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.

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."

Are Older Antidepressants Better For Depression In Parkinson's Disease?

A new study shows that antidepressant drugs which only affect serotonin, often used as first choice treatments, may not be best for depression in people with Parkinson's disease. The new research is published in the December 17, 2008, online issue of Neurology®, the medical journal of the American Academy of Neurology. Depression affects up to 50 percent of people with Parkinson's disease.


The study is the first to compare an older antidepressant that targets two receptors in the brain with a newer generation serotonin only-based drug and placebo. It is also the largest placebo-controlled study for Parkinson's disease depression.


In the study, scientists gave 52 people diagnosed with Parkinson's disease and depression either nortriptyline, a tricyclic antidepressant (TCA), paroxetine CR, a selective serotonin reuptake inhibitor (SSRI) or a placebo pill. Tricyclics affect both norepinephrine and serotonin, two different receptors in the brain. The people were tested for improvement of depression symptoms at two, four and eight weeks after starting treatment.


The study found that the people who took nortriptyline were nearly five times more likely to see improvement in depression symptoms when compared with the people who took paroxetine CR.


"I think that this study shows a number of important things. First, that people with Parkinson's disease can respond to antidepressants. This is important because depression in Parkinson's disease is underrecognized, underappreciated and undertreated. Commonly, the attitude is, of course you're depressed, you have a serious illness. This study shows that patients should have hope that they can be helped," said study author Matthew Menza, MD, a Professor of Psychiatry and Neurology with UMDNJ-Robert Wood Johnson Medical School in Piscataway, NJ. "Second, the study suggests that we may need to use medications that affect both serotonin and norepinephrine, not just serotonin, in the brain to be successful in treating depression related to Parkinson's disease."


Menza also says that in addition to the older antidepressant, nortriptyline, that was tested in the study, there are newer mediations that affect both serotonin and norepinephrinem, and these need to be tested.


Tricyclic antidepressants are one of the older classes of antidepressants and have been used since the 1950s. Tricyclics have an increased risk of overdose and death due to toxic effects on the heart and brain.


"People on a tricyclic antidepressant should have their dosages monitored closely by their doctor," said Menza.


The study was supported by the National Institute for Neurological Disorders and Stroke (NINDS).


The American Academy of Neurology, an association of more than 21,000 neurologists and neuroscience professionals, is dedicated to improving patient care through education and research. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as stroke, Alzheimer's disease, epilepsy, Parkinson's disease, and multiple sclerosis.


For more information about the American Academy of Neurology, visit aan.


American Academy of Neurology (AAN)

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neurology

Depression May Play A Bigger Role In Readjustment Than Previously Thought In Troubled Vets

Depression may be an unrecognized readjustment problem for recently returning veterans of the conflicts in Iraq and Afghanistan, according to a study released today at the American Psychological Association 115th Annual Convention. Researchers working with veterans referred for psychiatric evaluation from a primary care service found that major or minor depression was associated with domestic abuse and other family problems.


The researchers, at the University of Pennsylvania and the Mental Illness, Research Education, and Clinical Center at the Philadelphia VA Medical Center, looked at the family problems of 168 veterans who were referred for behavioral health evaluation and who had served in Iraq or Afghanistan since 2001. More than 40 percent were currently married or cohabiting, some 21 percent were recently separated or divorced and almost 55 percent had at least one child.


Two-thirds of the married/cohabiting veterans reported some type of family readjustment problem or conflict occurring several times a week: 42 percent felt like a guest in their household, 21.8 percent reported their children were not acting warmly or were afraid of them, and 35.7 percent were unsure about their role in regular household responsibilities. Veterans with depression or PTSD were more likely to experience these readjustment problems. The presence of family problems may limit the effectiveness of treatments for depression or PTSD because of the importance of positive family relationships to veterans' recovery. According to the researchers, the results suggest an opportunity to improve treatment for returning veterans by involving family in the veteran's recovery.


In addition, about 56 percent of the patients with current or recently separated partners reported severe conflicts involving "shouting, pushing or shoving," and 35 percent reported that this partner was afraid of them.


The researchers, led by Steven L. Sayers, PhD, of the Philadelphia VA Medical Center, noted that while there has been very little empirical research focused on the family problems of veterans in the first year or two following their return from a major military conflict, family problems among those with partners are common. The rates of problems found in this study were similar to those in longer-term studies of Vietnam veterans diagnosed with PTSD.


"In the current study, however, we did not find that PTSD was associated with overall rates of family problems," the researchers wrote. "In contrast, depression was most consistently related to the presence of both readjustment and domestic abuse problems." Many of the veterans at the Medical Center with PTSD were already in treatment in the Behavioral Health Service and so were not part of this primary care sample referred for evaluation.


The researchers found that specific role-related readjustment problems were related both to depression and PTSD. For example, whereas about 20 percent of the veterans reported that their children were afraid of them or did not act warmly, those with PTSD were at greater risk of this experience (36 percent).


Presentation: "Family Problems Among Recently Returning Military Veterans," Steven L. Sayers, PhD, Victoria Farrow, BA, Jennifer Ross, MS, Christine Beswick, BA, Lauren Sippel, BA, Vince Kane, MSW, David W. Oslin, MD Session 1012 Paper Session: Couples and Spousal Relationships, 8:00 - 8:50 AM, Friday, August 17, Moscone Center, East Mezzanine-South Building, Rooms 232 and 234


The American Psychological Association (APA), in Washington, DC, is the largest scientific and professional organization representing psychology in the United States and is the world's largest association of psychologists. APA's membership includes more than 148,000 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting health, education and human welfare.


American Psychological Association (APA)

750 First St., NE

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Less Than 50 Percent Of Men And Women With Depression See A Doctor For Treatment

Less than half of men and women in Ontario who may be suffering from depression see a doctor to treat their potentially debilitating condition, according to a new women's health study by researchers at St. Michael's Hospital and the Institute for Clinical Evaluative Sciences (ICES). What's more, many hospitalized for severe depression fail to see a doctor for follow-up care within 30 days of being discharged, and many head to hospital emergency departments for care. The findings suggest the need for a comprehensive care model involving a multidisciplinary team of health-care professionals, including family doctors and mental health specialists, to help women and men and better manage depression and improve their quality of life.



