Too much light at night can lead to symptoms of depression, according to a new study in mice.
Researchers found that mice housed in a lighted room 24 hours a day exhibited more depressive symptoms than did similar mice that had a normal light-dark cycle.
However, mice that lived in constant light, but could escape into a dark, opaque tube when they wanted showed less evidence of depressive symptoms than did mice that had 24-hour light, but only a clear tube in their housing.
"The ability to escape light seemed to quell the depressive effects," said Laura Fonken, lead author of the study and a graduate student in psychology at Ohio State University.
"But constant light with no chance of escape increased depressive symptoms."
The results suggest that more attention needs to be focused on how artificial lighting affects emotional health in humans, according to study co-author Randy Nelson, a professor of neuroscience and psychology at Ohio State.
"The increasing rate of depressive disorders in humans corresponds with the increasing use of light at night in modern society," he said.
"Many people are now exposed to unnatural light cycles, and that may have real consequences for our health."
The researchers presented the work Oct. 21 in Chicago at the annual meeting of the Society for Neuroscience. The study will also appear in the December 28, 2009 issue of the journal Behavioural Brain Research.
The study involved 24 male laboratory mice. Half were housed in light for 16 hours a day and darkness for 8 hours, while the other half had 24 hours of light. Half of each group had opaque tubes in their units that let them escape the light when they chose. The other half had similar tubes that were clear and let the light in.
After three weeks, the mice began a series of tests that are used to measure depression and anxiety in animals. Several of these tests are the same ones used by pharmaceutical companies to test anti-depressive and anti-anxiety drugs in animals before they are used in humans.
One depression test, for example, measured how much sugar water the mice drank. Mice generally like the drink, but those with depressive-like symptoms will not drink as much, presumably because they don't get as much pleasure from activities they usually enjoy.
In all the tests, mice housed in constant light with no chance to escape showed more depressive-like symptoms than those mice with normal light-dark cycles.
In some tests, mice that had tubes where they could escape the constant light showed no more depressive-like symptoms than did mice housed in normal light-dark cycles.
Unexpectedly, the results showed that, compared to the other mice, those that were housed in constant light actually showed lower levels of anxiety and lower levels of corticosterone, a stress hormone linked to symptoms of anxiety.
That was unexpected because anxiety and symptoms of depression often go together in humans. However, there are several possible reasons why the link wasn't found in this study.
For one, the mice were first tested for corticosterone after two weeks in constant light.
"That means they had been exposed to a possibly stressful environment for two weeks, and they may have simply adapted to the conditions and had a lowered stress response by that time," Nelson said.
Also, corticosterone concentrations generally vary as a result of the light-dark cycle, he said, and the mice no longer had those cues while living in constant light.
Moreover, these mice are nocturnal and they were being tested when they normally would have been asleep, a time when corticosterone levels are generally at their lowest.
The researchers are now testing animals that are diurnal - awake during the daylight - to see if the results are different.
Overall, the results provide additional evidence that the use of artificial light at night may have harmful effects on health.
"This is important for people who work night shifts, and for children and others who watch TV late into the night, disrupting their usual light-dark cycle," Fonken said.
There are many other practical implications. Nelson noted that most intensive care units are brightly lit all night long, which may add to the problems of their patients.
Other co-authors on the study were Joanna Workman and James Walton, graduate students at Ohio State; Jessica Ross, an undergraduate at Ohio State; M. Sima Finy, a former undergraduate at Ohio State and currently a graduate student at the University of Illinois; and Zachary Weil of Rockefeller University in New York City.
The research was supported by grants from the National Science Foundation.
суббота, 14 мая 2011 г.
Depression May Trigger Diabetes In Older Adults
Chronic depression or depression that worsens over time may cause diabetes in older adults, according to new Northwestern University research.
This is the first national study to suggest that depression alone -- and not lifestyle factors like being overweight - can trigger Type 2 diabetes in adults 65 and older, a population with a high prevalence of diabetes and depression. The report will be published April 23 in Archives of Internal Medicine.
The study examined 4,681 men and women 65 and older from Forsyth County, N.C.; Sacramento County, Calif.; Washington County, Md.; and Pittsburgh, Pa., annually for 10 years.
"This means doctors need to take depressive symptoms in older adults very seriously because of the effect it has on the likelihood of developing diabetes," said Mercedes Carnethon, lead author of the study and assistant professor of preventive medicine at Northwestern's Feinberg School of Medicine.
An estimated 2 million older adults suffer from clinical depression, the second highest incidence of any age group. People 65 and older also have the highest prevalence of Type 2 diabetes.
"Diabetes is a scourge," said Carnethon. "It causes heart disease, blindness, kidney disease, leg amputations and lowered cognitive function because it essentially degrades the small and large blood vessels."
The study differed from prior research in several ways. It is the first to examine the connection between increasing symptoms of depression over time and the incidence of diabetes.
