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Unpleasant taste — a neglected symptom in depression
Journal of Affective Disorders, 17 (1989) 291-293
291
Elsevier
JAD 00653
Short Communication
Unpleasant
taste -
a neglected symptom in depression
S.M. Miller ’ and G.J. Naylor ’ ’ Royal Dundee LiJJ Hosptal, LiJJ by Dundee, U.K. and ’ Unruersit_v of Dundee, Dundee, U.K. (Received 2 February 1989) (Revision received 27 February 1989) (Accepted 8 March 1989)
Summary Of 47 depressed patients, 19 reported the symptom of unpleasant taste. This symptom appeared unrelated to previous drug treatment. Also, in this study, there was no significant association with prognosis, severity or type of depression, or with various historical factors. Despite this, it would seem to be an underreported symptom, worthy of further investigation.
Key words:
Depression:
Symptomatology;
Taste
Introduction
other factors and prognosis.
As part of a clinical trial of a new antidepressant (Miller et al., 1988) we noted that many depressed patients reported the symptom of unpleasant taste on a baseline symptom checklist. The impression was of a relatively common symptom. There is, however, little literature on the subject, and it is not a symptom about which one enquires routinely whilst taking a standard psychiatric history. Despite this, the symptom is recognised: e.g., Henderson and Gillespie, in their Textbook of Psychiatry, describe ‘bad taste in the mouth’ as a symptom of simple depression. The present paper attempts to assess the incidence of this symptom and relate its occurrence to
Address for correspondence: Dr. SM. Miller, Senior Registrar, Royal Dundee Liff Hospital, Liff by Dundee. U.K. 0165-0327/89/$03.50
0 1989 Elsevier Science Publishers
such
as drug
treatment,
diagnosis
Method The patients were 50 consecutive referrals to the psychiatric out-patient clinic, aged 18-65 years, fulfilling Feighner’s criteria for the diagnosis of depression (Feighner et al., 1972) and also rating 17 or above on the Hamilton 21-item depression rating scale (Hamilton, 1960). Amongst those excluded were pregnant or lactating women, patients with severe co-existing disease and known abusers of alcohol or drugs. At initial assessment patients had been drugfree for 1 week apart from triazolam as hypnotic. A full psychiatric history was taken, and physical examination carried out. Questionnaires completed included: Newcastle Diagnostic Scale (Carney et al., 1965) Hamilton Depression Rating
B.V. (Biomedical
Division)
292
Scale (Hamilton, 1960) Beck Depression Inventory (Beck et al., 1961) Clinical Global Impressions (Guy, 1976), a Visual Analogue Scale and a Side Effects Symptom Checklist which included the symptom ‘unpleasant taste’. As part of the drug trial the patients were randomly allocated to placebo or active drug and were followed up over 4 weeks. Results
Of the initial 50 patients, three were unsuitable leaving 47 patients who entered the study. Of these 47, 19 reported the symptom of unpleasant taste (40%). Factors possibly relevant to the presence or absence of the symptom ‘unpleasant taste’ were compared. These included sex, age, menopausal status, presence of delusions, immediate previous antidepressant therapy (defined as antidepressant therapy within the previous 2 weeks), previous adequate trial of antidepressants, and family his-
TABLE
1
DISTRIBUTION OF RESULTS IN THOSE WITH AND THOSE WITHOUT THE SYMPTOM OF UNPLEASANT TASTE Unpleasant present Number Sex Female Male Age (years) Presence of delusions Postmenopausal Immediate previous antidepressant therapy Previous adequate trial of antidepressants Family history of depression Psychotic on Newcastle Agitation present on Hamilton scale Hamilton depression severity rating Beck depressive inventory score
taste
Unpleasant absent
19
28
12
20
43.1 f 12.05 6 6
41.7 i 12.94 6 8
8
12
9
16
9
17
6
8
24.8+
6.8
24.0+
3.2
27.1 f
8.2
26.0+
5.8
taste
