Survey: Post-Storm Mental Health Worsens

More Gulf Coast residents are thinking seriously about suicide or showing symptoms of post-traumatic stress disorder as the recovery from Hurricane Katrina inches along, a new survey finds.

The survey is a follow-up to one done six months after the hurricane, which found that few people in Louisiana, Mississippi and Alabama _ about 3 percent _ had contemplated suicide in the storm's aftermath.

That figure has now doubled in the three-state area and is up to 8 percent in the New Orleans area, according to Ronald Kessler of Harvard Medical School, lead researcher for the Hurricane Katrina Community Advisory Group.

More people also showed signs of post-traumatic stress disorder, 21 percent of those interviewed this year compared to 16 percent in the earlier survey.

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Your mama or your MAOA? Monoamine oxidase-A, co-implicated in mood and behavior disorders.

It is generally accepted that bad parenting leads to psychopathology -- unless the child is "resilient." But which kids are resilient? Those who overcome bad environments.

Is this a circular argument or nonsense? Some remarkable findings concerning this question have risen from an emerging interdisciplinary approach known as psychiatric epidemiology. Psychiatric epidemiology combines genetics, epidemiology and neuroscience to investigate how genes and environment affect vulnerability to psychiatric and mood disorders. Last year two of this discipline's leaders, Avshalom Caspi and Terrie Moffitt, reviewed its main findings in Nature Reviews Neuroscience. Their paper, "Gene-Environment Interactions in Psychiatry: Joining Forces with Neuroscience" [see abstract or pdf download of the paper] suggests that the gene may have less of a stranglehold on one's destiny than is often assumed. The paper also raises questions about why so-called maladaptive responses to environment, such as depression or passivity, have survived millennia of selective pressure.

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Happy Days: Unraveling the Mystery of How Antidepressants Work

The mechanism behind antidepressant drugs is unveiled, which could lead to better treatments for depression and anxiety disorders.

New research shows how certain antidepressants work, paving the way to new, improved versions of the drugs used to treat depression, anxiety and attention deficit disorder.

Two separate studies—published this week in Science and Nature—provide a window into the way tricyclic antidepressants, such as clomipramine and desipramine, provide therapeutic relief by adhering to proteins on the part of a nerve cell's outer membrane that extends into the brain's synapses (spaces between the cells). These so-called transporter proteins, so-named because they carry molecules inside the nerve cell, gobble up neurotransmitters (chemical messengers such as norepinephrine, serotonin and dopamine) sent by neighboring cells. The drainage of these neurotransmitters from synapses—resulting, ironically, from the reimportation of the chemical just secreted by the sending neuron—has been linked to anxiety disorders; tricyclic antidepressants boost the activity of these neurotransmitters in synapses. But scientists have never been sure how this was accomplished.

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Depression is over-diagnosed, psychiatrist claims

Too many people are being diagnosed with depression when they are merely unhappy, a senior psychiatrist said today.

Normal emotions are sometimes being treated as mental illness because the threshold for clinical depression is too low, according to Professor Gordon Parker.

Prof Parker said depression had become a "catch-all" diagnosis, driven by clever marketing from pharmaceutical companies and leading to the burgeoning prescription of antidepressant drugs.

Writing in the British Medical Journal (BMJ), he said the drugs were being marketed beyond their "true utility" in cases in which people were unhappy rather than clinically depressed.

The psychiatrist, of the University of New South Wales, Australia, said the "over-diagnosis" of depression began in the early 80s, when the diagnostic threshold for minor mood disorders was lowered.

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Relapse From Antidepressant Medication May Be Lack Of Response To Medication In The First Place

A new study by Rhode Island Hospital researchers indicates that a relapse during antidepressant continuation treatment may be due to a relapse in patients who were not true drug responders. The loss of drug response may be due to loss of placebo response (a positive medical response to taking a placebo as if it were an active medication.).

Historically, the treatment of depression is divided into three phases -- initial/acute, continuation and maintenance. During the initial phase, the goal is to reduce symptoms and psychosocial impairment. During the continuation phase, usually six months to one year after initial treatment response, the goal is to maintain the gains and prevent a relapse. In the maintenance phase, which occurs after a sustained period of improvement, the goal is to further maintain the gains and prevent recurrence of the disorder.

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Prenatal antidepressants linked to preterm births

Antidepressant drug use during pregnancy, but not depression itself, is associated with an increased risk of preterm birth and lower fetal age at delivery, according to results of a study published in the American Journal of Psychiatry.

"Depressive symptoms are not uncommon during pregnancy, and...symptoms may occur more frequently during pregnancy than in the postpartum period," write Dr. Rita Suri and colleagues from the University of California, Los Angeles. Depression during pregnancy and just after delivery "has been associated with low maternal weight gain, increased frequency of cigarette, alcohol, and substance use, and ambivalence about the pregnancy."