Previous studies linking diabetes to depression have been based on a one-time measure of depressive symptoms. A single measure could be based on an episode or event that has caused a person to feel blue for a limited amount of time.
Carnethon's study measured depressive symptoms at a single point in time as well as depressive symptoms over time. This approach paints a more accurate depiction of depressive symptoms. By measuring depressive symptoms before diabetes developed, she and colleagues were better able to investigate the causal effect between mood and diabetes.
The Northwestern study also factored out other known lifestyle causes of diabetes such as being overweight or getting little physical exercise.
"We know that overweight and obesity are the primary risk factors for diabetes and most people with Type 2 diabetes are overweight or obese," Carnethon said. "But even after we adjusted for [statistically accounted for] body mass index (measure of height versus weight), we still saw a residual association between depression and diabetes."
In addition, the study considered a key biological factor - a high level of inflammation common in depressed people -- that might have explained the link between depression and diabetes. Inflammation is estimated by the levels of an inflammatory protein in the blood called C-reactive protein. But even after accounting for levels of the protein, depressive symptoms were still associated with the development of diabetes.
Carnethon theorizes that the culprit responsible for diabetes in persons who are depressed is a high level of a stress hormone, cortisol. High levels of cortisol may decrease insulin sensitivity and increase fat deposits around the waist (a risk factor for diabetes). While her study was limited to older adults, she believes high cortisol levels in depressed younger adults may also put them at risk for diabetes.
Insulin enables glucose (sugar) to enter the body's cells to be used as fuel. When people are under acute stress or are depressed, the cells in the pancreas are suppressed and secrete less insulin to enable the body to sweep glucose out of the bloodstream. Compounding the problem, high cortisol levels decrease the muscles' sensitivity to insulin, which also could result in elevated glucose levels, Carnethon said.
"When you're depressed or under stress your body is trying to keep glucose in the bloodstream because it needs it for immediate energy," Carnethon noted. "So, it's blocking insulin action. And you may even be producing more glucose because your body thinks it needs the sugar."
Carnethon said the study shows the importance of screening older adults for depressive symptoms. "It's not a normal condition for older adults to be depressed," she said. "I think a lot of people say, 'Oh, they're old, they should be depressed. What does it matter if they're a little bit down?' Well, it does matter and you should treat it aggressively because it has effects on health beyond that of mood."
Collaborators on the report are from the University of Washington, Emory University and Wake Forest University.
Contact: Marla Paul
Northwestern University
This is the first national study to suggest that depression alone -- and not lifestyle factors like being overweight - can trigger Type 2 diabetes in adults 65 and older, a population with a high prevalence of diabetes and depression. The report will be published April 23 in Archives of Internal Medicine.
The study examined 4,681 men and women 65 and older from Forsyth County, N.C.; Sacramento County, Calif.; Washington County, Md.; and Pittsburgh, Pa., annually for 10 years.
"This means doctors need to take depressive symptoms in older adults very seriously because of the effect it has on the likelihood of developing diabetes," said Mercedes Carnethon, lead author of the study and assistant professor of preventive medicine at Northwestern's Feinberg School of Medicine.
An estimated 2 million older adults suffer from clinical depression, the second highest incidence of any age group. People 65 and older also have the highest prevalence of Type 2 diabetes.
"Diabetes is a scourge," said Carnethon. "It causes heart disease, blindness, kidney disease, leg amputations and lowered cognitive function because it essentially degrades the small and large blood vessels."
The study differed from prior research in several ways. It is the first to examine the connection between increasing symptoms of depression over time and the incidence of diabetes.
Previous studies linking diabetes to depression have been based on a one-time measure of depressive symptoms. A single measure could be based on an episode or event that has caused a person to feel blue for a limited amount of time.
Carnethon's study measured depressive symptoms at a single point in time as well as depressive symptoms over time. This approach paints a more accurate depiction of depressive symptoms. By measuring depressive symptoms before diabetes developed, she and colleagues were better able to investigate the causal effect between mood and diabetes.
The Northwestern study also factored out other known lifestyle causes of diabetes such as being overweight or getting little physical exercise.
"We know that overweight and obesity are the primary risk factors for diabetes and most people with Type 2 diabetes are overweight or obese," Carnethon said. "But even after we adjusted for [statistically accounted for] body mass index (measure of height versus weight), we still saw a residual association between depression and diabetes."
In addition, the study considered a key biological factor - a high level of inflammation common in depressed people -- that might have explained the link between depression and diabetes. Inflammation is estimated by the levels of an inflammatory protein in the blood called C-reactive protein. But even after accounting for levels of the protein, depressive symptoms were still associated with the development of diabetes.
Carnethon theorizes that the culprit responsible for diabetes in persons who are depressed is a high level of a stress hormone, cortisol. High levels of cortisol may decrease insulin sensitivity and increase fat deposits around the waist (a risk factor for diabetes). While her study was limited to older adults, she believes high cortisol levels in depressed younger adults may also put them at risk for diabetes.
