Depression Treatment Wanes Following FDA Warnings

Newly diagnosed cases of depression in America have dropped sharply since the government's warning of an increased risk of suicidal behavior among children and teens taking antidepressants, a new analysis finds.

Researchers at the University of Colorado say the U.S. Food and Drug Administration's advisories about the use of selective serotonin reuptake inhibitors (SSRIs) appear to be associated with "unintended" and "persistent" changes in the diagnosis and treatment of depression, especially in children and teens. They also observed a "spillover effect" on adult depression care.

"We don't know why; we just do know after the warnings these things did change, so it had an effect on treatment patterns for depression," said study co-author Robert J. Valuck, a professor of clinical pharmacy at the University of Colorado Denver's School of Pharmacy.

The report appears in the June issue of the Archives of General Psychiatry.

From the time the FDA issued its warning in 2003 through June 2007, primary-care physicians wrote 44 percent fewer SSRI prescriptions for pediatric patients than historical trends predicted, and 37 percent fewer for young adults. Yet there was no change in alternative medications or psychotherapy to compensate for the decline in SSRI prescriptions for these patients.

"It does look concerning, that the patients are not getting treated," said John F. Curry, director of clinical psychology training at Duke University Medical Center in Durham, N.C.

In October 2003, the FDA warned about the increased risk to children and teens of taking SSRIs, citing an increased risk of attempted suicide and suicidal behavior. A little over a year later, the agency directed pharmaceutical manufacturers to add a "black box" warning to medication labels, urging close monitoring of patients taking these drugs.

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Most kids get no therapy with antidepressants

At least half of U.S. children taking antidepressants aren't in therapy, suggests a large study, and that delays recovery while greatly increasing the number of kids on the medication who are suicidal.


"Therapy with antidepressants is the standard of care. But is it what's going on in the real world? No," says Sheila Marcus, child and adolescent psychiatry chief at the University of Michigan Medical School.

The report tracks insurance claims for antidepressants from a database of 6.8 million children and teens from 2002 to 2006. The analysis was done by Thomson Reuters, a research firm that helps companies evaluate health care.

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Seeking Treatment for Mental Disorders Has Lasting Effect

Middle-age patients taking medication for anxiety or depression are less likely to have mental disorders a decade later, a population-based study showed.

Among 157 patients who had a mental disorder at age 43, those who took antidepressants, anxiolytics, or both were 70% less likely to have a disorder 10 years later (OR 0.3, 95% CI 0.1 to 1.0), Ian Colman, Ph.D., of the University of Alberta here, and colleagues reported in the October issue of the British Journal of Psychiatry.

"What this tells us is that, if people get treated initially, they are less likely to have a relapse in the future," Dr. Colman said.

Because only 24.2% of those taking medications at age 43 were still being treated at age 53, the researchers said, the lasting benefits of taking antidepressants and anxiolytics "may be because of a demonstrated willingness to seek help rather than long-term maintenance therapy."

They said the lasting benefit may be "explained by an initial willingness to be treated, potential successful initial treatment, and an increased likelihood that these patients would seek and accept help when encountering symptoms of depression and anxiety in the future."

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Study rejects cost-effectiveness of CBT for adolescents

Cognitive behavioural therapy (CBT) for clinically depressed adolescents is not cost effective, researchers have found.

For those with moderate to severe major depression, the addition of CBT to drug therapy and active clinical care does not improve wellbeing enough to justify the cost, researchers have found.

The research team at the National Institute for Health Research Health Technology Assessment (NIHR HTA) compared the clinical benefits and cost-effectiveness of two treatments for depression.

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Long-Term Antidepressant Treatment Without Active Management Hardly Induces Remission: Presented at ECNP

A Scottish study identified a group of patients in primary care who are on long-term and stable treatment with selective serotonin reuptake inhibitors (SSRIs). A substantial proportion of patients displayed prevailing residual depressive and anxiety symptoms as well as sleep problems in spite of their treatment.

Alan Wade, MD, CPS Clinical Research Centre, Glasgow, Scotland, presented the study at a poster session on September 1 here at the 21st European College of Neuropsychopharmacology (ECNP) Congress.

Patients who were prescribed standard doses of antidepressants by their general practitioners without active management due to repeat prescriptions were identified from prescribing records in the West of Scotland.

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Sensitivity to antidepressants linked with TrkB-mediated neural proliferation

Scientists have unveiled a functional link between production of new neurons and the effectiveness of antidepressants (ADs) in an animal model. The study, published by Cell Press in the August 14 issue of the journal Neuron, provides exciting insight into a mechanism that might underlie a poor response to antidepressive medications for anxiety or depression.

Depression is a significant public health problem due to both its high prevalence and its devastating impact on individuals and society," says senior author Dr. Luis F. Parada from the University of Texas Southwestern Medical Center. "Despite much excitement generated by recent advances in the knowledge of brain development and function, the mechanisms underlying the pathogenesis of depression, as well as its amelioration by AD treatment, remain poorly understood."

