RxPG News : Depression

Does Dad's stress affect his unborn children?

Sat, 03 Sep 2011 23:00:00 PST

( from http://www.rxpgnews.com ) According to the results of a new study in Elsevier's Biological Psychiatry, it seems the answer may be "yes, but it's complicated".

The risk of developing depression, which is significantly increased by exposure to chronic stress, is influenced by both environment and genetics. The interplay of these two factors is quite complex, but in fact, there is even a third factor that most of us know nothing about – epigenetics. Epigenetics is the science of changes in genetic expression that are not caused by actual changes in DNA sequencing. It is these mechanisms that have been the recent focus of intergenerational investigations into the transmission of stress vulnerability.

Inheritance is complex. We've all known that mothers and fathers have tremendous influence on their children, but "this study highlights how complicated the relationship between genetic, epigenetic, and environmental contributions can be with regards to the inheritance of important behavioural traits," commented Dr. John Krystal, editor of Biological Psychiatry.

Most work to date has focused on maternal effects. In this fascinating new study, researchers investigated paternal effects instead, and found that male mice exposed to chronic stress pass those stress behaviours along to their offspring. Both their male and female offspring showed increased depression and anxiety-like behaviours, although the effects were stronger in males. Importantly, these behavioural changes were only present in offspring produced through natural reproduction, and not in those offspring that were produced via in vitro fertilization. That interesting twist suggests that most stress-related vulnerabilities are transmitted to subsequent generations behaviourally, rather than epigenetically.

"This type of translational animal work is important to help scientists focus their work in humans", explained lead author Dr. Eric Nestler, from Mount Sinai School of Medicine in New York. "These findings in mice raise the possibility that part of an individual's risk for clinical depression or other stress-related disorders may be determined by his or her father's life exposure to stress, a provocative suggestion that now requires direct study in humans."

Unhealthy eating leads to increased depression

Thu, 27 Jan 2011 06:47:30 PST

( from http://www.rxpgnews.com ) Researchers from the universities of Navarra and Las Palmas de Gran Canaria have demonstrated that the ingestion of trans-fats and saturated fats increase the risk of suffering depression, and that olive oil, on the other hand, protects against this mental illness.

They have confirmed this after studying 12,059 SUN Project volunteers over the course of six years; the volunteers had their diet, lifestyle and ailments analyzed at the beginning of the project, over its course and at the end of the project. In this way the researchers confirmed that despite the fact that at the beginning of the study none of the volunteers suffered from depression, at the end of the study 657 new cases had been detected.

Of all these cases, the participants with an elevated consumption of trans-fats (fats present in artificial form in industrially-produced pastries and fast food, and naturally present in certain whole milk products) "presented up to a 48% increase in the risk of depression when they were compared to participants who did not consume these fats," affirmed Almudena Sánchez-Villegas, Associate Professor of Preventive Medicine at the University of Las Palmas de Gran Canaria, first author of the article.

In addition, the study demonstrated a dose-response relationship, "whereby the more trans-fats were consumed, the greater the harmful effect they produced in the volunteers," the expert stated.

Furthermore, the team, directed by Miguel Ángel Martínez-González, Professor of Preventive Medicine at the University of Navarra, also analyzed the influence of polyunsaturated fats (abundant in fish and vegetable oils) and of olive oil on the occurrence of depression. "In fact, we discovered that this type of healthier fats, together with olive oil, are associated with a lower risk of suffering depression," emphasized the researcher and director of the SUN Project.

150 million persons depressed worldwide

Thus, the results of the study corroborate the hypothesis of a greater incidence of the disease in countries of the north of Europe compared to the countries of the south, where a Mediterranean dietary pattern prevails. Nevertheless, experts have noted that the incidence of the disease has increased in recent years, so that today some 150 million persons are affected worldwide, where it is the principal cause of loss of years of life in those countries with a medium-to-high per capita income.

This due, according to Almudena Sánchez Villegas, "to radical changes in the sources of fats consumed in Western diets, where we have substituted certain types of beneficial fats—polyunsaturated and monounsaturated in nuts, vegetable oils and fish—for the saturated and trans-fats found in meats, butter and other products such as mass-produced pastries and fast food".

In addition, the research—published in the online peer reviewed journal PLoS ONE—has been performed on a population with a low average intake of trans-fats, given that it made up only 0.4% of the total energy ingested by the volunteers. "Despite this, we observed an increase in the risk of suffering depression of nearly 50%. On this basis," concluded Miguel A. Martínez, "we derive the importance of taking this effect into account in countries like the U.S., where the percentage of energy derived from these foots is around 2.5%".

Finally, the analysis, headed by the University of Navarra and the University of Las Palmas de Gran Canaria, suggests that both depression as well as cardiovascular disease are influenced in a similar manner by diet, and might share similar mechanisms in their origin. This hypothesis is further suggested by numerous studies that indicate the harmful effect of trans-fats and saturated fats on the risk of cardiovascular disease.

Online CBT is Effective in Depression & Panic Disorders: RCT

Wed, 14 Apr 2010 11:58:28 PST

( from http://www.rxpgnews.com ) The online Cognitive Behaviour Therapy is as effective in treating panic disorder and depression as the traditional group-based method, a new study has found.

'Internet-based CBT is also more cost-effective than group therapy,' said Jan Bergstrom, a researcher with the Center for Psychiatry Research at the Swedish medical university Karolinska Institute.

'The results therefore support the introduction of internet treatment into regular psychiatry, which is also what the National Board of Health and Welfare recommends in its new guidelines for the treatment of depression and anxiety,' Bergstrom said.

It is estimated that depression affects some 15 percent and panic disorder 4 percent of all people during their lifetime.

Depression can include symptoms such as low mood, lack of joy, guilt, lethargy, concentration difficulties, insomnia and a low zest for life.

It is known from previous studies that CBT is an effective treatment for both panic disorder and depression. However, there is a lack of psychologists and psychotherapists that use CBT methods, and access to them varies greatly in Sweden as well as in many other countries. Internet-based CBT has therefore been developed, in which the patient undergoes an Internet-based self-help programme and has contact with a therapist by email.

In the internet-based CBT, the patient undergoes an online self-help counselling programme and can contact a therapist via email.

The new research is based on a random clinical trial of 104 patients with panic disorder and comparison of the effectiveness of internet-based CBT and group CBT within a regular healthcare service.

Both treatments worked very well and there was no significant difference between them, either immediately after treatment or at a six-month follow-up, the research said.

Care Management Reduces Suicidal Ideation in Geriatric Depression

Wed, 24 Jun 2009 04:00:00 PST

( from http://www.rxpgnews.com ) Depression in older adults too often goes unrecognized and untreated, resulting in untold misery, worsening of medical illness, and early death. A new study has identified one important remedy: Adding a trained depression care manager to primary care practices can increase the number of patients receiving treatment, lead to a higher remission rate of depression, and reduce suicidal thoughts.

"Almost one in 10 older adults in the United States has some form of depression, and one-fifth among them contemplates suicide. Two-thirds of these patients are treated by primary care physicians. Sadly, their depression is often inadequately treated due to the primary care physician's time constraints and the patient's reluctance to discuss their symptoms and adhere to treatment," says Dr. Alexopoulos.

The critical finding of the PROSPECT study is that adding a trained care manager to primary care practices increases the number of depressed older patients who receive treatment and improves their outcomes, not only in the short term, but over two years.

"This is important because depression can either become chronic or relapse after an initial improvement," adds Dr. Alexopoulos. "Most diseases have worse outcomes when an old person becomes depressed. Depression almost doubles the risk for death. It follows that treating depression effectively can reduce sickness, disability and death."

The study, conduced by NewYork Presbyterian/Weill Cornell, the University of Pittsburgh, and the University of Pennsylvania, followed 599 patients aged 60 years and older with depression at 20 primary care practices of varying sizes in New York and Pennsylvania. Participants were randomized to receive either the PROSPECT intervention or usual care. Those in the PROSPECT group were assigned a care manager -- a trained social worker, nurse or psychologist -- who helped the physician offer treatment according to accepted practice guidelines, monitored treatment response and provided follow-up over two years. Practice guidelines included the antidepressant citalopram (Celexa), with the option of other drugs or psychotherapy.

The PROSPECT intervention worked especially well for a subgroup of patients with major depression, the more severe form of the disease, with a greater number achieving remission, or the near absence of symptoms. Patients with minor depression had favorable outcomes regardless of their study group.

Various forms of care management are being used successfully for cardiovascular patients needing anticoagulation medication and for diabetes patients needing insulin monitoring, says Dr. Alexopoulos. "The PROSPECT study has demonstrated that care management is highly successful for older adults with major depression."

"At this time, our nation is focused on disease prevention as a way to improve the health of Americans and to reduce health care cost. Reducing depression over long periods of time can be one of the ways to achieve this objective," continues Dr. Alexopoulos. "Care management, like that of the PROSPECT study, is relatively inexpensive. Finding ways to reimburse it can make it broadly available and have a major impact on the overall heath care."

Incubator care at birth reduces depression risk in adult life

Sat, 15 Nov 2008 11:12:16 PST

( from http://www.rxpgnews.com ) Toronto, Nov 12 - A Canadian study says babies who receive incubator care after birth are two to three times less likely to suffer depression in their adult life.

The study was conducted by scientists from Montreal University, in collaboration with researchers from Montreal-based Sainte Justine Hospital Research Center, McGill University and Douglas Hospital Research Centre and the Britain-based Institute of Psychiatry at King's College over a period of many years.

The research was undertaken following observations about mammal behaviour where separation between mother and child after birth can lead to behavioural problems in adulthood.

'Our hypothesis was that mother-baby separation resulting from incubator care could heighten depression in adolescence or adulthood,' said study co-author and psychiatrist Richard E. Tremblay of Montreal University Monday.

'Instead, we found that incubator care could decrease the risk of depression two-to-three fold by the age of 21,' he added. It was close to three times for girls.

As part of the study, 1,212 children were recruited from kindergartens. These children had been picked up for another study in 1986.

The researchers obtained reports on their birth condition, obstetrical complications and incubator care from medical records.

After subjecting these participants to psychiatric assessments at the ages of 15 and 21, the researchers found that out of the 16.5 percent babies placed in incubators, only five percent suffered major depression by age 21.

Among those who were not placed in incubators, nine percent developed depression, which is the average rate in society.

The researchers found correlation between decreased depression and incubator care after factoring participant age, weight at birth, family adversity or maternal depression.

They also found that girls were three times less likely to experience depression by the age of 15 if they had received incubator care at birth.

'This difference was due to the fact that more girls experience depression than boys during adolescence and how boys suffer depression in later adolescent years,' said study co-author Frank Vitaro of Montreal University.

According to the researchers, children who received incubator care as babies, received more emotional support from their mothers throughout childhood because they were perceived as more vulnerable.

'Incubator care was not the sole factor that shielded participants from future depression,' said psychiatrist David Gourion of Montreal University.

'We believe that incubator care is a trigger for a complex chain of biological and emotional factors that helped decrease depression,' he said.

The study has been published in the journal Pyschiatry Research.

Depression during pregnancy doubles risk of premature delivery

Fri, 24 Oct 2008 13:33:39 PST

( from http://www.rxpgnews.com ) Washington, Oct 23 - Depressed pregnant women face twice the risk of premature delivery than their counterparts with no such symptoms, according to a new study.

Besides the increased risk of premature delivery, the study found that the risk grows with the severity of the depressive symptoms, among pregnant women.

These findings also provide preliminary evidence that social and reproductive risk factors, obesity, and stressful events may aggravate depression-premature delivery link, according to researchers.

'Premature delivery is the leading cause of infant mortality, and yet we don't know what causes it,' said co-author De-Kun Li, a reproductive and perinatal epidemiologist at Kaiser Permanente's Division of Research in Oakland.

'This study adds to emerging evidence that depression during early pregnancy may interfere with the neuroendocrine pathways and subsequently placental function,' Li said.

'The placenta and neuroendocrine functions play an important role in maintaining the health of a pregnancy and determining the onset of labour,' Li explained.

Because the majority of the women in the study did not use anti-depressants, the study provides a clear look at the link between depression and preterm delivery.

The study, among the first to examine depression and premature delivery in a representative and diverse population in the US, looked at 791 pregnant Kaiser Permanente members in San Francisco city and county from October 1996 through October 1998.

Researchers interviewed the women around their 10th week of pregnancy and found that 41 percent of the women reported significant or severe depressive symptoms, according to a Kaiser Permanente press release.

The women with less severe depressive symptoms had a 60 percent higher risk of premature delivery -- defined as delivery at less than 37 completed weeks of gestation -- compared with women without significant depressive symptoms, and the women with severe depressive symptoms had more than twice the risk.

In addition to being the leading cause of infant mortality and morbidity, preterm delivery is also the leading medical expenditure for infants, with estimated annual cost of about $26 billion in the US alone.

The study is published online in the Oxford University Press' journal Human Reproduction.

Depression is wrongly seen as natural part of getting older

Tue, 12 Aug 2008 10:02:41 PST

( from http://www.rxpgnews.com )

Photo by paveitapics

The vast majority of older people over the age of 65 in England have symptoms of depression are denied any help, according to a new report published today by Age Concern.

The charity found that shocking ageist attitudes held by many people, including GPs, and ageist rules in the NHS mean that an astounding eight out of ten older people with clinical depression don’t get any treatment. Most mental health services for depression exclude people aged 65 and older, despite the risk of depression increasing with age in later life.

Age Concern’s new campaign, ‘Down, but not out’, aims to improve the quality of life for older people with depression. Depression is the most common mental health problem in later life, affecting one in four older people yet it is often ignored. If depression is not identified and treated, it can lead to a life of misery. It can also cause other illnesses and, in extreme cases, can lead to suicide.

The charity will be helping older people to recognise the symptoms of depression and encouraging them to seek help. It will also be working with GPs to improve the diagnosis of older people with depression and ensure that effective treatments are available to all, regardless of age.

Poor health and problems, such as money worries, losing a loved one and stressful events like moving into a care home can trigger depression. Recently bereaved older people are three times more likely than married older people to show signs of depression.

Gordon Lishman, Director General of Age Concern, said:
“Negative attitudes about mental health problems make it very difficult for older people to talk about their feelings or to ask for help. It is scandalous that hundreds of thousands of older people may be denied treatment because depression is wrongly seen as a natural part of getting older.

“Older people deserve better treatment - there should be no excuse for inaction. Without a major change in policy and practice, there will be 3.5 million older people in UK with symptoms of depression by 2021.

“The Government and the NHS need to take action to stamp out ageist attitudes and practice, once and for all. The neglect of older people’s mental health ruins lives and must no longer be ignored.”

Awareness of depression is low among older people themselves and their relatives and is worse in some communities because of negative cultural perceptions of mental health problems. Beliefs about the origin of the illness and the high value placed on family reputation results in many black and minority ethnic (BME) elders, and their families, keeping the depression a secret.

Depression increases risk of Alzheimer's disease

Tue, 08 Apr 2008 09:38:07 PST

( from http://www.rxpgnews.com ) Washington, April 8 - Depressed people are more likely to develop Alzheimer's disease than those with a more positive outlook to life, says a new study.

The finding is based on a six-year survey of 486 healthy people aged 60 to 90. Of those, 134 people had experienced depression once, prompting them to seek medical advice - 33 of them developed Alzheimer's.

People who experienced depression were 2.5 times more likely to develop Alzheimer's disease than normal people, the study found.

The risk was four times greater for those who were depressed before 60, according to the study, which has been published in the latest issue of the journal Neurology.

'We don't know yet whether depression contributes to the development of Alzheimer's disease or whether another unknown factor causes both depression and dementia,' said the study's author Monique MBreteler of Erasmus University Medical Centre in Rotterdam.

'We'll need to do more studies to understand the relationship between depression and dementia.'

One theory is that depression leads to loss of brain cells, which contributes to Alzheimer's disease.

Antidepressants that are more efficient and faster

Tue, 05 Feb 2008 05:00:00 PST

( from http://www.rxpgnews.com ) In the PhD defended by the pharmacologist and biochemist Jorge Emilio Ortega Calvo at the University of the Basque Country, a new anti-depressant treatment strategy is proposed that is capable of improving on the current one with its drawbacks.

Depression is a chronic and recurrent illness that can affect at least 20% of the population at some period in their lifetime, according to a number of studies carried out. Moreover, according to the WHO, by 2020 emotional state disorders could be the foremost or second cause for sick leave from work in the developed countries. Current ant-depressive therapies, nevertheless, are far from optimum.

This was the theme of the PhD presented by the pharmacologist and biochemist from the Basque province of Gipuzkoa, Jorge Emilio Ortega Calvo, undertaken at the Faculty of Medicine and Odontology of the University of the Basque Country (UPV/EHU). Basically it was a study in which an analysis was undertaken of the action mechanisms of current antidepressant pharmacological drugs and new antidepressant treatment strategies put forward and that could be useful in the near future in order to address the failings in the current ones.

Depressed older people risk losing their minds

Tue, 09 Oct 2007 14:30:35 PST

( from http://www.rxpgnews.com ) New York, Oct 9 - Older people who suffer from depression face higher risk of losing intellectual ability, the results of a study conducted in the US show.

Depression is a disorder that affects the functioning of a person in day-to-day life. It is a strong mood involving sadness, discouragement, despair or hopelessness that lasts for weeks, months or even longer.

The study by University of Rochester Medical Centre researchers looked into 700 patients aged 65 years and over for more than two years. The findings of the study suggest that older people who are depressed may be intellectually impaired and lose executive functions, reports science portal EurekAlert.

Researchers looked at loss of executive functions of the participants that involve high-level mental processes such a making decisions, organising, planning and doing a series of things in sequence.

Trained interviewers reviewed each patient's primary care medical chart, recording information about mood and cognitive symptoms, disorders or treatments as well as active and past medical problems and current medications. Psychiatrists and researchers also assessed their levels of cognition, functional status and depression.

The study published in the American Journal of Psychiatry found that depression increased the risk of subsequent mental impairment. The scientists said the depression symptoms could act as predictors of future intellectual decline.

Antidepressant Augmentation Can Be Useful in Treatment Resistant Elderly Patients

Thu, 07 Jun 2007 16:00:00 PST

( from http://www.rxpgnews.com ) Adding a medication to a standard treatment regimen for major depressive disorder in the elderly improves chances of recovery in those who do not adequately respond to the first-course therapy or who relapse from it, finds a University of Pittsburgh School of Medicine study published in the June issue of the American Journal of Psychiatry, the official journal of the American Psychiatric Association. Up to 84 percent of the elderly who experience depression either fail to respond to first-course treatment or relapse during the first six to 12 weeks of treatment.

The study found that adding a second drug to the treatment of depressed participants over the age of 70 who either did not respond to initial treatment with the antidepressant paroxetine and interpersonal psychotherapy, or to those who responded to the initial treatment but quickly relapsed, caused the likelihood of recovery to rise from 40 percent to 60 percent. Recovery was slower in those who did not respond to the original treatment.

"Depression should not be considered a normal part of aging. The scientific evidence is growing that there are a number of effective treatment options available for people of all ages," said Mary Amanda Dew, Ph.D., professor of psychiatry, psychology and epidemiology at the University of Pittsburgh and lead author of the study.

The University of Pittsburgh researchers followed 105 adults aged 70 or older who had major depressive disorder and who did not respond to standardized treatment of paroxetine and interpersonal psychotherapy or who did respond but experienced an early recurrence of depressive symptoms. Participants were given one of three augmenting agents: sustained-release bupropion, nortriptyline or lithium. Researchers selected the additional agent that each participant received based on individual medical status and history. Thirty-six participants either declined new medicine or did not receive augmentation because of accompanying medical conditions.

Half of the patients who did not respond to the initial treatment responded to the augmentation therapy. It took a median 28 weeks for the participants to achieve recovery. Of the patients who relapsed after the initial therapy, 67 percent recovered after augmentation over a median recovery time of 24 weeks. Of the patients who responded to the first-course therapy of paroxetine and psychotherapy, 87 percent achieved recovery.

"While the recovery rates of those receiving augmentation are not as high as in those who responded to first-line therapy, the recovery rates are still high enough to suggest that augmentation should be tried when older adults' depression is not improving," said Dr. Dew.

Genetic variations may predispose some men to suicidal thoughts during treatment for depression

Thu, 07 Jun 2007 16:00:00 PST

( from http://www.rxpgnews.com ) Genetic variations may help explain why some men with depression develop suicidal thoughts and behaviors after they begin taking antidepressant medications, while most do not, according to a report in the June issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

Although most patients with depression respond favorably to antidepressant medications, a very small subgroup may experience worse symptoms after beginning treatment, according to background information in the article. "Regardless of treatment specificity, nearly all antidepressant medication studies find that some patients experience suicidality [suicidal thoughts and behaviors] after treatment initiation," the authors write. "Identification of this subpopulation before treatment would have tremendous clinical utility."

Roy H. Perlis, M.D., of Massachusetts General Hospital and Harvard Medical School, Boston, and colleagues studied 1,447 individuals with depression who were part of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, which was conducted from July 2001 to September 2006, and who did not express suicidal thoughts at the beginning of the study. The participants were men and women ages 18 to 75 years who had been diagnosed with non-psychotic major depressive disorder. They took the antidepressant citalopram hydrobromide for up to 12 weeks, following a protocol that advised follow-up treatment visits at two, four, six, nine and 12 weeks, with an optional visit at 14 weeks if needed. The patients' DNA was analyzed for common types of mutations nearby or within the CREB1 gene, which codes for a protein previously suggested to be involved in both antidepressant effects and suicide.

Of the 1,447 patients, 123 (8.5 percent) reported suicidal thoughts or behaviors during at least one follow-up visit, including 54 (10 percent) of the 539 men. Two of five single nucleotide polymorphisms (SNPs) - variations that occur when a single building block of DNA is altered - were significantly and strongly associated with the onset of suicidality in men, but not in women.

The researchers performed additional analyses suggesting these variations are not linked to suicidal thoughts and behaviors in men before treatment. "No statistically significant association was noted between any SNP and the presence or absence of baseline suicidality," the authors write. "Likewise, no evidence of association was noted between any SNP and history of lifetime suicide attempt."

Studies that link genes to illnesses are most compelling when there is additional evidence of that gene's function, the authors note. "We recently observed an association between the same CREB1 polymorphisms and a measure of anger expression among males but not females in a sample of 94 patients with major depressive disorder; hostility and anger expression have also been associated with suicide," they write.

"If replicated, this finding would suggest that pharmacogenetic testing could facilitate the identification of the small subset of individuals at greater risk during short-term antidepressant treatment," the authors conclude.

Antidepressant does not improve symptoms in advanced cancer patients without major depression

Tue, 05 Jun 2007 04:00:00 PST

( from http://www.rxpgnews.com ) The established antidepressant sertraline does not improve symptoms, wellbeing or survival in patients with advanced cancer who do not have major depression. The findings are reported early Online - timed to coincide with presentation of the paper at the American Society of Clinical Oncology meeting in Chicago ? and in the July edition of The Lancet Oncology.

Self-ratings of depression, mood, fatigue, and quality of life are significant predictors of survival in patients with advanced cancer. Although the simple explanation for this is that people close to death get very depressed, two previous small randomised trials showed substantial survival benefits with psychological treatments aimed to improve wellbeing. Therefore Dr Martin Stockler, National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Australia, and colleagues assessed the benefit on symptoms and survival of sertraline in patients with advanced cancer but no major depression.

The authors say: ?We postulated that sertraline might improve these features of health-related quality of life and increase overall survival by helping patients to cope better with their illness and treatment.?

Between 2001 and 2006, the researchers treated 189 patients with advanced cancer with 50mg sertraline each day, or placebo. They found that patients receiving sertraline experienced no significant effect on depression, anxiety, fatigue, wellbeing or quality of life. Their findings suggest the overmedicalisation (giving drugs to patients where the benefit is unclear or unproven) of patients with advanced cancer should be avoided.

However, the authors stress that sertraline use should continue in situations where it is of proven benefit ? such as patients with advanced cancer who have major depression.

They conclude: ?Treatment with a selective serotonin reuptake inhibitor [antidepressant] should be reserved for those with a proven indication.?

High-quality child care for low-income children offset the risk of later depression

Sun, 20 May 2007 04:00:00 PST

( from http://www.rxpgnews.com ) Young adults from low-income families who were in full-time early educational child care from infancy to age 5 reported fewer symptoms of depression than their peers who were not in this type of care, according to a new report. The early educational intervention also appears to have protected the children to some extent against the negative effects of their home environments.

The report, from the FPG Child Development Institute (FPG) at the University of North Carolina at Chapel Hill, uses data from the Abecedarian Project, a longitudinal study begun in 1972 in which 111 high-risk children were randomly assigned to early educational child care from infancy to age 5 or to a control group that received various other forms of child care. The study is published in the May/June 2007 issue of the journal Child Development.

Research has shown a relationship between poverty in early childhood and an increased risk for mental health problems in adulthood. A number of early intervention programs have been found to enhance the cognitive development and academic outcomes of children living in poverty, but less is known about the long-term effects of these programs on children's mental health.

In the Abecedarian Project, 98 percent of the children were black and all came from low-income families with demographic factors known to predict developmental delays or academic problems. As part of the study, developmental and demographic data were collected regularly during the early childhood years with follow-up assessments in adolescence and young adulthood.

The study followed up with 104 study participants when they were 21 and found that those who had participated in the child care program had fewer symptoms of depression than those who did not.

Early child care also moderated the effects of the children's home environments on subsequent feelings of depression. For children in the control group, the more negative the early home environment, the greater the likelihood of signs of depression.

