Depression double

Dysthymic Disorder. Dysthymic disorder differs from MDD by being more chronic and less severe. Yet, two issues can cloud the distinction. First, some patients experience double depression in which an episode of major depression is superimposed on dysthymia. This can make it difficult to assess treatment response when the baseline mood is dysthymia instead of a normal euthymic mood. Second, a few patients may experience a chronic major depressive episode, which, like dysthymic disorder, lasts 2 years or more. In contrast to dysthymic patients whose insidious onset of symptoms leaves them unable to say exactly when the depression started, most patients with chronic major depression can tell when their depression began. 

Dysthymic disorder, also called dysthymia, is by definition a chronic illness that lasts two or more years. It consists of persistently depressed mood that is not as severe as major depression. However, double depression can occur in which a major depressive episode is superimposed on a preexisting dysthymia. It is unclear whether double depression is actually two illnesses or a single illness that varies in severity over time. Please refer to Table 3.12 for diagnostic criteria of dysthymic disorder. 

The key task is distinguishing dysthymia from major depression. The similarity in symptoms and the potential for double depression can make this difficult. Major depression tends to have an episodic course, more neurovegetative symptoms, and more severe disability. On the other hand, dysthymia is a smoldering, unrelenting mood distnrbance. 

Factors associated with increased risk for recurrence in naturalistic studies of depressed children and adolescents may serve as guidance to the clinician to decide who needs maintenance treatment. These factors include history of prior depressive episodes, female sex, late onset, suicidality, double depression, subsyndromal symptoms, poor functioning, personality disorders, exposure to negative events (e.g., abuse, conflicts), and family history of recurrent MDD (<2 episodes) (Birmaher et ah, 1996 a,b Goodyer et ah, 1998 Fewin-sohn et ah, 1999 Rao et ah, 1999 Rueter et al., 1999 Weissman et ah, 1999a, b Klein et ah, 2001). 

A typical example of diagnostic splintering provides the group of mood disorders. One reads about major depression, minor depression, double depression, dysthymia, unipolar and bipolar depression, depressive personality, depression not otherwise specified, brief recurrent depression, subsyndromal symptomatic depression, mixed anxiety depression disorder, seasonal depression, and adjustment disorder with depressive mood. 

A recently conducted study compared the efficacy of IMI to that of sertraline in patients with double depression and chronic depression. After... 

Chronic dysthymia followed by major depressive disorder ( double depression ) Prompt relapse following prior treatment discontinuation Strong positive family history of recurrent mood disorders Coexisting medical problems or complication of aging that would make a future episode hazardous... 

Keller MB, Hanks DL Course and outcome in panic disorder and depression. J Clin Psychopharmacol Biol Psychiatry 17 551-570, 1993 Keller MB, Shapiro RW Double depression superimposition of acute depressive episodes on chronic depressive disorders. Am J Psychiatry 139 438-442, 1982 Keller MB, Shapiro RW, Lavori PW, et al Recovery in major depressive disorder analysis with the life table and regression models. Arch Gen Psychiatry 39 905-910, 1982a... 

Dysthymia is a low-grade but very chronic form of depression, which lasts for more than 2 years (Fig. 5—7). It may represent a relatively stable and unremitting illness of low-grade depression, or it may indicate a state of partial recovery from an episode of major depressive disorder. When major depressive episodes are superimposed on dysthymia, the resulting condition is sometimes called double depression (Fig. 5—8) and may account for many of those with poor interepisode recovery. 

FIGURE 5—8. Double depression is a syndrome characterized by oscillation between episodes of major depression and periods of partial recovery or dysthymia. 

Several subtypes of depression require specific treatment strategies that go beyond a simple course of conventional antidepressant therapy (these subtypes include bipolar depression, major depression with psychotic features, seasonal depression, atypical depression, comorbid anxiety disorder, comorbid substance abuse, double depression [major depression... 

Unfortunately dysthymic individuals can also suffer not only from chronic, low-grade depression but also from periods of major depression. These more severe episodes are superimposed on the chronic depression, and often, upon recovery from the major episode, the patient returns to his or her preclinical norm low-grade depression. Such disorders have been termed "double depression" (see figure 5-C). 