tory of depressive illness. Using chi-square tests. no significant difference was identified. There was no difference in the proportion of patients reporting unpleasant taste in those scoring over 5 in the Newcaste scale (= psychotic) and in those scoring less than 5 (= neurotic). Similarly the symptom did not correlate with any item on the Hamilton scale (e.g., retardation, suicidal ideas, etc.) (see Table 1). Severity of depression was compared, using the four rating scales. Again no significant difference was detected (using Mann-Whitney L/-tests) (see Table 1). To assess the possibility of prognostic significance of the symptom of unpleasant taste, we examined the change in scores on the four assessment measures of depression (i.e., Hamilton, Beck, Visual Analogue, Global) over week 0 to week 4. Using analysis of variance there was no significant difference between those positive and negative for the symptom ‘unpleasant taste’. Neither was there any difference when the additional factor of placebo vs. active drug treatment was considered in the analysis. Similarly, change in the symptom did not correlate with other measures of improvement in depression. Discussion
The symptom of unpleasant taste appears to be common, being present in 40% of our patient group. It did not appear to be related to age, sex, menopausal status, previous antidepressant treatment, family history of depression or type of depression. Nor did it appear to be related to the severity of depression as rated on the four scales. Taken along with the result showing no relation between diagnosis and unpleasant taste, it would seem that the symptom is not helpful in attempting to categorise type of depression. The presence or absence of unpleasant taste at initial assessment does not seem to be predictive of recovery. Neither was loss of the symptom related to recovery. This contrasts interestingly with the work of Connelly et al. (personal communication) who found that in in-patient depressives ‘impaired taste sensation’, objectively tested. did seem to improve with recovery from depression.
293
Disorders of taste have largely been neglected in psychiatry but both impaired taste and altered/unpleasant taste do seem to occur. Impairment (or loss) of taste is more certain but still underinvestigated (Steiner et al., 1969). It would seem, however, that the two symptoms of impairment and abnormal taste may be separate. It is interesting to speculate on the nature of the symptom ‘unpleasant taste’. It certainly does not appear, from our results, to be merely the after-effects of previous drug treatment. It is possible that it may be secondary to other depressive symptoms, e.g., constipation and furred tongue or altered salivation. One might consider whether the symptom is organic or hallucinatory. Hallucinations of taste may occur as a result of lesions in the region of the uncus causing parageusia - a perversion of taste (Brain’s Clinical Neurology). However, the unpleasant taste in our patients did not occur predominantly in those with delusions, making it less likely to be a psychotic symptom. In conclusion, it seems worthy of comment that such a common symptom should be so underinvestigated. Yet, despite this frequency, we have not been able to attach any significance to it.
References Beck, A.T.. Ward, C.H., Mendelson, M., Mock, _I.and Erbaugh, J. (1961) An inventory for measuring depression. Arch. Gen. Psychiatry 4, 561-569. Brain’s Clinical Neurology, 5th edn. Revised by Roger Bannister. Oxford University Press. London, p. 70. Carney, M.W.P.. Roth, M. and Garside, R.F. (1965) The diagnosis of depressive syndromes and the prediction of E.C.T. response. Br. J. Psychiatry Ill, 659-674. Feighner. J., Robins, E., Guze, S., Woodruff. R.. Winokur. G. and Munoz, R. (1972) Diagnostic criteria for use in psychiatric research. Arch. Gen. Psychiatry 26, 57-63. Guy, W. (1976) ECDEU Assessment Manual for Psychopharmacology. U.S. Department of Health, Education and Welfare. NIMH, Bethesda, MD. Hamilton. M. (1960) A rating scale for depression. J. Neural. Neurosurg. Psychiatry 23, 56-62. Henderson and Gillespie Textbook of Psychiatry, 10th edn. (1969). Revised by Ivor Batchlor. Oxford University Press, London, p, 224. Miller, SM.. Naylor. G.J., Murtagh, M. and Winslow. G. (1988) A double blind comparison of paroxetine and placebo in the treatment of depressed patients in a psychiatric out-patient clinic. Proceedings of Paroxetine Symposium. Rome. Steiner, J.E., Rosenthol-Zifroni, A. and Edelstein, E.G. (1969) Taste perception in depressive illness. Israeli Ann. Psychiatry Rel. Disc. 7, 223-232.
