Can Anticonvulsants Help Patients With Anxiety Disorders? What Does the Evidence Show?

Anxiety disorders are chronic conditions that follow a relapsing/remitting course.1 The evidence to support this view comes primarily from cross-sectional and retrospective assessments of duration of illness and, in part, from prospective studies. The waxing and waning nature of panic disorder and generalized anxiety disorder (GAD), for example, has been clearly demonstrated. Much less information is available about the course of illness of social phobia. However, both community studies and patient samples suggest an age of onset of social phobia in mid to late teens with a chronicity that is equal to or greater than that of panic disorder.2 Nevertheless, this recognition has not reshaped our basic treatment approach, which focuses almost entirely on the acute control of symptoms and only secondarily acknowledges relapse prevention.

In addition, the natural history of anxiety disorders is frequently complicated by Axis I and Axis II comorbidity that seems to be significantly higher among patients who seek treatment than in persons in the community who are not in treatment.1 In fact, it has been estimated that 73% of patients with panic disorder had other comorbid conditions that ranged from major depression to substance abuse until the onset of the Axis II disorders, mostly cluster C type 1 to 2. It is, therefore, evident that any long-term anxiolytic treatment strategy must take account of these high rates of comorbidity that appear to develop during the longitudinal phase of the anxiety disorder.

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ADHD Gene Doesn't Predict Response to Drugs

Canadian researchers report that their discovery of a gene variant that seems to affect the severity of attention-deficit hyperactivity disorder did not help them predict which patients are likely to respond to a class of drugs widely used to treat the disorder.

The lack of a connection between the variant and response to methylphenidates was a blow for researchers, who have hoped to use genetic data to better predict who might be the best candidates for this treatment. Ritalin is one example of a methylphenidate.

"It is a negative study," said Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Schneider Children's Hospital in New Hyde Park, N.Y. "The goal is to try and better identify patients who are best going to respond to which medicine, and they didn't get the findings they were hoping to find. Their theory wasn't supported by the data."

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AstraZeneca's Seroquel Cleared for Bipolar Disorder (Update2)

AstraZeneca Plc, the U.K.'s second-largest drugmaker, won U.S. approval to widen the use of its Seroquel antipsychotic medicine to treat bipolar disorder, pitting the treatment against Eli Lilly & Co.'s top-selling Zyprexa and Bristol-Myers Squibb Co.'s Abilify.

Patients may take the therapy as an adjunct to the standard treatments lithium or divalproex, London-based AstraZeneca said today in a statement.

Seroquel brought in $4.03 billion last year, making it AstraZeneca's second-best-selling product after Nexium for ulcers. AstraZeneca is trying to broaden the medicine's use to protect sales under threat from generic copies. The drugmaker this month asked the Food and Drug Administration to approve the therapy to treat generalized anxiety disorder.

``Seroquel is increasingly being rolled out for additional indications and may, in due course, become the go-to product for depressive disorders,'' Charles Stanley analyst Jeremy Batstone-Carr said in an e-mail.

READ MORE @ BLOOMBERG

Mood lifting - Growing evidence suggests that exercise is as good for your mental health as it is for your physical well-being

Monday mornings, Theo Baars's exhausting depression often tries to seduce him into just staying in bed. But then, he says, a staffer at Appleton House, a residence for people with psychotic disorders at McLean Hospital, comes into his room and says, insistently, "You want to go work out."

So Baars, a 22-year-old surfer and musician, drags himself to McLean's new gym and sweats through a half hour of presses and curls. And then, he finds, he doesn't want to go back to bed. And more: His confidence is pumped up. His thinking tends to be less delusional, more reality-based.

"Working out helps me get my self back," he said.

Baars's personal experience reflects longstanding wisdom that is now gaining the added heft that comes from carefully conducted research. Exercise, the studies increasingly suggest, may be as good for your brain as it is for your body, whether you are mentally ill or not.

As Cambridge psychiatrist and author Dr. John Ratey puts it, if exercise could be bottled, it would be the greatest blockbuster drug ever. "Exercise is medicine for the brain," he said.

