вторник, 17 мая 2011 г.

Antidepressant Associated Changes In Semen Parameters

The authors describe 2 patients who have had severely impaired sperm concentration and motility closely associated with the use of antidepressant medications.


They noted a temporal relationship between abnormal semen parameters and antidepressant therapy in these two patients. Each had normal semen parameters off medications.


The evaluation of each patient was unremarkable. While on antidepressant medications, both patients produced semen samples with marked impairment of sperm concentration and/or motility. Each patient demonstrated a normalization of sperm concentration and motility after discontinuation of antidepressants.


The authors hypothesize that Serotonin-reuptake inhibitor antidepressants may affect sperm transport, resulting in impaired sperm motility and concentration for some patients.

понедельник, 16 мая 2011 г.

Is The Tendency To Express Anxiety And Depression With Physical Symptoms Related To Poor Outcome?

This study, published in the last 2010 issue of Psychotherapy and Psychosomatics, indicate that concomitant physical symptoms in patients with depression and anxiety are associated with a poorer prognosis of symptoms of depression and anxiety and that it might prove worthwhile to pay attention to the role of multiple physical symptoms in the process of tailoring interventions to meet the needs of depressed and anxious patients in primary care.


A new study, published in the last 2010 issue of Psychotherapy and Psychosomatics by a group of researchers of the University of Amsterdam, has explored the relationship between multiple physical symptoms and the course of depressive and anxiety symptoms in primary care.


Up to 70% of depressed patients present themselves to their general practitioner with physical symptoms instead of psychological symptoms. Given this frequent co-occurrence, it seems plausible that multiple physical symptoms interfere with the course and outcome of symptoms of depression and anxiety. However, it is often difficult to determine whether multiple physical symptoms are an expression of co-morbidity with chronic medical conditions, or whether they are an expression of co-syndromality or somatization. This distinction however might not be relevant if there is no association between multiple physical symptoms and the course and outcome of depression and anxiety.


The Authors of this study hypothesized that multiple physical symptoms might have a generic, but also a differential, effect on the outcome of treatment. This study aims to test both hypotheses in a secondary analysis of data from a recently completed randomized clinical trial (RCT). This RCT assessed the effectiveness of up to 6 sessions of problem-solving treatment compared to 'care as usual' for patients suffering from depressive or anxiety symptoms in primary care. Patients were included in the current analysis if they had filled out the Hospital Anxiety and Depression Scale (HADS; n = 130) at baseline and at follow-up (after 3 months). The course of anxiety and depressive symptoms was defined as unfavorable if the improvement in HADS was ?‰¤ 50% at follow-up. Multiple physical symptoms were measured with the PHQ-15, a scale comprising 15 physical symptoms frequently reported in the outpatient setting (total score: 0 - 30).


The results of the adjusted logistic regression analysis indicate that the higher the score on the PHQ-15 at baseline, the less likely a patient was to experience a symptom reduction of at least 50% on the HADS. The likelihood of such an unfavorable course was about twice as high for patients scoring 1 SD above average on the PHQ-15. The adjusted odds ratio (OR) was 2.12 per 4.7 points (one SD) on the PHQ-15. The unadjusted OR, with only the PHQ-15 score as an independent variable, was 1.94 per SD (p = 0.012). Adding the interaction term 'randomization status times PHQ-15 score' to the logistic regression model resulted in no significant improvement (p = 0.823). This implies that the outcome was similar in both treatment groups, although this should be interpreted with caution due to the relatively small sample size. This suggests a generic negative influence of multiple physical symptoms on the effectiveness of treatment for symptoms of depression and anxiety in primary care. It is still unclear whether the physical symptoms were due to medical conditions, or whether they were medically unexplained symptoms. These data did not allow to make such a distinction, but this should be the topic of further research.


Either way, the findings of this study suggest that concomitant physical symptoms in patients with depression and anxiety are associated with a poorer prognosis of symptoms of depression and anxiety. In addition, it might prove worthwhile to pay attention to the role of multiple physical symptoms in the process of tailoring interventions to meet the needs of depressed and anxious patients in primary care. A useful tool might be the Diagnostic Criteria for use in Psychosomatic Research (DCPR) that have recently been evaluated in primary care. The DCPR classify 12 psychosomatic syndromes that may play a mediating role in the course and outcome of psychiatric disorders. An assessment according to these can be made by a general practitioner alone or together with a consultant-liaison psychiatrist who can also assist with the choice of treatment.


