Fighting The Depression

People With Type D Personalities Experience More Health Problems

2011-05-14T12:00:00.048-07:00

People who experience a lot of negative emotions and do not express these experience more health problems, says Dutch researcher Aline Pelle. She discovered that heart failure patients with a negative outlook reported their complaints to a physician or nurse far less often. The personality of the partner can also exert a considerable influence on these patients.

Aline Pelle investigated patients with a so-called type D personality. These people experience a lot of negative emotions and do not express these for fear of being rejected by others. It was already known that such a type of personality in heart failure patients is associated with anxiety and depression and a reduced state of health. However, Aline Pelle also described which processes might contribute to this.

Many of the patients with a negative outlook were found not to contact the physician or specialist nurse in the event of heart failure symptoms. As a result of this they were six times more likely to experience a worse state of health than non-type D heart failure patients.

Better not a cheerful partner

Pelle established that not just the patient's personality but also that of the partner had a significant effect on the patient's mood. In particular, the combination within the couple proved to be particularly important. Type D patients with a non-type D partner reported the lowest marriage quality, even lower than that of type D patients with a partner with just as negative an outlook.

No cause for death

Although a type D personality is associated with a range of negative health outcomes, Pelle's results did not demonstrate a correlation with an increased risk of dying from heart failure. This observation refutes the results from a previous study.

Aline Pelle's research was part of Johan Denollet's Vici project. He received a Vici grant from NWO's Innovational Research Incentives Scheme in 2004.

Symptoms Of Depression Associated With Development Of Diabetes In Older Adults

2011-05-14T12:00:00.047-07:00

Older adults who have had symptoms of depression whether those symptoms occurred once, increased or remained steady over a 10-year period may be more likely to develop diabetes than those without depressive symptoms, according to a report in the April 23 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

Previous research suggests that high levels of symptoms of depression, including irritability and trouble sleeping, are associated with increased risk of development of type 2 diabetes, according to background information in the article. However, with few exceptions, most of the studies have defined symptoms of depression based on a single survey filled out by participants. "Given the episodic nature of depression and depressive symptoms, a single self-report of symptoms may not fully characterize the association between depressive symptoms and diabetes," the authors write.

Mercedes R. Carnethon, Ph.D., of Feinberg School of Medicine, Northwestern University, Chicago, and colleagues followed a group of 4,681 participants age 65 and older (average age 72.7) who did not have diabetes at the beginning of the study in 1989. Each year for 10 years, the participants were evaluated for the presence of 10 symptoms of depression, including those related to mood, irritability, calorie intake, concentration and sleep. Symptoms were scored on a scale of zero to 30, with scores of eight or higher indicating high levels of symptoms. Sociodemographic characteristics, clinical measures including height and weight, and information about medication use that would indicate the development of diabetes were also updated annually.

At the beginning of the study, the average depressive symptom score was 4.5, and one-fifth of participants had a score of eight or higher. During the follow-up period, scores increased by at least five points in nearly half the participants, and 234 individuals developed diabetes. Rates of diabetes were higher among those with a score of eight or higher, compared with those who had scores below eight.

"In this sample of older adults, a single report of high depressive symptoms, an increase in symptoms with time and persistently high symptoms over time are each associated with an excess incidence of diabetes," the authors write. "Furthermore, increasing symptoms with time are associated with incident diabetes beyond initial high depressive symptoms and the association between increasing scores and incident diabetes was strongest among those with initially low baseline scores."

These associations were not explained by considering other risk factors for diabetes, including physical activity, smoking and body mass index. "The pathophysiologic mechanism for this association remains unclear," the authors write.

"Our findings in this population of older adults are of particular public health importance because there are 35 million U.S. adults older than 65 years," they conclude. Because an estimated 2 million older adults experience depression or a related illness and 15.3 percent of those over 65 have diabetes, "findings from this study of a novel and highly prevalent risk factor for diabetes have important implications for a substantial subset of our population."

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Improving Sleep Quality Could Ease Disability In Rheumatoid Arthritis Patients

2011-05-14T12:00:00.046-07:00

A study in the Feb. 15 issue of the Journal of Clinical Sleep Medicine found that poor sleep quality correlated with higher levels of depressive symptoms, greater pain severity, increased fatigue, and greater functional disability in patients with Rheumatoid Arthritis (RA). The study suggests that addressing sleep problems via pharmacological or behavioral interventions may have a critical impact on the health and lives of patients with RA.

The study represents a cross-sectional examination of the relationship between sleep quality and functional disability in 162 patients with RA. The sample had an average age of 58.5 years, and 76 percent were female. All patients had been diagnosed with RA for at least two years; on average, patients had RA for 14 years.

Participants completed the following questionnaires: Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory-II, Medical Outcomes Study Short Form - 36, and the Health Assessment Questionnaire. The results provided input on their sleep quality, depression, fatigue, and functional disability and pain severity, respectively. Patients also provided sociodemographic information and their medical history.

Results show that sleep quality has an indirect effect on functional disability after controlling for age, gender and number of comorbities. According to the PSQI results, 61 percent of patients were poor sleepers and 33 percent reported having pain that disturbed their sleep three or more times per week.

"The primary finding of our study is that poor sleep quality is associated with greater functional disability among patients with RA and this relationship may be explained by pain severity and fatigue," said lead author Dr. Faith S. Luyster, research assistant professor at the University of Pittsburgh School of Nursing in Pittsburgh, Pa. "These results highlight the importance of addressing sleep complaints among patients with RA. By treating sleep problems either pharmacologically or behaviorally, symptoms and activity limitations associated with RA may be reduced."

The study's finding that poorer sleep quality is associated with greater pain severity is consistent with recent evidence suggesting that sleep disruption may lower pain threshold and enhance pain in RA and otherwise healthy adults.

According to the National Institute of Health, RA is an inflammatory disease affecting about 1.3 million U.S. adults, and causes pain, swelling, stiffness, and loss of function in the joints. Disturbed sleep has been found to be a major concern among persons with RA.

Physical disability resulting from polyarticular joint disease in patients with RA may limit their ability to carry out daily activities such as dressing, walking, grooming, and writing - tasks that can be further restricted by fatigue, pain severity, and depression.

It is possible that functional disability may affect depression, pain severity and fatigue, which in turn may affect sleep quality. It is likely that the relationships are bidirectional to some extent.

"Not sleeping well at night can contribute to greater pain sensitivity and fatigue during the day which in turn can limit a patient's ability to engage in activities of daily living and discretionary activities," Luyster said.

Luyster noted that treating sleep disturbances in RA patients might have beneficial effects beyond improving sleep.

The study, "Sleep Quality and Functional Disability in Patients with Rheumatoid Arthritis," was supported by grants from the National Institute of Health.

Patients Hospitalized For Mental Illness In Ontario See Decrease In Signs Of Depression, Aggression

2011-05-14T12:00:00.045-07:00

In 2007-2008, there were more than 52,000 admissions to mental health beds in Ontario, and new data show that the vast majority of these showed improvements during their hospital stay. For example, the analysis found that 83% of people hospitalized for mental illness were showing signs of depression at the time of their admission. Of those, 75% showed a decrease in signs of depression by the time they were discharged. Likewise, the majority of patients who showed signs of aggression at the time of admission for a mental illness (representing 29% of mental health hospitalizations) saw a decrease in aggressive behaviour at the time of discharge.

The analysis released on March 31st by the Canadian Institute for Health Information (CIHI) presents new information relating to the characteristics and care needs of people 15 years of age and older admitted to a mental health bed in Ontario. Four out of five admissions were for people who had been living in a private residence before being admitted to hospital, and almost 9 out of 10 (89%) of those returned to that living setting upon discharge.

Exploring Hospital Mental Health Service Use in Ontario, 2007-2008 also demonstrates differences in life situations faced by those hospitalized for mental illness. People admitted to a mental health bed in Ontario were less likely than the general population to be employed (24% versus 64%), less likely to be married or living with a partner (29% versus 60%) and less likely to have received postsecondary education (39% versus 59%).

About CIHI

The Canadian Institute for Health Information (CIHI) collects and analyzes information on health and health care in Canada and makes it publicly available. Canada's federal, provincial and territorial governments created CIHI as a not-for-profit, independent organization dedicated to forging a common approach to Canadian health information. CIHI's goal: to provide timely, accurate and comparable information. CIHI's data and reports inform health policies, support the effective delivery of health services and raise awareness among Canadians of the factors that contribute to good health.

Source
Canadian Institute for Health Information

Skin Condition Associated With Depression, Anxiety And Suicidal Feelings

2011-05-14T12:00:00.044-07:00

Individuals with psoriasis appear to have an increased risk of depression, anxiety and suicidality, according to a report in the August issue of Archives of Dermatology, one of the JAMA/Archives journals.

Psoriasis affects 1 percent to 3 percent of the general population, and estimates suggest 0.4 percent to 2.3 percent of adults have the condition but have not been diagnosed. "Psoriasis has long been recognized to be associated with potentially adverse effects on mental health," the authors write. "In the 1960s, a popular ad campaign labeled the emotional burden of this skin disease as the 'heartbreak of psoriasis.' However, there have been relatively few studies evaluating psychological outcomes in patients with psoriasis."

Shanu Kohli Kurd, M.D., M.S.C.E, M.H.S., and colleagues at the University of Pennsylvania, Philadelphia, studied data from electronic medical records in the United Kingdom from 1987 to 2002. The analyses included 146,042 patients with mild psoriasis, 3,956 patients with severe psoriasis and 766,950 patients without psoriasis (five control patients for each patient with psoriasis, selected from the same practice and similar entry dates). Patients were defined as having new-onset depression, anxiety or suicidality if corresponding diagnostic codes appeared in their records after follow-up began.

Of patients with mild or severe psoriasis, 25.9 per 1,000 individuals per year were diagnosed with depression, 20.9 per 1,000 per year with anxiety and 0.9 per 1,000 per year with suicidality. The rate of these cases attributable to psoriasis was 11.8 per 1,000 individuals per year for depression, 8.1 per 1,000 per year for anxiety and 0.4 per 1,000 per year for suicidality.

"Stated another way, the excess risk attributable to psoriasis is one case of depression for every 39 patients with severe psoriasis per year (or per 87 patients in patients with mild psoriasis per year)," the authors write. "The excess risks associated with psoriasis for anxiety and suicidality correspond to one case per 123 and 2,500 patients with psoriasis per year, respectively." Considering this data and the prevalence of psoriasis in the U.K., the authors estimate that there are more than 10,400 diagnoses of depression, 7,100 of anxiety and 350 of suicidality related to psoriasis each year.

"It is important to identify these psychiatric disorders because they represent substantial morbidity that can be improved with a variety of pharmacological and non-pharmacological approaches," the authors conclude. "Recent data suggest that psychiatric co-morbidity may negative affect response to certain psoriasis treatments (e.g., photochemotherapy), while other studies suggest that control of psoriasis is associated with improvements in psychological symptoms. Future studies are necessary to determine the mechanisms by which psoriasis is associated with depression, anxiety and suicidality as well as approaches to prevent such adverse outcomes in patients with psoriasis."

Arch Dermatol. 2010;146[8]:848-855. 2010;146[8]:891-895.

Physical And Psychological Torture Have Similar Mental Effects

2011-05-14T12:00:00.043-07:00

Forms of ill treatment during captivity that do not involve physical pain - such as psychological manipulation, deprivation, humiliation and forced stress positions - appear to cause as much mental distress and traumatic stress as physical torture, according to a report in the March issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

Most widely accepted definitions of torture encompass both physical and mental pain and suffering, according to background information in the article. "After reports of human rights abuses by the U.S. military in Guantanamo Bay, Iraq and Afghanistan, a U.S. Defense Department working group report on detainee interrogations and a U.S. Justice Department memorandum on U.S. torture policy argued for a fairly narrow definition of torture that excludes mental pain and suffering caused by various acts that do not cause severe physical pain," the study authors write. The detention and interrogation procedures that are excluded from this definition include blindfolding and hooding, forced nudity, isolation and psychological manipulations.

Metin Basoglu, M.D., Ph.D., King's College, University of London, and colleagues interviewed 279 survivors of torture from Sarajevo in Bosnia and Herzegovina, Luka in Republica Srpska, Rijeka in Croatia and Belgrade in Serbia between 2000 and 2002. The survivors (average age 44.4, 86.4 percent men) were asked which of 54 war-related stressors and 46 different forms of torture they had experienced. Each participant then rated each event on scales of zero to four for distress (where zero was not at all distressing and four was extremely distressing) and loss of control (where zero was completely in control and four was not at all in control or completely helpless). Then, they reported how distressed or out of control they felt overall during the torture. Clinicians also assessed the survivors for post-traumatic stress disorder (PTSD) and other psychiatric conditions.

The participants reported an average of 19 war-related stressors and 19.3 types of torture. An average of 96.3 months had passed since their last torture experience. More than three-fourths (174) of the survivors had PTSD related to their torture at some point in their lives, 55.7 percent (128) had current PTSD, 17 percent (39) were currently depressed and 17.4 percent (40) had a past episode of major depression.

To more easily compare forms of torture, the researchers divided events into seven broad categories: sexual torture; physical torture; psychological manipulations, such as threats of rape or witnessing the torture of others; humiliating treatment, including mockery and verbal abuse; exposure to forced stress positions, such as bondage with rope or other restrictions of movement; loud music, cold showers and other sensory discomforts; and deprivation of food, water or other basic needs.

Participants who had undergone physical torture rated their experiences from 3.2 to 3.8 on the distress scale. Sixteen of the 33 stressors from other categories were rated in the same range of distress. "Sham executions, witnessing torture of close ones, threats of rape, fondling of genitals and isolation were associated with at least as much if not more distress than some of the physical torture stressors," the authors write. "There was thus substantial overlapping between physical torture and other stressors in terms of associated distress. The control ratings also showed a similar pattern."

Physical torture was not significantly associated with PTSD or depression, suggesting that both physical and non-physical treatments caused the conditions at similar rates. "The traumatic stress impact of torture (physical or non-physical torture and ill treatment) seemed to be determined by perceived uncontrollability and distress associated with the stressors," the authors continue.

The authors concluded that aggressive interrogation techniques or detention procedures involving deprivation of basic needs, exposure to adverse environmental conditions, forced stress positions, hooding or blindfolding, isolation, restriction of movement, forced nudity, threats, humiliating treatment and other psychological manipulations do not appear to be substantially different from physical torture in terms of the extent of mental suffering they cause, the underlying mechanisms of traumatic stress and their long-term traumatic effects. These findings do not support the distinction between torture versus "other cruel, inhuman and degrading treatment." Although international conventions prohibit both types of acts, "such a distinction nevertheless reinforces the misconception that cruel, inhuman and degrading treatment causes lesser harm and might therefore be permissible under exceptional circumstances. These findings point to a need for a broader definition of torture based on scientific formulations of traumatic stress and empirical evidence rather than on vague distinctions or labels that are open to endless and inconclusive debate and, most important, potential abuse."

(Arch Gen Psychiatry. 2007;64:277-285.)

This study was supported by grants from the Bromley Trust. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Editorial: No Difference Between Torture, Other Forms of Maltreatment

The distinction between torture and degrading treatment is not only useless, but also dangerous, writes Steven H. Miles, M.D., University of Minnesota, Minneapolis, in an accompanying editorial.

"Ba??o?°lu and colleagues show that the severity of long-lasting adverse mental effects is unrelated to whether the torture or degrading treatment is physical or psychological and unrelated to objective measures of the severity of techniques," Dr. Miles writes.

"The wrongness of these inflicted harms is compounded by the fact that most abused prisoners, including those in the present war on terror, are innocent or ignorant of terrorist activities. Innocent or not, torture survivors rarely get the mental health treatment they need. In addition, soldiers who participate in atrocities are themselves at increased risk of post-traumatic stress disorder."

Human rights - respecting nations and medical societies must band together to reinforce international authority against torture, he concludes. "In the 18th century, Europe abandoned legal interrogational torture on the twin conclusions that it was an affront to human dignity and a poor way to acquire information. Empirical research such as the article by Basoglu and colleagues can help us find that persuasive holding ground again."

(Arch Gen Psychiatry. 2007;64:275-276.)

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

Contact: Metin Basoglu

JAMA and Archives Journals

Transcendental Meditation Shown To Reduce Depression: New Studies

2011-05-14T12:00:00.042-07:00

The Transcendental Meditation® technique may be an effective approach to reduce symptoms of depression, according to two new studies to be presented at the 31st Annual Meeting of the Society of Behavioral Medicine in Seattle, Washington April 9th, 2010.

The studies, conducted at Charles Drew University in Los Angeles and University of Hawaii in Kohala included African Americans and Native Hawaiians, 55 years and older, who were at risk for cardiovascular disease. Participants were randomly allocated to the Transcendental Meditation program or health education control group, and assessed with a standard test for depression - the Center for Epidemiological Studies-Depression (CES-D) inventory over 9-12 months.