"As a leading cause of disease-related disability among women and men, depression puts a tremendous emotional and financial burden on people, their families and our health-care system," says Dr. Arlene Bierman, a physician at St. Michael's Hospital and principal investigator of the study Project for an Ontario Women's Health Evidence-Based Report (POWER). "Many Ontarians with depression are not treated for their condition and those who are often receive less than desired care. While there is a lot that is known about how to improve depression, we need to apply this to our work with patients if we want to improve the diagnosis and management of depression. "This involves better co-ordination among primary care and mental health-care professionals in both community and hospital settings," added Dr. Bierman, a researcher at ICES.



Nearly half a million Ontarians, aged 15 and older, suffer from depression. Worldwide, an estimated 154 million people are afflicted by the condition, which is responsible for lost productivity, increased disability claims and greater use of health-care services.



Key findings of the POWER study released today include:
Less than 50% of men and women with depression visited a doctor for care for their condition


33% of men and women discharged from hospital for severe depression did not see a doctor for a follow-up visit within 30 days


17% visited a hospital emergency room within 30 days of discharge from hospital while about 8% were readmitted to hospital


Many older adults started on antidepressant medication did not receive the recommended number of follow-up visits to manage their condition.


The lack of co-ordinated care for patients suggests the need for a collaborative care-model involving a team of health-care professionals, including mental health professionals and primary care providers.

"Research shows that patients cared for using a collaborative model are more likely to see improvement in symptoms, are able to better manage their depression and avoid multiple visits for emergency care," said Dr. Elizabeth Lin, lead author of the chapter and a research scientist at the Centre for Addiction and Mental Health (CAMH). A study by CAMH released earlier this year also found collaborative care to be a less costly and more effective way of providing mental health treatments for people on short-term disability leave for a psychiatric disorder.
















The study titled POWER (the Project for an Ontario Women's Health Evidence-Based Report), is funded by Echo: Improving Women's Health in Ontario, an agency of the Ontario Ministry of Health and Long-Term Care. It is the first study in the province to provide a comprehensive overview of women's health in relation to gender, income, education, ethnicity and geography. The findings are detailed in the report titled Depression - the third to be released this year as part of the study. Findings can be used by policymakers and health-care providers to improve access, quality and outcomes of care for Ontario women.



"The findings clearly support the need to re-evaluate the treatment of depression in Ontario," says Pat Campbell, CEO, Echo: Improving Women's Health in Ontario. "We need to provide better access and delivery of more appropriate and effective courses of care. The POWER Study makes a strong case for the adoption of collaborative care models - a key finding that can help inform system planning, program planning and policy development."



For more information on the POWER Study and its partners visit powerstudy.ca. Other findings from the study will be released later this year.



Dr. Arlene Bierman is a researcher in the Keenan Research Centre at the Li Ka Shing Knowledge Institute of St. Michael's Hospital, a scientist at ICES and Echo's Ontario Women's Health Council Chair in Women's Health at St. Michael's Hospital and the University of Toronto (Lawrence S. Bloomberg Faculty of Nursing).

Study Improves Recovery For Mothers With Depression, University Of Liverpool, England

Scientists at the University of Liverpool have developed a therapy programme to treat depression in women in developing countries. Although depression is a major health problem world-wide, experts say its impact is greatest in developing countries where 80% of the population live. Often there are no resources available to treat sufferers.


Professor Atif Rahman from the School of Population, Community and Behavioural Sciences developed a therapy programme while working as a Wellcome Trust Career Fellow in Tropical Medicine in Rawalpindi, Pakistan.


"Depression is one of the leading causes of mental illness in the world and when the condition affects mothers with newborn babies, it can lead to serious consequences" he says. "The impacts include low birth-weight, poor growth, frequent diarrhoea and the mother failing to ensure the child is properly immunised. These conditions tend to remain untreated in countries like Pakistan where only a fraction of the Government's budget is spent on health.


The programme, which is designed to be integrated into the routine work of ordinary village-based health workers, has been tested in Rawalpindi. Community health workers visiting expectant mothers are trained to use principles of cognitive behaviour therapy as treatment. Patients attend sessions every week in the last month of pregnancy, followed by three sessions in the first post-natal month, and nine monthly sessions thereafter.


The largest trial of the treatment of depression using community health workers from any country in the developing world involved 903 mothers - 463 of whom were in the therapy group. The mothers from this control group were twice as likely to be depressed as those given the therapy after six and 12 months.


The research is published in the Lancet.



The University of Liverpool is a member of the Russell Group of leading research-intensive institutions in the UK. It attracts collaborative and contract research commissions from a wide range of national and international organisations valued at more than ??108 million annually.


Source

Charlotte Roberts

Press Officer

University of Liverpool

Benefits Outweigh Risks Of Antidepressants For Children, Teens

A review of previous studies indicates that the benefits of antidepressants for children and teens with depression or anxiety disorders may outweigh their risks, and that the increased risk for suicidal thoughts and attempts from using these medications is not statistically significant, according to an article in JAMA.



Previous research has indicated that the usage of antidepressants among children and adolescents is associated with an increased risk for suicidal behavior and thoughts, and resulted in the issuing of mandated label warnings on pediatric antidepressant medications by the FDA, according to background information in the article.



Jeffrey A. Bridge, Ph.D., of The Ohio State University, Columbus, and colleagues conducted a review and meta-analysis of randomized controlled trials involving the pediatric usage of antidepressants for major depressive disorder (MDD), obsessive-compulsive disorder (OCD), and non-OCD anxiety disorders, and included recent trials that had not been incorporated into previous analyses, to assess their benefits and effect on risk of suicidal thoughts and attempts. The researchers conducted a search for studies through 2006 and identified and included 27 pediatric trials for their analysis: MDD (n = 15), OCD (n = 6), and non-OCD anxiety disorders (n = 6).