Insulin enables glucose (sugar) to enter the body's cells to be used as fuel. When people are under acute stress or are depressed, the cells in the pancreas are suppressed and secrete less insulin to enable the body to sweep glucose out of the bloodstream. Compounding the problem, high cortisol levels decrease the muscles' sensitivity to insulin, which also could result in elevated glucose levels, Carnethon said.
"When you're depressed or under stress your body is trying to keep glucose in the bloodstream because it needs it for immediate energy," Carnethon noted. "So, it's blocking insulin action. And you may even be producing more glucose because your body thinks it needs the sugar."
Carnethon said the study shows the importance of screening older adults for depressive symptoms. "It's not a normal condition for older adults to be depressed," she said. "I think a lot of people say, 'Oh, they're old, they should be depressed. What does it matter if they're a little bit down?' Well, it does matter and you should treat it aggressively because it has effects on health beyond that of mood."
Collaborators on the report are from the University of Washington, Emory University and Wake Forest University.
Contact: Marla Paul
Northwestern University
Study Finds That Smoking Is Linked With Risk Of Suicide
After an in-depth study among young people in Bavaria, German researchers found a clear and alarming link between smoking and the desire to kill oneself.
The investigation, published in the Journal of Affective Disorders, is based on data from a detailed psychology study launched in 1995 among 3,021 people aged 14-24 who lived in Munich.
They were interviewed again four years later, when 2,548 of the volunteers responded.
A quarter of these individuals never smoked, 40 per cent were defined as occasional smokers, 17 per cent as "non-dependent" regular smokers and 19 per cent as addicted smokers.
Among non smokers, nearly 15 per cent reported having had suicidal thoughts, defined as making plans to kill himself or herself or spending two weeks or longer with the wish to die.
The rate was around 20 per cent among occasional and non-dependent smokers, but among dependent smokers, suicidal ideation was 30 per cent.
An even more pronounced pattern was found among the 69 individuals who had actually tried to commit suicide.
Only 0.6 percent of the non-smokers said they had sought to end their life; among non-dependent smokers, the rate was 1.6 percent; but among addicted smokers, it was 6.4 per cent.
To ensure that the results were not being skewed by other factors, the researchers stripped out alcohol use, illicit drug use and a history of depression among the volunteers.
They found the result was the same: the more a person smoked, the likelier he or she would have suicidal ideation.
The authors, led by Thomas Bronisch of the Max Planck Institute of Psychiatry in Munich said, "Campaigns for reducing smoking should also point to the elevated risk of suicidality for occasional and regular smokers."
They acknowledge that there were limitations to their study.
One was that in the four-year follow-up, no suicides actually occurred, so that the conclusions of the study are based on suicidal ideas and attempts rather than the completion of the act.
Previous investigations have likewise seen an association between suicide and smoking but also left unsettled the big question as to whether smoking causes the malaise or is just a symptom of it.
Some research suggests that nicotine depletes a vital pleasure giving brain chemical called serotonin, and the risk could be higher among individuals with a genetic susceptibility to this effect.
Meanwhile, other research has suggested that tobacco smoke may contain antidepressant compounds that may encourage depressed individuals to smoke.
ash.uk
The investigation, published in the Journal of Affective Disorders, is based on data from a detailed psychology study launched in 1995 among 3,021 people aged 14-24 who lived in Munich.
They were interviewed again four years later, when 2,548 of the volunteers responded.
A quarter of these individuals never smoked, 40 per cent were defined as occasional smokers, 17 per cent as "non-dependent" regular smokers and 19 per cent as addicted smokers.
Among non smokers, nearly 15 per cent reported having had suicidal thoughts, defined as making plans to kill himself or herself or spending two weeks or longer with the wish to die.
The rate was around 20 per cent among occasional and non-dependent smokers, but among dependent smokers, suicidal ideation was 30 per cent.
An even more pronounced pattern was found among the 69 individuals who had actually tried to commit suicide.
Only 0.6 percent of the non-smokers said they had sought to end their life; among non-dependent smokers, the rate was 1.6 percent; but among addicted smokers, it was 6.4 per cent.
To ensure that the results were not being skewed by other factors, the researchers stripped out alcohol use, illicit drug use and a history of depression among the volunteers.
They found the result was the same: the more a person smoked, the likelier he or she would have suicidal ideation.
The authors, led by Thomas Bronisch of the Max Planck Institute of Psychiatry in Munich said, "Campaigns for reducing smoking should also point to the elevated risk of suicidality for occasional and regular smokers."
They acknowledge that there were limitations to their study.
One was that in the four-year follow-up, no suicides actually occurred, so that the conclusions of the study are based on suicidal ideas and attempts rather than the completion of the act.
Previous investigations have likewise seen an association between suicide and smoking but also left unsettled the big question as to whether smoking causes the malaise or is just a symptom of it.