"Clinically meaningful reductions in depressive symptoms were associated with practice of the Transcendental Meditation program," said Sanford Nidich, EdD, lead author and senior researcher at the Institute for Natural Medicine and Prevention at Maharishi University of Management. "The findings of these studies have important implications for improving mental health and reducing the risk of cardiovascular morbidity and mortality," said Dr. Nidich.

Participants in both studies who practiced the Transcendental Meditation program showed significant reductions in depressive symptoms compared to health education controls. The largest decreases were found in those participants who had indications of clinically significant depression, with those practicing Transcendental Meditation showing an average reduction in depressive symptoms of 48%.

"These results are encouraging and provide support for testing the efficacy of Transcendental Meditation as a therapeutic adjunct in the treatment of clinical depression," said Hector Myers, PhD, study co-author and professor and director of Clinical Training in the Department of Psychology at U.C.L.A.

The results of these studies are timely. For older Americans, depression is a particularly debilitating disease, with approximately 20% suffering from some form of depression. Overall, 18 million men and women suffer from depression in the United States. Depression is a major risk factor for cardiovascular disease, with even a moderate level of depressive symptoms associated with increased cardiac events.

"The clinically significant reductions in depression without drugs or psychotherapy in these studies suggest the Transcendental Meditation program may improve mental and associated physical health in older high risk subjects," said Robert Schneider MD FACC, director of MUM's Institute for Natural Medicine and Prevention.

"The importance of reducing depression in the elderly at risk for heart disease cannot be overestimated," said Gary P. Kaplan MD PhD, Clinical Associate Professor of Neurology NYU School of Medicine. "Any technique not involving extra medication in this population is a welcome addition. I look forward to further research on the Transcendental Meditation technique and prevention of depression in other at-risk elderly populations, including those with stroke and other chronic diseases."

The studies were funded by grants from the National Institutes of Health - National Heart Lung and Blood Institute and National Center for Complementary and Alternative Medicine.

Facts on Study Design
The first study was conducted in collaboration with Dr. Hector Myers at the Charles R. Drew University of Medicine and Science in Los Angeles. It included a subgroup of 59 African American men and women, 55 years and older, with a minimum carotid artery wall thickness of 0.65 for women and 0.72 for men.

The second study was conducted in collaboration with Dr. Andrew Grandinetti at the University of Hawaii. Data was collected on 53 Native Hawaiian men in Kohala, Hawaii, 55 years and older, who had at least one additional major risk factor for cardiovascular disease.

Measurements with the Center for Epidemiological Studies Depression (CES-D) Rating Scale were taken at baseline, 3-month posttest, and 9-12 month posttest, comparing Transcendental Meditation to health education controls.

Both African Americans and Native Hawaiians suffer from higher rates of cardiovascular disease compared to whites. African Americans have approximately 1.5 times the rate of cardiovascular morbidity and mortality and Native Hawaiians have 2 to 4 times the rate of cardiovascular disease compared to the whites.

Facts on Depression
12.4 million women and 6.4 million men in the U.S. suffer from depression.

Approximately 20% of the elderly suffers from some form of depression according the National Institutes of Health.

Depression is an important risk factor for the development and progression of cardiovascular disease (CVD). Research has found that a dose-response effect exists whereby the level of depressive symptoms is linearly associated with the prevalence of cardiac events. Even a moderate level of depressive symptoms increases the risk for cardiac events.

The Medical Outcomes Study determined that depression was more impairing in terms of patient functioning and well being than arthritis, diabetes mellitus, and hypertension, among others, and is more disruptive for social functioning than all of the chronic medical conditions.

Research has shown that approximately 50% of patients suffering from major depression can be left undiagnosed by general practitioners.

Depression accounts for $83.1 billion in medical care and workplace costs.

Study Indicates Effectiveness Of Online Screenings In Connecting Individuals At Risk For Depression To Treatment

2011-05-14T12:00:00.041-07:00

Screening for Mental Health, Inc., the leading nonprofit provider of online and in-person mental health screening programs, today released results from a follow-up study of participants in the 2008 National Depression Screening Day® (NDSD) online program. The study found that over half of participants sought depression treatment in the three months following their initial screening. NDSD, the nation's oldest voluntary, community-based screening program for depression and related disorders, provides individuals with the opportunity to complete a validated screening questionnaire, receive educational information about depression, and obtain a recommendation and referral for further evaluation if warranted.

"The results of this study are very encouraging as they reinforce the effectiveness of anonymous, web-based screening programs in connecting individuals at risk for depression with treatment resources," said Douglas G. Jacobs, M.D., Associate Clinical Professor of Psychiatry at Harvard Medical School and founder of Screening for Mental Health, Inc. "Early detection of mental health disorders such as depression greatly increases the chances that an individual will receive the appropriate treatment and experience a better quality of life."

The study was conducted by Robert Aseltine, Ph.D., Professor of Behavioral Sciences and Community Health and Director of the Institute for Public Health Research at the University of Connecticut Health Center. Dr. Aseltine surveyed 322 participants who completed the depression screening tool online between October and December of 2008 and sought to evaluate the success of online screenings in leading individuals into treatment. According to the Depression and Bipolar Support Alliance, nearly two thirds of people suffering from depression do not seek help, but the NDSD survey suggests that confidential online screenings, which are highly accessible and nonthreatening to users, may help to improve these statistics.

Findings from the survey include:

- 55% of participants sought depression treatment within three months of screening.

- 31% of these had never previously been treated for depression.

- Of those seeking treatment, 52% received both counseling and medication, 28% received medication only, and 13% received counseling only.

- Over one third of participants with a likelihood of depression said that medication had helped "a lot."

- 55% of those who initially scored "Very Likely for Depression"-the highest possible score range in the NDSD screening-were no longer in that range at follow up.

- 46% of those who initially scored "Likely for Depression" were in the "Unlikely for Depression" range at follow up.

In recognition of National Depression Screening Day on Thursday, October 8th, 2009 community organizations, primary care providers, colleges and military installations throughout the nation will offer free, anonymous mental health screenings to educate members of the public on the symptoms of depression and the appropriate course of action to take. Individuals will have the opportunity to complete a brief questionnaire, and speak with a health care professional regarding their personal situations. In addition to the in-person events, members of the public can also take the screening online at MentalHealthScreening.

"The goal of NDSD is to reach that portion of the population with depression who are not seeking help," said Jacobs. "We have found these questionnaires and screenings to be a critical first step in educating individuals on how to seek help themselves or help loved ones who may be struggling with depression by recognizing certain behaviors."

Source
Mental Health, Inc.

Relapse Of Depression Prevented In Many Women By Monthly Interpersonal Psychotherapy

2011-05-14T12:00:00.040-07:00

Most women with recurrent depression may be able to prevent subsequent depressive episodes with monthly maintenance interpersonal psychotherapy (IPT), say researchers from the University of Pittsburgh School of Medicine in a study published in the May issue of the American Journal of Psychiatry.

Researchers found that once-per-month maintenance IPT, a form of therapy which focuses on relationships and interpersonal events that tend to trigger depression, was effective in preventing recurrence of depression in women who achieved remission through IPT alone. In fact, women who received prophylactic IPT once a month were no more likely to have a recurrence of their depression than those who received IPT two or four times a month. Maintenance IPT was found to be less effective for preventing recurrence in women who achieved remission through combination IPT and antidepressant therapy.

"Studies have shown that when a person recovers from depression by using medication, the best way for them to stay well is to continue on the same dosage of medication. However, many people, especially women of childbearing age or those taking medications for other conditions, may not feel comfortable taking antidepressants for long periods of time," said Ellen Frank, Ph.D., professor of psychiatry, University of Pittsburgh School of Medicine. "We found that interpersonal psychotherapy is a valid alternative to help women with recurrent depression remain symptom-free, especially women who were able to recover from a depressive episode using therapy alone."

The Pittsburgh study looked at 99 women whose depressive episodes remitted after outpatient treatment with IPT alone and 32 women who achieved remission with outpatient IPT and antidepressant treatment. The women were randomly assigned to receive maintenance IPT focused on preventing future depressive episodes at intervals of once per week, twice per month or once per month over the course of two years, or until they had a subsequent depressive episode.

Of those who initially remitted with IPT alone, 74 completed the two-year maintenance phase. Only 19, or 26 percent, had a recurrence of depression. Of those who remitted with IPT and antidepressant therapy, 26 completed the maintenance phase. Half had a recurrence of depression. In both groups there was no significant difference in recurrence rates between those who received maintenance IPT weekly, bi-monthly or monthly.

"Our study indicates, as many prior studies have, that not every person's depression is the same, nor should each person be treated the same way," said Dr. Frank. "Some people respond best to therapy, others to medication and others to a combination of the two. It's important that clinicians evaluate their patients carefully to determine the best treatment for each individual."

The study was funded by the National Institute of Mental Health.

Other authors include David J. Kupfer, M.D., Daniel J. Buysse, M.D., Holly A. Swartz, M.D., Paul A. Pilkonis, Ph.D., Patricia R. Houck, M.S.H., Paola Rucci, Ph.D., Danielle M. Novick, M.S., Victoria J. Grochocinski, Ph.D., and Deborah M. Stapf, B.S., all of the University of Pittsburgh.

Contact: Jocelyn Uhl Duffy

University of Pittsburgh Schools of the Health Sciences

When People With Alzheimer's Disease Should Stop Driving: AAN Issues Guideline

2011-05-14T12:00:00.039-07:00

The American Academy of Neurology has issued a new guideline to help determine when people with Alzheimer's disease or another type of dementia should stop driving. The guideline is published in the April 12, 2010, online issue of Neurology®, the medical journal of the American Academy of Neurology, and was presented April 12, 2010, at the American Academy of Neurology's Annual Meeting in Toronto.

"While some people with dementia can still drive safely for a time, nearly all people with dementia will eventually have to give up driving," said lead guideline author Donald J. Iverson, MD, with the Humboldt Neurological Medical Group, Inc. in Eureka, Calif., and Fellow of the American Academy of Neurology. "It's important for doctors to discuss this with patients and caregivers soon after the diagnosis since restricted driving will affect the patient's quality of life and may lead to other health concerns such as depression."

The guideline recommends doctors use the Clinical Dementia Rating (CDR) scale to identify people with dementia at an increased risk of unsafe driving. The CDR provides a tool for clinicians to integrate information from caregivers and from direct examination of the patient to develop a comprehensive view of the dementia severity.

Evidence shows driving skills deteriorate with increasing dementia severity. "While patients with mild dementia, as a group, are higher-risk drivers, more recent studies report that as many as 76 percent are still able to pass an on-road driving test and can safely drive," said Iverson. "Faced with these facts, we needed to provide guidelines for doctors caring for these patients to identify those people at higher risk of unsafe driving, without unnecessarily restricting those who are safe drivers."

The guidelines also found that caregivers should trust their instincts. A study found that caregivers who rate a patient's driving as "marginal" or "unsafe" were often proven correct when the patient took an on-road driving test. On the other hand, patients who deemed their own driving as "safe" were not necessarily accurate in their own assessments.

Caregivers and family members play a role in identifying warning signs from unsafe drivers with dementia. These include:
Decreased miles being driven

Collisions

Moving violations

Avoiding certain driving situations, such as driving at night or in the rain

Aggressive or impulsive personality traits

"It is important that the decision to stop driving be directed by a doctor who is trained and experienced in working with people with dementia and their families," Iverson said. "Doctors should be aware that assessing driving ability is a complex process. More than one source of information is needed to make a judgment. In some situations, a dementia specialist may be needed."

Doctors, patients and caregivers must also know their state laws, since some states require that doctors report any medical conditions that may impact their ability to drive safely.

The guideline is an update of the 2000 American Academy of Neurology guideline on driving with dementia.

People With Severe Depression 'Find It Harder To Judge Facial Expressions'

2011-05-14T12:00:00.038-07:00

New research shows people with severe depression find it harder to interpret facial expressions than healthy people - particularly expressions of disgust.

The study, published in the August issue of the British Journal of Psychiatry, was carried out by researchers from the University of Otago in New Zealand. Researchers Katie Douglas and Professor Richard Porter asked 68 people who had been diagnosed with severe depression to take part in a facial expression recognition task. They were shown a total of 96 faces displaying 5 basic emotions: angry, happy, sad, fearful and disgusted expressions. The participants were also shown faces displaying neutral expressions. Their performance was compared with a control group of 50 healthy individuals.

The researchers found that the control group were significantly better than the depression group at recognising facial expressions of disgust, indicating an impairment in the ability of people with severe depression to recognise disgusted facial expressions.

Researcher Professor Richard Porter, of the Department of Psychological Medicine at the University of Otago, said: "The specific impairment we found in the ability of people with severe depression to recognise disgusted facial expressions has not been previously reported. However, disgust recognition has been shown to be impaired in patients with Parkinson's disease who are not taking medication. We know that people with Parkinson's disease don't have enough of a brain chemical called dopamine. It's possible that the ability to recognise disgust is associated with dopamine dysfunction in people with severe depression as well.

"Another explanation is that people's emotional processing is affected when they are severely depressed. Admission to a psychiatric hospital is stressful, and patients are removed from their usual social environment and placed in close proximity with other distressed individuals."

The researchers have called for further research into whether people who are successfully treated for severe depression become better at disgust recognition. If so, this could possibly be used as a marker of treatment outcome for people with major depression.

The study also found differences in the way the two groups interpreted neutral faces. Those people with depression were more likely to interpret neutral faces as sad, and less likely to interpret neutral faces as happy compared to the control group - findings which are consistent with previous research studies.

References:
"Recognition of disgusted facial expressions in severe depression,"

Douglas GM and Porter RJ (2010)

British Journal of Psychiatry, 197: 156-157

Heart Attack Patients With Depression Less Likely To Receive Priority Care In Emergency Rooms

2011-05-14T12:00:00.037-07:00

Heart attack patients with a history of depression presenting at emergency departments were less likely to receive priority care than people with other conditions, found a study published in CMAJ (Canadian Medical Association Journal).

Several studies indicate that people with heart attacks and depression have worse outcomes than people without, although emergency department care has not been looked at as a possible contributor. In the United States, more than six million patients with mental health issues are seen in emergency departments each year and six million people visit for chest pain.

This study, by researchers from the Institute of Clinical Evaluative Sciences, looked at data on 6,874 patients admitted to 96 acute care hospitals in Ontario, Canada from April 2004 to March 2005. They found that 680 of these heart attack patients had a history of depression recorded in their medical charts, and 39% of these were assigned a low priority triage score in the emergency department, compared with 32.7% of the other patients with heart attacks.

"Ten per cent of acute myocardial infarction patients seen in the emergency department had a history of depression recorded in their chart, and it was associated with an increased risk of receiving a low priority emergency department triage score, as well as delays in diagnostic testing and definitive care," writes Dr. Clare Atzema, Institute for Clinical Evaluative Sciences, with coauthors. "Interestingly, other components of the medical history, including the traditional cardiac risk factors of diabetes, smoking, hypercholesterolemia and hypertension, were not associated with triage score in the models; only depression affected the score."

As well, a lower triage priority based on charted depression resulted in delays in diagnosis and treatment by physicians, nurses, cardiologists and laboratory teams.

The authors suggest this lower prioritizing by emergency staff may be based on assumptions that patients' symptoms are anxiety-related rather than due to an actual heart attack. Less than 10% of patients who come to emergency rooms with heart attack symptoms, such as chest pain or shortness of breath, are found to be suffering from the condition. Therefore staff are actively looking for other possible sources for the patients' symptoms.

"We suspect that mistriage of these patients is not due to purposeful discrimination by emergency department staff, but rather that most emergency department staff are unaware of data that suggests a link between depression and coronary artery disease," write the authors. They suggest this information needs to be disseminated to emergency room staff.

Link to article

Source
Canadian Medical Association Journal

A New Classification Of Different Types Of Depression

2011-05-14T12:00:00.036-07:00

A new classification of depressive subtypes of depression has been proposed in the current issue of Psychotherapy and Psychosomatics. Lichtenberg and Belmaker argue that a simple diagnosis is no longer sufficient to guide treatment.

Recent years have witnessed a growing awareness of problems that call for a reassessment of how best to classify depression. It is unlikely that a syndrome as polymorphic and widely diagnosed as major depressive disorder (MDD) will reflect a single process. Attempts to delineate different forms of depression by statistically analyzing the symptomatology of large samples of patients without taking into consideration life events or childhood history have been unsuccessful. It may be necessary to consider childhood trauma, marital and employment stress, and medical health in diagnosing subtypes of depression. Epidemiologic data on the effects of childhood trauma, unemployment and divorce on depression incidence are strong. DSM-IV does make one allowance for circumstances by including a bereavement exclusion. However, it seems that bereavement is not different from other losses and stresses that are associated with depression.

In clinical practice, depression is often resistant to standard antidepressant medication, and a large percentage of patients respond just as well to placebo. The DSM broad diagnosis of MDD does not encourage a search for subtypes of depression that may require specific treatment. Most studies are commercially sponsored multicenter projects, and lump many possible subgroups under the rubric of MDD.