To further investigate, the researchers examined the effects of maternal depression and antidepressant drug use on fetal age and risk of preterm birth in a study of 90 pregnant women.

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Indications for Antidepressant use in patients with chronic pain disorders

....USE OF ANTIDEPRESSANTS IN THE MANAGEMENT OF CHRONIC PAIN
Pain and depression are closely intertwined, strongly hinting at a shared neurophysiology. As a consequence, one prevailing pharmacologic strategy identifies a central role for serotonin and norepinephrine reuptake inhibitors (SNRIs).1 Other justifications, even without a common biologic rationale, strongly support the use of antidepressants in the management of chronic pain. For example, chronic pain characteristically causes sleep problems, anxiety, and depression, all of which may improve with antidepressant treatment.2 Providing an effective, nonhabituating sleep medication that also improves mood may significantly enhance the patient’s quality of life....

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Antidepressant Gatekeeper - Structural and functional studies point to tricyclics' mechanism of action

AN IMPORTANT CLASS of drugs-tricyclic antidepressants (TCAs)—binds in a surprising place. That finding, based on studies with a bacterial protein, could influence the design of new drugs for depression.

According to two new studies, TCAs seal off a molecular passageway in a bacterial counterpart of human neurotransmitter transporter proteins (Nature, DOI: 10.1038/nature06038 and Science, DOI: 10.1126/science.1147614). The work indicates a molecular mechanism of action for this compound class.

Since the 1950s, TCAs such as desipramine (Norpramin and Pertofrane) have been prescribed to treat symptoms of depression. They prevent reuptake of serotonin and norepinephrine by binding to corresponding membrane-spanning neurotransmitter transporter proteins

READ MORE @ CHEMICAL & ENGINEERING NEWS

U.S. deems Wyeth schizophrenia drug not approvable

U.S. health officials have determined that a schizophrenia drug developed by Wyeth and two other drugmakers is not approvable, the companies said on Friday, dealing Wyeth a second setback in a month on a product potentially close to the market.

And in another blow to Wyeth, its partner on an experimental hepatitis C drug, ViroPharma Inc., said on Friday that the companies were stopping a clinical trial of the medicine due to safety concerns.

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Cheerful news for antidepressant research

Two research groups have independently reported new findings on the mechanism of action of an important class of antidepressant drugs. The work provides key insights into how tricyclic antidepressants interfere with neurophysiology at the molecular scale, and could eventually open the way to the development of more efficient therapies.

Tricyclic antidepressants (TCAs) are molecules that resemble a kite, with a central seven-membered ring trailing a short tail and flanked by two benzene rings. TCAs work by inhibiting neurons from taking up the monoamine neurotransmitters serotonin, norepinephrine and dopamine, which regulate mood. By blocking the re-uptake of these transmitters by their specific transporter proteins, the transmitter molecules remain in circulation for longer, prolonging their action.

However, the precise way in which the drugs work had remained unresolved. Now, Maarten Reith, Da-Neng Wang and colleagues1 at the New York University School of Medicine, US, and a team led by Eric Gouaux2 at the Oregon Health and Science University, US, have independently provided data on how TCA molecules bind to a bacterial analogue of a mammalian neurotransmitter transporter.

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Tailor-made Antidepressants?

....The most important consequence of research on interaction between genetic and environmental factors is that, in a foreseeable future, scientists will be able to produce measures to predict response to antidepressants taking into account each individual's genotype, i. e. they will be able to design tailor-made drugs according to each person's genetic configuration and their exposure to environmental factors....

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Efexor* XL (venlafaxine) May Help Adult Patients Prevent Recurrent Episodes of Depression for Up to Two Years

Clinical trial data showing that Efexor* XL (venlafaxine) helped patients prevent the recurrence of depression for up to two years1a, was presented at the British Association for Psychopharmacology summer meeting in Harrogate. It is the first time that a modern antidepressant has demonstrated prevention of recurrence, versus placebo, over a two year period.2 These findings reinforce guidance from the National Institute for Health and Clinical Excellence (NICE), that anti-depressants should be continued for two years in patients who have had 2 or more episodes. 3

Results from the Prevention of Recurrent Episodes of Depression with VENlafaxine XR for Two Years (PREVENT)1b study demonstrated that 70% of patients continued to respond to treatment with venlafaxine at doses 225mg/day and less over 2 years1c, and were therefore significantly more likely to remain recurrence-free than patients taking placebo.

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Suicide risk in adults lowered by antidepressants

Adults with depression who are treated with a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs) have a lower rate of suicide attempts, the results of a new study indicate.

In October 2004, the U.S. Food and Drug Administration (FDA) ordered drug labeling to warn of a possible link between antidepressant drug treatment and suicidal thoughts, or "ideation," and behavior in children and adolescents, the researchers note in the American Journal of Psychiatry. In May 2007, the warning was extended to include young adults.

Dr. Robert D. Gibbons, of the University of Illinois at Chicago, and colleagues examined the association between antidepressant treatment and suicide attempts in adult patients treated in the Veterans Administration health care system.

