In Japan reports of violence linked to SSRI antidepressants have raised
public awareness to the danger these drugs can pose. A Japanese psychiatrist
acknowledges:
"To say that being able to tell the difference between depressives and mild
manic-depressives is the test of a psychiatrist's true skill is no
exaggeration."
The absence of any empirically valid diagnostic tool in psychiatry puts
patients at risk of trial and error --i.e., Russian roulette--diagnostic and
treatment methods
She indicates that The Japanese Ministry of Health, Labor and Welfare has
investigated news reports about antidepressant users "who developed
increased feelings of hostility or anxiety, and have even committed sudden
acts of violence against others."
After its investigation, the Ministry decided to revise the label warnings
on SSRI antidepressant stating,
"There are cases where we cannot rule out a causal relationship [of
hostility, anxiety, and sudden acts of violence] with the medication."
So, why are millions of American children being prescribed a class of
mind-altering drugs that in some people INDUCE VIOLENCE against self and
others?
See, SSRI Stories, a website that chronicles news reports about violence,
murder and suicide in which SSRIs were implicated. So far there are 3,000
news reports posted: ssristories/
Source
Alliance for Human Research Protection
понедельник, 30 мая 2011 г.
суббота, 28 мая 2011 г.
Improving Mood And Serious Mental Illness With Physical Activity
A new study from Indiana University suggests that even meager levels of physical activity can improve the mood of people with serious mental illnesses (SMI) such as bipolar disorder, major depression and schizophrenia.
The study, published in the November issue of the International Journal of Social Psychiatry, both reinforces earlier findings that people with SMI demonstrate low levels of physical activity and supports the consideration of physical activity as a regular part of psychiatric rehabilitation.
"We found a positive association between physical activity level and positive mood when low to moderate levels of physical activity are considered," said study author Bryan McCormick, associate professor in IU's Department of Recreation, Park and Tourism Studies. "Physical activity interventions that require lower levels of exertion might be more conducive to improving transitory mood, or the ups and downs people with SMI experience throughout the day."
McCormick said physical activity often is advocated in addition to psychiatric treatment for people with SMI because of the significant health concerns common to this population. The low levels of physical activity also common to this population poses a major hurdle, however. For this study, physical activity is considered most forms of sustained movement, such as house cleaning, gardening, walking for transportation or formal exercise.
"The challenge is how to use naturally motivating activities that people have in their everyday lives to get them out and engaged," McCormick said.
About the study:
For seven consecutive days, researchers randomly paged study participants, who then filled out questionnaires about their mood and recent activities. The responses were matched with data collected during the previous 10 minutes using small light-weight accelerometers worn by the study participants. The equipment measured activity levels and duration. McCormick said this is the first time these research methods were combined, allowing researchers to look at study participants' daily ups and downs as they occur rather than trying to average the experiences.
The study involved 11 people from the U.S. and 12 people from Serbia. Central Europe is experiencing a shift from institutional care to community care for its citizens with SMI, similar to the shift seen in the U.S. in the 1970s. McCormick's research has been examining this, too, in comparison to U.S. populations. The findings were surprising in this particular study. "I was expecting a higher level of physical activity within the population of Eastern Europeans," he said. "We didn't see any differences."
The average physical activity level for both groups was comparable to that of sedentary adults, less than that of adults with a developmental disability and considerably less than that of active adults, according to earlier research by study co-author Georgia Frey, associate professor in IU's Department of Kinesiology.
The least active experiences captured in this study correlated with less positive moods.
The study notes that walking is one of the most frequently advocated forms of physical activity in psychiatric rehabilitation programs. Such programs, according to the study, would appear to afford both physiological and psychological benefits.
Co-authors include Frey; Chien-Tsung Lee, IU Department of Kinesiology, School of Health, Physical Education and Recreation; Sanghee Chun, IU School of HPER's Department of Recreation, Park and Tourism Studies; Jim Sibthorp, University of Utah, Salt Lake City; Tomislav Gajic, M.D., Branka Stamatovic-Gajic, M.D., and Milena Maksimovich, Department of Psychiatry, Health Centre Valjevo, Valjevo, Serbia.
"Predicting Transitory Mood From Physical Activity Level Among People With Severe Mental Illness in Two Cultures," International Journal of Social Psychiatry. 2008, 54: 527-538.
The study, published in the November issue of the International Journal of Social Psychiatry, both reinforces earlier findings that people with SMI demonstrate low levels of physical activity and supports the consideration of physical activity as a regular part of psychiatric rehabilitation.
"We found a positive association between physical activity level and positive mood when low to moderate levels of physical activity are considered," said study author Bryan McCormick, associate professor in IU's Department of Recreation, Park and Tourism Studies. "Physical activity interventions that require lower levels of exertion might be more conducive to improving transitory mood, or the ups and downs people with SMI experience throughout the day."
McCormick said physical activity often is advocated in addition to psychiatric treatment for people with SMI because of the significant health concerns common to this population. The low levels of physical activity also common to this population poses a major hurdle, however. For this study, physical activity is considered most forms of sustained movement, such as house cleaning, gardening, walking for transportation or formal exercise.
"The challenge is how to use naturally motivating activities that people have in their everyday lives to get them out and engaged," McCormick said.
About the study:
For seven consecutive days, researchers randomly paged study participants, who then filled out questionnaires about their mood and recent activities. The responses were matched with data collected during the previous 10 minutes using small light-weight accelerometers worn by the study participants. The equipment measured activity levels and duration. McCormick said this is the first time these research methods were combined, allowing researchers to look at study participants' daily ups and downs as they occur rather than trying to average the experiences.
The study involved 11 people from the U.S. and 12 people from Serbia. Central Europe is experiencing a shift from institutional care to community care for its citizens with SMI, similar to the shift seen in the U.S. in the 1970s. McCormick's research has been examining this, too, in comparison to U.S. populations. The findings were surprising in this particular study. "I was expecting a higher level of physical activity within the population of Eastern Europeans," he said. "We didn't see any differences."
The average physical activity level for both groups was comparable to that of sedentary adults, less than that of adults with a developmental disability and considerably less than that of active adults, according to earlier research by study co-author Georgia Frey, associate professor in IU's Department of Kinesiology.
The least active experiences captured in this study correlated with less positive moods.
The study notes that walking is one of the most frequently advocated forms of physical activity in psychiatric rehabilitation programs. Such programs, according to the study, would appear to afford both physiological and psychological benefits.
Co-authors include Frey; Chien-Tsung Lee, IU Department of Kinesiology, School of Health, Physical Education and Recreation; Sanghee Chun, IU School of HPER's Department of Recreation, Park and Tourism Studies; Jim Sibthorp, University of Utah, Salt Lake City; Tomislav Gajic, M.D., Branka Stamatovic-Gajic, M.D., and Milena Maksimovich, Department of Psychiatry, Health Centre Valjevo, Valjevo, Serbia.
"Predicting Transitory Mood From Physical Activity Level Among People With Severe Mental Illness in Two Cultures," International Journal of Social Psychiatry. 2008, 54: 527-538.
четверг, 26 мая 2011 г.
Measures To Help Unemployed People Who Are Experiencing Depression Or Anxiety To Get Back To Work, UK
A package of measures to help unemployed people who are experiencing depression or anxiety to get back to work were announced by Health Secretary Alan Johnson and Work and Pensions Secretary James Purnell,? ? including greater provision of? talking therapies and a new network of employment support workers.
Speeding up the roll out of talking therapies will provide better access to the services.? A greater number of people who are on long-term sick leave or unable to seek employment due to depression will be helped to recover so that they are ready to go back to work.
Around six million adults in the UK have depression or anxiety and many of these remain on incapacity benefits as they are unable to seek work.? ? In past recessions, we have seen the number of out-of-work people on inactive benefits rise, so this is one element of action being taken to prevent this happening again.
The new measures to enable the NHS to support people back to work include the development of complementary services to increase the availability of debt advice and family counselling, highlighting the vitally important role can played by the public services in supporting people through the economic downturn.
Mr Johnson today announced that the government is investing an extra ??13 million. This will fund:
- A faster roll out of talking therapy services around the country throughout 2009 with services beginning to be available in every area by 2010.
- Employment support workers linked to every talking therapy service, providing job support for people with common mental health problems and help people back to work.
- Health advisers on a dedicated NHS Direct phone line being trained to spot people who might be experiencing depression because of economic problems and refer then to help.
- Better online advice and information about the availability of services near to people's homes through NHS Choices
At the same time, PCTS will be encouraged to use up to ??80m of savings made by the NHS due to the temporary reduction in the rate of VAT to commission complementary services - including debt advice and family counselling - wherever there is local need.
The investment will also provide more training for staff in primary healthcare teams, helping them to recognise mental health problems that could be due in part to the economic downturn. The NHS is being encouraged to work with local partners to develop the public's skills in managing their mental wellbeing as a life skill.
There is not yet any indication that the economic downturn is having a negative impact on disadvantaged people in the labour market; in fact, the numbers of people on Incapacity Benefit are still falling. But the Government is determined to act to prevent people falling into long-term worklessness.
Talking therapy pilots Newham and Doncaster saw 5,000 extra people in 2007/8, with average waiting of only two weeks after a clinical decision to treat, down from an NHS average of around 14 months. More than half those treated by the Newham and Doncaster services achieved measurable recovery, in line with NICE evidence from clinical trials, and the number going to work rose by 10 per cent.
Alan Johnson said:
"In the current economic downturn, the potential exists for more people to become anxious or depressed and experience lower levels of mental well-being.
"If someone is feeling down after losing their job, then the best solution is a new job and we're helping people to find them wherever possible. But in some cases, depression and anxiety can be a barrier to getting another job.
"No one should be left in any doubt about where to turn. That's why I am going further and faster to make sure that services are in place to support people affected psychologically by the recession. The NHS as a whole will be better equipped to recognise these issues and refer people to appropriate treatment or support."
James Purnell said:
"When times are difficult people need more help not less. We know from previous recessions that simply pushing people onto inactive benefits can lead to a life time of dependency.
"We will do everything we can to support people during these difficult times. We are working across Government to give people with mental health conditions the help they need to stay in or get back to work."
The Department of Health has already set up 35 talking therapy services around the country and a further 81 are due to come on stream this year. The Department of Work and Pensions are piloting employment advisors strategically co-located at 12 of those service centres and a new network of employment caseworkers will ultimately ensure employment support across every service nationwide.
The Department of Health is improving access to Psychological Therapies (IAPT), with annual funding rising to ??173 million by 2010-11. This money will be used to train 3,600 extra therapists and treat 900,000 more people over three years.
Our programme for expanding psychological therapies has set up 35 new services in 35 PCTs this year and training more than 1,100 people to deliver cognitive behavioural therapy. More services will come on stream over the next two years.
The employment caseworkers network is building on a ??4 million DWP initiative that involves employment advisors working within 12 of the talking therapy services. The caseworkers will create close links with local employers, occupational health services and Job Centre Plus and provide tailored advice on getting back to work, taking into account someone's particular mental health condition.
On top of the 35 talking therapy services already up and running, a further 81 are due to come on stream in 2009, around 25% more than was originally planned.
Incapacity Benefit claimants with Mental and Behavioural Conditions are more likely to be on the benefit longer than other claimants. After 4 years 27% of Incapacity Benefit claimants with Mental and Behavioural Conditions are still on benefit, compared to 20% of other claimants.
Department of Health, UK
Speeding up the roll out of talking therapies will provide better access to the services.? A greater number of people who are on long-term sick leave or unable to seek employment due to depression will be helped to recover so that they are ready to go back to work.
Around six million adults in the UK have depression or anxiety and many of these remain on incapacity benefits as they are unable to seek work.? ? In past recessions, we have seen the number of out-of-work people on inactive benefits rise, so this is one element of action being taken to prevent this happening again.
The new measures to enable the NHS to support people back to work include the development of complementary services to increase the availability of debt advice and family counselling, highlighting the vitally important role can played by the public services in supporting people through the economic downturn.
Mr Johnson today announced that the government is investing an extra ??13 million. This will fund:
- A faster roll out of talking therapy services around the country throughout 2009 with services beginning to be available in every area by 2010.
- Employment support workers linked to every talking therapy service, providing job support for people with common mental health problems and help people back to work.
- Health advisers on a dedicated NHS Direct phone line being trained to spot people who might be experiencing depression because of economic problems and refer then to help.
- Better online advice and information about the availability of services near to people's homes through NHS Choices
At the same time, PCTS will be encouraged to use up to ??80m of savings made by the NHS due to the temporary reduction in the rate of VAT to commission complementary services - including debt advice and family counselling - wherever there is local need.
The investment will also provide more training for staff in primary healthcare teams, helping them to recognise mental health problems that could be due in part to the economic downturn. The NHS is being encouraged to work with local partners to develop the public's skills in managing their mental wellbeing as a life skill.
There is not yet any indication that the economic downturn is having a negative impact on disadvantaged people in the labour market; in fact, the numbers of people on Incapacity Benefit are still falling. But the Government is determined to act to prevent people falling into long-term worklessness.
Talking therapy pilots Newham and Doncaster saw 5,000 extra people in 2007/8, with average waiting of only two weeks after a clinical decision to treat, down from an NHS average of around 14 months. More than half those treated by the Newham and Doncaster services achieved measurable recovery, in line with NICE evidence from clinical trials, and the number going to work rose by 10 per cent.
Alan Johnson said:
"In the current economic downturn, the potential exists for more people to become anxious or depressed and experience lower levels of mental well-being.
"If someone is feeling down after losing their job, then the best solution is a new job and we're helping people to find them wherever possible. But in some cases, depression and anxiety can be a barrier to getting another job.
"No one should be left in any doubt about where to turn. That's why I am going further and faster to make sure that services are in place to support people affected psychologically by the recession. The NHS as a whole will be better equipped to recognise these issues and refer people to appropriate treatment or support."
James Purnell said:
"When times are difficult people need more help not less. We know from previous recessions that simply pushing people onto inactive benefits can lead to a life time of dependency.
"We will do everything we can to support people during these difficult times. We are working across Government to give people with mental health conditions the help they need to stay in or get back to work."
The Department of Health has already set up 35 talking therapy services around the country and a further 81 are due to come on stream this year. The Department of Work and Pensions are piloting employment advisors strategically co-located at 12 of those service centres and a new network of employment caseworkers will ultimately ensure employment support across every service nationwide.
The Department of Health is improving access to Psychological Therapies (IAPT), with annual funding rising to ??173 million by 2010-11. This money will be used to train 3,600 extra therapists and treat 900,000 more people over three years.
Our programme for expanding psychological therapies has set up 35 new services in 35 PCTs this year and training more than 1,100 people to deliver cognitive behavioural therapy. More services will come on stream over the next two years.
The employment caseworkers network is building on a ??4 million DWP initiative that involves employment advisors working within 12 of the talking therapy services. The caseworkers will create close links with local employers, occupational health services and Job Centre Plus and provide tailored advice on getting back to work, taking into account someone's particular mental health condition.
On top of the 35 talking therapy services already up and running, a further 81 are due to come on stream in 2009, around 25% more than was originally planned.
Incapacity Benefit claimants with Mental and Behavioural Conditions are more likely to be on the benefit longer than other claimants. After 4 years 27% of Incapacity Benefit claimants with Mental and Behavioural Conditions are still on benefit, compared to 20% of other claimants.
Department of Health, UK
вторник, 24 мая 2011 г.
Variations Of Post-Heart Attack Depression Affect Recovery, Reports The 'Harvard Heart Letter'
Recovering from a heart
attack is tough enough without facing depression. Yet that's exactly what
happens to nearly half of heart attack survivors. Depression after a heart
attack isn't a one-size-fits-all classification. Different variations have
different effects on the heart and recovery, reports the April 2007 issue
of the "Harvard Heart Letter."
People with post-heart attack depression are two to three times more
likely to have another heart attack or to die prematurely compared with
survivors who don't have depression. Depression that occurs for the first
time during recovery from a heart attack appears to be more dangerous than
depression that started before the attack.
Depression arises for various reasons. In some people, depression and
heart disease may reflect a genetic vulnerability that can trigger both
conditions. Depression that first appears after a heart attack may
represent fear of dying or grief over loss of health. Fear and grief don't
necessarily respond to the same treatment strategies, so figuring out the
cause of the problem may help in finding the right therapy.
The "Harvard Heart Letter" notes that breaking out of depression on
your own can be tough. Standard treatment includes talk therapy and
medication. If those don't help, ask your doctor for a referral to a
therapist who can help sort out your thoughts and hit on a more specific
treatment.
Some physicians see depression after a heart attack as an
understandable reaction that will go away as you get better. It is usually
much more than that. Regardless of its origin, getting help is good for
your heart, your health, and your life.
Harvard Heart Letter
health.harvard/heart
attack is tough enough without facing depression. Yet that's exactly what
happens to nearly half of heart attack survivors. Depression after a heart
attack isn't a one-size-fits-all classification. Different variations have
different effects on the heart and recovery, reports the April 2007 issue
of the "Harvard Heart Letter."
People with post-heart attack depression are two to three times more
likely to have another heart attack or to die prematurely compared with
survivors who don't have depression. Depression that occurs for the first
time during recovery from a heart attack appears to be more dangerous than
depression that started before the attack.
Depression arises for various reasons. In some people, depression and
heart disease may reflect a genetic vulnerability that can trigger both
conditions. Depression that first appears after a heart attack may
represent fear of dying or grief over loss of health. Fear and grief don't
necessarily respond to the same treatment strategies, so figuring out the
cause of the problem may help in finding the right therapy.
