Plagued by midsummer SADness

Seasonal Affective Disorder is normally banished by the sunshine, but this year it is lingering on, reports Chloe Rhodes

Now is the winter of our discontent. The fact that it's July is irrelevant.

Flooding, freak hail and attempted terrorist attacks have blighted what is usually our sunniest and most carefree time of year, while grey skies and incessant showers have turned midsummer into one long, gloomy February afternoon.

Everyone gets fed up when bad weather drags on, but for some people, including me, the lack of sunshine has a bigger impact.

One in 50 of us is thought to suffer from Seasonal Affective Disorder (SAD), the symptoms of which include lethargy, anxiety, irritability, loss of libido and depression. One in eight experiences a milder version known as winter blues, and both usually occur in the months between October and March, when daylight hours are reduced.

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Antidepressants most prescribed drugs in U.S.

Dr. Ronald Dworkin tells the story of a woman who didn't like the way her husband was handling the family finances. She wanted to start keeping the books herself but didn't want to insult her husband.

Antidepressants such as Paxil, Prozac and Lexapro are among America's most-prescribed drugs.

The doctor suggested she try an antidepressant to make herself feel better.

She got the antidepressant, and she did feel better, said Dr. Dworkin, who told the story in his book "Artificial Unhappiness: The Dark Side of the New Happy Class." But in the meantime, Dworkin says, the woman's husband led the family into financial ruin.

"Doctors are now medicating unhappiness," said Dworkin. "Too many people take drugs when they really need to be making changes in their lives."

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Pharma ads could come to Canada

Now the Supreme Court of Canada has upheld tobacco advertising restrictions, the next giant court battle -- over prescription drug marketing -- is around the corner.

Cross-examination of expert witnesses is set to begin this fall in a constitutional challenge that pits CanWest MediaWorks Inc. against a coalition of health, consumer and union groups.

CanWest, which owns a string of newspapers, as well as Global Television, wants the ban on so-called direct-to-consumer advertising of prescription drugs removed, arguing it's a violation of freedom of expression.

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Medicaid Recipients Have Trouble Finding Mental Health Care

Medicaid beneficiaries with substance abuse and mental disorders are less likely to use community services, even though most of the medical help for these disorders is community-based, a new study finds.

The study, which is published in the July issue of Psychiatric Services, examined where integrated treatments for co-occurring psychiatric and substance abuse disorders would be most needed for Medicaid recipients.

Psychiatric and substance abuse disorders are a major problem among the Medicaid population, which has 50 percent to 100 percent more cases than the general population.

Previous research has suggested that community-based treatment for these disorders is superior to treatment in hospitals, with the continuity of treatment being weaker and costs being higher in hospital settings. Because of this, care providers have focused on providing intervention programs in community settings, such as clinics and therapists' offices.

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Lilly May Face More Zyprexa Lawsuits After FDA Letter (Update2)

Eli Lilly & Co. may attract more lawsuits alleging it failed to warn users that a psychiatric drug was linked to diabetes after the pharmaceutical company received a letter from U.S. regulators.

The U.S. Food and Drug Administration told Lilly in March it would delay the approval of Symbyax for hard-to-treat depression because the agency wanted more information about the risk of diabetes in the medicine's prescribing label. Symbyax combines Lilly's antipsychotic pill Zyprexa and the antidepressant Prozac.

The FDA's request, in a letter to Lilly obtained by Bloomberg, may bolster plaintiffs' suits against the Indianapolis company over side effects tied to Zyprexa, lawyers said. Lilly has paid more than $1.2 billion to settle 29,000 claims that patients weren't adequately warned that Zyprexa can cause diabetes, weight gain and pancreas infections.

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Fewer kids on SSRI antidepressants

Within 2 years after the October 2003 FDA public health advisory about the risk of suicide in children taking a type of antidepressant called selective serotonin reuptake inhibitors (SSRIs), significant reductions in rates of diagnosis and antidepressant treatment of childhood depression occurred, researchers report.

"Antidepressant use was expected to decline, consistent with effects on other drugs after warnings are issued," Dr. Anne M. Libby of University of Colorado Health Science Center at Denver told Reuters Health.

However, "we were most surprised at the diagnosing rate decline, reversing a national trend as evidence of a decade of work to educate and promote depression treatment in primary care," she added.

"Our concern is the lack of treatment for a disorder that is quite serious in childhood, as depression is a large and significant risk factor for suicide," Libby added.

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Patients Use Less Medicine When They Must Pay More, Study Finds

Patients use fewer prescription drugs when they have to pay more for the medicines, according to research that suggests shifting health-care costs to consumers may lead to more serious illness over time.

Consumers spend 2 to 6 percent less on the drugs for every 10 percent increase in out-of-pocket costs, according to a review of 132 studies released today by the Rand Corp., a Santa Monica, California-based public policy institute.

