Depression: Stage KB

Sorensen L, Nielsen B, Stage KB, Brøsen K, Damkier P. · Amgros I/S, Dampfaergevej 22, København Ø, Denmark. · Nord J Psychiatry. · Pubmed #18622885 No free full text.

Abstract: The objective of the study was to develop, implement and evaluate two treatment algorithms for schizophrenia and depression at a psychiatric hospital department. The treatment algorithms were based on available literature and developed in collaboration between psychiatrists, clinical pharmacologists and a clinical pharmacist. The treatment algorithms were introduced at a meeting for all psychiatrists, reinforced by the project psychiatrists in the daily routine and used for educational purposes of young doctors and medical students. A quantitative pre-post evaluation was conducted using data from medical charts, and qualitative information was collected by interviews. In general, no significant differences were found when comparing outcomes from 104 charts from the baseline period with 96 charts from the post-intervention period. Most of the patients (65% in the post-intervention period) admitted during the data collection periods did not receive any medication changes. Of the patients undergoing medication changes in the post-intervention period, 56% followed the algorithms, and 70% of the patients admitted to the psychiatric hospital department for the first time had their medications changed according to the algorithms. All of the 10 interviewed doctors found the algorithms useful. The treatment algorithms were successfully implemented with a high degree of satisfaction among the interviewed doctors. The majority of patients admitted to the psychiatric hospital department for the first time had their medications changed according to the algorithms.

Stage KB, Kristoffersen J, Sørensen CH. · Odense Universitetshospital, Psykiatrisk Afdeling P, Odense C. · Ugeskr Laeger. · Pubmed #18078647 No free full text.

This publication has no abstract.

Stage KB, Middelboe T, Stage TB, Sørensen CH. · Department of Psychiatry, Odense University Hospital, Denmark. · Int J Chron Obstruct Pulmon Dis. · Pubmed #18046868 links to  free full text

Abstract: Depression is common in COPD patients. Around 40% are affected by severe depressive symptoms or clinical depression. It is not easy to diagnose depression in COPD patients because of overlapping symptoms between COPD and depression. However, the six-item Hamilton Depression Subscale appears to be a useful screening tool. Quality of life is strongly impaired in COPD patients and patients' quality of life emerges to be more correlated with the presence of depressive symptoms than with the severity of COPD. Nortriptyline and imipramine are effective in the treatment of depression, but little is known about the usefulness of newer antidepressants. In patients with milder depression, pulmonary rehabilitation as well as cognitive-behavioral therapy are effective. Little is known about the long-term outcome in COPD patients with co-morbid depression. Preliminary data suggest that co-morbid depression may be an independent protector for mortality.

Nielsen RE, Stage KB, Christensen PM, Mortensen S, Andersen LL, Damkier P. · Odense Universitetshospital, Psykiatrisk Afdeling, Odense C. · Ugeskr Laeger. · Pubmed #17484841 No free full text.

Abstract: Medical treatment of depression during pregnancy and breastfeeding often involves concern by both the patient and the doctor because of the fear of adverse reactions or malformations of the child. This article gives an updated review on how antidepressants, lithium, antipsychotics and ECT can be used during pregnancy and breastfeeding, and presents a treatment algorithm which is used at Odense University Hospital.

Mikkelsen RL, Middelboe T, Pisinger C, Stage KB. · Psychiatric Center Gentofte, Niels Andersens, Hellerup, Denmark. · Nord J Psychiatry. · Pubmed #14985157 No free full text.

Abstract: A review of the literature revealed high comorbidity of chronic obstructive pulmonary disease (COPD) and states of anxiety and depression, indicative of excess, psychiatric morbidity in COPD. The existing studies point to a prevalence of clinical significant symptoms of depression and anxiety amounting to around 50%. The prevalence of panic disorder and major depression in COPD patients is correspondingly markedly increased compared to the general population. Pathogenetic mechanisms remain unclear but both psychological and organic factors seem to play a role. The clinical and social implications are severe and the concurrent psychiatric disorders may lead to increased morbidity and impaired quality of life. Furthermore, the risk of missing the proper diagnosis and treatment of a concurrent psychiatric complication is evident when COPD patients are treated in medical clinics. Until now only few intervention studies have been conducted, but results suggest that treatment of concurrent psychiatric disorder leads to improvement in the physical as well as the psychological state of the patient. Panic anxiety as well as generalized anxiety in COPD patients is most safely treated with newer antidepressants. Depression is treated with antidepressants according to usual clinical guidelines. There is a need for further intervention studies to determine the overall effect of antidepressants in the treatment of anxiety and depression in this group of patients.

