelin B, Jonsson I. Source: Journal of Psychiatric and Mental Health Nursing. 2003 June; 10(3): 317-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12755916&dopt=Abstract

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Narcissism and depression: MMPI-2 evidence for the continuum hypothesis in clinical samples. Author(s): Watson PJ, Sawrie SM, Greene RL, Arredondo R. Source: Journal of Personality Assessment. 2002 August; 79(1): 85-109. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12227670&dopt=Abstract

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National Institutes of Health State-of-the-Science Conference Statement: Symptom Management in Cancer: Pain, Depression, and Fatigue, July 15-17, 2002. Author(s): Patrick DL, Ferketich SL, Frame PS, Harris JJ, Hendricks CB, Levin B, Link MP, Lustig C, McLaughlin J, Ried LD, Turrisi AT 3rd, Unutzer J, Vernon SW; National Institutes of Health State-of-the-Science Panel. Source: Journal of the National Cancer Institute. 2003 August 6; 95(15): 1110-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12902440&dopt=Abstract

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Nefazodone in psychotic unipolar and bipolar depression: a retrospective chart analysis and open prospective study on its efficacy and safety versus combined treatment with amitriptyline and haloperidol. Author(s): Grunze H, Marcuse A, Scharer LO, Born C, Walden J. Source: Neuropsychobiology. 2002; 46 Suppl 1: 31-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12571431&dopt=Abstract

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Negative mood, depressive symptoms, and major depression after smoking cessation treatment in smokers with a history of major depressive disorder. Author(s): Kahler CW, Brown RA, Ramsey SE, Niaura R, Abrams DB, Goldstein MG, Mueller TI, Miller IW. Source: Journal of Abnormal Psychology. 2002 November; 111(4): 670-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12428781&dopt=Abstract

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Neopterin production, tryptophan degradation, and mental depression--what is the link? Author(s): Widner B, Laich A, Sperner-Unterweger B, Ledochowski M, Fuchs D. Source: Brain, Behavior, and Immunity. 2002 October; 16(5): 590-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12401473&dopt=Abstract

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Neurobiological effects of childhood abuse: implications for the pathophysiology of depression and anxiety. Author(s): Penza KM, Heim C, Nemeroff CB. Source: Archives of Women's Mental Health. 2003 February; 6(1): 15-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12715261&dopt=Abstract

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Neurochemical aspects of susceptibility to depression. Author(s): Nathan PJ. Source: Jama : the Journal of the American Medical Association. 2003 September 10; 290(10): 1315-6; Author Reply 1316. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12966120&dopt=Abstract

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Neuroendocrine aspects of hypercortisolism in major depression. Author(s): Parker KJ, Schatzberg AF, Lyons DM. Source: Hormones and Behavior. 2003 January; 43(1): 60-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12614635&dopt=Abstract

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Neuropathological evidence for ischemia in the white matter of the dorsolateral prefrontal cortex in late-life depression. Author(s): Thomas AJ, Perry R, Kalaria RN, Oakley A, McMeekin W, O'Brien JT. Source: International Journal of Geriatric Psychiatry. 2003 January; 18(1): 7-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12497551&dopt=Abstract

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Neuropeptide Y (NPY) and depression: from animal studies to the human condition. Author(s): Redrobe JP, Dumont Y, Quirion R. Source: Life Sciences. 2002 November 8; 71(25): 2921-37. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12384178&dopt=Abstract

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Neuropeptides and the hypothalamic-pituitary-adrenocortical (HPA) system: review of recent research strategies in depression. Author(s): Hatzinger M. Source: World J Biol Psychiatry. 2000 April; 1(2): 105-11. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12607206&dopt=Abstract

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Neuropsychopharmacologic treatment of depression and other neuropsychiatric disorders in HIV-infected individuals. Author(s): Repetto MJ, Evans DL, Cruess DG, Gettes DR, Douglas SD, Petitto JM. Source: Cns Spectr. 2003 January; 8(1): 59-63. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12627050&dopt=Abstract

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Neuroscience. Depression drugs' powers may rest on new neurons. Author(s): Vogel G. Source: Science. 2003 August 8; 301(5634): 757. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12907775&dopt=Abstract

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Neurosteroids in depression: a review. Author(s): van Broekhoven F, Verkes RJ. Source: Psychopharmacology. 2003 January; 165(2): 97-110. Epub 2002 November 06. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12420152&dopt=Abstract

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Neurosurgery for intractable obsessive-compulsive disorder and depression: critical issues. Author(s): Greenberg BD, Price LH, Rauch SL, Friehs G, Noren G, Malone D, Carpenter LL, Rezai AR, Rasmussen SA. Source: Neurosurg Clin N Am. 2003 April; 14(2): 199-212. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12856488&dopt=Abstract

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Neuroticism and depression. Author(s): McWilliams L. Source: The British Journal of Psychiatry; the Journal of Mental Science. 2003 January; 182: 80; Author Reply 80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12509326&dopt=Abstract

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Neuroticism and depression. Author(s): Hodgins S, Ellenbogen M. Source: The British Journal of Psychiatry; the Journal of Mental Science. 2003 January; 182: 79-80; Author Reply 80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12509325&dopt=Abstract

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Neurotrophic effects of electroconvulsive therapy: a proton magnetic resonance study of the left amygdalar region in patients with treatment-resistant depression. Author(s): Michael N, Erfurth A, Ohrmann P, Arolt V, Heindel W, Pfleiderer B. Source: Neuropsychopharmacology : Official Publication of the American College of Neuropsychopharmacology. 2003 April; 28(4): 720-5. Epub 2002 October 10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12655317&dopt=Abstract

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New approaches in managing bipolar depression. Author(s): Keck PE Jr, McElroy SL. Source: The Journal of Clinical Psychiatry. 2003; 64 Suppl 1: 13-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12625800&dopt=Abstract

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New approaches to managing psychotic depression. Author(s): Schatzberg AF. Source: The Journal of Clinical Psychiatry. 2003; 64 Suppl 1: 19-23. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12625801&dopt=Abstract

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New hope in the treatment of painful symptoms in depression. Author(s): Briley M. Source: Curr Opin Investig Drugs. 2003 January; 4(1): 42-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12625027&dopt=Abstract

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New insights into the role of cortisol and the glucocorticoid receptor in severe depression. Author(s): Gold PW, Drevets WC, Charney DS. Source: Biological Psychiatry. 2002 September 1; 52(5): 381-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12242053&dopt=Abstract

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New perspectives in the acute treatment of bipolar depression. Author(s): Grunze H, Schlosser S, Walden J. Source: World J Biol Psychiatry. 2000 July; 1(3): 129-36. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12607221&dopt=Abstract

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NIH releases statement on managing pain, depression, and fatigue in cancer. Author(s): Ressel GW; National Institutes of Health. Source: American Family Physician. 2003 January 15; 67(2): 423-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12562162&dopt=Abstract

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Nitric oxide, stress, and depression. Author(s): McLeod TM, Lopez-Figueroa AL, Lopez-Figueroa MO. Source: Psychopharmacology Bulletin. 2001 Winter; 35(1): 24-41. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12397868&dopt=Abstract

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Non diagnosed depression among the institutionalized population in a rural area. Author(s): Perez-Jara J, Lucia E, Mayo F, Leon JJ, Alvarez J, Frei F, Enguix A. Source: International Journal of Geriatric Psychiatry. 2002 October; 17(10): 974-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12325060&dopt=Abstract

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Non-peptidic CRF1 receptor antagonists for the treatment of anxiety, depression and stress disorders. Author(s): Kehne J, De Lombaert S. Source: Current Drug Targets. Cns and Neurological Disorders. 2002 October; 1(5): 46793. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12769601&dopt=Abstract

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Nonsomatic treatment of depression. Author(s): Sherrill JT, Kovacs M. Source: Child Adolesc Psychiatr Clin N Am. 2002 July; 11(3): 579-93. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12222084&dopt=Abstract

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Norepinephrine alters the expression of genes involved in neuronal sprouting and differentiation: relevance for major depression and antidepressant mechanisms. Author(s): Laifenfeld D, Klein E, Ben-Shachar D. Source: Journal of Neurochemistry. 2002 December; 83(5): 1054-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12437576&dopt=Abstract

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Normal variation and abnormality: an empirical study of the liability distributions underlying depression and delinquency. Author(s): van den Oord EJ, Pickles A, Waldman ID. Source: Journal of Child Psychology and Psychiatry, and Allied Disciplines. 2003 February; 44(2): 180-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12587855&dopt=Abstract

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Normative data on cognitive measures of depression. Author(s): Dozois DJ, Covin R, Brinker JK. Source: Journal of Consulting and Clinical Psychology. 2003 February; 71(1): 71-80. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12602427&dopt=Abstract

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Nortriptyline for treatment-resistant depression. Author(s): Nierenberg AA, Papakostas GI, Petersen T, Kelly KE, Iacoviello BM, Worthington JJ, Tedlow J, Alpert JE, Fava M. Source: The Journal of Clinical Psychiatry. 2003 January; 64(1): 35-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12590621&dopt=Abstract

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Obesity-depression associations in the population. Author(s): Faith MS, Matz PE, Jorge MA. Source: Journal of Psychosomatic Research. 2002 October; 53(4): 935-42. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12377306&dopt=Abstract

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Obstructive sleep apnea and depression. Author(s): Baran AS, Richert AC. Source: Cns Spectr. 2003 February; 8(2): 120-34. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12612498&dopt=Abstract

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Occupational differences in levels of anxiety and depression: the Hordaland Health Study. Author(s): Sanne B, Mykletun A, Dahl AA, Moen BE, Tell GS; Hordaland Health Study. Source: Journal of Occupational and Environmental Medicine / American College of Occupational and Environmental Medicine. 2003 June; 45(6): 628-38. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12802216&dopt=Abstract

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Occurrence and course of suicidality during short-term treatment of late-life depression. Author(s): Szanto K, Mulsant BH, Houck P, Dew MA, Reynolds CF 3rd. Source: Archives of General Psychiatry. 2003 June; 60(6): 610-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12796224&dopt=Abstract

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Older community residents with depression: long-term treatment with sertraline. Randomised, double-blind, placebo-controlled study. Author(s): Wilson KC, Mottram PG, Ashworth L, Abou-Saleh MT. Source: The British Journal of Psychiatry; the Journal of Mental Science. 2003 June; 182: 492-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12777339&dopt=Abstract

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On the importance of anonymity in surveying medical student depression. Author(s): Myers M. Source: Academic Psychiatry : the Journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry. 2003 Spring; 27(1): 19-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12824116&dopt=Abstract

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On the role of menopause for sleep-endocrine alterations associated with major depression. Author(s): Antonijevic IA, Murck H, Frieboes RM, Uhr M, Steiger A. Source: Psychoneuroendocrinology. 2003 April; 28(3): 401-18. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12573305&dopt=Abstract

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On the role of serotonin in sleep regulation and depression. A commentary on "Neurobiological bases for the relation between sleep and depression" (J. Adrien). Author(s): Giedke H. Source: Sleep Medicine Reviews. 2003 February; 7(1): 101-2; Author Reply 103-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12586533&dopt=Abstract

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Onset of major depression during treatment for nicotine dependence. Author(s): Killen JD, Fortmann SP, Schatzberg A, Hayward C, Varady A. Source: Addictive Behaviors. 2003 April; 28(3): 461-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12628619&dopt=Abstract

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Open-label evaluation of venlafaxine sustained release in outpatients with generalized anxiety disorder with comorbid major depression or dysthymia: effectiveness, tolerability and predictors of response. Author(s): Perugi G, Frare F, Toni C, Ruffolo G, Torti C. Source: Neuropsychobiology. 2002; 46(3): 145-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12422062&dopt=Abstract

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Optimizing outcomes in depression: focus on antidepressant compliance. Author(s): Keller MB, Hirschfeld RM, Demyttenaere K, Baldwin DS. Source: International Clinical Psychopharmacology. 2002 November; 17(6): 265-71. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12409679&dopt=Abstract

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Oral versus written administration of the Geriatric Depression Scale. Author(s): Cannon BJ, Thaler T, Roos S. Source: Aging & Mental Health. 2002 November; 6(4): 418-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12425776&dopt=Abstract

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Outcomes of patients completing and not completing cognitive therapy for depression. Author(s): Cahill J, Barkham M, Hardy G, Rees A, Shapiro DA, Stiles WB, Macaskill N. Source: The British Journal of Clinical Psychology / the British Psychological Society. 2003 June; 42(Pt 2): 133-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12828803&dopt=Abstract

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Overcoming depression on the Internet (ODIN): a randomized controlled trial of an Internet depression skills intervention program. Author(s): Clarke G, Reid E, Eubanks D, O'Connor E, DeBar LL, Kelleher C, Lynch F, Nunley S. Source: Journal of Medical Internet Research [electronic Resource]. 2002 December; 4(3): E14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12554545&dopt=Abstract

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Overlap between emotional blunting, depression, and extrapyramidal symptoms in schizophrenia. Author(s): Muller M. Source: Schizophrenia Research. 2002 October 1; 57(2-3): 307. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12223263&dopt=Abstract

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Overview of existing research and information linking isotretinoin (accutane), depression, psychosis, and suicide. Author(s): O'Donnell J. Source: American Journal of Therapeutics. 2003 March-April; 10(2): 148-59. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12629595&dopt=Abstract

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Overview: depression in the elderly. Author(s): Serby M, Yu M. Source: The Mount Sinai Journal of Medicine, New York. 2003 January; 70(1): 38-44. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12516008&dopt=Abstract

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Parental acceptance, postpartum depression, and maternal sensitivity: mediating and moderating processes. Author(s): Crockenberg SC, Leerkes EM. Source: Journal of Family Psychology : Jfp : Journal of the Division of Family Psychology of the American Psychological Association (Division 43). 2003 March; 17(1): 80-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12666465&dopt=Abstract

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Parental care and personality in melancholic and nonmelancholic depression. Author(s): Whiffen VE, Parker GB, Wilhelm K, Mitchell PB, Malhi G. Source: The Journal of Nervous and Mental Disease. 2003 June; 191(6): 358-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12826916&dopt=Abstract

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Parental depression, child mental health problems, and health care utilization. Author(s): Olfson M, Marcus SC, Druss B, Alan Pincus H, Weissman MM. Source: Medical Care. 2003 June; 41(6): 716-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12773837&dopt=Abstract

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Paroxetine in major depression. Author(s): Jureidini J, Tonkin A. Source: Journal of the American Academy of Child and Adolescent Psychiatry. 2003 May; 42(5): 514; Author Reply 514-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12707552&dopt=Abstract

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Partial response as a predictor of outcome in geriatric depression. Author(s): Steffens DC, McQuoid DR, Krishnan KR. Source: The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry. 2003 May-June; 11(3): 340-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12724113&dopt=Abstract

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Past, present, and future directions for defining optimal treatment outcome in depression: remission and beyond. Author(s): Keller MB. Source: Jama : the Journal of the American Medical Association. 2003 June 18; 289(23): 3152-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12813121&dopt=Abstract

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Pathways to anaclitic and introjective depression. Author(s): Reis S, Grenyer BF. Source: Psychology and Psychotherapy. 2002 December; 75(Pt 4): 445-59. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12626134&dopt=Abstract

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Persecutory ideation and depression in mild violence among incarcerated adult males. Author(s): Beal CA, Kroner DG, Weekes JR. Source: International Journal of Offender Therapy and Comparative Criminology. 2003 April; 47(2): 159-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12710362&dopt=Abstract

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Persistent pain and depression: a biopsychosocial perspective. Author(s): Campbell LC, Clauw DJ, Keefe FJ. Source: Biological Psychiatry. 2003 August 1; 54(3): 399-409. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12893114&dopt=Abstract

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Personality and depression in women. Author(s): Widiger TA, Anderson KG. Source: Journal of Affective Disorders. 2003 March; 74(1): 59-66. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12646299&dopt=Abstract

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Personality traits, depression and migraine in women: a longitudinal study. Author(s): Mongini F, Keller R, Deregibus A, Raviola F, Mongini T, Sancarlo M. Source: Cephalalgia : an International Journal of Headache. 2003 April; 23(3): 186-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12662185&dopt=Abstract

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Physical and sexual abuse, depression and alcohol use disorders in adolescents: onsets and outcomes. Author(s): Clark DB, De Bellis MD, Lynch KG, Cornelius JR, Martin CS. Source: Drug and Alcohol Dependence. 2003 January 24; 69(1): 51-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12536066&dopt=Abstract

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Physical symptoms of depression as a public health concern. Author(s): Sartorius N. Source: The Journal of Clinical Psychiatry. 2003; 64 Suppl 7: 3-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12755645&dopt=Abstract

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Physical symptoms of depression: unmet needs in special populations. Author(s): Stewart DE. Source: The Journal of Clinical Psychiatry. 2003; 64 Suppl 7: 12-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12755647&dopt=Abstract

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Physical symptoms of depression: unmet needs. Author(s): Greden JF. Source: The Journal of Clinical Psychiatry. 2003; 64 Suppl 7: 5-11. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12755646&dopt=Abstract

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Placebo-controlled studies in depression: necessary, ethical and feasible. Author(s): Baldwin D, Broich K, Fritze J, Kasper S, Westenberg H, Moller HJ. Source: European Archives of Psychiatry and Clinical Neuroscience. 2003 February; 253(1): 22-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12664309&dopt=Abstract

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Platelet 5-HT concentration and comorbid depression in war veterans with and without posttraumatic stress disorder. Author(s): Muck-Seler D, Pivac N, Jakovljevic M, Sagud M, Mihaljevic-Peles A. Source: Journal of Affective Disorders. 2003 July; 75(2): 171-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12798257&dopt=Abstract

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Platelet surface glycoprotein expression in post-stroke depression: a preliminary study. Author(s): Cassidy EM, Walsh MT, O'Connor R, Condren RM, Ryan M, O'Keane V, Kenny D, Dinan T. Source: Psychiatry Research. 2003 May 30; 118(2): 175-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12798982&dopt=Abstract

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Population attributable risk of major depression for suicidal ideation in a random and representative community sample. Author(s): Goldney RD, Dal Grande E, Fisher LJ, Wilson D. Source: Journal of Affective Disorders. 2003 May; 74(3): 267-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12738045&dopt=Abstract

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Positive thinking in bereavement: is it related to depression, anxiety, or grief symptomatology? Author(s): Boelen PA, van den Bout J. Source: Psychological Reports. 2002 December; 91(3 Pt 1): 857-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12530735&dopt=Abstract

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Possible predictors of response to fluvoxamine for depression. Author(s): Morishita S, Arita S. Source: Human Psychopharmacology. 2003 April; 18(3): 197-200. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12672171&dopt=Abstract

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Postconcussive symptom report: the relative influence of head injury and depression. Author(s): Suhr JA, Gunstad J. Source: J Clin Exp Neuropsychol. 2002 December; 24(8): 981-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12650225&dopt=Abstract

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Postdisaster emotional distress, depression and event-related variables: findings across child and adolescent developmental stages. Author(s): McDermott BM, Palmer LJ. Source: The Australian and New Zealand Journal of Psychiatry. 2002 December; 36(6): 754-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12406117&dopt=Abstract

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Postnatal depression: working and learning with mothers. Author(s): Alabaster M. Source: Community Nurse. 2000 May; 6(4): 39-40. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12778523&dopt=Abstract

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Postpartum depression among African-American women. Author(s): Amankwaa LC. Source: Issues in Mental Health Nursing. 2003 April-May; 24(3): 297-316. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12623687&dopt=Abstract

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Postpartum depression predictors inventory--revised. Author(s): Beck CT. Source: Advances in Neonatal Care : Official Journal of the National Association of Neonatal Nurses. 2003 February; 3(1): 47-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12882181&dopt=Abstract

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Postpartum depression screening scale: Spanish version. Author(s): Beck CT, Gable RK. Source: Nursing Research. 2003 September-October; 52(5): 296-306. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14501544&dopt=Abstract

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Postpartum depression. Author(s): Blum LD. Source: The New England Journal of Medicine. 2003 March 27; 348(13): 1294. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12660400&dopt=Abstract

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Postpartum depression: what pediatricians need to know. Author(s): Chaudron LH. Source: Pediatrics in Review / American Academy of Pediatrics. 2003 May; 24(5): 15461. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12728188&dopt=Abstract

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Poststroke depression. Author(s): Carota A, Bogousslavsky J. Source: Adv Neurol. 2003; 92: 435-45. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12760211&dopt=Abstract

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Poststroke depression: getting the full picture. Author(s): Turner-Stokes L. Source: Lancet. 2003 May 24; 361(9371): 1757-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12781530&dopt=Abstract

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Poststroke depression: prevalence, diagnosis, treatment, and disease progression. Author(s): Robinson RG. Source: Biological Psychiatry. 2003 August 1; 54(3): 376-87. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12893112&dopt=Abstract

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Postsynaptic density-95 mimics and occludes hippocampal long-term potentiation and enhances long-term depression. Author(s): Stein V, House DR, Bredt DS, Nicoll RA. Source: The Journal of Neuroscience : the Official Journal of the Society for Neuroscience. 2003 July 2; 23(13): 5503-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12843250&dopt=Abstract

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Practical geriatrics: clinically significant nonmajor geriatric depression. Author(s): Lavretsky H, Kumar A. Source: Psychiatric Services (Washington, D.C.). 2003 March; 54(3): 297-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12610234&dopt=Abstract

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Pragmatic evaluation of computer-aided self-help for anxiety and depression. Author(s): Marks IM, Mataix-Cols D, Kenwright M, Cameron R, Hirsch S, Gega L. Source: The British Journal of Psychiatry; the Journal of Mental Science. 2003 July; 183: 57-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12835245&dopt=Abstract

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Pramipexole and pergolide in the treatment of depression in Parkinson's disease: a national multicentre prospective randomized study. Author(s): Rektorova I, Rektor I, Bares M, Dostal V, Ehler E, Fanfrdlova Z, Fiedler J, Klajblova H, Kulist'ak P, Ressner P, Svatova J, Urbanek K, Veliskova J. Source: European Journal of Neurology : the Official Journal of the European Federation of Neurological Societies. 2003 July; 10(4): 399-406. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12823492&dopt=Abstract

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Predictors of depression and life satisfaction among spousal caregivers in hospice: application of a stress process model. Author(s): Haley WE, LaMonde LA, Han B, Burton AM, Schonwetter R. Source: Journal of Palliative Medicine. 2003 April; 6(2): 215-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12854938&dopt=Abstract

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Predictors of response in depression. Author(s): Esposito K, Goodnick P. Source: The Psychiatric Clinics of North America. 2003 June; 26(2): 353-65. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12778838&dopt=Abstract

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Predisposition to depression: the role of attachment. Author(s): Beatson J, Taryan S. Source: The Australian and New Zealand Journal of Psychiatry. 2003 April; 37(2): 21925. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12656963&dopt=Abstract

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Premenstrual symptomatology, locus of control, anxiety and depression in women with normal menstrual cycles. Author(s): Lane T, Francis A. Source: Archives of Women's Mental Health. 2003 April; 6(2): 127-38. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12720063&dopt=Abstract

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Presence of atopy in first-degree relatives as a predictor of a female proband's depression: results from the Northern Finland 1966 Birth Cohort. Author(s): Timonen M, Jokelainen J, Herva A, Zitting P, Meyer-Rochow VB, Rasanen P. Source: The Journal of Allergy and Clinical Immunology. 2003 June; 111(6): 1249-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12789225&dopt=Abstract

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Prevalence and correlates of DSM-IV major depression in an Australian national survey. Author(s): Wilhelm K, Mitchell P, Slade T, Brownhill S, Andrews G. Source: Journal of Affective Disorders. 2003 July; 75(2): 155-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12798255&dopt=Abstract

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Prevalence of anxiety and depression among medical students of private university. Author(s): Inam SN, Saqib A, Alam E. Source: J Pak Med Assoc. 2003 February; 53(2): 44-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12705482&dopt=Abstract

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Prevalence of depression among general hospital surgical inpatients. Author(s): Vaeroy H, Juell M, Hoivik B. Source: Nordic Journal of Psychiatry. 2003; 57(1): 13-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12745787&dopt=Abstract

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Prevalence of depression and other psychiatric disorders among incarcerated youths. Author(s): Domalanta DD, Risser WL, Roberts RE, Risser JM. Source: Journal of the American Academy of Child and Adolescent Psychiatry. 2003 April; 42(4): 477-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12649635&dopt=Abstract

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Prevalence of depression in patients with coronary artery disease in a tertiary care hospital in Pakistan. Author(s): Bokhari SS, Samad AH, Hanif S, Hadique S, Cheema MQ, Fazal MA, Gul M, Bukhari SS, Khan AS. Source: J Pak Med Assoc. 2002 September; 52(9): 436-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12532585&dopt=Abstract

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Prevalence of major depression in deliberate self-harm individuals in Harare, Zimbabwe. Author(s): Chibanda D, Sebit MB, Acuda SW. Source: East Afr Med J. 2002 May; 79(5): 263-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12638812&dopt=Abstract

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Prevalence of sub-threshold depression in elderly patients with chronic obstructive pulmonary disease. Author(s): Yohannes AM, Baldwin RC, Connolly MJ. Source: International Journal of Geriatric Psychiatry. 2003 May; 18(5): 412-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12766917&dopt=Abstract

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Prevalence, etiology, and treatment of depression in Parkinson's disease. Author(s): McDonald WM, Richard IH, DeLong MR. Source: Biological Psychiatry. 2003 August 1; 54(3): 363-75. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12893111&dopt=Abstract

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Prevalence, recognition and management of depression in primary care in Germany: the Depression 2000 study. Author(s): Wittchen HU, Pittrow D. Source: Human Psychopharmacology. 2002 June; 17 Suppl 1: S1-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12404663&dopt=Abstract

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Prevention of relapse in residual depression by cognitive therapy: a controlled trial. Author(s): Paykel ES, Scott J, Teasdale JD, Johnson AL, Garland A, Moore R, Jenaway A, Cornwall PL, Hayhurst H, Abbott R, Pope M. Source: Archives of General Psychiatry. 1999 September; 56(9): 829-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12884889&dopt=Abstract

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Primary care attributes and care for depression among low-income African American women. Author(s): O'Malley AS, Forrest CB, Miranda J. Source: American Journal of Public Health. 2003 August; 93(8): 1328-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12893623&dopt=Abstract

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Problematising depression: young people, mental health and suicidal behaviours. Author(s): Bennett S, Coggan C, Adams P. Source: Social Science & Medicine (1982). 2003 July; 57(2): 289-99. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12765709&dopt=Abstract

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Prolactin response to fenfluramine administration in patients with unipolar and bipolar depression and healthy controls. Author(s): Sher L, Oquendo MA, Li S, Ellis S, Brodsky BS, Malone KM, Cooper TB, Mann JJ. Source: Psychoneuroendocrinology. 2003 May; 28(4): 559-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12689612&dopt=Abstract

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Prolonged cortical electrical depression and diffuse vasospasm without ischemia in a case of severe hemiplegic migraine during pregnancy. Author(s): Gonzalez-Alegre P, Tippin J. Source: Headache. 2003 January; 43(1): 72-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12864763&dopt=Abstract

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Prospective association between obesity and depression: evidence from the Alameda County Study. Author(s): Roberts RE, Deleger S, Strawbridge WJ, Kaplan GA. Source: International Journal of Obesity and Related Metabolic Disorders : Journal of the International Association for the Study of Obesity. 2003 April; 27(4): 514-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12664085&dopt=Abstract

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Psychoendocrine antecedents of persistent first-episode major depression in adolescents: a community-based longitudinal enquiry. Author(s): Goodyer IM, Herbert J, Tamplin A. Source: Psychological Medicine. 2003 May; 33(4): 601-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12785462&dopt=Abstract

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Psychological interventions for depression in adolescent and adult congenital heart disease. Author(s): Lip GY, Lane DA, Millane TA, Tayebjee MH. Source: Cochrane Database Syst Rev. 2003; (3): Cd004394. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12918013&dopt=Abstract

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Psychometric evaluation of the Chicago Multiscale Depression Inventory in multiple sclerosis patients. Author(s): Chang CH, Nyenhuis DL, Cella D, Luchetta T, Dineen K, Reder AT. Source: Multiple Sclerosis (Houndmills, Basingstoke, England). 2003 March; 9(2): 160-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12708812&dopt=Abstract

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Psychometric properties of the Beck Depression Inventory and the Zung Self Rating Depression Scale in adults with mental retardation. Author(s): Powell R. Source: Mental Retardation. 2003 April; 41(2): 88-95. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12622525&dopt=Abstract

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Psychopharmacologic treatment of depression during pregnancy. Author(s): Gold LH. Source: Curr Womens Health Rep. 2003 June; 3(3): 236-41. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12734035&dopt=Abstract

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Psychosocial and vascular risk factors of depression in later life. Author(s): Oldehinkel AJ, Ormel J, Brilman EI, van den Berg MD. Source: Journal of Affective Disorders. 2003 May; 74(3): 237-46. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12738042&dopt=Abstract

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Psychosocial aspects of diabetes with an emphasis on depression. Author(s): Harris MD. Source: Curr Diab Rep. 2003 February; 3(1): 49-55. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12643146&dopt=Abstract

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Psychosocial assessment and management of depression and anxiety in pregnancy. Key aspects of antenatal care for general practice. Author(s): Austin MP. Source: Aust Fam Physician. 2003 March; 32(3): 119-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12666348&dopt=Abstract

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Psychotic depression and mortality. Author(s): Vythilingam M, Chen J, Bremner JD, Mazure CM, Maciejewski PK, Nelson JC. Source: The American Journal of Psychiatry. 2003 March; 160(3): 574-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12611843&dopt=Abstract

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Qualitative analysis of verbal fluency in depression. Author(s): Fossati P, Guillaume le B, Ergis AM, Allilaire JF. Source: Psychiatry Research. 2003 January 25; 117(1): 17-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12581817&dopt=Abstract

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Qualitative study of patients' perceptions of the quality of care for depression in general practice. Author(s): Gask L, Rogers A, Oliver D, May C, Roland M. Source: The British Journal of General Practice : the Journal of the Royal College of General Practitioners. 2003 April; 53(489): 278-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12879827&dopt=Abstract

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Quality improvement report: Effect of a multifaceted approach to detecting and managing depression in primary care. Author(s): Scott J, Thorne A, Horn P. Source: Bmj (Clinical Research Ed.). 2002 October 26; 325(7370): 951-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12399349&dopt=Abstract

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Quality of accommodation and risk of depression in later life: an analysis of prospective data from the Gospel Oak Project. Author(s): Stewart R, Prince M, Harwood R, Whitley R, Mann A. Source: International Journal of Geriatric Psychiatry. 2002 December; 17(12): 1091-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12461756&dopt=Abstract

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Quality of life in OCD: differential impact of obsessions, compulsions, and depression comorbidity. Author(s): Masellis M, Rector NA, Richter MA. Source: Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie. 2003 March; 48(2): 72-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12655903&dopt=Abstract

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Quality of life in older adults receiving medications for anxiety, depression, or insomnia: findings from a community-based study. Author(s): Stein MB, Barrett-Connor E. Source: The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry. 2002 September-October; 10(5): 568-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12213691&dopt=Abstract

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Quality of life in patients with multiple sclerosis: the impact of fatigue and depression. Author(s): Janardhan V, Bakshi R. Source: Journal of the Neurological Sciences. 2002 December 15; 205(1): 51-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12409184&dopt=Abstract

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Questions raised by the cytokine hypothesis of depression. Author(s): de Beaurepaire R. Source: Brain, Behavior, and Immunity. 2002 October; 16(5): 610-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12401476&dopt=Abstract

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Race, quality of depression care, and recovery from major depression in a primary care setting. Author(s): Rollman BL, Hanusa BH, Belnap BH, Gardner W, Cooper LA, Schulberg HC. Source: General Hospital Psychiatry. 2002 November-December; 24(6): 381-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12490339&dopt=Abstract

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Randomized controlled trial of different models of care for nursing home residents with dementia complicated by depression or psychosis. Author(s): Brodaty H, Draper BM, Millar J, Low LF, Lie D, Sharah S, Paton H. Source: The Journal of Clinical Psychiatry. 2003 January; 64(1): 63-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12590626&dopt=Abstract

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Rate of oxygen consumption in seasonal and non-seasonal depression. Author(s): Pinchasov BB, Grischin OV, Putilov AA. Source: World J Biol Psychiatry. 2002 April; 3(2): 101-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12479083&dopt=Abstract

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Rates and predictors of mortality in an aging, rural, community-based cohort: the role of depression. Author(s): Ganguli M, Dodge HH, Mulsant BH. Source: Archives of General Psychiatry. 2002 November; 59(11): 1046-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12418938&dopt=Abstract

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Rationale and options for the long-term treatment of depression. Author(s): Keller MB. Source: Human Psychopharmacology. 2002 June; 17 Suppl 1: S43-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12404670&dopt=Abstract

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Re: Prophylactic therapy with lithium in elderly patients with Unipolar Major Depression. Author(s): Jainer AK, Soni N, Onalaja D. Source: International Journal of Geriatric Psychiatry. 2003 April; 18(4): 353-4; Author Reply 354. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12673613&dopt=Abstract

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Recall bias and major depression lifetime prevalence. Author(s): Patten SB. Source: Social Psychiatry and Psychiatric Epidemiology. 2003 June; 38(6): 290-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12799778&dopt=Abstract

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Recent developments in the psychobiology and pharmacotherapy of depression: optimising existing treatments and novel approaches for the future. Author(s): Farvolden P, Kennedy SH, Lam RW. Source: Expert Opinion on Investigational Drugs. 2003 January; 12(1): 65-86. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12517255&dopt=Abstract

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Recognition of depression among elderly recipients of home care services. Author(s): Brown EL, McAvay G, Raue PJ, Moses S, Bruce ML. Source: Psychiatric Services (Washington, D.C.). 2003 February; 54(2): 208-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12556602&dopt=Abstract

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Recognizing and meeting the needs of patients with mood disorders and comorbid medical illness: a consensus conference of the Depression and Bipolar Support Alliance. Author(s): Lewis L; Depression and Bipolar Support Alliance. Source: Biological Psychiatry. 2003 August 1; 54(3): 181-3. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12893091&dopt=Abstract

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Recognizing and screening for postpartum depression in mothers of NICU infants. Author(s): Beck CT. Source: Advances in Neonatal Care : Official Journal of the National Association of Neonatal Nurses. 2003 February; 3(1): 37-46. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12882180&dopt=Abstract

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Recovery from depression associated with Guillain Barre syndrome. Author(s): Gregory RJ. Source: Issues in Mental Health Nursing. 2003 March; 24(2): 129-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12554424&dopt=Abstract

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Recurrent brief depression--more investigations in clinical samples are now required. Author(s): Baldwin DS. Source: Psychological Medicine. 2003 April; 33(3): 383-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12701659&dopt=Abstract

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Recurrent brief depression--past and future. Author(s): Pezawas L, Angst J, Gamma A, Ajdacic V, Eich D, Rossler W. Source: Progress in Neuro-Psychopharmacology & Biological Psychiatry. 2003 February; 27(1): 75-83. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12551729&dopt=Abstract

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Regional cerebral blood flow in vascular depression assessed by 123I-IMP SPECT. Author(s): Kimura M, Shimoda K, Mizumura S, Tateno A, Fujito T, Mori T, Endo S. Source: Journal of Nippon Medical School = Nihon Ika Daigaku Zasshi. 2003 August; 70(4): 321-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12928712&dopt=Abstract

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Regulation of GRK 2 and 6, beta-arrestin-2 and associated proteins in the prefrontal cortex of drug-free and antidepressant drug-treated subjects with major depression. Author(s): Grange-Midroit M, Garcia-Sevilla JA, Ferrer-Alcon M, La Harpe R, Huguelet P, Guimon J. Source: Brain Research. Molecular Brain Research. 2003 March 17; 111(1-2): 31-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12654503&dopt=Abstract

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Relapse of major depression after complete and partial remission during a 2-year follow-up. Author(s): Pintor L, Gasto C, Navarro V, Torres X, Fananas L. Source: Journal of Affective Disorders. 2003 February; 73(3): 237-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12547292&dopt=Abstract

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Relation of levels of serum lipoproteins to depression after acute myocardial infarction. Author(s): Strik JJ, Lousberg R, Crijns HJ, Maes M, Honig A. Source: The American Journal of Cardiology. 2002 December 15; 90(12): 1368-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12480046&dopt=Abstract

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Relations of positive and negative affectivity to anxiety and depression in children: evidence from a latent variable longitudinal study. Author(s): Lonigan CJ, Phillips BM, Hooe ES. Source: Journal of Consulting and Clinical Psychology. 2003 June; 71(3): 465-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12795571&dopt=Abstract

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Relationship among gender, depression, and needle sharing in a sample of injection drug users. Author(s): Johnson ME, Yep MJ, Brems C, Theno SA, Fisher DG. Source: Psychology of Addictive Behaviors : Journal of the Society of Psychologists in Addictive Behaviors. 2002 December; 16(4): 338-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12503907&dopt=Abstract

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Relationship and differential validity of alexithymia and depression: a comparison of the Toronto Alexithymia and Self-Rating Depression Scales. Author(s): Muller J, Buhner M, Ellgring H. Source: Psychopathology. 2003 March-April; 36(2): 71-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12766316&dopt=Abstract

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Relationship between anxiety/depression and nausea: causal or associative? Author(s): Jagadisha D. Source: General Hospital Psychiatry. 2003 January-February; 25(1): 52; Author Reply 53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12583930&dopt=Abstract

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Relationship between body-mass index and depressive symptoms in patients with major depression. Author(s): Berlin I, Lavergne F. Source: European Psychiatry : the Journal of the Association of European Psychiatrists. 2003 March; 18(2): 85-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12711405&dopt=Abstract

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Relationship between coping, cognitive dysfunction and depression in multiple sclerosis. Author(s): Arnett PA, Higginson CI, Voss WD, Randolph JJ, Grandey AA. Source: Clin Neuropsychol. 2002 August; 16(3): 341-55. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12607147&dopt=Abstract

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Relationship between depression and work outcomes following liver transplantation: the nursing perspective. Author(s): Newton SE. Source: Gastroenterology Nursing : the Official Journal of the Society of Gastroenterology Nurses and Associates. 2003 March-April; 26(2): 68-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12682527&dopt=Abstract

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Relationship between major depression and heart rate variability. Clinical consequences and implications for antidepressive treatment. Author(s): Agelink MW, Boz C, Ullrich H, Andrich J. Source: Psychiatry Research. 2002 December 15; 113(1-2): 139-49. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12467953&dopt=Abstract

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Relationship between self-reported depression and self-reported visual function in Latinos. Author(s): Paz SH, Globe DR, Wu J, Azen SP, Varma R; Los Angeles Latino Eye Study. Source: Archives of Ophthalmology. 2003 July; 121(7): 1021-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12860807&dopt=Abstract

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Relationship of depression to diabetes types 1 and 2: epidemiology, biology, and treatment. Author(s): Musselman DL, Betan E, Larsen H, Phillips LS. Source: Biological Psychiatry. 2003 August 1; 54(3): 317-29. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12893107&dopt=Abstract

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Relationship of gender, depression, and health care delivery with antiretroviral adherence in HIV-infected drug users. Author(s): Turner BJ, Laine C, Cosler L, Hauck WW. Source: Journal of General Internal Medicine : Official Journal of the Society for Research and Education in Primary Care Internal Medicine. 2003 April; 18(4): 248-57. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12709091&dopt=Abstract

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Relationships between depression, lifestyle and quality of life in the community dwelling elderly: a comparison between gender and age groups. Author(s): Demura S, Sato S. Source: Journal of Physiological Anthropology and Applied Human Science. 2003 May; 22(3): 159-66. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12808229&dopt=Abstract

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Relative contributions of parent substance use and childhood maltreatment to chronic homelessness, depression, and substance abuse problems among homeless women: mediating roles of self-esteem and abuse in adulthood. Author(s): Stein JA, Leslie MB, Nyamathi A. Source: Child Abuse & Neglect. 2002 October; 26(10): 1011-27. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12398858&dopt=Abstract

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Reliability and factor structure of the Brazilian version of the Center for Epidemiologic Studies-Depression. Author(s): da Silveira DX, Jorge MR. Source: Psychological Reports. 2002 December; 91(3 Pt 1): 865-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12530737&dopt=Abstract

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Reliability and validity of the assessment of depression in general practice: the Short Depression Interview (SDI). Author(s): Terluin B, van Hout HP, van Marwijk HW, Ader HJ, van der Meer K, de Haan M, van Dyck R. Source: General Hospital Psychiatry. 2002 November-December; 24(6): 396-405. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12490341&dopt=Abstract

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Religious coping and depression among spouses of people with lung cancer. Author(s): Abernethy AD, Chang HT, Seidlitz L, Evinger JS, Duberstein PR. Source: Psychosomatics. 2002 November-December; 43(6): 456-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12444228&dopt=Abstract

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REM sleep latency and wakefulness in the first sleep cycle as markers of major depression: a controlled study vs. schizophrenia and normal controls. Author(s): Rotenberg VS, Shami E, Barak Y, Indursky P, Kayumov L, Mark M. Source: Progress in Neuro-Psychopharmacology & Biological Psychiatry. 2002 October; 26(6): 1211-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12452549&dopt=Abstract

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Reminiscence therapy for older women with depression. Effects of nursing intervention classification in assisted-living long-term care. Author(s): Jones ED. Source: Journal of Gerontological Nursing. 2003 July; 29(7): 26-33; Quiz 56-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12874937&dopt=Abstract

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Remission of depression and the Texas Medication Algorithm Project. Author(s): Trivedi MH. Source: Manag Care Interface. 2003; Suppl B: 9-13. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12647607&dopt=Abstract

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Remission of major depression and obsessive-compulsive disorder after a single unilateral ECT. Author(s): Thomas SG, Kellner CH. Source: The Journal of Ect. 2003 March; 19(1): 50-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12621279&dopt=Abstract

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Remission, residual symptoms, and nonresponse in the usual treatment of major depression in managed clinical practice. Author(s): Cuffel BJ, Azocar F, Tomlin M, Greenfield SF, Busch AB, Croghan TW. Source: The Journal of Clinical Psychiatry. 2003 April; 64(4): 397-402. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12716239&dopt=Abstract

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Reproductive senescence and depression revisited (again). Author(s): Kingsberg SA. Source: Menopause (New York, N.Y.). 2002 November-December; 9(6): 389-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12439096&dopt=Abstract

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Research issues in the study of difficult-to-treat depression. Author(s): Rush AJ, Thase ME, Dube S. Source: Biological Psychiatry. 2003 April 15; 53(8): 743-53. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12706958&dopt=Abstract

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Research on major depression: strategies and priorities. Author(s): Insel TR, Charney DS. Source: Jama : the Journal of the American Medical Association. 2003 June 18; 289(23): 3167-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12813123&dopt=Abstract

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Research to improve the quality of care for depression: alternatives to the simple randomized clinical trial. Author(s): TenHave TR, Coyne J, Salzer M, Katz I. Source: General Hospital Psychiatry. 2003 March-April; 25(2): 115-23. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12676425&dopt=Abstract

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Researchers probe depression in children. Author(s): Voelker R. Source: Jama : the Journal of the American Medical Association. 2003 June 18; 289(23): 3078-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12813098&dopt=Abstract

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Residual cognitive impairment in late-life depression after a 12-month period followup. Author(s): Portella MJ, Marcos T, Rami L, Navarro V, Gasto C, Salamero M. Source: International Journal of Geriatric Psychiatry. 2003 July; 18(7): 571-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12833300&dopt=Abstract

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Residual symptoms in depression: an emerging therapeutic target. Author(s): Fava GA, Fabbri S, Sonino N. Source: Progress in Neuro-Psychopharmacology & Biological Psychiatry. 2002 October; 26(6): 1019-27. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12452521&dopt=Abstract

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Residual symptoms in depression: can treatment be symptom-specific? Author(s): Menza M, Marin H, Opper RS. Source: The Journal of Clinical Psychiatry. 2003 May; 64(5): 516-23. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12755653&dopt=Abstract

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Response to Annie Anargyros-Klinger's 'Depression and Leo Tolstoy'. Author(s): Symington N. Source: The International Journal of Psycho-Analysis. 2002 December; 83(Pt 6): 1438-41; Author Reply 1441-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12521530&dopt=Abstract

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Response to ECT in major depression: are there differences between unipolar and bipolar depression? Author(s): Grunhaus L, Schreiber S, Dolberg OT, Hirshman S, Dannon PN. Source: Bipolar Disorders. 2002; 4 Suppl 1: 91-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12479688&dopt=Abstract

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Review: Beta-blockers increase fatigue and sexual dysfunction but not depression after myocardial infarction. Author(s): Ko DT, Hebert PR, Krumholz HM. Source: Acp Journal Club. 2003 January-February; 138(1): 30; Author Reply 30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12511138&dopt=Abstract

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Risk factors for depression among elderly community subjects: a systematic review and meta-analysis. Author(s): Cole MG, Dendukuri N. Source: The American Journal of Psychiatry. 2003 June; 160(6): 1147-56. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12777274&dopt=Abstract

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Risk factors for depression in postnatal first year, in eastern Turkey. Author(s): Inandi T, Elci OC, Ozturk A, Egri M, Polat A, Sahin TK. Source: International Journal of Epidemiology. 2002 December; 31(6): 1201-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12540723&dopt=Abstract

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Risk of postnatal depression after emergency delivery. Author(s): Koo V, Lynch J, Cooper S. Source: The Journal of Obstetrics and Gynaecology Research. 2003 August; 29(4): 246-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12959147&dopt=Abstract

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Risk-taking sexual behaviour and self-reported depression in middle adolescence--a school-based survey. Author(s): Kosunen E, Kaltiala-Heino R, Rimpela M, Laippala P. Source: Child: Care, Health and Development. 2003 September; 29(5): 337-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12904241&dopt=Abstract

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Role of estrogen in the treatment of depression. Author(s): Grigoriadis S, Kennedy SH. Source: American Journal of Therapeutics. 2002 November-December; 9(6): 503-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12424508&dopt=Abstract

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Role of perfectionism and personality disorder features in response to brief treatment for depression. Author(s): Shahar G, Blatt SJ, Zuroff DC, Pilkonis PA. Source: Journal of Consulting and Clinical Psychology. 2003 June; 71(3): 629-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12795586&dopt=Abstract

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Role of S-adenosyl-L-methionine in the treatment of depression: a review of the evidence. Author(s): Mischoulon D, Fava M. Source: The American Journal of Clinical Nutrition. 2002 November; 76(5): 1158S-61S. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12420702&dopt=Abstract

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Rumination as a common mechanism relating depressive risk factors to depression. Author(s): Spasojevic J, Alloy LB. Source: Emotion (Washington, D.C.). 2001 March; 1(1): 25-37. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12894809&dopt=Abstract

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S100B and response to treatment in major depression: a pilot study. Author(s): Arolt V, Peters M, Erfurth A, Wiesmann M, Missler U, Rudolf S, Kirchner H, Rothermundt M. Source: European Neuropsychopharmacology : the Journal of the European College of Neuropsychopharmacology. 2003 August; 13(4): 235-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12888182&dopt=Abstract

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Salivary cortisol patterns and cognitive speed in major depression: a comparison with allergic rhinitis and healthy control subjects. Author(s): den Hartog HM, Nicolson NA, Derix MM, van Bemmel AL, Kremer B, Jolles J. Source: Biological Psychology. 2003 April; 63(1): 1-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12706961&dopt=Abstract

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Screening elderly patients in an outpatient ophthalmology clinic for dementia, depression, and functional impairment. Author(s): Lee AG, Beaver HA, Jogerst G, Daly JM. Source: Ophthalmology. 2003 April; 110(4): 651-7; Discussion 657. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12689881&dopt=Abstract

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Screening for depression across the lifespan: a review of measures for use in primary care settings. Author(s): Sharp LK, Lipsky MS. Source: American Family Physician. 2002 September 15; 66(6): 1001-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12358212&dopt=Abstract

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Screening for depression among neuro-otology patients with and without identifiable vestibular lesions. Author(s): Grunfeld EA, Gresty MA, Bronstein AM, Jahanshahi M. Source: International Journal of Audiology. 2003 April; 42(3): 161-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12705781&dopt=Abstract

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Screening for depression in adults. Author(s): Das AK, Gross R, Weissman MM. Source: Annals of Internal Medicine. 2003 May 6; 138(9): 767; Author Reply 767-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12729436&dopt=Abstract

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Screening for depression in adults. Author(s): Coyne JC, Palmer SC, Sullivan PA. Source: Annals of Internal Medicine. 2003 May 6; 138(9): 767; Author Reply 767-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12729435&dopt=Abstract

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Screening for depression in chronic hemodialysis patients. Author(s): al-Hihi E, Awad A, Hagedorn A. Source: Mo Med. 2003 May-June; 100(3): 266-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12847869&dopt=Abstract

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Screening for depression in general practice and related medical settings. Author(s): Hickie IB, Davenport TA, Ricci CS. Source: The Medical Journal of Australia. 2002 October 7; 177 Suppl: S111-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12358569&dopt=Abstract

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Screening for depression in medical care: pitfalls, alternatives, and revised priorities. Author(s): Palmer SC, Coyne JC. Source: Journal of Psychosomatic Research. 2003 April; 54(4): 279-87. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12670603&dopt=Abstract

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Screening for depression in older people on medical wards: which cut-point should we use? Author(s): Cullum S, Nandhra H, Darley J, Todd C. Source: International Journal of Geriatric Psychiatry. 2003 April; 18(4): 358-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12673617&dopt=Abstract

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Screening for depression in primary care. Chosen tool makes little sense. Author(s): Brugha TS. Source: Bmj (Clinical Research Ed.). 2003 May 3; 326(7396): 982; Author Reply 982. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12727745&dopt=Abstract

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Screening for depression in primary care. Scientific and statistical errors should have been picked up in peer review. Author(s): Plummer WP. Source: Bmj (Clinical Research Ed.). 2003 May 3; 326(7396): 982; Author Reply 982. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12727777&dopt=Abstract

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Screening for depression in primary care. Study analysis and conclusions are flawed. Author(s): Fahey T, Sullivan F, MacGillivray S. Source: Bmj (Clinical Research Ed.). 2003 May 3; 326(7396): 982; Author Reply 982. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12727748&dopt=Abstract

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Screening for depression. Author(s): Ferrini R, Clark B. Source: American Family Physician. 2003 April 1; 67(7): 1561-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12722858&dopt=Abstract

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Screening for depression. Author(s): McCahill ME. Source: American Family Physician. 2002 September 15; 66(6): 952, 955. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12358221&dopt=Abstract

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Screening for late life depression: cut-off scores for the Geriatric Depression Scale and the Cornell Scale for Depression in Dementia among Japanese subjects. Author(s): Schreiner AS, Hayakawa H, Morimoto T, Kakuma T. Source: International Journal of Geriatric Psychiatry. 2003 June; 18(6): 498-505. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12789670&dopt=Abstract

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Screening for postpartum depression in an inner-city population. Author(s): Morris-Rush JK, Freda MC, Bernstein PS. Source: American Journal of Obstetrics and Gynecology. 2003 May; 188(5): 1217-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12748483&dopt=Abstract

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Screening for poststroke depression in a Hong Kong rehabilitation hospital: impact of different raters. Author(s): Tang WK, Ungvari GS, Chiu HF, Sze KH, Chan AS, Leung TL. Source: The Journal of Nervous and Mental Disease. 2003 July; 191(7): 474-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12891095&dopt=Abstract

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Self, friends, and lovers: structural relations among Beck Depression Inventory scores and perceived mate values. Author(s): Kirsner BR, Figueredo AJ, Jacobs WJ. Source: Journal of Affective Disorders. 2003 July; 75(2): 131-48. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12798253&dopt=Abstract

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Self-exclusion from health care in women at high risk for postpartum depression. Author(s): Murray L, Woolgar M, Murray J, Cooper P. Source: Journal of Public Health Medicine. 2003 June; 25(2): 131-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12848402&dopt=Abstract

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Self-report bias and underreporting of depression on the BDI-II. Author(s): Hunt M, Auriemma J, Cashaw AC. Source: Journal of Personality Assessment. 2003 February; 80(1): 26-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12584064&dopt=Abstract

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Sensitivity and specificity of memory dysfunction in schizophrenia: a comparison with major depression. Author(s): Egeland J, Sundet K, Rund BR, Asbjornsen A, Hugdahl K, Landro NI, Lund A, Roness A, Stordal KI. Source: J Clin Exp Neuropsychol. 2003 February; 25(1): 79-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12607174&dopt=Abstract

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Separate personality traits from states to predict depression. Author(s): Clark LA, Vittengl J, Kraft D, Jarrett RB. Source: Journal of Personality Disorders. 2003 April; 17(2): 152-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12755328&dopt=Abstract

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Sertraline as monotherapy in the treatment of psychotic and nonpsychotic depression. Author(s): Simpson GM, El Sheshai A, Rady A, Kingsbury SJ, Fayek M. Source: The Journal of Clinical Psychiatry. 2003 August; 64(8): 959-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12927014&dopt=Abstract

