Eva Biringer

Executive function improvement upon remission of recurrent unipolar depression

AbstractThe aim of the study was to investigate the improvement of executive function measures upon recovery from unipolar depression. Thirty patients who suffered from recurrent major unipolar depression were retested with regard to their executive function approximately two years after an initial baseline examination. At baseline, patients were depressed (average 17–item HAM–D score 21.8), at retesting they were partially or totally recovered (average HAM–D score 8.2). There was a significant positive association between improvement on the HAM–D and improvement of executive function. In those with complete recovery, overall executive function and most examined executive function measures were no longer different from the baseline performance of healthy controls (with the possible exception of semantic fluency and Stroop Colour–word). In conclusion, recovery from major unipolar depression was accompanied by a recovery of many aspects of executive function to a normal level. Our findings support previous studies that have shown that neuropsychological impairment associated with long–standing depressive symptomatology is reversible (i. e. state–related) in recurrent unipolar depression.

A longitudinal analysis of neurocognitive function in unipolar depression

Neurocognitive function is reduced in major depression, but uncertainties remain about if and to what extent improvement in neurocognitive function follows remission of depressive symptoms. A total of 30 patients with Diagnostic and Statistical Manual of Mental Disorders–Fourth Edition (DSM-IV) diagnosis of unipolar major depressive disorder (MDD) at baseline were tested neuropsychologically again, after a mean test–retest interval of 2 years. At retest, patients were partly or completely recovered from depression. Remission of depression was followed by improvement in verbal memory function up to the level of healthy controls, but no associations between improvement in depression and improvement in other dimensions of neurocognitive function were found. Neurocognitive function at baseline was not predictive of improvement in depressive symptoms over time. The present study provided some support for the state hypothesis as to the association between neurocognitive impairment and depression.

Frequency and characteristics of recurrent major depressed patients with unimpaired executive functions

Major depression is associated with impairment of cognitive functions, and especially higher-order cognitive processes referred to as executive functions (EF). Whether this is a general finding is unclear. Patients without EF impairment may have different treatment needs than patients with EF impairment, and will probably have a better everyday functioning. Thus, it is important to identify the prevalence and characteristics of depressed patients without EF impairment. Forty-three patients with recurrent major depressive disorder (19–51 years) and 50 healthy controls were included in the study. The subjects were assessed with neuropsychological tests selected to measure central areas of EF, and screened on clinical and demographic variables. Within the depressed group, a total of 56% were defined as EF unimpaired. These patients were characterised by higher intellectual abilities and fewer depression episodes than the subgroup of patients with EF impairment. The subgroups were similar in age at debut of illness, severity of depression, general psychopathology and global level of functioning. In conclusion, about half of patients with recurrent major depression have normal EF. Since cognitive impairment and depressive symptomatology seems to be distinct dimensions, a neuropsychological investigation could help to ensure optimal treatment in patients with recurrent major depression.

Increased Parietal and Frontal Activation after Remission from Recurrent Major Depression: A Repeated fMRI Study

Nine patients with unipolar major depression were scanned with MRI twice over a 2-year period, and compared with 12 healthy control subjects. All patients fulfilled criteria for major depressive disorder, recurrent type, at first scanning. Level of depressive psychopathology was assessed by the Hamilton Depression Rating Scale. The participants had to work on a mental arithmetics/working memory task while in the MR scanner. The task consisted of single digits (1 to 9) that were shown to the participant, who had to add the numbers in successive pairs and press a response button when the sum was 10. Neuronal activation was recorded based on the BOLD contrast phenomenon in a functional MRI protocol. The results showed significant increase in activation for the patients in the inferior frontal gyrus and the superior and inferior parietal lobule at the second compared with the first MR scanning session. There were also significant correlations between the HDRS scores and neuronal activation which showed a negative correlation particularly in the inferior frontal and parietal lobe areas, which overlapped with similar areas activated in the healthy control participants. This may indicate normalization of brain activation in depressed patients as a function of time from an illness phase to a remission/recovery state.

