Pharmacotherapy of depression in the medically ill: Directions for future research

Gregory, Robert J.; Jimerson, David C.; Walton, Barbara E.; Daley, Jennifer; Paulsen, Randall H.

doi:10.1016/0163-8343(92)90024-5

Cited by 20 publications

(5 citation statements)

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“…The lack of recognition of depression in cancer patients is well documented 41. Diagnosing depression in cancer patients is often not clearcut42 because the symptoms inherent to cancer disease often overlap with symptoms used as diagnostic criteria for depression, as established by the DSM‐IV.…”

Section: Discussionmentioning

confidence: 99%

Biomarkers of depression in cancer patients

Jehn

Kuehnhardt

Bartholomae

et al. 2006

Cancer

120

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BACKGROUND. Inflammation and perturbation of the hypothalamic‐pituitary‐adrenal (HPA) axis function appears to play a putative role in the etiology of depression. Patients with metastatic cancer demonstrate elevated prevalence rates for depression. The objective of the current study was to illustrate the efficacy of interleukin‐6 (IL‐6) and HPA axis function as adjuncts to support the diagnosis of depression in cancer patients. METHODS. Plasma concentrations of IL‐6 and cortisol were measured in 114 cancer patients with and without depression. The relative diurnal variation of cortisol (cortisol VAR), expressed as a percentage, was calculated. Receiver operating characteristics analysis was performed. RESULTS. Depression was associated with increased plasma concentrations of IL‐6 (18.7 pg/mL vs. 2.7 pg/mL; P < .001) and higher cortisol concentrations at 8 AM and 8 PM. The relative cortisol VAR (11.7% vs. 60.6%, respectively; P < .001) was found to be decreased in cancer patients with depression, indicating a disturbed circadian function of the HPA axis. As a biomarker of depression, IL‐6 yielded at a cutoff value of 10.6 pg/mL, a sensitivity of 79%, and a specificity of 87% (area under the curve [AUC] = 0.86; 95% confidence interval [95% CI], 0.78–0.94), whereas cortisol VAR demonstrated a sensitivity of 81% and a specificity of 88% (AUC = 0.85; 95% CI, 0.74–0.97) at a cutoff value of 33.5%. CONCLUSIONS. Depression is associated with increased plasma IL‐6 concentrations in patients with cancer. These patients demonstrate a dysfunction of the HPA‐axis, characterized by a decreased diurnal variation of cortisol. The high sensitivity and specificity of these parameters biomarkers of depression make IL‐6 and cortisol VAR helpful tools in the diagnosis of depression in patients with cancer. Cancer 2006. © 2006 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Biomarkers of depression in cancer patients

Jehn

Kuehnhardt

Bartholomae

et al. 2006

Cancer

120

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“…Certas doenças podem ser acompanhadas das chamadas depressões "secundárias", ou o problema médico pode ser conseqüência de um estado depressivo. Em outros casos, a doença clínica pode mimetizar um quadro depressivo (9) . Em um estudo realizado, foi encontrado 27% de indivíduos idosos com sintomatologia depressiva, sendo 19% com quadro de disforia, 4% com quadro de depressão sintomática, 2% de distimia, 1,2% de síndrome depressiva ansiosa e 0,8% de depressão maior (3) .…”

Section: Introductionunclassified

Associação entre aspectos depressivos e déficit visual causado por catarata em pacientes idosos

Ribeiro

Freitas

Araújo

et al. 2004

Arq. Bras. Oftalmol.