Sources: Journal of Psychotherapy and Psychosomatics, AlphaGalileo Foundation.

New Depression Therapy Gives Reason For Hope

A study at the University Clinics of Bonn and Cologne gives people with therapy-resistant depression reason for hope. The doctors treated two men and a woman with what is known as deep brain stimulation. All three patients have been suffering from very severe depression for several years which could neither be brought under control using medication nor by other therapies. During the simulation the condition of two of the three patients improved within a few days. Initial changes were even noticeable in a matter of minutes. The research team warn against exaggerated expectations in view of the small number of patients involved. Nevertheless, the results of the preliminary study are so sensational that they have now been published in the renowned journal Neuropsychopharmacology (doi: 10.1038/ sj.npp.1301408).



In deep brain stimulation (DBS) electrodes are implanted selectively in certain areas of the brain and are stimulated using an electric pulse generator. Up to now the procedure has mainly been used in the treatment of Parkinson's. It is currently being investigated whether it also helps with certain psychiatric diseases such as compulsive behavioural disorders. Initial tests on about two dozen patients worldwide also show that it could possibly also have an effect in the case of severe depression.



Previous tests have concentrated mainly on two areas of the brain in particular. "By contrast we stimulated a third region, the nucleus accumbens," the Bonn Professor of Psychiatry, Thomas E. Schl?¤pfer, explains. The nucleus accumbens is an important part of what is known as the "reward system". It ensures that we remember good experiences and puts us in a state of pleasurable anticipation. Without the reward system we would not make plans for the future, simply because we could not enjoy the fruits of these plans. "Inactivity and inability to enjoy things are two important signs of depression," Profesor Schl?¤pfer emphasises. "The conclusion is therefore obvious that the nucleus accumbens plays a key role in the genesis of the disease."



Initial effects minutes after onset of therapy



In their study the researchers report on two men and a woman who have been suffering from very severe depression for years. The researchers implanted electrodes in the nucleus accumbens, which they were able to stimulate using an electric pulse generator in the chest. Some of the effects were observable instantly. "One of the patients expressed the desire to go to the top of Cologne Cathedral a minute after the start of the stimulation and put this into practice the next day," Thomas Schl?¤pfer says. "The woman treated was similar. She said she would enjoy going bowling again." Nevertheless, the patients did not notice a direct improvement in their mood. Nor could they tell whether the pulse generator was switched on or off.



In the first few days of the DBS the symptoms of depression improved significantly in two of the three patients. Their condition remained constant for as long as they were undergoing treatment. However, as soon as the pulse generator was switched off, the depression recurred with full intensity. "The recurring symptoms were so severe that for ethical reasons we could not permit the treatment to be interrupted for as long as we had originally planned," Professor Schl?¤pfer emphasises.



While psychotropics generally interfere with the biochemistry of the brain, DBS acts locally in the affected areas. The doctors did not observe any side effects like those occurring after the use of antidepressants. The patients only complained about post-operative pain at the site of implantation. In the long term DBS does not seem to pose any major risks. There have been patients with Parkinson"s who have been using this kind of brain pacemaker for more than ten years without experiencing any problems.



Preliminary results



Even so, the research team caution against exaggerated expectations. "Of course, with so few patients, these are only fairly preliminary results," Professor Schl?¤pfer says. "Our follow-up experiments are showing even now that by no means every patient will respond to this therapy." In the case of operations on the brain, in particular, ethical factors also need to be taken into account, not least because such operations are always risky. For that reason, there were particularly stringent conditions attached to the patients" consent. "One thing has certainly been demonstrated by our research and that of others: DBS can help some people with depression even in cases which were assumed to be resistant to therapy."





Contact: Professor Thomas E. Schlaepfer


University of Bonn

Following Student Suicides Schools Often React Poorly, Experts Say

Many school officials react in exactly the wrong ways when one of their students completes suicide, according to the authors of a new book.



While they may be well-intentioned, administrators who don't send the right messages may make copycat suicides more likely, and are not providing the help needed by others hurting from the tragedy.