Is infertility really associated with higher levels of mental distress in the female population? Results from the North-Trøndelag Health Study and the Medical Birth Registry of Norway

Abstract Objective: To explore the effect of ever having tried to conceive for more than 12 months on levels of anxiety and depressive symptoms and to investigate if symptom levels of anxiety and depression in infertile women who remain childless, or go on to have children, respectively, differ from symptom levels in mothers without reports of infertility. Methods: Analyses were based on information from 12 584 Norwegian women aged 19–45 years who participated in the North-Trøndelag Health Study from 1995 to 1997 and data from the Medical Birth Registry of Norway. Anxiety and depressive symptoms were measured by the Hospital Anxiety and Depression Scale. Results: Having tried to conceive for more than 12 months (ever) was weakly associated with higher levels of depressive symptoms. In the categorical analyses, women with resolved infertility had higher levels of anxiety symptoms (B = 0.25 (95% confidence interval (CI) = 0.04–0.47)) and voluntarily childfree had lower levels of depressive symptoms (B = –0.05 (95% CI = –0.50 to –0.21)) than mothers without infertility. However, women with current primary or current secondary infertility had levels of anxiety and depression not significantly different from mothers without infertility. Conclusion: At the population level, and from a longitudinal perspective, unresolved infertility is less burdensome than findings from studies on women seeking help for infertility would suggest.

PW01-98 - No predictive value of anxiety- and depression symptoms for sub- or infertility

Objective Mental distress has been suggested as an etiological factor of fertility problems. The aim of the study was to investigate the predictive value of common mental symptoms for fertility problems in a population sample. Methods The predictive value of anxiety and depression symptoms for incident fertility problems over an 11 year span was investigated in a N=5,873 female sub-sample from the Nord-Trondelag Health Studies (HUNT 1 and HUNT 2). Only women who had not experienced fertility problems at the time of HUNT 1 were included. Fertility problems were reported retrospectively at HUNT 2. Sub-/infertility was defined as having tried to get pregnant for more than one year without success. Symptoms of anxiety and depression at HUNT 1 were measured by the one-dimensional 12-item Anxiety Depression Index (ADI). Results Mean age at HUNT 2 was 42 years (S.D. 4.96, range 28-49). N=152 reported having tried to get pregnant for more than one year. No predictive value of anxiety and/or depression symptoms for sub-/infertility was found (crude OR=0.97 (95% CI=0.82; 1.15), p=0.736; analyses adjusted for age, level of education, civil status, somatic conditions, parity, and gynaecological surgery: OR=0.97 (95% CI=0.81; 1.15), p=0.687). Results were comparable in a sub-sample who had never been pregnant. Conclusion There is no prospective effect of common mental health symptoms on incident fertility problems in women. This zero-finding emerges from a large population-based data set with a long follow-up interval, and it provides evidence against the hypothesised causal relationship between mental distress and sub-/infertility.

PW01-99 - Common mental disorders and fertility problems in the normal populaton

Objective Clinical studies have found higher occurrences of anxiety and depression in women who experience fertility problems. However, the relationship between common mental symptoms and sub-/infertility should also be investigated in the normal population. Methods In a valid N=15,000 sample of women (mean age=36 years, s.d.=8.4, range 19-49) in the Nord-Trondelag Health Study 1995-97 (HUNT 2), the relationship of anxiety- and/or depression with fertility problems was explored by means of logistic regression analysis. Psychological symptoms were measured by the 14-item Hospital Anxiety and Depression Scale (HADS) (cut-off=14+, i.e. 90 th percentile). Sub-/infertility was defined as having ever tried to get pregnant for more than one year without success. Analyses were adjusted for age, education, civil status, somatic conditions, parity, and gynaecological surgery. Results In all, 2,058 (14%) of women were sub- or infertile. Mean HADS total score was 7.8 (s.d. 5.73, range 0-35) in this group and 7.1 (s.d. 5.43, range 0-39) in the group without fertility problems. Odds ratios for fertility problems in the group that scored above HADS cut-off were 1.26 (95% CI=1.09; 1.45), p=0.002 in the crude analysis and 1.13 (95% CI=0.97;1.31), p=0.123 in the adjusted analysis. Conclusion The effect size for the relationship between common mental disorders and fertility problems in this epidemiological study was weak. However, it may represent a more true estimate of the relationship than findings from earlier clinical studies, as such clinical studies may be biased due to differences between help-seeking patients and healthy controls.