Jaap H.C. Jansen

The judgment of facial expressions by depressed patients, their partners and controls

BACKGROUND Research has shown that cognitive and interpersonal processes play significant roles in depression development and maintenance. Depressed patients judgments of emotions displayed in facial expressions, as well as those of their partners, allow for better understanding of these processes. METHODS In this study, twenty major depression outpatients, their partners and control persons (matched on the sex and age of the partner) judged facial expressions as to the emotions they felt were portrayed, at the patients outpatient admission. It was expected that the patients would judge the facial expression more negatively and less positively than their partners and that the partners would judge more negatively and less positively than the controls. RESULTS It was found that while both the patients and partners judged less positive emotions than the controls, the patients and partners did not judge the expressions differently. A trend in the same direction was found between the three groups as to judgment of negative emotions. CONCLUSION These findings are related back to interpersonal and cognitive theories of depression. LIMITATION A limitation of this study was the somewhat small patient population available for study. CLINICAL RELEVANCE This study helps to shed light on the similarity between interpersonal and cognitive processes of depressed patients and their partners.

Morning and evening light treatment of seasonal affective disorder: response, relapse and prediction

Patients with seasonal affective disorder were randomly assigned to treatment with light in the morning (9.00-12.00 a.m.; n = 16; ML) or evening (6.00-9.00 p.m.; n = 11; EL). An intensive 24-day assessment procedure revealed the same response rates: 57% for ML, 50% for EL. During the rest of the winter season a relatively low relapse rate of 54% was found. No differences between ML and EL were found in the time course of depressed mood or fatigue. A significant negative correlation was found between diurnal variation during baseline and therapeutic response: the larger the diurnal variation the less the response, indicating a potential negative predictive value for this symptom. There were no significant correlations between baseline fatigue or hypersomnia and response.

Can winter depression be prevented by light treatment

The administration of light at the development of the first signs of a winter depression appears to prevent it from developing into a full-blown depression. No patient from a group of 10 treated in this way developed any signs of depression during the rest of the winter season, while five of seven patients from a control group became depressed and needed treatment during the winter season.

Relationship between cognitive sensitivity to (symbolic) light in remitted seasonal affective disorder patients and the onset time of a subsequent depressive episode

The role of cognitive sensitivity to light in the development of seasonal affective disorder (SAD, winter type) was studied by comparing 29 SAD patients during remission with 29 non-depressed controls matched by sex and age, and by relating measures for cognitive sensitivity of remitted SAD patients to the onset of a depressive episode during the following autumn/winter. To ensure that only cognitive processes were involved, the subjects were exposed to symbolic light. Three schematic drawings of ambiguous faces expressing different emotions were embedded in light or dark backgrounds for this purpose. The subjects rated the various facial expressions with respect to the degree of elation-sadness, rejection-invitation, and activation-sleepiness. SAD patients saw larger differences in activation between faces embedded in light and dark backgrounds than controls, perceiving less activation in faces with dark backgrounds. Furthermore, the larger the difference that SAD patients saw in invitation between faces with light and dark backgrounds, the earlier they became depressed in the subsequent autumn/winter. Only the SAD patients who became depressed early (before December 21) differed from controls in the perception of invitation. Results are interpreted within the framework of psychological theories on the development of depression and suggest that altered cognitive sensitivity of SAD patients to light plays a role in the development of depressive episodes.

An attempt to prevent winter depression by light exposure at the end of September

Seasonal affective disorder (SAD), winter type, is characterized by the occurrence of depression in autumn/winter, followed by a complete recovery in spring/summer. In SAD patients, some atyp- ical symptoms are highly characteristic, such as hypersomnia, carbohydrate craving, weight gain, fatigue, and loss of social inter- actions (Rosenthal et ai 1984). The repeated occurrence of symp- toms during successive winters is one of the diagnostic criteria, l~lot every SAD patient becomes depressed every year, however. In prospective studies it was found that 70,4% of the SAD diagnosed subjects who were followed from a symptom-free moment at the end of September, became depressed during the following winter (Meesters et al 1991; 1993a), In a previous study it was found that severe winter depression can be prevented by light treatment administered at the first signs of an emerging winter depression, that is, the moment subjects reported complaints of slight depression (Meesters et al 1991; 1993a). In the present study, the question was raised whether light exposure given at the beginning of the winter season, when sub- jeers are still free of symptoms, could be successful in preventing the development of a winter depressmn during the rest of the season. Such a ueatment, which might prevent depression alto- gether, would be highly advantageous,

Depression relapse and ethological measures

Within the framework of interactional theories on depression, the question is raised whether depression relapse can be predicted by observable behavior of remitted patients and their interviewer during an interaction (i.e. discharge interview). Thirty-four patients were interviewed at hospital discharge and at a follow-up, 6 months later. Eight patients (23.5%) had relapsed at follow-up. Various behaviors of patients and interviewers were observed during an interview by ethological methods. One of the six patient behavioral factors, and none of the seven interviewer factors were related to relapse. Depression relapse patients displayed significantly less Active Listening (intense body touching and head movements during listening) during the interview at hospital discharge than those with stable remission. Results on Active Listening could not be explained by the degree of retardation (HRSD) and underlined the significance of interpersonal mechanisms in the onset and maintenance of depression.