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Treating depression with light therapy during pregnancy
S86
Abstracts / Journal of Affective Disorders 107 (2008) S53–S122
Chi square was used to determine difference in incidence of depression. Results: In a 12-month period, no significant difference in incidence of depression between the SC and CAU condition was found. But the overall relapse rate in both groups was low 25% indicating a bottom effect. Discussion: Preliminary findings do not favour stepped care over current clinical practice for the prevention of recurrence of depression in the elderly in terms of feasibility and effectiveness. Keywords: Depression, Elderly, Prevention
Conclusion: Light therapy might be considered a safe and viable alternative in the treatment of patients suffering from PMDD. CBT may play an important role in maintaining achieved gains. Keywords: Light therapy, PMDD, CBT doi:10.1016/j.jad.2007.12.072
[P1.40] Treating depression with light therapy during pregnancy
doi:10.1016/j.jad.2007.12.071
J. Haffmans*,a,b, M. Schoutena, L. den Hoeda a
[P1.39] The effects of light therapy and cognitive behavioral therapy in premenstrual dysphoric disorder (PMDD) J. Haffmans*,a,b, A. Richmonda, F. Landmana, M. Bloma a
Parnassia Bavo Group, The Netherlands Leiden University, The Netherlands
b
Introduction: Women may be at risk for biological clock desynchronisation, altered hormonal rhythms (e.g. during pregnancy, menstrual cycle, postpartum or following miscarriage or abortion, menopause) and subsequent for changes in mood. Premenstrual Dysphoric Disorder (PMDD) includes irritability, tension, loss of concentration, increased appetite, hypersomnia, low self-esteem and sensitivity to social rejection in the premenstrual week. Symptoms are comparable to atypical depression or depression NOS and seasonal Affective Disorder (SAD). The comparability of symptoms with SAD, urged us to use light therapy in the treatment of PMDD. Methods: Light therapy (10.000 lx 30') was applied periodically during the premenstrual week in 10 women. Results: A positive response was achieved in all women, as measured with the Symptom Check List, Quality of Life (Murphy et al., 2000), PMS list (Dutch Society of Obstetricians & Gynaecology). However, light therapy had to be reapplied during subsequent menstrual cycles, to maintain the significant decrease of symptoms. Subsequently, these women followed a CBT-group, in order to examine the effects of CBT on PMDD symptoms and to maintain the effects of light therapy on the long term and to create a ‘peer’ group.
Parnassia Bavo Group, The Netherlands Leiden University, The Netherlands
b
Introduction: Antidepressant medication has possible teratogenic effects, however a non-treated depression during pregnancy might also have harmful effects on the foetus. Promising results of light therapy (LT) in the treatment of depression during pregnancy were found earlier in two open studies with a few patients (Oren et al., 2002; Epperson et al., 2004). Methods: In this qualitative and quantitative study, the effects of light therapy on depression during pregnancy were examined on the short and long term (7 months). Seven patients (age 21–36 years; 14–31 weeks of pregnancy) suffering from depression, received light therapy during 3 weeks on a daily basis (09.00h) with an intensity of 10.000 lx for 30 min. Severity of the depression (QIDS-SR), severity of symptoms (SCL-90) and Quality of life (WHO-DAS, disability scale) were measured before and after treatment. Semi-structured interviews were performed before and 1 month after treatment with LT, recorded, and analysed by Kwalitan. Results: QIDS-SR, SCL-90, and WHO-DAS scores all showed a clear but nonsignificant reduction, probably due to the small number of patients. The qualitative analysis showed: a decrease of depressive complaints (52 to 12 respectively) after LT; Positive thoughts about motherhood (0–12); Negative thoughts about pregnancy (24–2); Complaints about anxiety (18–8); Level of energy (7–3); Irritability (9–4); Decrease of social contacts (13–3); Insomnia (7–1). All patients were very satisfied by receiving LT as an alternative treatment modality, were more talkative after LT. The results show a remarkable improvement on
Abstracts / Journal of Affective Disorders 107 (2008) S53–S122
