Sex Differences Seen in Response to Common Antidepressant

Women with depression may be much more likely than men to get relief from a commonly used, inexpensive antidepressant drug, a new national study finds. But many members of both sexes may find that it helps ease their depression symptoms.

The persistence of a gender difference in response to the drug — even after the researchers accounted for many complicating factors — suggests that there’s a real biological difference in the way the medication affects women compared with men. The reasons for that difference are still unclear, but further studies are now examining hormonal variations that may play a role.

The study involved citalopram, a commonly used antidepressant that is available both as a generic drug and under the brand name Celexa.

Researchers from the University of Michigan Depression Center and their colleagues from around the country tested the drug’s ability to help depression patients achieve remission, or total relief from their symptoms, in a multi-year study called STAR*D.

The gender differences emerged from a detailed analysis of data from 2,876 men and women who had a clear diagnosis of major depression, and took citalopram over a number of weeks, with the doses increasing over time.

In the end, women were 33 percent more likely to achieve a full remission of their depression, despite the fact that women in the study were more severely depressed than the men when the study began.

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Antipsychotic drug 'stroke risk'

More people than previously thought could be at higher risk of having a stroke caused by their antipsychotic drugs, say UK scientists.

Previous research suggested only some types of the drug increased the risk, particularly for people with dementia.

However a study published in the British Medical Journal says all forms of antipsychotics boost the risk, in all patients.

A mental health charity said patients on the drugs must be closely monitored.

Antipsychotic drugs are generally used to control psychotic symptoms in patients with disorders such as schizophrenia, and some severe forms of depression.

They are also thought to be widely used to control symptoms of dementia such as aggression, leading to accusations they were being used unnecessarily as a "chemical cosh" in some circumstances.

READ MORE @ BBC

Antidepressants need new nerve cells to be effective, UT Southwestern researchers find

Researchers at UT Southwestern Medical Center have discovered in mice that the brain must create new nerve cells for either exercise or antidepressants to reduce depression-like behavior.

In addition, the researchers found that antidepressants and exercise use the same biochemical pathway to exert their effects.

These results might help explain some unknown mechanisms of antidepressants and provide a new direction for developing drugs to treat depression, said Dr. Luis Parada, chairman of developmental biology and senior author of a study in the Aug. 14 issue of the journal Neuron.

In animals, it was already known that long-term treatment with antidepressants causes new nerve cells to be generated in a part of the brain called the dentate gyrus. Exercise, which can also relieve the symptoms of depression, stimulates the generation of new nerve cells in the same area.

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Antidepressant Medications May Have Alternate Use

A new study published in the August 15th issue of Biological Psychiatry finds that hippocampal neurogenesis (neuron birth in the hippocampus part of the brain) might be used by the monoaminergic antidepressants (related to the secretion of monoamine neurotransmitters such as dopamine and serotonin) to counteract the effects of stress, whereas similar effects could be achieved by directly targeting the hypothalamo-pituitary-adrenal (HPA) axis and related neuropeptides (amino acid chains).

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Anti-psychotic drug use in the elderly increases despite drug safety warnings

Three regulatory warnings of serious adverse events slowed the growth of use of atypical antipsychotic drugs among elderly patients with dementia, but they did not reduce the overall prescription rate of these drugs, found a research analysis of prescription drug claims data in Ontario http://www.cmaj.ca/press/pg438.pdf. The rate of use of these drugs actually increased 20% from the month prior to the first warning in September 2002 to the end of the study period in February 2007.

About 70% of people receiving antipsychotic drugs lived in nursing homes, and approximately 40% were aged 85 or older.

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Stigmatising attitude of medical students towards a psychiatry label

The aim of this study is to evaluate the effect of a psychiatric label attached to an apparently normal person on the attitude of final year medical students at a Nigerian university.

Methods: A questionnaire with sections on demographic information, a single-paragraph case description illustrating a normal person, a social distance scale and questions on expected burden was used to elicit responses from 144 final year medical students who have had previous exposure to psychiatric posting.

The students consisted of two randomly assigned groups; group A received a case description with a psychiatric label attached while group B received the same case description but without a psychiatric label.