Some research suggests that nicotine depletes a vital pleasure giving brain chemical called serotonin, and the risk could be higher among individuals with a genetic susceptibility to this effect.
Meanwhile, other research has suggested that tobacco smoke may contain antidepressant compounds that may encourage depressed individuals to smoke.
ash.uk
Why Does Anxiety Target Women More? FSU Researcher Awarded $1.8M Grant To Find Out
Anxiety disorders afflict women twice as often as men, but estrogen might not be the reason. Testosterone, though, could be.
That is one of the preliminary findings in the lab of Florida State University researcher Mohamed Kabbaj, associate professor in the College of Medicine. He recently was awarded a five-year, $1.8 million grant from the National Institute of Mental Health to investigate the sex differences in anxiety. His research team also is working to identify the role of a gene called zif268.
"It's a very important molecule," Kabbaj said. "So far, zif268 plays a major role in learning, memory and drug addiction. I think our work shows for the first time that it's also implicated in anxiety."
Years from now, the result may be drugs that can reduce anxiety more effectively.
In their lab, Kabbaj and his team exposed male and female rats to situations that provoked anxiety. They knew stress would activate the zif268 gene, so they explored the brains of the rats to see how the gene had expressed itself. Kabbaj called it "a fishing expedition."
The results surprised them. Only one part of the brain showed a difference in gene expression between males and females: the medial prefrontal cortex, the part of the brain that allows humans to experience emotions and the meaning of things.
"We were not expecting to see that," Kabbaj said, "so we wanted to follow up with functional studies to see if this difference between males and females has any significance in terms of anxiety and difference in social interaction."
Males have more zif268 in their prefrontal cortex than females do. Males also are less anxious. So the researchers reduced the expression of zif268 in the prefrontal cortex of the males. Result: The males became as anxious as the females.
"One of the questions you have to ask," Kabbaj said, "is why males have more zif than females. We think it's because of testosterone. Testosterone is keeping that level of zif very high.
"Our recent findings show that the hormone estrogen is not implicated in sex differences in anxiety. However, our preliminary data show the male hormone testosterone may be protecting male rats from developing anxiety. The fact that females do not have a lot of testosterone may put them at risk of developing anxiety disorders."
Kabbaj and his team think testosterone activates receptors in the prefrontal cortex, which in turn activate various molecules, and those molecules lead to the increased expression of zif, which then activates a series of other molecules. Their project also involves determining the exact molecular targets of zif268 that are relevant to sex differences in anxiety. They refer to these as the gene's downstream targets.
"If we could demonstrate the role of zif in anxiety, then we could design drugs that affect either its upstream or downstream targets to hopefully reduce anxiety in women," Kabbaj said. "If we increase zif expression in men that have some level of depression or anxiety, maybe we can help them, too."
That is one of the preliminary findings in the lab of Florida State University researcher Mohamed Kabbaj, associate professor in the College of Medicine. He recently was awarded a five-year, $1.8 million grant from the National Institute of Mental Health to investigate the sex differences in anxiety. His research team also is working to identify the role of a gene called zif268.
"It's a very important molecule," Kabbaj said. "So far, zif268 plays a major role in learning, memory and drug addiction. I think our work shows for the first time that it's also implicated in anxiety."
Years from now, the result may be drugs that can reduce anxiety more effectively.
In their lab, Kabbaj and his team exposed male and female rats to situations that provoked anxiety. They knew stress would activate the zif268 gene, so they explored the brains of the rats to see how the gene had expressed itself. Kabbaj called it "a fishing expedition."
The results surprised them. Only one part of the brain showed a difference in gene expression between males and females: the medial prefrontal cortex, the part of the brain that allows humans to experience emotions and the meaning of things.
"We were not expecting to see that," Kabbaj said, "so we wanted to follow up with functional studies to see if this difference between males and females has any significance in terms of anxiety and difference in social interaction."
Males have more zif268 in their prefrontal cortex than females do. Males also are less anxious. So the researchers reduced the expression of zif268 in the prefrontal cortex of the males. Result: The males became as anxious as the females.
"One of the questions you have to ask," Kabbaj said, "is why males have more zif than females. We think it's because of testosterone. Testosterone is keeping that level of zif very high.
"Our recent findings show that the hormone estrogen is not implicated in sex differences in anxiety. However, our preliminary data show the male hormone testosterone may be protecting male rats from developing anxiety. The fact that females do not have a lot of testosterone may put them at risk of developing anxiety disorders."
Kabbaj and his team think testosterone activates receptors in the prefrontal cortex, which in turn activate various molecules, and those molecules lead to the increased expression of zif, which then activates a series of other molecules. Their project also involves determining the exact molecular targets of zif268 that are relevant to sex differences in anxiety. They refer to these as the gene's downstream targets.
"If we could demonstrate the role of zif in anxiety, then we could design drugs that affect either its upstream or downstream targets to hopefully reduce anxiety in women," Kabbaj said. "If we increase zif expression in men that have some level of depression or anxiety, maybe we can help them, too."