positive thinking pattern and the emotional stance versus pregnancy. The improvement was reported from the second week of LT. Side effects were minimal and included nausea and headache during the first 2 weeks of treatment. Conclusion: LT in the treatment of depression during pregnancy is a safe and realistic alternative if medication is no option or not accepted by the patient. Keywords: Light therapy, Preganancy, Depression
S87
multivariate model. Additional information from predictors will be evaluated with a stepwise backward elimination method. Discussion: With this study we will present a clinical prognostic model that can easily be used in practice. When a clinician considers paroxetine for a specific patient with depressive disorder, our model could give insight into the prognosis for this patient. Keywords: Major depressive disorder, SSRI, Treatment response, Prognosis, Multivariate logistic regression
doi:10.1016/j.jad.2007.12.073 doi:10.1016/j.jad.2007.12.074
[P1.41] Prediction of response to paroxetine treatment in patients with a depressive disorder K.A. Wittkampf *, H.G. Ruhe, H.C. van Weert, J. Huyser, P.E. Bindels, A.H. Schene
[P1.42] Dimensional personality traits and treatment outcome in patients with major depressive disorder R.M. Bagby*,a,b, L.C. Quilty a,b, F. De Fruyt d, J.-P. Rolland e, S.H. Kennedy b,c, F. Rouillon e
University of Amsterdam, The Netherlands a
Introduction: Despite the introduction of different antidepressants, an unfavourable response to pharmacological intervention in the treatment of depression (MDD) occurs in 40–60% of the patients. The ability to select the most successful treatment and to predict the outcome of therapy for a patient would be of great value to both patients and physicians. The aim of this study is to investigate the prognostic value of a number of determinants for insufficient response to paroxetine treatment in patients with a depressive disorder. Methods: A set of predictors, based on a systematic review of prognostic factors in MDD, was collected in 107 primary care patients with MDD meeting DSM-IV criteria (assessed with the Structured Clinical Interview for DSMIV (SCID)), with Hamilton-scores (HDRS) of 19 and higher. These patients were openly treated with paroxetine for 6 weeks. After 6 weeks response was measured with Hamilton-scores. Response was defined as 50% decrease or more in Hamilton score compared to baseline. The following predictors will be analysed with multivariate logistic regression analysis: duration of the depressive episode, number of prior episodes, severity, psychiatric comorbidity, somatic comorbidity, social support, life events and Internal or External Locus of Control. After analysis a prognostic model will be constructed. Results: As the cohort was recently completed, we have not yet finished the analyses, which will be presented at the conference. We will first present univariate odds ratios per predictor with confidence intervals. Predictors with p = 0.1 in univariate models will be entered in a
Centre for Addiction & Mental Health, Canada University of Toronto, Canada c University Health Network, Canada d Ghent University, Belgium e Université de Paris, France b
Background: The aim of this study was to investigate the association between dimensional personality traits from the Five-Factor Model (FFM) and treatment outcome in patients with Major Depressive Disorder (MDD). Methods: Six hundred forty-nine outpatients with MDD participated in a multi-centre, randomised double-blind longitudinal study for 6 months. All patients received a combination of antidepressant medication and psychotherapy; they were randomised to medication condition (tianeptine or fluoxetine), and nonrandomly assigned to psychotherapy condition (supportive, cognitive-behavioural, or psychodynamic therapy). Patients were required to have a diagnosis of MDD based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. The Montgomery Asberg Depression Rating Scale was used to assess depression severity at pre- and post-treatment. The Système de Description en Cinq Dimensions was used to assess the personality domains of the FFM at pre-treatment. Results: Group comparisons revealed that patients who responded had lower Neuroticism (t = 4.22, p b .001), and higher Extraversion (t = 4.01, p b .001) and Openness to Experience (t = 3.57, p b .001) scores compared to non-responders. Regression analyses, which controlled