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Looking beyond the drug receptor for clues to drug effectiveness

Antipsychotic drugs that are widely used to treat schizophrenia and other problems may not work as scientists have assumed, according to findings from Duke University Medical Center researchers that could lead to changes in how these drugs are developed and prescribed.

Scientists have known that all antipsychotic drugs target the D2 receptor inside cells. New tests developed at Duke reveal that the biochemical pathways linked to this receptor – the pathways along which the drugs deliver their therapeutic effects – may function differently than previously understood.

The Duke team developed specialized tests and studied two main pathways that stem from the receptor. The first is the G-protein-dependent signaling pathway, and the other is the beta arrestin pathway.

Most antipsychotic drugs in use today were developed to target the G-protein signaling that occurs at the receptor. Only recently, beta-arrestin, a protein known as an "off-switch" for G-protein receptors, has been shown to also play a role in directing other cellular activities.

The tests uncovered surprising results. "Our work showed that all nine antipsychotic drugs we examined uniformly and more potently block the beta-arrestin pathway downstream of the D2 dopamine receptor," said Bernard Masri, Ph.D., lead author and postdoctoral researcher in the Duke Department of Cell Biology.

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Adding insult to surgical injury

MY WIFE Wendy recently underwent a routine colonoscopy at a teaching hospital in the Boston area. This effective and sometimes lifesaving procedure can locate and remove cancerous polyps in the colon (intestine). But Wendy was unlucky and experienced a medical injury that only occurs in one of 1,000 patients.

And as the hospital staff struggled to deal with the consequences of that injury, my wife and I got a first-hand look at the difficulty healthcare providers have in controlling patients' pain.

During her procedure, the colonoscope - a long, flexible, lighted tube - broke through the wall of her colon, creating a nickel-sized tear in the intestine. The injury could be seen immediately on the monitor. Wendy's doctor explained what had happened, apologized, and rushed her to the operating room for emergency surgery to prevent dangerous internal infections. The two-hour surgery was successful, and left Wendy with a 4-inch abdominal incision.

EWAD MORE @ BOSTON GLOBE

3.4 Million Seniors Hit Medicare 'Doughnut Hole'

In 2007, about 3.4 million Americans enrolled in the Medicare Part D drug plan reached a gap in their prescription coverage known as the "doughnut hole," leading some of them to stop taking prescribed drugs, says a Kaiser Family Foundation study released Thursday.

The analysis of data found that 26 percent of Part D enrollees who filled any prescriptions in 2007 reached the coverage gap. This includes 22 percent who were stuck in the gap for the remainder of the year and 4 percent who eventually received catastrophic coverage.

When they applied this estimate to the all Part D enrollees, the study authors concluded that last year about 3.4 million beneficiaries (14 percent of all Part D enrollees) reached the coverage gap and faced paying full cost for their prescriptions.

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Psychedelic drugs could heal thousands

New research into the benefits of hallucinogens alongside psychotherapy is welcome: in my experience they change lives

There is a horrible sense of meaninglessness and chaos that comes from the extreme loneliness of being cut off. Trauma, whether sustained in the family, or in the military during combat, renders millions feeling unsafe, insecure, mistrustful, and in the end isolated, lonely and desperate. Judith Lewis Herman, who wrote the definitive book on trauma and recovery, stated that all so-called mental illness and suffering could be seen as a person's misguided attempt to survive trauma. Fear separates, love unites. We all wish to grow to freedom, to belong, to participate. Hatred is like gangrene, shame is deadly. Forgiveness is but a faint hope.

Sandoz began to market LSD in 1947 as a psychiatric panacea, the cure for everything from schizophrenia to criminal behaviour, sexual perversions, alcoholism, and other addictions. During a 15-year period beginning in 1950, research on LSD and other hallucinogens generated over 1,000 scientific papers, several dozen books and six international conferences, and LSD was prescribed as an adjunct of psychotherapy to over 40,000 patients. The current research using psychedelics heralds a reawakening to the magnificent healing possibilities of these now prohibited substances. After over 40 years of repression or oppression, Rick Doblin of Multidisciplinary Association for Psychedelic Studies (Maps), and others are spearheading a more enlightened, less hysterical and terrified approach to the use of these substances. I am participating in what hopefully will be Canada's first government approved clinical trials in 40 years, sponsored and organised by Maps, evaluating MDMA-assisted psychotherapy for subjects with treatment-resistant post-traumatic stress disorder.

