Is mirtazapine augmentation effective for patients with obsessive-compulsive disorder who failed to respond to sertraline monotherapy? A placebo-controlled, double-blind, clinical trial.

Mirtazapine upsurges serotonergic activity by a mechanism different from reuptake inhibition. Our aim is to assess the efficacy of mirtazapine augmentation for patients with obsessive-compulsive disorder (OCD) who did not respond to sertraline monotherapy. Sixty-one patients suffering from OCD who were resistant to sertraline monotherapy were randomly allocated to receive mirtazapine (mean dosage = 39.56 mg/day) or placebo plus their current anti-OCD treatment (sertraline: average dose = 251.37 mg/day and 255.10 mg/day in the mirtazapine and placebo groups, respectively; P = 0.871). The primary outcome was OCD symptom severity as measured by Yale-Brown Obsessive-Compulsive Scale (YBOCS). Forty-five patients (22 in the mirtazapine group and 23 in the placebo group) completed the trial. Average YBOCS score decreased in the mirtazapine group from 27.14 ± 8.05 at baseline to 11.13 ± 4.27 at week 12. In the placebo group, average YBOCS score declined from 28.15 ± 3.27 at baseline to 18.94 ± 3.88 at week 12. Nine patients (40.90%) in the mirtazapine group and only one patient (4.34%) in the placebo group revealed at least a 35% decrease in YBOCS ( P < 0.000). We found that mirtazapine adds to the effect of sertraline in improving obsessive and compulsive symptoms in OCD patients.

Psychopathology in Elderly COVID-19 Survivors and Controls.

BACKGROUND: The highly infectious and pathogenic coronavirus-19 (COVID-19) has emerged to cause a global pandemic. In this cross-sectional comparative study, our objective is to compare the depression and anxiety symptoms in elderly COVID-19 survivors with a control group. METHOD: 69 elderly COVID-19 survivors (age 65 or older) within 2 weeks post-discharge were assessed for anxiety and depression symptoms by a package of self-rating scales (Geriatric Anxiety Scale-10 (GAS-10), Geriatric Depression Scale-15 (GDS-15) and General Health Questionar-28 (GHQ-28)). Their scores were compared with a group of aged-matched residents without COVID-19 in their community. RESULTS: The mean scores on GAS-10, GDS-15 and GHQ-28 in the COVID-19 survivors group and control group were 12.06 vs. 6.53 (p < .001), 12.48 vs. 5.73 (p < .001), 52.7 vs. 29.8 (p < .001), respectively. All of the COVID-19 survivors and 60% of the controls had scores in the pathological range of GHQ-28 scale. A total of 93.2% of COVID-19 survivors revealed anxiety symptoms in GAS-10 scale. This rate was 60% in the control group. A total of 86.6% of COVID-19 survivors compared to 46.6% of the controls reported symptoms of depression in GDS-15 scale. CONCLUSION: The rate of depression and anxiety symptoms in elderly COVID-19 survivors and controls found to be high during the pandemic. However, COVID-19 survivors significantly suffered more.

Is quetiapine effective for obsessive and compulsive symptoms in patients with bipolar disorder? A randomized, double-blind, placebo-controlled clinical trial.

BACKGROUND: The aim of this study is to examine the effects of quetiapine as an adjuvant treatment for obsessive-compulsive (OC) symptoms in patients with bipolar disorder (BD) type I. METHODS: In this 8-week double-blind placebo-controlled randomized clinical trial, 47 patients with BD in euthymic phase that had OC symptoms were randomly allocated to receive either quetiapine or placebo plus their routine medications (lithium + clonazepam). Yale-Brown Obsessive-Compulsive Scale (YBOCS) was used to assess the outcomes. Adverse effects were also recorded. RESULTS: Of 47 BD patients with OC symptoms that were randomly allocated in two groups of quetiapine (n = 24) and placebo group (n = 23), 40 patients (20 in quetiapine group and 20 in placebo group) completed the trial. Throughout the trial, the mean score of YBOCS in the quetiapine group dropped from 24.37 ± 1.51 to 15.26 ± 1.16 (P < .001) and in the placebo group decreased from 24.21 ± 1.33 to 23.94 ± 1.66 (P = 1.97). At the end of the study, 12 (60%) patients in the quetiapine group and 1 (5%) patient in the placebo group had more than 34% decline in YBOCS score (P < .001). No serious adverse effects were reported in two groups. CONCLUSIONS: Our double-blind placebo-controlled clinical trial showed that quetiapine may be an effective adjuvant agent for reducing OC symptoms in BD patients.

