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)
Chocolate Consumption Linked To Depression, Study
Women and men eat more chocolate as depressive symptoms increase, suggesting an association between mood and chocolate, say researchers at the University of California School of Medicine in San Diego.
Results of this paper, co-authored by Beatrice Golomb, MD, PhD, associate professor of medicine at UCSD School of Medicine, will appear in the April 26 issue of Archives of Internal Medicine.
"Our study confirms long-held suspicions that eating chocolate is something that people do when they are feeling down," said Dr. Golomb. "Because it was a cross sectional study, meaning a slice in time, it did not tell us whether the chocolate decreased or intensified the depression."
Golomb and her colleagues examined the relationship of chocolate consumption to mood in an adult study sample of about 1,000 subjects who were not on antidepressant medications and did not have any known cardiovascular disease or diabetes. Participants were asked questions regarding how many servings of chocolate they ate in a week, and were screened using the Center for Epidemiologic Studies Depression Scale (CES-D) to measure mood.
The researchers found that both men and women who had higher depression scores consumed almost 12 servings of chocolate per month, those with lesser depression scores ate about eight servings of chocolate per month, and those with no depression had five servings per month. No differentiation was made between dark and milk chocolate; a medium serving of chocolate was one ounce, which is slightly less than an average chocolate candy bar.
"The findings did not appear to be explained by a general increase in caffeine, fat, carbohydrate or energy intake, suggesting that our findings are specific to chocolate," said Golomb. There was also no difference in the consumption of other antioxidant-rich foods, such as fish, coffee, fruits and vegetables between those with depression and those without.
Golomb added that future studies will be required to determine the basis of this association, as well as the role of chocolate in depression, as cause or cure.
Additional contributors are Sabrina Koperski, University of California, San Diego, Department of Medicine, and Natalie Rose, University of California, Davis, Department of Obstetrics and Gynecology.
This study was funded by grants from the National Heart, Lung, and Blood Institute and the UCSD General Clinical Research Center.
Results of this paper, co-authored by Beatrice Golomb, MD, PhD, associate professor of medicine at UCSD School of Medicine, will appear in the April 26 issue of Archives of Internal Medicine.
"Our study confirms long-held suspicions that eating chocolate is something that people do when they are feeling down," said Dr. Golomb. "Because it was a cross sectional study, meaning a slice in time, it did not tell us whether the chocolate decreased or intensified the depression."
Golomb and her colleagues examined the relationship of chocolate consumption to mood in an adult study sample of about 1,000 subjects who were not on antidepressant medications and did not have any known cardiovascular disease or diabetes. Participants were asked questions regarding how many servings of chocolate they ate in a week, and were screened using the Center for Epidemiologic Studies Depression Scale (CES-D) to measure mood.
The researchers found that both men and women who had higher depression scores consumed almost 12 servings of chocolate per month, those with lesser depression scores ate about eight servings of chocolate per month, and those with no depression had five servings per month. No differentiation was made between dark and milk chocolate; a medium serving of chocolate was one ounce, which is slightly less than an average chocolate candy bar.
"The findings did not appear to be explained by a general increase in caffeine, fat, carbohydrate or energy intake, suggesting that our findings are specific to chocolate," said Golomb. There was also no difference in the consumption of other antioxidant-rich foods, such as fish, coffee, fruits and vegetables between those with depression and those without.
Golomb added that future studies will be required to determine the basis of this association, as well as the role of chocolate in depression, as cause or cure.
Additional contributors are Sabrina Koperski, University of California, San Diego, Department of Medicine, and Natalie Rose, University of California, Davis, Department of Obstetrics and Gynecology.
This study was funded by grants from the National Heart, Lung, and Blood Institute and the UCSD General Clinical Research Center.
Grants From Michael J. Fox Foundation Awarded To BIDMC Scientists For Parkinson's Research
Beth Israel Deaconess Medical Center (BIDMC) neurologists Alvaro Pascual-Leone, MD, PhD, and Daniel Tarsy, MD, have been awarded grants totaling more than $1.5 million from the Michael J. Fox Foundation for Parkinson's Research (MJFF) to conduct investigations aimed at improving the quality of life for patients with Parkinson's disease.
A chronic, degenerative disorder of the nervous system that affects one in 100 individuals over age 60, Parkinson's disease results from diminished levels of dopamine, the brain's chemical messenger responsible for transmitting the signals that enable us to coordinate movements. Although Parkinson's disease typically results in tremor, rigidity and other motor symptoms, a number of non-motor symptoms, including depression, cognitive impairment, and sleep problems can also affect patients with Parkinson's disease and, in many cases, can be even more disabling than the motor symptoms.
Pascual-Leone, Director of BIDMC's Berenson-Allen Center for Noninvasive Brain Stimulation, will oversee a three-year $1.498 million grant to investigate the use of repetitive transcranial magnetic stimulation (rTMS) therapy to control symptoms of Parkinson's disease. As part of the study, 160 patients will be enrolled in clinical trials at BIDMC and at three other North American centers including the University of Florida in Gainesville, the University of California in Los Angeles, and the Toronto (Canada) Western Research Institute-University of Toronto.
"Depression is very common among patients with Parkinson's disease and evidence suggests that it is not merely a response to chronic illness or motor impairments but, in fact, results from factors related to the degenerative brain process itself," notes Pascual-Leone, whose pioneering work has demonstrated that TMS therapy - in which a mild electric current is delivered through a magnetic coil placed over a patient's scalp to help adjust brain signals that have gone awry - can successfully treat depression in patients who have not responded to other therapies.
"Often patients with Parkinson's disease have significant motor problems despite treatment with medications," explains Pascual-Leone. "In our study, noninvasive brain stimulation will target one or both of two brain regions involved in motor or mood symptoms. We predict that rTMS will improve motor symptoms, depression, or both, depending on which brain regions are stimulated, and consequently, will become a valuable adjunct to medications."
In the second MJFF-funded project, Daniel Tarsy, MD, Director of BIDMC's Parkinson's Disease Center, will lead a study comparing two types of speech and voice therapy to determine which is more effective in treating the decreased voice volume experienced by many Parkinson's patients.
"Impaired speech can cause patients to suffer distress, social embarrassment and social isolation," explains Tarsy. "Musical therapy is currently being used for rehabilitation from other types of neurological conditions, such as language impairment following stroke. If singing therapy can also improve voice and speech disorders resulting from Parkinson's disease, this would represent an important alternative to existing speech therapy techniques."
A chronic, degenerative disorder of the nervous system that affects one in 100 individuals over age 60, Parkinson's disease results from diminished levels of dopamine, the brain's chemical messenger responsible for transmitting the signals that enable us to coordinate movements. Although Parkinson's disease typically results in tremor, rigidity and other motor symptoms, a number of non-motor symptoms, including depression, cognitive impairment, and sleep problems can also affect patients with Parkinson's disease and, in many cases, can be even more disabling than the motor symptoms.
Pascual-Leone, Director of BIDMC's Berenson-Allen Center for Noninvasive Brain Stimulation, will oversee a three-year $1.498 million grant to investigate the use of repetitive transcranial magnetic stimulation (rTMS) therapy to control symptoms of Parkinson's disease. As part of the study, 160 patients will be enrolled in clinical trials at BIDMC and at three other North American centers including the University of Florida in Gainesville, the University of California in Los Angeles, and the Toronto (Canada) Western Research Institute-University of Toronto.
"Depression is very common among patients with Parkinson's disease and evidence suggests that it is not merely a response to chronic illness or motor impairments but, in fact, results from factors related to the degenerative brain process itself," notes Pascual-Leone, whose pioneering work has demonstrated that TMS therapy - in which a mild electric current is delivered through a magnetic coil placed over a patient's scalp to help adjust brain signals that have gone awry - can successfully treat depression in patients who have not responded to other therapies.
"Often patients with Parkinson's disease have significant motor problems despite treatment with medications," explains Pascual-Leone. "In our study, noninvasive brain stimulation will target one or both of two brain regions involved in motor or mood symptoms. We predict that rTMS will improve motor symptoms, depression, or both, depending on which brain regions are stimulated, and consequently, will become a valuable adjunct to medications."
In the second MJFF-funded project, Daniel Tarsy, MD, Director of BIDMC's Parkinson's Disease Center, will lead a study comparing two types of speech and voice therapy to determine which is more effective in treating the decreased voice volume experienced by many Parkinson's patients.
"Impaired speech can cause patients to suffer distress, social embarrassment and social isolation," explains Tarsy. "Musical therapy is currently being used for rehabilitation from other types of neurological conditions, such as language impairment following stroke. If singing therapy can also improve voice and speech disorders resulting from Parkinson's disease, this would represent an important alternative to existing speech therapy techniques."
Feeling Gray, Not Blue, Using Colors To Describe Emotions
People with anxiety and depression are most likely to use a shade of gray to represent their mental state. Researchers writing in the open access journal BMC Medical Research Methodology describe the development of a color chart, The Manchester Color Wheel, which can be used to study people's preferred pigment in relation to their state of mind.
Peter Whorwell, Professor of Medicine and Gastroenterology at University Hospital South Manchester, worked with a team of researchers from the University of Manchester, UK, to create an instrument that would allow people a choice of colors in response to questions. He said, "Colors are frequently used to describe emotions, such as being 'green with envy' or 'in the blues'. Although there is a large, often anecdotal, literature on color preferences and the relationship of color to mood and emotion, there has been relatively little serious research on the subject".
The researchers created a wheel of colors of various intensities, including shades of gray. They then asked a control group of non-anxious, non-depressed people to describe which color they felt most 'drawn to', which was their favorite and whether any of the colors represented their current mood. When the test was repeated with anxious and depressed people, most chose the same 'drawn to' color as the healthy participants, yellow, and the same favorite color, blue. When asked which color represented their mood, however, most chose gray, unlike the healthy subjects who tended to pick a shade of yellow.
A separate group of healthy volunteers were also asked whether they associated any of the colors with positive or negative moods. According to Whorwell, "When we used these results to separate colours into positive, negative and neutral groups, we found that depressed individuals showed a striking preference for negative colors compared to healthy controls. Anxious individuals gave results intermediate to those observed in depression, with negative colors being chosen more frequently as well as positive colors being chosen less frequently than in the control test".
The Color Wheel provides a unique way of asking patients about their condition that dispenses with the need for language.
Notes:
The Manchester Color Wheel: development of a novel way of identifying color choice and its validation in healthy, anxious and depressed individuals
Helen R Carruthers, Julie Morris, Nicholas Tarrier and Peter J Whorwell
BMC Medical Research Methodology (in press)
Article available at journal website: biomedcentral/bmcmedresmethodol/
Peter Whorwell, Professor of Medicine and Gastroenterology at University Hospital South Manchester, worked with a team of researchers from the University of Manchester, UK, to create an instrument that would allow people a choice of colors in response to questions. He said, "Colors are frequently used to describe emotions, such as being 'green with envy' or 'in the blues'. Although there is a large, often anecdotal, literature on color preferences and the relationship of color to mood and emotion, there has been relatively little serious research on the subject".
The researchers created a wheel of colors of various intensities, including shades of gray. They then asked a control group of non-anxious, non-depressed people to describe which color they felt most 'drawn to', which was their favorite and whether any of the colors represented their current mood. When the test was repeated with anxious and depressed people, most chose the same 'drawn to' color as the healthy participants, yellow, and the same favorite color, blue. When asked which color represented their mood, however, most chose gray, unlike the healthy subjects who tended to pick a shade of yellow.
A separate group of healthy volunteers were also asked whether they associated any of the colors with positive or negative moods. According to Whorwell, "When we used these results to separate colours into positive, negative and neutral groups, we found that depressed individuals showed a striking preference for negative colors compared to healthy controls. Anxious individuals gave results intermediate to those observed in depression, with negative colors being chosen more frequently as well as positive colors being chosen less frequently than in the control test".
The Color Wheel provides a unique way of asking patients about their condition that dispenses with the need for language.
Notes:
The Manchester Color Wheel: development of a novel way of identifying color choice and its validation in healthy, anxious and depressed individuals
Helen R Carruthers, Julie Morris, Nicholas Tarrier and Peter J Whorwell
BMC Medical Research Methodology (in press)
Article available at journal website: biomedcentral/bmcmedresmethodol/
Neurological Basis Of Depression Following Sports Concussion Located By MNI Researchers
Researchers at the Montreal Neurological Institute of McGill University have identified the neurological basis of depression in male athletes with persisting post-concussion symptoms. The study, published in this week's issue of Archives of General Psychiatry, has important clinical implications for the treatment of individuals who have suffered a cerebral concussion.
