Moody Is the New Bipolar

In Eugene Jarecki's documentary film Why We Fight, about the U.S. military-industrial complex, U.S. foreign policy critic Chalmers Johnson states: "I guarantee you when war becomes that profitable, you are going to see more of it." Similarly, as mental illness has become extremely profitable, we are seeing more of it.

On September 4, 2007, the New York Times reported, "The number of American children and adolescents treated for bipolar disorder increased 40-fold from 1994 to 2003 ... Drug makers and company-sponsored psychiatrists have been encouraging doctors to look for the disorder."

Not too long ago, a child who was irritable, moody, and distractible and who at times sounded grandiose or acted without regard for consequences was considered a "handful." In the U.S. by the 1980s, that child was labeled with a "behavioral disorder" and today that child is being diagnosed as "bipolar" and "psychotic" -- and prescribed expensive antipsychotic drugs. Bloomberg News, also on September 4, 2007, reported, "The expanded use of bipolar as a pediatric diagnosis has made children the fastest-growing part of the $11.5 billion U.S. market for antipsychotic drugs."

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ADHD Brains Might Need More Growing Time

Scientists are divided on what causes attention deficit hyperactivity disorder, which affects 3 to 5 percent of school-age children. Some say it's a developmental delay, while others argue that the brains of children with ADHD are abnormal from the start. One puzzle: Some, but not all, kids seem to "grow out" of the disorder, which can cause restlessness, inattention, and difficulty focusing. An intriguing new finding by researchers at the National Institute of Mental Health, reported in today's Proceedings of the National Academy of Sciences, suggests that for about half of kids with ADHD, the troubling symptoms they experience in childhood could be a result simply of slower—but otherwise normal—maturation of the brain.

What should harried parents make of the findings? U.S. News asked Judith Rapoport, a coauthor of the study and chief of the child psychology branch at the National Institute of Mental Health. She has pioneered efforts to study the relationship between brain structure and mental disorders.

Rapoport cautions that the research is in the early stages. The delays, which put areas of the brain used in higher order decision making behind schedule by an average of three years, were most evident in areas at the front of the brain's outer covering, or cortex, that house the ability to control thinking, attention, and planning. In some of the children and teens with ADHD, the brain regions reached peak thickness when the children averaged 10.5 years old, compared with 7.5 in children without ADHD.

READ MORE @ US NEWS & WORLD REPORT

Brain Chemicals Involved In Aggression Identified: May Lead To New Treatments

School shootings. Muggings. Murder. Road rage. After decreasing for more than a decade, the rate of violent crime in the United States has begun to inch up again. According to the FBI's Uniform Crime Reporting Program, violent crime rose 2.3 percent in 2005 and 1.9 percent in 2006, the first steady increase since 1993.

And new studies are helping scientists gain deeper insight into the neurobiology of aggression and violence. One analysis of brain imaging studies has revealed that brain structures involved in making moral judgments are often damaged in violent individuals. Another study involving teenage boys suggests that disruptions in a brain region linked to impulsive, aggressive behavior may underlie a certain type of violent, reactive behavior.

Still other research has shed new light on the role that certain brain chemicals play in aggressive behavior, including in maternal aggression. And new animal studies reveal that aggressive encounters cause changes in the brains of aggressors as well as their victims that increase vulnerability to depression and immune-related illnesses.

READ MORE @ SCIENCE DAILY

Pharmacological Management of Major Depressive Disorder

About 121 million people worldwide suffer from depression. Major depression is one of the main causes of disability adjusted life years (DALY) as measured by the global burden of disease.1 The lifetime risk of major depression is about 15% for men and about 30% for women.2 Numerous types of depression exist, such as melancholic, atypical, psychotic, postpartum, bipolar, resistant, and mixed depression.3 The most commonly encountered types of depression and specific recommendations for their pharmacologic management are discussed below.
Many medications are used for the management of major depression. These include tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), selective norepinephrine reuptake inhibitors (SNRIs), second generation atypical antidepressants (eg, bupropion, mirtazapine), psychostimulants (eg, methylphenidate), mood stabilizers (eg, lithium), and augmentation drugs (eg, triiodothyronine). Antidepressants work through a variety of mechanisms, a topic beyond the scope of this newsletter, but generally influence the function of neurotrasmitters such as norepinephrine, serotonin, or dopamine by exerting an impact on the interaction of these neurotransmitters with their receptors.

