Stress, depression, and mania: relationship between perceived role of stressful events and clinical and biochemical characteristics

Abstract

We investigated the perceived role of stressful events in episodes of major affective disorder in patients studied in the NIMH Clinical Research Branch Collaborative Program on the Psychobiology of Depression (Biological Studies). Using items from the Schedule for Affective Disorders and Schizophrenia (SADS), episodes were divided into environment-sensitive (high perceived role of stressful events) and autonomous (minimal or no perceived role of stressful events). Patients with environment-sensitive episodes had fewer previous episodes and a longer index episode. The groups did not differ with respect to age, gender, education, socioeconomic group, diagnosis, severity of illness, or eventual response to treatment. Unipolar depressed patients with environment-sensitive episodes had lower CSF 5-HIAA than those with autonomous episodes. Among bipolar depressed patients, those with autonomous episodes had elevated excretion of O-methylated catecholamine metabolites and of epinephrine, while those with environment-sensitive episodes had normal excretion of catecholamines and metabolites. Manic subjects with environment-sensitive episodes had elevated norepinephrine excretion, while this was normal in manics with autonomous episodes. Relationships between environmental sensitivity of affective episodes and neurotransmitter function therefore appear to be related to the type of episode.

Stressful Life Events and Social Rhythm Disruption in the Onset of Manic and Depressive Bipolar Episodes

“…That early episodes are more subject to the influence of life events than later episodes has been suggested by Post 46 and others, 3,6,10,12,14,18,47 but remains controversial. 13,48,49 According to this hypothesis, an association between life events and onset would be expected among manic but not among depressed subjects, because manic patients in our study were younger and had fewer past episodes.…”

On Episode Sensitization in Recurrent Affective Disorders: The Role of Noise

“…For example, human beings are subjected to various and variable forms of life stress, which can be approximated as a complex 'noisy environment' interacting with the human organism (Glassner and Haldipur, 1983;Kennedy et al, 1983;Bidzinska, 1984;Ambelas, 1987;Swann et al, 1990;Charney et al, 1993;Castine et al, 1998). In addition, biological systemsFand brains in particularFthemselves are intrinsically noisy.…”

“…Finally, at the behavioral level, individuals face a variety of life stress, which differs in strength and impact and reaches from everyday hassles to social isolation up to the loss of significant others. In turn, such life stress might be viewed as a complex variable 'noisy environment' that individuals have to deal with and which will interact with any disease process (Glassner and Haldipur, 1983;Kennedy et al, 1983;Bidzinska, 1984;Ambelas, 1987;Swann et al, 1990;Charney et al, 1993;Castine et al, 1998).…”

Psychological Factors in the Development of Mood Disorders with a Seasonal Pattern

“…It has been shown that while the first episode of a mood disorder is very often associated with major psychoso cial stressors, subsequent ones may be triggered much more easily indicating that these later episodes occur in the context of increasing sensitization and vulnerability to recur rence [34][35][36][37].…”