The "Harvard Heart Letter" notes that breaking out of depression on
your own can be tough. Standard treatment includes talk therapy and
medication. If those don't help, ask your doctor for a referral to a
therapist who can help sort out your thoughts and hit on a more specific
treatment.
Some physicians see depression after a heart attack as an
understandable reaction that will go away as you get better. It is usually
much more than that. Regardless of its origin, getting help is good for
your heart, your health, and your life.
Harvard Heart Letter
health.harvard/heart
понедельник, 16 мая 2011 г.
Depression Patients More Apt To Receive Opioids For Chronic Pain
Chronic pain patients with a history of depression are three times more likely to receive long-term prescriptions for opioid medications like Vicodin compared to pain patients who do not suffer from depression, according to new research.
The study, published in the November-December issue of the journal General Hospital Psychiatry, analyzed the medical records of tens of thousands of patients enrolled in the Kaiser Permanente and Group Health plans between 1997 and 2005. Together, the insurers cover about 1 percent of the U.S. population. Long-term opioid use was defined as a patient receiving a prescription for 90 days or longer.
"It's very widespread," said Mark Sullivan, M.D., a study co-author and professor of psychiatry at the University of Washington. "It's a cause for concern because depressed patients are excluded from virtually all controlled trials of opioids as a high risk group [for addiction], so the database on which clinical practice rests doesn't include depressed patients."
Sullivan said most clinical trials exclude people with more than one disorder, but noted the problem is more worrisome here because depression affects so many - about 10 percent to 20 percent of the population.
The connection between pain and depression is complicated. First, no one really knows how often chronic pain and depression co-occur: 46 percent of patients seeing primary care doctors for ongoing pain have a history of depression and the vast majority of those seeing pain specialists have suffered both disorders, according to the authors.
"If you study depressed people, they tend to have lot of pain complaints that are poorly responsive to a lot of things so it's not surprising that they end up on opioids," Sullivan said.
Being depressed might make pain hurt more. "Emotional and physical pain aren't all that different," Sullivan added. "The same brain zones light up [in imaging studies]."
"Depression is mediated in some significant part by the brain's opioid receptor systems; these things run together at every level that you look at them," said Alex DeLuca, M.D., a consultant on pain and addiction and former chief of the Smithers Addiction Research and Treatment Center. He has no affiliation with the new study.
Consequently, it is impossible to tell whether pain is causing or exacerbating depression - or vice versa. To Sullivan, the bottom line is that "it is very important that opioid treatment for chronic pain does not replace or distract from treating mental disorders. 'Both' works better than 'either/or.'"
General Hospital Psychiatry is a peer-reviewed research journal published bimonthly by Elsevier Science. For information about the journal, contact Wayne Katon, M.D., at (206) 543-7177.
"Trends in long-term opioid therapy for noncancer pain among persons with a history of depression."
The study, published in the November-December issue of the journal General Hospital Psychiatry, analyzed the medical records of tens of thousands of patients enrolled in the Kaiser Permanente and Group Health plans between 1997 and 2005. Together, the insurers cover about 1 percent of the U.S. population. Long-term opioid use was defined as a patient receiving a prescription for 90 days or longer.
"It's very widespread," said Mark Sullivan, M.D., a study co-author and professor of psychiatry at the University of Washington. "It's a cause for concern because depressed patients are excluded from virtually all controlled trials of opioids as a high risk group [for addiction], so the database on which clinical practice rests doesn't include depressed patients."
Sullivan said most clinical trials exclude people with more than one disorder, but noted the problem is more worrisome here because depression affects so many - about 10 percent to 20 percent of the population.
The connection between pain and depression is complicated. First, no one really knows how often chronic pain and depression co-occur: 46 percent of patients seeing primary care doctors for ongoing pain have a history of depression and the vast majority of those seeing pain specialists have suffered both disorders, according to the authors.
"If you study depressed people, they tend to have lot of pain complaints that are poorly responsive to a lot of things so it's not surprising that they end up on opioids," Sullivan said.
Being depressed might make pain hurt more. "Emotional and physical pain aren't all that different," Sullivan added. "The same brain zones light up [in imaging studies]."
"Depression is mediated in some significant part by the brain's opioid receptor systems; these things run together at every level that you look at them," said Alex DeLuca, M.D., a consultant on pain and addiction and former chief of the Smithers Addiction Research and Treatment Center. He has no affiliation with the new study.
Consequently, it is impossible to tell whether pain is causing or exacerbating depression - or vice versa. To Sullivan, the bottom line is that "it is very important that opioid treatment for chronic pain does not replace or distract from treating mental disorders. 'Both' works better than 'either/or.'"
General Hospital Psychiatry is a peer-reviewed research journal published bimonthly by Elsevier Science. For information about the journal, contact Wayne Katon, M.D., at (206) 543-7177.
"Trends in long-term opioid therapy for noncancer pain among persons with a history of depression."
воскресенье, 15 мая 2011 г.
Astrazeneca Submits Supplemental New Drug Applications For Seroquel XR For The Treatment Of Bipolar Mania And Bipolar Depression
AstraZeneca announced that the company has submitted two separate supplemental New Drug Applications (sNDAs) to the U.S. Food and Drug Administration (FDA) for once-daily SEROQUEL XR™ (quetiapine fumarate) Extended-Release Tablets to seek approval for the treatment of manic episodes associated with bipolar disorder and the treatment of depressive episodes associated with bipolar disorder.
The bipolar mania submission is based on a clinical study of once-daily treatment with SEROQUEL XR, compared to placebo, with a primary endpoint of change in YMRS (Young Mania Rating Scale) total score (week 3), in 316 patients suffering from bipolar mania. The bipolar depression submission is supported by a clinical study of once-daily treatment with SEROQUEL XR, compared to placebo, with a primary endpoint of change from baseline in MADRS (Montgomery Asberg Depression Rating Scale) total score after 8 weeks of treatment, in 280 patients diagnosed with bipolar depression. 1 Doses of SEROQUEL XR administered in both the bipolar mania (400 mg to 800 mg/day) and bipolar depression (300 mg/day) studies were comparable to the FDA-approved recommended doses for SEROQUEL (quetiapine fumarate) immediate release tablets in those indications.1,2 Both studies met their primary endpoint and it is expected that they will be presented at major scientific congresses in 2008.
SEROQUEL XR is currently approved in 8 countries including US, Canada and The Netherlands, for the acute and maintenance treatment of schizophrenia in adults.
Launched in 1997, it is estimated that SEROQUEL has been prescribed to more than 25 million patients worldwide*. It is approved in 88 countries for the treatment of schizophrenia, in 79 countries for the treatment of bipolar mania, and in 11 countries including the USA for the treatment of bipolar depression. SEROQUEL XR was launched for the treatment of schizophrenia in the US in 2007, and its clinical development program and planned regulatory filings extend through bipolar disorder to major depressive disorder (MDD) and generalized anxiety disorder (GAD).
About AstraZeneca
AstraZeneca is a major international healthcare business engaged in the research, development, manufacture and marketing of prescription pharmaceuticals and the supply of healthcare services. It is one of the world's leading pharmaceutical companies with healthcare sales of $26.47 billion and leading positions in sales of gastrointestinal, cardiovascular, neuroscience, respiratory, oncology and infection products. AstraZeneca is listed in the Dow Jones Sustainability Index (Global) as well as the FTSE4Good Index.
*Estimate based upon: (1) assumptions as to persistence (the number of prescriptions per patient) based upon 2002 market research; and (2) projections of prescriptions since launch based upon information available in the US and 13 of the 50 other countries in which SEROQUEL is marketed.
References
1. Data on file, (US) DA-SXR-11.
2. SEROQUEL® (quetiapine fumarate) Prescribing Information.
astrazeneca
View drug information on Seroquel.
The bipolar mania submission is based on a clinical study of once-daily treatment with SEROQUEL XR, compared to placebo, with a primary endpoint of change in YMRS (Young Mania Rating Scale) total score (week 3), in 316 patients suffering from bipolar mania. The bipolar depression submission is supported by a clinical study of once-daily treatment with SEROQUEL XR, compared to placebo, with a primary endpoint of change from baseline in MADRS (Montgomery Asberg Depression Rating Scale) total score after 8 weeks of treatment, in 280 patients diagnosed with bipolar depression. 1 Doses of SEROQUEL XR administered in both the bipolar mania (400 mg to 800 mg/day) and bipolar depression (300 mg/day) studies were comparable to the FDA-approved recommended doses for SEROQUEL (quetiapine fumarate) immediate release tablets in those indications.1,2 Both studies met their primary endpoint and it is expected that they will be presented at major scientific congresses in 2008.
SEROQUEL XR is currently approved in 8 countries including US, Canada and The Netherlands, for the acute and maintenance treatment of schizophrenia in adults.
Launched in 1997, it is estimated that SEROQUEL has been prescribed to more than 25 million patients worldwide*. It is approved in 88 countries for the treatment of schizophrenia, in 79 countries for the treatment of bipolar mania, and in 11 countries including the USA for the treatment of bipolar depression. SEROQUEL XR was launched for the treatment of schizophrenia in the US in 2007, and its clinical development program and planned regulatory filings extend through bipolar disorder to major depressive disorder (MDD) and generalized anxiety disorder (GAD).
About AstraZeneca
AstraZeneca is a major international healthcare business engaged in the research, development, manufacture and marketing of prescription pharmaceuticals and the supply of healthcare services. It is one of the world's leading pharmaceutical companies with healthcare sales of $26.47 billion and leading positions in sales of gastrointestinal, cardiovascular, neuroscience, respiratory, oncology and infection products. AstraZeneca is listed in the Dow Jones Sustainability Index (Global) as well as the FTSE4Good Index.
*Estimate based upon: (1) assumptions as to persistence (the number of prescriptions per patient) based upon 2002 market research; and (2) projections of prescriptions since launch based upon information available in the US and 13 of the 50 other countries in which SEROQUEL is marketed.
References
1. Data on file, (US) DA-SXR-11.
2. SEROQUEL® (quetiapine fumarate) Prescribing Information.
astrazeneca
View drug information on Seroquel.
Postpartum Depression And Poor Sleep Quality Linked
Postpartum depression (PPD) can lead to poor sleep quality, recent research shows. A study published in the current issue of the Journal of Obstetric, Gynecologic, & Neonatal Nursing shows that depression symptoms worsen in PPD patients when their quality of sleep declines.
Sleep deprivation can hamper a mother's ability to care for her infant, as judgment and concentration decline. Sleep-deprived mothers also may inadvertently compromise their infants' sleep quality because infants often adopt their mothers' circadian sleep rhythms.
All new mothers experience some sleep loss following childbirth, as their estrogen and progesterone hormone levels plunge. They typically spend 20 percent more of the day awake than average during the first six weeks postpartum. Postpartum women wake more frequently and have less dream sleep than non-postpartum women, with women in their first month postpartum spending only 81 percent of their time in bed actually sleeping. Neurotransmitters that influence sleep quality also affect mood, raising sleep-deprived mothers' risk for depression. Approximately 6.5 to 13 percent of new mothers suffer from PPD in the United States, with there being more than 4.2 million births per year. This rate is nearly 50 percent among mothers in the lowest socioeconomic levels.
Study author Bobbie Posmontier of Drexel University compared sleep patterns of 46 postpartum women, half with symptoms of PPD and half without. Sleep patterns were monitored for seven consecutive days. Results showed that mothers suffering from PPD took longer to fall asleep and slept for shorter periods. The worse their sleep quality, the worse their depression.
Posmontier recommends clinicians treating women for PPD to address the importance of adequate sleep. "Mothers can develop a plan to have other family members help care for the baby at night," she said. "They also should practice good sleep hygiene. That includes going to bed at the same time every night, avoiding naps and steering clear of caffeine, exercise, nicotine and alcohol within four hours of bedtime."
This study is published in the November/December 2008 issue of the Journal of Obstetric, Gynecologic, & Neonatal Nursing.
Bobbie Posmontier is affiliated with Drexel University.
For over 35 years the Journal of Obstetric, Gynecologic, & Neonatal Nursing (JOGNN) has been a premier resource for health care professionals committed to clinical scholarship that advances the health care of women and newborns. With a focus on nursing practice, JOGNN addresses the latest research, practice issues, policies, opinions, and trends in the care of women, childbearing families, and newborns.
Wiley-Blackwell was formed in February 2007 as a result of the acquisition of Blackwell Publishing Ltd. by John Wiley & Sons, Inc., and its merger with Wiley's Scientific, Technical, and Medical business. Together, the companies have created a global publishing business with deep strength in every major academic and professional field. Wiley-Blackwell publishes approximately 1,400 scholarly peer-reviewed journals and an extensive collection of books with global appeal. For more information on Wiley-Blackwell, please visit blackwellpublishing/ or interscience.wiley/.
Sleep deprivation can hamper a mother's ability to care for her infant, as judgment and concentration decline. Sleep-deprived mothers also may inadvertently compromise their infants' sleep quality because infants often adopt their mothers' circadian sleep rhythms.
All new mothers experience some sleep loss following childbirth, as their estrogen and progesterone hormone levels plunge. They typically spend 20 percent more of the day awake than average during the first six weeks postpartum. Postpartum women wake more frequently and have less dream sleep than non-postpartum women, with women in their first month postpartum spending only 81 percent of their time in bed actually sleeping. Neurotransmitters that influence sleep quality also affect mood, raising sleep-deprived mothers' risk for depression. Approximately 6.5 to 13 percent of new mothers suffer from PPD in the United States, with there being more than 4.2 million births per year. This rate is nearly 50 percent among mothers in the lowest socioeconomic levels.
Study author Bobbie Posmontier of Drexel University compared sleep patterns of 46 postpartum women, half with symptoms of PPD and half without. Sleep patterns were monitored for seven consecutive days. Results showed that mothers suffering from PPD took longer to fall asleep and slept for shorter periods. The worse their sleep quality, the worse their depression.
Posmontier recommends clinicians treating women for PPD to address the importance of adequate sleep. "Mothers can develop a plan to have other family members help care for the baby at night," she said. "They also should practice good sleep hygiene. That includes going to bed at the same time every night, avoiding naps and steering clear of caffeine, exercise, nicotine and alcohol within four hours of bedtime."
This study is published in the November/December 2008 issue of the Journal of Obstetric, Gynecologic, & Neonatal Nursing.
Bobbie Posmontier is affiliated with Drexel University.
For over 35 years the Journal of Obstetric, Gynecologic, & Neonatal Nursing (JOGNN) has been a premier resource for health care professionals committed to clinical scholarship that advances the health care of women and newborns. With a focus on nursing practice, JOGNN addresses the latest research, practice issues, policies, opinions, and trends in the care of women, childbearing families, and newborns.
Wiley-Blackwell was formed in February 2007 as a result of the acquisition of Blackwell Publishing Ltd. by John Wiley & Sons, Inc., and its merger with Wiley's Scientific, Technical, and Medical business. Together, the companies have created a global publishing business with deep strength in every major academic and professional field. Wiley-Blackwell publishes approximately 1,400 scholarly peer-reviewed journals and an extensive collection of books with global appeal. For more information on Wiley-Blackwell, please visit blackwellpublishing/ or interscience.wiley/.
Post-Traumatic Stress Disorder Cases Likely To Increase In Japanese Tsunami Aftermath, Says Stress Expert
The Japanese tsunami took quite a massive toll, injuring and killing thousands and causing billions of dollars in destruction. But looking beyond physical destruction, the tsunami took an emotional toll on many as well. According to Dr. Gregory Jantz, author of "Moving Beyond Depression" and "Healing the Scars of Emotional Abuse" and founder of The Center for Counseling and Health Resources, cases of post-traumatic stress disorder are liable to be on the rise following the tsunami, particularly among already vulnerable adults and children.
Post-traumatic stress disorder (PTSD) is a type of anxiety disorder that often occurs in people who have seen or experienced a traumatic event that involved the threat of injury or death. PTSD sufferers re-experience the trauma, often through flashbacks and nightmares, which can lead to crippling social and mental results.
"As a result of the stress of the world economy, many adults are on the edge of an anxiety disorder. Children whom have been victims of emotional abuse are susceptible as well," says Dr. Jantz. "Feelings of powerlessness stemming from the tsunami are likely to trigger PTSD in many of these at-risk adults and children."
In addition, depression often coincides with PTSD, says Dr. Jantz. Short-term and long-term symptoms of depression include significant changes in appetite and sleep patterns, a loss of interest in formally enjoyable activities, feelings of restlessness and/or fatigue, inability to focus and increase irritability. Dr. Jantz offers a depression survey on The Center website for those who think they might be depressed.
Moreover, Dr. Jantz says a rise in addiction as a means to cope with the aftermath of the tsunami is very likely.
"In response to tragedy such as the Japanese tsunami, many turn to drug, alcohol and/or gambling to soothe feelings of helplessness, fear and anxiety," says Dr. Jantz.
For those suffering from post-traumatic stress disorder, depression and addiction following the tsunami, The Center for Counseling and Health Resources in Edmonds, WA specializes in providing whole-person treatment to promote emotional, physical and spiritual healing.
Post-traumatic stress disorder (PTSD) is a type of anxiety disorder that often occurs in people who have seen or experienced a traumatic event that involved the threat of injury or death. PTSD sufferers re-experience the trauma, often through flashbacks and nightmares, which can lead to crippling social and mental results.
"As a result of the stress of the world economy, many adults are on the edge of an anxiety disorder. Children whom have been victims of emotional abuse are susceptible as well," says Dr. Jantz. "Feelings of powerlessness stemming from the tsunami are likely to trigger PTSD in many of these at-risk adults and children."
