'Doctors should stop pushing drugs at depressed people'

Despite a large increase in cognitive behaviour therapy (CBT) doctors are still pushing drugs at patients, according to Dr Jennifer Wild, a senior lecturer at the Institute of Psychiatry.
In this week's Scrubbing Up, she argues that GPs need to understand that psychological therapies like CBT work and should choose to offer them.

People with depression often get better when they change the way they think.
Since therapy is more likely to achieve this with longer-lasting results than drugs, doctors need to stop pushing pills and start pushing treatments that work.

Depressed people feel low, worthless, and often suicidal. They need treatment.
Six million people suffer from depression and anxiety in the UK, and surveys show that most do not want to take drugs.

They want a treatment with long-lasting results.

READ MORE @ BBC NEWS"

'Distorted thinking'

This treatment is cognitive behavioural therapy (CBT).
CBT is based on a well-supported theory of how depression starts and what keeps it going: distorted thinking patterns.
Change people's thoughts and recovery occurs.

The Role of Antidepressants for the Treatment of Bipolar Depression

Although rapid-cycling bipolar disorder has been linked to the use of antidepressants, these treatments may still have a role in the management of patients with bipolar depression, said Stephen V. Sobel, MD, clinical instructor at the University of California, San Diego School of Medicine, in a presentation at the U.S. Psychiatric and Mental Health Congress is Las Vegas. Patients with bipolar disorder spend most of their time in depression, and antidepressants can alleviate these symptoms, said Sobel. “That’s why it’s so tempting to treat these patients with an antidepressant. But it’s important to be familiar with recent studies on the development of rapid-cycling bipolar disorder and to weigh the risks and benefits,” he said.

The use of antidepressants may increase a patient’s risk of rapid-cycling bipolar disorder. The Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) included 1742 patients treated with a variety of approved medications for bipolar I and bipolar II disorder, and 32% reported having rapid-cycling at baseline. After 2 years of treatment, 5% still had rapid-cycling bipolar disorder. Those who were treated with an antidepressant were 3.8 times more likely to have rapid-cycling bipolar disorder.1

READ MORE @ PSYCHIATRIC TIMES

Antidepressants 'work instantly'

Antidepressants get to work immediately to lift mood, contrary to current belief, UK researchers say.

Although patients may not notice the effects until months into the therapy, the team say they work subconsciously.

The action is rapid, beginning within hours of taking the drugs, and changes negative thoughts, according to the Oxford University researchers.

These subtle, positive cues may add up over time to lift the depression, the American Journal of Psychiatry reports.

It may also explain why talking therapies designed to break negative thought cycles can also help.

Psychiatrist Dr Catherine Harmer and her team at Oxford University closely studied the reactions of 33 depressed patients and 31 healthy controls given either an antidepressant or a dummy drug.

The depressed patients who took the active drug showed positive improvements in three specific measures within three hours of taking them.

These patients were more likely to think about themselves in a positive light, rather than dwelling on their bad points, the researchers said.

They were also more likely to see the positive in others. For example, if they saw a grumpy person they no longer internalised this to think that they must have done something wrong to upset the person.

READ MORE @ BBC NEWS

In praise of 'electroshock'

What does it feel like to be profoundly depressed?

“Sometimes you feel like your head is going to explode,” Richard Braudo explains. “There were times I was so depressed, I was comatose. You can reach the point where you don't want to live – the pain is too much.”

Mr. Braudo knows. His diagnosis: treatment-resistant bipolar affective disorder.

The Toronto lawyer and management consultant has survived 30 bouts of severe depression, each lasting many months, not to mention a couple of suicide attempts.

But, at the age of 55, he has finally achieved “stable wellness.”

Mr. Braudo credits electroconvulsive therapy for his recovery. He has undergone 10 courses of ECT since 1991, the last about 18 months ago – the longest period, by far, in his adult life that he has gone without a bout of depression.

He has chosen to tell his story to help counter the negative public image of ECT as barbaric and painful and to underscore that prescription drugs are not the be-all and end-all for people with psychiatric illnesses.

