Biological differences between melancholic and nonmelancholic depression subtyped by the CORE measure

Abstract

BackgroundThe purpose of this study was to compare melancholic patients rated by the CORE measure of observable psychomotor disturbance with nonmelancholic and control subjects across a set of biomarkers.MethodsDepressed patients were classified as melancholic or nonmelancholic by using the CORE measure. Both groups of patients, as well as control subjects, were compared for a set of clinical and laboratory measures. Serum levels of brain-derived neurotrophic factor, of two markers of oxidative stress (protein carbonyl content [PCC] and thiobarbituric acid reactive substances [TBARS]), and of several immunity markers (interleukin [IL]-2, IL-4, IL-6, IL-10, IL-17, tumor necrosis factor-alpha, and interferon-gamma) were analyzed.ResultsThirty-three depressed patients and 54 healthy controls were studied. Depressive patients showed higher IL-4, IL-6, and PCC values than healthy controls. Thirteen (39%) of the depressed patients were assigned as melancholic by the CORE measure. They generated lower interferon-gamma (compared with nonmelancholic depressed patients) and TBARS (compared with both the nonmelancholic subset and controls) and returned higher IL-6 levels than controls. Both depressive groups generated higher PCC scores than controls, with no difference between melancholic and nonmelancholic subsets.ConclusionA sign-based measure to rate melancholia was able to replicate and extend biological findings discriminating melancholic depression. Signs of psychomotor disturbance may be a useful diagnostic measure of melancholia.

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

“…Several other studies have compared nonmelancholic with melancholic patients based on this cutoff [4, 9, 43, 44]. Patients who scored < 8 points formed the NMD group, while those who scored ≥8 were classified as MD patients.…”

Temperament, personality, and treatment outcome in major depression: a 6-month preliminary prospective study

“…Patients were eligible to be included in the study if they met the following criteria: 1) they were outpatients who had a diagnosis of MDD as defined by the Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition (DSM-IV) criteria for single or recurrent depression; 2) their age was between 20 and 75 years; and 3) they were competent and able to provide informed consent. Patients were excluded from the study if they presented remarkable psychomotor disturbances (a core feature of melancholia)15 at baseline based on clinical assessment by the study’s psychiatrists. We initially contacted 74 patients and 56 met the criteria.…”

The Major Depressive Disorder Hierarchy: Rasch Analysis of 6 Items of the Hamilton Depression Scale Covering the Continuum of Depressive Syndrome

“…For example, experienced psychiatrists always considered that MDD could be categorized between a biological, "endogenous" depression-called melancholic depression-and a psychogenic, "exogenous" depression-called non-melancholic depression [16,17]. This perception is supported by controversial evidences that melancholic patients would have genetic and biological determinants; more severe symptomatology; more evidence of neurobiological abnormalities, especially of the hypothalamic-pituitary-adrenal axis; low response to placebo; and superior response to pharmacological and electroconvulsive therapies [5,[18][19][20]. With this concept in mind, Bech et al (1975) found a valid subgroup of six items of the 17-item Hamilton depression rating scale (HDRS-17) (21)(21)(21) [21] that could represent the "core symptoms" of MDD when evaluating melancholic patients by the 17-item HDRS-17 [21].…”