291
Elsevier
JAD 00653
Short Communication
Unpleasant
taste -
a neglected symptom in depression
S.M. Miller ’ and G.J. Naylor ’ ’ Royal Dundee LiJJ Hosptal, LiJJ by Dundee, U.K. and ’ Unruersit_v of Dundee, Dundee, U.K. (Received 2 February 1989) (Revision received 27 February 1989) (Accepted 8 March 1989)
Summary Of 47 depressed patients, 19 reported the symptom of unpleasant taste. This symptom appeared unrelated to previous drug treatment. Also, in this study, there was no significant association with prognosis, severity or type of depression, or with various historical factors. Despite this, it would seem to be an underreported symptom, worthy of further investigation.
Key words:
Depression:
Symptomatology;
Taste
Introduction
other factors and prognosis.
As part of a clinical trial of a new antidepressant (Miller et al., 1988) we noted that many depressed patients reported the symptom of unpleasant taste on a baseline symptom checklist. The impression was of a relatively common symptom. There is, however, little literature on the subject, and it is not a symptom about which one enquires routinely whilst taking a standard psychiatric history. Despite this, the symptom is recognised: e.g., Henderson and Gillespie, in their Textbook of Psychiatry, describe ‘bad taste in the mouth’ as a symptom of simple depression. The present paper attempts to assess the incidence of this symptom and relate its occurrence to
Address for correspondence: Dr. SM. Miller, Senior Registrar, Royal Dundee Liff Hospital, Liff by Dundee. U.K. 0165-0327/89/$03.50
0 1989 Elsevier Science Publishers
such
as drug
treatment,
diagnosis
Method The patients were 50 consecutive referrals to the psychiatric out-patient clinic, aged 18-65 years, fulfilling Feighner’s criteria for the diagnosis of depression (Feighner et al., 1972) and also rating 17 or above on the Hamilton 21-item depression rating scale (Hamilton, 1960). Amongst those excluded were pregnant or lactating women, patients with severe co-existing disease and known abusers of alcohol or drugs. At initial assessment patients had been drugfree for 1 week apart from triazolam as hypnotic. A full psychiatric history was taken, and physical examination carried out. Questionnaires completed included: Newcastle Diagnostic Scale (Carney et al., 1965) Hamilton Depression Rating
B.V. (Biomedical
Division)
292
Scale (Hamilton, 1960) Beck Depression Inventory (Beck et al., 1961) Clinical Global Impressions (Guy, 1976), a Visual Analogue Scale and a Side Effects Symptom Checklist which included the symptom ‘unpleasant taste’. As part of the drug trial the patients were randomly allocated to placebo or active drug and were followed up over 4 weeks. Results
Of the initial 50 patients, three were unsuitable leaving 47 patients who entered the study. Of these 47, 19 reported the symptom of unpleasant taste (40%). Factors possibly relevant to the presence or absence of the symptom ‘unpleasant taste’ were compared. These included sex, age, menopausal status, presence of delusions, immediate previous antidepressant therapy (defined as antidepressant therapy within the previous 2 weeks), previous adequate trial of antidepressants, and family his-
TABLE
1
DISTRIBUTION OF RESULTS IN THOSE WITH AND THOSE WITHOUT THE SYMPTOM OF UNPLEASANT TASTE Unpleasant present Number Sex Female Male Age (years) Presence of delusions Postmenopausal Immediate previous antidepressant therapy Previous adequate trial of antidepressants Family history of depression Psychotic on Newcastle Agitation present on Hamilton scale Hamilton depression severity rating Beck depressive inventory score
taste
Unpleasant absent
19
28
12
20
43.1 f 12.05 6 6
41.7 i 12.94 6 8
8
12
9
16
9
17
6
8
24.8+
6.8
24.0+
3.2
27.1 f
8.2
26.0+
5.8
taste