In addition, depression often coincides with PTSD, says Dr. Jantz. Short-term and long-term symptoms of depression include significant changes in appetite and sleep patterns, a loss of interest in formally enjoyable activities, feelings of restlessness and/or fatigue, inability to focus and increase irritability. Dr. Jantz offers a depression survey on The Center website for those who think they might be depressed.
Moreover, Dr. Jantz says a rise in addiction as a means to cope with the aftermath of the tsunami is very likely.
"In response to tragedy such as the Japanese tsunami, many turn to drug, alcohol and/or gambling to soothe feelings of helplessness, fear and anxiety," says Dr. Jantz.
For those suffering from post-traumatic stress disorder, depression and addiction following the tsunami, The Center for Counseling and Health Resources in Edmonds, WA specializes in providing whole-person treatment to promote emotional, physical and spiritual healing.
Wyeth Submits New Drug Application For Desvenlafaxine Extended Release (DVS-233) For Depression
Wyeth Pharmaceuticals, a division of Wyeth (NYSE:WYE), announced that it has submitted a New Drug Application (NDA) with the U.S. Food and Drug Administration (FDA) for desvenlafaxine extended release (DVS-233) for the treatment of major depressive disorder (MDD). Desvenlafaxine extended release represents Wyeth's ongoing commitment to research and development of new antidepressant therapies. The new compound was discovered and developed by Wyeth Research.
The clinical development program for major depressive disorder supporting the NDA investigated desvenlafaxine extended release, a serotonin/norepinephrine reuptake inhibitor (SNRI), in patients with a broad range of symptoms associated with depression, including both emotional and somatic symptoms.
"We know from clinical studies as well as clinical practice that there remain significant unmet needs in treating depressed patients," says Gary L. Stiles, M.D., Executive Vice President, Chief Medical Officer, Wyeth. "If approved, desvenlafaxine extended release will offer physicians a new clinically proven option for treating depression."
Facts About Depression
Following are facts that substantiate the significant unmet patient need for efficacy in antidepressants and the enormous societal impact of depression.
Depression is the most common serious mental disorder worldwide
· Depression affects approximately 121 million people worldwide and is the fourth leading cause of disability and premature death.
· The World Health Organization projects that by the year 2020, depressive disorders will become the second-leading cause of disability worldwide.
· Depression is the most prevalent mental health condition in the United States, affecting approximately 19 million American adults each year.
· Studies indicate that depressive episodes occur twice as frequently in women as in men.
Diagnostic criteria for Major Depressive Disorder include the following:
· Depressed mood most of the day, nearly every day (subjectively reported or observed by others)
· Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (subjectively reported or observed by others)
· Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day
· Insomnia or hypersomnia nearly every day
· Psychomotor agitation or retardation nearly every day (as observable by others, not merely subjective feelings)
· Fatigue or loss of energy nearly every day
· Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day
· Diminished ability to think or concentrate, or indecisiveness, nearly every day (subjectively reported or observed by others)
· Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
More treatment options are needed
· Researchers estimate that approximately 50 to 60 percent of patients suffering from depression respond to antidepressant therapy, leaving a large percentage of patients with unresolved depression.
· Patients who experience one episode of depression have a 50 percent chance that it will recur within five years.
About Antidepressants
Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with MDD and other psychiatric disorders. Anyone considering the use of any antidepressant in a child or adolescent must balance the risk with the clinical need. Patients who are started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber.
About Wyeth
Wyeth is one of the world's largest research-driven pharmaceutical and health care products companies. It is a leader in the discovery, development, manufacturing, and marketing of pharmaceuticals, vaccines, biotechnology products and nonprescription medicines that improve the quality of life for people worldwide. The Company's major divisions include Wyeth Pharmaceuticals, Wyeth Consumer Healthcare and Fort Dodge Animal Health.
Wyeth Pharmaceuticals
Wyeth Pharmaceuticals, a division of Wyeth, has leading products in the areas of women's health care, cardiovascular disease, central nervous system, inflammation, transplantation, hemophilia, oncology, vaccines and nutritional products.
The statements in this press release that are not historical facts are forward-looking statements based on current expectations of future events that involve risks and uncertainties including, without limitation, risks associated with the inherent uncertainty of the timing and success of pharmaceutical research, product development, manufacturing, commercialization, economic conditions including interest and currency exchange rate fluctuations, changes in generally accepted accounting principles, the impact of competitive or generic products, trade-buying patterns, wars or terrorist acts, product liability and other types of lawsuits, the impact of legislation and regulatory compliance and obtaining reimbursement, favorable drug pricing, access and other approvals, environmental liabilities, and patent, and other risks and uncertainties, including those detailed from time to time in the Company's periodic reports, including current reports on Form 8-K, quarterly reports on Form 10-Q and the annual report on Form 10-K, filed with the Securities and Exchange Commission. Actual results may vary materially from the forward-looking statements. The Company assumes no obligation to publicly update any forward-looking statements, whether as a result of new information, future events or otherwise.
wyeth
The clinical development program for major depressive disorder supporting the NDA investigated desvenlafaxine extended release, a serotonin/norepinephrine reuptake inhibitor (SNRI), in patients with a broad range of symptoms associated with depression, including both emotional and somatic symptoms.
"We know from clinical studies as well as clinical practice that there remain significant unmet needs in treating depressed patients," says Gary L. Stiles, M.D., Executive Vice President, Chief Medical Officer, Wyeth. "If approved, desvenlafaxine extended release will offer physicians a new clinically proven option for treating depression."
Facts About Depression
Following are facts that substantiate the significant unmet patient need for efficacy in antidepressants and the enormous societal impact of depression.
Depression is the most common serious mental disorder worldwide
· Depression affects approximately 121 million people worldwide and is the fourth leading cause of disability and premature death.
· The World Health Organization projects that by the year 2020, depressive disorders will become the second-leading cause of disability worldwide.
· Depression is the most prevalent mental health condition in the United States, affecting approximately 19 million American adults each year.
· Studies indicate that depressive episodes occur twice as frequently in women as in men.
Diagnostic criteria for Major Depressive Disorder include the following:
· Depressed mood most of the day, nearly every day (subjectively reported or observed by others)
· Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (subjectively reported or observed by others)
· Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day
· Insomnia or hypersomnia nearly every day
· Psychomotor agitation or retardation nearly every day (as observable by others, not merely subjective feelings)
· Fatigue or loss of energy nearly every day
· Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day
· Diminished ability to think or concentrate, or indecisiveness, nearly every day (subjectively reported or observed by others)
· Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
More treatment options are needed
· Researchers estimate that approximately 50 to 60 percent of patients suffering from depression respond to antidepressant therapy, leaving a large percentage of patients with unresolved depression.
· Patients who experience one episode of depression have a 50 percent chance that it will recur within five years.
About Antidepressants
Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with MDD and other psychiatric disorders. Anyone considering the use of any antidepressant in a child or adolescent must balance the risk with the clinical need. Patients who are started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber.
About Wyeth
Wyeth is one of the world's largest research-driven pharmaceutical and health care products companies. It is a leader in the discovery, development, manufacturing, and marketing of pharmaceuticals, vaccines, biotechnology products and nonprescription medicines that improve the quality of life for people worldwide. The Company's major divisions include Wyeth Pharmaceuticals, Wyeth Consumer Healthcare and Fort Dodge Animal Health.
Wyeth Pharmaceuticals
Wyeth Pharmaceuticals, a division of Wyeth, has leading products in the areas of women's health care, cardiovascular disease, central nervous system, inflammation, transplantation, hemophilia, oncology, vaccines and nutritional products.
The statements in this press release that are not historical facts are forward-looking statements based on current expectations of future events that involve risks and uncertainties including, without limitation, risks associated with the inherent uncertainty of the timing and success of pharmaceutical research, product development, manufacturing, commercialization, economic conditions including interest and currency exchange rate fluctuations, changes in generally accepted accounting principles, the impact of competitive or generic products, trade-buying patterns, wars or terrorist acts, product liability and other types of lawsuits, the impact of legislation and regulatory compliance and obtaining reimbursement, favorable drug pricing, access and other approvals, environmental liabilities, and patent, and other risks and uncertainties, including those detailed from time to time in the Company's periodic reports, including current reports on Form 8-K, quarterly reports on Form 10-Q and the annual report on Form 10-K, filed with the Securities and Exchange Commission. Actual results may vary materially from the forward-looking statements. The Company assumes no obligation to publicly update any forward-looking statements, whether as a result of new information, future events or otherwise.
wyeth
Mental Health America Calls On President To Reverse Policy Of Not Sending Condolence Letters To Families Of Soldiers Who Complete Suicide
Mental Health America is calling on President Obama to reverse a long-standing, unwritten policy of not sending Presidential letters of condolence to the families of service members who have completed suicide.
A resolution adopted by Mental Health America's Board of Directors states that a condolence letter can help eliminate the stigma and shame associated with suicide and provide emotional support to families.
"The lack of acknowledgment and condolence from the President can leave these families with an emotional vacuum and a feeling that somehow their sacrifices may not have been as great as others who died while in the military," the resolution states.
Mental Health America is also circulating an online petition through its Facebook page.
"Our nation face a critical challenge as we welcome our troops back from war," the petition state. "After bravely risking their lives for our country, these heroes and their families often return to strained relationships, depression and even Post-Traumatic Stress Disorder (PTSD). Our response as a grateful nation is critical, and there is a near epidemic of suicides among our Armed Forces."
Last month, in an effort initiated by Reps. Dan Burton (R-Ind.) and Patrick Kennedy (D-R.I.), 46 House members sent a letter to the President asking him to reverse the policy.
"By overturning this policy on letters of condolence to the families of suicide victims, you can send a strong signal that you will not tolerate a culture in our armed forces that discriminates against those with a mental illness," the lawmakers wrote.
Mental Health America and the House members also noted that current military funeral procedure treats both suicide and death in combat the same.
President Obama asked for a review of the policy several weeks ago. The White House said last month that is expects the review to be completed soon.
Source
Mental Health America
A resolution adopted by Mental Health America's Board of Directors states that a condolence letter can help eliminate the stigma and shame associated with suicide and provide emotional support to families.
"The lack of acknowledgment and condolence from the President can leave these families with an emotional vacuum and a feeling that somehow their sacrifices may not have been as great as others who died while in the military," the resolution states.
Mental Health America is also circulating an online petition through its Facebook page.
"Our nation face a critical challenge as we welcome our troops back from war," the petition state. "After bravely risking their lives for our country, these heroes and their families often return to strained relationships, depression and even Post-Traumatic Stress Disorder (PTSD). Our response as a grateful nation is critical, and there is a near epidemic of suicides among our Armed Forces."
Last month, in an effort initiated by Reps. Dan Burton (R-Ind.) and Patrick Kennedy (D-R.I.), 46 House members sent a letter to the President asking him to reverse the policy.
"By overturning this policy on letters of condolence to the families of suicide victims, you can send a strong signal that you will not tolerate a culture in our armed forces that discriminates against those with a mental illness," the lawmakers wrote.
Mental Health America and the House members also noted that current military funeral procedure treats both suicide and death in combat the same.
President Obama asked for a review of the policy several weeks ago. The White House said last month that is expects the review to be completed soon.
Source
Mental Health America
Best treatment for mild or moderate depression unclear
Guidelines for the management of mild or moderate depression are unclear because firm evidence is lacking, claim doctors
in this week's BMJ.
The (UK) National Institute for Clinical Excellence (NICE) provides clear guidance on the treatment of moderate to severe
depression, but what is less clear is the appropriate treatment for mild to moderate depression, write Gene Feder and
colleagues.
They say that the study on which the guidelines are based identifies evidence supporting problem solving therapies and
counselling, but evidence on other interventions is weak or absent.
Although these shortcomings are acknowledged, the guidelines offer limited advice on how to determine whether or not a
particular patient may benefit from treatment, they add.
They suggest that we need a better understanding of the interaction that occurs when individuals seek medical help for an
emotional problem. "This medicalisation of unhappiness would benefit from sociological as well as clinical research," they
conclude.
(Editorial: NICE guidelines for the management of depression)
bmj/cgi/content/full/330/7486/267
Contact:
Gene Feder, Professor of Primary Care Research and Development, Barts and the London, Queen Mary's School of Medicine and
Dentistry, London, UK
Email: g.s.federqmul.ac.uk
in this week's BMJ.
The (UK) National Institute for Clinical Excellence (NICE) provides clear guidance on the treatment of moderate to severe
depression, but what is less clear is the appropriate treatment for mild to moderate depression, write Gene Feder and
colleagues.
They say that the study on which the guidelines are based identifies evidence supporting problem solving therapies and
counselling, but evidence on other interventions is weak or absent.
Although these shortcomings are acknowledged, the guidelines offer limited advice on how to determine whether or not a
particular patient may benefit from treatment, they add.
They suggest that we need a better understanding of the interaction that occurs when individuals seek medical help for an
emotional problem. "This medicalisation of unhappiness would benefit from sociological as well as clinical research," they
conclude.
(Editorial: NICE guidelines for the management of depression)
bmj/cgi/content/full/330/7486/267
Contact:
Gene Feder, Professor of Primary Care Research and Development, Barts and the London, Queen Mary's School of Medicine and
Dentistry, London, UK
Email: g.s.federqmul.ac.uk
Psychotherapy, meds best for youth with obsessive compulsive disorder
Children and adolescents with Obsessive Compulsive Disorder (OCD) respond best to a combination of both psychotherapy and
an antidepressant, a major clinical trial has found. Supported by the National Institutes of Health's (NIH) National
Institute of Mental Health, the study recommends that treatment begin with cognitive behavior therapy (CBT), either alone or
with a serotonin reuptake inhibitor (SSRI) antidepressant. The research spotlights the need for improved access to CBT, since
most young people with OCD currently receive only the antidepressant, often combined with an antipsychotic medication. John
March, M.D., Duke University, Edna Foa, Ph.D., University of Pennsylvania, and colleagues report on the findings of the
Pediatric OCD Treatment Study (POTS) in the October 27, 2004 Journal of the American Medical Association (JAMA).
Ninety-seven 7-17 year-olds with OCD completed 12 weeks of treatment with either CBT, the SSRI sertraline, the combination
treatment, or a placebo. Independent evaluators, blind to their treatment status, assessed each patient every four weeks.
Patients in the study were typical of patients seen in clinical practice. For example, while industry-sponsored trials
commonly exclude patients with more than one condition, 80 percent of study participants had at least one additional
psychiatric disorder.
Combining sertraline and CBT was more effective than treatment with just one or the other. CBT alone did prove superior to
sertraline, which, in turn, was better than a placebo. By the end of the trial, the remission rates were 53.6 percent for
combined treatment, 39.3 percent for CBT, 21.4 percent for sertraline, and 3.6 percent for placebo.
CBT alone was more effective in the University of Pennsylvania site than at Duke University site, but the combination
treatment was equally effective at both sites, suggesting that it may be less susceptible to setting-specific variations. The
strong showing of CBT at the University of Pennsylvania led the researchers to recommend it as "a first line option" for
initial treatment. They point out, however, that "only a small minority" of children and adolescents with OCD receives such
state-of- the-art care.
"In the Treatment of Adolescents with Depression Study, which compared CBT with an SSRI and combination treatment, for teens
with depression, the medication proved superior to CBT. In this case the reverse was true but in both studies, combination
was superior. This underscores that different disorders in adolescents respond to different treatments," noted NIMH Director
Thomas Insel, M.D.
"We believe that the results of this study will contribute to the appreciation by non-physician mental health clinicians of
the strengths and limitations of pharmacological treatments and to the appreciation by physicians of the evidence-based
psychosocial treatments," states the article. "It is imperative that the focus of research turn to identifying and testing
dissemination strategies for CBT," the researchers add.
There were no episodes of mania, suicidality, or other serious adverse events during the course of the study.
Also participating in the study were Pat Gammon, Ph.D., Allan Chrisman, M.D., John Curry, Ph.D., David Fitzgerald, Ph.D., and
Kevin Sullivan, BA, all from Duke University Medical Center; Martin Franklin, Ph.D., Jonathan Huppert, Ph.D., MoiraRynn,
M.D., Ning Zhao, Ph.D., and Lori Zoellner, Ph.D., from the University of Pennsylvania; and Henrietta Leonard, M.D., Abbe
Garcia, Ph.D., and Jennifer Freeman, Ph.D., from Brown University. The principal statistician was Xin Tu, Ph.D. (University
of Pennsylvania).
NIMH is part of the National Institutes of Health (NIH), the Federal Government's primary agency for biomedical and
behavioral research. NIH is a component of the U.S. Department of Health and Human Services.
To learn more, visit:
Obsessive Compulsive Disorder (OCD):
nimh.nih/HealthInformation/ocdmenu.cfm
Treatment of Adolescents with Depression Study (TADS):
nimh.nih/press/prtads.cfm
Depression in children and adolescents:
nimh.nih/HealthInformation/depchildmenu.cfm
Contact: Jules Asher
NIMHpressnih
301-443-4536
NIH/National Institute of Mental Health
an antidepressant, a major clinical trial has found. Supported by the National Institutes of Health's (NIH) National
Institute of Mental Health, the study recommends that treatment begin with cognitive behavior therapy (CBT), either alone or
with a serotonin reuptake inhibitor (SSRI) antidepressant. The research spotlights the need for improved access to CBT, since
most young people with OCD currently receive only the antidepressant, often combined with an antipsychotic medication. John
March, M.D., Duke University, Edna Foa, Ph.D., University of Pennsylvania, and colleagues report on the findings of the
Pediatric OCD Treatment Study (POTS) in the October 27, 2004 Journal of the American Medical Association (JAMA).
