A new study by researchers in the UK suggests that antidepressants only benefit the very severely depressed and are no more effective than a placebo for
everyone else.
The meta-analytical study (ie one that systematically pools the results of other studies) is the work of Dr Irving Kirsch, from the University of Hull, and
his colleagues, and is published today, 26th February, in the open access journal PLoS Medicine.
Antidepressants are prescribed for the treatment of clinical depression, and the most widely used are the "new generation" drugs, the SSRIs such as
fluoxetine (Prozac) and venlafaxine (Effexor).
Previous meta-analytical studies of antidepressants have already suggested they have only modest benefits over placebos, and the authors pointed out that
when data from unpublished trials are included, the benefits are so small they fall below the criteria for clinical significance. What has not been clear in
the past however, is whether within this overall result, the effectiveness of antidepressants depends on how severely depressed patients are when they start
treatment.
Kirsch and colleagues pooled all the available full data sets from all clinical trials submitted to the US Food and Drug Administration (FDA) for licensing
four of the new generation of antidepressants, the SSRIs fluoxetine (Prozac), venlafaxine (Effexor), nefazodone (Serzone), and
paroxetine (Seroxat, Paxil). The data came from both published and unpublished trials.
The point of including data from unpublished as well as published trials, is to avoid potential bias arising from the omission of "disappointing" unpublished
findings.
SSRI stands for "selective serotonin reuptake inhibitors". This new type of antidepressant, like the older ones, works by attempting to stabilize chemicals
in the brain that influence mood, except that SSRIs specifically target and increase the circulating levels of a brain chemical called serotonin, a neurotransmitter that regulates
mood. They do this by inhibiting the reuptake of serotonin so that more of it is available for binding to cell receptors.
Using meta-analytical techniques (a way of pooling data from a range of studies as if they were one big study with broadly the same objectives) the authors
assessed the relation between the initial severity of depression and the improvements shown by drug and placebo groups, as well as the relation between
initial severity and differences in drug-placebo improvement scores.
The results showed that:
Drug-placebo differences got bigger as initial severity went up.
This difference was hardly noticeable at moderate levels of initial depression, went up to a relatively small difference for patients with severe
depression, and reached a level that would be classed as clinically significant only in those patients at the extreme end of the very depressed
scale.
The improvement seemed to result from the most severely depressed patients not responding as well to placebo compared to their less depressed
counterparts, than because they responded better to the active drug.
Kirsch and colleagues concluded that:
"Drug-placebo differences in antidepressant efficacy increase as a function of baseline severity, but are relatively small even for severely depressed
patients."
"The relationship between initial severity and antidepressant efficacy is attributable to decreased responsiveness to placebo among very severely depressed
patients, rather than to increased responsiveness to medication," they added.
In other words, the difference in effect between drug and placebo was only clinically significant in those patients who were very severely depressed at the
start of their treatment and this effect was more likely due to a weaker response to the placebo than a stronger response to the drug itself in that group.
This study is important because although licensing authorities like the FDA in the US and NICE (National Institute for Health and Clinical
Excellence) in the UK have approved SSRIs for treating depression, there are nagging doubts about how effective they are.
Depression, which affects about 1 in 6 people at some point in their life, is a serious medical condition characterized by imbalances in brain chemicals that
regulate mood. The illness, which can last for months and sometimes years, makes a person feel unmotivated, worthless, hopeless, and sometimes even that life is so futile
it would be better to be dead. Depression is often a cause of suicide.
Severity of depression is measured using a questionnaire called the Hamilton Rating Scale of Depression (HRSD) which comprises up to 21 items. If the total
score comes to 18 or more, the person is classed as severely depressed.
For an antidepressant to receive a license, clinical trials have to show that it can significantly improve the HRSD score compared to a placebo.
Different countries have slightly different clinical criteria for how much the HRSD score has to improve by before the drug can be licensed to treat
depression. In the UK, NICE require that the drug show an improvement in the HRSD score of 3.
A previous meta-analysis of published and unpublished trials sent to the FDA for licensing these drugs showed they only have an average benefit of 1.8 HRSD
points.
The reason this study was done was to find out if underneath this 1.8 average there might be subgroups of patients for whom the improvement score was
significantly higher, perhaps within the range required by NICE.