In fact, most clinicians subtype depression as a matter of course when describing patients to colleagues. It may be that the era of large commercial studies of antidepressants using MDD as a diagnosis is over. It may be possible to kick start the system by subtyping depression to encourage a period of small investigator-initiated studies of potential new treatments by subtype. In this paper, the Authors propose an intuition-based proposal for heuristically classifying depressions which, of course, is not an evidence-based replacement of the present DSM-IV MDD. These subtypes are the following:

Type A: Depression with Anxiety, characterized by an enduring tendency to experience anxiety and depression, and to show poor resilience under stress.

Type B: Acute Depression. This subtype has episodes that are relatively discreet and develop with no apparent precipitating stress, or the stress may be disproportionate to the intensity and duration of the depression. The severity of the depression can deteriorate into intense psychological pain and psychomotor retardation or agitation. Several authors have suggested that this subtype of depression should be termed 'melancholia'.

Type C: Adult Depression after Childhood Trauma. This form of depression may be unique. Individuals suffering early trauma or loss may develop lasting neurobiological changes, which render them vulnerable to stress throughout their life. In particular, sensitization of the hypothalamic-pituitary-adrenal (HPA) axis may remain throughout life.

Type D: Depressive Reaction to Separation Stress. This can be precipitated by acute psychosocial trauma such as bereavement, divorce, job loss or forced emigration, and may sometimes be more severe than other forms of depression. For months, and sometimes years afterwards, some may experience sadness, apathy, insomnia and pessimism.

Type E: Postpartum Depression. This has a typical peak onset in the first 3 months following delivery. There are vast reductions in estradiol and progesterone levels postpartum, but their exact relevance to the development of depression remains unproven. Psychosocial factors, such as an unsupportive partner or an unwanted pregnancy, have also repeatedly been found to be relevant to the development of postpartum depression.

Type F: Late-Life Depression. This occurs in elderly people with no prior personal or family history of depression, but often with risk factors for cardiovascular disease, such as hypertension, diabetes mellitus, smoking or hypercholesterolemia. The patient describes a gradual loss of energy and interest, and a diminishing ability to cope. Cognitive testing may show impairment.

Type G: Psychotic Depression. This form features delusions and severe disturbances in work and social function. Hyperactivity of the HPA axis as measured by dexamethasone nonsuppression is present in at least half of the patients. Antipsychotic medication in addition to antidepressants is indicated.

Type H: Atypical Depression. This subtype characterizes patients who show hypersomnia and hyperphagia instead of the insomnia and weight loss typical of acute depression. They have more anxiety, including panic disorder and social phobia, and they are more likely to be a suicide risk and to abuse drugs.

Type I: Bipolar Depression. This occurs in patients with previous episodes of mania and should also be considered in depressed patients with a strong family history of bipolar disorder.

Type J: Depression Secondary to Substance Abuse or to a Medical Condition. This subtype, which is recognized by DSM-IV, is a diverse group of disorders that can be difficult to treat. It is a striking biological fact that substances and medical conditions as diverse as therapeutic corticosteroids, illicit cocaine use or pancreatic carcinoma can cause depression.

Perhaps it is time for a paradigm shift. The subtypes discussed above can be operationalized, and new treatment trials powered for the smaller populations available for each subtype. The large pool of world depression investigators occupied with multicenter clinical trials of diminishing returns might be encouraged to initiate smaller trials in some of the specific subtypes. There is no guarantee of success in such a paradigm shift, but it is time for a change.

Subtyping of depression could lead to identification of subtypes that are more responsive to current pharmacological treatment, and aid in separating out the large burden of worldwide depression for which current antidepressants are not a highly effective treatment. This could help resolve the controversy over the appropriateness of current antidepressant education campaigns in the developing world.

No Link Found Between Internet Dependence And Gambling Addiction

2011-05-14T12:00:00.035-07:00

A study of university students found no overlap between those reporting excessive Internet use and those with problem gambling. However, both addictive behaviors are associated with psychological issues such as depression, anxiety, stress, and loneliness, according to a provocative Rapid Communication in Cyberpsychology, Behavior, and Social Networking, a peer-reviewed journal published by Mary Ann Liebert, Inc. The article is available free online here.

Both Internet dependence and problem gambling are typically viewed as behavioral addictions, and as such might be expected to affect the same individuals. But as N.A. Dowling, PhD, from the University of Melbourne, and M. Brown from Monash University, both in Australia, conclude in the article entitled, "Commonalities in the Psychological Factors Associated with Problem Gambling and Internet Dependence," these seem to be separate disorders that share common underlying psychological profiles, which has implications for their management.

Based on their assessment of a small group of university students in Australia, the authors report that similar vulnerabilities, attributable to feelings of anxiety, stress, depression, loneliness, and social isolation, appear to contribute to excesses in Internet use and gambling behavior. Effective treatments would likely integrate multiple types of interventions that target the specific problem behavior and the general tendency to addiction.

"It is clear that effectively evaluating and treating these disorders requires a clear understanding of the individual symptomatology and internal conflicts particular to each patient," says Brenda K. Wiederhold, PhD, MBA, BCIA, Editor-in-Chief of Cyberpsychology, Behavior, and Social Networking, from the Interactive Media Institute, San Diego, CA.

Depressed Heart Failure Patients May Benefit From Exercise Plus Psychological Counseling

2011-05-14T12:00:00.034-07:00

Aerobic exercise combined with cognitive behavioral therapy may improve physical function, reduce depressive symptoms and enhance quality of life in depressed heart failure patients, researchers reported at the American Heart Association's 9th Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke.

In a new study, researchers divided 74 heart failure patients with depression into four groups: one group received a 12-week, home-based program of exercise and psychological counseling; a second received psychological counseling alone; a third received exercise alone; and a fourth received usual care.

"By combining exercise with psychological counseling, these depressed patients do better in all parameters compared to the other groups," said Rebecca Gary, Ph.D., lead author of the study and assistant professor in the School of Nursing at Emory University in Atlanta, Ga. "This may be the best method for improving their depression, symptom severity, and quality of life."

Participants in the randomized, controlled pilot study were average age 66. The majority of patients were Caucasian and 57 percent were women. All participants were diagnosed with clinical depression, determined by psychiatric tests, using DSM-IV criteria and the Hamilton Rating Scale for Depression.

The participants were either New York Heart Association class II or class III heart failure patients. Class II patients have a slight limitation of physical activity. They are comfortable at rest but ordinary physical activity results in fatigue, palpitation, dyspnea or angina. Class III patients have a marked limitation of physical activity. They are comfortable at rest but less than ordinary activity causes fatigue, palpitation, dyspnea or angina.

"What makes this study different from other studies of exercise in heart failure patients is that all these patients were clinically depressed," Gary said.

The four groups were assessed at four time intervals: baseline, after the 12-week intervention program, following the three-month telephone follow-up and at six months.

The exercise component was a 12-week, progressive program, with low-to-moderate intensity exercise, involving walking outdoors. Patients were encouraged to walk three times per week for at least 30 minutes. Patients in the combined program or exercise-only group received heart rate monitors and were taught how to self-monitor their exertion level, and when to stop exercising. All patients, despite initial symptoms and some being quite debilitated, achieved these goals.

A physical function test, the six-minute walk test, was administered at each of the time intervals.

"The cognitive behavioral therapy was geared toward changing the attitude of the patients about their illness," Gary said. "We wanted them to change their negative thoughts and beliefs and restructure and reformat how they think about their illness and limitations. For example, we developed a volunteer and activities sign-up sheet in each community that provided transportation for those who wanted to get out of the home or contribute in some way."

Cognitive therapy sessions were conducted, one-on-one in the home, once a week, for 12 weeks by psychiatric nurse specialists and Ph.D. students trained in counseling techniques.

Patients in the combined exercise and behavioral therapy group improved significantly better in the six-minute walk test than the other groups.

The combined group lowered depression symptoms by 10 points over the usual care group. A decrease in scores of 50 percent or more or a HAM-D score of less than 8 indicates remission of depression symptoms. Interestingly, although depressive symptoms were also reduced in the counseling-only group, they perceived their quality of life to be worse than the combined group or exercise group. The combined group lowered depression symptoms by 10 points over the usual care group.

Co-authors are: S. Dunbar, D.S.N.; E. Cress, Ph.D.; and G. Cotsonsis, Ph.D.

The study received funding from the American Heart Association "Beginning Grant in Aid" program from the association's Southeast Affiliate.

The American Heart Association/American Stroke Association has a national movement, Start!, that encourages all Americans to incorporate walking into their lives. The hub of the Start! movement is MyStart! Online, a free, Web-based fitness and nutrition tracker that offers constant, measurable, personal improvement. Available at americanheart/start.

Statements and conclusions of abstract authors presented at American Heart Association/American Stroke Association scientific meetings are solely those of the abstract authors and do not necessarily reflect association policy or position. The association makes no representation or warranty as to their accuracy or reliability.

NR08-1052 (QCOR 08/Gary)

Abstract 118

A Lack In Research And Effective Treatments For Body Dysmorphic Disorder

2011-05-14T12:00:00.033-07:00

Medication and psychotherapy may be beneficial for patients suffering from body dysmorphic disorder (BDD). But a new Cochrane Review found that much more research is required to determine the most effective treatment and whether both approaches should be used in combination.

Body dysmorphic disorder affects as many as one in 20 people. Patients suffering from BDD worry obsessively about their physical appearance, with concerns frequently but not exclusively focused on the skin, hair and nose, and often have very low levels of self-esteem. Many are also diagnosed with depression and around a quarter may attempt suicide. According to Cochrane Researchers, however, there is currently very little evidence regarding the relative effectiveness of drug treatment and psychotherapy approaches.

"Given the number of people suffering from BDD and the level of distress caused, it is surprising that so little data is available on treatments. This is certainly a field that deserves additional attention and funding," said lead researcher, Jonathan Ipser, who works at the MRC Research Unit for Anxiety and Stress Disorders at the University of Stellenbosch, South Africa.

Ipser and colleagues carried out a systematic review of currently available evidence, analysing data from four trials, which together included 169 patients. They found that over half of people treated in a single trial with the antidepressant fluoxetine for 12 weeks showed improvement, compared to less than a quarter of those given a placebo. And in two 12 week trials of cognitive behavioural therapy (CBT), symptom severity was significantly reduced. Both types of treatment were well tolerated, with no severe adverse effects reported.

"Both approaches seem to be acceptable to patients with this condition, as shown by low drop-out rates in trials. There was also some suggestion that psychotherapy could reduce the risk of future relapse, although we need more data on long term treatment effects to confirm this," said Ipser.

Champix May Have Led To TV Editors Suicide

2011-05-14T12:00:00.032-07:00

A coroner has linked an anti-smoking drug to the death of a television editor who killed himself.

Omer Jama, 39, who worked for Sky Sports, was found dead at his home two months after being prescribed Champix to help him quit smoking.

An inquest in Bolton was told that Mr Jama had slashed his wrists and stabbed himself in the thigh and stomach.
However, the coroner, Jennifer Leeming, said she could not record a verdict of suicide and instead recorded an open verdict.

She said: "For me to register that he took his own life I would have to be satisfied he did the act which led to his death and he knew what he was doing."

"On the evidence before me I cannot say that was the case."

She said that she would write to the European Medicines Agency (EMA), which has been monitoring Champix since it was authorised in the EU in September 2006, to register the death as an "adverse event."

Julie Evans, a forensic toxicology expert, told the inquest that traces of the drug in Mr Jama's blood did not indicate an overdose. But she said reports from the United States had recorded "suicidal" thoughts in patients.

She said: "There is a possibility he could have been influenced by the side effects of the drug."

The EMA, which licensed the drug, issued guidance on its active ingredient, varenicline, to doctors two months after Mr Jama's death last October.

It said "updated warnings" were needed to raise awareness of cases of suicide attempts reported in patients after the drug was allegedly linked to 37 US suicide cases.

Last year, the EMA received 839 reports of adverse reactions, of which 46 were linked to depression and 16 to patients claiming to have suffered suicidal thoughts.

His brother, Ali Jama, 41, said: "It is clear from the evidence of the toxicologist that Champix's influence could have played a part. I would like to see more investigation done."

A spokesman for Pfizer, the makers of Champix, said, no causal link had been established between the drug and depression.

He said: "Depression, rarely including suicidal ideation [suicidal thoughts], has been reported in patients undergoing a smoking cessation attempt. These symptoms have also been reported while quitting with varenicline. A relationship between varenicline and the reported symptoms hasn't been established but in some reports a link couldn't be excluded."

In February, the National Institute for Health and Clinical Excellence recommended that the drug should be prescribed to smokers wanting to kick their habit. However, it said the full side effects of Champix were not yet known.

ash.uk

Scientists Launch Major Study Into Depression

2011-05-14T12:00:00.031-07:00

Depression will affect up to 25% of the population at some point in their lives. It also has been shown to have a strong genetic component. For example, if one of your close family members has depression, your chance of also being a sufferer is three to four times the general population risk.

Now University of Aberdeen researchers have joined forces with the University of Liverpool and the Institute of Psychiatry, King's College London to try to find the genetic causes of depression.

They believe the answers could lie with short DNA sequences which act as 'genetic switches' controlling key genes in an area of the brain that influences mood.

These switches ensure that certain genes are only used in the correct parts of the brain at the proper times and in the right dose. Any changes in these can cause imbalances in the amount of critical proteins in the brain that may increase susceptibility to depression.

Unlike genes, little is know of these switches, technically known as enhancers, because up until now they have been very hard to find.

Recently, however, it was found that these switches were so important in evolution that they have been kept, nearly unchanged, through hundreds of millions of years from a time before the dinosaurs.

Dr Alasdair MacKenzie, Senior Lecturer at the University of Aberdeen, and the scientist leading the study, explained: "Only by comparing the genomes of species as diverse as mice, marsupials and birds has it been possible to identify these switches as, in many cases, they are located far away from the genes they control. The distances involved are as surprising as having a light bulb in London with the switch for controlling it in Liverpool."

Comparing the genomes of different species has helped them to identify the switches responsible for controlling genes known to be involved in depression, as well as addiction, obesity and inflammatory pain.

This new study funded by the Medical Research Council will allow them to build on their earlier work and also analyse common sequence differences found in the general population which can result in increased risk of developing depression.

Researchers in Aberdeen and Liverpool will study the functional effect of these 'switch' sequences. Scientists at the Institute of Psychiatry at King's, led by Dr Gerome Breen and Professor Peter McGuffin, will look at common variations found in these sequences using DNA samples taken from thousands of patients with chronic depression.

It is hoped the three year study - which will also examine why some sufferers do not respond to anti-depressant treatments - will ultimately pave the way for new drugs to treat the condition.

Dr Alasdair MacKenzie said: "This study would have been impossible even four years ago. It is only through advances in the sequencing of the DNA of many different species that we can now use powerful computers to pick out the most important bits of the human genome that includes the switches needed to control genes.

"In addition to depression, this technology has the potential for exploring the causes of a number of other disorders including chronic pain, obesity or even cancer."

Professor Quinn at the University of Liverpool said: "This study hopes to discover how the same genes in different people are controlled in slightly different ways in the parts of the brain that control fear and mood.

"We hope to link differences in the switches that control these genes with susceptibility to distressing conditions such as depression and chronic anxiety. Also, we hope to find out how these differences may change the way that depressed patients respond to their medicines."

Dr Breen, jointly leading the Institute of Psychiatry at King's involvement, said: "We can now analyse millions of genetic variations in the human genome but it is only studies like that that will allows us to track down those that are important in disorders such as depression."

Professor McGuffin added: "We are delighted to be part of such a potentially exciting project and look forward to our collaboration further enlightening clinical research and practice."

Notes

The University of Aberdeen is a centre of excellence for life sciences. Translational research is a particular strength for the University as its health campus is based on one of the largest teaching hospital sites in Europe. Lately the University has made major strategic investments to consolidate its position as one of the world's key centres for R&D in life sciences and medical research. One of the UK's most progressive fundraising higher education institutions, Aberdeen has recently recruited more than 50 senior academic leaders from institutions all over the world.

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.

Institute of Psychiatry

The Institute of Psychiatry is part of King's College London and closely affiliated to the South London and Maudsley NHS Foundation Trust. The Institute is a world-renowned centre for treatment, research and training in psychiatry and mental health. The organisation is involved in pioneering new and improved ways of understanding and treating mental illness and brain disease. Its wide-ranging field of work includes depression, trauma, eating disorders, brain imaging, genetics and psychosis. iop.kcl.ac.uk

King's College London is one of the top 25 universities in the world (Times Higher 2007) and the fourth oldest in England. A research-led university based in the heart of London, King's has 19,300 students from more than 130 countries, and 5,000 employees. King's has an outstanding reputation for providing world-class teaching and cutting-edge research. The College is in the top group of UK universities for research earnings and has an annual income of approximately ??400 million. An investment of ??500 million has been made in the redevelopment of its estate.

