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.

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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.

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Mental illness and drug addiction may co-occur due to disturbance in part of the brain

Why do mental illness and drug addiction so often go together" New research reveals that this type of dual diagnosis may stem from a common cause: developmental changes in the amylagda, a walnut-shaped part of the brain linked to fear, anxiety and other emotions. A full report on why these “comorbid” disorders may develop appears in the December Behavioral Neuroscience, published by the American Psychological Association (APA).

Dual diagnosis is common yet difficult to treat. Addiction of all types – to nicotine, alcohol and drugs – is often found in people with a wide variety of mental illnesses, including anxiety disorders, unipolar and bipolar depression, schizophrenia, and borderline and other personality disorders. Lead author Andrew Chambers, MD, cites clinical reports that at least half the people who seek help with addiction or mental-health treatment have co-occurring disorders. Epidemiological data says that from two to five of every 10 anxious or depressed people, and from four to eight of every 10 people with schizophrenia, bipolar disorder, or antisocial personality, also have some type of addiction.

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One Gene Variant Puts Stressed Women At Risk For Depression; Has Opposite Effect In Men

A common variation in genes puts women who are under chronic stress at risk for increased depressive symptoms, but has the exact opposite effect in men, according to new findings from Duke University Medical Center researchers.

The researchers analyzed two independent samples of healthy individuals for the presence of a genetic variant that regulates levels of serotonin — a neurotransmitter that is linked to health in numerous ways, including emotion regulation.

One version of the gene puts women who are under chronic stress at risk for more severe depressive symptoms. But among men, the same gene variant appeared to be protective against depression. In fact, men with the opposite gene variant were the ones who experienced more depressive symptoms when under chronic stress.



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Novel Antidepressant Agomelatin Targets Melatonin and Serotonin Receptors: Presented at CPA

The soon-to-be-available antidepressant agomelatin offers excellent efficacy with great tolerability and sleep improvements to boot.

Raymond W. Lam, MD, Professor and Head of Clinical Neuroscience, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, Canada, presented the latest findings on this agent here at the 57th Annual Conference of the Canadian Psychiatric Association (CPA).

Agomelatin is a new antidepressant with a novel mechanism of action. It acts as an agonist to both the melatonin receptors MT1 and MT2. It is also an antagonist to the 5HT2C serotonin receptor. It also appears to have no other action in any other receptor site, and over 80 sites have been studied so far, said Dr. Lam.

Both the M1 and M2 receptors are known to be involved in regulation of circadian rhythms. Stimulation of M1 has a positive effect on sleep by attenuating the alerting signal produced by the suprachiasmatic nucleus (SCN) in the brain. M2 has a phase-shifting effect on circadian rhythms. Antagonism of the 5HT2C increases the activity of dopamine and noradrenalin in the frontal cortex, which can have both anxiolytic and antidepressant effects. It also promotes slow wave sleep or deep, restorative sleep.

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Lifespan link to depression drug

An antidepressant drug lengthens tiny worms' lives and offers hope of humans living longer too, US scientists say.

In the study, detailed in journal Nature, nematode worms were exposed to 88,000 chemicals in turn and mianserin extended lifespan by almost a third.

The drug seems to mimic the effects on the body of the only known animal long-life regime - virtual starvation.

Experts said the findings might point to there being genes in humans that could be targeted to increase lifespan.

READ MORE @ BBC

Hormonal Changes And Depression: What Is The Connection?

Women are more susceptible to mood disorders and depression during hormonal transitions, such as pregnancy, postpartum and perimenopause, according to a new report by the Society for Women's Health Research, a Washington, D.C.-based advocacy organization, released at a media briefing held at the Palace Hotel in New York City.

The report summarizes a June 2007 thought leaders' roundtable of eight national experts convened by the Society and the National Institute of Mental Health to discuss current efforts to understand the effects of hormonal transitions on mood disorders in women and to make recommendations for future research.