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Sertraline is more effective than imipramine in the treatment of non-melancholic depression: results from a multicentre, randomized study. Author(s): Baca E, Gonzalez de Chavez M, Garcia-Toro M, Perez-Arnau F, PorrasChavarino A. Source: Progress in Neuro-Psychopharmacology & Biological Psychiatry. 2003 May; 27(3): 493-500. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12691786&dopt=Abstract

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Serum cholesterol in treatment-resistant depression. Author(s): Papakostas GI, Petersen T, Sonawalla SB, Merens W, Iosifescu DV, Alpert JE, Fava M, Nierenberg AA. Source: Neuropsychobiology. 2003; 47(3): 146-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12759558&dopt=Abstract

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Severity, chronicity, and timing of maternal depression and risk for adolescent offspring diagnoses in a community sample. Author(s): Hammen C, Brennan PA. Source: Archives of General Psychiatry. 2003 March; 60(3): 253-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12622658&dopt=Abstract

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Short-term psychodynamic psychotherapy for depression: an examination of statistical, clinically significant, and technique-specific change. Author(s): Hilsenroth MJ, Ackerman SJ, Blagys MD, Baity MR, Mooney MA. Source: The Journal of Nervous and Mental Disease. 2003 June; 191(6): 349-57. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12826915&dopt=Abstract

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Short-term use of estradiol for depression in perimenopausal and postmenopausal women: a preliminary report. Author(s): Cohen LS, Soares CN, Poitras JR, Prouty J, Alexander AB, Shifren JL. Source: The American Journal of Psychiatry. 2003 August; 160(8): 1519-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12900318&dopt=Abstract

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Should primary care physicians screen for depression? Author(s): Tesar GE. Source: Cleve Clin J Med. 2003 June; 70(6): 488-90. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12828219&dopt=Abstract

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Shoulder EMG during depression raise in men with spinal cord injury: the influence of lesion level. Author(s): Newsam CJ, Lee AD, Mulroy SJ, Perry J. Source: J Spinal Cord Med. 2003 Spring; 26(1): 59-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12830971&dopt=Abstract

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Sleep disturbances and depression in the elderly in Japan. Author(s): Sukegawa T, Itoga M, Seno H, Miura S, Inagaki T, Saito W, Uegaki J, Miyaoka T, Momose I, Kasahara K, Oshiro R, Shimizu Y, Yasukawa R, Mihara T, Maeda T, Mizuno S, Tsubouchi K, Inami Y, Horiguchi J. Source: Psychiatry and Clinical Neurosciences. 2003 June; 57(3): 265-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12753565&dopt=Abstract

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Sleep in depression and sleep deprivation: a brief conceptual review. Author(s): Holsboer-Trachsler E, Seifritz E. Source: World J Biol Psychiatry. 2000 October; 1(4): 180-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12607213&dopt=Abstract

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Smoking related to anxiety and depression in Greek medical staff. Author(s): Tselebis A, Papaleftheris E, Balis E, Theotoka I, Ilias I. Source: Psychological Reports. 2003 April; 92(2): 529-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12785636&dopt=Abstract

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Social change, globalization and transcultural psychiatry--some considerations from a study on women and depression. Author(s): Dech H, Ndetei DM, Machleidt W. Source: Seishin Shinkeigaku Zasshi. 2003; 105(1): 17-27. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12701208&dopt=Abstract

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Social characteristics of seasonal affective disorder patients: comparison with suicide attempters with non-seasonal major depression and other mood disorder patients. Author(s): Pendse BP, Ojehagen A, Engstrom G, Traskman-Bendz L. Source: European Psychiatry : the Journal of the Association of European Psychiatrists. 2003 February; 18(1): 36-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12648896&dopt=Abstract

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Social roles, context and evolution in the origins of depression. Author(s): Brown GW. Source: Journal of Health and Social Behavior. 2002 September; 43(3): 255-76. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12467252&dopt=Abstract

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Social stress and women's risk for recurrent depression. Author(s): Hammen C. Source: Archives of Women's Mental Health. 2003 February; 6(1): 9-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12715260&dopt=Abstract

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Somatic symptoms for diagnosing major depression in cancer patients. Author(s): Akechi T, Nakano T, Akizuki N, Okamura M, Sakuma K, Nakanishi T, Yoshikawa E, Uchitomi Y. Source: Psychosomatics. 2003 May-June; 44(3): 244-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12724506&dopt=Abstract

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Somatic symptoms in treatment-resistant depression. Author(s): Papakostas GI, Petersen T, Denninger J, Sonawalla SB, Mahal Y, Alpert JE, Nierenberg AA, Fava M. Source: Psychiatry Research. 2003 May 1; 118(1): 39-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12759160&dopt=Abstract

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SSRIs in the treatment of depression in Parkinson's disease. Author(s): Leentjens AF, Vreeling FW, Luijckx GJ, Verhey FR. Source: International Journal of Geriatric Psychiatry. 2003 June; 18(6): 552-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12789682&dopt=Abstract

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ST segment depression criteria and the prevalence of silent cardiac ischemia in hypertensives. Author(s): Boon D, van Goudoever J, Piek JJ, van Montfrans GA. Source: Hypertension. 2003 March; 41(3): 476-81. Epub 2003 February 10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12623946&dopt=Abstract

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Stability of retrospective reports in depression: traumatic events, past depressive episodes, and parental psychopathology. Author(s): Schraedley PK, Turner RJ, Gotlib IH. Source: Journal of Health and Social Behavior. 2002 September; 43(3): 307-16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12467255&dopt=Abstract

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Stress, depression and the activation of the immune system. Author(s): Leonard B. Source: World J Biol Psychiatry. 2000 January; 1(1): 17-25. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12607229&dopt=Abstract

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Stress, social support and depression in single and married mothers. Author(s): Cairney J, Boyle M, Offord DR, Racine Y. Source: Social Psychiatry and Psychiatric Epidemiology. 2003 August; 38(8): 442-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12910340&dopt=Abstract

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Stressful neighborhoods and depression: a prospective study of the impact of neighborhood disorder. Author(s): Latkin CA, Curry AD. Source: Journal of Health and Social Behavior. 2003 March; 44(1): 34-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12751309&dopt=Abstract

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Subjective memory complaints of family members of patients with Alzheimer's disease and depression. Author(s): Heun R, Kockler M, Ptok U. Source: Dementia and Geriatric Cognitive Disorders. 2003; 16(2): 78-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12784031&dopt=Abstract

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Subjective memory impairment, cognitive function and depression--a community study in older Koreans. Author(s): Kim JM, Stewart R, Shin IS, Choi SK, Yoon JS. Source: Dementia and Geriatric Cognitive Disorders. 2003; 15(4): 218-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12626855&dopt=Abstract

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Substance P serum levels are increased in major depression: preliminary results. Author(s): Bondy B, Baghai TC, Minov C, Schule C, Schwarz MJ, Zwanzger P, Rupprecht R, Moller HJ. Source: Biological Psychiatry. 2003 March 15; 53(6): 538-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12644359&dopt=Abstract

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Suicidal ideation and frontal lobe dysfunction: a study examining the relationship between clinical frontal lobe tests depression and suicidal ideation. Author(s): Belderbos S, Shah A. Source: International Journal of Geriatric Psychiatry. 2003 June; 18(6): 545-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12789679&dopt=Abstract

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Suicide and major depression. Author(s): Wright G. Source: The American Journal of Psychiatry. 2003 June; 160(6): 1192-3; Author Reply 1193. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12777294&dopt=Abstract

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Suitable dose and duration of fluvoxamine administration to treat depression. Author(s): Morishita S, Arita S. Source: Psychiatry and Clinical Neurosciences. 2003 April; 57(2): 177-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12667164&dopt=Abstract

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Sylvia Plath and the depression continuum. Author(s): Ryle A. Source: Journal of the Royal Society of Medicine. 2003 September; 96(9): 471-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12949209&dopt=Abstract

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Sylvia Plath and the depression continuum. Author(s): Cooper B. Source: Journal of the Royal Society of Medicine. 2003 June; 96(6): 296-301. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12782699&dopt=Abstract

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Symptoms of depression and anxiety, and screening for mental disorders in migrainous patients. Author(s): Kowacs F, Socal MP, Ziomkowski SC, Borges-Neto VF, Toniolo DP, Francesconi CR, Chaves ML. Source: Cephalalgia : an International Journal of Headache. 2003 March; 23(2): 79-89. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12603363&dopt=Abstract

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Symptoms of depression as a risk factor for incident diabetes: findings from the National Health and Nutrition Examination Epidemiologic Follow-up Study, 19711992. Author(s): Carnethon MR, Kinder LS, Fair JM, Stafford RS, Fortmann SP. Source: American Journal of Epidemiology. 2003 September 1; 158(5): 416-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12936896&dopt=Abstract

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Symptoms of depression in older adults with multiple sclerosis (MS): comparison with a matched sample of younger adults. Author(s): Kneebone II, Dunmore EC, Evans E. Source: Aging & Mental Health. 2003 May; 7(3): 182-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12775398&dopt=Abstract

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Targeting smokers at increased risk for relapse: treating women and those with a history of depression. Author(s): Smith SS, Jorenby DE, Leischow SJ, Nides MA, Rennard SI, Johnston JA, Jamerson B, Fiore MC, Baker TB. Source: Nicotine & Tobacco Research : Official Journal of the Society for Research on Nicotine and Tobacco. 2003 February; 5(1): 99-109. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12745511&dopt=Abstract

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The association between age and depression in the general population: a multivariate examination. Author(s): Stordal E, Mykletun A, Dahl AA. Source: Acta Psychiatrica Scandinavica. 2003 February; 107(2): 132-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12534439&dopt=Abstract

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The association between depression and isotretinoin use in acne. Author(s): Ng CH, Schweitzer I. Source: The Australian and New Zealand Journal of Psychiatry. 2003 February; 37(1): 7884. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12534661&dopt=Abstract

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The benefit of oestrogens and progestogens in postnatal depression. Author(s): Karuppaswamy J, Vlies R. Source: Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology. 2003 July; 23(4): 341-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12881067&dopt=Abstract

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The challenge of comorbid disorders in patients with depression. Author(s): Rosenthal MH. Source: J Am Osteopath Assoc. 2003 August; 103(8 Suppl 4): S10-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12956252&dopt=Abstract

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The clinical profile of psychotic depression. Author(s): Samuel M, Varghese M. Source: The Australian and New Zealand Journal of Psychiatry. 2003 February; 37(1): 111. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12534668&dopt=Abstract

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The core elements of neurosis: mixed anxiety-depression (cothymia) and personality disorder. Author(s): Tyrer P, Seivewright H, Johnson T. Source: Journal of Personality Disorders. 2003 April; 17(2): 129-38. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12755326&dopt=Abstract

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The Danish PET/depression project: poor verbal fluency performance despite normal prefrontal activation in patients with major depression. Author(s): Videbech P, Ravnkilde B, Kristensen S, Egander A, Clemmensen K, Rasmussen NA, Gjedde A, Rosenberg R. Source: Psychiatry Research. 2003 May 1; 123(1): 49-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12738343&dopt=Abstract

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The dark days of postpartum depression. Primary care screening is essential. Author(s): Albert C. Source: Adv Nurse Pract. 2002 June; 10(6): 67-70. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12400366&dopt=Abstract

Studies 295

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The degree of depression in Hamilton rating scale is correlated with the density of presynaptic serotonin transporters in 23 patients with Wilson's disease. Author(s): Eggers B, Hermann W, Barthel H, Sabri O, Wagner A, Hesse S. Source: Journal of Neurology. 2003 May; 250(5): 576-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12736737&dopt=Abstract

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The Depression Anxiety Stress Scales (DASS): detecting anxiety disorder and depression in employees absent from work because of mental health problems. Author(s): Nieuwenhuijsen K, de Boer AG, Verbeek JH, Blonk RW, van Dijk FJ. Source: Occupational and Environmental Medicine. 2003 June; 60 Suppl 1: I77-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12782751&dopt=Abstract

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The Depression Anxiety Stress Scales (DASS): normative data and latent structure in a large non-clinical sample. Author(s): Crawford JR, Henry JD. Source: The British Journal of Clinical Psychology / the British Psychological Society. 2003 June; 42(Pt 2): 111-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12828802&dopt=Abstract

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The Depression-Arkansas scale: A validation study of a new brief depression scale in an HMO. Author(s): Walter LJ, Meresman JF, Kramer TL, Evans RB. Source: Journal of Clinical Psychology. 2003 April; 59(4): 465-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12652638&dopt=Abstract

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The economic burden of depression and the cost-effectiveness of treatment. Author(s): Wang PS, Simon G, Kessler RC. Source: Int J Methods Psychiatr Res. 2003; 12(1): 22-33. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12830307&dopt=Abstract

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The economic burden of depression with painful symptoms. Author(s): Greenberg PE, Leong SA, Birnbaum HG, Robinson RL. Source: The Journal of Clinical Psychiatry. 2003; 64 Suppl 7: 17-23. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12755648&dopt=Abstract

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The effect of depression on social engagement in newly admitted Dutch nursing home residents. Author(s): Achterberg W, Pot AM, Kerkstra A, Ooms M, Muller M, Ribbe M. Source: The Gerontologist. 2003 April; 43(2): 213-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12677078&dopt=Abstract

296 Depression

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The effect of peer support on postpartum depression: a pilot randomized controlled trial. Author(s): Dennis CL. Source: Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie. 2003 March; 48(2): 115-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12655910&dopt=Abstract

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The effects of psychotherapy, nefazodone, and their combination on subjective assessment of disturbed sleep in chronic depression. Author(s): Manber R, Rush AJ, Thase ME, Amow B, Klein D, Trivedi MH, Korenstein SG, Markowitz JC, Dunner DL, Munsaka M, Borian FE, Martin, Keller B. Source: Sleep. 2003 March 15; 26(2): 130-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12683470&dopt=Abstract

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The external validity of controlled clinical trials of psychotherapy for depression and anxiety: a naturalistic study. Author(s): Morrison KH, Bradley R, Westen D. Source: Psychology and Psychotherapy. 2003 June; 76(Pt 2): 109-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12855059&dopt=Abstract

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The heritability of bipolar affective disorder and the genetic relationship to unipolar depression. Author(s): McGuffin P, Rijsdijk F, Andrew M, Sham P, Katz R, Cardno A. Source: Archives of General Psychiatry. 2003 May; 60(5): 497-502. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12742871&dopt=Abstract

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The impact of apathy and depression on quality of life in patients infected with HIV. Author(s): Tate D, Paul RH, Flanigan TP, Tashima K, Nash J, Adair C, Boland R, Cohen RA. Source: Aids Patient Care and Stds. 2003 March; 17(3): 115-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12724007&dopt=Abstract

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The impact of synaptic depression following brain damage: a connectionist account of "access/refractory" and "degraded-store" semantic impairments. Author(s): Gotts SJ, Plaut DC. Source: Cognitive, Affective & Behavioral Neuroscience. 2002 September; 2(3): 187-213. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12775185&dopt=Abstract

Studies 297

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The influence of social support and problematic support on optimism and depression in chronic illness: a prospective study evaluating self-esteem as a mediator. Author(s): Symister P, Friend R. Source: Health Psychology : Official Journal of the Division of Health Psychology, American Psychological Association. 2003 March; 22(2): 123-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12683732&dopt=Abstract

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The myth of reserpine-induced depression: role in the historical development of the monoamine hypothesis. Author(s): Baumeister AA, Hawkins MF, Uzelac SM. Source: Journal of the History of the Neurosciences. 2003 June; 12(2): 207-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12953623&dopt=Abstract

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The neuropsychology of depression: a literature review and preliminary model. Author(s): Shenal BV, Harrison DW, Demaree HA. Source: Neuropsychology Review. 2003 March; 13(1): 33-42. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12691500&dopt=Abstract

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The perception of emotional chimeric faces in patients with depression, mania and unilateral brain damage. Author(s): Kucharska-Pietura K, David AS. Source: Psychological Medicine. 2003 May; 33(4): 739-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12785476&dopt=Abstract

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The pilot study of a telephone disease management program for depression. Author(s): Datto CJ, Thompson R, Horowitz D, Disbot M, Oslin DW. Source: General Hospital Psychiatry. 2003 May-June; 25(3): 169-77. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12748029&dopt=Abstract

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The prevalence and impact of large sudden improvements during adolescent therapy for depression: a comparison across cognitive-behavioral, family, and supportive therapy. Author(s): Gaynor ST, Weersing VR, Kolko DJ, Birmaher B, Heo J, Brent DA. Source: Journal of Consulting and Clinical Psychology. 2003 April; 71(2): 386-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12699032&dopt=Abstract

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The prolactin response to fenfluramine in depression: effects of melancholia and baseline cortisol. Author(s): Mulder RT, Porter RJ, Joyce PR. Source: Journal of Psychopharmacology (Oxford, England). 2003 March; 17(1): 97-102. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12680745&dopt=Abstract

298 Depression

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The relationship between chronic pain, immune function, depression, and health behaviors. Author(s): Vines SW, Gupta S, Whiteside T, Dostal-Johnson D, Hummler-Davis A. Source: Biological Research for Nursing. 2003 July; 5(1): 18-29. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12886667&dopt=Abstract

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The relationship between homework compliance and treatment outcomes among older adult outpatients with mild-to-moderate depression. Author(s): Coon DW, Thompson LW. Source: The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry. 2003 January-February; 11(1): 53-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12527540&dopt=Abstract

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The relationship of attachment style to depression, catastrophizing and health care utilization in patients with chronic pain. Author(s): Ciechanowski P, Sullivan M, Jensen M, Romano J, Summers H. Source: Pain. 2003 August; 104(3): 627-37. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12927635&dopt=Abstract

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The Spanish form of the Death Depression Scale. Author(s): Tomas-Sabado J, Gomez-Benito J. Source: Percept Mot Skills. 2003 February; 96(1): 49-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12705509&dopt=Abstract

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The symptoms of atypical depression. Author(s): Benazzi F. Source: Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie. 2003 June; 48(5): 350-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12866347&dopt=Abstract

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The tripartite model of anxiety and depression: symptom structure in depressive and hypertensive patient groups. Author(s): Marshall GN, Sherbourne CD, Meredith LS, Camp P, Hays RD. Source: Journal of Personality Assessment. 2003 April; 80(2): 139-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12700017&dopt=Abstract

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Therapeutic effects of milnacipran (serotonin noradrenalin reuptake inhibitor) on depression following mild and moderate traumatic brain injury. Author(s): Kanetani K, Kimura M, Endo S. Source: Journal of Nippon Medical School = Nihon Ika Daigaku Zasshi. 2003 August; 70(4): 313-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12928711&dopt=Abstract

Studies 299

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Therapeutic use of sleep deprivation in depression. Author(s): Giedke H, Schwarzler F. Source: Sleep Medicine Reviews. 2002 October; 6(5): 361-77. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12531127&dopt=Abstract

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Therapies for depression in Parkinson's disease. Author(s): Shabnam GN, Th C, Kho D, H R, Ce C. Source: Cochrane Database Syst Rev. 2003; (3): Cd003465. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12917968&dopt=Abstract

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They wound, work and womanize to mask depression. Boys don't cry. Author(s): Tumolo J. Source: Adv Nurse Pract. 2003 June; 11(6): 79-81. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12807062&dopt=Abstract

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Tianeptine and fluoxetine in major depression: a 6-week randomised double-blind study. Author(s): Novotny V, Faltus F. Source: Human Psychopharmacology. 2002 August; 17(6): 299-303. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12404675&dopt=Abstract

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Traumatic brain injury: depression, neurogenesis, and medication management. Author(s): Perna RB, Rouselle A, Brennan P. Source: The Journal of Head Trauma Rehabilitation. 2003 March-April; 18(2): 201-3. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12802228&dopt=Abstract

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Traumatic grief as a disorder distinct from bereavement-related depression and anxiety: a replication study with bereaved mental health care patients. Author(s): Boelen PA, van den Bout J, de Keijser J. Source: The American Journal of Psychiatry. 2003 July; 160(7): 1339-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12832252&dopt=Abstract

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Treating bipolar depression. Author(s): Shelton RC. Source: The Journal of Family Practice. 2003 March; Suppl: S14-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12676079&dopt=Abstract

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Treating childhood depression over videoconferencing. Author(s): Nelson EL, Barnard M, Cain S. Source: Telemedicine Journal and E-Health : the Official Journal of the American Telemedicine Association. 2003 Spring; 9(1): 49-55. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12699607&dopt=Abstract

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Treating depression in Alzheimer disease: efficacy and safety of sertraline therapy, and the benefits of depression reduction: the DIADS. Author(s): Lyketsos CG, DelCampo L, Steinberg M, Miles Q, Steele CD, Munro C, Baker AS, Sheppard JM, Frangakis C, Brandt J, Rabins PV. Source: Archives of General Psychiatry. 2003 July; 60(7): 737-46. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12860778&dopt=Abstract

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Treating depression in predominantly low-income young minority women: a randomized controlled trial. Author(s): Miranda J, Chung JY, Green BL, Krupnick J, Siddique J, Revicki DA, Belin T. Source: Jama : the Journal of the American Medical Association. 2003 July 2; 290(1): 5765. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12837712&dopt=Abstract

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Treating depression in primary care in low-income women in Santiago, Chile: a randomised controlled trial. Author(s): Araya R, Rojas G, Fritsch R, Gaete J, Rojas M, Simon G, Peters TJ. Source: Lancet. 2003 March 22; 361(9362): 995-1000. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12660056&dopt=Abstract

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Treating treatment-resistant depression. Whether to switch, augment, or combine therapies. Author(s): Bailey KP. Source: Journal of Psychosocial Nursing and Mental Health Services. 2003 June; 41(6): 14-20. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12812001&dopt=Abstract

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Treatment for Adolescents With Depression Study (TADS): rationale, design, and methods. Author(s): Treatment for Adolescents With Depression Study Team. Source: Journal of the American Academy of Child and Adolescent Psychiatry. 2003 May; 42(5): 531-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12707557&dopt=Abstract

Studies 301

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Treatment of bipolar depression: current status, continued challenges, and the STEPBD approach. Author(s): Thase ME, Bhargava M, Sachs GS. Source: The Psychiatric Clinics of North America. 2003 June; 26(2): 495-518. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12778844&dopt=Abstract

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Treatment of cytokine-induced depression. Author(s): Capuron L, Hauser P, Hinze-Selch D, Miller AH, Neveu PJ. Source: Brain, Behavior, and Immunity. 2002 October; 16(5): 575-80. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12401471&dopt=Abstract

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Treatment of depression in patients with heart disease. Author(s): Roose SP. Source: Biological Psychiatry. 2003 August 1; 54(3): 262-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12893102&dopt=Abstract

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Treatment of leuprolide-induced depression with intramuscular testosterone: a case report. Author(s): Freeman MP, Freeman SA. Source: The Journal of Clinical Psychiatry. 2003 March; 64(3): 341-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12716284&dopt=Abstract

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Treatment of major depression and anxiety with the selective serotonin re-uptake enhancer tianeptine in the outpatient psychiatric care setting of India. Author(s): Sonawalla S, Chakraborty N, Parikh R. Source: J Indian Med Assoc. 2003 February; 101(2): 116-7, 124. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12841497&dopt=Abstract

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Treatment of poststroke generalized anxiety disorder comorbid with poststroke depression: merged analysis of nortriptyline trials. Author(s): Kimura M, Tateno A, Robinson RG. Source: The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry. 2003 May-June; 11(3): 320-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12724111&dopt=Abstract

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Treatment-resistant depression: the patient perspective. Author(s): Lewis L, Hoofnagle L. Source: Biological Psychiatry. 2003 April 15; 53(8): 635-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12706949&dopt=Abstract

302 Depression

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Trends in elderly patients' office visits for the treatment of depression according to physician specialty: 1985-1999. Author(s): Harman JS, Crystal S, Walkup J, Olfson M. Source: The Journal of Behavioral Health Services & Research. 2003 July-September; 30(3): 332-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12875100&dopt=Abstract

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Unadjusted and adjusted prevalence of diagnosed depression in type 2 diabetes. Author(s): Nichols GA, Brown JB. Source: Diabetes Care. 2003 March; 26(3): 744-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12610032&dopt=Abstract

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Understanding adolescent depression in ethnocultural context. Author(s): Choi H. Source: Ans. Advances in Nursing Science. 2002 December; 25(2): 71-85. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12484642&dopt=Abstract

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Understanding changes in primary care clinicians' satisfaction from depression care activities during adoption of selective serotonin reuptake inhibitors. Author(s): Shye D, Brown JB, Mullooly JP, Nichols GA. Source: Am J Manag Care. 2002 November; 8(11): 963-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12437311&dopt=Abstract

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Understanding depression in men. Author(s): Walters P, Tylee A. Source: Practitioner. 2003 July; 247(1648): 598-602. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12879565&dopt=Abstract

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Understanding team-based quality improvement for depression in primary care. Author(s): Rubenstein LV, Parker LE, Meredith LS, Altschuler A, dePillis E, Hernandez J, Gordon NP. Source: Health Services Research. 2002 August; 37(4): 1009-29. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12236381&dopt=Abstract

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Understanding the causal relationship between patient-reported interpersonal and technical quality of care for depression. Author(s): Orlando M, Meredith LS. Source: Medical Care. 2002 August; 40(8): 696-704. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12187183&dopt=Abstract

Studies 303

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Unexplained fatigue syndromes in a multinational primary care sample: specificity of definition and prevalence and distinctiveness from depression and generalized anxiety. Author(s): Skapinakis P, Lewis G, Mavreas V. Source: The American Journal of Psychiatry. 2003 April; 160(4): 785-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12668371&dopt=Abstract

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Unmasking disease-specific cerebral blood flow abnormalities: mood challenge in patients with remitted unipolar depression. Author(s): Liotti M, Mayberg HS, McGinnis S, Brannan SL, Jerabek P. Source: The American Journal of Psychiatry. 2002 November; 159(11): 1830-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12411216&dopt=Abstract

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Untreated depression and hippocampal volume loss. Author(s): Sheline YI, Gado MH, Kraemer HC. Source: The American Journal of Psychiatry. 2003 August; 160(8): 1516-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12900317&dopt=Abstract

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Urinary incontinence and depression in middle-aged United States women. Author(s): Nygaard I, Turvey C, Burns TL, Crischilles E, Wallace R. Source: Obstetrics and Gynecology. 2003 January; 101(1): 149-56. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12517660&dopt=Abstract

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Use of a depression screening tool and a fluoxetine-based algorithm to improve the recognition and treatment of depression in cancer patients. A demonstration project. Author(s): Passik SD, Kirsh KL, Theobald D, Donaghy K, Holtsclaw E, Edgerton S, Dugan W. Source: Journal of Pain and Symptom Management. 2002 September; 24(3): 318-27. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12458113&dopt=Abstract

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Use of cognitive therapy for relapse prevention in chronic depression. Costeffectiveness study. Author(s): Scott J, Palmer S, Paykel E, Teasdale J, Hayhurst H. Source: The British Journal of Psychiatry; the Journal of Mental Science. 2003 March; 182: 221-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12611785&dopt=Abstract

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Use of paroxetine for the treatment of depression and anxiety disorders in the elderly: a review. Author(s): Bourin M. Source: Human Psychopharmacology. 2003 April; 18(3): 185-90. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12672169&dopt=Abstract

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Use of the reasons for depression questionnaire with adolescents. Author(s): Fitzgerald JM, Richardson H. Source: Journal of Clinical Psychology. 2002 September; 58(9): 1045-56. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12209864&dopt=Abstract

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Valid assessment of the clinical features of depression by relatives appears to slip under the RADAR. Author(s): Parker G, Gladstone G, Mitchell P, Welham K, Malhi G, Loo C. Source: The Australian and New Zealand Journal of Psychiatry. 2003 February; 37(1): 926. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12534663&dopt=Abstract

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Validation of the five-item geriatric depression scale in elderly subjects in three different settings. Author(s): Rinaldi P, Mecocci P, Benedetti C, Ercolani S, Bregnocchi M, Menculini G, Catani M, Senin U, Cherubini A. Source: Journal of the American Geriatrics Society. 2003 May; 51(5): 694-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12752847&dopt=Abstract

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Validity of the beck depression inventory, hospital anxiety and depression scale, SCL-90, and hamilton depression rating scale as screening instruments for depression in stroke patients. Author(s): Aben I, Verhey F, Lousberg R, Lodder J, Honig A. Source: Psychosomatics. 2002 September-October; 43(5): 386-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12297607&dopt=Abstract

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Validity of the Beck Depression Inventory-Fast Screen in multiple sclerosis. Author(s): Benedict RH, Fishman I, McClellan MM, Bakshi R, Weinstock-Guttman B. Source: Multiple Sclerosis (Houndmills, Basingstoke, England). 2003 August; 9(4): 393-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12926845&dopt=Abstract

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Validity of the Depression-Arkansas (D-ARK) Scale: a tool for measuring major depressive disorder. Author(s): Smith GR, Kramer TL, Hollenberg JA, Mosley CL, Ross RL, Burnam A. Source: Mental Health Services Research. 2002 September; 4(3): 167-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12385569&dopt=Abstract

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Validity of the hospital anxiety and depression scale for use with patients with noncardiac chest pain. Author(s): Kuijpers PM, Denollet J, Lousberg R, Wellens HJ, Crijns H, Honig A. Source: Psychosomatics. 2003 July-August; 44(4): 329-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12832599&dopt=Abstract

Studies 305

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Vascular disease, depression, and dementia. Author(s): Alexopoulos GS. Source: Journal of the American Geriatrics Society. 2003 August; 51(8): 1178-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12890087&dopt=Abstract

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Vascular risk to late-life depression: evidence from a longitudinal community study. Author(s): Hickie I, Simons L, Naismith S, Simons J, McCallum J, Pearson K. Source: The Australian and New Zealand Journal of Psychiatry. 2003 February; 37(1): 625. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12534658&dopt=Abstract

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Vasomotor symptoms are associated with depression in perimenopausal women seeking primary care. Author(s): Joffe H, Hall JE, Soares CN, Hennen J, Reilly CJ, Carlson K, Cohen LS. Source: Menopause (New York, N.Y.). 2002 November-December; 9(6): 392-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12439097&dopt=Abstract

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Violence and risk of PTSD, major depression, substance abuse/dependence, and comorbidity: results from the National Survey of Adolescents. Author(s): Kilpatrick DG, Ruggiero KJ, Acierno R, Saunders BE, Resnick HS, Best CL. Source: Journal of Consulting and Clinical Psychology. 2003 August; 71(4): 692-700. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12924674&dopt=Abstract

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Visual cortex: suppression by depression? Author(s): Mrsic-Flogel T, Hubener M. Source: Current Biology : Cb. 2002 August 20; 12(16): R547-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12194833&dopt=Abstract

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Visuo-motor coordination is normal in patients with major depression. Author(s): Hocherman S, Dimant A, Schwartz M. Source: Parkinsonism & Related Disorders. 2003 August; 9(6): 361-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12853236&dopt=Abstract

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Vitamin B12, folate, and homocysteine in depression: the Rotterdam Study. Author(s): Tiemeier H, van Tuijl HR, Hofman A, Meijer J, Kiliaan AJ, Breteler MM. Source: The American Journal of Psychiatry. 2002 December; 159(12): 2099-101. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12450964&dopt=Abstract

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What does the Keane PTSD scale of the MMPI measure? Repeated measurements in a group of patients with major depression. Author(s): Wetzel RD, Murphy GE, Simons A, Lustman P, North C, Yutzy S. Source: Psychological Reports. 2003 June; 92(3 Pt 1): 781-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12841442&dopt=Abstract

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When adolescents disagree with their mothers: CBCL-YSR discrepancies related to maternal depression and adolescent self-esteem. Author(s): Berg-Nielsen TS, Vika A, Dahl AA. Source: Child: Care, Health and Development. 2003 May; 29(3): 207-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12752611&dopt=Abstract

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When depression is the diagnosis, what happens to patients and are they satisfied? Author(s): Solberg LI, Fischer LR, Rush WA, Wei F. Source: Am J Manag Care. 2003 February; 9(2): 131-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12597601&dopt=Abstract

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When does ST-segment depression in the presence of a narrow QRS tachycardia signify ischemia? Author(s): Thompson C, Tsiperfal A. Source: Progress in Cardiovascular Nursing. 2003 Winter; 18(1): 60-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12624574&dopt=Abstract

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When joy becomes grief. Screening tools for postpartum depression. Author(s): Vieira T. Source: Awhonn Lifelines / Association of Women's Health, Obstetric and Neonatal Nurses. 2002 December; 6(6): 506-13. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12593259&dopt=Abstract

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When should a trial of fluoxetine for major depression be declared failed? Author(s): Quitkin FM, Petkova E, McGrath PJ, Taylor B, Beasley C, Stewart J, Amsterdam J, Fava M, Rosenbaum J, Reimherr F, Fawcett J, Chen Y, Klein D. Source: The American Journal of Psychiatry. 2003 April; 160(4): 734-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12668363&dopt=Abstract

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When the cradle falls II: The cost-effectiveness of treating postnatal depression in a psychiatric day hospital compared with routine primary care. Author(s): Boath E, Major K, Cox J. Source: Journal of Affective Disorders. 2003 April; 74(2): 159-66. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12706517&dopt=Abstract

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Which depression screening tools should be used in palliative care? Author(s): Lloyd-Williams M, Spiller J, Ward J. Source: Palliative Medicine. 2003 January; 17(1): 40-3. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12597464&dopt=Abstract

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Willingness to pay for depression treatment in primary care. Author(s): Unutzer J, Katon WJ, Russo J, Simon G, von Korff M, Lin E, Walker E, Ludman E, Bush T. Source: Psychiatric Services (Washington, D.C.). 2003 March; 54(3): 340-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12610241&dopt=Abstract

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Wolf-Hirschhorn (4p-)syndrome in a near adult with major depression; successful treatment with citalopram. Author(s): Verhoeven WM, Moog U, Wagemans AM, Tuinier S. Source: Genet Couns. 2002; 13(3): 297-301. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12416637&dopt=Abstract

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Women and depression: a millennial perspective. Author(s): Blehar MC, Keita GP. Source: Journal of Affective Disorders. 2003 March; 74(1): 1-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12646293&dopt=Abstract

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Women's conceptions of coping with major depression in daily life: a qualitative, salutogenic approach. Author(s): Skarsater I, Dencker K, Bergbom I, Haggstrom L, Fridlund B. Source: Issues in Mental Health Nursing. 2003 June; 24(4): 419-39. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12746183&dopt=Abstract

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Work, social, and family disabilities of subjects with anxiety and depression. Author(s): Kennedy BL, Lin Y, Schwab JJ. Source: Southern Medical Journal. 2002 December; 95(12): 1424-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12597311&dopt=Abstract

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Working memory and prefrontal cortex dysfunction: specificity to schizophrenia compared with major depression. Author(s): Barch DM, Sheline YI, Csernansky JG, Snyder AZ. Source: Biological Psychiatry. 2003 March 1; 53(5): 376-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12614990&dopt=Abstract

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Workplace bullying and the risk of cardiovascular disease and depression. Author(s): Kivimaki M, Virtanen M, Vartia M, Elovainio M, Vahtera J, KeltikangasJarvinen L. Source: Occupational and Environmental Medicine. 2003 October; 60(10): 779-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14504368&dopt=Abstract

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World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of bipolar disorders. Part I: Treatment of bipolar depression. Author(s): Grunze H, Kasper S, Goodwin G, Bowden C, Baldwin D, Licht R, Vieta E, Moller HJ; World Federation of Societies of Biological Psychiatry Task Force on Treatment Guidelines for Bipolar Disorders. Source: World J Biol Psychiatry. 2002 July; 3(3): 115-24. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12478876&dopt=Abstract

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CHAPTER 2. NUTRITION AND DEPRESSION Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and depression.

Finding Nutrition Studies on Depression The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “depression” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

7

Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

310 Depression

The following is a typical result when searching for recently indexed consumer information on depression: •

Dieting, essential fatty acid intake, and depression. Author(s): University of Arizona College of Public Health, Tucson 85724, USA. Source: Bruinsma, K A Taren, D L Nutr-Revolume 2000 April; 58(4): 98-108 0029-6643

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Estrogen and perimenopausal depression. Source: Anonymous Harv-Womens-Health-Watch. 2000 December; 8(4): 7 1070-910X

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Lifetime prevalence of major depression and its effect on treatment outcome in obese type II diabetic patients. Author(s): Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania. Source: Marcus, M D Wing, R R Guare, J Blair, E H Jawad, A Diabetes-Care. 1992 February; 15(2): 253-5 0149-5992

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Mental health. Relieving depression. Source: Anonymous Harv-Womens-Health-Watch. 2000 February; 7(6): 4-5 1070-910X

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Natural hazards. Tonic or toxic? Americans are gobbling up nature's remedies for everything from obesity to depression. Source: Spake, A US-News-World-Repage 2001 February 12; 130(6): 42-9 0041-5537

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Nutrition and depression: the role of folate. Author(s): Department of Psychiatry, Harvard Medical School, Boston, MA 02114, USA. Source: Alpert, J E Fava, M Nutr-Revolume 1997 May; 55(5): 145-9 0029-6643

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St. John's wort for depression. Source: Anonymous Harv-Womens-Health-Watch. 2000 November; 8(3): 1 1070-910X

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Study shows St. John's wort ineffective for major depression. Source: Anonymous FDA-Consum. 2002 May-June; 36(3): 8 0362-1332

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Three concentrations of St. John's Wort effective against depression. Source: Morien, K. HerbalGram. Austin, TX : American Botanical Council and the Herb Research Foundation. 2000. (49) page 25-26. 0899-5648

The following information is typical of that found when using the “Full IBIDS Database” to search for “depression” (or a synonym): •

31P-MRS study of acetyl-L-carnitine treatment in geriatric depression: preliminary results. Author(s): Neurophysics Laboratory, Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA. [email protected] Source: Pettegrew, Jay W Levine, Joseph Gershon, Samuel Stanley, Jeffrey A Servan Schreiber, David Panchalingam, Kanagasabai McClure, Richard J Bipolar-Disord. 2002 February; 4(1): 61-6 1398-5647

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Antidepressant activity of standardized extract of Bacopa monniera in experimental models of depression in rats. Author(s): Department of Pharmacology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India. Source: Sairam, K Dorababu, M Goel, R K Bhattacharya, S K Phytomedicine. 2002 April; 9(3): 207-11 0944-7113

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Anxiety, depression, and insomnia. Author(s): Department of Family Medicine, Louisiana State University Health Sciences Center, School of Medicine, 200 West Esplanade Avenue, Suite 510, Kenner, LA 70065, USA. [email protected] Source: Larzelere, M M Wiseman, P Prim-Care. 2002 June; 29(2): 339-60, vii 0095-4543

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APOE epsilon4 and low cholesterol as risks for depression in a biracial elderly community sample. Author(s): Department of Psychiatry and Behavioral Sciences, Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC 277100001, USA. [email protected] Source: Blazer, D G Burchett, B B Fillenbaum, G G Am-J-Geriatr-Psychiatry. 2002 SepOctober; 10(5): 515-20 1064-7481

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Are tryptophan and 5-hydroxytryptophan effective treatments for depression? A meta-analysis. Author(s): School of Population Health, Department of Public Health, University of Queensland Medical School, Herston 4006, Australia. [email protected] Source: Shaw, K Turner, J Del March, C Aust-N-Z-J-Psychiatry. 2002 August; 36(4): 48891 0004-8674

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Blockade of NMDA-receptors or calcium-channels attenuates the ischaemia-evoked efflux of glutamate and phosphoethanolamine and depression of neuronal activity in rat organotypic hippocampal slice cultures. Author(s): Departement de pharmacologie/APSIC, centre medical universitaire, rue Michel-Servet 1, 1211 Geneve 4, Switzerland. Source: Robert, F Bert, L Stoppini, L C-R-Biol. 2002 April; 325(4): 495-504 1631-0691

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Calcineurin regulates induction of late phase of cerebellar long-term depression in rat cultured Purkinje neurons. Author(s): Department of Biophysics, Graduate School of Science, Kyoto University, Sakyo-ku, Kyoto 606-8502, Japan. Source: Fujii, H Hirano, T Eur-J-Neurosci. 2002 November; 16(9): 1777-88 0953-816X

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Cerebellar long-term synaptic depression requires PKC-mediated activation of CPI17, a myosin/moesin phosphatase inhibitor. Author(s): Center for Cell Signaling, University of Virginia School of Medicine, Charlottesville, VA 22908, USA. Source: Eto, M Bock, R Brautigan, D L Linden, D J Neuron. 2002 December 19; 36(6): 1145-58 0896-6273

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Chronic inositol treatment reduces depression-like immobility of Flinders Sensitive Line rats in the forced swim test. Author(s): Beer Sheva Mental Health Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel. Source: Einat, Haim Belmaker, Robert H Zangen, Avraham Overstreet, D H Yadid, Gal Depress-Anxiety. 2002; 15(3): 148-51 1091-4269

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Clinical trials with hypericum extracts in patients with depression--results, comparisons, conclusions for therapy with antidepressant drugs. Author(s): [email protected] Source: Schulz, V Phytomedicine. 2002 July; 9(5): 468-74 0944-7113

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Control of lysine reactivity in four-helix bundle proteins by site-selective pKa depression: expanding the versatility of proteins by postsynthetic functionalization. Author(s): Department of Chemistry, Goteborg University, Sweden.

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Source: Andersson, L K Caspersson, M Baltzer, L Chemistry. 2002 August 16; 8(16): 3687-97 0947-6539 •

Depression and chronic diabetic foot disability. A case report of suicide. Author(s): Department of Orthopaedics and Podiatry, Loyola University Medical Center, 2160 South First Avenue, Maxwood, IL 60153, USA. Source: Walsh, S M Sage, R A Clin-Podiatr-Med-Surg. 2002 October; 19(4): 493-508 08918422

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Depression of fast excitatory synaptic transmission in large aspiny neurons of the neostriatum after transient forebrain ischemia. Author(s): Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA. Source: Pang, Z P Deng, P Ruan, Y W Xu, Z C J-Neurosci. 2002 December 15; 22(24): 10948-57 1529-2401

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Depression of Saccharomyces cerevisiae invasive growth on non-glucose carbon sources requires the Snf1 kinase. Author(s): Department of Chemical Engineering, University of Wisconsin, Madison, Madison, WI 53706, USA. Source: Palecek, S P Parikh, A S Huh, J H Kron, S J Mol-Microbiol. 2002 July; 45(2): 45369 0950-382X

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Determination of the dose of agomelatine, a melatoninergic agonist and selective 5HT(2C) antagonist, in the treatment of major depressive disorder: a placebocontrolled dose range study. Author(s): Service Hospitalo Universitaire de Sante Mentale et de Therapeutique, Hopital Sainte Anne, Paris, France. [email protected] Source: Loo, H Hale, A D'haenen, H Int-Clin-Psychopharmacol. 2002 September; 17(5): 239-47 0268-1315

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Effect of manganese on guinea pig ventricle: initial depression and late augmentation of contractile force. Author(s): Department of Pharmacology, Toho University School of Pharmaceutical Sciences, Funabashi, Chiba, Japan. [email protected] Source: Tanaka, H Ishii, T Fujisaki, R Miyamoto, Y Tanaka, Y Aikawa, T Hirayama, W Kawanishi, T Shigenobu, K Biol-Pharm-Bull. 2002 March; 25(3): 323-6 0918-6158

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Effect of nicotine and nicotinic receptors on anxiety and depression. Author(s): Department of Psychiatry, Yale University School of Medicine, 34 Park Street, New Haven, CT 06508, USA. Source: Picciotto, M R Brunzell, D H Caldarone, B J Neuroreport. 2002 July 2; 13(9): 1097-106 0959-4965

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Effects of U-50,488H, a kappa-opioid receptor agonist, on the learned helplessness model of depression in mice. Author(s): Department of Chemical Pharmacology, Faculty of Pharmacy, Meijo University, Japan. [email protected] Source: Ukai, M Suzuki, M Mamiya, T J-Neural-Transm. 2002 September; 109(9): 1221-5 0300-9564

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Exemplar: reversing respiratory depression. Source: Farland, A Nurs-N-Z. 2001 May; 7(4): 21 1173-2032

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Implications of self-administered St. John's wort for depression symptom management. Author(s): Marinette County Health & Human Service Department, University of Wisconsin-Madison School of Nursing, USA. [email protected] Source: Boehnlein, B Oakley, L D J-Am-Acad-Nurse-Pract. 2002 October; 14(10): 443-8 1041-2972

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Involvement of decreased myo-inositol transport in lipopolysaccharide-induced depression of phosphoinositide hydrolysis in vascular smooth muscle. Author(s): Department of Hygiene and Preventive Medicine, School of Medicine, Yamagata University, Iida-Nishi 2-2-2, Yamagata, Japan. Source: Sotoda, Yoko Negoro, Munetaka Wakabayashi, Ichiro FEBS-Lett. 2002 May 22; 519(1-3): 227-30 0014-5793

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Involvement of N-methyl-D-aspartate receptors for the Ptychodiscus brevis toxininduced depression of monosynaptic and polysynaptic reflexes in neonatal rat spinal cord in vitro. Author(s): Department of Physiology, Institute of Medical Sciences, Banaras Hindu University, 221005, Varanasi, India. Source: Singh, J N Deshpande, S B Neuroscience. 2002; 115(4): 1189-97 0306-4522

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Journal writing as a complementary therapy for reactive depression: a rehabilitation teaching program. Author(s): School of Nursing, University of Kansas Medical Center, Kansas City, KS, USA. Source: Smith, C E Holcroft, C Rebeck, S L Thompson, N C Werkowitch, M RehabilNurs. 2000 Sep-October; 25(5): 170-6 0278-4807

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Kindling enhances kainate receptor-mediated depression of GABAergic inhibition in rat granule cells. Author(s): Departments of Neurology and Physiology, Reed Neurological Research Center, UCLA School of Medicine, Los Angeles, CA 90095- 1769, USA. [email protected] Source: Behr, J Gebhardt, C Heinemann, U Mody, I Eur-J-Neurosci. 2002 September; 16(5): 861-7 0953-816X

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Late life depression. Author(s): Institute of Clinical Neuroscience Sahlgrenska, University Hospital Molndal, Sweden. Source: Gottfries, C G Eur-Arch-Psychiatry-Clin-Neurosci. 2001; 251 Suppl 2: II57-61 0940-1334

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Long-term depression and long-term potentiation in horizontal connections of the barrel cortex. Author(s): Department of Molecular and Cellular Neurobiology, Nencki Institute of Experimental Biology, 3 Pasteur St., 02-093 Warsaw, Poland. Source: Urban, J Kossut, M Hess, G Eur-J-Neurosci. 2002 November; 16(9): 1772-6 0953816X

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Naltrexone in the treatment of heroin dependence: relationship with depression and risk of overdose. Author(s): Turning Point Alcohol and Drug Centre, Fitzroy, Victoria, Australia. [email protected] Source: Ritter, A J Aust-N-Z-J-Psychiatry. 2002 April; 36(2): 224-8 0004-8674

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Neocortical long-term potentiation and long-term depression: site of expression investigated by infrared-guided laser stimulation. Author(s): Department of Clinical Neuropharmacology, Max-Planck-Institute of Psychiatry, 80804 Munich, Germany. [email protected] Source: Eder, M Zieglgansberger, W Dodt, H U J-Neurosci. 2002 September 1; 22(17): 7558-68 1529-2401

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Optical imaging of long-term depression in the mouse cerebellar cortex in vivo. Author(s): Department of Neuroscience, University of Minnesota, Minneapolis, Minnesota 55455, USA. Source: Gao, W Dunbar, R L Chen, G Reinert, K C Oberdick, J Ebner, T J J-Neurosci. 2003 March 1; 23(5): 1859-66 1529-2401

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Panic attack in a context of comorbid anxiety and depression in a Tibetan refugee. Author(s): Department of Social Medicine, Harvard Medical School, Boston, MA 02115, USA. Source: Jacobson, E Cult-Med-Psychiatry. 2002 June; 26(2): 259-79 0165-005X

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Role of selenium depletion in the etiopathogenesis of depression in patient with alcoholism. Source: Sher, L Med-Hypotheses. 2002 September; 59(3): 330-3 0306-9877

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S-adenosylmethionine and depression. Source: Nguyen, Minh Gregan, Angel Aust-Fam-Physician. 2002 April; 31(4): 339-43 0300-8495

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Sex hormones and their impact on dementia and depression: a clinical perspective. Author(s): Department of Psychiatry and Behavioural Science, University of Western Australia, Perth, WA 6847, Australia. [email protected] Source: Almeida, O P Barclay, L Expert-Opin-Pharmacother. 2001 April; 2(4): 527-35 1465-6566

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Sleep-wake effects of yohimbine and atropine in rats with a clomipramine-based model of depression. Author(s): Sleep Research Laboratory, Department of Psychiatry and Behavioral Neuroscience, Boston University School of Medicine, 715 Albany Street, Boston, MA 02118, USA. Source: Mavanji, V Datta, S Neuroreport. 2002 September 16; 13(13): 1603-6 0959-4965

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Spreading depression: imaging and blockade in the rat neocortical brain slice. Author(s): Department of Anatomy and Cell Biology, Queen's University, Kingston, Ontario K7L 3N6, Canada. Source: Anderson, T R Andrew, R D J-Neurophysiol. 2002 November; 88(5): 2713-25 0022-3077

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The role of noradrenaline and selective noradrenaline reuptake inhibition in depression. Author(s): Department of Pharmaceutical Sciences, University of Modena and Reggio Emilia, Modena, Italy. [email protected] Source: Brunello, N Mendlewicz, J Kasper, S Leonard, B Montgomery, S Nelson, J Paykel, E Versiani, M Racagni, G Eur-Neuropsychopharmacol. 2002 October; 12(5): 46175 0924-977X

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Thyroid hormone augmentation with levothyroxine in bipolar depression. Author(s): Department of Psychiatry and Psychotherapy, Charite, Humbo dt Univers ty Berlin, Germany. Source: Bauer, M Bipolar-Disord. 2002; 4 Suppl 1: 109-10 1398-5647

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Topiramate in treatment-resistant depression and binge-eating disorder. Author(s): Behavior Neurobiology Research Group, Neuroscience Laboratory, Biomedical Research Institute, Porto Alegre, PUC-RS, Brazil. [email protected] Source: Schmidt do Prado Lima, P A Bacaltchuck, J Bipolar-Disord. 2002 August; 4(4): 271-3 1398-5647

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Treatment of depression in idiopathic Parkinson's disease. Source: Anonymous Mov-Disord. 2002; 17 Suppl 4: S112-9 0885-3185

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Use of aromatherapy with hospice patients to decrease pain, anxiety, and depression and to promote an increased sense of well-being. Author(s): Department of Nursing, University of Nevada, Las Vegas, USA. Source: Louis, M Kowalski, S D Am-J-Hosp-Palliat-Care. 2002 Nov-December; 19(6): 381-6 1049-9091

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World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of bipolar disorders. Part I: Treatment of bipolar depression. Author(s): Department of Psychiatry, Ludwig-Maximilians-University, Nussbaumstrasse 7, 80336 Munich, Germany. [email protected] Source: Grunze, H Kasper, S Goodwin, G Bowden, C Baldwin, D Licht, R Vieta, E Moller, H J World-J-Biol-Psychiatry. 2002 July; 3(3): 115-24 1562-2975

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

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Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMD®Health: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html

The following is a specific Web list relating to depression; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation (some Web sites are subscription based): •

Vitamins Folic Acid Source: Healthnotes, Inc. www.healthnotes.com Folic Acid Source: Integrative Medicine Communications; www.drkoop.com Folic acid Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,887,00.html Niacin Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,892,00.html Pantothenic acid Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,882,00.html Pyridoxine Source: Integrative Medicine Communications; www.drkoop.com Pyridoxine Alternative names: Vitamin B6 (Pyridoxine) Source: Integrative Medicine Communications; www.drkoop.com

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Riboflavin Source: Integrative Medicine Communications; www.drkoop.com Thiamin (vitamin B Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10060,00.html Thiamine Source: Integrative Medicine Communications; www.drkoop.com Vitamin B Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10067,00.html Vitamin B complex Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,962,00.html Vitamin B1 (Thiamine) Source: Integrative Medicine Communications; www.drkoop.com Vitamin B12 Source: Healthnotes, Inc. www.healthnotes.com Vitamin B12 Source: Prima Communications, Inc.www.personalhealthzone.com Vitamin B2 (Riboflavin) Source: Integrative Medicine Communications; www.drkoop.com Vitamin B6 Source: Healthnotes, Inc. www.healthnotes.com Vitamin B6 Source: Prima Communications, Inc.www.personalhealthzone.com Vitamin B6 (Pyridoxine) Alternative names: Pyridoxine Source: Integrative Medicine Communications; www.drkoop.com Vitamin B6 (Pyridoxine) Source: Integrative Medicine Communications; www.drkoop.com Vitamin B9 (Folic Acid) Alternative names: Folate, Folic Acid Source: Integrative Medicine Communications; www.drkoop.com

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Vitamin C Source: Healthnotes, Inc. www.healthnotes.com Vitamin D Source: Healthnotes, Inc. www.healthnotes.com Vitamin E Source: Healthnotes, Inc. www.healthnotes.com Vitamin K Alternative names: Menadione, Menaphthone, Menaquinone, Phylloquinone Source: Integrative Medicine Communications; www.drkoop.com •

Minerals Acetyl-L-Carnitine Source: Healthnotes, Inc. www.healthnotes.com Aluminum, Calcium, and Magnesium-Containing Preparations Source: Integrative Medicine Communications; www.drkoop.com Biotin Source: Healthnotes, Inc. www.healthnotes.com Calcium Source: Healthnotes, Inc. www.healthnotes.com Calcium Source: Integrative Medicine Communications; www.drkoop.com Calcium Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,884,00.html Calcium Acetate Source: Healthnotes, Inc. www.healthnotes.com Calcium/magnesium Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,937,00.html Carnitine Source: Prima Communications, Inc.www.personalhealthzone.com Chromium Source: Healthnotes, Inc. www.healthnotes.com Copper Source: Healthnotes, Inc. www.healthnotes.com

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Fluoxetine Source: Healthnotes, Inc. www.healthnotes.com Folate Source: Integrative Medicine Communications; www.drkoop.com Folate Source: Prima Communications, Inc.www.personalhealthzone.com Gabapentin Source: Healthnotes, Inc. www.healthnotes.com Iron Source: Healthnotes, Inc. www.healthnotes.com Iron Source: Prima Communications, Inc.www.personalhealthzone.com Lecithin and choline Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10040,00.html Lecithin/Phosphatidylcholine/Choline Source: Healthnotes, Inc. www.healthnotes.com Magnesium Source: Healthnotes, Inc. www.healthnotes.com Magnesium Source: Integrative Medicine Communications; www.drkoop.com Magnesium Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,890,00.html Naproxen/Naproxen Sodium Source: Healthnotes, Inc. www.healthnotes.com Paroxetine Source: Healthnotes, Inc. www.healthnotes.com Potassium-Sparing Diuretics Source: Integrative Medicine Communications; www.drkoop.com Selenium Source: Healthnotes, Inc. www.healthnotes.com Selenium Source: Integrative Medicine Communications; www.drkoop.com

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Selenium Source: Prima Communications, Inc.www.personalhealthzone.com Selenium Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10055,00.html Vanadium Alternative names: Vanadate, Vanadyl Source: Integrative Medicine Communications; www.drkoop.com Zinc Source: Healthnotes, Inc. www.healthnotes.com •

Food and Diet Bluefish Source: Healthnotes, Inc. www.healthnotes.com Coffee Source: Healthnotes, Inc. www.healthnotes.com Fasting Diet Source: Healthnotes, Inc. www.healthnotes.com Gluten-Free Diet Source: Healthnotes, Inc. www.healthnotes.com Low-Fat Recipes Index Source: Healthnotes, Inc. www.healthnotes.com Nutritional Yeast Source: Integrative Medicine Communications; www.drkoop.com Omega-3 Fatty Acids Source: Integrative Medicine Communications; www.drkoop.com Omega-3 fatty acids Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,992,00.html Pumpkin Seeds Source: Healthnotes, Inc. www.healthnotes.com Pumpkin seeds Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,176,00.html

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Salmon Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,102,00.html

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CHAPTER 3. ALTERNATIVE MEDICINE AND DEPRESSION Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to depression. At the conclusion of this chapter, we will provide additional sources.

