Studies Try to Tease Apart the Links Between Depression and Heart Disease

People who are depressed are literally sick at heart: they have a significantly increased risk for cardiovascular disease, and no one knows exactly why. Now three new studies have tried to explain this, and they arrive at subtly different conclusions.

The first, led by Dr. Mary A. Whooley of the Veterans Affairs Medical Center in San Francisco, studied 1,017 patients with coronary artery disease for an average of more than four years. Although the study found an association of depression with heart disease, when researchers statistically corrected for other medical conditions, disease severity and physical inactivity, the association disappeared.

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'Not enough support' for mentally ill people to work

Government risks 'writing off' people with mental health problems due to lack of trained professionals

The government needs to take urgent action to make sure support and training is available to get more people with mental illness into work, say campaigners in a new report today.

The Sainsbury Centre for Mental Health (SCMH) and the College of Occupational Therapists have published a joint paper arguing that the government risks "writing off" people with mental health problems during the recession if it doesn't take action on employment support immediately.

The paper, 'Vocational Rehabilitation: what is it, who can deliver it and who pays?' claims there is a serious shortage of professionals "with the skills they need to offer expert help" to people who need it most. It says that without expert advisers trained to assess the employment needs of people with mental illness and to offer necessary support once jobs are found, the government will fail to keep its promise to help millions of people with mental health problems long term employment.

READ MORE @ THE GUARDIAN

Is There Really an Epidemic of Depression? A new book argues that the mental illness is being overdiagnosed

LEHRER: In your book, you take a critical look at major depressive disorder (MDD), a mental illness that will afflict approximately 10 percent of individuals at some point during their life. In recent decades, the number of cases of MDD has sharply increased. Are we currently experiencing an epidemic of depression? Or is this surge due to changes in diagnosis?

HORWITZ AND WAKEFIELD: Our book argues that, despite widespread beliefs to the contrary, the rate of depressive disorders in the population has not undergone a general upsurge. In fact, careful studies that use the same criterion for diagnosis over time reveal no change in the prevalence of depression. What has changed is the growing number of people who seek treatment for this condition, the increase in prescriptions for antidepressant medications, the number of articles about depression in the media and scientific literature, and the growing presence of depression as a phenomenon in popular culture. It is also true that epidemiological studies of the general population appear to reveal immense amounts of untreated depression. All of these changes lead to the perception that the disorder itself has become more common.

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Not All Antipsychotics Created Equal: Analysis Reveals Important Differences

An analysis of studies on antipsychotics reveals multiple differences among the newer, second-generation antipsychotics as well as the older medications, and suggests the current classification system blurs important differences, rendering it unhelpful. The analysis, partially funded by NIMH, was published online December 5, 2008, in The Lancet.

An analysis of studies on antipsychotics reveals multiple differences among the newer, second-generation antipsychotics as well as the older medications, and suggests the current classification system blurs important differences, rendering it unhelpful. The analysis, partially funded by NIMH, was published online December 5, 2008, in The Lancet.

Stefan Leucht, M.D., of Technische Universität München in Munich, Germany, and colleagues looked at 150 studies from all parts of the world with a total of 21,533 participants. By examining these double-blind studies, they were able to compare nine second-generation—also called atypical—antipsychotics with first-generation antipsychotics. They examined symptom reduction; quality of life; side effects such as movement disorders, weight gain and sedation ( sleepiness ); and other factors.

READ MORE @ MEDIA NEWSWIRE

Generic drug prices falling in US

Finally, a little good health care news for consumers: U.S. prices for generic prescription drugs, which already cost as little as one-third what their brand-name cousins do, have been getting cheaper and likely will keep doing so.

The causes? The ultra-low prices for generic prescriptions offered by giant retailers and drugstore chains and intense competition among the many generic drugmakers fighting for sales, according to health information firm IMS Health.

Those pricing pressures forced down dollar sales of generic drugs in the U.S. by 2.7 percent in the year ending in September, even though the number of generic prescriptions filled actually increased by 5.4 percent over the year before, IMS reported Wednesday.

"We're seeing the combination of pressure from large retailers to make generics available at ever-lower prices for their customers" and the intensified competition among generic drugmakers leading them to cut prices, said Murray Aitken, senior vice president of the Healthcare Insight unit at IMS.

READ MORE @ AP

Is There a Gene for Postpartum Depression?