READ MORE @ GLOBE AND MAIL

Depressed teens 'face adult risk'

Teenagers who have minor depression are at a higher risk of mental health problems later in life, a study says.

Psychiatrists at Columbia University and the New York State Psychiatric Institute spoke to 750 people.

Anxiety, severe depression and eating disorders were all far more common in 20 and 30-year-olds who had had minor depression as adolescents, they found.

The British Journal of Psychiatry report said further research was needed to unpick the reasons for the link.

UK charities said specialist services for young people were vital.

The study was based on interviews with 750 14 to 16-year-olds who were then assessed again as adults.

READ MORE @ BBC NEWS

Depression and The Recession: Cymbalta Sales Are on the Rise

During a downturn, we tend to seek the "bright spots" -- sectors or products that are doing well when all the rest are struggling. For example, there were plenty of reports over the past year about retail items -- lipstick, chocolate, and macaroni and cheese -- that were bucking downward trends and selling well during the slump. While these stories were cautiously upbeat, news of an uptick in antidepressant sales despite -- or perhaps because of -- the recession was just plain depressing.

Helplessness, pessimism and persistent sadness -- the main symptoms of depression -- didn't seem to abate as the economy crumbled. About 164 million antidepressant prescriptions were written in 2008, 4 million more than in 2007, according to IMS Health, a health-care information and consulting company.

Antidepressants were the third most prescribed type of drug in 2008, hitting $9.6 billion in sales, up from $9.4 billion the year before. Last month, Eli Lilly reported that second-quarter sales for Cymbalta -- which is on the verge of surpassing Effexor as the nation's best-selling antidepressant -- increased 14 percent over the past year. Our national reliance on these drugs is a stubborn trend. A study published in the August issue of Archives of General Psychiatry found that from 1996 to 2005, antidepressant use in the United States doubled.

READ MORE @ WASHINGTON POST

Touted "Depression Risk Gene" May Not Add to Risk After All

A gene variation long thought to increase a person’s risk for major depression when paired with stressful life events may actually have no effect, according to a new analysis. The result challenges a common approach to studying depression risk factors.

Most mental disorders are thought to be caused by a combination of many genetic risk factors interacting with environmental triggers. Finding the exact combinations of factors, however, has been a significant challenge. Advances during the past decade have led to powerful tools for studying how genes and the environment interact to affect the risk for disease. In 2003, these advances allowed scientists to show that variation in a gene called the serotonin transporter gene affected the risk of major depression in people who had a number of stressful life events over a 5-year period.

Serotonin is a chemical messenger that helps brain cells communicate. The serotonin transporter directs serotonin from the space between brain cells back into the cell for reuse. Since the most widely prescribed class of medication for treating major depression acts by blocking this protein, it’s been a prime suspect in mood and anxiety disorders.

READ MORE @ NIH Research Matters

Pregnant, depressed and confused? New guidelines clarify antidepressant risks, benefits

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Pregnant, depressed and confused? New guidelines clarify antidepressant risks, benefits
August 21, 2009 | 5:00 pm

Depression hits women in the childbearing years more than any other demographic, but how to deal with this most common of mental afflictions poses a conundrum: antidepressant medications have become the first line of defense against depression; but there's growing research evidence that they pose risks to a developing fetus.

It's a tightrope that obstetricians on the front lines of patient care have walked for years without guidance from their own leaders or the profession of psychiatry. Busy, concerned but operating in unfamiliar terrain, many obstetricians have pulled out their pads, written a prescription for an antidepressant, and hoped for the best. No surprise, then, that by 2003, 13% of pregnant women had taken an antidepressant at some point in their http://latimesblogs.latimes.com/booster_shots/2009/08/pregnant-depressed-and-confused-new-guidelines-clarify-antidepressant-risks-benefits.html -- twice the rate that was seen in 1999.

But on Friday, the American Psychiatric Assn. and the American College of Obstetricians and Gynecologists put a safety net under obstetricians and the pregnant women they treat. In a first-ever set of guidelines, the two physician groups offered obstetricians and their patients a set of clear road maps for treating depression in pregnancy.

The guidelines were published simultaneously in the ACOG journal Obstetrics and Gynecology and in the APA's journal, General Hospital Psychiatry.