And indeed, this is what Kirsch and colleagues found: the clinical criteria were only met when the drugs were used to treat the most severely depressed
patients, that is ones with an initial HRSD score of 28 or more, at the extreme end of the scale. And perhaps just as important, is the finding that this
effect did not arise as a result of responding to the drug, but because of decreased responsiveness to the placebo.
This last, rather surprising finding, provides a new direction for future research.
In the meantime, the UK's Royal College of Psychiatrists urges patients not to stop taking their prescribed antidepressants without seeing their doctor first.
"Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration."
Kirsch I, Deacon BJ, Huedo-Medina TB, Scoboria A, Moore TJ, et al.
PLoS Medicine Vol. 5, No. 2, e45
Published online: February 26, 2008.
doi:10.1371/journal.pmed.0050045
Click here for
Article.
Sources: PLoS Medicine press release, journal abstract and article.
, PhD
View drug information on Effexor; Paxil CR; Prozac Weekly.
понедельник, 13 июня 2011 г.
суббота, 11 июня 2011 г.
Loneliness May Be Alleviated By Animals, Gadgets, Spiritual Beliefs, Not Just People
New research at the University of Chicago finds evidence for a clever way that people manage to alleviate the pain of loneliness: They create people in their surroundings to keep them company.
"Biological reproduction is not a very efficient way to alleviate one's loneliness, but you can make up people when you're motivated to do so," said Nicholas Epley, Assistant Professor of Behavioral Science at the University of Chicago's Graduate School of Business. "When people lack a sense of connection with other people, they are more likely to see their pets, gadgets or gods as human-like."
Social scientists call this tendency "anthropomorphism." As a research topic, the phenomenon carries important therapeutic and societal implications, Epley said. He and his co-authors will publish their findings on anthropomorphism in the February issue of the journal Psychological Science. Also contributing to the research were Scott Akalis of Harvard University and the University of Chicago's Adam Waytz and John Cacioppo.
The behaviors they describe in the paper are not limited to the lonely. Nevertheless, they are well-known to casual observers, from the stereotype of the woman who lives alone surrounded by her menagerie of cats, to the movie portrayal of a tropical island castaway.
"In the movie Castaway, Tom Hanks was isolated on an island and found the social desolation to be one of the most daunting challenges with which he had to deal," said Cacioppo, the Tiffany and Margaret Blake Distinguished Service Professor in Psychology at the University of Chicago.
"He did so, in part, by anthropomorphizing a volleyball, Wilson, who became his friend and confidant while he was on the island." Although fictional, "Castaway depicts a deep truth about the irrepressibly social nature of Homo sapiens," Cacioppo said.
The researchers designed three experiments to test their expectations that lonely people are more likely to make up for their lack of social connection by creating humanlike connections with gadgets or pets, or to increase their belief in the supernatural.
In one experiment, the team found a correlation between how lonely people felt and their tendency to describe a gadget in terms of humanlike mental states.
In another experiment, the team made people feel lonely in the laboratory by asking them to write about a time when they felt lonely or isolated. Under those circumstances, they were more likely to believe in the supernatural, whether it be God, angels or miracles, than when they were not feeling lonely.
"If we made them feel lonely, they were also more likely to describe a pet, even if it wasn't their own pet, as having humanlike mental states that were related to social connection, like being more thoughtful, considerate and compassionate," Epley said.
The research further revealed that not just any negative emotional state produces this effect. "It's something special about loneliness," Epley said. Fear, for example, doesn't increase reported belief in God, or how people describe their pets.
Loneliness is both painful to experience and potentially deadly. "It's actually a greater risk for morbidity or mortality than cigarette smoking is. Being lonely is a bad thing for you," he said.
But anthropomorphizing pets or God may actually confer many of the same psychological and physical benefits that come from connections with other people. The same benefits may not apply to gadgets, which were a component of Epley's studies.
"Non-human connections can be very powerful," Epley said. "A brain's not so sensitive to whether it's a person or not. If it's something that has a lot of traits associated with what it means to be a human, then all the better for us, it seems."
The study also provides insight into the flip side of anthropomorphism: dehumanization. People who enjoy a strong sense of social connection are less likely to perceive humanlike mental states in people who seem different from them. Classic examples occur during times of war, during which a strong sense of nationalism or group identity tend to emerge.
"It may be that strong in-group identity is one of the things that facilitates dehumanizing the opposing side," Epley said.