"Without the proper knowledge and resources, many school administrators may implement strategies that could actually increase the risk of suicide among students," said Darcy Haag Granello, professor of counselor education at Ohio State University.



Granello is co-author of the book Suicide, Self-Injury and Violence in the Schools: Assessment, Prevention and Intervention Strategies. She co-authored the portion of the book dealing with suicide with her husband, Paul Granello, also an associate professor of counselor education at Ohio State.



While school officials may be well-meaning in their response to a suicide, the best way to react is actually counterintuitive to our cultural norms, said Paul Granello.



"We naturally want to have ceremonies and memorials, flowers at the fence and burning candles. But when you do this in the case of a suicide, it sends the wrong message to troubled youth who might also be contemplating suicide," he said.



"They may see this outpouring of grief as a glorification of the person who completed suicide. Some troubled people might think that they want to get all that attention, too. That could cause contagion."



Even the way school officials and others talk about a suicide can send the wrong message.



For example, many well-meaning adults may say that a student killed himself to "end the pain."



"What a dangerous message that is for young people," Darcy Granello said.



"It tells them that suicide is the way to end pain. But suicide is never that simple. There is never a direct line from some bad things happening to someone to a choice to complete suicide."



Instead, adults should talk about how suicide transfers pain from the person who killed him or herself to a whole community who is now in pain, she said.



Schools should avoid holding in-school memorials, or cancelling classes or school. And while education about mental health issues and suicide is important, schools should not do this in large assemblies. All these actions can serve to sensationalize the death.



For the same reason, school officials should minimize discussion of the details of the suicide.



"Students learn from hearing the story of the student death, and copycat suicides can result," Paul Granello said.



"Instead of focusing on the suicide itself, focus on what help if available and how people are responding to the grief. The focus should be on the community response."



But that doesn't mean suicide should not be discussed at all - quite the contrary, Darcy Granello emphasized.
















Schools should provide students with facts about suicide risk and mental health resources. This should be done in small groups, or individually if needed.



Adults shouldn't be afraid to talk about suicide and to directly ask troubled students if they are thinking about suicide, Darcy Granello said.



"There's a lot of research that shows that talking about suicide appropriately actually reduces the risk - it doesn't increase it," she said.



"Young people are already talking about suicide. They are just talking about it with friends and others who don't know any more than they do. We need to find ways to have the conversation with young people."



The main message to students should be that their problems are not unsolvable. In most case, suicides result from undiagnosed or untreated depression.



"About 80 percent of cases of depression are treatable," Paul Granello said. "The tragedy is that we have this epidemic of suicide among young people, when in most cases the cause is depression that could be treated."



Teachers and administrators should be especially alert after a suicide for students who may be taking the death particularly hard.



Studies show that only about one-quarter of young people would tell an adult if they knew of a peer with suicidal thoughts, according to Darcy Granello. That means that, after a suicide, many of the friends of the victim may be feeling guilty that they kept this secret.



"These young people are at a much higher risk of suicide themselves because they knew this secret and didn't do anything," she said.



"Part of the response by schools should be to work with all these friends who kept secrets. And part of the prevention strategy should be helping students recognize that keeping secrets about suicide is not smart."



While dealing with a suicide may seem overwhelming to school officials, there are resources to help them. The key is to have a plan in place before tragedy strikes.



"If you have a suicide at your school today, now is not the time to figure out what to do. That is how mistakes are made and inappropriate actions are taken," Darcy Granello said.



Fortunately for schools, a research-based plan for dealing with suicides is already available for them. It is called the School-based Youth Suicide Prevention Guide, available online through the Florida Mental Health Institute here.



"One of the things we tell schools all the time is that they don't have to invent a suicide prevention plan. It just needs implementation, it doesn't need recreating," Darcy Granello said.


Animal Study Suggests Potential New Treatment For Anxiety Disorders And Depression

New research on a brain chemical involved in development sheds light on why some individuals may be predisposed to anxiety. It also strengthens understanding of cellular processes that may be common to anxiety and depression, and suggests how lifestyle changes may help overcome both.



The animal study, in the May 13 issue of The Journal of Neuroscience, shows an important role for fibroblast growth factor 2 (FGF2), a chemical important in brain development, in anxiety. The findings advance understanding of cellular mechanisms involved in anxiety and illuminate the role of neurogenesis, or cell birth and integration in the adult brain, in this process. Together, these findings may offer new drug targets for the treatment of anxiety and potentially for depression as well.