2007 Bipolar Disorder Awareness Campaign Emphasizes Importance Of Accurate Diagnosis, Treatment And Recovery
The National Alliance on Mental Illness (NAMI) today launched its fifth annual Bipolar Disorder Awareness Day, emphasizing the need for accurate diagnosis and treatment. People diagnosed with bipolar disorder, which affects an estimated 10 million Americans, experience alternating episodes of mania (severe highs), depression (severe lows) and mixed states which contain elements of both. Unfortunately, seven out of ten people with bipolar disorder receive at least one misdiagnosis, and many wait years for accurate diagnosis.
Young adults may be particularly at risk for misdiagnosis. Due in part to the early age of onset, the extreme mood shifts that are symptomatic of bipolar disorder may be thought of as "teenage irritability," whereas manic stages may simply be thought of as elevated levels of excitement. In fact, 90 percent of people with bipolar disorder have been reported to experience onset before the age of 20.
"Oftentimes the early signs of bipolar disorder are mistaken for careless behavior or depression, which unfortunately means that many people living with this illness go undiagnosed for up to ten years," said Kenneth Duckworth, M.D., NAMI medical director and assistant professor of psychiatry at Harvard Medical School. "With accurate diagnosis, people with bipolar disorder can and do reclaim their lives. It is important for people with mental illness, as well as those who care for them, to remember that they can lead full and productive lives with the right treatment program."
Part of Mental Illness Awareness Week, Bipolar Disorder Awareness Day was created to educate Americans about bipolar disorder in an effort to raise awareness, promote early detection and accurate diagnosis, and reduce the stigma associated with mental illness.
Accurate Diagnosis & Treatment Are Key
If mania and depression are left untreated, people with bipolar disorder are at great risk for suicide, substance abuse, incarceration, and other harmful consequences. In fact, the mortality rate for people with untreated bipolar disorder is higher than it is for most types of heart disease and many types of cancer.
But with accurate diagnosis and treatment, people with bipolar disorder have better treatment success rates (80 percent) than people with heart disease (45 percent). Essential components of the treatment process for people living with bipolar disorder include medication, psychotherapy, support groups, and education about the illness. It is estimated that 80 percent to 90 percent of people with bipolar disorder can be treated effectively with medication and psychotherapy.
Mania & Depression Equally Destructive
Though often overlooked or misunderstood, mania can be just as destructive as depression. While someone experiencing an episode of mania may feel productive and self-confident, mania can also cause reckless decision-making that can have long-term consequences (financial, relationships, etc). Conversely, when depressed, people with bipolar disorder may experience a profoundly sad, irritable or 'flat' mood, losing interest in usual activities. Depression can also be physically debilitating, preventing a person with bipolar disorder from even getting out of bed.
When untreated, people with bipolar disorder are at great risk for suicide; approximately 25-50 percent of people with bipolar disorder attempt suicide at least once, one of the highest rates for any psychiatric disorder. Nearly 40 percent of those left untreated abuse alcohol and drugs, making it extremely difficult to hold down a steady job and in some instances, end up incarcerated.
About NAMI
NAMI supports a national grassroots effort to transform America's mental health care system, combat stigma, support research and attain adequate health insurance, housing, rehabilitation, jobs and family support for millions of Americans living with mental illnesses. NAMI's 1,100 affiliates are dedicated to public education, advocacy and support and receive generous donations from tens of thousands of individuals as well as grants from government, foundations and corporations. NAMI's greatest asset, however, is its volunteers - who donate an estimated $135 million worth of their time each year.
Signs of Bipolar Disorder
Characterized by extreme shifts in mood, energy, and functioning, bipolar disorder is a chronic condition and generally requires life-long treatment. Symptoms of mania include: increased physical and mental activity and energy; heightened mood, exaggerated optimism and self-confidence; excessive irritability and aggressive behavior; decreased need for sleep without experiencing fatigue; racing speech and thought, flight of ideas; impulsiveness, impaired judgment, and distractibility; and reckless behavior, such as spending sprees, sexual indiscretions, and/or alcohol abuse.
Depression may be characterized by loss of energy; prolonged sadness or unexplained crying spells; changes in appetite and sleep patterns; increased feelings of worry and anxiety; feelings of guilt or hopelessness; inability to concentrate or make decisions; social withdrawal; thoughts of suicide; and/or use of chemical substances or alcohol.
About Bipolar Disorder Awareness Day
This marks the fifth annual Bipolar Disorder Awareness Day, which was created by NAMI (National Alliance on Mental Illness) and is sponsored by Abbott Laboratories through an unrestricted educational grant. The program aims increase awareness of bipolar disorder, promote early detection and accurate diagnosis, and reduce stigma, with the ultimate goal of increasing public commitment to early intervention and provision of effective treatments.