Depression is one of a number of persisting symptoms experienced by athletes following sports concussion. The prevalence of depression in the general population is around 5%, whilst the prevalence of depression in head trauma patients can reach an astounding 40 %.
"Until now, very little was known about the neurological basis of the depression frequently reported by athletes following concussion,' says Dr. Alain Ptito, neuropsychologist and researcher at the MNI, and lead investigator for the study. Traditional testing methods for concussion yielded normal results with no obvious cognitive or neurological deficits. Persistent complaints have been perceived as subjective and ill-defined without neurological basis. Injury to the brain following concussion takes place at a microscopic level and is therefore difficult to measure in a patient.
Using enhanced brain imaging technology, researchers are now able to gain new insights into the damage caused by concussion. "Using functional MRI (fMRI), a computerized imaging technique that measures blood oxygen levels, we were able to detect areas of the brain with abnormal neural activity," explained Dr. Ptito. Dr. Ptito and colleagues tested fifty-six male athletes, 40 with concussion and 16 healthy controls. Using a depression index, 16 of the concussed subjects had no symptoms of depression, 16 expressed mild depression and 8 had moderate symptoms of depressions. Concussed athletes with depression showed reduced brain activity in regions known to be implicated in depression, specifically, the dorsolateral prefrontal cortex and striatum and attenuated deactivation in medial frontal and temporal regions. We discovered that concussed subjects with depression presented with the same pattern of brain activation as that seen for patients with major depression."
Other studies have shown a link between a history of brain injury and probability of developing major depression later in life. Therefore understanding the pathology of depression in concussed subjects has important implications for early intervention and successful outcomes.
This study was funded by the Canadian Institutes of Health Research (CIHR) and the Fonds de la Recherche en Sant?© du Qu?©bec.
About the MNI
The Montreal Neurological Institute is a McGill University research and teaching institute, dedicated to the study of the nervous system and neurological diseases. Founded in 1934 by the renowned Dr. Wilder Penfield, the MNI is one of the world's largest institutes of its kind. MNI researchers are world leaders in cellular and molecular neuroscience, brain imaging, cognitive neuroscience and the study and treatment of epilepsy, multiple sclerosis and neuromuscular disorders. The MNI, with its clinical partner, the Montreal Neurological Hospital (MNH), part of the McGill University Health Centre, continues to integrate research, patient care and training, and is recognized as one of the premier neuroscience centres in the world. At the MNI, we believe in investing in the faculty, staff and students who conduct outstanding research, provide advanced, compassionate care of patients and who pave the way for the next generation of medical advances. Highly talented, motivated people are the engine that drives research - the key to progress in medical care.
Depression is one of a number of persisting symptoms experienced by athletes following sports concussion. The prevalence of depression in the general population is around 5%, whilst the prevalence of depression in head trauma patients can reach an astounding 40 %.
"Until now, very little was known about the neurological basis of the depression frequently reported by athletes following concussion,' says Dr. Alain Ptito, neuropsychologist and researcher at the MNI, and lead investigator for the study. Traditional testing methods for concussion yielded normal results with no obvious cognitive or neurological deficits. Persistent complaints have been perceived as subjective and ill-defined without neurological basis. Injury to the brain following concussion takes place at a microscopic level and is therefore difficult to measure in a patient.
Using enhanced brain imaging technology, researchers are now able to gain new insights into the damage caused by concussion. "Using functional MRI (fMRI), a computerized imaging technique that measures blood oxygen levels, we were able to detect areas of the brain with abnormal neural activity," explained Dr. Ptito. Dr. Ptito and colleagues tested fifty-six male athletes, 40 with concussion and 16 healthy controls. Using a depression index, 16 of the concussed subjects had no symptoms of depression, 16 expressed mild depression and 8 had moderate symptoms of depressions. Concussed athletes with depression showed reduced brain activity in regions known to be implicated in depression, specifically, the dorsolateral prefrontal cortex and striatum and attenuated deactivation in medial frontal and temporal regions. We discovered that concussed subjects with depression presented with the same pattern of brain activation as that seen for patients with major depression."
Other studies have shown a link between a history of brain injury and probability of developing major depression later in life. Therefore understanding the pathology of depression in concussed subjects has important implications for early intervention and successful outcomes.
This study was funded by the Canadian Institutes of Health Research (CIHR) and the Fonds de la Recherche en Sant?© du Qu?©bec.
About the MNI
The Montreal Neurological Institute is a McGill University research and teaching institute, dedicated to the study of the nervous system and neurological diseases. Founded in 1934 by the renowned Dr. Wilder Penfield, the MNI is one of the world's largest institutes of its kind. MNI researchers are world leaders in cellular and molecular neuroscience, brain imaging, cognitive neuroscience and the study and treatment of epilepsy, multiple sclerosis and neuromuscular disorders. The MNI, with its clinical partner, the Montreal Neurological Hospital (MNH), part of the McGill University Health Centre, continues to integrate research, patient care and training, and is recognized as one of the premier neuroscience centres in the world. At the MNI, we believe in investing in the faculty, staff and students who conduct outstanding research, provide advanced, compassionate care of patients and who pave the way for the next generation of medical advances. Highly talented, motivated people are the engine that drives research - the key to progress in medical care.
New Program Puts The Brakes On Depression Roundabout
A University of Queensland researcher is offering people with depression a new, free program that is confidential and accessible to people across Australia, including those in remote areas.
"The year-long program is for adults who are not depressed at the moment, but who have had repeated bouts of depression," said UQ psychologist Professor David Kavanagh, who is working with researchers from the Universities of Wollongong and Canberra.
"People who volunteer for the program, called 'On Track', receive a series of letters or emails with advice on how to stay well.
"The letters help them stay in control by creating individualised plans.
"They send back information on what they have tried, and how they are feeling.
"We will give them feedback on their progress, and access to a toll-free telephone line for additional assistance. We also keep their doctors informed.
"This program avoids the need for face-to-face appointments that can be expensive and time-consuming - especially if you live outside a city or regional centre," Professor Kavanagh said.
"The program is based on a model that we have shown is successful in helping people take control of alcohol problems," Professor Kavanagh said.
"Volunteers will help us determine how well this program can help people with a history of depression - a serious illness that strikes more than one in six Australians at least once.
"About half of the people who experience depression have a period of recovery over the next year. Unfortunately, many of these people have more episodes.
"The more episodes they have, the more likely it is to return. It is also more likely if they stop taking medication too soon, or they still have some symptoms.
"People with depression are also more likely to smoke, be less active, and have an unhealthy diet. They are more likely to develop serious physical illnesses, and tend to die earlier.
"It doesn't have to be like this. The truth is that people with depression have a great deal to offer, and the start of the year is an ideal time to get off the depression roundabout and get back on track," Professor Kavanagh said.
People who want to take part in the program can call 1300 300 164 at any time and leave a message.
Fiona Kennedy
Research Australia
researchaustralia.au
"The year-long program is for adults who are not depressed at the moment, but who have had repeated bouts of depression," said UQ psychologist Professor David Kavanagh, who is working with researchers from the Universities of Wollongong and Canberra.
"People who volunteer for the program, called 'On Track', receive a series of letters or emails with advice on how to stay well.
"The letters help them stay in control by creating individualised plans.
"They send back information on what they have tried, and how they are feeling.
"We will give them feedback on their progress, and access to a toll-free telephone line for additional assistance. We also keep their doctors informed.
"This program avoids the need for face-to-face appointments that can be expensive and time-consuming - especially if you live outside a city or regional centre," Professor Kavanagh said.
"The program is based on a model that we have shown is successful in helping people take control of alcohol problems," Professor Kavanagh said.
"Volunteers will help us determine how well this program can help people with a history of depression - a serious illness that strikes more than one in six Australians at least once.
"About half of the people who experience depression have a period of recovery over the next year. Unfortunately, many of these people have more episodes.
"The more episodes they have, the more likely it is to return. It is also more likely if they stop taking medication too soon, or they still have some symptoms.
"People with depression are also more likely to smoke, be less active, and have an unhealthy diet. They are more likely to develop serious physical illnesses, and tend to die earlier.
"It doesn't have to be like this. The truth is that people with depression have a great deal to offer, and the start of the year is an ideal time to get off the depression roundabout and get back on track," Professor Kavanagh said.
People who want to take part in the program can call 1300 300 164 at any time and leave a message.
Fiona Kennedy
Research Australia
researchaustralia.au
House Committee Holds Hearing On Suicide Risks Among Veterans
Representatives from the Department of Veterans Affairs and veterans' groups testified on Wednesday at a House Veterans' Affairs Committee hearing examining the issue of suicide, CQ Today reports. The latest statistics gathered by VA do not "demonstrate an increased risk of suicide among (Iraq and Afghanistan) veterans compared to the age and gender-matched American population as a whole," according to Ira Katz, deputy chief for mental health care services at VA. The hearing followed recent media reports indicating that veterans returning from those war zones have nearly double the risk of committing suicide as non-veterans (Yoest, CQ Today, 12/12).
Katz said VA has made improvements in its efforts to reduce the suicide rate of veterans with the implementation of "a major suicide prevention program, the most comprehensive in the nation" (Hefling, AP/Long Island Newsday, 12/13). Katz also stressed the importance of adjusting for factors that could impact suicide data, saying, "Those who come to the VA for care tend to be older, less socio-economically well off, and more likely to have a mental health condition or another chronic illness." He added that it is "by no means surprising that those receiving care from VA have higher suicide rates that those in the general population" (CQ Today, 12/12).
Mike Bowman, a parent of an Illinois National Guard servicemember that committed suicide in 2005 after serving in Iraq, raised concern about the lack of a comprehensive system that keeps track of suicide among military personnel returning from Iraq and Afghanistan. Committee Chair Bob Filner (D-Calif.) questioned why comprehensive tracking was not in place already. According to AP/Newsday, VA tracks suicides among Iraq and Afghanistan veterans who have been discharged, while the Department of Defense tracks the number of suicides that take place in Iraq and Afghanistan (AP/Long Island Newsday, 12/13).
CBS' "Evening News" on Wednesday reported on the suicide hearing. The segment includes comments from Filner and Katz (Keteyian, "Evening News," CBS, 12/12). Video of the segment and expanded CBS News coverage are available online.
Katz said VA has made improvements in its efforts to reduce the suicide rate of veterans with the implementation of "a major suicide prevention program, the most comprehensive in the nation" (Hefling, AP/Long Island Newsday, 12/13). Katz also stressed the importance of adjusting for factors that could impact suicide data, saying, "Those who come to the VA for care tend to be older, less socio-economically well off, and more likely to have a mental health condition or another chronic illness." He added that it is "by no means surprising that those receiving care from VA have higher suicide rates that those in the general population" (CQ Today, 12/12).
Mike Bowman, a parent of an Illinois National Guard servicemember that committed suicide in 2005 after serving in Iraq, raised concern about the lack of a comprehensive system that keeps track of suicide among military personnel returning from Iraq and Afghanistan. Committee Chair Bob Filner (D-Calif.) questioned why comprehensive tracking was not in place already. According to AP/Newsday, VA tracks suicides among Iraq and Afghanistan veterans who have been discharged, while the Department of Defense tracks the number of suicides that take place in Iraq and Afghanistan (AP/Long Island Newsday, 12/13).
CBS' "Evening News" on Wednesday reported on the suicide hearing. The segment includes comments from Filner and Katz (Keteyian, "Evening News," CBS, 12/12). Video of the segment and expanded CBS News coverage are available online.
Peake Promises To Improve Mental Health Services
In related news, James Peake, President Bush's nominee for VA secretary, said he wants to work quickly to improve mental health care services for veterans, AP/Newsday reports. In a 22-page disclosure submitted to the Senate Veterans' Affairs Committee and acquired by the Associated Press, Peake said he wants to increase staff at VA clinics to help fight servicemembers' resistance to seek treatment for depression. Peake also said he wants to implement improved plans for veterans' health care in times of war and other national crises.
In addition, Peake said that he would work to retain top VA officials through measures that do not include performance bonuses awarded without regard to merit, as was the case under former VA Secretary Jim Nicholson, AP/Newsday reports. The Senate committee on Thursday will vote on his nomination (Yen, AP/Long Island Newsday, 12/13).
Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
Childhood Asthma Worsened By Stress And Depression, UB Researchers Show
Young people with asthma have nearly twice the incidence of depression compared to their peers without asthma, and studies have shown that depression is associated with increased asthma symptoms and, in some cases, death.
How stress and depression play upon one another to worsen asthma is a lingering question.
A new study by researchers at the University at Buffalo has shown that depressed children with asthma exhibit a dysregulation of the autonomic nervous system along with increased airway compromise.
