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Aart H Schene - One of the best experts on this subject based on the ideXlab platform.

  • impaired reward related learning signals in remitted unmedicated patients with Recurrent Depression
    Brain, 2019
    Co-Authors: Hanneke Geugies, Aart H Schene, Roel J T Mocking, Caroline A Figueroa, Paul F C Groot, Janbernard C Marsman, Michelle N Servaas, Douglas J Steele, Henricus G Ruhe
    Abstract:

    One of the core symptoms of major depressive disorder is anhedonia, an inability to experience pleasure. In patients with major depressive disorder, a dysfunctional reward-system may exist, with blunted temporal difference reward-related learning signals in the ventral striatum and increased temporal difference-related (dopaminergic) activation in the ventral tegmental area. Anhedonia often remains as residual symptom during remission; however, it remains largely unknown whether the abovementioned reward systems are still dysfunctional when patients are in remission. We used a Pavlovian classical conditioning functional MRI task to explore the relationship between anhedonia and the temporal difference-related response of the ventral tegmental area and ventral striatum in medication-free remitted Recurrent Depression patients (n = 36) versus healthy control subjects (n = 27). Computational modelling was used to obtain the expected temporal difference errors during this task. Patients, compared to healthy controls, showed significantly increased temporal difference reward learning activation in the ventral tegmental area (PFWE,SVC = 0.028). No differences were observed between groups for ventral striatum activity. A group × anhedonia interaction [t(57) = -2.29, P = 0.026] indicated that in patients, higher anhedonia was associated with lower temporal difference activation in the ventral tegmental area, while in healthy controls higher anhedonia was associated with higher ventral tegmental area activation. These findings suggest impaired reward-related learning signals in the ventral tegmental area during remission in patients with Depression. This merits further investigation to identify impaired reward-related learning as an endophenotype for Recurrent Depression. Moreover, the inverse association between reinforcement learning and anhedonia in patients implies an additional disturbing influence of anhedonia on reward-related learning or vice versa, suggesting that the level of anhedonia should be considered in behavioural treatments.

  • Understanding emotion and emotional scarring in Recurrent Depression
    Comprehensive Psychiatry, 2015
    Co-Authors: Gerard D. Van Rijsbergen, Aart H Schene, Jack Dekker, Steven D. Hollon, Hermien J. Elgersma, Claudi L H Bockting
    Abstract:

    Abstract Background A single-item assessment of sad mood after remission from MDD is predictive of relapse, yet the mechanisms that play a role in depressive relapse remain poorly understood. Methods In 283 patients, remitted from Recurrent Depression (DSM-IV-TR criteria; HAM-D 17 score ≤10), we examined emotional scarring, that is, whether the number of previous depressive episodes was associated with higher levels of sad mood as assessed with a 1-item Visual Analogue Mood Scale (VAMS). We then fitted a cross-sectional multivariate regression model to predict sad mood levels, including the Dysfunctional Attitude Scale Version-A, cognitive reactivity (Leiden Index of Depression Sensitivity), Ruminative Response Scale, and Everyday Problem Checklist. Results Patients with greater numbers of prior episodes experienced higher levels of sad mood after remission. In multivariate regression, intensity of daily stress and dysfunctional beliefs were associated with the VAMS (Adj. R 2 =.091) although not over and above depressive symptomatology (Adj. R 2 =.114). Cognitive reactivity was not associated with sadness. Conclusions Our finding that patients with more previous MDEs reported higher levels of sad mood while remitted could be indicative of emotional scarring. Dysfunctional beliefs and intensity of daily stress were associated with sad mood but not over and above residual symptoms. Thus, illness related characteristics especially are associated with sad mood after remission. More negative affect after remission could result in lower stress tolerance or more stress intensity could result in negative affect. Future studies should examine premorbid sadness in a longitudinal cohort, and should study the exact pathway from stress, affect, and cognition to relapse.

  • longitudinal hypothalamic pituitary adrenal axis trait and state effects in Recurrent Depression
    Psychoneuroendocrinology, 2012
    Co-Authors: Roel J T Mocking, Claudi L H Bockting, Maarten W J Koeter, Henricus G Ruhe, Ieke Visser, Johanna Assies, Miranda Olff, Aart H Schene
    Abstract:

    BACKGROUND: Hypothalamic-pituitary-adrenal (HPA)-axis hyperactivity has been observed in (Recurrent) major depressive disorder (MDD), although inconsistently and mainly cross-sectional. Longitudinal studies clarifying state-trait issues are lacking. We aimed to determine whether HPA-axis (hyper)activity in Recurrent MDD is: (I) reflecting a persistent trait; (II) influenced by depressive state; (III) associated with stress or previous episodes; (IV) associated with recurrence; and (V) influenced by cognitive therapy. METHODS: We included 187 remitted highly Recurrent MDD-patients (mean number of previous episodes: 6.3), participating in a randomized-controlled-trial investigating the preventive effect of additional cognitive therapy on recurrence. In an add-on two-staged patient-control and prospective-cohort design, we first cross-sectionally compared patients' salivary morning and evening cortisol concentrations with 72 age- and sex-matched controls, and subsequently longitudinally followed-up the patients with repeated measures after three months and two years. RESULTS: Patients had higher cortisol concentrations than controls (p<.001), which did not change by MDD-episodes during follow-up. HPA-axis activity had no relation with daily hassles or childhood life events. Cortisol concentrations were lower in patients with more previous episodes (p=.047), but not associated with recurrence(s) during follow-up. Finally, randomly assigned cognitive therapy at study-entry enhanced cortisol declines over the day throughout the two-year follow-up (p=.052). CONCLUSIONS: Our results indicate that remitted Recurrent MDD-patients have a persistent trait of increased cortisol concentrations, irrespective of stress. In combination with our finding that patients' cortisol concentrations do not change during new MDD-episodes (and thus not represent epiphenomenal or state-effects), our results support that hypercortisolemia fulfills the state-independence criterion for an endophenotype for Recurrent Depression.

  • prediction of recurrence in Recurrent Depression a 5 5 year prospective study
    The Journal of Clinical Psychiatry, 2010
    Co-Authors: Mascha Ten C Doesschate, Claudi L H Bockting, Maarten W J Koeter, Aart H Schene
    Abstract:

    OBJECTIVE: Depression is a disease with high recurrence rates. Identifying predictors of recurrence and their relative importance in patients with Recurrent Depression is important for a better understanding of the course of this disease. This type of knowledge can be used to optimize and tailor preventive strategies of recurrence. In this study, we examined predictors of recurrence over a 5.5-year follow-up period and quantified to which extent these predictors explained observed variation in recurrence. METHOD: Data from 172 remitted Recurrently depressed patients over a 5.5-year follow-up period were used. Recurrence was assessed with the Structured Clinical Interview for DSM-IV. Illness-, stress-, and coping-related factors were examined as predictors of recurrence. Multiple Cox regression analysis was used, and explained variation was assessed to quantify the relative importance of the predictors. Patients were recruited between February 2000 and September 2000. RESULTS: Number of previous episodes and residual symptoms explained each 15% of the variation in recurrence, indicating a medium effect size. The final multivariate prediction model included: a higher number of previous episodes, more residual symptoms, and lower levels of positive refocusing (explained variation 29%, indicating a strong effect size). CONCLUSION: In our multivariate prediction model, the number of previous episodes, residual symptoms, and a specific coping style were predictors of recurrence over a 5.5-year follow-up period in remitted Recurrently depressed patients. Preventive therapies should focus on these factors. Although a substantial part of variation in recurrence (29%) was explained by these predictors, most of it remains unexplained. Consequently, recurrence remains a difficult to predict and only partially understood phenomenon. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Register Identifier: ISRCTN68246470.

  • long term effects of preventive cognitive therapy in Recurrent Depression a 5 5 year follow up study
    The Journal of Clinical Psychiatry, 2009
    Co-Authors: Claudi L H Bockting, Philip Spinhoven, Maarten W J Koeter, Luuk Wouters, Aart H Schene
    Abstract:

    OBJECTIVE: Major depressive disorder (MDD) was projected to rank second on a list of 15 major diseases in terms of burden in 2030. A crucial part of the treatment of Depression is the prevention of relapse/recurrence in high-risk groups, ie, Recurrently depressed patients. The long-term preventive effects of group cognitive therapy (CT) in preventing relapse/recurrence in Recurrent Depression are not known. This article reports on the long-term (5.5-year) outcome of a randomized controlled trial to prevent relapse/recurrence in patients with Recurrent Depression. We specifically evaluated the long-term effects of CT in relation to the number of previous episodes experienced. METHOD: From February through September 2000, patients with Recurrent Depression (DSM-IV-diagnosed) who were in remission (N = 172) were recruited from primary and specialty care facilities. They were randomly assigned to treatment as usual (TAU) versus TAU augmented with brief group CT. The primary outcome measure was time to relapse/recurrence, which was assessed over 5.5 years. RESULTS: Over 5.5 years, augmenting TAU with CT resulted in a significant protective effect (P = .003), which intensified with the number of previous depressive episodes experienced. For patients with 4 or more previous episodes (52% of the sample), CT significantly reduced cumulative relapse/recurrence from 95% to 75% (medium effect size). CONCLUSIONS: Our findings indicate that brief CT, started after remission from a depressive episode on diverse types of treatment in patients with multiple prior episodes, has long-term preventive effects for at least 5.5 years. Implementation of brief relapse prevention CT should be considered in the continued care of patients with Recurrent Depression. TRIAL REGISTRATION: ccmo-online.nl Identifier: NTR454.

Ellen Frank - One of the best experts on this subject based on the ideXlab platform.