The early intervention does not appear to have changed home environments, according to Frances A. Campbell, a senior scientist at FPG and one of the authors of the study. Rather, it buffered, or protected, the children from the adverse effects of less-optimal early home environments. This evidence, indicating that good early childhood experiences can make a positive difference in the mental health of individuals born into poverty, underscores the importance of investing in high-quality early childhood experiences for poor children.

Study challenges stages of grief

Wed, 21 Feb 2007 13:44:52 PST

( from http://www.rxpgnews.com ) After the death of a loved one from natural causes, the normal responses from most people are acceptance and yearning for the deceased, according to a new study in the February 21 issue of JAMA that is an empirical examination of the stage theory of grief.

"The notion that a natural psychological response to loss involves an orderly progression through distinct stages of bereavement has been widely accepted by clinicians and the general public," the authors provide as background information in the article. The stage theory of grief (disbelief, yearning, anger, depression and acceptance) has become well-known and generalized to a wide variety of losses. "The identification of the patterns of typical grief symptom trajectories is of clinical interest because it enhances the understanding of how individuals cognitively and emotionally process the death of someone close. Such knowledge aids in the determination of whether a specific pattern of bereavement adjustment is normal or not."

Paul K. Maciejewski, Ph.D., from the Yale University School of Medicine, New Haven, Conn., and colleagues analyzed data collected between January 2000 and January 2003 from 233 individuals participating in the Yale Bereavement Study. The study participants had a family member or loved one who died from natural, not traumatic causes; and had at least one complete assessment of the five grief indicators included in the stage theory of grief within 24 months following the death. The vast majority (83.8 percent) of participants were spouses of the deceased. The remaining participants (16.2 percent) were adult children, parents, or siblings of the deceased.

"Counter to stage theory, disbelief was not the initial, dominant grief indicator," the researchers found. "Acceptance was the most frequently endorsed item and yearning was the dominant negative grief indicator from one to 24 months postloss. In models that take into account the rise and fall of psychological responses, once rescaled, disbelief decreased from an initial high at one month postloss, yearning peaked at four months postloss, anger peaked at five months postloss, and depression peaked at six months postloss." The authors add, "acceptance increased steadily through the study observation period ending at 24 months postloss."

"Identification of the normal stages of grief following a death from natural causes enhances understanding of how the average person cognitively and emotionally processes the loss of a family member," the authors write. "Regardless of how the data are analyzed, all of the negative grief indicators are in decline by approximately six months postloss. The persistence of these negative emotions beyond six months is therefore likely to reflect a more difficult than average adjustment and suggests the need for further evaluation of the bereaved survivor and potential referral for treatment," the authors conclude.

Research paper examines depression in three cities in Pakistan

Wed, 14 Feb 2007 10:09:46 PST

( from http://www.rxpgnews.com ) A paper authored by two Memorial University faculty members will be published Feb. 14 in PLoS ONE, the international, peer-reviewed, open-access, online publication from the Public Library of Science (PLoS). Drs. Amin A. Muhammad Gadit and Gerry Mugford are the authors of the paper, entitled, "Prevalence of depression among house holds in three capital cities of Pakistan: Need to revise the mental health policy."

Dr. Muhammad Gadit explained that Pakistan, among the other developing countries, has a higher prevalence rate of depression because of the current social adversities. "There is thus a great need for systematic studies on the prevalence of depression. Our study aims to explore the prevalence of depression among households in three capital cities of Pakistan."

A sample of 820 people was randomly selected and a cross sectional telephone based study was conducted for a duration of six months. "It was found that there was a regional variation in prevalence rates for depression among the three cities. Lahore had the highest number of depressives (53.4 per cent), as compared to Quetta (43.9 per cent) and Karachi (35.7 per cent). Middle age, female gender and secondary school level of education were significantly associated with depression among the study group."

Dr. Muhammad Gadit said the different rates of prevalence rate among three cities could be attributed to local cultural influence, geographical locations and social adversities and point to a need for revision of existing health policy by the government.

Depression may be involved in the initiation and progression of atherosclerosis

Mon, 05 Feb 2007 14:43:33 PST

( from http://www.rxpgnews.com ) Depressive symptomsespecially physical signs, such as fatigue and loss of appetitemay be associated with thickening arteries, which may reflect an early sign of coronary artery disease, according to a report in the February issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

Considerable evidence suggests that depression, anger and other negative emotions are associated with the risk for coronary artery disease, which occurs when the vessels carrying blood to the heart become narrowed and thickened. However, most studies have assessed the risk for heart attack or sudden cardiac death, according to background information in the article. Because these events are later steps in the development of coronary artery disease, it is currently unclear whether depression, anxiety and other negative emotions play a role in early disease processes.

Jesse C. Stewart, Ph.D., then at the University of Pittsburgh School of Medicine and now at Indiana UniversityPurdue University Indianapolis, and colleagues studied 324 men and women who were an average of 60.6 years old. At the beginning of the study, participants attended 11 visits in a five-month period, including a medical screening; testing for cardiovascular risk factors, including high blood pressure and high cholesterol; questionnaires to assess depression, anxiety, hostility and anger; and ultrasound tests to determine carotid artery intima-media thickness (IMT), a measure of the inner layers of the arteries that is related to early-stage coronary artery disease. Cardiovascular risk factors and IMT were assessed again after three years.

"Regression analyses indicated that higher depressive symptoms at baseline were associated with greater three-year change in carotid intima-media thickness, even after taking into account demographic factors, cardiovascular risk factors, medication use, medical conditions and other correlated negative emotions," the authors write. "Measures of anxiety symptoms, hostility, anger experience and anger expression were each unrelated to intima-media thickness change."

To further understand the role of specific depressive symptoms in IMT, the researchers separated the condition down into two components: a somatic-vegetative score, which includes physical indicators such as fatigue and appetite disturbance, and a cognitive-affective score, which includes sadness, pessimism and other emotions associated with depression. Analysis of each component revealed that the somatic-vegetative score, but not the cognitive-affective score, was linked to IMT thickness.

"Taken together, our results indicate that depression, but perhaps not anxiety and hostility/anger, may be involved in the initiation and/or progression of atherosclerosis," or hardening of the arteries, the authors write. "More specifically, our findings suggest that the somatic-vegetative features of depression that are not shared with other negative emotions may play an important role in the earlier stages of coronary artery disease development."

Few previous studies have looked at several negative emotions at once, but this approach will be critical in understanding the links between these psychological variables and physical disease, they conclude. "Identifying these components, in turn, may provide insights into the mechanisms underlying the negative emotioncoronary artery disease relationships and may facilitate the development of focused interventions designed to reduce the coronary artery disease risk of individuals prone to experience negative emotions."

People with low blood pressure may face depression

Thu, 25 Jan 2007 10:13:24 PST

( from http://www.rxpgnews.com ) London, Jan 25 - People suffering from low blood pressure may face the risk of being depressed and anxious, say researchers.

A Norwegian study analysed health reports from North-Trondelag County from the 1990s and found that of the 60,000 people detailed in them, those with low blood pressure most frequently suffered from anxiety issues or depression, reported UPI wire quoting Norwegian newspaper Aftenposten.

The study's findings expanded on a previous study that found a link between mental problems and blood pressure when dealing with the elderly, research fellow Bjorn Hildrum at Namsos Hospital said.

'The discovery is independent of both age and gender and as such is a universal phenomenon. Cardiovascular disease, medication for high blood pressure or depression or a range of other factors - none of these explain the link,' Hildrum said.

To help determine why the correlation exists, the Norwegian researchers will try to learn if low blood pressure helps facilitate depression and anxiety, or if the mental disorders lead to low blood pressure.

Certain anti-depressants double fracture risk

Tue, 23 Jan 2007 14:21:39 PST

( from http://www.rxpgnews.com ) New York, Jan 23 - Daily use of certain anti-depressant drugs could double the risk of fractures in adults above 50 years of age because of their effect on bone physiology, says a new study.

Researchers at the Centre for Bone and Periodontal Research at McGill University in Montreal evaluated 5,008 adults who were aged 50 and above.

They studied them for over five years to see if they experienced 'fragility' fractures -- the type suffered from relatively minor traumas such as falling out of bed, reported the online edition of health Magazine WebMD.

A total of 137 participants reported daily use of Selective Serotonin Reuptake Inhibitors - - a class of anti-depressants.

Despite adjusting for factors known to increase fracture risk like falls, low bone density and physical inactivity, the adults on SSRI anti-depressants had twice the risk of fractures than those not on antidepressants.

'In the SSRI group, there were 18 X-ray confirmed fragility fractures out of 137 people or 13.5 percent,' said researcher David Goltzman.

'In the non-user group, there were 317 X-ray confirmed fragility fractures out of 4,871 people, or 6.5 percent,' he added.

'If you are over 50 and your doctor prescribes an SSRI, go have a bone density test first, especially if you have had a fracture from a minor trauma,' suggested Goltzman.

The findings of the study appeared in the Jan 22 issue of the journal 'Archives of Internal Medicine'. But the researchers added that people should not stop taking SSRIs if their doctor thinks that drugs can help them battle depression.

People with depression could be prone to stroke

Mon, 08 Jan 2007 10:48:43 PST

( from http://www.rxpgnews.com ) New York, Jan 8 - People with symptoms of depression could face the risk of a stroke or mini stroke, says a new study. But the risk was not found among individuals older than 65.

Margaret Kelly-Hayes and her associates at Boston University studied 4,120 people for up to eight years. At the start, scores on a standard depression scale called the CES-D averaged six, reported Independent online.

However, nearly 11 percent scored 16 or greater, indicating the presence of depressive symptoms.

A total of 144 strokes and 84 mini-strokes occurred during follow-up, the team reported in the medical journal Stroke.

Among the subjects younger than 65 years, those with a CES-D score of 16 or higher were over four times more likely to have a stroke or mini stroke than those with lower depression scores.

The risk remained elevated even after factoring in other risk factors for stroke such as high blood pressure, diabetes, smoking, and educational levels.

In contrast, the stroke risk was unrelated to depressive symptoms among subjects older than 65 years of age, the researchers said.

Depression is a state of intense sadness, or despair that has advanced to the point of being disruptive to an individual's social functioning and activities of daily living. It affects about 16 percent of the people on at least one occasion in their lives.

Child abuse and neglect associated with increased risk of depression among young adults

Wed, 03 Jan 2007 03:23:17 PST

( from http://www.rxpgnews.com ) People who were abused and neglected during childhood have a higher risk of major depression when they become young adults, according to a report in the January issue of the Archives of General Psychiatry, one of the JAMA/Archives journals.

Child abuse has been linked to depression in clinical populations and community surveys, according to background information in the article. But few prospective longitudinal studies have examined the relationship between abuse or neglect in childhood and depression in adulthood.

Cathy Spatz Widom, Ph.D., then of the New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, and now of John Jay College of Criminal Justice, New York, and colleagues conducted a prospective study to determine whether abused and neglected children were at elevated risk of major depressive disorder (MDD) and psychiatric illness, compared with matched control subjects, when followed up into young adulthood. The study included 676 children with substantiated cases of physical and sexual abuse and neglect before the age of 11. They were matched based on age, race, sex, and approximate family social class with 520 non-abused and non-neglected children. All were followed up into young adulthood (average age: 28.7).

"The current results show that childhood physical abuse was associated with increased risk for lifetime MDD," the authors write. "We also provide new evidence that neglected children are at increased risk for depression as well."

Child abuse and neglect were associated with a 51 percent increased risk for current MDD in young adulthood. Children who were physically abused had a 59 percent increased risk of lifetime MDD. Those who experienced multiple types of abuse had a 75 percent increased risk of lifetime MDD. The risk of current MDD was 59 percent higher for those who were neglected.

Childhood sexual abuse was not associated with an elevated risk of MDD. "However, childhood victims of sexual abuse reported significantly more depression symptoms than controls," the authors point out.

"In addition, these findings reveal that onset of depression began in childhood for many of the children," they write. "Our age-at-onset findings reinforce the need to intervene early in the lives of these abused and neglected children, before depression symptoms cascade into other spheres of functioning."

Cost effectiveness of Combination Therapies in Severe Depression

Fri, 01 Dec 2006 15:24:40 PST

( from http://www.rxpgnews.com ) Psychological therapy and antidepressants given together (combination therapy) is likely to be a cost-effective treatment for severe depression, according to a new study.

But the cost-effectiveness of combination therapy for moderate depression is more uncertain.

The study, published in the December issue of the British Journal of Psychiatry, took the form of a decision analysis developed for the National Institute of Clinical Excellence (NICE, 2004) depression guideline to evaluate the likely costs and outcomes of the first-line use of antidepressant medication, or combination therapy, for moderate and severe depression in secondary care in the UK (National Collaborating Centre for Mental Health, 2005).

Systematic literature reviews were carried out to identify clinical, utility and cost data. A ‘decision analytic model’ was then developed to compare the effectiveness and costs of using antidepressant therapy alone with combination therapy for people with moderate and severe depression over a 3-month initial treatment period and 12-month follow-up.

The researchers chose cognitive behavioural therapy for their analysis, as it has a relatively large, high-quality evidence base compared with other psychological therapies provided by the NHS.

The antidepressant therapy consisted of 3 months of daily 40g fluoxetine, with an average of four specialist visits, assuming two visits by a consultant and two visits by a specialist registrar.

Combination therapy involved the use of this antidepressant treatment protocol and cognitive-behavioural therapy for 3 months. A full course included 16 sessions of about 50 minutes.

It was found that over the 15-month analysis period, combination therapy resulted in higher costs and an expected 0.16 increase per person in the probability of remission and no relapse, compared with antidepressants.

The cost per additional successfully treated patient was £4056. The cost per quality-adjusted life year gained was £5777 for severe depression, and £14,540 for moderate depression.

The results indicate that targeting combination therapy on severe forms of depression could be a more efficient way of using limited resources, say the researchers.

They comment that the cost results suggest that although the initial treatment cost of combination therapy is substantially higher, these costs are in part offset by savings from lower treatment costs in the subsequent year.

Based on this evidence, the NICE guideline for depression (2004) recommends combination therapy for severe depression and antidepressant therapy for moderate depression, with combination therapy as a second-line intervention.

Considering the importance of patient preference, recommendations are also made about the use of psychological interventions where patients declined antidepressant medication alone, or had previously not responded to it.

The consequent increase in the need for psychological treatments is likely to require additional resources in the NHS, mostly the cost and time implications of extra staff training and employment. These are currently under consideration by NICE and the NHS in England and Wales.

New brain-chemistry differences found in depressed women

Tue, 07 Nov 2006 14:26:00 PST

( from http://www.rxpgnews.com ) A new brain study finds major differences between women with serious depression and healthy women in a brain-chemical system that's crucial to stress and emotions.

The study adds further evidence that depression has its roots in specific alterations within the brain -- specifically in the endogenous opioid system that is a central part of the brain's natural pain and stress-reduction system. The findings also show significant variation between individuals with depression variation that seems to be linked to whether or not the patients respond to an antidepressant medication.

The study, performed by researchers at the University of Michigan Medical School affiliated with the U-M Depression Center, is published in the November issue of the Archives of General Psychiatry. It's based on brain imaging, blood chemistry and other data from 14 women with major depression, and 14 healthy women of about the same age and background. The women with depression were not taking antidepressants when the study began.

"This work gives further evidence of individual differences in brain mechanisms that are altered in major depression," says senior author Jon-Kar Zubieta, M.D., Ph.D., the Jenkins Research Professor of Depression and associate professor of psychiatry and radiology. "We found these differences in the response of the endogenous opioid system. Some women, but not others, with major depression, showed exaggerated responses in this system when undergoing an emotional challenge."

That emotional challenge was the summoning of memories of a very sad event in their lives, which the researchers asked the women to recall while they were lying in the positron emission tomography (PET) scanner having their brains imaged. The women recalled the death or serious illness of a friend or family member, a past divorce or breakup with a boyfriend, or other major difficulties. They also had their brains imaged during a neutral emotional state.

Just before the brain scans, the women also had their blood tested to measure levels of two hormones that are released in response to stress. The depressed women were then prescribed an antidepressant drug and reported regularly about their depression symptoms for the next ten weeks. Those whose depression hadn't eased by the end of the first month received a prescription for an increased dose of antidepressant.

"Women who had more pronounced responses in their stress response mechanisms during brain imaging also showed alterations in hormones, like cortisol, that are sometimes over-secreted in depression," Zubieta explains. "In addition, these women responded poorly to treatment with medication."

The research builds on previous studies that found differences in the body's and brain's stress-response system among people with depression. But this is the first time that specific differences in the mu-opioid system have been shown between people with depression and those without.

Zubieta performed the work with former doctoral student, Susan Kennedy, Ph.D., who is first author on the new paper. They used a brain-imaging technique that the U-M team has previously used to see how the brain responds to pain and to placebo pain treatment.

The technique uses a form of a drug called carfentanil, which binds to the same receptors on the surface of brain cells that brain chemicals called mu-opioids bind to. Mu-opioids, sometimes also called endorphins, reduce or block the spread of messages related to pain, stress and emotional distress between the body and the brain. They have been called the body's "natural painkillers." The drug is modified to allow it to be "seen" by the PET scanner, so that the researchers can create maps of the specific brain areas where the natural mu-opioids are more or less active at any given time.

In the new study, the researchers also found that the mu-opioid system was overactive in women with depression, even at baseline, when they weren't being asked to recall sad memories.

During the "sadness challenge", the non-depressed women did not show any activation of their mu-opioid system, but the depressed women had a significant activation of that system, and the level of that activation correlated with the intensity of their negative emotional state brought on by the sad memories. Among the non-depressed women, the mu-opioid system was actually less active in some parts of the brain than it had been before they recalled sad memories.

The researchers found differences among the depressed women, too, in some areas of the brain. In the rostral anterior cingulate, which is involved in mood regulation and the integration of sensations and emotions, women who later responded to antidepressant treatment had far lower mu-opioid responses than women who did not respond to medication.

The new findings add the mu-opioid system to the list of brain systems that appear to be altered in depression. Others include the corticotrophin-releasing hormone system, and those involved in noradrenaline, dopamine and serotonin production.

"Further research on these differences, and their relationship to patients' responses to various depression treatments, is crucial to the continued improvement in the understanding of depression and the development of better treatment strategies for patients," Zubieta says.

Stereotypical self-image interferes with depression treatment

Fri, 29 Sep 2006 16:15:00 PST

( from http://www.rxpgnews.com ) A mans stereotypical self-image as the strong, silent type and the stigma of depression are major reasons why older men are less likely than women to be referred to studies of depression, to seek treatment for depression, and to recognize and express symptoms of depression, according to clinicians and recruiters interviewed for a new study from the UC Davis Department of Psychiatry and Behavioral Sciences.

The study provides some of the strongest evidence to date that depressed older men are less likely than women to receive treatment for their depression, underscoring the importance of these barriers.

Among some older men, the study found, traditional views of masculinity and the stigma associated with mental illness lead to a tendency to reject a diagnosis of depression, and to conceal or mask symptoms of the condition. Authored by UC Davis associate professor of psychiatry professor Ladson Hinton, the study appears in the October 2006 edition of the American Journal of Geriatric Psychiatry. The study contributes further evidence to gender disparities in depression care documented in previous studies, and identifies reasons for these disparities.

The findings are important in the arena of public health because of depressions association with suicide in older adults. Older men have higher rates of completed suicide: 31.8 per 100,000 in men age 65 and older, compared with 4.1 per 100,000 in older women. The reasons for gender disparities in depression care among older adults are poorly understood, the study states.

Among the reasons found in prior research are more negative attitudes among men toward seeking help for mental health problems, lower disclosure rates of depressive symptoms, lower rates of health service use, and more atypical presentations of depression. However, the problem of under-treatment in older men has received little focused attention.

For their study, Hinton and his research team examined the data from a large, multisite study of a disease management program for late-life depression in primary care, called IMPACT (Improving Mood: Providing Access to Collaborative Treatment for Depression). The IMPACT participants were 1,800 adults 60 and older with major depression or dysthymic disorder from 18 primary care clinics, affiliated with eight health-care organizations in the United States.

The UC Davis researchers analyzed gender differences in history of depression treatment, as well as referral rates and symptoms. To better understand lower rates of depression treatment and referral to IMPACT of older men, the researchers also conducted qualitative interviews with 30 key individuals connected to IMPACT, including referring physicians, depression care managers and study recruiters, to learn about the challenges in recruiting and treating depressed older men.

Hinton and his team found that, compared with older women, older men were much less likely to be referred to IMPACT, to recognize and describe symptoms of depression, and to have received prior treatment for depression. The interviews identified factors that were important contributors to the gender disparities: the manner in which men experience and express their depression, traditional masculine values, and the stigma of depression.

The IMPACT interviewees reported that older men experience and express their depression in ways that do not fit well with diagnostic criteria, making a diagnosis more difficult. Some of the IMPACT principals speculated that older men might have more difficulty accessing and recognizing their feelings, while others believed men were actively trying to conceal or mask their depression. For example, one primary care provider, when asked if men present their depression differently from women, said, They try to hide it, basically, whereas women are more open and they come and talk because it is their nature for some reason.

Because older men tend not to endorse depressed mood or sadness, they were often felt to be more reluctant to accept the diagnosis of depression and the treatment recommendations, stated the UC Davis study.

Older men often described as old school or the John Wayne type were considered difficult to diagnose and treat because they perceived the cultural meaning of depression to be in conflict with their own view of themselves as men, the study says. It noted that clinicians made a direct connection between more traditional views of masculinity and difficulties with diagnosis and referral to specialty mental health.

One of the IMPACT clinicians said that in her view, giving up these core masculine views was an important step in the treatment process. Another physician reported that some older men just do not think that tough guys go talk to psychologists or psychiatrists, and fool around with that type of monkey business.

The association of depression with severe mental illness, or craziness, was another barrier to care, although it was cited less frequently than the other obstacles. One depression care manager cited stigma to explain the greater tendency of men to express their depression in physical rather than emotional terms. The manager said, They will not say, I feel sad or I feel depressed. Theyll say, I have a stomach ache. A primary care physician described a depressed and psychotic older man who was expressing suicidal thoughts, but nevertheless was unwilling to see a psychiatrist because he feared it would mark him as crazy.

Hinton and his team state that their findings suggest future avenues for education and intervention for older men with depression. When dealing with more traditional older depressed men, clinicians may need to tailor standard educational approaches to directly address the attitudinal barriers identified in the UC Davis study. One such initial approach might be to de-emphasize professional labels and place more emphasis on symptoms and sources of stress. Health-care providers interviewed by the UC Davis researchers suggested other strategies, such as using an open-ended interview style, using less direct or clinical (i.e., threatening) language to discuss depression, and involving family in all phases of treatment.

The researchers acknowledge that their study should be considered as exploratory and hypothesis-generating because of the modest number of interviews conducted. An expanded study with a more representative sample of clinicians and patients would be likely to deepen our understanding of the themes identified in the study, and to identify other important factors.

The public health importance of improving care for depression among older men is clear, the study states. Older men experience higher rates of completed suicide than any other age and gender group. Because depression is one of the most important suicide risk factors, elucidating gender-specific aspects of depression care has the potential to reduce this disparity, close the gender gap in depression treatment, and lessen the enormous burden of suffering for older adults and their families.

Exaggerated inflammatory response to psychological stress seen in major depression

Mon, 04 Sep 2006 16:03:00 PST

( from http://www.rxpgnews.com ) Individuals with major depression have an exaggerated inflammatory response to psychological stress compared to those who do not suffer from depression, according to a study by researchers at Emory University School of Medicine. Because an overactive inflammatory response may contribute to a number of medical disorders as well as to depression, the findings suggest that increased inflammatory responses to stress in depressed patients may be a link between depression and other diseases, including heart disease, as well as contributing to depression itself.

"Several examples of increased resting inflammation in depressed patients already exist in the literature, but this is the first time anyone has shown evidence to suggest that the inflammatory response to stress may be greater in depressed people," says Dr. Miller.

The study included 28 medically healthy male participants, half of whom were diagnosed with major depression and half of whom were not depressed. The participants were exposed to two moderately stressful situations during a 20-minute time period. Blood was collected every 15 minutes starting immediately before and then up to an hour and a half after the test to check for key indicators of inflammation. The researchers measured levels of a pro-inflammatory cytokine (a regulatory protein secreted by the immune system) called interleukin-6, and the activity of a pro-inflammatory signaling molecule in white blood cells called nuclear factor-kB.

While at rest (before the stress challenge), the depressed patients had increased inflammation relative to the control group. Both the depressed and the healthy groups showed an inflammatory response to the stress challenge, but people who were currently depressed exhibited the greatest increases of interleukin-6 and nuclear factor-kB.

"While inflammation is essential for us to fight bacterial and viral infections, too much inflammation can cause harm," says Dr. Miller. "There's always some collateral damage when the immune system gets fired up, and we now believe that too much inflammation, either at rest or during stress, may predispose people to become depressed or stay depressed." In addition, medical research over the last decade has shown that runaway inflammation may play a role in a number of disorders, including heart disease, cancer, and diabetes, all of which have been associated with depression.

People in the study who suffered from depression also had higher rates of early life stressful experiences. "We have found that this kind of personal life history may make people more likely to develop major depression and is actually common in depressed patients," says Dr. Heim.

It was part of a larger project at the Emory Conte Center for the Neuroscience of Mental Disorders led by Charles B. Nemeroff, MD, PhD, Reunette W. Harris Professor and Chair of Emory's Department of Psychiatry and Behavioral Sciences. The Conte Center is dedicated to understanding the contribution of early life abuse and neglect to the neurobiology of adulthood psychiatric disorders. Ongoing studies by Dr. Miller's team of researchers will attempt to determine how early life experiences contribute to excessive inflammatory stress responses.

