Antidepressants can be helpful but risky

Feelings of unhappiness, decreased energy, insomnia and irritability are all symptoms of depression. And antidepressants can help relieve depression.

But for some people, these drugs may also have dangerous or troubling side effects -- drowsiness, feelings of panic, nervousness, sexual problems, thoughts of suicide or weight gain -- and should be taken only by people who really need them. So it's alarming that a new study shows antidepressant use has nearly doubled in the United States since the mid-1990s.

In the study, published in the August issue of Archives of General Psychiatry, researchers analyzed data from a national survey of antidepressant use conducted in 1996 and again in 2005. The survey included people age 6 and older.

Between 1996 and 2005, the rate of those reporting that they had used antidepressants in the past year jumped from 5.8 percent to 10.1 percent. This translates to an increase from about 13.3 million people to 27 million. The change was more dramatic among whites than African Americans or Hispanics.

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Focus on Pharmacotherapy Studies in Elderly

The NIMH-sponsored New Clinical Drugs Evaluation Unit (NCDEU) meeting is a favored venue for reports and reviews of NIH-funded psychopharmacological studies, and this was true of the recent annual meeting in Hollywood, Fla. The meeting included a workshop on new investigations of antidepressant use in Alzheimer disease and a panel session on the safety of pharmacotherapy in older adults.

Two studies were developed, in part, in response to growing concern about both safety and lack of efficacy of antipsychotics for behavior symptoms in patients with dementia. These were the Depression in Alzheimer’s Disease Study–2 (DIADS-2) sertraline (Zoloft) trial, the citalopram (Celexa) versus antipsychotics nested study in the Clinical Antipsychotic Trials of Intervention Effectiveness–Alzheimer’s Disease (CATIE-AD), and the recently initiated Citalopram for Agitation in Alzheimer’s Disease (CITAD).

In describing the rationale and design of the CITAD study, Bruce Pollock, MD, Center for Addiction and Mental Health, questioned the premise for using antipsychotics in this population. “The neuropharmacologic rationale for using dopamine antagonists in elders with dopaminergic deficits is questionable,” Pollock indicated. “Agitation in Alzheimer disease is commonly derived from anxious, impulsive, and compulsive symptoms, which may be responsive to serotonergic agents.”

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The stigma of mental illness The suicides of a German footballer and two of my colleagues show how destructive is the stigma of psychiatric ill-health

Last week's suicide of the German goalkeeper Robert Enke revealed more than the terrible news of one man's death, the cruelty of depression and the pressures on sportsmen to protect the public's idealised view of them; it also exposed the ongoing shame and stigma of mental illness. For years he had been struggling with depression, kept secret from the public and his colleagues for fear of a vicious backlash that could, he apparently feared, raise questions about his capacity to care for his adopted baby girl and play for his nation.

Rather than risk this, and perhaps further despairing under the force of these private terrors, he chose the solution of death. That this seemed preferable to risking public awareness of his depression and the imagined consequences of personal shame, family destruction and exclusion from his nation's crucial sporting event, demonstrates something of the huge level of hatred that mental illness still evokes in the public imagination. The stigma only worsens the burden on those with mental health problems, typically reported as one in four of the adult population in the UK.

When people die by their own hand, a response of shocked disbelief, of the sense of an awful secret that has been starkly exposed, occurs all too often. How is it in this advanced age of emotional literacy, psychological self-help and media shrinks that the shame of depression and other mental illness causes people to desperately try to hide their problems rather than challenge society to accept that they, like so many others, are vulnerable?

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Depression, drugs linked to preterm birth

Pregnant women with a history of depression who used psychiatric medication have triple the risk of premature child delivery, U.S. researchers found.

Researchers at the University of Washington, University of Michigan and Michigan State University found that a combination of medication use and depression -- either before or during pregnancy was strongly linked to delivery before 35 weeks' gestation.

Lead author Amelia Gavin of the University of Washington said the findings highlight the need for carefully planned studies that can clarify associations between depression, psychiatric medications and preterm delivery.