It is thought to be the first study to examine pathways linking emotional stress, depressive symptoms, autonomic nervous system dysregulation and airway function in childhood asthma.
The study appears in the July 2009 issue of The Journal of Allergy and Clinical Immunology.
Bruce D. Miller, M.D., and Beatrice L. Wood, Ph.D., professors of psychiatry and pediatrics in the UB School of Medicine and Biomedical Sciences, designed and carried out the study in collaboration with other UB researchers.
"The autonomic nervous system, or ANS, is composed of two opposing divisions -- the sympathetic and parasympathetic nerves, which check one another and thus control critical body functions outside of conscious awareness," explained Miller, chief of the UB Division of Child & Adolescent Psychiatry and senior staff psychiatrist at Women & Children's Hospital of Buffalo, a UB-affiliated teaching hospital. "The ANS is influenced by stress and emotions."
"Children with asthma and high depression symptoms showed a preponderance of parasympathetic over sympathetic nervous system reactivity in the ANS," he continued. "This imbalance within the ANS could explain the increased airway resistance that we found in depressed asthmatic children in our study."
The study involved 90 children with asthma, aged 7-17. Forty-five asthmatic children with symptoms of depression were compared with 45 asthmatic children without symptoms of depression. Both groups viewed scary, sad (death) and happy scenes from the movie E.T.: The Extraterrestrial.
All children wore electrodes to collect data on heart and respiratory function, which showed the level of activation and reactivity of the sympathetic and parasympathetic divisions. The researchers assessed airway function before the movie, after the death scene and after the movie.
"The depressed group consistently showed greater parasympathetic activation along with decreased sympathetic activation in response to the emotional provocations - a pattern that would have a detrimental effect on the airways," said Miller.
"In contrast, the group without symptoms of depression showed consistent activation of the sympathetic pathway, which would support better airway function under stress. To our knowledge, this is the first report in the literature to demonstrate an association linking stress, depression and increased airway resistance in asthmatic children."
Results also showed that bias toward parasympathetic reactivity was most pronounced in the children during scenes portraying family distress or loss, death and dying.
"These findings reinforce previous results from our laboratory that associated relational stress within the family with child depression and increased asthma activity," said Wood.
"Although these findings are promising and support our hypotheses," she continued, "we need further studies to replicate and extend these findings, and to examine whether treatment for depression reduces shift to the parasympathetic and improves lung function in children with asthma."
The authors believe these findings indicate the importance of screening children with asthma for depressive symptoms, of following these children closely and referring them for psychosocial counseling when indicated.
Co-authors on the study were Mark Ballow, M.D., an asthma specialist from the UB Department of Pediatrics; ChiunYu Hsu, a student in the UB Neuroscience Graduate Program, and JungHa Lim, Ph.D, formerly a UB post-doctoral student, and currently on the faculty at Korea University.
The research was supported by grants from the National Institutes of Health.
How stress and depression play upon one another to worsen asthma is a lingering question.
A new study by researchers at the University at Buffalo has shown that depressed children with asthma exhibit a dysregulation of the autonomic nervous system along with increased airway compromise.
It is thought to be the first study to examine pathways linking emotional stress, depressive symptoms, autonomic nervous system dysregulation and airway function in childhood asthma.
The study appears in the July 2009 issue of The Journal of Allergy and Clinical Immunology.
Bruce D. Miller, M.D., and Beatrice L. Wood, Ph.D., professors of psychiatry and pediatrics in the UB School of Medicine and Biomedical Sciences, designed and carried out the study in collaboration with other UB researchers.
"The autonomic nervous system, or ANS, is composed of two opposing divisions -- the sympathetic and parasympathetic nerves, which check one another and thus control critical body functions outside of conscious awareness," explained Miller, chief of the UB Division of Child & Adolescent Psychiatry and senior staff psychiatrist at Women & Children's Hospital of Buffalo, a UB-affiliated teaching hospital. "The ANS is influenced by stress and emotions."
"Children with asthma and high depression symptoms showed a preponderance of parasympathetic over sympathetic nervous system reactivity in the ANS," he continued. "This imbalance within the ANS could explain the increased airway resistance that we found in depressed asthmatic children in our study."
The study involved 90 children with asthma, aged 7-17. Forty-five asthmatic children with symptoms of depression were compared with 45 asthmatic children without symptoms of depression. Both groups viewed scary, sad (death) and happy scenes from the movie E.T.: The Extraterrestrial.
All children wore electrodes to collect data on heart and respiratory function, which showed the level of activation and reactivity of the sympathetic and parasympathetic divisions. The researchers assessed airway function before the movie, after the death scene and after the movie.
"The depressed group consistently showed greater parasympathetic activation along with decreased sympathetic activation in response to the emotional provocations - a pattern that would have a detrimental effect on the airways," said Miller.
"In contrast, the group without symptoms of depression showed consistent activation of the sympathetic pathway, which would support better airway function under stress. To our knowledge, this is the first report in the literature to demonstrate an association linking stress, depression and increased airway resistance in asthmatic children."
Results also showed that bias toward parasympathetic reactivity was most pronounced in the children during scenes portraying family distress or loss, death and dying.
"These findings reinforce previous results from our laboratory that associated relational stress within the family with child depression and increased asthma activity," said Wood.
"Although these findings are promising and support our hypotheses," she continued, "we need further studies to replicate and extend these findings, and to examine whether treatment for depression reduces shift to the parasympathetic and improves lung function in children with asthma."
The authors believe these findings indicate the importance of screening children with asthma for depressive symptoms, of following these children closely and referring them for psychosocial counseling when indicated.
Co-authors on the study were Mark Ballow, M.D., an asthma specialist from the UB Department of Pediatrics; ChiunYu Hsu, a student in the UB Neuroscience Graduate Program, and JungHa Lim, Ph.D, formerly a UB post-doctoral student, and currently on the faculty at Korea University.
The research was supported by grants from the National Institutes of Health.
FDA Approves First Generic Effexor Extended Release Capsules To Treat Major Depressive Disorder
On June 28, the U.S. Food and Drug Administration approved the first generic version of Effexor XR capsules (venlafaxine hydrochloride) to treat major depressive disorder.
Venlafaxine hydrochloride extended-release capsules in 37.5 milligram, 75 milligram and 150 milligram strengths have been approved to be manufactured by TEVA Pharmaceuticals, North Wales, Pa.
"The approval of this widely used antidepressant is another example of the FDA's efforts to increase access to safe and effective generic drugs," said Keith Webber, Ph.D., deputy director of the Office of Pharmaceutical Science in the FDA's Center for Drug Evaluation and Research. "Access to treatments for depression is important because depression can interfere with a person's daily life and routine, which can significantly affect relationships with family and friends."
Symptoms of depression can include feelings of sadness, anxiety, emptiness, hopelessness, guilt, worthlessness or helplessness. Irritability and restlessness are also common symptoms of depression. Many people with depression lose interest in activities or hobbies and feel tired all the time.
The prescribing information (label) for the generic drug may differ from that of Effexor XR capsules because some uses of the drug and parts of the label are protected by patents and/or exclusivity held by the Effexor manufacturer, Wyeth Pharmaceuticals Inc.
Generic venlafaxine hydrochloride will have the same safety warnings as Effexor XR.
The drug has a boxed warning indicating that antidepressant medicines may increase suicidal thoughts or actions in some children, teenagers, and young adults within the first few months of treatment. The warning also notes that depression and other serious mental illnesses are the most important causes of suicidal thoughts and actions. Some people may have a particularly high risk of having suicidal thoughts or actions. These include people who have or have a family history of bipolar illness (also called manic-depressive illness) or suicidal thoughts or actions.
Venlafaxine hydrochloride extended-release capsules in 37.5 milligram, 75 milligram and 150 milligram strengths have been approved to be manufactured by TEVA Pharmaceuticals, North Wales, Pa.
"The approval of this widely used antidepressant is another example of the FDA's efforts to increase access to safe and effective generic drugs," said Keith Webber, Ph.D., deputy director of the Office of Pharmaceutical Science in the FDA's Center for Drug Evaluation and Research. "Access to treatments for depression is important because depression can interfere with a person's daily life and routine, which can significantly affect relationships with family and friends."
Symptoms of depression can include feelings of sadness, anxiety, emptiness, hopelessness, guilt, worthlessness or helplessness. Irritability and restlessness are also common symptoms of depression. Many people with depression lose interest in activities or hobbies and feel tired all the time.
The prescribing information (label) for the generic drug may differ from that of Effexor XR capsules because some uses of the drug and parts of the label are protected by patents and/or exclusivity held by the Effexor manufacturer, Wyeth Pharmaceuticals Inc.
Generic venlafaxine hydrochloride will have the same safety warnings as Effexor XR.
The drug has a boxed warning indicating that antidepressant medicines may increase suicidal thoughts or actions in some children, teenagers, and young adults within the first few months of treatment. The warning also notes that depression and other serious mental illnesses are the most important causes of suicidal thoughts and actions. Some people may have a particularly high risk of having suicidal thoughts or actions. These include people who have or have a family history of bipolar illness (also called manic-depressive illness) or suicidal thoughts or actions.
Giving Up Smoking Linked To Greater Happiness And Elevated Mood
It appears to be a myth that giving up smoking most likely makes you miserable. Brown University researchers found that those who were in the process of quitting smoking were never happier. Their study appears in an article in the journal Nicotine & Tobacco Research.
The authors explained that giving up smoking is known to be good for our physical health; however, nobody really seems to know whether the process makes us happy or depressed. One reads about smokers claiming to derive relief from anxiety and depression from their tobacco products.
Corresponding author, Christopher Kahler says smokers thinking of quitting should be encouraged by the double benefit - both physical and mental. Giving up is far from being a psychological nightmare done just for the sake of living a longer life, he added.
Kahler added:
"The assumption has often been that people might smoke because it has antidepressant properties and that if they quit it might unmask a depressive episode. What's surprising is that at the time when you measure smokers' mood, even if they've only succeeded for a little while, they are already reporting less symptoms of depression."
Kahler and team examined data on 236 male and female smokers who wanted to give up. They were also heavy social drinkers. They were all provided with smoking cessation counseling and nicotine patches and then set a date to give up smoking. A number of the participants were also given counseling on ways to cut down on their alcohol consumption.
They all underwent a standardized test for symptoms of depression seven days before they stopped smoking. Further psychological evaluations for depression took place 2, 8, 16 and 28 weeks after their quit date.
Of the 236 candidates:
99 failed straight away (never abstained)
44 were only found to be smoking free during their first evaluation after the quit date
33 abstained successfully right up to their 8-week check-up
33 abstained throughout the whole period of the study
29 exhibited none of the above-mentioned quitting behaviors
Among those who managed to quit for a while, the researchers found that they were in very high spirits (happy) during the check-ups when their smoking cessation was being successfully carried out. However, after failing their moods darkened significantly, and in many cases to lower depths than before the whole study began.
Kahler said that enhanced mood and periods of abstinence went hand-in-hand - the correlation was clear.
The participants who failed straight away were still followed up throughout the study and were found to be the unhappiest of all the groups. The ones who managed to abstain throughout the study period had the highest levels of happiness, the authors wrote.
Kahler believes it is possible to extrapolate from this study and generalize over the whole population, even though his participants were relatively heavy drinkers. He refers to a 2002 study of smokers who had all experienced episodes of depression in their lives, but did not all drink.
The authors added that the link between happiness and smoking cessation was strong, regardless of whether the participant was drinking less or the same - the constant was successful smoking cessation.
The researchers believe that giving up smoking relieves symptoms of depression and that it is a myth to believe smoking eases anxiety.
Kahler said:
"If they quit smoking their depressive symptoms go down and if they relapse, their mood goes back to where they were. An effective antidepressant should look like that."
"Time-Varying Smoking Abstinence Predicts Lower Depressive Symptoms Following Smoking Cessation Treatment"
Christopher W. Kahler, Nichea S. Spillane, Ph.D., Andrew M. Busch, Ph.D.,Adam M. Leventhal, Ph.D
Nicotine Tob Res (2010) doi: 10.1093/ntr/ntq213
The authors explained that giving up smoking is known to be good for our physical health; however, nobody really seems to know whether the process makes us happy or depressed. One reads about smokers claiming to derive relief from anxiety and depression from their tobacco products.
Corresponding author, Christopher Kahler says smokers thinking of quitting should be encouraged by the double benefit - both physical and mental. Giving up is far from being a psychological nightmare done just for the sake of living a longer life, he added.
Kahler added:
"The assumption has often been that people might smoke because it has antidepressant properties and that if they quit it might unmask a depressive episode. What's surprising is that at the time when you measure smokers' mood, even if they've only succeeded for a little while, they are already reporting less symptoms of depression."