"Biological reproduction is not a very efficient way to alleviate one's loneliness, but you can make up people when you're motivated to do so," said Nicholas Epley, Assistant Professor of Behavioral Science at the University of Chicago's Graduate School of Business. "When people lack a sense of connection with other people, they are more likely to see their pets, gadgets or gods as human-like."
Social scientists call this tendency "anthropomorphism." As a research topic, the phenomenon carries important therapeutic and societal implications, Epley said. He and his co-authors will publish their findings on anthropomorphism in the February issue of the journal Psychological Science. Also contributing to the research were Scott Akalis of Harvard University and the University of Chicago's Adam Waytz and John Cacioppo.
The behaviors they describe in the paper are not limited to the lonely. Nevertheless, they are well-known to casual observers, from the stereotype of the woman who lives alone surrounded by her menagerie of cats, to the movie portrayal of a tropical island castaway.
"In the movie Castaway, Tom Hanks was isolated on an island and found the social desolation to be one of the most daunting challenges with which he had to deal," said Cacioppo, the Tiffany and Margaret Blake Distinguished Service Professor in Psychology at the University of Chicago.
"He did so, in part, by anthropomorphizing a volleyball, Wilson, who became his friend and confidant while he was on the island." Although fictional, "Castaway depicts a deep truth about the irrepressibly social nature of Homo sapiens," Cacioppo said.
The researchers designed three experiments to test their expectations that lonely people are more likely to make up for their lack of social connection by creating humanlike connections with gadgets or pets, or to increase their belief in the supernatural.
In one experiment, the team found a correlation between how lonely people felt and their tendency to describe a gadget in terms of humanlike mental states.
In another experiment, the team made people feel lonely in the laboratory by asking them to write about a time when they felt lonely or isolated. Under those circumstances, they were more likely to believe in the supernatural, whether it be God, angels or miracles, than when they were not feeling lonely.
"If we made them feel lonely, they were also more likely to describe a pet, even if it wasn't their own pet, as having humanlike mental states that were related to social connection, like being more thoughtful, considerate and compassionate," Epley said.
The research further revealed that not just any negative emotional state produces this effect. "It's something special about loneliness," Epley said. Fear, for example, doesn't increase reported belief in God, or how people describe their pets.
Loneliness is both painful to experience and potentially deadly. "It's actually a greater risk for morbidity or mortality than cigarette smoking is. Being lonely is a bad thing for you," he said.
But anthropomorphizing pets or God may actually confer many of the same psychological and physical benefits that come from connections with other people. The same benefits may not apply to gadgets, which were a component of Epley's studies.
"Non-human connections can be very powerful," Epley said. "A brain's not so sensitive to whether it's a person or not. If it's something that has a lot of traits associated with what it means to be a human, then all the better for us, it seems."
The study also provides insight into the flip side of anthropomorphism: dehumanization. People who enjoy a strong sense of social connection are less likely to perceive humanlike mental states in people who seem different from them. Classic examples occur during times of war, during which a strong sense of nationalism or group identity tend to emerge.
"It may be that strong in-group identity is one of the things that facilitates dehumanizing the opposing side," Epley said.
четверг, 9 июня 2011 г.
Study Links Forgiveness To Less Back Pain, Depression
Forgiving nature benefits back
A new study from Duke University Medical Center demonstrates that among people who have chronic back pain, those who have forgiven others experience lower levels of pain and less associated psychological problems like anger and depression than those who have not forgiven.
The findings will be presented at the Conference on Forgiveness in Atlanta October 24-25.
ABSTRACT:
Carson, James: Correlates of Forgiveness & Preliminary Results from a Loving Kindness Meditation Intervention for Low Back Pain Patients
1. Discuss the value of fostering forgiveness among chronic pain patients.
2. Identify specific consistent relationships between measures of forgiveness and important aspects of living with persistent pain.
3. Recognize specific techniques for promoting forgiveness in medical patients.
This presentation will report data on baseline correlates of forgiveness and preliminary treatment outcomes among patients with persistent low back pain who are enrolled in a novel intervention study.
Chronic pain is a medical condition which is particularly relevant to the investigation of forgiveness. Anger and resentment - about an offender perceived as causing or aggravating their condition, or related to the chronicity of their condition - are emotions that are salient features of many persons' chronic pain experience.