  • pain predicts longer time to remission during treatment of Recurrent Depression
    The Journal of Clinical Psychiatry, 2005
    Co-Authors: Jordan F. Karp, David J. Kupfer, John Scott, Patricia R Houck, Charles F Reynolds, Ellen Frank
    Abstract:

    Introduction: Pain and Depression are mutually exacerbating. We know that both of these syndromes predict the future occurrence of the other. It has not been shown, however, whether the presence of pain slows the effect of treatment for Depression. We hypothesized that greater pain and somatic scores prior to treatment with imipramine and interpersonal psychotherapy would predict a slowed time to remission from Depression. Method: We performed secondary data analyses of an archived study. Subjects (N = 230) were between 21 and 65 years of age and were enrolled in a study of maintenance treatment for Recurrent unipolar Depression. Patients had to meet Research Diagnostic Criteria (RDC) for a major depressive episode and historical requirements for at least 3 prior episodes and clear remissions (according to RDC). Patients were also required to have a minimum Hamilton Rating Scale for Depression score of 15 and a minimum score of 7 on the Raskin Severity of Depression Scale. This report describes the acute treatment phase, during which all subjects received combination therapy consisting of imipramine hydrochloride (150 to 300 mg) and interpersonal psychotherapy. Pain and somatization were measured with the Hopkins Symptom Checklist. Results: Higher levels of both pain and somatization predicted a longer time to remission. After controlling for baseline severity of Depression, only pain was still significant in predicting a longer time to remission. Headache and muscle soreness were the 2 variables from the pain index whose presence independently predicted a slower remission. Both pain and somatization improved during acute treatment. Subjects with more pain and somatization, after controlling for severity of Depression, reported more suicidality. Women reported more pain than men. Conclusions: Pain, but not somatization, predicted a longer time to remission and may be a marker of a more difficult-to-treat Depression. Adults with Recurrent Depression should be screened for the presence of pain prior to treatment, as the presence of these symptoms may require more aggressive treatment or may be a marker for suicidality or the use of dual-mechanism antidepressants.

  • Imipramine and Sexual Dysfunction during the Long-term Treatment of Recurrent Depression
    Neuropsychopharmacology, 1994
    Co-Authors: Jordan F. Karp, A B Mceachran, Ellen Frank, Angela Ritenour, David J. Kupfer
    Abstract:

    Ninety patients in the maintenance therapy phase of the Pittsburgh Study of Maintenance Therapies in Recurrent Depression (Frank et al., 1990) were studied to determine possible relationships between the type of therapy (imipramine versus no drug) and the level of sexual functioning. The level of sexual functioning was determined by a composite subscale score of the Social Adjustment Scale which assessed (1) current level of enjoyment and interest in sex; (2) change in interest; (3) current frequency of sexual intercourse; (4) change in frequency; and (5) pain and/or difficulty reaching orgasm. Loss of libido was assessed by both the Hamilton Rating Scale for Depression and the SCL-90. Logistic regression analysis revealed no relationship between treatment with active imipramine and sexual functioning for the total group, or for females alone. Analysis of males alone revealed a decreased interest in sex among those treated with imipramine, but no significant differences in frequency or problems. The implications for maintenance pharmacotherapy and the cost/benefit ratio of unacceptable side effects versus drug efficacy are discussed.

  • Maintenance Therapies in Recurrent Depression: Psychotherapy and Combined Treatment
    Recurrent Mood Disorders, 1993
    Co-Authors: Ellen Frank, Dj Kupfer, T. Hamer
    Abstract:

    Unipolar illness follows a Recurrent and episodic course for the majority of individuals afflicted (Angst 1973; Keller et al. 1982). A single episode of Depression is disabling and often entails considerable economic cost and personal suffering; however, Recurrent Depression constitutes a major public health problem (Wells et al. 1989). Thus, the identification and prophylactic treatment of individuals who have a history of repeated episodes of Depression should be high clinical priorities. The advent of well-defined diagnostic criteria has made the identification of the Recurrent patient less difficult once the individual presents for treatment in a psychiatric setting. Unfortunately, however, many Recurrent depressives accept their frequent episodes as natural, if debilitating, mood variation, never thinking to seek treatment for them. Still others are seen in general medical settings, treated for each acute episode and discharged, only to suffer another recurrence.

  • Cost utility analysis of maintenance treatment for Recurrent Depression
    Controlled Clinical Trials, 1992
    Co-Authors: Mark S. Kamlet, Nancy Paul, Joel B. Greenhouse, David J. Kupfer, Ellen Frank, Martcia Wade
    Abstract:

    Abstract This paper presents a cost-utility analysis of three maintenance treatments for Recurrent Depression: interpersonal therapy (IPT-M), imipramine drug therapy (Drug), and a combination of the two. We base our analysis on the results of the University of Pittsburgh's Controlled Clinical Trial of Maintenance Therapies for Recurrent Depression. We construct a Markovian state-transition model to incorporate clinical effectiveness into cost and quality-of-life impacts; we assign empirical values to the parameters of this model; and we then use Monte Carlo analysis to compare the relative cost effectiveness of the different maintenance treatments. For the patients who met the eligibility standards for the study, Drug maintenance treatment is cost-effective in the strongest sense of the term compared to either a placebo group or IPT-M: it both improves expected lifetime health (measured in quality-adjusted life years, or QALYs) and reduces direct medical costs. This is true even when relatively severe side effects of the drug are considered. Compared to the placebo group, IPT-M and the combination of IPT-M and Drug each improve expected lifetime health, although in neither case are expected direct medical costs reduced. Still, the cost of the resulting health improvements, under $5000/QALY, are very reasonable. A similar conclusion holds comparing Drug and IPT-M to IPT-M alone. All of the above conclusions are quite robust to sensitivity analyses.