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Why Quitting Smoking Is So Difficult

New findings clarify the brain mechanisms that explain many aspects of dependency on nicotine, the addictive substance in tobacco. Among them: Individual differences in brain chemistry can have a profound effect on a person's susceptibility to addiction, and smoking may predispose adolescents to mental disorders in adolescence and adulthood. In addition, researchers have identified a potential neural network that regulates the body's craving response and have demonstrated how smoking may affect decision-making.

"As the negative health consequences of smoking have become more and more obvious, the majority of smokers have attempted to quit," says Marina Picciotto, PhD, of Yale University. "Unfortunately, people who want to quit often find that they cannot, and recent neuroscience research has identified many of the molecular mechanisms that lead to nicotine addiction.

"It is notable that many who smoke cigarettes have affective disorders, and many who have affective disorders such as major depression also smoke cigarettes and find it much harder to quit. We need new treatments for smoking cessation based on neuroscientific evidence and we need to understand the interaction between smoking and affective disorders so we can target new therapies to people who have the hardest time quitting."

READ MORE @ SCIENCE DAILY

Antidepressants, Exercise, Age, Even Food Intake, Affect Generation Of New Brain Cells

Recent research shows that the production of new brain cells may be crucial for antidepressants to be effective and that the medication's effectiveness is strongly influenced by age. What's more, meal frequency, type of food, and physical exercise affect the brain's ability to manufacture these new cells.

For the first time in nonhuman primate models, scientists have documented the cause-and-effect relationship between antidepressant drugs and neurogenesis. The researchers found that the antidepressant drug fluoxetine improved the behavior of macaque monkeys with depression-like symptoms.

They also discovered that administering the drugs to normally behaving monkeys did not influence their behavior but did alter their brains by boosting neurogenesis in the hippocampus, an area involved in memory and learning.

READ MORE @ SCIENCE DAILY

ADHD Medication Doesn't Work on Some Preschoolers - Children May Not Respond If They Have Other Disorders

Children diagnosed with Attention Deficit/Hyperactivity Disorder (ADHD) may not respond to methylphenidate, otherwise known as brand name Ritalin, if the child suffers from other behavioral and social disorders. The number of coexisting conditions can diminish the effectiveness of the medication, according to a new look at a study from the National Institutes of Health's National Institute of Mental Health (NIMH).

The Preschoolers with ADHD Treatment Study (PATS) was released last October, and showed that young children between the ages of 3 and 5 who were diagnosed with ADHD responded well to doses of methylphenidate. However, a new article published in the latest issue of the Journal of Child and Adolescent Psychopharmacology reports that the effectiveness of methylphenidate lessens if the child has other disorders, such as anxiety disorders, conduct disorder, and/or oppositional defiant disorder.

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Behavior therapy plus medication may help teens with depression and substance use disorders

The antidepressant fluoxetine combined with cognitive behavioral therapy appears as effective for treating depression among teens who also have substance use disorders as among those without substance abuse problems, according to a report in the November issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

“Adolescents with substance use disorders (SUDs) have higher rates of depression (15 percent to 24 percent) than adolescents in the general population,” the authors write as background information in the article. “Comorbid [co-occuring] depression is also associated with more severe substance abuse, poorer drug treatment outcomes and higher relapse rates.”

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U.S. rejects Glaxo's gepirone ER antidepressant

U.S. regulators have rejected GlaxoSmithKline Plc's (GSK.L: Quote, Profile, Research) experimental drug gepirone ER for adults with major depression.

The U.S. Food and Drug Administration (FDA) issued a not approvable letter for the extended-release tablets, which Glaxo had licensed from privately owned Fabre-Kramer Pharmaceuticals Inc in February, Europe's biggest drugmaker said on Saturday.

The news is a blow to Glaxo, which needs new drugs to make up for pending patent expiries on key blockbusters and a recent slump in sales of its second-biggest seller, the diabetes pill Avandia, which has been hit by fears over a possible link to heart attacks.

READ MORE @ REUTERS

Non-English Speakers Charge Bias in Prescription Labeling

Pharmacies across the city routinely fail to help non-English speakers understand their prescriptions, raising the chances that customers could harm themselves by taking medicines incorrectly, immigrant advocacy groups charge in a discrimination complaint that they plan to file today with the New York attorney general’s office.

The complaint names 16 pharmacies in Brooklyn, Queens and Long Island, most of them operated by chains. It argues that federal civil rights law and state health regulations require pharmacies to provide linguistic help to guarantee that people who speak little or no English receive equal access to health care. That assistance should include interpreters at pharmacies and written translations of medication instructions, the advocates say.

Nisha Agarwal, a lawyer for one of the groups filing the complaint, said the attorney general’s office had already issued subpoenas to several pharmacies listed in an earlier version of the complaint filed in July. The new version names more pharmacies, and an accompanying report includes more examples of comprehension problems non-English speakers have had.