Hildebrandt MG, Steyerberg EW, Stage KB, Passchier J, Kragh-Soerensen P, Anonymous00255. · Department of Psycchiatry, Center for Depression Research, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense C, the Netherlands. · Am J Psychiatry. · Pubmed #12944340 links to  free full text

Abstract: OBJECTIVE: Gender differences in antidepressant treatment response, side effects, dropout rates, and plasma concentrations were examined in patients with major and predominantly melancholic depression. METHOD: The study included a subgroup of 292 inpatients (96 men, 196 women) from three Danish double-blind, randomized, controlled trials. All patients completed a 5-week treatment period and fulfilled the DSM-III or DSM-III-R criteria for major depression. Clomipramine (150 mg/day) was the reference treatment, and comparable treatments were citalopram (40 mg/day), paroxetine (30 mg/day), and moclobemide (400 mg/day). Assessments were performed by using the 17-item Hamilton Depression Rating Scale and the Udvalg for Kliniske Undersøgelser Side Effect Rating Scale. In a subgroup of 110 patients, weekly measurements of clomipramine plasma concentrations were obtained. Nonparametric statistical tests and multiple linear and logistic regression models were used for statistical evaluations. RESULTS: Both genders had similar remission rates (Hamilton depression scale score <8) when treated with clomipramine and had significantly higher remission rates with clomipramine than with the comparable treatments. The plasma concentrations of clomipramine were significantly higher for female than for male patients. No gender differences were found in posttreatment Hamilton depression scale scores, nor did the therapeutic effects of treatment depend on gender. Rates of dropout and side effects were similar for men and women. No relationship between plasma concentrations, gender, and therapeutic outcome was found. CONCLUSIONS: In a group of patients with major and predominantly melancholic depression, differentiation according to gender was not important in treatment with common antidepressants. Women appeared to have higher plasma concentrations of tricyclic antidepressants than men. The consequences of this difference for clinical effects are unclear. Gender-specific recommendations for dosing of tricyclic antidepressants may be considered.

Hansen PE, Wang AG, Stage KB, Kragh-Sorensen P, Anonymous00202. · Department of Psychiatry, Psychiatric Hospital in Aarhus, Aarhus University Hospital, Aarhus, Denmark. · Acta Psychiatr Scand. · Pubmed #12752020 No free full text.

Abstract: OBJECTIVE: To identify psychopathological predictors for suicide in a population of major depressed Diagnostic Statistical Manual-III (DSM-III) in-patients. METHOD: A total of 210 previous participants in multicentre antidepressant drug trials, carried out in a randomized double-blind design, were followed prospectively through a maximum of 10 years. Patients with a drug or alcohol abuse were excluded. The association between suicide and the pretreatment psychopathological profile was analysed using survival statistics. RESULTS: The suicide rate for non-melancholic depressed patients was significantly higher than for melancholic depressed patients. Comorbid personality disorder was independently associated with an increased suicide rate [relative hazard 3.41(CI: 1.15-10.10)]. CONCLUSION: The study indicates that the non-melancholic aspect of depression, and especially comorbid personality disorder, is associated with an increased suicidal vulnerability.

Kristoffersen J, Sørensen CH, Nielsen CT, Stage KB. · Psykiatrisk Afdeling P, Odense Universitetshospital, DK-5000 Odense C. · Ugeskr Laeger. · Pubmed #19014722 No free full text.

Abstract: Psychotic depression is frequent among hospitalized patients diagnosed with major depression. Patients diagnosed with this type of depression display a number of specific characteristics. They have a higher risk of suicidal behaviour, they have a prolonged and more severe clinical picture and subsequently they have an increased risk of relapse. Studies show that monotherapy with antidepressants is more effective than antipsychotic monotherapy. Electroconvulsive therapy remains the most effective treatment, while tricyclic antidepressants in monotherapy are also effective. An antipsychotic drug can be added if no effect of monotherapeutic antidepressant treatment is observed within two to four weeks.

Sørensen CH, Stage KB. · Odense Universitetshospital, Psykiatrisk Afdeling, Odense C. · Ugeskr Laeger. · Pubmed #17484849 No free full text.

