Amy Farabaugh

Personality disorders and depression.

BACKGROUND Personality disorders (PDs) were assessed among depressed out-patients by clinical interview before and after antidepressant treatment with fluoxetine to assess the degree of stability of PD diagnoses and determine whether changes in PD diagnoses across treatment are related to the degree of improvement in depressive symptoms. METHOD Three hundred and eighty-four out-patients (55% women; mean age = 39.9 +/- 10.5) with major depressive disorder (MDD) diagnosed with the SCID-P were enrolled into an 8 week trial of open treatment with fluoxetine 20 mg/day. The SCID-II was administered to diagnose PDs at baseline and endpoint. RESULTS A significant proportion (64%) of our depressed out-patients met criteria for at least one co-morbid personality disorder. Following 8 weeks of fluoxetine treatment, there was a significant reduction in the proportion of patients meeting criteria for avoidant, dependent, passive-aggressive, paranoid and narcissistic PDs. From baseline to endpoint, there was also a significant reduction in the mean number of criteria met for paranoid, schizotypal, narcissistic, borderline, avoidant, dependent, obsessive-compulsive, passive aggressive and self-defeating personality disorders. While changes in cluster diagnoses were not significantly related to improvement in depressive symptoms, there were significant relationships between degree of reduction in depressive symptoms (percentage change in HAM-D-17 scores) and degree of change in the number of criteria met for paranoid, narcissistic, borderline and dependent personality disorders. CONCLUSIONS Personality disorder diagnoses were found to be common among untreated out-patients with major depressive disorder. A significant proportion of these patients no longer met criteria for personality disorders following antidepressant treatment, and changes in personality disorder traits were significantly related to degree of improvement in depressive symptoms in some but not all personality disorders. These findings suggest that the lack of stability of PD diagnoses among patients with current MDD may be attributable in part to a direct effect of antidepressant treatment on behaviours and attitudes that comprise PDs.

Tridimensional Personality Questionnaire Factors in Major Depressive Disorder: Relationship to Anxiety Disorder Comorbidity and Age of Onset

Objective: We used the Tridimensional Personality Questionnaire (TPQ) to study the relationship between temperamental traits and comorbid anxiety disorders as well as age of onset of major depressive disorder (MDD) in 263 patients with MDD. Methods: Patients recruited for a large clinical study on MDD underwent a Structured Clinical Interview for DSM-III-R assessment and were administered the self-rated TPQ [mean age = 39.5 ± 10.5 years, women = 138 (53%), initial 17-item Hamilton Rating Scale for Depression (HAM-D-17) score = 19.6 ± 3.4]. The TPQ was scored for three previously identified factors – harm avoidance (HA), novelty seeking (NS), and reward dependence (RD). Multiple linear regression methods were used to evaluate the relationship between TPQ factors and each comorbid anxiety disorder as well as between early- vs. late-onset MDD, after controlling for age, gender and initial HAM-D-17 score (when these were related to the dependent variable in simple regressions). Results: Social anxiety disorder in MDD was strongly associated with higher scores on HA and lower scores on NS and RD (t = 5.4, p < 0.0001; t = 2.6, p = 0.009; t = 2.2, p = 0.028, respectively). A diagnosis of generalized anxiety disorder in MDD was significantly related to higher HA scores (t = 2.8, p = 0.006). The presence of comorbid obsessive-compulsive disorder was associated with lower NS scores (t = 2.3, p = 0.023) as was that of comorbid panic disorder (t = 2.0, p = 0.051). Finally, the presence of simple phobias was associated with lower scores on RD (t = 2.4, p = 0.016). HA scores were higher in patients with early onset of MDD (adjusted p = 0.05). Early versus late onset of MDD was not significantly related to NS or RD scores. Limitations: Since our sample consisted of moderately depressed outpatients, our ability to generalize our findings to other populations is limited. Conclusions: Features of temperament are related to patterns of anxiety disorder comorbidity and age of onset among patients with MDD. Higher levels of HA and lower levels of RD and NS were associated with an increased risk of anxiety disorder comorbidity in our sample. HA may also be related to early onset of depression.