Kahler and team examined data on 236 male and female smokers who wanted to give up. They were also heavy social drinkers. They were all provided with smoking cessation counseling and nicotine patches and then set a date to give up smoking. A number of the participants were also given counseling on ways to cut down on their alcohol consumption.
They all underwent a standardized test for symptoms of depression seven days before they stopped smoking. Further psychological evaluations for depression took place 2, 8, 16 and 28 weeks after their quit date.
Of the 236 candidates:
99 failed straight away (never abstained)
44 were only found to be smoking free during their first evaluation after the quit date
33 abstained successfully right up to their 8-week check-up
33 abstained throughout the whole period of the study
29 exhibited none of the above-mentioned quitting behaviors
Among those who managed to quit for a while, the researchers found that they were in very high spirits (happy) during the check-ups when their smoking cessation was being successfully carried out. However, after failing their moods darkened significantly, and in many cases to lower depths than before the whole study began.
Kahler said that enhanced mood and periods of abstinence went hand-in-hand - the correlation was clear.
The participants who failed straight away were still followed up throughout the study and were found to be the unhappiest of all the groups. The ones who managed to abstain throughout the study period had the highest levels of happiness, the authors wrote.
Kahler believes it is possible to extrapolate from this study and generalize over the whole population, even though his participants were relatively heavy drinkers. He refers to a 2002 study of smokers who had all experienced episodes of depression in their lives, but did not all drink.
The authors added that the link between happiness and smoking cessation was strong, regardless of whether the participant was drinking less or the same - the constant was successful smoking cessation.
The researchers believe that giving up smoking relieves symptoms of depression and that it is a myth to believe smoking eases anxiety.
Kahler said:
"If they quit smoking their depressive symptoms go down and if they relapse, their mood goes back to where they were. An effective antidepressant should look like that."
"Time-Varying Smoking Abstinence Predicts Lower Depressive Symptoms Following Smoking Cessation Treatment"
Christopher W. Kahler, Nichea S. Spillane, Ph.D., Andrew M. Busch, Ph.D.,Adam M. Leventhal, Ph.D
Nicotine Tob Res (2010) doi: 10.1093/ntr/ntq213
PTSD Less Common Than Depression And Alcohol Misuse Amongst UK Troops
They found that the prevalence of all common mental disorders was 27.2%, and PTSD symptoms, 4.8%. There were no substantial differences in the prevalence of PTSD symptoms between US and UK troops deployed to Iraq, which had been previously found. In UK troops, the most common diagnoses were alcohol abuse (18.0%) and depression/anxiety (13.5%). The data also indicated that reservists who deployed to Iraq are at greater risk of psychiatric injury than regular personnel, thus initiatives in the UK to provide enhanced assistance to reservists are still pertinent.
Dr Iversen concludes: "This research has helped build a detailed picture of the specific heath needs of the UK military. These data should be particularly valuable for health service planners, providers and policy makers."
Notes: The prevalence of common mental disorders and PTSD in the UK military: using data from a clinical interview-based study
Amy C Iversen, Lauren van Staden, Jamie Hacker Hughes, Tess Browne, Lisa Hull, John Hall, Neil Greenberg, Roberto J Rona, Matthew Hotopf, Simon Wessely and Nicola T Fear
BMC Psychiatry (in press)
biomedcentral/bmcpsychiatry/
Dr Iversen concludes: "This research has helped build a detailed picture of the specific heath needs of the UK military. These data should be particularly valuable for health service planners, providers and policy makers."
Notes: The prevalence of common mental disorders and PTSD in the UK military: using data from a clinical interview-based study
Amy C Iversen, Lauren van Staden, Jamie Hacker Hughes, Tess Browne, Lisa Hull, John Hall, Neil Greenberg, Roberto J Rona, Matthew Hotopf, Simon Wessely and Nicola T Fear
BMC Psychiatry (in press)
biomedcentral/bmcpsychiatry/
Fluoxetine Plus Behavior Therapy Helps Teens With Substance Abuse Disorders And Depression
Teens who have depression and also have substance abuse disorders seem to benefit from a combination of fluoxetine and cognitive behavioral therapy, according to an article in Archives of Pediatrics & Adolescent Medicine (JAMA/Archives), November issue. The researchers found the combination treatment was as effective with this group of teenagers as it was among teenagers with depression who did not have substance abuse disorders.
The authors explain "Adolescents with substance use disorders (SUDs) have higher rates of depression (15% to 24%) than adolescents in the general population. Comorbid [co-occurring] depression is also associated with more severe substance abuse, poorer drug treatment outcomes and higher relapse rates."
Paula D. Riggs, M.D., University of Colorado Denver, and team carried out a randomized controlled trial with 126 teenagers who met the diagnostic criteria for major depressive disorder, lifetime conduct disorder and one or more substance abuse disorders (excluding tobacco). The patients were randomly selected to receive either 20 milligrams of fluoxetine per day, or a placebo each day. Both groups also received identical cognitive behavioral therapy.
Cognitive behavioral therapy is a type of psychotherapy which tackles the way you think and act rather than looking into past events. In the case of these teenagers the therapy focused on substance abuse rather than the depression.
The treatment period of this trial lasted 16 weeks. At the end of the period fluoxetine combined with cognitive therapy improved the patients' scores on one of the two depression scales used significantly more than for the placebo group. The other depression scale showed no significant difference in substance abuse or conduct disorder symptoms between the two groups of patients.
The researchers wrote "(The results) indicate that, in the context of cognitive behavior therapy (substance abuse treatment), co-occurring depression may improve or remit without antidepressant pharmacotherapy. However, if depression does not appear to be improving early in the course of substance treatment, fluoxetine treatment should be considered, even if adolescents are not yet abstinent, with weekly monitoring of treatment adherence, substance use, adverse effects and target symptom response."
"A Randomized Controlled Trial of Fluoxetine and Cognitive Behavioral Therapy in Adolescents With Major Depression, Behavior Problems, and Substance Use Disorders"
Paula D. Riggs, MD; Susan K. Mikulich-Gilbertson, PhD; Robert D. Davies, MD; Michelle Lohman, RN; Constance Klein, MSW; Shannon K. Stover, BA
Arch Pediatr Adolesc Med. 2007;161(11):1026-1034.
Click here to view abstract online
The authors explain "Adolescents with substance use disorders (SUDs) have higher rates of depression (15% to 24%) than adolescents in the general population. Comorbid [co-occurring] depression is also associated with more severe substance abuse, poorer drug treatment outcomes and higher relapse rates."
Paula D. Riggs, M.D., University of Colorado Denver, and team carried out a randomized controlled trial with 126 teenagers who met the diagnostic criteria for major depressive disorder, lifetime conduct disorder and one or more substance abuse disorders (excluding tobacco). The patients were randomly selected to receive either 20 milligrams of fluoxetine per day, or a placebo each day. Both groups also received identical cognitive behavioral therapy.
Cognitive behavioral therapy is a type of psychotherapy which tackles the way you think and act rather than looking into past events. In the case of these teenagers the therapy focused on substance abuse rather than the depression.
The treatment period of this trial lasted 16 weeks. At the end of the period fluoxetine combined with cognitive therapy improved the patients' scores on one of the two depression scales used significantly more than for the placebo group. The other depression scale showed no significant difference in substance abuse or conduct disorder symptoms between the two groups of patients.
The researchers wrote "(The results) indicate that, in the context of cognitive behavior therapy (substance abuse treatment), co-occurring depression may improve or remit without antidepressant pharmacotherapy. However, if depression does not appear to be improving early in the course of substance treatment, fluoxetine treatment should be considered, even if adolescents are not yet abstinent, with weekly monitoring of treatment adherence, substance use, adverse effects and target symptom response."
"A Randomized Controlled Trial of Fluoxetine and Cognitive Behavioral Therapy in Adolescents With Major Depression, Behavior Problems, and Substance Use Disorders"
Paula D. Riggs, MD; Susan K. Mikulich-Gilbertson, PhD; Robert D. Davies, MD; Michelle Lohman, RN; Constance Klein, MSW; Shannon K. Stover, BA
Arch Pediatr Adolesc Med. 2007;161(11):1026-1034.
Click here to view abstract online
Depression, Health Care Services And Heart Attacks -- What's The Connection?
Depression symptoms are associated with significantly higher use of healthcare services following a heart attack, according to a new study released today by the Centre for Addiction and Mental Health (CAMH). With approximately 70,000 Canadians experiencing a heart attack each year, this new data may help thousands of people get the care they need and reduce hospital visits.
"While we know that the use of health services is higher for people with depression symptoms, and depression is common for people who have had a heart attack, this is one of the first studies to quantify the relationship between depression symptoms, cardiac illness severity and their effect on health service consumption," explains Dr. Paul Kurdyak, head of CAMH's Centralized Assessment, Triage and Support research program and principal investigator for this research.
Data from almost 2000 heart attack patients showed that depression symptoms alone resulted in an increase in health service consumption with a:
Nine per cent increase in heart-related hospitalizations,
24 per cent increase in total re-hospitalization days, and
43 per cent increase in non-heart related hospitalizations visits following discharge after a heart attack.
Surprisingly, the data also showed that depression caused the greatest increase in health service use in those patients with lower cardiac illness severity, and therefore, the least need for those services. "What we're seeing is people who are clearly in distress seeking help from our healthcare system, but it may not include the right kind of help to address their distress," says Dr. Kurdyak.
While there are well-established and effective chronic cardiac care and depression intervention programs, "this data supports the need for integrating depression screening and case-management into existing cardiac care," says Dr. Kurdyak. "Integrated depression care for people who have had a heart attack can improve their quality of life and may reduce the apparent mismatch between need and service use."
The Centre for Addiction and Mental Health (CAMH) is Canada's largest mental health and addiction teaching hospital, as well as one of the world's leading research centres in the area of addiction and mental health. CAMH combines clinical care, research, education, policy development and health promotion to transform the lives of people affected by mental health and addiction issues.
CAMH is fully affiliated with the University of Toronto, and is a Pan American Health Organization/World Health Organization Collaborating Centre.
"While we know that the use of health services is higher for people with depression symptoms, and depression is common for people who have had a heart attack, this is one of the first studies to quantify the relationship between depression symptoms, cardiac illness severity and their effect on health service consumption," explains Dr. Paul Kurdyak, head of CAMH's Centralized Assessment, Triage and Support research program and principal investigator for this research.
Data from almost 2000 heart attack patients showed that depression symptoms alone resulted in an increase in health service consumption with a:
Nine per cent increase in heart-related hospitalizations,
24 per cent increase in total re-hospitalization days, and
43 per cent increase in non-heart related hospitalizations visits following discharge after a heart attack.
Surprisingly, the data also showed that depression caused the greatest increase in health service use in those patients with lower cardiac illness severity, and therefore, the least need for those services. "What we're seeing is people who are clearly in distress seeking help from our healthcare system, but it may not include the right kind of help to address their distress," says Dr. Kurdyak.
While there are well-established and effective chronic cardiac care and depression intervention programs, "this data supports the need for integrating depression screening and case-management into existing cardiac care," says Dr. Kurdyak. "Integrated depression care for people who have had a heart attack can improve their quality of life and may reduce the apparent mismatch between need and service use."
The Centre for Addiction and Mental Health (CAMH) is Canada's largest mental health and addiction teaching hospital, as well as one of the world's leading research centres in the area of addiction and mental health. CAMH combines clinical care, research, education, policy development and health promotion to transform the lives of people affected by mental health and addiction issues.
CAMH is fully affiliated with the University of Toronto, and is a Pan American Health Organization/World Health Organization Collaborating Centre.
Antidepressants May Help Fight Cancer By Boosting Body's Immune Response
A comprehensive review of current scientific literature, published in the peer-reviewed journal ecancer, has suggested that antidepressants can help the human body fight cancer by boosting its own immune response, amongst other mechanisms.
Not only this but they can help with side effects from chemotherapy such as aiding sleep, stimulating appetite, combating pain and avoiding depression.
Antidepressants work by affecting levels of chemicals known as prostaglandins*. These are ephemeral, infinitesimal signallers self-regulating every cell in the body, including those serving mood and immunity. When first discovered they were perceived as a master switch, but are now believed to regulate every component of cellular microanatomy and physiology, including those of the organelles, cytoskeleton, proteins, enzymes, nucleic acids and mitochondria.
Prostaglandins are responsible, paradoxically, for both cell function and dysfunction. Excessive prostaglandin synthesis depresses immune function and may induce cancer.