Effects of COVID-19 pandemic and lockdown on mental health of Iranian people.

INTRODUCTION: The highly contagious novel coronavirus disease 2019 (COVID-19) emerged recently as a global pandemic. An efficient way to mitigate the spread of the disease is lockdown and quarantine. OBJECTIVE: This study aimed to evaluate the Iranian population's mental health under lockdown during the COVID-19 pandemic. MATERIAL AND METHODS: The General Health Questionnaire-28 (GHQ-28) was utilized to assess the mental health and psychosocial wellbeing of Iranian residents through an online survey. The questionnaire was sent on April 3, 2020, and remained open to responses until April 10, 2020. This period was the time of complete lockdown in Iran. Inclusion criteria included either gender, reading Farsi, internet access, and being between the ages of 18 and 65. Respondents with scores ≥ 24 were classified as having psychiatric problems. RESULTS: Of 35,529 completed surveys, 28,790 were eligible for analysis. 73.4% of the respondents were female. The majority of the participants were between the ages of 26 to 45. Of the participants, 35.5% had scores in the pathological range. We found that females, younger residents, singles, and individuals with lower education had higher levels of psychopathology. CONCLUSIONS: Our study suggests that the psychological impacts of the COVID-19 pandemic and quarantine are wide-ranging, substantial, and can be long-lasting.

Is Sitagliptin Effective for Modulating Metabolic Disturbances Associated With Olanzapine in Schizophrenia Patients? A Double-blind Placebo-controlled Clinical Trial.

PURPOSE/BACKGROUND: The mortality rate of patients with schizophrenia due to metabolic disturbances is high. Our aim is to survey the effects of sitagliptin on metabolic disturbances associated with olanzapine in patients with schizophrenia. METHODS/PROCEDURES: In this 12-week double-blind placebo-controlled clinical trial, 71 patients taking olanzapine (10 to 30 mg) for at least 1 month were randomly allocated to enter 1 of the 2 treatment groups (olanzapine plus placebo or olanzapine plus sitagliptin). Sitagliptin was added to patients 'current medications with the dose of 100 mg/d. Physical examinations and measurement of anthropometric (body mass index and waist circumference) and laboratory parameters (fasting blood sugar, glycated hemoglobin, total cholesterol, low-density lipoprotein, high-density lipoprotein, and triglyceride) were measured at baseline, week 4, and week 12. The patients were assessed for any side effects of the medications in each visit. FINDINGS/RESULTS: Sixty-one patients (30 in the sitagliptin and 31 in the placebo group) completed the trial. The anthropometric measurements at the end of the study did not differ between the 2 groups. glycated hemoglobin and total cholesterol were significantly lower in the sitagliptin group after 12 weeks. Other metabolic profile revealed either no change or minimal magnitude changes. No major side effect was reported. IMPLICATIONS/CONCLUSIONS: Metabolic disturbances associated with olanzapine treatment in patients with schizophrenia can be modulated by sitagliptin.

Mental Health Patient Portals Aimed at Depression: A Picture Close to Reality.

Patient portals can have positive consequences in the empowerment of people with depression by raising awareness about their condition. Patient portals are important yet challenging technologies in the field of mental health care. We conducted a scoping review aiming to investigate some important characteristics and features of the mental health websites and related patient portal services for the target audience including people with depression. For this purpose, two reviewers independently entered the keywords in the popular search engines including Google, Yahoo, and Bing in April 2019, in order to find mental health websites that provide patient portal service targeting depression. Examination of the inclusion and exclusion criteria led finally to the selection of 31 websites. We found out that some features of patient portals including the online questionnaires, messaging between the patient and the healthcare provider, and medication refill were more consistent with the areas on which the mental healthcare providers focus, and thus can be effective in improving the progression of these areas. It is essential for patient portal providers to put more focus on expressing the patient portal's features and objectives on their websites. Besides, it is also necessary to conduct further research to investigate the obstacles and facilitators of the interactive features of the patient portals in the field of mental health care, particularly depression.

Pregabalin augmentation for resistant obsessive-compulsive disorder: a double-blind placebo-controlled clinical trial.