"According to the Depression and Bipolar Support Alliance, major depression is the leading cause of disability worldwide and costs the U.S. economy $70 billion annually in medical expenditures, lost productivity, and other expenses," says Thaddeus Pace, PhD, lead author on the paper. "This study is leading us toward finding out what actually causes depression and to identifying what aspects of immune system function are abnormal in depressed people. The goal is to find potential targets within the molecular machinery of the immune system so we can better treat major depression and minimize its consequences on health."

Ever-happy mice may hold key to new treatment of depression

Thu, 24 Aug 2006 13:13:00 PST

( from http://www.rxpgnews.com ) A new breed of permanently 'cheerful' mouse is providing hope of a new treatment for clinical depression. TREK-1 is a gene that can affect transmission of serotonin in the brain. Serotonin is known to play an important role in mood, sleep and sexuality. By breeding mice with an absence of TREK-1, researchers were able create a depression-resistant strain. The details of this research, which involved an international collaboration with scientists from the University of Nice, France, are published in Nature Neuroscience this week.

"Depression is a devastating illness, which affects around 10% of people at some point in their life," says Dr. Guy Debonnel an MUHC psychiatrist, professor in the Department of Psychiatry at McGill University, and principal author of the new research. "Current medications for clinical depression are ineffective for a third of patients, which is why the development of alternate treatments is so important."

Mice without the TREK-1 gene ('knock-out' mice) were created and bred in collaboration with Dr. Michel Lazdunski, co-author of the research, in his laboratory at the University of Nice, France. "These 'knock-out' mice were then tested using separate behavioral, electrophysiological and biochemical measures known to gauge 'depression' in animals," says Dr. Debonnel. "The results really surprised us; our 'knock-out' mice acted as if they had been treated with antidepressants for at least three weeks."

This research represents the first time depression has been eliminated through genetic alteration of an organism. "The discovery of a link between TREK-1 and depression could ultimately lead to the development of a new generation of antidepressant drugs," noted Dr. Debonnel.

According to Health Canada and Statistics Canada, approximately 8% of Canadians will suffer from depression at some point in their lifetime. Around 5% of Canadians seek medical advice for depression each year; a figure that has almost doubled in the past decade. Figures in the U.S. are comparable, with approximately 18.8 million American adults (about 9.5% of the population) suffering depression during their life.

Treating depression may raise anxiety levels

Tue, 15 Aug 2006 15:10:00 PST

( from http://www.rxpgnews.com ) An Indo-American team studying the brain of genetically engineered mice has found out why some people under treatment for depression are driven to commit suicide.

All antidepressant medications sold in the US are required to carry a warning that use of these drugs 'increased the risk of suicidal thinking and behaviour.' The US Food and Drug Administration (FDA) made this warning mandatory two years ago on the basis of short-term clinical studies in children and adolescents.

Now, for the first time, research led by Sumantra (Shona) Chattarji of the National Centre for Biological Sciences (NCBS) in Bangalore has provided a molecular basis for this connection between treatment for depression and suicidal thoughts.

In their report published in the prestigious Proceedings of the US National Academy of Sciences they claim to have identified a 'chameleon' like molecule in the brain that plays contrasting roles depending on which area of the brain it is present.

The researchers found that the molecule, called brain-derived neurotrophic factor (BDNF), lowers depression when present in 'hippocampus,' a part of the brain located inside the temporal lobe. But the same molecule increased the anxiety levels when present in another region called 'amygdala', an almond-shaped structure near the hippocampus.

The discovery of opposing roles for the same molecule in two different parts of the brain took the researchers by surprise.

'Ours is also the first finding, at the cellular level, to show that low depression and high anxiety can coexist in the brain,' Chattarji, who is an international fellow of the Wellcome Trust, told IANS.

The team observed this 'paradoxical co-existence' while studying the effect of chronic stress on the two regions (hippocampus and amygdala) of the brain in 'transgenic' mice that had been genetically engineered to overproduce BDNF.

Scientists know for decades that chronic stress that leads to depression damages the hippocampus and shrinks its size. 'Most research on the cognitive effects of chronic stress till now had focused on hippocampus,' Chattarji said. 'We wanted to depart from this traditional approach and see what chronic stress does to the neurons in amygdala which is the centre of emotions.'

The researchers found that, in the chronically stressed transgenic mice, BDNF acted as an antidepressant and prevented damage to the hippocampus as expected. However, over expression of BDNF in amygdala increased the anxiety level in the mice to such an extent that 'they spent most time in the dark afraid to come into the open,' Chattarji said.

Brain autopsy showed that amygdala of these stressed animals had actually grown bigger with more neuronal connections indicating heightened emotional activity and anxiety level.

According to Chattarji, the transgenic mice study has clearly shown that anti-depressants, while treating depressive symptoms can increase anxiety-like symptoms.

'In the case of humans what this means is that medications which help patients to overcome depression can raise their anxiety symptoms to levels that can drive some of them to commit suicide,' he said.

For the same reason, Chattarji has a word of caution against the use of same drugs in the treatment of both depression and anxiety.

'Our data indicate that BDNF plays different roles in depression and anxiety,' he said. 'Unless anti-depressants have a differential effect in the hippocampus and amygdala, they would not be expected to be effective anxiolytic (anxiety reducing) drugs.'

According to Chattarji, the finding is of 'enormous clinical significance' for managing stress-related disorders as it provides a benchmark for developing new drugs for treating depression without firing up the 'anxiety neurons' in amygdala.

'Depression and anxiety are like twin brothers with a difference,' Chattarji said. 'What we are telling the drug developers is that if they want to treat depression with a drug, they must study its action not only in hippocampus -- but also in amygdala which is the centre of emotions and the hub of anxiety.'

Chattarji's team included Arvind Govindarajan, Mimi Trinh, Nadya Mawjee and Susumu Tonegawa of the Massachusetts Institute of Technology in the US and B.S. Shankaranarayana Rao and Deepti Nair of the National Institute for Mental Health and Neurosciences (NIMHANS) in Bangalore.

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Dr. Chittaranjan Andrade, M.D. and Professor, Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore 560 029, India comments on the study
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I am profoundly skeptical about the clinical relevance of this study; and, whereas it certainly conveys useful information about the theoretical significance of neuroplastic changes in the hippocampus and amygdala, it certainly explains nothing about what we see when we treat patients with antidepressant drugs.

Consider the following:

1. The studies were conducted on transgenic rats which were genetically modified to overproduce BDNF. Yes, antidepressant drugs do increase BDNF levels, but probably not to the extent seen with genetic modification! And, for that matter, antipsychotic drugs and ECT also increase BDNF; do these cause suicidality? I think not!

2. Neuroplasticity with BDNF occurs across a time-frame of weeks. In contrast, the use of antidepressants results in an immediate increase in the availability of monoamine neurotransmitters at the synapse. This heightened activity at the postsynaptic receptors, particularly the 5-HT2 receptor, is responsible for the heightened anxiety, agitation, jitteriness etc. which occurs for a short while after antidepressant initiation, before the postsynaptic receptors compensatorily down regulate.

PNAS is an excellent journal. The study was a good one. I just think that the press is reading more into the study than the study warrants.

Depressed singles receive greater psychological benefits from getting married

Mon, 14 Aug 2006 13:51:00 PST

( from http://www.rxpgnews.com ) Depressed singles receive greater psychological benefits from getting married than those who are not depressed, new research shows.

While many studies have shown that marriage helps boost well-being, most studies have looked at a general, average population and don't examine whether some people were helped more by marriage than others.

Our findings question the common assumption that marriage is always a good choice for all individuals, said Adrianne Frech, co-author of the study and a doctoral student in sociology at Ohio State University.

Frech conducted the study with Kristi Williams, assistant professor of sociology at Ohio State. Williams said the study was the first to compare how depressed and non-depressed people benefit from marriage.

Those average' benefits of marriage may be largely limited to people who are depressed before they entered marriage, Williams said. There may not be strong benefits for everyone.

The researchers used data collected by the National Survey of Families and Households, which interviewed a representative sample of Americans in 1987-88 and then re-interviewed them in 1992-94. They used data from 3,066 people who were unmarried at the time of the first interview.

They measured depression using 12 questions in the survey which asked respondents the number of days in the last week that they felt like they could not shake off the blues, slept restlessly, or felt lonely.

For those who got married, the researchers also examined measures of marital happiness and marital conflict.

Frech said they were surprised that depressed people in this study benefited the most from marriage.

We actually found the opposite of what we expected, Frech said. We thought depressed people would be less likely to benefit from marriage because the depression of one spouse can put a strain on the marriage and undermine marital quality.

Indeed, the study confirmed Williams' previous research that found levels of marital quality and conflict were key in determining depression levels in individuals after marriage. As would be expected, people who report marriages that are high in quality and low in conflict are less likely to be depressed.

Also, the study found that depressed people who got married reported overall lower levels of marital quality than did individuals who were not depressed. But even so, depressed people still benefited more psychologically from marriage than did non-depressed people.

The results didn't show any differences between men and women in the links between marriage and depression.

Although the study didn't look at why depressed people benefit more from marriage, the researchers believe they may have more to gain.

If you start out happy, you don't have as far to go, Williams said. But also, depressed people may just be especially in need of the intimacy, the emotional closeness, and the social support that marriage can provide.

Marriage may give depressed people a greater sense that they matter to someone, while people who weren't depressed prior to marriage may have always thought that way.

The researchers noted that the people in this study had been married 5 years at most. There may changes in the psychological benefits as the marriage progresses, and as couples have children or get divorced.

But the results suggest that marriage doesn't have equal benefits for everyone.

We can't focus just on average effects of marriage on well-being, Frech said. As this study shows, there is a great deal of variability in the benefits of marriage.

STAR*D Trial: Third antidepressant medication might help in treatment-resistant depression

Mon, 10 Jul 2006 21:01:00 PST

( from http://www.rxpgnews.com ) The next wave of results from the nation's largest real-world study of treatment-resistant depression shows that patients had a moderate chance of becoming symptom-free when they switched to a third antidepressant medication, following two previously unsuccessful medication attempts. These results from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial, funded by NIMH, were published in the American Journal of Psychiatry on July 1, 2006.

During Levels 1 and 2 of the STAR*D trial, which started with 2,876 participants, about half of all patients became symptom-free. Of the other half, about one in five became symptom-free when they went on to Level 3 and switched medications again.

"STAR*D continues to provide valuable real-world information about treating depression," said NIMH Director Thomas R. Insel, M.D. "Not only are the results enlightening, but they are telling us that more research is needed to help people with this debilitating illness, especially those who have tried several treatments and the treatments have failed."

As in Level 2, patients in Level 3 were given the choice of either switching medications or adding another medication to their existing medication; 234 patients chose to switch medications in Level 3. The results for those who chose to add to their existing medication will be available later in 2006.

The patients were randomly assigned to take either mirtazapine (Remeron), an "atypical" antidepressant, or nortriptyline (Aventyl or Pamelor), a tricyclic antidepressant, for up to 14 weeks. Both work differently in the brain than the selective serotonin reuptake inhibitors (SSRIs) and other medication used in Levels 1 and 2 of the STAR*D trial.

Overall, the two medications were about equally effective with 10 to 20 percent of patients becoming symptom-free. The type and severity of side effects were similar for both medications. In addition, neither medication resulted in a faster improvement rate than the other, suggesting that no clear advantage exists for either medication.

"Patients who do not respond to two consecutive antidepressant trials should not give up. Many of them will get better if they keep trying different treatment regimens or combinations, although the benefits from a third trial of an antidepressant alone appear to be rather modest," said lead author Maurizio Fava, MD, of the Massachusetts General Hospital in Boston.

Residual Depressive Cognitions could Predict Relapse of Depressive Illness

Tue, 04 Jul 2006 13:26:00 PST

( from http://www.rxpgnews.com ) Some individuals with a history of depression may sink back into thinking patterns associated with the condition when faced with mild stresses or sadness, increasing their risk for relapse, according to a report in the July issue of the Archives of General Psychiatry, one of the JAMA/Archives journals.

Many patients who recover from depression eventually relapse, according to background information in the article. Management of depression usually focuses on alleviating symptoms rather than reducing the risk for recurrence or identifying patients who might relapse after successful treatment. Previous studies have found that some patients who have recovered from depression still show cognitive processes-patterns in thinking, learning and memory-commonly associated with the condition, while others in remission do not. Such cognitive processes include certain ways of explaining events or particular assumptions about self-worth.

Zindel V. Segal, Ph.D., University of Toronto and Centre for Addiction and Mental Health, Ontario, and colleagues randomly assigned 301 patients with major depressive disorder to receive either antidepressant medications or cognitive behavioral therapy (a kind of psychotherapy designed to modify the cognitive processes that are typically associated with depression). Ninety-nine of those whose depression went into remission participated in a second phase of the trial. These 99 participants rated their current mood on a visual scale from sad to happy and underwent an assessment of their dysfunctional attitudes, signs of the cognitive processes that are associated with depression. The researchers then provoked a sad mood by asking participants to listen to a piece of music and try to recall a time in their lives when they felt sad. After this exercise, the participants rated their mood and underwent the dysfunctional attitude assessment a second time and were observed bimonthly for the next 18 months.

Seventy-eight patients completed the full 18 months of follow-up; 47.5 percent of those who had recovered through antidepressant medication use and 39 percent of those who received cognitive behavioral therapy relapsed during that time period. Regardless of the type of treatment, those who had greater cognitive reactivity-that is, they displayed significantly more dysfunctional beliefs after the sad mood provocation than before it-were more likely to relapse during the 18-month follow-up. This association held true even when researchers considered the number of past episodes of depression each patient had experienced, previously the best known way to predict relapse. In addition, those who took antidepressants were more likely to have greater cognitive reactivity than those in the cognitive behavioral therapy group.

"Our study indicates that even a mild negative mood, when experienced by someone with a history of depression, can reinstate some of the cognitive features observed in depression itself," the authors write. "The presence of such reactivity in recovered patients signals a residual but heightened risk for episode relapse that has not been fully addressed by treatment."

Future depression management approaches might aim to help prevent relapse by teaching patients to reflect on the factors that influence their thinking, the authors suggest. "Such treatments may include components that first help patients deliberately monitor and observe their thinking patterns when they feel sad, and then help patients respond to these thoughts and feelings in a way that allows them to inhibit the cognitive elaboration of their content," they write.

Link Between Depression and Heart Disease

Tue, 04 Jul 2006 01:43:00 PST

( from http://www.rxpgnews.com ) Naturally occurring steroids in the body may make people with a history of depression more vulnerable to coronary heart disease, according to new research from the University of Birmingham.

The small-scale trial of Metyrapone, which inhibits the production of the steroid hormone cortisol, significantly improved the function of the blood vessel lining, known as 'endothelium', in people who had a history of depression. The results, which are published in the current edition of the Journal of the American College of Cardiology, suggest that cortisol may play a significant role in causing damage to the endothelium of people who have recurrent depression.

Professor Michael Frenneaux, British Heart Foundation Professor in Cardiology, who led the research, explains: "We already know that people with a history of depression are at greater risk of heart disease. Our previous work has also shown that these people have significant problems with the lining of their blood vessels, which increases their risk of vascular problems or coronary heart disease. These results suggest that cortisol plays a role in creating these problems, which increases the risk of heart disease."

66 people, half of whom had previously suffered from depression, were involved in the trial, taking either Metyrapone or a placebo. The trial looked to assess whether blocking cortisol could improve the function of the blood vessel lining. The research team measured each person's endothelial function before, and six hours after, receiving Metryapone, a drug which blocks the production of cortisol.

The results showed improvement in the function of the endothelium in those people who received Metyrapone compared to the control group.

Professor Frenneaux continues: "Those people with a history of depression who received a cortisol inhibitor showed an improvement in blood vessel function compared to the placebo group. Although this was a small-scale trial it does open up the possibility that suppressing cortisol in patients who have a history of depression could be a way of reducing their higher risk of developing heart disease."
ENDS

Social factors not hormones cause post-natal depression

Thu, 22 Jun 2006 05:11:00 PST

( from http://www.rxpgnews.com ) Women are being sold the idea that their bodies are biologically faulty and they need medication for PMS, post-natal depression and menopausal outbursts when in fact the pressures of being 'superwoman' are more likely to blame, says a leading expert.

Professor of Women's Health Psychology at the University of Western Sydney, Jane Ussher, has been researching the issue for 20 years and says that women are being controlled by medical practices which position their unhappiness as a biomedical condition.

"I would argue that PMS and PND are essentially a form of repressed rage women feel rather than a medical illness. Our research has shown that their distress often stems from women trying to do too much for everyone - except themselves," says Professor Ussher.

"The tags pre-menstrual syndrome, post-natal depression (PND) and menopause, have become catch-all diagnostic categories that attribute women's unhappiness to their reproductive bodies and legitimise medical management of their condition," says Professor Ussher.

"The problem with this view is that it ignores the fact that female unhappiness is often an understandable response to the realities of women's lives."

Professor Ussher has recently published a new book 'Managing the Monstrous Feminine: regulating the reproductive body' which explores the issues of PMS, post-natal depression and women experiences in mid-life.

Professor Ussher draws on in-depth interviews with British and Australian women and argues that women's premenstral, post-natal and menopausal distress or anger is often connected to the way women feel compelled to be the 'good wife, mother and emotional nurturer of others'.

"It's a form of self-censoring. Women feel that they are expected to cope with the gamut of responsibilities - including their job, partner, children, extended family, housework etc - without complaint.

"They become distressed about the state of their lives and seek help only to be told that it is likely to be the result of these three diagnostic tags." Professor Ussher argues that while medicine has constructed menopause as a disease requiring HRT medication, the notion of the menopausal woman being in a state of psychological turmoil is a myth.

"The rates of depression in women actually fall with age, with only 7 per cent of women aged 45-54 experiencing depression. The notion of the menopausal body causing upheaval and depression is nothing more than fiction," she says.

Professor Ussher says the common theme emerging from her work is that women often feel unsupported and misunderstood during their early reproductive lives, but that women are happier in their later years when their responsibilities ease and their lives become their own again.

"The post feminist body is a mirage. Women can now choose how to live their lives - to work, raise children, take time for themselves and be sexy to boot. They can have it all or so we are led to believe," she says.

"Our accounts from women challenge the two common life goals that frame women's lives from puberty onwards: the notion that a woman's happiness is to be gained though love, romance, meeting 'Mr Right' and living happily ever after; and that a woman's greatest satisfaction comes from caring, mothering and self-sacrifice.

"From our research it appears that for many women they only reach a position of equilibrium and peace when they can leave these myths behind, or realise they can't sustain them any more, or feel they have paid their dues, and can now turn to their own needs for the first time in their lives."

Professor Ussher says society needs to move beyond the 'blame game' and stop viewing women's bodies as the reason for their distress.

"Our studies have shown that women cope with changes and stress at different times in their lives if they are given time-out from their responsibilities and provided with some self-care options," she says.

"Taking steps to put themselves first reduces the impact of their symptoms and empowers women to refocus and not be afraid to ask for extra help or support if they need it.

"Women need to understand that it is okay to be vulnerable at certain times without letting it overwhelm them. It's also okay to say no - for many women, this is the most difficult technique to master of all."

No evidence for congenital abnormalities by paroxetine

Tue, 20 Jun 2006 00:49:00 PST

( from http://www.rxpgnews.com ) A study carried out by German researchers has failed to show that a popular antidepressant, paroxetine, causes congenital abnormalities if taken by pregnant women, the 22nd annual conference of the European Society of Human Reproduction and Embryology heard today (Monday).

Dr Wolfgang Paulus said the results were important because they contradicted a warning issued by the US Food and Drug Administration in October 2005 that the use of paroxetine (brand names: Seroxat, Paxil, Aropax, Deroxat or Pondera) could increase the risk of major congenital abnormalities. The warning may have caused women to terminate their pregnancies unnecessarily.

Dr Paulus, director of the Institute of Reproductive Toxicology at the University of Ulm, Germany, told a news briefing: "Our results show the importance of a reliable pharmaco-vigilance system documenting foetal outcome after medication in pregnancy. We need international networks of registries to do this, but financial support for this purpose is lacking. We hope for more serious efforts from the pharmaceutical industry and governmental authorities in Europe. We think that this is also an ethical challenge because many patients opt for termination of pregnancy due to fear of congenital malformations.

The FDA warning about the drug, which is a selective serotonin reuptake inhibitor (SSRI), was issued on the basis of unpublished research. "It showed that the absolute rate of major congenital malformations seen in the first trimester for paroxetine users was 4%, and 2% for cardiovascular malformations. Yet the retrospective study of 5,956 women by the producer, GlaxoSmithKline, had only 591 cases of medication with paroxetine during the first trimester and did not include controls of women not taking an antidepressant," he said.*

In contrast, the research carried out by Dr Paulus and his colleagues was a prospective follow-up study that collected data on pregnancy outcomes after medication with paroxetine in 119 women between 1990 and 2005. "Our national Teratology Information Service (TIS) was contacted by physicians and patients after exposure to paroxetine in the first trimester of pregnancy. We compared the results with a control group of 645 women over the same period of time, who had not been exposed, or not severely exposed, to the drug.

"We found that the rate of congenital abnormalities was not increased after using paroxetine in early pregnancy. Three abnormalities were reported after exposure to paroxetine: club feet after exposure throughout pregnancy, a large port wine mark after exposure up to the seventh week, and spastic torticollis (painful spasms of the neck muscles) after exposure in the first twelve weeks. However, in the non-paroxetine group there was a similar rate of abnormalities, with 25 out of 557 babies affected."

However, the researchers did find that the number of women deciding to terminate their pregnancies was much higher amongst the paroxetine group. "Eighteen out of 119 paroxetine users (just over 15%) preferred termination of pregnancy compared to 17 out of 645 women in the control group (2.6%). In most cases the patients opted for termination of pregnancy because of a combination of reasons: partly because of their depression, but also because of confusion caused by information on possible damage to the foetus from the package labelling.

"Our prospective controlled follow-up study does not support the assumption that paroxetine can cause congenital abnormalities. Although our study of 119 paroxetine users was relatively small, there are three other, peer-reviewed, published studies that show no increased rates of cardiovascular malformations with paroxetine, whereas there has been no published research that shows that paroxetine can cause abnormalities. We continue collecting data as a member of the European Network of Teratology Services (ENTIS) in order to reassure patients who need a long-term antidepressant medication."

Dr Paulus highlighted the damage that incomplete research can have not only on the unborn babies, through decisions to terminate pregnancies, but also on the mental and physical well-being of mothers, through not treating their depression or stopping their medication abruptly.

"Depression, anxiety, obsessive-compulsive disorder and premenstrual stress are common disorders during child-bearing years and can be treated with antidepressants such as paroxetine. Failure to treat depression during pregnancy can have significant negative ramifications for both mother and child. Women and their physicians should discuss this information and make an informed decision, whether or not to continue with paroxetine during pregnancy. Concerned patients can be offered ultrasound and echocardiogram, which can rule out foetal cardiac problems in early pregnancy. Antidepressants should never be stopped abruptly as this can have serious ramifications for the mother. If a woman does decide, following a discussion with her physician, that she wants to discontinue paroxetine, the drug should be slowly tapered off."

FDA approved Wellbutrin for seasonal affective disorder (SAD)

Tue, 13 Jun 2006 05:41:00 PST

( from http://www.rxpgnews.com ) The Food and Drug Administration (FDA) today approved Wellbutrin XL for prevention of major depressive episodes in patients with a history of seasonal affective disorder (SAD). This is the first drug approved for SAD. Wellbutrin XL (bupropion HCL extended release tablets) previously was approved for treatment of major depressive disorder.

SAD is characterized by recurrent major depressive episodes that usually coincide with the seasonal decrease of daylight during autumn and winter. The depressive episodes can last up to 6 months. Although patients with SAD may have depressive episodes during other times of the year, the diagnosis of seasonal affective disorder requires that the number of seasonal episodes substantially outnumber the non-seasonal episodes during the individual's lifetime.

A major depressive episode is defined as the presence of 5 or more of the 9 core symptoms of major depression for at least 2 weeks. The symptoms include: depressed mood; loss of interest; weight loss (or other weight or appetite changes); insomnia or hypersomnia; agitation or psychomotor retardation; fatigue; feelings of worthlessness or guilt; impaired concentration; suicidal thinking or behavior. One of the 5 symptoms must be either depressed mood or loss of interest in activities. Another essential feature of major depression is the presence of significant distress or impairment in social, occupational, or other important areas of functioning. A seasonal major depressive episode is defined by the identical features.

Seasonal affective disorder can significantly impair the quality of life of patients with this condition, said Dr. Steven Galson, Director for FDAs Center of Drugs and Research. Todays approval can help patients with this condition to avoid the depressive symptoms and impaired functioning that typically affect them in the fall and winter.

The effectiveness of Wellbutrin XL for the prevention of SAD episodes was established in 3 double-blind, placebo-controlled trials in adults with a history of major depressive disorder in autumn and winter. Treatment was initiated prior to the onset of symptoms in the autumn (September to November) and was discontinued following a two-week taper that began the first week of spring (fourth week of March). In these trials, the percentage of patients who were depression-free at the end of treatment was significantly higher for those on Wellbutrin XL than for those on placebo; for all 3 studies combined, the overall rate of patients depression-free at the end of treatment was 84 percent for those on Wellbutrin XL compared to 72 percent for those on placebo.