The researchers found: "Consistent with the analyses of the FDA, we found evidence of an overall small but increased risk of treatment-emergent suicidal ideation/suicide attempt. However, the pooled random-effects risk differences of suicidal ideation/suicide attempt for each indication were all less than 1 percent. There were no completed suicides in these trials."



"This meta-analysis of all available randomized clinical trials of antidepressant treatment of pediatric MDD, OCD, and non-OCD anxiety disorders shows evidence of efficacy for all three indications, although the effects were strongest for non-OCD anxiety disorders, intermediate for OCD, and more modest in MDD," the authors write. Adolescents appeared to respond better than children to antidepressants in trials of both depression and anxiety.



"Some may argue that any risk of suicidal ideation/suicide attempt cannot possibly justify treatment with antidepressants for children and adolescents. Instead, we believe that the strength of evidence presented here supports the cautious and well-monitored use of antidepressant medications as one of the first-line treatment options, with the recognition that efficacy appears greatest for non-OCD anxiety disorders, intermediate for OCD, and more modest for MDD. Since the choice of treatment should be the result of a collaborative discussion between clinician, family, and patient, the information presented in this report should allow for an informed evaluation of the potential benefits and risks of these medications vs. no treatment and provide a framework for their comparison with nondrug treatments as well," the researchers conclude.






(JAMA. 2007;297:1683-1696.)


Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.



Contact: Jocelyn Uhl Duffy

JAMA and Archives Journals

Gay Byrne Calls On Older Irish People To Look After Their Mental Health

Broadcaster Gay Byrne launched a new campaign to raise awareness of depression and the importance of mental health in later life. The campaign, by Lundbeck (Ireland) Ltd and supported by Age and Opportunity, is targeting older people who may be reluctant to talk to their doctors about their mental health. Many factors can trigger a period of depression. Research undertaken earlier this year shows that 79% of older people feel that losing friends and close relations to illness would definitely or probably lead to depression.1


"Depression can affect people at any age, young or old," said Professor Brian Lawlor, Consultant in OId Age Psychiatry, Trinity College Dublin and St James' Hospital. "While some people may view it as an inevitable part of aging, this is certainly not the case. It is important that older people should discuss their mental health and emotional wellbeing with their GP and not feel embarrassed about it. Sometimes we see older people being very stoical and not wanting to admit a weakness but mental health is as important as physical health and must be maintained."


Over one third of older people (37%) feel that it is a struggle to keep depression at bay. Interestingly, the average view of older men is considerably more positive than that of women, with older women admitting to greater age-related mental health challenges.


Getting older inevitably means a change in roles and lifestyle such as children leaving home, retirement, the development of physical health problems, experiencing bereavements or moving to a nursing home. These stressful life events can trigger feelings of loneliness and isolation and can lead to depression. Mobility can become limited which results in a loss of independence, possibly resulting in a spouse or child becoming the carer. This forced change of role in life can lead to an individual feeling depressed.


Mr Gay Byrne, broadcaster, said, "I am delighted to be supporting this wonderful initiative. While we are lucky to live in such a youthful and vibrant country it is important to remember that older people can be overlooked and ignored in society. This can lead to feelings of isolation. I would urge all those over 60 to be proactive about their mental health."


Ms Catherine Rose, CEO of Age and Opportunity said, "Our goal at Age & Opportunity is to create opportunities for people to continue to participate in all aspects of life as they age. We work in a range of areas forging links with local development organisations, arts, sports and education providers so as to create conditions where people can make choices and shape their own lives. Our programmes include, for example, the Bealtaine Festival, which celebrates creativity in older age, and which has been found to improve quality of life of participants and to enhance social connectedness. We endorse the Mind Yourself Depression in Later Life campaign and hope that it will encourage older people, as well as their families, to take a proactive approach to their mental health."


Symptoms of depression may include feeling depressed or low in mood most of the time, a loss of interest or enjoyment in life, feeling anxious, agitated or irritable, feeling guilty, changes to sleeping patterns, change in appetite, feeling tired a lot of the time or low energy levels. If you are experiencing any of the above symptoms and/or are having any thoughts of suicide or death, talk to a healthcare professional or with groups such as AWARE on low call 1890 303 302.


Lundbeck has produced an information booklet, 'Mind Yourself - Depression in Later Life", to help older people who may have depression.


References


1. Behaviour and Attitudes research, April 2010


This study is based on data from a survey of the adult population, undertaken by Behaviour & Attitudes for Lundbeck. Fieldwork was completed in April 2010 among a nationally representative, quota controlled sample of 1001 adults aged 16+. The sample mirrors the national population structure, based on the census of population, in terms of sex, age region and area of residence, and matches industry-agreed standards in respect of social class. Interviewing was undertaken face to face in-home, and interviewers were closely supervised and monitored. Survey design, fieldwork and analysis conform with the strict quality standards dictated by Behaviour & Attitudes membership of ESOMAR (European Code) and the Market Research Society (UK).

Shawn Colvin Goes Beyond the Music To Speak Out About Depression

Singer/Songwriter, Shawn Colvin Helping Launch National Education Campaign (USA) to Raise Awareness of Major Depressive Disorder and Importance of Seeking Medical Help


For three-time Grammy award-winner singer/songwriter Shawn Colvin, "the blues" is more than just a musical genre. Colvin, who has battled major depressive disorder for much of her life, is sharing her experience with others through a national education campaign, Beyond the Music: Shawn Colvin Speaks Out About Depression, sponsored by GlaxoSmithKline. The campaign is designed to raise awareness of the symptoms of depression and to motivate those who may be suffering from depressive symptoms to seek medical help.


Colvin has suffered from major depressive disorder on and off for more than 20 years. "During the worst times, I shut the world out, refusing to get out of bed. Even the smallest tasks were overwhelming," she said.