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Regimens: A Supplement Didn’t Help Heart Patients

Patients with heart disease are at greater risk of dying if they are depressed. And both depression and heart disease are characterized, among other things, by low levels of omega-3 fatty acids.

So scientists wondered whether heart patients with depression might benefit from a dose of omega-3s in their antidepressant medicine. In a clinical trial, two groups of heart patients taking the antidepressant sertraline (Zoloft) were randomly assigned to receive a supplement of either omega-3s or a corn oil placebo.

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Patients with long-term diseases to be assessed for depression

GPs must assess people with chronic diseases to see whether they are suffering from depression, under new guidelines.

GPs must assess all patients with long-term diseases such as cancer to see whether they are suffering from depression, under new guidelines published today.

Too many doctors and patients assume that fatigue and weight loss are a result of the disease or the medicines they are taking, according to experts who formulated the guidelines for the National Institute for Healthcare and Clinical Excellence (NICE).

Depression affects one in six people at some point, but is three times more common in people with chronic diseases than in the rest of the population.

John Hindle, a consultant physician with the Betsi Cadwaladr University local health board, who was on the guideline development group, said that improving people's mood may even make them physically better.

"We should give everybody with physical disease the opportunity to be asked about the symptoms of depression," he said.

GPs should be asking two key questions, the guidelines say: during the last month, has the patient been bothered by feeling down, depressed or hopeless in the last month or by having little interest or pleasure in doing things?

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Increase In Long-term Antidepressant Drug Use, UK Study Reveals

A dramatic rise in antidepressant prescriptions issued by GPs has been caused by a year on year increase in the number of people taking antidepressant drugs on a long-term basis, according to researchers from the University of Southampton.


In a paper, published in the printed edition of British Medical Journal (BMJ), scientists found that despite a drop in the number of new patients diagnosed with depression over 11 years, the number of prescriptions doubled.

"We estimate that more than 2 million people are now taking antidepressants long-term over several years, in particular women aged between 18 and 30," comments Tony Kendrick, a professor in Primary Medical Care of the University's School of Medicine, who led the study.

The number of prescriptions issued per patient rose from 2.8 in 1993 to 5.6 in 2004.

Prescription Pricing Authority data shows that more than 30 million prescriptions for SSRIs (selective serotonin reuptake inhibitors) such as Prozac and Seroxat, are now issued per year, twice as many as the early 1990s. Researchers at the University of Southampton found 90 per cent of people diagnosed with depression are now taking SSRIs either continuously or as repeated courses over several years.

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Why antidepressants don't work for so many Northwestern research finds drugs aim at wrong target

More than half the people who take antidepressants for depression never get relief.

Why? Because the cause of depression has been oversimplified and drugs designed to treat it aim at the wrong target, according to new research from the Northwestern University Feinberg School of Medicine. The medications are like arrows shot at the outer rings of a bull's eye instead of the center.

A study from the laboratory of long-time depression researcher Eva Redei, presented at the Neuroscience 2009 conference in Chicago this week, appears to topple two strongly held beliefs about depression. One is that stressful life events are a major cause of depression. The other is that an imbalance in neurotransmitters in the brain triggers depressive symptoms.

Both findings are significant because these beliefs were the basis for developing drugs currently used to treat depression.

Redei, the David Lawrence Stein Professor of Psychiatry at Northwestern's Feinberg School, found powerful molecular evidence that quashes the long-held dogma that stress is generally a major cause of depression. Her new research reveals that there is almost no overlap between stress-related genes and depression-related genes.

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MENTAL DISORDERS DON'T HINDER HEADACHE TREATMENT

Contrary to long-standing thinking, medications may offer comparable headache relief to those with and without mental disorders.

For an especially miserable time, mix recurring headaches with depression, anxiety or both. But people in such a fix have cause for optimism, courtesy of a team led by psychologist Bernadette Heckman of Ohio University in Athens.

Drug treatments for headaches work just as well for patients with these psychiatric disorders as for those with no such problems, Heckman and her colleagues report in the November Pain.

Researchers and clinicians generally assume that the presence of one or more psychiatric ailments worsens headache symptoms and thus the prospects for successful treatment. Heckman and her colleagues conducted one of the few prospective studies to test that conviction.

