Gender differences in major depressive disorder and bipolar disorder

This paper reviews the literature on gender differences in major depressive disorder (MDD) and bipolar disorder (BPD). Beginning in adolescence, women are at a higher risk than men of becoming depressed. Avenues of investigation that might ultimately help to explain this phenomenon include studies of gender differences in the processing of emotional stimuli, the psychotropic effects of gonadal steroids, and environment/gene interactions in men and women. With the exception of the elevated suicide rate among men, consistent gender differences in the course and symptoms of MDD have not been found. In BPD, women are more likely than men to develop a rapid-cycling course. Gender differences in treatment response, particularly in regard to mood stabilizing medications, warrant further study.     

Diurnal mood variation in major depressive disorder

Depression disturbs mood, but a clear picture of diurnal mood rhythms in depression has yet to emerge. This study examined variations in positive affect (PA) and negative affect (NA), two dimensions of mood that generate diurnal patterns among healthy individuals. Repeated measurements of NA and PA in daily life were obtained over 6 days from 47 depressed outpatients and 39 healthy individuals using the Experience Sampling Method. Relative to healthy individuals, depressed individuals exhibited increasing PA levels during the day with a later acrophase. In contrast, depressed persons' NA exhibited a more pronounced diurnal rhythm and was more variable from moment to moment than healthy individuals'. Ambulatory mood measurements in depression suggest distinct diurnal disturbances of positive and negative affect.     

Emotion context insensitivity in major depressive disorder

The present study tested 3 competing views of how depression alters emotional reactivity: positive attenuation (reduced positive), negative potentiation (increased negative), and emotion context insensitivity (ECI; reduced positive and negative). Normative and idiographic stimuli that elicited happy, sad, and neutral states were presented to currently depressed, formerly depressed, and healthy control individuals while experiential, behavioral, and autonomic responses were measured. Currently depressed individuals reported less sadness reactivity and less happiness experience across all conditions than did the other participants, and they exhibited a more dysphoric response to idiographic than to normative stimuli. Overall, data provide partial support for the positive attenuation and ECI views. Depression may produce mood-state-dependent changes in emotional reactivity that are most pronounced in emotion experience reports.     

Idiographic autobiographical memories in major depressive disorder

When cued with generic happy and sad words, depressed individuals have been found to articulate contextually impoverished, overgeneral memories of both positive and negative autobiographical events. The current study tested whether overgeneral memory is observed outside of the cue-word paradigm. Currently depressed, formerly depressed, and never-depressed controls underwent an idiographic interview procedure in which participants generated memories of their happiest and saddest lifetime events. Although depressed and nondepressed participants did not differ with respect to the specificity, retrieval difficulty, and emotionality of their saddest memories, depressed individuals' happiest memories were less specific, harder to retrieve, and less emotional than were nondepressed participants' happiest memories. The memory characteristics of formerly depressed participants largely resembled those of healthy controls. Overall, the present results suggest that meaningful cues trigger mood-congruent memory processing in currently, but not in formerly, depressed individuals.     

Perfectionism and depression symptom severity in major depressive disorder.

In recent years it has been recognized that perfectionism is a multidimensional construct and two Multidimensional Perfectionism Scales have been developed and investigated in relative isolation [Frost, R.O., Marten, P., Lahart, C., & Rosenblate, R. (1990). The dimensions of perfectionism. Cognitive Therapy and Research, 14, 449-468; Hewitt, P.L., & Flett, G.L. (1991). Perfectionism in the self and social contexts: Conceptualization, assessment and association with psychopathology. Journal of Personality and Social Psychology, 60, 456-470]. The present study sought to evaluate the association between various dimensions of perfectionism, higher-order personality dimensions, and self and observer rated depressive symptoms in a group of 145 patients with major depressive disorder. Only three of ten perfectionism dimensions (socially prescribed perfectionism, concern over mistakes and self-criticism) displayed medium to large correlations with depressive symptoms, especially self-report symptoms reflecting depressive cognitive distortions. The results are discussed in relation to the specificity of perfectionism dimensions to depression, adaptive versus maladaptive aspects of perfectionism, and in the context of previous research, much of which has relied on college student samples.     