Wellbutrin XLs labeling includes a black box warning concerning the increased risk of suicidal thoughts and behavior in pediatric patients treated with antidepressant medications. As with all antidepressants, Wellbutrin XL has a Medication Guide (MedGuide, or patient labeling) advising that pediatric patients on antidepressants should be watched closely for these serious symptoms. Important side effects to watch for with Wellbutrin XL, especially shortly after the initiation of the treatment, include agitation, anxiety and insomnia. Wellbutrin was safe and well tolerated by patients in the SAD trials.

It is important to note that Wellbutrin XL is indicated only for patients who meet strict diagnostic criteria of seasonal major depressive episodes. Such patients have a pattern of recurrent, clinically significant depressive symptoms with associated impairment of functioning. The clinician and patient should carefully assess the potential risks and benefits when considering treatment with Wellbutrin XL for SAD.

Depression and Diabetes: Which Comes First?

Tue, 13 Jun 2006 05:16:00 PST

( from http://www.rxpgnews.com ) The use of antidepressant drugs was associated with a significantly increased risk of developing type 2 diabetes in people who were already at greater risk of the disease and this effect was not seen in those taking the drug metformin, according to a report presented here today at the American Diabetes Association's 66th Annual Scientific Sessions. Other studies yielded conflicting reports on the role of depression in the risk for diabetes. Researchers concurred, however, that those who have diabetes and depression need better management for the latter, which can interfere with their ability to provide self care for their diabetes.

In a sub-analysis of the Diabetes Prevention Program, which sought to reduce progression to type 2 diabetes by either lifestyle modification or the drug metformin, compared with placebo, in people at very high risk for diabetes, we found that those in the lifestyle and placebo arms of the trial who were taking antidepressant drugs when they started the study, or who took them frequently during the study, were two to three times more likely to develop diabetes during the study, said Richard R. Rubin, PhD, Associate Professor, Medicine and Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD, who was a co-investigator in the study.

There was no increased risk of diabetes seen in those not taking antidepressants in the study, suggesting that the antidepressant medications predispose to diabetes. While it is well-known that some antipsychotic drugs may increase a persons risk for diabetes, this is the first indication that antidepressant drugs could increase the risk of diabetes. Although this finding occurred in an already high risk population, it has serious public health implications. Dr. Rubin noted that the association between antidepressants and diabetes has not been reported before, and the mechanism for this association is unknown. The effect remained when all likely risk factors, e.g. increased weight, were ruled out.

We have to keep in mind that that this occurred in a population at very high risk for diabetes so we dont know whether the findings would apply to the general population, said Dr. Rubin, but this should be explored further.

One surprising finding was that those who were on antidepressant medications, but who were in the metformin arm of the trial, did not have an increased risk of diabetes. Again, the reason for this finding is unknown.

Whether depression tends to cause type 2 diabetes or diabetes causes depression has been a chicken vs. egg issue for centuries. In 1674, British physician Thomas Wolfe said the cause of diabetes is extreme sorrow. In the 1950s, Karl Menninger sought a diabetogenic personality and did not find it. By the 1970s, the tables had turned, and it was generally thought that diabetes caused depression. In the 1990s, two major studies showed that depressed people develop diabetes at twice the rate of the non-depressed. Over time, research has tended to confirm that risk in some populations. However, the question has remained unresolved, and multiple papers on this topic are being presented at this years ADA meeting to address the issue.

Some 20.8 million adults and children in the United States have diabetes, a group of serious diseases characterized by high blood glucose levels that result from defects in the body's ability to produce and/or use insulin. Diabetes can lead to severely debilitating or fatal complications, such as heart disease, blindness, kidney disease, and amputations. It is the fifth leading cause of death by disease in the U.S.

Type 2 diabetes involves insulin resistance the bodys inability to properly use its own insulin. It usually occurs in those who are over 45 and overweight, but it has increasingly been seen in obese children and teens in recent years. Diabetes Comes First in This Study

Another study evaluated glucose tolerance in 443 generally healthy adults, of whom 14% were being treated for depression. Participants in this study were given a Patient Health Questionnaire (PHQ), a validated screening test for depressive symptoms that has good agreement with formal evaluations such as the Beck Depression Inventory.

We theorized that if the metabolic abnormality of diabetes comes first, then glucose intolerance should be associated with depression in individuals with undiagnosed diabetes and pre-diabetes, said Lawrence S. Phillips, MD, Professor of Medicine, Division of Endocrinology and Metabolism, Emory University School of Medicine, Atlanta, GA. However, the opposite occurred. After adjusting for age, BMI (an indicator of weight), gender, and race, glucose intolerance had no significant impact on PHQ, Dr. Phillips reported. Although diagnosed diabetes is associated with depression, previously unrecognized glucose intolerance is not in this study. The authors conclude that awareness of the health risks conferred by diabetes may contribute to depression, and the newly-diagnosed should be counseled and monitored for the development of depression.

Certainly people diagnosed with diabetes who are faced with a life of this chronic disease are at greater risk of depression, says Sherita Hill Golden, MD, Assistant Professor of Medicine and Epidemiology, The Johns Hopkins University School of Medicine, Baltimore, MD. But depression can also come from the other direction. If people have chronic stress and depression, associated hormonal changes can occur and physicians need to be aware that such patients may be at increased risk of other diseases, including type 2 diabetes.

In her presentation on Psychological Stress, Depression and Diabetes: The Neuroendocrine Link, she said that hypercortisolism associated with depression may be the pathway. She is further refining the association between hormone changes and diabetes by studying an elevation of the stress hormones cortisol and catecholamines which may be the potential link.

At the meeting, she reviewed studies that have noted the association going in both directions, that is diabetes causes depression, and depression causes diabetes. Dr. Golden spoke at the symposium on Cause or Consequence? Novel Complications Associated with Diabetes.

Those who treat people with diabetes and depression on a daily basis do not appear to be as concerned with the issue of which came first. Rather, the focus is on the results of this comorbidity, which was demonstrated in another study presented by Russell E. Glasgow, PhD, Senior Scientist in the Clinical Research Unit, Kaiser Permanente, Colorado, Denver, CO.

Depression interferes with your ability to problem solve, so these individuals are less able to manage their diabetes, said Dr. Glasgow. In this study, the authors evaluated how people with diabetes and depression handled different problems related to diabetes self-management, such as handling dietary choices or decisions regarding when to exercise. A counselor taped study participants responses to discern their ability to cope with the typical challenges that people with diabetes face. We found that people who do better on problem solving do a better job of self-managing with more frequent exercise sessions per week, and fewer calories consumed and their blood test results show better control of their diabetes and cholesterol, said Dr. Glasgow. Further, these achievements significantly were correlated with their level of depressive symptoms, in that those with the least depression did best.

People who have diabetes and depression need to have their depression addressed because it interferes with problem solving ability and therefore their ability to manage their disease, said Dr. Glasgow.

Brain images suggest vagal nerve stimulation for severe depression can take months to work

Fri, 26 May 2006 13:53:00 PST

( from http://www.rxpgnews.com ) It takes time between three and 12 months before a new type of therapy for treatment-resistant depression starts to benefit patients, according to new preliminary brain scan research that confirms earlier observations by psychiatrists about vagal nerve stimulation.

Saint Louis University, working in collaboration with Washington University School of Medicine, conducted a pilot study of brain scans of a small group of depressed patients who received vagal nerve stimulation after failing other therapies.

Positron emission tomography (PET) scans showed significant changes in brain activity starting three months after vagal nerve stimulation treatment began. These changes continued to evolve over the course of the next 21 months.

These changes in brain scans appear to "roughly parallel" the significantly delayed effects that psychiatrists observed in improvement in mood.

"The effects come after a significant period of treatment time," said Charles Conway, M.D., an assistant professor of psychiatry at Saint Louis University School of Medicine and the lead investigator of a vagal nerve stimulation research project conducted between 2000 and 2004.

Psychiatrists are not used to such a long time lag before a treatment begins to be effective, he added.

"This is very different from the delays we see with existing treatments for depression, including pharmacotherapy and electroconvulsive therapy (ECT)," Dr. Conway said. "The biggest changes in the brain that we're noting occur between 12 and 24 months after patients began receiving vagal nerve stimulation. In psychiatry, we're used to seeing results after six to 12 weeks."

Dr. Conway cautioned the findings are preliminary and need replication.

"But they suggest that in this type of therapy, the brain takes a relatively long time to change, perhaps as long as a year or more. In this sense, vagal nerve stimulation may represent a paradigm shift in the way we view depression treatment. Patients may have to be instructed to 'be patient,' with the expectations that the antidepressant effects will be slow to come."

The good news, however, seems to be that those who benefit from the treatment stay better.

"The existing evidence suggests that about 70 percent of patients who get better from vagal nerve stimulation at one year, stay better at two years," Dr. Conway said. "That is unheard of in a depressed population this severe, and suggests that the brain changes induced by this treatment appear to be long-lasting."

Dr. Conway examined the brain scans of patients at three, six, 12 and 24 months intervals after they began receiving vagal nerve stimulation. Eight patients participated in the study for the three and six month scans, six patients at 12 months and four patients at 24 months. The size of the study group grew smaller during the two year investigation.

"This is admittedly a very tiny population and the findings of this study are very preliminary. We need to do more research with a larger group of patients," Dr. Conway said. "That said, I think the findings are real and promising and beg more research."

Vagal nerve stimulation was approved in 2005 by the U.S. Food and Drug Administration to treat severe treatment-resistant depression. A vagal nerve stimulator is similar to a cardiac pacemaker and is implanted in the chest with leads that run under the skin to the vagal nerve in the neck. The device emits electrical pulses to simulate the brain, and also is used to treat epilepsy.

Doctors don't know exactly why vagal nerve therapy works, but Dr. Conway says his new research gives some clues.

When Dr. Conway examined the neuroimages of four patients 24 months after they began receiving vagal nerve stimulation, he found brain activity that was similar to what doctors see in patients who have received ECT.

"There actually appears to be decreased activity in regions of the prefrontal cortex, which is very much parallel to the findings of treatment response in ECT, and the opposite of findings seen in medication-response to depression."

He found unexpected action in the prefrontal cortex of the brain that is similar to brain activity in depressed patients immediately after they have received ECT and before its effect wears off.

"No one knows exactly how vagal nerve stimulation works. This suggests that one way in which it works may parallel ECT," Dr. Conway said.

"ECT had been considered to be the best therapy for treatment-resistant depression, but unfortunately the effects are not long-lasting. The data so far shows that one-third of the depressed patients who are treatment resistant are responsive to vagal nerve simulations and those who respond stay well."

Melatonin improves mood in winter depression

Sun, 07 May 2006 19:41:00 PST

( from http://www.rxpgnews.com ) Researchers at Oregon Health & Science University(OHSU) have found that melatonin, a naturally occurring brain substance, can relieve the doldrums of winter depression, also known as seasonal affective disorder, or SAD. The study is publishing online this week in the Proceedings of the National Academy of Science.

The study was led by Alfred Lewy, M.D., Ph.D., an internationally recognized pioneer in the study of circadian (24-hour) rhythm disturbances, such as those found in air travelers and shift workers, as well as in totally blind people.

Lewy and his colleagues in the OHSU Sleep and Mood Disorders Lab set out to test the hypothesis that circadian physiological rhythms become misaligned with the sleep/wake cycle during the short days of winter, causing some people to become depressed. Usually these rhythms track to the later dawn in winter, resulting in a circadian phase delay with respect to sleep similar to what happens flying westward. Some people appear to be tracking to the earlier dusk of winter, causing a similar amount of misalignment but in the phase-advance direction. Symptom severity in SAD patients correlated with the misalignment in either direction.

The treatment of choice for most SAD patients is bright light exposure, which causes phase advances when scheduled in the morning. Because patients know when they are exposed to bright light, however, there is a considerable placebo response associated with it. Melatonin can also cause phase advances, but it has to be taken in the afternoon. The Lewy team used afternoon melatonin to test if it was more antidepressant than melatonin taken in the morning, which causes phase delays.

The researchers randomly assigned 68 SAD patients to one of three treatment groups, taking placebo capsules or melatonin in the morning or afternoon for three weeks. After four years of study, they concluded that, similar to persistent jet lag, circadian misalignment is a major part of SAD.

Most patients, typically phase-delayed types or "night owls," have misalignment that responded best to taking low-dose melatonin in the afternoon or evening. A longer-than-expected subgroup of SAD patients, phase-advanced types or "morning larks," responded best to taking low-dose melatonin in the morning. Melatonin did not cause drowsiness, because the doses used were lower than what is usually taken at bedtime.

In addition to bright light exposure, another treatment may be in the offing once low-dose, sustained-release melatonin formulations become available. "However, people in the phase-advanced subgroup should use these treatments at different times of the day than the typically phase-delayed type of patient," explained Lewy, adding that more research is needed.

SSRI anti-depressants may cause stillbirth

Mon, 10 Apr 2006 13:54:00 PST

( from http://www.rxpgnews.com ) Women who take a type of antidepressant medication during pregnancy face the risk of a stillborn baby, warns a study.

Canadian researchers at the University of Ottawa compared the health of babies born to 972 women taking SSRI (selective serotonin reuptake inhibitors) with that of babies born to mothers who did not use anti-depressants.

They found that women using the drugs were twice as likely to have a stillbirth. They were also almost twice as likely to have a low birth weight baby, reported the online edition of BBC News.

Babies born to women using SSRIs were also more likely to have seizures, the study published in the American Journal of Obstetrics and Gynaecology said.

SSRIs work by increasing levels of the mood chemical serotonin in the brain. Babies born to women using SSRIs were also more likely to have seizures, the researchers said.

"Left untreated, the physical and psychological effects of depression can lead to problems during pregnancy," said Charlotte Davies of Tommy's, the baby charity.

"Sufferers of depression are far more likely to smoke, as well as lose their appetites and in extreme cases are more likely to attempt suicide, which can all have devastating effects on mother and baby."

Whilst this study has found a correlation between SSRIs and pregnancy complications, it has in no way confirmed a clear causal effect between the two.

The researchers said women using these anti-depressants should be fully briefed about the potential risk by their physicians. Pregnant women could opt for other types of anti-depressant medication, they said.

Brain imaging can predict effectiveness of CBT in depression

Mon, 03 Apr 2006 06:52:00 PST

( from http://www.rxpgnews.com ) Whether or not cognitive behavior therapy (CBT) will help a person recover from depression can be predicted through brain imaging, according to research results published by the University of Pittsburgh School of Medicine in the April issue of the American Journal of Psychiatry, the official journal of the American Psychiatric Association.

More than 17 million adults in the United States will experience at least one episode of major depression this year; of those who seek treatment, only 40 to 60 percent will respond to any given first-line treatment, whether it be therapy or medication. However, researchers have found that most eventually will respond once they find the right treatment. Being able to predict who will respond to CBT, and who will not, may prove to be a valuable tool for treating depression.

"For depression, there is no single medication or therapy that has been found to work as a primary treatment for most patients," said Greg J. Siegle, Ph.D., assistant professor of psychiatry, University of Pittsburgh School of Medicine. "We found that people with depression who have increased activity in one area of the brain and decreased activity in another in response to emotional stimuli are more likely to respond to a specific treatment--cognitive therapy. If this finding holds true, we may be able to predict what therapies will be most effective for individual patients by using imaging technology, bypassing the lengthy trial and error process that is often necessary to find the right treatment."

The study used functional magnetic resonance imaging (fMRI) to identify which areas of the brain were active or inactive when exposed to a negative stimulus. While undergoing fMRI, 14 unmedicated participants with depression and 21 control subjects who had never reported symptoms of depression were presented with emotional words and asked if those words applied to them. The participants with depression then completed 16 sessions of CBT over 12 weeks as part of a larger clinical trial.

Researchers found that compared to controls, nine of the participants with depression had decreased activity in a region of the brain called the subgenual cingulate cortex after they read negative words. Of those nine, seven recovered from their depressive symptoms after CBT. Only one of the five participants with depression who did not demonstrate decreased activity in the subgenual cingulate cortex recovered after CBT. Better recovery also was associated with increased activity after reading negative words in a brain region called the amygdala.

"The amygdala helps us to recognize things as being emotional. In some people with depression, the amygdala doesn't turn off as fast as it should after it recognizes something as being negative. The subgenual cingulate cortex regulates emotions and plays a part in turning the amygdala on and off," said Dr. Siegle. "If the amygdala doesn't get 'turned off' in a person with depression, when exposed to negative information, the person may ruminate, going over this information again and again. Cognitive behavioral therapy teaches people techniques to stop this rumination, so it makes sense that it would be a good treatment option for those people who can't turn off their amygdala," said Dr. Siegle.

Successful treatment of mothers with depression helps their children

Wed, 22 Mar 2006 07:10:00 PST

( from http://www.rxpgnews.com ) Children whose mothers are depressed are more likely to suffer from anxiety, mental-health problems and disruptive behavior than those whose moms aren't. And if the mothers don't get better, these kids' problems often become worse, new research shows.

Conversely, however, children whose mothers are successfully treated for their depressive symptoms show significant improvements themselves without any additional intervention or treatment of their own.

The study, available online today in the Journal of the American Medical Association, is the first, large-scale examination of the effects on kids when their mothers are treated for depression and scientifically monitored for a period of time. UT Southwestern Medical Center was one of several national sites participating in the study, which emphasizes the importance of evaluation and treatment of parental depression in an effort to help children and adolescents.

"The bottom line message is: 'Mothers who are depressed, go get treated for your depression. It will help not only you, but your child,'" said study co-author Dr. A. John Rush, vice chairman of clinical sciences and professor of psychiatry at UT Southwestern.

About one in 20 teens suffers from moderately severe to severe depression; it is one of the most common disorders of adolescence, according to the National Institute of Mental Health (NIMH). This means that in a high school population of 2,000 teenagers, 100 are likely to have a significant major depressive episode on any given day.

"Depression should not be taken lightly," said Dr. Madhukar Trivedi, study co-author and professor of psychiatry at UT Southwestern. "For kids' sakes particularly, we should be very aggressive in treating patients, particularly mothers. The more improved care we can provide to depressed mothers, the more benefit to their children."

Part of the largest national clinical trial on treatment for depression, called STAR*D (Sequenced Treatment Alternatives to Relieve Depression) coordinated by UT Southwestern and funded by the NIMH the mother-child study included more than 150 pairs of mothers and their children, who varied in age from 7 to 17. The mothers were treated for depression in eight primary-care and 11 psychiatric outpatient clinics across the country as part of the $35 million six-year STAR*D study.

Dr. Rush said mothers were studied rather than fathers because the rate of depression is higher in women than men, particularly in women of childbearing ages. Mothers are also more likely than fathers to bring their children in for assessments.

Children participating in STAR*D-Child were evaluated for depression at the beginning of the study and then reassessed after their mothers had been on antidepressant medications for three months. Many came into the study with significant problems - more than one-third had current psychiatric disorders including anxiety, depression and/or other disruptive behavior disorders. Almost half had a previous psychiatric disorder.

Three months later, kids whose moms remitted (or recovered from all depressive symptoms, based on a widely used measurement scale) showed an overall 11 percent decrease in rates of diagnoses for depression, as compared to an approximate 8 percent increase in rates of diagnoses in children of non-remitted mothers.

Of the children who were diagnosed with depression at the study's beginning, remission was reported in 33 percent of those whose mothers remitted, compared to only 12 percent remission rates in those whose mothers did not. Of the children with no diagnoses of depression at the study's onset, all children of remitted mothers remained symptom-free, while 17 percent of the children of non-remitted mothers acquired a diagnosis of depression during the three months.

Mothers who did not fully remit after three months, but did respond (showed a decrease in depressive symptoms by at least 50 percent) also had children who showed improvement. Additionally, when overall study results were analyzed based on mothers' educational levels, or both income and education, the statistics remained unchanged.

"A mother's depression does affect her kids," said Dr. Carroll W. Hughes, professor of psychiatry and rehabilitation counseling at UT Southwestern. "When she gets treated and gets better, lo and behold, her kids improve, too. A parent's depression not only has a strong impact on the family as a whole, but it often affects a child's functioning. It points out the need for parents to seek treatment for their depression.

Women with urinary incontinence face depression risk

Wed, 22 Mar 2006 01:27:00 PST

( from http://www.rxpgnews.com ) Women who suffer from urinary incontinence are more likely to be depressed, says a study.

Urinary incontinence is the inability to hold your urine until you get to a restroom. The condition is twice as common in women as in men, is often temporary, and can happen for various medical reasons.

The mix of depression and urinary incontinence is worse than either condition alone and doctors "need to be attentive to these findings", wrote University of Toronto researchers in Psychosomatics.

"It is imperative that women with either condition be screened for the other, no matter what their age group might be," the researchers said.

Between 10 percent and 50 percent of all women experience urinary incontinence at some point in their lives, it said.

Depression is also common, affecting more than nine percent of US adults in any given year, according to the National Institute of Mental Health (NIMH).

Anti-depressant use associated with increased risk for heart patients

Mon, 06 Mar 2006 17:24:00 PST

( from http://www.rxpgnews.com ) In a surprising finding, patients with coronary artery disease who take commonly used antidepressant drugs may be at significantly higher risk of death, Duke University Medical Center researchers have found.

Even after controlling for such factors as age, degree of heart disease and severity of depression, the researchers found that heart patients taking antidepressant medications had a 55 percent higher risk of dying. Previously, Duke researchers reported that the presence of depression is an important risk factor for heart patients. This new finding of the risk from anti-depressants raises issues about the optimal way to treat depression in cardiac patients, the researchers said.

According to Duke team leader Lana Watkins, Ph.D., the researchers believe their findings add further support for the potential role oft non-pharmocological approaches to treating depression, such as exercise, in reducing the risk of death in depressed heart patients. She said that physicians caring for heart patients who are taking antidepressants should monitor patients closely.

Watkins added that the design of the study prevents definitive conclusions regarding the effects of antidepressant drugs. In the current observational study, patients were not randomized to receive an antidepressant or a placebo drug, therefore characteristics of the patients, such as more likelihood for their depression or their medical condition to worsen, may be responsible for the effects, she said.

Randomized placebo-controlled trials are needed to not only replicate the Duke findings, but to better understand whether antidepressant use is identifying patients likely to have more severe or worsening depression or worsening medical disease during the follow-up period, Watkins added.

"This finding that antidepressant use was an independent risk factor for mortality in patients with coronary artery disease was quite unexpected," said Watkins, who presented the results of the Duke study March 4, 2006, at the annual meeting of the American Psychosomatic Society in Denver. The research was supported by the National Heart, Lung, and Blood Institute.

"We were surprised since antidepressants, particularly the newer class of antidepressants known as selective serotonin reuptake inhibitors (SSRI), have been generally considered safe," Watkins said. "However, even after taking into account many patient variables, as well as the type of antidepressant, the risk still remained. So there is something important going on here that we don't fully understand."

During the past decade, cardiologists and physicians have gained a greater appreciation that depression should be considered as an important risk factor for patients with coronary artery disease, said the researchers. For this reason, they have increasingly prescribed antidepressants for these patients; however, this increase in use has not been accompanied by conclusive scientific data on the effects of antidepressants especially SSRIs on mortality.

For her study, Watkins prospectively analyzed the clinical data of 921 Duke University Hospital patients receiving a cardiac angiography procedure to determine the extent of blockage in their coronary arteries. Of the total number of patients, just under one in five (19.4 percent) were taking an antidepressant; with SSRIs being taken by 66 percent of those patients.

During their hospitalization, patients were given the Beck Depression Inventory (BDI), a commonly used depression screening test. In general, patients with a BDI score of 10 or higher are considered depressed. In the Duke study, those patients who were not taking antidepressants had an average BDI score of 7, while those on antidepressants had an average score of 11, a statistically significant difference.

The patients were followed over an average of three years, and during that time 21.4 percent of the patients who were taking antidepressants had died, compared to 12.5 percent for those not on antidepressants.

After adjusting for such factors as age, gender, heart pumping strength, smoking history, degree of other illnesses, heart procedures, BDI score and education, the researchers found that patients taking antidepressants had a 55 percent higher risk of dying. The difference between SSRI and non-SSRI use 61 percent vs. 49 percent was not statistically significant.

Watkins said the future studies are needed to uncover the reasons responsible for depression's negative effect on mortality. Also, she said, researchers do not fully understand the physiological effects of SSRIs on patients with coronary artery disease.

While physicians do not know why there appears to be a link between depression and increased risk of mortality, there are a number of theories, said Watkins. Depression has been linked to supression of the immune system, as well as alteration of the aggregation properties of blood platelets. It has also been linked to other such cardiovascular risk factors as insulin resistance, hypertension, obesity, increased cigarette smoking, alcohol abuse and physical inactivity, she noted.

Brain Derived Neurotrophic Factor (BDNF) plays a role in development of social aversion

Sun, 12 Feb 2006 18:28:00 PST

( from http://www.rxpgnews.com ) A Florida State University scientist used a gene transfer technique to block the expression of a gene associated with clinical depression in a new study of mice that could lead to better treatment of human beings with this condition.

Carlos Bolanos, an assistant professor of psychology and neuroscience, was among a team of researchers that identified the role of a gene called Brain Derived Neurotrophic Factor (BDNF) in the development of social aversion. Mice treated with a transfer technique to block expression of the BDNF gene in a small area of the mid-brain did not develop the aversion despite repeated encounters with aggressive rodents. The study will be published in the Feb. 10 issue of the journal Science.

"It's very exciting because we are slowly but surely identifying mechanisms in the brain underlying psychiatric disorders that have a social withdrawal component, such as social phobia, depression and post-traumatic stress disorder, and that will allow us to find better ways to treat these disorders," Bolanos said. "This study is significant because it gives us an animal model of the disorder and opens up new areas of study."