Bipolar Disorder Awareness Day is part of NAMI's Mental Illness Awareness Week. For additional information on bipolar disorder or Bipolar Disorder Awareness Day, please visit nami/miaw.
Young adults may be particularly at risk for misdiagnosis. Due in part to the early age of onset, the extreme mood shifts that are symptomatic of bipolar disorder may be thought of as "teenage irritability," whereas manic stages may simply be thought of as elevated levels of excitement. In fact, 90 percent of people with bipolar disorder have been reported to experience onset before the age of 20.
"Oftentimes the early signs of bipolar disorder are mistaken for careless behavior or depression, which unfortunately means that many people living with this illness go undiagnosed for up to ten years," said Kenneth Duckworth, M.D., NAMI medical director and assistant professor of psychiatry at Harvard Medical School. "With accurate diagnosis, people with bipolar disorder can and do reclaim their lives. It is important for people with mental illness, as well as those who care for them, to remember that they can lead full and productive lives with the right treatment program."
Part of Mental Illness Awareness Week, Bipolar Disorder Awareness Day was created to educate Americans about bipolar disorder in an effort to raise awareness, promote early detection and accurate diagnosis, and reduce the stigma associated with mental illness.
Accurate Diagnosis & Treatment Are Key
If mania and depression are left untreated, people with bipolar disorder are at great risk for suicide, substance abuse, incarceration, and other harmful consequences. In fact, the mortality rate for people with untreated bipolar disorder is higher than it is for most types of heart disease and many types of cancer.
But with accurate diagnosis and treatment, people with bipolar disorder have better treatment success rates (80 percent) than people with heart disease (45 percent). Essential components of the treatment process for people living with bipolar disorder include medication, psychotherapy, support groups, and education about the illness. It is estimated that 80 percent to 90 percent of people with bipolar disorder can be treated effectively with medication and psychotherapy.
Mania & Depression Equally Destructive
Though often overlooked or misunderstood, mania can be just as destructive as depression. While someone experiencing an episode of mania may feel productive and self-confident, mania can also cause reckless decision-making that can have long-term consequences (financial, relationships, etc). Conversely, when depressed, people with bipolar disorder may experience a profoundly sad, irritable or 'flat' mood, losing interest in usual activities. Depression can also be physically debilitating, preventing a person with bipolar disorder from even getting out of bed.
When untreated, people with bipolar disorder are at great risk for suicide; approximately 25-50 percent of people with bipolar disorder attempt suicide at least once, one of the highest rates for any psychiatric disorder. Nearly 40 percent of those left untreated abuse alcohol and drugs, making it extremely difficult to hold down a steady job and in some instances, end up incarcerated.
About NAMI
NAMI supports a national grassroots effort to transform America's mental health care system, combat stigma, support research and attain adequate health insurance, housing, rehabilitation, jobs and family support for millions of Americans living with mental illnesses. NAMI's 1,100 affiliates are dedicated to public education, advocacy and support and receive generous donations from tens of thousands of individuals as well as grants from government, foundations and corporations. NAMI's greatest asset, however, is its volunteers - who donate an estimated $135 million worth of their time each year.
Signs of Bipolar Disorder
Characterized by extreme shifts in mood, energy, and functioning, bipolar disorder is a chronic condition and generally requires life-long treatment. Symptoms of mania include: increased physical and mental activity and energy; heightened mood, exaggerated optimism and self-confidence; excessive irritability and aggressive behavior; decreased need for sleep without experiencing fatigue; racing speech and thought, flight of ideas; impulsiveness, impaired judgment, and distractibility; and reckless behavior, such as spending sprees, sexual indiscretions, and/or alcohol abuse.
Depression may be characterized by loss of energy; prolonged sadness or unexplained crying spells; changes in appetite and sleep patterns; increased feelings of worry and anxiety; feelings of guilt or hopelessness; inability to concentrate or make decisions; social withdrawal; thoughts of suicide; and/or use of chemical substances or alcohol.
About Bipolar Disorder Awareness Day
This marks the fifth annual Bipolar Disorder Awareness Day, which was created by NAMI (National Alliance on Mental Illness) and is sponsored by Abbott Laboratories through an unrestricted educational grant. The program aims increase awareness of bipolar disorder, promote early detection and accurate diagnosis, and reduce stigma, with the ultimate goal of increasing public commitment to early intervention and provision of effective treatments.
Bipolar Disorder Awareness Day is part of NAMI's Mental Illness Awareness Week. For additional information on bipolar disorder or Bipolar Disorder Awareness Day, please visit nami/miaw.
Blood Test Predicts Cardiac Events And Death In Heart Patients
A simple blood test for the protein NT-proBNP accurately predicts the risk of heart attack, heart failure, stroke, and death in patients with known cardiovascular disease, according to a study led by a researcher at the San Francisco VA Medical Center.
The study of 987 men and women with stable coronary heart disease revealed that the higher a patient's level of NT-proBNP, the greater the chance the patient would die or have a cardiovascular event - heart attack, heart failure, or stroke.