  • Life stress and treatment course of Recurrent Depression: I. Response during index episode.
    Journal of Consulting and Clinical Psychology, 1992
    Co-Authors: Scott M. Monroe, David J. Kupfer, Ellen Frank
    Abstract:

    : Research on treatment course and outcome in Depression is mixed with respect to the implications of life stress. Several concerns are addressed in a prospective study of 91 individuals treated for Recurrent Depression. Specific forms of stress occurring before treatment entry predicted a poor clinical response both after 16 weeks and after a more extended intervention period. Specific forms of stress occurring during the 1st 6 weeks of treatment also predicted poor response after 16 weeks and after the extended intervention period. Severe stress occurring early in treatment predicted a longer time to attain relief for treatment responders. Concepts underlying the idea that stress-related disorders have a better clinical outcome are discussed, and it is proposed that life stress has different implications for individuals with and without Recurrent Depression.

David J. Kupfer - One of the best experts on this subject based on the ideXlab platform.

  • pain predicts longer time to remission during treatment of Recurrent Depression
    The Journal of Clinical Psychiatry, 2005
    Co-Authors: Jordan F. Karp, David J. Kupfer, John Scott, Patricia R Houck, Charles F Reynolds, Ellen Frank
    Abstract:

    Introduction: Pain and Depression are mutually exacerbating. We know that both of these syndromes predict the future occurrence of the other. It has not been shown, however, whether the presence of pain slows the effect of treatment for Depression. We hypothesized that greater pain and somatic scores prior to treatment with imipramine and interpersonal psychotherapy would predict a slowed time to remission from Depression. Method: We performed secondary data analyses of an archived study. Subjects (N = 230) were between 21 and 65 years of age and were enrolled in a study of maintenance treatment for Recurrent unipolar Depression. Patients had to meet Research Diagnostic Criteria (RDC) for a major depressive episode and historical requirements for at least 3 prior episodes and clear remissions (according to RDC). Patients were also required to have a minimum Hamilton Rating Scale for Depression score of 15 and a minimum score of 7 on the Raskin Severity of Depression Scale. This report describes the acute treatment phase, during which all subjects received combination therapy consisting of imipramine hydrochloride (150 to 300 mg) and interpersonal psychotherapy. Pain and somatization were measured with the Hopkins Symptom Checklist. Results: Higher levels of both pain and somatization predicted a longer time to remission. After controlling for baseline severity of Depression, only pain was still significant in predicting a longer time to remission. Headache and muscle soreness were the 2 variables from the pain index whose presence independently predicted a slower remission. Both pain and somatization improved during acute treatment. Subjects with more pain and somatization, after controlling for severity of Depression, reported more suicidality. Women reported more pain than men. Conclusions: Pain, but not somatization, predicted a longer time to remission and may be a marker of a more difficult-to-treat Depression. Adults with Recurrent Depression should be screened for the presence of pain prior to treatment, as the presence of these symptoms may require more aggressive treatment or may be a marker for suicidality or the use of dual-mechanism antidepressants.

  • Imipramine and Sexual Dysfunction during the Long-term Treatment of Recurrent Depression
    Neuropsychopharmacology, 1994
    Co-Authors: Jordan F. Karp, A B Mceachran, Ellen Frank, Angela Ritenour, David J. Kupfer
    Abstract:

    Ninety patients in the maintenance therapy phase of the Pittsburgh Study of Maintenance Therapies in Recurrent Depression (Frank et al., 1990) were studied to determine possible relationships between the type of therapy (imipramine versus no drug) and the level of sexual functioning. The level of sexual functioning was determined by a composite subscale score of the Social Adjustment Scale which assessed (1) current level of enjoyment and interest in sex; (2) change in interest; (3) current frequency of sexual intercourse; (4) change in frequency; and (5) pain and/or difficulty reaching orgasm. Loss of libido was assessed by both the Hamilton Rating Scale for Depression and the SCL-90. Logistic regression analysis revealed no relationship between treatment with active imipramine and sexual functioning for the total group, or for females alone. Analysis of males alone revealed a decreased interest in sex among those treated with imipramine, but no significant differences in frequency or problems. The implications for maintenance pharmacotherapy and the cost/benefit ratio of unacceptable side effects versus drug efficacy are discussed.

