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Am J Psychiatry 1997; 154:934-940
Copyright © 1997 by American Psychiatric Association
Reversed neurovegetative symptoms of depression: a community study of Ontario
RD Levitan, A Lesage, SV Parikh, P Goering and SH Kennedy
Clarke Institute of Psychiatry, Toronto, Ont., Canada. levitanr@cs.clarke-inst.on.ca
OBJECTIVE: Most research on depression with reversed neurovegetative
features (hypersomnia, hyperphagia, and weight gain) has been based on
site-specific clinic-based samples. The goal of this study was to delineate
the epidemiology of reversed symptoms in a large community sample and to
use other symptom patterns for comparison. METHOD: Interviewers assessed
8,116 subjects across Ontario, aged 15-64 years, by using the World Health
Organization Composite International Diagnostic Interview. Individuals who
met the DSM-III-R criteria for major depression, current or lifetime, were
classified into four groups on the basis of lifetime neurovegetative
symptoms: episodes of typical symptoms only, episodes of reversed symptoms
only, neither type, or both types (fluctuating-symptom group). The groups
were compared on demographic characteristics, comorbidity, disability, and
health care utilization. RESULTS: Of the 653 individuals with lifetime
major depression, 11.3% had episodes of reversed symptoms only, and another
5.8% were classified as fluctuating. Most of the differences among the four
groups were due to the unique characteristics of the groups with neither
type of episode or a fluctuating pattern; individuals who had experienced
only reversed symptoms were remarkably similar to those who had had only
typical symptoms. The fluctuating-symptom group had high rates of
comorbidity, substance abuse, and health care utilization. CONCLUSIONS:
Several popular beliefs about depression with reversed features did not
hold true for this community sample. Identifying individuals who fluctuate
between reversed and typical episodes may be important in studies of major
depression, in particular when reversed neurovegetative symptoms are a
consideration.
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