READ MORE @ BOSTON GLOBE

Depressed Teens More Likely To Get Better With Switch To Combination Therapy

More than half of teenagers with the most debilitating forms of depression that do not respond to treatment with selective serotonin reuptake inhibitors (SSRIs) show improvement after switching to a different medication combined with cognitive behavioral therapy, researchers at UT Southwestern Medical Center and their colleagues in a multicenter study have found.

Dr. Graham Emslie, professor of psychiatry and pediatrics at UT Southwestern and chief of child and adolescent psychiatry at Children's Medical Center Dallas, was a principal investigator in the study appearing in the Journal of the American Medical Association.

Adolescents with treatment-resistant depression have unique needs, for which standard treatments do not always work. "If an adolescent hasn't responded to an initial treatment, go ahead and switch treatments," said Dr. Emslie. "Our results should encourage clinicians to not let an adolescent stay on the same medication and still suffer."

The 334 study participants suffered from depression on average for about two years. The teenagers involved exhibited moderate to severe major depressive disorder, many with suicidal ideation. Historically, these types of patients have the worst treatment outcomes.

READ MORE @ SCIENCE DAILY

Study Suggests Risperidone Long-Acting Injection Combined With Standard Treatment Helped Delay Time To Relapse In Patients With Bipolar Disorder

Patients with frequently relapsing bipolar disorder had a significant delay in the time to an initial relapse when risperidone long-acting injection (RLAI) was combined with standard treatment, according to a new study. The study compared patients who received RLAI and standard treatment to those who received standard treatment combined with placebo.

The study was presented yesterday at the 14th Biennial Winter Workshop on Schizophrenia and Bipolar Disordersin Montreux, Switzerland.1 This one-year, phase 3, trial is the first placebo-controlled study to explore the use of a long-acting injection medication in the maintenance treatment of frequently relapsing bipolar disorder (FRBD). FRBD, defined as four or more manic or depressive episodes in the previous year that require a doctor's care, may affect 20% of the 27 million people with bipolar disorder worldwide.2, 3

The study compared the time to the next mood episode, also known as a relapse, in FRBD patients receiving RLAI plus standard treatment vs. patients receiving placebo plus standard treatment. For most patients, standard treatment consisted of mood stabilizers, antidepressants, anxiolytics or combinations thereof. The trial showed that time to relapse was significantly longer in patients receiving RLAI compared with placebo (p=0.004) and the relative risk of relapse was 2.4 times higher with placebo. The relapse rates were 47.8% with placebo and 22.2% with RLAI.

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Depression - the facts and the fables

If there's one thing I love, it's academics who take on the work of investigative journalism, because they are dogged. This has been a bad week for the SSRI antidepressants. First there's the stuff you already know: bad data got buried. In a cracking new analysis of the "publication bias" in the literature, a group of academics this week published a paper in the New England Journal of Medicine which listed all the trials on SSRIs that had ever been formally registered with the Food and Drug Administration, and then went to look for the same trials in the academic literature.

Thirty-seven studies were assessed by the FDA as positive and, with one exception, every single one of those positive trials got properly written up and published. Meanwhile, 22 studies that had negative or iffy results were simply not published at all, and 11 were written up and published in a way that described them as having a positive outcome.

You're a sophisticated reader, so you understand this doesn't mean that they're necessarily rubbish drugs, but you also understand that this is dodgy behaviour, all the same.

That's the easy one.

READ MORE @ THE GUARDIAN

The Politics Of Depression

There was a fascinating exchange of letters in this month's American Journal of Psychiatry concerning just how much depression doctors should accept in their patients and the implications of such decisions. What prompted the initial letter was the federally-funded STAR-D trial, which showed that current depression treatments--including some psychotherapies--are no where near as robust as doctors (and presumably patients) would like. What the trial showed, in short, was that various anti-depressants had anywhere from an 8 percent to 30 percent chance of success in remitting symptoms of depression.

That leaves a large subset of people who do not get relief using current therapies and that raises a host of practical issues for the mental health field. This situation affects millions of Americans.

READ MORE @ FURIOUS SEASONS