The Combined Health Information Database The Combined Health Information Database (CHID) is a bibliographic database produced by health-related agencies of the U.S. federal government (mostly from the National Institutes of Health) that can offer concise information for a targeted search. The CHID database is updated four times a year at the end of January, April, July, and October. Check the titles, summaries, and availability of CAM-related information by using the “Simple Search” option at the following Web site: http://chid.nih.gov/simple/simple.html. In the drop box at the top, select “Complementary and Alternative Medicine.” Then type “depression” (or synonyms) in the second search box. We recommend that you select 100 “documents per page” and to check the “whole records” options. The following was extracted using this technique: •

S-Adenosyl-L-Methionine for Treatment of Depression, Osteoarthritis, and Liver Disease Source: Rockville, MD: Agency for Healthcare Research and Quality. 2002. 6 p. Contact: Available from National Center for Complementary and Alternative Medicine Clearinghouse. P.O. Box 7923, Gaithersburg, MD 20898. (888) 644-6226; INTERNATIONAL PHONE: (301) 519-3153; TTY: (866) 464-3615; FAX: (866) 464-3616; EMAIL: [email protected]. PRICE: Free. Publication Number: D175. Summary: This evidence report/technology assessment summary from the Agency for Healthcare Research and Quality (AHRQ) provides a review of the published literature on the use of S-adenosyl-L-methionine (SAMe) for the treatment of osteoarthritis, depression, and liver disease (cholestasis of pregnancy). The literature review is used to evaluate evidence for the efficacy of SAMe. The summary includes a description of the methodology, including the search strategy; selection criteria; and data collection and

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analysis. The findings are then discussed followed by an overview of future research on the topic. Information is also given on when and where the full report will be available. 1 reference.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to depression and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “depression” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to depression: •

A dose-ranging study of the effects of ethyl-eicosapentaenoate in patients with ongoing depression despite apparently adequate treatment with standard drugs. Author(s): Peet M, Horrobin DF. Source: Archives of General Psychiatry. 2002 October; 59(10): 913-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12365878&dopt=Abstract

•

A double-blind, placebo-controlled study of the omega-3 fatty acid docosahexaenoic acid in the treatment of major depression. Author(s): Marangell LB, Martinez JM, Zboyan HA, Kertz B, Kim HF, Puryear LJ. Source: The American Journal of Psychiatry. 2003 May; 160(5): 996-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12727707&dopt=Abstract

•

A meta-analysis of repetitive transcranial magnetic stimulation in the treatment of depression. Author(s): Holtzheimer PE 3rd, Russo J, Avery DH. Source: Psychopharmacology Bulletin. 2001 Autumn; 35(4): 149-69. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12397863&dopt=Abstract

•

A randomized controlled comparison of electroconvulsive therapy and repetitive transcranial magnetic stimulation in severe and resistant nonpsychotic major depression. Author(s): Grunhaus L, Schreiber S, Dolberg OT, Polak D, Dannon PN. Source: Biological Psychiatry. 2003 February 15; 53(4): 324-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12586451&dopt=Abstract

•

A survey of herbal use in children with attention-deficit-hyperactivity disorder or depression. Author(s): Cala S, Crismon ML, Baumgartner J.

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Source: Pharmacotherapy. 2003 February; 23(2): 222-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12587812&dopt=Abstract •

Acute and chronic effects of citalopram on cerebral glucose metabolism in geriatric depression. Author(s): Smith GS, Kramer E, Hermann CR, Goldberg S, Ma Y, Dhawan V, Barnes A, Chaly T, Belakhleff A, Laghrissi-Thode F, Greenwald B, Eidelberg D, Pollock BG. Source: The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry. 2002 November-December; 10(6): 715-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12427580&dopt=Abstract

•

Add-on rTMS for treatment of depression: a pilot study using stereotaxic coilnavigation according to PET data. Author(s): Herwig U, Lampe Y, Juengling FD, Wunderlich A, Walter H, Spitzer M, Schonfeldt-Lecuona C. Source: Journal of Psychiatric Research. 2003 July-August; 37(4): 267-75. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12765849&dopt=Abstract

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Alternative treatments for depression: empirical support and relevance to women. Author(s): Manber R, Allen JJ, Morris MM. Source: The Journal of Clinical Psychiatry. 2002 July; 63(7): 628-40. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12143922&dopt=Abstract

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An open pilot study of nefazodone in depression with anger attacks: relationship between clinical response and receptor binding. Author(s): Mischoulon D, Dougherty DD, Bottonari KA, Gresham RL, Sonawalla SB, Fischman AJ, Fava M. Source: Psychiatry Research. 2002 December 30; 116(3): 151-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12477599&dopt=Abstract

•

An open-label pilot study of St. John's wort in juvenile depression. Author(s): Findling RL, McNamara NK, O'Riordan MA, Reed MD, Demeter CA, Branicky LA, Blumer JL. Source: Journal of the American Academy of Child and Adolescent Psychiatry. 2003 August; 42(8): 908-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12874492&dopt=Abstract

•

Anxiety and depression. Natural mood remedies. Author(s): Miller MC. Source: Newsweek. 2002 December 2; 140(23): 70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12501517&dopt=Abstract

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•

Anxiety, depression, and insomnia. Author(s): Larzelere MM, Wiseman P. Source: Primary Care. 2002 June; 29(2): 339-60, Vii. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12391715&dopt=Abstract

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Arterial endothelial function is impaired in treated depression. Author(s): Broadley AJ, Korszun A, Jones CJ, Frenneaux MP. Source: Heart (British Cardiac Society). 2002 November; 88(5): 521-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12381649&dopt=Abstract

•

Average sunrise time predicts depression prevalence. Author(s): Olders H. Source: Journal of Psychosomatic Research. 2003 August; 55(2): 99-105. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12932507&dopt=Abstract

•

Benefits of infant massage for mothers with postnatal depression. Author(s): Glover V, Onozawa K, Hodgkinson A. Source: Seminars in Neonatology : Sn. 2002 December; 7(6): 495-500. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12614602&dopt=Abstract

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Biological effects of stannous chloride, a substance that can produce stimulation or depression of the central nervous system. Author(s): Silva CR, Oliveira MB, Melo SF, Dantas FJ, de Mattos JC, Bezerra RJ, Caldeira-de-Araujo A, Duatti A, Bernardo-Filho M. Source: Brain Research Bulletin. 2002 November 30; 59(3): 213-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12431751&dopt=Abstract

•

Care for women with postpartum depression: “N*U*R*S*E” approach. Author(s): Sichel D, Driscoll JW. Source: Journal of Midwifery & Women's Health. 2002 September-October; 47(5): 392. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12361354&dopt=Abstract

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Changes in regional cerebral blood flow with venlafaxine in the treatment of major depression. Author(s): Davies J, Lloyd KR, Jones IK, Barnes A, Pilowsky LS. Source: The American Journal of Psychiatry. 2003 February; 160(2): 374-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12562589&dopt=Abstract

•

Clinical and biochemical observations during treatment of depression with electroacupuncture: a pilot study. Author(s): Pohl A, Nordin C.


Source: Human Psychopharmacology. 2002 October; 17(7): 345-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12415553&dopt=Abstract •

Clinical trials with hypericum extracts in patients with depression--results, comparisons, conclusions for therapy with antidepressant drugs. Author(s): Schulz V. Source: Phytomedicine : International Journal of Phytotherapy and Phytopharmacology. 2002 July; 9(5): 468-74. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12222670&dopt=Abstract

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Comment on “Repetitive transcranial magnetic stimulation versus electroconvulsive therapy for major depression: preliminary results of a randomized trial”. Author(s): Kellner CH, Husain M, Petrides G, Fink M, Rummans T. Source: Biological Psychiatry. 2002 November 15; 52(10): 1032-3; Discussion 1033. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12437944&dopt=Abstract

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Comparison of Lavandula angustifolia Mill. tincture and imipramine in the treatment of mild to moderate depression: a double-blind, randomized trial. Author(s): Akhondzadeh S, Kashani L, Fotouhi A, Jarvandi S, Mobaseri M, Moin M, Khani M, Jamshidi AH, Baghalian K, Taghizadeh M. Source: Progress in Neuro-Psychopharmacology & Biological Psychiatry. 2003 February; 27(1): 123-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12551734&dopt=Abstract

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Cytokines and depression. Author(s): Clow A. Source: Int Rev Neurobiol. 2002; 52: 255-73. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12498107&dopt=Abstract

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Depression and HIV infection: impact on immune function and disease progression. Author(s): Cruess DG, Petitto JM, Leserman J, Douglas SD, Gettes DR, Ten Have TR, Evans DL. Source: Cns Spectr. 2003 January; 8(1): 52-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12627049&dopt=Abstract

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Depression and quality of life: results of a follow-up study. Author(s): Angermeyer MC, Holzinger A, Matschinger H, Stengler-Wenzke K. Source: The International Journal of Social Psychiatry. 2002 September; 48(3): 189-99. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12413247&dopt=Abstract

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Depression in cancer: new developments regarding diagnosis and treatment. Author(s): Raison CL, Miller AH.

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Source: Biological Psychiatry. 2003 August 1; 54(3): 283-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12893104&dopt=Abstract •

Depression in children and adolescents. Author(s): Hazell P. Source: American Family Physician. 2003 February 1; 67(3): 577-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12588080&dopt=Abstract

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Depression in patients with heart failure: physiologic effects, incidence, and relation to mortality. Author(s): Thomas SA, Friedmann E, Khatta M, Cook LK, Lann AL. Source: Aacn Clinical Issues. 2003 February; 14(1): 3-12. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12574698&dopt=Abstract

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Depression, anxiety and quality of life: outcome 9 months after facial cosmetic surgery. Author(s): Meningaud JP, Benadiba L, Servant JM, Herve C, Bertrand JC, Pelicier Y. Source: Journal of Cranio-Maxillo-Facial Surgery : Official Publication of the European Association for Cranio-Maxillo-Facial Surgery. 2003 February; 31(1): 46-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12553927&dopt=Abstract

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Depression: the challenge for all healthcare professionals. Author(s): Moore K, McLaughlin D. Source: Nursing Standard : Official Newspaper of the Royal College of Nursing. 2003 March 12-18; 17(26): 45-52; Quiz 54-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12677820&dopt=Abstract

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Developing a culture-specific tool to assess postnatal depression in the Indian community. Author(s): Mantle F. Source: British Journal of Community Nursing. 2003 April; 8(4): 176-80. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12732834&dopt=Abstract

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Diagnosis and management of depression in primary care: a clinical update and review. Author(s): Remick RA. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 2002 November 26; 167(11): 1253-60. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12451082&dopt=Abstract

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Differential brain metabolic predictors of response to paroxetine in obsessivecompulsive disorder versus major depression. Author(s): Saxena S, Brody AL, Ho ML, Zohrabi N, Maidment KM, Baxter LR Jr.


Source: The American Journal of Psychiatry. 2003 March; 160(3): 522-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12611834&dopt=Abstract •

Diseases of the mind and brain: depression: a disease of the mind, brain, and body. Author(s): Gold PW, Charney DS. Source: The American Journal of Psychiatry. 2002 November; 159(11): 1826. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12411213&dopt=Abstract

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Does religious psychotherapy improve anxiety and depression in religious adults? A review of randomized controlled studies. Author(s): Berry D. Source: Int J Psychiatr Nurs Res. 2002 October; 8(1): 875-90. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12448875&dopt=Abstract

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Double-blind controlled investigation of bilateral prefrontal transcranial magnetic stimulation for the treatment of resistant major depression. Author(s): Loo CK, Mitchell PB, Croker VM, Malhi GS, Wen W, Gandevia SC, Sachdev PS. Source: Psychological Medicine. 2003 January; 33(1): 33-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12537034&dopt=Abstract

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Dysfunctional attitudes and 5-HT2 receptors during depression and self-harm. Author(s): Meyer JH, McMain S, Kennedy SH, Korman L, Brown GM, DaSilva JN, Wilson AA, Blak T, Eynan-Harvey R, Goulding VS, Houle S, Links P. Source: The American Journal of Psychiatry. 2003 January; 160(1): 90-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12505806&dopt=Abstract

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Effect of agomelatine in the chronic mild stress model of depression in the rat. Author(s): Papp M, Gruca P, Boyer PA, Mocaer E. Source: Neuropsychopharmacology : Official Publication of the American College of Neuropsychopharmacology. 2003 April; 28(4): 694-703. Epub 2002 October 17. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12655314&dopt=Abstract

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Effect of maternal docosahexaenoic acid supplementation on postpartum depression and information processing. Author(s): Llorente AM, Jensen CL, Voigt RG, Fraley JK, Berretta MC, Heird WC. Source: American Journal of Obstetrics and Gynecology. 2003 May; 188(5): 1348-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12748510&dopt=Abstract

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Effects of animal-assisted therapy on patients' anxiety, fear, and depression before ECT. Author(s): Barker SB, Pandurangi AK, Best AM.

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Source: The Journal of Ect. 2003 March; 19(1): 38-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12621276&dopt=Abstract •

Effects of antidepressant pharmacotherapy after repetitive transcranial magnetic stimulation in major depression: an open follow-up study. Author(s): Schule C, Zwanzger P, Baghai T, Mikhaiel P, Thoma H, Moller HJ, Rupprecht R, Padberg F. Source: Journal of Psychiatric Research. 2003 March-April; 37(2): 145-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12842168&dopt=Abstract

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Efficacy of repetitive transcranial magnetic stimulation in depression: a review of the evidence. Author(s): Aarre TF, Dahl AA, Johansen JB, Kjonniksen I, Neckelmann D. Source: Nordic Journal of Psychiatry. 2003; 57(3): 227-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12775299&dopt=Abstract

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Efficacy of St. John's wort extract WS 5570 in major depression: a double-blind, placebo-controlled trial. Author(s): Lecrubier Y, Clerc G, Didi R, Kieser M. Source: The American Journal of Psychiatry. 2002 August; 159(8): 1361-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12153829&dopt=Abstract

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Focal brain stimulation with repetitive transcranial magnetic stimulation (rTMS): implications for the neural circuitry of depression. Author(s): Lisanby SH. Source: Psychological Medicine. 2003 January; 33(1): 7-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12537031&dopt=Abstract

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Glucose metabolic response to total sleep deprivation, recovery sleep, and acute antidepressant treatment as functional neuroanatomic correlates of treatment outcome in geriatric depression. Author(s): Smith GS, Reynolds CF 3rd, Houck PR, Dew MA, Ma Y, Mulsant BH, Pollock BG. Source: The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry. 2002 September-October; 10(5): 561-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12213690&dopt=Abstract

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Implications of self-administered St. John's wort for depression symptom management. Author(s): Boehnlein B, Oakley LD.


Source: Journal of the American Academy of Nurse Practitioners. 2002 October; 14(10): 443-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12426801&dopt=Abstract •

Internet support groups for depression: a 1-year prospective cohort study. Author(s): Houston TK, Cooper LA, Ford DE. Source: The American Journal of Psychiatry. 2002 December; 159(12): 2062-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12450957&dopt=Abstract

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Lack of a therapeutic effect of a 2-week sub-threshold transcranial magnetic stimulation course for treatment-resistant depression. Author(s): Boutros NN, Gueorguieva R, Hoffman RE, Oren DA, Feingold A, Berman RM. Source: Psychiatry Research. 2002 December 30; 113(3): 245-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12559481&dopt=Abstract

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Left dorso-lateral repetitive transcranial magnetic stimulation affects cortical excitability and functional connectivity, but does not impair cognition in major depression. Author(s): Shajahan PM, Glabus MF, Steele JD, Doris AB, Anderson K, Jenkins JA, Gooding PA, Ebmeier KP. Source: Progress in Neuro-Psychopharmacology & Biological Psychiatry. 2002 June; 26(5): 945-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12369271&dopt=Abstract

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Left prefrontal transcranial magnetic stimulation (TMS) treatment of depression in bipolar affective disorder: a pilot study of acute safety and efficacy. Author(s): Nahas Z, Kozel FA, Li X, Anderson B, George MS. Source: Bipolar Disorders. 2003 February; 5(1): 40-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12656937&dopt=Abstract

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Linking chronic pain and depression. Author(s): Gray E. Source: Nursing Standard : Official Newspaper of the Royal College of Nursing. 2001 March 7-13; 15(25): 33-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12211823&dopt=Abstract

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Long term depression of human nociceptive skin senses induced by thin fibre stimulation. Author(s): Nilsson HJ, Psouni E, Schouenborg J. Source: European Journal of Pain (London, England). 2003; 7(3): 225-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12725845&dopt=Abstract

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Long-term depression induced by sensory deprivation during cortical map plasticity in vivo. Author(s): Allen CB, Celikel T, Feldman DE. Source: Nature Neuroscience. 2003 March; 6(3): 291-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12577061&dopt=Abstract

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Major depression in patients with substance use disorders: relationship to 12-Step self-help involvement and substance use outcomes. Author(s): Kelly JF, McKellar JD, Moos R. Source: Addiction (Abingdon, England). 2003 April; 98(4): 499-508. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12653819&dopt=Abstract

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Mechanism of action of St John's wort in depression : what is known? Author(s): Butterweck V. Source: Cns Drugs. 2003; 17(8): 539-62. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12775192&dopt=Abstract

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Modulating dysfunctional limbic-cortical circuits in depression: towards development of brain-based algorithms for diagnosis and optimised treatment. Author(s): Mayberg HS. Source: British Medical Bulletin. 2003; 65: 193-207. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12697626&dopt=Abstract

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Neural mechanism of propofol anesthesia in severe depression: a positron emission tomographic study. Author(s): Ogawa K, Uema T, Motohashi N, Nishikawa M, Takano H, Hiroki M, Imabayashi E, Ohnishi T, Inoue T, Takayama Y, Takeda M, Matsuda H, Andoh T, Yamada Y. Source: Anesthesiology. 2003 May; 98(5): 1101-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12717131&dopt=Abstract

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Neurobiological bases for the relation between sleep and depression. Author(s): Adrien J. Source: Sleep Medicine Reviews. 2002 October; 6(5): 341-51. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12531125&dopt=Abstract

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Neurobiology: The importance of depression. Author(s): Stevens CF. Source: Nature. 2003 January 2; 421(6918): 29-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12511938&dopt=Abstract

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Neurocognitive effects of repetitive transcranial magnetic stimulation in severe major depression.


Author(s): Martis B, Alam D, Dowd SM, Hill SK, Sharma RP, Rosen C, Pliskin N, Martin E, Carson V, Janicak PG. Source: Clinical Neurophysiology : Official Journal of the International Federation of Clinical Neurophysiology. 2003 June; 114(6): 1125-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12804681&dopt=Abstract •

Omega-3 fatty acids for depression in pregnancy. Author(s): Chiu CC, Huang SY, Shen WW, Su KP. Source: The American Journal of Psychiatry. 2003 February; 160(2): 385. Erratum In: Am J Psychiatry. 2003 April; 160(4): 810. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12562593&dopt=Abstract

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Panic attack in a context of comorbid anxiety and depression in a Tibetan refugee. Author(s): Jacobson E. Source: Culture, Medicine and Psychiatry. 2002 June; 26(2): 259-79. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12211327&dopt=Abstract

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Pathways linking depression, adiposity, and inflammatory markers in healthy young adults. Author(s): Miller GE, Freedland KE, Carney RM, Stetler CA, Banks WA. Source: Brain, Behavior, and Immunity. 2003 August; 17(4): 276-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12831830&dopt=Abstract

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Patient attitudes regarding causes of depression: implications for psychoeducation. Author(s): Srinivasan J, Cohen NL, Parikh SV. Source: Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie. 2003 August; 48(7): 493-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12971021&dopt=Abstract

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Plasma concentrations of neuroactive steroids before and after repetitive transcranial magnetic stimulation (rTMS) in major depression. Author(s): Padberg F, di Michele F, Zwanzger P, Romeo E, Bernardi G, Schule C, Baghai TC, Ella R, Pasini A, Rupprecht R. Source: Neuropsychopharmacology : Official Publication of the American College of Neuropsychopharmacology. 2002 November; 27(5): 874-8. Erratum In: Neuropsychopharmacology. 2003 March; 28(3): 610-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12431862&dopt=Abstract

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Plasma fatty acid composition and depression are associated in the elderly: the Rotterdam Study. Author(s): Tiemeier H, van Tuijl HR, Hofman A, Kiliaan AJ, Breteler MM.

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Source: The American Journal of Clinical Nutrition. 2003 July; 78(1): 40-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12816769&dopt=Abstract •

Postpartum depression, culture and African-American women. Author(s): Amankwaa LC. Source: J Cult Divers. 2003 Spring; 10(1): 23-9. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12776544&dopt=Abstract

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Prefrontal cortex transcranial magnetic stimulation does not change local diffusion: a magnetic resonance imaging study in patients with depression. Author(s): Li X, Nahas Z, Lomarev M, Denslow S, Shastri A, Bohning DE, George MS. Source: Cogn Behav Neurol. 2003 June; 16(2): 128-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12799599&dopt=Abstract

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Psycho-neuro-immunological treatment of hepatocellular carcinoma with major depression--a single case report. Author(s): Jozuka H, Jozuka E, Suzuki M, Takeuchi S, Takatsu Y. Source: Current Medical Research and Opinion. 2003; 19(1): 59-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12661782&dopt=Abstract

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Receptor and transporter imaging studies in schizophrenia, depression, bulimia and Tourette's disorder--implications for psychopharmacology. Author(s): Kasper S, Tauscher J, Willeit M, Stamenkovic M, Neumeister A, Kufferle B, Barnas C, Stastny J, Praschak-Rieder N, Pezawas L, de Zwaan M, Quiner S, Pirker W, Asenbaum S, Podreka I, Brucke T. Source: World J Biol Psychiatry. 2002 July; 3(3): 133-46. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12478878&dopt=Abstract

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Regional brain metabolic correlates of alpha-methylparatyrosine-induced depressive symptoms: implications for the neural circuitry of depression. Author(s): Bremner JD, Vythilingam M, Ng CK, Vermetten E, Nazeer A, Oren DA, Berman RM, Charney DS. Source: Jama : the Journal of the American Medical Association. 2003 June 18; 289(23): 3125-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12813118&dopt=Abstract

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Relaxation and imagery for anxiety and depression control in community patients with advanced cancer. Author(s): Sloman R. Source: Cancer Nursing. 2002 December; 25(6): 432-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12464834&dopt=Abstract


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Repetitive transcranial magnetic stimulation (rTMS) in major depression: relation between efficacy and stimulation intensity. Author(s): Padberg F, Zwanzger P, Keck ME, Kathmann N, Mikhaiel P, Ella R, Rupprecht P, Thoma H, Hampel H, Toschi N, Moller HJ. Source: Neuropsychopharmacology : Official Publication of the American College of Neuropsychopharmacology. 2002 October; 27(4): 638-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12377400&dopt=Abstract

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Repetitive transcranial magnetic stimulation : does it have potential in the treatment of depression? Author(s): Padberg F, Moller HJ. Source: Cns Drugs. 2003; 17(6): 383-403. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12696999&dopt=Abstract

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Repetitive transcranial magnetic stimulation for the treatment of depression. Systematic review and meta-analysis. Author(s): Martin JL, Barbanoj MJ, Schlaepfer TE, Thompson E, Perez V, Kulisevsky J. Source: The British Journal of Psychiatry; the Journal of Mental Science. 2003 June; 182: 480-91. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12777338&dopt=Abstract

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Repetitive transcranial magnetic stimulation treatment of comorbid posttraumatic stress disorder and major depression. Author(s): Rosenberg PB, Mehndiratta RB, Mehndiratta YP, Wamer A, Rosse RB, Balish M. Source: The Journal of Neuropsychiatry and Clinical Neurosciences. 2002 Summer; 14(3): 270-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12154150&dopt=Abstract

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Self-administered treatment in stepped-care models of depression treatment. Author(s): Scogin FR, Hanson A, Welsh D. Source: Journal of Clinical Psychology. 2003 March; 59(3): 341-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12579549&dopt=Abstract

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Six-month depression relapse rates among women treated with acupuncture. Author(s): Gallagher SM, Allen JJ, Hitt SK, Schnyer RN, Manber R. Source: Complementary Therapies in Medicine. 2001 December; 9(4): 216-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12184348&dopt=Abstract

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Somatization, anxiety and depression in a drug-free residential therapeutic community. Author(s): Metrikin AS, Galanter M, Dermatis H, Bunt G.

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Source: The American Journal on Addictions / American Academy of Psychiatrists in Alcoholism and Addictions. 2003 January-February; 12(1): 60-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12623741&dopt=Abstract •

Songwriting and digital video production interventions for pediatric patients undergoing bone marrow transplantation, part I: an analysis of depression and anxiety levels according to phase of treatment. Author(s): Robb SL, Ebberts AG. Source: Journal of Pediatric Oncology Nursing : Official Journal of the Association of Pediatric Oncology Nurses. 2003 January-February; 20(1): 2-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12569430&dopt=Abstract

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St John's wort and depression. Author(s): Cott J, Wisner KL. Source: Jama : the Journal of the American Medical Association. 2002 July 24-31; 288(4): 448; Author Reply 448-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12132966&dopt=Abstract

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St John's wort and depression. Author(s): Linde K, Melchart D, Mulrow CD, Berner M. Source: Jama : the Journal of the American Medical Association. 2002 July 24-31; 288(4): 447-8; Author Reply 448-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12132965&dopt=Abstract

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St John's wort and depression. Author(s): Volp A. Source: Jama : the Journal of the American Medical Association. 2002 July 24-31; 288(4): 447; Author Reply 448-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12132964&dopt=Abstract

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St John's wort and depression. Author(s): Spielmans GI. Source: Jama : the Journal of the American Medical Association. 2002 July 24-31; 288(4): 446-7; Author Reply 448-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12132963&dopt=Abstract

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St John's wort and depression. Author(s): Wheatley D. Source: Jama : the Journal of the American Medical Association. 2002 July 24-31; 288(4): 446; Author Reply 448-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12132962&dopt=Abstract


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St John's wort and depression. Author(s): Jonas W. Source: Jama : the Journal of the American Medical Association. 2002 July 24-31; 288(4): 446; Author Reply 448-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12132961&dopt=Abstract

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St John's wort as treatment for depression. Author(s): Oppel L. Source: Can Fam Physician. 2002 August; 48: 1290; Author Reply 1290. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12228953&dopt=Abstract

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St John's wort for the treatment of depression. Author(s): Shelton RC. Source: Lancet. Neurology. 2002 September; 1(5): 275. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12849421&dopt=Abstract

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St. John's wort for depression. Author(s): Ogletree RL Jr, Ross BS, Strong RK. Source: Adv Nurse Pract. 2001 August; 9(8): 30-1, 70. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12420462&dopt=Abstract

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Structural and energetic processes related to P300: LORETA findings in depression and effects of antidepressant drugs. Author(s): Anderer P, Saletu B, Semlitsch HV, Pascual-Marqui RD. Source: Methods Find Exp Clin Pharmacol. 2002; 24 Suppl D: 85-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12575474&dopt=Abstract

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Synaptic depression in the localization of sound. Author(s): Cook DL, Schwindt PC, Grande LA, Spain WJ. Source: Nature. 2003 January 2; 421(6918): 66-70. Erratum In: Nature. May 8; 423(6936): 197. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12511955&dopt=Abstract

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The acceptability of a culturally-tailored depression education videotape to African Americans. Author(s): Primm AB, Cabot D, Pettis J, Vu HT, Cooper LA. Source: Journal of the National Medical Association. 2002 November; 94(11): 1007-16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12443007&dopt=Abstract

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The combined dexamethasone-CRH test before and after repetitive transcranial magnetic stimulation (rTMS) in major depression.

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Author(s): Zwanzger P, Baghai TC, Padberg F, Ella R, Minov C, Mikhaiel P, Schule C, Thoma H, Rupprecht R. Source: Psychoneuroendocrinology. 2003 April; 28(3): 376-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12573303&dopt=Abstract •

The effect of a history of alcohol dependence in adult major depression. Author(s): Rae AM, Joyce PR, Luty SE, Mulder RT. Source: Journal of Affective Disorders. 2002 August; 70(3): 281-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12128240&dopt=Abstract

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The efficacy and safety of bilateral rTMS in medication-resistant depression. Author(s): Cohen CI, Amassian VE, Akande B, Maccabee PJ. Source: The Journal of Clinical Psychiatry. 2003 May; 64(5): 613-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12755672&dopt=Abstract

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The role of alternative medicine in treating postnatal depression. Author(s): Mantle F. Source: Complementary Therapies in Nursing & Midwifery. 2002 November; 8(4): 197203. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12463609&dopt=Abstract

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Thyroid hormone augmentation with levothyroxine in bipolar depression. Author(s): Bauer M. Source: Bipolar Disorders. 2002; 4 Suppl 1: 109-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12479694&dopt=Abstract

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Transcranial direct current stimulation: a new treatment for depression? Author(s): Nitsche MA. Source: Bipolar Disorders. 2002; 4 Suppl 1: 98-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12479691&dopt=Abstract

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Transcranial magnetic stimulation in patients with bipolar depression: a double blind, controlled study. Author(s): Dolberg OT, Dannon PN, Schreiber S, Grunhaus L. Source: Bipolar Disorders. 2002; 4 Suppl 1: 94-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12479689&dopt=Abstract

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Transcranial magnetic stimulation in the treatment of depression. Author(s): Gershon AA, Dannon PN, Grunhaus L. Source: The American Journal of Psychiatry. 2003 May; 160(5): 835-45. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12727683&dopt=Abstract


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Treating depression comorbid with anxiety--results of an open, practice-oriented study with St John's wort WS 5572 and valerian extract in high doses. Author(s): Muller D, Pfeil T, von den Driesch V. Source: Phytomedicine : International Journal of Phytotherapy and Phytopharmacology. 2003; 10 Suppl 4: 25-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12807339&dopt=Abstract

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Treatment-resistant depression: new therapies on the horizon. Author(s): Trivedi MH. Source: Annals of Clinical Psychiatry : Official Journal of the American Academy of Clinical Psychiatrists. 2003 March; 15(1): 59-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12839433&dopt=Abstract

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Treatments for depression: wisdom imparted from treatments discarded. Author(s): Overholser JC. Source: International Journal of Psychiatry in Medicine. 2002; 32(4): 317-36. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12779182&dopt=Abstract

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Troponin T and quantitative ST-segment depression offer complementary prognostic information in the risk stratification of acute coronary syndrome patients. Author(s): Kaul P, Newby LK, Fu Y, Hasselblad V, Mahaffey KW, Christenson RH, Harrington RA, Ohman EM, Topol EJ, Califf RM, Van de Werf F, Armstrong PW; PARAGON-B Investigators. Source: Journal of the American College of Cardiology. 2003 February 5; 41(3): 371-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12575962&dopt=Abstract

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Use of aromatherapy with hospice patients to decrease pain, anxiety, and depression and to promote an increased sense of well-being. Author(s): Louis M, Kowalski SD. Source: Am J Hosp Palliat Care. 2002 November-December; 19(6): 381-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12442972&dopt=Abstract

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Vagal tone as an indicator of treatment response in major depression. Author(s): Chambers AS, Allen JJ. Source: Psychophysiology. 2002 November; 39(6): 861-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12462513&dopt=Abstract

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Volunteering and depression: the role of psychological and social resources in different age groups. Author(s): Musick MA, Wilson J. Source: Social Science & Medicine (1982). 2003 January; 56(2): 259-69. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12473312&dopt=Abstract

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What Does ECS Stand for? Repetitive Transcranial Magnetic Stimulation in Depression. Volume 2, Number 3, Part 2 (June 1, 2001), pages S21-S29. Author(s): Nahas Z, Li X, Chae JH, Oliver NC, Anderson B, Kapp B, George MS. Source: Epilepsy & Behavior : E&B. 2001 August; 2(4): 375. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12609217&dopt=Abstract

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

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Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.com®: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.healthnotes.com/

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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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Open Directory Project: http://dmoz.org/Health/Alternative/

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HealthGate: http://www.tnp.com/

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WebMD®Health: http://my.webmd.com/drugs_and_herbs

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

The following is a specific Web list relating to depression; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation (some Web sites are subscription based): •

General Overview Age-Related Cognitive Decline Source: Healthnotes, Inc. www.healthnotes.com AIDS and HIV Source: Integrative Medicine Communications; www.drkoop.com Alcohol Withdrawal Source: Healthnotes, Inc. www.healthnotes.com


Alcoholism Source: Integrative Medicine Communications; www.drkoop.com Alzheimer's Disease Source: Healthnotes, Inc. www.healthnotes.com Alzheimer's Disease Source: Integrative Medicine Communications; www.drkoop.com Alzheimer's Disease, Non-Alzheimer's Dementia, and Normal Age-Related Memory Loss Source: Prima Communications, Inc.www.personalhealthzone.com Amenorrhea Source: Integrative Medicine Communications; www.drkoop.com Anorexia Nervosa Source: Integrative Medicine Communications; www.drkoop.com Anxiety Source: Healthnotes, Inc. www.healthnotes.com Anxiety Source: Integrative Medicine Communications; www.drkoop.com Anxiety and Panic Attacks Source: Prima Communications, Inc.www.personalhealthzone.com Asthma Source: Healthnotes, Inc. www.healthnotes.com Autism Source: Healthnotes, Inc. www.healthnotes.com Back Pain, Low Source: Integrative Medicine Communications; www.drkoop.com Bipolar Disorder Source: Healthnotes, Inc. www.healthnotes.com Blood Pressure, High Source: Integrative Medicine Communications; www.drkoop.com Blood Sugar, Low Source: Integrative Medicine Communications; www.drkoop.com Bone Loss Source: Integrative Medicine Communications; www.drkoop.com Breast Cancer Source: Healthnotes, Inc. www.healthnotes.com

342 Depression

Bulimia Nervosa Source: Integrative Medicine Communications; www.drkoop.com Burns Source: Integrative Medicine Communications; www.drkoop.com Cancer, Colorectal Source: Integrative Medicine Communications; www.drkoop.com Cancer, Prostate Source: Integrative Medicine Communications; www.drkoop.com Candida/Yeast Hypersensitivity Syndrome Source: Prima Communications, Inc.www.personalhealthzone.com Cardiovascular Disease Overview Source: Healthnotes, Inc. www.healthnotes.com Celiac Disease Source: Healthnotes, Inc. www.healthnotes.com Cholesterol, High Source: Integrative Medicine Communications; www.drkoop.com Chronic Candidiasis Source: Healthnotes, Inc. www.healthnotes.com Chronic Fatigue Syndrome Source: Healthnotes, Inc. www.healthnotes.com Chronic Fatigue Syndrome Source: Integrative Medicine Communications; www.drkoop.com Chronic Obstructive Pulmonary Disease Source: Healthnotes, Inc. www.healthnotes.com Colorectal Cancer Source: Integrative Medicine Communications; www.drkoop.com Constipation Source: Integrative Medicine Communications; www.drkoop.com Dementia Source: Integrative Medicine Communications; www.drkoop.com Depression Source: Healthnotes, Inc. www.healthnotes.com Depression Source: Integrative Medicine Communications; www.drkoop.com


Depression Source: Integrative Medicine Communications; www.drkoop.com Depression (Mild to Moderate) Source: Prima Communications, Inc.www.personalhealthzone.com Dysphagia Source: Integrative Medicine Communications; www.drkoop.com Eating Disorders Source: Healthnotes, Inc. www.healthnotes.com Eating Disorders, Anorexia Source: Integrative Medicine Communications; www.drkoop.com Eating Disorders, Bulimia Source: Integrative Medicine Communications; www.drkoop.com Epilepsy Source: Integrative Medicine Communications; www.drkoop.com Fatigue, Chronic Syndrome Source: Integrative Medicine Communications; www.drkoop.com Fibromyalgia Source: Healthnotes, Inc. www.healthnotes.com Fibromyalgia Source: Integrative Medicine Communications; www.drkoop.com Gastroesophageal Reflux Disease Source: Integrative Medicine Communications; www.drkoop.com Headache, Tension Source: Integrative Medicine Communications; www.drkoop.com Heartburn Source: Integrative Medicine Communications; www.drkoop.com High Blood Pressure Source: Integrative Medicine Communications; www.drkoop.com High Cholesterol Source: Integrative Medicine Communications; www.drkoop.com HIV and AIDS Source: Integrative Medicine Communications; www.drkoop.com HIV and AIDS Support Source: Healthnotes, Inc. www.healthnotes.com

344 Depression

Hypercholesterolemia Source: Integrative Medicine Communications; www.drkoop.com Hyperparathyroidism Source: Integrative Medicine Communications; www.drkoop.com Hypertension Source: Integrative Medicine Communications; www.drkoop.com Hypochondriasis Source: Integrative Medicine Communications; www.drkoop.com Hypoglycemia Source: Healthnotes, Inc. www.healthnotes.com Hypoglycemia Source: Integrative Medicine Communications; www.drkoop.com Hypothyroidism Source: Healthnotes, Inc. www.healthnotes.com Hypothyroidism Source: Integrative Medicine Communications; www.drkoop.com Inflammatory Bowel Disease Source: Integrative Medicine Communications; www.drkoop.com Insomnia Source: Integrative Medicine Communications; www.drkoop.com Insomnia Source: Prima Communications, Inc.www.personalhealthzone.com Irritable Bowel Syndrome Source: Healthnotes, Inc. www.healthnotes.com Irritable Bowel Syndrome Source: Integrative Medicine Communications; www.drkoop.com Lactose Intolerance Source: Healthnotes, Inc. www.healthnotes.com Low Back Pain Source: Integrative Medicine Communications; www.drkoop.com Low Blood Sugar Source: Integrative Medicine Communications; www.drkoop.com Lupus Source: Integrative Medicine Communications; www.drkoop.com


Malabsorption Source: Healthnotes, Inc. www.healthnotes.com Manic depression Source: Integrative Medicine Communications; www.drkoop.com Menopausal Symptoms (Other Than Osteoporosis) Source: Prima Communications, Inc.www.personalhealthzone.com Menopause Source: Healthnotes, Inc. www.healthnotes.com Menopause Source: Integrative Medicine Communications; www.drkoop.com Menstruation, Absence of Source: Integrative Medicine Communications; www.drkoop.com Migraine Headaches Source: Healthnotes, Inc. www.healthnotes.com Miscarriage Source: Integrative Medicine Communications; www.drkoop.com Osteoporosis Source: Integrative Medicine Communications; www.drkoop.com Pain Source: Healthnotes, Inc. www.healthnotes.com Parathyroid, Overactive Source: Integrative Medicine Communications; www.drkoop.com Parkinson's Disease Source: Healthnotes, Inc. www.healthnotes.com Parkinson's Disease Source: Integrative Medicine Communications; www.drkoop.com Photodermatitis Source: Integrative Medicine Communications; www.drkoop.com PMS Source: Integrative Medicine Communications; www.drkoop.com PMS Alternative names: Premenstrual Stress Syndrome Source: Prima Communications, Inc.www.personalhealthzone.com Post Traumatic Stress Disorder Source: Integrative Medicine Communications; www.drkoop.com

346 Depression

Premenstrual Syndrome Source: Healthnotes, Inc. www.healthnotes.com Premenstrual Syndrome Source: Integrative Medicine Communications; www.drkoop.com Prostate Cancer Source: Integrative Medicine Communications; www.drkoop.com Prostatitis Source: Healthnotes, Inc. www.healthnotes.com PTSD Source: Integrative Medicine Communications; www.drkoop.com Recurrent Ear Infections Source: Healthnotes, Inc. www.healthnotes.com Schizophrenia Source: Healthnotes, Inc. www.healthnotes.com Seasonal Affective Disorder Source: Healthnotes, Inc. www.healthnotes.com Seizure Disorders Source: Integrative Medicine Communications; www.drkoop.com Senile Dementia Source: Integrative Medicine Communications; www.drkoop.com Serum Sickness Source: Integrative Medicine Communications; www.drkoop.com Sexual Dysfunction Source: Integrative Medicine Communications; www.drkoop.com Shingles and Postherpetic Neuralgia Source: Healthnotes, Inc. www.healthnotes.com Skin Disorders, Photodermatitis Source: Integrative Medicine Communications; www.drkoop.com Sleeplessness Source: Integrative Medicine Communications; www.drkoop.com Spastic Colon Source: Integrative Medicine Communications; www.drkoop.com Spontaneous Abortion Source: Integrative Medicine Communications; www.drkoop.com


Stress Source: Integrative Medicine Communications; www.drkoop.com Stroke Source: Integrative Medicine Communications; www.drkoop.com Sunburn Source: Integrative Medicine Communications; www.drkoop.com Swallowing, Difficulty Source: Integrative Medicine Communications; www.drkoop.com Systemic Lupus Erythematosus Source: Integrative Medicine Communications; www.drkoop.com Tension Headache Source: Healthnotes, Inc. www.healthnotes.com Tension Headache Source: Integrative Medicine Communications; www.drkoop.com Thyroid, Underactive Source: Integrative Medicine Communications; www.drkoop.com Ulcerative Colitis Source: Integrative Medicine Communications; www.drkoop.com Weight Loss and Obesity Source: Healthnotes, Inc. www.healthnotes.com •

Alternative Therapy Acupuncture Source: Healthnotes, Inc. www.healthnotes.com Acupuncture Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,663,00.html Aromatherapy Source: Integrative Medicine Communications; www.drkoop.com Aromatherapy Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,664,00.html Ayurveda Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,672,00.html

348 Depression

Bach flower remedies Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,673,00.html Biofeedback Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,675,00.html Body oriented emotional release psychotherapy Alternative names: Neo-Reichian emotional release work Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/b.html Colon therapy Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,682,00.html Color therapy Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,683,00.html Crystal healing Alternative names: crystal therapeutics crystal therapy crystal work Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/c.html Dance therapy Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,687,00.html Detoxification therapy Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10119,00.html Guided imagery Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,699,00.html Herbal Medicine Source: Integrative Medicine Communications; www.drkoop.com


Homeopathy Source: Integrative Medicine Communications; www.drkoop.com Homeopathy Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,703,00.html Light therapy Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,713,00.html Magnet therapy Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,715,00.html Massage Source: Integrative Medicine Communications; www.drkoop.com Massage therapy Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,716,00.html Meditation Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,717,00.html Music therapy Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,719,00.html Native American medicine Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,721,00.html Naturopathy Source: Integrative Medicine Communications; www.drkoop.com Prayer Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,728,00.html

350 Depression

Psychic Self-Defense Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/p.html Qigong Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,729,00.html Reiki Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,731,00.html Repressed memory therapy Alternative names: RMT Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/r.html Tai Chi Source: Integrative Medicine Communications; www.drkoop.com Therapeutic touch Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,739,00.html Traditional Chinese Medicine Source: Integrative Medicine Communications; www.drkoop.com Writing therapy Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,745,00.html Yoga Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,746,00.html


•

Chinese Medicine Chenxiang Alternative names: Chinese Eaglewood Wood; Lignum Aquilariae Resinatum Source: Chinese Materia Medica Fuke Tongjing Wan Alternative names: Fuke Tongjing Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Fuke%20Tongjing%20Wan&m h=10&sb=---&view_records=View+Records Gansui Alternative names: Gansui Root; Radix Kansui Source: Chinese Materia Medica Hehuanhua Alternative names: Albizia Flower; Flos Albiziae Source: Chinese Materia Medica Mabo Alternative names: Puff-ball; Lasiosphaera seu Calvatia Source: Chinese Materia Medica Meihua Alternative names: Plum Flower; Flos Mume Source: Chinese Materia Medica Muli Alternative names: Oyster Shell; Concha Ostreae Source: Chinese Materia Medica Muxiang Alternative names: Slender Dutchmanspipe Root; Qingmuxiang; Radix Aristolochiae Source: Chinese Materia Medica Nanshashen Alternative names: Fourleaf Ladybell Root; Radix Adenophorae Source: Chinese Materia Medica Naolejing Alternative names: Naolejing Syrup Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Naolejing&mh=10&sb=--&view_records=View+Records

352 Depression

Shixiang Zhitong Wan Alternative names: Shixiang Zhitong Pills; Shixiang Zhitong Wan
(Shi Xiang Zhi Tong Wan) Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Shixiang%20Zhitong%20Wan &mh=10&sb=---&view_records=View+Records Tumuxiang Alternative names: Inula Root; Radix Inulae Source: Chinese Materia Medica Walengzi Alternative names: Arc Shell; Concha Arcae Source: Chinese Materia Medica Zhebeimu Alternative names: Thunberg Fritillary Bulb; Zhebeimu (Zhe Bei Mu); Bulbus Fritillariae Thunbergii Source: Chinese Materia Medica Zhimu Alternative names: Common Anemarrhena Rhizome; Rhizoma Anemarrhenae Source: Chinese Materia Medica •

Homeopathy Actaea racemosa Source: Healthnotes, Inc. www.healthnotes.com Arsenicum album Source: Healthnotes, Inc. www.healthnotes.com Aurum metallicum Source: Healthnotes, Inc. www.healthnotes.com Calcarea carbonica Source: Healthnotes, Inc. www.healthnotes.com Causticum Source: Healthnotes, Inc. www.healthnotes.com Cimicifuga Source: Healthnotes, Inc. www.healthnotes.com Ignatia Source: Healthnotes, Inc. www.healthnotes.com Kali phosophoricum Source: Healthnotes, Inc. www.healthnotes.com


Natrum carbonicum Source: Healthnotes, Inc. www.healthnotes.com Natrum muriaticum Source: Healthnotes, Inc. www.healthnotes.com Phosphorus Source: Healthnotes, Inc. www.healthnotes.com Pulsatilla Source: Healthnotes, Inc. www.healthnotes.com Sepia Source: Healthnotes, Inc. www.healthnotes.com Staphysagria Source: Healthnotes, Inc. www.healthnotes.com •

Herbs and Supplements 5-HTP Source: Integrative Medicine Communications; www.drkoop.com 5-HTP (5-Hydroxytryptophan) Source: Prima Communications, Inc.www.personalhealthzone.com 5-Hydroxytryptophan Source: Healthnotes, Inc. www.healthnotes.com 5-Hydroxytryptophan (5-HTP) Source: Integrative Medicine Communications; www.drkoop.com Aesculus Alternative names: Horse Chestnut; Aesculus hippocastanum L. Source: Alternative Medicine Foundation, Inc. www.amfoundation.org ALA Source: Integrative Medicine Communications; www.drkoop.com Allopurinol Source: Healthnotes, Inc. www.healthnotes.com Alpha-Linolenic Acid (ALA) Source: Integrative Medicine Communications; www.drkoop.com Amino Acids Overview Source: Healthnotes, Inc. www.healthnotes.com Aminoglycosides Source: Integrative Medicine Communications; www.drkoop.com

354 Depression

Antibiotic Combination: Sulfa Drugs Source: Integrative Medicine Communications; www.drkoop.com Anticonvulsants Source: Healthnotes, Inc. www.healthnotes.com Antidepressants Source: Healthnotes, Inc. www.healthnotes.com Antituberculosis Agents Source: Integrative Medicine Communications; www.drkoop.com Arnica Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,753,00.html Asian Ginseng Alternative names: Panax ginseng Source: Integrative Medicine Communications; www.drkoop.com Astragalus mem Alternative names: Huang-Qi; Astragalus membranaceus Source: Alternative Medicine Foundation, Inc. www.amfoundation.org Astragalus sp Alternative names: Vetch, Rattlepod, Locoweed; Astragalus sp. Source: Alternative Medicine Foundation, Inc. www.amfoundation.org Ava Source: Integrative Medicine Communications; www.drkoop.com Barbiturates Source: Integrative Medicine Communications; www.drkoop.com Berberis Alternative names: Barberry; Berberis sp. Source: Alternative Medicine Foundation, Inc. www.amfoundation.org Beta-Carotene Source: Prima Communications, Inc.www.personalhealthzone.com Bisphosphonate Derivatives Source: Integrative Medicine Communications; www.drkoop.com Black Cohosh Source: Prima Communications, Inc.www.personalhealthzone.com Black cohosh Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10009,00.html


Brahmi Alternative names: Centella asiatica , Centella, March Pennywort, Indian Pennywort, Hydrocotyle, Brahmi (Sanskrit), Luei Gong Gen (Chinese)(Note: Gotu kola should not be confused with kola nut.) Source: Integrative Medicine Communications; www.drkoop.com Brewer's Yeast Alternative names: Nutritional Yeast Source: Integrative Medicine Communications; www.drkoop.com Bupropion Source: Healthnotes, Inc. www.healthnotes.com Caprylic acid Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10111,00.html Cardiac Glycosides Source: Integrative Medicine Communications; www.drkoop.com Celecoxib Source: Healthnotes, Inc. www.healthnotes.com CELERY SEED Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Centella Source: Integrative Medicine Communications; www.drkoop.com Centella asiatica Alternative names: Centella asiatica , Centella, March Pennywort, Indian Pennywort, Hydrocotyle, Brahmi (Sanskrit), Luei Gong Gen (Chinese)(Note: Gotu kola should not be confused with kola nut.) Source: Integrative Medicine Communications; www.drkoop.com Cephalosporins Source: Integrative Medicine Communications; www.drkoop.com Chamaemelum nobile Source: Integrative Medicine Communications; www.drkoop.com Chamomile, Roman Alternative names: Chamaemelum nobile Source: Integrative Medicine Communications; www.drkoop.com Chasteberry Source: Prima Communications, Inc.www.personalhealthzone.com