Ninety-seven 7-17 year-olds with OCD completed 12 weeks of treatment with either CBT, the SSRI sertraline, the combination
treatment, or a placebo. Independent evaluators, blind to their treatment status, assessed each patient every four weeks.
Patients in the study were typical of patients seen in clinical practice. For example, while industry-sponsored trials
commonly exclude patients with more than one condition, 80 percent of study participants had at least one additional
psychiatric disorder.
Combining sertraline and CBT was more effective than treatment with just one or the other. CBT alone did prove superior to
sertraline, which, in turn, was better than a placebo. By the end of the trial, the remission rates were 53.6 percent for
combined treatment, 39.3 percent for CBT, 21.4 percent for sertraline, and 3.6 percent for placebo.
CBT alone was more effective in the University of Pennsylvania site than at Duke University site, but the combination
treatment was equally effective at both sites, suggesting that it may be less susceptible to setting-specific variations. The
strong showing of CBT at the University of Pennsylvania led the researchers to recommend it as "a first line option" for
initial treatment. They point out, however, that "only a small minority" of children and adolescents with OCD receives such
state-of- the-art care.
"In the Treatment of Adolescents with Depression Study, which compared CBT with an SSRI and combination treatment, for teens
with depression, the medication proved superior to CBT. In this case the reverse was true but in both studies, combination
was superior. This underscores that different disorders in adolescents respond to different treatments," noted NIMH Director
Thomas Insel, M.D.
"We believe that the results of this study will contribute to the appreciation by non-physician mental health clinicians of
the strengths and limitations of pharmacological treatments and to the appreciation by physicians of the evidence-based
psychosocial treatments," states the article. "It is imperative that the focus of research turn to identifying and testing
dissemination strategies for CBT," the researchers add.
There were no episodes of mania, suicidality, or other serious adverse events during the course of the study.
Also participating in the study were Pat Gammon, Ph.D., Allan Chrisman, M.D., John Curry, Ph.D., David Fitzgerald, Ph.D., and
Kevin Sullivan, BA, all from Duke University Medical Center; Martin Franklin, Ph.D., Jonathan Huppert, Ph.D., MoiraRynn,
M.D., Ning Zhao, Ph.D., and Lori Zoellner, Ph.D., from the University of Pennsylvania; and Henrietta Leonard, M.D., Abbe
Garcia, Ph.D., and Jennifer Freeman, Ph.D., from Brown University. The principal statistician was Xin Tu, Ph.D. (University
of Pennsylvania).
NIMH is part of the National Institutes of Health (NIH), the Federal Government's primary agency for biomedical and
behavioral research. NIH is a component of the U.S. Department of Health and Human Services.
To learn more, visit:
Obsessive Compulsive Disorder (OCD):
nimh.nih/HealthInformation/ocdmenu.cfm
Treatment of Adolescents with Depression Study (TADS):
nimh.nih/press/prtads.cfm
Depression in children and adolescents:
nimh.nih/HealthInformation/depchildmenu.cfm
Contact: Jules Asher
NIMHpressnih
301-443-4536
NIH/National Institute of Mental Health
Researchers Explore The Antidepressant Effects Of Ketamine
Drug treatments for depression can take many weeks for the beneficial effects to emerge. The excruciating and disabling nature of depression highlights the urgency of developing treatments that act more rapidly. Ketamine, a drug used in general medicine as an anesthetic, has recently been shown to produce improvements in depressed patients within hours of administration. A new study being published in the February 15th issue of Biological Psychiatry provides some new insight into the mechanisms by which ketamine exerts its effects.
Ketamine is classified as an N-methyl d-aspartate (NMDA) glutamate receptor antagonist. Maeng and colleagues now provide new evidence that these antidepressant effects of NMDA receptor antagonists are mediated by their ability to increase the stimulation of a-amino-3-hydroxy-5-methylisoxazole-4-propionic acid (AMPA) glutamate receptors. In other words, their findings indicate that the antidepressant-like effects of drugs like ketamine are dependent on AMPA receptor stimulation. This suggests that drugs that enhance AMPA receptor function might have rapid antidepressant properties.
Dr. Husseini Manji, corresponding author on this paper and a Deputy Editor of Biological Psychiatry, explains that "by aiming new medications at more direct molecular targets, such as NMDA or AMPA, we may be able to bypass some of the steps through which current antidepressants indirectly exert their effects a roundabout route that accounts for the long time it takes for patients to begin feeling better with the conventional medications." He adds, "Today's antidepressant medications eventually end up doing the same thing, but they go about it the long way around, with a lot of biochemical steps that take time. Now we've shown what the key targets are and that we can get at them rapidly."
This study is especially important because even though this important antidepressant effect has been found in ketamine, its use also has significant drawbacks. According to John H. Krystal, M.D., Editor of Biological Psychiatry and affiliated with both Yale University School of Medicine and the VA Connecticut Healthcare System, "the only NMDA receptor antagonist found to be effective so far, ketamine, produces transient changes in perception and impairments in cognition." It is also in the same class of drugs as PCP (phencyclidine) and can cause hallucinations, among other side effects. Dr. Krystal notes that "it is possible that drugs that directly enhance the activity of AMPA glutamate receptors, the AMPAkines, would have antidepressant effects similar to ketamine, without the unwanted side effects." Exploring the antidepressant effects of the AMPAkines will now be an important target for researchers.
ELSEVIER
Radarweg 29
Amsterdam
elsevier
Ketamine is classified as an N-methyl d-aspartate (NMDA) glutamate receptor antagonist. Maeng and colleagues now provide new evidence that these antidepressant effects of NMDA receptor antagonists are mediated by their ability to increase the stimulation of a-amino-3-hydroxy-5-methylisoxazole-4-propionic acid (AMPA) glutamate receptors. In other words, their findings indicate that the antidepressant-like effects of drugs like ketamine are dependent on AMPA receptor stimulation. This suggests that drugs that enhance AMPA receptor function might have rapid antidepressant properties.
Dr. Husseini Manji, corresponding author on this paper and a Deputy Editor of Biological Psychiatry, explains that "by aiming new medications at more direct molecular targets, such as NMDA or AMPA, we may be able to bypass some of the steps through which current antidepressants indirectly exert their effects a roundabout route that accounts for the long time it takes for patients to begin feeling better with the conventional medications." He adds, "Today's antidepressant medications eventually end up doing the same thing, but they go about it the long way around, with a lot of biochemical steps that take time. Now we've shown what the key targets are and that we can get at them rapidly."
This study is especially important because even though this important antidepressant effect has been found in ketamine, its use also has significant drawbacks. According to John H. Krystal, M.D., Editor of Biological Psychiatry and affiliated with both Yale University School of Medicine and the VA Connecticut Healthcare System, "the only NMDA receptor antagonist found to be effective so far, ketamine, produces transient changes in perception and impairments in cognition." It is also in the same class of drugs as PCP (phencyclidine) and can cause hallucinations, among other side effects. Dr. Krystal notes that "it is possible that drugs that directly enhance the activity of AMPA glutamate receptors, the AMPAkines, would have antidepressant effects similar to ketamine, without the unwanted side effects." Exploring the antidepressant effects of the AMPAkines will now be an important target for researchers.
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Ketamine May Relieve Depression Quickly For Those With Treatment-Resistant Bipolar Disorder
A single intravenous dose of the anesthetic agent ketamine appears to reduce symptoms of depression within 40 minutes among those with bipolar disorder who have not responded to other treatments, according to a report in the August issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
"Bipolar disorder is one of the most severe psychiatric disorders and ranks in the top 10 causes of medical disability worldwide," the authors write as background information in the article. About 4 percent of Americans will develop bipolar disorder in their lifetimes, and depressive symptoms dominate for most of the course of the illness. Several treatments for bipolar depression are currently approved, but some patients do not respond to these therapies despite adequate trials. In addition, existing treatments are associated with a lag of onset; most patients do not respond within the first week of therapy, resulting in considerable illness and increased suicide risk.
One reason for the lack of better therapies is a limited understanding of the neurobiological basis of bipolar disorder, the authors note. However, recent research suggest dysfunction in the brain's glutamatergic system-which plays a role in information processing and memory formation-may contribute. Nancy Diazgranados, M.D., M.S., and colleagues at the National Institute of Mental Health, Bethesda, Md., assessed the effectiveness of one modulator of this system-ketamine hydrochloride, commonly used as an anesthetic-for bipolar depression.
From October 2006 through June 2009, 18 participants with bipolar depression that had failed to respond to the medications lithium or valproate received an intravenous infusion of either ketamine or a placebo on two test days two weeks apart. The order of the infusions was randomly assigned. Participants were assessed using a depression rating scale before each injection and then 40, 80, 120 and 230 minutes and one, two, three, seven, 10 and 14 days afterward.
Within 40 minutes, those who received ketamine experienced a significant improvement in depressive symptoms compared with those who took placebo, an improvement that was largest at day two and remained significant through day three. At some point during the course of the trial, 71 percent of participants responded to ketamine and 6 percent responded to placebo.
"These findings are particularly noteworthy because a substantial proportion of study participants had been prescribed complex polypharmacy regimens in the past with substantial treatment failures," the authors write. "The mean [average] number of past antidepressant trials was seven, and more than 55 percent of participants failed to respond to electroconvulsive therapy. The toll of this protracted and refractory illness on the subjects was evident, in that two-thirds of participants were on psychiatric disability and nearly all were unemployed."
No serious adverse effects were reported during the study. The results lend support to the hypothesis that the glutamatergic system is implicated in the development of bipolar disorder, and that targeting it may lead to improved therapies. "Future research will need to address whether differences in kinetics associated with intravenous administration-which allows for faster absorption and avoids hepatic metabolism-are important or necessary for rapid antidepressant effects to occur," the authors write. In addition, "future studies should examine strategies for long-term maintenance of ketamine's rapid antidepressant response."
Arch Gen Psychiatry 2010;67[8]:793-802.
"Bipolar disorder is one of the most severe psychiatric disorders and ranks in the top 10 causes of medical disability worldwide," the authors write as background information in the article. About 4 percent of Americans will develop bipolar disorder in their lifetimes, and depressive symptoms dominate for most of the course of the illness. Several treatments for bipolar depression are currently approved, but some patients do not respond to these therapies despite adequate trials. In addition, existing treatments are associated with a lag of onset; most patients do not respond within the first week of therapy, resulting in considerable illness and increased suicide risk.
One reason for the lack of better therapies is a limited understanding of the neurobiological basis of bipolar disorder, the authors note. However, recent research suggest dysfunction in the brain's glutamatergic system-which plays a role in information processing and memory formation-may contribute. Nancy Diazgranados, M.D., M.S., and colleagues at the National Institute of Mental Health, Bethesda, Md., assessed the effectiveness of one modulator of this system-ketamine hydrochloride, commonly used as an anesthetic-for bipolar depression.
From October 2006 through June 2009, 18 participants with bipolar depression that had failed to respond to the medications lithium or valproate received an intravenous infusion of either ketamine or a placebo on two test days two weeks apart. The order of the infusions was randomly assigned. Participants were assessed using a depression rating scale before each injection and then 40, 80, 120 and 230 minutes and one, two, three, seven, 10 and 14 days afterward.
Within 40 minutes, those who received ketamine experienced a significant improvement in depressive symptoms compared with those who took placebo, an improvement that was largest at day two and remained significant through day three. At some point during the course of the trial, 71 percent of participants responded to ketamine and 6 percent responded to placebo.
"These findings are particularly noteworthy because a substantial proportion of study participants had been prescribed complex polypharmacy regimens in the past with substantial treatment failures," the authors write. "The mean [average] number of past antidepressant trials was seven, and more than 55 percent of participants failed to respond to electroconvulsive therapy. The toll of this protracted and refractory illness on the subjects was evident, in that two-thirds of participants were on psychiatric disability and nearly all were unemployed."
No serious adverse effects were reported during the study. The results lend support to the hypothesis that the glutamatergic system is implicated in the development of bipolar disorder, and that targeting it may lead to improved therapies. "Future research will need to address whether differences in kinetics associated with intravenous administration-which allows for faster absorption and avoids hepatic metabolism-are important or necessary for rapid antidepressant effects to occur," the authors write. In addition, "future studies should examine strategies for long-term maintenance of ketamine's rapid antidepressant response."
Arch Gen Psychiatry 2010;67[8]:793-802.
Mechanism In Memory Development Discovered In Flies That May Help Parkinson's Patients
Before swatting at one of those pesky flies that come out as the days lengthen and the temperature rises, one should probably think twice. A University of Missouri researcher has found, through the study of Drosophila (a type of fruit fly), that by manipulating levels of certain compounds associated with the "circuitry" of the brain, key genes related to memory can be isolated and tested. The results of the study may benefit human patients suffering from Parkinson's disease and could eventually lead to discoveries in the treatment of depression.
"The implication for human health is that it could influence our understanding of the cognitive decline associated with Parkinson's disease and depression in humans," said Troy Zars, MU assistant professor of biological science in the College of Arts and Science.
The idea that animals have a system that can match the quality of a memory with the significance of the memory is well established. If the event is significant, the memory and detail surrounding it is much stronger, lasts longer and is more easily recalled compared to more insignificant or common events. The problem the study addresses is the understanding of the mechanism by which that occurs.
"We have developed a strategy to address how this matching occurs, so we can 'turn that crank' over and over again. It allows us to answer the questions, 'What gene is it" How does it function" How does it interact with other proteins"' We can find brand-new, completely unexpected things," Zars said.
A major goal of neuroscience is to discover and study memory-forming structures within a brain. Zars said he works with Drosophila because they are a well-established genetic model, have a relatively less complex brain than the mouse or human (250,000 neurons versus 100 billion neurons), and have a broad repertoire of behaviors.
Memory in the flies was tested using a specialized chamber in which single flies were allowed to wander freely. The chamber was outfitted with heating elements. When the fly moved to a particular side, the whole chamber rapidly heated to an uncomfortable temperature. The flies eventually learned, or remembered, to avoid that half if brain "circuitry" is functioning properly. A mutation in certain flies, however, altered the levels of serotonin and dopamine, which resulted in lower memory scores.
"This research is important because by studying a simple brain it will help us ultimately understand complex neural systems," Zars said. Zars' study was published this week in Proceedings of the National Academy of Sciences.
"The implication for human health is that it could influence our understanding of the cognitive decline associated with Parkinson's disease and depression in humans," said Troy Zars, MU assistant professor of biological science in the College of Arts and Science.
The idea that animals have a system that can match the quality of a memory with the significance of the memory is well established. If the event is significant, the memory and detail surrounding it is much stronger, lasts longer and is more easily recalled compared to more insignificant or common events. The problem the study addresses is the understanding of the mechanism by which that occurs.
"We have developed a strategy to address how this matching occurs, so we can 'turn that crank' over and over again. It allows us to answer the questions, 'What gene is it" How does it function" How does it interact with other proteins"' We can find brand-new, completely unexpected things," Zars said.
A major goal of neuroscience is to discover and study memory-forming structures within a brain. Zars said he works with Drosophila because they are a well-established genetic model, have a relatively less complex brain than the mouse or human (250,000 neurons versus 100 billion neurons), and have a broad repertoire of behaviors.
Memory in the flies was tested using a specialized chamber in which single flies were allowed to wander freely. The chamber was outfitted with heating elements. When the fly moved to a particular side, the whole chamber rapidly heated to an uncomfortable temperature. The flies eventually learned, or remembered, to avoid that half if brain "circuitry" is functioning properly. A mutation in certain flies, however, altered the levels of serotonin and dopamine, which resulted in lower memory scores.
"This research is important because by studying a simple brain it will help us ultimately understand complex neural systems," Zars said. Zars' study was published this week in Proceedings of the National Academy of Sciences.
Common Mechanisms: Inflammation, Depression And Antidepressant Response
Major depressive disorder is a common and complex condition that impacts about 15% of the population of the United States, yet very little is known about the mechanisms behind the psychiatric disorder. What is known is that there are clinical parallels between depressive symptoms and the symptoms of certain inflammatory disorders.
In findings published electronically in Molecular Psychiatry, researchers from University of Miami found polymorphisms in inflammation-related genes that are associated with susceptibility to major depression and antidepressant response. Two genes critical for T-cell function in the immune system have been associated with susceptibility for major depressive disorder and antidepressant treatment response: PSMB4 (proteasome beta 4 subunit) and TBX21 (T-bet).
The study population was made up of 284 depressed Mexican-Americans from Los Angeles who were already enrolled in a pharmacogenetic study of antidepressant treatment response. The control group was made up of 331 individuals from the same community.
"Our findings suggest that a simple blood test to look for these genes could help us identify people who are at risk for depression," said Ma-Li Wong, M.D., professor and vice chair for translational research in the Department of Psychiatry and Behavioral Sciences at the Miller School of Medicine and lead author of the study. "We would know to watch these people in stressful situations, such as a soldier in combat, and intervene earlier to get them the help they need."
Interestingly, genetic variations in PSMB4 and TBX21 may also be relevant to two immune disorders, psoriasis and asthma. Both of these disorders are known to be co-morbid withmajor depressive disorder and are related to psychosocial stressors.