A Double-Blind, Randomized, Pilot Dose-Finding Study of Maca Root (L. Meyenii) for the Management of SSRI-Induced Sexual Dysfunction

We sought to determine whether maca, a Peruvian plant, is effective for selective‐serotonin reuptake inhibitor (SSRI)‐induced sexual dysfunction. We conducted a double‐blind, randomized, parallel group dose‐finding pilot study comparing a low‐dose (1.5 g/day) to a high‐dose (3.0 g/day) maca regimen in 20 remitted depressed outpatients (mean age 36 ± 13 years; 17 women) with SSRI‐induced sexual dysfunction. The Arizona Sexual Experience Scale (ASEX) and the Massachusetts General Hospital Sexual Function Questionnaire (MGH‐SFQ) were used to measure sexual dysfunction. Ten subjects completed the study, and 16 subjects (9 on 3.0 g/day; 7 on 1.5 g/day) were eligible for intent‐to‐treat (ITT) analyses on the basis of having had at least one postbaseline visit. ITT subjects on 3.0 g/day maca had a significant improvement in ASEX (from 22.8 ± 3.8 to 16.9 ± 6.2; z =−2.20, P= 0.028) and in MGH‐SFQ scores (from 24.1 ± 1.9 to 17.0 ± 5.7; z =−2.39, P= 0.017), but subjects on 1.5 g/day maca did not. Libido improved significantly (P < 0.05) for the ITT and completer groups based on ASEX item #1, but not by dosing groups. Maca was well tolerated. Maca root may alleviate SSRI‐induced sexual dysfunction, and there may be a dose‐related effect. Maca may also have a beneficial effect on libido.

A Controlled Trial of Bupropion Added to Nicotine Patch and Behavioral Therapy for Smoking Cessation in Adults With Unipolar Depressive Disorders

Although there is a strong relationship between depression and smoking, most nicotine dependence treatment trials exclude depressed smokers. Our objective was to determine whether bupropion improves abstinence rates and abstinence-associated depressive symptoms when added to transdermal nicotine replacement therapy (NRT) and group cognitive behavioral therapy (CBT) in smokers with unipolar depressive disorder (UDD). Adult smokers with current (n = 90) or past (n = 109) UDD were randomly assigned to receive bupropion or placebo added to NRT and CBT for 13 weeks. In the primary analysis, with dropouts considered smokers, 36% (35/97) of those on bupropion and 31% (32/102) on placebo attained biochemically validated 7-day point prevalence abstinence at end of treatment (not significant). Because of a high dropout rate (50%) and a significant difference in abstinence status at dropout by treatment group, a traditional intent-to-treat analysis with last observation carried forward imputation of abstinence status was performed. In this secondary analysis, 56% (54/97) of those on bupropion and 41% (42/102) on placebo met criteria for abstinence at end of trial, &khgr;2 = 4.18, P = 0.04. Nicotine replacement therapy usage and absence of a comorbid anxiety disorder predicted abstinence. Abstinence was associated with increased depressive symptoms, regardless of bupropion treatment. Thus, in the primary analysis, bupropion neither increased the efficacy of intensive group CBT and NRT for smoking cessation in smokers with UDD nor prevented abstinence-associated depressive symptoms. Bupropion seemed to provide an advantage for smoking cessation for those who remained in the trial. The dropout rate was high and was characterized by a higher prevalence of current comorbid anxiety disorder. Given the high abstinence rate achieved with CBT plus NRT, a ceiling effect related to the high level of intervention received by all subjects may have prevented an adequate test of bupropion.

Depression and suicidal ideation in college students.

Background/Aims: Suicide is one of the leading causes of death in college students and is often associated with depression. The aim of this study was to assess the rates of suicidal ideation (SI) on college campuses and to identify its correlates. Methods: On-campus depression screening sessions were conducted at 3 universities (n = 898; 55% female; mean age 20.07 ± 1.85 years). Participants completed the Beck Depression Inventory (BDI; mean ± SD of total score = 6.27 ± 6.31) and other measures. Eighty-four students endorsed a ‘1’ on the BDI suicidality item, suggesting thoughts of suicide. Results: Results showed that students with greater depression severity, higher levels of hopelessness, and poorer quality of life were more likely to endorse SI. Conclusion: Factors associated with SI highlighted in this study may aid in the identification of college students at risk for suicide.

