Toward a Biochemical Classification of Depressive Disorders

Schildkraut, Joseph J.

doi:10.1001/archpsyc.1978.01770360040004

Cited by 75 publications

(5 citation statements)

References 7 publications

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“…According to Schildkraut and Klein, anhedonia is the distinctive feature of major depressive disorder, while demoralized patients experience a sense of inefficacy in dealing with a stressful situation rather than anhedonia 39 . According to Klein, demoralization should not be confused with what he called "endogenomorphic depression", a construct that maps closely onto the category of "major depressive disorder with melancholia" in DSM-III.…”

Section: Major Depressive Disordermentioning

confidence: 99%

Distress, demoralization and psychopathology: Diagnostic boundaries

Figueiredo

2013

Eur. J. Psychiat.

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-Background and Objectives:The objectives of the manuscript are: (a) to review the understanding of demoralization and its assessment; (b) to describe its clinical progression; (c) to explain the differences between demoralization and other form of psychological distress; (d) to propose a set of criteria for future research on demoralization.Methods: A MEDLINE search using the keywords distress, subjective incompetence, depression, demoralization, helplessness, hopelessness and psychopathology was conducted. This was supplemented by a manual search of the literature.Results: Demoralization can be distinguished from passing or transient distress, nonspecific distress, sub-threshold depression or anxiety, and certain mental disorders. Demoralization can be a risk factor for the manifestation of psychopathology, the prodromal phase of a mental disorder, or a trigger for exacerbation or recurrence of psychiatric distress symptoms. The domains of distress and demoralization are described and research diagnostic criteria for demoralization are presented.Conclusions: The scales discussed in this article differ in their time frames and have not yet been applied to the same population at the same time. The role of demoralization as a risk factor for mental disorders is just beginning to be understood. The domains and the diagnostic criteria for demoralization presented in this article need to be confirmed by epidemiological and empirical studies. Future research should continue to clarify its role in the pathogenesis of both mental disorders and physical illnesses and identify appropriate interventions for its arrest or prevention. ObjectivesThis article has the following objectives: (a) to review the evolving understanding of demoralization and the methods proposed for its assessment; (b) to describe the clinical progression of demoralization; (c) to explain the differences between demoralization and passing or transient distress, non-specific distress and sub-threshold depression or anxiety, as well as the differences between demoralization and mental disorders such as major depressive disorder, dysthymic disorder, acute stress disorder, posttraumatic stress disorder, and adjustment disorder; and (d) to propose a set of criteria that may be considered for future research on demoralization. Understanding demoralizationAs defined by Frank, demoralization is the state of mind of a person deprived of spirit or courage, disheartened, bewildered, and thrown into disorder or confusion. He proposed that this state of mind occurs in many persons who seek psychotherapy, whatever their diagnostic label 1,2 . Demoralization always takes place within the context of a past, present, anticipated or imagined stressful situation. To further characterize the concept of demoralization, it has been proposed that the clinical hallmark of demoralization is "subjective incompetence" (SI) and that demoralization involves both SI and symptoms of distress, such as depression, anxiety, resentment, anger, or combinations thereof 3,4 . S...

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Section: Major Depressive Disordermentioning

confidence: 99%

Distress, demoralization and psychopathology: Diagnostic boundaries

Figueiredo

2013

Eur. J. Psychiat.

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“…1980, State-dependent and state-independent factors seem to influence MHPG excretion. Compared to normal controls, urinary MHPG has been reported to be significantly lower in bipolar patients during the depres sive phase [Beckmann and Goodwin, 1980;Maas ct al., 1973;Schildkraut et al, 1978] and higher during the manic phase [Bond et al. 1972;Jones et al.…”

Section: Introductionmentioning

confidence: 99%

Urinary MHPG, Stress Response, Personality Factors and Somatosensory Evoked Potentials in Normal Subjects and Patients with Major Affective Disorders