An ideal anticancer agent would inhibit prostaglandins in such a manner as to shut down the pathogenesis of cancer. The article indicates that antidepressants have such properties.
Report author, Dr Julian Lieb of Vermont, USA, concludes that antidepressants have the potential to arrest, prevent, reverse and palliate cancer. He also points out that short of that they have many other uses in cancer care.
Antidepressants can reduce the severity and frequency of hot flushes in patients treated with chemotherapy, and venlafaxine (Effexor) remit acute neurosensory symptoms secondary to oxaliplatin chemotherapy. The monoamine oxidase inhibitors deprenyl and clorgyline protect nonmalignant cells from ionizing radiation and chemotherapy toxicity, and such antidepressants as nefadazone are capable of reversing chemotherapy-induced vomiting.
The report notes that as the response to antidepressants is highly specific, many patients require multiple trials before responding. It found that some subjects are non-responsive to all antidepressants, and some may relapse due to getting used to the drug. However, adjusting prostaglandins can induce both pro and anti-cancer actions. The constant presence of this paradox means that antidepressants may be capable of initiating or accelerating cancer and thus maintaining close clinical observation and limiting the duration of drug trials is essential.
The review also points out that epidemiological studies have failed to confirm the suspicion that antidepressants may induce breast cancer. However, breast cancer has been reported in three men taking selective serotonin reuptake inhibitors.
Dr Lieb added: "Wherever prostaglandin-synthesizing enzymes convert arachidonic acid to prostaglandins there are possible sites of action of antidepressants. By maintaining these enzymes within physiological limits, antidepressants shut down the mechanisms of carcinogenesis. Considerable evidence now shows that antidepressants are cytotoxic, cytostatic, convert multidrug resistant cells to sensitive, and protect nonmalignant cells from ionizing radiation and chemotherapy.
Antidepressants have potent pain relieving properties alone, or through enhancing narcotics, and they enhance sleep, appetite and occasionally energy. Their immuno-stimulating and antimicrobial properties may help with infection secondary to chemotherapy or radiation. Alleviation of anxiety, depression, fear of death, recrimination and remorse by antidepressants can be very beneficial, though care must be taken to monitor for negative effects such as intensification of depression or pain. Overall, the positive effects of antidepressants in cancer therapeutics far outweigh the negatives."
*A prostaglandin is any member of a group of lipid compounds that are derived enzymatically from fatty acids and have important functions in the body.
ecancermedicalscience is an open-access, peer-reviewed cancer journal founded by the European Institute of Oncology.
Cancer Intelligence publishes ecancermedicalscience.
ecancermedicalscience
View drug information on Effexor.
Not only this but they can help with side effects from chemotherapy such as aiding sleep, stimulating appetite, combating pain and avoiding depression.
Antidepressants work by affecting levels of chemicals known as prostaglandins*. These are ephemeral, infinitesimal signallers self-regulating every cell in the body, including those serving mood and immunity. When first discovered they were perceived as a master switch, but are now believed to regulate every component of cellular microanatomy and physiology, including those of the organelles, cytoskeleton, proteins, enzymes, nucleic acids and mitochondria.
Prostaglandins are responsible, paradoxically, for both cell function and dysfunction. Excessive prostaglandin synthesis depresses immune function and may induce cancer.
An ideal anticancer agent would inhibit prostaglandins in such a manner as to shut down the pathogenesis of cancer. The article indicates that antidepressants have such properties.
Report author, Dr Julian Lieb of Vermont, USA, concludes that antidepressants have the potential to arrest, prevent, reverse and palliate cancer. He also points out that short of that they have many other uses in cancer care.
Antidepressants can reduce the severity and frequency of hot flushes in patients treated with chemotherapy, and venlafaxine (Effexor) remit acute neurosensory symptoms secondary to oxaliplatin chemotherapy. The monoamine oxidase inhibitors deprenyl and clorgyline protect nonmalignant cells from ionizing radiation and chemotherapy toxicity, and such antidepressants as nefadazone are capable of reversing chemotherapy-induced vomiting.
The report notes that as the response to antidepressants is highly specific, many patients require multiple trials before responding. It found that some subjects are non-responsive to all antidepressants, and some may relapse due to getting used to the drug. However, adjusting prostaglandins can induce both pro and anti-cancer actions. The constant presence of this paradox means that antidepressants may be capable of initiating or accelerating cancer and thus maintaining close clinical observation and limiting the duration of drug trials is essential.
The review also points out that epidemiological studies have failed to confirm the suspicion that antidepressants may induce breast cancer. However, breast cancer has been reported in three men taking selective serotonin reuptake inhibitors.
Dr Lieb added: "Wherever prostaglandin-synthesizing enzymes convert arachidonic acid to prostaglandins there are possible sites of action of antidepressants. By maintaining these enzymes within physiological limits, antidepressants shut down the mechanisms of carcinogenesis. Considerable evidence now shows that antidepressants are cytotoxic, cytostatic, convert multidrug resistant cells to sensitive, and protect nonmalignant cells from ionizing radiation and chemotherapy.
Antidepressants have potent pain relieving properties alone, or through enhancing narcotics, and they enhance sleep, appetite and occasionally energy. Their immuno-stimulating and antimicrobial properties may help with infection secondary to chemotherapy or radiation. Alleviation of anxiety, depression, fear of death, recrimination and remorse by antidepressants can be very beneficial, though care must be taken to monitor for negative effects such as intensification of depression or pain. Overall, the positive effects of antidepressants in cancer therapeutics far outweigh the negatives."
*A prostaglandin is any member of a group of lipid compounds that are derived enzymatically from fatty acids and have important functions in the body.
ecancermedicalscience is an open-access, peer-reviewed cancer journal founded by the European Institute of Oncology.
Cancer Intelligence publishes ecancermedicalscience.
ecancermedicalscience
View drug information on Effexor.
Results Of 2009 Pfizer Index Show Unemployed Claim To Have Four Times Higher Rate Of Depression
The results of the 2009 Pfizer Health Index announced at the Royal College of Physicians Ireland reveal that the recently unemployed are four times more likely to claim to have depression than the general population. There is also evidence that the recession is leading to anxiety over money, is bad for self-esteem and is leading to relationship tension. The greatest impact of the recession is apparent among those between the ages of 25 and 50, who are parents and who live in urban areas. The Pfizer Health Index, now in its fourth year, details the findings of a nationally representative quantitative market research survey of the health and wellbeing of the Irish population. This year the study also looks at the impact of the recession on people's lives, with particular focus of those who had been recently unemployed.
Roughly half of the adult population claim that they are finding it hard to make ends meet and similar numbers are shopping in cheaper retail outlets and socialising less. A third indicated that they are booking less holidays in Ireland and abroad and about a fifth are having problems with mortgage or loan repayments. The most fundamental impact however relates to the reduction of salary, hours worked or indeed the loss of jobs. 16% - about a seventh of the adult population - indicated that their salary has been reduced at work. 13% indicate that their hours of work have been reduced. Furthermore 7% indicate that they themselves have lost their job.
"This research shows that the downturn in the economy is having a major effect on Irish society," said Dr Maureen Gaffney, Psychologist at the launch of the Health Index. "We are seeing a shift in priorities. Up to quite recently job security and finances would not have been the major concern that they are now. However there is a positive aspect with the research showing that those who are newly unemployed are taking the opportunity to create a healthier lifestyle for themselves. It is heartening to see that many people recently unemployed are facing this adversity with courage and determination, and taking control of those aspects of their lives that they have control - their health, their fitness and their life priorities."
There is significant evidence that the recently unemployed have cut back their spending on medication. 29% of the unemployed sample and 17% of the wider sample are buying less over the counter medication while 14% of people have cut down on prescription medicines, rising to 20% in the unemployed people. 24% of people are more reluctant to visit a health care professional, rising to 29% in those unemployed. 10% are more reluctant to bring a child to a doctor, rising to 13% in those unemployed. On a positive note unemployment seems to provide an opportunity to take more exercise and become healthier, with 45% of the unemployed sample stating they plan to become more active. They also intend to become less stressed, give up smoking and drink less.
Also speaking at the launch, David Coleman, Clinical Psychologist, Author, TV and Radio Broadcaster, commented; "The recession is having a considerable effect on people's lifestyles with less money being spent for the family themselves. Whilst this research shows that the recession may be having a negative effect on some people, it may present an opportunity for people to assess their lives and their priorities. The emphasis for some may be to spend more time with family and increase quality family time together. Simple changes such as eating meals together or doing fun activities with your children can make an enormous change to the wellbeing of a family."
Although personal and family health continue to be a key priority for Irish adults, job security, finances and money are all rising as key issues of concern. Concerns about the cost of living would appear to have been replaced by more immediate concerns for personal finance and job security. This would suggest that the downturn in the economy has changed the priorities of Irish adults. Priorities differ markedly relating to one's age. Older adults, principally those over the age of 50, are more intensely focussed on personal health. Family health is a priority for those aged 35-50, particularly for women in this age bracket. Personal and family health is much less important for those below the age of 35. A key focus now for those under 35 is financial and monetary issues, as well as job security.
The 2009 Pfizer Health Index found the Irish adults continue to rate themselves highly in terms of their own health. The average person rates his or her health at almost 8 out of ten (7.9), using a scale where 10 denotes excellent health and 1 very poor health. This is a slight increase on the 2008 Health Index where the average score was recorded as 7.8. The average health of the recently unemployed is scored as 7.5 out of 10, which is slightly lower than the overall national average. 24% of those who are recently unemployed score themselves as 6 out of 10 or worse, in comparison with just 17% of the population at large. With regards to health reform issues the priorities for Irish people are consistent over the previous Health Indices. Hospital beds are rated as the greatest priority by 53% of the population, followed by medical cards (11%), screening programmes (10%) and greater access to GPs (8%).
"The results from this year's Index give us an insight into how the Irish population are managing in the recession," said Tara Delaney, Director of External Affairs, Pfizer Healthcare Ireland. "Our society is going through immense change which for some may require an adjustment to lifestyle. The downturn in the economy is forcing all of us to examine our priorities. We hope that the research presented today will provide a focus on the importance of health in our society."
Source
Pfizer Health Index
Roughly half of the adult population claim that they are finding it hard to make ends meet and similar numbers are shopping in cheaper retail outlets and socialising less. A third indicated that they are booking less holidays in Ireland and abroad and about a fifth are having problems with mortgage or loan repayments. The most fundamental impact however relates to the reduction of salary, hours worked or indeed the loss of jobs. 16% - about a seventh of the adult population - indicated that their salary has been reduced at work. 13% indicate that their hours of work have been reduced. Furthermore 7% indicate that they themselves have lost their job.
"This research shows that the downturn in the economy is having a major effect on Irish society," said Dr Maureen Gaffney, Psychologist at the launch of the Health Index. "We are seeing a shift in priorities. Up to quite recently job security and finances would not have been the major concern that they are now. However there is a positive aspect with the research showing that those who are newly unemployed are taking the opportunity to create a healthier lifestyle for themselves. It is heartening to see that many people recently unemployed are facing this adversity with courage and determination, and taking control of those aspects of their lives that they have control - their health, their fitness and their life priorities."
There is significant evidence that the recently unemployed have cut back their spending on medication. 29% of the unemployed sample and 17% of the wider sample are buying less over the counter medication while 14% of people have cut down on prescription medicines, rising to 20% in the unemployed people. 24% of people are more reluctant to visit a health care professional, rising to 29% in those unemployed. 10% are more reluctant to bring a child to a doctor, rising to 13% in those unemployed. On a positive note unemployment seems to provide an opportunity to take more exercise and become healthier, with 45% of the unemployed sample stating they plan to become more active. They also intend to become less stressed, give up smoking and drink less.
Also speaking at the launch, David Coleman, Clinical Psychologist, Author, TV and Radio Broadcaster, commented; "The recession is having a considerable effect on people's lifestyles with less money being spent for the family themselves. Whilst this research shows that the recession may be having a negative effect on some people, it may present an opportunity for people to assess their lives and their priorities. The emphasis for some may be to spend more time with family and increase quality family time together. Simple changes such as eating meals together or doing fun activities with your children can make an enormous change to the wellbeing of a family."
Although personal and family health continue to be a key priority for Irish adults, job security, finances and money are all rising as key issues of concern. Concerns about the cost of living would appear to have been replaced by more immediate concerns for personal finance and job security. This would suggest that the downturn in the economy has changed the priorities of Irish adults. Priorities differ markedly relating to one's age. Older adults, principally those over the age of 50, are more intensely focussed on personal health. Family health is a priority for those aged 35-50, particularly for women in this age bracket. Personal and family health is much less important for those below the age of 35. A key focus now for those under 35 is financial and monetary issues, as well as job security.
