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.

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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.

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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.

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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."

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Little evidence to support therapies for post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) is a severe and ongoing emotional reaction to an extreme psychological trauma; it affects significant numbers of people, in particular military personnel and veterans, who have seen active duty in war zones.

It also affects people who have suffered major injuries or illnesses.

As many as 25% or more of patients that suffer from PTSD will have attempted suicide.

It is thought to be basically an anxiety disorder and is different from normal grief and adjustment after traumatic events; symptoms which appear within the first month of the trauma are called acute stress disorder but if no improvement of symptoms are seen after a month, PTSD is diagnosed.

PTSD is divided into three categories: Acute PTSD which subsides within three months; if symptoms persist, the diagnosis is changed to chronic PTSD.

The third category, delayed-onset PTSD, may occur months, years or even decades after the traumatic event.

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Evidence unclear on treating US veterans' stress

Many U.S. combat veterans from Iraq and Afghanistan are clearly suffering from post-traumatic stress disorder but it is not at all clear which treatments work to help them, an Institute of Medicine panel said on Thursday.

The only therapies that have been shown to work are so-called exposure therapies, in which people are guided in a gradual, step-by-step confrontation with a fear or stressor, the expert committee said.

"At this time, we can make no judgment about the effectiveness of most psychotherapies or about any medications in helping patients with PTSD," said Dr. Alfred Berg of the University of Washington in Seattle.

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How Schizophrenia Develops: Major Clues Discovered

Schizophrenia may occur, in part, because of a problem in an intermittent on/off switch for a gene involved in making a key chemical messenger in the brain, scientists have found in a study of human brain tissue. The researchers found that the gene is turned on at increasingly high rates during normal development of the prefrontal cortex, the part of the brain involved in higher functions like thinking and decision-making -- but that this normal increase may not occur in people with schizophrenia.

The gene, GAD1, makes an enzyme essential for production of the chemical messenger, called GABA. The more the gene is turned on, the more GABA synthesis can occur, under normal circumstances. GABA helps regulate the flow of electrical traffic that enables brain cells to communicate with each other. It is among the major neurotransmitters in the brain.

Abnormalities in brain development and in GABA synthesis are known to play a role in schizophrenia, but the underlying molecular mechanisms are unknown. In this study, scientists discovered that defects in specific epigenetic actions -- biochemical reactions that regulate gene activity, such as turning genes on and off so that they can make substances like the GAD1 enzyme -- are involved.

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Schizophrenics gain by practice, not meds

A U.S. study suggested cognitive gains in schizophrenic patients treated with newer antipsychotic medications are due to practice effects, not the drugs.

Second-generation antipsychotic medicines were designed to improve the speed, clarity, and rationality of thought among people with schizophrenia and other psychotic illnesses.

But psychiatric researchers at the Zucker Hillside Hospital and the Feinstein Institute for Medical Research studied the cognitive performance of 104 people newly diagnosed with schizophrenia who were taking second-generation medicines.

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Valdoxan(R), the First Melatonergic Antidepressant, Confirms its Efficacy in Preventing Relapse Whatever the Severity of the Depression

Valdoxan(R) (agomelatine), the first melatonergic antidepressant, is an effective, long-term treatment for Major Depressive Disorder (MDD) according to new data presented today at the European College of Neurospsychopharmacology(ECNP) annual congress. The new international study showed Valdoxan's efficacy in preventing relapse in out-patients with MDD over six-months, irrespective of the severity of depression(1).

"The short term efficacy of this novel antidepressant has already been demonstrated in several clinical studies", points out study investigator Professor Guy Goodwin from the Department of Psychiatry,University of Oxford, UK. "This new study demonstrated the long-term efficacy of Valdoxan in the prevention of depressive relapses, after an initial response to the drug, over a treatment period of six months. The results show that Valdoxan is a promising therapeutic agent for the short-and-long-term management of MDD, which offers remission to our depressed patients with very few adverse effects".

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Mental Disorders Are Disorders Of The Brain

Depression, anxiety disorders such as panic disorder and obsessive-compulsive disorders, alcohol and drug dependence, dementia and Parkinson's disease are just a few examples of "disorders of the brain."

The size, the burden and cost of brain disorders in the EU is immense, and has so far been underestimated," as Prof. Dr. Hans Ulrich Wittchen emphasized at the Official Press Conference to the 20th ECNP Congress for Neuropsychopharmacology in Vienna (October 13-17, 2007).

Increasing Lifetime Risk -- Unmet Needs

Mental disorders such as anxiety and depressive disorders are disorders of the brain and involve complex patterns of disturbances of cognition (such as perception, attention, memory), affect and emotion (such as depressed mood, panic), somatic functioning (e.g. appetite, heart rate variability) and behaviour. These patterns and disturbances are all associated with disturbances in the transmitter systems of the brain and the central nervous system. What is special about most mental disorders is that they predominantly manifest early in life, before the age of 20. They are also associated across the life span with a high risk of developing complications and other -- so called comorbid -- disorders.

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Depressed at work? Get a new career

Child care workers, home health care aides and other people who provide personal services have the highest rates of depression among U.S. workers, according to a new survey to be published on Monday.

It found that 10.8 percent of personal care and service workers and 10.3 percent of food preparation and serving workers -- both usually low-paying jobs -- experienced one or more major depressive episodes in the past year.

The least depressing careers appear to lie in architecture, engineering, the sciences and in the installation, maintenance and repair fields, the survey from the Substance Abuse and Mental Health Services Administration found.

READ MORE @ REUTERS