Depression abates with constant electrical stimulation, study finds

Of 20 patients with chronic major depression resistant to drugs, a dozen were helped by stimulation in a part of the brain believed to regulate sadness.

People with otherwise untreatable depression improved in a small clinical trial after receiving continuous electrical stimulation of a part of the brain that scientists believe regulates sadness.

A report this week in the journal Biological Psychiatry said 12 of 20 patients with chronic major depression benefited from the electronic device. For seven of the 12, the disease went into remission. The benefits were sustained over the course of the one-year study, researchers said.

"These were patients at the end of the road. They had tried other treatments and nothing seemed to stick," said University of Toronto neurosurgeon Andres M. Lozano, who led the study.

READ MORE @ LOS ANGELES TIMES

Grassley Vows to Pressure NIH Over Grants

The ranking Republican on the Senate Finance Committee wants the National Institutes of Health to revoke grants to academic scientists who fail to report financial conflicts of interest to their institutions, the Iowa Senator tells The Chronicle of Higher Education.

His remarks come after targeting Harvard University, Stanford University and the University of Cincinnati, because some academics underreported their own financial interests in research projects supported by the NIH. Institutions are required by federal regulation to report the existence of those conflicts to the agency. Grassley is seeking info from 20 other institutions about financial conflicts among their scientists, including Brown University’s Martin Keller, and the American Psychiatric Association.

Since 1995, an NIH regulation has required scientists to report to their universities any “significant financial interests” they hold in research projects financed by the agency. Those are defined as income or equity interest of $10,000 from a company or 5-percent ownership of its stock. The universities, in turn, are required to tell the NIH whether they were able to manage or eliminate the conflicts in order to avoid bias in the research findings, the paper notes.

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Herbal Remedy No Better Than Placebo in Treating ADHD

Parents of children and adolescents with ADHD should give their offspring physician-prescribed treatments rather than herbal remedies, according to the results of a new placebo-controlled trial.

One popular botanical compound is no more effective than placebo for treating symptoms of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents, according to a report in the June 11 Journal of the American Medical Association.

Some parents have attempted to treat their children and adolescents with the herbal remedy because of the side effects associated with stimulant medications or because stimulants have not been effective in reducing the symptoms associated with ADHD in their offspring, stated the report.

READ MORE @ PSYCHIATRIC NEWS

Nine out of 10 people with mental illness suffer discrimination, says report

Nine out of 10 people with mental health problems do not go out or apply for jobs due to the stigma associated with their condition, a report said today.

They feel most discriminated against by their family (36%), followed by their employers (35%), neighbours (31%) and friends (25%), according to the survey by the mental health charity Rethink.

The groups most likely to be accepting are children, teachers, shopkeepers and public transport workers.

The results of the survey, which consulted more than 3,000 people in England, have been released ahead of an £18m mental health anti-stigma campaign that will be launched across the UK in January.

Paul Corry, Rethink's director of public affairs, said: "Our research clearly shows that stigma and discrimination are ruining people's lives. People with mental health problems have enough on their plates without facing additional pressure caused by other people's archaic and bigoted opinions.

READ MORE @ THE GUARDIAN

Mental Health Costs to Drop After Override of Medicare Veto - Medicare patients' copays for psychiatric care will fall from 50% to 20% by 2014

There's some little-noticed good news for patients in the Medicare Improvements for Patients and Providers Act of 2008 that became law with Congress's override of President Bush's veto on Tuesday: Medicare beneficiaries in need of mental health services will soon face lower coinsurance payments and will have improved access to certain medications.

"We're going to save lives with this bill," says Nada Stotland, president of the American Psychiatric Association. The new law reduces the out-of-pocket cost for outpatient mental health services from the current 50 percent coinsurance payment to a 20 percent copay—matching the copay required for other types of medical care—by the year 2014. The reduction in beneficiaries' out-of-pocket costs will be phased in. Medicare recipients will continue to pay a 50 percent copay until 2010; in 2010 and 2011, they'll pay 45 percent; in 2012, 40 percent; in 2013, 35 percent; and in 2014, they'll have a 20 percent copay.

READ MORE @ U.S. NEWS & WORLD REPORT

Treating Depression Reduces Risk Of Heart Disease

Patients suffering from major depression are at an increased risk for cardiovascular disease, but treating these patients with medication can greatly reduce the risk, according to new findings by researchers at the University of Miami Miller School of Medicine. The results of their study are published in the July 16 issue of the journal PLoS ONE.

The researchers specifically studied the stress-hemoconcentration, which is a blood chemistry work-up that includes a blood cell count, hematocrit values, hemoglobin, total serum protein, and albumin. The stress-hemoconcentration increases during psychological stress, such as that caused by depression, and the increase is a risk factor for heart disease.