Institute of Psychiatry

Linkages Between Serotonin Reuptake Inhibitors And Bone Mass Found By Forsyth Scientists

2011-05-14T12:00:00.030-07:00

Scientists at The Forsyth Institute have found that fluoxetine (Prozac), a drug used in the treatment of depression and obsessive-compulsive disorders, increases bone mass. The team of researchers analyzed the ability of fluoxetine to stimulate new bone formation under normal conditions and to block bone loss caused by inflammation or estrogen loss due to ovariectomy. They found that the antidepressant induced the formation of new bone under normal conditions and reversed total bone loss triggered by inflammation.

Bone destruction is characteristic of several chronic inflammatory diseases including rheumatoid arthritis and gum disease. Previous research has shown a correlation between the serotonin transporter -- serotonin is the chemical substance involved in transmitting signals between neurons and which plays a role in anxiety and mood disorders-- and bone destructive cells (osteoclasts). (Fluoxetine is a serotonin reuptake inhibitor (SSRIs).) However, it was not clear what role serotonin played in bone metabolism.

Summary of Study

Trabecular bone, one of two main types of bone, is spongy, and makes up the bulk of the interior of most bones, including the vertebrae. After a six-week treatment with fluoxetine, laboratory mice showed increased trabecular bone volume and total volume in femurs and vertebrae as determined by micro-computed tomography. Fluoxetine-treated animals were not protected from bone loss after ovariectomy, suggesting that its anabolic effect requires the presence of estrogen. The effect on bone loss was also investigated following a bacterial-mediated inflammatory challenge. Injections of lipopolysaccharide (LPS), a component of the membrane of certain strains of bacteria, resulted in an increased number of osteoclasts and net bone loss. However, LPS given with fluoxetine caused new bone formation and a net gain in bone mass. The study concluded that fluoxetine treatment in vivo leads to increased bone mass under normal physiological conditions or inflammatory conditions, but does not prevent bone loss associated with estrogen deficiency.

This research, which will be published in the next issue of the Journal of Cellular Biochemistry, currently available online, was led by Ricardo Battaglino, PhD, Assistant Member of the Staff in the Department of Cytokine Biology at The Forsyth Institute.

"As this class of medication is widely prescribed and used across all age groups, the consequences of the relationship between these drugs and bone metabolism may be very relevant to public health. This work will help us learn more about the underlying causes of osteoporosis and gain a new understanding of bone formation at a molecular level," said Dr. Battaglino. "Furthermore, this research provides exciting clues on how to prevent destructive bone loss and even improve bone mass in certain medical/dental conditions."

The research was funded in part by a grant from the National Institute of Dental and Craniofacial Research. This work was done in collaboration with Ralph Mueller, Ph.D., SNF Professor of Bioengineering at the Institute for Biomedical Engineering University and Swiss Federal Institute of Technology (ETH) in Zurich, Switzerland whose laboratory analyzed changes in bone microarchitecture in response to fluoxetine treatment. Other contributors included Dr. Dana Graves, Boston University School of Dental Medicine, and Dr. Philip Stashenko, Dept. of Cytokine Biology, Forsyth.

The Forsyth Institute is the world's leading independent organization dedicated to scientific research and education in oral, craniofacial and related biomedical sciences.

Contact: Jennifer Kelly

Forsyth Institute

View drug information on Prozac Weekly.

Unexpected Side Effect: Makes You Happier

2011-05-14T12:00:00.029-07:00

In a study published in The Journals of Gerontology (Medical Sciences), researchers found that a brain fitness program measured initially for its impact on cognitive abilities in older adults also had a significant beneficial impact on symptoms of depression.

The findings are part of an ongoing study of older Americans funded by the National Institutes of Health and known as the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study. With 2,832 participants, the ACTIVE study is the largest community-based multi-site randomized controlled trial ever conducted that focuses on maintaining or improving cognitive abilities of older people.

The ACTIVE study randomly assigned participants to four groups: one group did computerized brain exercises, a second group took classes in memory strategies, a third group took classes in reasoning and a fourth group served as a control that engaged in no special activity. Groups that did an activity engaged in the activity for a total of 10 hours. Participants completed those activities by October 1999, and their outcomes have continued to be tracked and published in follow-up reports.

While earlier reporting on the study was on primary measures of cognition and secondary measures of quality of life, this new report on 2,036 participants is the first to focus on secondary measures of how cognitive training affects mood.

Researchers found that participants in the study who engaged in the computerized brain exercises, which were designed to improve visual speed, accuracy and expanse of processing, had significantly better outcomes in key measures related to mood in one-year and five-year follow-ups. Participants in the other three groups did not have similar beneficial outcomes on this measure.

The study used a standard measure of depression known as the CES-D-12, a 12-item scale for depressive symptoms from the Center for Epidemiological Studies. Researchers found that only study participants who used the computer-based brain exercises received some protection against worsening depressive symptoms as compared against the control group. In fact, those who used the computer-based exercises were 30% less at risk than the other groups.

Researchers hypothesized two possible reasons why the brain exercise group was less susceptible to worsening depressive symptoms. First, they observed that the group had experienced an increase in brain processing speed and other quality of life measures that may have made their day to day experiences more positive. Second, they observed that the attentional demands and rewards and the procedural learning requirements of the computer program may have stimulated the chemical system or other parts of the brain that affect mood.

"Earlier findings have shown that these particular brain exercises improve speed of processing, health related quality of life and ability to engage in activities required for independent living," said Fred Wolinsky, PhD of the University of Iowa, the lead author on this study. "This study is important because it shows that a relatively small amount of the right kind of brain fitness training can change the trajectory of aging, even five years later, by helping people experience a happier life. In the end, that's really what we all want for ourselves and our loved ones."

The training used in the study is now commercially available for the first time as part of the InSight brain fitness program from Posit Science. Posit Science distributes its programs to the public through its website, through national insurers and through hundreds of classes at retirement communities, senior centers and adult education programs.

About Posit Science:

Posit Science is the leading provider of clinically validated brain fitness programs. The company works with more than 50 scientists from prestigious universities to design and test its computer-based programs. More than 30 published peer reviewed papers show that in randomized controlled trials the company's patented technologies significantly increase processing speed, improve memory and attention, and enhance the quality of everyday life. While such benefits have been shown across groups in studies, individual results will vary, and Posit Science makes no claims with respect to the prevention or treatment of disease. Posit Science has received grants from the National Institutes of Health and has received numerous awards and accolades. The company's products, scientists and science are currently featured in the PBS documentaries "The Brain Fitness Program" and "Brain Fitness 2: Sight and Sound." In addition to being sold direct to consumer via the company's website, its products are distributed without charge to policyholders by leading health, long term care and auto insurers, are sold by hundreds of authorized providers and are used in hundreds of daily classes at retirement communities, adult education programs and hospitals.

Posit Science

PositScience

Knee Arthritis Symptoms In Older Adults Adversely Affected By Depression

2011-05-14T12:00:00.028-07:00

Clinical depression can exacerbate the symptoms of knee arthritis beyond what is evident on X-rays, according to a new study from the Journal of Bone and Joint Surgery (JBJS). Patients with mild to moderate knee arthritis are especially affected by depression, the study notes.

"Knee osteoarthritis is a common cause of pain and impairment in older adults," said Tae Kyun Kim, MD, study author and director of the Division of Knee Surgery and Sports Medicine at Seoul National University Bundang Hospital's Joint Reconstruction Center. "Often, the level of arthritic symptoms reported by patients is much more severe than what is represented by X-rays, which can make it difficult for the doctor to treat.

"The results of this study indicate that depression can play a major role in the way patients experience the symptoms of knee arthritis, and that even when X-rays show the arthritis is not severe, patients with depression may report significant pain," Dr. Kim said. "The relationship between pain and depression suggests that both should be considered by physicians when treating patients with knee osteoarthritis, particularly in those with X-rays not indicating severe damage to the joint."

The study included 660 men and women aged 65 years or older who were evaluated for the severity of their knee arthritis on X-rays, as well as symptom severity. Patient interviews and questionnaires were used to assess coincident depressive disorders. The study was conducted as a part of the Korean Longitudinal Study on Health and Aging (KLoSHA).

As expected, the researchers found the levels of pain attributed to knee arthritis were higher in patients whose X-rays indicated greater joint damage; however, they also found depressive disorders were associated with an increase in pain in patients with mild to moderate knee arthritis, even when X-rays did not show significant joint damage.

"When evaluating the results of this study, the contribution of depression to knee osteoarthritis symptoms was almost as important as the damage indicated on X-rays," Dr. Kim noted.

Knee arthritis typically affects men and women over 50 years of age, and occurs most frequently in people who are overweight. Common symptoms include:
pain or stiffness in or around the knee;
swelling of the knee;
limited range of motion when walking or moving the knee; or
knee weakness or a feeling of instability.

In more severe cases, the knee joint may appear deformed, such as bowlegged or knock-kneed appearance, either bulging outward or toward the side of the leg. Knee replacement surgery is often performed in patients with severe symptoms.

Although studies have indicated depression is not uncommon among older adults, it remains largely underdiagnosed. According to the National Institute of Mental Health (NIMH):
The risk of depression increases with other illnesses and when ability to function becomes limited.
Estimates of major depression in older people range from 1 percent to 5 percent among those living in the community, to as high as 11.5 percent in hospital patients and 13.5 percent in those who require home healthcare.
An estimated 5 million older adults have mild depression, which is often undiagnosed. Symptoms of depression may include:
feelings of sadness or hopelessness;
loss of interest in activities that were once enjoyed;
change in appetite or sleep patterns;
difficulty thinking and remembering; or
frequent thoughts of death or dying.

"Despite the reported satisfactory outcomes of knee replacement surgery a percentage of patients still experience knee pain and impaired movement," said Dr. Kim said. "Sometimes pain and disability after surgery is medically unexplained, so in these patients screening for depression might be a very good option."

Disclosure:
In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from Pfizer Global Pharmaceuticals (Grant No. 06-05-039) and Seongnam City Government in Korea (Grant No. 800-20050211). Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Sex and drug use increase teen suicide risk

2011-05-14T12:00:00.027-07:00

Teens who engage in high-risk behaviors involving sex and drugs have significantly higher odds of depression, suicidal thoughts and suicide attempts than teens who say no to sex and drugs, according to a study.

"These results suggest that healthcare professionals who identify adolescent patients reporting sexual intercourse or drug use should strongly consider screening for depression and risk of suicide," says study author Denise D. Hallfors, Ph.D., a Senior Research Scientist at the Pacific Institute for Research and Evaluation in Chapel Hill, North Carolina.

Adolescents are no strangers to the phenomena of depression and suicide. Previous research found 28 percent of U.S. high school students experienced severe depression, and the third leading cause of death for 15- to 19-year-olds is suicide. Suicide death rates among 15- to 19-year-olds doubled between 1960 and 2001, according to the study.

Hallfors and colleagues analyzed various sex and drug behavior patterns via data from a survey of nearly 19,000 teens in grades 7 through 12. The data were gathered in the mid-1990s from 132 U.S. schools as part of the National Longitudinal Study of Adolescent Health.

The researchers clustered the teens in 16 groups according to their behaviors. Groups included the abstainers, who eschewed sex and drugs; sex dabblers; alcohol and sex dabblers; teens with multiple sexual partners; and illegal drug users.

Abstainers had the lowest levels of depression, suicidal thoughts and suicide attempts, while teens in groups associated with sex and drugs, and heavy use of illegal drugs such as marijuana had the highest levels. In between were the dabblers in sex, drugs, alcohol and tobacco.

The results appear in the current issue of the American Journal of Preventive Medicine.

The researchers found girls less likely than boys to pursue high-risk behaviors, but girls who did were more vulnerable than boys to the constellation of depression, suicidal thoughts and suicide attempts.

Another interesting finding involved the association of socioeconomic status with depression. While higher socioeconomic status reduced the likelihood of depression by about half, it increased the risk of suicidal thoughts. Hallfors and colleagues call for more research to examine this phenomenon.

Further research is needed to understand which comes first: sex and drugs or poor mental health. But until then, Hallfors and colleagues advise healthcare professionals to screen all teens for sexual behaviors and drug use. Those who engage in such behaviors-especially those who do more than dabble in them-should be screened for depression and suicide risk also.

"It is particularly important not to miss opportunities to diagnose depression because effective treatments are available, or to overlook suicide risk because suicide can be prevented," Hallfors says.

Funding for the study was from the National Institute of Drug Abuse.

FOR MORE INFORMATION:

Health Behavior News Service: (202) 387-2829 or hbns.

Interviews: Contact Denise Hallfors, PhD, (919) 265-2600 or e-mail HallforsPIRE.

American Journal of Preventive Medicine: Contact the editorial office at (858) 457-7292.

Center for the Advancement of Health

Contact: Ira R. Allen

Director of Public Affairs

202.387.2829

presscfah

Caregiver Support Key To Improved Health, Fewer Nursing Home Placements, Jefferson Researchers Find

2011-05-14T12:00:00.026-07:00

Helping caregivers take care of themselves is key to enabling them to better deal with family members with dementia, a recent study by Thomas Jefferson University researchers shows. In fact, those caregivers who were provided extra, individualized support had less depression and were able to keep family members in adult day services - and out of nursing homes - much longer than those who did not get the extra attention.

According to Laura N. Gitlin, PhD, director of the Center for Applied Research on Aging and Health (CARAH) at Thomas Jefferson University in Philadelphia - who led the study in conjunction with Karen Reever, former executive director of Mid County Senior Services in Newtown Square, PA - one goal of adult day services (ADS) is to reduce nursing home placements. Families caring for older adults with impairment often use ADS, where their family members can receive meals and participate in therapeutic activities throughout the day. Some ADS centers offer some support for family members in the form of education workshops, but there is no systematic approach to offering caregiver support.

"Research shows that family members who use adult day services often still experience depression and feel burdened because, despite the respite that ADS offers, the caregiver still does the bulk of the work," says Dr. Gitlin. This burden of work can lead to caregiver burn-out, which often results in the need to place the older adult in a nursing home.

Dr. Gitlin and Ms. Reever, along with a team of service providers wanted to see whether providing systematic care management for the family caregiver as part of the daycare service would benefit the patient and family. They looked at three adult day service centers, with two of the centers offering the Adult Day Services Plus (ADS Plus) program, which involved extra services for caregivers. "We worked with Mid County to design and evaluate a program that would be cost-efficient by building on the existing ADS staff," explains Dr. Gitlin. Caregivers were interviewed at the time of registering for adult day services, and their own needs were assessed. Services were tailored for the individual needs of caregivers.

Such services included targeted education, referral for counseling or other services, strategies for caring for oneself, and strategies for managing complex problematic behaviors, such as resistance to care, verbal abuse, and agitation due to confusion.

The findings, reported in The Gerontologist, "were positive and immediate," says Dr. Gitlin. "The caregivers appreciated that they could always call or see the social worker at the adult day center. They said that the program offered them 'a safety net' and shared comments such as 'you were there for me' and 'I felt comforted.' There was an increase in caregiver confidence in managing problematic behaviors and less depression. The care manager succeeded in introducing effective strategies and addressing the caregivers' own needs.

"It will behoove adult day services to pay more systematic attention to the needs of family caregivers as a way to further support the impaired older adult," says Dr. Gitlin.

The study also found that nursing home placement dropped and ADS use increased in those families that received the ADS Plus program. "Older adults are generally in adult daycare for a short time, maybe as a last step before the family finds they need to place their loved one in a nursing home," explains Dr. Gitlin. "A major finding of this study was that over time, participants who received the ADS Plus program used 37 more days of ADS than those without it. As a result, twice the number of patients in the control group entered a nursing home compared to those in the study groups. Increased use of the ADS centers yields enhanced quality of life for both the caregiver and the patient, and it also means increased revenue for the center itself."

The next steps for this research will involve a larger multi-site research demonstration project. "We want to find out if the ADS Plus Program can work in settings that service different families from diverse socioeconomic and cultural backgrounds," says Dr. Gitlin. "There is national interest in exploring these issues. Implementing the ADS Plus program in existing adult day services would not take much effort. "The costs include brief training of existing staff and reshuffling staff hours to enable a systematic approach to working with the family caregiver. After an initial assessment of the family caregiver, most contact can occur by telephone, at the time the family caregiver drops off their family member at the center or via mail. It would require little training and resources to have a great impact."

Contact: Steve Benowitz

Thomas Jefferson University

First Study To Show That Highly Variable Sleep Schedules Predict Elevated Suicide Risk

2011-05-14T12:00:00.025-07:00

Highly variable sleep schedules predict an elevated risk for suicide independent of depression in actively suicidal young adults, according to a research abstract presented Tuesday, June 8, 2010, in San Antonio, Texas, at SLEEP 2010, the 24th annual meeting of the Associated Professional Sleep Societies LLC.