Anger can be a major complicating factor in the treatment of persistent pain, and also negatively impact patients' interactions with family members, co-workers, and health care providers.
The overall purpose of this study is to explore whether a novel, positive emotion-oriented strategy - loving-kindness meditation, a centuries-old Buddhist approach to developing love and forgiveness - can foster forgiveness, reduce anger, and improve the pain and adjustment of these patients.
Forgiveness in this context is understood as a person's act of deliberately giving up anger and resentment felt toward an offender, and fostering qualities of love, understanding, and compassion in their place. In this randomized controlled trial, patients are being assigned to the loving-kindness meditation protocol or a standard care control condition.
Findings will be reported on the baseline relationship of forgiveness to pain, anger, depression, and psychological distress among 58 patients. Taken together, these findings suggest that there is a strong and consistent relationship between forgiveness and important aspects of living with persistent pain, including pain itself and measures of adjustment.
Preliminary treatment outcomes based on data from the first 33 randomized patients will also be reported. To our knowledge, this is the first study to investigate forgiveness in a medical population. Potential implications of our preliminary findings will be discussed, along with methodological issues in the study of forgiveness among medical patients.
Dr. Carson is Clinical Associate and Post Doctoral Fellow, Department of Pain Prevention and Treatment Research Program, Dept. of Psychiatry, Duke University Medical Center.
A new study from Duke University Medical Center demonstrates that among people who have chronic back pain, those who have forgiven others experience lower levels of pain and less associated psychological problems like anger and depression than those who have not forgiven.
The findings will be presented at the Conference on Forgiveness in Atlanta October 24-25.
ABSTRACT:
Carson, James: Correlates of Forgiveness & Preliminary Results from a Loving Kindness Meditation Intervention for Low Back Pain Patients
1. Discuss the value of fostering forgiveness among chronic pain patients.
2. Identify specific consistent relationships between measures of forgiveness and important aspects of living with persistent pain.
3. Recognize specific techniques for promoting forgiveness in medical patients.
This presentation will report data on baseline correlates of forgiveness and preliminary treatment outcomes among patients with persistent low back pain who are enrolled in a novel intervention study.
Chronic pain is a medical condition which is particularly relevant to the investigation of forgiveness. Anger and resentment - about an offender perceived as causing or aggravating their condition, or related to the chronicity of their condition - are emotions that are salient features of many persons' chronic pain experience.
Anger can be a major complicating factor in the treatment of persistent pain, and also negatively impact patients' interactions with family members, co-workers, and health care providers.
The overall purpose of this study is to explore whether a novel, positive emotion-oriented strategy - loving-kindness meditation, a centuries-old Buddhist approach to developing love and forgiveness - can foster forgiveness, reduce anger, and improve the pain and adjustment of these patients.
Forgiveness in this context is understood as a person's act of deliberately giving up anger and resentment felt toward an offender, and fostering qualities of love, understanding, and compassion in their place. In this randomized controlled trial, patients are being assigned to the loving-kindness meditation protocol or a standard care control condition.
Findings will be reported on the baseline relationship of forgiveness to pain, anger, depression, and psychological distress among 58 patients. Taken together, these findings suggest that there is a strong and consistent relationship between forgiveness and important aspects of living with persistent pain, including pain itself and measures of adjustment.
Preliminary treatment outcomes based on data from the first 33 randomized patients will also be reported. To our knowledge, this is the first study to investigate forgiveness in a medical population. Potential implications of our preliminary findings will be discussed, along with methodological issues in the study of forgiveness among medical patients.
Dr. Carson is Clinical Associate and Post Doctoral Fellow, Department of Pain Prevention and Treatment Research Program, Dept. of Psychiatry, Duke University Medical Center.
вторник, 7 июня 2011 г.
Getting Dirty May Lift Your Mood
Treatment of mice with a 'friendly' bacteria, normally found in the soil, altered their behavior in a way similar to that produced by antidepressant drugs, reports research published in Neuroscience.
These findings, identified by researchers at the University of Bristol and colleagues at University College London, aid the understanding of why an imbalance in the immune system leaves some individuals vulnerable to mood disorders like depression.
Dr Chris Lowry, lead author on the paper from Bristol University, said: "These studies help us understand how the body communicates with the brain and why a healthy immune system is important for maintaining mental health. They also leave us wondering if we shouldn't all be spending more time playing in the dirt."