“Contrary to conventional clinical wisdom, many patients with psychiatric disorders responded favorably to headache treatment,” Heckman says.

The team found that, during six months of treatment at any of four outpatient headache clinics, rates of improvement in headache frequency and intensity were about the same for patients with depression, anxiety, a combination of the two or no psychiatric disorders.

In a comment published with the new study, psychologist Todd Smitherman of the University of Mississippi in Oxford and psychiatrist Donald Penzien of the University of Mississippi Medical Center in Jackson say that the new findings “give us pause to reconsider our earlier predictions” that people with mental disorders respond poorly to headache treatment.

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Men on Tricyclic Antidepressant More Likely to Think of Suicide

All antidepressants may not be created equal when it comes to worsening of suicidal ideation during treatment, researchers found.

Men taking nortriptyline (Aventyl, Pamelor) were 2.4 times more likely to have an increase in suicidal thoughts than were those taking escitalopram (Lexapro), Nader Perroud, MD, of King's College London, and colleagues reported online in BMC Medicine.

Nortriptyline, a tricyclic antidepressant, was also associated with a 9.8-fold higher risk of new onset of suicidal ideation compared with the selective serotonin reuptake inhibitor (SSRI) in the prospective open-label trial.

The reason behind the difference may be that nortriptyline acts predominantly on the noradrenergic system, which, when overactive, is associated with anxiety and agitation.
Because "suicidal ideation is more common in agitated and irritable types of depression," the researchers said, "it is possible that nortriptyline may induce or worsen suicidal thoughts in some male subjects possibly through an induction of this more agitated type of depression."

Another possibility is that nortriptyline is less effective against mood symptoms, they noted.

All antidepressants now carry black box warnings of suicidality risk, particularly in children and young adults, and especially early in treatment, but whether this risk differs between agents or by gender has been debated.

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'ECG for the mind' could diagnose depression in an hour

An innovative diagnostic technique invented by a Monash University researcher could dramatically fast-track the detection of mental and neurological illnesses.

Monash biomedical engineer Brian Lithgow has developed electrovestibulography which is something akin to an 'ECG for the mind'. Patterns of electrical activity in the brain's vestibular (or balance) system are measured against distinct response patterns found in depression, schizophrenia and other Central Nervous System (CNS) disorders.

The vestibular system is closely connected to the primitive regions of the brain that relate to emotions and behaviour, so Lithgow saw the diagnostic potential of measuring and comparing different patterns of electrovestibular activity.

Working with psychiatry researchers at Monash University's Alfred Psychiatry Research Centre (MAPrc) in Melbourne, Australia, he tested volunteers and found distinct response patterns, or "biomarkers", that distinguished different CNS diseases from each other and from regular electrovestibular activity.

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Can depression cause osteoporosis?

[Studies indicate that a link exists and that the risk of bone disease is further increased by behaviour and medication, "One theory is that stress hormones released during depression may play a role ... The other theory is that if you suffer a bone fracture, your quality of life goes down. The question is, is it causal?" ]

In the feel-good French movie Amélie, audiences are introduced to an eccentric old character held hostage by his home and his own body. He's dubbed "The Glass Man."

Raymond Dufayel was born with bones as brittle as crystal. All the furniture in his Parisian apartment is padded, explains the narrator, and a simple handshake could crush his fingers. He's been trapped inside his home for 20 years and leads a small, lonely life.

In the 2000 thriller Unbreakable, a comic book specialist played by Samuel L. Jackson, nicknamed "Mr. Glass," is convinced he's found a real-life superhero in an unremarkable security guard played by Bruce Willis. His obsession is fuelled by his own crystalline skeleton and a villainous drive to find purpose for his lonesome, handicapped life.

Tall tales from cinematic imaginations? Of course. Entirely without foundation? Not so for those suffering from osteoporosis.

When Debbie Howe suffered a spinal fracture after bending over to pick up her baby, she was housebound for six months, and told she had the bones of 75-year-old woman. Six weeks later, she broke another vertebra from raising her arms over her head to shampoo her hair. She was 36 at the time.