The 2009 Pfizer Health Index found the Irish adults continue to rate themselves highly in terms of their own health. The average person rates his or her health at almost 8 out of ten (7.9), using a scale where 10 denotes excellent health and 1 very poor health. This is a slight increase on the 2008 Health Index where the average score was recorded as 7.8. The average health of the recently unemployed is scored as 7.5 out of 10, which is slightly lower than the overall national average. 24% of those who are recently unemployed score themselves as 6 out of 10 or worse, in comparison with just 17% of the population at large. With regards to health reform issues the priorities for Irish people are consistent over the previous Health Indices. Hospital beds are rated as the greatest priority by 53% of the population, followed by medical cards (11%), screening programmes (10%) and greater access to GPs (8%).
"The results from this year's Index give us an insight into how the Irish population are managing in the recession," said Tara Delaney, Director of External Affairs, Pfizer Healthcare Ireland. "Our society is going through immense change which for some may require an adjustment to lifestyle. The downturn in the economy is forcing all of us to examine our priorities. We hope that the research presented today will provide a focus on the importance of health in our society."
Source
Pfizer Health Index
Insomnia In Parents Can Result In Sleep Problems, Suicidal Behavior Among Their Offspring
A history of chronic insomnia in parents is not only associated with elevated risk for insomnia but also with elevated risks for use of hypnotics, psychopathology and suicidal behavior in adolescent offspring, according to a research abstract presented at SLEEP 2008, the 22nd Annual Meeting of the Associated Professional Sleep Societies (APSS).
The study, authored by Xianchen Liu, MD, PhD, of the University of Pittsburgh, focused on 798 teenagers (450 boys and 348 girls), with an average age of 14.4 years, who completed a sleep and health questionnaire.
According to the results, compared with adolescents of parents without insomnia, participants of insomnia parents were more than twice more likely to report insomnia, daytime fatigue, and use of hypnotics. Adolescents of insomnia parents were also more likely to have depression, anxiety, and suicidal ideation and suicide attempts during the past year.
"These results suggest that a history of chronic insomnia in parents is not only associated with elevated risk for insomnia, but also with elevated risks for a wide range of mental health problems, substance use, and suicidal behavior in adolescent offspring," said Dr. Liu. "Family sleep interventions may be important to enhance sleep quality and decrease risks for sleep disturbance, psychopathology and suicidal behavior in adolescents. Further studies are warranted to examine how and the extent to which genetic and environmental factors interact in determining sleep disturbances and psychopathology among adolescents."
Insomnia is a classification of sleep disorders in which a person has trouble falling asleep, staying asleep or waking up too early. It is the most commonly reported sleep disorder.
It is recommended that adolescents get nine hours of nightly sleep.
The American Academy of Sleep Medicine (AASM) offers the following tips on how to get a good night's sleep:
Follow a consistent bedtime routine.
Establish a relaxing setting at bedtime.
Get a full night's sleep every night.
Avoid foods or drinks that contain caffeine, as well as any medicine that has a stimulant, prior to bedtime.
Do not stay up all hours of the night to "cram" for an exam, do homework, etc. If after-school activities are proving to be too time-consuming, consider cutting back on these activities.
Keep computers and TVs out of the bedroom.
Do not go to bed hungry, but don't eat a big meal before bedtime either.
Avoid any rigorous exercise within six hours of your bedtime.
Make your bedroom quiet, dark and a little bit cool.
Get up at the same time every morning.
Those who suspect that they might be suffering from insomnia, or another sleep disorder, are encouraged to consult with their primary care physician or a sleep specialist.
More information about insomnia is available from the AASM at sleepeducation/Disorder.aspx?id=6, and "teens and sleep", including a new questionnaire that assesses the level of sleepiness in adolescents, at: sleepeducation/Topic.aspx?id=71.
The annual SLEEP meeting brings together an international body of 5,000 leading researchers and clinicians in the field of sleep medicine to present and discuss new findings and medical developments related to sleep and sleep disorders.
More than 1,000 research abstracts will be presented at the SLEEP meeting, a joint venture of the AASM and the Sleep Research Society. The three-and-a-half-day scientific meeting will bring to light new findings that enhance the understanding of the processes of sleep and aid the diagnosis and treatment of sleep disorders such as insomnia, narcolepsy and sleep apnea.
SleepEducation, a patient education Web site created by the AASM, provides information about various sleep disorders, the forms of treatment available, recent news on the topic of sleep, sleep studies that have been conducted and a listing of sleep facilities.
The study, authored by Xianchen Liu, MD, PhD, of the University of Pittsburgh, focused on 798 teenagers (450 boys and 348 girls), with an average age of 14.4 years, who completed a sleep and health questionnaire.
According to the results, compared with adolescents of parents without insomnia, participants of insomnia parents were more than twice more likely to report insomnia, daytime fatigue, and use of hypnotics. Adolescents of insomnia parents were also more likely to have depression, anxiety, and suicidal ideation and suicide attempts during the past year.
"These results suggest that a history of chronic insomnia in parents is not only associated with elevated risk for insomnia, but also with elevated risks for a wide range of mental health problems, substance use, and suicidal behavior in adolescent offspring," said Dr. Liu. "Family sleep interventions may be important to enhance sleep quality and decrease risks for sleep disturbance, psychopathology and suicidal behavior in adolescents. Further studies are warranted to examine how and the extent to which genetic and environmental factors interact in determining sleep disturbances and psychopathology among adolescents."
Insomnia is a classification of sleep disorders in which a person has trouble falling asleep, staying asleep or waking up too early. It is the most commonly reported sleep disorder.
It is recommended that adolescents get nine hours of nightly sleep.
The American Academy of Sleep Medicine (AASM) offers the following tips on how to get a good night's sleep:
Follow a consistent bedtime routine.
Establish a relaxing setting at bedtime.
Get a full night's sleep every night.
Avoid foods or drinks that contain caffeine, as well as any medicine that has a stimulant, prior to bedtime.
Do not stay up all hours of the night to "cram" for an exam, do homework, etc. If after-school activities are proving to be too time-consuming, consider cutting back on these activities.
Keep computers and TVs out of the bedroom.
Do not go to bed hungry, but don't eat a big meal before bedtime either.
Avoid any rigorous exercise within six hours of your bedtime.
Make your bedroom quiet, dark and a little bit cool.
Get up at the same time every morning.
Those who suspect that they might be suffering from insomnia, or another sleep disorder, are encouraged to consult with their primary care physician or a sleep specialist.
More information about insomnia is available from the AASM at sleepeducation/Disorder.aspx?id=6, and "teens and sleep", including a new questionnaire that assesses the level of sleepiness in adolescents, at: sleepeducation/Topic.aspx?id=71.
The annual SLEEP meeting brings together an international body of 5,000 leading researchers and clinicians in the field of sleep medicine to present and discuss new findings and medical developments related to sleep and sleep disorders.
More than 1,000 research abstracts will be presented at the SLEEP meeting, a joint venture of the AASM and the Sleep Research Society. The three-and-a-half-day scientific meeting will bring to light new findings that enhance the understanding of the processes of sleep and aid the diagnosis and treatment of sleep disorders such as insomnia, narcolepsy and sleep apnea.
SleepEducation, a patient education Web site created by the AASM, provides information about various sleep disorders, the forms of treatment available, recent news on the topic of sleep, sleep studies that have been conducted and a listing of sleep facilities.
Geisinger Launches Healthcare Book Series
Geisinger and BC Decker have announced the release of a book series, entitled Frequently Asked Questions. The series features clear, concise answers to common healthcare questions drawn from the clinical practices of eight veteran Geisinger clinicians.
Each book unfolds in a Question and Answer format on a range of topics within a single clinical practice specialty.
The first six books in the series, Depression (Susan Paolucci, MD and Stephen Paolucci, MD), Low Back Pain (David Gutknecht, MD), Menopause (Valerie Weber, MD), Rheumatoid Arthritis (Eric Newman, MD and Cynthia Matzko, RN, MSN) Weight Management: Adults (Christopher Still, DO) and Weight Management: Children and Adolescents (William Cochran, MD) are must-reads for today's patients.
FAQ acquaints readers with the healthcare questions Geisinger clinicians say they are most frequently asked. The books are edited by Sandra A. Buckley, Director, Geisinger Editorial Office.
"FAQ books build on the insight and time-honored wisdom of Geisinger specialists who have developed reputations for their straightforward and easy-to-understand communication skills," says Bruce Hamory, Chief Medical Officer, Geisinger Health System. "The FAQ series provides invaluable knowledge that will help people successfully understand a diagnoses and how to best manage a disease."
"Every person who wants to gain a basic knowledge of one of these health-related topics should pick up one of the books," says Brian Decker, President of BC Decker. "The titles are designed so readers can immediately find answers to their questions for instant impact and results."
Six new titles, including Migraines, Type 2 Diabetes, Otitis Media (Ear Infections) and Osteoporosis will be added to the series within the next two years, according to Dr. Hamory.
Retailing for $16.95, the books are available at select Weis, Giant and Wegman's Pharmacies, and at the Abigial Gift Ship (Geisinger Medical Center), and via the internet at bcdecker/ and amazon/.
About Geisinger Health System:
Geisinger Health System is one of the nation's leading fully integrated healthcare providers. Founded in 1915, Geisinger serves more than two million residents throughout central and northeastern Pennsylvania. The physician-led organization is at the forefront of the country's rapidly emerging electronic health records movement. Geisinger includes three major regional medical centers, a 650-member group practice, a not-for-profit health insurance company, and the Geisinger Center for Health Research - dedicated to creating innovative new models for patient care, satisfaction and clinical outcomes.
Contact: Patti Urosevich
Geisinger Health System
Each book unfolds in a Question and Answer format on a range of topics within a single clinical practice specialty.
The first six books in the series, Depression (Susan Paolucci, MD and Stephen Paolucci, MD), Low Back Pain (David Gutknecht, MD), Menopause (Valerie Weber, MD), Rheumatoid Arthritis (Eric Newman, MD and Cynthia Matzko, RN, MSN) Weight Management: Adults (Christopher Still, DO) and Weight Management: Children and Adolescents (William Cochran, MD) are must-reads for today's patients.
FAQ acquaints readers with the healthcare questions Geisinger clinicians say they are most frequently asked. The books are edited by Sandra A. Buckley, Director, Geisinger Editorial Office.
"FAQ books build on the insight and time-honored wisdom of Geisinger specialists who have developed reputations for their straightforward and easy-to-understand communication skills," says Bruce Hamory, Chief Medical Officer, Geisinger Health System. "The FAQ series provides invaluable knowledge that will help people successfully understand a diagnoses and how to best manage a disease."
"Every person who wants to gain a basic knowledge of one of these health-related topics should pick up one of the books," says Brian Decker, President of BC Decker. "The titles are designed so readers can immediately find answers to their questions for instant impact and results."
Six new titles, including Migraines, Type 2 Diabetes, Otitis Media (Ear Infections) and Osteoporosis will be added to the series within the next two years, according to Dr. Hamory.
Retailing for $16.95, the books are available at select Weis, Giant and Wegman's Pharmacies, and at the Abigial Gift Ship (Geisinger Medical Center), and via the internet at bcdecker/ and amazon/.
About Geisinger Health System:
Geisinger Health System is one of the nation's leading fully integrated healthcare providers. Founded in 1915, Geisinger serves more than two million residents throughout central and northeastern Pennsylvania. The physician-led organization is at the forefront of the country's rapidly emerging electronic health records movement. Geisinger includes three major regional medical centers, a 650-member group practice, a not-for-profit health insurance company, and the Geisinger Center for Health Research - dedicated to creating innovative new models for patient care, satisfaction and clinical outcomes.
Contact: Patti Urosevich
Geisinger Health System
Symptoms Of Depression Increase During Medical Internship
The percentage of clinicians who meet criteria for depression appears to increase significantly during medical internship, according to a report posted online today that will appear in the June print issue of Archives of General Psychiatry, one of the JAMA/Archives journals. Increased work hours, stressful life events, genetic predisposition and receiving a medical education in the United States are among the factors that appear to be associated with depressive symptoms among medical interns.
"Internship is known to be a time of high stress," the authors write as background information in the article. "New physicians are faced with long work hours, sleep deprivation, loss of autonomy and extreme emotional situations." Although some studies have assessed rates of depression among medical interns and found them higher than in the general population, few have explored the specific factors responsible.
