Journal of affective disorders
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Comparative Study
Symptomatologic analysis of psychotic and non-psychotic depression.
The aim of the present study is to evaluate the symptomatologic presentation of delusional compared to non-delusional major depressive episodes. ⋯ Our data support the hypothesis of delusional depression as a more severe form of mood disorder.
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Comparative Study
Altered [3H]imipramine and 5-HT2 but not [3H]paroxetine binding sites in platelets from depressed patients.
Serotonergic system alterations were studied in 51 depressed patients classified according to DSM-III-R criteria for major depression with melancholia compared to 31 healthy controls. ⋯ Taken together, these results suggest that [3H]imipramine and 5HT2 receptors may be good biological markers for serotonergic dysfunction in depressive disorders.
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Comparative Study
The effect of stress on salivary cortisol in panic disorder patients.
Various findings suggest the possibility of an abnormal cortisol response to CRH in panic disorder patients, which raises the question of whether such patients might also produce an abnormal cortisol response to stress. The purpose of the present study was to use salivary cortisol measurement in assessing differences in response to novelty/mild stress situations between panic disorder subjects and controls. ⋯ Twenty-four panic disorder (PD) sufferers and 15 panic-free control subjects were tested on a range of psychometric and physiological measures, at both the start and the end of an experimental session. Subjects were tested at the beginning for state anxiety, salivary cortisol, heart rate, and blood pressure, and these tests were repeated at the end of the session. The state anxiety scores (STAI) showed a reduction in anxiety level over the test period for both groups, and there was a corresponding fall in both blood pressure and heart rate. Cortisol levels also fell over the course of the session in the control group, but in the PD group cortisol levels showed no such reduction. In addition, there was a significant difference in the levels of cortisol at the start of the session between the two groups (PD group lower). These data indicate a possible alteration in cortisol responsiveness to stress/novelty situations in PD subjects. This was considered to be consistent with previous suggestions of HPA axis dysregulation in PD patients, although our research indicates unresponsiveness rather than responsiveness to be a factor to be considered for future investigation.
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Mirtazapine is a presynaptic alpha-2 antagonist that has dual action by increasing noradrenergic and serotonergic neurotransmission. The enhancement of serotonergic neurotransmission is specifically mediated via 5-HT1 receptors because mirtazapine is a postsynaptic serotonergic 5-HT2 and 5-HT3 antagonist. In addition, mirtazapine has only a weak affinity for 5-HT1 receptors and has very weak muscarinic anticholinergic and histamine (H1) antagonist properties. ⋯ In addition, mirtazapine does not appear to be associated with sexual dysfunction. Mirtazapine has shown no significant cardiovascular adverse effects at multiples of 7 to 22 times the maximum recommended dose. Mirtazapine is a unique addition to the antidepressant armamentarium as first-line therapy in patients with major depression and symptoms of anxiety/agitation or anxiety/somatization or complaints of insomnia and as a useful alternative in depressed patients who do not adequately respond to or are intolerant of tricyclic antidepressants or serotonin-specific reuptake inhibitors.
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Suicide is a major health problem, showing an increasing tendency in many developed countries. In this synthetic review, having briefly described the possible risk factors of suicide, those recent strategies that have been proved to be effective methods of reducing the suicide rate are summarised. ⋯ Training health-care workers in order to increase their knowledge on the means of suicide prevention and educating patients so as to improve their compliance is highly beneficial. Since health care professionals can help only those patients who contact them, public education on the symptoms, dangers and the treatable nature of depression, other psychiatric illnesses and psychological crises becomes also very important.