  • Management of Recurrent Depression.
    The Journal of Clinical Psychiatry, 1993
    Co-Authors: David J. Kupfer
    Abstract:

    : Research completed over the past decade has established the chronic and Recurrent nature of major Depression. To date, treatment for the prevention of recurrence has promoted the use of "maintenance" doses of antidepressant medications that are lower than the effective for the acute phase of treatment. Long-term randomized, double-blind studies of tricyclic antidepressant (TCA) maintenance therapy have shown, however, that full-dose treatment strategy has a highly significant prophylactic effect in preventing a new episode of Depression for up to 5 years. Monthly interpersonal psychotherapy has also been shown to have a modest but significant effect on survival. Although prophylaxis with full-dose TCAs can be well tolerated by patients when proper education and support are provided, newer antidepressant agents with milder side effect profiles are being studied for their efficacy in long-term management of Depression. The results of 1-year studies of maintenance therapy with serotonin selective reuptake inhibiting agents suggest that these medications will play a major role in prophylaxis for Recurrent Depression.

  • Cost utility analysis of maintenance treatment for Recurrent Depression
    Controlled Clinical Trials, 1992
    Co-Authors: Mark S. Kamlet, Nancy Paul, Joel B. Greenhouse, David J. Kupfer, Ellen Frank, Martcia Wade
    Abstract:

    Abstract This paper presents a cost-utility analysis of three maintenance treatments for Recurrent Depression: interpersonal therapy (IPT-M), imipramine drug therapy (Drug), and a combination of the two. We base our analysis on the results of the University of Pittsburgh's Controlled Clinical Trial of Maintenance Therapies for Recurrent Depression. We construct a Markovian state-transition model to incorporate clinical effectiveness into cost and quality-of-life impacts; we assign empirical values to the parameters of this model; and we then use Monte Carlo analysis to compare the relative cost effectiveness of the different maintenance treatments. For the patients who met the eligibility standards for the study, Drug maintenance treatment is cost-effective in the strongest sense of the term compared to either a placebo group or IPT-M: it both improves expected lifetime health (measured in quality-adjusted life years, or QALYs) and reduces direct medical costs. This is true even when relatively severe side effects of the drug are considered. Compared to the placebo group, IPT-M and the combination of IPT-M and Drug each improve expected lifetime health, although in neither case are expected direct medical costs reduced. Still, the cost of the resulting health improvements, under $5000/QALY, are very reasonable. A similar conclusion holds comparing Drug and IPT-M to IPT-M alone. All of the above conclusions are quite robust to sensitivity analyses.

  • Life stress and treatment course of Recurrent Depression: I. Response during index episode.
    Journal of Consulting and Clinical Psychology, 1992
    Co-Authors: Scott M. Monroe, David J. Kupfer, Ellen Frank
    Abstract:

    : Research on treatment course and outcome in Depression is mixed with respect to the implications of life stress. Several concerns are addressed in a prospective study of 91 individuals treated for Recurrent Depression. Specific forms of stress occurring before treatment entry predicted a poor clinical response both after 16 weeks and after a more extended intervention period. Specific forms of stress occurring during the 1st 6 weeks of treatment also predicted poor response after 16 weeks and after the extended intervention period. Severe stress occurring early in treatment predicted a longer time to attain relief for treatment responders. Concepts underlying the idea that stress-related disorders have a better clinical outcome are discussed, and it is proposed that life stress has different implications for individuals with and without Recurrent Depression.

Claudi L H Bockting - One of the best experts on this subject based on the ideXlab platform.

  • The association between the number of previous episodes and modifiable vulnerability factors in remitted patients with Recurrent Depression.
    PLOS ONE, 2018
    Co-Authors: Margo De Jonge, Claudi L H Bockting, Patricia Van Oppen, Jaap Peen, Martijn J. Kikkert, Jack Dekker
    Abstract:

    OBJECTIVE: Remitted patients with a history of several previous major depressive episodes have a higher risk of relapse/recurrence than patients with fewer previous episodes, and the probability of another episode increases progressively with each successive episode. This study examines the association between the number of previous episodes and modifiable vulnerability factors in remitted patients with Recurrent Depression. METHODS: Patients with Recurrent Depression (DSM-IV-diagnosed) who were in remission (N = 214) were recruited between September 2011 and July 2016. The association was examined between the number of previous episodes and the following factors: i.e. interpersonal functioning, daily stress, sense of mastery, coping and dysfunctional beliefs. RESULTS: A history of more previous episodes was associated with higher levels of interpersonal problems (P < .001), daily stress (P = .04) and a lower sense of mastery (P = .05). Interpersonal problems were most strongly associated with more previous episodes in a Generalized Linear Regression model. In the domain of interpersonal problems, the subscales that showed the strongest relationship were domineering/controlling, vindictive/self-centred, socially inhibited and self-sacrificing. CONCLUSIONS: Patients with a history of more depressive episodes reported higher levels of interpersonal problems, daily stress and a lower sense of mastery. Future studies should examine these factors in a longitudinal cohort and look at whether the effect of interventions to prevent relapse can be explained by targeting these psychological factors. TRIAL REGISTRATION: Netherlands Trial Register: 2599.

