Major Depressive Disorder (MDD) is one of the most common psychiatric conditions affecting adults and afflicts approximately 5% of the world's population. MDD is highly co-morbid with cardiovascular disease, a major source of morbidity and mortality. Although a number of pathological changes observed in MDD may impact cardiovascular health, no single mechanism has been identified that can explain this association. Both MDD and CVD are more common in women, and pregnancy may represent a period of elevated risk for both depression and changes in cardiovascular health that may never fully resolve in the years following pregnancy. This study of 61 pregnant women during their third trimester of pregnancy investigated whether depressive symptoms (as measured by the Edinburgh Postnatal Depression Scale, or EPDS) are associated with decreased heart rate variability, a well-known marker of cardiovascular risk. Additionally, this study will investigate whether Plasminogen Activator Inhibitor-1 and 2 (PAI-1 and PAI-2) mediate this association. These pro-thrombotic proteins have long been linked to the presence and severity of cardiovascular disease, and an emerging body of evidence suggests that plasma concentrations of these proteins may also be elevated in Major Depressive Disorder. Heart rate variability was significantly reduced among participants who had clinically significant depressive symptoms during the third trimester (EPDS >14), although adjustment for age, body mass index, smoking, education level and use of psychiatric medication fully attenuated this relationship. PAI-1 and PAI-2 measured via ELISA assay in a subset of the study population (n=23) was found to not mediate this association. This study is the first of its kind to evaluate the role of PAI-1 in psychiatric illness during pregnancy, and may serve as the impetus for further research aimed at elucidating the relationship between mental health and cardiovascular risk during gestation. / Thesis / Master of Science (MSc)

No / Depression in patients receiving palliative and end-of-life care is difficult to distinguish from grief and sadness. However, there are some important distinctions and it is a clinical condition that is treatable and should not be considered a necessary or normal part of the dying process. This article examines the nature of depression and describes the stress vulnerability model of depression, linking it to recent developments in the neurobiology of depression. It also discusses how to distinguish depression from other symptoms that patients may be experiencing.

Major Depressive Disorder (MDD) is a severe psychiatric disorder affecting approximately 12% of men and 25% of women nationally in the nonclinical population. The aim of this research was to determine if lay individuals could differentiate between MDD and normal sadness. To evaluate the lay understanding of MDD and normal sadness, students at a large Southeastern university read four vignettes describing varying severity levels of MDD and normal sadness and then answered a variety of questions relating to the vignettes. Additionally, the lay conceptualizations of MDD were compared and contrasted to the professional conceptualizations of MDD. The principal hypothesis was that lay individuals could not differentiate between clinical depression and normal sadness because the two concepts have become synonymous in today’s society. In fact, results showed that lay individuals could not differentiate between threshold MDD and subthreshold MDD.

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Major depressive disorder (MDD) is a debilitating disorder characterized by significant mood disturbance. In laboratory studies, MDD has been characterized by both blunted positive (PER) and negative emotional reactivity (NER). However, mood disordered persons' emotional reactivity has rarely been studied in naturalistic settings, and it is unknown how less severe forms of depression relate to emotional reactivity. To address these issues, the current study utilized two naturalistic sampling methods (the Day Reconstruction Method and the Experience Sampling Method) to examine PER and NER to daily life events in 35 individuals currently experiencing a major depressive episode (MDD), 26 individuals currently experiencing a minor depressive episode (mD), and 38 healthy controls. Both methods demonstrated that individuals with major and minor depression exhibited blunted PER relative to controls. In surprising contrast to previous laboratory findings, both individuals with MDD and mD showed increased NER relative to controls. Correlational analyses with severity measures indicated that depression and anxiety severity were positively related to NER and negatively related to PER. Findings suggest that NER in mood disorders may diverge as a function of assessment context and may be heightened in naturalistic environments. Despite the fact that mD is a milder mood disorder, findings suggest that mD results in similar emotional impairments as found in MDD.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 6 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

Background: Major depression is one of the most prevalent, disabling, and costly illnesses worldwide. Despite a 400% increase in antidepressant medication use since 1988, fewer than half of treated depression patients experience a clinically meaningful reduction in symptoms and uncertainty exists regarding how to successfully obtain symptom remission. Identifying homogenous subgroups based on clinically observable characteristics could improve the ability to efficiently predict who will benefit from which treatments. Methods: Latent class analysis and latent transition analysis (LTA) were applied to data from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study to explore how to efficiently identify subgroups comprised of the multiple dimensions of depression and examine changes in subgroup membership during treatment. The specific aims of this dissertation were to: 1) evaluate latent depression subgroups for men and women prior to antidepressant treatment; 2) examine transitions in these subgroups over 12 weeks of citalopram treatment; and 3) examine differences in functional impairment between women’s depression subgroups throughout treatment. Results: Four subgroups of depression were identified for men and women throughout this work. Men’s subgroups were distinguished by depression severity and psychomotor agitation and retardation. Severity, appetite changes, insomnia, and psychomotor disturbances characterized women’s subgroups. Psychiatric comorbidities, especially anxiety disorders, were related to increased odds of membership in baseline moderate and severe depression subgroups for men and women. After 12 weeks of citalopram treatment, depression severity and psychomotor agitation were related to men’s chances of improving. Severity and appetite changes were related to women’s likelihood of improving during treatment. When functional impairment was incorporated in LTA models for women, baseline functional impairment levels were related to both depression subgroups at baseline and chances of moving to a different depression subgroup after treatment. Conclusion: Depression severity, psychomotor disturbances, appetite changes, and insomnia distinguished depression subgroups in STAR*D. Gender, functional impairment, comorbid psychiatric disorders, and likelihood of transitioning to subgroups characterized by symptom improvement differed between these subgroups. The results of this work highlight how relying solely on summary symptom rating scale scores during treatment obscures changes in depression that might be informative for improving treatment response.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2009.