"The transition to parenthood is filled to the brim with behavioral extremes. Parents who are otherwise emotionally stable are in one moment thrilled and happier than they have ever been and confused and fearful the next. Afriend of mine once theorized that these reactions occur because "parenting is an amateur sport" played by persons who are highly motivated to do the right thing but who often have no idea what that right thing is."

For some couples, the transition to parenthood is not filled with this rich mixture of great perplexity and great joy. For them, parenthood is mostly filled with sadness and even despair. Postpartum depression was originally coined to describe this experience in the mother, although it is becoming clear that fathers can experience very similar emotions too.

Is there a molecular basis for postpartum depression—at least for the type that mothers experience? Recent findings, which I describe here, may answer this question. First, we will focus on several background behavioral and molecular issues and then move on to some interesting data about births in genetically manipulated laboratory animals. Feel free to skip to the “Data” section if postpartum depression rates and g-aminobutyric acid (GABA) receptor biology are working parts of your vocabulary.

READ MORE @ PSYCHIATRIC TIMES

Experts urge wider use of brain-boosting drugs

Three job candidates sit in a quiet room, straining over a tough exam. But one of them has taken a memory-enhancing drug the other two couldn't afford. Is the test fair?

In another futuristic scenario, a drug can help airline pilots keep focused during a long flight, though it causes some side effects. May an airline require pilots to take the drug?

Get ready to confront such questions in daily life, a group of scientists and policy experts urge in a thought-provoking commentary published online Sunday by the journal Nature.

Brain research is accelerating, and a new era of "cognitive enhancement" - the use of brain-stimulating drugs and devices by healthy people - is approaching, the authors said.

READ MORE @ S.F. CHRONICLE

Antipsychotics in Children: Experts Report Mixed Results

Studies of antipsychotics in child prenpresented at the 48th Annual New Clinical Drugs Evaluation Unit (NCDEU) Meeting, conducted by the NIMH in Phoenix, May 27-30, provide some data where there have been relatively little on the increasing use of these agents.

In a panel discussion on ethics applications in child and adolescent psychopharmacology research and practice, panel chair Christopher Kratochvil, MD, University of Nebraska, noted, “while children have additional protections as a vulnerable population in research, recognition of underserved treatment needs is driving demand for psychopharmacology progress.”

As psychopharmacotherapy in children may be expanding faster than its evidence base, however, there is also increasing concern that risk-benefit is not being adequately assessed. In the October issue of the Archives of Pediatric and Adolescent Medicine, a retrospective cohort study of antipsychotic use in children and adolescents reveals that these agents are associated with increased risk of adverse metabolic and cardiovascular events.[1] Neurological adverse events in this cohort were reported separately in the Journal of Child Neurology.[2]

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AstraZeneca Was Aware of Seroquel Risks in 2000, Records Show

AstraZeneca Plc., facing more than 15,000 consumer claims alleging the antipsychotic drug Seroquel causes diabetes, knew about the risk as far back as 2000, according to company documents shown in federal court.

AstraZeneca Global Safety Officer Wayne Geller concluded there was “reasonable evidence to suggest Seroquel therapy can cause” diabetes and related conditions, according to documents presented yesterday in federal court in Tampa, Florida. Geller drew his conclusions following a review of available studies and internal trials, according to the documents.

The internal documents were shown publicly for the first time during a hearing over the qualifications of expert witnesses the plaintiffs plan to use at trial. They are to testify in a lawsuit over the drug’s effects when the proceeding begins in February. While portions of the documents were shown in court, the filings remain sealed at the request of the London-based pharmaceutical company.

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No Reason to Prefer Atypical Antipsychotics over Older Drugs

The common distinction between first- and second-generation antipsychotic drugs has no scientific basis and should be dropped, said researchers here.

A meta-analysis of 150 double-blind studies found little evidence that newer, so-called atypical antipsychotic drugs are more effective than older drugs for symptoms of schizophrenia, reported Stefan Leucht, M.D., of Munich Technical University, and colleagues online in The Lancet.

The researchers also found that although newer drugs induced fewer extrapyramidal effects than haloperidol (Haldol) that was not the case when compared with low-potency first-generation agents.

"Second-generation antipsychotic drugs differ in many properties" -- including structure and mode of action as well as clinical effects -- "and are not a homogeneous class," the researchers concluded.

"Improper generalization creates confusion and, as a result, the classification [of first- versus second-generation agents] might be abandoned," they said.