READ MORE @ LOS ANGELES TIMES

New link between depression and heart disease

Researchers have identified an enzyme that may trigger depressive symptoms in patients with heart disease and may help to explain why general antidepressants are often not as effective for these specific patients.

"Our study confirms that depressive symptoms are associated with inflammation in patients with heart disease and suggests a mechanism by which the brain might be affected," says Walter Swardfager, lead author of a new study and PhD candidate in the Neuropsychopharmacology Research Program at Sunnybrook Health Sciences Centre.

The research focuses on an enzyme that is part of the inflammatory process in patients with coronary artery disease (CAD). The enzyme breaks down the amino acid tryptophan and it is associated with damage to brain cells. Findings show a significant association between activation of this enzyme and the degree of depressive symptoms in these patients. They also identify a trend towards even higher levels in those suffering from clinical depression.

"This enzyme makes 'brain unfriendly' chemicals," says Dr. Krista Lanctôt, principal investigator and head of the Neuropsychopharmacology Research Program at Sunnybrook. "We are trying to chase down a treatment for patients with CAD that will block the enzyme and/or prevent the inflammatory process in the first place."

When to Avoid Antidepressants in Bipolar Patients

Patients with bipolar depression who exhibit even minimal manic symptoms are at heightened risk for switching into mania if they receive antidepressant medication, according to a new report from the Bipolar Collaborative Network.1

This finding from the multinational sites of the former Stanley Foundation Bipolar Network emerged in a post hoc analysis of 176 patients who participated in a 10-week controlled trial of adjunctive antidepressant medication for bipolar I or II depression. The investigators sought to identify clinical correlates for the development of treatment-emergent affective switching from patient demographics and baseline symptoms.

Possible risk factors for affective switch, which have been previously suggested, include comorbid substance abuse, younger age, decreased thyroid-stimulating hormone, and rapid cycling. Although none of these factors were predictive in this study, the investigators acknowledged that their modest effect size precluded ruling these out in other populations. They characterize this study, however, as the first controlled assessment of antidepressant treatment in bipolar depression to correlate a specific phenomenological presentation at baseline with affective switching in subsequent antidepressant treatment.

READ MORE @ PSYCHIATRIC TIMES

Older drug seen better for Parkinson's depression

People with Parkinson's disease who need treatment for depression seem to do better with an older antidepressant than a newer agent, according to a small clinical trial.

"Individuals with depression and Parkinson's disease do respond to antidepressants," Dr. Matthew Menza told Reuters Health. "This is important because depression in Parkinson's disease is often under-recognized, under-appreciated and under-treated. Commonly, the attitude is, 'of course you're depressed, you have a serious illness.' We have now demonstrated that one should be hopeful that treatment will help."

There have been few head-to-head trials of different antidepressants for Parkinson's patients with depression, Menza, of the Robert Wood Johnson Medical School in Piscataway, New Jersey, and his group note in the medical journal Neurology.

To investigate, they compared the older "tricyclic" antidepressant nortriptyline with the newer "SSRI" agent paroxetine in 52 people with Parkinson's disease diagnosed with major depression. Nortriptyline is available in generic form and under the brand name Pamelor, and paroxetine CR is known by the brand names Paxil and Seroxat.

READ MORE @ REUTERS

Studies Try to Tease Apart the Links Between Depression and Heart Disease

People who are depressed are literally sick at heart: they have a significantly increased risk for cardiovascular disease, and no one knows exactly why. Now three new studies have tried to explain this, and they arrive at subtly different conclusions.

The first, led by Dr. Mary A. Whooley of the Veterans Affairs Medical Center in San Francisco, studied 1,017 patients with coronary artery disease for an average of more than four years. Although the study found an association of depression with heart disease, when researchers statistically corrected for other medical conditions, disease severity and physical inactivity, the association disappeared.

READ MORE @ NY TIMES

Watch for depression in the elderly - Know the signs, step in if necessary

Experts are quick to say that depression isn't a normal part of aging, nor is it a sign of weakness.

But older family members who suffer from the condition may need your help to overcome those misconceptions and get treatment.

