Drug-Induced Depression

189

144

Background: Although numerous studies have documented the psychiatric and physiological effects of anabolic-androgenic steroids (AAS) in males, virtually no studies have investigated the effects of illicit AAS use in women. Methods: We performed psychiatric and medical evaluations of 75 dedicated women athletes, recruited by advertisement primarily from gymnasiums in the Boston, Mass., area. Results: Twenty-five (33%) of the women reported current or past AAS use. Users were more muscular than nonusers and reported use of many other ‘ergogenic’ (performance-enhancing) drugs in addition to AAS. Some described a frank syndrome of ergogenic polysubstance dependence, often with significant morbidity. Fourteen (56%) of the users reported hypomanic symptoms during AAS use and 10 (40%) reported depressive symptoms during AAS withdrawal, but none met full DSM-IV criteria for a hypomanic or major depressive episode. Nineteen (76%) users reported at least one adverse medical effect associated with AAS use. Perhaps the most interesting findings were several unusual psychiatric syndromes reported by both the AAS users and nonusers. These included rigid dietary practices (which we have termed ‘eating disorder, bodybuilder type’), nontraditional gender roles and chronic dissatisfaction and preoccupation with their physiques (a syndrome which we have termed ‘muscle dysmorphia’). Conclusions: Dedicated women athletes exhibit not only AAS abuse, but use of many other ergogenic drugs, sometimes associated with significant morbidity. In addition, these athletes frequently display several psychiatric syndromes which have not previously been well described.

Section: Discussionsupporting

confidence: 67%

Psychiatric and Medical Effects of Anabolic-Androgenic Steroid Use in Women

Gruber

Pope²

1999

189

144

“…Many drugs can produce depression as well [11]. These need to be evaluated prior to initiating aggressive therapy for TRD [12].…”

Section: Discussionmentioning

confidence: 99%

Treatment-Resistant Depression

Ananth

1998

Our ability to treat depression has improved with the availability of receptor-specific and chemically diverse groups of antidepressants. Even now, most of the short-term studies indicate that about 20% of depressed patients remain resistant to treatment. Therefore, it is important to properly assess the treatment-resistant depressed (TRD) patients and to separate the truly refractory patients from those inadequately treated. Undiagnosed medical conditions should be eliminated. TRD is neither a clinically nor a biologically identifiable entity. As there are no established methods for the treatment of TRD, all options should be considered. The clinician can be enriched by the knowledge of the treatment modalities available, and yet, in treating an individual patient, clinical skills, intuitive judgment, family history of response to drugs and side effects, all play a vital role. Several of the approaches described in the paper indicate available methods and their merits in general but there is no way of ascertaining by which particular method a patient should be treated. The three common methods of treatment are substitution of one antidepressant drug for another, combination therapies and augmentation techniques. These are based on clinical experiences and not research findings. Therefore the treatment of TRD patients is more an art than a science. The physician should assess all the psychopathological, phenomenological and psychosocial variables to appropriately treat an individual patient.

“…The symptoms attributed to MD in ICD-10 – reduction of energy, increased fatiguability and diminished activity, impaired concentration and attention, motor agitation or retardation, disturbed sleep, diminished appetite – can often be seen in old age and may not be specifically attributed to depression. They can be seen in medical illnesses such as cardiovascular diseases leading to cardiac insufficiency, chronic obstructive pulmonary diseases, electrolyte disturbances as occur in badly managed diabetes mellitus, anemia, lymphoma and other diseases of the blood, and gastrointestinal and endocrine (thyroid) disease; they also can occur as side effects of medications, for example β-blockers [4, 23, 25, 26, 27]. Only when these conditions can be excluded can the described symptoms be considered as nonorganic and genuine symptoms of depression.…”

Section: Problems Of Definition and Diagnosis Of Sdmentioning

confidence: 99%

The Prevalence and Differential Diagnosis of Subclinical Depressive Syndromes in Inpatients 60 Years and Older

Schneider

Kruse²,

Nehen

et al. 2000

Background: Depressive syndromes that do not comply with the diagnostic criteria for specific depressive disorders are designated as ‘subclinical’ or ‘subsyndromal’ depressive syndromes. Using our own data from a clinical study, this paper outlines the significance of subclinical depressive syndromes and demonstrates the problems of differentiating between depressive and subclinical depression (SD) syndromes and organic mood disorders especially in an elderly population with medical comorbidity. Methods: Two hundred and sixty-two patients aged 60 years and older in a general hospital were investigated, using a clinical psychiatric interview, expert ratings and self-report scales after extensive internal medical diagnostic evaluation. Results: When, without further differentiation as to their origin, all symptoms required by symptom checklists according to ICD-10 were considered for the diagnosis of major depression (MD), 35.5% of the study participants fulfilled the diagnostic criteria. After differentiating for etiology of symptoms, MD was found in only 14.1%, SD was diagnosed in 17.6% and organic mood disorder in 12.2% of the study participants. In another 41 patients (15.6%), symptoms of depression not fulfilling ICD-10 criteria were classified as being of organic or drug-induced origin. SD patients were in a mean position between nondepressive and depressive patients with regard to social isolation and physical impairment; women were overrepresented in the depressive and subdepressive groups. Conclusions: SD and organic mood disorder are common and helpful diagnostic categories in the elderly. The results show that in old age there is substantial danger of confounding MD, SD and organic mood disorder, thus leading to erroneously high prevalence rates of MD and underestimations of organic mood disorder if depressive symptoms are recorded only by self-report scales or a symptom checklist. Both internal and psychosomatic-psychotherapeutic competence as well as a liaison service in general hospitals are necessary for the differential diagnosis of MD, SD and organic mood disorder in the elderly with medical comorbidity.