RxPG News : Depression

Depression during pregnancy doubles risk of premature delivery

Fri, 24 Oct 2008 13:33:16 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.

Depressed older people risk losing their minds

Tue, 09 Oct 2007 14:30:12 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.

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

Sun, 20 May 2007 03:59:37 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.

Light therapy fights doldrums with sun substitute

Tue, 19 Dec 2006 09:04:55 PST

( from http://www.rxpgnews.com ) Berlin, Dec 19 - It starts when the days get shorter in late autumn and often does not disappear until March: winter depression.

It not only causes sufferers long periods of feeling down, but also is accompanied by other aggravations such as restless sleep, loss of drive and a state of anxiety. Experts say one of the best ways of alleviating the problem is light therapy.

The problem occurs because when the days get shorter and there is less daylight, the body produces more melatonin, a hormone that causes drowsiness.

'A slightly depressed mood during the dark months of the year is nothing unusual,' said Jürgen Zulley, a sleep therapist at the University of Regensburg in southeastern Germany.

As opposed to a normal feeling of melancholy, winter depression is characterised by an added need to sleep, ongoing lack of energy and strength, trouble concentrating and overall diminished vitality.

Malek Bajbouj, psychiatrist at Berlin's Charité university hospital, said a person is said to be suffering winter depression when the depressive state occurs every day, lasts two weeks or longer and when the episodes occur in at least two consecutive years.

Light therapy is the most practical solution, an expert says.

A special lamp is used to provide the sensation of bright sunlight. The therapy can take place at a doctor's office or at home. The lamp's white rays of light shine into the retina, stimulating areas of the brain, which in turn produce the hormone serotonin. A filter blocks out harmful UV rays.

The length of time spent looking at the lamp depends on its strength. Stronger light require just 30 minutes daily, while those with less strength require as much as two hours.

'The best time to use the light is in the morning so that the body recognises that the day has begun,' said Bajbouj. Properly used, the lamp's bright light helps the inner clock regain its timing. The result is clearer thinking, better sleep and the ability to enjoy life to the fullest again.

Thomas Schluepfer, deputy director of the Clinic for Psychiatry and Psychology at the University Hospital in Bonn, recommends that people who suffer winter depression buy their own lamp.

'The whiter the light, the more effective it is,' said Bajbouj, adding that taking a 'light shower' in a solarium can improve someone's mood, but it does not have the hormonal effect of a prescribed light therapy. 'Aside from that the UV rays in solarium light can damage the skin.'

Basically, any natural light source can improve mood. Zulley also recommends moderate exercise in fresh air, preferably for an hour during midday when the sunlight is strongest. Even when it is cloudy, the sunlight is strong enough to make a difference, he added.

Drug approval processes may have delayed warnings about safety of Paroxetine

Mon, 10 Jul 2006 07:23:37 PST

( from http://www.rxpgnews.com ) Drug approval processes may have delayed warnings about the safety of antidepressants, argues a senior doctor in this weeks BMJ.

Following GlaxoSmithKlines recent letter to doctors pointing to a sixfold increase in the risk of suicidal behaviour in adults taking paroxetine, Professor David Healy examines the regulation of selective serotonin reuptake inhibitors (SSRIs) and asks were mistakes made and could they have been avoided?

In February 1990 an article raised concerns that the recently licensed fluoxetine might trigger suicide acts in depressed patients. Subsequent trials showed a doubling of rates of suicidal acts between active treatment and placebo, but it was only in a recent study reviewing over 700 trials that this difference became significant.

This trend should have been seen by both companies and regulators as something that required investigation, writes the author.

Trials in children conducted from the mid-1990s also show a doubling of the risks of suicidal acts with SSRIs. These results have recently formed the basis of warnings about the use of SSRIs in children. Trials in adults show a similar risk ratio yet, until May 2006, no warnings were issued for adults.

Although data submitted to the FDA show an excess of suicides with every antidepressant licensed since 1987 compared with placebo, this simple but crucial finding continues to be obscured, he says.

He also examines the way in which the data were presented to regulators by manufacturers, and suggests that inappropriate inclusion of suicidal acts in the placebo group biased estimates of suicide risk. Subsequent rigid interpretation of these data by the regulators may have delayed warnings of dangers of suicidal acts, he adds.

Having re-analysed the evidence, he suggests that the best estimate for the likely risk of suicide on SSRIs over placebo is 2.6 (more than double the risk) and he calls for suitably powered studies to settle the issue.

He also believes that greater data transparency and statistical sophistication might lead to earlier research to discriminate between those who do well on new drugs and those who do not.