356 Depression

Chasteberry Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,767,00.html Citalopram Source: Healthnotes, Inc. www.healthnotes.com Clozapine Source: Healthnotes, Inc. www.healthnotes.com Cyclosporine Alternative names: Neoral, Sandimmune Source: Prima Communications, Inc.www.personalhealthzone.com Damiana Alternative names: Turnera diffusa Source: Healthnotes, Inc. www.healthnotes.com Damiana Source: Prima Communications, Inc.www.personalhealthzone.com DAMIANA Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Dehydroepiandrosterone (DHEA) Source: Healthnotes, Inc. www.healthnotes.com Dehydroepiandrosterone (DHEA) Source: Integrative Medicine Communications; www.drkoop.com DHA Source: Integrative Medicine Communications; www.drkoop.com DHEA Source: Integrative Medicine Communications; www.drkoop.com DHEA (Dehydroepiandrosterone) Source: Prima Communications, Inc.www.personalhealthzone.com Diclofenac Source: Healthnotes, Inc. www.healthnotes.com DMAE Source: Healthnotes, Inc. www.healthnotes.com DMAE Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10023,00.html


Docosahexaenoic Acid Source: Healthnotes, Inc. www.healthnotes.com Docosahexaenoic Acid (DHA) Source: Integrative Medicine Communications; www.drkoop.com English Lavendar Source: Integrative Medicine Communications; www.drkoop.com Ephedra Alternative names: Ephedra sinensis, Ma huang Source: Integrative Medicine Communications; www.drkoop.com Ephedra (Ma huang) Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,777,00.html Ephedra sinensis Source: Integrative Medicine Communications; www.drkoop.com Estrogens (Combined) Source: Healthnotes, Inc. www.healthnotes.com Etodolac Source: Healthnotes, Inc. www.healthnotes.com Eugenia Clove Alternative names: Cloves; Eugenia sp. Source: Alternative Medicine Foundation, Inc. www.amfoundation.org Flurbiprofen Source: Healthnotes, Inc. www.healthnotes.com Fluvoxamine Source: Healthnotes, Inc. www.healthnotes.com Forskolin Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10025,00.html French Lavendar Source: Integrative Medicine Communications; www.drkoop.com GABA (Gamma-Amino Butyric Acid) Source: Healthnotes, Inc. www.healthnotes.com Garcinia cambogia Alternative names: Citrin, Gambooge Source: Alternative Medicine Foundation, Inc. www.amfoundation.org

358 Depression

Gentamicin Source: Healthnotes, Inc. www.healthnotes.com Ginger Alternative names: Zingiber officinale Source: Integrative Medicine Communications; www.drkoop.com Ginger Source: Prima Communications, Inc.www.personalhealthzone.com Ginkgo Alternative names: Ginkgo biloba Source: Alternative Medicine Foundation, Inc. www.amfoundation.org Ginkgo Source: Prima Communications, Inc.www.personalhealthzone.com GINKGO Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Ginkgo biloba Source: Healthnotes, Inc. www.healthnotes.com Ginkgo Biloba Alternative names: Maidenhair Tree Source: Integrative Medicine Communications; www.drkoop.com Ginkgo Biloba Source: Integrative Medicine Communications; www.drkoop.com Ginkgo biloba Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,788,00.html Ginseng (Panax) Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10029,00.html Ginseng, Asian Alternative names: Panax ginseng Source: Integrative Medicine Communications; www.drkoop.com Glimepiride Source: Healthnotes, Inc. www.healthnotes.com Glutamic Acid Source: Healthnotes, Inc. www.healthnotes.com


Glutamine Source: Prima Communications, Inc.www.personalhealthzone.com Glutamine Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10030,00.html Glutathione Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,854,00.html Gotu Kola Alternative names: Centella asiatica , Centella, March Pennywort, Indian Pennywort, Hydrocotyle, Brahmi (Sanskrit), Luei Gong Gen (Chinese)(Note: Gotu kola should not be confused with kola nut.) Source: Integrative Medicine Communications; www.drkoop.com Green Tea Alternative names: Camellia sinensis Source: Healthnotes, Inc. www.healthnotes.com Histamine H2 Antagonists Source: Integrative Medicine Communications; www.drkoop.com HOPS Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hydantoin Derivatives Source: Integrative Medicine Communications; www.drkoop.com Hydrocotyle Source: Integrative Medicine Communications; www.drkoop.com Hypericum perforatum Alternative names: St. John's Wort Source: Integrative Medicine Communications; www.drkoop.com Hypericum perforatum Source: Integrative Medicine Communications; www.drkoop.com Ibuprofen Source: Healthnotes, Inc. www.healthnotes.com Indapamide Source: Healthnotes, Inc. www.healthnotes.com Indian Pennywort Source: Integrative Medicine Communications; www.drkoop.com

360 Depression

Indomethacin Source: Healthnotes, Inc. www.healthnotes.com Inhalant, Systemic, and Topical Corticosteroids Source: Integrative Medicine Communications; www.drkoop.com Inositol Source: Healthnotes, Inc. www.healthnotes.com Inositol Source: Prima Communications, Inc.www.personalhealthzone.com Jamaica Dogwood Alternative names: Piscidia erythrina, Piscidia piscipula Source: Integrative Medicine Communications; www.drkoop.com Kava Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,798,00.html Kava Kava Alternative names: Piper methysticum, Ava Source: Integrative Medicine Communications; www.drkoop.com Ketoprofen Source: Healthnotes, Inc. www.healthnotes.com Ketorolac Source: Healthnotes, Inc. www.healthnotes.com Klamathweed Source: Integrative Medicine Communications; www.drkoop.com Klamathweed Alternative names: St. John's Wort Source: Integrative Medicine Communications; www.drkoop.com Kochia Alternative names: Summer Cypress, Fireweed; Kochia scoparia (L.) Schrad Source: Alternative Medicine Foundation, Inc. www.amfoundation.org KOLA Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Lavandula Alternative names: Lavender; Lavandula sp. Source: Alternative Medicine Foundation, Inc. www.amfoundation.org


Lavandula angustifolia Source: Integrative Medicine Communications; www.drkoop.com Lavender Alternative names: Lavandula officinalis Source: Healthnotes, Inc. www.healthnotes.com Lavender Alternative names: Lavandula angustifolia, English Lavendar, French Lavendar Source: Integrative Medicine Communications; www.drkoop.com LAVENDER Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Lavender Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,799,00.html Lecithin Source: Prima Communications, Inc.www.personalhealthzone.com Lepidium sp Alternative names: Cress; Lepidium sp. Source: Alternative Medicine Foundation, Inc. www.amfoundation.org Levodopa/Carbidopa Alternative names: Sinemet Source: Prima Communications, Inc.www.personalhealthzone.com Lithium Source: Healthnotes, Inc. www.healthnotes.com Loop Diuretics Source: Integrative Medicine Communications; www.drkoop.com L-Tyrosine Source: Healthnotes, Inc. www.healthnotes.com Ma huang Source: Integrative Medicine Communications; www.drkoop.com Macrolides Source: Integrative Medicine Communications; www.drkoop.com Maidenhair Tree Alternative names: Ginkgo Biloba Source: Integrative Medicine Communications; www.drkoop.com

362 Depression

Maidenhair Tree Source: Integrative Medicine Communications; www.drkoop.com Marsh Pennywort Alternative names: Centella asiatica , Centella, March Pennywort, Indian Pennywort, Hydrocotyle, Brahmi (Sanskrit), Luei Gong Gen (Chinese)(Note: Gotu kola should not be confused with kola nut.) Source: Integrative Medicine Communications; www.drkoop.com Matricaria Alternative names: Chamomile; Matricaria chamomilla Source: Alternative Medicine Foundation, Inc. www.amfoundation.org Melaleuca Alternative names: Tea Tree Oil; Melaleuca alternifolia Source: Alternative Medicine Foundation, Inc. www.amfoundation.org Melatonin Source: Healthnotes, Inc. www.healthnotes.com Melatonin Source: Integrative Medicine Communications; www.drkoop.com Melatonin Source: Prima Communications, Inc.www.personalhealthzone.com Melatonin Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,804,00.html Melissa Source: Prima Communications, Inc.www.personalhealthzone.com Menadione Source: Integrative Medicine Communications; www.drkoop.com Menaphthone Source: Integrative Medicine Communications; www.drkoop.com Menaquinone Source: Integrative Medicine Communications; www.drkoop.com Mentha Alternative names: Pennyroyal; Mentha/Hedeoma pulegium Source: Alternative Medicine Foundation, Inc. www.amfoundation.org Mentha x piperita Source: Integrative Medicine Communications; www.drkoop.com


Metoclopramide Source: Healthnotes, Inc. www.healthnotes.com Milk thistle Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10044,00.html Mirtazapine Source: Healthnotes, Inc. www.healthnotes.com Mixed Amphetamines Source: Healthnotes, Inc. www.healthnotes.com Monophasic, Biphasic, and Triphasic Preparations Source: Integrative Medicine Communications; www.drkoop.com Nabumetone Source: Healthnotes, Inc. www.healthnotes.com NADH Source: Healthnotes, Inc. www.healthnotes.com NADH Source: Prima Communications, Inc.www.personalhealthzone.com Nefazodone Source: Healthnotes, Inc. www.healthnotes.com Non-steroidal Anti-Inflammatory Drugs Source: Healthnotes, Inc. www.healthnotes.com OAT Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Oral Contraceptives Source: Healthnotes, Inc. www.healthnotes.com Oxaprozin Source: Healthnotes, Inc. www.healthnotes.com Panax Alternative names: Ginseng; Panax ginseng Source: Alternative Medicine Foundation, Inc. www.amfoundation.org Panax ginseng Source: Integrative Medicine Communications; www.drkoop.com Penicillin Derivatives Source: Integrative Medicine Communications; www.drkoop.com

364 Depression

Peppermint Alternative names: Mentha x piperita Source: Integrative Medicine Communications; www.drkoop.com Perphenazine Source: Healthnotes, Inc. www.healthnotes.com Phenelzine Source: Healthnotes, Inc. www.healthnotes.com Phenylalanine Source: Healthnotes, Inc. www.healthnotes.com Phenylalanine Source: Integrative Medicine Communications; www.drkoop.com Phenylalanine Source: Prima Communications, Inc.www.personalhealthzone.com Phosphatidylserine Source: Healthnotes, Inc. www.healthnotes.com Phosphatidylserine Source: Prima Communications, Inc.www.personalhealthzone.com Phosphatidylserine (PS) Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,813,00.html Phylloquinone Source: Integrative Medicine Communications; www.drkoop.com Piper methysticum Source: Integrative Medicine Communications; www.drkoop.com Piper nigrum Alternative names: Black Pepper Source: Alternative Medicine Foundation, Inc. www.amfoundation.org Piroxicam Source: Healthnotes, Inc. www.healthnotes.com Piscidia erythrina Source: Integrative Medicine Communications; www.drkoop.com Piscidia piscipula Source: Integrative Medicine Communications; www.drkoop.com


PMS Herbal combination Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,947,00.html Pregnenolone Source: Healthnotes, Inc. www.healthnotes.com Pregnenolone Source: Prima Communications, Inc.www.personalhealthzone.com Progesterone Source: Healthnotes, Inc. www.healthnotes.com Pumpkin Alternative names: Cucurbita pepo, Cucurbita maxima Source: Healthnotes, Inc. www.healthnotes.com Quinolones Source: Integrative Medicine Communications; www.drkoop.com Rofecoxib Source: Healthnotes, Inc. www.healthnotes.com Roman Chamomile Alternative names: Chamaemelum nobile Source: Integrative Medicine Communications; www.drkoop.com Rosemary Alternative names: Rosmarinus officinalis Source: Integrative Medicine Communications; www.drkoop.com ROSEMARY Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Rosmarinus officinalis Source: Integrative Medicine Communications; www.drkoop.com Ruta Alternative names: Rue; Ruta graveolens L. Source: Alternative Medicine Foundation, Inc. www.amfoundation.org S-Adenosylmethionine (SAMe) Source: Integrative Medicine Communications; www.drkoop.com Salsalate Source: Healthnotes, Inc. www.healthnotes.com SAMe Source: Healthnotes, Inc. www.healthnotes.com

366 Depression

SAMe Source: Integrative Medicine Communications; www.drkoop.com SAMe (S-Adenosylmethionine) Source: Prima Communications, Inc.www.personalhealthzone.com SAMe (S-adenosylmethionine) Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,818,00.html Selegiline Source: Healthnotes, Inc. www.healthnotes.com Sertraline Source: Healthnotes, Inc. www.healthnotes.com St. John's Wort Alternative names: Hypericum perforatum Source: Healthnotes, Inc. www.healthnotes.com St. John's Wort Alternative names: Hypericum perforatum, Klamathweed Source: Integrative Medicine Communications; www.drkoop.com St. John's Wort Alternative names: Hypericum perforatum Source: Integrative Medicine Communications; www.drkoop.com St. John's Wort Source: Prima Communications, Inc.www.personalhealthzone.com ST. JOHN'S WORT Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca St. John's wort Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,824,00.html Sulindac Source: Healthnotes, Inc. www.healthnotes.com Terminalia Alternative names: Myrobalans; Terminalia arjuna Source: Alternative Medicine Foundation, Inc. www.amfoundation.org Tetracycline Derivatives Source: Integrative Medicine Communications; www.drkoop.com


Thioridazine Source: Healthnotes, Inc. www.healthnotes.com Trazodone Source: Healthnotes, Inc. www.healthnotes.com Tricyclic Antidepressants Source: Healthnotes, Inc. www.healthnotes.com Tyrosine Source: Integrative Medicine Communications; www.drkoop.com Tyrosine Source: Prima Communications, Inc.www.personalhealthzone.com Valerian Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10064,00.html Valeriana Alternative names: Valerian; Valeriana officinalis Source: Alternative Medicine Foundation, Inc. www.amfoundation.org Valproic Acid Source: Healthnotes, Inc. www.healthnotes.com Vanadate Source: Integrative Medicine Communications; www.drkoop.com Vanadyl Source: Integrative Medicine Communications; www.drkoop.com Venlafaxine Source: Healthnotes, Inc. www.healthnotes.com Vervain Alternative names: Verbena officinalis Source: Healthnotes, Inc. www.healthnotes.com WILD INDIGO Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Yohimbe Alternative names: Pausinystalia yohimbe Source: Healthnotes, Inc. www.healthnotes.com Yohimbe Source: Prima Communications, Inc.www.personalhealthzone.com

368 Depression

Zingiber Alternative names: Ginger; Zingiber officinale Roscoe Source: Alternative Medicine Foundation, Inc. www.amfoundation.org Zingiber officinale Source: Integrative Medicine Communications; www.drkoop.com

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

369

CHAPTER 4. DISSERTATIONS ON DEPRESSION Overview In this chapter, we will give you a bibliography on recent dissertations relating to depression. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “depression” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on depression, we have not necessarily excluded nonmedical dissertations in this bibliography.

Dissertations on Depression ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to depression. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: •

Aggressive Behavior, Moral Judgment, and Depression in 11--13 Year Old Hispanic Boys by Lopez, Robert F. Phd from St. John's University (new York), 2002, 130 pages http://wwwlib.umi.com/dissertations/fullcit/3037896

•

Agrarian Experimentation and Failure in Depression Mississippi: New Deal and Socialism, the Tupelo Homesteads and the Delta and Providence Cooperative Farms (mississippi) by Smith, Fred C. Ma from Mississippi State University, 2002, 145 pages http://wwwlib.umi.com/dissertations/fullcit/1410619

•

Agricultural Depression in the 1920's: Economic Fact or Statistical Artifact? by Johnson, H. Thomas, Phd from The University of Wisconsin - Madison, 1969, 253 pages http://wwwlib.umi.com/dissertations/fullcit/7003570

370 Depression

•

Agriculture's Second Great Depression of the Twentieth Century: Federal Policy and the Agricultural Economy of the 82-county Primary Memphis Trade Region (pmtr) between 1969 and 1987 (tennessee, Kentucky, Missouri, Arkansas, Mississippi) by Campbell, Timothy Richard, Phd from The University of Memphis, 1995, 307 pages http://wwwlib.umi.com/dissertations/fullcit/9535140

•

Alcoholism and Depression in Women by Turner, Sandra G., Phd from Rutgers the State University of New Jersey - New Brunswick, 1987, 116 pages http://wwwlib.umi.com/dissertations/fullcit/8803523

•

Alfred Adler's Individual Psychology and Theory of Depression: a Synthesis in Retrospect by Taub, Rena R., Dsw from Yeshiva University, 1984, 127 pages http://wwwlib.umi.com/dissertations/fullcit/8502735

•

Alternative Birth Settings and Post-partum Depression: a Comparative Analysis by Falahi-kharaghani, Roya, Phd from Southern Illinois University at Carbondale, 1990, 317 pages http://wwwlib.umi.com/dissertations/fullcit/9129821

•

A California Middletown: the Social History of San Jose in the Depression. by Matthews, Glenna Christine, Phd from Stanford University, 1977, 270 pages http://wwwlib.umi.com/dissertations/fullcit/7712667

•

A Causal Model of Adolescent Depression (depression) by Brage, Diane Grace, Phd from The University of Nebraska - Lincoln, 1990, 169 pages http://wwwlib.umi.com/dissertations/fullcit/9121911

•

A Comparative Analysis between the Financial Instability Hypothesis and the Monetary Theory of Deep Depressions for the Interwar Period: a Non-nested Test of Hypothesis (business Cycles, Economic Fluctuations, Debt Deflation) by Gomez, Richard James, Phd from University of California, Davis, 1986, 277 pages http://wwwlib.umi.com/dissertations/fullcit/8621493

•

A Comparison between Mothers of Failure-to-thrive and Thriving Infants on Measures of Social Support, Stress, Depression, Anxiety, Intergenerational Factors, and Mother-infant Interaction (nonorganic, Maltreatment, Psychosocial Ftt, Nutritional Abuse, Neg by O'regan, Mary K. W., Dsw from The University of Utah, 1985, 549 pages http://wwwlib.umi.com/dissertations/fullcit/8527097

•

A Comparison of Adult Children of Alcoholic Families with Adult Children from Nonalcoholic Families on Depression, Self-esteem, and Anxiety (adult Children of Alcoholics) by Dodd, David Tennyson, Ii, Phd from University of North Texas, 1990, 75 pages http://wwwlib.umi.com/dissertations/fullcit/9114107

•

A Comparison of Agoraphobics, Anxiety Neurotics, and Depressive Neurotics Using the Mmpi and the Beck Depression Inventory by Jasin, Susan Elizabeth, Phd from Temple University, 1981, 155 pages http://wwwlib.umi.com/dissertations/fullcit/8210578

•

A Comparison of Depression, Stress and Self-image between Younger and Older Adolescent Mothers by Kitzrow, Martha Anne, Phd from Oregon State University, 1990, 136 pages http://wwwlib.umi.com/dissertations/fullcit/9032675

•

A Comparison of Effectiveness of Group Assertive Training and Self-esteem Enhancement Group Therapy in Decreasing Anxiety, Depression and Aggression

Dissertations 371

While Concurrently Increasing Assertiveness and Self-esteem by Martinez, Manuel, Phd from University of Colorado at Boulder, 1981, 152 pages http://wwwlib.umi.com/dissertations/fullcit/8200805 •

A Comparison of Health Care Aide's and Self-perceptions of Physical Functioning in Elderly Patients with Depression and Dementia by Pivarnik, Neil Charles, Edd from Columbia University Teachers College, 1989, 98 pages http://wwwlib.umi.com/dissertations/fullcit/9013571

•

A Comparison of High and Low General Levels of Reinforcement on Self-reported Depression, Anger, and Somatic Symptoms in Female Spousal Caregivers of Alzheimer Patients and Spouses of Healthy Men by Souder, J. Elaine, Phd from Boston College, 1987, 194 pages http://wwwlib.umi.com/dissertations/fullcit/8903997

•

A Comparison of Individual and Group Therapy on Self-concept and Depression of Patients with Spinal Cord Injury. by Riggin, Ona Ziehli, Edd from Memphis State University, 1976, 149 pages http://wwwlib.umi.com/dissertations/fullcit/7629243

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A Comparison of Perceived Locus of Control and Depression in Persian Muslim Immigrants by Alai, Mojtaba, Phd from United States International University, 1994, 133 pages http://wwwlib.umi.com/dissertations/fullcit/9502362

•

A Comparison of the Conversation Involvement of Nonlonely and Chronically Lonely Individuals (communication, Shyness, Depression) by Bell, Robert Alan, Phd from The University of Texas at Austin, 1984, 190 pages http://wwwlib.umi.com/dissertations/fullcit/8508249

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A Comparison of the Effectiveness of Group Therapy on Divorce Adjustment and Depression for Separated and Divorced Persons by Barlow, Larry Oliver, Phd from The Florida State University, 1982, 194 pages http://wwwlib.umi.com/dissertations/fullcit/8229144

•

A Comparison of the Effects of Life Review and Reminiscence Group Counseling on Depression, Life Satisfaction and Self-esteem of Older Persons by Capps, Harry Edward, Phd from Wayne State University, 1998, 194 pages http://wwwlib.umi.com/dissertations/fullcit/9827192

•

A Comparison of the Levels of Physical Activity, Self-esteem, and Depression among Sheltered Battered Women, Nonsheltered Battered Women, and Nonbattered Women by Bozeman, Tina Michelle; Da from Middle Tennessee State University, 2001, 94 pages http://wwwlib.umi.com/dissertations/fullcit/3030575

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A Comparison of the Psychological Effects of Hemodialysis and Continuous Ambulatory Peritoneal Dialysis (anxiety, Depression, Sickness Impact) by Bauer, Barbara Gruger, Phd from University of Missouri - Columbia, 1984, 135 pages http://wwwlib.umi.com/dissertations/fullcit/8425607

•

A Comparison of Three Approaches to Reduce Marital Problems and Symptoms of Depression (china) by Huang, Mei-kuei; Phd from University of Florida, 2001, 183 pages http://wwwlib.umi.com/dissertations/fullcit/3039774

•

A Comparison of Three Diagnostic Procedures for Identifying Depression in Children and Adolescents: Clinical Diagnoses, a Structured Interview and a

372 Depression

Depression Rating Scale by Pellegrino, Joseph Ferdinando, Phd from University of Virginia, 1992, 190 pages http://wwwlib.umi.com/dissertations/fullcit/9324847 •

A Comparison of Video-tape and Programmed Instruction As Training Devices to Discriminate the Emotion Commonly Referred to As Depression by Di Mattia, Dominic Joseph, Edd from University of Massachusetts, 1970, 145 pages http://wwwlib.umi.com/dissertations/fullcit/7024266

•

A Competitive Business: the Ideologies, Cultures, and Practices of Men's and Women's College Sports during the Depression by Austin, Bradley Ellis; Phd from The Ohio State University, 2001, 329 pages http://wwwlib.umi.com/dissertations/fullcit/3022439

•

A Confirmatory and Exploratory Analysis of Exner's Comprehensive System: a Crossvalidation of the Affect Cluster and Depression Index by Piacentini, Teresa Marie; Phd from Fairleigh Dickinson University, 2002, 265 pages http://wwwlib.umi.com/dissertations/fullcit/3041692

•

A Cross-cultural Study on Depression among Foreign Graduate Students from Six Selected Areas by Liu, Zaida Vega, Edd from Peabody College for Teachers of Vanderbilt University, 1985, 168 pages http://wwwlib.umi.com/dissertations/fullcit/8517423

•

A Cross-cultural Study on the Role of Social Networks and Acculturation in the Physical and Psychological Functioning of Chinese Students (physical Functioning, Depression) by Davis, Cynthia Lynne, Phd from University of California, Los Angeles, 1993, 160 pages http://wwwlib.umi.com/dissertations/fullcit/9408215

•

A Developmental View of Depression in Children: the Relationship of Symptomatology to Age by Price, Susan Karyl, Phd from University of Minnesota, 1988, 129 pages http://wwwlib.umi.com/dissertations/fullcit/8911022

•

A Field Assessment of the Relationships among Interpersonal Communication Competence, Social Support, and Depression among Caregivers for Individuals with Alzheimer's Disease by Query, Jim L., Jr., Phd from Ohio University, 1990, 245 pages http://wwwlib.umi.com/dissertations/fullcit/9030057

•

A Gentle Reconstruction: Depression Post Office Murals and Southern Culture by Beckham, Sue Bridwell, Phd from University of Minnesota, 1984, 343 pages http://wwwlib.umi.com/dissertations/fullcit/8424666

•

'a Good Many Shrewd Knocks': the Faces of Depression in the Life and Art of Virginia Woolf by Pogell, Sarah C. Phd from Washington University, 2001, 296 pages http://wwwlib.umi.com/dissertations/fullcit/3032736

•

A Grotesque Spectacle: American Theatre of the Great Depression As Cultural History by Fearnow, Mark Allen, Phd from Indiana University, 1990, 208 pages http://wwwlib.umi.com/dissertations/fullcit/9107275

•

A Laboratory Test of the Expanded Hopelessness Theory of Depression: towards a Clearer Understanding of the Relationship between Inferential Feedback, Depressive Symptoms, and Depressogenic Inferences by De Fronzo, Roseanne; Phd from Drexel University College of Nursing and Health Professions, 2002, 145 pages http://wwwlib.umi.com/dissertations/fullcit/3061997

Dissertations 373

•

A Life Review Intervention with Elderly Subjects Assessing for Impact on Depression and Life Satisfaction by Arland, William Thomas, Edd from University of Maine, 1989, 78 pages http://wwwlib.umi.com/dissertations/fullcit/9023842

•

A Linguistic Analysis of Cognitions in Depression by Rockwood, Gary F., Phd from Indiana University, 1991, 140 pages http://wwwlib.umi.com/dissertations/fullcit/9212304

•

A Local Church Depression Ministry. by Hutchison, Ashmead Scott, Dmin from The Eastern Baptist Theological Seminary, 1975, 153 pages http://wwwlib.umi.com/dissertations/fullcit/7526115

•

A Longitudinal Study of Anxiety: Noted Relationships between Anxiety, Depression, Parenting Style, and Academic Achievement by Rector, Cherie Lynn, Phd from University of Southern California, 1994 http://wwwlib.umi.com/dissertations/fullcit/f1557411

•

A Longitudinal Study of Childhood Risk Factors for Hospitalization under a Depression-related Diagnosis by Heringa, Marcia Sue; Phd from University of Georgia, 2002 http://wwwlib.umi.com/dissertations/fullcit/f410417

•

A Longitudinal Study of Preparation for Childbirth, Pain in Labour and Postnatal Depression by Leachman, Jennifer, Phd from University of Bath (united Kingdom), 1988, 327 pages http://wwwlib.umi.com/dissertations/fullcit/DX84607

•

A Meta-analysis of the Efficacy of Cognitive Therapy, Pharmacotherapy, and the Combination of Cognitive Therapy and Pharmacotherapy in the Treatment of Depression by Davis, Andrew Spencer, Edd from Idaho State University, 1991, 113 pages http://wwwlib.umi.com/dissertations/fullcit/9129319

•

A Multivariate Regression Examination of Stressful Life Events, Social Support, and the Postpartum Depression Syndrome by Cohen, David A., Phd from University of Southern California, 1983 http://wwwlib.umi.com/dissertations/fullcit/f3032981

•

A Multivariate Study of Depression in Elderly Caucasian Women by Sigurdson, Marion Kay, Phd from Indiana State University, 1979, 154 pages http://wwwlib.umi.com/dissertations/fullcit/8101029

•

A New Treatment Modality for Social Work Practice: Integrating Cognitive Behavioral Theory and Interpersonal Theory in the Treatment of Major Depression by Jensen, Carla C., Phd from University of Denver, 1990, 259 pages http://wwwlib.umi.com/dissertations/fullcit/9026958

•

A Preventive Intervention for Postpartum Depression in Primiparous Women by Meeker, Cynthia Ann Houtman, Phd from University of Kansas, 1984, 169 pages http://wwwlib.umi.com/dissertations/fullcit/8424337

•

A Program Design to Screen and Treat Parents Suffering from Postpartum Depression by Ganesh, Jan Allison; Psyd from Carlos Albizu University, 2002, 90 pages http://wwwlib.umi.com/dissertations/fullcit/3067814

374 Depression

•

A Prospective Study of Postpartum Depression a Test of the Cognitive Vulnerability Model by Acton, Robert Gordon; Phd from The University of Saskatchewan (canada), 1988 http://wwwlib.umi.com/dissertations/fullcit/NL45027

•

A Role-learning Model for the Study of Historical Change in Parent Behavior; with a Test of the Model on the Behavior of American Parents in the Great Depression by Mechling, Jay Edmund, Phd from University of Pennsylvania, 1971, 275 pages http://wwwlib.umi.com/dissertations/fullcit/7126060

•

'a Second Severance from the Body of Our Mother': Manic-depression and the Search for Identity in Selected Novels of Virginia Woolf by Caramagno, Thomas Carmelo, Phd from University of California, Los Angeles, 1984, 339 pages http://wwwlib.umi.com/dissertations/fullcit/8411849

•

A Social and Economic History of Columbia, South Carolina, during the Great Depression, 1929-1940. by Lofton, Paul Stroman, Jr., Phd from The University of Texas at Austin, 1977, 346 pages http://wwwlib.umi.com/dissertations/fullcit/7729061

•

A Society Unto Themselves: a Theoretical and Empirical Examination of Women's Proclivity for Depressive Disorders by Schwartz, Sharon, Phd from Columbia University, 1985, 402 pages http://wwwlib.umi.com/dissertations/fullcit/8523237

•

A Structural Analysis of Depression and Its Relationship to Perfectionism, Selfesteem and Racial Identity in African American College Students by Crow, Germayne Monteil; Phd from Auburn University, 2002, 82 pages http://wwwlib.umi.com/dissertations/fullcit/3043994

•

A Structural Analysis of Relationships among Stress, Social Support, Dysfunctional Attitudes, and Depression in Older Adults by Hyers, Darryl Ann, Phd from The University of North Carolina at Greensboro, 1995, 149 pages http://wwwlib.umi.com/dissertations/fullcit/9531843

•

A Structural Equation Model of the Relationship between Dependency, Burden Selfimage, and Depression among Chronically Ill Elders by Dyeson, Timothy Bruce, Phd from The University of Texas at Arlington, 1997, 120 pages http://wwwlib.umi.com/dissertations/fullcit/9804662

•

A Study of Adolescent Depression, Suicide, Self-esteem and Family Strengths in Special Education Female Students Compared with Regular Education Female Students by Harper, Diane Joan Provencher, Phd from Walden University, 1996, 130 pages http://wwwlib.umi.com/dissertations/fullcit/9840083

•

A Study of Bereavement and the (reactive) Depression That May Result from It: with Specific Reference to the Function of Faith by Mbogori, Elijah K., Phd from University of Aberdeen (united Kingdom), 1991, 390 pages http://wwwlib.umi.com/dissertations/fullcit/DX97621

•

A Study of Black Politics and Protest in Depression-decade Chicago: 1930-1939 by Reed, Christopher Robert, Phd from Kent State University, 1982, 474 pages http://wwwlib.umi.com/dissertations/fullcit/8216951

•

A Study of Childhood Depression with Special Emphasis on Classroom Behaviour by Morris, Mary L; Phd from University of Toronto (canada), 1978 http://wwwlib.umi.com/dissertations/fullcit/NK38788

Dissertations 375

•

A Study of Depression and Self-esteem in Moderately Gifted and Nongifted Children by Davis, Susan Dolores, Edd from United States International University, 1995, 117 pages http://wwwlib.umi.com/dissertations/fullcit/9604726

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A Study of Depression in Learning Disabled Adolescents by Bonner, Mary Elaine, Phd from The University of Mississippi, 1986, 124 pages http://wwwlib.umi.com/dissertations/fullcit/8703466

•

A Study of Hwa-byung in Korean Society: Narcissistic/masochistic Self-disorder and Christian Conversion (psychosomatic Illness, Depression, Anxiety Disorder) by Hwang, Yong Hoon, Phd from Princeton Theological Seminary, 1995, 225 pages http://wwwlib.umi.com/dissertations/fullcit/9530825

•

A Study of the Effect of a Six-week Counseling Group on Well-being and Depression Scores and Ratings of Self-perceived Health of Elderly African-american Participants by Baker, Barbara Elaine, Edd from Peabody College for Teachers of Vanderbilt University, 1990, 80 pages http://wwwlib.umi.com/dissertations/fullcit/9027441

•

A Study of the Effects of Group Assertion Training on Anxiety, Depression, Selfconcept and Assertiveness in Heroin Addicts by Herdey, Janice Joy, Phd from University of Southern California, 1982 http://wwwlib.umi.com/dissertations/fullcit/f91062

•

A Study of the Impact of Managed Health Care in the Treatment of Adult Patients Identified with Depression by Troast, Thomas Paul, Phd from The University of Wisconsin - Milwaukee, 1997, 186 pages http://wwwlib.umi.com/dissertations/fullcit/9822100

•

A Study of the Life Events-illness Relationship in Women: the Roles of Perception of Life Events, Personality, and Life-style in the Prediction of Physical Illness and Depression by Zone, Joan Bricks, Phd from The University of Utah, 1986, 115 pages http://wwwlib.umi.com/dissertations/fullcit/8610412

•

A Study of the Relationship between Depression and Factors in the Rehabilitation Process of the Hospitalized Spinal-cord Injured Patient by Klas, Leroy Dean, Phd from The University of Utah, 1970, 163 pages http://wwwlib.umi.com/dissertations/fullcit/7022249

•

A Study of the Relationship between Family Structure and Depression. by Panides, Wallace Constantine, Phd from The Florida State University, 1975, 128 pages http://wwwlib.umi.com/dissertations/fullcit/7526805

•

A Study of the Relationship of Negative Affectivity and Learning Problems in Children (depression, Anxiety) by Leavitt, Bryce James, Phd from Indiana University, 1996, 143 pages http://wwwlib.umi.com/dissertations/fullcit/9627371

•

A Study of the Social Origins of Clinical Depression in Black Women by Ricard, John H., Dsw from The Catholic University of America, 1985, 206 pages http://wwwlib.umi.com/dissertations/fullcit/8515072

•

A Study of the Use of Music Therapy Techniques in a Group for the Treatment of Adolescent Depression by Hendricks, C. Bret; Edd from Texas Tech University, 2001, 156 pages http://wwwlib.umi.com/dissertations/fullcit/3005267

376 Depression

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A Study to Determine the Effect of a Life-skills Related Suicide Prevention Curriculum on the Depression Levels of Adolescents (life Skills-related) by Taylor, Charlotte Murrow, Edd from Memphis State University, 1992, 145 pages http://wwwlib.umi.com/dissertations/fullcit/9224290

•

A Study to Determine the Effect of Exercise on Depression in Middle-aged Women by Weaver, Dolores Custer, Da from Middle Tennessee State University, 1984, 180 pages http://wwwlib.umi.com/dissertations/fullcit/8422552

•

A Systematic Investigation of Two Psychological Treatments of Depression by Shaw, Brian Frank; Phd from The University of Western Ontario (canada), 1975 http://wwwlib.umi.com/dissertations/fullcit/NK24664

•

A Test of the Cognitive Model of Depression by Carlomagno, Alfred, Dsw from Adelphi University, School of Social Work, 1989, 167 pages http://wwwlib.umi.com/dissertations/fullcit/8909436

•

A Test of the Cognitive Triad in Beck's Cognitive Theory of Depression by Giles, Donna; Phd from The University of Western Ontario (canada), 1982 http://wwwlib.umi.com/dissertations/fullcit/NK54096

•

A Theory-driven, Multiple-case Study Program Evaluation of a School-based Depression Prevention Intervention by Moothart, Mary Minnehan; Phd from The University of Iowa, 1999, 227 pages http://wwwlib.umi.com/dissertations/fullcit/9945433

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A Time of Crisis: Japan, the Great Depression, and Relief Policy by Smith, Kerry Douglas, Phd from Harvard University, 1994, 501 pages http://wwwlib.umi.com/dissertations/fullcit/9500202

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Academic Grades, Delinquency, and Depression among Ethnically Diverse Youth: the Influences of Parental Connection, Regulation, and Psychological Control by Bean, Roy A., Phd from Brigham Young University, 1997, 133 pages http://wwwlib.umi.com/dissertations/fullcit/9806351

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Acculturation and Depression among Puerto Ricans and Puerto Rican Veterans in the Continental United States by Ramos, Blanca Magdalena, Phd from State University of New York at Albany, 1997, 260 pages http://wwwlib.umi.com/dissertations/fullcit/9816263

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Acculturation of Immigrants from Spain: Implications for Symptoms of Depression and Anxiety by Lozano Mulone, Jacqueline; Psyd from Hofstra University, 2002, 119 pages http://wwwlib.umi.com/dissertations/fullcit/3072176

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Acculturation, Psychological Adjustment (stress, Depression, Self-esteem), and the Academic Achievement of Jamaican Immigrant College Students by Buddington, Steve Apalong; Phd from Tulane University, 2000, 172 pages http://wwwlib.umi.com/dissertations/fullcit/9971278

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Acculturative Stress and Depression among Homeless Hispanic Males (men) by Danaher-nash, Zelda, Phd from California School of Professional Psychology - Los Angeles, 1994, 98 pages http://wwwlib.umi.com/dissertations/fullcit/9429321

Dissertations 377

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Adaptive Coping Strategies of Othermothers: an Examination of Social Support, Spirituality, Stress and Depression by Smith, Pamela L. Phd from University of Maryland, Baltimore, 2003, 156 pages http://wwwlib.umi.com/dissertations/fullcit/3083297

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Adhd: Social Skills Effects on Impulsivity and Depression (attention Deficit Hyperactivity Disorder) by Harper, Karen Ann, Phd from The Fielding Institute, 1996, 223 pages http://wwwlib.umi.com/dissertations/fullcit/9621989

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Adlerian Life Style and Clinical Depression in Mothers of Disturbed Children by Earles, Thomas Drew, Phd from Georgia State University, 1982, 140 pages http://wwwlib.umi.com/dissertations/fullcit/8226145

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Adlerian Life Style, Social Interest, and Depression in Parents by Highlander, Don Hugh, Jr., Phd from Georgia State University, 1984, 114 pages http://wwwlib.umi.com/dissertations/fullcit/8412516

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Adolescent Depression by Richards, John Dean, Phd from The University of Utah, 1983, 85 pages http://wwwlib.umi.com/dissertations/fullcit/8325640

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Adolescent Depression and Family Cohesion (depression) by Bougere, Alan Achille, Dsw from Tulane University, School of Social Work, 1992, 110 pages http://wwwlib.umi.com/dissertations/fullcit/9302856

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Adolescent Depression in Public Schools by Johnson, Bruce B., Phd from Marquette University, 1990, 103 pages http://wwwlib.umi.com/dissertations/fullcit/9101416

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Adolescent Depression: the Impact of Parental Divorce during Childhood As It Manifests Itself in Adolescence (depression, Divorce) by Pool, Elsa-rae, Dsw from Tulane University, School of Social Work, 1993, 153 pages http://wwwlib.umi.com/dissertations/fullcit/9403436

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Adult Education As a Welfare Measure during the Great Depression: a Historical Case Study of the Educational Program of the Civilian Conservation Corps, 1933-1942 by Ralston, Charles Frederick; Ded from The Pennsylvania State University, 2000, 443 pages http://wwwlib.umi.com/dissertations/fullcit/9998416

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Affect and Cognitions in Obese Binge Eaters: the Association between Depression, Anxiety, and Bulimic Cognitions by Lazarus, Shulamit, Phd from The University of North Carolina at Chapel Hill, 1991, 108 pages http://wwwlib.umi.com/dissertations/fullcit/9216744

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African-american Adolescent Girls and Fathers: Paternal Contribution to Depression, Self-efficacy, and Religiosity by Jackson, Jennifer Lee; Phd from Columbia University, 2003, 106 pages http://wwwlib.umi.com/dissertations/fullcit/3077192

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American Money and the German Economy: Economics and Politics on the Eve of the Great Depression by Mcneil, William Charles, Phd from University of California, Berkeley, 1981, 498 pages http://wwwlib.umi.com/dissertations/fullcit/8200203

378 Depression

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America's Depression Culture: Social Art and Literature of the 1930s by Peeler, David P., Phd from The University of Wisconsin - Madison, 1980, 440 pages http://wwwlib.umi.com/dissertations/fullcit/8020579

•

An Analysis of Anxiety and Depression Levels in Out-of-treatment Drug Abusers: Implications for Counseling by Ataabadi, Ali Nateghi, Edd from Texas Southern University, 1997, 139 pages http://wwwlib.umi.com/dissertations/fullcit/9809905

•

An Analysis of Depression and Social Support among Blacks in the United States by Dumas, Tracey Chante; Phd from University of Oregon, 2002, 120 pages http://wwwlib.umi.com/dissertations/fullcit/3072579

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An Analysis of Learning Disabilities and Childhood Depression in Pre-adolescent Students by Bonomo, Janice Abrams, Edd from Indiana University of Pennsylvania, 1990, 132 pages http://wwwlib.umi.com/dissertations/fullcit/9024303

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An Analysis of the Mood Depression, As Perceived by Treatment Counselors, in Alcohol Dependent Patients in a Twenty-eight Day Hospital Based Treatment Program (addiction, Chemical-dependence) by Vrechek, Nancy Marie, Phd from University of Georgia, 1984, 92 pages http://wwwlib.umi.com/dissertations/fullcit/8421165

•

An Analysis of the Proposed Subtype: Hopelessness Depression by Stockum, Robert Weston, Phd from Ohio University, 1999, 241 pages http://wwwlib.umi.com/dissertations/fullcit/9923675

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An Analysis of the Relationships between Problems, Anxiety, Depression, and Hostility of Suburban Teachers by Johnson, Weston Rayfield, Edd from University of Northern Colorado, 1982, 164 pages http://wwwlib.umi.com/dissertations/fullcit/8305235

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An Analysis of Unemployment Solutions Proposed in Selected American Journals of Opinion during the Great Depression by Fuchs, David William, Phd from New York University, 1968, 968 pages http://wwwlib.umi.com/dissertations/fullcit/6811815

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An Assessment of Life Satisfaction and Depression in Community Elderly and Their Relationship to Other Demographic and Social Variables (geriatrics) by Skoglund, Pennelope A., Phd from University of Colorado at Boulder, 1986, 178 pages http://wwwlib.umi.com/dissertations/fullcit/8618999

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An Assessment of Support Group Participation on Depression and Adherence in Veterans with Hepatitis C by Chun, Doris Sohyun; Phd from New York University, 2002, 154 pages http://wwwlib.umi.com/dissertations/fullcit/3045705

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An Assessment of the Effects of the Psychoeducational Workshop on Minor Depression for Enrollees in a Hospital-based 55plus(rtm) Program by Mullen, Robert P., Edd from University of Arkansas, 1998, 116 pages http://wwwlib.umi.com/dissertations/fullcit/9838317

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An Efficacy Study of Group and Individual Cognitive-behavioral Therapy Combined with Pharmacotherapy in the Treatment of Major Depression by Johnson, Susan Claire, Phd from The University of Wisconsin - Madison, 1989, 261 pages http://wwwlib.umi.com/dissertations/fullcit/9013351

Dissertations 379

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An Empirical Analysis of Uncertainty and Investment during the Great Depression (business Cycles) by Zalewski, David Alan, Phd from Clark University, 1993, 219 pages http://wwwlib.umi.com/dissertations/fullcit/9323648

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An Empirical Examination of the Roles That Consumption, Investment and Money Played during the Great Depression by Agee, Steven Craig, Phd from University of Kansas, 1982, 194 pages http://wwwlib.umi.com/dissertations/fullcit/8301707

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An Empirical Exploration of Predictions Arising from a Cognitive-behavioral Model of Depression among Persons with Spinal Cord Injury by Tirch, Dennis D. Phd from Fairleigh Dickinson University, 2002, 132 pages http://wwwlib.umi.com/dissertations/fullcit/3032986

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An Empirical Study of the Relationship between Vital Longevity, Retirement and Depression (older Adults) by Watson, Marian L., Edd from Northern Illinois University, 1993, 346 pages http://wwwlib.umi.com/dissertations/fullcit/9414842

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An Evaluation of Depression, Self-efficacy, Satisfaction with Life and Perceived Access to Medical Care across Stages of Hiv Infection (immune Deficiency) by Didona, Toni Marie, Phd from Florida International University, 1994, 224 pages http://wwwlib.umi.com/dissertations/fullcit/9420379

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An Evaluation of Two Methods of Diagnosing Depression in Clinic Outpatients by Ellis, Lynn Fred, Phd from The University of Michigan, 1984, 77 pages http://wwwlib.umi.com/dissertations/fullcit/8502803

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An Examination of Adolescent Life Event Stressors and Their Relationship with Depression, Anxiety, and Irritability by Esman, Flora B., Phd from The University of Toledo, 1992, 242 pages http://wwwlib.umi.com/dissertations/fullcit/9229638

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An Examination of Beck's Theory Within the Context of Post-partum Depression by Olioff, Mark; Phd from Mcgill University (canada), 1982 http://wwwlib.umi.com/dissertations/fullcit/NK64532

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An Examination of Certain Psychosocial Factors Involved in the Prediction of Depression by Sherman, Daniel Philip, Phd from Southern Illinois University at Carbondale, 1982, 194 pages http://wwwlib.umi.com/dissertations/fullcit/8321466

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An Examination of Change in Anger and Depression during Early Stages of Therapy (treatment Efficacy) by Tatera, David Michael, Phd from University of Southern California, 1995, 110 pages http://wwwlib.umi.com/dissertations/fullcit/9617145

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An Examination of Depression in Adolescence: Its Relationship to Egocentrism and Interpersonal Relationships by Caravias, Mary, Phd from University of Toronto (canada), 1991, 132 pages http://wwwlib.umi.com/dissertations/fullcit/NN73845

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An Examination of Effectiveness of a Sleep Induction Audiotape in Conjunction with a Standardized Behavioral Treatment Protocol on Anxiety, Depression, Psychosocial Functioning, and Sleep among a Clinical Population with Insomnia by Dunn, Jeffrey Allan; Phd from The Florida State University, 2001, 304 pages http://wwwlib.umi.com/dissertations/fullcit/3021555

380 Depression

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An Examination of Environmental Stressors, Social Mediators, Depression and Suicidal Ideation in Academically Gifted and Non-gifted Adolescents (gifted) by Baker, Jean A., Phd from The University of Wisconsin - Madison, 1992, 255 pages http://wwwlib.umi.com/dissertations/fullcit/9221898

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An Examination of Models of Efficacy and Esteem Pathways to Depression in Young Adulthood by Smith, Heather Marie; Phd from The Ohio State University, 2002, 115 pages http://wwwlib.umi.com/dissertations/fullcit/3059326

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An Examination of Social Skills and Family Environment and Their Relationship to Childhood Depression (depression) by Crook, Kimberly Frances, Phd from The University of Texas at Austin, 1994, 237 pages http://wwwlib.umi.com/dissertations/fullcit/9428492

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An Examination of the Monetary Hypothesis of the Depression and Interest Rates (price Expectation, Fisher Effect, Macroeconomics, Finance) by True, Bruce Norris, Phd from University of California, Los Angeles, 1985, 115 pages http://wwwlib.umi.com/dissertations/fullcit/8525885

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An Examination of the Post-stroke and Vascular Depression Hypotheses among Geriatric Rehabilitation Patients by Mast, Benjamin Todd; Phd from Wayne State University, 2002, 106 pages http://wwwlib.umi.com/dissertations/fullcit/3038203

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An Examination of the Reinforcement Process in Mild and Clinical Depression by Morelli, Rosa M; Phd from Queen's University at Kingston (canada), 1984 http://wwwlib.umi.com/dissertations/fullcit/NK65917

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An Experimental Analysis of Training the Anticipation and Performance of Reinforcing Activities in the Treatment of Depression. by Anton, Jane Lee, Phd from Stanford University, 1974, 147 pages http://wwwlib.umi.com/dissertations/fullcit/7506802

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An Exploration of the Relationship between Amish Identity and Depression among the Old Order Amish by Reiling, Denise Mae; Phd from Michigan State University, 2000, 426 pages http://wwwlib.umi.com/dissertations/fullcit/9985454

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An Exploratory and Confirmatory Factor-analytic Investigation of the Tripartite Model of Anxiety and Depression in Older Adults by Burdenski, Thomas Kevin, Jr. Phd from Texas A&m University, 2002, 267 pages http://wwwlib.umi.com/dissertations/fullcit/3072414

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An Exploratory Study Examining the Interactions between Depression, Health Status, Memory-efficacy, and Selected Demographic Variables with the Metamemory of Older Adults by Mcdougall, Graham Joseph, Jr., Phd from The University of Texas at Austin, 1991, 187 pages http://wwwlib.umi.com/dissertations/fullcit/9128304

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An Exploratory Study of Student-teacher Morale with Reference to the Determination of the Existence of a Depression Period during Student-teaching. by Arneson, David Michael, Edd from University of Northern Colorado, 1976, 273 pages http://wwwlib.umi.com/dissertations/fullcit/7711045

Dissertations 381

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An Exploratory Study of the Effects of Humor on Depression and Hopelessness of Incarcerated Males (men Inmates) by Silverman, Stanley Ronald, Phd from University of Maryland College Park, 1994, 141 pages http://wwwlib.umi.com/dissertations/fullcit/9508054

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An Intervention Program for Children of Recently Hospitalized, Depressed Mothers (maternal Depression) by Bennett, Robert Bruce, Dsw from The University of Utah, 1991, 97 pages http://wwwlib.umi.com/dissertations/fullcit/9129289

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An Intraindividual Study of the Relationship between Pain and Depression by Tarbell, Sally Elizabeth; Phd from York University (canada), 1984 http://wwwlib.umi.com/dissertations/fullcit/NK61526

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An Investigation into Neglected (untreated) Late Life Depression among Lonely, Community-dwelling Elderly by Merkel, Katherine Lee; Phd from Walden University, 2001, 172 pages http://wwwlib.umi.com/dissertations/fullcit/3000385

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An Investigation into the Construct of Global Self-esteem Using Selected Measures of Self-esteem, Depression, and Directiveness (construct Validity) by Chen, Steven John, Phd from Brigham Young University, 1991, 153 pages http://wwwlib.umi.com/dissertations/fullcit/9131146

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An Investigation into the Effects of Aerobic Exercise on Anxiety and Depression by Eby, John M; Edd from University of Toronto (canada), 1984 http://wwwlib.umi.com/dissertations/fullcit/NL23527

•

An Investigation of Antidepressant Mechanisms in an Animal Model of Depression by Jesberger, James A; Phd from The University of Saskatchewan (canada), 1984 http://wwwlib.umi.com/dissertations/fullcit/NK65355

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An Investigation of Anxiety, Depression and Family Role Involvement of Adolescent Males Whose Fathers Have Cardiovascular Disability by Chiampi, John David, Phd from University of Pittsburgh, 1982, 119 pages http://wwwlib.umi.com/dissertations/fullcit/8218150

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An Investigation of Holism in Student Personnel Work, with Special Emphasis on the Depression Year 1931-1932 by Dewey, Mary Evelyn, Phd from Syracuse University, 1967, 339 pages http://wwwlib.umi.com/dissertations/fullcit/6807054

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An Investigation of Some Neuropsychological, Cognitive and Behavioral Aspects of Depression by Johnson, Olive Skene; Phd from The University of British Columbia (canada), 1980 http://wwwlib.umi.com/dissertations/fullcit/NK51710

•

An Investigation of the Perceptions of Bullying and Victimization among Students in Grades 7 and 8: Prevalence; Relationship to Gender, Grade Level, Ethnicity; and Selfesteem and Depression by Seals, Dorothy L. Edd from Delta State University, 2002, 90 pages http://wwwlib.umi.com/dissertations/fullcit/3059493

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An Investigation of the Relation between Depression and Hostility of Adolescent Girls Suffering Father Loss. by Diamond, Charles, Edd from Boston University School of Education, 1973, 92 pages http://wwwlib.umi.com/dissertations/fullcit/7323546

382 Depression

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An Investigation of the Relationship between Depression and Assertiveness in Egyptian Depressed Subjects by Ghareeb, Ghareeb Abdel-fattah, Phd from University of Pittsburgh, 1983, 190 pages http://wwwlib.umi.com/dissertations/fullcit/8411698

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An Investigation of the Relationship between Levels of Physical Activity and Levels of Depression by Lipira, Patsy Kay, Edd from University of Arkansas, 1993, 100 pages http://wwwlib.umi.com/dissertations/fullcit/9434911

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An Investigation of the Relationship between Perceived Social Support, Support Satisfaction and Depression among Working Female Caregivers by Mitchell, Margaret Lucretia, Dsw from Fordham University, 1991, 184 pages http://wwwlib.umi.com/dissertations/fullcit/9203420

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An Investigation of the Relationship of Perceived Family Dynamics to Depression and Anxiety Experienced by Hospitalized Coronary Patients by Fussell, Juanita, Edd from Peabody College for Teachers of Vanderbilt University, 1985, 77 pages http://wwwlib.umi.com/dissertations/fullcit/8517412

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An Investigation of the Relationships among Attributional Style, Hardiness, Gender, and Depression As Predictors of Coping with Real Life Events by Chemically Dependent Inpatients by Voyce, Jo Ann, Phd from University of Missouri - Kansas City, 1996, 115 pages http://wwwlib.umi.com/dissertations/fullcit/9701858