Abstract: Depression is an independent risk factor for ischemic heart disease and is related to increased cardiovascular mortality. Post myocardial infarction depression is related to less compliance with medical treatment, less participation in cardiac rehabilitation, less modification of life style factors and increased mortality. So far, routine treatment with selective serotonin re-uptake inhibitors is not warranted as the evidence is insufficient. Improved cooperation between general practice, cardiologists and psychiatrists is necessary in order to identify and treat this group of patients.

Stage KB, Sørensen CH. · Odense Universitetshospital, Psykiatrisk Afdeling P, Odense C. · Ugeskr Laeger. · Pubmed #17484839 No free full text.

Abstract: Depression is one of the most economically burdensome diseases with serious consequences for patients as well as their families. Many depressed patients are not treated because they neither contact a doctor nor are diagnosed correctly. Today, it is generally accepted that depression is not just one disease but is composed of subgroups, each requiring its own specific treatment. In mild to moderate depression SSRIs or other newer antidepressants can be used but in cases of severe melancholic or psychotic depression TCAs or ECT are the treatments of choice.

Sørensen J, Stage KB, Damsbo N, Le Lay A, Hemels ME. · CAST - Centre for Applied Health Services Research and Technology Assessment, University of Southern Denmark. J. B. Winsløws Vej 9B, Odense C, DK-5000, Denmark. · Nord J Psychiatry. · Pubmed #17454724 No free full text.

Abstract: The objective of this study was to model the cost-effectiveness of escitalopram in comparison with generic citalopram and venlafaxine in primary care treatment of major depressive disorder (baseline scores 22-40 on the Montgomery-Asberg Depression Rating Scale, MADRS) in Denmark. A three-path decision analytic model with a 6-month horizon was used. All patients started at the primary care path and were referred to outpatient or inpatient secondary care in the case of insufficient response to treatment. Model inputs included drug-specific probabilities derived from systematic literature review, ad-hoc survey and expert opinion. Main outcome measures were remission defined as MADRS < or = 12 and treatment costs. Analyses were conducted from healthcare system and societal perspectives. The human capital approach was used to estimate societal cost of lost productivity. Costs were reported in 2004 DDK. The expected overall 6-month remission rate was higher for escitalopram (64.1%) than citalopram (58.9%). From both perspectives, the total expected cost per successfully treated patient was lower for escitalopram (DKK 22,323 healthcare, DKK 72,399 societal) than for citalopram (DKK 25,778 healthcare, DKK 87,786 societal). Remission rates and costs were similar for escitalopram and venlafaxine. Robustness of the findings was verified in multivariate sensitivity analyses. For patients in primary care, escitalopram appears to be a cost-effective alternative to (generic) citalopram, with greater clinical benefit and cost-savings, and similar in cost-effectiveness to venlafaxine.

Stage KB, Anonymous00169. · Department of Psychiatry, Odense University Hospital, DK-5000, Odense C, Denmark. · Nord J Psychiatry. · Pubmed #16195134 No free full text.

Abstract: From a clinical point of view, orthostatic hypotension is a significant side effect during antidepressant treatment, particularly in the case of tricyclic antidepressants (TCAs). This prospective, randomized clinical trial evaluated the effects of clomipramine and moclobemide on orthostatic blood pressure during treatment for depression. One hundred and fifteen depressed inpatients, age up to 70 years, were randomized to treatment with either moclobemide (400 mg/day) or clomipramine (150 mg/day) after 1 week of placebo treatment. Orthostatic blood pressure was measured weekly over the 6-week study period. Clomipramine, but not moclobemide, caused a statistically significant fall in systolic (F = 9.37, P = 0.0037) and diastolic orthostatic blood pressure (F = 3.74, P = 0.0017). In the clomipramine-treated group of patients, we found no correlation between subjective complaints of orthostatic dizziness and the size of systolic orthostatic blood pressure. In conclusion, this study indicates that moclobemide does not induce orthostatic side effects, which is a significant problem in treatment with TCAs. However, the choice of antidepressants depends on other factors as well, e.g. the therapeutic efficacy.

Stage KB, Middelboe T, Pisinger C. · Department of Psychiatry, Odense University Hospital, Odense C, Denmark. · Acta Psychiatr Scand. · Pubmed #15740469 No free full text.

