When Antidepressant Drugs Are Not Enough - A New Study On Their Combination With Psychotherapy

A group of Dutch investigators has reported on a new study on the combination of antidepressant drugs and psychotherapy in the September issue of Psychotherapy and Psychosomatics.

Although several forms of effective therapy exist for outpatients suffering from major depressive disorder, many patients do not profit from treatment. Combining psychotherapy and medication may be an effective strategy. However, earlier studies have rarely found a clear advantage for the combination. Where an advantage was found, a possible placebo effect of adding 2 types of treatment could not be ruled out as cause for the superior effect of the combination. A total of 353 patients were screened, of whom 193 were randomized over 4 conditions: nefazodone plus clinical management, interpersonal psychotherapy (IPT), the combination of the two or the combination of IPT and pill-placebo. All patients suffered from major depressive disorder and had a score of at least 14 on the 17-item Hamilton Rating Scale (HAMD).

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Adverse drug reactions rise sharply, study says

The number nearly triples since the FDA began a new reporting system in 1998. The main culprits are painkillers.

The number of serious adverse events and deaths attributed to prescription medications has nearly tripled since the Food and Drug Administration initiated a system in 1998 to make it easier to report significant side effects, researchers said today.

Twenty percent of drugs accounted for 87.1% of adverse effects, and the biggest offenders were painkillers and drugs that modify the immune system to treat arthritis, according to the report in the Archives of Internal Medicine.

A quarter of the increase could be attributed to a boost in prescriptions and another 15% to the introduction of new biotechnology drugs since 1998, but the rest of the increase could not be explained, said drug safety expert Thomas J. Moore of the Institute for Safe Medication Practices in Huntingdon Valley, Pa.

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Suicides up after warning, study shows

A 22% drop in prescriptions for antidepressants for teens and children following government warnings about hazards of the drugs led to a sharp increase in suicides the following year, according to Chicago researchers.

The change in labeling in 2003 warned that use of the drugs could increase suicidal thoughts and behavior among youths, but the labeling seems to have backfired, according to a report in the September issue of the American Journal of Psychiatry.

In the year after the change in labeling, the suicide rate rose 14% among those younger than 19, the largest increase since the government started collecting suicide statistics in 1979, said biostatistician Robert D. Gibbons and his colleagues at the University of Illinois at Chicago.

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McGill study promises faster-acting anti-depressants

A McGill University study has found that a new class of drugs known as serotonin4 (5-HT4) receptor agonists may take effect four to seven times faster than traditional selective serotonin reuptake inhibitors (SSRIs). The study, led by former McGill post-doctoral fellow in psychiatry Guillaume Lucas with his supervisor, the late Dr. Guy Debonnel, was published in the September 6 issue of the journal Neuron.

Existing SSRI-class drugs, widely prescribed as anti-depressants, can take up to six weeks to become effective, with potentially serious clinical consequences. Dr. Lucas, now an associate researcher at the Centre de Recherche Fernand Séguin of Université de Montréal, said, "These delays are not only a matter of patient comfort, it's really important, especially when you are treating major depressions that could lead to suicide."

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Teen antidepressant warning had ripple effect

Following the US Food and Drug Administration's warning about the possible risk of suicide among teens when they're treated with antidepressant drugs known as SSRIs, the rates of diagnosis and treatment of depression among adults have declined significantly, according to a new report.

"While some degree of decline in antidepressant prescribing was not unexpected after the black box warning was issued, few if any had predicted diagnosing to decline, or that other modes of treatment (psychotherapy or other medications) would remain relatively unchanged," Dr. Robert J. Valuck told Reuters Health. "It was thought that the latter two may increase to compensate for fewer antidepressant prescriptions being written."

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Study Provides Snapshot of ADHD Prevalence in U.S, Children

Almost 9% of U.S. children ages 8 to 15 meet standard diagnostic criteria for attention-deficit/hyperactivity disorder (ADHD), but less than half of them receive treatment.

Only 47.9% of the 2.4 million who met Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria for ADHD had reportedly had their conditions diagnosed by a health care professional or been treated with medication, according to a report in the September issue of the Archives of Pediatrics & Adolescent Medicine.

A research team led by Tanya E. Froehlich, M.D., of Cincinnati Children's Hospital Medical Center did a cross-sectional phone survey of the parents or caregivers of 3,082 eight- to 15-year old children who were participants in the National Health and Nutrition Examination Survey.

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Lilly's Schizophrenia Drug Targets Different Brain Chemicals

Eli Lilly and Co.'s experimental schizophrenia drug, which may replace its top-selling Zyprexa, was just as effective without causing patients to gain weight, according to a study.

Unlike other schizophrenia medicines on the market, the new compound doesn't target dopamine, a chemical that functions within the brain's reward system. It affects glutamate, involved in learning and memory. The study showed the new drug candidate to be as effective as Zyprexa in reducing symptoms such as hallucinations and social withdrawal.

The new drug candidate, dubbed LY2140023, would be the first for the disorder affecting glutamates, a company official said. Zyprexa, with $4.3 billion in 2006 sales, now faces competition from less expensive copies in Canada and Germany, the Indianapolis-based company said on June 8. The drug's U.S. patent expires in 2011.

``Discovering an antipsychotic drug that doesn't work through dopamine is the holy grail of drug development,'' said Gerald Marek, Lilly's chief scientific officer of psychiatric disorders, in an Aug. 30 telephone interview. ``It looks like we've hit upon a target that will ultimately do this.''

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More Children Being Treated for Bipolar Disorder

The number of American children and adolescents treated for bipolar disorder increased 40-fold from 1994 to 2003, researchers are to report on Tuesday, in the most comprehensive study to look at the controversial diagnosis. And experts say the numbers have almost certainly risen further in the years since.

