Illuminating a seasonal disorder

About this time each year, Lisa Morris starts yearning for more light in her life.

The 31-year-old mother of two from Middle River suffers from seasonal affective disorder (SAD), a condition that prompts her to turn on a specially designed fluorescent lamp for up to an hour every morning when she rises.

Purchased from a medical supply outlet, the light helps ward off the ailment's most common symptoms: persistent fatigue, oversleeping and an increased appetite for sugary and starchy foods that often leads to weight gain.

"The light therapy does do the trick - but I still have my moments where I just want to go up and lay down in my room and not get up," Morris says.

The winter solstice occurred shortly after 1 a.m. today - the lowest point in a pattern of diminishing sunlight that begins each fall as the tilt of the earth's axis sends the northern hemisphere away from the sun. Today we get only 9 hours of sun.

Although SAD symptoms typically begin in September and October as the days get shorter, experts say the solstice period is when the effects of seasonal depression can be most pronounced, particularly if the condition is left untreated.

"It can really affect people for a major chunk of their lives, in a big way," said Dr. David Neubauer, a Johns Hopkins psychiatrist.

READ MORE @ BALTIMORE SUN

Parents Defend School’s Use of Shock Therapy

Nearly a year ago, New York made plans to ban the use of electric shocks as a punishment for bad behavior, a therapy used at a Massachusetts school where New York State had long sent some of its most challenging special education students.

But state officials trying to limit New York’s association with the school, the Judge Rotenberg Educational Center in Canton, southwest of Boston, and its “aversive therapy” practices have found a large obstacle in their paths: parents of students who are given shocks.

“I understand people who don’t know about it think it is cruel,” said Susan Handon of Jamaica, Queens, whose 20-year-old daughter, Crystal, has been at Rotenberg for four years. “But she is not permanently scarred and she has really learned that certain behaviors, like running up and hitting people in the face, are not acceptable.”

Indeed, Rotenberg is full of children who will run up and hit strangers in the face, or worse. Many have severe types of dysfunction, including self-mutilation, head banging, eye gouging and biting, that can result from autism or mental retardation. Parents tend to be referred there by desperate education officials, after other institutions have decided they cannot keep the child.

READ MORE @ NY TIMES

Generic Antidepressant May Affect Wyeth

The difference between a pill and a capsule might not seem big, but it could result in hundreds of millions of dollars in lost sales for Wyeth's top drug.

The Madison, N.J.-based company makes the best-selling antidepressant in the world, Effexor, with sales on pace to exceed $3.7 billion this year. The most common version is an extended-release capsule, Effexor XR.

Until recently, it seemed Wyeth would be the exclusive seller of extended-release Effexor in the United States through July 2010, thanks to its resolution of patent litigation in 2005.

But now Wyeth's market exclusivity is being threatened. Sun Pharmaceutical Industries Ltd., a generics manufacturer in India, has applied for U.S. Food and Drug Administration approval to sell a drug with the same active ingredient as Effexor XR, but with an important difference: It's an extended-release tablet, not a capsule.

FDA approval of what is likely to be a lower-priced drug from Sun might come when patent protection for Effexor's active ingredient, venlafaxine, runs out in June 2008. Patent protection for the capsule formulation expires later. Sun's different formulation should allow it to sidestep Wyeth's patent rights, and Wyeth already has told Sun it won't sue for patent infringement.

READ MORE @ AP

Not Yet: CDC panel questions antidepressant gene test

About half of all depressed people who take standard antidepressant drugs fail to improve. Some suffer unpleasant side effects and abandon the medicines, while others simply don't feel better. Commercial tests claim to predict, by a genetic analysis, how well individual patients will fare on different antidepressants, but a panel convened by the Centers for Disease Control and Prevention (CDC) in Atlanta now says that the tests don't work as advertised.

The panel "discourages" use of such tests until further studies clarify their value, according to a statement the group published in the December Genetics in Medicine.