Abstract: OBJECTIVE: To determine if the presence of depression in patients suffering from chronic obstructive pulmonary disease (COPD) would have an independent impact on mortality. METHOD: Prospective evaluation of the impact of depression according to the ICD-10 criteria for depression. Cox proportional hazards regression was used to evaluate the independent impact of depression after controlling for significant univariate clinical predictors in the data set. Consenting out-patients (n = 49) who meet the criteria for COPD between September 1997 and September 1998. There were no age limits (range: 53-90 years). The sample was 67% female. Survival status at follow-up after a mean of 803 days was measured. RESULTS: At follow-up, 16 patients had died. Depression significantly reduced the mortality risk at follow-up (hazard ratio, 0.30; 95% confidence interval, 0.10-0.93; P = 0.037). The impact of depression remained after control for forced expiratory volume during the first second (FEV1), the only multivariate significant predictor of mortality in the data set (hazard ratio, 0.27; 95% confidence interval, 0.09-0.84; P = 0.024). CONCLUSION: Depression in out-patients suffering from COPD appears to be an independent protector for mortality. Additional studies in larger samples are needed to replicate this finding and to determine possible underlying pathogenetic mechanisms.

Stage KB, Casier P, Trosko O. · Odense Universitetshospital, Psykiatrisk Afdeling P. · Ugeskr Laeger. · Pubmed #15101118 No free full text.

This publication has no abstract.

Hildebrandt MG, Stage KB, Kragh-Soerensen P, Anonymous00384. · Department of Psychiatry, Centre for Depression Research, University of Southern Denmark, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense C, Denmark. · Psychopathology. · Pubmed #14504455 No free full text.

Abstract: BACKGROUND: Studies of gender differences in the clinical presentation of depression have provided divergent results. This study aimed at analyzing gender differences in severity, symptomatology and distribution of melancholia in major depression. SAMPLING AND METHODS: The study comprised 930 in- and out-patients (652 women, 278 men) from 6 randomized controlled trials. All patients fulfilled DSM-III or DSM-III-R criteria for major depression. The 17-item Hamilton Depression Scale (HDS) was applied to all patients. A multi-axial evaluation was completed using the Newcastle 1 Depression Rating Scale from 1965 for melancholia (N1) in a subsample of patients (n = 439). A factor analysis on the HDS was performed. Non-parametric statistical tests were used and only gender differences greater than 20% were considered clinically relevant. RESULTS: The median on the HDS total score was 22 and the median number of symptoms was 13 for both men and women. Presentation of specific symptoms was similar for men and women. The factor analysis revealed no gender differences, and neither did analyses on symptoms of Axes II and IV. According to the N1, 80% of the men and 66% of the women suffered from melancholic depression (p = 0.004). CONCLUSIONS: In a large and broad sample of in- and out-patients with major depression, the severity and symptomatology of depression were similar for men and women. Melancholic depression was significantly more frequent among male than female patients. Inclusion and exclusion criteria in the randomized controlled trials provided a selected group of patients, which limited the generalisability of the results to an exclusive subgroup of patients treated for depression in routine clinical practice.

Stage KB, Middelboe T, Pisinger C. · Department of Psychiatry, Odense University Hospital, Denmark. · Nord J Psychiatry. · Pubmed #12888404 No free full text.

Abstract: OBJECTIVE: To estimate the validity of the Hamilton Depression Scale (HDS) in a population of patients with chronic obstructive pulmonary disease (COPD). METHODS: Forty-nine patients with moderate to severe COPD were examined using the ICD-10 criteria for depression. The mean age of the patients was 71 years and 33 (64%) were women. Forty-six (94%) of the patients were also evaluated using the 17-item HDS including the six-item Hamilton Depression subscale (HDSS). Internal and external validity were measured using factor analysis, Cronbach Coefficient alpha, Loevinger coefficient of homogeneity, correlation analysis and ROC-curves. RESULTS: Twenty-three (47%) of the patients were depressed according to the ICD-10 criteria for depression. The HDSS but not the HDS showed a good internal validity. An acceptable external validity was furthermore shown for the HDSS. CONCLUSION: The HDSS can be recommended as a suitable depression rating scale for COPD patients.

Hildebrandt MG, Stage KB, Kragh-Soerensen P. · University of Southern Denmark, Odense, Denmark. · Acta Psychiatr Scand. · Pubmed #12580826 No free full text.