READ MORE @ MEDICAL NEWS TODAY

Partially Shared Genetic Profile Between Schizophrenia And Bipolar Disorder

Both schizophrenia and bipolar disorder can be disabling conditions, and both present clinically with significant mood and psychotic symptoms. These two illnesses also share genetic variants that might be involved in the predisposition to both disorders.

A new study sought to analyze the patterns of gene expression in the brains of individuals diagnosed with one of these disorders to search for a common "characteristic [genetic] signature."

Using microarray gene expression, Drs. Ling Shao and Marquis Vawter tested whether there was a core set of genes shared in the predisposition or long term consequences of both illnesses. The researchers found 78 dysregulated genes, representing genes involved in nervous system development and cell death, which displayed differential expression compared to control subjects.

As Dr. Vawter further explains, "the pattern of dysregulation was similar in the prefrontal cortex for both illnesses and pointed to key processes. Part of the set of core genes could be explained by medication responses; however most of these core genes did not appear to be correlated to medication response."

READ MORE @ SCIENCE DAILY

FDA Extends Black-Box Warning to All Antipsychotics

New studies and label warnings about the risks of all antipsychotics have not made clinical decisions any easier for physicians, patients, and caregivers.

Three years after the Food and Drug Administration (FDA) instituted a black-box warning for all second-generation antipsychotic (SGA) medications about increased risk of death in elderly dementia patients, a similar warning is being added to the labels of first-generation antipsychotics (FGAs) such as haloperidol and perphenazine.

The FDA announced its decision in mid-June after reviewing two epidemiological studies, both conducted in Canada, that were published in 2007. The two studies found mortality rates in elderly patients taking FGAs to be comparable to or higher than the rates in patients taking SGAs.

In a study by Sebastian Schneeweiss, M.D., and colleagues, the mortality hazard ratio in the FGA-treated elderly patients was 1.47 times that of SGA-treated patients within 180 days after starting the antipsychotic prescription. Included in this study were more than 37,000 people in British Columbia aged 65 and older who were started on antipsychotic medications. About one-third of these patients received FGA prescriptions, and the rest were given the newer SGAs. The study was published in the February 2007 Canadian Medical Association Journal.

READ MORE @ PSYCHIATRIC NEWS

Antidepressants linked to non-Hodgkin lymphoma

Long-term users of so-called tricyclic antidepressants are at increased risk of non-Hodgkin lymphoma (NHL), new research confirms.

"We previously reported an increased incidence of NHL among long-term users of tricyclic antidepressant medication in a population-based cohort of more than 30,000 users of antidepressant medications," Dr. Susanne Oksbjerg Dalton, of the Danish Cancer Society, Copenhagen, and colleagues point out.

Another population-based study did not confirm these findings, but "it did suggest a possible excess of NHL with tricyclic antidepressant medication among the long-term users," they also note.

In the July issue of Epidemiology, Dalton's group reports an update of their population-based cohort, increasing the sample size to the entire population of 354,551 adults in North Jutland County. Between 1989 and 2003, the researchers compared the incidence of NHL among antidepressant users and nonusers.

READ MORE @ REUTERS

Depression And Antidepressants Increase Risk Of Falling In Later Life

Depression And Antidepressants Increase Risk Of Falling In Later Life

Older people have a high risk for falls and the ensuing injuries. This risk, according to an article released on June 17, 2008 in the open-access journal PLoS ONE, is increased by the presence of depression, and increased even more with medication for depression.

Falls are a common problem in seniors, who often have impaired reflexes and strength. As depression is diagnosed, these same patients are often administered medication, including Selective Serotonin Reuptake Inhibitors (SSRIs), which form the most commonly prescribed family of antidepressants.

According to the published article, depression has been previously correlated with falls: "People with depression and those taking antidepressants, especially SSRIs, are 50% more likely to fall than other older people," said lead author and associate professor Ngaire Kerse. He additionally pointed out the importance of falls in caring for the elderly, as they are "very common and risk factors for falls are easy to identify. "

READ MORE @ MEDICAL NEWS TODAY

New Study Replicates Association Between Genetic Variation And Antidepressant Treatment Response

Pharmacogenetics, the study of genetic variation that influences an individual's response to drugs, is an important and growing focus in all of medical research, including psychiatry. It is a complex field, however, revealed by the lack of consistent and replicable findings across multiple studies, but some encouraging results are beginning to emerge.

A new study evaluated genetic markers in the treatment response of antidepressants and this work implicates the same markers as found in a prior trial.

Lekman and colleagues, using clinical data and DNA samples from the largest depression treatment study to date, the STAR*D study, compared individual treatment response (the reduction or remission of depressive symptoms) to individual genotypes. The researchers found that certain markers, or variations, in the FKBP5 gene are associated with treatment response to citalopram, a widely used antidepressant drug. In other words, patients with a particular genotype tended to respond better to the antidepressant treatment than others.