"That isn't to say that eventually there won't be a role for these tests. We just don't know what that role is yet," says panel member Joan Scott of the Genetics and Public Policy Center in Washington, D.C.

The tests scan a person's DNA for variations in genes for two key liver enzymes. These enzymes break down selective serotonin reuptake inhibitors (SSRIs), a standard class of antidepressants that includes fluoxetine (Prozac) and nearly a dozen other drugs. Variations in the two enzymes affect how quickly different people clear SSRIs from their blood, which in turn influences the drugs' effectiveness.

READ MORE @ SCIENCE NEWS

Brain Center May Link Addiction, Mental Illness

Developmental problems involving a walnut-shaped part of the brain called the amygdala -- linked to fear, anxiety and other emotions -- may explain why mental illness and addiction often appear together, researchers say.

Many kinds of addiction -- such as those for alcohol, drugs and nicotine -- occur in people with various kinds of mental illness, including depression, schizophrenia and anxiety disorders, according to background information in an American Psychological Association news release about the Indiana University study.

Two to five of every 10 anxious or depressed people, and four to eight of every 10 people with schizophrenia, biopolar disorder or antisocial personality, also have some form of addiction, according to epidemiological data.

In this study, published in the December issue of Behavioral Neuroscience, the researchers compared the behavior of adult rats whose amygdalas were surgically damaged in infancy and adult rats with intact amygdalas.

READ MORE @ FORBES

More Keys To Maintain Your Brain

Here I continue with a subject I can't resist and can certainly use - a series of tips on how to maintain and enhance brainpower. (See earlier column from Dec. 13.) In introducing them, the authors of the book where I found them, You: Staying Young: The Owner's Manual for Extending Your Warranty, Dr. Michael F. Roizen, of the Cleveland Clinic, and Dr. Mehmet Oz, of Columbia University, have some wise words: "There are many ways to keep your brain operating at maximum efficiency, maximum power, and maximum quality."

o get you into the right mood and eliminate any room for excuses, I'll start with a few of the easiest ones.

Feed On Brain Food. Yes, there is such a thing. Serve up one of our best friends, those omega-3 fatty acids found in greatest abundance in the fat of such fish as salmon, mahi-mahi, tuna and herring. These omega-3s have multiple beneficial effects: (1) They improve the function of your message-sending neurotransmitters (chemicals that carry messages back and forth between nerve cells), (2) they slow cognitive decline in people who are at risk, and (3) keep arteries clear, which means they also keep an adequate supply of blood flowing to the brain.

Drs. Roizen and Oz, the authors, suggest you aim for 13 ounces of fish a week, or if you prefer take two grams of metabolically distilled fish oil a day or DHA (a form of omega-3) from algae or an ounce of walnuts every day.

READ MORE @ THE BULLETIN

Brought on by Darkness, Disorder Needs Light

n a few days, the winter solstice will plunge us into the longest and darkest night of the year. Is it any surprise that we humans respond with a holiday season of relentless cheer and partying?

It doesn’t work for everyone, though. As daylight wanes, millions begin to feel depressed, sluggish and socially withdrawn. They also tend to sleep more, eat more and have less sex. By spring or summer the symptoms abate, only to return the next autumn.

Once regarded skeptically by the experts, seasonal affective disorder, SAD for short, is now well established. Epidemiological studies estimate that its prevalence in the adult population ranges from 1.4 percent (Florida) to 9.7 percent (New Hampshire).

Researchers have noted a similarity between SAD symptoms and seasonal changes in other mammals, particularly those that sensibly pass the dark winter hibernating in a warm hole. Animals have brain circuits that sense day length and control the timing of seasonal behavior. Do humans do the same?

READ MORE @ NY TIMES

Dangerous drugs continue to be prescribed to seniors: CBC report

Doctors are continuing to prescribe drugs dangerous to seniors in spite of government warnings, a CBC News investigation reveals.