Interest in the project arose after human cancer patients being treated with the bacteria Mycobacterium vaccae unexpectedly reported increases in their quality of life. Lowry and his colleagues reasoned that this effect could be caused by activation of neurons in the brain that contained serotonin.
When the team looked closely at the brains of mice, they found that treatment with M. vaccae activated a group of neurons that produce the brain chemical serotonin. The lack of serotonin in the brain is thought to cause depression in people, thus M. vaccae's effects on the behavior of mice may be due to increasing the release of serotonin in parts of the brain that regulate mood.
The new research supports this hypothesis, but future studies will be designed to determine if M. vaccae, other bacteria, or pharmaceutical compounds have antidepressant properties through activation of this group of serotonin neurons.
BRISTOL UNIVERSITY
Senate House
Tyndall Avenue
Bristol
bristol.ac.uk
These findings, identified by researchers at the University of Bristol and colleagues at University College London, aid the understanding of why an imbalance in the immune system leaves some individuals vulnerable to mood disorders like depression.
Dr Chris Lowry, lead author on the paper from Bristol University, said: "These studies help us understand how the body communicates with the brain and why a healthy immune system is important for maintaining mental health. They also leave us wondering if we shouldn't all be spending more time playing in the dirt."
Interest in the project arose after human cancer patients being treated with the bacteria Mycobacterium vaccae unexpectedly reported increases in their quality of life. Lowry and his colleagues reasoned that this effect could be caused by activation of neurons in the brain that contained serotonin.
When the team looked closely at the brains of mice, they found that treatment with M. vaccae activated a group of neurons that produce the brain chemical serotonin. The lack of serotonin in the brain is thought to cause depression in people, thus M. vaccae's effects on the behavior of mice may be due to increasing the release of serotonin in parts of the brain that regulate mood.
The new research supports this hypothesis, but future studies will be designed to determine if M. vaccae, other bacteria, or pharmaceutical compounds have antidepressant properties through activation of this group of serotonin neurons.
BRISTOL UNIVERSITY
Senate House
Tyndall Avenue
Bristol
bristol.ac.uk
воскресенье, 5 июня 2011 г.
Obesity Associated With Depression And Vice Versa
Obesity appears to be associated with an increased risk of depression, and depression also appears associated with an increased risk of developing obesity, according to a meta-analysis of previously published studies in the March issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
"Both depression and obesity are widely spread problems with major public health implications," the authors write as background information in the article. "Because of the high prevalence of both depression and obesity, and the fact that they both carry an increased risk for cardiovascular disease, a potential association between depression and obesity has been presumed and repeatedly been examined." Understanding the relationship between the two conditions over time could help improve prevention and intervention strategies.
Floriana S. Luppino, M.D., of Leiden University Medical Center and GGZ Rivierduinen, Leiden, the Netherlands, and colleagues analyzed the results of 15 previously published studies involving 58,745 participants that examined the longitudinal (over time) relationship between depression and overweight or obesity.
"We found bidirectional associations between depression and obesity: obese persons had a 55 percent increased risk of developing depression over time, whereas depressed persons had a 58 percent increased risk of becoming obese," the authors write. "The association between depression and obesity was stronger than the association between depression and overweight, which reflects a dose-response gradient."
Sub-analyses demonstrated that the association between obesity and later depression was more pronounced among Americans than among Europeans, and stronger for diagnosed depressive disorder compared with depressive symptoms.
Evidence of a biological link between overweight, obesity and depression remains uncertain and complex, but several theories have been proposed, the authors note. Obesity may be considered an inflammatory state, and inflammation is associated with the risk of depression. Because thinness is considered a beauty ideal in both the United States and Europe, being overweight or obese may contribute to body dissatisfaction and low self-esteem that places individuals at risk for depression. Conversely, depression may increase weight over time through interference with the endocrine system or the adverse effects of antidepressant medication.
The findings are important for clinical practice, the authors note. "Because weight gain appears to be a late consequence of depression, care providers should be aware that within depressive patients weight should be monitored. In overweight or obese patients, mood should be monitored. This awareness could lead to prevention, early detection and co-treatment for the ones at risk, which could ultimately reduce the burden of both conditions," they conclude.