The symptoms of a major depressive episode may include: constant feelings of sadness, irritability, or tension; decreased interest or pleasure in usual activities or hobbies; loss of energy, feeling tired despite lack of activity; a change in appetite, with significant weight loss or weight gain; a change in sleeping patterns, such as difficulty sleeping, early morning awakening, or sleeping too much; restlessness or feeling slowed down; decreased ability to make decisions or concentrate; feelings of worthlessness, hopelessness or guilt; thought of suicide or death.


With the help of her doctor, Colvin says she learned that major depressive disorder, commonly referred to as depression, is a medical illness and not a personal failure that she should be able to fix on her own. "Since seeking help and getting appropriate treatment for my depression, I have felt more engaged with and closer to family and friends, and have been able to fully capture my creativity."


While touring the country this summer, Colvin, who is best known for her #1 hit "Sunny Came Home," will be talking about her battle with major depressive disorder in an effort to raise awareness about the disease and to motivate others to talk to their doctor if they are experiencing symptoms of depression. More information is available at [insert URL]. "Depression can be paralyzing, making you feel hopeless and helpless. But just taking the first step- deciding to seek help from a doctor-can make all the difference," emphasized Colvin.


Major depressive disorder is believed to be related to physical changes in the brain and connected to an imbalance of brain chemicals, called neurotransmitters, that transmit signals in the brain.


Approximately 14 million adults in the U.S. suffer from major depressive disorder in a given a year.


"The good news is that major depressive disorder is very treatable - approximately 80 percent of people can be effectively treated," said Dr. Norman Sussman, Professor of Psychiatry, New York University School of Medicine. "People who think they may be experiencing symptoms of major depressive disorder should talk with their physician and together determine the appropriate therapy.















Treatment options may include counseling and/or antidepressant medications."


"Over the years, my doctor prescribed different antidepressants. I started taking Wellbutrin® tablets (bupropion hydrochloride) nine years ago and it has effectively treated my depression and I have fewer sexual side effects," said Colvin. "And now I'm taking Wellbutrin XLTM , which I only have to take once a day."


"Because medications can only help if you take them consistently as your doctor prescribes, it is important for people to talk to their doctor about concerns they may have about potential side effects, or about their preferences, such as dosing schedules, in order to find a treatment that is right for them," said Dr. Sussman. "For instance, once-daily Wellbutrin XLTM may offer greater convenience than medications requiring multiple daily doses."


IMPORTANT SAFETY INFORMATION


Wellbutrin XLTM is indicated for the treatment of major depressive disorder in adults aged 18 and older.


People taking Wellbutrin XLTM may be at risk for seizure, which is increased in people with certain medical problems or in people taking certain medicines. People who have had a seizure or eating disorder, should not take Wellbutrin XLTM.. People should not use Wellbutrin XLTM if they take a monoamine oxidase inhibitor (MAOI), or any medicine that contains bupropion such as Wellbutrin SR® or Zyban®. People should not take Wellbutrin XLTM if they are are abruptly stopping the use of alcohol or sedatives, as the risk of seizure may increase. When used with a nicotine patch or alone, there is a risk of increased blood pressure, sometimes severe. To reduce the risk of serious side effects, people should tell their doctor if they have liver or kidney problems.


Other side effects may include weight loss, dry mouth, nausea, difficulty sleeping, dizziness, and sore throat.


Whether or not a person is taking antidepressants, they or their family should call a doctor right away if they have worsening depression, thoughts of suicide, or sudden or severe changes in mood or behavior, especially at the beginning of treatment or after a change in dose. (See Patient Information:


What is important information I should know and share with my family about taking antidepressants, available at wellbutrin-xl.)


ABOUT GLAXOSMITHKLINE


GlaxoSmithKline, one of the world's leading research-based pharmaceutical and healthcare companies, is committed to improving the quality of human life by enabling people to do more, feel better and live longer. GlaxoSmithKline has U.S. operations in Philadelphia and Research Triangle Park, N.C.


Please consult full prescribing information available at wellbutrin-xl or by contacting Robin


Gaitens at GlaxoSmithKline at 919-483-2839.


References


1. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC,


American Psychiatric Association, 2000.


2. Kessler RC, Berglund P, Demler O, et al. The Epidemiology of Major Depressive Disorder. JAMA. 2003;289:3095-3105.


Robin Gaitens Contact: TBD

GlaxoSmithKline Ogilvy PR Worldwide

(919) 483-2839 (212) 880-XXXX

GSK Investigation Concludes

The MHRA has concluded its four year investigation into Glaxosmithkline and its antidepressant drug Seroxat. The investigation focused on whether GSK had failed to inform the MHRA of information it had on the safety of Seroxat in under 18's in a timely manner. The investigation was undertaken with a view to a potential criminal prosecution for breach of drug safety legislation. It was the largest investigation of its kind in the UK, and included the scrutiny of over 1 million pages of evidence.


The decision taken by Government Prosecutors, based on the investigation findings and legal advice, is that there is no realistic prospect of a conviction in this case, and that the case should not proceed to criminal prosecution. The legislation in force at the time was not sufficiently strong or comprehensive as to require companies to inform the regulator of safety information when the drug was being used for, or tested outside its licensed indications.


GSK provided the MHRA with data from clinical trials in May 2003, confirming that patients under 18 had a higher risk of suicidal behaviour if they were treated with Seroxat than if they received a placebo; and that Seroxat was ineffective in treating depressive illness in under 18's. Acting upon this information the MHRA immediately reviewed the data and published advice to all doctors that Seroxat should not be used in under 18's. The investigation arose from concern that GSK had held the information for some time before this and failed to disclose it.


Professor Kent Woods, MHRA Chief Executive, said: "I remain concerned that GSK could and should have reported this information earlier than they did. All companies have a responsibility to patients, and should report any adverse data signals to us as soon as they discover them. This investigation has revealed important weaknesses in the drug safety legislation in force at the time. Subsequent legislation has partially addressed the problem, but we will take immediate steps to ensure the law is strengthened further, so that there can be no doubt as to companies' obligations to report safety issues."


See website to download full report and related documents.

mhra.uk

Depression Predicts Increases In Inflammatory Protein Linked To Heart Disease

Which comes first, depression or inflammation?