READ MORE @ NY TIMES

Aripiprazole Decreases Symptoms of Mania in Paediatric Bipolar Disorder: Presented at AACAP

Children and adolescents at the onset of bipolar disorder may achieve improvements in manic symptoms with aripiprazole, according to research presented here at the 54th Annual Meeting of the American Academy of Child & Adolescent Psychiatry (AACAP).

Lead author Kiki D. Chang, MD, Assistant Professor and Director, Pediatric Mood Disorders Clinic, Child and Adolescent Psychiatry, Stanford University School of Medicine, Stanford, California, United States, and colleagues undertook a 54-centre, 4-week study of 296 patients 10 to 17 years of age with bipolar disease.

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Concomitant Psychotropic Medications Overprescribed in Foster-Care Youth: Presented at AACAP

Nearly 20% of youths in foster care receiving psychotropic medications received two or more such drugs in the same drug class, in a study presented here at the 54th Annual Meeting of the American Academy of Child & Adolescent Psychiatry (AACAP).

Professionally developed monitoring guidelines would help to validate any necessary prescriptions for multiple psychotropic medications, noted lead author Julie M. Zito, PhD, MS, Associate Professor in Pharmacy and Psychiatry, Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, Maryland, United States.

Dr. Zito and colleagues selected a random sample (n = 472) from a total of 32,135 Medicaid foster-care enrolees in Texas in 2004. All subjects were 19 years of age or younger (64% over the age of 10; 5% were age 4 years and under) and all received at least one psychotropic drug in the study year (2004).

The psychotropic drugs were classified under 8 drug descriptions: anticonvulsants; alpha agonists; antianxiolytics; antidepressants (selective serotonin reuptake inhibitors, tricyclic antidepressants, other); antipsychotics (atypical and conventional); ADHD drugs (amphetamines, methylphenidate, atomoxetine); lithium; and miscellaneous.

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Previous Suicidality a Greater Risk Than Antidepressant Medication in Suicidal Teens: Presented at AACAP

Antidepressant drugs have a lesser effect on teenagers' risk of suicidality than do female gender and previous plans to kill oneself within the past year, according to research presented here at the 54th Annual Meeting of the American Academy of Child & Adolescent Psychiatry (AACAP).

Lead author Neera Ghaziuddin, MD, MRCPsych, Associate Professor, Department of Psychiatry, University of Michigan Health System, Ann Arbor, Michigan, United States explained that previous paediatric studies have not examined antidepressants in conjunction with other psychiatric medications in the teenage population. Additionally, antidepressant trials with depressed youth have generally excluded acutely suicidal patients.

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Use of Antidepressants in Pregnancy Affects Neonatal Outcomes: Presented at AACAP

Babies born to mothers who take antidepressant medication during pregnancy have high levels of cortisol in cord-blood at birth, and their mothers are more likely to experience delivery complications, according to a study presented here at the 54th Annual Meeting of the American Academy of Child & Adolescent Psychiatry (AACAP).

When examined at 2 weeks of age, the infants of women taking antidepressants demonstrated more tremulousness and were more excitable than infants born to women not taking antidepressants.

The study results were presented by lead author Sheila Marcus, MD, Clinical Associate Professor, Departments of Psychiatry and Depression Center, University of Michigan, Ann Arbor, Michigan, United States, on October 24.

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Bipolar Disorder or Manic Depression Causes and Treatment

Bipolar disorder is a psychiatric condition defined as recurrent episodes of significant disturbance in mood. These disturbances can occur on a spectrum that ranges from debilitating depression to unbridled mania. Individuals suffering from bipolar disorder typically experience fluid states of mania, hypomania or what is referred to as a mixed state in conjunction with depressive episodes. These clinical states typically alternate with a normal range of mood. While dealing with bipolar disorder isn’t always easy, it doesn’t have to run your life. With proper treatment and a solid support system, people with bipolar disorder are capable of leading rich and fulfilling lives. They can hold jobs, sustain loving marriages, raise children, and be productive members of society. But in order to successfully manage bipolar disorder, it is essential to fully understand the condition and its challenges.

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Decision-makers Seek Internal Balance, Not Balanced Alternatives

A researcher at the University of California, San Diego (UCSD) School of Medicine suggests that psychiatrists may need to approach the treatment of psychiatric patients from a new direction -- by understanding that such individuals' behavior and decision-making are based on an attempt to reach an inner equilibrium.

Martin Paulus, M.D., professor in UCSD's Department of Psychiatry, has compiled a body of growing evidence that human decision-making is inextricably linked to an individuals' need to maintain a homeostatic balance.