  • Understanding emotion and emotional scarring in Recurrent Depression
    Comprehensive Psychiatry, 2015
    Co-Authors: Gerard D. Van Rijsbergen, Aart H Schene, Jack Dekker, Steven D. Hollon, Hermien J. Elgersma, Claudi L H Bockting
    Abstract:

    Abstract Background A single-item assessment of sad mood after remission from MDD is predictive of relapse, yet the mechanisms that play a role in depressive relapse remain poorly understood. Methods In 283 patients, remitted from Recurrent Depression (DSM-IV-TR criteria; HAM-D 17 score ≤10), we examined emotional scarring, that is, whether the number of previous depressive episodes was associated with higher levels of sad mood as assessed with a 1-item Visual Analogue Mood Scale (VAMS). We then fitted a cross-sectional multivariate regression model to predict sad mood levels, including the Dysfunctional Attitude Scale Version-A, cognitive reactivity (Leiden Index of Depression Sensitivity), Ruminative Response Scale, and Everyday Problem Checklist. Results Patients with greater numbers of prior episodes experienced higher levels of sad mood after remission. In multivariate regression, intensity of daily stress and dysfunctional beliefs were associated with the VAMS (Adj. R 2 =.091) although not over and above depressive symptomatology (Adj. R 2 =.114). Cognitive reactivity was not associated with sadness. Conclusions Our finding that patients with more previous MDEs reported higher levels of sad mood while remitted could be indicative of emotional scarring. Dysfunctional beliefs and intensity of daily stress were associated with sad mood but not over and above residual symptoms. Thus, illness related characteristics especially are associated with sad mood after remission. More negative affect after remission could result in lower stress tolerance or more stress intensity could result in negative affect. Future studies should examine premorbid sadness in a longitudinal cohort, and should study the exact pathway from stress, affect, and cognition to relapse.

  • longitudinal hypothalamic pituitary adrenal axis trait and state effects in Recurrent Depression
    Psychoneuroendocrinology, 2012
    Co-Authors: Roel J T Mocking, Claudi L H Bockting, Maarten W J Koeter, Henricus G Ruhe, Ieke Visser, Johanna Assies, Miranda Olff, Aart H Schene
    Abstract:

    BACKGROUND: Hypothalamic-pituitary-adrenal (HPA)-axis hyperactivity has been observed in (Recurrent) major depressive disorder (MDD), although inconsistently and mainly cross-sectional. Longitudinal studies clarifying state-trait issues are lacking. We aimed to determine whether HPA-axis (hyper)activity in Recurrent MDD is: (I) reflecting a persistent trait; (II) influenced by depressive state; (III) associated with stress or previous episodes; (IV) associated with recurrence; and (V) influenced by cognitive therapy. METHODS: We included 187 remitted highly Recurrent MDD-patients (mean number of previous episodes: 6.3), participating in a randomized-controlled-trial investigating the preventive effect of additional cognitive therapy on recurrence. In an add-on two-staged patient-control and prospective-cohort design, we first cross-sectionally compared patients' salivary morning and evening cortisol concentrations with 72 age- and sex-matched controls, and subsequently longitudinally followed-up the patients with repeated measures after three months and two years. RESULTS: Patients had higher cortisol concentrations than controls (p<.001), which did not change by MDD-episodes during follow-up. HPA-axis activity had no relation with daily hassles or childhood life events. Cortisol concentrations were lower in patients with more previous episodes (p=.047), but not associated with recurrence(s) during follow-up. Finally, randomly assigned cognitive therapy at study-entry enhanced cortisol declines over the day throughout the two-year follow-up (p=.052). CONCLUSIONS: Our results indicate that remitted Recurrent MDD-patients have a persistent trait of increased cortisol concentrations, irrespective of stress. In combination with our finding that patients' cortisol concentrations do not change during new MDD-episodes (and thus not represent epiphenomenal or state-effects), our results support that hypercortisolemia fulfills the state-independence criterion for an endophenotype for Recurrent Depression.

  • prediction of recurrence in Recurrent Depression a 5 5 year prospective study
    The Journal of Clinical Psychiatry, 2010
    Co-Authors: Mascha Ten C Doesschate, Claudi L H Bockting, Maarten W J Koeter, Aart H Schene
    Abstract:

    OBJECTIVE: Depression is a disease with high recurrence rates. Identifying predictors of recurrence and their relative importance in patients with Recurrent Depression is important for a better understanding of the course of this disease. This type of knowledge can be used to optimize and tailor preventive strategies of recurrence. In this study, we examined predictors of recurrence over a 5.5-year follow-up period and quantified to which extent these predictors explained observed variation in recurrence. METHOD: Data from 172 remitted Recurrently depressed patients over a 5.5-year follow-up period were used. Recurrence was assessed with the Structured Clinical Interview for DSM-IV. Illness-, stress-, and coping-related factors were examined as predictors of recurrence. Multiple Cox regression analysis was used, and explained variation was assessed to quantify the relative importance of the predictors. Patients were recruited between February 2000 and September 2000. RESULTS: Number of previous episodes and residual symptoms explained each 15% of the variation in recurrence, indicating a medium effect size. The final multivariate prediction model included: a higher number of previous episodes, more residual symptoms, and lower levels of positive refocusing (explained variation 29%, indicating a strong effect size). CONCLUSION: In our multivariate prediction model, the number of previous episodes, residual symptoms, and a specific coping style were predictors of recurrence over a 5.5-year follow-up period in remitted Recurrently depressed patients. Preventive therapies should focus on these factors. Although a substantial part of variation in recurrence (29%) was explained by these predictors, most of it remains unexplained. Consequently, recurrence remains a difficult to predict and only partially understood phenomenon. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Register Identifier: ISRCTN68246470.