Buchsbaum¹,

Muscettola²,

Goodwin³

1981

Neuropsychobiology

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Stressful procedures are reported to increase urinary MHPG in both noraml and depressed patients. Bipolar depressed patients are alos shown to be especially pain tolerant in comparison to normals. In the present study, 12 depressed patiens (6 bipolar and 6 unipolar patients) and 10 normal volunteers had average evokded potentials recorded for visual and painful electrical stumuli. MHPG urinary excretion was measured during this session and during an unstimulated resting session on the home ward. Male normal volunteers showed a significant increase in urinary MHPG under stress, while no MHPG increment was noted for the depressed patient group. Depth of depression, assessed by the Zung and Beck scales, was found to be correlated with the reduced urinary MHPG response to stress. Possible interpretations of the results are discussed.

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“…The following state-dependent neurobiological changes that have been documented as being similar between MDD in humans and mammalian hibernation offer further support for the metabolic depression theory of MDD (21): reversible subclinical hypothyroidism (28,29), increased serum cortisol concentration (30)(31)(32), acute phase protein response (33)(34)(35)(36)(37)(38), low respiratory quotient (39)(40)(41)(42), oxidative stress response (43)(44)(45), and decreased neurotransmitter levels (39,46,47). Black bears (Ursus americanus) were suggested and used as an animal model for MDD to study the process of hypometabolism during hibernation (21) because many of the similar neurobiological changes between MDD and mammalian hibernation had been observed in studies of bears, especially black bears, during hibernation (29,32,36,37,40,45).…”

Section: Introductionmentioning

confidence: 83%

Downregulation of cyclic adenosine monophosphate levels in leukocytes of hibernating captive black bears is similar to reported cyclic adenosine monophosphate findings in major depressive disorder

Tsiouris

Flory

2023

Front. Psychiatry

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IntroductionCyclic adenosine monophosphate (cAMP) levels in the lymphoblasts and leukocytes of patients with major depressive disorder (MDD) have been reported to be downregulated compared to in controls. cAMP is a derivative of adenosine triphosphate (ATP), and low ATP turnover has been reported in the state of hypometabolism associated with human MDD and with mammalian hibernation due to suppression of mitochondrial metabolism. Similarities have been noted between many state-dependent neurobiological changes associated with MDD in humans and with mammalian hibernation.MethodsTo compare cAMP levels between human MDD and mammalian hibernation and to investigate whether cAMP downregulation is another state-dependent neurobiological finding, we measured cAMP concentrations in lysed leukocytes, plasma, and serum in serial blood specimens from nine female captive black bears (Ursus americanus; CBBs), and cortisol levels in serum from 10 CBBs.ResultsCortisol levels were significantly higher during hibernation in CBBs, confirming previous findings in hibernating black bears and similar to findings in humans with MDD. cAMP levels were significantly lower during hibernation versus active states (pre-hibernation and exit from hibernation) and were similar to the cAMP downregulation reported in MDD patients versus euthymic patients or controls. cAMP level changes during the different states (hibernation, pre-hibernation, active) confirm their state-dependent status.DiscussionThese findings are similar to the neurobiological findings associated with the hypometabolism (metabolic depression) observed during mammalian hibernation and reported during MDD. A sudden increase in cAMP levels was observed before entrance into pre-hibernation and during exit from hibernation. Further investigation is suggested into the possible role of elevated cAMP levels in initiation of the chain reaction of changes in gene expression, proteins, and enzymes leading to the suppression of mitochondrial metabolism and to low ATP turnover. This process leads to hypometabolism, the old adaptive mechanism that is used by organisms for energy preservation and is associated with both mammalian hibernation and human MDD.

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Toward a Biochemical Classification of Depressive Disorders

Cited by 75 publications

References 7 publications

Distress, demoralization and psychopathology: Diagnostic boundaries

Distress, demoralization and psychopathology: Diagnostic boundaries

Urinary MHPG, Stress Response, Personality Factors and Somatosensory Evoked Potentials in Normal Subjects and Patients with Major Affective Disorders

Downregulation of cyclic adenosine monophosphate levels in leukocytes of hibernating captive black bears is similar to reported cyclic adenosine monophosphate findings in major depressive disorder

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