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Antipsychotics in the Treatment of Comorbid Anxiety in Bipolar Disorder

The comorbidity of anxiety disorders with bipolar disorder is a rule, not an exception, with a negative impact on both course and treatment outcome. So far, there are no guidelines or consensus for the treatment of this comorbidity. There are also no efficacy data that support the use of antidepressants or benzodiazepines in the treatment of anxiety disorder in this population. Benzodiazepines, the second-line agents for some primary anxiety disorders, may be riskier for patients with bipolar disorder because they are associated with a high rate of comorbid substance use disorder. Some preliminary data have shown that antipsychotics, especially atypical anti- psychotics, may be a viable alternative for patients with comorbid bipolar and anxiety disorders with or without substance use disorder.

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Success Or Failure Of Antidepressant Citalopram Predicted By Gene Variation

A variation in a gene called GRIK4 appears to make people with depression more likely to respond to the medication citalopram (Celexa) than are people without the variation, a study by the National Institute of Mental Health (NIMH), part of the National Institutes of Health, has found.

The increased likelihood was small, but when people had both this variation and one in a different gene shown to have a similarly small effect in an earlier study, they were 23 percent more likely to respond to citalopram than were people with neither variation.

The finding addresses a key issue in mental health research: the differences in people's responses to antidepressant medications, thought to be based partly on differences in their genes. Some patients respond to the first antidepressant they attempt, but many don't. Each medication takes weeks to exert its full effects, and patients' depression may worsen while they search for a medication that helps. Genetic studies, such as the one described here, may lead to a better understanding of which treatments are likely to work for each patient.

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Are antidepressants taking the edge off love?

Sure, we know about the sexual side effects of SSRIs. But researchers now wonder if that's the only aspect of romance the drugs can influence.

LOVE'S first rush is a private madness between two people, all-consuming and, if mutually felt, endlessly wonderful.

Couples think about the other obsessively -- on a roller coaster of euphoria when together, longing when apart.

"It's temporary insanity," says Helen Fisher, an evolutionary anthropologist at Rutgers University.

Now, from her studies of the brains of lovers in the throes of the initial tumble, Fisher has developed a controversial theory. She and her collaborator, psychiatrist J. Anderson Thomson of the University of Virginia, believe that Prozac, Zoloft, Paxil and other antidepressants alter brain chemistry so as to blunt the intense cutting edge of new love.

READ MORE @ LOS ANGELES TIMES

RCP: Healthy siblings of people with schizophrenia have problems recognising facial emotion

People with schizophrenia and their healthy siblings have problems recognising facial emotion in others, according to a new study.

Research suggests that schizophrenia has a substantial genetic component. Cognitive and social abilities, as well as the volumes of brain regions involved in emotion processing, such as the amygdala, have been found to vary along a continuum when people with schizophrenia, their siblings and controls are compared.

This study, published in the August 2007 issue of the British Journal of Psychiatry, set out to establish whether facial expression recognition is impaired in healthy siblings of people experiencing their first episode of schizophrenia.

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Shire's new ADHD medication now available

Shire says Vyvanse, its once-daily medication approved to treat the symptoms of attention deficit hyperactivity disorder, is now available in US pharmacies nationwide.

In a clinical study, Vyvanse provided consistent ADHD symptom control throughout the day based upon parent reports in the morning (approximately 10am), afternoon (approximately 2pm), and early evening (approximately 6pm).

READ MORE @ PHARMACEUTICAL BUSINESS REVIEW

BIPOLAR DISORDER: a new holistic approach

Treatment of mood disturbance in bipolar disorder is undergoing a paradigm shift. Traditionally, drug therapy has been focussed on efficacy in acute mania or depression. Now psychiatrists are realising the need to evaluate drug treatments from other perspectives, Their full effects as acute and mood-stabilising agents, side effect profiles, effects on neurocognitive functioning, quality of life, and on psychosocial functioning, are also important when considering therapy.

Bipolar disorder, the condition where mood swings between varying degrees of mania, hypomania, mixed states, depression and major depressive disorder, is now the sixth leading cause of disability according to the World Health Organization (1). But although bipolar disorder is as common as diabetes, much of it still goes unrecognised and inadequately treated. Official estimates put prevalence at between 1 to 4 per cent of the population but some researchers believe the real figure is closer to 10 per cent if the whole spectrum of bipolar disorder is included (2).

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Regional training to help law enforcement officers manage psychiatric crises

Some two dozen law enforcement officers from around the region will undergo intensive training this week in how to safely and effectively deal with people in psychiatric crisis.

Organizers hope to help them learn how to defuse the tension that often surrounds these crises and reduce the likelihood of a tragic outcome.

It’s something that’s needed, said Michele Periolat, a trainer with the Minnesota Crisis Intervention Team Officers Association.

READ MORE @ West Central Tribune