"After adjusting for all other risk factors, it's clear that this marker is picking up something that we are otherwise unable to detect with standard tests such as echocardiography," says principal investigator Mary Whooley, MD, a staff physician at SFVAMC and an associate professor of medicine at the University of California, San Francisco.
The study appears in the January 10, 2007 issue of Journal of the American Medical Association.
NT-proBNP is a marker in the blood for BNP, a hormone that "goes up during times of cardiac stretch or stress," explains Whooley. "When the heart wall is over-expanded by too much blood volume, or damaged by lack of blood flow to the heart itself, BNP goes up, and NT-proBNP along with it."
Patients in the study were divided into four quartiles depending on their NT-proBNP blood levels, and followed for an average of 3.7 years each. Twenty-six percent died or had a cardiovascular event during the course of the study. The study reports that "each increasing quartile was associated with a greater risk of cardiovascular events or death." Patients in the quartile with the highest levels of the biomarker were 3.4 times more likely to die or have a cardiovascular event than patients in the group with the lowest levels.
Whooley cautions that the NT-proBNP test is "not something that we should order on every patient who comes in for a routine checkup," but would be most useful for patients with known coronary heart disease. "In the general population, the incidence of heart disease is so low relative to the incidence in heart disease patients that you get many more false positive results than true positives, which really lowers the value of the test," she says. "It's much better at predicting risk in a population with a high incidence of heart disease."
Whooley also notes that, even among heart patients, the value of the test is limited "because all of the therapies available to prevent cardiovascular events should already be used among these patients. The best it can do is help identify candidates for more aggressive therapy."
She says that one additional step for researchers is to see "whether there are therapeutic interventions that still remain to be developed that might prevent heart patients with elevated BNP from doing worse."
Patients in the current study were all enrolled in the Heart and Soul Study, a multi-year prospective study of one thousand heart patients directed by Whooley that is designed to investigate whether depression predicts heart disease. "Because the Heart and Soul Study measures heart disease so carefully, our data set has become extremely valuable for a wide range of cardiovascular studies, many of which have nothing to do with our original hypothesis," Whooley says. "This study is just one example."
Co-authors of the current study were Kirsten Bibbins-Domingo, MD, PhD, and Reena Gupta, MD, of UCSF and San Francisco General Hospital; Beeya Na, of SFVAMC; Alan H.B. Wu, PhD, of UCSF and SFGH; and Nelson B. Schiller, MD, of UCSF and SFVAMC.
The study was supported by grants from the Robert Wood Johnson Foundation, the National Heart, Lung, and Blood Institute, and the UCSF Research Evaluation and Allocation Committee; NT-proBNP assays were funded by Roche Diagnostics Corporation.
The Heart and Soul study is funded by the Department of Veterans Affairs and by grants from the National Heart, Lung, and Blood Institute, the American Federation for Aging Research, the Robert Wood Johnson Foundation, and the Nancy Kirwan Heart Research Fund that were administered by the Northern California Institute for Research and Education.
NCIRE is the largest research institute associated with a VA medical center. Its mission is to improve the health and well-being of veterans and the general public by supporting a world-class biomedical research program conducted by the UCSF faculty at SFVAMC.
SFVAMC has the largest medical research program in the national VA system, with more than 200 research scientists, all of whom are faculty members at UCSF.
UCSF is a leading university that advances health worldwide by conducting advanced biomedical research, educating graduate students in the life sciences and health professions, and providing complex patient care.
Contact: Steve Tokar
University of California - San Francisco
The study of 987 men and women with stable coronary heart disease revealed that the higher a patient's level of NT-proBNP, the greater the chance the patient would die or have a cardiovascular event - heart attack, heart failure, or stroke.
"After adjusting for all other risk factors, it's clear that this marker is picking up something that we are otherwise unable to detect with standard tests such as echocardiography," says principal investigator Mary Whooley, MD, a staff physician at SFVAMC and an associate professor of medicine at the University of California, San Francisco.
The study appears in the January 10, 2007 issue of Journal of the American Medical Association.
NT-proBNP is a marker in the blood for BNP, a hormone that "goes up during times of cardiac stretch or stress," explains Whooley. "When the heart wall is over-expanded by too much blood volume, or damaged by lack of blood flow to the heart itself, BNP goes up, and NT-proBNP along with it."
Patients in the study were divided into four quartiles depending on their NT-proBNP blood levels, and followed for an average of 3.7 years each. Twenty-six percent died or had a cardiovascular event during the course of the study. The study reports that "each increasing quartile was associated with a greater risk of cardiovascular events or death." Patients in the quartile with the highest levels of the biomarker were 3.4 times more likely to die or have a cardiovascular event than patients in the group with the lowest levels.