According to the National Institute of Mental Health, approximately 40 million Americans adults have anxiety disorders, and 14.8 million suffer from major depression. These disorders often co-occur: people with anxiety frequently also have depression, and research suggests that the two disorders may share common causes. Previous human studies led by the senior author, Huda Akil, PhD, at the University of Michigan and her collaborators in the Pritzker Consortium, showed that people with severe depression had low levels of FGF2 and other related chemicals. However, it was unclear whether reductions in FGF2 were the cause or effect of the disease.



This new study, led by Javier Perez, PhD, also at the University of Michigan, examined FGF2 levels in rats selectively bred for high or low anxiety for over 19 generations. Consistent with the human depression studies, the researchers found lower FGF2 levels in rats bred for high anxiety compared to those bred for low anxiety.


The study also suggests that environmental enrichment reduces anxiety by altering FGF2. Other researchers have shown that anxiety behaviors in rats can be modified by making changes to their environment, perhaps akin to lifestyle changes for people. Perez and colleagues found that giving the high-anxiety rats a series of new toys reduced anxiety behaviors and increased their levels of FGF2. Furthermore, they found that FGF2 treatment alone reduced anxiety behaviors in the high-anxiety rats.



"We have discovered that FGF2 has two important new roles: it's a genetic vulnerability factor for anxiety and a mediator for how the environment affects different individuals. This is surprising, as FGF2 and related molecules are known primarily for organizing the brain during development and repairing it after injury," Perez said.



Finally, the findings suggest that part of FGF2's role in reducing anxiety may be due to its ability to increase the survival of new cells in a brain region called the hippocampus. Previous research has suggested that depression decreases the production and incorporation of new brain cells, a process called neurogenesis. Although the researchers found that high-anxiety rats produced the same number of new brain cells as low-anxiety rats, they found decreased survival of new brain cells in high-anxiety rats compared to low-anxiety rats. However, FGF2 treatment and environmental enrichment each restored brain cell survival.



"This discovery may pave the way for new, more specific treatments for anxiety that will not be based on sedation - like currently prescribed drugs - but will instead fight the real cause of the disease," said Pier Vincenzo Piazza, MD, PhD, Director of the Neurocentre Magendie an INSERM/University of Bordeaux institution in France, an expert on the role of neurogenesis in addiction and anxiety who was not involved in the current study.



The research was supported by the National Institute of Mental Health, National Institute on Drug Abuse, Office of Naval Research, and The Pritzker Neuropsychiatric Disorders Research Fund.


STAR*D Study Examines Effect Of Genetic Variation In Treatment Resistant Depression

Researchers are now better able to predict which patients will respond to treatment for depression through the presence of genetic markers, according to results from a major NIH study on treatment resistant depression released at the annual meeting of the American College of Neuropsychopharmacology.



"Medications to treat depression are widely available, but no one treatment works for everyone. Additionally, it can be difficult to predict which patients will experience harmful or unpleasant side effects," said Francis McMahon, MD, Chief of Genetic Basis of Mood & Anxiety Disorders, National Institute of Mental Health. "We are seeking to better understand why this is the case, and, using genetic markers, develop personalized treatments that give patients the best chance at remission."



The research is part of a landmark clinical trial known as Sequenced Treatment Alternatives to Relieve Depression, or STAR*D. The STAR*D is the only large sample of patients who suffer from major depression, and who are treatment resistant with the same drug for a significant period of time.



McMahon examined the effects of polymorphisms (common differences in DNA sequences) of 68 genes on treatment effectiveness and incidence of side effects. Analysis of the data showed that polymorphisms in a gene that regulates serotonin was positively associated with treatment outcome. McMahon concluded that individuals who carried two copies of the polymorphism associated with response were 18% more likely to respond to treatment than those who did not.



Polymorphisms in 2 other genes - a receptor for the brain chemical glutamate and a protein involved in neurogenesis - were also associated with treatment effectiveness. Neurogenesis is a dynamic process in the brain through which neural connections are formed and lost. Patients who carried all 3 response-associated polymorphisms were 40% more likely to respond to treatment than those who carried none of them.