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Brain scans 'may detect OCD risk'

Brain scans may be able to reveal which people are at genetic risk of developing obsessive compulsive disorder (OCD), researchers say.

Individuals with OCD and their close relatives have distinctive patterns in their brain structure, a team at Cambridge University found.

The genes responsible remain unknown, but it appears they change the brain's anatomy, which may aid diagnosis.

The study is published in the latest edition of the journal Brain.

OCD is an anxiety disorder in which the person is compelled by irrational fears and thoughts to repeat seemingly needless actions over and over again.

It can manifest itself in repetitive behaviours, such as excessive hand washing, cleaning or repeated checking, affects 2%-3% of the population and is known to run in families.

READ MORE @ BBC

Transcranial Magnetic Stimulation Repels Severe Depression

Transcranial magnetic stimulation significantly reduces acute symptoms of major depression and offers an alternative to conventional therapy, investigators in a multicenter trial have concluded.

Patients treated with transcranial magnetic stimulation had almost a twofold higher remission rate at six weeks compared with patients who received sham therapy in the randomized study, John P. O'Reardon, M.D., of the University of Pennsylvania, and colleagues reported in the Dec. 1 issue of Biological Psychiatry.

As many as 40% of patients with major depression do not get adequate improvement in symptoms with medication and psychotherapy, the investigators noted. Depression may progress into treatment-resistant illness for which transcranial magnetic stimulation could be useful.

Transcranial magnetic stimulation involves discharge of a time-varying current from an insulated coil placed on the scalp surface. The discharge generates a brief dynamic magnetic field that induces current flow when reaching a conductive medium, such as neural tissue. The current offers the potential to modulate neural circuitry in a therapeutic fashion.

Ritalin: The scandal of kiddy coke

When he was in the throes of his worst tantrums, Daniel Fletcher would rip wallpaper off the walls at home and hit and kick anyone who came near him.

Once, he put his pet mouse in the microwave. On another occasion he jumped out of a moving car.

He was first diagnosed with Attention-Deficit Hyperactivity Disorder (ADHD) at the age of two, and just three years later the little boy was prescribed the amphetamine-like drug Ritalin.

The effect, says his mother Hayley, was a loss of appetite but no difference in his behaviour.

"So the doctor kept upping the doses until he was on six times the normal dose, yet he was still hyperactive."

Eight months ago, Daniel, now 14, was put on Risperdal - an antipsychotic drug usually given to schizophrenics.

"It was as if my son had been replaced by a doped-up zombie,' says Hayley, 35, who took him off it a month later.

READ MORE @ DAILY MAIL

Trials in Obsessive Compulsive Disorder Highlight Group Therapy, Escitalopram, and Anticonvulsants: Presented at CPA

The latest research on the management of obsessive compulsive disorder (OCD) suggests that cognitive behaviour therapy (CBT) can be as effective in groups and in the office as it is in one-on-one sessions and in the home. Also, the antidepressant escitalopram and anticonvulsants topiramate and lamotrigine may play a more important therapeutic role than has previously been recognised.

Pratap Chokka, MD, Associate Clinical Professor, University of Alberta, Psychiatrist, Grey Nuns Hospital, Edmonton, Canada, presented the latest findings on the management of OCD here on November 17 at the 57th Annual Conference of the Canadian Psychiatric Association (CPA).

Currently, CBT is a mainstay of treatment for OCD. As a stand-alone treatment, it has been found in some studies to be as effective as antidepressants. While one-on-one CBT therapy was believed until recently to be the most effective option, 2007 data has revealed that, in fact, both individual and group therapy are effective. While response rates were faster with individual therapy, overall response rates were similar with both modalities. This is an important finding for a real world setting, where patients are often on waiting lists to receive CBT, said Dr. Chokka.

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Dementia relief, with a huge side effect

The off-label use of some drugs is helping elderly patients, but may be killing thousands.

Two years ago, federal regulators sounded a dire warning: Elderly people with dementia who take drugs like Seroquel, Risperdal and Zyprexa could suffer the ultimate side effect.