"Those were some pretty grey days," Howe, now 57, said in her King City home.

Over the last decade or so, the relationship between depression, the use of antidepressants and osteoporosis has been the subject of a growing body of research.

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Treatment guidelines issued on depression during pregnancy

For women with serious conditions, medication may be the best route, but 'talk therapy' may alleviate suffering for others, according to a document prepared by two national physicians groups.

For the nearly one in four women who experience symptoms of depression during pregnancy, physicians on the front lines have long had little more than a prescription for antidepressants and a massive dose of uncertainty to offer.

The result: At last count, roughly 13% of pregnant women in the United States took antidepressant medications at some point in their pregnancy -- often with little to guide them in weighing the risks the drugs may pose to their fetus against the misery and dangers of untreated depression.

In a bid to resolve that conundrum, two of the nation's leading physicians groups have issued the first guidelines for the treatment of depression during pregnancy.

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Depression After ACS Worsens Outcomes

Persistent depression after acute coronary syndrome continues to be a risk factor for early death for up to seven years, researchers said.

With a median of 6.7 years of follow-up, patients who encountered major depression after acute coronary syndrome -- and whose depression did not improve with treatment -- had a hazard ratio for death of 2.39 (95% CI 1.50 to 3.81) compared with those showing substantial improvement, according to Alexander Glassman, MD, of Columbia University, and colleagues.

The study involved patients in the randomized SADHART trial, which involved treatment with , sertraline (Zoloft) or placebo. Those who took their medications on schedule were more likely to show improvement in depression scores, the researchers wrote in the September issue of Archives of General Psychiatry.

Hence, they said, "physicians need to aggressively treat depression and be diligent in promoting adherence to guideline cardiovascular drug therapy."

The SADHART study (Sertraline Antidepressant Heart Attack Randomized Trial) began in 2000 with 369 patients hospitalized for acute coronary syndrome who were found to have major depression on screening.

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Pills and America's pursuit of happiness

Antidepressant use has soared during the recession but reaching for the pill bottle goes back decades.

Of all the bitter pills Americans are swallowing nowadays, from joblessness to home foreclosures to runaway national debt, it might come as no surprise that a pill of another sort is flying off the shelves at a recession-defying pace – the antidepressant.

It's an easy jump to conclude that hard times are turning the country comfortably numb, as the Washington Post suggested in a weekend report on the sales of the drug Cymbalta, up 14 per cent since the summer of 2008 and now among America's most popular happy pills.

Drill deeper and you will find that the U.S., though far and away a world leader with its $10-billion-a-year antidepressant habit, is not alone.

Over the summer, British politicians fretted over the impact of recession on mental health amid data showing a spike of 2.1 million antidepressant prescriptions last year, when the downturn took its first precipitous dive.

Same in India, where pharmaceutical firms reported a 20 per cent expansion of the antidepressant market in the year ending December 2008. And in New Zealand, where the global plunge was linked to reports of a near doubling in antidepressant prescriptions between 2002 and 2008.

But drill down deeper still and the story behind the flurry of cause-and-effect headlines is far more nuanced.

While many researchers acknowledge there is likely an uptick in med sales as a consequence of the poor economy, most say it is driven as much or more by trends decades in the making.

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Cymbalta's waning patent and generic rivals soon could threaten Lilly's sales

Eli Lilly has enjoyed a wave of success with antidepressants, but analysts say such expertise must now bring new revenue growth.

Eli Lilly and Co. built a large part of its fortune selling medications for gloom, anxiety and withdrawal.

Now the question is: Can the Indianapolis drug maker keep riding the antidepressant wave? Can it find its next Prozac, its next Cymbalta?

Use of antidepressants in the U.S. doubled from 1996 to 2005, as more people sought out treatment and the stigma of depression has fallen, according to a study published in the August issue of the Archives of General Psychiatry. All told, about 10 percent of Americans, or 27 million people, were prescribed an antidepressant in 2005, up sharply from 13 million people a decade earlier.