The regulators seem stuck in a world where balancing evidence of potential benefit against actual risk causes real problems, he writes. The SSRI and rofecoxib disasters have harmed public confidence in drugs. We urgently need to learn how to regulate both the risks and benefits of new treatments more effectively.

BMJ Editor, Fiona Godlee also touches on this issue in her Editor's choice column. She talks of "an overpowerful under-regulated drug industry and a research establishment and publishing industry in its thrall." A radical solution would be to stop allowing drug companies to evaluate their own products. Is this feasible? Is it the answer? she asks.

Living in the past indicates dissatisfaction with present

Sat, 01 Apr 2006 19:13:37 PST

( from http://www.rxpgnews.com ) It might seem quite natural for the elderly to often slip happily into reminiscence but living in the past could indicate dissatisfaction with the present, says psychologists.

This phenomenon becomes a problem when an elderly relative starts living completely in the past and ignores the present. While some might welcome a break from older relatives repeating boring old yarns, it is not a normal symptom of ageing.

People who are unhappy with their surroundings might find it easier to retreat into the past. Studies have shown that older people with a positive self-image and perception of others enjoy the present more.

Indeed, there are many reasons why the past is so important to many senior citizens.

"As one ages, one is more physically limited, not as mobile and has problems seeing and hearing," says Jochen Tenter, specialist in clinical geriatry.

For many, life becomes less exciting. Lacking stimulus, people tend to focus on their inner life. "They can rely on that. It is dependable and no one can take it away," explains Tenter.

Society also often contributes to the problem.

"Elderly people are often marginalised because they cannot participate in life as actively as young people," observes Georg Adler, director of the Central Institute of Mental Health in Mannheim, Germany.

"If older people are fully valued and taken seriously, then they go about their lives and the present day much more positively. Memories and old stories are not necessarily bad," states Ursula Lehr, gerontologist and honorary chairwoman of the Federal Working Group on Seniors' Organisations (BAGSO) in Bonn.

"Many people begin to take account of their lives as they get old, and that dredges up a lot of memories," explains Lehr. It only becomes problematic for children and grandchildren when the same stories are told over and over again and only a proactive approach will help.

"If you are really interested in the stories, ask for details. That makes it more interesting for the storyteller," suggests Tenter.

"A person repeats everything if he gets no feedback," explains Lehr. Instead, annoyed relatives should make it clear whether they already know the stories.

It would be better to say, "You have told me that so often already," advises Tenter.

Instead of living silently in the past, older people should seek contact with the younger generation. "Inter-generational contacts are advisable to put a stop to the past-oriented thinking," said Tenter. Additionally, it has been shown that contacts with unfamiliar people are also helpful.

"That way you get new impressions and maybe get to play a new role."

Psychologists and gerontologists also recommend that middle-aged people should be sure to maintain contacts and keep their spirits up. "That can mean games, dancing, sports or advanced crossword puzzles," recommends Tenter.

Further, Lehr says that elderly should keep themselves abreast of current affairs. "Old people should read a newspaper, watch the news, make dates and then discuss it all."

However, old stories should not be lost under any circumstances. "Young people should ask older people to write down their experiences and impressions," advises Lehr.

After all, telling old stories from old times is not just an expression of boredom or dissatisfaction.

So young, so sad, so listen - Relaunched

Fri, 02 Sep 2005 02:32:38 PST

( from http://www.rxpgnews.com ) The Royal College of Psychiatrists is relaunching this highly popular cartoon-illustrated* book, first published in 1995, with a new Foreword by Philip Pullman, acclaimed author of the trilogy His Dark Materials and other works.

So Young, So Sad, So Listen was written for parents and teachers of young people with depression. The authors hope that social workers, health visitors and family doctors will also find it useful, as well as some teenagers themselves.

The aim of the book is to help those involved to recognise the signs of depression in the young and to understand the possible causes. The authors, psychiatrist Philip Graham and psychotherapist Carol Hughes, provide practical advice and information about the wide range of help and support available.

In his Foreword Philip Pullman describes depression as "a savage and merciless disease". "Whatever the cause and wherever it comes from, if depression strikes you when you're young it strikes very hard indeed."

Around 5 in 100 teenagers in the UK are seriously depressed, and at least twice that number show significant distress. In troubled inner-city areas, the level of depression among the young may be twice this. As many as 2 or 3 girls in every 100 make a suicide attempt at some time during their teenage years.

Carol Hughes underlines the importance of listening to the young person with depression. "Try listening with the heart and not just the ears... Behind every attention-seeker is a real problem that perhaps the child needs to dramatise in order to ensure an audience."