Srijan Sen, M.D., Ph.D., then of Yale University, New Haven, Conn., and now of the University of Michigan, Ann Arbor, and colleagues studied 740 interns entering residency programs in 13 U.S. hospitals in 2007 or 2008. Participants completed a secure online survey to assess their symptoms of depression, along with personal and medical education factors and several psychological measures. After three, six, nine and 12 months, the interns completed follow-up surveys regarding depressive symptoms, internship variables (such as work hours and perceived medical errors) and other life stresses. A subgroup of 409 participants (63 percent) provided saliva samples for genetic analysis.
Average depression scores increased during internship; on a scale of zero to 27, where scores of 10 or greater indicate depression, the average score increased from 2.4 before internship to an average of 6.4 during internship. In addition, the proportion of participants who met criteria for depression increased from 3.9 percent before internship to an average of 25.7 percent during internship.
"A series of factors measured prior to internship (female sex, U.S. medical education, difficult early family environment, history of major depression, lower baseline depressive symptom score and higher neuroticism) and during internship (increased work hours, perceived medical errors and stressful life events) was associated with a greater increase in depressive symptoms during internship," the authors write.
"It is also interesting to note that a number of factors, such as medical specialty and age, were not associated with the development of depression," the authors write. "With effective interventions to help prevent the onset of depression now available, the predictive factors identified herein could allow at-risk interns to take steps before the onset of symptoms to lower their chances of developing depression."
Arch Gen Psychiatry.
2010;67[6]:(doi:10.1001/archgenpsychiatry.2010.41).
Source
Archives of General Psychiatry
"Internship is known to be a time of high stress," the authors write as background information in the article. "New physicians are faced with long work hours, sleep deprivation, loss of autonomy and extreme emotional situations." Although some studies have assessed rates of depression among medical interns and found them higher than in the general population, few have explored the specific factors responsible.
Srijan Sen, M.D., Ph.D., then of Yale University, New Haven, Conn., and now of the University of Michigan, Ann Arbor, and colleagues studied 740 interns entering residency programs in 13 U.S. hospitals in 2007 or 2008. Participants completed a secure online survey to assess their symptoms of depression, along with personal and medical education factors and several psychological measures. After three, six, nine and 12 months, the interns completed follow-up surveys regarding depressive symptoms, internship variables (such as work hours and perceived medical errors) and other life stresses. A subgroup of 409 participants (63 percent) provided saliva samples for genetic analysis.
Average depression scores increased during internship; on a scale of zero to 27, where scores of 10 or greater indicate depression, the average score increased from 2.4 before internship to an average of 6.4 during internship. In addition, the proportion of participants who met criteria for depression increased from 3.9 percent before internship to an average of 25.7 percent during internship.
"A series of factors measured prior to internship (female sex, U.S. medical education, difficult early family environment, history of major depression, lower baseline depressive symptom score and higher neuroticism) and during internship (increased work hours, perceived medical errors and stressful life events) was associated with a greater increase in depressive symptoms during internship," the authors write.
"It is also interesting to note that a number of factors, such as medical specialty and age, were not associated with the development of depression," the authors write. "With effective interventions to help prevent the onset of depression now available, the predictive factors identified herein could allow at-risk interns to take steps before the onset of symptoms to lower their chances of developing depression."
Arch Gen Psychiatry.
2010;67[6]:(doi:10.1001/archgenpsychiatry.2010.41).
Source
Archives of General Psychiatry
Genes Linked With Stress Altered By Yo-Yo Dieting
Stressed-out mice with a history of dieting ate more high-fat foods than similarly stressed mice not previously on diets, according to a new study in the Dec. 1 issue of The Journal of Neuroscience. The findings suggest that moderate diets change how the brain responds to stress and may make crash dieters more susceptible to weight gain.
In this study, researchers at the University of Pennsylvania led by Tracy Bale, PhD, examined the behavior and hormone levels of mice on limited diets. After three weeks of fewer calories, the mice lost 10 to 15 percent of their body weight, similar to human diet weight loss.
One in every three Americans is now obese. "Yo-yo dieting" - temporarily losing weight only to regain it, plus more - is a well-known phenomenon. While previous studies show that mice on lifelong calorie-restricted diets live as much as 50 percent longer than their well-fed peers, little is known about the long-term consequences of quick-fix diets.
Bale and her colleagues found the mice had increased levels of the stress hormone corticosterone and displayed depression-like behavior. The authors also discovered that several genes important in regulating stress and eating had changed. Previous research shows that experiences can alter the form and structure of DNA, an effect known as epigenetics. Even after the mice were fed back to their normal weights, the epigenetic changes remained.
To investigate whether those molecular changes might affect future behavior, the researchers put the mice in stressful situations and monitored how much fatty foods they ate. The previously restricted mice ate more high-fat food than normal mice.
"These results suggest that dieting not only increases stress, making successful dieting more difficult, but that it may actually 'reprogram' how the brain responds to future stress and emotional drives for food," Bale said.
The findings illustrate the underlying mechanisms for why a piece of pizza is so appealing after a stressful day at work. The authors suggest that future weight loss drugs may target these stress-related molecules.
Jeffrey Zigman, MD, PhD, an expert in endocrinology, diabetes, and metabolism at the University of Texas Southwestern Medical Center who was unaffiliated with the study, said the conditions the mice experienced mimic the type of psychosocial stress that people often experience.
"This study highlights the difficult road that human dieters often travel to attain and maintain their weight loss goals," Zigman said. "It also suggests that management of stress during dieting may be key to achieving those goals."
The research was supported by the University of Pennsylvania Diabetes Center, National Institute of Diabetes, Digestive and Kidney Disease, the Health Research Formula Fund, and AstraZeneca.
In this study, researchers at the University of Pennsylvania led by Tracy Bale, PhD, examined the behavior and hormone levels of mice on limited diets. After three weeks of fewer calories, the mice lost 10 to 15 percent of their body weight, similar to human diet weight loss.
One in every three Americans is now obese. "Yo-yo dieting" - temporarily losing weight only to regain it, plus more - is a well-known phenomenon. While previous studies show that mice on lifelong calorie-restricted diets live as much as 50 percent longer than their well-fed peers, little is known about the long-term consequences of quick-fix diets.
Bale and her colleagues found the mice had increased levels of the stress hormone corticosterone and displayed depression-like behavior. The authors also discovered that several genes important in regulating stress and eating had changed. Previous research shows that experiences can alter the form and structure of DNA, an effect known as epigenetics. Even after the mice were fed back to their normal weights, the epigenetic changes remained.
To investigate whether those molecular changes might affect future behavior, the researchers put the mice in stressful situations and monitored how much fatty foods they ate. The previously restricted mice ate more high-fat food than normal mice.
"These results suggest that dieting not only increases stress, making successful dieting more difficult, but that it may actually 'reprogram' how the brain responds to future stress and emotional drives for food," Bale said.
The findings illustrate the underlying mechanisms for why a piece of pizza is so appealing after a stressful day at work. The authors suggest that future weight loss drugs may target these stress-related molecules.
Jeffrey Zigman, MD, PhD, an expert in endocrinology, diabetes, and metabolism at the University of Texas Southwestern Medical Center who was unaffiliated with the study, said the conditions the mice experienced mimic the type of psychosocial stress that people often experience.
"This study highlights the difficult road that human dieters often travel to attain and maintain their weight loss goals," Zigman said. "It also suggests that management of stress during dieting may be key to achieving those goals."
The research was supported by the University of Pennsylvania Diabetes Center, National Institute of Diabetes, Digestive and Kidney Disease, the Health Research Formula Fund, and AstraZeneca.
Australian Researchers Halve Relapses In Bipolar Disorder
Melbourne mental health researchers have succeeded in halving the number of relapses experienced by people with bipolar disorder which strikes two in 100 Australians, accounts for 12 per cent of suicides each year and costs the country at least $1.5 billion annually(1).
With funding from the MBF Foundation and Beyond Blue, a team led by the Mental Health Research Institute of Victoria has developed an innovative structured group program to help people with bipolar disorder to better manage their condition.
The 12-session program, led by trained mental health clinicians, enables people battling the disorder to effectively monitor their mood, assess personal triggers and early warning signs of oncoming illness and take the necessary steps to stay well.
In a controlled randomised study of 84 people diagnosed with bipolar disorder, those on the special intervention program had half the number of relapses after 12 months as the control group which continued with normal treatment. Even with modern drug therapies that act as mood stabilisers, relapse rates for people with bipolar disorder are as high as 40 per cent in the first year and almost 75 per cent over five years.
MBF general manager health product, Michael Carafillis, said the new program provides a much-needed bridge between the mental health services that treat people when they are acutely ill and the GPs and private psychiatrists who provide ongoing care.
"Bipolar is a complicated disease involving periods of depression and mania and its sufferers don't always take their medications when they should," said Mr Carafillis.
"People with the condition straddle the divide between public and private systems resulting in poor continuity of care for many sufferers. They tend to gain access to the public system in the most severely disabling phase of their illness, typically mania, and are often too ill and the disorder too complex to be easily managed in primary care."
Professor David Castle at the Mental Health Research Institute of Victoria said providing people with bipolar disorder with the right tools and strategies to better self-manage their disease in a supportive group environment can substantially reduce the burden on individuals, their families and the health system.
Buoyed by the exciting results, the research team is now training clinicians in metropolitan and regional Victoria. The development of an accompanying service delivery framework, already being implemented in parts of Victoria, South Australia and the ACT, will enable the program to be rolled out in other states. (1) Access Economics report (2003) commissioned by SANE Australia
With funding from the MBF Foundation and Beyond Blue, a team led by the Mental Health Research Institute of Victoria has developed an innovative structured group program to help people with bipolar disorder to better manage their condition.
The 12-session program, led by trained mental health clinicians, enables people battling the disorder to effectively monitor their mood, assess personal triggers and early warning signs of oncoming illness and take the necessary steps to stay well.
In a controlled randomised study of 84 people diagnosed with bipolar disorder, those on the special intervention program had half the number of relapses after 12 months as the control group which continued with normal treatment. Even with modern drug therapies that act as mood stabilisers, relapse rates for people with bipolar disorder are as high as 40 per cent in the first year and almost 75 per cent over five years.
MBF general manager health product, Michael Carafillis, said the new program provides a much-needed bridge between the mental health services that treat people when they are acutely ill and the GPs and private psychiatrists who provide ongoing care.
"Bipolar is a complicated disease involving periods of depression and mania and its sufferers don't always take their medications when they should," said Mr Carafillis.
"People with the condition straddle the divide between public and private systems resulting in poor continuity of care for many sufferers. They tend to gain access to the public system in the most severely disabling phase of their illness, typically mania, and are often too ill and the disorder too complex to be easily managed in primary care."
Professor David Castle at the Mental Health Research Institute of Victoria said providing people with bipolar disorder with the right tools and strategies to better self-manage their disease in a supportive group environment can substantially reduce the burden on individuals, their families and the health system.
Buoyed by the exciting results, the research team is now training clinicians in metropolitan and regional Victoria. The development of an accompanying service delivery framework, already being implemented in parts of Victoria, South Australia and the ACT, will enable the program to be rolled out in other states. (1) Access Economics report (2003) commissioned by SANE Australia
APA Applauds Congressional Efforts To Promote Research And Education On Mental Illnesses, USA
Arlington, Va. -The American Psychiatric Association (APA) applauds the efforts of U.S. Representative Sue Myrick (R-N.C.) who initiated an Energy and Commerce Subcommittee on Health hearing held today on mental health disorders, entitled "Mental Illness and Brain Disease: Dispelling Myths and Promoting Recovery Through Awareness and Treatment." At the hearing, overseen by Subcommittee Chairman Representative Nathan Deal (R-Ga.), experts testified about important advances in research that have improved the treatment options for mental disorders like depression, bipolar disorder, and schizophrenia.
Over the past five years, the nation has more than doubled its investment in the study of the human brain and behavior, leading to a vastly expanded understanding of postpartum depression, bipolar disorder and attention-deficit/hyperactivity disorder, to name a few. With the aid of this research and consumer education, physicians can accurately diagnose and effectively treat patients with mental health concerns.
"The need for research on mental disorders is vital for our troops [returning from combat] and to all American citizens," testified Raymond DePaulo, Jr., M.D., Henry Phipps Professor and Chairman of the Department of Psychiatry at The Johns Hopkins University School of Medicine, and a member of the APA Committee on Psychiatric Diagnosis and Assessment. "About 15 million people in the United States at any given time have major depression or some form of manic depression. The prevalence for depression runs very high, as do the costs to the individual and the country as a whole. It is imperative that we invest more time and money towards this 'Cancer of the 21st Century,' so that treatments can lead to cures and hopes into reality."
The APA encourages everyone to learn more about the facts on mental illnesses. For more information, visit the APA's "Healthy Minds. Healthy Lives." Web site HealthyMinds for free public education materials.