Tlie structure of boehmite consists of double layers in wliich the oxygen ions exliibit cubic packing. Hydroxyl ions of one double layer are located over the depression between OH ions in the adjacent layer such that the double layers are linked by hydrogen bonds between hydroxyls in neighboring planes. Tliere is some technical production and use of synthetically produced boehmite. 

There are numerous solubility data in the literature the standard reference is by Seidell (loc. cit.). Valuable as they are, they nevertheless must be used with caution because the solubihty of compounds is often influenced by pH and/or the presence of other soluble impurities which usually tend to depress the solubihty of the major constituents. While exact values for any system are frequently best determined by actual composition measurements, the difficulty of reproducing these solubility diagrams should not be underestimated. To obtain data which are readily reproducible, elaborate pains must be taken to be sure the system sampled is at equihbrium, and often this means holding a sample at constant temperature for a period of from 1 to 100 h. While the published cui ves may not be exac t for actual solutions of interest, they generally will be indicative of the shape of the solubility cui ve and will show the presence of hydrates or double salts. 

Gadduin analysis, Gadduin (method of), this method (Q. J. Exp. Physiol. 40, 49-74, 1955) compares equiactive concentrations of an agonist in the absence and presence of a concentration of noncompetitive antagonist that depresses the maximal agonist response. These are compared in a double reciprocal plot (or variant thereof) to yield the equilibrium dissociation constant of the noncompetitive antagonist-receptor complex (see Chapters 6.4 and 12.2.8). 

Gadduin equation (noncompetitive antagonism), this technique measures the affinity of a noncompetitive antagonist based on a double reciprocal plot of equiactive agonist concentrations in the absence and presence of the noncompetitive antagonist. The antagonist must depress the maximal response to the agonist for the method to be effective see Chapter 6.4. 

Camptothecins (irinotecan, topotecan) are derived from the bark of the Chinese tree Xi Shu (Camptotheca accuminata). They inhibit topoisomerase I thus effecting double strand breaks. Unwanted effects include diarrhea and reversible bone marrow depression. 

The method of Gaddum compares equiactive concentrations of agonist in the absence and presence of a concentration of noncompetitive antagonist that depresses the maximal agonist response. These concentrations are compared in a double-reciprocal plot (or... 

Raoult observed that many substances dissolved in benzene, nitrobenzene, and ethylene dibromide, gave depressions only half the normal, and this he explained as due to a polymerisation of the solute to double molecules ... 

But when solutions of salts in water were found to give depressions considerably in excess of the normal, usually approaching double that amount at high dilution, the interpretation was by no... 

Administration of trimethadione (Tridione) may result in hematologic changes, such as pancytopenia (decrease in all the cellular components of the blood), leukopenia, aplastic anemia, and thrombocytopenia Also reported are various types of skin rashes, diplopia (double vision), vomiting, changes in blood pressure, CNS depression, photosensitivity, and fatal nephrosis. Because these dm have been associated with serious adverse reactions and fetal malformations, they should be used only when other less toxic dm are not effective in controlling seizures. The oxazolidinediones may precipitate a tonic-clonic seizure... 

Dorus and colleagues (1989) conducted a multicenter, double-blind, placebo-controlled trial in depressed and nondepressed alcoholic veterans. A total of 457 male alcoholic patients, of whom approximately one-third were depressed, were randomly assigned to receive either 600-1,200 mg/day of lithium or a comparable number of placebo capsules. No significant differ-... 

Nortriptyline. Nortriptyhne, a tricychc antidepressant, has been shown in double-blind, placebo-controlled randomized trials to be superior to placebo for smoking cessation (Prochazka et al. 1998). Nortriptyline appears to have efficacy comparable to that of bupropion for smoking cessation (Hall et al. 2002). The efficacy of this agent may be improved with more intensive behavioral therapies (Hall et al. 1998). Nortriptyline s mechanism of action is thought to relate to its noradrenergic and serotonergic reuptake blockade, because these two neurotransmitters have been implicated in the neurobiology of nicotine dependence. Side effects of nortiptyline are typical of tricyclic antidepressants and include dry mouth, blurred vision, constipation, and orthostatic hypotension. Nortriptyline appears to have some utility for smokers with a past history of major depression, and it can be recommended as a second-... 

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