More than two years ago, CBC News first reported that more than a million seniors were prescribed atypical antipsychotics. Atypical antipsychotics are specific kinds of antipsychotic drugs. They are considered by many experts to be ineffective or even dangerous for elderly patients.

Health Canada followed up with warnings pointing to the drugs' side effects — including a 60 per cent greater risk of death in seniors who were taking the drugs than in patients taking placebos — gleaned from 13 scientific studies. It also warned that elderly patients taking atypical antipsychotics were almost twice as likely to die from side effects such as heart failure.

In its advisory, Health Canada requested that the drugs' manufacturers include a warning describing the risk in the safety information sheet provided along with the drugs, and that health care providers refrain from relying too much on the drugs to treat dementia.

READ MORE @ CBC

Campaign on Childhood Mental Illness Succeeds at Being Provocative

We have your son. We will make sure he will no longer be able to care for himself or interact socially as long as he lives.

— Autism

SO reads one of the six “ransom notes” that make up a provocative public service campaign introduced this week by the New York University Child Study Center to raise awareness of what Dr. Harold S. Koplewicz, the center’s founder and director, called “the silent public health epidemic of children’s mental illness.”

Produced pro bono by BBDO, an Omnicom agency that worked on two previous campaigns for the Child Study Center, the campaign features scrawled and typed communiqués as well as simulations of classic ransom notes, composed of words clipped from a newspaper.

In addition to autism, there are ominous threats concerning depression, obsessive-compulsive disorder, attention-deficit hyperactivity disorder, Asperger’s syndrome and bulimia. The campaign’s overarching theme is that 12 million children “are held hostage by a psychiatric disorder.”

The public service announcements began running this week in New York magazine and Newsweek as well as on kiosks, billboards and construction sites around New York City.

“Children’s mental disorders are truly the last great public health problem that has been left unaddressed,” said Dr. Koplewicz, adding: “It’s like with AIDS. Everyone needs to be concerned and informed.”

READ MORE @ NY TIMES

Biocapture Surfaces Produced For Study Of Brain Chemistry

A research team at Penn State has developed a novel method for attaching small molecules, such as neurotransmitters, to surfaces, which then are used to capture large biomolecules. By varying the identity and spacing of the tethered molecules, researchers can make the technique applicable to a wide range of bait molecules including drugs, chemical warfare agents, and environmental pollutants. Ultimately, the researchers also hope to identify synthetic biomolecules that recognize neurotransmitters so that they can fabricate extremely small biosensors to study neurotransmission in the living brain.

In the brain, dozens of different small signaling molecules interact with thousands of large receptive proteins as part of the fundamental communication process between nerve cells. This cacophony of specific interactions is highly dependent on nanoscale molecular structure. One key to advancing our understanding of how the brain works is to identify the nature of the association between neurotransmitters and their binding partners.

READ MORE @ SCIENCE DAILY

Carbamazepine Gets Warning on Stevens-Johnson Syndrome, Toxic Epidermal Necrolysis

Carbamazepine, a drug used to treat epilepsy and bipolar disorder, will now come with new warnings that Asian patients should undergo genetic testing before using the drug. According to the Food & Drug Administration (FDA), a human leukocyte antigen called HLA-B*1502 that is exclusive to people with Asian ancestry makes it more likely that carbamazepine will cause the serious skin disorders Stevens-Johnson Syndrome and toxic epidermal necrolysis.

Carbamazepine is an anticonvulsant and mood stabilizing drug, used primarily in the treatment of epilepsy and bipolar disorder. It is also used to treat other disorders, including Attention Deficit Hyperactivity Disorder and schizophrenia. It is sold under the brand names Carbatrol, Equetro and Tegretol.

