Melancholia: definitions, risk factors, personality, neuroendocrine markers and differential antidepressant response.
OBJECTIVE
To evaluate the CORE measure of melancholia, against the DSM-IV construct of melancholia. To evaluate the validity of both the CORE and DSM-IV constructs of melancholia against psychosocial risk factors, anxiety and personality disorder comorbidity, neuroendocrine markers and differential anti depressant response to fluoxetine and nortriptyline.


METHODS
One hundred and ninety-five outpatients with major depression were evaluated for melancholia with both the DSM-IV criteria and the CORE evaluation. Both constructs were evaluated for validity against psychosocial risk factors, comorbidity, biological markers and differential antidepressant response.


RESULTS
The CORE measure has satisfactory interrater reliability when used dimensionally, but has unacceptably low agreement for making a categorical diagnosis of melancholia. There is remarkably poor agreement (kappa = 0.11) between the CORE and DSM-IV criteria for melancholia. Neither the DSM-IV nor CORE criteria for melancholia identified subgroups of patients with better childhood environments or less anxiety or personality disorder comorbidity. The CORE criteria for melancholia, but not DSM-IV, identified patients with neuroendocrine disturbance. CORE scores also were associated with differential responses to fluoxetine and nortriptyline, but not in anticipated directions. Thus, high CORE scores were associated with a higher recovery rate with fluoxetine than nortriptyline.


CONCLUSIONS
While the episode specifier of melancholia should be retained in diagnostic systems, the DSM-IV criteria were not validated against any of the variables examined in this study. The CORE construct of melancholia, was validated against neuroendocrine measures, and was associated with a differential antidepressant response. However, the limits imposed by interrater reliability,suggest the CORE measure should be used dimensionally and not to make a categorical diagnosis of melancholia.
Joyce
Peter R
PR
Department of Psychological Medicine, Christchurch School of Medicine and Health Sciences, New Zealand. peter.joyce@chmeds.ac.nz
Mulder
Roger T
RT
Luty
Suzanne E
SE
McKenzie
Janice M
JM
Sullivan
Patrick F
PF
Abbott
Robyn M
RM
Stevens
Isobel F
IF
D000367:Age Factors; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000097:blood / Q000188:drug therapy* / Q000523:psychology*; D005473:Fluoxetine / Q000627:therapeutic use*; D006801:Humans; D009661:Nortriptyline / Q000627:therapeutic use*; D010551:Personality / Q000187:drug effects*; D011569:Psychiatric Status Rating Scales; D011596:Psychomotor Disorders / Q000523:psychology; D015203:Reproducibility of Results; D012307:Risk Factors; D012737:Sex Factors
D018687:Antidepressive Agents, Second-Generation; D000929:Antidepressive Agents, Tricyclic; D005473:Fluoxetine; D009661:Nortriptyline