Abstracts / Journal of Affective Disorders 107 (2008) S53–S122
Chi square was used to determine difference in incidence of depression. Results: In a 12-month period, no significant difference in incidence of depression between the SC and CAU condition was found. But the overall relapse rate in both groups was low 25% indicating a bottom effect. Discussion: Preliminary findings do not favour stepped care over current clinical practice for the prevention of recurrence of depression in the elderly in terms of feasibility and effectiveness. Keywords: Depression, Elderly, Prevention
Conclusion: Light therapy might be considered a safe and viable alternative in the treatment of patients suffering from PMDD. CBT may play an important role in maintaining achieved gains. Keywords: Light therapy, PMDD, CBT doi:10.1016/j.jad.2007.12.072
[P1.40] Treating depression with light therapy during pregnancy
doi:10.1016/j.jad.2007.12.071
J. Haffmans*,a,b, M. Schoutena, L. den Hoeda a
[P1.39] The effects of light therapy and cognitive behavioral therapy in premenstrual dysphoric disorder (PMDD) J. Haffmans*,a,b, A. Richmonda, F. Landmana, M. Bloma a
Parnassia Bavo Group, The Netherlands Leiden University, The Netherlands
b
Introduction: Women may be at risk for biological clock desynchronisation, altered hormonal rhythms (e.g. during pregnancy, menstrual cycle, postpartum or following miscarriage or abortion, menopause) and subsequent for changes in mood. Premenstrual Dysphoric Disorder (PMDD) includes irritability, tension, loss of concentration, increased appetite, hypersomnia, low self-esteem and sensitivity to social rejection in the premenstrual week. Symptoms are comparable to atypical depression or depression NOS and seasonal Affective Disorder (SAD). The comparability of symptoms with SAD, urged us to use light therapy in the treatment of PMDD. Methods: Light therapy (10.000 lx 30') was applied periodically during the premenstrual week in 10 women. Results: A positive response was achieved in all women, as measured with the Symptom Check List, Quality of Life (Murphy et al., 2000), PMS list (Dutch Society of Obstetricians & Gynaecology). However, light therapy had to be reapplied during subsequent menstrual cycles, to maintain the significant decrease of symptoms. Subsequently, these women followed a CBT-group, in order to examine the effects of CBT on PMDD symptoms and to maintain the effects of light therapy on the long term and to create a ‘peer’ group.
Parnassia Bavo Group, The Netherlands Leiden University, The Netherlands
b
Introduction: Antidepressant medication has possible teratogenic effects, however a non-treated depression during pregnancy might also have harmful effects on the foetus. Promising results of light therapy (LT) in the treatment of depression during pregnancy were found earlier in two open studies with a few patients (Oren et al., 2002; Epperson et al., 2004). Methods: In this qualitative and quantitative study, the effects of light therapy on depression during pregnancy were examined on the short and long term (7 months). Seven patients (age 21–36 years; 14–31 weeks of pregnancy) suffering from depression, received light therapy during 3 weeks on a daily basis (09.00h) with an intensity of 10.000 lx for 30 min. Severity of the depression (QIDS-SR), severity of symptoms (SCL-90) and Quality of life (WHO-DAS, disability scale) were measured before and after treatment. Semi-structured interviews were performed before and 1 month after treatment with LT, recorded, and analysed by Kwalitan. Results: QIDS-SR, SCL-90, and WHO-DAS scores all showed a clear but nonsignificant reduction, probably due to the small number of patients. The qualitative analysis showed: a decrease of depressive complaints (52 to 12 respectively) after LT; Positive thoughts about motherhood (0–12); Negative thoughts about pregnancy (24–2); Complaints about anxiety (18–8); Level of energy (7–3); Irritability (9–4); Decrease of social contacts (13–3); Insomnia (7–1). All patients were very satisfied by receiving LT as an alternative treatment modality, were more talkative after LT. The results show a remarkable improvement on
Abstracts / Journal of Affective Disorders 107 (2008) S53–S122