READ MORE @ NEWS INFERNO

Effective new treatment for schizophrenia

Schizophrenia is one of the most debilitating of the major psychiatric disorders, and is also one of the most difficult to treat. Although numerous antipsychotic treatments are available, they can cause significant side effects and many patients experience only a partial relief of their symptoms and up to 30% no relief at all. In a new study scheduled for publication in the December 15th issue of Biological Psychiatry, Marder and colleagues examined the efficacy and safety of a new psychotropic agent for the treatment of schizophrenia in a 6-week, randomized, placebo-controlled trial.

The authors studied paliperidone extended-release (ER) tablets, an investigational drug which orally delivers the active metabolite of the drug risperidone, which is an already established efficacious antipsychotic. The authors recruited 444 patients who were experiencing an acute episode of schizophrenia and, after evaluating the severity of their symptoms, administered one of four treatments for 6 weeks: 6 mg or 12 mg/day of paliperidone ER, 10 mg/day of olanzapine (the active comparator), or placebo. During the six weeks of treatment, the investigators monitored the patients for side effects and assessed their symptom improvement.

READ MORE @ EUREKALERT

British Psychiatrists Criticize Rise Of Bipolar Disorder In Adults, Children

David Healy and his colleague Joanna Le Noury have a new paper out, which examines the rise of bipolar disorder in both adults and children and puts it all in some kind of historical context. It's a lengthier examination of what Healy calls disease mongering than his PLoS paper of 2006. If you want to avoid my summary of this new piece, which I think is a withering attack on just about everyone in the mental health industry, then read their paper here (it's a .pdf file).

This is a lengthy post, but I think it's worth laying out the authors' key points since they are pushing back against some powerful forces in our culture and, at the end, asking if the bipolar child paradigm isn't a new form of Munchausen’s syndrome. I should also note that this site makes an appearance by inference in the article, which was published in the International Journal of Risk & Safety in Medicine.

READ MORE @ FURIOUS SEASONS

Possible Markers For Mental Illness Discovered

Researchers have discovered natural genetic differences that might help predict the most effective antipsychotic drugs for particular patients with mental disorders such as schizophrenia, Parkinson's and drug addiction.

They found the differences in the gene for a molecule called the dopamine D2 receptor (DRD2), a protein present on brain cells that are sensitive to the neurotransmitter dopamine.

The receptor is known to play a key role in memory and in a variety of mental illnesses. Most antipsychotic drugs work at least in part by blocking this protein, but scientists don't yet understand how this helps patients. Nor can they explain why some people respond well to certain antipsychotic drugs and others respond poorly.

READ MORE @ SCIENCE DAILY

How moods affect our health

HAVING AN ARGUMENT

As your irritation mounts, you can feel your blood pressure rising. And that's exactly what is happening to your body when you have an argument. The effects, it seems, can be lasting. In the week after the irritating incident, you just need to think about the argument and your blood pressure will rise again, according to research published in the International Journal of Psychophysiology. So if you've recently experienced a dispute, a seething irritation or a simple frustration, you could be best off forgetting about it.

A half-hour argument with your lover can also slow your body's ability to heal by at least a day. In couples who regularly argue, that healing time is doubled again. Researchers at Ohio State University discovered this by testing married couples with a suction device that created tiny blisters on their arm. When couples were then asked to talk about an area of disagreement that provoked strong emotions, the wounds took around 40 per cent longer to heal. This response, say researchers, was caused by a surge in cytokines – immune-molecules that trigger inflammation. Chronic high levels of these are linked to arthritis, diabetes, heart-disease and cancer.

READ MORE @ THE INDEPENDENT

Brain Differences Identified In Adolescents With Mental Illness

Puberty may have an impact on areas of the brain that contribute to bipolar disorder or schizophrenia in youth, according to a study presented December 7 at the annual meeting of the American College of Neuropsychopharmacology (ACNP).

Researchers studying the brains of youth with bipolar disorder (also known as manic depressive illness) and schizophrenia found that these children have size differences in some brain areas between these disorders and between genders. These changes exist in key areas of the brain that are involved in reward, motivation, sensory input, emotion and memory, and researchers say examining these areas can help researchers understand developmental processes that occur around the time mental disorders develop.