In the experiment, the researchers subjected mice to daily bouts of social threats and subordination by aggressive rodents and continuous sensory contact with the aggressors for 10 days. Afterward, the defeated mice avoided any social contact by spending most of their time in the corner of their cages opposite other mice, including those that had not been aggressive toward them.

The defeated mice also displayed little interest in sexual interaction and showed decreased preference for palatable sugary drinks over plain water. A month later, the rodents' interest in sex and sweets had returned, but the social avoidance remained.

The researchers found that long-term use of antidepressants, such as fluoxetine (Prozac) and imipramine (Trofanil), were successful in reversing the social withdrawal in these mice. But the successful use of the gene therapy approach to block the expression of the BDNF gene in a highly localized area of the brain suggests the potential for the development of new drug therapies with fewer side effects.

"We have made great progress in our understanding of how antidepressants work, but despite years of research, our knowledge of the changes that these drugs induce in the brain is rudimentary," Bolanos said. "Though available treatments for depression are generally safe and effective, they are still not ideal. It takes long-term treatment before seeing clinical benefit, and potential side effects are a serious problem. The findings of this study provide exciting new leads and point to potential strategies, such as developing drugs capable of targeting specific proteins in restricted brain areas."

SSRIs linked with increased risk of persistent pulmonary hypertension in newborns

Fri, 10 Feb 2006 15:52:00 PST

( from http://www.rxpgnews.com ) A University of California , San Diego (UCSD) School of Medicine collaborative study with Boston University s Slone Epidemiology Center found an increased risk of persistent pulmonary hypertension (PPHN) in newborns of mothers who used certain commonly prescribed antidepressants in late pregnancy. The results of the study will be published in the February 9 issue of the New England Journal of Medicine.

According to the study authors, PPHN is a serious condition that typically involves severe respiratory failure in a newborn infant and requires immediate treatment. The condition occurs in about one to two per thousand babies. The new study findings indicate that pregnant women who take one of the antidepressants known as selective serotonin reuptake inhibitors or SSRIs, such as Prozac ® , Paxil ® or Zoloft ® , in the second half of pregnancy have a small but significantly increased chance of delivering an infant who develops PPHN. The study found that exposure to antidepressants other than SSRIs did not pose a risk for PPHN. In addition, women who discontinued use of SSRIs in the first half of pregnancy did not have an increased risk of delivering a child with the condition.

These findings may be important for pregnant women and clinicians when making decisions about the most appropriate treatments for depression late in pregnancy.

Lead author on the study, Christina Chambers, Ph.D., M.P.H., of the Departments of Pediatrics and Family and Preventive Medicine at UCSD, worked with a team of investigators who identified at birth 377 infants with PPHN and 836 normal newborns from 97 delivery hospitals in four metropolitan centers in the U.S. and Canada between 1998 and 2003. The study was part of the ongoing Birth Defects Surveillance Program being conducted by the Slone Epidemiology Center with the collaboration of 17 San Diego County hospitals including UCSD Medical Center.

Within six months after birth, the researchers examined the records and carefully interviewed the mothers of children with PPHN and the mothers of the matched control infants selected from the same hospitals. The mothers in both groups were asked specifically about the use of any antidepressant medications during pregnancy, the names of products used, and the timing in gestation when the mother used the medication. Mothers were also queried about a wide variety of other maternal exposures, medical history, pregnancy history, and lifestyle factors.

Based on our findings, we estimate that six to twelve mothers per thousand who use an SSRI after 20 weeks gestation, are likely to deliver a child with PPHN, said Chambers. Put in practical terms, the risk is relatively low -- about 99 percent of women exposed to one of these medications during the latter half of pregnancy will deliver an infant unaffected by PPHN.

Our findings suggest that prenatal exposure to SSRIs might contribute to the pathological origin of this disorder, says Chambers. She adds that although the study cannot establish cause, several possible mechanisms suggesting an association between the use of the SSRIs and PPHN are plausible.

Although the researchers noted an increased risk of PPHN in infants whose mothers took SSRIs late in pregnancy, the research team points out that mothers may need to continue SSRI treatment during pregnancy in order to care for themselves appropriately. The findings of this study might be factored into decisions about continuing treatment with SSRIs into late pregnancy.

The research team consisted of Chambers, Sonia Hernandez-Diaz, M.D. Dr.P.H of Slone Epidemiology Center at Boston University School of Public Health, Linda J. Van Marter, M.D., Ph.D of Boston Childrens Hospital, Brigham and Womens Hospital, and Harvard Medical School, Martha M. Werler, Sc.D, and Allen A. Mitchell, M.D. of Slone Epidemiology Center, and Kenneth Lyons Jones, M.D. of the UCSD Department of Pediatrics.

Chambers is Program Director of the California Teratogen Information Service (CTIS). CTIS operates a statewide telephone service and a clinical research program from the Department of Pediatrics at UCSD with satellite offices at UCLA, Los Angeles Childrens Hospital and Stanford University. Founded in 1979, this program provides no-cost, confidential information regarding the fetal safety of medications, chemicals, or other agents when used in pregnancy. The CTIS Pregnancy Risk Information line provides information to over 8,000 callers per year including pregnant or pre-pregnant women and health care providers located throughout the state of California. The CTIS program also conducts pregnancy outcome research studies so that evidence-based information can be developed for women with similar questions in the future.

Depression frequent and highly persistent in 'oldest old'

Mon, 23 Jan 2006 17:22:00 PST

( from http://www.rxpgnews.com ) Amongst the oldest old (85-plus), depression is frequent and highly persistent, according to a new study from The Netherlands.

Despite its negative consequences, little is known about the natural history of depression in the oldest old. This study, published in the January 2006 issue of the British Journal of Psychiatry, examined the incidence, course and predictors of depression in the general population of people aged over 85.

The Leiden 85-plus Study is a population-based prospective study of a large number of community-dwelling older adults living in Leiden in The Netherlands. Between 1997 and 1999 all those born in 1912-1914 were enrolled in the month of their 85th birthday.

At the beginning of the study, 500 participants were visited by medical staff and research nurses. During these baseline visits, face-to-face interviews were carried out, an electrocardiogram was recorded and blood samples collected.

Follow-up interviews using the Geriatric Depression Scale were carried out for all eligible participants each year during the study period of four years.

It was found that at baseline, 67% of those studied had no significant symptoms of depression. During follow-up, however, the average depression score increased significantly up to the age of 89, and the annual risk for the emergence of depression was 6.8%.

Institutionalisation and poor daily functioning were associated with an increased risk of the development of depression.

Among the 77 participants with depression at baseline, the annual remission rate was only 14%. In more than half of the patients with a remission of depression, the researchers observed a relapse of depression during follow-up. No predictors of remission could be identified.

The authors of the study comment that a strong tendency for chronic depression has been reported in the younger elderly. Persistence of depression could be extrapolated to the oldest old.

Cognitive impairment or early-stage dementia may well play an important role in the high incidence of depression and its persistence in the oldest old, but the underlying mechanisms are still unresolved.

From a clinical perspective it is very important to know that depression occurs often in this age group, and has a poor prognosis. More active diagnosis and treatment of depression is needed, as treatment of depression in the oldest old is potentially as rewarding as in younger people.

Radio Frequency-powered Neural Stimulator (RFNS) as treatment for depression, seizures

Sat, 21 Jan 2006 22:04:00 PST

( from http://www.rxpgnews.com ) Researchers from the University of Pittsburgh, with the help of a team of Pittsburgh high school science teachers, have developed a wireless device that is implanted in the neck to fight depression and epileptic seizures. The U.S. Food and Drug Administration already has approved a wired version of the device, but that one carries risks and several undesirable side effects.

It has been known for several years that stimulating the vagus nerve, which connects the brain to several major organs, can offset drug-resistant epileptic seizures. Last summer, the FDA approved vagus nerve stimulation (VNS) for use to treat severe depression as well. The only current manufacturer of a VNS device is Cyberonics Inc. of Houston. In the company's product, a pulse generator is surgically implanted into the left side of the chest, and a wire extends from the device up through the left side of the neck to wrap around the nerve. Patients must undergo additional surgery to change the battery every three to eight years. The device can be turned off at any time with a magnetic wand.

VNS has few of the side effects of traditional treatments for depression: no sexual dysfunction or memory impairment and minimal sleep disturbance and weight gain, which are often associated with antidepressants or shock therapy. However, there is a risk of infection due to the surgical incisions, and the long wire lead may cause painful adhesions and restricted movement. Additionally, side effects include hoarseness, shortness of breath, and voice alteration, although these are alleviated when the device is turned off.

Last summer, eight teachers from City of Pittsburgh high schools came to Pitt under a National Science Foundation-funded program in which they divided their time between Pitt's Learning Research and Development Center and a research project of their choosing. Four of the teachers chose to work on a device to prevent seizures under the guidance of Marlin Mickle, Nickolas A. DeCecco Professor of Electrical and Computer Engineering at Pitt, director of the University's Radio Frequency Identification Center for Excellence and John A. Swanson Institute for Technical Excellence; Michael Lovell, associate professor of industrial and mechanical engineering and associate dean for research in Pitt's School of Engineering; Robert Sclabassi, professor of neurological surgery, neuroscience, psychiatry, electrical and mechanical engineering, and bioengineering and director of UPMC's Center for Clinical Neurophysiology; and Pitt electrical engineering graduate student Steven Hackworth.

The group hoped to treat seizures by modifying a method for deep-brain stimulation (DBS), which Mickle, Lovell, and Hackworth had developed, that uses radio frequency technology to help treat diseases such as Parkinson's. The major technical challenge they had to overcome was to convert the voltage source required for DBS to the current source required for the seizure treatment.

The solution they developed is the Radio Frequency-powered Neural Stimulator (RFNS). The RFNS is made up of a receiving device implanted under the skin of the neck and a powering device placed near the skin at the same site, under a collar. Because this requires only one surgical incision, rather than the two required by VNS, the risk of infection is reduced. Other advantages of RFNS over the existing VNS system include no invasive tunneling from the shoulder to the neck region and an external battery, which reduces the need for subsequent surgeries and further lowers the risk of infection.

The next step for the researchers is to license the technology to a company, which would then need to obtain FDA approval.

Antidepressants may affect human immune system

Sat, 21 Jan 2006 21:54:00 PST

( from http://www.rxpgnews.com ) Drugs that treat depression by manipulating the neurotransmitter serotonin in the brain may also affect the user's immune system in ways that are not yet understood, say scientists from Georgetown University Medical Center and a Canadian research institute.

That's because the investigators found, for the first time, that serotonin is passed between key cells in the immune system, and that the chemical is specifically used to activate an immune response. They do not know yet, however, whether these SSRI (selective serotonin reuptake inhibitors) drugs "including the brands Prozac, Zoloft, Paxil and others" could have either a beneficial or a damaging effect on human immunity.

"The wider health implication is that commonly used SSRI antidepressants, which target the uptake of serotonin into neurons, may also impact the uptake in immune cells," said Gerard Ahern, Ph.D., assistant professor of Pharmacology at Georgetown and lead researcher on the study.

He said that while it may be possible that SSRI drugs may restore a healthy immune function in people who are depressed and prone to infections, it is possible that they might also bolster immunity to the point that they trigger autoimmune disease. "At this point we just don't know how these drugs might affect immunity, so we really need to clarify the normal role of serotonin in immune cell functioning," Ahern said.

The surprising finding that serotonin is rapidly passed between immune cells in a manner similar to its transmission between brain neurons was revealed in mid-October, when the research team published the findings in the journal Blood. In December, the discovery was highlighted for the general scientific audience by the journal Nature Reviews Immunology, and now the research team is working to produce an animal model that may help describe the precise nature of this interaction.

"The novelty is that we reveal a potential communication, involving the transmitter serotonin, between immune cells that is normally only found between neurons," Ahern said.

In addition to Ahern, Peta Connell, Ph.D., from the Robarts Research Institute in Canada, was also a co-lead researcher on the study. Scientists from the Robarts Research Institute also contributed to the work.

In the brain, serotonin transmission between neurons is associated with feelings of pleasure, mood, and appetite, and the class of antidepressants known as SSRIs keeps serotonin active within the synaptic spaces between neurons, enhancing the chemical's positive effects. Unlike in the brain, which uses chemical messengers to communicate between nerve cells, the immune system is believed to "converse" through physical contact -- one type of immune cell touches another, setting off a response.

Specifically, "antigen presenting cells" display their antigens (bits of a foreign invader) to T-cells, and a resulting physical coupling between the antigens and the T-cells will prompt the T-cells to divide and expand in population, triggering an immune response designed to destroy the invader. This process may take hours.

What the Georgetown researchers found, however, is that dendritic cells -- the most powerful of the antigen-presenting cells and the ones that can find invaders that have never infected the body and "educate" the immune system to fight them -- also use serotonin to quickly excite a T-cell response. They discovered that these dendritic cells can rapidly secrete serotonin, which activates serotonin receptors on certain types of T-cells.

"In addition to the physical contact, it surprised us to find that these immune cells also have machinery to take up serotonin and to secrete it in an excitatory manner," Ahern said. "The point behind this transmission is not entirely clear, but it appears to be an additional way of stimulating a T cell response."

Drugs that block serotonin reuptake "likely change some of the parameters of T-cell activation, but we don't know yet if it enhances or inhibits the total immune response," Ahern said. "But it is something that should be explored because we really have no idea what SSRIs are doing to people's immune systems."

Heritability of major depression is higher in women

Sat, 07 Jan 2006 17:55:00 PST

( from http://www.rxpgnews.com ) Virginia Commonwealth University researchers have found that genes contribute more strongly to the risk of depression in women than in men, and that there may be some genetic factors that are operating uniquely in one sex and not in the other.

In the January issue of the American Journal of Psychiatry, researchers reported that heritability of depression is higher in women approximately 42 percent -- than in men, where it is approximately 29 percent.

Our work, together with colleagues at the Karolinska Institute in Sweden, represents the largest epidemiological study of depression in twins done to date. In addition, it broadly replicates what has been shown by our earlier work using the Virginia Twin Registry. In particular, we have shown that depression is a moderately heritable disorder, suggesting that genetic factors are important, but by no means overwhelming, said Kenneth S. Kendler, M.D., a professor of psychiatry and human genetics in VCUs School of Medicine and lead author on the study.

The research team employed twin study models to evaluate lifetime major depression of approximately 42,000 twins, including 15,000 complete pairs from the Swedish National Twin Registry.

According to Kendler, the sex-effects are of two kinds quantitative and qualitative. He said that quantitative sex-effects examine whether heritability is different in males compared with females, and if the overall importance of genetic factors differs between the sexes; whereas qualitative sex-effects examine whether the same genes are playing a role in males and females.

For example, Kendler said there may be genes that alter the risk for depression in a womans response to cyclic sex hormones, particularly in the postpartum period. Such genes would impact a womans risk for major depression, but would not be active in men because men lack the relevant hormonal milieu.

The Virginia Twin Registry is now part of the VCU Mid-Atlantic Twin Registry (MATR), which contains a population-based record of twins from Virginia, North Carolina and South Carolina.

Suicide risk decrease after initiation of antidepressants

Sun, 01 Jan 2006 20:41:00 PST

( from http://www.rxpgnews.com ) The risk of serious suicide attempts or death by suicide generally decreases in the weeks after patients start taking antidepressant medication, according to a new study led by Group Health Cooperative researchers and published in the January issue of The American Journal of Psychiatry. The study also found that the risk of suicidal behavior after starting 10 newer antidepressant medications is less than the risk posed by older medications.

These findings challenge a 2004 advisory by the U.S. Food and Drug Administration (FDA), which warned that suicidal behavior may emerge after treatment with the newer antidepressant drugs has begun.

"Our findings show that, fortunately, suicide attempts and death by suicide are rare following the initiation of antidepressants," says Greg Simon, MD, MPH, a Group Health psychiatrist and the lead researcher on the study. "The period right after people start taking antidepressant medication is not a period of increased risk. In fact, risk after starting medication is lower than before."

This study is the first published analysis to compare the risk of suicide attempts before treatment to the risks following treatment. It is based on computerized medical and pharmacy records for more than 65,000 patients who filled prescriptions for antidepressants from 1992 to 2003. Deaths by suicide were determined from death certificates and suicide attempts were identified from hospital discharge data.

Group Health researchers found that the number of suicide attempts fell by 60 percent in adults during the month after antidepressant treatment began, and declined further in the following five months. Among the 65,103 patients taking antidepressants, there were 31 completed suicides in the six months following the antidepressant prescription. That rate was not higher in the one month after the prescription than in subsequent months. The study also found that newer antidepressants were associated with a faster decline in rates of suicidal behavior than older drugs.

Adolescents in the study had more suicide attempts than adults. The researchers found that the rate for the first six months of antidepressant treatment was 314 attempts per 100,000 in teens and 78 attempts per 100,000 in adults. As with adults, the rate was highest in the month before treatment and declined by about 60 percent after treatment began.

Given recent public concern over a possible link between suicide and antidepressants, Simon says he fears people may mistakenly believe that suicidal behavior is common after taking antidepressant medications. That misperception could lead to fewer people with depression being treated with medications proven to be effective in battling depression, he adds.

"There may be subgroups of people who become more agitated or suicidal after taking these drugs, and those people should seek help from a doctor or therapist right away if that happens," says Simon. "But our study showed that on average, the risk of suicide actually goes down after people start taking the antidepressant."

Simon agrees with the FDA's recommendations that doctors carefully monitor people taking antidepressants. "Keeping a close watch on patients after they begin taking these drugs is a good idea--although not because these medicines are especially risky or dangerous," he says. "Patients need to be monitored to ensure they're getting the right medication in the amount that can help them feel better."

Swimming with dolphins can alleviate depression

Fri, 25 Nov 2005 17:44:00 PST

( from http://www.rxpgnews.com ) Swimming with dolphins is an effective treatment for mild to moderate depression, say researchers in this weeks BMJ.

Their findings support the theory of biophilia, which shows how human health and wellbeing are dependent on our relationships with the natural environment.

The study was carried out in Honduras and involved 30 patients diagnosed with mild or moderate depression. Half were assigned to the experimental group and half to the control group.

Over a two-week period, participants in the experimental group swam and snorkelled in the water with dolphins for one hour a day. Participants in the control group were assigned to the same water activities, but in the absence of dolphins, to control for the influence of water and the natural setting.

All participants discontinued antidepressant drugs or psychotherapy at least four weeks before entering the study, and were not allowed to take drugs during the study. Depression scores were measured before the study and at the end of treatment.

Although some participants dropped out of the study, the average severity of the depressive symptoms was more reduced in the experimental group than in the control group.

Animal facilitated therapy with dolphins is more effective than water therapy in treating people with mild to moderate depression, say the authors. Despite some study limitations, the effects exerted by the animals were significantly greater than those of just the natural setting.

The echolocation system, the aesthetic value, and the emotions raised by the interaction with dolphins may explain the mammals healing properties, they suggest.

Three months after the study, participants in both groups also reported lasting improvement and did not require treatment. This suggests that in patients with mild or moderate depression, using drugs or conventional psychotherapy may not be necessary when biophilic treatment with animals is used, they conclude.

Promising Results from CCBT in Depression

Thu, 10 Nov 2005 19:01:00 PST

( from http://www.rxpgnews.com ) Internet-delivered cognitive-behavioural therapy should be pursued further as a complement to treatment, or treatment alternative, for mild to moderate depression, a new study from Sweden has found.

It is known that major depression can be treated with cognitive-behavioural therapy, but as skilled therapists are in short supply there is a need for self-help approaches. Many people with depression use the internet for discussion of their symptoms and to share their experiences.

This study, published in the November issue of the British Journal of Psychiatry, set out to compare the effects of an internet-administered self-help programme, including participation in a monitored, web-based discussion group, with participation in a web-based discussion group only.

117 people with mild to moderate depression who met a number of inclusion criteria were included in this randomised controlled trial. The majority came from smaller cities, villages and places outside the larger cities (where university clinics are usually based).

36 participants in the treatment group and 49 in the control group completed post-treatment measures.

In total the rate of withdrawal from the programme was 27%. The main reason given was that the treatment was too demanding. Thus the rates of withdrawal differed between the treatment group (37%) and the control group (18%).

It was found that the active treatment, which included standard cognitive-behavioural approaches and behavioural changes, resulted in decreased depressive symptoms immediately after treatment and at the six-month follow-up. There were also benefits in terms of anxiety symptoms and quality of life.

There was no change in depressive symptoms among the participants in the web-based discussion group only.

Being engaged in self-help seemed to affect the tendency to participate in a discussion group, with less activity in the group who received the active treatment immediately.

The authors of the study comment that adjusting the text in the treatment programme and allowing a longer treatment period could possibly reduce rates of withdrawal.

They conclude that internet-based self-help facilitates the spread of cognitive behavioural therapy for depression to those who do not usually have access to this form of treatment.

The outcome with internet-based therapy resembles that in controlled studies of clinician-delivered therapy.

Abortion Does Not Raise Risk Of Depression

Sat, 29 Oct 2005 14:42:00 PST

( from http://www.rxpgnews.com ) Claims that terminating an unwanted first pregnancy raises the risk of depression is called into question in a study published online by the BMJ. In fact, the authors suggest that abortion may be linked to a lower risk of depression through beneficial effects on education, income, and family size. The study involved 1,247 US women who aborted or delivered an unwanted first pregnancy between 1970 and 1992. The women were interviewed over several years to examine the relation between pregnancy outcome and later depression.

Terminating compared with delivering an unwanted first pregnancy was not directly related to risk of depression. Instead, women who delivered before 1980 had a significantly higher risk of depression than all other groups.

The abortion group also had a significantly higher mean education and income and lower total family size, all of which were associated with a lower risk of depression.

These results cannot be explained by underreporting of abortion, say the authors, because findings did not vary in groups known to vary in underreporting. Furthermore, women with higher depression scores were more willing to provide confidential abortion card information.

Despite some study limitations, they conclude that there is no credible evidence that choosing to terminate an unwanted first pregnancy puts women at higher risk of subsequent depression.

They suggest that if the goal is to reduce womens risk for depression, research should focus on how to prevent and ameliorate the effect of unwanted childbearing, particularly for younger women.

New Surgical Treatment For Severe Depression

Sun, 09 Oct 2005 00:09:00 PST

( from http://www.rxpgnews.com ) Treatment-resistant depression is a severe form of the illness that affects 20% of patients with depression.

A team of psychiatrists and neurosurgeons at the University of California, San Diego (UCSD) Medical Center is the first in the area to offer implantation of a device recently approved by the Food and Drug Administration (FDA) for treating patients with treatment-resistant depression.

Called Vagus Nerve Stimulation (VNS), the therapy is delivered from a pacemaker-like generator implanted in the chest that sends mild and intermittent electrical pulses through the vagus nerve in the neck to the brain. The vagus nerve, one of the 12 cranial nerves, serves as the bodys information highway connecting the brain to many major organs. Several studies have shown that VNS therapy may modulate neurotransmitters such as serotonin and norepinephrine thought to be involved in mood regulation.

The treatment was approved by the FDA in July of this year as an adjunctive long-term treatment for chronic or recurrent depression in patients 18 years of age and older who are experiencing a major depressive episode that has not responded adequately to four or more antidepressant treatments.

Patients referred by their physicians to the UCSD Medical Center for the surgery are carefully evaluated by a team consisting of the neurosurgeon and psychiatrists, to determine that the patient is an appropriate candidate for VNS therapy. Mounir Soliman, M.D., Assistant Clinical Professor of Psychiatry, Clinical Service Chief and Medical Director for UCSDs Psychopharmacology Research Initiatives Center of Excellence (PRICE) is leader of the VNS research and clinical team at UCSD. UCSD Medical Center is one of two initial California sites, along with Stanford University, identified by VNS manufacturer Cyberonics as a Center of Excellence for treatment and training with VNS Therapy.

The UCSD team also includes neurosurgeon Robert J. Buchanan, M.D., Assistant Professor of Surgery/Neurosurgery, Psychiatry and Radiology; Shannon Chavez, M.D., Assistant Clinical Professor and Medical Director of UCSD Outpatient Psychiatry Services, and David Feifel, M.D., Ph.D., Associate Professor and Director of UCSDs Neuropsychiatry and Behavioral Medicine Unit.

The device is monitored much like an oral drug, with varied dosage of the electric stimulation called neuro-modulation. The device sends precisely timed and measured mild pulses to the vagus nerve 24 hours a day. Some studies have shown that improvement of depressive symptoms with VNS is delayed but sustainable, said Soliman. The device was approved by the FDA in 1997 as an adjunctive therapy for epilepsy. About 30 to 40 percent of patients with epilepsy have other neurological or psychiatric disorders, one of them being major depressive disorder. It was found that, in epilepsy patients who underwent the VNS surgery even if their epilepsy was not cured their depression lifted, he said. This led researchers to pursue the surgery for patients with treatment-resistant depression. UCSDs Department of Psychiatry was a site of clinical trials of VNS for depression prior to FDA approval.

So far the results of studies of VNS in treatment-resistant depression are promising, and we are committed to studying its use and defining the efficacy of this innovative therapy, said Solimon.

Severe carbohydrate cravers experienced the most benefit from chromium picolinate supplementation

Thu, 29 Sep 2005 21:20:00 PST

( from http://www.rxpgnews.com ) A randomized, double-blind, placebo-controlled study assessing chromium picolinate supplementation in 113 people with atypical depression found that a subset of patients who reported the highest levels of carbohydrate cravings demonstrated significantly greater reductions than the placebo group on four items on the Hamilton Depression Rating Scale (HAM-D-29): carbohydrate craving, appetite increase, increased eating, and diurnal variation of feeling (mood variation throughout the day). The study, published today in the Journal of Psychiatric Practice, found that 65 percent of the chromium picolinate patients with high carbohydrate craving versus 33 percent of those receiving placebo had significantly greater improvements on total HAM-D-29 scores (p less than 0.05). HAM-D-29 is a standard tool commonly used in assessing severity of symptoms in depressed patients.