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Associação entre aspectos depressivos e déficit visual causado por catarata em pacientes idososObjetivo: Investigar a associação entre a presença de sintomas depressivos e a deficiência visual causada por catarata no paciente idoso. Métodos: Vinte e três pacientes com catarata e acuidade visual inferior a 20/200 no melhor olho foram avaliados. As idades variavam de 60 a 93 anos. Antes da cirurgia de catarata e um mês após, os sintomas depressivos foram avaliados pela Escala de Depressão Geriátrica (EDG). Resultados: A cirurgia melhorou a visão para 20/50, ou melhor, em todos os pacientes. Antes e após a cirurgia de catarata foram encontrados 11 (47,82%) e 10 (43,47%) indivíduos com escores indicativos de depressão respectivamente (p=1,0; teste de McNemar). Antes da cirurgia observamos o valor mediano da EDG de 5,0 e após a cirurgia a EDG apresentou o valor mediano de 4,0 (p = 0,012; Wilcoxon pareado). Neste período os sintomas indicativos de depressão diminuíram significativamente, de valores entre 3 a 8 pontos para valores entre 3 a 6 pontos. Conclusões: Sintomas depressivos são prevalentes e persistentes entre pacientes idosos, entretanto os níveis dos sintomas indicativos de depressão diminuem significativamente com a melhora da visão. (1-4) . A perda visual desencadeia um processo de alteração emocional e psicológica que se caracteriza basicamente por desordem de ajustamento e depressão (5) . Estas alterações geralmente são acompanhadas por incapacidades para as atividades do dia a dia (1) . No idoso, a diminuição da capacidade visual geralmente se deve a doenças oculares crônicas que vão diminuindo a visão de maneira progressiva (6)(7) . Problemas oftalmológicos estão associados a altas taxas de depressão e a dificuldades para as atividades diárias, levando a condutas inadequadas uma vez que sintomas de depressão se assemelham a sintomas relacionados às alterações nas atividades diárias e vice-versa (8) . A relação entre a depressão e o problema clínico é complexa. A doença clínica pode precipitar um distúrbio depressivo preexistente. Certas doenças podem ser acompanhadas das chamadas depressões "secundárias", ou

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“…Hypocholesterolemia has been associated with depression, suicide, and affective disorders, as described elsewhere in this book (see also Glueck, Kuller, et al, 1994;Glueck, Tieger, et al, 1994). These affective disorders are often associated with acute and chronic medical illness (Andrykowski, 1994;Clark & Steer, 1994;Gregory, Jimerson, Walton, Daley, & Paulsen, 1992). Given the well established causal relationship between acute and chronic illness and hypocholesterolemia, the association between hypocholesterolemia and affective disorders may be secondary to the association between affective disorders and illness.…”

Section: Relationship With Affectmentioning

confidence: 99%

Hypocholesterolemia, hypolipoproteinemia, and risk of death.

Verdery¹

1997

Lipids, Health, and Behavior.

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Although it is well established that high levels of cholesterol and certain lipoproteins are strongly associated with increased risk for coronary artery disease, cerebrovascular disease, and death from myocardial infarction and stroke, the association of low levels of cholesterol and certain lipoproteins with increased prevalence of other diseases and risk of death from these diseases has been equally well established. The earliest reports of association of low cholesterol levels with disease, particularly malnutrition and cancer, are from the 1930s (G. L. Muller, 1930). Reports from the 1940s describe the association between low cholesterol levels and acute febrile illnesses (Nishita, 1941).Since these early studies on low blood lipid levels in chronic and acute disease, there have been significant changes in both our understanding of the biochemistry of lipids and lipoproteins and the methodology used to measure blood lipids and lipoproteins. Initially, blood lipid levels measured included only total cholesterol, triglyceride, and phospholipid. In the 1 9 5 0 ~~ lipoproteins were discovered to be the carriers of these lipids, and measurements of specific lipoproteins, primarily chylomicrons, very low density lipoproteins (VLDLs), low density lipoproteins (LDLs), and high density lipoproteins (HDLs), became necessary to understand the characteristics of dyslipoproteinemias. More recently, the proteins associated with lipoproteins, apolipoproteins, have been exhaustively studied. Each lipoprotein species has specific apolipoproteins that are important structural elements and help regulate the metabolism of the lipids that are carried.Careful metabolic studies of synthesis and turnover rates of apolipoproteins have shown that to a great extent, levels of cholesterol and other lipids and of specific lipoproteins are regulated by synthesis and turnover rates of associated apolipoproteins and levels of certain enzymes, including lipoprotein lipase (LPL), hepatic triglyceride lipase (WGL), lecithin cho-This work was supported in part by National Institute on Aging Grant SERCA KOl-AGO0414 and the Arizona Center on Aging,

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Pharmacotherapy of depression in the medically ill: Directions for future research

Cited by 20 publications

References 50 publications

Biomarkers of depression in cancer patients

Biomarkers of depression in cancer patients

Associação entre aspectos depressivos e déficit visual causado por catarata em pacientes idosos

Hypocholesterolemia, hypolipoproteinemia, and risk of death.

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