positive thinking pattern and the emotional stance versus pregnancy. The improvement was reported from the second week of LT. Side effects were minimal and included nausea and headache during the first 2 weeks of treatment. Conclusion: LT in the treatment of depression during pregnancy is a safe and realistic alternative if medication is no option or not accepted by the patient. Keywords: Light therapy, Preganancy, Depression
S87
multivariate model. Additional information from predictors will be evaluated with a stepwise backward elimination method. Discussion: With this study we will present a clinical prognostic model that can easily be used in practice. When a clinician considers paroxetine for a specific patient with depressive disorder, our model could give insight into the prognosis for this patient. Keywords: Major depressive disorder, SSRI, Treatment response, Prognosis, Multivariate logistic regression
doi:10.1016/j.jad.2007.12.073 doi:10.1016/j.jad.2007.12.074
[P1.41] Prediction of response to paroxetine treatment in patients with a depressive disorder K.A. Wittkampf *, H.G. Ruhe, H.C. van Weert, J. Huyser, P.E. Bindels, A.H. Schene
[P1.42] Dimensional personality traits and treatment outcome in patients with major depressive disorder R.M. Bagby*,a,b, L.C. Quilty a,b, F. De Fruyt d, J.-P. Rolland e, S.H. Kennedy b,c, F. Rouillon e
University of Amsterdam, The Netherlands a
Introduction: Despite the introduction of different antidepressants, an unfavourable response to pharmacological intervention in the treatment of depression (MDD) occurs in 40–60% of the patients. The ability to select the most successful treatment and to predict the outcome of therapy for a patient would be of great value to both patients and physicians. The aim of this study is to investigate the prognostic value of a number of determinants for insufficient response to paroxetine treatment in patients with a depressive disorder. Methods: A set of predictors, based on a systematic review of prognostic factors in MDD, was collected in 107 primary care patients with MDD meeting DSM-IV criteria (assessed with the Structured Clinical Interview for DSMIV (SCID)), with Hamilton-scores (HDRS) of 19 and higher. These patients were openly treated with paroxetine for 6 weeks. After 6 weeks response was measured with Hamilton-scores. Response was defined as 50% decrease or more in Hamilton score compared to baseline. The following predictors will be analysed with multivariate logistic regression analysis: duration of the depressive episode, number of prior episodes, severity, psychiatric comorbidity, somatic comorbidity, social support, life events and Internal or External Locus of Control. After analysis a prognostic model will be constructed. Results: As the cohort was recently completed, we have not yet finished the analyses, which will be presented at the conference. We will first present univariate odds ratios per predictor with confidence intervals. Predictors with p = 0.1 in univariate models will be entered in a
Centre for Addiction & Mental Health, Canada University of Toronto, Canada c University Health Network, Canada d Ghent University, Belgium e Université de Paris, France b
Background: The aim of this study was to investigate the association between dimensional personality traits from the Five-Factor Model (FFM) and treatment outcome in patients with Major Depressive Disorder (MDD). Methods: Six hundred forty-nine outpatients with MDD participated in a multi-centre, randomised double-blind longitudinal study for 6 months. All patients received a combination of antidepressant medication and psychotherapy; they were randomised to medication condition (tianeptine or fluoxetine), and nonrandomly assigned to psychotherapy condition (supportive, cognitive-behavioural, or psychodynamic therapy). Patients were required to have a diagnosis of MDD based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. The Montgomery Asberg Depression Rating Scale was used to assess depression severity at pre- and post-treatment. The Système de Description en Cinq Dimensions was used to assess the personality domains of the FFM at pre-treatment. Results: Group comparisons revealed that patients who responded had lower Neuroticism (t = 4.22, p b .001), and higher Extraversion (t = 4.01, p b .001) and Openness to Experience (t = 3.57, p b .001) scores compared to non-responders. Regression analyses, which controlled