Clinical Subtypes of Depression Are Associated with Specific Metabolic Parameters and Circadian Endocrine Profiles in Women: The Power Study

Major depressive disorder (MDD) has been associated with adverse medical consequences, including cardiovascular disease and osteoporosis. Patients with MDD may be classified as having melancholic, atypical, or undifferentiated features. The goal of the present study was to assess whether these clinical subtypes of depression have different endocrine and metabolic features and consequently, varying medical outcomes.Premenopausal women, ages 21 to 45 years, with MDD (N = 89) and healthy controls (N = 44) were recruited for a prospective study of bone turnover. Women with MDD were classified as having melancholic (N = 51), atypical (N = 16), or undifferentiated (N = 22) features. Outcome measures included: metabolic parameters, body composition, bone mineral density (BMD), and 24 hourly sampling of plasma adrenocorticotropin (ACTH), cortisol, and leptin.Compared with control subjects, women with undifferentiated and atypical features of MDD exhibited greater BMI, waist/hip ratio, and whole body and abdominal fat mass. Women with undifferentiated MDD characteristics also had higher lipid and fasting glucose levels in addition to a greater prevalence of low BMD at the femoral neck compared to controls. Elevated ACTH levels were demonstrated in women with atypical features of depression, whereas higher mean 24-hour leptin levels were observed in the melancholic subgroup.Pre-menopausal women with various features of MDD exhibit metabolic, endocrine, and BMD features that may be associated with different health consequences.ClinicalTrials.gov NCT00006180

Continuity and Cascade in Offspring of Bipolar Parents: A Longitudinal Study of Externalizing, Internalizing, and Thought Problems

There is growing evidence that many offspring of bipolar parents will develop moderate to severe forms of psychopathology during childhood and adolescence. The purpose of this study was to apply growth curve models to evaluate developmental progression with regard to continuity and cascades representative within the context of a family risk study of bipolar disorder (BD). Repeated assessments of externalizing, internalizing, and thought problems, spanning more than a decade, were examined in a total of 94 offspring of parents with BD (O-BD), major depressive disorder (O-UNI), or no significant psychiatric or medical problems (O-WELL). Continuity was defined by the growth curve of the O-WELL group who exhibited low levels of problems from early childhood through late adolescence. Discontinuity, as evidenced by greater complexity of growth curves relative to the O-WELL group, was exhibited in the at- risk offspring groups for internalizing problems. Different patterns of developmental cascades were supported for the at-risk group with O-UNI showing a robust cascade from self-regulatory deficits (externalizing problems) to internalizing problems. There was also support for a cascade from self-regulatory deficits to thought problems across the entire group (with some support that this pattern was accounted for primarily by O-BD). This study not only serves to advance our understanding of the risks associated with a family history of BD, but also provides a novel approach to examining developmental cascades

Metabolic, body composition, and bone mineral density measures.

<p>Values are reported as mean ± SD or percent.</p><p>Sample size in parenthesis, unless otherwise indicated.</p><p>Significant comparisons, assessed as p≤.05 nominal value.</p>a<p>Atypical differs from control.</p>b<p>Melancholic differs from control.</p>c<p>Undifferentiated differs from control.</p

Demographic characteristics of depressive subtypes of women with unipolar MDD.

<p>Values are reported as mean ± SD or percent.</p><p>Sample size in parenthesis, unless otherwise indicated.</p><p>Significant comparisons, assessed as p≤.05 nominal value.</p><p><b>Overall</b>: overall test.</p>a<p>Atypical differs from control.</p>b<p>Undifferentiated differs from control.</p

Synopsis of significant findings in the three subtypes of depression vs. healthy controls.

<p>Synopsis of significant findings in the three subtypes of depression vs. healthy controls.</p

Circadian profiles of plasma ACTH, cortisol, and leptin.

<p>Circadian profiles of plasma ACTH, cortisol, and leptin.</p

Clinical characteristics of depressive subtypes of women with unipolar MDD.

<p>Values are reported as mean ± SD or percent.</p><p>Sample size in parenthesis, unless otherwise indicated.</p><p>Significant comparisons, assessed as p≤.05 nominal value.</p>b<p>Atypical differed from undifferentiated.</p