Most experts believe the jump reflects the fact that doctors are more aggressively applying the diagnosis to children, not that the number of new cases has gone up. But the magnitude of the increase is surprising to many experts, who say it is likely to intensify a debate over the validity of the diagnosis that has shaken the field of child psychiatry in recent years.

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Practice guideline for the assessmet and treatment of patients with suicidal behaviors

BIBLIOGRAPHIC SOURCE(S)
American Psychiatric Association. Practice guideline for the assessment and treatment of patients with suicidal behaviors. Arlington (VA): American Psychiatric Association; 2003 Nov. 117 p. [846 references]
GUIDELINE STATUS
This is the current release of the guideline.
MAJOR RECOMMENDATIONS
Each recommendation is identified as falling into one of three categories of endorsement, indicated by a bracketed Roman numeral following the statement. The three categories represent varying levels of clinical confidence regarding the recommendation. Definition of grades of recommendation [I-III] are presented at the end of the "Major Recommendations" field.

Suicide Assessment

The psychiatric evaluation is the essential element of the suicide assessment process [I]. During the evaluation, the psychiatrist obtains information about the patient's psychiatric and other medical history and current mental state (e.g., through direct questioning and observation about suicidal thinking and behavior as well as through collateral history, if indicated). This information enables the psychiatrist to 1) identify specific factors, signs, and symptoms that may generally increase or decrease risk for suicide or other suicidal behaviors and that may serve as modifiable targets for both acute and ongoing interventions, 2) address the patient's immediate safety and determine the most appropriate setting for treatment, and 3) develop a multiaxial differential diagnosis to further guide planning of treatment. The breadth and depth of the psychiatric evaluation aimed specifically at assessing suicide risk will vary with setting; ability or willingness of the patient to provide information; and availability of information from previous contacts with the patient or from other sources, including other mental health professionals, medical records, and family members. Although suicide assessment scales have been developed for research purposes, they lack the predictive validity necessary for use in routine clinical practice. Therefore, suicide assessment scales may be used as aids to suicide assessment but should not be used as predictive instruments or as substitutes for a thorough clinical evaluation [I].

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Topics to Review with Patients When considering use of antidepressants

University of Oklahoma College of Medicine
INTRODUCTION
To increase the chance of successful pharmacologic antidepressant therapy for patients with depression, clinicians should review several specific topics with their patients before the initiation of such therapy. Discussion points range from alternatives to pharmacologic therapy to common adverse effects of specific medications.
Clinicians can begin the discussion by soliciting specific aspects of the patient’s condition, including any previous experience with antidepressant therapy, the patient’s expectations for therapy, and any external sources of information regarding therapy. After establishing expectations and understanding the past history of the patient’s condition, alternatives to drug therapy may be considered and discussed.

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Pharmageddon: the prescription pill epidemic

Our increasing reliance on pills has resulted in a 27 per cent rise in prescriptions written by doctors in just five years. It's costing the NHS £10bn a year, £200m of which is wasted on drugs that are never used. Nina Lakhani reports on a dangerous addiction.

Britain is in the grip of a prescription drug-taking epidemic, with unprecedented numbers of medicines being handed out by GPs, costing billions of pounds and stretching already tight NHS resources to breaking point.

Prescription drug use has increased by 27 per cent in the past the five years and the NHS drug bill topped £10bn in 2006. GPs prescribed 918 million medicines last year compared with 721 million five years ago, according to figures obtained by The Independent on Sunday.

Health experts put rocketing prescription numbers down to medical advances, but also point to poor prescribing by GPs, growing public demand for a "pill for every ill" and aggressive marketing tactics by the pharmaceutical industry, which prompted one MP to warn that the UK is heading towards what he called "pharmageddon".

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Headway in developing a faster-acting antidepressant

The key might be provided by studying the effect that ketamine, an anesthetic, has on a neurotransmitter.

After years of little progress, scientists are making headway in the search for a better, faster-acting antidepressant. Experiments with an anesthetic called ketamine have yielded important clues about the biology of depression, leading scientists to attack the mood disorder in new ways.

Improved treatments are sorely needed. Depression affects about one in 10 adult Americans each year, while current drugs work in only 50% to 60% of patients, can cause sexual problems and take weeks to work. They also carry a small risk of suicidal thoughts and behaviors in adolescents and young adults.

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Bipolar Disorder Relapses Halved WIth New Program

Melbourne mental health researchers have succeeded in halving the number of relapses experienced by people with bipolar disorder which strikes two in 100 Australians, accounts for 12 per cent of suicides each year and costs the country at least $1.5 billion annually.

With funding from the MBF Foundation and Beyond Blue, a team led by the Mental Health Research Institute of Victoria has developed an innovative structured group program to help people with bipolar disorder to better manage their condition.

The 12-session program, led by trained mental health clinicians, enables people battling the disorder to effectively monitor their mood, assess personal triggers and early warning signs of oncoming illness and take the necessary steps to stay well.

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US OKs J&J drug for 2 mental disorders in children

Johnson & Johnson (JNJ.N: Quote, Profile, Research) won U.S. approval to promote the drug Risperdal for treating schizophrenia and bipolar disorder in children and teenagers, officials said on Wednesday.

The prescription drug is the first medicine cleared specifically to treat schizophrenia in children, the Food and Drug Administration said.

Risperdal is already sold to treat adults with schizophrenia and bipolar disorder, as well as for irritability associated with autism in children ages 5 to 16.

Doctors have been using Risperdal and other antipsychotic medicines to treat schizophrenia and bipolar disorder, but the FDA stamp of approval will allow Johnson & Johnson to promote the drug for schizophrenic patients ages 13 to 17, and for short-term treatment of bipolar episodes in ages 10 to 17.

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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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