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An Investigation of the Relationships among Depression, Locus-of-control, and Assertive Behavior in Freshman College Women. by Borovay, Rena Frajtag, Phd from University of Miami, 1977, 164 pages http://wwwlib.umi.com/dissertations/fullcit/7721909

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An Investigation of the Relationships among Personal Resources, Coping Styles, and Depression in College Students by Pooput, Kanda, Phd from University of Missouri Columbia, 1992, 129 pages http://wwwlib.umi.com/dissertations/fullcit/9400052

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An Outline of Clergy Depression with Suggested Procedures and Strategies for Healing by Haynes, Ralph Douglas, Dmin from Fuller Theological Seminary, Doctor of Ministry Program, 1986, 259 pages http://wwwlib.umi.com/dissertations/fullcit/8720764

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Anaclitic and Introjective Dimensions and Depression in Borderline Personality Disorder by Trifiletti, Robert James; Phd from University of Calgary (canada), 1989 http://wwwlib.umi.com/dissertations/fullcit/NL54340

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Analysis of State Markers for Alcohol Consumption and Trait Markers for Alcohol Dependence and Depression by Martinez, Larry Dean; Phd from University of Colorado Health Sciences Center, 2002, 186 pages http://wwwlib.umi.com/dissertations/fullcit/3056500

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Analysis of the Genetic Basis of Inbreeding Depression in the Pacific Oyster Crassostrea Gigas by Bucklin, Katherine Adelaide; Phd from University of California, Davis, 2002, 139 pages http://wwwlib.umi.com/dissertations/fullcit/3062193

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And Still They Rise: an Examination of Risk and Protective Factors for Depression and Antisocial Behavior in African American Adolescents by House, Laura Elizabeth; Phd from Howard University, 2001, 159 pages http://wwwlib.umi.com/dissertations/fullcit/3040807

Dissertations 383

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Anger and Depression among Incarcerated Juvenile Delinquents: a Pilot Intervention by Tellier, Jen Emily, Psyd from The Wright Institute, 1998, 93 pages http://wwwlib.umi.com/dissertations/fullcit/9912972

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Antecedents of the 1929 Recession (commercial Banking, Finance, Depression, Stock Market, Business Cycles) by Hanson, Richard X., Phd from University of California, Los Angeles, 1986, 93 pages http://wwwlib.umi.com/dissertations/fullcit/8621072

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Anti-depression Public Works: Federal-aid Roadbuilding, 1920--1922 by Davis, John Oscar; Phd from Iowa State University, 2002, 401 pages http://wwwlib.umi.com/dissertations/fullcit/3061823

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Anxiety and the Benzodiazepine/gaba-chloride Ionophore Receptor Complex: Implications for Learned Helplessness, Coping and Behavioral Depression (librium, Escape Deficit, B-carboline) by Drugan, Robert Charles, Phd from University of Colorado at Boulder, 1984, 114 pages http://wwwlib.umi.com/dissertations/fullcit/8428645

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Anxiety, Depression, and Posttraumatic Stress Disorder: Health Conditions of Women Who Cope with Conjugal Violence by Tyson, Sheryl; Phd from University of California, Los Angeles, 2002, 404 pages http://wwwlib.umi.com/dissertations/fullcit/3059554

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Apocalyptic Metaphors in John Ford's 'the Hurricane' and Other American Films of the 1930s (great Depression) by Fitzsimmons, Lorna, Phd from The University of Texas at Dallas, 1994, 190 pages http://wwwlib.umi.com/dissertations/fullcit/9424282

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Arkansas during the Great Depression. by Rison, David Ellery, Phd from University of California, Los Angeles, 1974, 178 pages http://wwwlib.umi.com/dissertations/fullcit/7429274

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Art for the People: Art in Michigan Sponsored by the Treasury Section of Fine Arts, 1934 to 1943. (volumes I and Ii) (murals, Depression) by Ruby, Christine Muriel Nelson, Phd from The University of Michigan, 1986, 474 pages http://wwwlib.umi.com/dissertations/fullcit/8702821

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Artists Respond to the Great Depression and the Threat of Fascism: the New York Artists' Union and Its Magazine 'art Front' (1934-1937) by Tyler, Francine, Phd from New York University, 1991, 427 pages http://wwwlib.umi.com/dissertations/fullcit/9124769

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Aspects of Emotional Expression in Flat Affect Schizophrenia and Depression by Novack, Danielle Lee; Phd from New York University, 2002, 213 pages http://wwwlib.umi.com/dissertations/fullcit/3048851

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Assertiveness, Social Support, and Susceptibility to Depression: an Analysis Using Induced Mood by Croner, Christopher James; Phd from Southern Illinois University at Carbondale, 2002, 175 pages http://wwwlib.umi.com/dissertations/fullcit/3065347

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Assessing Change in Psychosocial Treatment for Depression from Multiple Perspectives: the Client, the Significant Other, and the Mental Health Professional by Park, Sun-young; Phd from The University of Chicago, 2002, 231 pages http://wwwlib.umi.com/dissertations/fullcit/3060251

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Assessing Depressive Symptoms Using the Child Depression Scale and the Children's Depression Inventory: a Cross Cultural Comparison of Children in Puerto

384 Depression

Rico and the United States by Lopez, Nancy, Phd from The University of Wisconsin Madison, 1985, 121 pages http://wwwlib.umi.com/dissertations/fullcit/8513465 •

Assessing Distress in Couples with Cancer: a Life Cycle View (caregiver Burden, Depression) by Dwyer, Timothy Francis, Phd from Purdue University, 1995, 202 pages http://wwwlib.umi.com/dissertations/fullcit/9601490

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Assessing Grief, Depression, and Coping Behaviors of Women Participating in in Vitro Fertilization Embryo Transfer by Lukse, Michelle Prince, Phd from The University of North Carolina at Greensboro, 1991, 119 pages http://wwwlib.umi.com/dissertations/fullcit/9204450

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Assessing Level of Outness among Gay, Lesbian, and Bisexual Individuals and Its Relation to Depression, Anxiety, and Self-esteem by Bosker, Mary Jane; Phd from Southern Illinois University at Carbondale, 2002, 145 pages http://wwwlib.umi.com/dissertations/fullcit/3083228

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Assessing the Usefulness of the Informant in Identifying Late Life Depressive Disorders by Mcavay, Gail; Phd from Columbia University, 2002, 220 pages http://wwwlib.umi.com/dissertations/fullcit/3048188

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Assessment of Clinical Depression in Public School Teachers Experiencing Career Burnout by Fisher, Ronald Paul, Phd from University of Georgia, 1995, 120 pages http://wwwlib.umi.com/dissertations/fullcit/9604041

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Assessment of Depression among Bilingual Adolescent Hispanics (reynolds Adolescent Depression Scale) by Davis, Kerry Ann, Phd from The University of Utah, 1991, 122 pages http://wwwlib.umi.com/dissertations/fullcit/9135359

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Assessment of Depression in School-age Children: a Cross-cultural Comparison of Mexican American and Caucasian Students by Rybolt, Yvette Dawson, Phd from The University of Arizona, 1994, 222 pages http://wwwlib.umi.com/dissertations/fullcit/9517585

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Assessment of Family Environment and Marital Functioning in Couples with Bipolar Affective Disorder and Major Depression by Jabalpurwala, Sheila Kaizer, Phd from Hofstra University, 1994, 152 pages http://wwwlib.umi.com/dissertations/fullcit/9425242

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Associations among Subclinical Attention Deficit Hyperactivity Disorder, Substance Abuse, and Depression in Young Adults by Nunes, Michael Anthony; Ms from California State University, Fresno, 2002, 48 pages http://wwwlib.umi.com/dissertations/fullcit/1412220

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Atlanta, the Depression, and the New Deal (south, Urban, Georgia) by Fleming, Douglas Lee, Phd from Emory University, 1984, 388 pages http://wwwlib.umi.com/dissertations/fullcit/8504952

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Attachment Behaviors, Depression, and Anxiety in Nonoffending Mothers of Child Sexual Abuse Victims by Lewin, Linda Carol; Phd from The University of Toledo, 2000, 86 pages http://wwwlib.umi.com/dissertations/fullcit/9969434

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Attention Mechanisms in Bipolar Depression by Burdick, Katherine Elizabeth; Phd from City University of New York, 2002, 119 pages http://wwwlib.umi.com/dissertations/fullcit/3063809

Dissertations 385

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Attribution Theory and Ecclesiogenic Depression (depression) by Homan, Kenneth Bruce, Phd from The University of Iowa, 1990, 314 pages http://wwwlib.umi.com/dissertations/fullcit/9112433

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Attributional Style and Depression in Adolescents with Asperger Syndrome by Barnhill, Eugena Patricia; Phd from University of Kansas, 2000, 167 pages http://wwwlib.umi.com/dissertations/fullcit/9985099

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Attributional Style and Depression in Chronic Pain Patients Receiving Worker's Compensation Benefits (pain Management) by Mcguigan, Jane Boyer, Phd from University of Maryland College Park, 1992, 182 pages http://wwwlib.umi.com/dissertations/fullcit/9234621

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Attributional Style in Three Outpatient Groups: Relationship to Negative Life Events and Depression by Wilson, James Clinton, Phd from The University of Arizona, 1985, 142 pages http://wwwlib.umi.com/dissertations/fullcit/8517506

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Autobiographical Memory Analysis and Micro-narrative Coherence in Brief Experiential Psychotherapy for Depression: an Exploratory Analysis by Rotonditrevisan, Debra L. Ma from York University (canada), 2002, 341 pages http://wwwlib.umi.com/dissertations/fullcit/MQ71620

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Baltimore: the Depression Years by Argersinger, Jo Ann Eady, Phd from The George Washington University, 1980, 362 pages http://wwwlib.umi.com/dissertations/fullcit/8014054

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Battered Women: the Relationship between Depression, Coping Skills, and Assertiveness (women) by Margan, Halina Ring, Dsw from Tulane University, School of Social Work, 1990, 276 pages http://wwwlib.umi.com/dissertations/fullcit/9119999

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Behavioral and Cognitive Factors in the Co-occurrence of Depression and Marital Dissatisfaction by Assh, Sharon Donna; Phd from The University of New Brunswick (canada), 1989 http://wwwlib.umi.com/dissertations/fullcit/NL55792

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Beneath the Poverty Line during the Great Depression: the Measurement and Demographic Composition of Poverty in 1939 by Barrington, Linda, Phd from University of Illinois at Urbana-champaign, 1991, 287 pages http://wwwlib.umi.com/dissertations/fullcit/9210737

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Between the Scylla and Charybdis of Anarchy and Despotism: the State, Capital, and the Working Class in the Great Depression, Toronto, 1929-1940 (ontario) by Klee, Marcus Aurelius, Phd from Queen's University at Kingston (canada), 1999, 531 pages http://wwwlib.umi.com/dissertations/fullcit/NQ35966

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Biofeedback-assisted, Client-centered Counseling in the Treatment of Anxiety and Depression in Mastectomy Patients by Lazar, Janice Claire Morgan, Phd from Michigan State University, 1981, 121 pages http://wwwlib.umi.com/dissertations/fullcit/8212419

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Black Adolescent Alcohol Abusers: Severity of Alcohol Use, History of Child Abuse and Current Level of Depression by London, Dyanne Patricia, Phd from Boston University, 1990, 124 pages http://wwwlib.umi.com/dissertations/fullcit/9001154

386 Depression

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Black Female Domestics during the Great Depression in New York City 1930-1940 by Clegg, Brenda Faye, Phd from The University of Michigan, 1983, 222 pages http://wwwlib.umi.com/dissertations/fullcit/8324157

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Black Playwrights of the Federal Theatre Project during the Great Depression: a Critical Analysis of Select Works, 1935-1939 by Caple, Horace B., Phd from The Union Institute, 1991, 312 pages http://wwwlib.umi.com/dissertations/fullcit/9204657

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Blame, Depression and Coping in Battered Women by Porter, Carol Anne; Phd from The University of British Columbia (canada), 1983 http://wwwlib.umi.com/dissertations/fullcit/NK65006

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Boston during the Great Depression: 1929-1940. by Trout, Charles Hathaway, Phd from Columbia University, 1972, 692 pages http://wwwlib.umi.com/dissertations/fullcit/7309051

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Brain Imaging Studies of Medial Temporal Structures and the Pituitary Gland in Early Onset Depression by Macmaster, Frank P. Msc from Dalhousie University (canada), 2002, 121 pages http://wwwlib.umi.com/dissertations/fullcit/MQ75513

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Brain Reward System Dysfunction in Major Depressive Disorder: Differential Behavioural Response to D-amphetamine and Corresponding Neuroanatomical Substrates by Tremblay, Lescia Kryworuchko; Phd from University of Toronto (canada), 2002, 167 pages http://wwwlib.umi.com/dissertations/fullcit/NQ74757

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Bringing Religion Back In: the Life Stress Process and the Study of Depression by Ellison, Christopher Gaillard, Phd from Duke University, 1991, 309 pages http://wwwlib.umi.com/dissertations/fullcit/9424617

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Burden and Depression in Caregivers of Senile Dementia Patients in Korea by Shin, Seung Yeun, Phd from Columbia University, 1995, 191 pages http://wwwlib.umi.com/dissertations/fullcit/9606953

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Business Responses to Crisis: the Depression 1929-1932. by Trommald, Elliott Corbett, Phd from State University of New York at Buffalo, 1977, 474 pages http://wwwlib.umi.com/dissertations/fullcit/7719485

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Calling All Cars: Radio Crime Dramas and the Construction of Policing during the Depression Era by Battles, Kathleen Marie; Phd from The University of Iowa, 2002, 279 pages http://wwwlib.umi.com/dissertations/fullcit/3073349

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Calling the Soul Back to the Heart: Soul Loss, Depression and Healing among Indigenous Mexicans (zapotec) by Taub, Bonnie, Phd from University of California, Los Angeles, 1992, 215 pages http://wwwlib.umi.com/dissertations/fullcit/9310870

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Catholicism and the Industrial Worker during the Great Depression by Betten, Neil Bernard, Phd from University of Minnesota, 1968, 269 pages http://wwwlib.umi.com/dissertations/fullcit/6901489

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Change in Locus of Control, Anxiety, Depression and Social Behavior As a Function of Time in Methadone Maintenance Therapy by Hanbury, Raymond Francis Jr., Phd from New York University, 1980, 198 pages http://wwwlib.umi.com/dissertations/fullcit/8017503

Dissertations 387

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Change Versus Stability in Depression and Social Support among Caregivers of Impaired Elders by Coon, David Wayne, Phd from Stanford University, 1996, 206 pages http://wwwlib.umi.com/dissertations/fullcit/9702882

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Changes in Depression and Self-esteem of Spouses of Stroke Patients with Aphasia As a Result of Group Counseling by Emerson, Roger Walter, Phd from Oregon State University, 1980, 100 pages http://wwwlib.umi.com/dissertations/fullcit/8005612

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Charles L. Mcnary and the Republican Party during Prosperity and Depression by Johnson, Roger Taylor, Phd from The University of Wisconsin - Madison, 1967, 418 pages http://wwwlib.umi.com/dissertations/fullcit/6712435

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Child Adjustment and Maternal Depression As Predictors of Partner Dissatisfaction by Sonnenklar, Jill Weinstein; Phd from St. John's University (new York), 2002, 107 pages http://wwwlib.umi.com/dissertations/fullcit/3054363

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Childhood and Maternal Depression in a Clinical Population by Lasko, Carol Ann, Phd from The University of Akron, 1990, 304 pages http://wwwlib.umi.com/dissertations/fullcit/9110810

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Childhood Depression and Social Skill Deficits (depression) by Linn, James Lee, Phd from The University of Texas at Austin, 1989, 187 pages http://wwwlib.umi.com/dissertations/fullcit/9016928

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Childhood Depression: Relationships between Parent, Child, and Clinician Reports by Fegurgur, Mary Katherine; Psyd from Alliant International University, San Diego, 2002, 86 pages http://wwwlib.umi.com/dissertations/fullcit/3061077

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Childhood Depression: Educational Implications and Criteria for Screening Children (depression Screening) by Hecht, Janet L., Phd from Stanford University, 1992, 125 pages http://wwwlib.umi.com/dissertations/fullcit/9221621

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Childhood Parental Loss and Adult Depression: an Evaluation of Psychoanalytic, Attachment, and Sociological Theories by Mcleod, Jane Donnell, Phd from The University of Michigan, 1987, 265 pages http://wwwlib.umi.com/dissertations/fullcit/8801372

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Childrearing, Social Contact, and Depression: a Structural Analysis of the Transition to Parenthood by Munch-rotolo, Allison Christi; Phd from The University of Arizona, 2000, 308 pages http://wwwlib.umi.com/dissertations/fullcit/9972088

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Children's Interests / Mothers' Rights: Women, Professionals, and the American Family, 1920-1945 (day Care, Mental Hygiene, Great Depression, World War Ii) by Michel, Sonya Alice, Phd from Brown University, 1986, 475 pages http://wwwlib.umi.com/dissertations/fullcit/8617598

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China under the Depression: the Regional Economy of the Lower Yangzi Delta, 19311937 by Shiroyama, Tomoko, Phd from Harvard University, 1999, 392 pages http://wwwlib.umi.com/dissertations/fullcit/9935900

388 Depression

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Chinese Causal Beliefs and Help Seeking Preferences Concerning Depression by Sinclair, David Byron; Phd from University of Alberta (canada), 2000, 222 pages http://wwwlib.umi.com/dissertations/fullcit/NQ60025

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Chronic Illness and Depression among Women: the Role of Social Support by Fuller, Taleria Renee; Phd from Wayne State University, 2000, 163 pages http://wwwlib.umi.com/dissertations/fullcit/9966140

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Citizen Savers: the Family Economy, Financial Institutions, and Social Policy in the Northeastern United States from the Market Revolution to the Great Depression by Wadhwani, Rohit Daniel; Phd from University of Pennsylvania, 2002, 451 pages http://wwwlib.umi.com/dissertations/fullcit/3055007

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Clinical Depression: a Sociological Inquiry by Brissett, Dennis D., Phd from University of Minnesota, 1966, 281 pages http://wwwlib.umi.com/dissertations/fullcit/6801596

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Clinical Treatments of Depression by Orth, Deborah Kay, Edd from West Virginia University, 1979, 369 pages http://wwwlib.umi.com/dissertations/fullcit/8012905

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Cognitive and Behavioral Approaches to the Modification of Depression by Taylor, Frederick George; Phd from Queen's University at Kingston (canada), 1974 http://wwwlib.umi.com/dissertations/fullcit/NK21168

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Cognitive Correlates of Depression in Regular Education and Emotionally Disturbed Children by Little, Vija Karlija Ziemelis, Phd from Texas A&m University, 1989, 213 pages http://wwwlib.umi.com/dissertations/fullcit/9015538

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Cognitive Factors Associated with Depression in Presbyterian (usa) Clergy: a Comparison Study with Mental Health Counselors by Griffin, Wayne David, Phd from University of Florida, 1993, 230 pages http://wwwlib.umi.com/dissertations/fullcit/9505765

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Cognitive Markers in Adolescent Major Depression by Haley, Glenn Michael Thompson; Phd from Simon Fraser University (canada), 1988 http://wwwlib.umi.com/dissertations/fullcit/NL48748

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Cognitive Patterns in Symptomatic Depression between Unipolar and Bipolar Depressives (mood Disorder, Clinical, Abnormal Psychology, Affective Disorders) by Brown, Paul Wendell, Phd from The University of Mississippi, 1984, 75 pages http://wwwlib.umi.com/dissertations/fullcit/8502608

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Cognitive Therapy and Michel Foucault As Resources for a Feminist Theological Approach to the Pastoral Care and Counseling of Depression in Women As Construed by a Biopsychosocial Model of Depression by Dunlap, Susan Jane, Phd from Princeton Theological Seminary, 1994, 273 pages http://wwwlib.umi.com/dissertations/fullcit/9509081

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Cognitive Therapy: Intervention with the Depressed Elderly (depression) by Dehope, Eileen Kathryn, Dsw from University of Pennsylvania, 1990, 302 pages http://wwwlib.umi.com/dissertations/fullcit/9113875

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Cognitive Versus Instrumental Views of the Negative Bias in Depression by Nussbaum, Karen Lee, Phd from University of Washington, 1980, 130 pages http://wwwlib.umi.com/dissertations/fullcit/8026284

Dissertations 389

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Cognitive Vulnerability to Depression: Attention and Memory Biases in Neverdepressed Daughters of Depressed Mothers by Traill, Saskia Katherine; Phd from Stanford University, 2002, 110 pages http://wwwlib.umi.com/dissertations/fullcit/3067965

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College Athletics and Physical Education in Ohio during the Depression by Barnett, Clarence Robert, Phd from The Ohio State University, 1972, 312 pages http://wwwlib.umi.com/dissertations/fullcit/7301932

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College Mental Health Provider's Ability to Identify Dating Violence As the Etiology of Depression in a Battered College Female by Ellis, Gayle Marie; Phd from The University of Wisconsin - Madison, 2001, 127 pages http://wwwlib.umi.com/dissertations/fullcit/3012564

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College Student Expectations about Counseling by a Peer or Professional Counselor for Two Types of Problems (counseling Expectations, Peer Counselor, Depression, Alcoholism) by Weathington, Faith Myer, Edd from Auburn University, 1991, 83 pages http://wwwlib.umi.com/dissertations/fullcit/9217914

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Colorado and the Great Depression: Business Thought in a Time of Crisis by Sims, Robert Carl, Phd from University of Colorado at Boulder, 1970, 159 pages http://wwwlib.umi.com/dissertations/fullcit/7121626

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Commonality of Factors in the Personal Histories of Severely Disabled Schizophrenia and Bipolar Disorder/major Depression Clients by Monschke, Alice Allen, Phd from Kansas State University, 1997, 239 pages http://wwwlib.umi.com/dissertations/fullcit/9817170

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Communication in Marital Dyads Implications for Interactional Approaches to Depression by Kowalik, Debra Lynn; Phd from The University of Western Ontario (canada), 1989 http://wwwlib.umi.com/dissertations/fullcit/NL49316

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Communication Processes of Depression: an Analysis of Verbal Interactions of Depressed College Students with Their Nondepressed Peers by Ziomek, Madelyn Marie, Phd from University of California, Berkeley, 1989, 221 pages http://wwwlib.umi.com/dissertations/fullcit/9006583

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Communism and the Canadian Working Class during the Great Depression the Workers' Unity League, 1930-1936 by Manley, John; Phd from Dalhousie University (canada), 1984 http://wwwlib.umi.com/dissertations/fullcit/NK66123

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Community and Crisis: Black Harlem in the Great Depression (harlem, New York) by Greenberg, Cheryl Lynn, Phd from Columbia University, 1988, 461 pages http://wwwlib.umi.com/dissertations/fullcit/9102420

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Comorbidity between Conduct Disorder and Major Depression: Phenomenology, Correlates, Course, and Familial Aggregation by Seeley, John Robert; Phd from University of Oregon, 2001, 84 pages http://wwwlib.umi.com/dissertations/fullcit/3035576

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Comparison of Adolescent Pic-r and Mmpi Depression Scores to Dsm-iii Criteria by Lavenau, David B., Psyd from Rosemead School of Psychology, Biola University, 1988, 87 pages http://wwwlib.umi.com/dissertations/fullcit/8725083

390 Depression

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Competition and Productivity in the Depression-era Steel Industry by Bertin, Amy Lynn, Phd from Harvard University, 1994, 148 pages http://wwwlib.umi.com/dissertations/fullcit/9514760

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Components of Stress: Anxiety, Depression, and Alienation (workplace, Coping Mechanism) by Tucker, Brian, Phd from Cornell University, 1986, 261 pages http://wwwlib.umi.com/dissertations/fullcit/8623208

•

Concurrent Validity of the Suicide Probability Scale (depression) by Lee, W. Vernon, Phd from Temple University, 1992, 74 pages http://wwwlib.umi.com/dissertations/fullcit/9227492

•

Cone: a Personal-computer Program Simulating Aquifer Tests for Teaching Groundwater Concepts (depression Cone, Hydrology, Geology) by Brooks, Thomas David, Phd from University of Idaho, 1995, 80 pages http://wwwlib.umi.com/dissertations/fullcit/9606358

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Congruence between Child Self-reports and Those of Their Parents and Teachers on Anxiety and Depression: a Preliminary Investigation of Parameters of Agreement by Brook, William Samuel, Phd from The University of Texas at Austin, 1995, 197 pages http://wwwlib.umi.com/dissertations/fullcit/9617180

•

Connecticut in the Great Depression, 1929-1933. by Lombardo, Peter Joseph, Jr., Phd from University of Notre Dame, 1979, 257 pages http://wwwlib.umi.com/dissertations/fullcit/7919951

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Consumption and Income Distribution: the Revised Standard Income Theory with Application to the Great Depression. by Nagle, Reid, Phd from The Johns Hopkins University, 1979, 196 pages http://wwwlib.umi.com/dissertations/fullcit/7914297

•

Contemporary American Poets, Poetry Writing, and Depression by Staltaro, Shirley Oribio; Psyd from Alliant International University, Fresno, 2002, 60 pages http://wwwlib.umi.com/dissertations/fullcit/3062692

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Contracts, Collapse, and Coercion: a Katallactic Reappraisal of the Great Depression by Cochran, Jay, Iii; Phd from George Mason University, 1999, 168 pages http://wwwlib.umi.com/dissertations/fullcit/9949089

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Coping As a Mediator or Moderator of Temperament Risk for Depression and Alcohol Involvement by Mckernon, Wendy L. Phd from Loyola University of Chicago, 2002, 97 pages http://wwwlib.umi.com/dissertations/fullcit/3077495

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Coping Factors That Affect Depression in African American Female Survivors of Child Sexual Abuse: Family Cohesion, Involvement at Church or Temple And, Mother's Perception of Daughter's Depression by Kelley, Robin T. Phd from University of Maryland College Park, 2002, 224 pages http://wwwlib.umi.com/dissertations/fullcit/3055583

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Coping in Adolescent-mother Conflictual Interactions As a Predictor of Adolescent Depression by Bonica, Cheryl A. Phd from University of Massachusetts Amherst, 2002, 87 pages http://wwwlib.umi.com/dissertations/fullcit/3056200

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Coping Strategies, Life Perceptions and Depression in Adolescents by Kay, Lori Ann, Phd from University of Toronto (canada), 1995, 150 pages http://wwwlib.umi.com/dissertations/fullcit/NN07319

Dissertations 391

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Correlates of Demoralization/depression and Related Conditions in Primary Support Persons Caring for Dependent Elderly Relatives (burden, Family) by Brieff, Robert Lewis, Edd from Columbia University Teachers College, 1986, 384 pages http://wwwlib.umi.com/dissertations/fullcit/8620339

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Correlates of Depression Following Romantic Breakups in Adolescence by Peresie, Cheryl Ann; Phd from Ball State University, 2002, 81 pages http://wwwlib.umi.com/dissertations/fullcit/3057050

•

Correlates of Depression in Fifth and Sixth-grade School Children by Berenson, Naomi Janet, Phd from Hofstra University, 1987, 246 pages http://wwwlib.umi.com/dissertations/fullcit/8800451

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Correlates of Self-concept and Depression among Left Hemiplegic Male Patients Disabled by Stroke (stroke Patients) by Galura-siasoco, Gloria Samia, Phd from New York University, 1991, 162 pages http://wwwlib.umi.com/dissertations/fullcit/9136313

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Correlation of Marital Satisfaction and Depression among Couples Where One Spouse Has Become Involuntarily Unemployed by Kessler, Esther, Phd from Seton Hall University, College of Education and Human Services, 1995, 204 pages http://wwwlib.umi.com/dissertations/fullcit/9619188

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Cortisol Release, Memory Dysfunction and Depression by Walder, Deborah Joy; Phd from Emory University, 2002, 87 pages http://wwwlib.umi.com/dissertations/fullcit/3059029

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Couples Coping with Cancer: a Combined Interactional and Problem-solving Approach to Depression by Mcclure, Kelly Sprague; Phd from Mcp Hahnemann University, 2002, 131 pages http://wwwlib.umi.com/dissertations/fullcit/3041287

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Creating the American Paper Boy: Circulation Managers and Middle-class Route Service in Depression-era America by Postol, Todd Alexander, Phd from The University of Chicago, 1997, 305 pages http://wwwlib.umi.com/dissertations/fullcit/9811921

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Critical Life Events, Irrational Beliefs and Locus of Control As Components of Steady State Depression by Pellegrini, Wayne L; Phd from University of Ottawa (canada), 1979 http://wwwlib.umi.com/dissertations/fullcit/NK44123

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Cultivating the Terrain: Public Image and Politics of California Farming from the Depression to the Postwar Years by Bradley, Karen Jane, Phd from University of California, Berkeley, 1995, 341 pages http://wwwlib.umi.com/dissertations/fullcit/9621060

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Cultural Values, Depression, and Social Anxiety in Asian American Adolescents by Zheng, Shufeng; Phd from The University of Utah, 2001, 123 pages http://wwwlib.umi.com/dissertations/fullcit/3031632

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Culture and the Self: Implications for Koreans' Mental Health (depression, Immigrants) by Hyun, Kyoung Ja, Phd from The University of Michigan, 1995, 195 pages http://wwwlib.umi.com/dissertations/fullcit/9610147

392 Depression

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Dancing on Our Graves: Addressing Issues of Depression in Church-going Christian Women of African Descent. Developing Models of Care for Women of Color by Balamani, Michele Deleaver, Dmin from United Theological Seminary, 1997, 135 pages http://wwwlib.umi.com/dissertations/fullcit/9819536

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Darkening Mirrors: Imperial Representation, Otherness and Subjectivity in African American Performance during the Depression Era by Batiste, Stephanie Leigh; Phd from The George Washington University, 2003, 408 pages http://wwwlib.umi.com/dissertations/fullcit/3075177

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Death of a Parent When Children Are Young and Development of Depression in Childhood (bereavement, Mother Loss, Father Loss) by Barile, Bernard Joseph, Phd from University of Pittsburgh, 1984, 190 pages http://wwwlib.umi.com/dissertations/fullcit/8500152

•

Dementia and Depression: a Study of Prevalence in an Elderly Residential Setting by Marrocco, Geraldine Fahy, Edd from Columbia University Teachers College, 1996, 134 pages http://wwwlib.umi.com/dissertations/fullcit/9620160

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Dependence upon Unsustaining Environments As an Antecedent Variable of Depression. by Wetzel, Janice Wood, Phd from Washington University, 1976, 152 pages http://wwwlib.umi.com/dissertations/fullcit/7704060

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Depression across Cultures: the Construction of Depressive Disturbances in Greater Sao Paulo, Brazil by Pereira De Miranda, Damiana; Phd from The University of Arizona, 1999, 358 pages http://wwwlib.umi.com/dissertations/fullcit/9946866

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Depression America and Its Movies by Bergman, Andrew Lawrence, Phd from The University of Wisconsin - Madison, 1970, 285 pages http://wwwlib.umi.com/dissertations/fullcit/7024684

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Depression among a National Probability Sample of Post-hospitalized Patients and Matched Controls by Ricks, Paul Grant, Drph from University of California, Berkeley, 1985, 181 pages http://wwwlib.umi.com/dissertations/fullcit/8524865

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Depression among African Patients: Three Diagnostic Approaches by Fisha, Senathi; Dphil from University of Pretoria (south Africa), 2002 http://wwwlib.umi.com/dissertations/fullcit/f779521

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Depression among Married Female Applicants for Mental Health Service in Southwest Missouri by Fillinger, John W., Edd from University of Northern Colorado, 1983, 98 pages http://wwwlib.umi.com/dissertations/fullcit/8408146

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Depression and Adjustment in Marriage by Olin, George V., Edd from East Texas State University, 1984, 175 pages http://wwwlib.umi.com/dissertations/fullcit/8425049

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Depression and Alcohol Problems in Women by Turnbull, Joanne Emily, Phd from The University of Michigan, 1986, 310 pages http://wwwlib.umi.com/dissertations/fullcit/8612643

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Depression and Anxiety in Cancer Patients Seeking Psychosocial Therapy by Nicholl, Sheldon William; Ma from Lakehead University (canada), 2002, 69 pages http://wwwlib.umi.com/dissertations/fullcit/MQ70798

Dissertations 393

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Depression and Anxiety in Postmenopausal Women: a Study of Black, White, and Hispanic Women by Groessl, Patricia Ann, Edd from Western Michigan University, 1987, 87 pages http://wwwlib.umi.com/dissertations/fullcit/8714651

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Depression and Conduct Disorders As Co-morbid Conditions in Students Who Have Been Suspended from Regular High School Units and Are Attending an Alternative School by Thomas, Gale Denise, Phd from Georgia State University, 1992, 131 pages http://wwwlib.umi.com/dissertations/fullcit/9220336

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Depression and Decline: Newark, New Jersey: 1929-1941 by Stellhorn, Paul Anthony, Phd from Rutgers the State University of New Jersey - New Brunswick, 1982, 416 pages http://wwwlib.umi.com/dissertations/fullcit/8214711

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Depression and Fatigue in Cancer Patients: Implications for Mental Health Practitioners by Van Duursen, Theresa Renee Tiedemann; Phd from University of Northern Colorado, 2002, 113 pages http://wwwlib.umi.com/dissertations/fullcit/3071871

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Depression and Learning Disabilities by Freeman, Emily; Phd from Dalhousie University (canada), 1986 http://wwwlib.umi.com/dissertations/fullcit/NL33154

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Depression and Life Satisfaction in Black, White and Latina Grandmothers Parenting Their Grandchildren by Melton, Carolyn Elaine; Msw from California State University, Long Beach, 2002, 74 pages http://wwwlib.umi.com/dissertations/fullcit/1410815

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Depression and Locus-of-control in College Students with Learning Disabilities by Stephens, Martha Craig, Phd from University of Georgia, 1989, 290 pages http://wwwlib.umi.com/dissertations/fullcit/9003465

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Depression and Loneliness in the Early Adolescent, Learning-disabled Population by Finkelstein, Robert J., Phd from Hofstra University, 1995, 92 pages http://wwwlib.umi.com/dissertations/fullcit/9610412

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Depression and Marital Interaction: an Analysis of Systemic Patterns of Marital Communication by Jabs, Carol Ann; Phd from The University of Chicago, 2000, 146 pages http://wwwlib.umi.com/dissertations/fullcit/9959095

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Depression and Marital Satisfaction, among Married Women Ages 25 to 44, As a Function of Intimacy, Control, and Interpersonal Dependency by Adams, Sheryl Lee, Phd from The Florida State University, 1989, 250 pages http://wwwlib.umi.com/dissertations/fullcit/8915734

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Depression and New Deal in Pendleton: a History of a West Virginia County from the Great Crash to Pearl Harbor, 1929-1941 by Taylor, John Craft, Phd from The Pennsylvania State University, 1980, 890 pages http://wwwlib.umi.com/dissertations/fullcit/8024498

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Depression and New Deal in Virginia by Heinemann, Ronald Lynton, Edd from University of Virginia, 1968, 329 pages http://wwwlib.umi.com/dissertations/fullcit/6903979

394 Depression

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Depression and Perception of Maternal Rejection in Latency-age, African American Children of Alcoholic Mothers by Marse, Karen; Phd from Seton Hall University, College of Education and Human Services, 2002, 121 pages http://wwwlib.umi.com/dissertations/fullcit/3041328

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Depression and Physical Illness: a Longitudinal Analysis of the National Health and Nutrition Examination Survey Data by Skarupski, Kimberly Ann, Phd from Case Western Reserve University, 1996, 227 pages http://wwwlib.umi.com/dissertations/fullcit/9720448

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Depression and Preattributions for Life Problems and Pleasures a Test of Kelley's Model by Flett, Gordon L; Phd from University of Toronto (canada), 1988 http://wwwlib.umi.com/dissertations/fullcit/NL46376

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Depression and Reinforcement : a Test of Three Hypotheses by Rowney, J. I. A; Phd from University of Calgary (canada), 1975 http://wwwlib.umi.com/dissertations/fullcit/NK25058

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Depression and Right Hemisphere Dysfunction in Children with Learning Disabilities by Chaskelson, Marsha Ina, Phd from Boston College, 1985, 148 pages http://wwwlib.umi.com/dissertations/fullcit/8601576

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Depression and Self-silencing in Lesbian and Heterosexual Women by Kirk, Samantha Ann; Phd from West Virginia University, 2002, 146 pages http://wwwlib.umi.com/dissertations/fullcit/3055924

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Depression and Smoking Relapse: an Evaluation of Nicotine Mechanisms by Balabanis, Mark Homer; Phd from University of Pittsburgh, 2002, 113 pages http://wwwlib.umi.com/dissertations/fullcit/3066932

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Depression and Social Anxiety among Asian and European Americans: the Roles of Self-discrepancy, Optimism, and Pessimism by Hardin, Erin Elizabeth; Phd from The Ohio State University, 2002, 190 pages http://wwwlib.umi.com/dissertations/fullcit/3049032

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Depression and the Disablement Process in Older People by Jordan, Anne K. Phd from The Pennsylvania State University, 1999, 163 pages http://wwwlib.umi.com/dissertations/fullcit/9960614

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Depression and the Magnet School Adolescent: Identification, Prevelance, Related Characteristics, and Directions for Treatment by Manning, Bradley Jack; Phd from The Ohio State University, 2002, 136 pages http://wwwlib.umi.com/dissertations/fullcit/3062648

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Depression and Underachievement in the Gifted Male Adolescent by Thomsen, Alice K., Phd from Seton Hall University, School of Education, 1985, 120 pages http://wwwlib.umi.com/dissertations/fullcit/8617877

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Depression and War: Three Essays on the Canadian Economy, 1930--1945 by Rogers, Sean Harris; Phd from Mcgill University (canada), 2000, 245 pages http://wwwlib.umi.com/dissertations/fullcit/NQ70191

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Depression As a Predictor of Ischemic Heart Disease by Rowan, Paul John; Phd from The University of Alabama, 2002, 173 pages http://wwwlib.umi.com/dissertations/fullcit/3067307

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Depression As Loneliness in Post-generative Women: a Crisis of Faith Development by Mader, Shirley Titcomb, Phd from Boston University, 1986, 424 pages http://wwwlib.umi.com/dissertations/fullcit/8624466

Dissertations 395

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Depression As Related to Family Abuse and Family Structure in an Urban Community by Traylor, Lawrence Henry, Edd from Texas Southern University, 1996, 128 pages http://wwwlib.umi.com/dissertations/fullcit/9810252

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Depression Era Extremists: a Study of Three Demagogues and Their Tactics. by Bouton, Michael Wickham, Da from Illinois State University, 1978, 212 pages http://wwwlib.umi.com/dissertations/fullcit/7913036

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Depression Identification among Nursing Home Residents: the Gds Vs. the Mds by Heiser, Deborah Sue; Phd from Fordham University, 2003, 140 pages http://wwwlib.umi.com/dissertations/fullcit/3077254

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Depression in a Preventive Group Intervention for Couples: Individual and Group Level Effects by Brooks, Heidi Stultz; Phd from University of California, Berkeley, 2002, 73 pages http://wwwlib.umi.com/dissertations/fullcit/3063303

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Depression in Adolescence by Marziali, Elsa A., Dsw from Smith College School for Social Work, 1971, 221 pages http://wwwlib.umi.com/dissertations/fullcit/7208403

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Depression in Adolescents by Chow, Hau Lin, Phd from University of Alberta (canada), 1990, 317 pages http://wwwlib.umi.com/dissertations/fullcit/NN64992

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Depression in Adolescents with Attention Deficit Hyperactivity Disorder: Using Conditional Probabilities Based on Teacher Ratings from the Behavior Assessment System for Children by Barton, Nancy Faye; Phd from Oklahoma State University, 1999, 107 pages http://wwwlib.umi.com/dissertations/fullcit/9942420

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Depression in Adolescents: Some Cognitive Developmental Considerations by Griffin, Mary Elizabeth, Phd from University of Pittsburgh, 1988, 123 pages http://wwwlib.umi.com/dissertations/fullcit/8815227

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Depression in Alabama Women with Hiv (immune Deficiency) by Rehner, Timothy Alan, Phd from The University of Alabama, 1994, 165 pages http://wwwlib.umi.com/dissertations/fullcit/9508506

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Depression in Assisted Living Facilities by Wagenaar, Deborah Banazak; Ms from Michigan State University, 2002, 79 pages http://wwwlib.umi.com/dissertations/fullcit/1411991

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Depression in Early Adolescence: Life Events, Ongoing Stressors, and Causal Attribution Linkages in Urban Black Youth (low Socioeconomic, Success, Failure, Interpersonal, Relationships) by Hargrow, Mary Elizabeth, Phd from University of California, Los Angeles, 1985, 189 pages http://wwwlib.umi.com/dissertations/fullcit/8601898

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Depression in Mormon Women by Spendlove, David Craig, Phd from The University of Utah, 1982, 133 pages http://wwwlib.umi.com/dissertations/fullcit/8305425

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Depression in Nonfamilial Caregivers of Young Children: Prevalence and Associations with Caregiver Behavior in Child Care Settings by Hamre, Bridget Kathleen; Phd from University of Virginia, 2002, 177 pages http://wwwlib.umi.com/dissertations/fullcit/3057475

396 Depression

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Depression in Normal Subjects : Predisposing Cognitive Factors and Precipitating Situations by Wright, Phillip Grant; Phd from Mcgill University (canada), 1977 http://wwwlib.umi.com/dissertations/fullcit/NK35818

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Depression in Older Adults: an Examination of Expressive Features by Metz, Helen Emily, Phd from Columbia University, 1987, 114 pages http://wwwlib.umi.com/dissertations/fullcit/8724067

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Depression in Parents of Clinic-referred Children: Links with the Marital, Parentchild, and Child Behavior Domains by Hawkins, Heidi Noell; Phd from Bowling Green State University, 2002, 135 pages http://wwwlib.umi.com/dissertations/fullcit/3066552

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Depression in Pregnancy As It Relates to Feminine Identification Conflict and Perceived Environmental Support by Rothstein, Arnold, Dsw from Smith College School for Social Work, 1971, 146 pages http://wwwlib.umi.com/dissertations/fullcit/7208405

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Depression in Students with Learning Disabilities As Examined by a Developmental Model and Influenced by Hemispheric Differences by Wright-strawderman, Carol, Phd from The University of New Mexico, 1988, 149 pages http://wwwlib.umi.com/dissertations/fullcit/8905771

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Depression in the Caregiving Mothers of Adult Schizophrenics: a Test of the Resource Deterioration Model by Hobbs, Tom Ray, Phd from The University of Alabama, 1994, 136 pages http://wwwlib.umi.com/dissertations/fullcit/9522425

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Depression in Underachieving Gifted High School Students and Effects of a Brief Intervention Strategy (counseling, Reframing, One-session) by Gill, Fredda Herndon, Edd from Virginia Polytechnic Institute and State University, 1984, 125 pages http://wwwlib.umi.com/dissertations/fullcit/8507187

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Depression in Young and Old Adults: the Relative Efficacy of Cognitive Versus Behavioral Group Therapy Interventions by Grossman-morris, Cheryl Fern, Phd from State University of New York at Buffalo, 1986, 239 pages http://wwwlib.umi.com/dissertations/fullcit/8629069

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Depression of Intrinsically Motivated Performance by Rewards the Role of Frustration-mediated Contrast Effects by Dimitroff, George; Phd from University of Toronto (canada), 1984 http://wwwlib.umi.com/dissertations/fullcit/NK62116

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Depression of Intrinsically Motivated Performance by Rewards: the Role of Frustration-mediated Contrast Effects by Dimitroff, George Peter, Phd from University of Toronto (canada), 1984 http://wwwlib.umi.com/dissertations/fullcit/f2126917

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Depression of Murine Hepatic Mixed Function Oxidase during Infection with Listeria Monocytogenes by Azri, Shana; Phd from Dalhousie University (canada), 1988 http://wwwlib.umi.com/dissertations/fullcit/NL49802

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Depression Pioneers: the Conclusion of an American Odyssey. Oklahoma to California, 1930-1950, a Reinterpretation by Manes, Sheila Goldring, Phd from University of California, Los Angeles, 1982, 469 pages http://wwwlib.umi.com/dissertations/fullcit/8219731

Dissertations 397

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Depression Politics in Michigan, 1929-1933 by Ortquist, Richard Theodore, Jr., Phd from The University of Michigan, 1968, 281 pages http://wwwlib.umi.com/dissertations/fullcit/6912198

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Depression, Anxiety, and Locus of Control in a Terminal Versus Nonterminal Population by Burns, Kathleen Marie, Edd from The University of Utah, 1984, 61 pages http://wwwlib.umi.com/dissertations/fullcit/8424970

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Depression, Cognitive Distortion and Self-efficacy in Chronic-pain Patients by Sprague, Ann M; Phd from University of Windsor (canada), 1986 http://wwwlib.umi.com/dissertations/fullcit/NL29293

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Depression, Exercise Schemas, and Physical Self-efficacy by Clark, Camillia Grace; Phd from Fielding Graduate Institute, 2002, 144 pages http://wwwlib.umi.com/dissertations/fullcit/3037965

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Depression, Hopelessness, and Problem-solving in Three Latino Groups by Alberti, Roxana Dearing, Phd from University of Southern California, 1996, 72 pages http://wwwlib.umi.com/dissertations/fullcit/9720174

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Depression, Learning Disabilities, and Social Competence in Prepubertal Children (childhood Depression) by Acker, Haskell Brewington, Phd from Georgia State University, 1990, 158 pages http://wwwlib.umi.com/dissertations/fullcit/9102990

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Depression, Life Satisfaction, and the Will to Live in College-educated 67-72 Year Old Men (employment, Retirement, Aged) by Boy, Stephen Francis, Phd from Boston College, 1986, 153 pages http://wwwlib.umi.com/dissertations/fullcit/8616090

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Depression, Prosperity, and Economic Policy in Japan: Crisis and Stabilization in a Long-run Perspective by Metzler, Mark David, Phd from University of California, Berkeley, 1998, 552 pages http://wwwlib.umi.com/dissertations/fullcit/9922968

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Depression, Self-esteem and Attributional Style As Predictors of Students' Satisfaction with College Life by Abdullatif, Hassan I., Edd from Indiana University, 1992, 163 pages http://wwwlib.umi.com/dissertations/fullcit/9306146

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Depression, Self-focused Attention, and Causal Analysis by Musson, Robert F., Phd from Northwestern University, 1988, 240 pages http://wwwlib.umi.com/dissertations/fullcit/8823012

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Depression, Strain, and Health Outcomes in Caregivers of Cognitively Impaired, Hospitalized Patients: Do Ace Units Help? by Fritsch, Thomas; Phd from Miami University, 2000, 121 pages http://wwwlib.umi.com/dissertations/fullcit/9964487

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Depression, Stress, and Social Supports among Single Mothers of Young Children Exhibiting Severe Behavior Problems by Stanley-bryson, Kaye Lynne, Phd from Kent State University, 1995, 107 pages http://wwwlib.umi.com/dissertations/fullcit/9631221

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Depression--a Theological Disorder (counseling Psychology) by Probst, Theodor, Dmin from Westminster Theological Seminary, 1984, 231 pages http://wwwlib.umi.com/dissertations/fullcit/8425223

398 Depression

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Depressive Cognitions in University Students an Investigation of Two Theories of Depression by Breiter, Hans Juergen; Phd from The University of Western Ontario (canada), 1985 http://wwwlib.umi.com/dissertations/fullcit/NK66057

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Depressive Disorders in Primary School Children: Development of a Screening Instrument and Refinement of Dsm-iv Criteria to Account for Developmental Stage by Van Der Westhuizen, Deborah; Md from University of Pretoria (south Africa), 2002 http://wwwlib.umi.com/dissertations/fullcit/f779505

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Depressive Symptoms, Depletion or Developmental Change? Multidimensionality in the Geriatric Depression Scale According to Contemporary Interpretations of the Disengagement Theory of Aging by Adams, Kathryn Betts; Phd from University of Maryland, Baltimore, 2000, 150 pages http://wwwlib.umi.com/dissertations/fullcit/9998795

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Depressotypic Cognitive Patterns in Conjugal Bereavement and Major Depression by Robinson, Paul J; Phd from York University (canada), 1987 http://wwwlib.umi.com/dissertations/fullcit/NL35793

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Desert Myth: the Great Plains Environment and Depression America by Lookingbill, Brad Darren, Phd from The University of Toledo, 1995, 320 pages http://wwwlib.umi.com/dissertations/fullcit/9601627

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Despair and Depression on Dissolution of an Intimate Relationship and the Healing Process: a Cultural Perspective (divorce, Separation, Cohabitation) by Scalice, Marybeth, Edd from Boston University, 1986, 780 pages http://wwwlib.umi.com/dissertations/fullcit/8615335

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Determining the Structure of Client Participation in Interpersonal Psychotherapy for Depression: Is It Different for Male and Female Clients? by Jones, Marylouise Evans; Phd from Loyola University of Chicago, 2002, 381 pages http://wwwlib.umi.com/dissertations/fullcit/3039286

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Development and Test of a Model That Explains Depression among Korean Older Immigrants in the United States by Sung, Hyunsook, Phd from Indiana University, 1998, 141 pages http://wwwlib.umi.com/dissertations/fullcit/9932709

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Dieting Behaviors in a Community Sample: Associations with Depression, Drug Use, Health and Personality Revealed Through Latent Variable Methods by Zimmer-schur, Lori Ann, Phd from University of Southern California, 1993 http://wwwlib.umi.com/dissertations/fullcit/f2402547

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Differences between Undergraduate and Graduate Students in Self-concept and Depression by Woolley, Ann Lynette; Phd from Andrews University, 2002, 246 pages http://wwwlib.umi.com/dissertations/fullcit/3058318

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Differences in Family Functioning between Hospitalized Children with Depression and Behavior Problems by Kline, Paul Michael, Dsw from Boston College, 1990, 205 pages http://wwwlib.umi.com/dissertations/fullcit/9119367

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Differences in Self-esteem and Depression among Parents of Individuals with Mental Retardation by Graham, Edward William, Dsw from Boston College, 1992, 124 pages http://wwwlib.umi.com/dissertations/fullcit/9232380

Dissertations 399

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Differential Coping Strategies, Anxiety, Depression, and Symptomatology among African-american Women with Hiv/aids by Arrindell, Janis Marie; Phd from Howard University, 2003, 188 pages http://wwwlib.umi.com/dissertations/fullcit/3085404

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Differentiating Attentional Functions in Children with Adhd, Anxiety, and Depression (attention Deficit Hyperactivity Disorder) by Michaels, Katherine Louise, Phd from University of Georgia, 1996, 133 pages http://wwwlib.umi.com/dissertations/fullcit/9624072

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Diffusion during Depression: the Adoption of the Tractor by Illinois Farmers by Graham, Robert Charles, Phd from University of Illinois at Urbana-champaign, 1985, 188 pages http://wwwlib.umi.com/dissertations/fullcit/8521772

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Digging for Dollars: the Impact of the New Deal on the Professionalization of American Archaeology (depression, Relief, Wpa, Paradigm) by Fagette, Paul Harvey, Jr., Phd from University of California, Riverside, 1985, 421 pages http://wwwlib.umi.com/dissertations/fullcit/8524482

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Dirtied Faces: Crisis and the Representation of Childhood and Youth on the Broadway Stage during the Great Depression by Turner, Julius Jeffrey; Phd from University of Colorado at Boulder, 2000, 239 pages http://wwwlib.umi.com/dissertations/fullcit/9969415

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Dissenting Science: Psychologists' Democratic Critique during the Depression Era by Pandora, Katherine Ann, Phd from University of California, San Diego, 1993, 537 pages http://wwwlib.umi.com/dissertations/fullcit/9405457

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Distress in Major Adult Roles and Depression among White Men and Women by Schaeffer, Nora Cate, Phd from The University of Chicago, 1984 http://wwwlib.umi.com/dissertations/fullcit/T-28957

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Does Maternal Psychopathology Affect Child Clinical Assessment? a Test of the Generality and Specificity of the Depression→distortion Theory by Chi, Terry Chih-hsiang; Phd from University of California, Berkeley, 2002, 108 pages http://wwwlib.umi.com/dissertations/fullcit/3082141

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Doing Things and Talking It Out: Themes of Resistance in Young Adults' Accounts of Parental Depression by Dufraimont, Daniel Gordon; Msc from University of Guelph (canada), 2002, 99 pages http://wwwlib.umi.com/dissertations/fullcit/MQ71779

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'don't Buy from Where You Can't Work': Black Urban Boycott Movements during the Depression, 1929-1941. by Hunter, Gary Jerome, Phd from The University of Michigan, 1977, 329 pages http://wwwlib.umi.com/dissertations/fullcit/7726272

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Double Depression in Male Veterans: a Descriptive and Comparative Study in a Rural Department of Veterans Affairs Medical Center by Dixon, Danny Roy, Phd from University of Georgia, 1997, 78 pages http://wwwlib.umi.com/dissertations/fullcit/9817792