BACKGROUND AND OBJECTIVE: Glutamate dysfunction has been shown to be associated with pathophysiology of obsessive-compulsive disorder (OCD). Our objective is to survey the effects of pregabalin (a glutamate-modulating agent) as an augmenting treatment for resistant OCD. PATIENTS AND METHODS: In this 12-week double-blind placebo-controlled clinical trial, 56 patients with resistant OCD were randomly allocated to receive either pregabalin or placebo plus their current medication (sertraline). Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was used to evaluate the outcomes. Adverse effects were also registered. RESULTS: Of the 56 patients with resistant OCD who were randomly allocated in 2 groups of pregabalin (n = 28) and placebo group (n = 28), 42 patients (22 in pregabalin group and 20 in placebo group) completed the trial. Throughout the trial, the mean score decreased from 26.13± 7.03 to 8.81 ± 3.47 in the pregabalin group (p < 0) and from 26.85 ± 4.34 to 17.63 ± 4.22 in the placebo group (p < 0). At the end of trial, 16 (57.14%) patients in the pregabalin group and 2 (7.14%) patients in the placebo group showed more than 35% decline in YBOCS (p < .01). The pregabalin group showed good tolerability and safety. CONCLUSIONS: Our study revealed that pregabalin, as an augmenting medication, is more effective than placebo in the treatment of patients with resistant OCD.

Fluvoxamine combination therapy with tropisetron for obsessive-compulsive disorder patients: A placebo-controlled, randomized clinical trial.

BACKGROUND: About 50% of obsessive-compulsive disorder patients still suffer significant symptoms even after the recommended first-line therapy. This demonstrates the necessity to investigate strategies to improve alleviation of symptoms. OBJECTIVE: The main objective of this study was to investigate the efficacy of a 5-hydroxytryptophan 3 receptor antagonist, tropisetron, as an adjuvant therapy to selective serotonin reuptake inhibitors, in ameliorating obsessive-compulsive disorder symptoms. METHODS: Men and women between the ages of 18-60 years diagnosed with obsessive-compulsive disorder, based on DSM5, who had a Yale-Brown obsessive compulsive scale score of more than 21 were recruited in a double-blinded, parallel-group, placebo-controlled, clinical trial of 10 weeks to receive either tropisetron (5 mg twice daily) and fluvoxamine (100 mg daily initially followed by 200 mg daily after week 4) or placebo and fluvoxamine. The primary outcome of interest in this study was the Yale-Brown obsessive compulsive scale total score decrease from baseline. RESULTS: One hundred and eight participants were equally randomized into two groups; 48 participants in each group finished the trial. The Yale-Brown obsessive compulsive total score significantly dropped in both groups while the tropisetron group participants experienced a significantly higher decrease in their scores (Greenhouse-Geisser F(1.53-65.87)=3.516, p-value=0.04). No major adverse effect was observed in any of the groups. CONCLUSION: This trial showed a significant efficacy for tropisetron over placebo in treatment of obsessive-compulsive disorder symptoms when added to fluvoxamine.

Aripiprazole as an adjuvant treatment for obsessive and compulsive symptoms in manic phase of bipolar disorder: A randomized, double-blind, placebo-controlled clinical trial.

BACKGROUND AND OBJECTIVE: Our Objective is to study the effects of aripiprazole as an adjuvant treatment for obsessive and compulsive (OC) symptoms in patients with bipolar disorder (BD) type I, manic phase. PATIENTS AND METHODS: In this 8-week, double-blind, placebo-controlled randomized clinical trial, 56 patients with BD who had OC symptoms were randomly allocated to receive aripiprazole or placebo plus their routine medication regimen (lithium + clonazepam). Yale Brown obsessive compulsive behavior scale (YBOCS) was administered to evaluate the outcomes. Adverse effects were also registered. RESULTS: Of 56 BD patients with OC symptoms which were randomly allocated in two groups of aripiprazole (n = 29) and placebo group (n = 27), 46 patients (23 in aripiprazole group and 23 in placebo group) completed the trial. Throughout the trial, the mean score of YBOCS in the aripiprazole group decreased from 21 ±â€¯4.81 to 9.6 ±â€¯2.2 (P < 0.001) and in the placebo group dropped from 20.46 ±â€¯4.8 to 17.32 ±â€¯3.7 (P < 0.001). At the end of the study, 21 (91.30%) patients in the aripiprazole group and 1 (4.34%) patient in the placebo group had >34% decline in YBOCS score (P < 0.01). No serious adverse effects were reported in any groups. CONCLUSIONS: The results of our study revealed that aripiprazole can be used as an effective adjuvant agent for treatment of obsessive and compulsive symptoms in manic patients.