To help solve this long standing chicken and egg conundrum, researchers led by Jesse Stewart, Ph.D., assistant professor of psychology at Indiana University-Purdue University Indianapolis asked two critical questions. Does depression lead to elevated inflammatory proteins in the human body? Or does an increase in these proteins lead to depression? They found that the answer to the first question appears to be "yes," and the answer to the second question may be "no" among healthy adults.



The researchers report that depressive symptoms are associated with increases over time in interleukin-6, an inflammatory protein that predicts cardiovascular events. In contrast, levels of interleukin-6 were not related to later increases in depressive symptoms.



The new study, published in the October 2009 issue of the journal Brain, Behavior and Immunity, is the first to examine both directions of the depression-inflammation connection and to measure the physical symptoms of depression, such as fatigue and sleep disturbance, in addition to the cognitive-emotional symptoms, such as pessimism and sadness.



Several previous studies have linked depression to increased inflammatory protein levels measured at the same time. These studies, however, cannot speak to which is the cause and which is the effect. "There is two-way communication between the brain and the immune system, so we had to determine whether activation of the body's immune system sent a signal to the brain to affect mood and behavior or whether the depression activated the immune system," said Dr. Stewart, a clinical health psychologist in IUPUI's School of Science and an IU Center for Aging Research affiliated scientist.



Participants in the study were 263 healthy men and women aged 50-70 years at the start of the study. They were tested at baseline and again six years later to determine their levels of depressive symptoms and interleukin-6. Levels of C-reactive protein, another inflammatory protein, were also measured but were not related to depression.



The strength of the association of depression with future heart disease is similar to that of traditional risk factors like smoking, high blood pressure and elevated cholesterol, according to Dr. Stewart.



"Promotion of inflammation may be one pathway through which depression may 'get under the skin' to negatively influence cardiovascular health. The link to cardiovascular disease demonstrates that there may be physical as well as mental health reasons to treat depression," said Dr. Stewart.



Co-authors of "A Prospective Evaluation of the Directionality of the Depression-Inflammation Relationship" are Kevin Rand, Ph.D., of the Department of Psychology in the School of Science at IUPUI; Matthew Muldoon, M.D., M.P.H., and Thomas Kamarck, Ph.D., of the University of Pittsburgh.



This study was funded by the National Heart, Lung, and Blood Institute.

Maternal depression can seriously affect a child's development

OTTAWA - One in ten women who are pregnant will experience depression and approximately 13 per cent of new mothers
experience postpartum depression.


Maternal depression can have serious and lasting consequences on a child's development. That is why the Canadian Paediatric
Society's Psychosocial Committee has released a new statement that explores the issue of maternal depression and its affect
on child development. The statement reviews the role of the child's physician in the detection of symptoms of maternal
depression, and in the coordination of appropriate support and management.


"The role of the paediatrician or the physician caring for the infant is to make sure that he or she is thriving in an
adequate, nurturing environment," says Dr. Anne-Claude Bernard-Bonnin, the author of the statement Maternal depression and
child development. "Early recognition of depression is important because a depressed mother will not be in the best position
to understand the cues or signals of her baby. Their interaction will be hampered by the fact that she will not be able to
respond to her child's needs appropriately. Because the physician who takes care of infant also sees the new mother
regularly, he or she might be able to pick up a problem and take action."


The consequences of maternal postpartum depression are not restricted to infancy, but can also extend into toddlerhood,
preschool age, and even school age children. Children of depressed mothers are at risk for developmental and behavioural
problems and may be predisposed for developing depressive disorders themselves.


"Maternal depression can affect children through childhood and adolescence in various degrees," says Dr. Bernard-Bonnin. "A
child not only needs good nutrition and care but also a needs nurturing mother. It is important that the physician be
thinking of this issue."


The statement reviews treatment options and their affect on the infant during pregnancy and breast-feeding. Among the
statement's recommendations:


-- As long-term studies have not shown adverse affects, mothers who have taken anti-depressant medication during pregnancy
should be reassured about the neuro-development of their child.


-- Mothers who have taken anti-depressant medication during lactation should be reassured that much of the evidence to date
shows that there are no neurological or developmental abnormalities in children exposed through breast-milk to such
medication.


The Canadian Paediatric Society is a national professional association, representing more than 2,200 paediatricians, that
advocates for the health needs of children and youth. Its peer-review journal, Paediatrics & Child Health, is published 10
times a year and circulated to 15,500 child health care professionals. For more information about depression in pregnant
women and mothers and how children are affected visit cps.ca & caringforkids.cps.ca.



Media inquiries:

Christine LaRocque

(613) 526-9397, ext. 234

mediacps.ca
Canadian Paediatric Society

Biological Link Established Between Tumors And Depression

In a study that could help explain the connections between depression and cancer, researchers at the University of Chicago have used an animal model to find, for the first time, a biological link between tumors and negative mood changes.



The team determined that substances associated with depression are produced in increased quantities by tumors and are transmitted to the brain.



Additionally, pathways that normally moderate the impact of depression-causing substances are disrupted when a tumor develops.



The research further showed that tumors induce changes in gene expression in the hippocampus, the portion of the brain that regulates emotion. Although researchers have long known that depression is a common outcome for people diagnosed with cancer, they had not known if it was brought on by a patient learning of the diagnosis or the result of treatments such as chemotherapy. Now a third source may have been identified.



"Our research shows that two types of tumor-induced molecules, one secreted by the immune system and another by the stress axis, may be responsible," said Leah Pyter, a postdoctoral fellow and lead author of a paper, "Peripheral Tumors Induce Depressive-like Behaviors and Cytokine Production and Alter Hypothalamic-Pituitary-Andrenal Axis Regulation," which is published in the current issue of the Proceedings of the National Academy of Sciences.



"Both of these substances have been implicated in depression, but neither has been examined over time frames and magnitudes that are characteristic of chronic diseases such as cancer," she said.



For their research, the team conducted a series of tests on about 100 rats, some of whom had cancer to determine their behavioral responses in tests of emotional state.