She gives some basic ideas on how to be emotionally available to young people (which is a surprisingly difficult task), and advises on how to access further specialist help if home, school and GP support prove not to be enough.

Carol Hughes also highlights the difficult area of 'secrets' or 'confidentiality', where for instance a young person begs a well-meaning friend to keep quiet about their depression. This can be a potentially very dangerous position to be in, with the confidante becoming isolated, out of their depth and overwhelmed perhaps with secret details of suicidal intentions.

So Young, So Sad, So Listen reviews the range of talking treatments available, from cognitive-behavioural therapy to family or group therapy, and individual psychoanalytic psychotherapy. Although physical treatments are usually less important than talking treatments, they are sometimes helpful and can occasionally turn out to be the most important part of the treatment.

There have been a number of concerns aired publicly about giving young people antidepressant tablets or other drugs used to treat depression in adults. Prof. Graham outlines the limited but definite place of medication in treating depression in the young, always taking into account the need for very careful monitoring.

What happens to depressed children and young people? Some, with milder forms of depression, will improve over weeks or months, especially if their problems are recognised and they receive sympathetic help. More serious forms of depression may not fare as well, and perhaps as many of half of those will go into adult life with a high likelihood of recurrence.

But the authors conclude that there is always much that can be done to help a depressed child or teenager, as well as other members of the family.

Royal College of Psychiatrists welcomes nice guidelines and MHRA advice on prescribing of SSRI medication in adults

Tue, 07 Dec 2004 06:03:38 PST

( from http://www.rxpgnews.com ) The Royal College of Psychiatrists welcomes the much-awaited publication of the National Institute for Clinical Excellence (NICE) guidelines for Depression and Anxiety, and are pleased that the Medicines and Healthcare products Regulatory Body (MHRA) are now able to communicate its verdict on the safety of Selective Serotonin Reuptake Inhibitors (SSRIs) and newer antidepressant drugs for adults.

BACKGROUND
Large numbers of people have gained benefit from the use of SSRIs and related drugs, and for most people they appear to be free from the more serious side-effects. In recent years, there has been a great deal of uncertainty and concern amongst large groups of patients about the use of SSRIs, and clarity about the evidence for efficacy and safety has been needed.

It is essential that people with depression, their carers, and clinicians, are able to make treatment decisions on the basis of a full appraisal of all the evidence about efficacy and safety. This is a crucial step in improving confidence in clinical decision-making and the development of evidence-based guidelines.

NICE GUIDELINES
The NICE guideline on depression, based upon the published evidence, suggests that SSRIs are effective treatments for moderate to severe depression. The guidelines developers have not, however, been able to access all unpublished trials.

The new NICE guidelines, incorporating the advice from the MHRA, now recommend greater caution in the use of SSRIs, including more intensive monitoring, especially when prescribing these and related drugs for younger adults (18 - 30 years), who may be at higher risk of developing suicidal thoughts, particularly in the first month or so of treatment.

The College welcomes the recommendation that patients will also need to know of the risks of withdrawal/discontinuation, as these may occur on stopping these drugs or when reducing the dose.

With these (and other) cautions in place, we believe that patients and clinicians will feel more confident about the safe use of these drugs.

MHRA ADVICE
The College considers it is very important that the MHRA has based its report upon both published and unpublished trials, and has made considerable effort to procure all the unpublished trials held by some of the pharmaceutical industry.

We therefore have some concerns that the MHRA has not been able to examine all the evidence upon which this guidance should be based, at least for some of the drugs considered.

It is also unclear whether there has been an adequate examination of the efficacy of the SSRIs and related newer drugs.

The Royal College of Psychiatrists stands by its evidence to the Parliamentary Health Select Committee last month on the role of the pharmaceutical industry, which began:

'The decision to give/receive treatment should be based upon the balance of risks and benefits. If the benefits outweigh the risks, the treatment is worth considering. If the risks outweigh the benefits, alternative treatments should be sought. To make a decision to give/receive a treatment, the doctor and patient should know about ALL the risks and potential benefits of the treatment.

Most of our knowledge about the benefit and harm associated with any drug comes from clinical research undertaken by drug companies. If pharmaceutical companies only publish clinical research that is positive, and hold back on publishing clinical research which is negative (selective reporting), then patients may well be given treatments which, unknown to either the patient or the doctor, are likely to do more harm than good.'

The Royal College of Psychiatrists is particularly pleased that the MHRA, NICE and the National Collaborating Centre for Mental Health1 will be meeting in the new year to review the current problems in accessing full safety and efficacy data, and to address the uncertainty this creates for patients, for carers, and for guideline developers.