Results indicate that a sample of actively suicidal undergraduate students had a delayed mean bedtime of 2:08 a.m.; restricted total sleep time of 6.3 hours; and highly variable sleep schedules, with time of mean sleep onset varying by three hours and time of sleep offset varying by 2.8 hours. However, accounting for baseline depression severity, sleep variability was the only sleep measurement to individually predict increases in suicidal risk at one week and three weeks. Sleep irregularity also was the only sleep-related variable to predict greater mood lability, which in turn predicted elevated suicidal symptoms.

"To our knowledge, this is the first study to evaluate the unique association between sleep and suicide risk using an objective assessment of sleep and a prospective study design," said principal investigator Rebecca Bernert, PhD, Fellow in the Department of Psychiatry and Behavioral Sciences at Stanford University. "We found that a high degree of irregularity in sleep predicted increases in suicidal symptoms, conferring risk above and beyond the influence of depression. Given that the relationship between sleep disturbances and suicide appears to exist independent of depressed mood, we propose that sleep disturbances may instead confer risk via impaired mood regulation and increased mood lability."

The three-week study was conducted at the Florida State University Laboratory for the Study of the Psychology and Neurobiology of Mood Disorders, Suicide, and Related Conditions. Bernert and laboratory director Thomas Joiner, PhD, studied 49 actively suicidal undergraduate students between the ages of 19 and 23 years; 71 percent were female.

Symptom severity was assessed at baseline, one week and three weeks using the Beck Depression Inventory and Beck Scale for Suicide. Sleep data were obtained by wrist actigraphy for one week, and sleep variability was calculated as the standard deviation of sleep onsets and offsets, summed. Mood lability was evaluated across the same timeframe using daily visual analogue scale mood ratings.

According to Bernert, identifying sleep irregularity as a stand-alone risk factor for suicidal ideation could have important clinical implications.

"Compared to other suicide risk factors such as a past suicide attempt, disturbed sleep is modifiable, often visible and amenable to treatment," she said. "In this way, the study of sleep may inform suicide risk assessment and represent a clinically unique opportunity for intervention."

In 2007 Bernert and Joiner published a review of the literature on sleep disturbances and suicide risk in the journal Neuropsychiatric Disease and Treatment. Among several theories, underlying neurobiological factors such as serotonergic neurotransmission were proposed to play a role in the relationship between sleep and suicide, although this has yet to be tested.

The study was supported by a National Research Service Award from the National Institutes of Health.

Common Mental Disorders May Be More Common Than We Think

2011-05-14T12:00:00.024-07:00

The prevalence of anxiety, depression and substance dependency may be twice as high as the mental health community has been led to believe.

It depends on how one goes about measuring.

Duke University psychologists Terrie Moffitt and Avshalom Caspi and colleagues from the United Kingdom and New Zealand used a long-term tracking study of more than 1,000 New Zealanders from birth to age 32 to reach the conclusion that people vastly underreport the amount of mental illness they've suffered when asked to recall their history years after the fact.

But such self-reporting from memory is the basis of much of what we know about the prevalence of anxiety, depression, alcohol dependence and marijuana dependence. Longitudinal studies like the Dunedin Study in New Zealand that track people over time are rare and expensive, Moffitt said.

"If you start with a group of children and follow them their whole lives, sooner or later almost everybody will experience one of these disorders," said Moffitt, the Knut Schmitt-Nielsen professor of psychology and neuroscience at Duke.

The Great Smoky Mountains Study, a similar effort based at Duke, has tracked 1,400 American children from age 9-13 into their late 20s and found similar patterns, said Jane Costello, a professor medical psychology at Duke who runs the study.

"I think we've got to get used to the idea that mental illness is actually very common," Costello said. "People are growing up impaired, untreated and not functioning to their full capacity because we've ignored it."

The prevalence of mental illness has been hotly debated by policy makers and mental health providers for many years. The pharmaceutical and health insurance industries also have a stake in the debate, Moffitt said.

The best retrospective studies, the US National Comorbidity Surveys (NCS) and the New Zealand Mental Health Survey, have found the incidence of depression from ages 18 to 32 at a rate of about 18 percent. But they have been roundly criticized by some for their rates being too high. The latest analysis from the Dunedin Study found 41 percent of that age range had experienced clinically significant depression.

Similarly, the survey studies have reported a 6 to 17 percent lifetime rate of alcohol dependence between ages 18-32, versus nearly 32 percent in the Dunedin Study.

Guidelines published by the American Psychiatric Association that set the bar for defining what is and isn't a treatable illness are currently being revised by a rewriting of the authoritative Diagnostic and Statistical Manual of Mental Disorders (DSM). But given the findings of these longitudinal studies, the stringency of the diagnostic criteria might need to be reconsidered, said Moffitt, who is on the committee writing the new DSM-Vstandards.

"Researchers might begin to ask why so many people experience a disorder at least once during their lifetimes and what this means for the way we define mental health, deliver services and count the economic burdens of mental illness," Moffitt said.

On the one hand, it could be argued that the diagnostic standards have been set too low if so many people can be considered mentally ill. On the other hand, perhaps these findings argue for more and better mental health care because the disorders are more common than anyone had realized.

"There are two opposing camps, and I'm agnostic about that," Moffitt said.

At the very least, maybe these findings can help reduce the stigma against mental illness and mental health care, Moffitt added. New Zealand, for example, has begun a new campaign of public service announcements featuring sports heroes saying they've experienced mental health issues.

"If we're serious about this problem, we need to get serious about preventing it," Costello added. "We do know a lot more about prevention now."

Moffitt and Caspi's findings from the Dunedin Study appear online in the journal Psychological Medicine. Their work was supported by the New Zealand Health Research Council, the US National Institutes of Health and the UK Medical Research Council.

CQ's Carey Discusses SCHIP, Mental Health Parity, Postpartum Depression Bills

2011-05-14T12:00:00.023-07:00

Mary Agnes Carey, associate editor of CQ HealthBeat, discusses House Democrats' failure to override President Bush's veto of SCHIP legislation, a House mental health parity bill and legislation that would expand postpartum depression research in this week's "Health on the Hill from kaisernetwork and CQ."

House Democrats fell 13 votes short of the two-thirds majority needed to override the veto of legislation that would have reauthorized and expanded SCHIP. According to Carey, Democrats plan to send another SCHIP proposal to Bush within the next two weeks, but they have said that they will not compromise on the number of children who would be covered under an expansion of the program or on funding SCHIP with a 61-cent-per-pack increase in the federal cigarette tax. Democrats also intend to continue seeking more Republican votes to gain the two-thirds majority, Carey says. She adds that House and Senate Republicans have offered an alternative SCHIP measure that would increase funding for the program by $11 billion over five years. Under the measure, states would be required to prove that they have covered 90% of eligible children in families earning up to 200% of the federal poverty level before expanding coverage to children in families with incomes up to 250% of the poverty level. Bush administration officials said they plan to meet with Democrats to discuss an SCHIP compromise, according to Carey.

Carey also discusses the House Energy and Commerce Committee's recent approval of mental health parity legislation. The bill now will head to the House floor, where it is expected to pass. According to Carey, the House version of the bill would require insurers to cover more mental health services than the Senate bill, which likely will create difficulties when it comes to reconciling the two bills. The Bush administration, business groups and many in the mental health community oppose the House's expansion of coverage.

In addition, Carey discusses legislation passed by the House that would direct NIH to expand research initiatives and increase public awareness of postpartum depression. The bill would require basic research into the causes of the condition and the development of improved screening and diagnostic techniques, as well as information and education programs for health care professionals and the public. The measure also calls for a study that would explore the mental health consequences of pregnancy outcomes, including abortion, Carey says (Carey, "Health on the Hill from kaisernetwork and CQ," 10/22).

The complete audio version of "Health on the Hill," transcript and resources for further research are available online at kaisernetwork.

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© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Cedars-Sinai Studying Whether Omega-3 Fatty Acids Can Help Depression

2011-05-14T12:00:00.022-07:00

Researchers at Cedars-Sinai Medical Center's Department of Psychiatry and Behavioral Neurosciences are seeking participants for a clinical trial examining whether two polyunsaturated Omega-3 fatty acids are effective treatments for depression.

The two fatty acids being studied -- docosahexanoic acid (DHA) and eicosapentanoic acid (EPA) -- are found naturally in fish oil, flaxseed and walnuts. Previous studies have indicated that nutritional supplements that contain Omega-3 fatty acids can be an effective treatment for depression, but this is the first to systematically test the two specific fatty acids against each other and against placebo in a large sample of people with major depression. DHA and EPA have anti-inflammatory properties and help stabilize brain cell membranes, both of which play a role in mood regulation.

The National Institutes of Health (NIH)-sponsored study, held in collaboration with Massachusetts General Hospital, will recruit a total of 300 adults ages 18-80 who are experiencing significant symptoms of major depressive disorder and are in good health. The five-year study is designed to test the safety, effectiveness and tolerability of DHA and EPA against each other and a placebo. Participants will receive one of the two drugs or a placebo for eight weeks in a randomized, double-blind manner.

Major depression affects at least 15 percent of the adult population. Unlike normal emotional experiences of sadness, loss or passing mood states, major depression is persistent and can significantly interfere with an individual's thoughts, behavior and physical health. While it can be effectively treated, it is a leading cause of disability in the U.S. and in many other countries.

The Cedars-Sinai team, lead by principal investigator and department chair Mark Hyman Rapaport, M.D., will examine the effect of the therapies on participants' symptoms, quality of life and psychosocial function. They will also examine how fatty acids in the blood and proteins involved in immune function are affected by Omega-3s. Participants will receive free and confidential evaluation and treatment as part of the study. No healthcare insurance is required. A comprehensive medical evaluation - including physical examination, laboratory tests and EKG - may be provided at no charge.

"The reported side effects of Omega-3 treatments have been mild and include upset stomach and a fishy taste in the mouth. There do not appear to be risks to the liver or adverse interactions with most other medications," said Rapaport, though he added that people who have bleeding disorders or who are taking blood thinners should not use Omega-3 fatty acids. "This study is one of several investigations of alternative and complementary medicine that our department has pursued over the past decade. Expanding our psychiatry studies to include natural treatments has shown promising benefits to patients suffering from a variety of mental illnesses."

One of only 10 hospitals in California whose nurses have been honored with the prestigious Magnet designation, Cedars-Sinai Medical Center is one of the largest nonprofit academic medical centers in the Western United States. For 19 consecutive years, it has been named Los Angeles' most preferred hospital for all health needs in an independent survey of area residents. Cedars-Sinai is internationally renowned for its diagnostic and treatment capabilities and its broad spectrum of programs and services, as well as breakthroughs in biomedical research and superlative medical education. It ranks among the top 10 non-university hospitals in the nation for its research activities and its human research protection program is fully accredited by the Association for the Accreditation of Human Research Protection Programs, Inc. (AAHRPP).

Cedars-Sinai Medical Center

Major Depressive Disorder Guidelines Issued By American Psychiatric Association

2011-05-14T12:00:00.021-07:00

The new guidelines for major depressive disorder by the American Psychiatric Association (APA) are an update on the last ones issued in 2000, they include recommendations on electro-convulsive therapy and other somatic treatments, antidepressant drugs, psychotherapies and new evidence based therapies. The APA says its new guidelines also addresses alterative and complementary therapies, treatment approaches for depression in pregnant mothers, and recommendations for depression cases that do not respond to treatment.

Alan J. Gelenberg, M.D., chair of the work group that prepared the guidelines, said:

The five-year process of intense review, discussion and thoughtful revision-making has led us to
today's release of new guidelines that we believe will improve patient care. We are hopeful these
guidelines will lead to improved lives for many patients.

The APA informs that the 100-member group which drafted the guidelines consisted of clinical experts in the treatment and assessment of major depressive disorder, patient advocacy groups and APA members. They examined more than 13,000 peer-reviewed articles that had been published since 1999, the cut-off point for the previous guidelines, to 2006.

The new guidelines include the following key changes:

Rating scales - a doctor- and/or patient-administered rating scale should be used to assess the type, frequency, and severity of psychiatric symptoms so that treatment can be tailored to match patient needs.
Treatment-resistant depression - electroconvulsive therapy has compelling evidence in its favor as treatment for individuals who have not responded to several medication trials. Additional potential treatments include vagus nerve stimulation and transcranial magnetic stimulation. Another option may also be the administration of MAOIs (monoamine oxidase inhibitors).
Physical activity - aerobic exercise and/or resistance training have, according to randomized and controlled trials provided modest improvement in mood symptoms. Depressive symptoms rates in the general population may also be brought down through regular exercise; especially among elderly individuals and patients who also have other medical problems.
Stronger maintenance treatment - patients who have risk factors for recurrence should receive stronger maintenance treatment (after continuation phase). Patients with chronic illness, as well as those who have had at least three previous depressive episodes should receive maintenance treatment.

Major Depressive Disorder
The symptoms of Major Depression or Major Depressive Disorder can seriously affect the patient's family and personal relationships, as well as work and/or school life. The impact can eventually affect the individual's physical health. The effect on functioning and well-being can be as debilitating as diabetes or other serious chronic conditions, say experts.
An individual who has a major depressive episode may:

Have a very low mood which spreads through all aspects of their life
Find it extremely difficult to enjoy activities which used to be pleasurable
Have continuous feelings and thoughts of worthlessness, exaggerated or inappropriate guilt, helplessness and self-hatred.
There may be symptoms of psychosis in very severe cases
Find it hard to concentrate and focus on things
Those with melancholic or psychotic features may have memory problems
Have a reduced libido (sex drive)
Withdraw from social situations and activities
Have thoughts of suicide and/or death
Fatigue, headaches and digestive problems may also be exhibited

A significant number of individuals with major depressive disorder suffer from insomnia - according to the NIH (National Institutes of Health), 4 in every 5 people with depression have insomnia. In some cases the problem may be oversleeping - hypersomnia.

New Mothers Should Be Screened Regularly For Postpartum Depression

2011-05-14T12:00:00.020-07:00

Physicians should screen mothers for postpartum depression regularly for at least a year following childbirth to better identify women who develop symptoms throughout the year and those whose depression persists, University of Rochester Medical Center researchers say.

"If you only screen early or if you only screen once, you will miss some," said Linda Chaudron, M.D., an assistant professor of psychiatry, pediatrics and obstetrics and gynecology at the Medical Center who is leading a series of studies focusing on postpartum depression.

In a recent analysis of records from a pediatric clinic that uses a common postpartum questionnaire to screen mothers, Chaudron and the research group found that of women who scored high on a depression screening scale sometime in the postpartum year, 26 percent did not develop high symptom levels of postpartum depression until after three months and that 33 percent had high levels throughout the year. The results of the study are published in the July/August issue of the journal Ambulatory Pediatrics.

"I was surprised at the high percentage of women who continued to be depressed throughout the year," Chaudron said.

Earlier this year, New Jersey Governor Jon S. Corzine signed legislation requiring health care professionals providing postnatal care to screen new mothers for postpartum depression, and requiring health care professionals to educate women and their families about the disorder. Health care providers in several other states have adopted similar screening programs.

"With the increased attention to screening, we ought to have a better idea about when to screen," Chaudron said. "There are a lot more women we need to be thinking about, identifying and helping get treatment."

Pediatricians and other physicians who refer mothers for treatment of depression also can help track how mothers are doing, even if they are in treatment.

"They should find out how the mother is doing and whether she is receiving the proper treatment," Chaudron said.

The study reported in Ambulatory Pediatrics was limited. The records covered only 49 mothers. But Chaudron said the report highlighted that women can develop new symptoms later in the year and can continue to have symptoms for many months.

According to the American Psychiatric Association, symptoms of postpartum depression include sadness, sluggishness, fatigue, feelings of hopelessness, disturbances of sleep or appetite, lack of interest in the baby, uncontrollable crying, mood swings and fear of harming the baby. Many mothers also report significant anxiety. Postpartum depression is different from "baby blues," a mild, short-lived depression that many women experience in the first few days or weeks following childbirth. Postpartum depression affects one in eight women and lasts more than two weeks. It can interfere with daily living for a longer period of time.

Medication and talk therapy are effective treatments for postpartum depression. "Support groups also can decrease the isolation and stigma that depressed mothers can feel," Chaudron said.

Understanding postpartum depression is critical to improving care for mothers and infants. Chaudron and her colleagues currently are conducting a variety of studies, including looking at the course of postpartum depression, exploring the relationship between postpartum depression and anxiety, and investigating the use of an antidepressant for the treatment of postpartum depression.

The National Institute of Mental Health funded the reported study and is supporting other postpartum studies by Chaudron. She also has funding from the Obsessive-Compulsive Foundation and Forest Laboratories Inc.

Contact: Michael Wentzel

University of Rochester Medical Center

In Spain Almost 1 Quarter Of Women Take Antidepressants

2011-05-14T12:00:00.019-07:00

Psychopharmaceutical use has risen over recent years. This is fact, but what is not clear is the reason why. Researchers from four Madrid-based health centres have shown that family conflict is not a significant factor. However, the results published in the journal Atenci??n Primaria are striking: in Spain, 24% of women take antidepressants and more than 30% take tranquillisers.