Arch Gen Psychiatry. 2010;67[3]:220-229.
Source
Archives of General Psychiatry
"Both depression and obesity are widely spread problems with major public health implications," the authors write as background information in the article. "Because of the high prevalence of both depression and obesity, and the fact that they both carry an increased risk for cardiovascular disease, a potential association between depression and obesity has been presumed and repeatedly been examined." Understanding the relationship between the two conditions over time could help improve prevention and intervention strategies.
Floriana S. Luppino, M.D., of Leiden University Medical Center and GGZ Rivierduinen, Leiden, the Netherlands, and colleagues analyzed the results of 15 previously published studies involving 58,745 participants that examined the longitudinal (over time) relationship between depression and overweight or obesity.
"We found bidirectional associations between depression and obesity: obese persons had a 55 percent increased risk of developing depression over time, whereas depressed persons had a 58 percent increased risk of becoming obese," the authors write. "The association between depression and obesity was stronger than the association between depression and overweight, which reflects a dose-response gradient."
Sub-analyses demonstrated that the association between obesity and later depression was more pronounced among Americans than among Europeans, and stronger for diagnosed depressive disorder compared with depressive symptoms.
Evidence of a biological link between overweight, obesity and depression remains uncertain and complex, but several theories have been proposed, the authors note. Obesity may be considered an inflammatory state, and inflammation is associated with the risk of depression. Because thinness is considered a beauty ideal in both the United States and Europe, being overweight or obese may contribute to body dissatisfaction and low self-esteem that places individuals at risk for depression. Conversely, depression may increase weight over time through interference with the endocrine system or the adverse effects of antidepressant medication.
The findings are important for clinical practice, the authors note. "Because weight gain appears to be a late consequence of depression, care providers should be aware that within depressive patients weight should be monitored. In overweight or obese patients, mood should be monitored. This awareness could lead to prevention, early detection and co-treatment for the ones at risk, which could ultimately reduce the burden of both conditions," they conclude.
Arch Gen Psychiatry. 2010;67[3]:220-229.
Source
Archives of General Psychiatry
пятница, 3 июня 2011 г.
A Simple Intervention For General Practice To Improve Depression Care
German researchers from the Institutes for General Practice in Frankfurt / Main and Jena have achieved positive results from a sustainable intervention in the primary care practice (Annals of Internal Medicine, volume 151, number 6, Sep. 15, 2009). The international relevance of the trial is also highlighted in the editorial. The cluster-randomized controlled intervention trial (PRimary care Monitoring for depressive Patients Trial - PRoMPT-projekt.de) evaluated the effects of practice-based health care assistants making structured monthly follow-up phone calls to patients with depression, with the aim of assessing depression symptoms and reporting back to the general practitioner. "The practice team is then in a position to recognize and react to any deterioration immediately and last but not least prompt patients to self care," said the principal investigator Dr. Jochen Gensichen.
626 patients with depression from 74 general practices in Germany participated in the trial. In 2008, the research team, that includes Prof. Dr. Jochen Gensichen (University Hospital Jena) and Prof. Dr. Ferdinand Gerlach (University of Frankfurt / Main), were awarded the "German Research Award for Primary Health Care - Dr Lothar Beyer Award".
In Germany, around 4 million people aged between 18 and 65 suffer from depression and for most of them one of the 50,000 primary care practices is their first and principal port of call.
626 patients with depression from 74 general practices in Germany participated in the trial. In 2008, the research team, that includes Prof. Dr. Jochen Gensichen (University Hospital Jena) and Prof. Dr. Ferdinand Gerlach (University of Frankfurt / Main), were awarded the "German Research Award for Primary Health Care - Dr Lothar Beyer Award".
In Germany, around 4 million people aged between 18 and 65 suffer from depression and for most of them one of the 50,000 primary care practices is their first and principal port of call.
среда, 1 июня 2011 г.
Depression More Likely In Older Women Than In Older Men
According
to a recent report in the Archives of General Psychiatry,
older women
are more likely to become depressed and to remain depressed than older
men, but less likely to die while depressed.
Lisa C. Barry of the Yale University School of Medicine and colleagues
performed the study in light of the fact that the prevalence of
depression is disproportionately higher in older women than men, and
the reason is unknown. They note that one to two percent of older
adults living in the community experience major depression and as many
as two out of every ten experience symptoms of depression. It is
uncertain as to why older women are more likely than older men to
experience these symptoms.