Comparing escitaloipram with sertraline for obsessive and compulsive symptoms in patients with obsessive compulsive disorder: A comparative double blind clinical trial.

BACKGROUND: Escitalopram has some unique features among selective serotonin reuptake inhibitors. The aim of this survey is to compare the efficacy of escitalopram with sertraline on obsessive and compulsive symptoms in patients with Obsessive Compulsive Disorder (OCD). METHODS: In this 12-week double blind controlled randomized clinical trial, 57 patients with OCD were randomly allocated to receive escitalopram or sertraline. Yale Brown obsessive compulsive behavior scale (YBOCS) was used to assess the outcomes. Adverse effects were also recorded. RESULTS: 41 patients (20 in the escitalopram group and 21 in the sertraline group) completed the trial. In the escitalopram group 15 (70%) patients and in the sertraline group 16 (76.19%) patients showed more than 34% decrease in mean YBOCS score at the end of the trial (P=0.531). The two groups revealed significant decrease in YBOCS scores without significant difference (P=0.861) at week 12. No serious adverse effects were reported. CONCLUSIONS: Our results demonstrated that escitalopram is as effective as sertraline in treatment of obsessions and compulsions in patients with OCD. However, it needs to be noted that our study is preliminary and larger double blind controlled studies are needed to confirm the results.

Memantine as an Adjuvant Treatment for Obsessive Compulsive Symptoms in Manic Phase of Bipolar Disorder: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial.

PURPOSE/BACKGROUND: The aim of this study is to examine the effects of memantine as an adjuvant treatment for obsessive compulsive (OC) symptoms in patients with bipolar disorder (BD) type I, manic phase. METHODS/PROCEDURES: In this 16-week double-blind placebo-controlled randomized clinical trial, 58 patients in the manic phase of BD who had OC symptoms were randomly allocated to receive memantine or placebo plus their routine medications (lithium + olanzapine + clonazepam). The Yale Brown Obsessive Compulsive Behavior Scale was used to assess the outcomes. Adverse effects were also recorded. FINDINGS/RESULTS: Thirty-eight patients (19 in the memantine group and 19 in the placebo group) completed the trial. Throughout the trial, the mean score decreased from 20.26 ± 5.91 to 9.73 ± 5.44 in the memantine group (P < 0.000) and from 22.89 ± 5.70 to 16.63 ± 4.00 in the placebo group (P < 0.000). At the end of the study, 15 (78.94%) patients in the memantine group and 7 (36.84%) patients in the placebo group demonstrated more than 34% decline in the Yale Brown Obsessive Compulsive Behavior Scale score (P < 0.01). No serious adverse effects were reported. IMPLICATIONS/CONCLUSIONS: Our double-blind controlled clinical trial showed that memantine is an effective adjuvant agent for reducing OC symptoms in patients with BD. However, it needs to be noted that our study is preliminary, and larger double-blind controlled studies are needed to confirm the results.

Duloxetine Augmentation in Resistant Obsessive-Compulsive Disorder: A Double-Blind Controlled Clinical Trial.

INTRODUCTION: The aim of this study is to evaluate the efficacy of duloxetine augmentation in treatment of resistant obsessive-compulsive disorder (OCD). METHODS: This augmentation trial was designed as an 8-week randomized controlled, double-blind study. Forty-six patients experiencing OCD who had failed to respond to at least 12 weeks of treatment with a selective serotonin reuptake inhibitor (fluoxetine, citalopram, or fluvoxamine) were randomly allocated to receive duloxetine or sertraline plus their current anti-OCD treatment. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was the primary outcome measure. Treatment response was defined as 25% or more decrease in scores of Y-BOCS. The mean dosage of duloxetine was 44.4 mg/d (range, 20-60 mg/d), and the mean dosage of sertraline was 123.8 mg/d (range, 50-200 mg/d). RESULTS: Forty-six patients (24 of 30 in duloxetine group and 22 of 27 in sertraline group) completed the trial. Both groups showed improvement during the 8-week study period (mean Y-BOCS total score at week 8 as compared with baseline: P < 0.001 & P < 0.001) without significant difference (P = 0.861). Those receiving duloxetine plus their initial medications experienced a mean decrease of 33.0% in Y-BOCS score, and the patients with sertraline added to their initial medication experienced a mean decrease of 34.5% in Y-BOCS. DISCUSSION: Our double-blind controlled clinical trial showed duloxetine to be as effective as sertraline in reducing obsessive and compulsive symptoms in patients with resistant OCD. However, it needs to be noted that our study is preliminary, and larger double-blind placebo-controlled studies are necessary to confirm the results.