READ MORE @ SCIENCE DAILY

Schizophrenia discovery opens path to new treatments

Schizophrenia has been linked to a split protein, opening a path to a new class of treatments for the common mental illness.
Pregnancy stress linked to child schizophrenia
Hope for new schizophrenia drugs
Schizophrenia genes blessed by evolution

It was once thought - wrongly - that sufferers have a "split personality" but now, researchers at the Flanders Institute for Biotechnology, VIB, and University of Leuven have discovered that faulty snipping of a protein called neuregulin, or Nrg-1, lies at the basis of the development of the disease.

Greater understanding of this molecular process is a first step toward improved diagnosis of the one in 100 people who suffer from the delusions, hallucinations and disturbed thinking and more effective treatment of schizophrenia and other related disorders.

Up to now, no clear cause of schizophrenia has been found, although hereditary factors certainly play a role along with living and working conditions, with the condition being more common in urban dwellers and younger people.

However, previous scientific studies have suggested that faulty functioning of the Nrg-1 protein plays a role.

READ MORE @ TELEGRAPH

Politics In The Suicide Black Box Decision For Bipolar, Epilepsy Meds

As some of you know, yesterday the FDA's psychopharmacology advisory committee declined to approve the FDA's recommendation that a black box warning be added to 11 anti-seizure drugs used to treat bipolar disorder and epilepsy. I've not seen a lot of press on the decision yet, so the committee's reasoning is not clear to me, but you can glean a bit from this early piece by the Dow Jones News Service:

"Panel members raised concerns about the unintended consequences of adding a black-box warnings to epilepsy [drugs], saying such a move would make doctors wary of prescribing the drugs.

"Panel member Sean Hennessy, a doctor, said he thinks there should be an additional warning on epilepsy drug labels, but added the FDA's analysis shows suicidal risks are 'modest.'

"'To me (the data) says there ought to be a warning, but given what we know about the effects on prescribing, I don't know if they rise to the level of a black box,' Hennessy said.

"GlaxoSmithKline Plc's (GSK) Jack Modell, vice president of clinical development, said his company believes additional warnings should be included on the label. An FDA analysis showed that Glaxo's epilepsy drug Lamictal had a higher increased risk of suicidal behavior and suicidal thoughts than other drugs."

READ MORE @ FURIOUS SEASONS (PHILIP DAWDY)

Do Antidepressants Make Bones Brittle?

Older adults may get a needed mood boost from a prescribed antidepressant, but they're also at increased risk for bone fractures, a growing number of studies suggest.

In one of the latest reports, Leslie Spangler, a researcher at Group Health, a Seattle-based health plan, found that antidepressant use in postmenopausal women, who averaged 64 years of age, was linked to an increased risk of fractures of the spine and other sites.

"Our study didn't show any strong association between antidepressants and wrist fractures and hip fractures," she said. "It did find an association with spine fracture."

Those women on antidepressants had a 30 percent increased risk of spine fracture, she said, and a 20 percent increased risk of any type of fracture.

Spangler's team based its findings on a review of data from more than 93,000 women enrolled in the large Women's Health Initiative Observational Study. First, the researchers looked at antidepressant use, then they looked at the incidence of fractures. The findings were published in the May issue of theJournal of General Internal Medicine.

READ MORE @ WASHINGTON POST

Psychiatric Group Faces Scrutiny Over Drug Industry Ties

It seemed an ideal marriage, a scientific partnership that would attack mental illness from all sides. Psychiatrists would bring to the union their expertise and clinical experience, drug makers would provide their products and the money to run rigorous studies, and patients would get better medications, faster.

But now the profession itself is under attack in Congress, accused of allowing this relationship to become too cozy. After a series of stinging investigations of individual doctors’ arrangements with drug makers, Senator Charles E. Grassley, Republican of Iowa, is demanding that the American Psychiatric Association, the field’s premier professional organization, give an accounting of its financing.

The association is the voice of establishment psychiatry, publishing the field’s major journals and its standard diagnostic manual.

“I have come to understand that money from the pharmaceutical industry can shape the practices of nonprofit organizations that purport to be independent in their viewpoints and actions,” Mr. Grassley said Thursday in a letter to the association.

READ MORE @ NY TIMES

Risks of Suicidal Ideation and Behavior with Epilepsy Drugs Reaffirmed

All epilepsy drugs should carry a warning -- not necessarily boxed -- about increased risks for suicidal ideation and behavior, a joint meeting of two FDA committees concluded here.