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Down in the Dumps: Place, Modernity, and the American Depression by Scandura, Janette M., Phd from University of Michigan, 1997, 271 pages http://wwwlib.umi.com/dissertations/fullcit/9811182

400 Depression

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Dysfunctional Attitudes and the Cognitive Treatment of Depression by Keller, Kevin Edward, Phd from University of Missouri - Columbia, 1980, 190 pages http://wwwlib.umi.com/dissertations/fullcit/8117447

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Dysfunctional Attitudes and Vulnerability to Depression Implications for Stress Appraisals and Coping by Cane, Douglas B; Phd from The University of Western Ontario (canada), 1988 http://wwwlib.umi.com/dissertations/fullcit/NL43283

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Dysfunctional Attitudes, Performance Deficits and Vulnerability to Depression by Olinger, Linda Joan; Phd from The University of Western Ontario (canada), 1984 http://wwwlib.umi.com/dissertations/fullcit/NK60089

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Early Intervention and Major Depressive Disorder by Quiring, Jason Matthew; Phd from University of Oregon, 2002, 123 pages http://wwwlib.umi.com/dissertations/fullcit/3055704

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Early Manifestations of Depression: Temperamental and Parental Influences by Bateman, Alison Elizabeth; Phd from Pacific Graduate School of Psychology, 2003, 119 pages http://wwwlib.umi.com/dissertations/fullcit/3055182

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Easing the Burden: the Era of Depression and New Deal in Mississippi. by Tate, Roger D., Jr., Phd from The University of Tennessee, 1978, 230 pages http://wwwlib.umi.com/dissertations/fullcit/7823356

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Economic Depression in Higher Education; Emory University, the University of Georgia and Georgia Tech, 1930-1940 (1930s, New Deal, Great Depression) by Reeves, Mary Garwood, Phd from Georgia State University, 1985, 366 pages http://wwwlib.umi.com/dissertations/fullcit/8604320

•

Economic Depression in Maryland and Virginia, 1783-1787 by Maganzin, Louis, Phd from Georgetown University, 1967, 294 pages http://wwwlib.umi.com/dissertations/fullcit/6801893

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Economic Policy and Political Leadership in the German Depression 1930-1936 by Heyl, John David, Phd from Washington University, 1971, 396 pages http://wwwlib.umi.com/dissertations/fullcit/7119817

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Education and the Great Depression: an Inquiry into the Social Ideas and Activities of Radical American Educators during the Economic Crisis of the 1930's by Baskin, Alex, Edd from Wayne State University, 1966, 478 pages http://wwwlib.umi.com/dissertations/fullcit/6710472

•

Effect of Religious Coping on Post-stroke Depression by Garvin, Kathy Campbell; Psyd from Regent University, 2003, 57 pages http://wwwlib.umi.com/dissertations/fullcit/3085842

•

Effectiveness of a Clinical Intervention Program for Reduction of Pain, and Concomitant Symptoms of Anxiety, Depression, and Hostility in Individuals Experiencing Chronic Pain (rehabilitation) by Linzer, Marc Rubin, Phd from The University of Arizona, 1986, 109 pages http://wwwlib.umi.com/dissertations/fullcit/8704778

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Effectiveness of Teaching Postpartum Depression Screening Methods Using Lecture and Group Discussion for Undergraduate Nursing Students by Thomas, Usha; Ms from D'youville College, 2002, 86 pages http://wwwlib.umi.com/dissertations/fullcit/1408480

Dissertations 401

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Effects of Depression and Substance Use on Head and Neck Cancer Mortality by Ehlers, Shawna Lee; Phd from The University of Iowa, 2002, 109 pages http://wwwlib.umi.com/dissertations/fullcit/3058400

•

Effects of Depression on Learned Resourcefulness and Prenatal Self-care Practices in Pregnant Women with and without Hiv Seropositivity in Thailand by Sae-han, Chayanin; Phd from Case Western Reserve University (health Sciences), 2002, 229 pages http://wwwlib.umi.com/dissertations/fullcit/3058842

•

Effects of Disputation Strategies in Rational Emotive Behavior Therapy (rebt) on the Treatment of Depression by Moriarty, Dana Lieber; Phd from Hofstra University, 2002, 207 pages http://wwwlib.umi.com/dissertations/fullcit/3041340

•

Effects of Four-day and Five-day Academic Weeks on Stress and Depression Levels in Gifted Secondary Students by Howe, Isabelle Hamilton, Edd from Texas Tech University, 1986, 140 pages http://wwwlib.umi.com/dissertations/fullcit/8707914

•

Effects of Individual Leisure Counseling on Perceived Freedom in Leisure, Perceived Self-efficacy, Depression, and Abstinence of Adults in a Residential Program for Substance Dependence by Collins, G. Colleen, Edd from Temple University, 1997, 192 pages http://wwwlib.umi.com/dissertations/fullcit/9813485

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Effects of Relaxation among Sixth-graders on Achievement, Self-esteem, Anxiety and Depression (sixth Graders, Relaxation Training) by Campo, Peter Angelo, Phd from Temple University, 1993, 109 pages http://wwwlib.umi.com/dissertations/fullcit/9316461

•

Effects of Scientific Weight Training and Muscle Building Nutrition on Self-reports of Mild to Moderate Depression by Pendola, David P., Edd from United States International University, 1995, 373 pages http://wwwlib.umi.com/dissertations/fullcit/9543294

•

Effects of Separation on Vietnamese Unaccompanied Minors: Assessment Through the Use of the Kinetic Family Drawing Test, Hopkins Symptom Checklist-25, and the Vietnamese Depression Scale (refugee Children, Art Therapy) by Mcclementshammond, Ronna Beth, Edd from Rutgers the State University of New Jersey - New Brunswick, 1993, 191 pages http://wwwlib.umi.com/dissertations/fullcit/9328921

•

Effects of Survival Skills Workshops on Depression and Attributional Style of Urban Women in Poverty by Mckeehan, Janice Carol, Phd from Kansas State University, 1992, 170 pages http://wwwlib.umi.com/dissertations/fullcit/9235640

•

Effects of the Great Depression on Private Higher Education: Impact on Private College and University Planning by Hostetler, James Michael, Edd from Western Michigan University, 1989, 207 pages http://wwwlib.umi.com/dissertations/fullcit/9015612

•

Effects of the New Beginnings Program at Polk Community College on Depression, Anxiety, and Self-esteem by Pimpinelli, Angelo Richard, Phd from The Union for Experimenting Colleges and Universities, 1989, 123 pages http://wwwlib.umi.com/dissertations/fullcit/9010766

402 Depression

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Effects of the Type a Behavior Pattern, Depression and the Duration of Noncontrol on the Illusion of Control by Dresel, K. Michael; Phd from The University of Manitoba (canada), 1985 http://wwwlib.umi.com/dissertations/fullcit/NK57764

•

Efficacy of an Aerobic Exercise Program As Treatment for Depression and Anxiety in Alcohol and Chemically Dependent Adults by Deivert, Richard Galen, Phd from The Pennsylvania State University, 1990, 135 pages http://wwwlib.umi.com/dissertations/fullcit/9032269

•

Efficacy of Cognitive Therapy for Adolescent Depression and the Relationship of Empathy to Outcome (psychotherapy) by Brent, Richard P., Edd from The University of Rochester, 1987, 166 pages http://wwwlib.umi.com/dissertations/fullcit/8705919

•

Elation-depression and Skill As Determinants of Desire for Excitement by Ludwig, Lawrence Donald, Phd from The University of Wisconsin - Madison, 1971, 215 pages http://wwwlib.umi.com/dissertations/fullcit/7209137

•

Eleanor Roosevelt and Federal Responsibility and Responsiveness to Youth, the Negro, and Others in Time of Depression by Abramowitz, Mildred Winer, Phd from New York University, 1970, 265 pages http://wwwlib.umi.com/dissertations/fullcit/7113628

•

Eliminating Self-defeating Behavior: a Method of Treating Depression by Perkins, Steven Eugene, Phd from Brigham Young University, 1981, 113 pages http://wwwlib.umi.com/dissertations/fullcit/8208399

•

Emotional Availability and Depression in Mothers of Preschool Children by Terry, Gale Janette, Phd from Smith College School for Social Work, 1990, 118 pages http://wwwlib.umi.com/dissertations/fullcit/9017238

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Empathy Levels and Depression in Physically-abusive Adolescent Mothers and Nonphysically-abusive Adolescent Mothers (child Abuse) by Marino, Marie Ann, Edd from Columbia University Teachers College, 1992, 175 pages http://wwwlib.umi.com/dissertations/fullcit/9228504

•

Emphatically Middling : a Critical Examination of Canadian Poetry in the Great Depression by Thompson, Joyce Lesley; Phd from Queen's University at Kingston (canada), 1975 http://wwwlib.umi.com/dissertations/fullcit/NK24892

•

Empirical Evaluation of a Three Stage Screening Model for Adolescent Depression by Evert, Thomas Frank, Phd from The University of Wisconsin - Madison, 1987, 452 pages http://wwwlib.umi.com/dissertations/fullcit/8723327

•

Employees' Knowledge and Fears about Depression at the Workplace by Orvis, Barbara Jean Bridgford; Phd from University of Minnesota, 2001, 217 pages http://wwwlib.umi.com/dissertations/fullcit/3020605

•

En Defensa De La Raza: the Los Angeles Mexican Consulate and Colonia Mexicana during the Great Depression. by Balderrama, Francisco Enrique, Phd from University of California, Los Angeles, 1978, 244 pages http://wwwlib.umi.com/dissertations/fullcit/7901331

Dissertations 403

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Endocrine Dysfunction in Primary Depressive Disorders in the Mentally Retarded and Its Behavioral Correlates by Pawlarczyk, Douglas Joseph, Phd from The University of North Dakota, 1984, 174 pages http://wwwlib.umi.com/dissertations/fullcit/8507632

•

'enter the Dream House': the British Film Industry and the Working Classes in Depression England, 1929 - 1939 by Shafer, Stephen Craig, Phd from University of Illinois at Urbana-champaign, 1982, 424 pages http://wwwlib.umi.com/dissertations/fullcit/8218560

•

Environmental Implications of Zooarchaeological Measures of Resource Depression by Wolverton, Steven John; Phd from University of Missouri - Columbia, 2001, 181 pages http://wwwlib.umi.com/dissertations/fullcit/3013044

•

Essays in Empirical Macroeconomics: Interpreting the Productivity Resurgence since 1980, and Nominal Wage Stickiness in the Great Depression by Carey, Kevin Joseph, Phd from Princeton University, 1994, 143 pages http://wwwlib.umi.com/dissertations/fullcit/9519127

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Ethnic Community in Economic Crisis: New York Jews and the Great Depression (new York City) by Wenger, Beth S., Phd from Yale University, 1992, 370 pages http://wwwlib.umi.com/dissertations/fullcit/9315272

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Ethnic Variations in Women's Report of Depression: a Question of Women's Adaptation to Changing Gender Roles (black, Asian, Stress/support) by Oakley, Linda Denise, Phd from University of Washington, 1985, 163 pages http://wwwlib.umi.com/dissertations/fullcit/8521643

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Evaluating an Interpersonal Model of Depression with Adults with Down Syndrome by Ailey, Sarah Herrink; Phd from University of Illinois at Chicago, Health Sciences Center, 2002, 152 pages http://wwwlib.umi.com/dissertations/fullcit/3058228

•

Evaluation Du Radar a Ouverture Synthetique En Bande C (5.26 Ghz), Selon Deux Angles De Depression (37a Et 60a), Pour Le Domaine Agricole by Poirier, Sylvain; Phd from Universite Laval (canada), 1987 http://wwwlib.umi.com/dissertations/fullcit/NL39092

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Evolution of Mating System and Inbreeding Depression in the Mimulus Moschatus (scrophulariaceae) Alliance by Carlson, Matthew Lawrence; Phd from University of Alaska Fairbanks, 2002, 221 pages http://wwwlib.umi.com/dissertations/fullcit/3059719

•

Exercise and Clinical Depression: Examining Psychological Mechanisms by Craft, Lynette Leigh; Phd from Michigan State University, 2002, 108 pages http://wwwlib.umi.com/dissertations/fullcit/3064213

•

Exercise and Its Effect on Hopelessness and Depression in an Aging Female Population in Eastern Oklahoma by Hembree, Lynna Diane; Phd from University of Arkansas, 2000, 109 pages http://wwwlib.umi.com/dissertations/fullcit/9987255

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Exercise As a Treatment for Depression Within a National Health Service (antidepressant, Aerobic Exercise, General Practioner) by Mutrie, Nanette, Phd from The Pennsylvania State University, 1986, 188 pages http://wwwlib.umi.com/dissertations/fullcit/8615227

404 Depression

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Exercise As It Relates to Depression and Locus-of-control by Brawner, Patricia Sparks, Phd from University of Georgia, 1989, 106 pages http://wwwlib.umi.com/dissertations/fullcit/9003371

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Exercise Vs. Imipramine in the Treatment of Clomipramine-induced Depression in Male Rats by Yoo, Ho Sang, Phd from University of Georgia, 1995, 127 pages http://wwwlib.umi.com/dissertations/fullcit/9604090

•

Exiled America: Sherwood Anderson, Thomas Hart Benton, Benjamin A. Botkin, Constance Rourke, Arthur Raper and the Great Depression (anderson Sherwood, Benton Thomas Hart, Botkin Benjamin A. , Rourke Constance, Raper Arthur) by Moore, David Ryan, Phd from Brown University, 1992, 297 pages http://wwwlib.umi.com/dissertations/fullcit/9308857

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Expectations, Outcome, and Patient Satisfaction with Mental Health Treatment (depression, Treatment Satisfaction) by Harrington, Janice, Phd from The University of Michigan, 1993, 152 pages http://wwwlib.umi.com/dissertations/fullcit/9319534

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Exploration Des Caracteristiques Graphiques Du Temps Vecu Dans La Depression Majeure a Travers Le Dessin D'une Ligne De Vie (french Text) by Dasseville, Violaine Nathalie; Ma from Concordia University (canada), 2002, 63 pages http://wwwlib.umi.com/dissertations/fullcit/MQ72963

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Exploring Symptoms of Depression in School Children by Berg, Derek Heath; Med from Queen's University at Kingston (canada), 2002, 153 pages http://wwwlib.umi.com/dissertations/fullcit/MQ65601

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Factors Associated with Depression and Low Life Satisfaction in the Low-income, Frail Elderly by Rogers, Anissa Taun, Phd from The University of Utah, 1997, 152 pages http://wwwlib.umi.com/dissertations/fullcit/9724461

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Factors Contributing to Depression in Mexicans and Central Americans by Arias, Luz Cristina; Msw from California State University, Long Beach, 2002, 63 pages http://wwwlib.umi.com/dissertations/fullcit/1410278

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Factors Involved in Depression and Facilitation of Transmission at Crayfish Opener Neuromuscular Synapses by Acosta-urquidi, Juan; Phd from University of Toronto (canada), 1981 http://wwwlib.umi.com/dissertations/fullcit/NK46990

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Factors Related to the Ability of Certain Small, Private, Liberal Arts Colleges to Cope with the New Depression in Higher Education. by Wormley, Wayne Marvin, Phd from Stanford University, 1978, 244 pages http://wwwlib.umi.com/dissertations/fullcit/7822593

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'faking Good' and 'faking Bad' on the Beck Depression Inventory and Variables Which Might Contribute to 'faking' by Adult Clients of a Community Mental Health Center. by Davis, Thomas Whitmell, Phd from Duke University, 1978, 99 pages http://wwwlib.umi.com/dissertations/fullcit/7912786

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Family Adaptability, Cohesion and Conflict in Families with Rheumatoid Arthritis, Chronic Pain and Depression by Caldwell, Karen Leigh, Phd from Virginia Polytechnic Institute and State University, 1988, 106 pages http://wwwlib.umi.com/dissertations/fullcit/8910943

Dissertations 405

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Family Caregivers of the Elderly: the Relationship between Dementia Caregiver Burden, Caregiver Depression and Beliefs about Caregiving by Mantell, Robert Alan; Phd from University of Minnesota, 2000, 180 pages http://wwwlib.umi.com/dissertations/fullcit/9966249

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Family Resilience and Parental Competence: Contributors to Variation on Child Depression Scores in Divorced and Intact Families by Wolfe, Lesa; Phd from University of Calgary (canada), 2001, 223 pages http://wwwlib.umi.com/dissertations/fullcit/NQ64847

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Family Structure and Depression: a Study of Puerto Rican Women in New York by Rodriguez-gomez, Jose Raul, Phd from Fordham University, 1993, 116 pages http://wwwlib.umi.com/dissertations/fullcit/9324625

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Family Therapy with Multigenerational Households: Factors Related to Changes in Depression for Dependent and Non-dependent Elderly (dependent Elderly) by Mitchell, Tim, Phd from Brigham Young University, 1993, 70 pages http://wwwlib.umi.com/dissertations/fullcit/9316737

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Faulkner and the Great Depression: Aesthetics, Ideology, and the Politics of Art (william Faulkner) by Atkinson, Theodore B., Iii; Phd from Louisiana State University and Agricultural & Mechanical College, 2001, 257 pages http://wwwlib.umi.com/dissertations/fullcit/3016525

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Fear, Anger and Depression in Organizations: a Study of the Emotional Consequences of Power. by Myers, Robert J., Phd from St. John's University (new York), 1977, 271 pages http://wwwlib.umi.com/dissertations/fullcit/7900274

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Female Adolescents Identified and Not Identified As Victims of Sexual Abuse: Selfesteem, Depression, Gender-related Personality Traits, and Social Desirability (adolescents) by Brown, Madonna Houltram, Phd from University of Southern California, 1991 http://wwwlib.umi.com/dissertations/fullcit/f1378084

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Feminist Consciousness Raising, Self-concept and Depression. by Weitz, Rose, Phd from Yale University, 1978, 236 pages http://wwwlib.umi.com/dissertations/fullcit/7819491

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Fetal Attachment: Measurement Matters. Relationships among Depression, Marital Satisfaction and Emotional Intelligence by Kunkel, Gail F. Ma from York University (canada), 2002, 162 pages http://wwwlib.umi.com/dissertations/fullcit/MQ75398

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Fighting the Fascist Option in the Great Depression: Raymond Swing, Dale Carnegie and the Cultural History of the Specter of Fascism in the 1930s' United States by Krueckeberg, John Christian, Phd from The University of Arizona, 1997, 589 pages http://wwwlib.umi.com/dissertations/fullcit/9738942

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Forgiveness and Survivors of Sexual Abuse: Relationships among Forgiveness of the Perpetrator, Spiritual Well-being, Depression and Anxiety by Wilson, Heather Patricia, Phd from Boston University, 1994, 239 pages http://wwwlib.umi.com/dissertations/fullcit/9422514

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'forward to a Farm': the Back-to-the-land Movement As a Relief Initiative in Saskatchewan during the Great Depression by Bowen, Dawn Suzanne, Phd from Queen's University at Kingston (canada), 1998, 279 pages http://wwwlib.umi.com/dissertations/fullcit/NQ27817

406 Depression

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Frank Capra Malgre Lui: a Filmmaker and the Contradictions of American Society, 1928-1934 (depression) by Zagarrio, Vito, Phd from New York University, 1995, 303 pages http://wwwlib.umi.com/dissertations/fullcit/9528546

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Free Gold As a Constraint on Monetary Policy during the Early Stages of the Great Depression by Mcelhone, Josephine Matilda, Phd from Iowa State University, 1970, 119 pages http://wwwlib.umi.com/dissertations/fullcit/7107307

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From Depression to Defense: the Reconstruction Finance Corporation: 1932-1940 by Olson, James S., Phd from State University of New York at Stony Brook, 1972, 350 pages http://wwwlib.umi.com/dissertations/fullcit/7229359

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Gender and Crisis: Women's Employment Patterns during the Great Depression (women Workers, Ohio, New York) by Mutari, Ellen Macdonald, Phd from The American University, 1995, 122 pages http://wwwlib.umi.com/dissertations/fullcit/9603510

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Gender and Depression: an Evaluation of Social Role Explanations by Michello, Janet Anne, Phd from The University of Akron, 1989, 177 pages http://wwwlib.umi.com/dissertations/fullcit/8922326

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Gender Differences in Adolescent Depression: a Consequence of Exposure to Adverse Life Circumstances and the Loss of Parent Support by Rudolph, Barbara Ann, Phd from The University of Wisconsin - Madison, 1996, 267 pages http://wwwlib.umi.com/dissertations/fullcit/9708696

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Gender Differences in Depression an Examination of Chronic Life Conditions, Personal Mastery, and Coping by Miles, Jaye; Phd from The University of Manitoba (canada), 1989 http://wwwlib.umi.com/dissertations/fullcit/NL47951

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Gender Differences in the Relationship between Attributions, Consequences and Depression by Coben, Robert Alan, Phd from University of Kansas, 1991, 117 pages http://wwwlib.umi.com/dissertations/fullcit/9238627

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Gender Differences in the Relationship between Depression, Internalizing/externalizing Problems, and Personality Styles in Adolescents by Mabery, Deborah Lynn; Psyd from Pace University, 2002, 106 pages http://wwwlib.umi.com/dissertations/fullcit/3056050

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Gender Identity and Risk for Depression by Martin, Penny Louise; Phd from University of Miami, 2002, 127 pages http://wwwlib.umi.com/dissertations/fullcit/3050742

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Gender Roles, Self-esteem, Depression and Perceived Parental Practices: Trajectories among Culturally Diverse Urban Adolescent Girls by Younes, Maha M. Phd from New York University, 2002, 170 pages http://wwwlib.umi.com/dissertations/fullcit/3062857

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Gender, Sex Typing, and Vulnerability to Depression: Extending Self-discrepancy Theory by Mendelson, Tamar; Phd from Duke University, 2002, 140 pages http://wwwlib.umi.com/dissertations/fullcit/3063196

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Gendering Work and Welfare: Women's Relationship to Wage-work and Social Policy in Canada during the Great Depression by Hobbs, Margaret Helen, Phd from University of Toronto (canada), 1995, 361 pages http://wwwlib.umi.com/dissertations/fullcit/NN02769

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Genetic and Environmental Influences on Associations between Marital Relationships and Depression in Women by Spotts, Erica Lynn; Phd from The George Washington University, 2002, 117 pages http://wwwlib.umi.com/dissertations/fullcit/3032770

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Genetic Factors Involved in Depressive Behavior and Stress Reactivity in an Amimal Model of Depression by Solberg, Leah Catherine; Phd from Northwestern University, 2002, 312 pages http://wwwlib.umi.com/dissertations/fullcit/3071713

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George Mcgill of Kansas: Depression Senator (agriculture, New Deal) by Shockley, Dennis Monleauh, Phd from Kansas State University, 1986, 255 pages http://wwwlib.umi.com/dissertations/fullcit/8705861

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Gis-based Parameterization for Hydraulic Modeling of Watersheds with Depression Storage by Sebti, Saleh; Msc from University of Guelph (canada), 2002, 215 pages http://wwwlib.umi.com/dissertations/fullcit/MQ67376

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Giving Voice to Hope in the Despair of Aging Women: an Approach to Despair, Depression and Anxiety by Ungerstedt-savage, Lena Therese, Edd from Boston University, 1987, 248 pages http://wwwlib.umi.com/dissertations/fullcit/8704819

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Giving Voice to Women's Experience of Depression by Reilly, Mary Louise, Phd from University of Victoria (canada), 1993, 281 pages http://wwwlib.umi.com/dissertations/fullcit/NN90166

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Good Neighbours in Depression : the United States and Colombia, 1928-1938 by Randall, Stephen J; Phd from University of Toronto (canada), 1972 http://wwwlib.umi.com/dissertations/fullcit/NK31316

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Good Neighbours in Depression: the United States and Colombia, 1928-1938. by Randall, Stephen James, Phd from University of Toronto (canada), 1972 http://wwwlib.umi.com/dissertations/fullcit/f1224055

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Government Policy, Working Women and Feminism in the Great Depression: Section 213 of the 1932 Economy Act by Scime, Joy Anne, Phd from State University of New York at Buffalo, 1987, 290 pages http://wwwlib.umi.com/dissertations/fullcit/8727743

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Group Counseling As an Intervention in Anger Expression and Depression in Older Adults by Johnson, Wanda Yates, Phd from University of North Texas, 1988, 105 pages http://wwwlib.umi.com/dissertations/fullcit/8908922

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Harlem in the Great Depression: 1928-1936 by Greene, Larry Alfonso, Phd from Columbia University, 1979, 584 pages http://wwwlib.umi.com/dissertations/fullcit/8222397

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Harry L. Hopkins: Spokesman for Franklin D. Roosevelt in Depression and War by Cotham, Perry Coleman, Phd from Wayne State University, 1970, 369 pages http://wwwlib.umi.com/dissertations/fullcit/7117253

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Health of the State: British and American Public Health Policies in the Depression and World War Ii by Adams, Paul Langford, Dsw from University of California, Berkeley, 1979, 501 pages http://wwwlib.umi.com/dissertations/fullcit/8014585

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Helplessness and Self-blame Attributions in Depression: Investigation of One Possible Resolution of This Paradox among College Students in Taiwan (china) by Wu, Li-chuan, Phd from University of Oregon, 1994, 247 pages http://wwwlib.umi.com/dissertations/fullcit/9434804

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Helplessness, Depression, and Mood in End-stage Renal Disease by Devins, Gerald Michael; Phd from Mcgill University (canada), 1983 http://wwwlib.umi.com/dissertations/fullcit/NK54777

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Helplessness, Sex Roles and Depression by Billingsley, Ralph; Phd from University of Windsor (canada), 1986 http://wwwlib.umi.com/dissertations/fullcit/NL29282

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Herbert Hoover and the Farm Crisis of the Twenties: a Study of the Commerce Department's Efforts to Solve the Agricultural Depression, 1921-1928 by Koerselman, Gary Harlan, Phd from Northern Illinois University, 1971, 417 pages http://wwwlib.umi.com/dissertations/fullcit/7129820

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Herbert Hoover's Economic Foreign Policies for Dealing with the Great Depression: 1929-1933. by Vlaun, Joan Gloria, Phd from New York University, 1977, 265 pages http://wwwlib.umi.com/dissertations/fullcit/7721328

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Hollywood and Political Issues: Three Films of the Depression Era. by Mcconnell, Robert Lee, Phd from The University of Iowa, 1977, 286 pages http://wwwlib.umi.com/dissertations/fullcit/7728487

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Homeless Single Female Heads-of-households: Assessment of Crisis-related Levels of Depression, Self-esteem, and Anxiety As Well As Factors Associated with Homelessness (single Women, Women Heads of Households) by England, Diane Lynn, Phd from The University of Texas at Arlington, 1992, 142 pages http://wwwlib.umi.com/dissertations/fullcit/9301606

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Hoover, the Banks, the Depression: the Iowa Experience, 1930-1933 by Coquillette, Calvin Whitney, Phd from The University of Iowa, 1997, 343 pages http://wwwlib.umi.com/dissertations/fullcit/9819927

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Hoovervilles: Homelessness and Squatting in California during the Great Depression by Gold, Christina Anne Sheehan, Phd from University of California, Los Angeles, 1998, 373 pages http://wwwlib.umi.com/dissertations/fullcit/9823494

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Hopelessness Depression in Women: the Role of Parental Rejection, Attributional Style, and Daily Stress by Gordon, Rebecca Elaine, Edd from Northern Illinois University, 1990, 141 pages http://wwwlib.umi.com/dissertations/fullcit/9118756

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Hopelessness, Depression, and Adolescent Suicidal Behaviors in a Rural Population by Grothus-magee, Marion Donna, Phd from Purdue University, 1992, 92 pages http://wwwlib.umi.com/dissertations/fullcit/9301305

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Hours Vs. Employment: the Determinants of Labor Market Adjustment since the Great Depression by Golden, Lonnie Mark, Phd from University of Illinois at Urbanachampaign, 1985, 225 pages http://wwwlib.umi.com/dissertations/fullcit/8600194

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How Board Certified Family Practice Physicians in Rural Kansas Diagnose and Treat Depression by Kelly, Steven Glenn; Dha from Medical University of South Carolina College of Health Professions, 2002, 80 pages http://wwwlib.umi.com/dissertations/fullcit/3066106

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Hurricane High. Part I: Tropical Depression (original Writing, Novel Section) by Fontenot, Kenneth John; Ma from University of Houston-clear Lake, 2002, 166 pages http://wwwlib.umi.com/dissertations/fullcit/1410039

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Hypnosis for Major Depression: Complementary Strategy or Contraindication? a Survey of Members of Asch, Sceh, and Division 30 by Hensel, Carolyn S. Phd from The University of Wisconsin - Milwaukee, 2001, 216 pages http://wwwlib.umi.com/dissertations/fullcit/3033211

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Identification of a Visual or Auditory Modality Profile Preference of Child and Parent: a Comparative Study of Latency Age Children Diagnosed As Conduct Disorder or Depressive Disorder (sensory Modality Profile, Maternal Depression) by Friedman, Dianne De Lys, Phd from Smith College School for Social Work, 1994, 187 pages http://wwwlib.umi.com/dissertations/fullcit/9502462

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Idled Outside, Overworked Inside: the Political Economy of Prison Labor during Depressions in Chicago, 1871-1897 (illinois, Economic Depression, Unemployment) by Phelps, Margaret Dorsey, Phd from The University of Iowa, 1992, 425 pages http://wwwlib.umi.com/dissertations/fullcit/9308106

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Illinois State Bank Failures in the Great Depression by Guglielmo, Mark Anthony, Phd from The University of Chicago, 1998, 107 pages http://wwwlib.umi.com/dissertations/fullcit/9841523

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Images of Order: American Comic Strips during the Depression, 1929-1938 by Young, William Henry, Phd from Emory University, 1969, 259 pages http://wwwlib.umi.com/dissertations/fullcit/6919621

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Images of Women during the Great Depression and the Golden Age of American Film by Medeiros, Patricia, Phd from University of California, San Diego, 1988, 544 pages http://wwwlib.umi.com/dissertations/fullcit/8817171

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Immigrants and the 1930's: Ethnicity and Alienage in Depression and On-coming War. by Thatcher, Mary Anne, Phd from University of California, Los Angeles, 1973, 342 pages http://wwwlib.umi.com/dissertations/fullcit/7411579

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Incidence and Characteristics of Depression in Late Childhood an Exploratory Study by Paananen, Noreen Ruth; Phd from University of Alberta (canada), 1983 http://wwwlib.umi.com/dissertations/fullcit/NK67534

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Indicators of Adolescent Depression Within the Millon Adolescent Personality Inventory (depression) by Clinton, Marian Marie Haddock, Phd from Texas Woman's University, 1990, 206 pages http://wwwlib.umi.com/dissertations/fullcit/9119206

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Indonesia in the Great Depression: a Study of East Sumatra and Jogjakarta in the 1930's. by O'malley, William Joseph, Phd from Cornell University, 1977, 411 pages http://wwwlib.umi.com/dissertations/fullcit/7728400

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Infertility and Marital Adjustment: the Influence of Perception of Social Support, Privacy Preference and Level of Depression by Maillet, Margaret Haviland; Phd from Louisiana State University and Agricultural & Mechanical College, 2002, 118 pages http://wwwlib.umi.com/dissertations/fullcit/3069721

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Inflationary Measures: Consumption and Depression in Gertrude Stein, Louis Zukofsky and Ezra Pound (stein Gertrude, Zukofsky Louis, Pound Ezra) by Carson, Luke Brendan, Phd from University of California, Los Angeles, 1993, 470 pages http://wwwlib.umi.com/dissertations/fullcit/9408226

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Institutional Revisions: Modernism and American Public Schools from the Depression Through the Second World War by Weisser, Amy Suzanne, Phd from Yale University, 1995, 529 pages http://wwwlib.umi.com/dissertations/fullcit/9538697

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Intellectual and Memory Abilities of Elderly Psychiatric Outpatients with Coexisting Dementia and Depression by Breen, Alan Richard, Phd from University of Washington, 1982, 135 pages http://wwwlib.umi.com/dissertations/fullcit/8218206

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Intensity and Mastery in Physical Activity As Related to Depression and Mood by Monk, Susan V., Phd from The Pennsylvania State University, 1990, 194 pages http://wwwlib.umi.com/dissertations/fullcit/9032345

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Interdisciplinary Training in the Treatment of Depression by Silverstone, Naomi, Dsw from The University of Utah, 1991, 279 pages http://wwwlib.umi.com/dissertations/fullcit/9208455

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Interferon Linked Depression of Hepatic Cytochrome P-450 by Singh, Gurmit; Phd from Dalhousie University (canada), 1982 http://wwwlib.umi.com/dissertations/fullcit/NK53783

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Inter-informant Agreement and Childhood Depression by Crocker, Alison Denise, Phd from University of Windsor (canada), 1994, 234 pages http://wwwlib.umi.com/dissertations/fullcit/NN93261

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Interpersonal Schemas in Major Depression and Axis Ii Disorders by Cohen, Eliana; Phd from York University (canada), 2002, 198 pages http://wwwlib.umi.com/dissertations/fullcit/NQ71968

Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.

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CHAPTER 5. CLINICAL TRIALS AND DEPRESSION Overview In this chapter, we will show you how to keep informed of the latest clinical trials concerning depression.

Recent Trials on Depression The following is a list of recent trials dedicated to depression.8 Further information on a trial is available at the Web site indicated. •

Adult Outpatients with Major Depressive Disorder Condition(s): Major Depressive Disorder Study Status: This study is currently recruiting patients. Sponsor(s): Wyeth-Ayerst Research Purpose - Excerpt: To compare the antidepressant efficacy and safety of subjects receiving DVS-233 SR versus subjects receiving placebo. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00063206

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Bone Mineral Density in Patients with Major Depression Condition(s): Healthy; Involutional Depression; Osteoporosis Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Mental Health (NIMH) Purpose - Excerpt: Researchers have observed significant decreases in the levels of bone density in 24 pre-menopausal women diagnosed with depression, as compared to 24 matched pre-menopausal women without depression. Bone density levels were noted to

8

These are listed at www.ClinicalTrials.gov.

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be significantly lower than normal at several sites (femoral neck decreased by 13.6%, Ward's triangle decreased by 13.6%, and trochanter decreased by 10.8%). Previous studies suggest that levels as low as those observed in these 24 women are associated with increased chances of fracture by 50%. Exactly what causes the decrease in bone density is unknown, but researchers have made note that these women have increased levels of cortisol in their urine. Cortisol is a hormone produced by the adrenal gland and is elevated in patients with Cushing's syndrome. The high levels of cortisol in patients with Cushing's syndrome, works against the cells normally responsible for bone formation (osteoblasts). Like patients with Cushing's syndrome, depressed patients produce high levels of cortisol. However, researchers think that it is unlikely that cortisol alone could be responsible for the very low densities in bone. It is likely that depressed patients have additional hormonal and biochemical abnormalities that can contribute to low bone mineral densities. Researchers believe that patients diagnosed with depression may have impaired calcium absorption. It is unknown if the abnormal calcium absorption is a result of the condition of depression or a side effect of the drugs used to treat depression. Researchers hope to determine an estimate of the true fractional calcium absorption (TFCA) by using non-radioactive calcium isotopes. Patients will be given 46Ca or 44Ca, a non-radioactive calcium isotope that can be taken by mouth and 42Ca a non-radioactive calcium isotope that must be injected directly into the vein. Researcher will then check levels of isotopes in the patient's urine after 24 hours in order to estimate the true fractional calcium absorption (TFCA). Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00001413 •

Brain Chemical Receptor Effects in Patients with Panic Disorder and Post-Traumatic Stress Disorder Condition(s): Panic Disorder; Posttraumatic Stress Disorder; Major Depressive Disorder Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Mental Health (NIMH) Purpose - Excerpt: The purpose of this study is to examine how certain brain chemicals work in patients with Panic Disorder (PD) and Post-Traumatic Stress Disorder (PTSD) with and without major depressive disorder (MDD). Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00025974

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Brain Regulation of Emotions in People with Depression and Anhedonia Condition(s): Major Depressive Disorder Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Mental Health (NIMH) Purpose - Excerpt: This study will use magnetic resonance imaging (MRI) to examine how the brain regulates emotions in healthy people and in patients who have major depression and anhedonia (loss of feeling of pleasure in things that normally give pleasure). Healthy normal volunteers and patients between 18 and 50 years of age with major depression, with or without significant anhedonia, are eligible for this study.

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Candidates will be screened with a psychiatric interview, a physical examination that will include blood and urine samples, and an electrocardiogram, and a questionnaire about their emotions. Participants will perform a monetary reward task while lying in an MRI scanner. The task is similar to playing a computer video game with the possibility of winning cash. The amount of cash is largely dependent on the subject's performance. The accumulated amount of cash earned in a session will fluctuate depending on the subject's continuing performance level. That is, during a single session, a subject could lose money earned early in the session if his or her performance later in the session is not as good as earlier. MRI pictures will be taken during performance of the task. MRI uses a magnetic field and radio waves to produce images of body tissues and organs. The patient lies on a table that is moved into the scanner (a narrow cylinder) and wears earplugs to muffle loud knocking and thumping sounds that occur during the scanning process. The procedure will last about 1 to 1-1/2 hours. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00059579 •

Clinical Trial of Estrogen for Postpartum Depression Condition(s): Postpartum Depression Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Mental Health (NIMH) Purpose - Excerpt: The purpose of this study is to evaluate the effectiveness of 17 betaestradiol, a form of estrogen, in treating women with postpartum depression (PPD). Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00059228

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Clinical trials of three non-drug treatments for winter depression (SAD). Condition(s): Seasonal Affective Disorder; Mood Disorders; Depressive Disorders Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Mental Health (NIMH) Purpose - Excerpt: We are offering non-pharmacologic therapy for alleviation of symptoms associated with depressed mood that recurs annually in fall or winter. The treatments are self-administered at home by the patient, with close clinical supervision. Our trials use specially designed devices that replenish two different environmental elements, naturally occurring light and negative ions in the air. Both factors may be reduced in winter, bringing on depression. Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00006517

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Clinical trials of two non-drug treatments for chronic depression Condition(s): Mood Disorders; Depressive Disorders; Depression; Chronic depression; Nonseasonal depression Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Mental Health (NIMH) Purpose - Excerpt: This study investigates the potential efficacy of two nonpharmacologic treatments for nonseasonal depression, bright light exposure or highdensity negative air ion exposure. Treatments are self-administered at home by the patient under close clinical supervision. Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00006172

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Combination Therapy for the Treatment of Chronic Depression Condition(s): Depression; Depressive Disorder Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Mental Health (NIMH) Purpose - Excerpt: The purpose of this study is to determine whether psychotherapy is an effective treatment for patients with chronic depression who have not completely responded to antidepressant medication. Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00057551

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Continuation Electroconvulsive Therapy vs Medication to Prevent Relapses in Patients with Major Depressive Disorder Condition(s): Major Depressive Disorder Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Mental Health (NIMH) Purpose - Excerpt: The purpose of this study is to compare the safety and effectiveness of two treatments to prevent relapses in seriously ill patients with major depressive disorder (MDD) who have responded to electroconvulsive therapy (ECT). Patients will either continue to receive ECT (continuation electroconvulsive therapy [C-ECT]), or they will be treated with antidepressant medications. ECT is a highly effective treatment for MDD; however, relapses are a major concern. To prevent relapse in patients who have responded to ECT, the common treatment is antidepressants as continuation therapy (following the initial therapy in order to continue treating the disorder). Relapses, however, can still occur even after antidepressant continuation therapy. This study will evaluate a potent antidepressant combination in order to prevent relapse. C-ECT is another option that needs to be tested. If the patient responds to the first round of ECT, he/she will be assigned randomly (like tossing a coin) to either continue receiving ECT or to receive an antidepressant combination of nortriptyline plus lithium (NOR-Li) for 6 months. The patient will have psychological tests before, shortly after, and 3 months after the first round of ECT, and at the end of the 6-month continuation trial. Patients will be monitored for symptoms and side effects. All patients will have urine tests to test

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for drug abuse. An individual may be eligible for this study if he/she: Has major depressive disorder and responds positively to ECT treatment and is 18 to 80 years old. Phase(s): Phase IV Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000375 •

Depression Study In Adults Condition(s): Major Depressive Disorder Study Status: This study is currently recruiting patients. Sponsor(s): (Sponsor Name Pending) Purpose - Excerpt: A Placebo Controlled Study Evaluating Efficacy, Safety and Tolerability of Medication in Patients with Major Depressive Disorder (MDD) Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00057239

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Depression Study In Elderly Patients Condition(s): Major Depressive Disorder Study Status: This study is currently recruiting patients. Sponsor(s): (Sponsor Name Pending) Purpose - Excerpt: Major Depressive Disorder (MDD) Study in Elderly Outpatients Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00067444

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Drug Treatment for Depressed Alcoholics (naltrexone/fluoxetine) Condition(s): Alcoholism; Depression Study Status: This study is currently recruiting patients. Sponsor(s): National Institute on Alcohol Abuse and Alcoholism (NIAAA) Purpose - Excerpt: This study will examine the effects of combing naltrexone and fluoxetine (Prozac) versus fluoxetine and placebo in alcoholics with co-occurring major depression. Both groups will actively participate in the 6-month study, which includes weekly individual Dual Disorders Recovery Counseling during the first month and every two weeks during the second through sixth months, plus the naltrexone and fluoxetine or fluoxetine and placebo. Subjects will complete follow-up assessments at 9 and 12 months. Phase(s): Phase IV Study Type: Interventional

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Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00006204 •

Heart Disease Risk Factors in Major Depression Condition(s): Adrenal Gland Hyperfunction; Cardiovascular Disease; Involutional Depression Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Mental Health (NIMH) Purpose - Excerpt: Patients with major depression have an increased risk for coronary artery disease, independent of smoking and traditional cardiac risk factors. Several hormonal changes that occur with depression may be associated with this increased risk. Our hypothesis is that one of these is probably related to the decreased response to insulin (insulin resistance). This study will examine insulin resistance in patients with major depression and, how severe it is and why it occurs. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00001969

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Interactions of Depressed Mothers with Their Infants Condition(s): Healthy; Depression Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Child Health and Human Development (NICHD) Purpose - Excerpt: This study will examine 1) differences among mothers' behaviors and how these behaviors influence their infants' reactions, and 2) how mother-child interactions relate to children's temperament, and cognitive (thought processing) abilities, and other areas of development. Depressed and non-depressed Englishspeaking mothers between 20 and 45 years of age, with an infant 4 months or younger, may be eligible for this study. Candidates will be screened with a mailed survey regarding their moods and feelings. Participants will undergo the following procedures: - Psychiatric Interview: Subjects will participate in a 30-90 minute interview consisting of a series of standardized questions about the their behaviors and feelings. Participants whose interviews suggest a condition that may impact their mental health will be referred to the study clinician for follow-up to confirm or clarify the preliminary findings. Continued participation in the study will be determined following this. Home Visit: A study investigator will visit the home for 1 hour to film the mother and baby during the mother's typical daily activities. This visit will take place when the baby is about 5 months old. At the end of the visit, the mother will be given a variety of surveys to fill out at home and return at the next visit (see Lab Visit below). The survey questions deal with the mother's relationship with her partner, support from people in her life, typical behaviors of her infant, and how often she feels certain emotions. A packet of surveys will also be left for the participant's partner to complete and mail back to the investigator. The partner may or may not be the child's biological father and may or may not choose to participate in the study. - Lab Visit: Within 1 week of the home visit, the mother and child will come to the NICHD clinic for about 2 hours. During this time, the mother will return the previous surveys and fill out another one regarding her current mood. She will then interact with her child, who will be seated in front of her. The 20-minute session will be videotaped. (There will be breaks during the session.) The

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mother will be instructed about how she should act (happy or sad). She and her baby will then participate in a variety of filmed situations that will induce certain emotions in the baby, such as happiness, fear, activity, frustration, and interest, in order to learn how different children react to different situations. Participants will be contacted to continue the study when their babies are 12 months old and again when the children are 24 months old. The above procedures will be repeated and some new measures will be added for toddlers that involve activities investigating aspects of early language and social reasoning.. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00044174 •

Lethargic Depression Study Condition(s): Major Depressive Disorder Study Status: This study is currently recruiting patients. Sponsor(s): (Sponsor Name Pending) Purpose - Excerpt: Major Depressive Disorder (MDD) study in patients with decreased energy, pleasure and interests Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00064467

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Major Depressive Disorder Study In Adults Condition(s): Major Depressive Disorder Study Status: This study is currently recruiting patients. Sponsor(s): (Sponsor Name Pending) Purpose - Excerpt: A study to obtain safety and tolerability data Phase(s): Phase IV Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00049972

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MRI Study of Brain Activity and Risk for Depression in Adolescents Condition(s): Involutional Depression; Anxiety Disorders Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Mental Health (NIMH) Purpose - Excerpt: This study will use magnetic resonance imaging (MRI) to investigate brain changes in adolescents at risk for Major Depressive Disorder. It also calls for healthy volunteers to compare to children at risk for major depression. Study Type: Observational Contact(s): see Web site below

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Web Site: http://clinicaltrials.gov/ct/show/NCT00047944 •

Optimizing Electroconvulsive Therapy for Depression Condition(s): Depression; Depressive Disorder; Bipolar Disorder Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Mental Health (NIMH) Purpose - Excerpt: The purpose of this study is to evaluate electroconvulsive therapy (ECT) administered concurrently with antidepressant medication. This study will also compare two different types of ECT. Phase(s): Phase IV Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00045916

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Serotonin Function During Depression Condition(s): Depression, Involutional; Healthy Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Mental Health (NIMH) Purpose - Excerpt: Serotonin is a chemical involved in regulation of emotions, anxiety, sleep, stress hormones, and other body functions. The purpose of this study is to use a procedure called tryptophan depletion to study the function of serotonin in people with depression and in healthy volunteers. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00033787

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Study Of Adults With Depression Condition(s): Major Depressive Disorder Study Status: This study is currently recruiting patients. Sponsor(s): (Sponsor Name Pending) Purpose - Excerpt: A Placebo Controlled Study Evaluating Efficacy, Safety and Tolerability of Medication in Patients with Major Depressive Disorder (MDD) Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00057226

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Study Of Depression In Adults Condition(s): Major Depressive Disorder Study Status: This study is currently recruiting patients. Sponsor(s): (Sponsor Name Pending)

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Purpose - Excerpt: A Placebo Controlled Study Evaluating Efficacy, Safety and Tolerability of Medication in Patients with Major Depressive Disorder (MDD) Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00057213 •

The Effects of Hormones in Postpartum Mood Disorders Condition(s): Depressive Disorder; Mood Disorder; Postpartum Depression Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Mental Health (NIMH) Purpose - Excerpt: The purpose of this study is to determine how women who have experienced a postpartum mood disorder respond to estrogen and progesterone in comparison to women who have had an episode of major depression not related to PPD, and in comparison with women who have not experienced mood disorders. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00001481

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The Study of Olanzapine Plus Fluoxetine in Combination for Treatment-Resistant Depression Without Psychotic Features Condition(s): Depressive Disorders Study Status: This study is currently recruiting patients. Sponsor(s): Eli Lilly and Company Purpose - Excerpt: The purposes of this study are to determine: * Whether olanzapine plus fluoxetine in combination will help patients with treatment-resistant major depression. * The safety of olanzapine plus fluoxetine in combination, plus and any side effects that might be associated with the combination. * The effectiveness of olanzapine plus fluoxetine compared to olanzapine and fluoxetine alone. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00035321

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Therapy for Depression with Co-occurring Panic or Anxiety Symptoms Condition(s): Depression; Mood Disorder; Anxiety Disorder; Panic Disorder; Major Depressive Disorder Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Mental Health (NIMH) Purpose - Excerpt: The purpose of this study is to develop and test a new therapy designed to treat depressed patients with co-occurring symptoms of panic or anxiety. Phase(s): Phase I; Phase II

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Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00051207 •

Treatment for Adolescents With Depression Study (TADS) Condition(s): Major Depressive Disorder; Depression Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Mental Health (NIMH) Purpose - Excerpt: TADS is designed to compare the effectiveness of established treatments for teenagers suffering from major depressive disorder (MDD). The treatments are: psychotherapy ("talking therapy"); medication; and the combination of psychotherapy and medication. Altogether, 432 teenagers (both males and females) ages 12 to 17, will take part in this study at 12 sites in the United States. The TADS design will provide answers to the following questions: What is the long-term effectiveness of medication treatment of teenagers who have major depression? What is the long-term effectiveness of a specific psychotherapy ("talking therapy) in the treatment of teenagers who have major depression? How does medication treatment compare with psychotherapy in terms of effectiveness, tolerability and teenager and family acceptance? And, What is the cost-effectiveness of medication, psychotherapy and combined treatments? The medication being used in this study is called fluoxetine. Fluoxetine is also known as Prozac. Research has shown that medications like Prozac help depression in young persons. Fluoxetine has been approved by the FDA for use in the treatment of adult depression and is under study for children and teenagers. The psychotherapy or "talking therapy" being used in this study is called Cognitive Behavioral Therapy (CBT). CBT is a talking therapy that will teach both the teenager and his or her family member (e.g., parent) new skills to cope better with depression. Specific topics include education about depression and the causes of depression, setting goals, monitoring mood, increasing pleasant activities, social problem-solving, correcting negative thinking, negotiation, compromise and assertiveness. CBT sessions may also help with resolving disagreements as they affect families. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00006286

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Treatment Of Resistant Depression In Adolescents (TORDIA) Condition(s): Major Depressive Disorder; Dysthymic Disorder; Depression Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Mental Health (NIMH) Purpose - Excerpt: This is a study of depression in adolescents, ages 12 to 18, who are currently taking a prescribed selective serotonin reuptake inhibitor (SSRI) antidepressant medication but are still experiencing depression. The purpose of the study is to determine how best to treat adolescents with depression that is "resistant" to the first SSRI they have tried. In addition to receiving a complete psychiatric evaluation, participants will be randomly assigned to receive one of three other antidepressant medications, either alone or in combination with cognitive behavioral therapy.