"This is a state of dynamic equilibrium, much like controlling body temperature," said Paulus. "How humans select a particular course of action may be in response to raising or lowering that 'set point' back to their individual comfort zone. In people with psychiatric disorders or addictions, the thermostat may be broken."

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Forest Laboratories' Lexapro Still Leads First-Line Therapy in the Treatment of Major Depression, but Atypical Antipsychotics Are Coming On Strong

Decision Resources, one of the world's leading research and advisory firms focusing on pharmaceutical and healthcare issues, finds that Forest Laboratories' Lexapro leads first-line therapy in the treatment of major depression. According to the new report entitled Treatment Algorithms in Major Depression, selective serotonin reuptake inhibitors (SSRIs), which include Lexapro, serve 63.6 percent of patients on first-line therapy. Surveyed physicians say the reasons for SSRIs being so heavily used are efficacy, cost and physician familiarity. Eighty percent of surveyed psychiatrists and 70 percent of surveyed primary care physicians (PCPs) say they choose SSRIs over benzodiazepines because of efficacy. Forty-nine percent of surveyed psychiatrists cite cost as the prime reason they choose SSRIs over serotonin/norepinephrine reuptake inhibitors (SNRIs), while 49 percent of PCPs say they choose SSRIs over SNRIs owing to familiarity with the former class.

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Confronting Sadness in Seniors

A bit of sadness is a common companion of aging. Over time, after all, seniors may lose vigor, independence, and even loved ones. But when melancholy becomes outright depression, the elderly are at risk of diabetes, heart disease, and even suicide. It's often up to their unofficial caretakers—their children—to spot depression's signs and take steps to address it.

Depression often manifests differently in the elderly than in younger people. Rather than expressing feelings of sadness, depressed seniors may describe physical complaints—increased aches and pains, headaches, weakness, and, commonly, trouble sleeping. "Look for changes in levels of interest, too," says Dan Blazer, professor of psychiatry and behavioral sciences at Duke University Medical Center. Increases in anxiety, irritability, withdrawal, and a decrease in attention to appearance are also common signs. Sometimes, depression arises because of a physical health problem, says Gary Moak, president of the American Association for Geriatric Psychiatry and a professor at the University of Massachusetts Medical School. For example, he says, "as many as 40 percent of stroke victims will develop depression, because many [strokes] occur in an area of the brain that's closely related to the processing and management of emotions." Overall, about 1 in 5 people age 65 and older has depression, according to Moak. The vast majority don't receive the professional treatment they need.

READ MORE @ US NEWS & WORLD REPORT

Psychiatric Conditions Increase the Risk of Heart Disease

Although mortality rate among people suffering from cardiovascular diseases has declined in the United States over the past years, patients suffering from acute mental illness remain deprived of the benefits experienced by healthy individuals. These views were expressed in the Journal of the American Medical Association (JAMA) by a psychiatrist --John W. Newcomer at Washington University School of Medicine in St. Louis.

Newcomer, who is the professor of psychiatry and psychology and of medicine and medical director of the Center for Clinical Studies at Washington University, said that people suffering from mental ailments including schizophrenia, bipolar disorder and various forms of depression live 25 -30 years shorter than those with no such ailments. Though suicide remains one of the major causes of death among these individuals, but most of them die prematurely on account of cardiovascular diseases.

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Veterans are denied mental health help

After two combat tours in Iraq on a "quick reaction team" that picked up body parts after suicide bombings, Donald Schmidt began suffering from nightmares and paranoia. Then he had a nervous breakdown.

The military discharged Schmidt last Oct. 31 for problems they said resulted not from post-traumatic stress disorder but rather from a personality disorder that pre-dated his military service.

Schmidt's mother, Patrice Semtner-Myers, says her son was told that if he agreed to leave the Army he'd get full benefits. Earlier this month, however, they got a bill in the mail from a collection agency working for the government, demanding that he repay his re-enlistment bonus, plus interest — $14,597.72.

Schmidt, 23, who lives near Peoria, Ill., is one of more than 22,000 service members the military has discharged in recent years for "pre-existing personality disorders" it says were missed when they signed up.

"They used these guys up, and now they're done with them and they're throwing them away," Semtner-Myers said.

Her frustration extends to Capitol Hill, where the stage is being set for a confrontation between Congress and the Pentagon.

Rep. Bob Filner, D-Calif., chairman of the House Veterans Affairs Committee, calls the treatment of these troops "disgraceful."

READ MORE @ ST. LOUIS POST DISPATCH