tory of depressive illness. Using chi-square tests. no significant difference was identified. There was no difference in the proportion of patients reporting unpleasant taste in those scoring over 5 in the Newcaste scale (= psychotic) and in those scoring less than 5 (= neurotic). Similarly the symptom did not correlate with any item on the Hamilton scale (e.g., retardation, suicidal ideas, etc.) (see Table 1). Severity of depression was compared, using the four rating scales. Again no significant difference was detected (using Mann-Whitney L/-tests) (see Table 1). To assess the possibility of prognostic significance of the symptom of unpleasant taste, we examined the change in scores on the four assessment measures of depression (i.e., Hamilton, Beck, Visual Analogue, Global) over week 0 to week 4. Using analysis of variance there was no significant difference between those positive and negative for the symptom ‘unpleasant taste’. Neither was there any difference when the additional factor of placebo vs. active drug treatment was considered in the analysis. Similarly, change in the symptom did not correlate with other measures of improvement in depression. Discussion
The symptom of unpleasant taste appears to be common, being present in 40% of our patient group. It did not appear to be related to age, sex, menopausal status, previous antidepressant treatment, family history of depression or type of depression. Nor did it appear to be related to the severity of depression as rated on the four scales. Taken along with the result showing no relation between diagnosis and unpleasant taste, it would seem that the symptom is not helpful in attempting to categorise type of depression. The presence or absence of unpleasant taste at initial assessment does not seem to be predictive of recovery. Neither was loss of the symptom related to recovery. This contrasts interestingly with the work of Connelly et al. (personal communication) who found that in in-patient depressives ‘impaired taste sensation’, objectively tested. did seem to improve with recovery from depression.
293
Disorders of taste have largely been neglected in psychiatry but both impaired taste and altered/unpleasant taste do seem to occur. Impairment (or loss) of taste is more certain but still underinvestigated (Steiner et al., 1969). It would seem, however, that the two symptoms of impairment and abnormal taste may be separate. It is interesting to speculate on the nature of the symptom ‘unpleasant taste’. It certainly does not appear, from our results, to be merely the after-effects of previous drug treatment. It is possible that it may be secondary to other depressive symptoms, e.g., constipation and furred tongue or altered salivation. One might consider whether the symptom is organic or hallucinatory. Hallucinations of taste may occur as a result of lesions in the region of the uncus causing parageusia - a perversion of taste (Brain’s Clinical Neurology). However, the unpleasant taste in our patients did not occur predominantly in those with delusions, making it less likely to be a psychotic symptom. In conclusion, it seems worthy of comment that such a common symptom should be so underinvestigated. Yet, despite this frequency, we have not been able to attach any significance to it.
References Beck, A.T.. Ward, C.H., Mendelson, M., Mock, _I.and Erbaugh, J. (1961) An inventory for measuring depression. Arch. Gen. Psychiatry 4, 561-569. Brain’s Clinical Neurology, 5th edn. Revised by Roger Bannister. Oxford University Press. London, p. 70. Carney, M.W.P.. Roth, M. and Garside, R.F. (1965) The diagnosis of depressive syndromes and the prediction of E.C.T. response. Br. J. Psychiatry Ill, 659-674. Feighner. J., Robins, E., Guze, S., Woodruff. R.. Winokur. G. and Munoz, R. (1972) Diagnostic criteria for use in psychiatric research. Arch. Gen. Psychiatry 26, 57-63. Guy, W. (1976) ECDEU Assessment Manual for Psychopharmacology. U.S. Department of Health, Education and Welfare. NIMH, Bethesda, MD. Hamilton. M. (1960) A rating scale for depression. J. Neural. Neurosurg. Psychiatry 23, 56-62. Henderson and Gillespie Textbook of Psychiatry, 10th edn. (1969). Revised by Ivor Batchlor. Oxford University Press, London, p, 224. Miller, SM.. Naylor. G.J., Murtagh, M. and Winslow. G. (1988) A double blind comparison of paroxetine and placebo in the treatment of depressed patients in a psychiatric out-patient clinic. Proceedings of Paroxetine Symposium. Rome. Steiner, J.E., Rosenthol-Zifroni, A. and Edelstein, E.G. (1969) Taste perception in depressive illness. Israeli Ann. Psychiatry Rel. Disc. 7, 223-232.