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Participants will be monitored for 24 weeks and will receive follow-up psychiatric evaluations for one year. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00018902 •

Treatment of Vascular Depression Condition(s): Depressive Disorder; Depression Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Mental Health (NIMH) Purpose - Excerpt: The purpose of this study is to determine the effectiveness of the antidepressant sertraline (Zoloft) in treating people with vascular depression. A second goal is to determine how well a Magnetic Resonance Imaging (MRI) scan and tests of concentration, thought, and memory can predict response to antidepressant medications. This study will also test the effects of frontal lobe dysfunction on treatment response. Phase(s): Phase IV Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00045773

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Treatments for Depression: Drug vs. Psychotherapy Condition(s): Depression Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Mental Health (NIMH) Purpose - Excerpt: The purpose of this study is to compare supportive expressive psychodynamic therapy to antidepressant medication plus Clinical Management for the treatment of patients with Major Depressive Disorder (MDD). A second goal is to evaluate the long-term effects of these 2 treatments on the recurrence of depression. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00043550

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Vascular Depression and Magnetic Stimulation Therapy Condition(s): Depressive Disorder; Depression Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Mental Health (NIMH) Purpose - Excerpt: The purpose of this study is to examine the effectiveness of rapidtranscranial magnetic stimulation (rTMS) in the treatment of vascular depression. Phase(s): Phase III

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Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00044798 •

Acupuncture in the Treatment of Depression Condition(s): Depressive Disorders; Depression Study Status: This study is no longer recruiting patients. Sponsor(s): National Center for Complementary and Alternative Medicine (NCCAM) Purpose - Excerpt: The current large randomized placebo-controlled trial is testing the ability of acupuncture to treat major depression. The study is unique in that treatment effects will be from the perspective of both Western psychiatry and Chinese medicine. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00010517

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Depression Study Condition(s): Major Depressive Disorder Study Status: This study is no longer recruiting patients. Sponsor(s): (Sponsor Name Pending) Purpose - Excerpt: A Placebo Controlled Study Evaluating Efficacy And Safety of Medication In Patients With Major Depressive Disorder (MDD) Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00048204

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Dose Escalation, Double-Blind Treatment with Duloxetine Hydrochloride Once Daily Dosing for Evaluation of Safety in Major Depression Condition(s): Major Depressive Disorder Study Status: This study is no longer recruiting patients. Sponsor(s): Eli Lilly and Company Purpose - Excerpt: The Purposes of this Study are to determine: The safety of duloxetine and any side effects that might be associated with it. Whether duloxetine can help patients with major depression. It is possible that information collected during this study will be analyzed by the sponsor in the future to evaluate duloxetine for other possible uses or for other medical or scientific purposes other than those currently proposed. Duloxetine might not have any good effects for you. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00042575

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Long Term Treatment of Patients with Major Depressive Disorder with an Investigational Compound Condition(s): Major Depressive Disorder Study Status: This study is no longer recruiting patients. Sponsor(s): (Sponsor Name Pending) Purpose - Excerpt: A clinical study to determine the efficacy and safety of an investigational medication in the treatment of depression. Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00048594

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Treatment of Patients with Major Depressive Disorder with an Investigational Compound Condition(s): Major Depressive Disorder Study Status: This study is no longer recruiting patients. Sponsor(s): (Sponsor Name Pending) Purpose - Excerpt: A clinical study to determine the efficacy and safety of an investigational medication in the treatment of depression. Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00034944

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Treatment of Patients with Major Depressive Disorder with an Investigational Compound Condition(s): Major Depressive Disorder Study Status: This study is no longer recruiting patients. Sponsor(s): (Sponsor Name Pending) Purpose - Excerpt: A clinical study to determine the efficacy and safety of an investigational medication in the treatment of depression Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00034983

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Treatment of patients with Major Depressive disorder with an investigational compound Condition(s): Major Depressive Disorder Study Status: This study is no longer recruiting patients. Sponsor(s): (Sponsor Name Pending) Purpose - Excerpt: A clinical study to determine the efficacy and safety of an investigational medication in the treatment of depression Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00035009

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Treatment of Patients with Major Depressive Disorder with an Investigational Compound Condition(s): Major Depressive Disorder Study Status: This study is no longer recruiting patients. Sponsor(s): (Sponsor Name Pending) Purpose - Excerpt: A clinical study to determine the efficacy and safety of an investigational medication in the treatment of depression Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00048607

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Acute Effectiveness of Additional Drugs to the Standard Treatment of Depression Condition(s): Bipolar Disorder; Depressive Disorder Study Status: This study is completed. Sponsor(s): National Institute of Mental Health (NIMH) Purpose - Excerpt: This study will compare the effectiveness of relatively new antidepressants which have different mechanisms of action. Buproprion (Wellbutrin) works on dopamine and the dopaminergic pathway. Sertraline (Zoloft) works as a selective serotonin reuptake inhibitor (SSRI). Venlafaxine (Effexor) works as a mixed serotonin, norepinephrine, and dopamine reuptake inhibitor. Subjects enrolled in this study will be patients diagnosed with a bipolar disorder who are presently taking medication to prevent the symptoms of the disease (prophylactic treatment), but have had breakthrough episodes of depression despite taking their medication. Patients will receive any one of the three antidepressant medications as noted above plus a placebo inactive sugar pill, in order to mask which antidepressant is being prescribed) in addition to their regular medication for bipolar disorder. All of the doses will be calculated as effective for the treatment of a unipolar major depressive disorder. The patient will continue receiving the medication for ten weeks. The effectiveness of the drug treatment will be measured by using three different scales; 1. Inventory for Depressive Symptoms - Clinicians form (IDS-C) 2. Clinical Global Impression scale(CGIBP) 3. Life Charting Methodology (LCM) Patients who do not respond to their medication within ten weeks from the beginning of the study will be considered as nonresponders and be offered the opportunity to start the study again, taking one of the two remaining medications. For example, if a patient was assigned to take Wellbutrin but it was ineffective, he/she could re-enter the study and be given either Zoloft or Effexor. Patients that do respond in the first ten weeks of the study will be eligible to continue taking the medication for one year to assess the long term effectiveness of the drug on preventing episodes of depression and to assess for any possible differential induction of mania. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00001483

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Consequences of Conjugal Bereavement in Adults Condition(s): Bereavement; Depressive Disorder; Immunologic Disease; Mental Disorder; Sleep Disorder

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Study Status: This study is completed. Sponsor(s): National Institute of Mental Health (NIMH) Purpose - Excerpt: Bereavement refers to the expected reactions and sadness associated with the loss of a loved one. It has been reported that the loss of a spouse is rated as the major life stressor among survivors of varying ages and diverse cultural backgrounds. Statistics have shown that in the United States over 800,000 men and women lose a spouse each year. A wide range of symptoms has been associated with bereavement including; depressed mood, tearfulness, sleep disturbances, and irrational behavior. Previous studies have shown that up to 50% of bereaved individuals can develop major depression. Bereavement has also been associated with dysfunction of the immune system. As a result, bereaved adults are more vulnerable to infection. However, the exact relationship between bereavement and immunity is uncertain. Researchers firmly believe that a relationship does exist between stress, more specifically bereavement, immunity, and the increased chance of dying following the loss of a long-term spouse. The objective of this study is to find possible links between bereavement, depression, and the immune system. This study will follow a group of elderly bereaved spouses and a group of elderly people who have not lost a long-term spouse. The group of bereaved individuals will be followed for approximately 13 months after the loss of their spouse and the group of controls will be followed for 13 months after entering the study. Researchers will make note of any clinical, biological, and immunological changes in any participants of the study. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00001659 •

Duloxetine Versus Placebo in the Prevention of Relapse of Major Depressive Disorder Condition(s): Depressive Disorder Study Status: This study is completed. Sponsor(s): Eli Lilly and Company Purpose - Excerpt: The purpose of this study is to determine if duloxetine is effective when compared to placebo in preventing recurrence of major depressive disorder in patients who have responded to open-label duloxetine treatment. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00036309

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Open-Label Treatment with Duloxetine Hydrochloride Once-Daily Dosing for Evaluation of Stabilization Dose in Patients with Major Depression Condition(s): Major Depressive Disorder Study Status: This study is not yet open for patient recruitment. Sponsor(s): Eli Lilly and Company Purpose - Excerpt: The purposes of this study are to determine: The safety of duloxetine and any side effects that might be associated with it. Whether duloxetine can help

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patients with major depression. The safety associated with switching from a medication you may be taking for depression to taking duloxetine. It is possible that information collected during this study will be analyzed by the sponsor in the future to evaluate duloxetine for other possible uses or for other medical or scientific purposes other than those currently proposed. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00042562 •

Progestin (progesterone-like hormones) induced dysphoria (depressed mood, irritability, anxiety) Condition(s): Depressive Disorder; Mood Disorder; Psychomotor Agitation Study Status: This study is completed. Sponsor(s): National Institute of Mental Health (NIMH) Purpose - Excerpt: Often women are prescribed hormone replacement therapy (HRT) during the perimenopause or menopause. Hormone replacement therapy includes both estrogen and progesterone. The estrogen component of HRT helps to relieve the symptoms and has a beneficial effect on the heart and bones, but estrogen also increases the risk of uterine cancer. The progesterone component of the HRT (progestin) works to prevent the increased risk of uterine cancer. There is evidence that some women experience unpleasant mood symptoms (such as irritability, depressed mood and anxiety) while receiving hormone replacement therapy (HRT) while taking the progestin / progesterone component of the HRT. This study is designed to evaluate the ability of progestins to produce negative mood symptoms in women. Researchers intend on doing this by comparing the effects of medroxyprogesterone acetate (Provera) and a placebo inactive sugar pill. Patient's moods will be monitered based on their response to questionnaires answered in the outpatient clinic and at home. This research will attempt to answer the following questions: 1. Are progestins associated with changes in mood during hormone replacement therapy? 2. If progestins are associated with mood disturbance, is it because they are blocking the beneficial effects of estrogen? Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00001770

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Treatment Effects on Platelet Calcium in Hypertensive and Depressed Patients Condition(s): Depression; Hypertension Study Status: This study is not yet open for patient recruitment. Sponsor(s): Department of Veterans Affairs Medical Research Service; SmithKline Beecham Purpose - Excerpt: This study aims to determine if treatment with an SSRI antidepressant medication, paroxetine, is associated with cellular calcium response to serotonin, platelet serotonin receptors, and improvement in mood in depressed patients with or without hypertension. It is hypothesized that platelets of hypertensive patients with depressive symptomatology with be hyper-responsive to serotonin. Additionally, treatment with an SSRI antidepressant is expected to produce a down-regulation of the

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serotonin receptor with an associated reduction in platelet cytosolic calcium response as well as improved mood. Phase(s): Phase IV Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00018759 •

Treatment of Major Depression with St. John's Wort (Hypericum) Condition(s): Major Depression Study Status: This study is completed. Sponsor(s): National Institute of Mental Health (NIMH); National Center for Complementary and Alternative Medicine (NCCAM) Purpose - Excerpt: The purpose of this trial is to study the acute efficacy and safety of a standardized extract of the herb Hypericum perforatum (St. John's Wort), called hypericum for purposes of this trial, in the treatment of patients with major depression. Clinical depression is a serious medical disorder that can be debilitating and can lead to suicide. There is growing public interest in claims that hypericum may be an effective treatment for depression. Although it is widely prescribed in Europe, no studies of its long-term use have been conducted, and published studies have treated different types of patients and have used several different doses. The toxicity and side effects of hypericum appear to be substantially less than those of standard tricyclic antidepressant medications, and thus hypericum may be more acceptable to patients. In addition, the cost is significantly less than standard antidepressant medications. Published studies assessed acute efficacy and lasted between 4 and 12 weeks (most being 4-6 weeks). The longer-term effects of hypericum have not been evaluated. There is a need for a largescale, controlled clinical trial to assess whether Hypericum has a significant therapeutic effect in patients with clinical depression. Patients are assigned randomly (like tossing a coin) to receive St. John's wort, Sertraline (Zoloft), or a placebo (sugar pill) for 8 weeks. This is a double-blind study, meaning neither the patient nor the doctor will know which treatment is being assigned. Patients who respond well to the treatment will continue on the assigned treatment for an additional 4 months. Patients will have regular follow-up visits to monitor their symptoms and any side effects they experience. Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00005013

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Treatment Resistant Depression Study Condition(s): Depression; Major Depressive Disorder Study Status: This study is completed. Sponsor(s): Johnson & Johnson Pharmaceutical Research and Development, L.L.C. Janssen Pharmaceutica Purpose - Excerpt: A Study to evaluate the efficacy and safety of risperidone in patients with treatment-resistant depression. Phase(s): Phase III Study Type: Interventional

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Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00044681 •

Use of Bone Biopsy to Better Understand the Causes of Decreased Bone Mineral Density in Depression Condition(s): Bone Diseases, Metabolic; Depression, Involutional; Osteoporosis Study Status: This study is completed. Sponsor(s): National Institute of Mental Health (NIMH) Purpose - Excerpt: In this study researchers would like to learn more about the low levels of bone mineral density seen in approximately half of women in their forties diagnosed as currently having or previously had depression. Bones are always undergoing a process of building (formation) and breakdown (resorption). This process is referred to as bone remodeling. When more bone is formed than resorbed, the density (level of calcium) in bone increases and the bones become stronger. However, if more bone is resorbed than formed the density of bone decreases and the bones become weak. This condition is called osteoporosis. It is unknown if women with depression have decreased bone mineral density as a result of too much breakdown of bone or not enough building. It is important to know the cause of low bone mineral density because it will influence the way a patient is treated. Medications like bisphosphonates are used when there is too much bone breakdown. Growth hormone replacement can be given in cases where there is not enough bone production. Presently, bone biopsy and a procedure known as histomorphometry can determine what processes are going on in bones. Researchers have decided to use a sample of bone (biopsy) from part of the hip bone (iliac crest). In addition, researchers will collect a sample of bone marrow (the soft tissue found in the center of bones) to tell them more about the biochemical, cellular, and molecular processes that may be contributing to the problem of decreased bone density in depressed premenopausal women. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00001916

Keeping Current on Clinical Trials The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to the Web site at http://www.clinicaltrials.gov/ and search by “depression” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials:

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For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/

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For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html

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For cancer trials, visit the National Cancer Institute: http://cancertrials.nci.nih.gov/

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For eye-related trials, visit and search the Web page of the National Eye Institute: http://www.nei.nih.gov/neitrials/index.htm

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For heart, lung and blood trials, visit the Web page of the National Heart, Lung and Blood Institute: http://www.nhlbi.nih.gov/studies/index.htm

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For trials on aging, visit and search the Web site of the National Institute on Aging: http://www.grc.nia.nih.gov/studies/index.htm

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For rare diseases, visit and search the Web site sponsored by the Office of Rare Diseases: http://ord.aspensys.com/asp/resources/rsch_trials.asp

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For alcoholism, visit the National Institute on Alcohol Abuse and Alcoholism: http://www.niaaa.nih.gov/intramural/Web_dicbr_hp/particip.htm

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For trials on infectious, immune, and allergic diseases, visit the site of the National Institute of Allergy and Infectious Diseases: http://www.niaid.nih.gov/clintrials/

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For trials on arthritis, musculoskeletal and skin diseases, visit newly revised site of the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health: http://www.niams.nih.gov/hi/studies/index.htm

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For hearing-related trials, visit the National Institute on Deafness and Other Communication Disorders: http://www.nidcd.nih.gov/health/clinical/index.htm

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For trials on diseases of the digestive system and kidneys, and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/patient/patient.htm

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For drug abuse trials, visit and search the Web site sponsored by the National Institute on Drug Abuse: http://www.nida.nih.gov/CTN/Index.htm

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For trials on mental disorders, visit and search the Web site of the National Institute of Mental Health: http://www.nimh.nih.gov/studies/index.cfm

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For trials on neurological disorders and stroke, visit and search the Web site sponsored by the National Institute of Neurological Disorders and Stroke of the NIH: http://www.ninds.nih.gov/funding/funding_opportunities.htm#Clinical_Trials

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CHAPTER 6. PATENTS ON DEPRESSION Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.9 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “depression” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on depression, we have not necessarily excluded nonmedical patents in this bibliography.

Patents on Depression By performing a patent search focusing on depression, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an 9Adapted from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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example of the type of information that you can expect to obtain from a patent search on depression: •

.beta..sub.3 -Adrenoceptor agonists and antagonists for the treatment of intestinal motility disorders, depression, prostate disease and dyslipidemia Inventor(s): Kreutter; David K. (Madison, CT), Dow; Robert L. (Waterford, CT) Assignee(s): Pfizer Inc (New York, NY) Patent Number: 5,627,200 Date filed: September 26, 1994 Abstract: This invention relates to methods for treating intestinal motility disorders, intestinal ulcerations, including inflammatory bowel disease, ulcerative colitis, Crohn's disease and proctitis, and gastrointestinal ulcerations, depression, prostate disease and dyslipidemia by administering a.beta..sub.3 -adrenoceptor antagonist or agonist. Excerpt(s): This invention relates to methods for treating or preventing intestinal motility disorders, depression, prostate disease and dyslipidemia by administering a.beta..sub.3 -adrenoceptor antagonist or agonist. This invention also relates to pharmaceutical compositions for treating or preventing intestinal motility disorders, depression, prostate disease and dyslipidemia comprising a.beta..sub.3 -adrenoceptor antagonist or agonist.....beta.-Adrenergic receptors have been categorized into.beta..sub.1,.beta..sub.2 and.beta..sub.3 -subtypes. Agonists of.beta.-receptors promote the activation of adenylyl cyclase. Activation of.beta..sub.1 -receptors invokes increases in heart rate while activation of.beta..sub.2 -receptors induces relaxation of skeletal muscle tissue which produces a drop in blood pressure and the onset of smooth muscle tremors. Activation of.beta..sub.3 -receptors is known to stimulate lipolysis (the breakdown of adipose tissue triglycerides to glycerol and free fatty acids), and thereby promote the loss of fat mass. Compounds that stimulate.beta..sub.3 -receptors are therefore useful as anti-obesity agents. In addition, compounds which are.beta..sub.3 adrenoceptor agonists have hypoglycemic or anti-diabetic activity, but the mechanism of this effect is unknown.... Until recently.beta..sub.3 -adrenoceptors were thought to be found predominately in adipose tissue..beta..sub.3 -receptors are now known to be located in such diverse tissues as the intestine and the brain. J. Clin. Invest., 91, 344 (1993). Stimulation of the.beta..sub.3 -receptor has been demonstrated to cause relaxation of smooth muscle in colon and trachea. Life Sciences, 44, 19, 1411 (1989); Br. J. Pharm., 112, 55 (1994). For example, stimulation of.beta..sub.3 -receptors has been found to induce relaxation of histamine-contracted guinea pig ileum, J. Pharm. Exp. Ther., 260, 1, 192 (1992). Web site: http://www.delphion.com/details?pn=US05627200__

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1-Oxo-1H-naphtho [2,1-b] pyran derivatives for treating depression Inventor(s): Passerini; Norina (Milan, IT), Ermili; Aldo (Genoa, IT), Roma; Giorgio (Genoa, IT), Balbi; Alessandro (Genoa, IT), Mazzei; Mauro (Genoa, IT) Assignee(s): Carlo Erba S.p.A. (IT) Patent Number: 4,001,424 Date filed: March 12, 1976

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Abstract: 1-Oxo-1H-naphtho [ 2,1-b] pyran derivatives, such as, for instance, 1-oxo-3-(Nmethyl-N-ethyl) amino-1H-naphtho [2,1-b] pyran, are disclosed, as well as pharmaceutical compositions containing same and the method of treating depression by administering such compositions.These compounds are active on the central nervous system, and therefore function as antidepressive agents. Excerpt(s): Each of the R.sub.1 and R.sub.2 groups, being the same or different, may be hydrogen, C.sub.1 -C.sub.6 alkyl, C.sub.2 -C.sub.6 alkenyl, or R.sub.1 and R.sub.2, taken together with the nitrogen atom, may form a monocyclic ring which may contain one or more other heteroatoms, under the condition that, when both R and R.sub.3, R.sub.4, R.sub.5 are hydrogen, R.sub.1 and R.sub.2 cannot be both methyl or both ethyl or both propyl, and not even can they be, taken together with the nitrogen atom, the Npyrrolidinyl or the N-piperidyl radical; as well as pharmaceutically acceptable salts of the compounds of formula (I).... When R.sub.1 and R.sub.2, taken together with the nitrogen atom, form a heteromonocyclic ring, said ring is preferably azacycloheptyl or, when at least one of R, R.sub.3, R.sub.4, R.sub.5, is different from hydrogen, said heteromonocyclic ring may also be the N-pyrrolidinyl or the N-piperidyl radical.... Another object of the present invention is represented by pharmaceutical compositions containing a suitable carrier and, as an active principle, a compound of formula (I) of a salt thereof, wherein R, R.sub.3, R.sub.4 and R.sub.5 are as hereabove defined, and wherein R.sub.1 and R.sub.2 may be not only defined as hereabove indicated, but also, even when both R and R.sub.3, R.sub.4, R.sub.5 are hydrogen, they may be both methyl or both ethyl or both propyl or, taken together with the nitrogen atom, they may be the N-pyrrolidinyl or the N-piperidyl radical. Web site: http://www.delphion.com/details?pn=US04001424__ •

Aminoalkyloximes for treating depression and affective disorders Inventor(s): Shutske; Gregory M. (Pittstown, NJ), Freed; Brian S. (Phillipsburg, NJ), Tomer, IV; John D. (Perkasie, PA), Hamer; R. Richard L. (Lebanon, NJ) Assignee(s): Hoechst Marion Roussel, Inc. (Cinncinnati, OH) Patent Number: 5,686,447 Date filed: June 1, 1995 Abstract: Novel aminoalkyloximes, precursors and processes for the preparation thereof, and methods of treating depression and obsessive compulsive disorders are described. Excerpt(s): As used throughout the specification and appended claims, the term "alkyl" refers to a straight or branched chain hydrocarbon radical containing no unsaturation and having 1 to 8 carbon atoms. Examples of alkyl groups are methyl, ethyl, 1-propyl, 2propyl, 1-butyl, 1-hexyl, 3-hexyl, 4-heptyl, 2-octyl and the like. The term "alkoxy" refers to a monovalent substituent which consists of an alkyl group linked through an ether oxygen having its free valence bond from the ether oxygen. Examples of alkoxy groups are methoxy, ethoxy, propoxy, 1-butoxy, 1-pentoxy, 3-hexoxy, 4-heptoxy, 2-octoxy and the like. The term "alkanol" refers to a compound formed by a combination of an alkyl group and hydroxy radical. Examples of alkanols are methanol, ethanol, 1- and 2propanol, 2,2-dimethylethanol, hexanol, octanol and the like. The term "halogen" refers to a member of the family fluorine, chlorine, bromine, or iodine. The term "lower" as applied to any of the aforementioned groups refers to a group having a carbon skeleton containing up to and including 6 carbon atoms.... The compounds of the present

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invention which lack an element of symmetry exist as optical antipodes and as the racemic forms thereof. The optical antipodes may be prepared from the corresponding racemic forms by standard optical resolution techniques, involving, for example, the separation of diastereomeric salts of those instant compounds characterized by the presence of a basic amino group and an optically active acid, or by synthesis from optically active precursors.... In the Z-isomer, the aminoalkyloxy group of the oxime function and the phenyl moiety, the group of greater priority, are cis to each other and in the E-isomer, the aminoalkyloxy group of the oxime function and the phenyl moiety, are trans to each other. The wiggly (.about.) line in the formulas of the aminoalkyloximes of formula 1 indicate that the compound may be the E- or Z-isomer. See B. Unterhalt, Methodicum Chimicum 6, 403 (1975), for a discussion of the E-Z nomenclature. Web site: http://www.delphion.com/details?pn=US05686447__ •

Antidepressant polycyclic imides to treat depression Inventor(s): Moyer; John A. (New Hope, PA), Stack; Gary P. (Ambler, PA) Assignee(s): American Home Products Corporation (New York, NY) Patent Number: 5,134,141 Date filed: September 6, 1991 Abstract: A method for relieving depression with decahydro-3-[4-[4-(2-pyrimidinyl)-1piperazinyl]butyl]-1,5-methano-6,7,9-m etheno-2H-pentaleno[1,2-d]azepine-2,4(3H)dione, or a pharmaceutically acceptable salt thereof. Excerpt(s): U.S. Pat. No. 4,957,913 discloses a method of treatment of rhypertension which involves administration of one of a series of serotoninergic polycyclic imides. One of these imides is decahydro-3-[4-[4-(2-pyrimidinyl)-1-piperazinyl]butyl]-1,5-methano6,7,9-m etheno-2H-pentaleno[1,2-d]azepine-2,4(3H)-dione (I).... In accordance with this invention there is provided a method for treating depression which comprises administering, orally or parenterally, to a patient suffering from depression, an antidepressant amount of compound I, or a pharmaceutically acceptable salt thereof.... The pharmaceutically acceptable salts are those derived from such organic and inorganic acids as: acetic, lactic, citric, tartaric, succinic, maleic, fumaric, malonic, gluconic, hydrochloric, hydrobromic, phosphoric, nitric, sulfuric, methane sulfonic, and similarly known acceptable acids. Web site: http://www.delphion.com/details?pn=US05134141__

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Apparatus And Method For Adjunct (Add-On) Therapy For Depression, Migraine, Neuropsychiatric Disorders, Partial Complex Epilepsy, Generalized Epilepsy And Involuntary Movement Disorders Utilizing An External Stimulator Inventor(s): Boveja; Birinder Bob (8879 S. Chestnut Hill Way, Highlands Ranch, CO 80130) Assignee(s): none reported Patent Number: 6,356,788 Date filed: November 30, 2000

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Abstract: An apparatus and method for adjunct (add-on) therapy of depression, migraine, neuropsychiatric disorders, partial complex epilepsy, generalized epilepsy and involuntary movement disorders comprises an implantable lead-receiver, and an external stimulator having controlling circuitry, a power source, and a coil to inductively couple the stimulator to the lead-receiver. The external stimulator emits electrical pulses to stimulate a cranial nerve such as the left vagus nerve according to a predetermined program. In a second mode of operation, an operator may manually override the predetermined sequence of stimulation. Excerpt(s): This invention relates generally to electrical stimulation therapy for neurologic and neuropsychiatric disorders, more specifically to neuromodulation therapy for depression, migraine, and neuropsychiatric disorders, as well as adjunct treatment for partial complex, generalized epilepsy and involuntary movement disorders utilizing an implanted lead-receiver and an external stimulator.... It has been observed clinically that electrical stimulation therapy for seizures produced mood improvement independent of the anti-seizure effects. This discovery led to medical research into the therapeutic effects of electrical stimulation for depression. Medical research has shown beneficial medical effects of vagus nerve stimulation (VNS) for severely depressed patients.... Vagus nerve stimulation, and the profound effects of electrical stimulation of the vagus nerve on central nervous system (CNS) activity, extends back to the 1930's. Medical studies in clinical neurobiology have advanced our understanding of anatomic and physiologic basis of the anti-depressive effects of vagus nerve stimulation. Web site: http://www.delphion.com/details?pn=US06356788__ •

Apparatus and method for transcranial magnetic brain stimulation, including the treatment of depression and the localization and characterization of speech arrest Inventor(s): Epstein; Charles M. (Atlanta, GA), Davey; Kent R. (New Smyrna Beach, FL) Assignee(s): Emory University (Atlanta, GA) Patent Number: 6,425,852 Date filed: January 18, 2000 Abstract: An apparatus and method for transcranial magnetic brain stimulation. The apparatus allows transcranial stimulation at higher power efficiency and lower heat generation than prior available magnetic stimulator coils without an iron core. Use of the apparatus allows an improved method for active localization of language function. The device can also be used in rapid rate transcranial magnetic stimulation for the treatment of depression. Excerpt(s): The present invention relates to an apparatus for transcranial magnetic brain stimulation. The invention also relates to methods for localizing and characterizing speech arrest, and for treatment of depression using transcranial magnetic stimulation.... Magnetic stimulation of neurons has been heavily investigated over the last decade. Almost all magnetic stimulation work has been done in vivo. The bulk of the magnetic stimulation work has been in the area of brain stimulation.... Cohen has been a rather large contributor to this field of research (See e.g., T. Kujirai, M. Sato, J. Rothwell, and L. G. Cohen, "The Effects of Transcranial Magnetic Stimulation on Median Nerve Somatosensory Evoked Potentials", Journal of Clinical Neurophysiology and Electro Encephalography, Vol. 89, No. 4, 1993, pps. 227-234, the disclosure of which is fully incorporated herein by reference.) This work has been accompanied by various other

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research efforts including that of Davey, et al. and that of Epstein (See, K. R. Davey, C. H. Cheng, C. M. Epstein "An Alloy--Core Electromagnet for Transcranial Brain Stimulation", Journal of Clinical Neurophysiology, Volume 6, Number 4, 1989; and, Charles Epstein, Daniel Schwartzberg, Kent Davey, and David Sudderth, "Localizing the Site of Magnetic Brain Stimulation in Humans", Neurology, Volume 40, April 1990, pps. 666-670, the disclosures of which are fully incorporated herein by reference). Web site: http://www.delphion.com/details?pn=US06425852__ •

Cholecystokinin antagonists useful for treating depression Inventor(s): Woodruff; Geoffrey N. (Braughing, GB) Assignee(s): Warner-Lambert Company (Morris Plains, NJ) Patent Number: 5,217,957 Date filed: August 20, 1991 Abstract: The invention concerns cholecystokinin (CCK) antagonists useful in the treatment major and minor forms of depression. CCK-B, -A, and mixed -A and -B antagonists are useful. Especially useful are CCK.sub.B antagonists such as CI-988. Excerpt(s): Cholecystokinin (CCK) is a neuropeptide with a widespread distribution in brain. CCK receptors are classified into two types; CCK.sub.A and CCK.sub.B, both of which are present in brain (Woodruff, G. N. and Hughes, J., 1991, Ann. Rev. Pharmacol. 31, 469-501).... Mixed CCK.sub.A and CCK.sub.B antagonists include but are not limited to (1S-trans)-N-[.alpha.-methyl-N-[[(2-methylcyclohexyl)oxy]carbonyl]-D-trypt ophyl]L-3-(phenylmethyl)-.beta.-alanine.... The above CCK antagonists have been described in EPA 0405537. These antagonists are also described in U.S. application Ser. No. 07/629,809, filed Dec. 19, 1990, the disclosure of which is hereby incorporated by reference. Web site: http://www.delphion.com/details?pn=US05217957__

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Combination treatment for depression Inventor(s): Howard, Jr. Harry Ralph (Bristol, CT) Assignee(s): Pfizer Inc. (New York, NY) Patent Number: 6,436,938 Date filed: October 9, 2001 Abstract: The present invention relates to a method of treating depression, especially refractory depression, in a mammal, including a human, by administering to the mammal a sigma receptor ligand in combination with an antidepressant agent. It also relates to pharmaceutical compositions containing a pharmaceutically acceptable carrier, a sigma receptor ligand and a serotonin reuptake inhibitor. Excerpt(s): The present invention relates to a method of treating depression, especially refractory depression, in a mammal, including a human, by administering to the mammal a sigma receptor ligand in combination with a Serotonin Reuptake Inhibitor (SRI). It also relates to pharmaceutical compositions containing a pharmaceutically acceptable carrier, a sigma receptor ligand and a Serotonin Reuptake Inhibitor (SRI).... Major depression is characterized by feelings of intense sadness and despair, mental

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slowing and loss of concentration, pessimistic worry, agitation, and self-deprecation. Physical changes also occur, especially in severe or "melancholic" depression. These include insomnia or hypersomnia, anorexia and weight loss (or sometimes overeating), decreased energy and libido, and disruption of normal circadian rhythms of activity, body temperature, and many endocrine functions.... Serotonin Selective Reuptake Inhibitors (SSRIs) currently provide efficacy in the treatment of major depressive disorder (MDD) and are generally perceived by psychiatrists and primary care physicians as effective, well-tolerated and easily administered. However, they are associated with undesirable features, such as high incidence of sexual dysfunction, delayed onset of action and a level of non-responsiveness estimated to be as high as 30% (see M. J. Gitlin, Journal of Clinical Psychiatry, 1994, 55, 406-413 and R. T. Segraves, Journal of Clinical Psychiatry, 1992, 10(2), 4-10). Preclinical and clinical evidence has indicated that the sexual dysfunction associated with SSRI therapy can be reduced through the use of monoamine reuptake inhibitors (SRI) and dopamine reuptake inhibitors (DRIs), such as bupropion (see A. K. Ashton, Journal of Clinical Psychiatry, 1998, 59(3), 112-115). Furthermore, the combination of SRI and DRI may hasten the onset of action as well as offering relief to refractory patients, possibly through a synergistic mechanism (see R. D. Marshall et al, Journal of Psychopharmacology, 1995, 9(3), 284286) and prove beneficial in the treatment of substance abuse and attention deficit hyperactivity disorder (ADHD) according to Barrickman et al, Journal of the American Academy of Child and Adolescent Psychology, 1995, 34(5), 649 and Shekim et al, Journal of Nervous and Mental Disease, 1989, 177(5), 296. Web site: http://www.delphion.com/details?pn=US06436938__ •

Combined use of pramipexole and sertraline for the treatment of depression Inventor(s): Maj; Jerzy (Kracau, PL) Assignee(s): Boehringer Ingelheim Pharma KG (Ingelheim, DE) Patent Number: 6,255,329 Date filed: July 6, 1999 Abstract: The present invention relates to the use of 2-amino-4,5,6,7-tetrahydro-6-npropylamino-benzothiazole (pramipexole), the (+)- or (-)- enantiomer thereof, or one of the pharmacologically acceptable salts thereof, in conjunction with sertraline for the improved treatment of depression and depressive states. Excerpt(s): The present invention relates to an agent with an antidepressant activity containing 2-amino-4,5,6,7-tetrahydro-6-n-propylamino-benzothiazole, the (+) or (-) enantiomer thereof, the pharmacologically acceptable acid addition salts thereof and a conventional antidepressant. The combination of pramipexole and sertraline is of particular interest.... Pramipexole--(-)-2-amino-6-n-propylamino-4,5,6,7tetrahydrobenzo-thiazole-- is a dopamine-D.sub.3 /D.sub.2 agonist, the synthesis of which is described in European Patent 186 087 and U.S. Pat. No. 4,886,812. Pramipexole is known primarily for treating schizophrenia and particularly for the treatment of Parkinson's disease. German Patent Application DE 38 43 227 discloses that pramipexole lowers the prolactin serum level, and it is also known from German Patent Application DE 39 33 738 to use pramipexole to lower high TSH levels. Its transdermal administration is disclosed in U.S. Pat. No. 5,112,842, and WO Patent Application PCT/EP93/03389 describes the use of pramipexole as an antidepressant.... Details of the preparation of the title compound can be found in EP-A 85 116 016, and reference is hereby made specifically to the literature cited therein.

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Web site: http://www.delphion.com/details?pn=US06255329__ •

Composition and method of treating depression using a pentacyclic nucleus opioid antagonist in combination with a tricyclic antidepressant Inventor(s): Dante; Lee G. (Merion Station, PA) Assignee(s): Nagle, Esq. John S. (Thousand Oaks, CA) Patent Number: 5,856,332 Date filed: August 28, 1996 Abstract: A new composition and method for treating depression is claimed comprising administering to a patient exhibiting said illness or illnesses a pharmacologically effective dose of an opioid antagonist having a pentacyclic nucleus, and a pharmacologically effective dose of a tricyclic antidepressant. Excerpt(s): The present invention relates to the use of an opioid antagonist such as naltrexone in combination with one or more serotonin (5-hydroxytryptamine or 5-HT) or norepinephrine reuptake inhibitor(s) and/or lithium to treat mental or emotional disorders characterized by depression, obsessiveness, depression with anxiety, mania, manic depression, depression with manic episodes, and depression concomitant with an illness causing seizures which are inhibited by carbamazepine, or a combination of any of these mental or emotional illnesses, or mental or emotional illnesses with seizures. The inventor has discovered that naltrexone is useful in combination with lithium and/or one or more serotonin (5-HT) uptake inhibitor and/or norepinephrine (N.E.) uptake inhibitor drug compounds in treating patients whose depression and/or associated mental illnesses or conditions were refractory to drug treatment using one or more known antidepressant agents or agents for manic and manic depressive disorders such as lithium, and tricyclic and a-typical antidepressants including, but not limited to clomipramine, amitriptyline, imipramine, sertraline and nortriptyline that inhibit 5-HT and/or N.E. reuptake.... The inventor has further discovered that such treatment using naltrexone in combination with lithium and/or 5-HT or N.E. reuptake inhibitors is effective even where benzodiazepines are concurrently administered to treat anxiety. Additionally, the inventor has discovered that lithium in combination with naltrexone in some cases reduces manic and manic depressive bipolar symptoms.... A general discussion of the effectiveness of tricyclic antidepressants and non-tricyclic a-typical antidepressants in inhibiting 5-HT and/or N.E. neuronal synaptic reuptake and in treating depression, along with the pharmacology of these compounds is found in Goodman and Gillman, The Pharmacological Basis of Therapeutics, 7th and 8th Eds. (MacMillan Publ. Co.) Chapt. 19, Section 11 "Drugs Used in the Treatment of Disorders of Mood", incorporated by reference herein. According to the present invention, tricyclic antidepressants include, but are not limited to, imipramine, amitriptyline, trimipramine, doxepin, desipramine, nortriptyline, protriptyline, amoxapine, clomipramine, maprotriline, and carbamazepine, and their pharmaceutically effective salts and esters, such as, but not limited to their hydrochlorides, maleates, tartrates and lactates. Although carbamazepine is approved in the U.S. as antiepileptic, it is chemically related to tricyclic antidepressants, its actions on human brain neurons are not completely known, and for the present invention it is classified as a tricyclic antidepressant. See, Goodman and Gillman, The Pharmacological Basis of Therapeutics, referenced above, 7th Ed., page 457 et seq. Web site: http://www.delphion.com/details?pn=US05856332__

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Composition and method of treating depression using naloxone or naltrexone in combination with a serotonin reuptake inhibitor Inventor(s): Dante; Lee G. (Merion Station, PA) Assignee(s): Nagle; John S. (Thousand Oaks, CA) Patent Number: 5,817,665 Date filed: November 20, 1995 Abstract: This invention relates to a composition and method for treating depression by administering to a patient a pharmacologically effective dose of an opioid antagonist having a pentacyclic nucleus structurally analogous to naltrexone, and a pharmacologically effective dose of a nontricyclic antidepressant Excerpt(s): The present invention relates to the use of an opioid antagonist such as naltrexone in combination with one or more serotonin (5-hydroxytryptamine or 5-HT) or norepinephrine reuptake inhibitor(s) and/or lithium to treat mental or emotional disorders characterized by depression, obsessiveness, depression with anxiety, mania, manic depression, depression with manic episodes, and depression concomitant with an illness causing seizures which are inhibited by carbamazepine, or a combination of any of these mental or emotional illnesses, or mental or emotional illnesses with seizures. The inventor has discovered that naltrexone is useful in combination with lithium and/or one or more serotonin (5-HT) uptake inhibitor and/or norepinephrine (N.E.) uptake inhibitor drug compounds in treating patients whose depression and/or associated mental illnesses or conditions were refractory to drug treatment using one or more known antidepressant agents or agents for manic and manic depressive disorders such as lithium, and tricyclic and a-typical antidepressants including, but not limited to clomipramine, amitriptyline, imipramine, sertraline and nortriptyline that inhibit 5-HT and/or N.E. reuptake.... The inventor has further discovered that such treatment using naltrexone in combination with lithium and/or 5-HT or N.E. reuptake inhibitors is effective even where benzodiazepines are concurrently administered to treat anxiety. Additionally, the inventor has discovered that lithium in combination with naltrexone in some cases reduces manic and manic depressive bipolar symptoms.... A general discussion of the effectiveness of tricyclic antidepressants and non-tricyclic a-typical antidepressants in inhibiting 5-HT and/or N.E. neuronal synaptic reuptake and in treating depression, along with the pharmacology of these compounds is found in Goodman and Gillman, The Pharmacological Basis of Therapeutics, 7th and 8th Eds. (MacMillan Publ. Co.) Chapt. 19, Section 11 "Drugs Used in the Treatment of Disorders of Mood", incorporated by reference herein. According to the present invention, tricyclic antidepressants include, but are not limited to, imipramine, amitriptyline, trimipramine, doxepin, desipramine, nortriptyline, protriptyline, amoxapine, clomipramine, maprotriline, and carbamazepine, and their pharmaceutically effective salts and esters, such as, but not limited to their hydrochlorides, maleates, tartrates and lactates. Although carbamazepine is approved in the U.S. as antiepileptic, it is chemically related to tricyclic antidepressants, its actions on human brain neurons are not completely known, and for the present invention it is classified as a tricyclic antidepressant. See, Goodman and Gillman, The Pharmacological Basis of Therapeutics, referenced above, 7th Ed., page 457 et seq. Web site: http://www.delphion.com/details?pn=US05817665__

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Composition for relieving stress anxiety, grief, and depression Inventor(s): Sahley; Billie J. (5426 King Albert, San Antonio, TX 78229) Assignee(s): none reported Patent Number: 5,681,578 Date filed: January 22, 1996 Abstract: A composition for relieving stress, anxiety, grief, and depression includes GABA (gamma amino butyric acid), glutamine, glycine, magnesium, passion flower, primula officinalis, and vitamin B-6. Excerpt(s): The present invention relates to a composition of matter for enhancing the body's ability to cope with stress, anxiety, grief, and depression and, more particularly, but not by way of limitation, to a compositional blend of amino acids, herbs, and vitamin B-6 that reduces stress, anxiety, grief, and depression by aiding the natural inhibitory neurotransmitter system of the brain.... The brain controls the human body and is responsible for every thought, sensation, behavior, and memory. For the brain to control the human body, its individual cells must be in constant communication. That communication occurs through the release of neurotransmitters at the synapse between two neurons of individual brain cells. Neurotransmitters chemically transmit necessary information such as emotional responses, pain sensations, and voluntary muscle movements. Furthermore, certain neurotransmitters are inhibitory and actually prevent responses such as the emotional ones of anxiety and/or grief. Thus, neurotransmitters are essential to the mental, emotional, and physical well being of any person because, without sufficient levels, the brain cells do not properly communicate.... Although neurotransmitters are extremely important, few people receive sufficient amounts of the nutrients necessary to stimulate proper neurotransmitter production. Thus, if a person experiences stress, anxiety, grief, and/or depression, associated mental and emotional responses are magnified, particularly when certain inhibitory neurotransmitters are deficient. Current treatments for the above conditions, which consist primarily of prescription drugs, only provide temporary relief and often exacerbate the problem. Prescription drugs either stimulate the excessive release of pre-existing neurotransmitters or serve as a substitute for them. That excessive release or substitution relieves the condition, however, such relief is only temporary because, once the drug wears off, the condition returns. Furthermore, excessive release of neurotransmitters often produces a more acute condition because it depletes available neurotransmitters without satisfactory replenishment. Thus, prescription drugs, which only temporarily relieve the condition without providing a lasting cure, often facilitate a chronic condition requiring prolonged drug use. Web site: http://www.delphion.com/details?pn=US05681578__

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Compositions and method of treating cardio-, cerebro-vascular and alzheimer's diseases and depression Inventor(s): Tashiro; Renki (Asahichyo 2-24-15, Fuchyu, Tokyo, JP), Pater; Ruth H. (106 Tuckahoe Trace, Yorktown, VA 23693) Assignee(s): none reported Patent Number: 5,589,182 Date filed: December 6, 1993

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Abstract: A pharmaceutical composition suitable for the treatment of a condition selected from the group consisting of cardiovascular disease, cerebrovascular disease, Alzheimer's disease, depression or combinations thereof comprising various mixtures of the aqueous extracts of tissue of specific Chinese plants and herbs. A method of preparing the pharmaceutical compositions of the invention and a method for treating a patient therewith are also disclosed. Excerpt(s): The present invention relates to a therapeutic composition derived from Chinese herbs and plants.... There is a current revival of interest in Chinese folk medicines which are principally derived from Chinese herbs or other types of plants. This interest in Chinese herbs was prompted by Chinese folklore wherein a number of such herbs have been reputed to have anti-infective activity and to be well-tolerated by humans. A subset of these herbs also appears to exhibit anti-HIV activity [Chang et al, Antiviral Research, Vol. 9, pages 163-176 (1988); and Chang et al, Antiviral Research, Vol. 11, page 263-273 (1989)].... However, Chinese folk medicine is based largely on anecdotal observations spanning the past several thousands of years. Hence, the effectiveness of the medicinal herbs used by folk medicine practitioners has, for the most part, not been substantiated by scientific methods. Despite this lack of scientific proof, it is quite possible that some herbal remedies may have specific therapeutic action, as was proven to be the case with the anti-malarial, qinghaosu, and perhaps even anti-HIV activity [Klayman, Science, vol. 228, pages 1049-1055 (1985)]. Consequently, with regard to the possible anti-HIV activity among Chinese herbal extracts, an urgent need exists for: (1) the identification of effective therapeutic herbal extracts, (2) the substantive documentation, by modern scientific methods, of the effectiveness of these herbal extracts against various pathological states, and (3) the identification of effective therapeutic Chinese herbal extracts that are less toxic than the currently available agents. Web site: http://www.delphion.com/details?pn=US05589182__ •

Cyclohexadiene derivatives useful in the treatment of depression Inventor(s): Urbahns; Klaus (Wuppertal, DE), Heine; Hans-Georg (Krefeld, DE), Junge; Bodo (Wuppertal, DE), Schohe-Loop; Rudolf (Wuppertal, DE), Wollweber; Hartmund (Wuppertal, DE), Sommermeyer; Henning (Koln, DE), Glaser; Thomas (Overath, DE), Wittka; Reilinde (Koln, DE), De Vry; Jean-Marie-Viktor (Rosrath, DE) Assignee(s): Bayer Aktiengesellschaft (Leverkusen, DE) Patent Number: 5,652,264 Date filed: March 27, 1996 Abstract: The cyclohexadiene derivatives are prepared by reaction of cyclohexanones with amines and subsequent dehydration. The compounds are effective in the treatment of depression on account of their property of being selective modulators of calcium channel-dependent potassium channels. Excerpt(s): The present invention relates to cyclohexadiene derivatives, a process for their preparation and their use as medicaments, in particular as cerebrally active agents.... It is already known that 3,6-cyclohexadiene-2-phenyl-1,3-dicarboxylic acid esters have a muscle contraction-inhibiting action [cf. for this Chem. Pharm. Bull., 39 (11), 2915-23, 1991; GB 87-18906 870810/GB 87-19441 870817].... and their salts. Web site: http://www.delphion.com/details?pn=US05652264__

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Diagnosis of depression by linkage of a polymorphic marker to a segment of chromosome 19P13 bordered by D19S247 and D19S394 Inventor(s): Peroutka; Stephen J. (1025 Tournament Dr., Hillsborough, CA 94010) Assignee(s): none reported Patent Number: 5,879,884 Date filed: June 7, 1995 Abstract: The invention maps a gene (dep) associated with depression to the p13 region of chromosome 19. The invention exploits this discovery to provide methods of diagnosing depression, methods of screening for the dep gene, and libraries of cloned segments including the dep gene. Excerpt(s): The present invention relates generally to the diagnosis and treatment of depression.... Depression is a clinical disorder that may begin at any age, although it usually begins in the mid-20s and 30s. The Diagnostic and Statistical Manual-IV (DSMIV) criteria used to diagnose depression are provided in Table 1. These symptoms may develop over days to weeks. Some people have only a single episode, with a full return to premorbid function. However, more than 50 percent of those who initially suffer a single major depressive episode eventually develop another.... The point prevalence for major depressive disorder in the Western industrialized nations is 2.3 to 3.2 percent for men and 4.5 to 9.3 percent for women. The lifetime risk for major depressive disorder is 7 to 12 percent for men and 20 to 25 percent for women. Risk factors for major depressive disorder include female gender (especially during the postpartum period), a history of depressive illness in first-degree relatives and prior episodes of major depression. Patients with major depressive disorder have substantial amounts of physical and psychological disability, as well as occupational difficulties. Untreated major depressive disorder has a substantial effect on health and functioning. Physical complaints are also common during a major depressive episode. Web site: http://www.delphion.com/details?pn=US05879884__

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Materials and methods for the treatment of depression Inventor(s): Druzgala; Pascal (Santa Rosa, CA) Assignee(s): Aryx Therapeutics (Sunnyvale, CA) Patent Number: 6,469,064 Date filed: April 24, 2001 Abstract: The subject invention provides compounds which are easily metabolized by the metabolic drug detoxification systems. Particularly, fluvoxamine analogs which have been designed to include esters within the structure of the compounds are taught. Also provided are methods of treating depression and affective disorders, such as obsessive compulsive disorder. Pharmaceutical compositions of the fluvoxamine analogs are also taught. Excerpt(s): Major depression represents one of the most common mental illness, affecting between 5-10% of the population. The disease is characterized by extreme changes in mood which may also be associated with psychoses. It has generally been found that most antidepressant agents exert significant effects on the regulation of monoamine neurotransmitters, including serotonin.... A number of types of antidepressants have been developed in recent years. Many of these compounds

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regulate serotonin (5-hydroxytryptamine; 5-HT). Trazodone controls the actions of 5-HT while fluoxetine is a potent and selective inhibitor of 5-HT reuptake. 3Chloroimipramine which inhibits both 5-HT and norepinephrine reuptake has been extensively used as an antidepressant in Europe and Canada. Other compounds which are of current interest or have been examined as antidepressants include fluvoxamine, citalopram, zimeldine, sertraline, bupropion and nomifensine. Fluvoxamine facilitates serotoninergic neurotransmission via potent and selective inhibition of serotonin reuptake into presynaptic neurons.... The serotonergic neural system of the brain have been shown to influence a variety of physiologic functions, and the compounds of the present invention are predicted to have the ability to treat in mammals, including humans, a variety of disorders associated with this neural system, such as eating disorders, depression, obsessive compulsive disorders, panic disorders, alcoholism, pain, memory deficits and anxiety. Other indications for antidepressants, such as fluvoxamine, include unipolar depression, dysthymia, bipolar depression, treatmentresistant depression, depression in the medically ill, panic disorder, obsessivecompulsive disorder, eating disorders, social phobia, and premenstrual dysphoric disorder. Web site: http://www.delphion.com/details?pn=US06469064__ •

Method and compositions for controlling pain, depression and sedation Inventor(s): Crosby; Martin G. (Mt. Pleasant, SC) Assignee(s): Serotonin Industries of Charleston (Charleston, SC) Patent Number: 4,698,342 Date filed: May 20, 1986 Abstract: Compositions are disclosed for controlling pain, depression, and sedation. The compositions comprise a serotonin precursor such as L-tryptophan or L-5hydroxytryptophan in combination with a serotonin-specific reuptake inhibitor such as trazodone. In a preferred embodiment, the compositions are coadministered with a narcotic, the composition substantially potentiating the analgesic effect of the narcotic. Excerpt(s): This invention relates to medicinal compositions comprising a serotinin precursor such as L-tryptophan and a serotonin-specific reuptake inhibitor such as trazodone. The compositions are useful in controlling pain sedation, and depression in animals. This invention further relates to a method of controlling pain, depression and sedation in animals which comprises admininstering the medicinal compositions of this invention or components thereof internally. The invention also relates to the method of coadministering the compositions of this invention or components thereof with narcotics to achieve potentiation of the analgesic effect of the narcotic.... The use of narcotics is widespread for the control of chronic pain such as that sometimes encountered n advanced disease states of cancer patients. However, long term use of narcotics is met with increasing tolerance in most patients, requiring increased dosages and more frequent administration to achieve a reasonable comfort level. The opiate effects thereof produce a depressant effect with limits dosages and interrupts normal sleep patterns with long term use. Additionally, it frequently becomes impossible to ease the patient's pain to any reasonable degree.... In addition to the opiate effects, it is known that there is a transient increase in brain serotonin levels following administration of a narcotic, e.g., (at an interval of approximately thirty minutes). This increase in brain serotonin levels produced by the administered narcotics produces an

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analgesic effect. Serotonin is a known calmative neurotransmitter and produces a certain degree of sedation as well. Web site: http://www.delphion.com/details?pn=US04698342__ •

Method and compositions using 1-aryl-1,2,3,4-tetrahydro-.beta.-carboline-3-carboxylic acid for treating depression Inventor(s): Payne; Alan J. (Noblesville, IN), Aylott; Michael V. (Thorntown, IN), Moore; Jimmie L. (Indianapolis, IN), Yokley; Edward M. (Cambridge, MA) Assignee(s): The Dow Chemical Company (Midland, MI) Patent Number: 4,336,260 Date filed: March 2, 1979 Abstract: Treatment of central nervous system depression in a mammal using method and compositions employing 1-aryl-1,2,3,4-tetrahydro-.beta.-carboline-3-carboxylic acids, esters and pharmaceutically-acceptable salts. Excerpt(s): The synthesis of various 1-aryl-1,2,3,4-tetrahydro-.beta.-carboline-3carboxylic acids have been described in the literature. See J. Biol. Chem. 113, 759 (1936) and J. Amer. Chem. Soc. 70, 219 (1948). Other.beta.-carboline derivatives lacking the aryl substitution serve as intermediates in the preparation of compounds having psychoactive properties. See U.S. Pat. Nos. 3,644,384 and 3,717,638. Compounds less closely related in structure have been found to possess central nervous activity. See U.S. Pat. Nos. 3,478,051 and 3,551,450.... The invention also includes the pharmaceuticallyacceptable salts of the.beta.-carboline carboxylic acids, i.e. where R is hydrogen, used in the practice of the present invention. Pharmaceutically-acceptable salts refer to the acid addition salts of those bases which will form a salt with a carboxylic acid and which will not cause an adverse physiological effect when administered to an animal at dosages consistent with good pharmacological activity. Suitable bases thus include, for example, the alkali metal and alkaline earth metal hydroxides, carbonates, and bicarbonates such as sodium hydroxide, potassium hydroxide, calcium hydroxide, potassium carbonate, sodium bicarbonate, magnesium carbonate and the like, ammonia, primary, secondary, and tertiary amines and the like. Also aluminum salts of the instant compounds may be obtained by treating the corresponding sodium salt with an appropriate aluminum complex such as aluminum chloride hexahydrate, etc.... In general, the compounds of the present invention are effective when administered in daily dosages of from about 0.5 mg to about 80 mg of active ingredient per kilogram of body weight to relieve depression in a mammal. The compounds are administered internally as a psychoactive composition to a mammal either orally or parenterally by subcutaneous, intravenous or intraperitoneal injection or the like, or by implantation or the like, oral administration being preferred. The effective antidepressant amount of the compounds of the invention to be administered internally to a mammal, that is the amount which is effective to substantially relieve a mammal of the symptoms of depression, can vary depending upon such factors as the animal treated, the particular compound administered, the period of administration, and the method of administration. Web site: http://www.delphion.com/details?pn=US04336260__