"The use of psychopharmaceuticals is often related to family or work-related problems. We wanted to see if there was actually a positive link between the consumption of antidepressants and benzodiazepines and any kind of family dysfunction", Sonsoles P?©rez, lead author of the study published in the renowned journal Atenci??n Primaria, and a doctor at the Las ??guilas Health Centre in Madrid, tells SINC.

The authors studied 121 women aged between 25 and 65, using family dysfunction surveys (the Apgar test), and the additive scale used to evaluate social readjustment (SLE). The psychopharmaceuticals analysed were antidepressants and benzodiazepines (anxiolytics such as lorazepam and bromazepam).

"Although one might think that family conflicts lead to greater consumption of psychopharmaceuticals among women, we did not find any such relationship", the researcher says, adding that the use of such drugs depends a lot on the population segment taking them. "Some people with family, work-related or financial problems do not feel able to tackle their problems and fall back on the use of drugs", P?©rez points out.

The results show that 24% of women in Spain use antidepressants and 30.6%, benzodiazepines, which are sometimes also used to help people sleep. In 78.6% of cases, these drugs are prescribed in primary health centres. The diagnosis is recorded in the patient's medical records in 64.5% of cases, with the primary causes being depression (11.6%), anxiety (9.9%) and insomnia (3.3%).

The scientists also found that benzodiazepine use increases with age. However, they did not find the same with antidepressant use. "We think that greater training is needed in identifying SLE and family dysfunction, and recording these in patients' records in order to help psychologists, psychiatrists and primary healthcare specialists", P?©rez concludes.

How is family conflict measured?

The relationship between the use of psychopharmaceuticals and family dysfunction has not been well studied. In order to gain a better understanding of family impacts on healthcare, and the effects of this illness on the family, the experts use numerical family functioning scales, such as the Apgar family test and the Stressful Life Events scale (SLE).

The first of these, developed in 1978 by Gabriel Smilkstein, allows measurements to be made of the functional health of a family using parameters such as adaptability (family resources for problem solving), participation (cooperation of family members), growth gradient (physical, emotional and social maturity on the basis of mutual support), affection (caring and loving relationships between members of the family group), and resolution (time-sharing and provision of resources to support all members of the family).

SLEs, events that the patient has suffered over the past year, act as triggers causing suffering and stress, and cause emotional problems in the individual and the family, such as the death of a partner, separation, imprisonment, being fired and unemployment. Each event is assigned a score based on its severity of between 100 (the most serious event), and 11 (the least serious). Patients are classified as high risk (with a score of 4,300), mid-risk (300-199), and low risk (less than 199).

References:

Sonsoles P?©rez Cuadrado, Cristina Mor??n Tiesta, Pilar Carre?±o Freire, Teresa Su??rez Del Villar Acebal, Estefan?a C??mara Sola y Yolanda Beatriz S??nchez Fern??ndez. "Consumo de psicof??rmacos y disfunci??n familiar". Atenci??n Primaria; 41(3):153-157 marzo de 2009.

Biovail Receives Canadian Approval For Wellbutrin(R) XL For The Prevention Of Seasonal Major Depressive Illness

2011-05-14T12:00:00.018-07:00

Biovail Corporation (NYSE: BVF) (TSX: BVF) announced that it has received a Notice of Compliance from the Therapeutic Products Directorate (TPD) for its supplemental New Drug Submission (sNDS) for a new indication for Wellbutrin® XL in Canada - the prevention of major depressive illness with an autumn-winter seasonal pattern.

The approval of Wellbutrin® XL for this indication represents a significant milestone for Biovail and for Canadian healthcare, as it represents the first time in Canada that a medication has received an indication for the prevention of this type of major depressive illness. Many patients with major depressive disorder have a seasonal pattern to their disease. For the first time, their physicians will have the option to prescribe an agent specifically indicated to prevent their seasonal major depressive episodes.

"Seasonal major depressive illness is a serious and often under-diagnosed type of depression," says Scott Smith, Vice-President and General Manager of Biovail Pharmaceuticals Canada (BPC), the Canadian sales and marketing division of the Company, that will introduce this new indication to Canadian health care professionals in 2008. "The approval of Wellbutrin® XL as a prevention for this type of depression offers new hope to patients who dread the onset of winter, and the episodes of major depression that often come with it."

"Physicians who already appreciate the unique combination of first-line efficacy with low incidence of sexual dysfunction and weight gain offered by Wellbutrin® XL, will have a new reason to choose it for their patients."

The approval of Wellbutrin® XL in seasonal major depressive illness represents Biovail's third Notice of Compliance in the past six months.

The efficacy of Wellbutrin® XL for the prevention of seasonal major depressive episodes was established in three, double-blind, placebo-controlled trials in adult outpatients with a history of major depressive disorder with an autumn-winter seasonal pattern, as defined by Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria.

About Major Depression

Depression affects an estimated 4%, or 1.3 million Canadians every year, and over the course of their lifetime between 8% and 9% of Canadians will experience a major depressive episode. A recent study conducted by Health Canada suggests that depression and distress cost Canadians at least $14.4 billion per year in treatment, medication, lost productivity and premature death. Depression is the second-leading cause of long-term disability among workers.

About Seasonal Major Depressive Illness

The most common characteristic is the regular onset and remission of major depression in the fall or winter, with remission in the spring. Less commonly, there may be recurrent summer depressive episodes. Diagnosis includes a pattern of seasonal onset and remission, with absence of non-seasonal depressive episodes, over at least two years. Prevalence of Seasonal Major Depression increases with higher latitudes. In Canada, it is estimated that Seasonal Major Depressive Illness affects between 3% and 5% of adult Canadians (as many as 1.7 million persons), while another 10% to 15% have a milder form of the same disorder. Characteristic symptoms include prominent lack of energy and extreme passivity, hypersomnia, overeating, weight gain and craving for carbohydrates.

About Wellbutrin® XL

Wellbutrin® XL is a once-daily extended-release formulation of bupropion hydrochloride, and it is the first and only once-daily norepinephrine dopamine reuptake inhibitor for the treatment of depression in adults. Once-daily Wellbutrin® XL is an effective first-line treatment for depression, offering a low incidence of sexual dysfunction, weight gain, and somnolence. This tolerability profile is important, given that drug-related side effects of anti-depressants are a major reason why treatment may be discontinued.

Wellbutrin® XL was commercialized in Canada in April 2006 by BPC. Biovail developed the formulation for Wellbutrin XL® and, in October 2001, entered into a distribution-and-supply agreement with GlaxoSmithKline (GSK) for the United States and the rest of the world, excluding Canada. GSK subsequently commercialized Wellbutrin XL® in the U.S. in September 2003. In June 2006, GSK received approval from the United States Food and Drug Administration (FDA) for Wellbutrin XL® for the prevention of seasonal major depressive illness.

Wellbutrin®, Wellbutrin® SR and Wellbutrin® XL are trademarks of The GlaxoSmithKline Group of Companies, and are used by Biovail under license.

Caution Regarding Forward-Looking Information and "Safe Harbor" Statement Under the Private Securities Litigation Reform Act of 1995

To the extent any statements made in this press release contain information that is not historical, these statements are forward-looking statements within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended, and within the meaning of the "safe harbor" provisions of applicable Canadian securities legislation. These forward-looking statements relate to, among other things, our objectives, goals, strategies, intentions, plans, estimates and outlook, and can generally be identified by the use of words such as "believe", "anticipate", "expect", "intend", "plan", "will", "may" and other similar expressions. In addition, any statements that refer to expectations, projections or other characterizations of future events or circumstances are forward-looking statements.

Although Biovail believes that the expectations reflected in such forward-looking statements are reasonable, such statements involve risks and uncertainties, and undue reliance should not be placed on such statements. Certain material factors or assumptions are applied in making forward-looking statements, and actual results may differ materially from those expressed or implied in such statements. Important factors that could cause actual results to differ materially from these expectations include, among other things: acceptance and demand for new pharmaceutical products and new indications for existing products, the impact of competitive products and pricing, regulatory matters including compliance with pharmaceutical regulations, availability of raw materials and finished products, the regulatory environment, the outcome of legal proceedings and other risks detailed from time to time in the Company's filings with the Securities and Exchange Commission and the Canadian Securities Administrators, as well as the Company's ability to anticipate and manage the risks associated with the foregoing. Additional information about these factors and about the material factors or assumptions underlying such forward-looking statements may be found in the body of this news release, as well as under the heading "Risk Factors" contained in Item 3(D) of Biovail's most recent Annual Report on Form 20-F/A. Biovail cautions that the foregoing list of important factors that may affect future results is not exhaustive. When relying on our forward-looking statements to make decisions with respect to the Company, investors and others should carefully consider the foregoing factors and other uncertainties and potential events. We undertake no obligation to update or revise any forward-looking statement.

About Biovail Corporation

Biovail Corporation is a specialty pharmaceutical company, engaged in the formulation, clinical testing, registration, manufacture, and commercialization of pharmaceutical products utilizing advanced drug-delivery technologies.

Biovail Corporation

Personality Traits Associated With Stress And Worry Can Be Hazardous To Your Health

2011-05-14T12:00:00.017-07:00

Personality traits associated with chronic worrying can lead to earlier death, at least in part because these people are more likely to engage in unhealthy behaviors, such as smoking, according to research from Purdue University.

"Research shows that higher levels of neuroticism can lead to earlier mortality, and we wanted to know why," said Daniel K. Mroczek, (pronounced Mro-ZAK) a professor of child development and family studies. "We found that having worrying tendencies or being the kind of person who stresses easily is likely to lead to bad behaviors like smoking and, therefore, raise the mortality rate.

"This work is a reminder that high levels of some personality traits can be hazardous to one's physical health."

Chronic worrying, anxiety and being prone to depression are key aspects of the personality trait of neuroticism. In this study, the researchers looked at how smoking and heavy drinking are associated with the trait. A person with high neuroticism is likely to experience anxiety or depression and may self-medicate with tobacco, alcohol or drugs as a coping mechanism.

They found that smoking accounted for about 25 percent to 40 percent of the association between high neuroticism and mortality. The other 60 percent is unexplained, but possibly attributed to biological factors or other environmental issues that neurotic individuals experience, Mroczek said.

The researchers analyzed data of 1,788 men and their smoking behavior and personality traits over a 30-year period from 1975 to 2005. The data was part of the VA Normative Aging Study, which is a long-term study of aging men based at the Boston VA Outpatient Clinic.

Mroczek and his co-authors, Avron Spiro III and Nicholas A. Turiano, published their findings in this month's Journal of Research in Personality.

A better understanding of the bridge between personality traits and physical health can perhaps help clinicians improve intervention and prevention programs, Mroczek said.

"For example, programs that target people high in neuroticism may get bigger bang for the buck than more widespread outreach efforts," he said. "It also may be possible to use personality traits to identify people who, because of their predispositions, are at risk for engaging in poor health behaviors such as smoking or excessive drinking."

The National Institute on Aging and the U.S. Department of Veterans Affairs supported this work.

Significant Number Of Fathers Experience Prenatal, Postpartum Depression

2011-05-14T12:00:00.016-07:00

About 10 percent of fathers experience prenatal or postpartum depression, with rates being highest in the 3 to 6 month postpartum period, according to an analysis of previous research appearing in the May 19 issue of JAMA, a theme issue on mental health.

James F. Paulson, Ph.D., of the Eastern Virginia Medical School, Norfolk, Va., presented the findings of the study at a JAMA media briefing on mental health.

It is well established that maternal prenatal and postpartum depression is prevalent and has negative personal, family, and child developmental outcomes, but the prevalence, risk factors and effects of depression among new fathers is not well understood, and has received little attention from researchers and clinicians, according to background information in the article.

Dr. Paulson and co-author Sharnail D. Bazemore, M.S., of the Eastern Virginia Medical School, conducted a meta-analysis to determine estimates and variability in rates of paternal prenatal and postpartum depression and its association with maternal depression. The authors included studies that documented depression in fathers between the first trimester and the first postpartum year, and identified 43 studies involving 28,004 participants for inclusion in the analysis.

Among the findings of the researchers:

- The overall estimate of paternal depression was 10.4 percent (estimated 12-month prevalence of depression among men in the general population is 4.8 percent).

- There was considerable variability between different time periods, with the 3- to 6-month postpartum period showing the highest rate (25.6 percent) and the first 3 postpartum months showing the lowest rate (7.7 percent).

- Differences were observed across study locations, with higher rates of prenatal and postpartum depression reported in the United States (14.1 percent vs. 8.2 percent internationally).

- There is a moderate correlation between depression in fathers and mothers.

"There are many implications of these findings. The observation that expecting and new fathers disproportionately experience depression suggests that more efforts should be made to improve screening and referral, particularly in light of the mounting evidence that early paternal depression may have substantial emotional, behavioral, and developmental effects on children. The correlation between paternal and maternal depression also suggests a screening rubric depression in one parent should prompt clinical attention to the other. Likewise, prevention and intervention efforts for depression in parents might be focused on the couple and family rather than the individual," the authors write.

"Future research in this area should focus on parents together to examine the onset and joint course of depression in new parents. This may increase our capacity for early identification of parental depression, add leverage for prevention and treatment, and increase the understanding of how parental depression conveys risk to infants and young children."

JAMA. 2010;303[19]:1961-1969.

Source
Journal of the American Medical Association

Suicidal Thoughts In Army Vets 'Under The Radar,' Says Specialist

2011-05-14T12:00:00.015-07:00

University at Buffalo researcher John Violanti, Ph.D.,
a specialist in suicide among police officers, is preparing to conduct
a study on suicide risk among returning veterans. The U.S. Army
yesterday reported a "stunning spike" in the number of soldiers taking
their own lives.

Violanti currently is testing a computer-based psychological "task"
which measures how quickly persons associate feelings of self-harm, as
a way of detecting "under the radar" suicidal thought.

"I feel that military personnel will not readily admit suicidal
thoughts," Violanti says. "This new test gets to real feelings at a
subconscious level. It is called IAT (Implicit Association Testing) and
was developed at Harvard.

"Suicide among returning veterans is a big problem," says Violanti.
"On their psychological evaluation when they return there is only one
question on suicide - "Are You Depressed?" Who is going to answer
that?"

Violanti is a Vietnam Vet and former member of the New York State
Police. As a research associate professor in the UB School of Public
Health and Health Profession, he has studied suicide among police
officers and the effects of policing on officers' health for 16 years.

According to the Army's report, the number of soldiers who committed
suicide in January could be as high as 24, which would be the highest
monthly total since the Army began collecting data on suicides.
January's suicide total may be more than the number of soldiers killed
in combat in Iraq and Afghanistan during the month.

The University at Buffalo is a premier research-intensive public
university, a flagship institution in the State University of New York
system and its largest and most comprehensive campus. UB's more than
28,000 students pursue their academic interests through more than 300
undergraduate, graduate and professional degree programs. Founded in
1846, the University at Buffalo is a member of the Association of
American Universities. The School of Medicine and Biomedical Sciences,
School of Dental Medicine, School of Nursing, School of Pharmacy and
Pharmaceutical Sciences and School of Public Health and Health
Professions are the five schools that constitute UB's Academic Health
Center.

The University at Buffalo

Could Acetaminophen Ease Psychological Pain?

2011-05-14T12:00:00.014-07:00

Headaches and heartaches. Broken bones and broken spirits. Hurting bodies and hurt feelings. We often use the same words to describe physical and mental pain. Over-the-counter pain relieving drugs have long been used to alleviate physical pain, while a host of other medications have been employed in the treatment of depression and anxiety. But is it possible that a common painkiller could serve double duty, easing not just the physical pains of sore joints and headaches, but also the pain of social rejection? A research team led by psychologist C. Nathan DeWall of the University of Kentucky College of Arts and Sciences Department of Psychology has uncovered evidence indicating that acetaminophen (the active ingredient in Tylenol) may blunt social pain.

"The idea - that a drug designed to alleviate physical pain should reduce the pain of social rejection - seemed simple and straightforward based on what we know about neural overlap between social and physical pain systems. To my surprise, I couldn't find anyone who had ever tested this idea," DeWall said.

According to a study due to be published in the journal Psychological Science, DeWall and colleagues were correct. Physical and social pain appear to overlap in the brain, relying on some of the same behavioral and neural mechanisms.

DeWall and colleagues investigated this connection through two experiments. In the first experiment, 62 healthy volunteers took 1,000 milligrams daily of either acetaminophen or a placebo. Each evening, participants reported how much they experienced social pain using a version of the "Hurt Feelings Scale" - a measurement tool widely accepted by psychologists as a valid measure of social pain. Hurt feelings and social pain decreased over time in those taking acetaminophen, while no change was observed in subjects taking the placebo. Levels of positive emotions remained stable, with no significant changes observed in either group. These results indicate that acetaminophen use may decrease self-reported social pain over time, by impacting emotions linked to hurt feelings.