"Rats are commonly used to test drugs that are being studied for potential human benefits, such as treating depression," said Brian Prendergast, Associate Professor of Psychology at the University of Chicago, and the senior author on the study. "In this case, examining behavioral responses to tumors in non-human animals is particularly useful because the rats have no awareness of the disease, and thus their behavioral changes were likely the result of purely biological factors."



The team used tests commonly used in testing anti-depressants on rats and found that the rats with tumors became less motivated to escape when submitted to a swimming test, a condition that is similar to depression in humans. The rats with tumors also were less eager to drink sugar water, a substance that usually attracts the appetites of healthy rats.



Further tests revealed that the rats with tumors had increased levels of cytokines in their blood and in the hippocampus when compared with healthy rats. Cytokines are produced by the immune system, and an increase in cytokines has been linked to depression.



The team also found that stress hormone production also was altered in rats with tumors. The rats with tumors also had dampened production of the stress hormone corticosterone. The hormone helps regulate the impact of cytokines and reducing its production therefore increases the impact of cytokines.



The project was supported by an American Cancer Society fellowship, an NIH grant and a grant from the Brian Research Foundation.

Mental Health Of Americans Still Greatly Affected By Sept. 11 Terrorism

Long after Sept. 11, 2001, Americans' terrorism-related thoughts and fears are associated with increased depression, anxiety, hostility, posttraumatic stress and drinking, University of Illinois at Chicago researchers have found.



UIC researchers examined the extent to which the strength of people's post-Sept. 11 beliefs and fears, as assessed in 2003, predicted a range of psychological distress and alcohol abuse in 2005. Data were derived from a mail survey, which began before Sept. 11 and continued in 2005.



The study, led by Judith Richman, professor of epidemiology in psychiatry, is published in the February issue of the Journal of the American Public Health Association.



Richman and her colleagues measured the effect of larger, macro-level sociological stressors -- rather than personal or micro-level events, such as a death in the family or financial difficulties -- on mental health.



The terrorist events of Sept. 11 signaled a significant change in the socio-political outlook of many Americans and in their feelings of safety and well-being.



Richman and others have shown that the events of Sept. 11 have been associated with feelings of distress and anxiety, and these feelings have led to problematic drinking. However, previous research focused on distress at the time of the traumatic event, and predictions about future negative behaviors were hard to assess.



In the new study, 30 percent of participants reported feeling very or extremely more pessimistic about world peace, and 27.6 percent reported they had less faith in the government's ability to protect them.



"Our research showed that, four years after 9/11, terrorism fears and beliefs predicted distress and escape motives for drinking similarly in both men and women, with only men showing an increase in deleterious drinking levels," Richman said. She also indicated that macro socio-political events such as acts of terrorism and large-scale disasters and their effects on distress levels should be considered in future research.







The study was funded by a grant from the National Institute on Alcohol Abuse and Alcoholism.



UIC ranks among the nation's top 50 universities in federal research funding and is Chicago's largest university with 25,000 students, 12,000 faculty and staff, 15 colleges and the state's major public medical center. A hallmark of the campus is the Great Cities Commitment, through which UIC faculty, students and staff engage with community, corporate, foundation and government partners in hundreds of programs to improve the quality of life in metropolitan areas around the world.

Studies Look At Medicaid Proof-of-Citizenship Requirements, Depression Treatment Among Black Coronary Heart Disease Patients

"Ethnic Differences in the Treatment of Depression in Patients With Ischemic Heart Disease," American Heart Journal: The study examines the differences in depressive symptoms and antidepressant treatment among blacks and whites undergoing a coronary angiography to diagnose heart disease. Blacks have an increased risk of mortality from coronary heart disease and traditional risk factors do not fully account for the disparity. For the study, Duke University Medical Center researchers assessed the depressive symptoms of 727 whites and 137 blacks undergoing the diagnostic procedure. Researchers also looked at data describing cardiovascular risk factors and the type of medications being used by the patients, including antidepressants. There was no significant difference in the severity of depressive symptoms between blacks and whites, but researchers found that the rate for antidepressant use among whites was 21%, compared with 11.7% for blacks. The study concludes that the ethnic differences in the management of depression "suggests that more careful assessment of depression, especially in African-Americans, is necessary to optimize care of patients with" coronary heart disease (Waldman et al., American Heart Journal, October 2008).

"Assessing the Effects of Medicaid Documentation Requirements on Health Centers and Their Patients: Results of a 'Second Wave' Survey," George Washington University School of Public Health and Health Services' Geiger Gibson/RCHN Community Health Foundation Research Collaborative: The study is the second in a two-part study that examines the effects of Medicaid citizenship documentation requirements. Researchers find that 75% of community health centers continue to experience significant problems with the requirements for one or more eligible patient groups because of the requirements and nearly one-half of health centers continue to report Medicaid application and enrollment delays and disruptions. The report also found that changes implemented to address these issues have done little to alleviate the problems (George Washington University Medical Center release, 10/21).


Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation.

© 2008 Advisory Board Company and Kaiser Family Foundation.?  All rights reserved.

New Guidance On Diabetes And Depression

The National Institute for Health and Clinical Excellence (NICE) has published guidance on the treatment and management of depression in adults with chronic physical health problems, including diabetes, heart disease and cancer.


Serious health concerns can have a big impact on an individual's psychological wellbeing, with depression being approximately two to three times more common in people with a chronic physical health problem than in people who have good physical health.


About the guidelines


This guidelines make recommendations on the identification, treatment and management of depression in adults aged 18 years and older who also have a chronic physical health problem or a musculoskeletal, respiratory or neurological disorder.


Diabetes UK's response


"Depression is twice as common in people with diabetes," said Stella Valerkou, Senior Policy Officer at Diabetes UK.


"It can have a significant impact on an individual's wellbeing and their ability to self-manage their diabetes, putting them at risk of developing the serious complications of the condition.


"Evidence has shown the treatment of psychological conditions can lead to improvement in health outcomes, as well as reducing psychological distress. As such, Diabetes UK welcomes the development of guidelines to support the management of depression in people living with long-term conditions such as diabetes.