Carbohydrate cravings, weight gain and unexplained fatigue are characteristic symptoms of atypical depression, a common but frequently undiagnosed depressive disorder affecting up to 42 percent of the 19 million Americans diagnosed with depression. "These results suggest that the use of chromium picolinate may be beneficial for patients with atypical depression who also have severe carbohydrate craving," said the study's lead investigator, John P. Docherty, M.D., president and CEO of Comprehensive NeuroScience Inc, and adjunct professor of psychiatry at Weill Medical College of Cornell University. "For years, the link between depression, insulin sensitivity, and the value of dietary chromium picolinate has been hinted at in small studies and this trial may bring us closer to understanding the connection."

Study Design
The study, "A Double-Blind, Placebo-Controlled, Exploratory Trial of Chromium Picolinate in Atypical Depression: Effect of Carbohydrate Craving" was an 8 week, multi-center trial of 113 randomized adult outpatients with atypical depression. Patients ranged from age 18-65 years of age.

The 110 patients constituting the intent-to-treat (ITT) population received 600 mcg/day of elemental chromium, as Chromax chromium picolinate (n = 70) or placebo (n = 40).

This ITT group was defined as patients who received at least one dose of study medication and completed at least one study evaluation, while the evaluable population was the subset of 75 patients (n=50 chromium picolinate and 25 placebo) who took at least 80 percent of the study product with no significant protocol deviations. Primary efficacy measures were the 29-item Hamilton Depression Rating Scale and the Clinical Global Impressions Improvement Scale (CGI-I). Nutrition 21 (NASDAQ: NXXI) supplied Chromax chromium picolinate for the clinical trial.

Investigators found no significant difference between the chromium picolinate and placebo groups on overall improvement on the primary efficacy measures (both the placebo and treatment groups significantly improved from baseline). However, the chromium picolinate group in the evaluable populations showed significantly greater improvements in four HAM-D-29 items: carbohydrate craving, appetite increase, increased eating, and diurnal variation of feeling. In addition, the chromium picolinate group reporting the highest levels of carbohydrate craving showed significantly greater improvements than the placebo group on overall HAM-D-29 scores. These results held true for both the ITT group (65% chromium picolinate versus 33% placebo) and the evaluable group (80% chromium picolinate versus 38% placebo). The high carbohydrate cravers in the ITT population treated with chromium picolinate also showed significant improvement compared with placebo on three of the same HAM-D-29 items: carbohydrate craving, appetite increase and increased eating. Chromium picolinate was well tolerated throughout the study and treatment-associated adverse events were minimal and not statistically or clinically different from those seen in the placebo group.

"These findings also suggest that physicians and mental health professionals should be alert to patients who report carbohydrate craving as it may signal the possible presence of a more serious underlying medical condition, such as atypical depression," Dr. Docherty said. "The use of antidepressants, mood stabilizers, and antipsychotics that are commonly prescribed to treat depression can often worsen carbohydrate cravings. A treatment that effectively reduces carbohydrate cravings and has a favorable tolerability and side-effect profile would be a very useful contribution to improve overall health outcomes." Chromium is an essential trace mineral whose main function is to work with insulin to metabolize carbohydrates, fats and proteins. When chromium is bound to picolinic acid to create chromium picolinate, absorption in the body is significantly improved. Recently the U.S. Food and Drug Administration recognized chromium picolinate as a safe nutritional supplement.

Downward Social Shift Quadruples Male Depression Risk

Thu, 15 Sep 2005 17:55:00 PST

( from http://www.rxpgnews.com ) Men who experienced a downward social shift were four times more likely to experience depression than men who improved their social status, whereas there was no marked difference in mental health between women who had moved up or down the social ladder.

In the study, researchers from the University of Newcastle upon Tyne used the occupation of the head of the household as the marker for social status, and surveyed men and women born in 1947 in Newcastle from childhood to age 50.

Their findings could be explained by the fact that men born in this era gained much of their self-esteem from their careers, whereas women found fulfilment from other social pursuits outside work, such as children and friendships. Its also possible that women are more emotionally resilient in this type of situation, say the researchers.

The study is published today in the Journal of Epidemiology and Community Health. Lead researcher, Dr Paul Tiffin, who also works as a psychiatrist with Tees and North East Yorkshire NHS Trust, said: The Newcastle Thousand Families Study gave us an opportunity to try and understand more about how socioeconomic circumstances throughout life might be linked to mental well-being in middle age. With an increasing emphasis on the promotion of good health, findings such as these are likely to challenge those involved in health and social policy.

The study used data from 224 men and 283 women in the Thousand Families Study, a Newcastle University project which has examined the health and social circumstances of children born in Newcastle upon Tyne in May and June 1947 throughout their lives.

Information on participants mental health was gained from a 28-part questionnaire which probed stress and anxiety levels, general mood, and tendency to suicidal thoughts, amongst other markers.

Study co-author and Director of the Thousand Families Study, Dr Mark Pearce, of Newcastle Universitys School of Clinical Medical Sciences, said: Its possible that this reaction is typical of this post-war generation, where the man expected to be the main breadwinner of the household and took a significant knock to his self-esteem when he was not able to achieve this. Women, on the other hand, perhaps viewed having a successful family life as more important than their careers.

Having robust mental health is just as important as good physical health the two are often interdependent. Depression can lead to a vicious circle where poor mental health and lack of engagement with society becomes the norm for an individual.

Dr Tiffin added Whilst we must be cautious in generalising our findings to other populations, our findings do suggest that its important for governments and other agencies to consider the wider effect of mass redundancies and drastic economic changes. The tendency is to focus on the financial losses that workers and their families experience but this research shows that the psychological effects should equally be taken into account and acted upon.

Depression may worsen heart failure by increasing TNF-alpha

Fri, 09 Sep 2005 16:00:00 PST

( from http://www.rxpgnews.com ) New research suggests that depression may hasten the progression of heart disease by increasing the levels of a key protein that causes inflammation.

In a study of 32 people with heart failure, the 14 patients who felt the most depressed had nearly twice the levels of this protein in their blood.

The protein, tumor necrosis factor alpha (TNF-alpha), is one member of a large family of proteins called cytokines, chemical messengers that are mobilized when the body is injured or has an infection. These cytokines often cause inflammation in their effort to repair an injured or infected area of the body. In the case of heart failure, this inflammation makes it even more difficult for the heart to pump blood. (Heart failure is a disease in which the heart loses the ability to pump blood with normal efficiency.)

People with heart failure typically have much higher TNF-alpha levels than people without the disease, said Amy Ferketich, the study's lead author and an assistant professor of public health at Ohio State .

But depression seems to make levels of this cytokine even higher, which is bad for patients.

The study's results appear in a recent issue of the American Heart Journal. Ferketich worked with Ohio State colleagues Jeanette Pohorence Ferguson, a graduate student in pathology, and Philip Binkley, a professor of internal medicine.

They recruited 32 patients from the heart failure clinic at Ohio State . The participants answered the 21-question Beck Depression Inventory, a tool that physicians and scientists use to measure symptoms of depression. Answers to each question are given a value of zero (no symptoms at all) to 3 (severe symptoms). A score of 10 or more suggests that a patient has at least mild symptoms of depression.

The researchers drew blood samples from each patient. From these samples they evaluated levels of three cytokines: TNF-alpha, interleukin-6 (IL-6) and interleukin-1beta (IL-1beta). Previous research by other scientists has shown that the three cytokines, which all cause inflammation, are elevated in patients with heart failure.

Indeed, all of the patients in the study had higher-than-normal levels of each cytokine. However, TNF-alpha was still markedly higher in patients who reported feeling depressed on a regular basis.

We were surprised to find that this wasn't the case for the other two cytokines, Ferketich said. That suggests that something about depression may trigger the production of TNF-alpha.

The researchers measured cytokine levels in picograms, or trillionths of a gram. Patients with scores of 10 or higher on the BDI had levels of TNF-alpha nearly twice that of patients with a score less than 10 (4.9 pg/ml vs. 2.7 pg/ml.)

Levels of the other two cytokines were similar for depressed and non-depressed patients: 5.9 pg/ml vs. 5.1 pg/ml for IL-6 and 4.4 pg/ml and 3.6 pg/ml for IL-1beta, respectively.

Other researchers estimate that anywhere from 24 to 42 percent of heart failure patients also suffer from depression.

Depression clearly raises the levels of one cytokine, which plays a role in increasing inflammation, Ferketich said. What we don't know for sure is if depression causes the inflammation which may lead to heart failure or if heart failure causes depression which accelerates inflammation.

A study at Duke University found that patients with major depression are twice as likely to die or to be re-admitted to the hospital a second time within 12 months.

Patients with heart disease are prone to developing depression, Ferketich said. Physicians need to pay more attention to this. But research still needs to be done to find out if treating patients with anti-depressants would help to actually slow the progression of heart disease.

Telephone-administered psychotherapy effective in multiple sclerosis

Tue, 06 Sep 2005 06:52:00 PST

( from http://www.rxpgnews.com ) Although two-thirds of depressed patients prefer psychotherapy over antidepressants, only 10 to 45 percent ever make a first appointment and nearly half will drop out before the end of treatment, background information in the article states. Barriers to receiving psychotherapy include physical impairments, transportation problems, proximity of services and lack of time or financial resources. In the 1990s, the use of telephone psychotherapy increased in part due to the advent of 1-900 number counseling services and the increased use of telephone support services by insurance and medical groups.

David C. Mohr, Ph.D., from the University of California, San Francisco, and colleagues tested the efficacy of telephone-administered psychotherapy for depression in patients with multiple sclerosis (MS). One hundred twenty-seven patients were randomized into one of two 16-week psychotherapies: telephone-administered cognitive-behavioral therapy (T-CBT) or telephone-administered supportive emotion-focused therapy (T-SEFT). The two therapies differ in that the goal of T-CBT is to "teach skills that help participants manage cognitions and behaviors that contribute to depression and improve skills in managing stressful life events and interpersonal difficulties," while T-SEFT has the goal of "increasing participants' level of experience of their internal world." All patients spoke with a psychologist on the phone for 50 minutes each week and were followed-up for 12 months.

The researchers found that over 16 weeks, improvements were significantly greater for T-CBT compared with T-SEFT for major depressive disorder frequency, and on some depression ratings scales. Treatment gains were retained during the 12-month follow-up, however, differences across treatments were no longer evident.

"This sample of MS patients had impairments that affected their ability to engage in social roles, as evidenced by the assessed functional impairment and the fact that 74 percent of the sample was not in the workforce. The use of telephone-administered therapies may also overcome various other barriers in the general population arising from transportation problems, lack of services in the area, child care problems, lack of time, and stigma," the authors write.

The authors concluded: "To facilitate decisions about the benefits, risks, and utility of telephone-administered psychotherapies, it will be important to examine if the outcomes of telephone-administered therapies are equivalent to face-to-face interventions and if the apparent reductions in attrition associated with telephone administration of psychotherapy can be confirmed in such a comparative trial."

Antidepressant Paroxetine Shown to Increase Suicidal Tendencies in Adults

Mon, 22 Aug 2005 15:15:00 PST

( from http://www.rxpgnews.com ) Adult patients taking the antidepressant drug paroxetine are at higher risk of attempting to commit suicide than those not taking medication. A new analysis, published in BMC Medicine, of previous clinical data on paroxetine use adds the antidepressant to the list of Selective Serotonin Reuptake Inhibitors (SSRIs) that have been shown to increase suicidal tendencies in adult patients with depression.

Ivar Aursnes and colleagues from the University of Oslo, Norway, reanalysed data from 16 selected paroxetine trials. In the trials, patients diagnosed with depression had been randomly given either paroxetine or a placebo drug. Neither the participants nor the researchers conducting the initial studies knew what the participants had been given. Aursnes et al. did a new statistical analysis of the results of these studies, to evaluate the incidence of suicide attempts in both groups. In their analysis, they took into account the amount of time the participants had been exposed to paroxetine. Their results show that there were seven suicide attempts in the group on paroxetine, and only one among the patients on placebo.

Paroxetine has been shown to increase suicidal attempt rates in children and teenagers, but previous studies have failed to reach a conclusion as regards the effects of the drug on suicide attempt rates in adult patients. Gunnell et al., in the February 19th 2005 issue of the BMJ, warned doctors about an increased risk of suicidal behaviour in patients treated with SSRIs. Their conclusion was based on analyses of clinical data submitted by the pharmaceutical companies that produce SSRIs to the Medicine and Healthcare products Regulatory Agency. But Gunnell et al.'s study had not properly included data on paroxetine.

Aursnes et al. conclude that "the recommendation of restrictions in the use of paroxetine in children and adolescents conveyed by regulatory agencies lately should include usage in adults". They confirm that all SSRIs increase suicidal tendencies in depressed adults, "the data strongly suggest that the use of SSRIs are connected with increased intensity per year of suicidal attempts".

Depression linked to previously unknown dopamine regulator par-4

Fri, 29 Jul 2005 15:34:00 PST

( from http://www.rxpgnews.com ) Researchers from Harvard Medical School have found a molecule that is unexpectedly involved in dopamine signaling, and in a manner that supports the potential of dopamine as an alternative target for treating depression. The results provide evidence that there is a molecular link between impaired dopamine signaling and depression, which affects 16 percent of the adult population in the United States.

Li-Huei Tsai, Harvard Medical School (HMS) professor of pathology, HMS research fellow Sang Ki Park, and colleagues worked with mice and found a novel function for the molecule Par-4 (prostate apoptosis response 4)--as a binding partner for dopamine receptor D2. When mice deficient in Par-4 were subjected to stress, they showed depression-like behaviors, proposing Par-4as a molecular link between dopamine signaling and depression. Par-4 was previously implicated as a proapoptotic factor in neurodegenerative diseases such as Alzheimer's disease. These new findings reveal an unexpected role for Par-4 in the dopamine system and present a rare glimpse of molecular mechanisms behind clinical depression.

"Current antidepression therapies are mostly based on the deficiency or imbalance of the serotonin and noradrenaline systems. Our study highlights the importance of the dopamine system, a less appreciated target in the current antidepression therapies," said Tsai, also a Howard Hughes Medical Institute investigator.

Although the cause of depression is multifaceted, a hypothesis based on deficiency or imbalance of serotonin and/or noradrenaline as the root of depression has been a central topic of research. Drugs that currently treat depression (SSRIs and MAOIs, which acutely modify levels of serotonin or noradrenaline at the synapse) have significant delays before becoming effective, and a large percentage of people are resistant to the current therapies, leaving room for improvement of therapeutic strategies.

The brain's mood, reward, and motivation circuits are mainly governed by dopamine and have been regarded as potential alternative targets for treating depression. Many of these functions are integrated by the medium spiny neurons of the striatum, which lie below the cortex of the brain and respond to dopamine. Dopamine exerts its function in target cells through five known subtypes of dopamine receptors to regulate motor control, stereotypic behaviors, arousal, mood, motivation, and endocrine function. Impairment in the function of dopamine D2 receptor is implicated in various neuropsychiatric disorders including schizophrenia and drug addiction.

Understanding the details of the modulatory events in D2 dopamine receptormediated intracellular signaling may provide novel therapeutic targets for treating various associated disorders.

Male GPs are far more likely to prescribe antidepressants

Fri, 22 Jul 2005 16:40:00 PST

( from http://www.rxpgnews.com ) Research by the Mental Health Foundation today revealed that male GPs are far more likely to prescribe antidepressants as a first treatment response to patients with mild or moderate depression than female GPs (61 per cent, compared to 37 per cent), and are twice as likely to think them effective (43 per cent, compared to 17 per cent).

Female GPs are much more likely to believe that counselling is the most effective response (70 per cent, compared to 47 per cent of male GPs). However, female GPs are not much more likely to refer patients to it (39 per cent, compared to 26 per cent of male GPs), perhaps due to lack of availability and long waiting lists.

The Mental Health Foundation commissioned the NOP poll of 200 GPs as part of its Up and Running? Campaign, which aims to increase the use of exercise-on-prescription as a treatment for mild and moderate depression. The charity is committed to developing the use of non-medical ways of promoting good mental health and helping people with mental health problems recover.

To obtain the views of patients, the charity also questioned 180 people with experience of depression about their strategies for coping. Two-thirds of those questioned had tried exercise as a strategy, and 81 per cent of these said it was effective. However, when patients presented symptoms of depression to their GPs, 60 per cent were offered antidepressants, 42 per cent were offered counselling, and only 2 per cent were offered exercise on prescription. Yet, for those who had tried antidepressants, half (50 per cent) said that the side effects had been troubling.

Dr Andrew McCulloch, Chief Executive of the Mental Health Foundation, said:
"The evidence we have strongly suggests that while people think that exercise is effective in treating depression, and have even used it to manage their depression, GPs still aren't offering it to patients as much as antidepressants and counselling. This indicates that we need to change the attitudes and prescribing behaviours of GPs, and educate them about the effectiveness of exercise referral and other non-medical treatments so that patients are given more choice.

It is difficult to imagine patients with a physical health condition as common as depression facing so much of a lottery when they seek help. GPs' knowledge and beliefs, coupled with a chronic shortage of any choice of treatments in many areas, means that people presenting with mental health problems face an obstacle course in finding a treatment that will work for them."

Pain generated by damage to the nervous system can be treated with antidepressants

Wed, 20 Jul 2005 15:07:00 PST

( from http://www.rxpgnews.com ) Antidepressant drugs such as amitriptyline are effective against a variety of neuropathic pains.

Neuropathic pains result when injury or disease causes damage to the nervous system. These pains can last for months or years after any injury has healed. The damage may be in peripheral nerves that run through the body and limbs, or within the central nervous system in the spine or brain. Patients with this form of pain are frequently given antidepressant drugs, and researchers who have assessed the findings of 50 trials conducted around the world conclude that there is good evidence that at least some of them work well.

The most convincing evidence was for amitriptyline in doses up to 150mg per day, which achieved at least moderate pain relief. It was difficult to assess the value of selective serotonin reuptake inhibitors (SSRIs) as there are few trials in neuropathic pain. The Cochrane Review Authors also found that there was insufficient high quality evidence for them to draw any conclusions about St John's Wort, venlafaxine and L-tryptophan.

"The clinical impression is that antidepressants are effective and this review confirms this belief," said lead author Tiina Saarto who works in Helsinki University Central Hospital, Helsinki, Finland. "If the drug is going to be affective, it normally starts to reduce pain within a few days of starting to take it."

Antidepressants had most effect treating diabetic neuropathy and post-herpetic neuralglia. There was limited evidence that they could also help people with central pain, atypical facial pain and pain after breast cancer treatment. There was a lack of evidence that they helped people with HIV-related neuropathic pain or 'burning mouth syndrome'.

Transcranial Magnetic Stimulation aid severe depression

Wed, 13 Jul 2005 12:48:00 PST

( from http://www.rxpgnews.com ) For severe depression, electro-shock therapy is nowadays the last hope. However, it can impair memory for weeks after therapy. A less aggressive alternative seems to be provided by what is known as "transcranial magnetic stimulation". This is the conclusion arrived at by doctors and psychologists of the Bonn University Clinic in an article which has just appeared in the British Journal of Psychiatry (vol. 186 [2005], pp. 410-416).

Nowadays depression is seen as amenable to treatment: with psychotherapy or medication most patients affected can be assisted out of their depressive phase. About five per cent of all patients, however, fall into such profound depression that they do not respond to these methods. Because depression is one of the most frequent psychological diseases every sixth person suffers from it at least once in their lives this affects a large number of people.

In these cases electro-shock therapy is one option. This involves the patient being anaesthetised. Then the doctors pass electrical impulses through the patient's head via two electrodes, thereby triggering an epileptic spasm. This changes the cerebral chemistry in the area of the forehead, a region which, among other things, regulates the emotions and steers the psycho-motor reflexes.

Effective therapy bad image

One in two patients who previously did not respond to other therapies improve after a series of therapy to the extent that therapy can be continued by using medication or psychotherapy. 'In the severest cases of depression electro-shock therapy is nowadays still an important therapeutic option,' the head of the Bonn Psychiatric Clinic, Professor Wolfgang Maier, emphasises. Despite this, the public image of this method has long been very negative not least due to the movie classic 'One Flew Over the Cuckoo's Nest'. In the film the inmate of a psychiatric clinic (played by Jack Nicholson) is subjected to electro-shock to curb his rebellious behaviour.

The type of electro-shock now used is regarded as a form of therapy which is well tolerated by patients. However, the therapy may impair memory even several weeks later. 'As a rule, this impairment of memory does gradually recede, but understandably it is often experienced by patients as annoying,' Bonn lecturer Dr. Michael Wagner says. The reason is that the flow of electricity is not precise enough, also hitting the hippocampus, our brain's 'memory centre'.

This is why recently a different therapy has come to the fore which has few side-effects: in 'transcranial magnetic stimulation' (TMS) the doctors place a coil on the patient's forehead. For several minutes this produces a strong pulsating magnetic field which in turn produces a flow of electrical current. However, this is so weak that it does not trigger an epileptic attack. The patient remains fully conscious during the treatment.

The Bonn researchers have treated a total of 30 patients suffering from severe depression either with electro-shock or magnetic stimulation. Both methods were roughly equally effective: every second patient experienced a marked alleviation of their depression a week after their stint of therapy. 'Admittedly, the division of the groups was not made on a random basis, which reduces the reliability of the findings,' Dr. Wagner warns. 'The number of patients taking part is also too small for us to draw final conclusions about the effectiveness.' However, other studies also confirm that the effect of magnetic stimulation is to improve the patient's mood.

Memory unimpaired by magnetic stimulation

The patients who had been treated with magnetic stimulation later did as well as or even better than before therapy. By contrast, the patients taking part in electro-shock suffered memory loss, psychologist Svenja Schulze-Rauschenbach confirmed. Even so, magnetic stimulation is not a miracle cure, since, like electro-shock, it is not a lasting cure for depression. The patients still have to continue to be treated afterwards with other methods. 'TMS is just a new therapeutic tool which can't help in all cases of depression,' adds Michael Wagner, cautioning against excessively high expectations.

There are only a few institutions in Germany where the effects of this relatively new therapy for severe depression are being investigated. However, new instruments are in the offing which could be even more effective. The magnetic field which they produce is so strong that it can trigger an epileptic spasm. Yet unlike with electro-shock the flow of current in TMS remains restricted to the area of the brain which is responsible for mood the hippocampus is not affected. Dr. Wagner says, 'We are therefore hoping that this will be an additional very effective method without undesirable side-effects.'

Prenatal efforts ineffective in treating postnatal depression

Sun, 10 Jul 2005 15:21:00 PST

( from http://www.rxpgnews.com ) The key to preventing postpartum depression may be individual support provided after birth by a health professional and tailored to a mother's needs, says a University of Toronto researcher.

"Health professionals want to identify pregnant women who may be at risk for postpartum depression in hopes of initiating preventive strategies," says U of T nursing professor Cindy-Lee Dennis. "But in my review of studies from around the world, I found no preventive effect of any strategy initiated before birth, including prenatal classes specifically targeting postpartum depression. It's not because the interventions are theoretically weak, but it's because compliance is low women are busy and don't attend the classes."

After sifting through hundreds of studies, Dennis conducted a systematic review and meta-analysis of 15 randomized control trials focusing on prevention of postpartum depression. The trials involved 7,697 women. Her study is published in the July 2 issue of the British Medical Journal.

The evidence suggests postpartum depression may be preventable, says Dennis. In analyzing the prevention strategies used, Dennis found an overall 19 per cent reduction in postpartum depression. Individual assessment and intensive support provided by a health professional to at-risk women after they give birth was the most successful approach to preventing postpartum depression; group-based strategies weren't as effective. Risk factors for postpartum depression include past psychiatric history, a significant number of life stressors and lack of support.

"Individual, flexible postpartum care provided by a health professional and based on maternal need may have a preventive effect," Dennis says. "You must have a structured assessment within the first four weeks after birth with referrals to appropriate services that are accessible."

Dennis says her findings have implications for clinicians. "This systematic review tells us what type of strategy we can use to help prevent postpartum depression, when and how we should implement the strategy and with which clients," she says. "It's a nice summary of current research that health professionals can use as a tool when seeking to treat new mothers."

Consistent association between physical health and depression amongst old

Tue, 05 Jul 2005 22:23:00 PST

( from http://www.rxpgnews.com ) A Europe-wide study has shown a consistent association between declining physical health and depression amongst older people.

Links between physical health and depression have been found across cultures amongst adults up to the age of 65. In later life, the impact of physical health on depression is much more substantial, and may depend on sociocultural factors.

Published in the July issue of the British Journal of Psychiatry, this study set out to examine cross-national differences in the association between physical health and depressive symptoms in elderly people across western Europe.

EURODEP Concerted Action is a consortium of 14 research groups from 11 European countries, all engaged in population-based research into late-life depression. The overall sample size of the pooled EURODEP data amounts to 22,570 respondents aged 65 and over.

In this study, the European countries were categorised in 'building blocs: 'Western Isles' (England and Ireland); 'Nordic' (Iceland, Sweden and Finland); 'Western continent' (Belgium, Germany and The Netherlands); and 'Southern/Mediterranean (south of France, Italy and Spain).

Measures were compared of demographic variables, depressive symptoms, physical health (functional limitations and chronic physical conditions) and cognitive functioning in each building bloc.