Whooley cautions that the NT-proBNP test is "not something that we should order on every patient who comes in for a routine checkup," but would be most useful for patients with known coronary heart disease. "In the general population, the incidence of heart disease is so low relative to the incidence in heart disease patients that you get many more false positive results than true positives, which really lowers the value of the test," she says. "It's much better at predicting risk in a population with a high incidence of heart disease."
Whooley also notes that, even among heart patients, the value of the test is limited "because all of the therapies available to prevent cardiovascular events should already be used among these patients. The best it can do is help identify candidates for more aggressive therapy."
She says that one additional step for researchers is to see "whether there are therapeutic interventions that still remain to be developed that might prevent heart patients with elevated BNP from doing worse."
Patients in the current study were all enrolled in the Heart and Soul Study, a multi-year prospective study of one thousand heart patients directed by Whooley that is designed to investigate whether depression predicts heart disease. "Because the Heart and Soul Study measures heart disease so carefully, our data set has become extremely valuable for a wide range of cardiovascular studies, many of which have nothing to do with our original hypothesis," Whooley says. "This study is just one example."
Co-authors of the current study were Kirsten Bibbins-Domingo, MD, PhD, and Reena Gupta, MD, of UCSF and San Francisco General Hospital; Beeya Na, of SFVAMC; Alan H.B. Wu, PhD, of UCSF and SFGH; and Nelson B. Schiller, MD, of UCSF and SFVAMC.
The study was supported by grants from the Robert Wood Johnson Foundation, the National Heart, Lung, and Blood Institute, and the UCSF Research Evaluation and Allocation Committee; NT-proBNP assays were funded by Roche Diagnostics Corporation.
The Heart and Soul study is funded by the Department of Veterans Affairs and by grants from the National Heart, Lung, and Blood Institute, the American Federation for Aging Research, the Robert Wood Johnson Foundation, and the Nancy Kirwan Heart Research Fund that were administered by the Northern California Institute for Research and Education.
NCIRE is the largest research institute associated with a VA medical center. Its mission is to improve the health and well-being of veterans and the general public by supporting a world-class biomedical research program conducted by the UCSF faculty at SFVAMC.
SFVAMC has the largest medical research program in the national VA system, with more than 200 research scientists, all of whom are faculty members at UCSF.
UCSF is a leading university that advances health worldwide by conducting advanced biomedical research, educating graduate students in the life sciences and health professions, and providing complex patient care.
Contact: Steve Tokar
University of California - San Francisco
Brief Psychological Therapy Is Effective In Primary Care
Brief therapy at the GP's surgery can effectively treat anxiety and depression. Researchers writing in the open access journal BMC Medicine found that cognitive behaviour therapy (CBT) was effective for treating anxiety disorders, while CBT, problem solving therapy (PST) and counseling were all equally effective in treating depression and mixed anxiety and depression.
John Cape worked with a team of researchers from University College London to pool the results of 34 studies involving 3962 patients. He said, " Our meta-analysis suggests that brief CBT, counseling and PST were all effective in treating depression and mixed anxiety and depression. No significant difference was found between CBT, counseling and PST on metaregression, when controlling for diagnosis. But so far only brief CBT has been studied for treatment of anxiety disorders".
Psychological therapy provided within primary care settings for depression and anxiety is usually brief. In the UK, for example, six sessions is a common treatment length. The researchers found that such brief therapies are effective for routine delivery in primary care, but they caution that effect sizes are low when compared to patients receiving these treatments over a longer duration in secondary care. Speaking about these results, Cape said, "While our study indicates that brief CBT appears to be particularly effective for anxiety disorders, there appears little to choose between brief CBT, counseling and PST for treatment of depression and mixed anxiety and depression"
Notes:
Brief psychological therapies for anxiety and depression in primary care: meta-analysis and meta-regression
John Cape, Craig Whittington, Marta Buszewicz, Paul Wallace and Lisa Underwood
BMC Medicine (in press)
John Cape worked with a team of researchers from University College London to pool the results of 34 studies involving 3962 patients. He said, " Our meta-analysis suggests that brief CBT, counseling and PST were all effective in treating depression and mixed anxiety and depression. No significant difference was found between CBT, counseling and PST on metaregression, when controlling for diagnosis. But so far only brief CBT has been studied for treatment of anxiety disorders".
Psychological therapy provided within primary care settings for depression and anxiety is usually brief. In the UK, for example, six sessions is a common treatment length. The researchers found that such brief therapies are effective for routine delivery in primary care, but they caution that effect sizes are low when compared to patients receiving these treatments over a longer duration in secondary care. Speaking about these results, Cape said, "While our study indicates that brief CBT appears to be particularly effective for anxiety disorders, there appears little to choose between brief CBT, counseling and PST for treatment of depression and mixed anxiety and depression"
Notes:
Brief psychological therapies for anxiety and depression in primary care: meta-analysis and meta-regression
John Cape, Craig Whittington, Marta Buszewicz, Paul Wallace and Lisa Underwood
BMC Medicine (in press)
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