"We were very excited about these initial findings," DeWall said. "The next step was to identify the neural mechanisms underlying the findings."

In the second experiment, 25 healthy volunteers took 2,000 milligrams daily of either acetaminophen or a placebo. After three weeks of taking the pills, subjects participated in a computer game rigged to create feelings of social rejection. Functional magnetic resonance imaging (fMRI) employed during the game revealed that acetaminophen reduced neural responses to social rejection in brain regions associated with the distress of social pain and the affective component of physical pain (the dorsal anterior cingulate cortex and anterior insula). In other words, the parts of the brain associated with physical lit up in the placebo subjects when they were rejected, while the acetaminophen group displayed significantly less activity in these brain areas in response to rejection.

According to the academic paper detailing the experiments: "...findings suggest that at least temporary mitigation of social pain-related distress may be achieved by means of an over-the-counter painkiller that is normally used for physical aches and pains. Furthermore, many studies have shown that being rejected can trigger aggressive and antisocial behavior, which could lead to further complications in social life... .If acetaminophen reduces the distress of rejection, the antisocial behavioral consequences of rejection may be reduced as well."

Researchers caution that readers should not immediately stock up on acetaminophen to ease social pain and anxiety, noting "[t]o be sure, our findings do not constitute a call for widespread use of acetaminophen to cope with all types of personal problems. Future research is needed to verify the potential benefits of acetaminophen on reducing emotional and antisocial responses to social rejection." Long-term use of acetaminophen has also been linked to serious liver damage, so it is important for patients to follow all package directions and consult their physicians if they are contemplating taking any medication for an off-label use.

"This research has the potential to change how scientists and laypersons understand physical and social pain. Social pain, such as chronic loneliness, damages health as much as smoking and obesity. We hope our findings can pave the way for interventions designed to reduce the pain of social rejection," DeWall said.

Brain Study Suggests Antidepressants 'Work Within Hours'

2011-05-14T12:00:00.013-07:00

People who experience high levels of anxiety could benefit from a single high dose of a common antidepressant that has been shown to reduce anxiety within three hours.

Dr Susannah Murphy, a neuroscientist at the Psychopharmacology and Emotion Research Laboratory at the University of Oxford, has conducted a study looking at the impact of two antidepressants, citalopram and reboxetine, which respectively work on the serotonin and noradrenaline neurotransmitters in the brain that control mood. She presented her findings at the Royal College of Psychiatrists' International Congress in Edinburgh.

The study involved giving 42 healthy patients either one of the two drugs, or a placebo, then showing them a picture with two faces on it - one with a neutral expression and the other looking fearful. Researchers then measured the speed with which the volunteers reacted to the images.

Anxiety is linked to 'hypervigilance', and the faster the reaction the more anxious and concerned about a perceived threat a person is. Dr Murphy and her colleagues found that both citalopram and reboxetine reduced their vigilance to fearful facial expressions. The antidepressants could be used both in the short- and long-term to enhance psychological therapies, such as cognitive behavioural therapy, she told to delegates at the International Congress.

Curious about the impact of antidepressants on the brain, Dr Murphy gave 26 healthy volunteers a single 20mg dose of citalopram and three hours later scanned their brains while the participants completed the facial expression task. She found that the amygdala, a chestnut-sized structure buried deep in the brain and linked to processing emotions and reading emotions in others, showed high levels of activity.

Citalopram and reboxetine are conventionally believed to have a delay of several weeks before the onset of their therapeutic effects - but Dr Murphy's study shows clearly that doses can have a neurochemical effect within hours.

She told delegates: "It's quite extraordinary that these changes take place so early. It really challenges us to think quite differently about the way antidepressants work. It's a different message for patients - as soon as you start taking the drugs it starts changing the way the brain works. It doesn't have to take weeks.

"When you are anxious you are hypervigilant to the social signals that people give off and you can interpret them negatively. For instance, at the end of a presentation or talk, if someone stands up and asks you a question and they look at you - are they looking at you in a positive or a negative way? All of that feeds into your reaction."

References:

International Congress of the Royal College of Psychiatrists, Edinburgh, 21-24 June 2010.

Even Adoptive Parents Suffer From The 'Blues'

2011-05-14T12:00:00.012-07:00

The unmet or unrealistic expectations adoptive parents often have is a recurring theme in postadoption depression, according to research from Purdue University.

"People often hear about postpartum blues when having a baby, but the emotional well-being of adoptive parents once the child is placed in the home is not really talked about," said Karen J. Foli, an assistant professor of nursing and an adoptive mother. "In this study, the majority of the adoptive parents who self-reported having experienced depression after the child was placed in their home often described unmet or unrealistic expectations of him or herself, the child, family and friends, or society.

"For example, some parents shared that they did not anticipate that bonding with their child would be a struggle or that family members or friends would not offer the same support that birthparents enjoy."

The signs and symptoms of depression include depressed mood, decreased interest or pleasure in activities, significant weight changes, difficulty sleeping or excessive sleeping, feeling agitated, fatigue, excessive guilt and shame, and indecisiveness.

"Postadoption depression not only affects the parents, but it also has an influence on the well-being of the child," she said.

Foli, who is co-author of the book "The Post-Adoption Blues: Overcoming the Unforeseen Challenges of Adoption," interviewed 21 adoptive parents about their adoption and depression experiences, as well as 11 adoption experts and professionals. The adopted children's range of age at placement was newborn to 12 years, and when the study was conducted the children's ages ranged from 12 months to 24 years. Foli's findings are published in this month's Western Journal of Nursing Research.

"Many adoptive parents spend their time during the adoption process demonstrating they are not only going to be fit parents, but super parents, and then they struggle with trying to be the world's best parent when the child is placed in the home," Foli said. "Adoptive parents also may experience feelings about their legitimacy as a parent, or even surprise if they don't readily bond with the infant or child."

Other factors that contribute to postadoption depression may include the expectations surrounding the child's attachment to the parent, a lack of peers, the lack of boundaries with birthparents in open adoptive agreements, and society's attitude toward adoptive families as a whole. Adoptive parents also are tired by the time the child comes into the home, Foli said. They have endured a rigorous adoption process and much of their lives have been out of their control.

"Obtaining that next form or checking that next box while waiting for the child can shift the focus away from parenting and emphasize the process of adoption," Foli said.

It's estimated there are 2 million adoptive parents in the United States. Adoptions can take place through public agencies, international organizations, private organizations, kinship agreements or tribal adoptions.

"Even though adoption continues to grow in the United States and become more mainstream, there is conventional wisdom that implies adoption was 'Plan B' for the parents," Foli said. "New adoptive parents often realize they weren't as prepared as they thought they were and the child's needs may overwhelm them. Some family members may not be receptive to news about an adoption or they may even treat the adopted children differently. Some parents in the study reported that acquaintances or strangers felt entitled to ask probing questions about the adoption, such as, 'How much did the child cost?'"

The adoption professionals who participated in the study said parents were often reluctant to admit their struggles out of fear and shame. Parents also echoed feelings of extreme guilt and confusion over how they were struggling, particularly after their intense longing and eagerness to bring a child home.

"We need to empower parents to share their feelings with adoption-smart professionals, online or face-to-face support groups, trusted significant others, and friends," Foli said. "Parents should realize they are not being disloyal to their children or families to feel the way they do. Health-care providers, especially nurses, can be instrumental in detecting issues related to depression or the mental well-being of the parents. Being more open about such concerns can lead to a healthier, happier family. By helping themselves, they are helping their children."

This research was in association with a book project supported by Rodale Press.

Abstract:

Depression in Adoptive Parents: A Model of Understanding Through Grounded Theory

Karen J. Foli

A limited number of studies have explored parental depression in the postadoption time periods and these studies frequently lack a social context of the adoptive parent experience. The objective of this study is to form a midrange theoretical interpretation of parental postadoption depression as shared by adoptive parents and experts through a grounded theory approach. Semistructured interviews of adoptive parents, who acknowledge being depressed after the child is placed in the home, and adoption experts are audiotaped, transcribed and coded to reveal themes. In total, 30 interviews are conducted. Researchers are also participant-observers during an adoptive parent support group meeting. Data reveal current themes in relation to postadoption depression. These themes take into account the various contexts of adoption (international and domestic, public and private, etc.) Parents express unfulfilled and unrealistic expectations in the domains of self, child, family or friends, and society or others. A theoretical model is presented to facilitate the understanding of depression reported by adoptive parents.

Aspect Medical Systems Announces Positive Results Of BRITE Major Depression National Study

2011-05-14T12:00:00.011-07:00

Aspect Medical Systems, Inc. (NASDAQ: ASPM) announced that study results from the BRITE (Biomarkers for Rapid Identification of Treatment Effectiveness) trial in major depression demonstrate that the company's EEG-based Antidepressant Treatment Response (ATR) indicator is a significant predictor of patient response and remission from depression when utilized one week following initiation of treatment with escitalopram.

The BRITE trial was conducted in collaboration with leading investigators from 10 facilities across the United States and enrolled more than 300 patients. Patient response was defined by researchers as a 50 percent improvement in depression symptoms as measured by the Hamilton Depression Rating Scale (HAM-D) after seven weeks of treatment, and remission was defined as recovery from depression (HAM-D

Increased Risk Of Depression Among Young Adults Associated With Child Abuse And Neglect

2011-05-14T12:00:00.010-07:00

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

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

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

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

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

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

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

(Arch Gen Psychiatry. 2007;64:49-56.)

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

Contact: Chris Godek

JAMA and Archives Journals

Combination Of Personality Traits Increases Risk For Heart Disease

2011-05-14T12:00:00.009-07:00

Frequent bouts of depression, anxiety, hostility and anger are known to increase a person's risk for developing coronary heart disease, but a combination of these "negative" personality traits may put people at especially serious risk, according to a study by researchers at Duke University Medical Center.

"The risk of developing coronary heart disease due to a combination of negative personality traits in people has never before been explored," said the study's senior investigator, Edward C. Suarez, Ph.D., an associate professor of psychiatry. "Although each of the negative traits significantly predicted heart disease, having the combination of these traits was the most powerful predictor of heart disease."

Similar patterns have been reported with three traditional risk factors of heart disease -- high blood pressure, elevated cholesterol levels and excessive weight -- where each factor independently increases risk but their presence together predicts a greater risk of future heart disease, Suarez said

The findings appear in an early online edition of the November/December 2006 issue of the journal Psychosomatic Medicine.

The team analyzed data on 2,105 military veterans who served in the Vietnam War and took part in the U.S. Air Force Health Study, in which researchers tracked the health of participants for 20 years. None of the men enrolled had heart disease when the study began.

At the start of the study, participants took a personality inventory test, called the Minnesota Multiphasic Personality Inventory, in which they stated whether or not they thought of themselves as possessing various personality and behavioral traits. At six intervals during the study, the participants underwent physical examinations that recorded health information, including blood pressure rates, cholesterol levels and body mass index, that can indicate whether or not someone is at risk for developing coronary heart disease.

Suarez said his team looked for a possible correlation between each individual negative personality trait and development of coronary heart disease, and then for a possible correlation between a combination of the negative personality traits and the development of coronary heart disease.

The researchers found that each negative personality trait, by itself, was significantly associated with increased risk for heart disease. However, when they analyzed all of the traits in combination, they found statistical evidence that the clustering of traits was the best predictor of a person's risk for heart disease, Suarez said.

According to the researchers, the findings may prompt physicians to include an assessment of personality traits as well as physical health measurements in determining a patient's overall risk for heart disease.

"In the future, doctors may wish to explore the use of earlier interventions aimed at diminishing negative personality traits in people who may be most at risk for future heart disease," Suarez said.

Although the study's findings are suggestive, the study had several limitations, Suarez said. Among them, he said, the participants were all men, and most of them were white, and so the findings cannot be generalized with certainty to nonwhites and females.

His team currently is designing a comprehensive intervention program to help patients learn to cope with their feelings of hostility, anger, anxiety and depression as well as reduce their physical risk factors for heart disease.

"We want to help people at earlier points in their life by teaching them ways to cope with problems and how to make wiser choices that promote health," Suarez said. "By helping them before they ever show clinical signs of heart disease, we may be able to help them avoid the disease altogether."

The research was funded by the National Institutes of Health.

Other researchers involved in the study were Stephen Boyle of Duke University Medical Center and Joel Michalek of the University of Texas Health Sciences Center at San Antonio.

Contact: Tracey Koepke

Duke University Medical Center

New Brain-Chemistry Differences Found In Depressed Women

2011-05-14T12:00:00.008-07:00

A new brain study finds major differences between women with serious depression and healthy women in a brain-chemical system that's crucial to stress and emotions.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

In addition to Zubieta and Kennedy, the research team included Elizabeth Young, M.D., of the Department of Psychiatry, and Robert Koeppe, Ph.D., of the Department of Radiology. Zubieta and Young are members of the U-M Molecular and Behavioral Neuroscience Institute. The study was funded by the Pritzker Foundation and by the National Institute of Mental Health.

Reference: Arch Gen. Psych., Vol 63, pp 1199-1206, Nov. 2006.

For more information on the U-M Depression Center, the nation's first comprehensive center devoted to research, treatment, education and public policy in depression and related disorders, visit depressioncenter/.

Contact: Kara Gavin

University of Michigan Health System

Treating SSRI Resistant Depression

2011-05-14T12:00:00.007-07:00

When your antidepressant medication does not work, should you switch to a different medication from the same class or should you try an antidepressant medication that has a different mechanism of action? This is the question asked by researchers in a new report scheduled for publication in Biological Psychiatry on April 1st.

Papakostas and colleagues compared two strategies for treating symptoms of major depressive disorder that do not respond to treatment with a selective serotonin reuptake inhibitor (SSRI) antidepressant: either switching to a second SSRI or to a non-SSRI antidepressant. Some common SSRI antidepressants are fluoxetine (Prozac), citalopram (Celexa) and sertraline (Zoloft), while examples of a few common non-SSRI antidepressants are venlafaxine (Effexor) and buproprion (Wellbutrin, Zyban). The authors combined 4 studies comparing these two types of treatment strategies and performed a meta-analysis on the pooled data.

Dr. George I. Papakostas, corresponding author on this project, explains the results: "Switching from a selective serotonin reuptake inhibitor to a drug with a different mechanism of action was found to be slightly more effective and slightly less-well tolerated than switching to a non-SSRI drug." Looking at the findings from a clinical perspective, the advantage in effectiveness means that 22 depressed people would need to be switched to treatment with a non-SSRI for one additional person to obtain relief from their symptoms.

John H. Krystal, M.D., Editor of Biological Psychiatry and affiliated with both Yale University School of Medicine and the VA Connecticut Healthcare System, adds that this result "may be related to the fact that while somewhat different, the medications evaluated in this report all acted on the monoamine systems of the brain." Because of the particular design of this study, the authors explain that "subsequent studies examining whether differences in efficacy between these two treatments exist for specific subpopulations, symptoms, or symptom clusters are warranted." Dr. Krystal concludes that while this advantage could be important, "there continues to be a pressing need to introduce new antidepressant medications that target novel brain mechanisms."

ELSEVIER

Radarweg 29

Amsterdam

elsevier

View drug information on Celexa; Effexor; Prozac Weekly.

Mass. Court Limits Job Protection For Unpaid Maternity Leave To Eight Weeks

2011-05-14T12:00:00.006-07:00

On Monday, the Massachusetts Supreme Judicial Court ruled that women are entitled to eight weeks of unpaid maternity leave without risking job loss under state law but that they are not protected after that time, the Boston Globe reports.

The decision was praised as a victory for business interests by John Barter, a lawyer representing telecommunications firm Global NAPs, Inc. A woman sued the president of the company in 2005 after she was fired upon returning from about 10 weeks of unpaid maternity leave. The woman claimed that her employer gave her permission to take more than eight weeks of unpaid leave.

The ruling is limited to women whose maternity leave falls under the state law, generally those who work for small businesses with at least six employees. The federal Family and Medical Leave Act of 1993 allows up to 12 weeks of unpaid leave and job protections for people who work for employers with 50 or more employees. Monday's ruling does not affect federal leave protections.

The court ruled 4-3 that the 1972 Massachusetts Maternity Leave Act guarantees eight weeks off to women who give birth or adopt a child, after which they are legally allowed to return to their job or a comparable one. However, "[o]nce a female employee is absent from employment for more than eight weeks, she is no longer within the purview of the [law] and, consequently, is not afforded the protections conferred by the statute," Justice Francis Spina wrote for the majority (Saltzman, Boston Globe, 8/10). Women who are promised longer maternity leaves by their employers can sue for breach of contract if they are later fired for taking more than eight weeks, the ruling said (AP/Boston Herald, 8/9).

The ruling clarifies some uncertainty about interpretation of the law. Business advocates had argued that the Massachusetts Commission Against Discrimination, the state agency that enforces the law, had given workers flexibility in applying the law, exposing businesses to lawsuits. MCAD countered that a firm cutoff at eight weeks could allow employers to offer women longer leaves and fire them when they returned (Boston Globe, 8/10).