  • long term effects of preventive cognitive therapy in Recurrent Depression a 5 5 year follow up study
    The Journal of Clinical Psychiatry, 2009
    Co-Authors: Claudi L H Bockting, Philip Spinhoven, Maarten W J Koeter, Luuk Wouters, Aart H Schene
    Abstract:

    OBJECTIVE: Major depressive disorder (MDD) was projected to rank second on a list of 15 major diseases in terms of burden in 2030. A crucial part of the treatment of Depression is the prevention of relapse/recurrence in high-risk groups, ie, Recurrently depressed patients. The long-term preventive effects of group cognitive therapy (CT) in preventing relapse/recurrence in Recurrent Depression are not known. This article reports on the long-term (5.5-year) outcome of a randomized controlled trial to prevent relapse/recurrence in patients with Recurrent Depression. We specifically evaluated the long-term effects of CT in relation to the number of previous episodes experienced. METHOD: From February through September 2000, patients with Recurrent Depression (DSM-IV-diagnosed) who were in remission (N = 172) were recruited from primary and specialty care facilities. They were randomly assigned to treatment as usual (TAU) versus TAU augmented with brief group CT. The primary outcome measure was time to relapse/recurrence, which was assessed over 5.5 years. RESULTS: Over 5.5 years, augmenting TAU with CT resulted in a significant protective effect (P = .003), which intensified with the number of previous depressive episodes experienced. For patients with 4 or more previous episodes (52% of the sample), CT significantly reduced cumulative relapse/recurrence from 95% to 75% (medium effect size). CONCLUSIONS: Our findings indicate that brief CT, started after remission from a depressive episode on diverse types of treatment in patients with multiple prior episodes, has long-term preventive effects for at least 5.5 years. Implementation of brief relapse prevention CT should be considered in the continued care of patients with Recurrent Depression. TRIAL REGISTRATION: ccmo-online.nl Identifier: NTR454.

Philip Spinhoven - One of the best experts on this subject based on the ideXlab platform.

  • Mindfulness facets and Big Five personality facets in persons with Recurrent Depression in remission
    Personality and Individual Differences, 2017
    Co-Authors: Philip Spinhoven, Marloes J. Huijbers, Yixia Zheng, Johan Ormel, Anne E. M. Speckens
    Abstract:

    Abstract Studies examining mindfulness in relation to personality traits have been mainly conducted in non-clinical samples and resulted in mixed findings. The present cross-sectional study examined which mindfulness facets are most strongly associated with Big Five personality domains and facets implicated in the onset and possible relapse/recurrence of Recurrent Depression. Using data from the MOMENT study, we included 278 adult persons with Recurrent Depression in remission (SCID-I), who had completed baseline measurements of mindfulness (FFMQ) and personality (NEO PI-R). Using exploratory factor analysis, we observed that the mindfulness facets of acting with awareness, non-judging and non-reactivity loaded positively and the neuroticism facets loaded negatively on the first factor (called self-regulation) and that the mindfulness facets of observing and describing and the openness to experience facets loaded positively on the second factor (called self-awareness) of the identified five-factor solution. Lower-level facet analyses taking the multidimensional nature of mindfulness and personality traits into account clearly show that mindful self-regulation skills are associated with neuroticism, which is a known risk factor for relapse/recurrence of Depression in persons with Recurrent Depression. Future longitudinal studies are needed to assess whether these mindful self-regulation skills may constitute a protective factor in the relationship of neuroticism with Depression.

  • discontinuation of antidepressant medication after mindfulness based cognitive therapy for Recurrent Depression randomised controlled non inferiority trial
    British Journal of Psychiatry, 2016
    Co-Authors: Marloes J. Huijbers, Philip Spinhoven, Johan Ormel, J Spijker, Henricus G Ruhe, Digna J F Van Schaik, Patricia Van Oppen, Willem A Nolen, Willem Kuyken, Gert Jan Van Der Wilt
    Abstract:

    BACKGROUND: Mindfulness-based cognitive therapy (MBCT) and maintenance antidepressant medication (mADM) both reduce the risk of relapse in Recurrent Depression, but their combination has not been studied. AIMS: To investigate whether MBCT with discontinuation of mADM is non-inferior to MBCT+mADM. METHOD: A multicentre randomised controlled non-inferiority trial (ClinicalTrials.gov:NCT00928980). Adults with Recurrent Depression in remission, using mADM for 6 months or longer (n= 249), were randomly allocated to either discontinue (n= 128) or continue (n= 121) mADM after MBCT. The primary outcome was depressive relapse/recurrence within 15 months. A confidence interval approach with a margin of 25% was used to test non-inferiority. Key secondary outcomes were time to relapse/recurrence and Depression severity. RESULTS: The difference in relapse/recurrence rates exceeded the non-inferiority margin and time to relapse/recurrence was significantly shorter after discontinuation of mADM. There were only minor differences in Depression severity. CONCLUSIONS: Our findings suggest an increased risk of relapse/recurrence in patients withdrawing from mADM after MBCT.

