Major Depressive Disorder

Objective: To assess cognition in major depressed (MD), Alzheimer's disease (AD), and depression in AD elderly. Method: Subjects were evaluated by Mini Mental, Rey Auditory Verbal Learning Test, Rey Complex Figure, Digit Span, Similarities, Trail Making A/B, Verbal Fluency and Stroop. One-way ANOVA and multivariate models were used to compare the performance of each group on neuropsychological tests. Results: We evaluated 212 subjects. Compared to MD, attention, working memory, processing speed and recall showed significantly better in controls. Controls showed significantly higher performance in all cognitive measures, except in attention compared to AD. Verbal fluency, memory, processing speed and abstract reasoning in MD was significantly higher compared to AD. AD was significantly better in general cognitive state than depression in AD. All other cognitive domains were similar. Conclusion: A decreasing gradient in cognition appeared from the control to depression in AD, with MD and AD in an intermediate position.

Response styles theory promotes rumination as a central cognitive construct driving negative mood and depression, and past research suggests that at least part of the mechanism driving rumination's depressogenic effect is through inhibiting the individual's ability to shift attentional focus away from negative environmental stimuli. In the current study, we hypothesized that high trait rumination would be associated with impaired recovery of the body's biological response to psychological stress. In a community sample of depressed (n=31) and non-depressed (n=33) adolescents we assessed rumination and the more adaptive trait of distraction and problem-solving with the Children's Response Styles Questionnaire (CRSQ; Abela 2000), and diagnostic status was confirmed using the Child and Adolescent Schedule of Affective Disorders and Schizophrenia (K-SADS; Kaufman et al. Journal of the American Academy of Child and Adolescent Psychiatry 36:980-988, 1997). Participants completed the Trier Social Stress Test (TSST; Kirschbaum et al. Neuropsychobiology 28:76-81, 1993), and the focus of our analyses was the change in salivary cortisol concentration between peak cortisol output (25 min post-stressor) and a sample taken during the "Recovery" period 65 minutes poststressor. Consistent with the predictions of response style theory, among the depressed adolescents only, high trait rumination was associated with delayed post-stressor cortisol recovery, whereas high trait distraction and problem-solving was associated with more rapid recovery. In contrast, response styles were not associated with cortisol recovery in the nondepressed group. These findings implicate impaired poststress cortisol recovery as a potential mechanism underlying the pathological effect of rumination on the development and maintenance of Major Depressive Disorder (MDD).

To evaluate the efficacy and tolerability of once-daily extended release quetiapine fumarate (quetiapine XR) as monotherapy treatment for major depressive disorder (MDD). This 8-week (6-week active-treatment, randomized phase; 2-week posttreatment drug-discontinuation/tapering phase), multicenter, double-blind, randomized, parallel-group, placebo- and active-controlled, phase 3 study was conducted between April 2006 and May 2007. In total, 612 patients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)-defined MDD were randomly assigned to quetiapine XR 150 mg/day or 300 mg/day, duloxetine 60 mg/day (active control), or placebo. The primary endpoint was the change from baseline to week 6 in Montgomery-Asberg Depression Rating Scale (MADRS) total score. At week 6, both doses of quetiapine XR (p < .001) and duloxetine (p < .01) significantly reduced mean MADRS total score versus placebo. A significant reduction was seen at week 1 with quetiapine XR 150 mg/day and 300 mg/day versus placebo (p < .01), but not with duloxetine. Response rates (>or= 50% reduction in MADRS total score) at week 6 were significantly higher for both doses of quetiapine XR (p < .01) and duloxetine (p < .05) versus placebo. Remission rates (MADRS score <or= 8) were significantly higher for quetiapine XR 300 mg/day and duloxetine versus placebo (p < .05), but not for quetiapine XR 150 mg/day. Hamilton Rating Scale for Depression, Hamilton Rating Scale for Anxiety, and Clinical Global Impressions-Severity of Illness total scores and the proportion of patients with Clinical Global Impressions-Improvement scores of 1 or 2 ("much/very much improved") were significantly improved with both doses of quetiapine XR and duloxetine versus placebo. The most common adverse events reported were dry mouth, sedation, and somnolence for quetiapine XR and nausea, headache, dizziness, and dry mouth for duloxetine. Quetiapine XR monotherapy (150 mg/day and 300 mg/day) is effective, with safety and tolerability consistent with the known profile of quetiapine XR, in the treatment of patients with MDD, with onset of symptom improvement demonstrated at week 1. clinicaltrials.gov Identifier: NCT00321490.

Primary objective: To investigate the association between reported past traumatic brain injury (TBI) and demographic, neuropsychiatric and criminographic parameters among individuals recently received into custody. Research design: A random sample of men recently received into the New South Wales (Australia) criminal justice system were screened for a history of TBI and the details of up to five separate TBI episodes were obtained. We also screened for depression, psychosis, personality disorder, drug and alcohol use, and 'social connectedness'. Main outcome and results: Among the 200 study participants, 82% reported past TBI. TBI was associated with a history of engagement in contact sports, school expulsion, daily illicit drug use, depression and psychosis. Conclusions: Past TBI is common among prisoners entering the criminal justice system and, amongst other correlates, appears to be highly associated with increased rates of major mental illness.