Citation source:
Polymorphisms in inflammation-related genes are associated with susceptibility to major depression and antidepressant response
Ma-Li Wong Chuanhui Dong Jorge Maestre-Mesa Julio Licinio
Molecular Psychiatry advance online publication, 27 May 2008; doi:10.1038/mp.2008.59
Molecular Psychiatry is a peer-reviewed independent journal that publishes groundbreaking research in psychiatry and related fields. The journal's Impact Factor is 11.804, 2nd of 95 in Psychiatry
Journal e-Mail: JLozanomed.miami
Website: nature/mp
Editor: Julio Licinio, M.D.
University of Miami Miller School of Medicine
In findings published electronically in Molecular Psychiatry, researchers from University of Miami found polymorphisms in inflammation-related genes that are associated with susceptibility to major depression and antidepressant response. Two genes critical for T-cell function in the immune system have been associated with susceptibility for major depressive disorder and antidepressant treatment response: PSMB4 (proteasome beta 4 subunit) and TBX21 (T-bet).
The study population was made up of 284 depressed Mexican-Americans from Los Angeles who were already enrolled in a pharmacogenetic study of antidepressant treatment response. The control group was made up of 331 individuals from the same community.
"Our findings suggest that a simple blood test to look for these genes could help us identify people who are at risk for depression," said Ma-Li Wong, M.D., professor and vice chair for translational research in the Department of Psychiatry and Behavioral Sciences at the Miller School of Medicine and lead author of the study. "We would know to watch these people in stressful situations, such as a soldier in combat, and intervene earlier to get them the help they need."
Interestingly, genetic variations in PSMB4 and TBX21 may also be relevant to two immune disorders, psoriasis and asthma. Both of these disorders are known to be co-morbid withmajor depressive disorder and are related to psychosocial stressors.
Citation source:
Polymorphisms in inflammation-related genes are associated with susceptibility to major depression and antidepressant response
Ma-Li Wong Chuanhui Dong Jorge Maestre-Mesa Julio Licinio
Molecular Psychiatry advance online publication, 27 May 2008; doi:10.1038/mp.2008.59
Molecular Psychiatry is a peer-reviewed independent journal that publishes groundbreaking research in psychiatry and related fields. The journal's Impact Factor is 11.804, 2nd of 95 in Psychiatry
Journal e-Mail: JLozanomed.miami
Website: nature/mp
Editor: Julio Licinio, M.D.
University of Miami Miller School of Medicine
New Strategy For Developing Antidepressants
Researchers may be able to develop an antidepressant which takes effect almost immediately by directly targeting novel molecules in the brain instead of taking a less direct route, which can lead to longer times for medication to take effect, according to a new study presented at the American College of Neuropsychopharmacology (ACNP) annual meeting. The antidepressant is also thought to be effective in people for whom previous treatments have been ineffective. This human and rodent research is among the first to examine the effects of rapid antidepressant strategies.
Lead researcher and ACNP member Husseini Manji, M.D., director of the mood and anxiety disorders program at the National Institute of Mental Health (NIMH), says one of the major limitations in existing pharmacological treatments for major depression is the time between starting to take the medication, and when it starts to alleviate the depression, often a period of one month or longer. He adds that strategies that work at much faster rates would have a tremendous impact for Americans who suffer from depression - nearly 21 million annually, according to NIMH.
"Today's antidepressant medications eventually end up doing the same thing, but they go about it the long way around, with a lot of biochemical steps that take time. Now we've shown what the key targets are and that we can get at them rapidly," says Dr. Manji. "This research is leading to some very real possibilities for a whole new generation of antidepressant medications."
The study looked at patients in a "difficult to treat" group, meaning individuals who had not responded to other treatments including psychotherapy, traditional antidepressants or electroconvulsive therapy. This group did not attempt all treatment options, like medication. Researchers treated the depressed patients intravenously with ketamine, a general anesthetic usually used for minor surgical procedures in which muscle relaxation is not required. The doses of ketamine used in this study were considerably lower than when it is used as an anesthetic.
Ketamine produced results much more quickly than traditional antidepressants because it acted directly upon critical molecules in important neuronal circuits instead of having to bypass multiple locations en route to those circuits. Typically, currently available antidepressant medications work via serotonin or norepinephrine, neurotransmitters which act within the brain to help regulate emotion and cognition.
The results showed that patients responded after only two hours, and within 24 hours, 70% had responded. Patients were followed over time, and 35% maintained their response for up to one week. Traditional antidepressants usually take many weeks, or even months, to begin to work. "This is intriguing data which suggests that targeting these important molecules in critical circuits would be extremely helpful in treating depression more quickly, before it worsens and becomes more severe," Dr. Manji said.
The researchers also studied rodents to determine whether they could get medication to highly responsive brain areas more quickly. By looking at different biomarkers - specific physical features used to measure the progress of a disease or condition - in mice and rats, researchers came closer to identifying at what point in the biochemical process medication might become effective, which would ultimately lead to faster treatment.
Treating patients with rapid strategies is essential since some patients who suffer from depression are tempted to stop their medication if it doesn't work quickly enough.
Ongoing human studies using magnetoencephalography (MEG) are also helping to identify the specific brain circuits through which these rapid antidepressant effects occur. Identifying these precise circuits may lead to the development of molecules with even more precise effects, and therefore fewer side effects.
ACNP, founded in 1961, is a professional organization of more than 700 leading scientists, including four Nobel Laureates. The mission of ACNP is to further research and education in neuropsychopharmacology and related fields in the following ways: promoting the interaction of a broad range of scientific disciplines of brain and behavior in order to advance the understanding of prevention and treatment of disease of the nervous system including psychiatric, neurological, behavioral and addictive disorders; encouraging scientists to enter research careers in fields related to these disorders and their treatment; and ensuring the dissemination of relevant scientific advances.
Lead researcher and ACNP member Husseini Manji, M.D., director of the mood and anxiety disorders program at the National Institute of Mental Health (NIMH), says one of the major limitations in existing pharmacological treatments for major depression is the time between starting to take the medication, and when it starts to alleviate the depression, often a period of one month or longer. He adds that strategies that work at much faster rates would have a tremendous impact for Americans who suffer from depression - nearly 21 million annually, according to NIMH.
"Today's antidepressant medications eventually end up doing the same thing, but they go about it the long way around, with a lot of biochemical steps that take time. Now we've shown what the key targets are and that we can get at them rapidly," says Dr. Manji. "This research is leading to some very real possibilities for a whole new generation of antidepressant medications."
The study looked at patients in a "difficult to treat" group, meaning individuals who had not responded to other treatments including psychotherapy, traditional antidepressants or electroconvulsive therapy. This group did not attempt all treatment options, like medication. Researchers treated the depressed patients intravenously with ketamine, a general anesthetic usually used for minor surgical procedures in which muscle relaxation is not required. The doses of ketamine used in this study were considerably lower than when it is used as an anesthetic.
Ketamine produced results much more quickly than traditional antidepressants because it acted directly upon critical molecules in important neuronal circuits instead of having to bypass multiple locations en route to those circuits. Typically, currently available antidepressant medications work via serotonin or norepinephrine, neurotransmitters which act within the brain to help regulate emotion and cognition.
The results showed that patients responded after only two hours, and within 24 hours, 70% had responded. Patients were followed over time, and 35% maintained their response for up to one week. Traditional antidepressants usually take many weeks, or even months, to begin to work. "This is intriguing data which suggests that targeting these important molecules in critical circuits would be extremely helpful in treating depression more quickly, before it worsens and becomes more severe," Dr. Manji said.
The researchers also studied rodents to determine whether they could get medication to highly responsive brain areas more quickly. By looking at different biomarkers - specific physical features used to measure the progress of a disease or condition - in mice and rats, researchers came closer to identifying at what point in the biochemical process medication might become effective, which would ultimately lead to faster treatment.
Treating patients with rapid strategies is essential since some patients who suffer from depression are tempted to stop their medication if it doesn't work quickly enough.
Ongoing human studies using magnetoencephalography (MEG) are also helping to identify the specific brain circuits through which these rapid antidepressant effects occur. Identifying these precise circuits may lead to the development of molecules with even more precise effects, and therefore fewer side effects.
ACNP, founded in 1961, is a professional organization of more than 700 leading scientists, including four Nobel Laureates. The mission of ACNP is to further research and education in neuropsychopharmacology and related fields in the following ways: promoting the interaction of a broad range of scientific disciplines of brain and behavior in order to advance the understanding of prevention and treatment of disease of the nervous system including psychiatric, neurological, behavioral and addictive disorders; encouraging scientists to enter research careers in fields related to these disorders and their treatment; and ensuring the dissemination of relevant scientific advances.
Minister Devins Opens The International Association For Suicide Prevention's Congress "Preventing Suicide Across The Life Span: Dreams And Realities"
Mr Jimmy Devins, T.D., Minister for State at the Department of Health and Children, was speaking yesterday Wednesday 29th August in Killarney at the official opening of the Twenty Fourth Biennial World Congress of the International Association for Suicide Prevention.
The Congress is a biennial event organised under the auspices of the International Association for Suicide Prevention and is being hosted in Ireland by the Irish Association of Suicidology. Delegates from all over the world are attending this event to discuss the latest research and initiatives relating to suicide prevention, self harm and mental health promotion. The event is supported by the World Health Organisation, World Federation for Mental Health, World Psychiatric Association and the HSE's National Office for Suicide Prevention.
The Minister thanked the Irish Association of Suicidology for hosting the Conference entitled "Preventing Suicide Across the Life Span: Dreams and Realities". The Minister welcomed the delegates and contributors from at home and abroad to the Congress and said "it is a great honour for the island of Ireland to host such a prestigious and important event. It is a great opportunity both to learn from experience and research worldwide, but also to contribute and showcase some of the important work that is being carried out in Ireland.
Preventing suicide and reducing the rate of suicide is an urgent public health issue which is a priority for this Government. It goes right to the heart of our efforts and policies to create a healthy, prosperous and socially inclusive Ireland. The combined input of views from Irish and international experts in relation to the phenomena of suicide will I am sure advance future research and knowledge in relation to suicide prevention"
dohc.ie
The Congress is a biennial event organised under the auspices of the International Association for Suicide Prevention and is being hosted in Ireland by the Irish Association of Suicidology. Delegates from all over the world are attending this event to discuss the latest research and initiatives relating to suicide prevention, self harm and mental health promotion. The event is supported by the World Health Organisation, World Federation for Mental Health, World Psychiatric Association and the HSE's National Office for Suicide Prevention.
The Minister thanked the Irish Association of Suicidology for hosting the Conference entitled "Preventing Suicide Across the Life Span: Dreams and Realities". The Minister welcomed the delegates and contributors from at home and abroad to the Congress and said "it is a great honour for the island of Ireland to host such a prestigious and important event. It is a great opportunity both to learn from experience and research worldwide, but also to contribute and showcase some of the important work that is being carried out in Ireland.
Preventing suicide and reducing the rate of suicide is an urgent public health issue which is a priority for this Government. It goes right to the heart of our efforts and policies to create a healthy, prosperous and socially inclusive Ireland. The combined input of views from Irish and international experts in relation to the phenomena of suicide will I am sure advance future research and knowledge in relation to suicide prevention"
dohc.ie
Lifespan In C. Elegans Extended By Antidepressant
A team of scientists led by Howard Hughes Medical Institute (HHMI) investigator Linda B. Buck has found that a drug used to treat depression can extend the lifespan of adult roundworms.
Buck and colleagues Michael Petrascheck and Xiaolan Ye report in the November 22, 2007, issue of the journal Nature, that the antidepressant drug mianserin can extend the lifespan of the nematode Caenorhabditis elegans by about 30 percent.
Intriguingly, the drug may act by mimicking the effects of caloric restriction, which has been shown to retard the effects of aging in a variety of animals ranging from worms and flies to mammals.
"Our studies indicate that lifespan extension by mianserin involves mechanisms associated with lifespan extension by dietary restriction," said Buck, a member of the Basic Sciences Division of the Fred Hutchinson Cancer Research Center in Seattle. "We don't have an explanation for this. All we can say is that if we give the drug to caloric restricted animals, it doesn't increase their lifespan any further. That suggests the same mechanism may be involved."
Researchers don't yet understand exactly how mianserin staves off the effects of aging. But the drug appears to act the same way in both C. elegans and humans: by blocking certain receptors for the neurotransmitter serotonin. Serotonin is a chemical that cells use to communicate, helping them regulate many functions, including mood, appetite, and sensory perception.
Buck said it was a surprise to find that a drug used to treat depression in humans could extend lifespan in worms. The researchers in Buck's lab found that in addition to inhibiting certain serotonin receptors in the worm, it also blocked receptors for another neurotransmitter, octopamine.
A number of observations support the idea that serotonin and octopamine may complement one another in a physiological context, Buck explained, with serotonin signaling the presence of food and octopamine signaling its absence or a state of starvation. C. elegans, for instance, usually only lays eggs when food is on hand. But serotonin stimulates egg laying in the absence of food, while octopamine inhibits egg laying even when food is nearby. Another example of interplay between the two chemicals is that pharyngeal pumping, the mechanism by which worms ingest food, is jump-started by serotonin and thwarted by octopamine.
"In our studies, mianserin had a much greater inhibitory effect on the serotonin receptor than the octopamine receptor," she said. "One possibility is that there is a dynamic equilibrium between serotonin and octopamine signaling and the drug tips the balance in the direction of octopamine signaling, producing a perceived, though not real, state of starvation that activates aging mechanisms downstream of dietary restriction."
Buck and her colleagues chose to focus on the effects of mianserin based on the results of a search through 88,000 chemicals for agents that extended the lifespan of nematodes. They found 115 such chemicals. In follow-up studies of one chemical, they found four additional compounds, including mianserin, that extended lifespan by 20-33 percent. All four compounds inhibit certain types of serotonin receptors in humans.
"We screened a wide variety of chemicals without knowing anything about them except that they were small molecules," Buck noted. "By screening adult animals with this extremely varied panel of compounds, we hoped to identify drugs that could increase lifespan in adults, even though some might have a deleterious effect on the developing animal."
By identifying drugs that influence lifespan, Buck added, it may be possible to home in on how those drugs act and contribute to a growing body of knowledge about the genetic mechanisms of aging.
"Other researchers have done beautiful work using molecular genetic approaches to identify genes involved in aging," she said. "We decided to take a chemical approach. By finding chemicals that enhance longevity, and then finding the targets of those chemicals, it may be possible to identify additional genes important in aging. In addition, the chemical approach could point to drugs suitable for testing in mammals."
Buck said that her group has yet to identify what kinds of cells are affected by the drug, because while the serotonin receptors involved are only found on neurons, many types of cells -- not just cells of the nervous system -- have receptors for octopamine.
Buck and colleagues Michael Petrascheck and Xiaolan Ye report in the November 22, 2007, issue of the journal Nature, that the antidepressant drug mianserin can extend the lifespan of the nematode Caenorhabditis elegans by about 30 percent.
Intriguingly, the drug may act by mimicking the effects of caloric restriction, which has been shown to retard the effects of aging in a variety of animals ranging from worms and flies to mammals.
"Our studies indicate that lifespan extension by mianserin involves mechanisms associated with lifespan extension by dietary restriction," said Buck, a member of the Basic Sciences Division of the Fred Hutchinson Cancer Research Center in Seattle. "We don't have an explanation for this. All we can say is that if we give the drug to caloric restricted animals, it doesn't increase their lifespan any further. That suggests the same mechanism may be involved."
Researchers don't yet understand exactly how mianserin staves off the effects of aging. But the drug appears to act the same way in both C. elegans and humans: by blocking certain receptors for the neurotransmitter serotonin. Serotonin is a chemical that cells use to communicate, helping them regulate many functions, including mood, appetite, and sensory perception.
Buck said it was a surprise to find that a drug used to treat depression in humans could extend lifespan in worms. The researchers in Buck's lab found that in addition to inhibiting certain serotonin receptors in the worm, it also blocked receptors for another neurotransmitter, octopamine.
A number of observations support the idea that serotonin and octopamine may complement one another in a physiological context, Buck explained, with serotonin signaling the presence of food and octopamine signaling its absence or a state of starvation. C. elegans, for instance, usually only lays eggs when food is on hand. But serotonin stimulates egg laying in the absence of food, while octopamine inhibits egg laying even when food is nearby. Another example of interplay between the two chemicals is that pharyngeal pumping, the mechanism by which worms ingest food, is jump-started by serotonin and thwarted by octopamine.
"In our studies, mianserin had a much greater inhibitory effect on the serotonin receptor than the octopamine receptor," she said. "One possibility is that there is a dynamic equilibrium between serotonin and octopamine signaling and the drug tips the balance in the direction of octopamine signaling, producing a perceived, though not real, state of starvation that activates aging mechanisms downstream of dietary restriction."
Buck and her colleagues chose to focus on the effects of mianserin based on the results of a search through 88,000 chemicals for agents that extended the lifespan of nematodes. They found 115 such chemicals. In follow-up studies of one chemical, they found four additional compounds, including mianserin, that extended lifespan by 20-33 percent. All four compounds inhibit certain types of serotonin receptors in humans.
"We screened a wide variety of chemicals without knowing anything about them except that they were small molecules," Buck noted. "By screening adult animals with this extremely varied panel of compounds, we hoped to identify drugs that could increase lifespan in adults, even though some might have a deleterious effect on the developing animal."
By identifying drugs that influence lifespan, Buck added, it may be possible to home in on how those drugs act and contribute to a growing body of knowledge about the genetic mechanisms of aging.
"Other researchers have done beautiful work using molecular genetic approaches to identify genes involved in aging," she said. "We decided to take a chemical approach. By finding chemicals that enhance longevity, and then finding the targets of those chemicals, it may be possible to identify additional genes important in aging. In addition, the chemical approach could point to drugs suitable for testing in mammals."