READ MORE @ MEDPAGE TODAY

Stress-Related Disorders Affect Brain's Processing of Memory

Researchers using functional MRI (fMRI) have determined that the circuitry in the area of the brain responsible for suppressing memory is dysfunctional in patients suffering from stress-related psychiatric disorders. Results of the study will be presented today at the annual meeting of the Radiological Society of North America (RSNA).

"For patients with major depression and other stress-related disorders, traumatic memories are a source of anxiety," said Nivedita Agarwal, M.D., radiology resident at the University of Udine in Italy, where the study is being conducted, and research fellow at the Brain Imaging Center of McLean Hospital, Department of Psychiatry at Harvard Medical School in Boston. "Because traumatic memories are not adequately suppressed by the brain, they continue to interfere with the patient's life."

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Few Young Adults Seek Treatment for Psych Disorders Alcohol, nicotine use, personality illnesses common, study shows

Psychiatric disorders are common among young adults in the United States, but few seek treatment, a new report shows.

To reach this finding, U.S. researchers analyzed data from more than 5,000 respondents, aged 19 to 25, who took part in the National Epidemiologic Survey on Alcohol and Related Conditions.

The study found that 45.8 percent of the 2,188 college students and 47.7 percent of the young adults not in college met the criteria for at least one psychiatric disorder, but only 25 percent of those with disorders sought treatment over a one-year period.

Among college students, the most common disorders were alcohol use (20.4 percent) and personality disorders (17.7 percent). The most common disorders among young adults not in college were personality disorders (21.6 percent) and nicotine dependence (20.7 percent).

READ MORE @ U.S. NEWS & WORLD REPORT

Zapping depression - Approval of a new kind of treatment reflects advances in fields that involve electrical stimulation of the brain.

In the late 1700s, Italian anatomist Luigi Galvani made a dead frog's muscles twitch when struck by a spark, a discovery that paved the way for the modern understanding of electricity's role in living things. It is the basis for countless medical technologies like the pacemaker.

But electricity does not travel easily through the skull to the brain, the organ responsible for every purposeful twitch and altered mood. So when a group of British scientists in 1985 used magnetic pulses from outside the head to induce an electrical field inside the brain - and got a subject's hands to move - their colleagues clamored for a chance to zap themselves.

That breakthrough, known as transcranial magnetic stimulation (TMS), led to the Food and Drug Administration's approval last month of the first noninvasive, non-pharmacological treatment for depression.

As a practical matter, approval of the device made by Neuronetics Inc., a five-year-old Malvern company, is intended for patients with major treatment-resistant depression who do not respond to any one medication. Millions of Americans fail to benefit from antidepressants, and millions more quit because of side effects.

READ MORE @ PHILADELPHIA INQUIRER

Tragedies Underscore Crisis in U.S. Public Mental Health System: National Advocacy Organization Demands Reforms

In the wake of the deaths of two persons in public psychiatric institutions - highlighting a pattern of abuse and neglect of those who have psychiatric disabilities - a national coalition of such individuals is calling on the incoming Obama administration and the nation's top mental health officials to institute widespread, substantive reforms in America's mental health treatment system. These would include raising standards and regulatory expectations, and identifying and funding pilot programs to demonstrate best practices in psychiatric emergency, inpatient and community-based care.
The death of Steven Sabock, a 50-year-old man diagnosed with bipolar disorder who died on April 29 in a North Carolina state psychiatric institution after he had choked on medication - while, nearby, hospital employees, ignoring his plight, entertained themselves with cards and TV - is just one example of the dangerous dysfunction of the public mental health system, said Dan Fisher, M.D., Ph.D., of the National Coalition of Mental Health Consumer/Survivor Organizations (NCMHCSO).

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Depression Treatment: Mindfulness-based Cognitive Therapy As Effective As Anti-depressant Medication, Study Suggests

Research shows for the first time that a group-based psychological treatment, Mindfulness Based Cognitive Therapy (MBCT), could be a viable alternative to prescription drugs for people suffering from long-term depression.

In a study, published December 1, 2008 in the Journal of Consulting and Clinical Psychology, MBCT proved as effective as maintenance anti-depressants in preventing a relapse and more effective in enhancing peoples' quality of life. The study also showed MBCT to be as cost-effective as prescription drugs in helping people with a history of depression stay well in the longer-term.

The randomised control trial involved 123 people from urban and rural locations who had suffered repeat depressions and were referred to the trial by their GPs. The participants were split randomly into two groups. Half continued their on-going anti-depressant drug treatment and the rest participated in an MBCT course and were given the option of coming off anti-depressants.