A Japanese treatment used in major depressive disorder in adolescence

The purpose of the present report is to study the efficacy of a Dohsahou, a Japanese Psychorehabilitation method, in a treatment of major depression in three men (M age = 20 yr.), selected randomly for treatment. Initially, participants' baseline condition was assessed with the Beck Depression Inventory, Hamilton Rating Scale for Depression, and the Family Assessment of Depression Questionnaire. Each subject had 12 sessions of 45 min. training over 4 wk. Postassessment and follow-up assessment were done. Findings for pre- and posttreatment test data indicated depression was reduced, being mainly evident in cognitive, somatic, and affective symptoms related to lower depression.     

Cognitive and neural consequences of memory suppression in major depressive disorder

Negative biases in cognition have been documented consistently in major depressive disorder (MDD), including difficulties in the ability to control the processing of negative material. Although negative information-processing biases have been studied using both behavioral and neuroimaging paradigms, relatively little research has been conducted examining the difficulties of depressed persons with inhibiting the retrieval of negative information from long-term memory. In this study, we used the think/no-think paradigm and functional magnetic resonance imaging to assess the cognitive and neural consequences of memory suppression in individuals diagnosed with depression and in healthy controls. The participants showed typical behavioral forgetting effects, but contrary to our hypotheses, there were no differences between the depressed and nondepressed participants or between neutral and negative memories. Relative to controls, depressed individuals exhibited greater activity in right middle frontal gyrus during memory suppression, regardless of the valence of the suppressed stimuli, and differential activity in the amygdala and hippocampus during memory suppression involving negatively valenced stimuli. These findings indicate that depressed individuals are characterized by neural anomalies during the suppression of long-term memories, increasing our understanding of the brain bases of negative cognitive biases in MDD.     

抑郁症患者工作记忆内情绪刺激加工的特点及其机制

抑郁症患者在工作记忆内情绪刺激加工的特点为倾向于加工与负性心境一致的材料, 被认为是抑郁症认知易感性的核心特征。目前研究者们围绕抑郁症工作记忆中央执行系统三个子功能的情绪刺激加工特点及其作用机制进行了大量研究, 发现在更新功能上, 患者难以移除负性情绪信息, 且在正性信息的加工上存在缺损; 在抑制功能上, 患者难以抑制无关负性情绪信息进入工作记忆; 在转换功能上, 患者情绪材料转换困难的研究证据尚不充分。神经生理与脑成像的研究初步表明, 工作记忆中的情绪刺激加工与抑郁症患者背外侧前额叶和前扣带回的功能激活水平异常有关。未来研究需评估工作记忆三个子功能对抑郁症状的差异性贡献及在情绪刺激加工上的统一性, 并探究其随疾病发生发展变化的轨迹, 谨慎选取并评估不同情绪刺激材料指标的诱发效应及其对工作记忆功能的独特影响。在此基础上, 深入探究工作记忆内情绪刺激加工的神经机制, 为工作记忆偏向矫正干预的临床应用及其预期效果提供理论依据和方向。     

The symptomatic expression of major depressive disorder in adolescents and young adults

Data from the Oregon Adolescent Depression Project were used to examine the symptomatic expression of major depressive disorder (MDD) as a function of age and gender. The objective was to investigate the phenomenological nature of MDD among a cohort of adolescents as they progressed into early adulthood. The analyses were based on 564 participants who had experienced MDD in their lifetime. No systematic differences in the relative rate of occurrence of specific symptoms across episodes and only minor symptom differences between male and female participants were found. Age did not significantly influence the symptom picture. Stability of specific symptoms and episode severity across episodes was low. The results are discussed within the context of a stressor-symptom matching model.     