Buck said that her group has yet to identify what kinds of cells are affected by the drug, because while the serotonin receptors involved are only found on neurons, many types of cells -- not just cells of the nervous system -- have receptors for octopamine.
Neurocrine Announces Top-Line Results Of Corticotropin Releasing Factor Antagonist GSK561679 For Treatment Of Major Depressive Disorder
Neurocrine Biosciences, Inc. (Nasdaq: NBIX) announced top-line efficacy and safety results from a Phase II clinical trial utilizing Corticotropin Releasing Factor (CRF1) receptor antagonist GSK561679 in patients currently experiencing a major depressive episode. This double-blind, placebo controlled trial randomized 150 patients into two treatment arms, 350 mg of GSK561679 daily and placebo, and was conducted in the United States by GlaxoSmithKline (GSK) under the GSK/Neurocrine CRF1 collaboration. The primary endpoint was change from baseline in the Bech Melancholia scale at Week 6 and a key secondary endpoint was change from baseline in the HAMD-17 scale at Week 6.
Results of statistical analysis using the intent-to-treat population revealed no benefit of GSK561679 compared with placebo on both the Bech Melancholia and HAMD-17 endpoints. The top-line results are based on the six week placebo-controlled portion of the study for the intent to treat population of 145 patients. From a safety perspective, there were no significant adverse events, and the drug was generally well tolerated.
"It is clear from this study that CRF1 remains a difficult drug target in the drive to improve current pharmaceutical therapies for depression," said Kevin Gorman, President and Chief Executive Officer of Neurocrine Biosciences. "We plan to meet with GSK in the coming months after the full clinical data set is complete to determine the next steps for the CRF depression program."
Three separate academic collaborative clinical trials are ongoing to evaluate the effects of GSK561679 in Post Traumatic Stress Disorder, anxiety and alcoholism.
In addition to historical facts, this press release may contain forward-looking statements that involve a number of risks and uncertainties. Among the factors that could cause actual results to differ materially from those indicated in the forward-looking statements are risks and uncertainties associated with Neurocrine's business and finances in general, as well as risks and uncertainties associated with the Company's CRF program and Company overall. Specifically, the risks and uncertainties the Company faces with respect to the Company's CRF program include, but are not limited to, risk that GSK may terminate its development of GSK561679 and/or its collaboration with the Company; risk that the ongoing GSK561679 clinical trials will fail to demonstrate that GSK561679 is safe and effective; risk that the Company's CRF program backup product candidates will not prove suitable for clinical development; risk that the Company will be unable to raise additional funding required to complete development of its CRF program product candidates; risk associated with the Company's dependence on corporate partners for future clinical development, commercial manufacturing and marketing and sales activities; uncertainties relating to patent protection and intellectual property rights of third parties; risks and uncertainties relating to competitive products and technological changes that may limit demand for the Company's CRF program products; and the other risks described in the Company's report on Form 10-K for the year ended December 31, 2009 and reports on Form 10-Q for the quarter ended June 30, 2010. Neurocrine undertakes no obligation to update the statements contained in this press release after the date hereof.
Results of statistical analysis using the intent-to-treat population revealed no benefit of GSK561679 compared with placebo on both the Bech Melancholia and HAMD-17 endpoints. The top-line results are based on the six week placebo-controlled portion of the study for the intent to treat population of 145 patients. From a safety perspective, there were no significant adverse events, and the drug was generally well tolerated.
"It is clear from this study that CRF1 remains a difficult drug target in the drive to improve current pharmaceutical therapies for depression," said Kevin Gorman, President and Chief Executive Officer of Neurocrine Biosciences. "We plan to meet with GSK in the coming months after the full clinical data set is complete to determine the next steps for the CRF depression program."
Three separate academic collaborative clinical trials are ongoing to evaluate the effects of GSK561679 in Post Traumatic Stress Disorder, anxiety and alcoholism.
In addition to historical facts, this press release may contain forward-looking statements that involve a number of risks and uncertainties. Among the factors that could cause actual results to differ materially from those indicated in the forward-looking statements are risks and uncertainties associated with Neurocrine's business and finances in general, as well as risks and uncertainties associated with the Company's CRF program and Company overall. Specifically, the risks and uncertainties the Company faces with respect to the Company's CRF program include, but are not limited to, risk that GSK may terminate its development of GSK561679 and/or its collaboration with the Company; risk that the ongoing GSK561679 clinical trials will fail to demonstrate that GSK561679 is safe and effective; risk that the Company's CRF program backup product candidates will not prove suitable for clinical development; risk that the Company will be unable to raise additional funding required to complete development of its CRF program product candidates; risk associated with the Company's dependence on corporate partners for future clinical development, commercial manufacturing and marketing and sales activities; uncertainties relating to patent protection and intellectual property rights of third parties; risks and uncertainties relating to competitive products and technological changes that may limit demand for the Company's CRF program products; and the other risks described in the Company's report on Form 10-K for the year ended December 31, 2009 and reports on Form 10-Q for the quarter ended June 30, 2010. Neurocrine undertakes no obligation to update the statements contained in this press release after the date hereof.
Post Traumatic Stress Symptoms Common After Heart Attack
Many people experience symptoms of post-traumatic stress following a heart attack, and anxiety, depression and social withdrawal are also commonplace. These are the findings of a study by Susan Ayers of the University of Sussex and colleagues Claire Copland and Emma Dunmore, published recently, in the British Journal of Health Psychology.
Seventy four people who had experienced a heart attack in the previous 12 weeks and who were attending cardiac rehabilitation programmes took part in the study. The sample was predominantly male (76 per cent) with an average age of 62 years. Participants completed questionnaires assessing post traumatic stress disorder (PTSD) symptoms, as well as perceptions of the severity of their heart attack and the extent to which they believed their lives were in danger. Physical health, anxiety, depression and impairment of social activities were also measured, as were dysfunctional coping strategies such as denial and avoidance.
Of the participants, 16 per cent met clinical criteria for acute PTSD and a further 18 per cent reported moderate to severe symptoms. Those with PTSD symptoms were more likely to have poorer psychological health and social impairments. Findings revealed that people who tended to use denial and avoidance coping strategies were more likely to develop PTSD symptoms - this was a more powerful predictor of symptoms than patients' perceptions of the severity of the heart attack and the threat to life.
Dr Ayers said: "Around 150,000 people in the UK survive the acute stage of a heart attack each year. Feelings of fear, anxiety and depression are common after such an event. The findings of this study suggest that a high proportion experience very severe distress - this has the potential to impair recovery, quality of life and threaten future health. It is therefore vital that cardiac patients are screened for psychological distress, such as anxiety, depression and PTSD, and offered appropriate treatment if necessary."
Source
British Psychological Society
Seventy four people who had experienced a heart attack in the previous 12 weeks and who were attending cardiac rehabilitation programmes took part in the study. The sample was predominantly male (76 per cent) with an average age of 62 years. Participants completed questionnaires assessing post traumatic stress disorder (PTSD) symptoms, as well as perceptions of the severity of their heart attack and the extent to which they believed their lives were in danger. Physical health, anxiety, depression and impairment of social activities were also measured, as were dysfunctional coping strategies such as denial and avoidance.
Of the participants, 16 per cent met clinical criteria for acute PTSD and a further 18 per cent reported moderate to severe symptoms. Those with PTSD symptoms were more likely to have poorer psychological health and social impairments. Findings revealed that people who tended to use denial and avoidance coping strategies were more likely to develop PTSD symptoms - this was a more powerful predictor of symptoms than patients' perceptions of the severity of the heart attack and the threat to life.
Dr Ayers said: "Around 150,000 people in the UK survive the acute stage of a heart attack each year. Feelings of fear, anxiety and depression are common after such an event. The findings of this study suggest that a high proportion experience very severe distress - this has the potential to impair recovery, quality of life and threaten future health. It is therefore vital that cardiac patients are screened for psychological distress, such as anxiety, depression and PTSD, and offered appropriate treatment if necessary."
Source
British Psychological Society
Study Identifies Predictors Of Bipolar Disorder Risk
A new study presented today at the
159th Annual Scientific Meeting of the American Psychiatric Association
(APA) in Toronto, Canada identified five predictors for bipolar disorder
risk in patients who have been unsuccessfully treated with antidepressants.
Researchers concluded that significant risk factors of bipolar disorder
among patients already diagnosed with major depression were anxiety,
feelings of people being unfriendly, family history of bipolar disorder, a
recent diagnosis of depression, and legal problems.
The study also found that forty-three percent of patients who responded
positively to any three risk factors, screened positive for bipolar
disorder using the Mood Disorder Questionnaire (MDQ), a validated screener
for bipolar disorder. In addition, one-third of patients whose medication
for their depression was not right for them and that they had been told by
a doctor they had anxiety and felt people were unfriendly toward them,
screened positive for bipolar disorder, using the MDQ.
Based on these findings, a brief assessment tool was derived that can
be used to identify bipolar disorder risk.
"Bipolar depression may be difficult for both patients and doctors to
identify because the symptoms are often confused with major depression,"
said Joseph R. Calabrese, M.D., Professor of Psychiatry, Case Western
Reserve University and Director, Mood Disorders Program, University
Hospitals of Cleveland. "Given the difficulty of diagnosing bipolar
disorder, the five predictors identified in this study may help physicians
better assess a patient's risk for bipolar disorder, which could lead to
more effective treatment."
The study findings coincide with previous research that suggests nearly
half of all patients who have bipolar disorder will first be diagnosed with
major depression. Inappropriate treatment due to misdiagnosis can have a
harmful effect on patients potentially making the illness harder to treat;
antidepressants alone have been shown to induce mania or hypomania (a mild
form of mania) in some patients with bipolar depression. Furthermore,
people with untreated bipolar disorder can experience a greater frequency
of manic and depressive episodes, causing significant disruption in their
personal and professional lives.
"Many people with bipolar disorder face up to ten years of coping with
symptoms before getting an accurate diagnosis," said Karl Ackerman,
President of the Manic-Depressive and Depressive Association of Boston.
"For me, it was twelve years. Looking back, I realize the anxiety I
experienced along with my depression could have been another sign of
bipolar disorder. These predictors can be useful for patients who are
dealing with depression that isn't helped by medication."
"It's important for people who are suffering from depression to talk to
their doctors about other experiences and symptoms over their lifetime --
especially times when they were feeling really well," said Gary Sachs, MD,
Associate Professor of Psychiatry, Harvard Medical School and Director,
Bipolar Disorder Clinic and Research Program, Massachusetts General
Hospital. "Many patients with bipolar disorder go too long without a
correct diagnosis. This can mean years lost to an illness that can be
successfully managed when correctly diagnosed and treated. The predictors
identified in this study may help physicians and patients identify
depression associated with bipolar disorder rather than unipolar mood
disorder."
Study Design
The study was designed to identify predictors of bipolar disorder risk
among patients treated for major depression. Psychiatrists from community
and private practice clinic settings randomly selected patients who were
unsuccessfully treated with antidepressants. Patients self-reported
demographics, family history, co-morbid health status, alcohol/drug use,
legal problems, and current depression using the Centers for Epidemiologic
Studies Depression (CES-D) scale. Screening for bipolar disorder was
self-reported using the Mood Disorder Questionnaire (MDQ), a validated
screening instrument for Bipolar I and II disorders.
Of the 602 patients enrolled in the study, 18.6% screened positive for
bipolar disorder using the MDQ (MDQ+). Researchers identified five
significant variables associated with bipolar disorder risk: the CESD item
"people were unfriendly" (p
159th Annual Scientific Meeting of the American Psychiatric Association
(APA) in Toronto, Canada identified five predictors for bipolar disorder
risk in patients who have been unsuccessfully treated with antidepressants.
Researchers concluded that significant risk factors of bipolar disorder
among patients already diagnosed with major depression were anxiety,
feelings of people being unfriendly, family history of bipolar disorder, a
recent diagnosis of depression, and legal problems.
The study also found that forty-three percent of patients who responded
positively to any three risk factors, screened positive for bipolar
disorder using the Mood Disorder Questionnaire (MDQ), a validated screener
for bipolar disorder. In addition, one-third of patients whose medication
for their depression was not right for them and that they had been told by
a doctor they had anxiety and felt people were unfriendly toward them,
screened positive for bipolar disorder, using the MDQ.
Based on these findings, a brief assessment tool was derived that can
be used to identify bipolar disorder risk.
"Bipolar depression may be difficult for both patients and doctors to
identify because the symptoms are often confused with major depression,"
said Joseph R. Calabrese, M.D., Professor of Psychiatry, Case Western
Reserve University and Director, Mood Disorders Program, University
Hospitals of Cleveland. "Given the difficulty of diagnosing bipolar
disorder, the five predictors identified in this study may help physicians
better assess a patient's risk for bipolar disorder, which could lead to
more effective treatment."
The study findings coincide with previous research that suggests nearly
half of all patients who have bipolar disorder will first be diagnosed with
major depression. Inappropriate treatment due to misdiagnosis can have a
harmful effect on patients potentially making the illness harder to treat;
antidepressants alone have been shown to induce mania or hypomania (a mild
form of mania) in some patients with bipolar depression. Furthermore,
people with untreated bipolar disorder can experience a greater frequency
of manic and depressive episodes, causing significant disruption in their
personal and professional lives.
"Many people with bipolar disorder face up to ten years of coping with
symptoms before getting an accurate diagnosis," said Karl Ackerman,
President of the Manic-Depressive and Depressive Association of Boston.
"For me, it was twelve years. Looking back, I realize the anxiety I
experienced along with my depression could have been another sign of
bipolar disorder. These predictors can be useful for patients who are
dealing with depression that isn't helped by medication."
"It's important for people who are suffering from depression to talk to
their doctors about other experiences and symptoms over their lifetime --
especially times when they were feeling really well," said Gary Sachs, MD,
Associate Professor of Psychiatry, Harvard Medical School and Director,
Bipolar Disorder Clinic and Research Program, Massachusetts General
Hospital. "Many patients with bipolar disorder go too long without a
correct diagnosis. This can mean years lost to an illness that can be
successfully managed when correctly diagnosed and treated. The predictors
identified in this study may help physicians and patients identify
depression associated with bipolar disorder rather than unipolar mood
disorder."
Study Design
The study was designed to identify predictors of bipolar disorder risk
among patients treated for major depression. Psychiatrists from community
and private practice clinic settings randomly selected patients who were
unsuccessfully treated with antidepressants. Patients self-reported
demographics, family history, co-morbid health status, alcohol/drug use,
legal problems, and current depression using the Centers for Epidemiologic
Studies Depression (CES-D) scale. Screening for bipolar disorder was
self-reported using the Mood Disorder Questionnaire (MDQ), a validated
screening instrument for Bipolar I and II disorders.
Of the 602 patients enrolled in the study, 18.6% screened positive for
bipolar disorder using the MDQ (MDQ+). Researchers identified five
significant variables associated with bipolar disorder risk: the CESD item
"people were unfriendly" (p
Treating Depression In Mothers Of Older Children
Depression among economically disadvantaged mothers could last well beyond the postpartum period and become a chronic condition, suggests a new study by researchers at Yale School of Medicine. The study also finds that symptoms could improve with brief treatment.
The results were presented by lead author Carol C. Weitzman, M.D., associate professor of pediatrics and in the Child Study Center at Yale School at Yale School of Medicine, at the Pediatric Academic Societies (PAS) Annual Meeting in Vancouver, British Columbia Medicine.
Depression in underserved women of childbearing age is extremely common, and nearly one in five mothers of children age one and older reports moderate to severe depressive symptoms, according to Weitzman.
"This finding reinforces that depression in mothers is not restricted to the postpartum period, and in fact after the postpartum period as children get older, the prevalence of maternal depression may be higher," said Weitzman.
Maternal depression has been linked to health and developmental problems in children. Therefore, to optimize children's health, mothers who are depressed should be identified and treated, said Weitzman. As parents routinely bring their children for check-ups, this may present an opportunity to identify depressed mothers, as so many women do not seek treatment for their symptoms, she notes.
In the study, Weitzman and her colleagues asked 931 mothers to complete a 16-item measure of depression severity before a well-child visit in a clinic that care for disadvantaged children. Women who screened positive were interviewed to confirm that they had depressive symptoms.
Seventy-one mothers with depression were randomly assigned to receive either six sessions of on-site cognitive behavior therapy or case management, which consisted of speaking with a social worker and getting assistance with referrals. Their children's social-emotional functioning was measured before and after treatment.
Results showed that 45 percent of mothers screened positive for depressive symptoms (26 percent had mild symptoms, 13 had moderate symptoms and 6 percent had severe symptoms). All of the women who received treatment showed improvements in their depression symptoms. The scores improved greatly in women who received cognitive behavioral therapy, while those who received case management did not show a dramatic change.
Children under age four whose mothers received cognitive behavioral therapy also had fewer behavioral challenges. No significant changes were reported among the women who received case management or those with children older than age four.
"A depressed parent can have a significant effect on a child," said Weitzman. "Brief on-site treatment can help reduce symptoms of depression in a mother and may also improve her perspective about her child's behavior."
The study was funded by the Robert Wood Johnson, Finding Answers, Disparities Research for Change and the Children's Fund of Connecticut.
The results were presented by lead author Carol C. Weitzman, M.D., associate professor of pediatrics and in the Child Study Center at Yale School at Yale School of Medicine, at the Pediatric Academic Societies (PAS) Annual Meeting in Vancouver, British Columbia Medicine.