It was found that the pattern of associations between physical health variables and depressive symptoms in later life was very similar in the 11 countries studied.

In the majority of centres, there was a linear association between depressive symptoms and disability, as well as with chronic diseases, indicating a 'dose-response' relationship.

Furthermore, the relative contribution of these aspects of physical health showed the same pattern in all centres involved: disability had a stronger association with depression than chronic diseases.

The findings are compatible with previous studies without a cross-national approach, and suggest that sociological and cultural factors give way to life-cycle perspectives and biological mechanisms that affect all people, irrespective of cultural traditions.

Some differences between the main regions of Europe were found in this study, however. In contrast to what was expected, the association between physical health and depressive symptoms was somewhat more pronounced in the UK and Ireland, compared with western Europe or the Scandinavian countries.

One explanation may be that health services are less accessible in Britain. Indeed, the national expenditure per capita in Britain in 1990 was clearly below that of most other western European countries, in spite of at least equally high standards in the British health care system. Further research is needed in this area.

The authors of the study comment that as physical disability is closely linked with depressive symptoms in later life, assessment and management of disability is needed in the treatment of depression in the older population.

This study has demonstrated that the application of brief, harmonised procedures to identify the causes of depressive symptoms is feasible across cultures.

Self-harm in older people with depression

Thu, 02 Jun 2005 16:24:00 PST

( from http://www.rxpgnews.com ) A poorly integrated social network and hopelessness are signs of an increased likelihood of self-harm among older people with depression.

The aims of this study, published in the June issue of the British Journal of Psychiatry, were to determine clinical factors that might help to identify those older adults with depression who are most at risk of self-harm and suicide.

76 adults aged 65 and over who had self-harmed were studied prospectively. They were assessed for depression, hopelessness and suicidal intent, and interviewed by a psychiatrist.

Levels of social support from statutory and voluntary agencies, and from family and friends, were also assessed, and information obtained about life events and difficulties during the six months before the episode of self-harm.

The comparison group consisted of 50 people aged 65 or over referred to their local community mental health team for the elderly with a diagnosis of depression. The assessment process was similar to that in the self-harm group, but the reference point for life events was six months before the onset of the current depressive episode.

It was found that 66% of those in the self-harm group showed significant suicidal intent, and in 67% of cases the researcher felt that the participant had wished to die at the time of their self-harm episode.

A similar proportion of participants in both the self-harm and the control group had first-episode depression, compared with recurrent depression or bipolar affective disorder.

Participants in the self-harm group were much more likely to respond 'yes' to the question 'Do you feel that your situation is hopeless?' and 'no' to the question 'Do you think it is wonderful to be alive now?'

Participants in the self-harm group were also more likely to score higher on thoughts of suicide and self-harm than the control group, and rate themselves as more sad, but were less likely to cry than the controls.

Both groups had similar rates of severe life events (around 40%) during the six months before the episode of self-harm or onset of depression.

The authors of the study comment that although life events are important in leading to self-harm and depression, they do not act alone as precipitating factors for self-harm in elderly people with depression.

The role of life events in interaction with other factors, especially social support, appears to be influential. Loneliness, lack of support from services and poor integration in the community are significant factors in determining suicidal behaviour in older adults.

This study has important service and clinical implications for older people, in particular those with depression who have self-harmed. Such individuals should receive a skilled and detailed assessment of both risk and need.

Teenage depression can become a life-long illness

Sun, 29 May 2005 16:23:00 PST

( from http://www.rxpgnews.com ) "Adolescent depression can be as high as 20 percent or higher," said Hammen, who has studied depression for more than 30 years. "While these numbers are alarming, and depression can be impairing, most of the depressions will be short-lived and most of these kids will not go on to have further depression.

"Many things can make teenagers depressed, but in about 60 percent of the cases, the depression does not foretell future depression. Of those who have adolescent depression, perhaps 40 percent will have recurring depression, and many of those will likely be life-long."

Hammen has been conducting a long-term study over the last 10 years of 800 families with children now in their 20s, along with Patricia Brennan from Emory University in Atlanta. The subjects are among 7,000 families in Australia who have been studied since the children were five years old by researchers from the University of Queensland.

About half of the children in the current study who showed depression by age 15 had recurring depression by age 20, and those who did have a distinctive profile, Hammen and Brennan found. Their preliminary analysis indicates the adolescents who showed depression by age 15 and again between 15 and 20 also had anxiety disorders and poor social relationships such as fewer friends or more conflict in their relationships.

"We have found that the risk for recurring depression occurs in the kids who had early depression and social difficulties," Hammen said. "Kids depressed by 15 who function normally in social relationships did not go on to have depression by 20. Poor social functioning by age 15, such as not having stable friendships, looks like a risk factor for recurring depression.

"The kids with depression at both 15 and 20 have a very high rate before age 15 of fears, phobias, anxiety, and panic reactions," she said. "In many cases, they were showing anxious, fearful and distressed symptoms as early as age five."

Twenty percent of the children of depressed mothers developed depression by age 15, a rate of depression twice as high as that of the children of non-depressed mothers.

Girls were more than twice as likely as boys to show depression at both ages 15 and 20, Hammen said.

Parents commonly do not see depression in their children, she said.

"Parents often don't pick up on inner despair or distress, and notice depression mainly as irritability or loss of enjoyment of activities their kids used to enjoy," Hammen said. "If it goes on for a month, I think the parent should pay more attention and not just dismiss the behavior as part of adolescence."

"Most of the time when children are depressed, there's something wrong in their lives, and the situation that's causing the depression needs to be addressed," Hammen said. "Kids often get depressed because bad things happen to them that they don't have the coping skills to deal with."

Women are especially at increased risk for depression from stress factors, particularly interpersonal stress, such as poor relationships marked by as conflicts.

"Most depression, particularly for women, is triggered by negative social connections, such as relationship problems, arguments, break-ups, and not having close friends," Hammen said.

Interpersonal stress plays a large role in women's depression, Hammen has found.

Not all depression is alike, Hammen said, noting it can be mild or severe, a single episode or recurring.

Major episodes of depression last for at least two weeks, with impairment in performing daily activities, and a combination of symptoms such as a depressed mood, loss of enjoyment in previously pleasurable activities, changes in appetite, changes in sleep patterns, loss of motivation and energy, difficulty concentrating, and negative thoughts about themselves and the future, including suicidal thoughts.

People who are depressed often select themselves into stressful environments, or contribute to such environments through difficult relationships with romantic partners or families, that may result in chronic or recurring depression for themselves, Hammen said.

Hammen has studied depression in adolescents and adults, and has studied children of depressed mothers. Depressed mothers often themselves had mothers who were depressed. Her research is funded by the National Institute of Mental Health.

"By age 15, the children of depressed mothers had a higher risk of depression, but the risk for depression is not just from genetics," Hammen said. "The risk is from a cascade of events that occur in depressed families, environmental and psychological factors that are the determinants of whether the kids become depressed.

"If the mother is depressed and had stressful family factors like a bad marriage, then the child is more likely to have social and interpersonal problems and more likely to have stressful life events associated with depression."

In the Australia study, Hammen is testing whether it makes a difference when in the child's life the mother was depressed and whether the mother's depression was severe or mild. Mild depression does not have much impact on the child unless it is chronic, she said.

Hammen and Brennan plan to study the link between maternal depression and youth depression, as well as interpersonal problems such as domestic violence and early pregnancy.

Hammen has debunked myths about depression, including this one:

"A lot of people think depression stems from a weakness in character, and that you should just keep a stiff upper lip," Hammen said. "It's a myth. People cannot simply will depression away. It can be a serious impairment, and may require treatment. It's not a weakness of will."

Depression is common in patients after heart attack

Fri, 27 May 2005 13:17:00 PST

( from http://www.rxpgnews.com ) Researchers at Johns Hopkins' Evidenced-Based Practice Center have found that one in five patients hospitalized for heart attack experiences a major depression. According to the Hopkins cardiologists who conducted the study, these depressed patients are 50 percent more likely than other heart attack patients to need hospital care for a heart problem again within a year and three times as likely to die from a future attack or other heart-related conditions.

"Although there is not much time to do a full psychiatric assessment of heart attack patients in the hospital, it is important to evaluate for depression because of the impact on the patient's quality of life and future medical health," says study co-lead author and cardiologist David Bush, M.D., an associate professor at The Johns Hopkins University School of Medicine and its Heart Institute. He acknowledges that it can be really hard to tell who is most likely to get depressed because the average patient is recuperating and ready to go home from the hospital after 72 hours, and many symptoms of depression develop later.

Co-lead study author and fellow Hopkins cardiologist Roy Ziegelstein, M.D., describes depression after heart attack as a complex interaction of neural hormones, biological changes and sensory perceptions that medicine has only begun to study and explain. "It is far more complex an issue than just being sad or feeling blue for a short period," he says. "What we're talking about here is a serious illness."

Brain fatty acid levels linked to depression

Thu, 26 May 2005 18:52:00 PST

( from http://www.rxpgnews.com ) During recent years, omega-3 fatty acids have enjoyed increased popularity as numerous studies have shown that supplementing diets with fish oil (a natural source of this polyunsaturated fatty acid) does everything from reducing the risk of heart disease to preventing arthritis. There is also evidence that depression may be associated with a dietary deficiency in omega-3 fatty acids. This "phospholipid hypothesis" of depression has been supported by research showing that omega-3 fatty acid concentration in the blood of depressed patients is lower than that in control patients.

"The "phospholipid hypothesis" of depression postulates that decreased omega-3 fatty acid intake, and hence, perhaps decreased brain omega-3 fatty acid content, could be responsible for the disease," explains Dr. Pnina Green of Tel Aviv University. "In humans, because of high dietary variability and the obvious inability to examine brain tissue, the theory is backed up mainly by indirect evidence. The availability of the Flinders Sensitive Line rat, an animal model of depression, overcomes both these obstacles."

In the Journal of Lipid Research study, Dr. Green in collaboration with Dr Gal Yadid of Bar-Ilan University, Ramat Gan, used the Flinders Sensitive Line rats to investigate the link between omega-3 fatty acids and depression. They examined the brains of the depressed rats and compared them with brains from normal rats. Surprisingly, they found that the main difference between the two types of rats was in omega-6 fatty acid levels and not omega-3 fatty acid levels. Specifically, they discovered that brains from rats with depression had higher concentrations of arachidonic acid, a long-chain unsaturated metabolite of omega-6 fatty acid.

Arachidonic acid is found throughout the body and is essential for the proper functioning of almost every body organ, including the brain. It serves a wide variety of purposes, from being a purely structural element in phospholipids to being involved in signal transduction and being a substrate for a host of derivatives involved in second messenger function.

"The finding that in the depressive rats the omega-3 fatty acid levels were not decreased, but arachidonic acid was substantially increased as compared to controls is somewhat unexpected," admits Dr. Green. "But the finding lends itself nicely to the theory that increased omega-3 fatty acid intake may shift the balance between the two fatty acid families in the brain, since it has been demonstrated in animal studies that increased omega-3 fatty acid intake may result in decreased brain arachidonic acid."

Although far less attention has been paid to dietary requirements for omega-6 fatty acids, which can be found in most edible oils and meat, perhaps in the future depression may be controlled by increasing omega-3 fatty acid intake and decreasing omega-6 fatty acid intake.

Isotretionoin Does not Aggravate Depression

Wed, 18 May 2005 16:59:00 PST

( from http://www.rxpgnews.com ) Adolescents with moderate to severe acne experienced a reduction rather than an increase in symptoms of depression while taking the medication isotretinoin, according to a study in the May issue of the Archives of Dermatology, one of the JAMA/Archives journals.

"Acne can be a painful and disfiguring disease that leaves some individuals with permanent physical and psychological scars," according to background information in the article. A synthetic vitamin A, isotretinoin, which was approved by the Food and Drug Administration in 1982, is the most effective therapy for acne that is unresponsive to other treatment. However, an increasing number of cases of suicide and depression in patients using isotretinoin has raised concern and brought about new labeling and patient-informed consent involving possible psychiatric side effects.

Christina Y. Chia, M.D., from Saint Louis University Health Sciences Center, St. Louis, and colleagues investigated whether patients with moderate to severe acne treated with isotretinoin experienced an increase in depressive symptoms compared with patients treated with conservative therapy. At the beginning of the study, the researchers assessed 132 patients ages 12 to 19 years for depression using the Center for Epidemiologic Studies Depression Scale (CES-D). Scores of 17 or above were considered suggestive of depression. Fifty-nine patients received isotretinoin and 73 patients were prescribed conservative therapy, which included a topical antibiotic, topical retinoid, and an oral antibiotic. Depression was assessed three to four months after treatment.

The researchers found that patients in the isotretinoin group did not experience an increase in depressive symptoms. At baseline, 14.3 percent of those in the isotretinoin group and 19.2 percent in the conservative therapy group had CES-D scores of 17 or higher. At follow-up, 8.2 percent of patients in the isotretinoin group and 15.4 percent in the conservative therapy group had CES-D scores suggestive of depression. From baseline to follow-up, the rate of new cases of depression was 4.1 percent in the isotretinoin group and 3.8 percent in the conservative therapy group.

"The use of isotretinoin in the treatment of moderate-severe acne in adolescents did not increase depressive symptoms. On the contrary, our study shows that treatment of acne improves depressive symptoms," the authors write. "Significant psychological stress has been documented among patients with even mild or moderate acne. This observation emphasizes that dermatologists must be cognizant of the relationship between skin disease and depression and be able to recognize depressive symptoms in their patients with acne, particularly adolescents."

Gene May Increase Depression Susceptibility

Mon, 09 May 2005 21:02:00 PST

( from http://www.rxpgnews.com ) A brain scan study suggests that a suspect gene may increase susceptibility to anxiety and depression* by weakening a circuit for processing negative emotion. People with the depression-linked gene variant showed less gray matter and weaker connections in the mood-regulating circuit. How well the circuit was connected accounted for nearly 30 percent of their anxious temperament, researchers at the National Institute of Health's (NIH) National Institute of Mental Health (NIMH) found. Dr. Daniel Weinberger and colleagues report on their brain imaging genetics study in the May 8, 2005 online edition of Nature Neuroscience.

"We discovered the mood-regulating circuit by using the gene to interrogate the imaging data," explained Weinberger. "The brain handles information much like an orchestra. So we asked questions akin to 'Are the violin and the clarinet playing the same tune and to what extent might this gene account for it?'"

In this case, it turned out that the amygdala, a fear processing hub deep in the brain and the cingulate, an emotion-dampening center located near the front of the brain, were playing a duet under the baton of the depression-linked gene.

The gene codes for the serotonin transporter, the protein in brain cells that recycles the chemical messenger after it's been secreted into the synapse, the gulf between cells. Since the most widely prescribed class of antidepressants act by blocking this protein, researchers have focused on possible functional consequences of a slight variation in its DNA sequence across individuals. Everyone inherits two copies of the gene, one from each parent, which comes in two common versions: short and long. The short version makes less protein, resulting in less recycling, increased levels of serotonin in the synapse, and more serotonin-triggered cellular activity. Previous NIMH-supported studies had shown that inheriting the short variant more than doubles risk of depression following life stresses,** boosts amygdala activity while viewing scary faces,*** and has been linked to anxious temperament. Yet, how it works at the level of brain circuitry remained a mystery.

The NIMH research team first scanned 114 healthy subjects using magnetic resonance imaging (MRI). Those with at least one copy of the short variant had less gray matter, neurons and their connections, in the amygdala-cingulate circuit than those with two copies of the long variant.

Next, using functional magnetic resonance imaging (fMRI), the researchers monitored the brain activity of 94 healthy participants while they were looking at scary faces, which activates fear circuitry. Those with the short variant showed less functional connectivity, in the same circuit.

Nearly 30 percent of subjects' scores on a standard scale of "harm avoidance," an inherited temperament trait associated with depression and anxiety, was explained by how well the mood-regulating circuit was connected.

"Until now, it's been hard to relate amygdala activity to temperament and genetic risk for depression," said Dr. Andreas Meyer-Lindenberg, a lead author. "This study suggests that the cingulate's ability to put the brakes on a runaway amygdala fear response depends upon the degree of connectivity in this circuit, which is influenced by the serotonin transporter gene."

Since serotonin activity plays a key role in wiring the brain's emotion processing circuitry during early development, the researchers propose that the short variant leads to stunted coupling in the circuit, a poorly regulated amygdala response and impaired emotional reactivity â resulting in increased vulnerability to persistent bad moods and eventually depression as life's stresses take their toll.

Other members of the NIMH team were: Dr. Lukas Pezawas, Dr. Bhaskar Kolachana, Dr. Michael Egan, Dr. Venakata Mattay, Emily Drabant, Beth Verchinski, and Karen Munoz. Dr. Ahmad Hariri, University of Pittsburgh, also participated in the study.

'Promiscuous' area of brain could explain role of antidepressants

Thu, 07 Apr 2005 18:11:00 PST

( from http://www.rxpgnews.com ) A study at Baylor College of Medicine in Houston may lead to a better understanding of how antidepressants like Prozac work and how to make them more effective.

According to results published in today's issue of the journal Neuron, a study in mice proposes that dopamine and serotonin neurotransmitter systems in the brain occasionally get their signals crossed, causing delays in stabilizing mood.

"This study provides a new site for drug discovery in one of the biggest market for drugs those that treat symptoms of depression," said Dr. John Dani, professor of neuroscience at BCM and lead author of the study.

Dani's study, funded by the National Institutes of Health, offers an alternative explanation for the delayed effect of most antidepressants.

"Some scientists thought that you had to take an antidepressant for weeks because as serotonin is elevated, some of its receptors had to turn off and become desensitized rather than be stimulated," Dani said. "That didn't make a lot of sense to us since desensitization is usually a rapid mechanism."

Serotonin and dopamine neurotransmitter systems, which factor heavily in regulating mood, emotional balance, and psychosis, are released and reabsorbed in the striatum, an area of the brain which affects motivation and reward-based learning. Dani's findings indicate that these systems may be less selective and more "promiscuous" than previously believed.

"There has been a fundamental principal in neuroscience that a neuron releases one neurotransmitter," said Dani. "We have come to realize that neurotransmitters aren't the perfect 1-to-1signalers that we assumed they're a little promiscuous. That is, rather than transporting one neurotransmitter, these systems may transport other neurotransmitters as well."

A better understanding of how antidepressants work would come as welcome news to those who suffer from depressive disorders, a leading cause of disability worldwide. Over 14 million adults experience depression each year in the United States alone.

"Instead of taking serotonin up as they normally would into serotonin neurons, it is taken up into the terminals for dopamine so that now when your neurons fire to send a dopamine signal, they're actually also sending a little bit of a serotonin signal," Dani said. "This kind of interaction among neurotransmitter systems alters the timing of how these neurotransmitter systems act, and in that way, it certainly impacts how you process information."

Depression is commonly treated with selective serotonin reuptake inhibitors (SSRIs) like Prozac to elevate and prolong the presence of the neurotransmitter serotonin in the brain. By blocking the uptake of serotonin after its initial release, conventional antidepressants provide the brain more serotonin for a longer period of ti

Negative self-beliefs are risk factor for depression in women

Wed, 06 Apr 2005 18:32:00 PST

( from http://www.rxpgnews.com ) Women who hold negative beliefs about themselves are at increased risk of becoming depressed, according to a new study.

These negative beliefs are not early symptoms of depression, but represent a vulnerability that persists over time.

It is known that negative beliefs about the self, the world and the future are common during an episode of depression. According to the American psychologist Aaron Beck's influential cognitive theory, people who hold negative self-beliefs when they are otherwise well are vulnerable to developing depression in the future.

To date this theory has not been verified experimentally. This prospective study set out to test whether women with negative self-beliefs were at risk of developing depression.

The information was collected from 12,003 women recruited during early pregnancy as part of the Children of the 90s project which is based at the University of Bristol*. Questionnaires included measures of depressive symptoms and negative self-beliefs. Regular follow-up questionnaires were sent during pregnancy and following childbirth.

The study published in the April 2005 issue of the British Journal of Psychiatry was found that of 8540 women not depressed when recruited, 8.6% became depressed 14 weeks later. Those with the highest scores for negative self-beliefs were more likely to become depressed than those with the lowest scores.

The size of the association between negative self-beliefs score at baseline and later onset of depression at 8 weeks, 8 months, 21 months and 32 months after childbirth remained relatively constant. By comparison, the association between baseline depressive symptom score and the later onset of depression diminished over time.

The researchers comment that this is the first study to report that negative self-beliefs that are associated with a future onset of depression can be identified in people who are otherwise well.

The fact that high levels of negative self-beliefs can predict onset of depression more than three years later suggests that such beliefs represent a long-lasting vulnerability to depression, rather than being an early sign of a depressive episode.

These findings support a crucial part of Aaron Beck's theory of depression, which states that negative self-beliefs are stable patterns of thinking that lead to long-term vulnerability to developing depression.

The origins of negative self-beliefs have not been investigated. It is thought that they might arise from adverse experiences, particularly during childhood, when self-belief structures relating to other people and the world at large are first formed.

Understanding how people develop these negative self-beliefs could lead to preventive measures that could reduce the burden of depression in the population.

Cordance QEEG can assess Susceptibility to Antidepressant Side Effects

Thu, 31 Mar 2005 16:10:00 PST

( from http://www.rxpgnews.com ) In a finding that opens new doors to determining susceptibility to antidepressant side effects, researchers at the UCLA Neuropsychiatric Institute report that changes in brain activity prior to treatment with antidepressants can flag patient vulnerability.

The study is the first to link brain function and medication side effects, and to show a relationship between brain function changes during brief placebo treatment and later side effects during treatment with medication.

The study's unique design compares brain function changes in healthy research subjects with no history of depression while taking an antidepressant vs. placebo, a pill with inactive ingredients. In addition, all participants took only placebo for one week prior to randomization to medication or placebo.

Using "cordance," a quantitative electroencephalography (QEEG) imaging technique developed at UCLA, the research team found changes in brain function in the prefrontal region during the one-week placebo lead-in were related to side effects in subjects who received an antidepressant.

"This finding shows the promise of new ways for assessing susceptibility to antidepressant side effects," said Aimee M. Hunter, lead author and research fellow at the UCLA Neuropsychiatric Institute.

"The ability to identify individuals who are at greatest risk of side effects would greatly improve the success rate of antidepressant treatment," Hunter said. "For example, physicians might select a medication with a lower side-effect profile, start medication at a lower dose or opt for psychotherapy alone when treating patients susceptible to antidepressant side effects."

Antidepressant side effects can be related to medication or to factors such as patient expectations derived from educational materials or consultations with a physician, but determining vulnerability or cause in a clinical setting is difficult.

To overcome this hurdle, the UCLA research team used healthy subjects so that brain function would not be affected by illness or changes in the illness. The team examined QEEG cordance during a placebo lead-in so brain function changes in the first phase of the trial could arise from only non-medication factors.

The study enrolled 32 healthy subjects who had never suffered from depression. All underwent a one-week, single-blind placebo lead-in before being randomized to four weeks of double-blind treatment with the antidepressant venlafaxine or placebo. Members of the research team met with subjects at seven time points over the course of the study -- at baseline, the end of the placebo lead-in, after randomization and weekly after randomization.

A research nurse obtained side effect reports during each visit, systematically asking subjects about specific complaints, including gastrointestinal upset, cardiovascular disturbance, sleep disturbance, anxiety and agitation. EEG readings were obtained at visits throughout the study. Changes in prefrontal brain function observed before start of medication signaled a greater number of adverse effects during antidepressant treatment.

Successful treatment of depression slows slow physical decline in older adults

Fri, 18 Mar 2005 22:45:00 PST

( from http://www.rxpgnews.com ) Successful treatment of depression not only improves older adults' emotional health, but also helps them perform such daily activities as remembering to take medications. This is the first study to report that successful treatment of depression in older adults also improves their ability to perform tasks critical to independent living such as keeping track of medications or managing money. Prior clinical trials of successful treatment of depression in this age group reported improvement in emotional functioning, but had not demonstrated that improved emotional health also translated into improved physical health. Older adults with depression report persistent greater functional impairment than those without depression.

"This study is important for two reasons," said Christopher Callahan, M.D., Cornelius W. and Yvonne Pettinga Professor in Aging Research at the IU School of Medicine. "First, it shows that even older adults with failing physical health can be successfully treated for depression. Second, it shows that treating the depression also helps slow the physical decline."

Dr. Callahan is director of the Indiana University Center for Aging Research and principal author of the article.

Study participants were placed randomly into two groups. One group received standard care for depression from their primary care physician. A depression clinical specialist (a nurse or psychologist) as well the patient's primary care physician co-managed depression treatment for those in the second group.

In both groups, patients whose depression improved were more likely to experience improvement in physical functioning than patients whose depression was not successfully treated, the study found.

Depression was more likely to improve in those who received treatment by collaborative care management than those who had usual care. One hallmark of the intervention was the "stepped care" approach or the ability to increase the intensity of the treatment over time if patients did not respond to initial treatments.

This study is part of Project IMPACT, which followed 1,801 patients age 60 and older with major depressive symptoms for 12 months. Participants in the IMPACT study, the largest clinical trial of late-life depression reported to date, were from 18 primary care clinics across the United States.

"Patients with late-life depression often experience a downward spiral of worsening depression and function," the study authors concluded. "Effective treatment of late-life depression by a collaborative stepped-care program in primary care may interrupt this downward spiral."

In an accompanying editorial, Duke University's Dan Blazer, M.D., Ph.D., noted the bench-to-bedside practicality of this research. "The findings of the IMPACT study are prime for translation into clinical practice changes that will improve the quality of life for many older adults. Primary care practices take note!"