"There's a huge increase in the recognition of depression and its symptoms," said Dr. Jim Martinez, an Indianapolis psychiatrist and adviser to Lilly. "And I think we've seen a growing improvement in public attitudes around seeking care for this disease."

But in recent years, the market has faced growing headwinds. Industry sales from antidepressants dipped nearly 14 percent in the past four years, even as the number of prescriptions dispensed for the pills has continued to climb. Medco Health Solutions, a huge pharmacy company that studies drug trends, is forecasting that use of antidepressants is likely to grow slowly over the next three years.

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Online Psychiatric Counseling Appears Effective New Study Shows Remote Counseling Online Can Have Mental Health Benefits

If you're feeling depressed but can't see a shrink in person, the next best thing may be instant messaging, according to a new British study.

Online cognitive behavioral therapy for depression -- with patients and therapists communicating in real time via instant messaging, or IM -- was not only effective, but could broaden access to treatment, researchers reported in the Aug. 22 issue of The Lancet.

After four months, 38 percent of patients who had participated in the Internet-based therapy program had recovered from depression, compared with 24 percent of those in a control group, according to Dr. David Kessler of the University of Bristol.

After eight months' follow-up, 42 percent of the treatment group -- but only 26 percent of controls -- had recovered.

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Antidepressants once seen as miracle drugs: now risks are becoming evident

Since the horror of the Thalidomide scandal in the 1960s, pharmaceutical companies and medicines regulators have been acutely aware of the dangers drugs may pose to the unborn child.

Establishing what the effect of a drug may be on a foetus, however, is no simple task. Companies must rely on animal studies in the early stages of research and hope that the drug will behave in humans in the same way. Trials on pregnant women are rarely carried out, for obvious reasons.

Depression and anxiety became big business for the pharmaceutical industry in the 1990s as doctors became better at diagnosing the problems, exposing a population of over-achieving, highly-stressed, worried-well.

Women, always more willing to see a doctor than men, were a large proportion of those diagnosed and put on SSRIs (selective serotonin reuptake inhibitors) such as Prozac and the British drug Seroxat, known as Paxil in the US. For a while, these seemed to be the new miracle drugs. They were safer than older antidepressants because the severely depressed could not overdose on them.

But in court cases about to begin in the US, it will be argued that insufficient attention was paid to the possible dangers for young women who were pregnant or might become pregnant and more particularly, for their babies.

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Study shows schools could help in reducing depression

Research by the University of Queensland has shown school intervention programs could help radically reduce the amount ofhttp://www.thetechherald.com/article.php/200930/4122/Study-shows-schools-could-help-in-reducing-depression being prescribed to adolescent boys.

School Counsellor Mark Taylor, who led the research, said that schools could help students deal with depression by teaching more conflict resolution and positive thinking, as well as encouraging more outdoor activities.

Dr Taylor said he was concerned not enough was being done to look at underlying conditions of adolescents' depression.

“Working in a school setting as a counsellor I became concerned about the numbers of students who were being prescribed antidepressants, without what I considered to be enough effort to find out what was going on in the lives of these students,” Dr Taylor said in a University of Queensland (UQ) news release.

“I wanted to substantiate that there are viable alternatives to antidepressants which can significantly reduce depressive symptoms.”

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Depression Poses Pregnancy Risks

Thanks to high-profile celebrities like Brooke Shields, postpartum depression is out of the closet and discussed as something to recognize and treat.

But less well known is depression during pregnancy -- a common problem as well, and one that also can be risky for the unborn baby, experts now know.

A depressed woman, for instance, is more likely to give birth early, increasing health risks for the baby.

Depression during pregnancy is more common than most people believe, agree Dr. De-Kun Li, a reproductive perinatal epidemiologist in the research division at Kaiser Permanente in Oakland, Calif., and Dr. Diana Dell, a psychiatrist and obstetrician-gynecologist at Duke University Medical Center in Durham, N.C.

One or two of every 10 pregnant women have symptoms of major depression, according to the March of Dimes. Those who have had a bout of depression before are more likely to get it again. And Li said that others might have depressive symptoms -- short of clinical depression but still bothersome and unhealthy.

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