Patents 445

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Method for alleviating depression Inventor(s): Sagen; Jacqueline (2509 W. Farwell, Chicago, IL 60645), Sortwell; Caryl E. (4548 N. Sheridan, Chicago, IL 60640), Pappas; George D. (506 W. Roscoe St., Chicago, IL 60657) Assignee(s): none reported Patent Number: 4,980,174 Date filed: December 23, 1988 Abstract: A novel method for alleviating depression comprises implanting monoamine producing living cells in the CNS of depressive subjects. Excerpt(s): Depression is the most common of the major mental illnesses. It is characterized by feelings of prolonged intense sadness and despair without an apparent cause, and is often accompanied by mental and physical disruption, including loss of concentration, pessimism, insomnia, weight loss, and decreased energy. A significant percentage of patients with this disorder display suicidal behavior during their lifetime. Many of these patients respond well to tricyclic antidepressants, the treatment of choice for this condition. Although quite effective in many patients, the efficacy is dependent on continued long-term drug usage. This condition cannot always be guaranteed due to patient non-compliance and numerous unpleasant side effects.... It has been reported that behavior can be altered by transplanting pharmacologically relevant tissues into the central nervous system (for review, see Azmitia and Bjorklund, 1987 Ann. N.Y. Acad. Sci. 495: 813). For example, it has been shown that sensitivity to pain can be reduced by transplanting opioid peptide-containing cells into pain modulatory regions of the CNS (Sagen et al. 1987 Exp. Brain Res. 67: 373-379). Other laboratories have shown that it is possible to alleviate cognitive or motor deficits in lesioned animals following neural transplantation. The latter studies have led to clinical trials for the alleviation of Parkinson's disease symptoms using neutral transplantation (Backlund et al. 1987 Ann. N.Y. Acad. Sci. 495: 658-670). However, there is no prior report that depression can be alleviated by CNS transplantation.... It is, therefore, an object of the present invention to provide a method for alleviating depression by transplanting live monoaminecontaining cells into the central nervous system (CNS) where a source of monoamines is needed. Web site: http://www.delphion.com/details?pn=US04980174__

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Method for preventing or treating depression employing a combination of an ace inhibitor and a drug that acts at serotonin receptors Inventor(s): Horovitz; Zola P. (Princeton, NJ) Assignee(s): E. R. Squibb & Sons, Inc. (Princeton, NJ) Patent Number: 5,032,578 Date filed: September 17, 1990 Abstract: A method is provided for inhibiting onset of or treating depression by administering an ACE inhibitor, such as captopril, fosinopril, zofenopril or ceranapril in combination with a drug that acts at serotonin receptors such as zacopride, over a prolonged period of treatment. Excerpt(s): The present invention relates to a method for inhibiting onset of or treating depression employing an angiotensin converting enzyme (ACE) inhibitor such as

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captopril, SQ 29,852, zofenopril, fosinopril or enalapril, in combination with a drug that interacts with serotonin receptors in the brain, such as zacopride.... U.S. Pat. No. 4,912,096 to Sudilovsky discloses a method for preventing or treating depression employing an angiotensin converting enzyme inhibitor which is ceranapril (SQ29,852), zofenopril or fosinopril.... U.S. Pat. Nos. 4,046,889 and 4,105,776 to Ondetti et al discloses proline derivatives, including captopril, which are angiotensin converting enzyme (ACE) inhibitors useful for treating hypertension. Web site: http://www.delphion.com/details?pn=US05032578__ •

Method for the diagnosis of depression based on monitoring blood levels of arginine vasopressin and/or thymopoietin Inventor(s): Goldstein; Gideon (30 Dorison Dr., Short Hills, NJ 07078), Culler; Michael D. (Easton, PA) Assignee(s): Goldstein; Gideon (Short Hills, NJ) Patent Number: 5,591,588 Date filed: September 20, 1994 Abstract: The invention provides a novel means of diagnosing, or confirming a diagnosis of, affective disorders, such as depression, based on the blood levels of arginine vasopressin and thymopoietin, either alone or in combination. Excerpt(s): The present invention relates generally to methods for diagnosis of disorders characterized by depression and stress. More particularly, the invention provides a novel means of making or confirming a diagnosis of an affective disorder, such as depression, based on the blood levels of arginine vasopressin and thymopoietin, either individually or in combination.... Arginine vasopressin (AVP), a neurohormone also known as anti-diuretic hormone, is characterized by a nine amino acid, partially cyclic structure. AVP has been reported to be associated in serum with a binding protein, called neurophysin [Brain Peptides, (D. T. Krieger et al, eds.), John Wiley & Sons, New York, pp. 598-611 (1983)]. AVP is secreted from two major locations in the brain, from hypothalamic parvicellular neurons in the paraventricular nucleus, which also produce corticotropin releasing factor (CRF), and from magnocellular neurons in the supraoptic and paraventricular nuclei [F. A. Antoni, in Frontiers in Neuroendocrinology, 14(2):76122 (1993)]. CRF is known to synergize with AVP to stimulate ACTH release.... It has been demonstrated that, following the application of chronic stress paradigms in laboratory animals, there is an increase in the level of AVP in the paraventricular nucleus of the hypothalamus. This AVP level is disproportionately large compared with the increase observed in CRF levels [Antoni, cited above; D. C. De Goeij et al, Endocrinol., 131:847 (1992)]. Following chronic stress, AVP levels within CRF-containing neurons within the paraventricular nucleus of the hypothalamus of laboratory animals have been reported to increase by over 8 fold, while the increase in CRF levels was 1.5 fold. This disproportionate increase in the level of AVP in this portion of the hypothalamus as compared with CRF has also been observed to be maintained at the level of the median eminence, the terminal bed from which AVP and CRF are released to stimulate ACTH secretion from the pituitary. Web site: http://www.delphion.com/details?pn=US05591588__

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Method for the treatment of depression Inventor(s): Tyers; Michael B. (Ware, GB2) Assignee(s): Glaxo Group Limited (London, GB2) Patent Number: 5,246,941 Date filed: January 15, 1993 Abstract: The invention relates to the use of compounds which act as antagonists of 5hydroxytryptamine (5-HT) at 5-HT.sub.3 receptors for the treatment of depression. Excerpt(s): This invention relates to a new medical use for certain chemical compounds and pharmaceutical compositions containing them. In particular it relates to the use in the treatment of depression of compounds which act as antagonists of 5hydroxytryptamine (5-HI) at receptors known in the art as 5-HT.sub.3, 5-HT`M` or 5-HI `M`-like' receptors. Such receptors have been described for example by Forzard et al., Eur. J. Pharmacol., 1979, 59, 195-210; Ireland, Straughan and Tyers, Br. J. Pharmacol., 1982, 75, 16P; Humphrey, Neuropharm., 1984, 23, 1503-1570; Richardson et al., Nature, 1985, 316, 126-131; and Bradley et al., Neuropharm., 1986, 25, 563-576. Receptors of this type are now designated as 5-HT.sub.3 receptors.... 5-HT receptors of this type are located, for example, on the terminals of afferent sensory neurones, in the isolated guinea-pig ileum preparation and are also present in the central nervous system. Compounds which act an antagonists of 5-HT at 5-HT.sub.3 receptors may be identified using standard tests, for example, in vitro by measuring their inhibition of the depolarising effect of 5-HT on the rat or rabbit isolated vagus nerve, or the tachycardia produced by 5-HT in the rabbit isolated heart or the contraction produced by 5-HT in the guinea-pig isolated ileum, or in vivo by measuring their effect on the Von BezoldJarisch reflex (induced by 5-HT) as described, for example, in the above-mentioned references.... A variety of compounds which act as antagonists of 5-HT at 5-HT.sub.3 receptors have been described in the art. These compounds are generally azabicyclo derivatives and/or benzoic acid derivatives, or imidazole derivatives. The azabicyclo derivatives include compounds containing a bridged piperidyl group, such as a tropyl, pseudotropyl, homotropyl or quinucilindyl group, and they preferably contain a carbocyclic or heterocyclic aromatic group linked, for example as an ester or amide, to the azabicyclic ring. The aromatic group may be for example an optionally substituted phenyl, indolyl, benzofuranyl, benzothienyl, benzisoxazolyl, indazolyl or pyrimidinyl group. Web site: http://www.delphion.com/details?pn=US05246941__

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Method for the treatment of depression Inventor(s): Hammarberg; Eva Maria (Sodertalje, SE), Johansson; Lars George (Sodertalje, SE), Larsson; Lars-Gunnar (Holo, SE), Noreen; Rolf (Huddinge, SE), Renyi; Lucy Anna (Skarholmen, SE), Ross; Svante Bertil (Sodertalje, SE), Sohn; Daniel Dungan (Sodertalje, SE), Svensson; Bjorn Eric (Sodertalje, SE), Thorberg; Seth-Olov (Jarna, SE) Assignee(s): Astra Aktiebolag (Sodertalje, SE) Patent Number: 5,641,807 Date filed: May 30, 1995

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Abstract: A method is disclosed for the treatment of depression by the administration of 3-amino-5-carbamoylchromans and 8-fluoro-3-amino-5-carbamoylchromans or enantiomers or salts thereof. Excerpt(s): The present invention relates to new substituted-3-amino-chromans and thiochromans, enantiomers and salts thereof, processes for their preparation, pharmaceutical compositions containing said therapeutically active compounds as well as new intermediates useful in the preparation of the therapeutically active compounds and to the use of said active compounds in therapy.... An object of the invention is to provide compounds for therapeutic use, especially compounds having a therapeutic activity via the central nervous system (CNS). A further object is to provide compounds having a selective effect on the 5-hydroxy-tryptamine receptors in mammals including man.... It is also an object of the invention to provide a compound with a therapeutic effect after oral administration. Web site: http://www.delphion.com/details?pn=US05641807__ •

Method for treating depression Inventor(s): Palfreyman; Michael G. (Fegersheim, FR), McDonald; Ian A. (Truchtersheim, FR) Assignee(s): Merrell Toraude et Compagnie (Strasbourg, FR) Patent Number: 4,413,012 Date filed: May 26, 1982 Abstract: 2-Amino-3-(3'-hydroxyphenyl)-3-butenoic acid or 2-amino-3-(3', 4'dihydroxyphenyl)-3-butenoic acid can be used to treat depression either alone or in combination with an extracerebrally acting AADC inhibitor. Excerpt(s): This invention relates to a novel method for treating depression.... The class of compounds known as monoamine oxidase inhibitors (MAO inhibitors) has been employed in psychiatry for over 20 years for the treatment of depression, [See Goodman and Gilman, The Pharmacological Basis of Therapeutics, 6th Ed, McMillan Publishing Co., Inc., N.Y., 1980, pages 427-430]. MAO inhibitors currently used in the USA for treating depression are tranylcypromine (PARNATE, SKF), phenelzine (NARDIL, Parke-Davis), and isocarboxazid (MARPLAN, Roche). In addition, another MAO inhibitor, pargyline (EUTRON, Abbott), is available for the treatment of hypertension [See Physicians' Desk Reference, 34th Ed., Medical Economics Co., Oradell, N.J., 1980, pages 1327-1328 (phenelzine), pages 1466-1468 (isocarboxazid), pages 1628-1630 (tranylcypromine) and pages 521-522 (pargyline)]. MAO inhibitors can also be employed to treat other psychiatric disorders, such as phobic anxiety states.... It is believed that the MAO inhibitors act to alleviate psychiatric disorders, such as depression, by increasing the concentration of one or more biogenic monoamines in the central nervous system. The monoamine oxidase enzyme (MAO) plays an important role in the metabolic regulation of the monoamines since it catalyzes the biodegradation of the monoamines through oxidative deamination. By inhibiting MAO, the degradation of the monoamines is blocked, and the result is an increase in the availability of the monoamines for their physiological functions. Among the physiologically active monoamines which are known substrates for MAO are: (a) the so-called "neurotransmitter" monoamines, such as the catecholamines (e.g. dopamine, epinephrine, and norepinephrine) and the indoleamines (e.g. tryptamine and 5-

Patents 449

hydroxytryptamine), (b) the so-called "trace" amines (e.g. o-tyramine, phenethylamine, tele-N-methylhistamine), and (c) tyramine. Web site: http://www.delphion.com/details?pn=US04413012__ •

Method for treating depression Inventor(s): Sabelli; Hector C. (2400 Lakeview, #2802, Chicago, IL 60614) Assignee(s): none reported Patent Number: 5,455,276 Date filed: May 20, 1993 Abstract: Pharmaceutical compositions for treating psychiatric disorders are provided. The compositions include 2-phenylethylamine ("PEA") and at least one inhibitor of monoamine oxidase B. Methods for the treatment of psychiatric disorders, including depression, using the disclosed pharmaceutical compositions are also provided. Excerpt(s): The present invention relates to pharmaceutical compositions and their use in the treatment of psychiatric disorders. More particularly, the invention relates to pharmaceutical compositions that include 2-phenylethylamine and at least one inhibitor of monoamine oxidase B, and to methods of using such compositions in the treatment of psychiatric disorders.... The need for new antidepressant agents arises from the limited efficacy, slowness of action, and adverse side-effects of many currently available compounds. For instance, some tricyclic antidepressants can cause sedation and atropine-like effects. Still other antidepressants can produce agitation that some persons feel lead them to increase suicidal ideation.... L-phenylalanine is an essential amino acid which is decarboxylated in the brain and peripheral tissues to form 2-phenylethylamine ("PEA"). PEA is then metabolized by monoamine oxidase type B [Yang and Neff, J. Pharmacol. Exp. Ther., 187:365-371 (1973)] to form phenylacetic acid ("PAA"). PEA is normally found stored and metabolized in brain and peripheral tissues. [Sabelli et al., Acta Physiological Polonica, 24:33-40 (1973); Inwang et al., J. Neurochem., 20:1469-1473 (1973); Mosnain et al., Biol. Psychiatry, 6:235-257 (1973a); Boulton et al., Br. J. Pharmacol., 59:209-214 (1977); Jackson and Temple, Comp. Gen. Pharmacol., 1:155- 157 (1970); Phillips et al., J. Neurochem., 33:159-161 (1979); Durden and Phillips, J. Neurochem., 34:1725-1732 (1980)]. Web site: http://www.delphion.com/details?pn=US05455276__

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Method for treating depression Inventor(s): Oxenkrug; Gregory (Newton, MA) Assignee(s): St. Elizabeth's Medical Center of Boston, Inc. (Boston, MA) Patent Number: 6,562,858 Date filed: April 12, 2001 Abstract: The present invention discloses a method for the treatment of depression in a human being identified as having depression. This method comprises the administration of a therapeutically effective depression treatment amount of M-3 agonists, 5-MCA-NAT or an analog, to said human being. The 5-MCA-NAT, or an analog, thereof may be administered alone or in combination with other agents, as Ca.sup.++ antagonists.

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Excerpt(s): The present invention relates to the method of treatment of depression in a human being identified as having depression. This method comprises the administration of a therapeutically effective depression treatment amount of agonists of melatonin-type 3 receptors (MT-3); 5 MCA-NAT and its analogs. MT-3 agonists may be administered alone or in combination with other agents, e.g. Ca.sup.++ antagonists.... Depression is a difficult mental disorder to treat. Patients having such a disorder are often reluctant to seek the medical attention necessary to diagnose the disorder. Such reluctance is often related to the patient's fear of the stigma associated with seeking psychiatric help or to the patient's feeling of worthlessness associated with depression. Moreover, once the patients seek competent psychiatric help, it is difficult to successfully treat the disorder through psychoanalytic approach alone.... In the Diagnostic and Statistical Manual of Mental disorders, Fourth Edition, (DSM IV published by the American Psychiatric Association, depressive disorders are classified under mood disorders and are divided into three types: major depressive disorder, dysthymic disorder and depressive disorder not otherwise specified. Major depressive disorder and dysthymic disorder are differentiated based on chronicity, severity and persistence. In major depression, the depressed mood must be present for two weeks. In dysthymic disorder, the depressed mood must be present for two weeks. In dysthymic disorder the depressed mood must be present most days over a period of two years. Usually, major depressive disorder is characterized by its sharp contrast to usual functioning. A person with a major depressive episode can be functioning and feeling normal and suddenly develop severe symptoms of depression. By contrast, a person with dysthymic disorder has chronic depression with less severe symptoms than major depression. Web site: http://www.delphion.com/details?pn=US06562858__ •

Method for treating depression and anxiety using phenyl hydrazo compounds Inventor(s): Abdallah; Abdulmuniem H. (Midland, MI), Shea; Philip J. (Midland, MI) Assignee(s): The Dow Chemical Company (Midland, MI) Patent Number: 4,150,133 Date filed: April 18, 1978 Abstract: Methods and pharmaceutical compositions using substituted phenyl hydrazo compounds for the treatment of depression and/or anxiety in a mammal. Excerpt(s): Halo-substituted phenylazoimidazoles are described at CA 72:111427a (Khim. Geterotsikl Soedin 916-22, 1969). Other substituted phenylazoimidazoles are shown in J. Chem. Soc., 115, 226 (1919) and in J. Chem. Soc., 117, 1426 (1920). None of the references cited disclose the use of the compounds to treat an animal.... U.S. Pat. No. 3,480,630 discloses the use of 2-arylhydrazino-imidazoline-(2) as a hypotensive in warmblooded animals.... The invention also includes the pharmaceutically-acceptable salts of the compounds used in the practice of the present invention. As used in the specification and claims, the term "pharmaceutically-acceptable salts" refers to non-toxic acid addition salts of the active compounds, the anions of which are relatively innocuous to animals at dosages consistent with good antidepressant and antianxiety activity so that the beneficial effects of the free base are not vitiated by the side effects ascribable to the anions. Pharmaceutically-acceptable salts include those derived from mineral acids such as hydrochloric and sulfuric and from organic acids such as lactic, maleic, succinic, fumaric, glutaric, citric, malic, p-toluenesulfonic, methanesulfonic, and tartaric acid and the like.

Patents 451


Method for treating depression and other maladies by means of patient-created symptom graphs Inventor(s): Cohen; Kopel H. (58 Kettle Creek Rd., Weston, CT 06880) Assignee(s): none reported Patent Number: 4,346,697 Date filed: March 5, 1979 Abstract: The invention relates to a patient symptom chart on which symptom related graphs are created by the patient and a process of using these graphs in the treatment of various maladies including depression. Decision point plans or charts can also be used by the consulting physician in conjunction with the patient created graphs. Excerpt(s): This invention relates to a process of treating individuals afflicted by maladies and, in particular, by depression by means of symptom charts which are used in conjunction with the administration of medications. The invention also includes a decision point plan chart to be used by the physician in charge of the patient's treatment in interpreting and prescribing medication based on patient-created graphs.... According to a preferred embodiment of the invention, depression is treated by administering to the patient on a periodic basis, such as a daily basis, anti-depression medication, such as a tricylic, the dosages of which will depend upon the patient's long-term reaction to the medication as indicated by the patient-created symptom graphs, which graphs are conveniently interpreted by the physician with the help of a decision point plan chart.... The patient is provided with a depression symptom chart which includes a plurality of symptom fields with each field corresponding to one particular symptom which is associated with depression, such as, for example, sleeplessness, loss of appetite, loss of energy, or inability to concentrate. Each of the symptom fields which relates to one of these symptoms would include a plurality of symptom indicatives arranged in a progressive series ranging from a symptom indicative relating to an extreme depressive state, through intermediate depressive states indicating improvement relative to the extreme state, up through a positive condition indicative which would generally correspond to the absence of depression. These symptom indicatives are arranged as one coordinate of a graph which is to be completed by the patient during this treatment period when he will be receiving medication. The other coordinate of the graph would correspond to the time period of treatment. Each day the patient would indicate on the graph the symptom indicative within each symptom field which most closely corresponds to his condition on that particular day. After a period of time there will be thereby created a graph of the patient's reaction to the medication. The fact that the graph is patient-created fosters a therapeutic alliance between the patient and the physician which can independently aid in the treatment of the patient in that the patient will participate actively in his treatment and this can improve ultimate patient progress. Web site: http://www.delphion.com/details?pn=US04346697__

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Method for treating depression using optically pure (-)-bupropion Inventor(s): Young; James W. (Palo Alto, CA) Assignee(s): Sepracor, Inc. (Marlborough, MA) Patent Number: 6,369,113 Date filed: June 27, 2001 Abstract: Methods and compositions are disclosed utilizing the optically pure (-)-isomer of bupropion, which is a potent drug for treating depression. Excerpt(s): This invention relates to methods of treatment and pharmaceutical compositions employing the compound (-)-buproplon.... Many organic compounds exist in optically active forms, i.e., they have the ability to rotate the plane of plane-polarized light. In describing an optically active compound, the prefixes D and L or R and S are used to denote the absolute configuration of the molecule about its chiral center(s). The prefixes (+) and (-) or d and 1 are employed to designate the sign of rotation of planepolarized light by the compound, with (-) or 1 meaning that the compound is levorotatory. A compound prefixed with (+) or d is dextrorotatory. For a given chemical structure, these compounds, called stereoisomers, are identical except that they are mirror images of one another. A specific stereoisomer may also be referred to as an enantiomer, and a mixture of such isomers is often called an enantiomeric or racemic mixture.... Stereochemical purity is of importance in the field of pharmaceuticals, where 16 of the 20 most prescribed drugs exhibit chirality. A case in point is provided by the Lform of the.beta.-adrenergic blocking agent, propranolol, which is known to be 100 times more potent than the D-enantiomer. Web site: http://www.delphion.com/details?pn=US06369113__

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Method for treating depression with d-fenfluramine Inventor(s): Wurtman; Richard J. (Boston, MA), Wurtman; Judith J. (Boston, MA), O'Rourke; Dermot (Charlestown, MA) Assignee(s): Massachusetts Institute of Technology (Cambridge, MA) Patent Number: 4,649,161 Date filed: June 16, 1986 Abstract: D-fenfluramine is administered to a human patient having seasonal depression or other forms of bipolar depression in order to alleviate or cure the depression. Excerpt(s): This invention relates to a method for treating depression in humans with dfenfluramine.... Bipolar depressions often, but not always, are characterized by alternating periods of depression and hypomania. At the present time, there are available a wide variety of modes of treating patients afflicted with bipolar depression including psychiatric treatment and the administration of pharmaceutical compositions to the patient.... Prior to the present invention, the efficacy of d-fenfluramine in treating depression is specifically contraindicated, Physician's Desk Reference, 1985, page 1658. The d-fenfluramine has been disclosed in U.S. Pat. No. 3,198,834 to have an anorexigenic effect. In addition, U.S. Pat. No. 4,309,445 discloses that d-fenfluramine can be administered to patients having a syndrome of abnormal carbohydrate craving between meals in order to reduce the craving of carbohydrate without inhibiting the intake of protein by the patient.

Patents 453


Method for treating depression with olanzapine Inventor(s): Tollefson; Gary D (Indianapolis, IN) Assignee(s): Eli Lilly and Company (Indianapolis, IN) Patent Number: 5,958,921 Date filed: June 18, 1998 Abstract: This invention relates to the use of the antipsychotic drug olanzapine for the treatment of depression, including depressive signs and symptoms and Major Depression. Excerpt(s): This invention relates to a method for treating depression using 2-methyl-4(4-methyl-1-piperazinyl)-10H-thieno›2,3-b!›1,5!benzodiazepine.... Major Depressive Disorder is associated with a high mortality. Up to 15% of individuals with severe Major Depressive Disorder die by suicide. Epidemiological evidence also suggests that there is a fourfold increase in death rates in individuals with Major Depressive Disorder who are over age 55 years. Individuals admitted to nursing homes with Major Depressive Disorder have a markedly increased likelihood of death in the first year.... Depression is a prevalent condition. The lifetime risk for Major Depressive Disorder in community samples has varied from 10% to 25% for women and 5% to 12% for men. The prevalence of Major Depressive Disorder appear to be unrelated to ethnicity, education, income, or marital status. Web site: http://www.delphion.com/details?pn=US05958921__

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Method for treating depression, obsessive compulsive disorder, and anxiety with N-acetyl serotonin Inventor(s): Oxenkrug; Gregory F. (Newton, MA), Requintina; Pura J. (West Kingston, RI) Assignee(s): St. Elizabeth's Medical Center of Boston (Boston, MA) Patent Number: 6,011,054 Date filed: November 4, 1998 Abstract: The present invention relates to a method of treatment of depression in a human being identified as having depression. This method comprises the administration of a therapeutically effective depression treatment amount of N-acetylserotonin (NAS), also referred to as N-acetyl-5-hydroxytryptamine, to a human being identified as having depression. The NAS may be administered alone or in combination with other agents, e.g., Ca.sup.++ antagonists. Excerpt(s): The present invention relates to a method of treatment of depression in a human being identified as having depression. This method comprises the administration of a therapeutically effective depression treatment amount of Nacetylserotonin (NAS) to a human being identified as having depression. NAS may be administered alone or in combination with other agents, e.g., Ca.sup.++ antagonists.... Serotonin has been long ago considered to have the important role in the mechanism of antidepressant effect (see Lapin & Oxenkrug, 1969). Pineal gland has the highest concentration of serotonin in comparison with the other brain structures. Pineal

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serotonin is acetylated with the formation of N-acetylserotonin (NAS). NAS is further methylated by the hydroxy-indole-O-methyltransferase (HIOMT) to produce melatonin (5-methoxy-N-acetyltryptamine) (see Reiter, 1991). Melatonin exerted antidepressantlike activity in the "frog" test: potentiated the sedative effect of reserpine (Skene & Potgieter, 1981) and of selective MAO-A inhibitors (Requintina et al., 1994). We have recently observed the antidepressant-like activity of melatonin in the mouse tail suspension test (Prahie et al., in preparation). Selective MAO-A inhibitors (and some other antidepressants) stimulate the pineal NAS and melatonin production (Oxenkrug et al., 1994: see for rev. Oxenkrug, 1991). It was suggested that selective MAO-A inhibitors (and some other antidepressants) might correct the circadian rhythms abnormalities (and, thus, exert their antidepressant action) via their melatoninergic effects (Oxenkrug et al., 1986; see Oxenkrug, 1991).... Although NAS was viewed mainly only as an intermediate product of melatonin biosynthesis from serotonin, it was reported that some of its effects (i.e., hypothermic and analgesic) differed (qualitatively or quantitatively) from that of serotonin and melatonin (Morton, 1987; Psarakis et al., 1988). Web site: http://www.delphion.com/details?pn=US06011054__ •

Method for treatment of anxiety and depression Inventor(s): Molinoff; Perry B. (Weston, CT), Dunbar; Geoffrey C. (Middleton, CT) Assignee(s): Bristol-Myers Squibb Company (Princeton, NJ) Patent Number: 6,312,717 Date filed: June 14, 1999 Abstract: An improved method of treatment for anxiety and/or depression provides a quicker and more robust anxiolytic/antidepressant activity to a patient suffering from depression. The method comprises the concurrent administration of effective doses of certain azapirones, such as buspirone, given in a manner that suppresses formation of the 1-(2-pyrimidinyl)piperazine metabolite; and a 5-HT1A autosomal receptor antagonist, such as pindolol. Excerpt(s): The present invention relates to an improved method for treating anxious and/or depressed patients. Concurrent administration of certain azapirones with a 5HT1A autosomal receptor antagonist provides faster onset of anxiolytic and antidepressant actions. By administering the azapirone in such a manner that formation of the 1-(2-pyrimidinyl)piperazine metabolite (1-PP) is minimized, a more robust therapeutic effect is achieved.... These particular azapirones containing the pyrimidinylpiperazine moiety as an integral part of their molecular structure give rise to 1-(2-pyrimidinyl)piperazine (1-PP) as their major metabolite. This metabolite is seen in greatest abundance following oral administration. The most studied and well-known member of this compound class is buspirone, an important antianxiety agent first approved for use in anxious patients in 1986. Although buspirone has been disclosed as having antidepressant properties by Robinson, et al., J. Clin. Psychopharmacol. , 1990, 10:675-765; it has not been generally considered to be as efficacious as classical antidepressant agents.... However, Blier, et al. in Neuropsychopharmacol. , 1997, 16:333338; reported that buspirone exhibited both an efficacy and onset of action that was superior to classical antidepressants when the buspirone was combined with the 5HT1A autosomal receptor blocker, pindolol. Both agents were administered separately by the oral route to a group of depressed patients in the study described by Blier.

Patents 455


Method for treatment of depression Inventor(s): Tyers; Michael Brian (Ware, GB) Assignee(s): Glaxo Group Limited (GB) Patent Number: 6,221,878 Date filed: March 10, 1995 Abstract: The invention relates to the use of compounds which act as antagonists of 5hydroxytryptamine (5-HT) at 5-HT.sub.3 receptors for the treatment of depression. Excerpt(s): This invention relates to a new medical use for certain chemical compounds and pharmaceutical compositions containing them. In particular it relates to the use in the treatment of depression of compounds which act as antagonists of 5hydroxytryptamine (5-HT) at receptors known in the art as 5-HT.sub.3, 5-HT`M` or 5HT `M'-like` receptors. Such receptors have been described for example by Fozard et al., Eur. J. Pharmacol., 1979, 59, 195-210; Ireland, Straughan and Tyers, Br. J. Pharmacol., 1982, 75, 16P; Humphrey, Neuropharm., 1984, 23, 1503-1570; Richardson et al., Nature, 1985, 316, 126-131; and Bradley et al., Neuropharm., 1986, 25, 563-576. Receptors of this type are now designated as 5-HT.sub.3 receptors.... 5-HT receptors of this type are located, for example, on the terminals of afferent sensory neurones, in the isolated guinea-pig ileum preparation and are also present in the central nervous system. Compounds which act as antagonists of 5-HT at 5-HT.sub.3 receptors may be identified using standard tests, for example, in vitro by measuring their inhibition of the depolarising effect of 5-HT on the rat or rabbit isolated vagus nerve, or the tachycardia produced by 5-HT in the rabbit isolated heart or the contraction produced by 5-HT in the guinea-pig isolated ileum, or in vivo by measuring their effect on the Von BezoldJarisch reflex (induced by 5-HT) as described, for example, in the above-mentioned references.... A variety of compounds which act as antagonists of 5-HT at 5-HT.sub.3 receptors have been described in the art. These compounds are generally azabicyclo derivatives and/or benzoic acid derivatives, or imidazole derivatives. The azabicyclo derivatives include compounds containing a bridged piperidyl group, such as a tropyl, pseudotropyl, homotropyl or quinoclidinyl group, and they preferably contain a carbocyclic or heterocyclic aromatic group linked, for example as an ester or amide, to the azabicyclic ring. The aromatic group may be for example an optionally substituted phenyl, indolyl, benzofuranyl, benzothienyl, benzisoxazolyl, indazolyl or pyrimidinyl group. Web site: http://www.delphion.com/details?pn=US06221878__

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Method of detecting depression Inventor(s): Correa; Elsa I. (11726 Greenspring Ave., Lutherville, MD 21093), Barrick; Christina Barrett (305 Chestnut Glen Garth, Towson, MD 21204) Assignee(s): none reported Patent Number: 5,882,203 Date filed: May 31, 1995

456 Depression

Abstract: The present invention relates to a method of detecting depression and its severity. A series of statements formulated to detect the presence and severity of depression are presented to the subject in a multiple item visual analog format. The subject's answers are given a numerical value. The total score is then normatively ranked to determine the presence and severity of the depression. Excerpt(s): This invention relates methods of psychological evaluation, and more particularly to a method of psychological testing that detects depression.... Depression is a prevalent condition that affects more than six million Americans each year. (Weissmian et al., 1988). Depression is a mental disorder involving complex behavioral, psychological, and physiological systems. (DSM-IV). Depression can impair functional capacity, cause distress or increase the risk of suffering pain, disability and death. (DSMIV) When depression is detected it can be treated with psychotherapy and/or medication.... It is, of course, known in the art to determine characteristics of human test subjects by asking them to select appropriate responses to printed statements, as disclosed in U.S. Pat. No. 4,627,010 issued to Von Fellenberg. Web site: http://www.delphion.com/details?pn=US05882203__ •

Method of diagnosing, tracking, and treating depression Inventor(s): Sparhawk, Jr. G. Roger (10015 Crestridge Dr., Chardon, OH 44024) Assignee(s): none reported Patent Number: 6,322,503 Date filed: February 17, 2000 Abstract: The present invention relates to a method of diagnosing, tracking, and rating depressive symptoms in order to predict responses to specific treatments and guide further adjustments and interventions to treatments. The present invention permits rapid and meaningful depressive symptom severity ratings even when conventional or verbal symptom descriptions are difficult or impossible. The present invention further provides a means for detecting and quantifying intense emotional pain, including depression subtypes and major depressions with psychotic features. The present invention also provides a means of quantitative comparisons for the results of successive treatment trials. The present invention covers the whole range of depression symptom diagnosis and requires no literacy or minimal mental capacities from the patients. Furthermore, the present invention minimizes bias in order to avoid over or under diagnosis and treatments. In addition, the present invention provides a method by which immediate feedback and/or immediate outcome data may be gathered regarding the existence or non-existence of depressive symptoms in an individual. Excerpt(s): The present invention relates generally to a method of psychiatric treatment, and in particular to tracking and rating depressive symptoms in a rapid, meaningful, and quantitative comparable way for treatment.... Cost effectiveness has always been emphasized in the healthcare industry. With an estimated of $44 billion spent annually in the US to treat depression while only 6% of the health insurance policies provide outpatient benefits for psychiatric disorders, cost effectiveness is even more urgent in the psychiatric field.... Many rating scales measuring symptoms of mental disorders and depressions have been developed over the years in order to achieve cost effectiveness in the psychiatric field. These rating scales act as check-lists for clinicians and diagnosticians, monitoring patients' responses to certain treatments or reactions to environmental changes. These rating scales generally adopt a verbal symptom

Patents 457

description method, relying on patients to verbally describe their feelings or elect from one of the verbally-described scenarios to match their feelings. Then, these rating scales rely on clinicians or diagnosticians to `rate` the patients based on patients' responses. Web site: http://www.delphion.com/details?pn=US06322503__ •

Method of treating depression Inventor(s): Gahwyler; Max (Darien, CT) Assignee(s): American Home Products Corporation (New York, NY) Patent Number: 4,110,438 Date filed: March 21, 1977 Abstract: A method of treating depression using luteinizing hormone-releasing hormone is disclosed. Excerpt(s): This invention relates to a method of treating depression with luteinizing hormone-releasing hormone.... The most extensively used method for treating moderate to severe depression involves the administration of tricyclic antidepressant agents. Examples of such agents are amitriptyline, nortriptyline, imipramine, desipramine and doxepin. These drugs, however, have several disadvantages. Among the serious disadvantages are a delayed onset of effectiveness of one to two weeks, and side effects such as atropine-like side effects, e.g., dry mouth, tachycardia, etc., and central nervous system side effects, e.g., parkinsonism, drowsiness, etc.... Consequently, efforts have recently been made to develop an improved method for treating depression. For example, see N. P. Plotalkoff, U.S. Pat. No. 3,737,549, issued June 5, 1973 relating to the treatment of depression with thyrotropin releasing agent. However, none of these recent efforts have replaced or supplemented the above mentioned method. Web site: http://www.delphion.com/details?pn=US04110438__

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Method of treating depression Inventor(s): Valle; Ronald (36 Fitch St., Carteret, NJ 07008) Assignee(s): none reported Patent Number: 4,260,600 Date filed: October 22, 1979 Abstract: A method of treating depression by administering several active compounds throughout the day to a patient in need of such treatment. Also included are pharmaceutical composition claims incorporating these compounds. Excerpt(s): This invention relates to a method of treating depression by administering to a patient in need thereof several active compounds forming a novel combination. The invention also relates to pharmaceutical composition claims which incorporate the novel combination of active compounds. The compounds which form this novel combination are all known and are known for their adrenergic, antihistamine, analgesic or antipyretic uses, such as for example to relieve the symptons of a common cold.... I have found that by using a particular combination of these compounds, in a particular dosage range an antidepressive yet tranquilizing effect results. As such using my combination for this use avoids the use of other well known, costly, prescription only tranquilizers or

458 Depression

antidepression drugs with their resultant potentially dangerous and in many cases unknown side effects and habit forming tendencies. The compounds which make up my combination are readily available, are quite safe for their uses, and are not as costly as the prescription tranquilizers and antidepressants.... (1) Phenylephrine hydrochloride which is (R)-3-hydroxy-.alpha.-[(methylamino)methyl]benzenemethanol hydrochloride. This compound alone has a therapeutic use as an adrenergic. Web site: http://www.delphion.com/details?pn=US04260600__ •

Method of treating depression Inventor(s): Lahti; Robert A. (Galesburg, MI) Assignee(s): The Upjohn Company (Kalamazoo, MI) Patent Number: 4,386,079 Date filed: November 23, 1981 Abstract: A method of treating depression in humans which comprises administering orally to humans an antidepressant effective amount of a compound having the formula I.sub.1 wherein Y is alkyl of from 1 to 3 carbons, inclusive; A is ethylene or --CH.sub.2 CH(CH.sub.2 Cl)--, T and T.sub.1 are the same or different and are SR.sub.3, OR or NR.sub.1 R.sub.2; R is hydrogen, alkyl of from 1 through 6 carbons, aryl, aralkyl or I(a) with the proviso that when one of T or T.sub.1 is NR.sub.1 R.sub.2 then the other cannot be SR.sub.3 or OR. Excerpt(s): This invention pertains to novel processes for preparing phosphorus derivatives of metronidazole. The invention is also particularly directed to the use of novel chloro containing phosphorus derivatives of metronidazole as intermediates in these processes. Furthermore, the intermediates are compounds which insofar as is presently known no one has previously prepared. Finally, the phosphorus derivatives of metronidazole prepared by the novel processes of the invention include novel analogs thereof.... The compounds of formula I.sub.1 include metronidazole phosphate and its salts which are disclosed in U.S. Pat. No. 4,160,827, which in turn are derivatives of the antibiotic compound metronidazole which is disclosed in U.S. Pat. No. 2,944,061. Furthermore, Belgian Pat. No. 873,973 which is equivalent to U.S. Pat. No. 4,160,827 discloses the use of pyrophosphoryl tetrachloride in a process which phosphorylates metronidazole. However, the process disclosed in the Belgian patent is distinguishable from that of the present invention. Particularly, the crystalline intermediates of the present invention have not previously been known. Therefore, it is now understood that the process conditions of the present invention are not appreciated in the prior art. Numerous advantages accrue from use of the invention process and novel intermediates therein such as purification of metronidazol phosphate and preparation of additional analogs not known in previous processes.... In general, phosphorylations of alcohols with phosphoryl trichloride and pyrophosphoryl tetrachloride are well known. Representative references of such phosphorylations include Koransky, W. et al., "Phosphorylation of Nucleosides with Pyrophosphoryl Chloride", Z. Naturforsch, 17, pp. 291-5 (1962), CA, 57, 12609D (1962); Miki, P. et al., "A Phosphorylation of Steroids and A Dienone-Phenol Rearrangement leading to a Secosteroidal Aldehyde Which Has a Strong Toxicity", Chem. Pharm. Bull., Vol. 22, No. 7, pp. 1439-50 (1974); Cremlyn, R. J. W. et al., "A Simple Phosphorylation Procedure for Cyclic Alcohols", Synthesis, pp. 64850 (1971). Additionally, hydrolysis of phosphorus dichlorides are also known. For example, see Koransky et al. cited above, as well as, Lacey, et al., "A Simple Synthesis of Choline Alkyl Phosphates", Tetrahedron Letters, Vol. 21, pp. 2017-20 (1980). However,

Patents 459

none of the above references teach the phosphorylation of metronidazole or the novel compounds of the present invention. Web site: http://www.delphion.com/details?pn=US04386079__ •

Method of treating depression Inventor(s): Griffith; Robert W. (Basking Ridge, NJ), Singer; Jack (Short Hills, NJ) Assignee(s): Sandoz, Inc. (E. Hanover, NJ) Patent Number: 4,593,031 Date filed: June 5, 1985 Abstract: This invention relates to a composition and method for potentiating the antidepressant effect of dibenzocycloheptadiene-type antidepressant agents, for example, nortriptyline, in the treatment of depression, especially geriatric depression, by administering them in combination with an approximately 1:1:1 by weight mixture of dihydroergocryptine (2:1.alpha.:.beta.), dihydroergocornine and dihydroergocristine. Excerpt(s): This invention relates to a method of potentiating the antidepressant effect of dibenzocycloheptadiene-type antidepressant agents, for example, nortriptyline, in the treatment of depression, especially geriatric depression, and in particular, senile dementia with depression, by administering them in combination with an essentially 1:1:1 by weight mixture of dihydroergocryptine (2:1.alpha.:.beta.), dihydroergocornine and dihydroergocristine or a pharmaceutically acceptable acid addition salt thereof, which is referred to herein as the ergopeptide component.... This invention further relates to a composition useful in treating depression, in particular, geriatric depression, comprising a therapeutic effective amount of a dibenzocycloheptadiene antidepressant and a potentiating effective amount of the ergopeptide component. The composition is especially useful in treating senile dementia with depression, e.g., as defined by DMS-III Diagnostic Criteria, American Psychiatric Association (290.21) Diagnostic and Statistical Manual of Mental Disorders (Third Edition).... Depression is one of the most common psychiatric disturbances seen by the physician, especially in the elderly patient. The treatment of depression has generally been improved dramatically by the development of tricyclic antidepressive agents such as the benzocycloheptadiene-type antidepressants. Unfortunately, the therapeutic effect of such agents is often accompanied by troublesome side effects such as anticholinergic, cardiovascular and central nervous system (CNS) reactions. In the geriatric patient, these side effects are especially problematical, necessitating the use of lower daily doses of the antidepressant. At the lower doses, the effect of the drug is often less than that desired. Web site: http://www.delphion.com/details?pn=US04593031__

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Method of treating depression Inventor(s): Buyske; Donald A. (18 Sherman Ave., Morris Plains, NJ 07950) Assignee(s): none reported Patent Number: 4,868,218 Date filed: April 18, 1989 Abstract: The monamine oxidase inhibitor drug L-deprenyl (phenylisopropyl methyl propynyl amine) is safely and conveniently used for the treatment of mental depression

460 Depression

in a formulation applied to the skin of the patient. In this way the danger of side reaction due to the consumption of foods containing tyramine (the cheese effect) is minimized. Unlike other monamine oxidase drugs, such as Parnate, L-deprenyl does not cause skin irritation when used in this way. Excerpt(s): My present invention relates to the therapeautic administration of the drug L-deprenyl a method of treating human subjects suffering from depression and, more particularly, to (levo phenyl isopropyl methyl propynyl amine) for this purpose. For brevity, L-deprenyl will often be denoted below as LDY.... Two general classes of organic pharmaceuticals useful in the treatment of the mental disease depression in humans have been recognized: (1) tricyclic antidepressants, as exemplified by amitriptyline and protriptylene, and (2) monoamine oxidase inhibitors (MAOI), as exemplified by the commercially available drugs Nardil, Parnate, and L-deprenyl.... Because the cheese effect can cause very serious medical problems, including death in severe cases, MAOI drugs are little used, even though they are generally free from the other more common side effects of the tricyclic drugs and are believed to have at least equal effectiveness in the treatment of most types of depression. Web site: http://www.delphion.com/details?pn=US04868218__ •

Method of treating depression Inventor(s): Wallace; Jan D. (Ann Arbor, MI) Assignee(s): Warner-Lambert Company (Morris Plains, NJ) Patent Number: 5,025,035 Date filed: October 12, 1990 Abstract: The instant invention is a novel use of known cyclic amino acids. Such compounds, including gabapentin, are useful for treating major and minor forms of depression. Excerpt(s): The present invention relates to a novel therapeutic use of a known compound, gabapentin, its derivatives, and pharmaceutically acceptable salts. The present invention concerns a method for treating depression in a mammal in need of such treatment.... U.S. Pat. No. 4,024,175 and its divisional 4,087,544 cover the compounds of the instant invention, methods for preparing them, and several uses thereof. The uses disclosed are: protective effect against cramp induced by thiosemicarbazide; protective action against cardiazole cramp; the cerebral diseases epilepsy, faintness attacks, hypokinesia, and cranial traumas; and improvement in cerebral functions. The compounds are useful in geriatric patients. The patents are hereby incorporated by reference.... There is no disclosure in the above references to make obvious the present invention of novel uses of compounds of U.S. Pat. No. 4,024,175 to treat depression. Web site: http://www.delphion.com/details?pn=US05025035__

Patents 461

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Method of treating depression Inventor(s): Buyske, deceased; Donald A. (late of Lake Worth, FL), Buyske, administratrix; by Susan G. (New York, NY) Assignee(s): Somerset Pharmaceuticals, Inc. (Tampa, FL) Patent Number: RE34,579 Date filed: August 27, 1991 Abstract: The monamine oxidase inhibitor drug L-deprenyl (phenylisopropyl methyl propynyl amine) is safely and conveniently used for the treatment of mental depression in a formulation applied to the skin of the patient. In this way the danger of side reaction due to the consumption of foods containing tyramine (the cheese effect) is minimized. Unlike other monamine oxidase drugs, such as Parnate, L-deprenyl does not cause skin irritation when used in this way. Excerpt(s): My present invention relates to the therapeutic administration of the drug Ldeprenyl a method of treating human subjects suffering from depression and, more particularly, to (levo phenyl isopropyl methyl propynyl amine) for this purpose. For brevity, L-deprenyl will often be denoted as LDY.... Two general classes of organic pharmaceuticals useful in the treatment of the mental disease depression in humans have been recognized: (1) tricyclic antidepressants, as exemplified by amitriptyline and protriptylene, and (2) monoamine oxidase inhibitors (MAOI), as exemplified by the commercially available drugs Nardil, Parnate, and L-deprenyl.... Both types of drugs are generally regarded as effective, but both have undesirable side effects. For tricyclic drugs, recognized side effects include dry mouth, orthostatic hypotension, and impotence, and these effects are frequent. The most significant side effect of the MAOI drugs is a rare but serious one: sudden and dangerous life-threatening elevation of blood pressure when the patent taking such drugs also consumes foods high in the naturally occurring substance tyramine. Cheese is the most common food containing large amounts of tyramine, so that this side effect is often known colloquially in the medical profession as the "cheese effect". Web site: http://www.delphion.com/details?pn=US0RE34579__

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Method of treating depression and pre-menstrual syndrome using chromium Inventor(s): McLeod; Malcolm N. (419 Lakeshore La., Chapel Hill, NC 27514) Assignee(s): none reported Patent Number: 5,972,390 Date filed: February 19, 1998 Abstract: The method of this invention is directed to a treatment of depression in men and women and to a treatment of pre-menstrual syndrome (PMS) in women by administering to a patient a therapeutically effective amount of chromium in a pharmaceutically acceptable form either alone or in conjunction with the administration of a standard antidepressant composition, such as a selective serotonin reuptake inhibitor composition. Chromium, preferably in the form of chromium picolinate, is administered to the patient at dosages in a preferred range of about 200 to about 500 micrograms chromium. Excerpt(s): The present invention relates generally to a treatment for depression and to a treatment of pre-menstrual syndrome, and more particularly to the treatment of

462 Depression

depression using chromium and to the treatment of pre-menstrual syndrome using chromium. The present invention also particularly relates a method of improving the effectiveness of an antidepressant composition by administering chromium to a patient concurrently with the administration of an antidepressant composition to the patient.... It will be appreciated by those having ordinary skill in the art that depression is a difficult mental disorder to treat. Patients having such a disorder are often reluctant to seek the medical attention necessary to diagnose the disorder. Such reluctance is often related to the patient's fear of the stigma associated with seeking psychiatric help or to the patient's feelings of worthlessness associated with depression. Moreover, once patients seek competent psychiatric help, it is difficult to successfully treat the disorder through psychoanalytic approaches alone.... In the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, (DSM IV) published by the American Psychiatric Association, depressive disorders are classified under mood disorders and are divided into three types: major depressive disorder, dysthymic disorder and depressive disorder not otherwise specified. Major depressive disorder and dysthymic disorder are differentiated based on chronicity, severity and persistence. In major depression the depressed mood must be present for two weeks. In dysthymic disorder the depressed mood must be present most days over a period of two (2) years. Usually major depressive disorder is characterized by its sharp contrast to usual functioning. A person with a major depressive episode can be functioning and feeling normally and suddenly develop severe symptoms of depression. By contrast a person with dysthymic disorder has chronic depression with less severe symptoms than major depression. Web site: http://www.delphion.com/details?pn=US05972390__ •

Method of treating depression and tri-substituted amines therefor Inventor(s): Minchin; Michael C. W. (Oxford, GB2), White; John F. (Wokingham, GB2) Assignee(s): John Wyeth & Brother, Limited (Maidenhead, GB2) Patent Number: 5,527,955 Date filed: December 23, 1993 Abstract: The invention concerns a method for treating depression or senile dementia using a compound which acts selectively as an agonist of gamma aminobutyric acid (GABA) at GABA autoreceptors with the proviso that the compound is not fengabine and progabide. Excerpt(s): This invention relates to use of a new pharmacological activity and to certain amines possessing said pharmacological activity, to processes for preparing them and to pharmaceutical compositions containing them. More particularly this invention relates to the treatment of depression.... In the UK the annual referral rate for depression is around 300-400 per 10.sup.5 population of whom 10-15% require hospitalisation. At present the most effective and safe treatment for severe depression involves electroconvulsive therapy (ECT) where the patient receives a series of controlled electric shocks. However such treatment understandably engenders an atavistic fear and apprehension in many patients. It also has undesirable side-effects, notably disturbance of memory.... The mode of action of ECT remains unknown but in recent years much has been learnt about the biological effects of electroconvulsive shock (ECS) in animals. In particular, repeated ECS, given in ways closely mimicking those used to administer ECT clinically, elicits in rodents changes in monoamine functions. These include: increased 5-HT-mediated behaviour, increased dopaminergic behaviour and depressed

Patents 463

beta-adrenoceptor binding and sensitivity of the coupled adenylate cyclase. The last is also seen following chronic treatment with a number of antidepressant drugs. Web site: http://www.delphion.com/details?pn=US05527955__ •

Method of treating depression using 1-threo-methylphenidate Inventor(s): Midha; Kamal K. (Hamilton, BM), Teicher; Martin (Waltham, MA), Kumar; Vijai (Morris Plains, NJ) Assignee(s): Pharmaquest Limited (Hamilton, BM) Patent Number: 6,395,752 Date filed: August 11, 2000 Abstract: A method of treating dysphoria or depression is disclosed in a patient which comprises the step of administering orally or non-orally to said patient, a therapeutically effective amount of 1-threo-methylphenidate or a pharmaceutically acceptable acid addition salt thereof. Excerpt(s): This invention relates to a method of treating depression in a patient by oral or non-oral administration of 2S,2'S-methyl 2-phenyl-2-(2'-piperidyl) acetate, commonly known as 1-threo-methylphenidate, hereinafter referred to as 1-MPH and to pharmaceutical compositions containing 1-MPH designed to deliver 1-MPH to the central nervous system. More particularly the method of treatment is designed to provide relief to a depressed patient who is awaiting the onset of the antidepressive action of an antidepressant such as a selective serotonin re-uptake inhibitor, or any other class of antidepressant that requires administration over 2 to 6 weeks to demonstrate therapeutic effect.... Orally administered racemic d1-threo-methylphenidate (d1-MPH) is widely used in the treatment of Attention-Deficit Hyperactivity Disorder (ADHD) in children and adults and also in the treatment of depression in patients suffering from cancer or AIDS, compulsive shopping disorder, narcolepsy, and hypersomnia. It is known that the therapeutic effect of d1-MPH in the treatment of ADHD in children is attributable to d-MPH (Srinivas et al, Clin. Pharmacol. Therap. 52, 561 to 568, 1992). Until recently, however, little was known about the potential pharmacological and/or therapeutic roles of 1-MPH because concentrations of 1-MPH in plasma and brain are very low due to extensive enantioselective first pass metabolism of 1-MPH after oral administration of d1-MPH (Srinivas et al, Pharm. Res. 10, 14 to 21, 1993). After intravenous administration of d1-MPH, however, both enantiomers of threomethylphenidate are taken up into the brain although their patterns of distribution are different (Ding et al, Psychopharmacology 131, 71 to 78, 1997).... The use of oral stimulants such as dextroamphetamine or d1-MPH in the treatment of severe depressive disorders in the elderly or terminally ill depressed patients has been the subject of many studies over the years. After reviewing 85 publications on the subject, Satel and Nelson (J. Clin. Psychiat. 50, 241 to 249, 1989) were critical of the fact that many of the studies reported were methodologically unsophisticated and/or uncontrolled. They concluded that while stimulants are no more effective than a placebo in the treatment of primary depression, stimulants may be of value in the treatment of refractory patients and medically ill patients. Similarly, Chiarello and Cole (Arch. Gen. Psychiat. 44, 276 to 285, 1997) reviewed 81 publications and concluded that many of the older studies are inadequate although there was some evidence to support the use of psychostimulants in selected clinical instances. Emptage and Smith (Annals of Pharmacotherapy, 30, 151 to 157, 1996) reviewed 43 studies published from 1986 to 1995 and concluded that oral-MPH appears to be a safe and effective treatment for depressed, medically ill, elderly

464 Depression

patients to provoke a rapid onset of antidepressant activity. Recently Wallace and coworkers (Am. J. Psychiat. 152, 929 to 931, 1995) conducted what they termed the first placebo-controlled double blind trial to demonstrate the efficacy of oral d1-MPH in older, medically ill depressed patients. The benefit of oral d1-MPH was statistically and clinically significant despite the small number of patients in the study (n=16). Depressive symptoms decreased markedly in 7 subjects (Hamilton depression scale decreased by >55%), moderately in a further 3 subjects (Hamilton depression scale decreased by 30 to 55%), minimally in 3 subjects (Hamilton depression scale decreased by 55%), moderately in a further 3 subjects (Hamilton depression scale decreased by 30 to 55%), minimally in 3 subjects (Hamilton depression scale decreased by

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