Animal studies have indicated that chronic treatment with ADs leads to production of new neurons in a part of the brain called the hippocampus. Exercise, such as running, which has a documented positive impact on mental health, also stimulates hippocampal neurogenesis. In both cases, new neurons arise from neural progenitor cells (NPCs) that seem to be required for the behavioral response to ADs.

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Treating Depression Reduces Risk Of Heart Disease

Patients suffering from major depression are at an increased risk for cardiovascular disease, but treating these patients with medication can greatly reduce the risk, according to new findings by researchers at the University of Miami Miller School of Medicine. The results of their study are published in the July 16 issue of the journal PLoS ONE.

The researchers specifically studied the stress-hemoconcentration, which is a blood chemistry work-up that includes a blood cell count, hematocrit values, hemoglobin, total serum protein, and albumin. The stress-hemoconcentration increases during psychological stress, such as that caused by depression, and the increase is a risk factor for heart disease.

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New Study Replicates Association Between Genetic Variation And Antidepressant Treatment Response

Pharmacogenetics, the study of genetic variation that influences an individual's response to drugs, is an important and growing focus in all of medical research, including psychiatry. It is a complex field, however, revealed by the lack of consistent and replicable findings across multiple studies, but some encouraging results are beginning to emerge.

A new study evaluated genetic markers in the treatment response of antidepressants and this work implicates the same markers as found in a prior trial.

Lekman and colleagues, using clinical data and DNA samples from the largest depression treatment study to date, the STAR*D study, compared individual treatment response (the reduction or remission of depressive symptoms) to individual genotypes. The researchers found that certain markers, or variations, in the FKBP5 gene are associated with treatment response to citalopram, a widely used antidepressant drug. In other words, patients with a particular genotype tended to respond better to the antidepressant treatment than others.

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Head fake - How Prozac sent the science of depression in the wrong direction

PROZAC IS ONE of the most successful drugs of all time. Since its introduction as an antidepressant more than 20 years ago, Prozac has been prescribed to more than 54 million people around the world, and prevented untold amounts of suffering.

But the success of Prozac hasn't simply transformed the treatment of depression: it has also transformed the science of depression. For decades, researchers struggled to identify the underlying cause of depression, and patients were forced to endure a series of ineffective treatments. But then came Prozac. Like many other antidepressants, Prozac increases the brain's supply of serotonin, a neurotransmitter. The drug's effectiveness inspired an elegant theory, known as the chemical hypothesis: Sadness is simply a lack of chemical happiness. The little blue pills cheer us up because they give the brain what it has been missing.

There's only one problem with this theory of depression: it's almost certainly wrong, or at the very least woefully incomplete. Experiments have since shown that lowering people's serotonin levels does not make them depressed, nor does it does not make them depressed, nor does it worsen their symptoms if they are already depressed.

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Treatment-Resistant Depression Affects Millions of Americans Each Year

Millions of Americans with depression are able to successfully manage their condition with a combination of available therapies. However, according to an article in the Journal of Clinical Psychiatry, up to 35 percent of patients treated for depression may have a little-known condition called Treatment-Resistant Depression, or TRD.

“There are evolving definitions of TRD among the research community, but at this point, a TRD diagnosis is usually given to a patient with major depressive disorder who has failed two adequate trials of an antidepressant medication,” said Dr. W. Clay Jackson, a primary care physician and assistant professor of clinical psychiatry at the University of Tennessee.

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Antidepressant Found To Alleviate Symptoms Of Irritable Bowel Syndrome In Adolescents

Researchers at Mattel Children's Hospital UCLA have found that low-dose antidepressant therapy can significantly improve the overall quality of life for adolescents suffering from irritable bowel syndrome, or IBS. The syndrome affects 6 percent of middle school students and 14 percent of high school kids in the United States.

he study, published in the May issue of the peer-reviewed Journal of Pediatrics, is the first of its kind to look at the effects of amitriptyline, a tricyclic antidepressant, in the pediatric IBS population, researchers said.

The research was conducted between 2002 and 2005 and involved 33 newly diagnosed IBS patients, including 24 girls, between the ages of 12 and 18.

Irritable bowel syndrome causes discomfort in the abdomen, along with diarrhea, constipation or both. Currently, there is no cure, and treatments only lessen the symptoms.

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The Increasing Use Of Antidepressants: Some Reasons For Concern

Two articles in the March issue of the European Journal Psychotherapy and Psychosomatics raise serious concern about the increasing use of antidepressant medications. In the first article, David Healy and collaborators (University of Cardiff) formulate a critique of many studies which try to support the use of antidepressants on the basis of variations in suicide rates.

The Authors compare suicide rates in the Nordic countries with autopsy and ill-defined death rates, and antidepressant sales, during the period 1961 through to 2003, finding a close correlation between suicide rates and both autopsy and ill-defined death rates.The Authors conclude that the role of autopsies and other factors in the registration of a death as a suicide appear to need further clarification.

In another article Mojtabai and collaborators analyze the increase in antidepressant medication in the US in the past decade in two US general population surveys.

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