Depression in underserved women of childbearing age is extremely common, and nearly one in five mothers of children age one and older reports moderate to severe depressive symptoms, according to Weitzman.
"This finding reinforces that depression in mothers is not restricted to the postpartum period, and in fact after the postpartum period as children get older, the prevalence of maternal depression may be higher," said Weitzman.
Maternal depression has been linked to health and developmental problems in children. Therefore, to optimize children's health, mothers who are depressed should be identified and treated, said Weitzman. As parents routinely bring their children for check-ups, this may present an opportunity to identify depressed mothers, as so many women do not seek treatment for their symptoms, she notes.
In the study, Weitzman and her colleagues asked 931 mothers to complete a 16-item measure of depression severity before a well-child visit in a clinic that care for disadvantaged children. Women who screened positive were interviewed to confirm that they had depressive symptoms.
Seventy-one mothers with depression were randomly assigned to receive either six sessions of on-site cognitive behavior therapy or case management, which consisted of speaking with a social worker and getting assistance with referrals. Their children's social-emotional functioning was measured before and after treatment.
Results showed that 45 percent of mothers screened positive for depressive symptoms (26 percent had mild symptoms, 13 had moderate symptoms and 6 percent had severe symptoms). All of the women who received treatment showed improvements in their depression symptoms. The scores improved greatly in women who received cognitive behavioral therapy, while those who received case management did not show a dramatic change.
Children under age four whose mothers received cognitive behavioral therapy also had fewer behavioral challenges. No significant changes were reported among the women who received case management or those with children older than age four.
"A depressed parent can have a significant effect on a child," said Weitzman. "Brief on-site treatment can help reduce symptoms of depression in a mother and may also improve her perspective about her child's behavior."
The study was funded by the Robert Wood Johnson, Finding Answers, Disparities Research for Change and the Children's Fund of Connecticut.
In Order To Minimize Risks, A New Family-Focused Model Of Depression Care Is Needed
Health and social service professionals who care for adults with depression should not only tackle their clients' physical and mental health, but also detect and prevent possible spillover effects on their children, says a new report from the National Research Council and Institute of Medicine. To achieve this new family-focused model of depression care, federal and state agencies, nonprofits, and the private sector will have to experiment with nontraditional ways of organizing, paying for, and delivering services, said the committee that wrote the report.
Depression affects roughly 7.5 million parents -- about one in five -- in the United States annually, and about 15.6 million children under 18 live with an adult who has had major depression in the past year, the report notes. Effective tools and strategies exist to treat and prevent depression, but only one-third of adult sufferers get treatment. Although many factors affect children's development, parental depression can increase the chances for health, emotional, and behavioral problems in children. The report does not suggest that every parent with depression will inadvertently or deliberately cause harm to their children, but rather that parental depression increases the risks for spillover consequences during critical periods of child and adolescent development.
"To break the vicious circle of depression, we need to refocus our view of this illness through a broader lens that sees the whole family, not just the individual with depression," said committee chair and psychiatrist Mary Jane England, president, Regis College, Weston, Mass. "Our report describes a new vision for depression care that would provide comprehensive services not just to adults, but to their children as well. It will take significant policy changes to make this vision a reality, but the benefits warrant the effort."
Endeavors to increase the family focus on depression should aim to remove barriers that inhibit more coordinated care across organizations and among service providers. Children and adults are treated by separate health care providers who too often do not look at the whole family, and many health and social services are disconnected. Few programs and health care providers routinely ask patients with depression if they have children and if their depression has affected their family members. Health plans are not geared to pay for services delivered in nontraditional settings.
Fathers and mothers may benefit from counseling to improve their parenting and coping skills, and children may need treatment for emotional, behavioral, or physical problems. Services need to be available in a range of locations that include not just obstetrics-gynecology and pediatric clinics, but also Head Start facilities, schools, prisons, other community locations, and even people's homes, the report says. This means that clinicians must gain experience in delivering services in a variety of settings. States should revise policies that prohibit services outside of clinical settings. Federal agencies should establish a national program to improve the abilities of primary care providers, mental health professionals, and those who treat substance abuse to identify, treat, and prevent depression and lessen its effects on children of all ages.
Public and private health insurance plans should support access to screening, treatment, and supportive services. The Centers for Medicare and Medicaid Services (CMS) could extend Medicaid services provided to new mothers to two years after birth, which includes a critical period of early childhood development, the report says. CMS could reimburse primary care providers for mental health services and cover preventive services for children at risk of developing health problems, rather than covering only treatment. Private health plans could pay for parental depression screening and treatment, and support the implementation of effective models of depression care in a range of settings.
Lack of insurance coverage is not the only reason that two-thirds of people with depression do not get treatment. Public and private groups also need to tackle the insufficient numbers of care providers and facilities, difficulties that low-income individuals in particular confront in traveling to service providers, and the stigma associated with mental illness.
Given the variation in health and social services across states, broad experimentation with service strategies will be needed. Governors of each state should convene a task force of state and local agencies to coordinate efforts and to design and implement an array of programs involving multiple organizations and settings. State officials should document their activities and results so that they can learn from one another.
The study was sponsored by the Robert Wood Johnson Foundation, Annie E. Casey Foundation, California Endowment, U.S. Health Resources and Services Administration, and U.S. Substance Abuse and Mental Health Services Administration.
Depression affects roughly 7.5 million parents -- about one in five -- in the United States annually, and about 15.6 million children under 18 live with an adult who has had major depression in the past year, the report notes. Effective tools and strategies exist to treat and prevent depression, but only one-third of adult sufferers get treatment. Although many factors affect children's development, parental depression can increase the chances for health, emotional, and behavioral problems in children. The report does not suggest that every parent with depression will inadvertently or deliberately cause harm to their children, but rather that parental depression increases the risks for spillover consequences during critical periods of child and adolescent development.
"To break the vicious circle of depression, we need to refocus our view of this illness through a broader lens that sees the whole family, not just the individual with depression," said committee chair and psychiatrist Mary Jane England, president, Regis College, Weston, Mass. "Our report describes a new vision for depression care that would provide comprehensive services not just to adults, but to their children as well. It will take significant policy changes to make this vision a reality, but the benefits warrant the effort."
Endeavors to increase the family focus on depression should aim to remove barriers that inhibit more coordinated care across organizations and among service providers. Children and adults are treated by separate health care providers who too often do not look at the whole family, and many health and social services are disconnected. Few programs and health care providers routinely ask patients with depression if they have children and if their depression has affected their family members. Health plans are not geared to pay for services delivered in nontraditional settings.
Fathers and mothers may benefit from counseling to improve their parenting and coping skills, and children may need treatment for emotional, behavioral, or physical problems. Services need to be available in a range of locations that include not just obstetrics-gynecology and pediatric clinics, but also Head Start facilities, schools, prisons, other community locations, and even people's homes, the report says. This means that clinicians must gain experience in delivering services in a variety of settings. States should revise policies that prohibit services outside of clinical settings. Federal agencies should establish a national program to improve the abilities of primary care providers, mental health professionals, and those who treat substance abuse to identify, treat, and prevent depression and lessen its effects on children of all ages.
Public and private health insurance plans should support access to screening, treatment, and supportive services. The Centers for Medicare and Medicaid Services (CMS) could extend Medicaid services provided to new mothers to two years after birth, which includes a critical period of early childhood development, the report says. CMS could reimburse primary care providers for mental health services and cover preventive services for children at risk of developing health problems, rather than covering only treatment. Private health plans could pay for parental depression screening and treatment, and support the implementation of effective models of depression care in a range of settings.
Lack of insurance coverage is not the only reason that two-thirds of people with depression do not get treatment. Public and private groups also need to tackle the insufficient numbers of care providers and facilities, difficulties that low-income individuals in particular confront in traveling to service providers, and the stigma associated with mental illness.
Given the variation in health and social services across states, broad experimentation with service strategies will be needed. Governors of each state should convene a task force of state and local agencies to coordinate efforts and to design and implement an array of programs involving multiple organizations and settings. State officials should document their activities and results so that they can learn from one another.
The study was sponsored by the Robert Wood Johnson Foundation, Annie E. Casey Foundation, California Endowment, U.S. Health Resources and Services Administration, and U.S. Substance Abuse and Mental Health Services Administration.
Negative Body Image Related To Depression, Anxiety And Suicidality
Adolescents with negative body image concerns are more likely to be depressed, anxious, and suicidal than those without intense dissatisfaction over their appearance, even when compared to adolescents with other psychiatric illnesses, according to a new study by researchers at Bradley Hospital, Butler Hospital and Brown Medical School.
Researchers assessed the prevalence and clinical correlates of body image concerns including: body dysmorphic disorder (BDD), eating disorders (ED) (such as bulimia or anorexia), and other clinically significant concerns over shape/weight in adolescent inpatients at Bradley Hospital, the nation's first psychiatric hospital for children and adolescents. Classic BDD is a preoccupation with an imagined physical defect in appearance or a vastly exaggerated concern about a minimal defect, like a crooked nose or imperfect complexion. Weight-related BDD, however, is classified as distressing and impairing preoccupations with one's weight and shape - ie: thinking one's thighs are too fat or one's waist is too big.
The study found that one third of inpatient adolescents had problematic body image concerns, and that these patients were more severely ill than other adolescent inpatients in a number of important domains. Specifically, those with BDD and shape/weight preoccupations had significantly higher levels of depression, anxiety, and suicidality than other patients with no body image concerns. Those with eating disorders had significantly higher rates of depression than those without body image concerns.
"These findings underscore just how central feelings about one's appearance tend to be in the world of teenagers and how impairing these concerns can be," says lead author, Jennifer Dyl, PhD, with Bradley Hospital and Brown Medical School.
This is the first study to show that adolescents with BDD and with shape/weight preoccupations display higher levels of symptoms in areas like depression, anxiety and suicidality, as compared to other adolescents presenting with psychiatric disorders such as behavioral, psychotic, or mood and anxiety disorders who do not have body image concerns.
"This is important because distressing and impairing body image concerns appear to be very prevalent among adolescents with psychiatric illnesses, and are related to a higher degree of distress and impairment," says author Jennifer Kittler, PhD with Bradley Hospital and Brown Medical School.
An additional finding revealed that in addition to higher levels of depression, anxiety and suicidality, patients with shape/weight preoccupations expressed higher levels of dissociation (a coping style characterized by blocking out emotions), sexual preoccupation/distress, and post-traumatic stress disorder (PTSD), suggesting that such concerns may be related to the experience of past physical or sexual abuse.
Interestingly, the authors found that the majority of the adolescents in the study were not actually overweight.
Two hundred and eight consecutively admitted patients (ages 12 to 17) on the adolescent inpatient unit of Bradley Hospital completed the Body Dyspmorphic Disorder Questionnaire (BDDQ) as part of their admission evaluation. The questionnaire assesses the presence of BDD by asking whether respondents are very worried about how they look, think about their appearance problems a lot, and wish they could think about them less, and whether their main appearance concern is that they are not thin enough, or might become too fat. It also asks for the amount of time that they spend focusing on appearance concerns.
"We found that 6.7 percent of patients on the adolescent inpatient unit at Bradley Hospital met criteria for classic (non-weight-related) BDD, but that a much higher percentage (22.1 percent) exhibited distressing and impairing concerns with their weight and shape," says Kittler.
The study will be published in the June 2006 issue of the journal of Child Psychiatry and Human Development.
Body image concerns under-recognized in teens
These findings are especially concerning for treatment providers and parents, the authors say, because the majority of adolescents in this study were not receiving psychiatric treatment specifically targeted towards their body image problems. They were most commonly being treated for mood disorders, anxiety disorders, and posttraumatic stress disorder and these body image preoccupations may well have been contributing to the events leading to their hospitalization.
"We have indeed seen a number of teens entering the hospital whose negative feelings about their appearance is a major influence on suicidal thoughts and even suicide attempts, a fact which is often initially not recognized by parents and even professionals," says Dyl.
The authors looked at whether individuals determined to have BDD via a self-report measure were diagnosed with BDD by their clinician. They found that only 1 of 14 participants with definite or probable BDD was diagnosed with BDD in the clinical record.
"This is likely due to clinicians' lack of systematic questioning about BDD, as well as patients' embarrassment and reluctance to reveal their symptoms, which may be particularly characteristic of adolescents," they write.
The authors conclude that severe body image disturbances among adolescents are likely to be under-recognized and under-treated, and may be related to other forms of psychological distress (including depression and suicidality). They also note that since many adults presenting in psychiatric settings often report that preoccupation with their appearance first began in adolescence, it is all the more important to recognize and begin to treat body dysmorphic disorder and other body image concerns in the teenage years, to prevent the problem from becoming a more chronic condition.
Even in the absence of an eating disorder, the study finds that body image concerns can be impairing, preoccupying and distressing for teens, taking up a great deal of mental energy and detracting from their quality of life.
"Helping teens verbalize their negative feelings and concerns about their appearance is the first step in getting them to value themselves as individuals and recognize the importance of other non-weight, or non-appearance-based qualities and activities as contributors to their self-esteem and self-worth," Dyl explains.
Carol L. Vieira
cvieira1lifespan
Lifespan
lifespan/
Researchers assessed the prevalence and clinical correlates of body image concerns including: body dysmorphic disorder (BDD), eating disorders (ED) (such as bulimia or anorexia), and other clinically significant concerns over shape/weight in adolescent inpatients at Bradley Hospital, the nation's first psychiatric hospital for children and adolescents. Classic BDD is a preoccupation with an imagined physical defect in appearance or a vastly exaggerated concern about a minimal defect, like a crooked nose or imperfect complexion. Weight-related BDD, however, is classified as distressing and impairing preoccupations with one's weight and shape - ie: thinking one's thighs are too fat or one's waist is too big.
The study found that one third of inpatient adolescents had problematic body image concerns, and that these patients were more severely ill than other adolescent inpatients in a number of important domains. Specifically, those with BDD and shape/weight preoccupations had significantly higher levels of depression, anxiety, and suicidality than other patients with no body image concerns. Those with eating disorders had significantly higher rates of depression than those without body image concerns.
"These findings underscore just how central feelings about one's appearance tend to be in the world of teenagers and how impairing these concerns can be," says lead author, Jennifer Dyl, PhD, with Bradley Hospital and Brown Medical School.
This is the first study to show that adolescents with BDD and with shape/weight preoccupations display higher levels of symptoms in areas like depression, anxiety and suicidality, as compared to other adolescents presenting with psychiatric disorders such as behavioral, psychotic, or mood and anxiety disorders who do not have body image concerns.
"This is important because distressing and impairing body image concerns appear to be very prevalent among adolescents with psychiatric illnesses, and are related to a higher degree of distress and impairment," says author Jennifer Kittler, PhD with Bradley Hospital and Brown Medical School.
An additional finding revealed that in addition to higher levels of depression, anxiety and suicidality, patients with shape/weight preoccupations expressed higher levels of dissociation (a coping style characterized by blocking out emotions), sexual preoccupation/distress, and post-traumatic stress disorder (PTSD), suggesting that such concerns may be related to the experience of past physical or sexual abuse.
Interestingly, the authors found that the majority of the adolescents in the study were not actually overweight.
Two hundred and eight consecutively admitted patients (ages 12 to 17) on the adolescent inpatient unit of Bradley Hospital completed the Body Dyspmorphic Disorder Questionnaire (BDDQ) as part of their admission evaluation. The questionnaire assesses the presence of BDD by asking whether respondents are very worried about how they look, think about their appearance problems a lot, and wish they could think about them less, and whether their main appearance concern is that they are not thin enough, or might become too fat. It also asks for the amount of time that they spend focusing on appearance concerns.
"We found that 6.7 percent of patients on the adolescent inpatient unit at Bradley Hospital met criteria for classic (non-weight-related) BDD, but that a much higher percentage (22.1 percent) exhibited distressing and impairing concerns with their weight and shape," says Kittler.
The study will be published in the June 2006 issue of the journal of Child Psychiatry and Human Development.
Body image concerns under-recognized in teens
These findings are especially concerning for treatment providers and parents, the authors say, because the majority of adolescents in this study were not receiving psychiatric treatment specifically targeted towards their body image problems. They were most commonly being treated for mood disorders, anxiety disorders, and posttraumatic stress disorder and these body image preoccupations may well have been contributing to the events leading to their hospitalization.
"We have indeed seen a number of teens entering the hospital whose negative feelings about their appearance is a major influence on suicidal thoughts and even suicide attempts, a fact which is often initially not recognized by parents and even professionals," says Dyl.
The authors looked at whether individuals determined to have BDD via a self-report measure were diagnosed with BDD by their clinician. They found that only 1 of 14 participants with definite or probable BDD was diagnosed with BDD in the clinical record.
"This is likely due to clinicians' lack of systematic questioning about BDD, as well as patients' embarrassment and reluctance to reveal their symptoms, which may be particularly characteristic of adolescents," they write.
The authors conclude that severe body image disturbances among adolescents are likely to be under-recognized and under-treated, and may be related to other forms of psychological distress (including depression and suicidality). They also note that since many adults presenting in psychiatric settings often report that preoccupation with their appearance first began in adolescence, it is all the more important to recognize and begin to treat body dysmorphic disorder and other body image concerns in the teenage years, to prevent the problem from becoming a more chronic condition.
Even in the absence of an eating disorder, the study finds that body image concerns can be impairing, preoccupying and distressing for teens, taking up a great deal of mental energy and detracting from their quality of life.
"Helping teens verbalize their negative feelings and concerns about their appearance is the first step in getting them to value themselves as individuals and recognize the importance of other non-weight, or non-appearance-based qualities and activities as contributors to their self-esteem and self-worth," Dyl explains.
