Standardized psychotherapy and pharmacotherapy are effective for patients with major depression with and without a generalized anxiety disorder. However, the longer time to recovery for the former group and lack of response to these treatments by patients with lifetime panic disorder suggest that primary care physicians should carefully assess history of anxiety disorder among depressed patients so as to select a proper intervention.

Background-Cognitive impairment in bipolar disorder has been associated with poor functional outcomes. We examined the relation of self-reported cognitive problems to employment trajectory in patients diagnosed with bipolar I disorder.Methods-154 bipolar I disorder patients were followed for 15-43 months at the Bipolar Disorders Center for Pennsylvanians. Using a multinomial logistic regression we examined predictors of employment group including self-reported cognitive problems, mood symptoms, education and age. Cognitive functioning was measured via 4 self-report items assessing memory/concentration at baseline and termination. Employment status was recorded at baseline and termination. Employment was categorized as working (full-time, part-time, homemaker, volunteer) or not working (leave of absence, disability, unemployed, no longer volunteering) at each time point. Patients were categorized as good stable, improving, worsening and poor stable.Results-Baseline self-reported concentration problems and years of education significantly predicted employment trajectory. Limitations-Post-hoc analyses of existing clinical dataConclusions-Self-reported concentration problems assessed in the context of specific areas of functioning may serve as a sensitive predictor of functional outcome in patients diagnosed with bipolar I disorder.

Our findings suggest that rapid improvement after achieving a therapeutic dose of a mood stabilizer is clinically significant and represents a surrogate endpoint in the treatment of bipolar I depression. Larger, prospective, and controlled studies are needed to verify our results and to identify additional indicators for a mood stabilizer and antidepressant combination treatment strategy.

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While concurrent monitoring of sleep is considered to be a necessary component of evaluating nocturnal penile tumescence (NPT), in order to ensure that NPT data are not invalidated by fragmented sleep or diminished REM sleep, it is not known whether NPT recording itself disrupts sleep beyond the expected first night effect. In this study of 42 outpatient men with major depression and 36 normal control subjects, we found no effect of NPT recording on measures of sleep continuity, proportion of NREM to REM sleep, or REM sleep in either depressed or healthy control subjects.