New Study study shows link between depression and worsening heart disease

Thu, 10 Mar 2005 16:24:00 PST

( from http://www.rxpgnews.com ) Depression is known to be "hard on the heart" now researchers are a step closer to understanding why. A new Columbia University Medical Center study examining potential links between depression and heart disease found that heart disease patients who showed symptoms of depression were substantially less adherent to taking a prescribed medicine than patients without depression. Patients who continued to show signs of depression three months after a heart attack or angina only took prescribed medications 67 percent of the time, compared to almost 90 percent in non-depressed patients.

The research, which was presented for the first time at the 63rd American Psychosomatic Society Annual Meeting is part of the Coronary Psychosocial Patient Evaluation Study (COPES), a multi-site, multi-project consortium that is funded by the National Heart, Lung, and Blood Institute. According to Karina W. Davidson, Ph.D., assistant professor of medicine at Columbia University Medical Center and principal investigator of the study, it was known that depression in heart disease patients increases the risk of death after a heart attack, but the explanation for the link had remained unclear until now.

"Taking your medication as prescribed is crucial for improving your chances of good recovery after a heart attack but many doctors struggle with getting patients to take their medication on schedule," said Dr. Davidson. "Our study was designed to test if depression may be a significant factor in reducing adherence, thus potentially explaining why depression carries such a negative prognosis for the heart disease patients."

The study showed that patients who were not depressed in hospital were highly adherent they took the correct dosage of aspirin on 88% of all monitored days. The researchers then divided the depressed patients into 2 subgroups: those who remained depressed 3 months after the ACS, and those whose depressive symptoms had remitted by then. Only patients with persistent levels of depression significantly differed in their level of adherence from non-depressed patients: they took the correct dosage only 2/3 or 67% of the time, as compared to 86% in patients whose depressive symptoms spontaneously remitted after 3 months.

"This is a huge difference that could have an impact on patient survival", concludes Dr. Davidson. "Moreover, it is of great significance to cardiologists and their patients, since medication adherence is a relatively simple, potentially modifiable behavior."

The study objectively measured adherence to aspirin, a standard medication in heart disease patients, by using an electronic Medication Event Monitoring System (MEMS) - an electronic device stored in the cap of a pill bottle that records the date and time whenever the cap is opened. The study included 53 patients from the coronary care and cardiac care step-down units of three university hospitals who had survived an Acute Coronary Syndrome (ACS), which includes either a heart attack or documented unstable angina.

Testing new methods of enhanced care for depression

Fri, 04 Mar 2005 20:57:00 PST

( from http://www.rxpgnews.com ) Researchers at the University of York are investigating a new method of organising care for some of the three million adults in the UK who suffer from clinical depression.

The innovative regime known as 'collaborative care' has been developed over the last decade, principally in the USA, but it has never been used in the UK.

It involves a case manager, supervised by experts in mental health, working alongside the general practitioner, to improve the management of patients' symptoms.

The supply of psychological therapy for depression sufferers in the UK is patchy while about half the people prescribed antidepressant medication abandon it within a week, often due to adverse initial side-effects.

Professor Richards said: "There is a substantial body of evidence to suggest that this collaborative approach improves depression care but all that evidence has been gathered outside the UK, mainly in the USA. In consultation with organisations in the field and patients, our research will develop a UK-appropriate protocol that is faithful to the original models, while taking account of our different health system."

A small randomised control trial will then aim to discover what sort of health professional would best fill the role of case manager. Initially, they will be nurses, counsellors or graduate primary care mental health workers, who have been introduced into the NHS in the last two years.

The trial will establish the pattern and nature of contact between case manager and patient. Case managers will use the telephone as the principal means of contact, though only after an initial face-to-face meeting.

Professor Richards added: "Case managers will help patients to manage their medication and give low-intensity psychological help. Treatment will be much more structured than counselling. Telephone contact will allow case managers to deal with more patients as well as being less burdensome for patients. Each telephone consultation is likely to last 15 minutes or so.

"At any one time, between six and eight per cent of people in this country are suffering from depression. The World Health Organisation will very soon declare that the economic burden of depression worldwide will be second only to that of coronary heart disease.

"This study will helpus to determine whether collaborative care can provide a more effective and efficient approach to the treatment of this distressing illness."

Electrical deep brain stimulation can dramatically alleviate treatment refractory depression

Tue, 01 Mar 2005 17:46:00 PST

( from http://www.rxpgnews.com ) Electrical deep brain stimulation can dramatically alleviate depression that is resistant to other treatments, researchers have found in an initial study on six patients. The finding is important, they said, because up to 20 percent of patients with depression fail to respond to standard treatments--requiring combinations of antidepressant drugs, psychotherapy, and electroconvulsive treatment (ECT) that still may fail. The number of resistant depression patients can be large, since depression is the leading source of disability in adults under age 50 in North America.

The 6 month study led by Helen Mayberg of Emory University School of Medicine and colleagues showed that the patients reported immediate improvements in mood when the electrical stimulation of a few volts was applied to the implanted electrodes. These effects persisted in four of the patients for the full 6 months, with three patients achieving remission or near remission of the depression. No psychological side effects were reported, and other adverse effects were limited to minor infections around the implant site, which were treatable with antibiotics, wrote the researchers.

The researchers concluded that, although the study was limited in scope and length, deep brain stimulation "may represent an effective, novel intervention for severely disabled patients with treatment-resistant depression."

The six patients who participated in the study showed severe depression according to the Hamilton Depression Rating Scale. They had all failed to respond to at least four different treatments, including drugs, psychotherapy, and ECT.

The researchers implanted the array of electrodes in a region called the "subgenual cingulate region," which their earlier studies had indicated to be overactive in treatment-resistant depression.

Precisely calibrated stimulation of a few volts produced immediate effects, the researchers wrote. "All patients spontaneously reported acute effects including 'sudden calmness or lightness,' 'disappearance of the void,' sense of heightened awareness, increased interest, 'connectedness,' and sudden brightening of the room, including a description of the sharpening of visual details and intensification of colors in response to electrical stimulation," wrote the researchers. These effects were reversed when stimulation was turned off and returned when it was resumed.

"Unexpectedly, with application of stimulation for progressively longer periods (from 1 to 3 hr), there was an increasing and correspondingly longer carry-over of the beneficial behavioral effects beyond cessation of the stimulation," reported the researchers.

During the initial weeks of stimulation, "Patients and their families described renewed interest and pleasure in social and family activities, decreased apathy and anhedonia, as well as an improved ability to plan, initiate, and complete tasks that were reported as impossible to attempt prior to surgery."

Analysis of brain activity using positron emission tomography revealed that the deep brain stimulation corrected abnormal hyperactivity in the subgenual cingulate region, which was correlated with abnormally decreased activity in the prefrontal cortex of the brain.

Psychological testing showed that the surgery did not reduce cognitive function in the patients. In fact, patients showed significant improvement in hand-eye coordination, verbal fluency, and judgment of risk.

Over a 6 month period of chronic stimulation, four of the patients continued to show significant antidepressant response, with three showing remission or near remission of illness, reported the researchers.

Research shows St. John's Wart as effective as Paroxetine

Fri, 11 Feb 2005 19:43:00 PST

( from http://www.rxpgnews.com ) A specially manufactured extract from the herb St John's Wort is at least as effective in treating depression as a commonly prescribed anti-depressant, according to new research published on bmj.com today.

St John's Wort* and the anti-depressant drug Paroxetine** were used in a trial to treat patients with moderate or severe depression. The researchers asked 301 participants of both sexes from German mental health centres to take part in the trial. The two drugs were taken by the patients aged 18-70 over a six week period during 2000 -2003.

At the end of the trial half (61 out of 122) of those who took St John's Wort found their symptoms in decline, whilst only a third (43 out of 122) of those taking Paroxetine went into remission.

Participants also suffered more side-effects by taking Paroxetine with 269 adverse effects being reported over the treatment period. Those taking St John's Wort reported 172 adverse effects the most common in both cases being stomach disorders.

The authors support the use of St John's Wort as an alternative to treat depression and welcome more research in this area.

Multiple Medication Use Increase as a Function of Age and Antidepressant Use,studies show

Sun, 06 Feb 2005 11:57:00 PST

( from http://www.rxpgnews.com ) Two new studies show that combinations of medications taken by patients vary widely, making it extremely difficult to monitor or predict drug-drug interactions.The articles published in the January 2005 issue of the Journal of Psychiatric Practice found that virtually no two patients on more than one drug were taking the same combination of medications,which highlights the difficulty of monitoring for and predicting potentially dangerous drug-drug interactions.

The articles present the results of two studies of multiple medication use(MMU)in outpatients in the Veterans Affairs (VA) Healthcare System. MMU was found to increase as a function of both age and whether the patient was taking an antidepressant,with over a third of older patients on antidepressants taking eight or more medications.

The number of patients taking unique combinations of drugs (a combination different from any other patient in the sample) ranged from 70% in younger patients not taking antidepressants to 96% in older patients taking antidepressants.

These figures mean that no single prescriber can have extensive clinical experience with the combined effects of all of the medications his or her patients are taking, setting the stage for potentially adverse drug-drug interactions.

"The frequency and complexity of multiple medication use was surprising and troubling,"said Sheldon Preskorn,MD, principal investigator on the studies."It underscores the importance and the difficulty of avoiding complex and potentially dangerous drug-drug interactions."

The study results reinforce and extend the message of the recent Health, United States 2004 report from the Centers for Disease Control.The CDC reported that almost half of all Americans are taking at least one prescription drug, while, among those 65 years of age and older, five out of six are taking at least one medication and almost half are taking three or more.The CDC study also found that antidepressant use has almost tripled over the last decade, with 10% of adult women and 4% of men now taking antidepressants.

These results are also relevant to the issue of potentially dangerous drug-drug interactions--a problem that has been receiving increasing attention in recent years as highlighted by the withdrawal of drugs such as Vioxx and Seldane from the U.S. market.

The first study,Complexity of Medication Use in the Veterans Affairs Healthcare System: Part I.Outpatient Use in Relation to Age and Number of Prescribers,examined levels of medication use and complexity of drug regimens in a sample of 7,000 outpatients in Veterans Integrated Service Network 15 in the U.S. midwest.The investigators wanted to determine how use of multiple medications related to age and number of prescribers and if it was possible to identify frequently used medication combinations,in order to better predict and prevent adverse drug interactions.

The investigators found that,of the 5003 patients currently taking prescriptions medications,38% were receiving five or more drugs and 14% were taking eight or more.It was also not possible to identify commonly used medication combinations in this population.Almost three quarters of the patients were receiving a unique combination of drugs different from any other patient in the sample, and there was no single combination that occurred in even 1% of the patients.

The second study, Complexity of Medication Use in the Veterans Affairs Healthcare System: Part I.Antidepressant Use Among Younger and Older Outpatients,compared medication use in patients receiving antidepressant medications with patients not receiving antidepressants.The investigators found that patients receiving antidepressants were likely to be receiving significantly higher numbers of other medications than patients not taking antidepressants, with 24% of younger patients and 38% of older patients on antidepressants receiving eight or more medications (compared to 6% and 13% in those not receiving antidepressants).Again no single combination of medications occurred in even 1% of patients.

The large number of unique drug combinations involving antidepressants is especially troubling,since some antidepressants have significant potential to cause serious drug interactions.

The investigators strongly recommended more education for prescribers,pharmacists,healthcare organizations and patients about the complexity of drug prescribing and how it limits our ability to detect and prevent potential adverse drug interactions.They also advocated increased research to identify common medication combinations and evaluate their potential for adverse interactions as well as improved drug alert systems that are more capable of identifying potential problems involving multiple medications.

Female monkeys can be a useful model for learning more about depression in women

Fri, 21 Jan 2005 13:39:00 PST

( from http://www.rxpgnews.com ) The scientists found that depressed female monkeys become socially withdrawn and have reduced body fat, low levels of activity, high heart rates and disruptions in hormone levels all of which are known or suspected characteristics of major depression in women. Their research is based on female monkeys because women are 66 percent more likely than men to experience depression during their lifetimes.

"We believe these monkeys can be a useful model for learning more about depression in women," said Carol Shively, Ph.D., professor of pathology at Wake Forest Baptist. "Current ways to treat depression are only partially successful. This may be an important opportunity to develop and test new treatments."

She said that with current treatments, there's often a difference between men and women in effectiveness and side effects. The animal model will allow scientists to evaluate the effectiveness of treatment specifically in females, the population at greatest risk.

The study involved 36 adult female cynomolgus monkeys, who normally live in social groups in the wild. For most of the research, the animals lived in groups of four and their social interactions and behavior were observed. Depressive behavior included a slumped or collapsed body posture accompanied by a lack of response to events or objects in the environment in which other monkeys were interested.

The researchers found that the depressed monkeys had suppressed ovarian function, but continued to have menstrual periods. Irregular ovulation can lead to low estrogen levels, which have been associated in both women and monkeys with increased risk of disease in the arteries leading to the heart.

"This suggests the possibility that depressed women may have low ovarian function that goes unnoticed because they still have menstrual periods," said Shively. "If this turns out to be accurate, it could explain, in part, the observed relationship between coronary artery disease and depression."

The researchers said monkeys may be particularly useful for learning more about human depression for several reasons. In women, depression is often associated with changes in reproduction, including the beginning of menstruation (premenstrual syndrome or PMS), pregnancy, the post-partum period and perimenopause. Monkeys have menstrual cycles that are very similar to those of women.

"Further studies of monkeys may inform us about the nature of the relationship between reproductive function and mood in females," said Shively.

In addition, depression is higher among people with low levels of education and income. Some female monkeys face social stress that is similar to the stress that humans with low socioeconomic status experience. In some cases, these monkeys were also more prone to depression.

"What we've observed in these monkeys is the first animal model of social stress-related depression in females," said Shively.

In monkeys, the social stress comes from the social hierarchies they naturally form when they live in groups. Monkeys that are the low-status or "subordinate" animals in the group face more aggression, are more vigilant, spend less time being groomed a friendly behavior by monkey standards and spend more time alone. Previous research has shown that they have increased heart rates, more of the stress hormone cortisol and more cardiovascular disease than dominant monkeys.

Depressive disorders affect about 19 million Americans yearly. The lifetime prevalence rate of major depression in women is 21 percent, compared to 12.7 percent for men. Depression in women can have negative effects on children as well as marriage. In addition, women who develop depression before age 18 are less likely to obtain a college or graduate degree, reducing their future earning potential.

Hepatitis C patients are less likely to have a good outcome if they develop depression

Sun, 16 Jan 2005 13:38:00 PST

( from http://www.rxpgnews.com ) An article appearing in the January 2005 issue of Brain, Behavior and Immunity suggests that developing depression while on interferon-alpha plus ribavirin may impact how well the medications work.

In a study conducted in the Department of Psychiatry and Behavioral Sciences at Emory University School of Medicine, Charles L. Raison, MD, Andrew Miller, MD, and colleagues, observed that patients who develop depressive symptoms during interferon-alpha plus ribavirin therapy were significantly less likely to have cleared the hepatitis C virus from their blood following six months of treatment.

"Hepatitis C infection affects three to five million Americans, and is the leading cause of liver transplantation," said Dr. Raison. "With advances in treatment, 40-50 percent of patients can be cleared of the virus. Unfortunately, however, the current treatment for hepatitis C interferon-alpha plus ribavirin produces a high rate of psychiatric side effects that have long been recognized as impediments to successful antiviral therapy. In the past we primarily worried that depression interfered with quality of life, or would cause patients to stop taking the medicine. These new data suggest that even if patients stay on treatment, they are less likely to have a good outcome if they develop depression."

The study examined 103 participants who received pegylated interferon-alpha-2b plus ribavirin (PEG IFN/ribavirin). All participants were psychiatrically evaluated prior to initiation of the medication and at 4, 8, 12 and 24 weeks of PEG IFN/ribavirin treatment.

Only 34% of the patients who had a significant increase in depression cleared the hepatitis C virus from their blood at 24 weeks, as compared to 59%-69% of patients with milder increases in depression. The effect of depression on viral clearance persisted even after adjusting for factors known to affect treatment outcome, such as viral genotype, or whether medications had to be reduced.

"The findings of this study provide preliminary evidence that baseline mood state should be assessed in patients prior to commencing treatment," said Dr. Raison. "Significant deviations from this state may increase the likelihood of treatment failure. Moreover, these findings provide further support that the development of depression can have a negative impact on health outcomes in medically ill subjects."

Researchers from the Rollins School of Public Health, Emory University and the Department of Medicine, Gasteroenterology and Hepatology, Weill Medical College of Cornell University were also involved in the study. The study was supported by grants from the National Institute of Mental Health, ScheringPlough, and the Centers for Disease Control and Prevention.

Mutant gene linked to treatment-refractory depression

Wed, 15 Dec 2004 18:53:00 PST

( from http://www.rxpgnews.com ) A mutant gene that starves the brain of serotonin, a mood-regulating chemical messenger, has been discovered and found to be 10 times more prevalent in depressed patients than in control subjects, report researchers funded by the National Institutes of Health's National Institute of Mental Health (NIMH) and National Heart Lung and Blood Institute (NHLBI). Patients with the mutation failed to respond well to the most commonly prescribed class of antidepressant medications, which work via serotonin, suggesting that the mutation may underlie a treatment-resistant subtype of the illness.

The mutant gene codes for the brain enzyme, tryptophan hydroxylase-2, that makes serotonin, and results in 80 percent less of the neurotransmitter. It was carried by nine of 87 depressed patients, three of 219 healthy controls and none of 60 bipolar disorder patients. Drs. Marc Caron, Xiaodong Zhang and colleagues at Duke Unversity announced their findings in the January 2005 Neuron, published online in mid-December.

"If confirmed, this discovery could lead to a genetic test for vulnerability to depression and a way to predict which patients might respond best to serotonin-selective antidepressants," noted NIMH Director Thomas Insel, M.D.

The Duke researchers had previously reported in the July 9, 2004 Science that some mice have a tiny, one-letter variation in the sequence of their tryptophan hydroxylase gene (Tph2) that results in 50-70 percent less serotonin. This suggested that such a variant gene might also exist in humans and might be involved in mood and anxiety disorders, which often respond to serotonin selective reuptake inhibitors (SSRIs) antidepressants that block the re-absorption of serotonin, enhancing its availability to neurons.

In the current study, a similar variant culled from human subjects produced 80 percent less serotonin in cell cultures than the common version of the enzyme. More than 10 percent of the 87 patients with unipolar major depression carried the mutation, compared to only one percent of the 219 controls. Among the nine SSRI-resistant patient carriers, seven had a family history of mental illness or substance abuse, six had been suicidal and four had generalized anxiety.

Although they fell short of meeting criteria for major depression, the three control group carriers also had family histories of psychiatric problems and experienced mild depression and anxiety symptoms. This points up the complexity of these disorders, say the researchers. For example, major depression is thought to be 40-70 percent heritable, but likely involves an interaction of several genes with environmental events. Previous studies have linked depression with the same region of chromosome 12, where the tryptophan hydroxylase-2 gene is located. Whether the absence of the mutation among 60 patients with bipolar disorder proves to be evidence of a different underlying biology remains to be investigated in future studies.

The researchers say their finding provides a potential molecular mechanism for aberrant serotonin function in neuropsychiatric disorders.

Also participating in the study were: Raul Gainetdinov, Jean-Marin Beaulieu, Tatyana Sotnikova, Lauranell Burch, Redford Williams, David Schwartz, and Ranga Krishnan, Duke University.

###

In addition to grants from NIMH and NHLBI, the study was also funded by the Human Frontiers Science Program and the Canadian Institute of Health Research.

Better life quality with ECT in depression

Thu, 04 Nov 2004 15:30:00 PST

( from http://www.rxpgnews.com ) Electroconvulsive therapy (ECT) improves quality of life and functioning in people with severe depression, a new study has found.

For many years ECT has been seen as a highly controversial therapy for major depression. The National Institute for Clinical Excellence (NICE) has recommended limiting its use, partly because of the inadequacy of research into the effects of ECT on quality of life and individual function.

This prospective study from the USA, published in the November issue of the British Journal of Psychiatry, set out to examine the effects of ECT on function and quality of life, particularly as they relate to changes in mood and cognition in the month following this therapy.

77 depressed patients aged over 18, with no history of schizophrenia, schizoaffective disorder, active substance misuse, learning disability or neurological disorder were recruited. No patient had received ECT during the previous four months.

Participants received treatment with antidepressant medication during the month-long period of observation after ECT treatment. Depression severity and cognition were assessed 1-3 days before ECT, immediately afterwards, and at two and four weeks after ECT.

66% of the participants were found to respond positively to ECT. They showed improvement in every measure of mood, most measures of cognition, quality of life and function both at two and four weeks after ECT treatment. Further, the majority of the changes measured were statistically significant.

The authors of the study comment that change in perceived quality of life seemed to be most influenced by changes in mood, whereas change in function was related to change in cognition.

The results of this study support that premise that ECT produces a net improvement in health for most patients. A restrictive attitude towards ECT is not warranted on the basis of its effects on quality of life and function.

Reference:
McCall WV, Dunn A and Rosenquist PB (2004) Quality of life and function after electroconvulsive therapy. British Journal of Psychiatry, 185, 405-409.

Depression in mothers linked to anti-social behaviour in children

Wed, 22 Sep 2004 22:42:00 PST

( from http://www.rxpgnews.com ) A new twin study has found that maternal depression is associated with child anti-social behaviour (ASB).

By the time the children of depressed mothers are seven, there is a significant relationship between the degree of maternal depression and the level of child ASB.

It is believed that children of depressed mothers have increased conduct problems, presumably because maternal depression can disrupt a mother';s ability to provide an adequate care-giving environment.

Alternatively, the association between maternal depression and child ASB may come about because a) some depressed women are likely to have anti-social personality traits that get passed onto their children; b) some depressed women are likely to mate with, and bear the children of, anti-social men; or c) children of depressed mothers inherit a genetic liability for psychological problems.

The aim of this study was to test whether the association between maternal depression and child ASB at the age of seven is still significant after making allowance for the influence of genetic risk and both parents'; history of anti-social personality disorder (ASPD) symptoms. ASPD symptoms include illegal behaviour, deceitfulness, aggression, and recklessness.

Data were gathered from the E-risk study, a representative group of 1116 twin pairs assessed at five and seven years of age. Mothers were interviewed about major depressive disorder symptoms and ASPD symptoms themselves and in their children';s fathers. Mothers and teachers also reported on children';s conduct problems.

It was found that diagnosable depression occurringin mothers after, but not before, the twins'; birth was associated with child ASB. The more chronic the mother';s depression, the worse the child ASB was at age seven.

Genetic factors, and parents'; history of ASPD, accounted for the majority of the observed association between maternal depression and child ASB.

However, maternal depression continued to predict child ASB significantly, even after taking into account genetic risk and parental ASPD symptoms. In other words, maternal depression is not only the cause of the children';s ASB, but one of several causes.

Mothers with both depression and ASBD symptoms were likely to provide less than satisfactory parenting, and their children had the highest levels of ASB.

The researchers conclude that studies ignoring genetic transmission overestimate social transmission effects, because both genetic and environmental processes are involved in creating risk for ASB in the children of depressed mothers.

Interventions for depressed mothers aiming to reduce conduct problems in their children should address parents' anti-social personality, as well as mothers' depression.

Higher rates of depression found among white pupils

Sat, 04 Sep 2004 22:48:00 PST

( from http://www.rxpgnews.com ) The largest UK study of psychological distress among ethnic minority adolescents has found higher rates of depressive symptoms among non-UK White pupils compared with White UK pupils.

However, there were lower rates of psychological distress among Bangladeshi pupils compared with White pupils, despite the highest levels of socio-economic disadvantage being found among the Bangladeshi community.

Research shows that in adults the prevalence of psychological distress varies between ethnic groups, which has been explained by differences in socio-economic status. This study set out to investigate whether the same is true of adolescents.

A cross-sectional questionnaire survey was used to assess 2790 male and female pupils aged 11-14 from a representative sample of 28 East London secondary schools.

Ethnicity was self-rated by the adolescents, and socio-demographic factors obtained from questions about parental employment status, household crowding, family car ownership and eligibility for school meals. Data on mental and physical health were also collected.

It was found that more than three quarters (78%) of the children studied were non-White. 79% had been born in the UK, and 9% had been in the UK for less than five years. The largest ethnic groups were Bangladeshi (25%), White UK (21%) and Black (20%).

All ethnic groups experienced high levels of familial social disadvantage compared with the national average, but this was most evident in the Bangladeshi group.

Rates of psychological distress were similar to rates in UK national samples in boys and girls. These rates increased with age in girls and decreased in boys, in keeping with other studies.

However, Bangladeshi pupils, although highly socially disadvantaged, had a lower risk of psychological distress than White UK pupils. The authors of the study suggest that ethnically-related protective factors, including high ethnic density in the East London Bangladeshi population, may be in operation.

Such factors might also include high levels of family support, religious belief, strong cultural identity and cohesion. If any of these are protective of mental health in the face of social adversity, there may be implications for the prevention of psychological distress in adolescents.

Non-UK White girls had higher rates of depressive symptoms than White UK girls, although this finding was not as marked when recent migration was taken into account. It may be that stressors associated with migration, such as traumatic experiences in the country of origin, separation from parents and friends, and difficulties adjusting to a new, alien environment adversely affect mental health.

This study is further evidence that local services need to know their community well, and be able to interpret local needs. Health promotion strategies that aim to reduce psychological distress in adolescents should focus on understanding the full range of potential protective factors, including cultural ones.