Carol L. Vieira
cvieira1lifespan
Lifespan
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Older Cancer Patients With Depression Can Be Treated Effectively With Collaborative Approach In Primary-Care Settings
Depression in older cancer patients is very common, and has debilitating effects on their quality of life both during and after treatment. University of Washington (UW) researchers are showing that there are ways to better this situation.
"Little is known about the optimal approach to treating depression in this population, and older cancer patients are less likely to be treated for their depression than are younger cancer patients," said Dr. Jesse Fann, University of Washington associate professor of psychiatry and behavioral sciences. Fann is the director of psychiatric services at the Seattle Cancer Care Alliance, and an investigator in the Clinical Research Division at the Fred Hutchinson Cancer Research Center in Seattle.
Fann and his colleagues evaluated the effectiveness in older, depressed cancer patients of an intervention called Improving Mood-Promoting Access to Collaborative Treatment (IMPACT), in comparison to a similar set of patients receiving usual care. All participants had either major depression or a type of chronic depression called dysthymia, or a combination of both.
IMPACT participants worked with a depression care manager in their primary-care clinic for up to a year. Under the supervision of the patient's primary-care provider and a psychiatrist, the care manager offered the patient support in taking anti-depressants if prescribed by the primary-care provider, education about depression, care coordination and structured counseling sessions that helped the patient engage in pleasant activities and that taught problem-solving skills.
The intervention was tested in 18 primary-care clinics in 5 states. The clinics served a variety of different socio-economic, geographic, and ethnic populations.
At the end of six months, 55 percent of the patients in the IMPACT group and 34 percent of the usual care participants showed a 50 percent or greater reduction in their depression symptoms. The IMPACT participants also had higher remission rates from depression, more depression-free days, less fatigue, a better quality of life, less functional impairment and fewer thoughts of death. Many of these benefits persisted during the one-year follow up period after the intervention was completed.
"Among the functional impairments older cancer patients can experience with depression are fatigue and thinking problems, such as forgetfulness, feeling mentally slowed down, and having difficulty concentrating or solving problems. Decisions that used to be straightforward or easy for them have become challenging," Fann explained.
Based on their findings, the researchers concluded that the IMPACT collaborative care program is feasible and more effective than standard care in managing depression among older cancer patients in primary-care, and is widely applicable.
"The IMPACT intervention can be successfully provided in diverse types of primary-care settings in various locations, and not just at specialized cancer centers. It can literally double the likelihood that the patient's depression will improve over time," said Dr. Jurgen Unutzer, UW professor of psychiatry and behavioral sciences and a co-investigator on the study with Fann and Dr. Ming-Yu Fan, UW research assistant professor of psychiatry and behavioral sciences.
The results were published Oct. 20, in a supplement of the Journal of General Internal Medicine on cancer survivorship care in primary-care.
Obtaining effective treatment for depression is vital, explained Fann, because of the serious, troubling effects depression has on many cancer patients: A depressed person may feel less motivated to exercise or eat well, to carry out treatment plans or be an active participant in their care. The risk of suicide is twice as high among older cancer patients compared to the general population, and the risk is even higher with older age. Some depressed patients question if cancer treatment is worth it, even if they don't plan to end their lives. Patients may rebuff family and friends, and feel incapable of making arrangements for the future.
"Depression may persist after the cancer is successfully treated or in remission. They have survived the disease, but still can't re-engage in life." Unutzer added. "Patients may feel unable to enjoy or make use of the time that has been added to their life."
The elderly are the largest segment of our population with cancer, and older cancer patients are becoming a significant segment of primary care practice, Fann and Unutzer said. By supporting depression care in primary-care settings, they added, health-care providers can help older cancer patients truly benefit from advances in cancer treatment by improving their quality of life.
Their suggestion to older cancer patients: "If you have depression, you don't have to 'just live with it.' Treatment may increase the odds that you will feel less tired and feel more like getting on with life. You dealt with cancer, and you can do something about depression."
The 'Improving Primary Care for Older Adults with Cancer and Depression" study was supported by grants from the John A. Hartford Foundation, the California Health Care Foundation, the Hogg Foundation, and the Robert Wood Johnson Foundation.
"Little is known about the optimal approach to treating depression in this population, and older cancer patients are less likely to be treated for their depression than are younger cancer patients," said Dr. Jesse Fann, University of Washington associate professor of psychiatry and behavioral sciences. Fann is the director of psychiatric services at the Seattle Cancer Care Alliance, and an investigator in the Clinical Research Division at the Fred Hutchinson Cancer Research Center in Seattle.
Fann and his colleagues evaluated the effectiveness in older, depressed cancer patients of an intervention called Improving Mood-Promoting Access to Collaborative Treatment (IMPACT), in comparison to a similar set of patients receiving usual care. All participants had either major depression or a type of chronic depression called dysthymia, or a combination of both.
IMPACT participants worked with a depression care manager in their primary-care clinic for up to a year. Under the supervision of the patient's primary-care provider and a psychiatrist, the care manager offered the patient support in taking anti-depressants if prescribed by the primary-care provider, education about depression, care coordination and structured counseling sessions that helped the patient engage in pleasant activities and that taught problem-solving skills.
The intervention was tested in 18 primary-care clinics in 5 states. The clinics served a variety of different socio-economic, geographic, and ethnic populations.
At the end of six months, 55 percent of the patients in the IMPACT group and 34 percent of the usual care participants showed a 50 percent or greater reduction in their depression symptoms. The IMPACT participants also had higher remission rates from depression, more depression-free days, less fatigue, a better quality of life, less functional impairment and fewer thoughts of death. Many of these benefits persisted during the one-year follow up period after the intervention was completed.
"Among the functional impairments older cancer patients can experience with depression are fatigue and thinking problems, such as forgetfulness, feeling mentally slowed down, and having difficulty concentrating or solving problems. Decisions that used to be straightforward or easy for them have become challenging," Fann explained.
Based on their findings, the researchers concluded that the IMPACT collaborative care program is feasible and more effective than standard care in managing depression among older cancer patients in primary-care, and is widely applicable.
"The IMPACT intervention can be successfully provided in diverse types of primary-care settings in various locations, and not just at specialized cancer centers. It can literally double the likelihood that the patient's depression will improve over time," said Dr. Jurgen Unutzer, UW professor of psychiatry and behavioral sciences and a co-investigator on the study with Fann and Dr. Ming-Yu Fan, UW research assistant professor of psychiatry and behavioral sciences.
The results were published Oct. 20, in a supplement of the Journal of General Internal Medicine on cancer survivorship care in primary-care.
Obtaining effective treatment for depression is vital, explained Fann, because of the serious, troubling effects depression has on many cancer patients: A depressed person may feel less motivated to exercise or eat well, to carry out treatment plans or be an active participant in their care. The risk of suicide is twice as high among older cancer patients compared to the general population, and the risk is even higher with older age. Some depressed patients question if cancer treatment is worth it, even if they don't plan to end their lives. Patients may rebuff family and friends, and feel incapable of making arrangements for the future.
"Depression may persist after the cancer is successfully treated or in remission. They have survived the disease, but still can't re-engage in life." Unutzer added. "Patients may feel unable to enjoy or make use of the time that has been added to their life."
The elderly are the largest segment of our population with cancer, and older cancer patients are becoming a significant segment of primary care practice, Fann and Unutzer said. By supporting depression care in primary-care settings, they added, health-care providers can help older cancer patients truly benefit from advances in cancer treatment by improving their quality of life.
Their suggestion to older cancer patients: "If you have depression, you don't have to 'just live with it.' Treatment may increase the odds that you will feel less tired and feel more like getting on with life. You dealt with cancer, and you can do something about depression."
The 'Improving Primary Care for Older Adults with Cancer and Depression" study was supported by grants from the John A. Hartford Foundation, the California Health Care Foundation, the Hogg Foundation, and the Robert Wood Johnson Foundation.
Depressed patients who complain of physical, not psychological symptoms need different treatment approach, study finds
A primary care depression intervention is more effective for patients with predominantly psychological versus physical
symptoms, according to this group-randomized trial involving 200 patients.
A two-year ongoing intervention for patients who complained of psychological symptoms improved clinical outcomes while
reducing outpatient costs by $980 per patient.
In contrast, a two-year ongoing intervention for patients who complained exclusively of physical symptoms failed to improve
clinical outcomes beyond usual care, while increasing outpatient costs by $1,378 per patient over two years.
The
findings suggest a need for developing new intervention approaches for depressed patients who complain of physical symptoms.
RTC of a Care Manager Intervention for Major Depression in Primary Care: 2-Year Costs for Patients with Physical vs
Psychological Symptoms
By L. Miriam Dickson, Ph.D., et al
Angela Lower - aloweraafp
American Academy of Family Physicians
January/February Annals of Family Medicine tip sheet
Annals of Family Medicine is a peer-reviewed research journal that provides a cross-disciplinary forum for new,
evidence-based information affecting the primary care discipline. Launched in May 2003, the journal is sponsored by six
family medical organizations, including the American Academy of Family Physicians, the American Board of Family Practice, the
Society of Teachers of Family Medicine, the Association of Departments of Family Medicine, the Association of Family Practice
Residency Directors and the North American Primary Care Research Group. The journal is published six times each year and
contains original research from the clinical, biomedical, social and health services areas, as well as contributions on
methodology and theory, selected reviews, essays and editorials. A board of directors with representatives from each of the
sponsoring organizations oversees Annals. Complete editorial content and interactive discussion groups can be accessed free
of charge on the journal's Web site, American Academy of Family
Physicians.
symptoms, according to this group-randomized trial involving 200 patients.
A two-year ongoing intervention for patients who complained of psychological symptoms improved clinical outcomes while
reducing outpatient costs by $980 per patient.
In contrast, a two-year ongoing intervention for patients who complained exclusively of physical symptoms failed to improve
clinical outcomes beyond usual care, while increasing outpatient costs by $1,378 per patient over two years.
The
findings suggest a need for developing new intervention approaches for depressed patients who complain of physical symptoms.
RTC of a Care Manager Intervention for Major Depression in Primary Care: 2-Year Costs for Patients with Physical vs
Psychological Symptoms
By L. Miriam Dickson, Ph.D., et al
Angela Lower - aloweraafp
American Academy of Family Physicians
January/February Annals of Family Medicine tip sheet
Annals of Family Medicine is a peer-reviewed research journal that provides a cross-disciplinary forum for new,
evidence-based information affecting the primary care discipline. Launched in May 2003, the journal is sponsored by six
family medical organizations, including the American Academy of Family Physicians, the American Board of Family Practice, the
Society of Teachers of Family Medicine, the Association of Departments of Family Medicine, the Association of Family Practice
Residency Directors and the North American Primary Care Research Group. The journal is published six times each year and
contains original research from the clinical, biomedical, social and health services areas, as well as contributions on
methodology and theory, selected reviews, essays and editorials. A board of directors with representatives from each of the
sponsoring organizations oversees Annals. Complete editorial content and interactive discussion groups can be accessed free
of charge on the journal's Web site, American Academy of Family
Physicians.
In Cyber Bullying, Depression Hits Victims Hardest
Young victims of electronic or cyber bullying - which occurs online or by cell phone - are more likely to suffer from depression than their tormentors are, a new study finds.
Traditional bullying, the kind that occurs in the school building or face-to-face, is different. Victims and bully-victims - those who both dish it out and take it - are more likely to suffer from depression than are those who are bullies, but not victims.
"The type of bullying we're looking at peaks in middle school," said study co-author Ronald Iannotti, Ph.D.
Researchers at the Eunice Kennedy Shriver National Institute of Child and Human Health Development looked at survey results on bullying behaviors and signs of depression in 7,313 students in grades six through 10.
Cyber bullying is a relatively new area of study. Lead author Jing Wang, Ph.D., said the greater depression in victims alone compared to others involved in cyber bullying was unexpected.
Jorge Srabstein, M.D., who has no affiliation with the new study, said the findings "really highlight the toxicity of cyber bullying." He is medical director of the Clinic for Health Problems Related to Bullying at Children's National Medical Center.
In traditional bullying, "somebody writes an insult on the bathroom wall and it's confined to the environment of the school," Srabstein said. But with cyber bullying, "in the majority of victimization, there is a wider resonance of abuse, to all corners of the world."
"Individuals can be more isolated when bullying occurs by cell phone or computer," Iannotti said. "The mechanism for cyber bullying is 'I'm making fun of you; I could have made a photo of you that's not even true and it can go to Facebook.' The audience is much greater. That can be devastating - not knowing how many people have seen that text message or photo."
Data from the Health Behavior in School-Aged Children 2005 Survey showed that more than half of students either had bullied others or experienced verbal bullying, like name-calling, at least once in the past couple of months and more than half were involved in relational bullying, like isolation from peers. About a fifth had either engaged in or experienced physical bullying, like hitting, and about 14 percent were involved in cyber bullying.
Gender was not a factor: boys and girls equally were vulnerable.
What was not clear is which comes first: "We can't be sure whether depressed kids have lower self-esteem and so are more easily bullied or the other way around," Iannotti said.
In 2006, Megan Meier, a Missouri teen, committed suicide because of online bullying. In a case that illustrates how the trend can cross boundaries of age and identity, her adult tormentors pretended to be a boy who first befriended, then insulted, and finally "dumped" her.
A new Missouri law requires school districts to add the terms "cyber-bullying" and "electronic communications" to existing anti-bullying policies and other states have enacted similar laws.
In his June testimony before the U.S. House Education and Labor Committee, Srabstein gave recommendations to address student cyber safety in the context of the Elementary and Secondary School Education Act reauthorization.
In worldwide efforts, a common thread is that you cannot confront bullying without educating people and changing the community culture.
"Children might not be aware that they incidents they have experienced are cyber bulling," Wang said.
Many kids are reluctant to speak up. "Unfortunately, it's universally ingrained that reporting bullying is being a 'snitch' and trying to get someone in trouble," Srabstein said. "Instead of punishing perpetrators, they should undergo counseling about the harm they have inflicted and understand that they must to stop the mistreatment."
"Kids may be reluctant to tell their parents in case they lose their computer or cell phone privileges," Iannotti said. On the other side, he said, "parents should monitor children's phones and computers," another tough sell.
Congressional testimony on student cyber safety
Wang J, Nansel TR, Iannotti RJ. Cyber bullying and traditional bullying: differential association with depression. J Adol Health online, 2010.
Traditional bullying, the kind that occurs in the school building or face-to-face, is different. Victims and bully-victims - those who both dish it out and take it - are more likely to suffer from depression than are those who are bullies, but not victims.
"The type of bullying we're looking at peaks in middle school," said study co-author Ronald Iannotti, Ph.D.
Researchers at the Eunice Kennedy Shriver National Institute of Child and Human Health Development looked at survey results on bullying behaviors and signs of depression in 7,313 students in grades six through 10.
Cyber bullying is a relatively new area of study. Lead author Jing Wang, Ph.D., said the greater depression in victims alone compared to others involved in cyber bullying was unexpected.
Jorge Srabstein, M.D., who has no affiliation with the new study, said the findings "really highlight the toxicity of cyber bullying." He is medical director of the Clinic for Health Problems Related to Bullying at Children's National Medical Center.
In traditional bullying, "somebody writes an insult on the bathroom wall and it's confined to the environment of the school," Srabstein said. But with cyber bullying, "in the majority of victimization, there is a wider resonance of abuse, to all corners of the world."
"Individuals can be more isolated when bullying occurs by cell phone or computer," Iannotti said. "The mechanism for cyber bullying is 'I'm making fun of you; I could have made a photo of you that's not even true and it can go to Facebook.' The audience is much greater. That can be devastating - not knowing how many people have seen that text message or photo."
Data from the Health Behavior in School-Aged Children 2005 Survey showed that more than half of students either had bullied others or experienced verbal bullying, like name-calling, at least once in the past couple of months and more than half were involved in relational bullying, like isolation from peers. About a fifth had either engaged in or experienced physical bullying, like hitting, and about 14 percent were involved in cyber bullying.
Gender was not a factor: boys and girls equally were vulnerable.
What was not clear is which comes first: "We can't be sure whether depressed kids have lower self-esteem and so are more easily bullied or the other way around," Iannotti said.
In 2006, Megan Meier, a Missouri teen, committed suicide because of online bullying. In a case that illustrates how the trend can cross boundaries of age and identity, her adult tormentors pretended to be a boy who first befriended, then insulted, and finally "dumped" her.
A new Missouri law requires school districts to add the terms "cyber-bullying" and "electronic communications" to existing anti-bullying policies and other states have enacted similar laws.
In his June testimony before the U.S. House Education and Labor Committee, Srabstein gave recommendations to address student cyber safety in the context of the Elementary and Secondary School Education Act reauthorization.
In worldwide efforts, a common thread is that you cannot confront bullying without educating people and changing the community culture.
"Children might not be aware that they incidents they have experienced are cyber bulling," Wang said.
Many kids are reluctant to speak up. "Unfortunately, it's universally ingrained that reporting bullying is being a 'snitch' and trying to get someone in trouble," Srabstein said. "Instead of punishing perpetrators, they should undergo counseling about the harm they have inflicted and understand that they must to stop the mistreatment."
"Kids may be reluctant to tell their parents in case they lose their computer or cell phone privileges," Iannotti said. On the other side, he said, "parents should monitor children's phones and computers," another tough sell.
Congressional testimony on student cyber safety
Wang J, Nansel TR, Iannotti RJ. Cyber bullying and traditional bullying: differential association with depression. J Adol Health online, 2010.
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