"However, we are disappointed further options for psychological therapies were not recommended in the guideline as this will limit an individual's choice in this area."

Source
Diabetes UK

Likely Cause Of Postpartum Blues And Depression Identified

Unique biochemical crosstalk that enables a fetus to get nutrition and oxygen from its mother's blood just may cause common postpartum blues, researchers say.


That crosstalk allows the mother's blood to flow out of the uterine artery and get just a single cell layer away from the fetus' blood, says Dr. Puttur D. Prasad, biochemist in the Medical College of Georgia School of Medicine.


That controlled exchange between the blood of mother and fetus is courtesy of the placenta regulating levels of serotonin, a neurotransmitter commonly associated with depression. But platelets that enable blood clotting also secrete serotonin which prompts platelets to aggregate and the placenta to want to get rid of it.


"If there were no proper control here, blood leaving the mother's blood vessel would trigger release of serotonin, platelets would aggregate, vessels constrict and the fetus wouldn't get what it needs," says Dr. Prasad. An MCG research team led by Dr. Vadivel Ganapathy first reported evidence of serotonin transporter gene expression in the placenta back in 1989 in the Journal of Biological Chemistry. Now they know the gene plays an important role in the crosstalk that forestalls clotting until after birth.


When the fetus and placenta are gone, blood continues flowing from the mother's uterine artery until platelets move in to stop it, Dr. Prasad explains. Serotonin levels begin to rise and interact with receptors on the smooth muscle of the uterus. This stimulates production of interleukin-1 beta which the MCG researchers found regulates expression of serotonin-hoarding transporters. Interleukin-1 beta gets in the mother's bloodstream, crosses the blood brain barrier and creates more serotonin transporters on the neurons when they are not needed.


Until interleukin-1 beta levels normalize, there's too little communication between serotonergic neurons and moms get the blues, says Dr. Prassad. "We believe that 80 percent of women experience postpartum blues because of this effect of interleukin-1 beta. If our hypothesis holds true, lowering interleukin-1 beta levels may be a better treatment option." He notes that while serotonin reuptake inhibitors, commonly used for depression, work well in these women, transferring the drug to the baby during nursing can be problematic.


But there's more. In more serious postpartum depression, polymorphisms or variations of the serotonin transporter gene - which already have been linked to non-pregnancy related depression - appear to make bad matters worse because they are even better at taking up serotonin, he says.


Dr. Prasad, in collaboration with Dr. Sandra Pittman, director of MCGHealth's Healthy Start program, already put the laboratory findings into practice in a small study of 50 women enrolled in the federally funded program for women with high-risk pregnancies in the rural Georgia counties of Burke and McDuffie. The program was a perfect fit for the research. Healthy Start identifies women as early in pregnancy as possible who are at risk because of medical, psychosocial and/or environmental problems, Dr. Pittman says.















"We enroll women who are without housing, who are living from place to place. We often see women who are medically high risk in combination with social and environmental challenges," she says. They complete depression screenings before and after birth and refer for mental health counseling as part of their efforts to help women deal with difficult pregnancies and possibly fragile infants. Depression can make life harder for the mother and impede bonding with a new baby, Dr. Pittman says. Over the last year, when they also looked at the blood of some of these women, they found transiently elevated levels of interleukin-1 beta.


Dr. Prasad recently received a $900,000, three-year grant from the U.S. Department of Health and Human Services' Health Resources and Services Administration that enables the MCG researchers to follow 300 more women to see if their blood also bears out his hypotheses. They'll look at interleukin-1 beta levels before delivery and at certain intervals afterward to see if they increase after delivery, then level off as Dr. Prasad suspects. They'll also analyze DNA to see if women identified with more serious postpartum depression have some of the same variations of the serotonin transporter gene already identified with non-pregnancy related depression.


Many studies have looked at these genetic variations in non-pregnancy-related depression but not in postpartum depression, Dr. Prasad says.


They expect their studies will advance the understanding of the biochemical basis of postpartum blues and depression and point toward ways to better identify and treat it.


Up to 80 percent of women experience at least a few weeks of postpartum blues, 10-15 percent have more serious depression that may last a month or more and 1-5 percent experience severe psychosis that can last up to a year, Dr. Prasad says.


Rapidly changing hormone levels have been blamed for postpartum blues and depression, although hormone therapy doesn't seem to help. "We are thinking that one of the things that is missing immediately following delivery is the placenta, and that this initiates a cascade of events leading to postpartum blues/depression."


Medical College of Georgia

Stereotypes Contribute To Older Men Seeking, Receiving Depression Care Less Frequently

A man's 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 depression's 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.' They'll 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."


The second author on the study was Mark Zweifach, a psychiatrist from Kaiser Permanente, Southern California. Other collaborators on the study were Sabine Oishi and Lingqui Tang, both from UCLA; and Jurgen Unutzer, from the University of Washington. The study was funded by the John A. Hartford Foundation and the National Institute on Aging.


The American Journal of Geriatric Psychiatry, published monthly, is the official journal of the American Association for Geriatric Psychiatry and can be found online at AJGPonline.


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Treating Depression Can Help Heart Rate Variability Recovery After Heart Attack And Other Coronary Syndromes

A patient with depression may find it harder to recover his/her heart rate variability after a heart attack, increasing his/her chances of coronary death. Patients who are successfully treated for depression tend to experience improvement in heart rate variability after acute coronary syndromes, compared to depressed patient's who aren't (treated for depression), says an article in Archives of General Psychiatry (JAMA/Archives), September issue.


The degree to which your heart rate changes from beat to beat in response to normal impulses is known as your heart rate variability.


The authors wrote "Low heart rate variability predicts death after myocardial infarction (heart attack). It is reduced in depressed compared with non-depressed patients after myocardial infarction and has been proposed to be a mediator of the increased mortality associated with depression." Patients without depression who have an acute coronary episode experience a fall in heart rate variability - this recovers substantially in the months after an episode (not completely).