Comparing the Effects of Sertraline with Duloxetine for Depression Severity and Symptoms: A Double-Blind, Randomized Controlled Trial.

BACKGROUND AND OBJECTIVE: Selecting the most effective treatment for major depressive disorder (MDD) is a challenge for clinicians. The aim of this study was to compare the effects of sertraline with duloxetine on major depression signs and symptoms. METHODS: The trial was a 6-week, randomized, controlled, double-blind study. Sixty-three patients with diagnosis of MDD according to DSM-IV-TR criteria were randomly assigned to receive either duloxetine (31 patients) or sertraline (32 patients). The mean dosage of duloxetine was 55 mg/day (range 40-60 mg/day) and the mean dosage of sertraline was 146 mg/day (range 50-200 mg/day). Subjects were assessed at baseline, and at the end of week 6. Depression severity and symptoms were assessed by 21-item Hamilton Depression Rating Scale (HAM-D). RESULTS: Of 63 patients who were randomized to treatment, 54 patients including 28 in the sertraline group and 26 in the duloxetine group completed the trial. The HAM-D total score for both groups was significantly reduced at the end of the trial period without significant difference from each other (p = 0.463). Of the symptoms studied, psychomotor retardation, general somatic symptoms and sexual problems improved more in the duloxetine group. On the other hand, agitation, anxiety symptoms and hypochondriasis ameliorated better in the sertraline group. There was no difference between the two groups regarding the other symptoms. CONCLUSIONS: Our study shows that the antidepressant mechanism of action has influence on its effects on different signs and symptoms. Clinician awareness of an antidepressant's special effects can help in selecting appropriate medicine.

Study the effects of saffron on depression and lipid profiles: A double blind comparative study.

UNLABELLED: Depression is a one of the most prevalent psychiatric disorder. Despite several pharmacological treatments, still treating depression is a challenge. Herbal medicine that is better culturally accepted may play an important role in treatment of depression. In this double blind placebo controlled clinical trial, 40 patients that were suffering from major depression according to DSM-IV criteria were randomly allocated to take either fluoxetine and saffron (20 patients) or fluoxetine and placebo (20 patients). The patients of the two groups were evaluated with Beck depression scale at the beginning of the study and after four weeks. Lipid profile (total Triglyceride (TG) level, total cholesterol level, low density lipoprotein (LDL) level and high density lipoprotein (HDL) level) of the patients also was measured at the beginning and end of the trial. 30 patients (19 in saffron group and 11 in placebo group) completed the study. The two groups improved significantly in depression severity at the end of the study without significant difference (P: 0.560). The lipid profile of the two groups did not change significantly. Our study did not demonstrate antidepressive effects for saffron. We did not observe any lipid lowering effect in saffron group too. Of note is that our study is preliminary and larger studies with more patients and longer duration are needed to prove our results. CLINICAL TRIAL REGISTRATION NUMBER: IRCT 2013110915334.

Comparing Gabapentin with Clonazepam for Residual Sleeping Problems following Antidepressant Therapy in Patients with Major Depressive Disorder: A Randomized Clinical Trial.