Abstract: OBJECTIVE: Gender differences in severity and symptomatology of depression in a large and representative sample of depressive patients from general practice were examined. METHOD: During a 2-year study period, 31 Danish general practitioners consecutively assessed patients, aged >18, for depression. A total of 1033 patients (692 female, 341 male) fulfilled ICD-10 criteria for depressive disorders. Gender differences were examined with regard to severity and symptomatology of depression. RESULTS: The severity of depression was similar for men and women with the following distribution: 22% mild, 56% moderate and 23% severe depressive episodes. The mean number of symptoms presented was 6.6 of 10 for both genders. There were no gender differences in prevalence of single depressive symptoms. CONCLUSION: No gender differences in the severity or symptomatology of depression were found in a highly representative sample of patients with depressive disorders.

Stage KB, Kragh-Sørensen PB, Anonymous00167. · Department of Psychiatry, Bispebjerg University Hospital, Copenhagen, Denmark. · Acta Psychiatr Scand. · Pubmed #12086226 No free full text.

Abstract: OBJECTIVE: The aim of this study was to determine whether age itself is a significant factor in predicting adverse drug reactions in depressed inpatients treated with clomipramine. METHOD: The study involved 150 hospitalized, depressed patients treated with 150 mg clomipramine per day. Changes in orthostatic blood pressure during treatment as well as the patients' complaint about side-effects was examined with regard to age. The sample was divided into younger (<56) and older (56-70) groups. RESULTS: No significant differences between younger and older subjects were found on any of the 44 side-effects recorded. However, older depressed patients suffer from more pronounced orthostatic hypotension than younger patients. CONCLUSION: Older depressed patients who have been treated with clomipramine suffer from more severe orthostatic hypotension than younger patients. However, with the right precautions it is safe to treat older patient up to the age of 70 years with a tricyclic antidepressant.

Pedersen SH, Stage KB, Bertelsen A, Grinsted P, Kragh-Sørensen P, Sørensen T. · Department of Psychiatry, Odense University Hospital, DK-5000 Odense C, Odense, Denmark. · J Affect Disord. · Pubmed #11356244 No free full text.

Abstract: BACKGROUND: The rate of recognition of depressive disorder in general practice is reported to be low. Current classification systems, i.e. ICD-10 and DSM-III-R, and DSM-IV with operational diagnostic criteria, have led to greater agreement concerning the diagnosis of depressive disorder. The aim of this study was to assess the applicability and validity of the ICD-10 criteria for depression in general practice in Denmark. METHODS: After a 1-day training course in the ICD-10 criteria for depression, ten general practitioners, during an 8-week period assessed all patients aged 18 or older for depressive symptoms in accordance with the ICD-10 criteria. RESULTS: Among a total of 3505 consultations, 116 patients (3.3%) met the criteria for a depressive episode. Of these, 80 (68.8%) accepted to be reinterviewed by a psychiatrist, who confirmed the diagnosis of depressive disorder in 57 of the 80 patients (71.3%). LIMITATIONS: The number of 'false negative' cases are unknown in the study. CONCLUSION: The ICD-10 criteria for depression seem to be appropriate and valid in general practice.

Stage KB, Bech P, Kragh-Sørensen P, Nair NP, Katona C. · Department of Psychiatry, Odense University Hospital, DK-5000, C, Odense, Denmark. · J Affect Disord. · Pubmed #11313090 No free full text.

Abstract: BACKGROUND: Depression is the most prevalent psychiatric disorder in the elderly and several studies indicate that 10-15% of persons over 65 years suffer from significant depressive symptoms. Despite the high prevalence, most cases of depression in the elderly remain unrecognized and untreated, maybe because of a different pattern of symptoms across age groups. The objective of the study was to compare symptomatology and diagnostic profile between younger and elderly DSM-III and DSM-III-R major depressed inpatients and to advise an appropriate depression scale for the elderly. METHODS: The study covers 461 depressed inpatients evaluated with the Hamilton Depression Scale and the Newcastle 1965 Scale. To find differences between younger and elderly patients, the symptomatology was analyzed stepwise by principal component analyses, latent structure analyses and single item analyses. RESULTS: No clinically significant differences in symptomatology between younger and elderly depressed patients were found. The DSM-IV concept of Major Depression and the ICD-10 criteria for depression was not influenced by patients' age. LIMITATIONS: All patients were hospitalized and mainly endogenously depressed and generalization of the results to other populations should be made with caution. Only pretreatment data was analyzed. CONCLUSIONS: The DSM-IV concept of Major Depression and the ICD-10 criteria for depression can be used without modification for age.