In a dissenting opinion, Justice Margot Botsford also argued that the ruling could allow employers to renege on leave offers after employees return by citing the eight-week limitation in the state law. "An employer following such a course is using the statutory limitation as a shield to 'affect' -- that is, to ignore -- its own agreement to offer a longer leave and a job on return, a course of action plainly prohibited by the statute's third paragraph," Botsford wrote (AP/Boston Herald, 8/9).

State Senate Approves Postpartum Depression Bill

Meanwhile, the state Senate on Monday gave final approval to a bill (S 527) that aims to help women with postpartum depression, thus sending the bill to Gov. Deval Partick (D), the Boston Globe reports. The bill would require Massachusetts health insurers to submit annual reports on their efforts to screen for postpartum depression. The bill also would create a special commission tasked with determining the most effective ways to prevent, detect and treat postpartum depression, and making recommendations on public policies. The Department of Public Health also would develop policies and regulations to address postpartum depression, including the use of screening tools and the creation of public and professional education programs (Boston Globe, 8/9).

Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families.

© 2010 National Partnership for Women & Families. All rights reserved.

Link Between Depression And Higher Death Rates From All Causes Among Elderly With Diabetes

2011-05-14T12:00:00.005-07:00

In a large group of Medicare beneficiaries with diabetes, depression was associated with a higher death rate from all causes during a two-year study period. The findings are published in the October 2008 Journal of General Internal Medicine.

Lead author Dr. Wayne Katon, professor of psychiatry and behavioral sciences at the University of Washington (UW), noted that previous research indicates that depression and diabetes is a potentially lethal mix among young to middle-aged patients. Depression also puts patients at greater risk of complications from their diabetes. This more recent study suggests that depression is also a risk factor for mortality in older patients with diabetes. Most Medicare beneficiaries, like the ones in this study, are over age 65. The mean age of the participants was 75.6 years.

The study tracked 10,704 Medicare beneficiaries with diabetes who were enrolled in a disease management program in Florida. They were surveyed at the start of the study with a health assessment questionnaire. Evidence of depression among members of the group came from physician diagnosis, patient reports of having a prescription for an antidepressant in the year before the survey, or patient answers to a brief screening test. For the next two years, the research team recorded the death and cause of death of participants through bi-monthly checks of Medicare claims and eligibility files, or from phone calls with the participants' families.

The research team found that patients with both diabetes and depression had an increased risk of about 36 percent to 38 percent of dying from any cause during the two-year follow-up. Participants with a physician diagnosis of depression were significantly younger than their cohorts, more likely to be female, had more severe medical illness, were less likely to be African-American, and more likely to be Hispanic. These variables were controlled for in the analysis of increased risk. A total of 12.1 percent of participants who had both disorders died during that period. Among those without depression, 10.4 percent died.

Participants who had been treated with one or more antidepressant medications in the year before the study had a 24 percent increased risk of mortality, compared to non-depressed participants. According to the study authors, those patients may have been treated with antidepressants because their depressive symptoms were more severe and persistent than those of more mildly depressed patients who weren't prescribed antidepressants.

There was no difference in the rate of cardiovascular or cerebrovascular events between those treated with antidepressants and those who had no indication of depression.

"Rates of mortality from vascular disease may be decreasing in recent years among patients with diabetes due to more aggressive treatment of high blood pressure, cholesterol, and glucose levels," the researchers surmised, "as well as widespread use of preventative medications such as aspirin and beta blockers."

According to the authors, there may be several reasons why depression worsens chronic diseases such as diabetes. Depression has been associated with inadequate self-care and harmful habits like smoking or overeating. Depression is also associated with nervous system and endocrine system problems, and with inflammatory markers.

The authors noted their study's limitations: the participants were from one geographic region of the United States, and the follow-up period was relatively short. Defining depression in part by physician diagnosis and treatment, they added, may have selected for participants with more severe illness. The study was also not able to obtain information on education, income, weight, smoking habits, physical activity, or compliance in taking medication.

In addition to Katon, the researchers included Drs. Ming-Yu Fan and Jurgen Unutzer from the UW, Dr. Jennifer Taylor from Green River Health in Tampa, Fl.; Dr. Harold Pincus from Columbia University and the Rand Corporation; and Michael Schoenbaum from the National Institutes of Health (NIH) in Bethesda, Md.

Grants from the National Institute of Mental Health of the NIH funded the study.

Confidential Treatment Programs For Physicians With Mental Illness - Statement Of American Medical Student Association

2011-05-14T12:00:00.004-07:00

The American Medical Student Association (AMSA) supports confidential treatment programs for physicians with mental illness, including substance abuse, despite recent scrutiny. Mental illness is a chronic disease and all patients deserve the same privacy rights. To treat physicians differently is discriminatory. Such discriminatory treatment is perpetuated by stigma in society regarding persons with mental illness. AMSA has long supported efforts to educate the public about the prevalence and treatability of mental illness in order to eliminate the stigma that prevents the diagnosis and successful treatment of the mentally ill.

This past year, AMSA has collaborated with government officials, non-governmental organizations, medical students and faculty members from academic medical centers, to develop an anti-stigma campaign whose purpose will be to educate future physicians about this stigma, and try to eliminate its effects.

It is also critical that medical education incorporates this issue within its curriculum. The disgrace associated with mental illness has profound effects among its population. According to data released by the National Association of State Mental Health Program Directors last year, patients with severe and persistent mental illness die an average of 25 years earlier than the general population, due to other chronic diseases such as heart disease, diabetes, and cancer. Patients need to be diagnosed and treated in a timely and fair manner.

Attributed to Michael Ehlert, M.D., AMSA National President

About the American Medical Student Association

The American Medical Student Association (AMSA), with more than a half-century history of medical student activism, is the oldest and largest independent association of physicians-in-training in the United States. Founded in 1950, AMSA is a student-governed, non-profit organization committed to representing the concerns of physicians-in-training. With more than 68,000 members, including medical and premedical students, residents and practicing physicians, AMSA is committed to improving medical training as well as advancing the profession of medicine. AMSA focuses on four strategic priorities, including universal healthcare, disparities in medicine, diversity in medicine and transforming the culture of medical education.

To learn more about AMSA, our strategic priorities, or joining the organization, please visit us online at amsa.

Ancient Sheep Help Pinpoint Brain Timing Mechanisms Linked To Seasonal Affective Disorder

2011-05-14T12:00:00.003-07:00

New research by Aberdeen scientists suggests that Seasonal Affective Disorder (SAD) relates to an ancient timing mechanism in the brain dating back millions of years.

Discoveries by a University of Aberdeen-led team, involving collaborators in Edinburgh and Strasbourg, and published in the latest issue of Current Biology, shed new insights into the mechanisms by which seasonal rhythms are generated.

The researchers studied the primitive Soay breed of sheep, which relies on its strong seasonal biology to survive wild on the N. Atlantic islands of St Kilda.

They identified a new role for a chemical known as thyroid stimulating hormone (TSH), which is secreted by cells in the pituitary gland and is already known to control the thyroid gland.

The new work reveals that a specialised group of pituitary TSH-secreting cells signal directly to the brain to control the sheep's seasonal behaviour.

This surprising discovery reverses the "master - slave" relationship between the brain and the pituitary, found in all vertebrates including humans, in which brain signals control pituitary hormone secretion.

Dr Hazlerigg, Reader in Zoology at the University of Aberdeen said: "Our research points to an ancient seasonal timing mechanism that survives in modern vertebrates. Some humans may retain remnants of this ancient seasonal timing mechanism which would explain why they experience SAD.

It is now hoped that identifying this new role for TSH may lead to better understanding of seasonal or thyroid disorders in humans.

Dr Hazlerigg continues: "Our next target is to understand exactly what TSH does when it gets into the brain to cause changes in behaviour and hormone secretion. By defining these pathways we hope to increase our understanding not only of the control mechanisms in seasonal animals but also of SAD."

University of Aberdeen

Antidepressant side effects - Brain activity prior to treatment flags vulnerability

2011-05-14T12:00:00.002-07:00

In a finding that opens new doors to determining susceptibility to antidepressant side effects, researchers at the UCLA
Neuropsychiatric Institute report that changes in brain activity prior to treatment with antidepressants can flag patient
vulnerability.

Published in the April 2005 edition of the peer-reviewed journal Neuropsychopharmacology, the study is the first to link
brain function and medication side effects, and to show a relationship between brain function changes during brief placebo
treatment and later side effects during treatment with medication.

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

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

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

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

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

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

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

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

Grants from the National Institute of Mental Health, the National Alliance for Research in Schizophrenia and Depression, and
Lilly Research Laboratories funded the project.
Other members of the research team included Dr. Andrew F. Leuchter, Melinda L. Morgan, Dr. Ian A. Cook, Michelle Abrams and
Barbara Siegman at UCLA, and Drs. David J. DeBrota and William Z. Potter at Lilly Research Laboratories.

This study is part of a larger program headed by Leuchter in the UCLA Laboratory of Behavioral Pharmacology focusing on the
use of QEEG cordance to predict and detect responses to antidepressant medications and placebo.

The UCLA Neuropsychiatric Institute is an interdisciplinary research and education institute devoted to the understanding of
complex human behavior, including the genetic, biological, behavioral and sociocultural underpinnings of normal behavior, and
the causes and consequences of neuropsychiatric disorders. In addition to conducting fundamental research, the institute
faculty seeks to develop effective treatments for neurological and psychiatric disorders, improve access to mental health
services, and shape national health policy regarding neuropsychiatric disorders. More information is available online at npi.ucla and at placebo.ucla.

Contact: Dan Page

dpagemednet.ucla

310-794-2265

University of California - Los Angeles

ucla

Depression recovery undermined by thyroid condition

2011-05-14T12:00:00.001-07:00

According to a study in Greece, an autoimmune thyroid condition could undermine the recovery of some patients with depression.

You can read about this in BMC Psychiatry.

Doctors could also use indicators of thyroid function to predict how well their patients should respond to the antidepressants they give them.

The researchers monitored 90 people. Thirty were healthy people while the other thirty had major depressions. All the 90 people were tested for thyroid function.

Some of the patients with depression had elevated levels of thyroid binding inhibitory immunoglobins in their blood. The levels of thyroid function indicators FT3, FT4 and TSH were normal.

If you have high levels of immunoglobins your thyroid gland function can be affected.

The researchers wrote 'Although thyroid gland dysfunction is not common in depression, there is evidence suggesting the presence of an underlying autoimmune process affecting the thyroid gland in depressive patients.

"The finding that depression often co-exists with autoimmune subclinical thyroiditis suggests that depression may cause alterations in the immune system, or that, in fact, it is an autoimmune disorder itself.'

The researchers re-assessed the patients after two years to see how well they had responded to treatment.

The higher the levels of thyroid hormone and thyroid binding inhibitory immunoglobin in their blood the less well the patients responded to treatment for their depressions.

Depressive Symptoms In Daughters Increased By Mothers' Mental Games

2011-05-14T12:00:00.000-07:00

A new study in the journal Family Relations examined the effects of a mother's psychological control on the risk for depression of African American adolescents. Researchers found that girls whose mothers played mental games with them like making them feel guilty or withdrawing expressions of love reported much higher levels of depressive symptoms and lower levels of personal agency.

Psychological control did not affect the psychological well-being of boys.

Jelani Mandara and Crysta L. Pikes examined a sample of 152 African American students in the ninth through twelfth grade at a high school in a large Midwestern city. The sample consisted of 102 females and 50 males. Researchers assessed the degree to which maternal psychological control had an effect on depressive symptoms.

Mandara and Pikes suggested that, "The key for practitioners will be to impress upon parents the need to find a balance between psychological autonomy and behavioral regulation at each stage of their children's development."

This study is published in the December 2008 issue of Family Relations. Media wishing to receive a PDF of this article may contact journalnewsbos.blackwellpublishing.

To view the abstract for this article, please click here.

Jelani Mandara is affiliated with Northwestern University.

A premier, applied journal of family studies, Family Relations is mandatory reading for family scholars and all professionals who work with families, including: family practitioners, educators, marriage and family therapists, researchers, and social policy specialists. The journal's content emphasizes family research with implications for intervention, education, and public policy, always publishing original, innovative and interdisciplinary works with specific recommendations for practice.

Intra Cellular Therapies Announces The Discovery Of Potent Antidepressant Activity In ITI-007

2011-05-13T13:35:00.001-07:00

Intra-Cellular Therapies, Inc., announced additional preclinical data from its ongoing development
programs for ITI-007, the Company's first-in-class dual 5HT2A receptor
antagonist/dopamine receptor phosphoprotein modulator (DPPM), and ITI-722,
a low-dose formulation of ITI-007, which are in development for
schizophrenia and sleep disorders, respectively. These new data demonstrate
ITI-007 has preclinical activity both in vitro and in vivo as an
antidepressant.

ITI-007 acts as a potent inhibitor of the serotonin transporter (SERT),
a major target for most antidepressant drugs. To examine whether this in
vitro activity could be predictive of behavioral activity in vivo, the
antidepressant effect of ITI-007 was investigated using an animal model of
depression involving social stress. Repeated treatment of ITI-007 improved
performance in this animal model, consistent with antidepressant-like
efficacy. The combined actions of ITI-007 as a SERT inhibitor, a 5HT2A
receptor antagonist, and a DPPM may provide a unique, antidepressant drug
with a more optimal profile, including a lack of sexual side effects common
to other antidepressant drugs.

"These studies demonstrate ITI-007 may have antidepressant activity in
addition to its potential in treating sleep maintenance insomnia and
psychosis in patients," stated Sharon Mates, Ph.D., Chairman and Chief
Executive Officer of Intra-Cellular Therapies. "We believe ITI-007
represents a unique compound that may have broad use in treating many
neuropsychiatric and neurodegenerative disorders where sleep problems,
depression, or psychosis are prominent symptoms, including schizophrenia,
affective disorders, and Parkinson's disease."

About ITI-007

ITI-007 is an orally available compound which combines potent 5HT2A
receptor antagonism with cell-type-specific modulation of phosphoprotein
pathways downstream of dopamine receptors. As a dopamine receptor
phosphoprotein modulator (DPPM), ITI-007 has dual properties; it acts as a
post-synaptic antagonist and as a pre-synaptic partial agonist. The
combination of ITI-007's high-potency blockade of 5HT2A receptors and
unique dopamine receptor activity will make it possible for the first time,
to select a clinical dose capable of saturating 5HT2A receptors while
permitting the "dialing in" of an optimal amount of dopamine receptor
modulation. The ability to optimize the level of dopamine receptor
modulation holds promise for the reduction of psychotic symptoms without
incurring high levels of dopamine antagonism that cause motor disturbances
and other deleterious side effects. In addition, the wide separation of
affinity at 5HT2A and D2 receptors may allow for administration of the
appropriate amount of dopamine modulation for antipsychotic maintenance
therapy in the treatment of bipolar disorders. ITI-007 also has nanomolar
affinity for the serotonin transporter (SERT). ITI-007 has a much lower
propensity than several currently marketed antipsychotic drugs to bind
receptors that mediate deleterious cardiovascular events, sedation and
rapid and significant weight gain.

About ITI-722

A low-dose formulation of ITI-007, called ITI-722, is being developed
simultaneously for the treatment of sleep maintenance insomnia in the
general population. Due to the unique separation of D2 and 5HT2A receptor
affinities, at low doses, ITI-722 acts primarily as a 5HT2A receptor
antagonist. Additionally, its profile suggests the compound may be
appropriate for the treatment of sleep disorders that accompany
neurodegenerative disorders, such as Parkinson's disease.

About Depression

Depression is a common psychiatric disorder affecting approximately 20
million people in the United States. It is characterized by a pervasive low
mood, loss of interest in usual activities and diminished ability to
experience pleasure. Although the term "depression" is commonly used to
describe a temporarily depressed mood when one "feels blue," clinical
depression is a serious and often disabling condition that can
significantly affect a person's work, family and school life, sleeping and
eating habits, general health, and ability to enjoy life. Having depression
is also a major risk factor for suicide; in addition, people with
depression suffer from higher mortality from other causes. Moreover,
depression is a common co- morbid diagnosis in schizophrenia, being present
in over 30% of people with schizophrenia in many studies.

About Intra-Cellular Therapies

Intra-Cellular Therapies, Inc. (ITI), is a biopharmaceutical company
that is developing novel drugs for the treatment of diseases and disorders
of the Central Nervous System (CNS). Building on the science generated from
the Nobel Prize winning laboratory of Dr. Paul Greengard at The Rockefeller
University, the Company develops compounds that have the potential to treat
a wide range of diseases associated with the CNS. To aid in the development
process, the Company incorporates its CNSProfile(TM), a state-of-the-art
platform that allows ITI to choose compounds with the strongest potential
to succeed in these difficult to treat diseases.