Alexander H. Glassman, M.D., of the Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, New York, and team looked at 290 patients with depression three weeks after they had been hospitalized for acute coronary syndrome - their heart rate variability was measured. They were then randomly selected to either receive sertraline, which is an antidepressant, or just a placebo, for a period of 24 weeks. At 16 weeks they all had their heart rate variability measured again. The scientists also rated each patient's depression (for severity) and their clinical response to treatment.


The researchers had found that previous episodes of depression were clearly linked to lower heart rate variability at the beginning of the study. At 16-weeks into the trial those patients who were still suffering from depression had slower heart rate variability recovery rates than those whose depression was either improving or had gone. In fact, some of the still-depressed patients had poorer heart rate variability readings at 16-weeks.


The writers explained "Both sertraline treatment and symptomatic recovery from depression were associated with increased heart rate variability compared with placebo-treated and non-recovered post - acute coronary syndrome control groups, respectively, but this results primarily from decreased heart rate variability in the comparison groups."


Why there is a link between heart rate variability, depression and cardiac death is unclear, the researchers said. "What is clear is that depression is associated with biological changes involving increased heart rate, inflammatory response, plasma norepinephrine, platelet reactivity, decreased heart rate variability and now absent post - acute coronary syndrome heart rate variability recovery, all of which is associated with life-threatening consequences. Understanding why these characteristics so strongly associate with depression is crucial to understanding the nature of depression itself. From a clinician's point of view, patients with depression after myocardial infarction, especially those with prior episodes, should be both carefully watched and aggressively treated, because they are at an elevated cardiac risk and less likely to get better spontaneously," they concluded.


"Heart Rate Variability in Acute Coronary Syndrome Patients With Major Depression Influence of Sertraline and Mood Improvement"

Alexander H. Glassman, MD; J. Thomas Bigger, MD; Michael Gaffney, PhD; Louis T. Van Zyl, MB, ChB, MMed (Psych)

Arch Gen Psychiatry. 2007;64:1025-1031.


Click here to view article online

Childhood Trauma And Risk For Chronic Fatigue Syndrome Connected By Biological Link

Childhood trauma is a potent risk factor for development of chronic fatigue syndrome (CFS), according to a study by researchers at Emory University School of Medicine and the Centers for Disease Control and Prevention (CDC). The study is published in the Jan. 5, 2009Archives of General Psychiatry.



Results of the study confirm that childhood trauma, particularly emotional maltreatment and sexual abuse, is associated with a six-fold increased risk for CFS. The risk further increases with the presence of posttraumatic stress disorder symptoms.



The study also found that low levels of cortisol, a hallmark biological feature of CFS, are associated with childhood trauma. Cortisol is frequently referred to as the "stress hormone" and is important to regulate the body's response to stress. A lack of cortisol's effects may cause altered or prolonged stress responses.



"The study indicates that low cortisol levels may actually reflect a marker for the risk of developing CFS rather than being a sign of the syndrome itself," said Christine M. Heim, PhD, lead author of the study and associate professor in the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine.



The population-based study analyzed data from 113 people with CFS, and a control group of 124 people without CFS, drawn from a sample of almost 20,000 Georgians. The results confirm earlier findings from a 2006 study conducted in Wichita, Kan.



Study participants completed a self-reported questionnaire on five different types of childhood trauma including emotional, physical and sexual abuse, and emotional and physical neglect. Researchers also collected saliva samples from participants to record levels of cortisol over one hour after awakening, typically an individual's highest cortisol levels for the day.



"When looking at CFS cases with and without histories of childhood trauma, only those with childhood trauma had the classic low cortisol levels often seen in CFS cases," explains Heim.



"It is important to emphasize that not all patients with CFS have been through childhood trauma," she says. "CFS may be part of a spectrum of disorders associated with childhood adversity, which includes depression and anxiety disorders."



Certain experiences children have while the brain is developing and vulnerable can make a difference in the way the body reacts to stress later in life, and may have long-term health consequences.



"Trauma that occurs at different times in childhood may be linked to different long term changes. It's an area in which more work is needed," says Heim.







This study was supported by a grant from the Centers for Disease Control and Prevention.



Reference: Childhood Trauma and Risk for Chronic Fatigue Syndrome: Association with Neuroendocrine Dysfunction, Archives of General Psychiatry 2009; Vol. 66 (1): 72-80



The Robert W. Woodruff Health Sciences Center of Emory University is an academic health science and service center focused on missions of teaching, research, and health care. Its components include schools of medicine, nursing, and public health; the Yerkes National Primate Research Center; the Emory Winship Cancer Institute; and Emory Healthcare, the largest, most comprehensive health system in Georgia. The Health Sciences Center has a $2.3 billion budget, 17,000 employees, 2,300 full-time and 1,900 affiliated faculty, 4,300 students and trainees, and a $4.9 billion economic impact on metro Atlanta.

Neurobiological Mechanisms In Major Depressive Disorder

Genes, psychological adversity in childhood, and recent or ongoing psychological stress may combine to cause major depression, write Dr. Sanjay Mathew and colleagues from Mount Sinai School of Medicine in New York in a review published in CMAJ.


"Major depressive disorder is thought to result from the complex interplay of multiple inherited factors and subsequent exposure to a wide range of environmental variables through life," write Dr. Mathew and coauthors.


The review provides a framework for this complex disease that requires a diverse approach in research, diagnosis and treatment. Current treatment options are limited by their delayed onset of action, lack of efficacy and adverse outcomes.


The authors conclude that "much needs to be explored in terms of how genes interact with other environmental variables to influence the risk of major depressive disorder."


About CMAJ


CMAJ is the leading health sciences journal in Canada. CMAJ is a general medical journal publishing original research and review articles, commentaries and editorials, practice updates, an arts and ideas section and health news. Published continuously since 1911, new issues are uploaded on cmaj.ca every second Monday at 4:30 p.m. EST/EDT. cmaj.ca contains the complete editorial contents of CMAJ, supplemented by a variety of interactive features and additional content.

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