Other investigators have knocked down genes involved with neurogenesis or blocked neurogenesis directly in rodents, which eliminated the animals' ability to respond to anti-depressants. This supports the hypothesis that neurogenesis is involved in the response to antidepressant treatment in humans.



McMahon and colleagues studied over 1900 study participants with major depression who donated a blood sample and received the antidepressant citalopram over a period of at least 6 weeks.



In addition to providing valuable information that may be ultimately useful in a clinical treatment setting, the study is part of a larger movement in depression research.



"This is the beginning of a new generation of studies to help clinicians personalize treatment." noted Dr. Thomas Insel, Director of the National Institute of Mental Health (NIMH). "I predict that genomics will be an important tool for future psychiatrists treating people with depression just as it is being used today by oncologists selecting treatments for breast cancer or lymphoma."



McMahon noted that this success is just the beginning. "Ultimately, our goal is to put together a panel of genetic markers that can guide treatment decisions and help doctors choose an antidepressant that will work best for an individual patient."







ACNP held its Annual Meeting December 3 - 7, 2006, in Hollywood, FL.



ACNP, founded in 1961, is a professional organization of more than 700 leading scientists, including three Nobel Laureates. The mission of ACNP is to further research and education in neuropsychopharmacology and related fields in the following ways: promoting the interaction of a broad range of scientific disciplines of brain and behavior in order to advance the understanding of prevention and treatment of disease of the nervous system including psychiatric, neurological, behavioral and addictive disorders; encouraging scientists to enter research careers in fields related to these disorders and their treatment; and ensuring the dissemination of relevant scientific advances. A non-profit organization, ACNP receives revenues from a variety of sources including membership dues, publication sales, registration fees, and pharmaceutical industry grants.



Contact: Sharon Reis


GYMR

Depression Risk In Rheumatoid Arthritis Patients Increased By Low Socioeconomic Status

A recent study confirmed that low socioeconomic status (SES) is associated with higher risk of depressive symptoms in patients with rheumatoid arthritis (RA). Statistically significant differences in race, public versus tertiary-care hospital, disability and medications were found between depressed and non-depressed patients. Study findings are reported in the February issue of Arthritis Care & Research, a journal published by Wiley-Blackwell on behalf of the American College of Rheumatology (ACR).



Roughly 1.3 million Americans are affected by RA - a chronic autoimmune disease that can cause functional limitations and may lead to physical disability in many patients. Prior studies have shown that depression is common, occurring in 13% to 42% of RA patients and is associated with worse outcomes, including greater risk of heart attack, suicide, and death. In the U.S., socioeconomic position as measured by race, gender, age, income, education and health access has significant impact on overall health.



Mary Margaretten, M.D., from the Arthritis Research Group at the University of California, San Francisco (UCSF) and lead study author explained, "We assessed the extent to which low SES influences the relationship between disability and depression in order to better identify those patients at higher risk for depression." Researchers used data obtained from the UCSF RA cohort in which participants were enrolled from an urban county, public hospital that serves the poor and a referral, tertiary-care medical center. The data included 824 visits for 466 patients, 223 from the public hospital and 243 from the tertiary-care clinic.



Analysis showed that 37% of participants had moderate to severe depression, scoring 10 or higher on the Patient Health Questionnaire (PHQ-9). The mean Health Assessment Questionnaire (HAQ) score was 1.2 and the disease activity score (DAS28) was 4, indicating fairly high levels of functional impairment and disease activity, respectively. Researchers also found significant differences between depressed and non-depressed patients related to race, public versus university hospital, functional limitation and disease modifying anti-rheumatic drug (DMARD) treatment. Differences in depression severity were not impacted by gender, age, disease duration, steroid use and dose, or biologic therapy.



Furthermore, the team found that county hospital patients also had significantly higher depression scores (PHQ-9 of 7.3) than patients at the university medical center (PHQ-9 of 5.7). An interaction existed between socioeconomic status and disability such that the association of functional limitation with depression scores was stronger for patients at the public hospital clinic compared to those at the tertiary-care clinic.



Dr. Margaretten concluded, "For the same level of disability, patients with low SES may be more likely to experience depression. Detection and documentation of the differing effects of disability on depression between patients of different socioeconomic status can help rheumatologists improve health outcomes by initiating appropriate and timely treatment for depression."