Distinguishing Subgroups Based on Psychomotor Functioning among Patients with Major Depressive Disorder

Abstract

Background: Retardation and agitation are symptoms of major depressive disorder (MDD), and their presence could play a role in determining clinically meaningful depressive subtypes such as nonmelancholic depression (NMD) and melancholic depression (MD). In this project, we explored whether three depression subgroups (NMD, MD with psychotic symptoms, and MD without psychotic symptoms) could be distinguished based on objective measures of psychomotor functioning. Methods: Sixty-nine patients with MDD underwent extensive clinical and psychomotor testing prior to treatment with electroconvulsive therapy. Psychomotor functioning was assessed subjectively using the Core Assessment of Psychomotor Change (CORE) and objectively by means of both 24-h actigraphy and performance on a fine motor drawing task. Results: The daytime activity levels measured by actigraphy were significantly lower (F = 7.1, p = 0.0004) in MD patients both with and without psychotic symptoms than in those with NMD. No objective psychomotor variable was able to distinguish between melancholic patients with and those without psychotic symptoms. Conclusions: The depression subtypes NMD, MD with psychotic symptoms, and MD without psychotic symptoms are not marked by increasing psychomotor retardation, possibly because psychomotor disturbance in MD with psychotic symptoms often consists of agitation rather than retardation, or a mixture of the two. However, psychomotor functioning as measured by actigraphy can be used to distinguish between NMD patients and MD patients.

Electroconvulsive therapy and psychiatric readmission in major depressive disorder – A population‐based register study

“…ECT has been found to be especially effective in older patients 37 . Psychotic symptoms and psychomotor retardation are more common in older individuals, and patients with such symptoms tend to respond better to ECT, which could explain the results of the present study 38,39 . To date, there is sparse evidence supporting that older patients have decreased risk of readmission after ECT 40 and that younger individuals are at increased risk when compared with older patients treated with ECT 10 .…”

Observer-rated retardation but not agitation corresponds to objective motor measures in depression

“…This study included 73 patients (56 women, 17 men) with an MDD or a depressive episode in bipolar disorder (according to the DSM-IV-TR) recruited from the inpatient and outpatient department of Duffel Psychiatric Hospital (Belgium); their mean age was 58.8 (±15.1) years, and the (average) duration of a depressive episode was 14.3 (±18.1) months. These patients were awaiting treatment with electroconvulsive therapy (ECT) and are part of the PROTECT cohort (8). Diagnoses were confirmed by the MINI diagnostic interview version 6.0 and, at inclusion, patients had to score ≥ 17 on the Hamilton Depression Rating Scale-17 items (HDRS17) (9).…”

Pharmacological treatment for insomnia in patients with major depressive disorder

“…The association of early morning awakenings and abnormal distributions of REM sleep is also typical of major depressive episodes, especially those with melancholic characteristics (73) records wake-sleep cycles over several days, weeks or months which this enables the recording of both periods with Zeitgebers (i.e., constraints that influence the person's rhythms, such as work, physical activity of meal times) and periods without (74). Actigraphy is a useful and validated tool to assess psychomotor activity and sleep-wake rhythms in MDD (75,76). Combined with PSG, actigraphy provides objective assessments of sleep and rhythms, helping to determine biological validity in behavior-based parameters including MDD subtypes, severity of symptoms across different domains of depressive psychopathology, and prediction of relapse (76)(77)(78) Although time-consuming and relatively expensive, objective assessments with the use of PSG and actigraphy in MDD have recently shown to be helpful in predicting critical outcomes in MDD.…”

“…Actigraphy is a useful and validated tool to assess psychomotor activity and sleep-wake rhythms in MDD (75,76). Combined with PSG, actigraphy provides objective assessments of sleep and rhythms, helping to determine biological validity in behavior-based parameters including MDD subtypes, severity of symptoms across different domains of depressive psychopathology, and prediction of relapse (76)(77)(78) Although time-consuming and relatively expensive, objective assessments with the use of PSG and actigraphy in MDD have recently shown to be helpful in predicting critical outcomes in MDD. In a recent study by Bernet et al (79), the presence of suicidal ideation in subjects with treatment resistant MDD was associated with less NREM Stage 4 sleep, and higher nocturnal wakefulness, regardless of severity of symptoms.…”