They could die.

Yet today, about one in four nursing home residents still take these antipsychotic drugs. Sales to the elderly continue to rise, generating a total of $13-billion in revenues for their manufacturers this year.

The disconnect between government warnings about the increased risk of death and physician prescribing practices led a prominent Food and Drug Administration safety expert to make a stunning estimate.

Dr. David Graham, who had blown the whistle on the dangers of Vioxx, was back before a congressional panel in February. He testified that Zyprexa and other antipsychotics kill about 15,000 nursing home residents each year.

His pronouncement did not spark any followup investigations; it did not prompt government-sponsored research for safer alternatives. Instead, there was resounding silence.

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Study Questions 'Real World' Benefits of Newer Antipsychotics

The second-generation antipsychotics may not change the compromised neurobiology that underlies cognitive deficits.

Are the cognitive benefits claimed by manufacturers of second-generation antipsychotics an artificial result of repetitive practice in test conditions?

That's what a randomized trial of risperidone and olanzapine comparing cognitive improvements among first-episode schizophrenia patients and healthy controls suggests. Risperidone is marketed by Janssen Pharmaceutica as Risperdal, and olanzapine is marketed by Eli Lilly and Co. as Zyprexa.

The study, reported in the October Archives of General Psychiatry, found that the cognitive improvements among patients were consistent in magnitude with the "practice effects"—the effects of exposure, familiarity, and procedural learning that naturally occur in test conditions—seen in healthy patients.

READ MORE @ PSYCHIATRIC NEWS

Lower Response Rates To Antidepressants Found With African-Americans, Latinos

Drawing from data in the nation's largest real-world study of treatment-resistant depression, a team led by researchers at Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center reported in November's Medical Care journal that African-Americans and Latinos didn't respond as well as whites to medication for their depression.

The study suggests that the lower response rates may stem from differences in socioeconomic background -- rather than race or ethnicity per se. When some of the socioeconomic and health disparities present when subjects entered the study were taken into account, the researchers found the response to antidepressant medications was more similar among all groups.

Dr. Ira Lesser, a LA BioMed investigator who authored the report along with a team of researchers including LA BioMed investigator Daniel B. Castro, said these findings suggest African-Americans and Latinos from lower socioeconomic backgrounds may need more than medication to be treated successfully for depression.

READ MORE @ SCIENCE DAILY

ADHD Drugs Ineffective Over The Long Term

Apart from being ineffective over the long term, ADHD (attention deficit/hyperactivity disorder) drugs may also undermine your child's physical growth, a BBC television program, Panorama, has revealed. Scientists seem to be saying that claims made about ADHD drugs some years ago were overstated.

A long-term monitoring program involving 600 kids across the United States since the beginning of the 1990s was shown in the TV program - with some of its results. It is called the Multimodal Treatment Study of Children with ADHD. The study concluded that over the long term, such ADHD drugs as Concerta and Ritalin have no demonstrable benefit for children - long term means after three years of taking the drug(s).

The use of ADHD drugs in much of the developed world has doubled over the last five years - many say it has become a cure-all for bad behavior.

READ MORE @ MEDICAL NEWS TODAY

ADHD Drugs Ineffective Over The Long Term

Apart from being ineffective over the long term, ADHD (attention deficit/hyperactivity disorder) drugs may also undermine your child's physical growth, a BBC television program, Panorama, has revealed. Scientists seem to be saying that claims made about ADHD drugs some years ago were overstated.

A long-term monitoring program involving 600 kids across the United States since the beginning of the 1990s was shown in the TV program - with some of its results. It is called the Multimodal Treatment Study of Children with ADHD. The study concluded that over the long term, such ADHD drugs as Concerta and Ritalin have no demonstrable benefit for children - long term means after three years of taking the drug(s).

The use of ADHD drugs in much of the developed world has doubled over the last five years - many say it has become a cure-all for bad behavior.

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."

READ MORE @ ALTERNET

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