  • Patients with a preference for medication do equally well in mindfulness-based cognitive therapy for Recurrent Depression as those preferring mindfulness
    Journal of Affective Disorders, 2016
    Co-Authors: Marloes J. Huijbers, Philip Spinhoven, Digna J F Van Schaik, Willem A Nolen, Anne E. M. Speckens
    Abstract:

    BACKGROUND: Previous studies have suggested that patients' treatment preferences may influence treatment outcome. The current study investigated whether preference for either mindfulness-based cognitive therapy (MBCT) or maintenance antidepressant medication (mADM) to prevent relapse in Recurrent Depression was associated with patients' characteristics, treatment adherence, or treatment outcome of MBCT. METHODS: The data originated from two parallel randomised controlled trials, the first comparing the combination of MBCT and mADM to MBCT in patients preferring MBCT (n=249), the second comparing the combination to mADM alone in patients preferring mADM (n=68). Patients' characteristics were compared across the trials (n=317). Subsequently, adherence and clinical outcomes were compared for patients who all received the combination (n=154). RESULTS: Patients with a preference for mADM reported more previous depressive episodes and higher levels of mindfulness at baseline. Preference did not affect adherence to either MBCT or mADM. With regard to treatment outcome of MBCT added to mADM, preference was not associated with relapse/recurrence (χ(2)=0.07; p=.80), severity of (residual) depressive symptoms during the 15-month follow-up period (β=-0.08, p=.49), or quality of life. LIMITATIONS: The group preferring mADM was relatively small. The influence of preferences on outcome may have been limited in the current study because both preference groups received both interventions. CONCLUSIONS: The fact that patients with a preference for medication did equally well as those with a preference for mindfulness supports the applicability of MBCT for Recurrent Depression. Future studies of MBCT should include measures of preferences to increase knowledge in this area.

  • long term effects of preventive cognitive therapy in Recurrent Depression a 5 5 year follow up study
    The Journal of Clinical Psychiatry, 2009
    Co-Authors: Claudi L H Bockting, Philip Spinhoven, Maarten W J Koeter, Luuk Wouters, Aart H Schene
    Abstract:

    OBJECTIVE: Major depressive disorder (MDD) was projected to rank second on a list of 15 major diseases in terms of burden in 2030. A crucial part of the treatment of Depression is the prevention of relapse/recurrence in high-risk groups, ie, Recurrently depressed patients. The long-term preventive effects of group cognitive therapy (CT) in preventing relapse/recurrence in Recurrent Depression are not known. This article reports on the long-term (5.5-year) outcome of a randomized controlled trial to prevent relapse/recurrence in patients with Recurrent Depression. We specifically evaluated the long-term effects of CT in relation to the number of previous episodes experienced. METHOD: From February through September 2000, patients with Recurrent Depression (DSM-IV-diagnosed) who were in remission (N = 172) were recruited from primary and specialty care facilities. They were randomly assigned to treatment as usual (TAU) versus TAU augmented with brief group CT. The primary outcome measure was time to relapse/recurrence, which was assessed over 5.5 years. RESULTS: Over 5.5 years, augmenting TAU with CT resulted in a significant protective effect (P = .003), which intensified with the number of previous depressive episodes experienced. For patients with 4 or more previous episodes (52% of the sample), CT significantly reduced cumulative relapse/recurrence from 95% to 75% (medium effect size). CONCLUSIONS: Our findings indicate that brief CT, started after remission from a depressive episode on diverse types of treatment in patients with multiple prior episodes, has long-term preventive effects for at least 5.5 years. Implementation of brief relapse prevention CT should be considered in the continued care of patients with Recurrent Depression. TRIAL REGISTRATION: ccmo-online.nl Identifier: NTR454.

  • preventing relapse recurrence in Recurrent Depression with cognitive therapy a randomized controlled trial
    Journal of Consulting and Clinical Psychology, 2005
    Co-Authors: Claudi L H Bockting, Philip Spinhoven, Aart H Schene, Maarten W J Koeter, Luuk Wouters, Jochanan Huyser, Jan H Kamphuis
    Abstract:

    This article reports on the outcome of a randomized controlled trial of cognitive group therapy (CT) to prevent relapse/recurrence in a group of high-risk patients diagnosed with Recurrent Depression. Recurrently depressed patients (N = 187) currently in remission following various types of treatment were randomized to treatment as usual, including continuation of pharmacotherapy, or to treatment as usual augmented with brief CT. Relapse/recurrence to major Depression was assessed over 2 years. Augmenting treatment as usual with CT resulted in a significant protective effect, which intensified with the number of previous depressive episodes experienced. For patients with 5 or more previous episodes (41% of the sample), CT reduced relapse/recurrence from 72% to 46%. Our findings extend the accumulating evidence that cognitive interventions following remission can be useful in preventing relapse/recurrence in patients with Recurrent Depression.