Diagnosis and Classification Subtyping of Depressive Disorders: Comparison of Three Methods

4 OZET: Depresif bozukluklar›n alttiplendirmesi: Uc yontemin karfl›laflt›r›lmas› Amac: Melankolik ve melankolik olmayan depresyon, dep- resyonun s›n›fland›r›lmas›nda belki de en yayg›n kabul go- ren ayr›m noktas›d›r. Bu cal›flman›n amac› depresyonun be- lirti, fliddet ve biyolojik tabanl› s›n›flamalar›n› karfl›laflt›r- makt›r. Yontem: Depresyon tan›s› alm›fl 78 hastadan oluflan ornek- lemde ilk olarak SCID-I'in 14 depresif belirtisi kullan›larak kume analizi yap›lm›flt›r. ‹kinci olarak biyolojik tabanl› s›n›f- lama icin DST (deksametazon supresyon testi) sonuclar› ve son olarak da fliddet ac›s›ndan HDRS (Hamilton Depresyon Derecelendirme Olcei) puanlar›na gore (yuksek ve dufluk fliddet gruplar›) grupland›r›lm›fllard›r. Bu gruplar biyolojik deiflkenler (tiroid stimule edici hormon -TSH, bazal ve deksametazon sonras› kortizol duzeyleri), klinik (yafl, bafl- lang›c yafl›, depresyon fliddeti, psikososyal stresorler, kiflilik bozukluu) ve demografik deiflkenler ac›s›ndan karfl›laflt›- r›lm›flt›r. Bulgular: DSM-IV'e gore melankoli tan›s› alm›fl grubun ku- me analizi sonucu endojen grup olarak belirlenmifl grupla yuksek derecede uygunluk gosterdii belirlendi. Kume analizine gore endojen depresyon olarak tan›mlanan gru- bun yafl ortalamas›n›n daha yuksek, klinik ac›dan depres- yon derecesinin daha fliddetli ve bazal kortizol duzeylerinin daha yuksek olduklar› bulundu. HDRS puanlar›na gore da- ha ciddi depresyonu olan grubun TSH duzeyleri daha du- fluk bulundu. DST (deksametazon supresyon testi) kortizol yan›t› bask›lanmam›fl hastalarda aile oykusunde daha fazla depresif bozukluk olan bireyler olduu saptand›. Sonuc: Cal›flmam›z›n sonucu endojen veya melankolik depresyonun farkl› klinik ve biyolojik ozelliklere sahip oldu- ¤u hipotezini k›smen dorulamaktad›r. ABSTRACT: Diagnosis and classification subtyping of depressive disorders: comparison of three methods Objective: Melancholic versus non-melancholic depression dichotomy is perhaps the most widely accepted distinction in categorization of depression. This research aims to compare symptom based, severity based, and biology based categorization of depression. Methods: To achieve this, the cluster analysis was performed on a sample of 78 depressed patients, f›rst by using 14 SCID-I depressive symptoms. Patients were clustered again with regard to post dexhametasone cortisol levels (suppressed vs non-suppressed groups), and lastly according to HDRS (Hamilton Depression Rating Sacale) scores (high vs low severity groups). Biological (thyroid stimulating hormone -TSH, basal and post dexhametasone cortisol levels), clinical (age, age of onset, severity of depression, psychosocial stressors, and personality disorder) and demographic variables of these categories were compared. Results: There was a high degree of accordance between the cluster analytically derived endogenous group and the DSM-IV diagnosis of melancholia. Cluster analytically generated endogenous group were older, more severely depressed, and had higher basal cortisol levels than non- endogenous depressive subtype. Severely depressed group according to HDRS scores had lower TSH levels. Only DST (dexamethasone suppression test) non-suppressive patients had more depressive disorders in their family. Conclusions: The results of our study partly support the hypothesis that endogenous and melancholic depression have distinct clinical and biological features.