READ MORE @ SCIENCE DAILY

Treating depression seen important in heart failure

Depression increases the risk of death in patients with heart failure, but the risk apparently disappears with antidepressant use, according to a study.

"Recent studies suggest that the use of antidepressants may be associated with increased mortality (death) in patients with cardiac disease," Dr. Christopher M. O'Connor, of Duke University Medical Center, Durham, North Carolina, and colleagues note in the medical journal Archives of Internal Medicine.

"Because depression has also been shown to be associated with increased mortality in these patients, it remains unclear if this association is attributable to the use of antidepressants or to depression."

The researchers therefore studied roughly 1,000 patients hospitalized for heart failure who were followed up annually. The authors prospectively collected data on depression status and use of antidepressants.

READ MORE @ REUTERS

Ailing FDA May Need a Major Overhaul, Officials and Groups Say

The Obama administration will inherit a Food and Drug Administration widely seen as struggling to protect Americans from unsafe medication, contaminated food and a flood of questionable imports from China and other countries.

Shaken by a series of alarming failures, the FDA desperately needs an infusion of strong leadership, money, technology and personnel -- and perhaps a major restructuring, say former officials, members of Congress, watchdog groups and various government reports.

"Everywhere you go, you hear the same chorus: The agency's in trouble," said David A. Kessler, who served as FDA commissioner under Presidents George H.W. Bush and Bill Clinton. "There's a general perception the agency is suffering mightily."

With nearly 11,000 employees and an annual budget of more than $2 billion, the FDA is charged with overseeing products that account for one-quarter of consumer spending in the United States, including over-the-counter and prescription medications, heart valves, stents and other medical devices, the blood supply, and food.

READ MORE @ WASHINGTON POST

AP IMPACT: Govt pays for risky unapproved drugs

The government is paying millions for risky medications that have never been reviewed for safety and effectiveness but are still covered under Medicaid, an Associated Press analysis of federal data has found.

Taxpayers have shelled out at least $200 million since 2004 for such drugs. Yet the Food and Drug Administration says unapproved prescription drugs are a public health problem, and some unapproved medications have been linked to dozens of deaths.

Millions of private patients are taking them as well, and their availability may create a false sense of security.

The AP analysis found that Medicaid, which serves low-income people, paid nearly $198 million from 2004 to 2007 for more than 100 unapproved drugs. Data for 2008 were not available but unapproved drugs still are being sold. The AP checked the medications against FDA databases, using agency guidelines to determine if they were unapproved. The FDA says there may be thousands of such drugs on the market.

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Two Antidepressants Taken During Pregnancy Linked To Heart Anomalies In Babies

Women who took the antidepressant fluoxetine during the first three months of pregnancy gave birth to four times as many babies with heart problems as women who did not and the levels were three times higher in women taking paroxetine.

Although some of the conditions were serious, others were not severe and resolved themselves without the need for medical intervention, according to a three-country study in the November issue of the British Journal of Clinical Pharmacology.

Researchers have advised women taking the drugs to continue unless they are advised to stop by their doctor or consultant. But they are being urged to give up smoking, as the study also found that more than ten cigarettes a day was associated with a five-fold increase in babies with major heart problems.

The team has also suggested that women on fluoxetine should be given a foetal echocardiogram in their second trimester to diagnose possible heart anomalies.

READ MORE @ SCIENCE DAILY

Study Calls for Greater Scrutiny of 'Off-Label' Drug Use Doctors often prescribe medicines for conditions that haven't been studied thoroughly

It's called "off-label" prescribing, and it's the common practice of doctors prescribing a drug to treat a disease or condition that's different from the one studied by federal regulators that led to the drug's approval in the first place.

Despite the scope of the practice, there's often little evidence that using a drug for an unapproved purpose is always beneficial or safe, a new study found.

The study by American researchers has identified 14 widely prescribed medications that they think need additional study to see how effective and safe they are for off-label use. Many of the drugs are antidepressants and antipsychotics.

"Off-label prescribing is not based on the same level of evidence as on-label prescribing," said study lead researcher Surrey Walton, an assistant professor of pharmacy administration at the University of Illinois at Chicago.

Most patients aren't aware that once a drug is approved for one use, any doctor can prescribe it for any other use, Walton explained. Doctors may turn to a drug for off-label use, because studies or evidence suggest that it might benefit a patient with a disease or condition that was not studied when U.S. Food and Drug Administration regulators approved the drug in the first place.

READ MORE @ U.S. NEWS & WORLD REPORT