Effects of daily events on mood states in major depressive disorder

Major depressive disorder (MDD) is characterized by high negative affect (NA) and low positive affect (PA), but little is known about emotional reactivity in daily life. The authors used experience sampling methodology to investigate changes in NA and PA following minor daily events in MDD compared with healthy participants. Contrary to expectation, MDD participants did not report more frequent negative events, although they did report fewer positive events. Multilevel regression showed that both NA and PA responses to negative events were blunted in the MDD group, whereas responses to positive events were enhanced. NA responses to negative events persisted longer in MDD participants. Depressed participants with a positive family history or longer current episodes showed relatively greater NA responses to negative events.     

Negative mood,depressive symptoms,and major depression after smoking cessation treatment in smokers with a history of major depressive disorder

Negative mood, depressive symptoms, and major depressive episodes (MDEs) were examined in 179 smokers with a history of major depression in a trial comparing standard smoking cessation treatment to treatment incorporating cognitive-behavioral therapy for depression (CBT-D). Early lapses were associated with relatively large increases in negative mood on quit date. Mood improved in the 2 weeks after quit date among those returning to regular smoking but not among those smoking moderately. Continuous abstinence was associated with short- and long-term reductions in depressive symptoms. MDE incidence during follow-up was 15.3% and was not associated with abstinence. Unexpected was that CBT-D was associated with greater negative mood and depressive symptoms and increased MDE risk. Results suggest complex bidirectional associations between affect and smoking outcomes.     

Positive memory enhancement training for individuals with major depressive disorder

When in a negative mood state, individuals with major depressive disorder (MDD) may have difficulties recalling positive autobiographical memories in a manner that repairs that negative mood. Using cognitive bias modification techniques, investigators have successfully altered different aspects of cognition among individuals with MDD. However, little has been done to investigate the modification of positive autobiographical memory recall. This study examined the impact of a novel positive memory enhancement training (PMET) on the memories and subjective affective experiences of individuals with MDD (N = 27). Across a series of trials, participants first recalled a sad memory to elicit a negative mood state. They then recalled a happy memory and completed procedures to elicit a vivid, here-and-now quality of the memory. PMET procedures were hypothesized to promote mood repair via the recall of increasingly vivid and specific positive memories. PMET participants demonstrated improved memory specificity and greater perceived ability to “relive” positive memories. The procedures also repaired mood; PMET participants’ affect following recall of positive memories did not differ from control participants’ affect following recall of neutral memories. Results provide preliminary support for PMET as a method to improve the quality of positive memories and facilitate emotion regulation in MDD.     

Word use of outpatients with a personality disorder and concurrent or previous major depressive disorder

In a recent study, Rude, Gortner, and Pennebaker (2004) found word use to be related to depression and vulnerability to depression in the essays of college students. We sought to replicate and extend these findings in a clinical sample. Written essays of 304 psychiatric outpatients with a personality disorder and a mixed psychiatric profile on DSM-IV axis-I and 108 healthy controls were examined with word count software. Data on the tendency to be discrepant about the current self compared to a more ideal self were also gathered. We found that psychiatric outpatients in general used more words referring to the self and negative emotion words and fewer positive emotion words, compared to healthy controls. However, word-use proved unrelated to depression specifically. Actual-ideal self discrepancies were related to patient status and to current depression. Contrary to our hypothesis, these discrepancies did not correlate with the use of words referring to the self. We conclude that the negative content and self-focus of written essays and high levels of discrepancy reflect a negative thinking style that is common to a range of psychiatric disorders rather than being specific to depression.     