About the American Psychiatric Association:
The American Psychiatric Association is the nation's leading medical specialty society whose more than 36,000 physician members specialize in diagnosis, treatment, prevention and research of mental illnesses including substance use disorders.
Visit the APA at psych and HealthyMinds.
Over the past five years, the nation has more than doubled its investment in the study of the human brain and behavior, leading to a vastly expanded understanding of postpartum depression, bipolar disorder and attention-deficit/hyperactivity disorder, to name a few. With the aid of this research and consumer education, physicians can accurately diagnose and effectively treat patients with mental health concerns.
"The need for research on mental disorders is vital for our troops [returning from combat] and to all American citizens," testified Raymond DePaulo, Jr., M.D., Henry Phipps Professor and Chairman of the Department of Psychiatry at The Johns Hopkins University School of Medicine, and a member of the APA Committee on Psychiatric Diagnosis and Assessment. "About 15 million people in the United States at any given time have major depression or some form of manic depression. The prevalence for depression runs very high, as do the costs to the individual and the country as a whole. It is imperative that we invest more time and money towards this 'Cancer of the 21st Century,' so that treatments can lead to cures and hopes into reality."
The APA encourages everyone to learn more about the facts on mental illnesses. For more information, visit the APA's "Healthy Minds. Healthy Lives." Web site HealthyMinds for free public education materials.
About the American Psychiatric Association:
The American Psychiatric Association is the nation's leading medical specialty society whose more than 36,000 physician members specialize in diagnosis, treatment, prevention and research of mental illnesses including substance use disorders.
Visit the APA at psych and HealthyMinds.
Drugs hardly work for children with depression side effects are significant
According to Australian researchers, drugs hardly work for children and teenagers with depression. In a study, they also found that antidepressants have significant side-effects on this age group.
The scientists examined the effects of Prozac, Zoloft and Paxil. They carefully examined the data of five published trials on these drugs. In comparison to placebos, these drugs offered very modest benefits. However, the risks are significant.
You can read about this study in the British Medical Journal (bmj).
Jon Jureidini, the head of this study, said "If the drugs were highly advantageous over placebo, then you'd live with the risks……If the drugs were completely safe, then you might argue that there's nothing wrong with giving something that's only slightly better than a placebo." Jon Jureidini is a child psychiatrist, in Adelaide, Australia.
He then went on to say that the two situations he mentioned do not exist. The benefits of the drug are minimal and the side effects are significant.
Dr. Jureidini said that non-child psychiatrists should not be prescribing SSRIs (selective serotonin reuptake inhibitors) initially (they should not be the ones who start the kids on these drugs.
Antidepressants for kids have been the target of many criticisms by experts recently.
Recently the UK Department of Health advised all its doctors not to prescribe antidepressants to kids, with the exception of Prozac. It said most of the drugs are not effective and that many provoke suicidal thoughts and behaviour (US spelling 'behavior').
View drug information on Paxil CR; Prozac Weekly; Zoloft.
The scientists examined the effects of Prozac, Zoloft and Paxil. They carefully examined the data of five published trials on these drugs. In comparison to placebos, these drugs offered very modest benefits. However, the risks are significant.
You can read about this study in the British Medical Journal (bmj).
Jon Jureidini, the head of this study, said "If the drugs were highly advantageous over placebo, then you'd live with the risks……If the drugs were completely safe, then you might argue that there's nothing wrong with giving something that's only slightly better than a placebo." Jon Jureidini is a child psychiatrist, in Adelaide, Australia.
He then went on to say that the two situations he mentioned do not exist. The benefits of the drug are minimal and the side effects are significant.
Dr. Jureidini said that non-child psychiatrists should not be prescribing SSRIs (selective serotonin reuptake inhibitors) initially (they should not be the ones who start the kids on these drugs.
Antidepressants for kids have been the target of many criticisms by experts recently.
Recently the UK Department of Health advised all its doctors not to prescribe antidepressants to kids, with the exception of Prozac. It said most of the drugs are not effective and that many provoke suicidal thoughts and behaviour (US spelling 'behavior').
View drug information on Paxil CR; Prozac Weekly; Zoloft.
Newer Antidepressants Not Always Better
New antidepressants might be no more effective than the best existing drugs, according to two new systematic reviews that compared 12 commonly used medications.
"Patients are usually encouraged to take the newest medication," said lead author Andrea Cipriani, M.D., of the University of Verona, in Italy. "But it's better to have an old treatment that has been proved with many patients and many years in the market."
The reviews suggest that sertraline sold under the brand name Zoloft since 1991 could be the best initial choice of antidepressant in people with acute major depression. The generic formulation produced the best balance of effectiveness, tolerability and purchase price, the authors say.
Patients also did well on one of the newest antidepressants, escitalopram (Lexapro), but it is not yet available in lower-cost generic form. The authors note that comprehensive economic studies are necessary to evaluate overall cost-effectiveness of various treatments.
Cipriani said that the review recommendations are for new episodes of depression. "If a patient is taking another drug and doing well, we are not saying he has to change."
The reviews appear in the most recent issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.
Depression is the fourth-leading cause of disease burden worldwide and antidepressant drugs are now the mainstay of treatment for moderate to severe cases. The aim of the two reviews was to compare the benefits and side effects of sertraline and escitalopram, respectively, with those of other antidepressants during the first six to 12 weeks of treatment.
Cipriani noted that all of the included studies compared one drug against another not to a placebo so the results reveal not the absolute effect, but rather the relative advantages and disadvantages of various medications.
In addition, these reviews rely on summary data from each study, rather than individual patient data. Future studies that go into greater detail can help identify the best medications for various subgroups of patients such as men vs. women, teens vs. adults and so on.
For sertraline, the reviewers included 59 randomized controlled trials totaling about 10,000 participants. Sertraline proved more effective than fluoxetine (Prozac), but less effective than mirtazapine (Remeron). In terms of side effects, bupropion (Wellbutrin) was easier to tolerate than sertraline, while the latter outscored amitriptyline (Elavil), imipramine (Tofranil), paroxetine (Paxil) and mirtazapine (Remeron).
For escitalopram, the reviewers included 22 randomized controlled trials totaling about 4,000 participants. Few statistically significant differences appeared in this review, although escitalopram was more effective than citalopram (Celexa) and fluoxetine (Prozac) and had fewer side effects than duloxetine (Cymbalta). The drug manufacturer sponsored most of the studies in this review, so there may be biases in favor of escitalopram.
Rather than seeking genuine advances in treatment, the review authors say, some pharmaceutical companies seem to be introducing close chemical cousins of generic medications. By gaining patent protection for the "new" drug, a company can market it as a higher-priced brand name product.
Sponsorship bias is a recurring concern in trials of virtually all new medications. In the Cochrane reviews themselves, one of the co-authors has received research funds and speaking fees from the companies Asahi Kasei, Astellas, Dai-Nippon Sumitomo, Eisai, Eli Lilly, GlaxoSmithKline, Janssen, Kyowa Hakko, Meiji, Nikken Kagaku, Organon, Otsuka, Pfizer and Yoshitomi. The Japanese Ministry of Education, Science and Technology, and the Japanese Ministry of Health, Labour and Welfare have also funded some of his research.
However, the co-authors of these Cochrane reviews also published a recent study in The Lancet that was free of any potential funding bias. The study also used a more complex statistical method to analyze data from 117 randomized controlled trials involving 25,928 participants.
The findings support the Cochrane reviews, Cipriani said, with sertraline and escitalopram ranking as the best treatments.
"Such findings have enormous implications," said Sagar Parikh, M.D., of the University of Toronto, in a commentary published along with The Lancet study. "For the clinician, prudent engagement of the patient in treatment ideally involves giving the patient a choice.??¦ A new gold standard of reliable information has been compiled for patients to review."
In early studies, new medical treatments are typically compared to sham treatments. Once the effectiveness of certain approaches is well established, new options must be judged against the best existing treatments.
Cipriani argued that this time has come for antidepressants, and that sertraline is the drug to beat. "We need new treatments in psychiatry, but they have to be proved better than other treatments," he said. "We should be comparing new drugs to the best available existing drugs."
The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions.
Cipriani A, La Ferla, et al. Setraline versus other antidepressive agents for depression. The Cochrane Database of Systematic Reviews 2009, Issue 2.
Cipriani A, Santilli C, et al. Escitalopram versus other antidepressive agents for depression. The Cochrane Database of Systematic Reviews 2009, Issue 2.
"Patients are usually encouraged to take the newest medication," said lead author Andrea Cipriani, M.D., of the University of Verona, in Italy. "But it's better to have an old treatment that has been proved with many patients and many years in the market."
The reviews suggest that sertraline sold under the brand name Zoloft since 1991 could be the best initial choice of antidepressant in people with acute major depression. The generic formulation produced the best balance of effectiveness, tolerability and purchase price, the authors say.
Patients also did well on one of the newest antidepressants, escitalopram (Lexapro), but it is not yet available in lower-cost generic form. The authors note that comprehensive economic studies are necessary to evaluate overall cost-effectiveness of various treatments.
Cipriani said that the review recommendations are for new episodes of depression. "If a patient is taking another drug and doing well, we are not saying he has to change."
The reviews appear in the most recent issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.
Depression is the fourth-leading cause of disease burden worldwide and antidepressant drugs are now the mainstay of treatment for moderate to severe cases. The aim of the two reviews was to compare the benefits and side effects of sertraline and escitalopram, respectively, with those of other antidepressants during the first six to 12 weeks of treatment.
Cipriani noted that all of the included studies compared one drug against another not to a placebo so the results reveal not the absolute effect, but rather the relative advantages and disadvantages of various medications.
In addition, these reviews rely on summary data from each study, rather than individual patient data. Future studies that go into greater detail can help identify the best medications for various subgroups of patients such as men vs. women, teens vs. adults and so on.
For sertraline, the reviewers included 59 randomized controlled trials totaling about 10,000 participants. Sertraline proved more effective than fluoxetine (Prozac), but less effective than mirtazapine (Remeron). In terms of side effects, bupropion (Wellbutrin) was easier to tolerate than sertraline, while the latter outscored amitriptyline (Elavil), imipramine (Tofranil), paroxetine (Paxil) and mirtazapine (Remeron).
For escitalopram, the reviewers included 22 randomized controlled trials totaling about 4,000 participants. Few statistically significant differences appeared in this review, although escitalopram was more effective than citalopram (Celexa) and fluoxetine (Prozac) and had fewer side effects than duloxetine (Cymbalta). The drug manufacturer sponsored most of the studies in this review, so there may be biases in favor of escitalopram.
Rather than seeking genuine advances in treatment, the review authors say, some pharmaceutical companies seem to be introducing close chemical cousins of generic medications. By gaining patent protection for the "new" drug, a company can market it as a higher-priced brand name product.
Sponsorship bias is a recurring concern in trials of virtually all new medications. In the Cochrane reviews themselves, one of the co-authors has received research funds and speaking fees from the companies Asahi Kasei, Astellas, Dai-Nippon Sumitomo, Eisai, Eli Lilly, GlaxoSmithKline, Janssen, Kyowa Hakko, Meiji, Nikken Kagaku, Organon, Otsuka, Pfizer and Yoshitomi. The Japanese Ministry of Education, Science and Technology, and the Japanese Ministry of Health, Labour and Welfare have also funded some of his research.
However, the co-authors of these Cochrane reviews also published a recent study in The Lancet that was free of any potential funding bias. The study also used a more complex statistical method to analyze data from 117 randomized controlled trials involving 25,928 participants.
The findings support the Cochrane reviews, Cipriani said, with sertraline and escitalopram ranking as the best treatments.
"Such findings have enormous implications," said Sagar Parikh, M.D., of the University of Toronto, in a commentary published along with The Lancet study. "For the clinician, prudent engagement of the patient in treatment ideally involves giving the patient a choice.??¦ A new gold standard of reliable information has been compiled for patients to review."
In early studies, new medical treatments are typically compared to sham treatments. Once the effectiveness of certain approaches is well established, new options must be judged against the best existing treatments.
Cipriani argued that this time has come for antidepressants, and that sertraline is the drug to beat. "We need new treatments in psychiatry, but they have to be proved better than other treatments," he said. "We should be comparing new drugs to the best available existing drugs."
The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions.
Cipriani A, La Ferla, et al. Setraline versus other antidepressive agents for depression. The Cochrane Database of Systematic Reviews 2009, Issue 2.
Cipriani A, Santilli C, et al. Escitalopram versus other antidepressive agents for depression. The Cochrane Database of Systematic Reviews 2009, Issue 2.
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