We look forward to working with these organisations, in whatever way we can, to improve current uncertainties and to support these organisations in their efforts in strengthening confidence in the evidence base upon which clinical decisions and guidelines are currently developed.

Internet therapy for depression

Mon, 04 Oct 2004 15:39:38 PST

( from http://www.rxpgnews.com ) Little is known about the effectiveness of educational interventions for reducing the stigma associated with depression. A new study from Australia has found that the internet can offer an opportunity for people with depression to access programmes that reduce personal stigma.

Published in the October issue of the British Journal of Psychiatry, the study set out to investigate the effects on stigma of two internet depression sites.

A sample of 525 people with raised scores on a depression assessment scale were randomly allocated to a depression information site (BluePages), a cognitive-behavioural skills training website (MoodGYM), or an attention control condition.

The BluePages website provided information about depression, symptoms, sources of help, treatments and prevention. It stated that depression is as disabling as multiple sclerosis, can and should be treated, and stressed the importance of seeking help. The site included biographies of famous people with depression.

The MoodGYM website consisted of five interactive modules covering cognitive therapy, behavioural methods for overcoming negative thinking, relaxation, problem solving, assertiveness and self-esteem training, and strategies for coping with relationship break-up.

Participants were directed to read a different specified module of both sites each week for five weeks, and were in weekly telephone contact of ten minutes with an interviewer who monitored their progress.

The control intervention involved five weekly telephone contacts of 10 minutes with an interviewer, who asked open-ended questions about factors that might influence depression, including physical and artistic activities, hobbies and educational activities, relationships, social support, financial management, work stress and relationships, health and nutrition and alcohol intake.

Personal stigma (personal stigmatising attitudes to depression) and perceived stigma (perception of what most other people believe) were assessed before and after the intervention.

It was found that, relative to the control, the internet sites significantly reduced personal stigma, although the effects were small. BluePages had no effect on perceived stigma, but MoodGYM was associated with an increase in perceived stigma relative to the control.

The authors of the study comment that whatever mechanism led to increased perceived stigma in the MoodGYM group, it did not influence their personal views. It may be advisable for clinicians delivering cognitive-behavioural therapy to consider strategies for reducing perceived stigma.

Interestingly, the control group showed a decrease in perceived stigma. Whereas interviews with the internet participants focused on programme activities and feedback, questions asked of control participants related to their own personal experiences. Perhaps the experience of talking to another, non-judgemental person affected participants' perceptions about the attitudes of others.

Changes in personal stigma were not related to changes in depressive symptoms. Controlling for intervention, neither were theses changes connected to depression literacy nor to cognitive-behavioural therapy literacy.

The authors of the study conclude that depression literacy and cognitive behavioural therapy programmes can be helpful in decreasing personal stigma in people with depression. The internet offers an opportunity to disseminate such programmes widely and at low cost, but further research is needed.

Reference:
Griffiths KM, Christensen H, Jorm AF, Evans K and Groves C (2004) Effect of web-based depression literacy and cognitive-behavioural therapy interventions on stigmatising attitudes to depression: Randomised controlled trial, British Journal of Psychiatry, 185, 342-349.

SSRI "addiction is a myth"

Sat, 10 Jul 2004 22:50:38 PST

( from http://www.rxpgnews.com ) Up to two out of three people who come off modern anti-depressants suffer short-term withdrawal symptoms including dizziness, nausea and low mood. But it is impossible for anyone to become addicted to SSRIs, the Royal College of Psychiatrists heard today.

"Worries about addiction have arisen because doctors mistake these withdrawal symptoms for continuing depression and put people back on antidepressants, instead of reassuring them that the symptoms will soon go,' Dr Peter Haddad, a psychiatrist at the Community Mental Health Centre in Manchester, told the College's annual conference. "Typically the symptoms stop immediately the drug is restarted which gives people the impression that they are addicted.

But Dr Haddad said that dependency in the sense of having a powerful urge to continue a drug, often for more gratification, does not happen with SSRIs. Antidepressants do not have street value. People do not forge
prescriptions for fluoxetine. Nor do they register with multiple GPs, turn up at A&E departments to get more supplies or lie in bed craving an antidepressant,' he said. "As long as it is used widely, antidepressants have clear benefits, allowing people to get on with their lives.'

But he admitted there could be problems, perhaps explaining why thousands of people went on to websites to saying they were addicted to SSRIs. "I have seen people with apparently intractable withdrawal symptoms but I am always able to help them come off the drug eventually.' He said people needed reassurance that the symptoms were temporary. If necessary, the drug could be restarted and then doses could be reduced slowly.