The brains of children with bipolar disorder are different from the brains of children with schizophrenia, and there are brain differences between boys and girls, and investigators say such findings can help them better understand gender's role in brain processes, and how it affects the development of mental illness. Additionally, they could help lay the foundation for identifying different possible treatment approaches to these illnesses in boys and girls.

READ MORE @ SCIENCE DAILY

Research finds link between depression

Findings suggest patterns of risk in co-occurring conditions

Depression nearly triples the risk of death following a heart attack, even when accounting for other heart attack risk factors, according to research presented today at the American College of Neuropsychopharmacology (ACNP) annual meeting, which showed that among 360 depressed, post myocardial infarction patients followed for more than six years, those who did not recover from their depression in the first six months were more than twice as likely to die.

This study was one of several presented at a panel which examined the links between depression and vascular disease. “There is an unequivocal link between depression and heart disease, but it is not clear what causes this link,” said Alexander Glassman, M.D., Professor of Psychiatry at Columbia University, College of Physicians and Surgeons and ACNP member. “There is a whole series of factors that link depression and heart disease and we are just beginning to understand how antidepressants act in people who have these conditions together.” Additional risk factors that tend to be major medical predictors of death from a heart attack include the severity of the heart attack and variability in various measures of heart function during recovery.

READ MORE @ EUREKALERT

Flawed Studies Underscore Need for More Rigorous PTSD Research

Despite PTSD's prominence in a trauma-ridden world, therapies for the disorder rest on some very slim reeds, says the Institute of Medicine.

"Significant gaps" in the evidence underlying nearly all treatments for posttraumatic stress disorder make it impossible to judge their value, according to a study released in October by the Institute of Medicine (IOM).

Poorly designed and executed studies have failed to include enough veterans or account for important comorbidities like depression, substance abuse, or traumatic brain injury, said the IOM committee that conducted the study.

READ MORE @ PSYCHIATRIC NEWS

Antipsychotics, Nursing Homes And Abuse

Keeping them quiet down on the farm. That’s the tone of one story after another these days about how nursing homes increasingly give antipsychotics to patients, whether they need them or not. And of course, the tab is often picked up, unnecessarily by Medicaid, for instance. A couple of weeks ago, The St. Petersburg Times ran such a piece in which Barbara Hengstebeck, executive director of the Coalition to Protect America’s Elders in Tallahassee, Fla., offered an explanation: “A lot of people feel like the elderly in nursing homes are expendable.”

The latest spend-a-gram comes from The Wall Street Journal, which notes that the Centers for Medicare & Medicaid Services says nearly 21 percent of nursing-home patients who don’t have a psychosis diagnosis are on antipsychotic drugs. The use comes amid a wider debate about how to care for the rising numbers of seniors, many of whom have behavior problems stemming from dementia. And a big question, the paper writes, is whether to use a medical model - administering these meds as the way to alleviate distressing symptoms or trying to find other ways to help these patients.

READ MORE @ PHARMALOT

Newly-identified Exercise Gene Could Help With Depression

Boosting an exercise-related gene in the brain works as a powerful anti-depressant in mice--a finding that could lead to a new anti-depressant drug target, according to a Yale School of Medicine report in Nature Medicine.

"The VGF exercise-related gene and target for drug development could be even better than chemical antidepressants because it is already present in the brain," said Ronald Duman, professor of psychiatry and senior author of the study.

Depression affects 16 percent of the population in the United States, at a related cost of $83 billion each year. Currently available anti-depressants help 65 percent of patients and require weeks to months before the patients experience relief.

Duman said it is known that exercise improves brain function and mental health, and provides protective benefits in the event of a brain injury or disease, but how this all happens in the brain is not well understood. He said the fact that existing medications take so long to work indicates that some neuronal adaptation or plasticity is needed.

READ MORE @ SCIENCE DAILY