BACKGROUND AND OBJECTIVE: Residual sleeping disturbances after improvement of depression in major depressed patients are associated with more functional problems, increased relapses and more risk of becoming resistant to treatment. The aim of this study was to compare the efficacy of gabapentin with clonazepam for treating residual sleeping disturbances. METHODS: This comparative trial was designed as a randomized, controlled, double-blind study. Sixty-three patients with a DSM-IV diagnosis of major depressive disorder (MDD) who had been treated with one of the selective serotonin reuptake inhibitors (SSRIs; fluoxetine, citalopram or sertraline) were included in the study. The patients' depression had improved [Hamilton Depression Rating Scale (HDRS) <10] but they were complaining of sleeping problems [Pittsburgh Sleep Quality Index (PSQI) >5; Insomnia Severity Index (ISI) >8]. Patients were randomized to receive a flexible dose of gabapentin (100-600 mg/day) or clonazepam (0.5-2 mg/day) beside their current antidepressant medication for a period of 4 weeks. Outcome measures were PSQI, ISI and Clinical Global Impression (CGI). RESULTS: Our results demonstrated that similar to the clonazepam group, sleeping problems improved significantly in the gabapentin group at the end of the trial (PSQI: P = 0.001, Z = 3.549; ISI: P = 0.001, Z = 3.347). The two groups did not show a significant difference in treating residual sleep disturbances (PSQI: P = 0.234, Z = 1.432; ISI: P = 0.456, Z = 1.347). CONCLUSION: This study revealed that gabapentin is comparable to clonazepam for treating sleeping problems associated with major depression.

Topiramate augmentation in patients with resistant major depressive disorder: a double-blind placebo-controlled clinical trial.

BACKGROUND: Despite evolution of new antidepressant treatment, clinicians still encounter challenges in the treatment of depressed patients. Looking for new medications that can potentiate the effects of current antidepressants seems to be necessary. Our objective is to survey the efficacy of topiramate augmentation in resistant major depressive disorder (MDD). METHOD: This augmentation trial was designed as an 8-week randomized, placebo-controlled, double-blind study. Fifty three patients with DSM-IV diagnosis of MDD who had failed to respond to at least 8 weeks of treatment with an adequate dose of one of the SSRIs (fluoxetine, citalopram or serteraline) were included in the study. Patients were randomized to receive a flexible dose of topiramate (100-200 mg/day) or placebo beside their current antidepressant medication for a period of eight weeks. Outcome measures were Hamilton Depression Scale (HAM-D) and Clinical Global Impression (CGI). RESULTS: 42 patients completed the study and there were 6 and 5 dropouts in topiramate and placebo groups, respectively. The topiramate group demonstrated significant improvement over the study period based on mean HAM-D score at week 8 compared to baseline (P = .000, Z = 3.699). Those receiving topiramate demonstrated to have a mean decrease of 32.0% in HAM-D score, compared to only 5.5% for those receiving placebo. Depressed mood, suicidality, insomnia (early, middle and late), agitation and anxiety symptoms were significantly improved in the topiramate group. CONCLUSION: Our double-blind placebo-controlled study demonstrated that topiramate augmentation potentiate the efficacy of selective serotonin reuptake inhibitors (SSRIs) in treatment of resistant major depressive disorder. Of note is that our study is preliminary and larger double-blind studies are needed to confirm the results.

Clinical characteristics of patients with major depressive disorder with and without hypothyroidism: a comparative study.

INTRODUCTION: Differentiating major depressive disorder (MDD) without hypothyroidism from MDD associated with hypothyroidism can be challenging. Therefore some authors have suggested that thyroid function should be tested in all depressed patients. This study compared the clinical characteristics of patients with MDD associated with hypothyroidism with those of patients with MDD without hypothyroidism. METHOD: Thyroid function tests were administered to 75 patients (60 female and 15 male) who met DSM-IV criteria for MDD. The 15 patients with hypothyroidism (8 with subclinical hypothyroidism and 7 with overt hypothyroidism) were compared with the other 60 patients with regard to depressive characteristics. The primary measure of depressive signs and symptoms used to assess depression severity and symptoms was the Hamilton Rating Scale for Depression, first 17 items (Ham-D-17). Baseline demographic data, including age and sex, were also compared. RESULT: The two groups did not differ significantly in severity of overall depression at baseline, as measured by total score on the Ham-D-17 (P=0.471, Z=0.970). Patients with MDD without hypothyroidism had worse scores on item 1 (depressed mood), item 2 (feelings of guilt), item 3 (suicidality), item 6 (late insomnia), and item 16 (loss of weight). In contrast, depressed patients with hypothyroidism had more severe anxiety symptoms and greater agitation (items 9, 10, and 11). CONCLUSION: Our results may help clinicians differentiate MDD associated with hypothyroidism from MDD without hypothyroidism. Depressed patients with hypothyroidism had more anxiety symptoms and greater agitation, but they had fewer severe core depressive symptoms and biological signs of MDD. (Journal of Psychiatric Practice. 2011;17:67-71).