Companies seeking to hold the line on health-care spending are requiring employees to pay higher deductibles for insurance or offering co-insurance plans that split costs. A study this year in the journal Health Affairs found consumers may spend $440.8 billion out of pocket in 2016, 76 percent more than in 2006. More study is needed to determine if such increases will cause consumers to skip necessary treatment, researchers said.

``For patients with certain chronic illnesses, when you increase cost sharing on the pharmacy side, you end up with more hospitalizations and more use of emergency departments,'' said Dana Goldman, the study's lead author and Rand's director of health economics, in a telephone interview yesterday. The research was presented today in the Journal of the American Medical Association

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Suicide attempts decline after depression treatment

In a study of more than 100,000 patients treated for depression, suicide attempts declined during the first month of treatment—whether that treatment consisted of medication, psychotherapy, or both. The findings, published in the July American Journal of Psychiatry, show a similar pattern for populations of adolescents and young adults (up to age 24) as for older adults.

The study sheds new light on the “black box” advisory the FDA placed in 2004 and has revised since then, said a psychiatrist who led the study. The advisory—which has concerned many patients, families, and care providers—warns that suicidal behavior may emerge soon after people younger than 25 start treatment with newer antidepressant medications called selective serotonin reuptake inhibitors (SSRIs). It was spurred by randomized placebo-controlled trials showing that starting to take an SSRI can make thoughts of suicide more common among some teens and young adults.

The study is the first published research to compare the risk of suicide attempts before and after the start of treatment with not only antidepressants but also psychotherapy. It is based on computerized medical and pharmacy records for more than 109,000 patients who started treatment for depression from 1996 to 2005

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Analysis: SSRIs-fetal brain defect linked

Two new studies of anti-depressant use during pregnancy have found new evidence of a previously suspected link between anti-depressants and fetal heart defects. In addition, a troubling connection to additional problems with the fetus's developing skull and intestines have been identified for the first time.

The new research -- published in the June 28 New England Journal of Medicine -- includes a review of national data on birth defects by researchers at the Centers for Disease Control that found women who took a class of anti-depressants called selective serotonin re-uptake inhibitors, or SSRIs, had a 2.4 percent higher risk of having an infant with anencephaly, or no brain.

The study also linked SSRI use with craniosynostosis, when the skull forms too early so the brain cannot grow properly, and gastroschisis, when organs protrude from the navel.

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Dosage Adjustment in Special Populations

Special consideration may be necessary when prescribing pharmacologic therapy for depression and anxiety disorders in certain populations of patients. These populations are diverse in demographics and symptomatology. As a result, discussions of the special considerations their comorbid conditions require tend to be outside of the mainstream literature. This article discusses 3 special populations: patients with traumatic brain injury (TBI), patients with HIV or AIDS, and Asian Americans. When prescribing pharmacologic therapy for depression to patients in these special populations, clinicians must perform thorough patient assessments, maintain a high index of suspicion for comorbidities, and proceed with slow and gentle titration of medications.

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Antidepressant studies find low birth-defect risk

Use of antidepressants by pregnant women doesn't significantly increase the risk of birth defects, with rare exceptions, two studies found.

The overall risk of having a child with a defect increased by less than 1 percent in women on the drugs, including Pfizer Inc.'s Zoloft, GlaxoSmithKline PLC's Paxil and Forest Laboratories Inc.'s Celexa, according to research published today in The New England Journal of Medicine.

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Approval of J&J's Antipsychotic Delayed for Teens

U.S. regulators delayed a request by Johnson & Johnson to expand use of its top-selling Risperdal to include schizophrenia and bipolar disorder in adolescents.

The FDA didn't request new studies on the treatment in a letter to the company, J&J said in a statement today. J&J said it would work with the agency to complete prescribing information on the drug, which is already approved for use in children with autism and adults with schizophrenia and bipolar disorder.

Use of antipsychotic drugs for younger patients has risen sharply in recent years, prompting concern among some doctors and parents about side effects including weight gain and diabetes. Risperdal, which generated $4.2 billion last year, is the second such drug delayed by U.S. regulators for teen use. Eli Lilly's Zyprexa was held up in April.

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Errors Drop 66% When Doctors Computerize Prescriptions

Medication errors such as prescribing or administering the wrong drugs to patients dropped 66% in hospitals used a computerized system to record doctors' orders.

Prescription errors costing each U.S. hospital as much as $5.6 million a year declined when doctors directly entered their instructions into an electronic system, rather than having staff transcribe handwritten notes, according to a review by the University of Minnesota of 12 separate studies.