Cognitive–Behavioral Therapy for Patients With Parkinson’s Disease and Comorbid Major Depressive Disorder

Background Depression has been recognized as a common feature of Parkinson’s disease (PD), and is the most prevalent psychiatric disorder in PD patients. Objective The authors sought to determine whether cognitive– behavioral therapy (CBT) is effective in the treatment of depression within the context of PD (dPD). Method The authors enrolled 8 depressed PD patients into an open treatment study of 12 weeks of individual CBT treatment. Results There was a significant linear decrease in mean Hamilton Rating Scale for Depression (17-item) scores over Weeks 0 to 12, and 57% of patients (4/7) met criteria for remission at endpoint. Conclusion This uncontrolled study suggests that CBT may be effective in treating dPD and may be an alternative or adjunct to pharmacological treatment.

Relationship between sleep disturbance and depression, anxiety, and functioning in college students.

Sleep disturbance (SD) has complex associations with depression, both preceding and following the onset and recurrence of depression. We hypothesized that students with depressive symptoms with SD would demonstrate a greater burden of comorbid psychiatric symptoms and functional impairment compared to students with depressive symptoms without SD.

The potential relationship between levels of perceived stress and subtypes of major depressive disorder (MDD)

Objective:  We wanted to explore whether major depressive disorder (MDD) subtypes (melancholic depression, atypical depression, double depression, and MDD with anger attacks) were related to levels of perceived stress, as measured by the Perceived Stress Scale (PSS).

Gender, Depressive Symptoms and Patterns of Alcohol Use among College Students

Background: Serious alcohol-related negative consequences are associated with a number of drinking behaviors among college students. Thus, it is critical to identify students who are at greater risk for hazardous drinking. Although some studies have shown that depressive symptoms may be associated with alcohol use in this population, findings are not consistent. The current study extends previous research by investigating the relationship between depressive symptoms, daily alcohol use and compulsive drinking among college students and whether gender moderates these relationships. Sampling and Methods: The participants were 904 college students (495 females; mean age = 20.07 ± 1.85 years) who filled out questionnaires that focused on drinking behaviors and severity of depressive symptoms. Results: Gender moderated the relationship between depressive symptoms and daily alcohol consumption. In male college students, worse depressive symptoms were associated with increased daily alcohol use and with greater risk for compulsive drinking. In female college students, worse depressive symptoms increased the risk for compulsive drinking, but not for greater daily alcohol use. Conclusions: Results suggest that prevention programs aimed at decreasing harmful alcohol use among college students must take into consideration the role of both gender and depressive symptoms in the development of problematic drinking behaviors.

The prevalence of compulsive eating and exercise among college students: an exploratory study

Eating disturbances continue to grow among college students, and researchers have begun to investigate factors that may lead to abnormal eating behaviors in this population. Recent research has also suggested that excessive exercise can become a compulsive behavior that may affect psychological health. The aim of this exploratory study was to evaluate the relationships between both compulsive eating and exercise, and demographic and clinical variables in a college population. Participants were 589 undergraduates (mean age 20 years) recruited during a mental health screening at two different campuses. Participants completed a screening package of measures including a questionnaire about socio-demographic data, the Beck Depression Inventory (BDI), the Beck Hopelessness Scale (BHS), the Consumptive Habits Questionnaire (CHQ), the Modified Overt Aggression Scale-Self-rated version (MOAS), and the Quality of Life Enjoyment and Satisfaction Questionnaire-Short version (QLESQ). A prevalence rate of 7.2% was found for compulsive eating and 18.1% for compulsive exercise, as measured by the CHQ. Only 11 participants (1.9%) reported both compulsive eating and exercise. There was no significant relationship between compulsive eating and compulsive exercise. The results suggest that college students may represent a group at high risk of developing abnormal eating behaviors and compulsive exercise.