Evaluation of cognitive diathesis-stress models in predicting major depressive disorder in adolescents

Diathesis-stress predictions regarding the onset of adolescent major depression and nonmood disorders were tested. Adolescents (N = 1,507) were assessed for dysfunctional attitudes and negative attributional style, as well as current depressive symptoms, current depressive and nondepressive diagnoses, and past and family histories of psychopathology. Approximately 1 year later, participants were reassessed on all measures. Analyses supported A. T. Beck's (1976) theory of depression (at the level of a trend) but not the hopelessness theory of depression. Findings were suggestive of a threshold view of vulnerability to depression; for those who experienced negative life events, depressive onset was related to dysfunctional attitudes but only when dysfunctional attitudes exceeded a certain level (low = intermediate < high). For participants who scored either very high or very low on both dysfunctional attitudes and negative attributional style, nonsignificant findings were obtained.     

Switching and backward inhibition in major depressive disorder: the role of rumination

Previous studies have demonstrated that individuals with major depressive disorder have difficulties switching attention from one task set to another. In the current study we examined whether ruminative thinking drives the switching deficits of depressed individuals. A secondary, more exploratory, goal of this study was to examine whether state rumination would impair depressed individuals' ability to activate a new task set, to inhibit a no longer relevant task set, or both. Participants underwent either a rumination induction or a distraction induction and then completed a backward inhibition task that measures general switching abilities and the ability to inhibit previous task sets. Although depression was not related to switching ability as a main effect, depressed individuals who were induced to ruminate exhibited poorer switching ability than did both depressed and control individuals who were distracted from ruminating and control participants who were induced to ruminate. These findings suggest that depressed individuals are characterized by switching deficits only if they are ruminating. Moreover, the finding that state rumination did not affect participants' ability to inhibit previous task sets suggests that state rumination primarily impairs noninhibitory task-switching processes. It is interesting that the opposite pattern of results was obtained for trait rumination, which was related to inhibitory deficits during switching, but not to generally poorer switching. Thus, state and trait rumination may be associated with dissociable cognitive deficits.     

Obsessive-compulsive disorder and the five-factor model of personality: distinction and overlap with major depressive disorder

Research on individual differences in obsessive-compulsive disorder (OCD) has focused largely on analogue models with participants experiencing sub-clinical obsessions and/or compulsions. Few studies have examined the association between normal, dimensional personality traits and obsessive-compulsive symptomatology in a clinical sample. The purpose of this study was to examine personality differences in patients with a primary diagnosis of OCD (n = 98) or major depression (n = 98) using the domains and facets of the five-factor model of personality (FFM). Patients completed the self-report version of the Revised NEO Personality Inventory (NEO PI-R). When contrasted with community controls (Revised NEO Personality Inventory (NEO-PI-R) and NEO Five-Factor Inventory (NEO-FFI) professional manual, Psychological Assessment Resources, Odessa, FL, 1992), participants with OCD were found to differ across the domains (and facets) of neuroticism, extraversion, and conscientiousness and the facets of openness and agreeableness. Further, when compared to depressed participants, those with OCD were found to be more extraverted, agreeable, conscientious and less neurotic. With the exception of the conscientiousness domain (and facets), these significant differences were maintained even after controlling for depression severity. These results highlight the unique associations between trait domains and facets of the FFM and OCD.     

Sadness and amusement reactivity differentially predict concurrent and prospective functioning in major depressive disorder

Depressed individuals often fail to react to emotionally significant stimuli. The significance of this pattern of emotional dysregulation in depression is poorly understood. In the present study, depressed and nondepressed participants viewed standardized neutral, sad, fear, and amusing films; and experiential, behavioral, and physiological responses to each film were assessed. Compared with nondepressed controls, depressed participants reported sadness and amusement in a flattened, context-insensitive manner. Those depressed participants who reported the least reactivity to the sad film exhibited the greatest concurrent impairment. Prospectively, the depressed participant who exhibited the least behavioral and heart rate reactivity to the amusing film were the least likely to recover from depression. Loss of the context-appropriate modulation of emotion in depression may reflect a core feature of emotion dysregulation in this disorder.