Differences in depressive symptom profile between males and females.

BACKGROUND: It is widely held that there are no differences in the symptom profile of male and female depression. Studies to date that have found differences have used different methodologies and had inconsistent findings. Here we compare the clinical profile of major depression for men and women from a sample of almost 600 well-characterized individuals with recurrent major depressive disorder (MDD). METHODS: Subjects were recruited as part of a large genetic-epidemiological study of MDD. Clinical assessments included semi-structured interviews and case-note review. Clinical profiles during 'worst ever' (WE) depressive episode were scored using the OPCRIT checklist. Profiles for 199 males were compared to 399 females. RESULTS: Females with depression tended to have an earlier age-at-onset (p<0.0001), exhibited more frequent depressive episodes (p<0.005), had a greater number of depressive symptoms (p<0.001), and reported much higher rates of atypical depressive features (p<0.007) during their WE episode of depression. Logistic regression analysis identified that earlier age-at-onset of depression, excessive self-reproach and diminished libido were the best predictors of female depression. LIMITATIONS: Retrospective recall by subjects of depressive symptoms, which may be prone to recall bias. CONCLUSIONS: There are differences in the clinical course and symptom profile of male and female depression. Further study is required to identify the biological correlates of these differences and to characterize their clinical importance.

Is depression severity the sole cause of psychotic symptoms during an episode of unipolar major depression? A study both between and within subjects.

BACKGROUND: Despite the common clinical assumption that psychosis is an indicator of severity in depression, it is not known what determines the presence of psychotic features in major depression. Our aim was to answer the question: Is depression severity the sole cause of psychotic symptoms during an episode of unipolar major depression? METHODS: In a sample of 585 patients from the UK, meeting criteria for both DSM-IV and ICD-10 major recurrent depression, we assessed measures of severity of depression and the presence of psychotic features, both within and between subjects. RESULTS: Within patients, psychotic episodes tended to be more severe than non-psychotic episodes. However, between patients there was wide variation in severity in both those that did, and did not, experience psychotic episodes. LIMITATIONS: We used retrospective interview information together with case note data. Our cases may not be typical of usual case loads because they were selected to avoid family history of bipolar illness or schizophrenia. CONCLUSIONS: Individuals with a predisposition to psychotic features tend to display such features during more severe episodes of depression. However, patients with no history of psychosis may experience non-psychotic depressive episodes of equal or greater severity, in terms of depressive symptomatology, compared to patients with psychotic depression. Thus, there is individual variation in susceptibility to psychosis during mood episodes and severity is not the sole determinant.