The researchers used a sample of about 750 individuals age 70 and older
(averaging 78.4 years) in 1998. Participants provided demographic
information, took cognitive tests, and reported any medical conditions
at the beginning of the study and every 18 months over a period of 72
months. There was a preliminary screening for symptoms of depression
during the previous week such as lack of appetite, feeling sad, or
problems related to sleep.
The analysis revealed that after controlling for demographic traits,
"women had a higher likelihood of transitioning from non-depressed to
depressed and a lower likelihood of transitioning from depressed to
non-depressed or death." About 35.7% of the participants were depressed
at some point, and 17.8% remained depressed during two consecutive
follow-up periods, 11.2% during three consecutive follow-up periods,
6.3% during four, and 4.5% during all five follow-up
evaluations. The researchers found that more women than men were
depressed at each 18-month evaluation, and women were more likely than
men to experience depression at later follow-ups.
The authors maintain that their findings provide strong evidence that
depression is more persistent in older women than older men due to the
observed consistency over the four time intervals. However, women are
more likely to receive medications or other treatment for depression,
and so the results are somewhat surprising. Barry and colleagues state
that future research should focus on whether or not women are less
likely to respond to conventional treatment or they receive different
treatment than men for late-life depression. They conclude by noting
that "nearly 40 percent of the depressed participants in this study
were depressed during at least two consecutive time points,
highlighting the need to initiate and potentially maintain
antidepressant treatment after resolution of the initial depressive
episode."
Higher Burden of Depression Among Older Women: The Effect of
Onset, Persistence, and Mortality Over Time
Lisa C. Barry, Heather G. Allore, Zhenchao Guo, Martha L. Bruce, Thomas
M. Gill
Archives of General Psychiatry, Volume 65, No. 2,
pp172-178, February 2008
Click
Here to See Abstract Online
Written by: Peter M Crosta
to a recent report in the Archives of General Psychiatry,
older women
are more likely to become depressed and to remain depressed than older
men, but less likely to die while depressed.
Lisa C. Barry of the Yale University School of Medicine and colleagues
performed the study in light of the fact that the prevalence of
depression is disproportionately higher in older women than men, and
the reason is unknown. They note that one to two percent of older
adults living in the community experience major depression and as many
as two out of every ten experience symptoms of depression. It is
uncertain as to why older women are more likely than older men to
experience these symptoms.
The researchers used a sample of about 750 individuals age 70 and older
(averaging 78.4 years) in 1998. Participants provided demographic
information, took cognitive tests, and reported any medical conditions
at the beginning of the study and every 18 months over a period of 72
months. There was a preliminary screening for symptoms of depression
during the previous week such as lack of appetite, feeling sad, or
problems related to sleep.
The analysis revealed that after controlling for demographic traits,
"women had a higher likelihood of transitioning from non-depressed to
depressed and a lower likelihood of transitioning from depressed to
non-depressed or death." About 35.7% of the participants were depressed
at some point, and 17.8% remained depressed during two consecutive
follow-up periods, 11.2% during three consecutive follow-up periods,
6.3% during four, and 4.5% during all five follow-up
evaluations. The researchers found that more women than men were
depressed at each 18-month evaluation, and women were more likely than
men to experience depression at later follow-ups.
The authors maintain that their findings provide strong evidence that
depression is more persistent in older women than older men due to the
observed consistency over the four time intervals. However, women are
more likely to receive medications or other treatment for depression,
and so the results are somewhat surprising. Barry and colleagues state
that future research should focus on whether or not women are less
likely to respond to conventional treatment or they receive different
treatment than men for late-life depression. They conclude by noting
that "nearly 40 percent of the depressed participants in this study
were depressed during at least two consecutive time points,
highlighting the need to initiate and potentially maintain
antidepressant treatment after resolution of the initial depressive
episode."
Higher Burden of Depression Among Older Women: The Effect of
Onset, Persistence, and Mortality Over Time
Lisa C. Barry, Heather G. Allore, Zhenchao Guo, Martha L. Bruce, Thomas
M. Gill
Archives of General Psychiatry, Volume 65, No. 2,
pp172-178, February 2008
Click
Here to See Abstract Online
Written by: Peter M Crosta
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