"The problem is more complicated than bad handwriting or individual negligence," said Tatyana A. Shamliyan, a research associate at the University of Minnesota's School of Public Health. "There are several steps, and through all the steps errors can be introduced."

Switching from handwritten prescriptions to direct computer entry by doctors would reduce the medication errors that injure or kill half a million patients each year, the researchers said.

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Psychiatrists Top in Drug Maker Gifts

As states begin to require drug companies disclose their payments to doctors for lectures and other services, a pattern has emerged: psychiatrists earn more money from drug makers than doctors in any other specialty.

How this money may be influencing psychiatrists and other doctors has become one of the most contentious issues in health care. For instance, the more psychiatrists have earned from drug makers, the more they have prescribed a new class of powerful medicines known as atypical antipsychotics to children, for whom the drugs are especially risky and mostly unapproved.

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Anti-depressants weaken elderly bones

Two studies published add to growing evidence the most popular class of drugs taken to treat depression may contribute to fragile bones in elderly people.

The research focused on a class of antidepressant drugs called selective serotonin reuptake inhibitors. Millions of people, including many elderly, take these drugs, known as SSRIs, which include Eli Lilly's Prozac, known generically as fluoxetine.

Two teams of researchers found that older men and women taking SSRIs had more bone loss than those not taking the drugs, which account for more than 60 percent of U.S. antidepressant drug prescriptions. A drop in bone mass can lead to osteoporosis and bone fractures.

A team led by Dr. Susan Diem of the University of Minnesota tracked 2,722 women, average age 78, including 198 SSRI users. They measured their bone mineral density five years apart

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Hospitalised Heart Patients Safer with Anti-depressants

According to the research findings, patients with “acute coronary syndrome” are less likely to have certain subsequent heart-related events if they are taking a selective serotonin reuptake inhibitor or SSRI. Primarily used for relieving depression, SSRI drugs also stop platelets from clumping together.

Led by Dr. Roy C. Ziegelstein, the research team based their study on the fact that SSRIs are often used for treating anxiety and depression in coronary heart disease patients. They wanted to ascertain if this has an effect on the patients’ outcome.

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BEHAVIOUR DRUGS FOR CHILDREN 'UBIQUITOUS'

Canadian children are being widely prescribed antipsychotic drugs for behaviour and mood problems, with a significant proportion of the powerful drugs going to children under the age of nine, new research shows.

Ninety-four per cent of 176 child psychiatrists in Canada surveyed are prescribing drugs known as atypical antipsychotics for a variety of disorders and symptoms, including anxiety, attention-deficit hyperactivity disorder and "poor frustration tolerance."

While most prescriptions were for children 13 and older, researchers found that a "surprising" number were for the very young: Twelve per cent of all prescriptions were for children aged eight or under, including three-year-olds.

None of the drugs has been officially approved for use in children. All are in a different class from Ritalin, a stimulant used to treat attention deficit disorder in children.

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FDA Delays Risperdal For Teenagers

Untold numbers 0f kids may be prescribed antipsychotics on an off-the-label basis every year, but the FDA held back from giving Johnson & Johnson its blessing to market the drug officially to teenagers suffering from schizophrenia.

The agency has issued an approvable letter in response to the drugmaker’s request to market Risperdal for schizophrenia in youngsters between 13 and 17, and for short-treatment of bipolar mania associated with bipolar I disorder in kids between 10 and 17. J&J was quick to note, however, that the FDA didn’t request new studies, according to its statement today.

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Gates Vows to Fix Mental Health System

Defense Secretary Robert Gates promised Thursday to speed up changes to the military's much-criticized mental health system, declaring ''this is something that we can, must and will get fixed.''

A study released last week said more money and people are needed to care for troops suffering depression, anxiety, post-traumatic stress symptoms and other mental health problems because of their war experiences. It also said the Pentagon needs to build a culture of support throughout the military to help remove the stigma of asking for and getting psychological help.

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On the Horizon, Personalized Depression Drugs

Imagine that you are depressed and see a psychiatrist who explains that you have clinical depression and would benefit from an antidepressant. So far, so good. But then the doctor tells you there is a 60 percent chance that you’ll feel better with this antidepressant and that it could take as long as four to six weeks to find out, during which time you’ll probably have some side effects from the drug.

With a simple blood test, the doctor will be able to characterize a patient’s unique genetic profile, determining what biological type of depression the patient has and which antidepressant is likely to work best.

Scientists have identified genetic variations that affect specific neurotransmitter functions, which could explain why some patients respond to some drugs but not to others. For example, some depressed patients who have abnormally low levels of serotonin respond to S.S.R.I.’s, which relieve depression, in part, by flooding the brain with serotonin. Other depressed patients may have an abnormality in other neurotransmitters that regulate mood, like norepinephrine or dopamine, and may not respond to S.S.R.I.’s.

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