"In the elderly community, there is a lot of stigma still about depression and anxiety," said Dr. Greg Jicha, a neurologist at the University of Kentucky Sanders-Brown Center on Aging. "People are very hesitant to seek out any kind of help for these sorts of things."

Jicha believes it's important for relatives to be alert to signs of depression in older people to help restore joy in their lives and keep them from entering nursing homes too early. He recommends raising a red flag with primary care physicians, who may otherwise miss the signs.

READ MORE @ LOUISVILLE COURIER-JOURNAL

Redundancy and a depression

Philip Joslin, a senior clinician at Lifeworks, a private clinic in London dealing with addictions and depression, believes redundancy “is not just a matter of economic survival. It threatens people’s very identity”.

As the economy slows and jobs are cut, psychiatric practices based in London’s financial centre are reporting a rise in referrals. Mark Beadle, chief executive of Capio Nightingale Hospitals, a provider of private psychiatric treatment, says the number of City workers coming to his clinics with depression or anxiety has risen by 30 to 40 per cent.

The psychological impact of redundancy goes beyond those whose jobs are cut, however. Christine Martin, therapist and partner at Haswell, Martin & Rose, a private practice based in central London, says: “Redundancy raises a wide range of issues – for the person losing their job, for the ‘survivor’ who hasn’t been made redundant and also the people managing the process such as human resources professionals.”

READ MORE @ FINANCIAL TIMES

Antidepressant Use Tied to Poorer Driving - But experts aren't sure if the pills, or underlying depression, are to blame

Taking prescription antidepressants while still highly depressed could impair driving ability, a new study suggests.

"We already know that depression causes concentration problems," said study author Holly J. Dannewitz. "And now it appears that people taking antidepressants who also have relatively higher depression scores fare significantly worse when attempting to perform a computerized simulation of driving."

Dannewitz conducted her research while a graduate student at the University of North Dakota in Grand Forks, where she is currently a psychology resident in a private practice.

She and her colleagues were scheduled to present their findings Sunday the American Psychological Association annual meeting, in Boston.

READ MORE @ U.S. NEWS & WORLD REPORT

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.

READ MORE @ BOSTON GLOBE

Hunger hormone increases during stress, may have antidepressant effect

New research at UT Southwestern Medical Center may explain why some people who are stressed or depressed overeat.

While levels of the so-called "hunger hormone" ghrelin are known to increase when a person doesn't eat, findings by UT Southwestern scientists suggest that the hormone might also help defend against symptoms of stress-induced depression and anxiety.

"Our findings in mice suggest that chronic stress causes ghrelin levels to go up and that behaviors associated with depression and anxiety decrease when ghrelin levels rise. An unfortunate side effect, however, is increased food intake and body weight," said Dr. Jeffrey Zigman, assistant professor of internal medicine and psychiatry at UT Southwestern and senior author of a study appearing online today and in a future print edition of Nature Neuroscience.

Dr. Michael Lutter, instructor of psychiatry at UT Southwestern and lead author of the study, said, "Our findings support the idea that these hunger hormones don't do just one thing; rather, they coordinate an entire behavioral response to stress and probably affect mood, stress and energy levels."

READ MORE @ EUREKALERT

Antidepressants Alone: Not For Bipolar Depression

Psychiatrists have cautioned against the use of antidepressants alone in people with bipolar disorders, saying they could worsen a patient's condition by causing a destabilisation in mood.

Dr Ajeet Singh and Professor Michael Berk, consultant psychiatrists from the University of Melbourne, state in the current edition of Australian Prescriber that the goal of treatment in bipolar disorder is to stabilise mood, and antidepressants may defeat this purpose if they are not taken with other drugs.

"Patients may need an antidepressant, but this must be taken with a mood-stabilising drug. Antidepressants place patients at risk of switching to elevated phases of the disorder and rapid cycling patterns," they say in the article.

Patients should not simply be left on antidepressants long term without review, say the authors, as there is no good evidence of efficacy in the maintenance phase. If symptoms of elevated mood emerge, the patient should have their dose of the antidepressant reduced or stopped.

READ MORE @ MEDICAL NEWS TODAY