In January, the FDA released results of an analysis that found almost double the risk of suicidality with the use of 11 drugs used to treat epilepsy or psychiatric conditions. (See: FDA Finds Suicidal Behavior in Studies of 11 Epilepsy Drugs)

Today, a joint meeting of the FDA's Peripheral and Central Nervous System Drugs Advisory Committee and the Psychopharmacologic Drugs Advisory Committee voted overwhelmingly in favor of the agency's conclusions that the finding of increased risk should apply not only to all of the drugs in the analysis, but to all anticonvulsants currently on the market.

The committees also voted to describe the risks in a medication guide that would be handed out to patients who were prescribed the drugs.

However, the idea of including a black box warning on the drugs was rejected. Committee members feared that such a warning would discourage physicians from appropriately prescribing the drugs to those who need them.

READ MORE @ MEDPAGE TODAY

Abuses Are Found in Online Sales of Medication

A large majority of 365 Internet sites that advertise or sell controlled medications by mail are offering to supply the drugs without a proper prescription, according to a new study. The online trade is stoking the rising abuse of addictive and dangerous prescription drugs, the authors and federal officials say.

Drugs offered online include generic versions of opiates like OxyContin, methadone and Vicodin, which are legitimately prescribed as painkillers; benzodiazepines like Xanax and Valium, which are prescribed for anxiety; and stimulants like Ritalin.

Federal and state efforts to crack down on Internet sales appear to have reduced the number of sites offering such drugs, from 581 last year, said Joseph A. Califano Jr., director of the National Center on Addiction and Substance Abuse at Columbia University.

“Nevertheless, anyone of any age can obtain dangerous and addictive prescription drugs with the click of a mouse,” Mr. Califano said. The center is issuing the study, the latest of five annual surveys, on Wednesday.

READ MORE @ NY TIMES

Some Antidepressants Associated With Gastrointestinal Bleeding

A class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs) appear to be associated with bleeding in the upper gastrointestinal tract, according to a new article. The effects appear increased when antidepressants are combined with other stomach-harming medications and decreased when acid-suppressing agents are used.

Since the early 1990s, case reports have suggested an association between SSRIs and bleeding in the upper gastrointestinal (GI) tract, according to background information in the article. "The wide use of this drug class requires research to provide more accurate risk estimates, to identify factors that may further increase the risk and, in particular, to determine whether using acid-suppressing agents may reduce the risk," the authors write. "It is also important to determine whether venlafaxine hydrochloride, a new antidepressant related to SSRIs, also increases the risk of bleeding, as some individual case reports have suggested."

READ MORE @ SCIENCE DAILY

Some Antidepressants Work Quickly

pillsA single antidepressant tablet makes a depressed person see the world in a more positive light just four hours after swallowing it, suggests a new study.

Dr Philip Cowen, professor of pharmacology at the Department of Psychiatry at the University of Oxford, told delegates at the Royal College of Psychiatrists’ Annual Meeting in London that antidepressant medication starts to work far faster than most clinicians assume.

“Depressed people interpret the world in a negative way,” he said. “They become stuck in this state. Negativity causes depression and depression causes negativity and, whatever happens, events will be interpreted in a negative way.”

Antidepressants elevate mood, which in turn leads to a depressed person becoming more positive and interpreting things that happen to them in a positive way. Prof Cowen said: “Antidepressants change biases. People who take them begin to see the world in a positive light,” said Prof Cowen

But it does not take weeks for this change to happen. Prof Cowen and his colleagues gave 30 depressed people one single 4mg dose of reboxetine – which inhibits the update of both serotonin and noradrenaline in the brain – and compared them with 30 ‘controls’ who were given a placebo or dummy pil

RAD MORE @ PSYCHCENTRAL

Head fake - How Prozac sent the science of depression in the wrong direction

PROZAC IS ONE of the most successful drugs of all time. Since its introduction as an antidepressant more than 20 years ago, Prozac has been prescribed to more than 54 million people around the world, and prevented untold amounts of suffering.

But the success of Prozac hasn't simply transformed the treatment of depression: it has also transformed the science of depression. For decades, researchers struggled to identify the underlying cause of depression, and patients were forced to endure a series of ineffective treatments. But then came Prozac. Like many other antidepressants, Prozac increases the brain's supply of serotonin, a neurotransmitter. The drug's effectiveness inspired an elegant theory, known as the chemical hypothesis: Sadness is simply a lack of chemical happiness. The little blue pills cheer us up because they give the brain what it has been missing.

There's only one problem with this theory of depression: it's almost certainly wrong, or at the very least woefully incomplete. Experiments have since shown that lowering people's serotonin levels does not make them depressed, nor does it does not make them depressed, nor does it worsen their symptoms if they are already depressed.

READ MORE @ BOSTON GLOBE