READ MORE @ THE GUARDIAN

Redundancy and a depression

Philip Joslin, a senior clinician at Lifeworks, a private clinic in London dealing with addictions and depression, believes redundancy “is not just a matter of economic survival. It threatens people’s very identity”.

As the economy slows and jobs are cut, psychiatric practices based in London’s financial centre are reporting a rise in referrals. Mark Beadle, chief executive of Capio Nightingale Hospitals, a provider of private psychiatric treatment, says the number of City workers coming to his clinics with depression or anxiety has risen by 30 to 40 per cent.

The psychological impact of redundancy goes beyond those whose jobs are cut, however. Christine Martin, therapist and partner at Haswell, Martin & Rose, a private practice based in central London, says: “Redundancy raises a wide range of issues – for the person losing their job, for the ‘survivor’ who hasn’t been made redundant and also the people managing the process such as human resources professionals.”

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FDA’s off-label policing criticized - GAO says agency moves too slowly

When a state trooper pulls over a speeding motorist, the officer usually writes out a ticket on the spot.

When federal regulators catch a drug company peddling prescription drugs for an unapproved use, it takes them an average of seven months to issue a warning, according to a draft report by congressional investigators. It typically takes four more months for the company to fix the problem. During that time, a lot prescriptions can be written.

The report from the Government Accountability Office delves into a gray area of medical practice and federal oversight: the use of medications to treat conditions other than the ones the drugs were approved for, a practice known as “off-label” prescribing.

Although widely accepted, off-label prescribing can amount to an uncontrolled experiment. While some patients benefit, others get drugs that do not do them much good and end up wasting money. Some people have been harmed by unexpected side effects.

What makes the practice so difficult to get a handle on is a web of seemingly contradictory laws and regulations.

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Stigma of mental illness pervasive: CMA head: 10% of Canadians think those who are ill could 'just snap out of it' if they wanted to, new survey finds

Almost half of Canadians believe that a diagnosis of mental illness is merely an "excuse for poor behaviour and personal failings" and one in 10 thinks that people with mental illness could "just snap out of it if they wanted," according to the startling findings of a new opinion poll.

The survey, commissioned by the Canadian Medical Association, shows that the stigma of mental illness remains pervasive, making it the "final frontier of socially acceptable discrimination," Canada's top doctor says.

Brian Day, a Vancouver orthopedic surgeon and president of the CMA, said the survey "shines a harsh, and frankly unflattering, light on the attitudes we Canadians have concerning mental health."

But he added that it is best to expose such views and tackle them head-on rather than allow stigma to fester. "It's important that these data be out there and we discuss them," Dr. Day said.

READ MORE @ THE GLOBE AND MAIL

Antidepressant Use Tied to Poorer Driving - But experts aren't sure if the pills, or underlying depression, are to blame

Taking prescription antidepressants while still highly depressed could impair driving ability, a new study suggests.

"We already know that depression causes concentration problems," said study author Holly J. Dannewitz. "And now it appears that people taking antidepressants who also have relatively higher depression scores fare significantly worse when attempting to perform a computerized simulation of driving."

Dannewitz conducted her research while a graduate student at the University of North Dakota in Grand Forks, where she is currently a psychology resident in a private practice.

She and her colleagues were scheduled to present their findings Sunday the American Psychological Association annual meeting, in Boston.

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FDA approves first drug for Huntington's disease

The U.S. Food and Drug Administration today approved tetrabenazine, the first drug approved for use in the United States to treat Huntington's disease, a fatal, inherited neurodegenerative disorder for which there is no cure. The action comes about eight months after an advisory panel unanimously voted to advise FDA to make the medication available to treat the disease.

The drug is already widely used in Europe, Canada and Australia to treat one of the most disabling symptoms of Huntington's disease, involuntary writhing movements known as chorea. Chorea is one of the trademark symptoms of the disease, which directly affects about 30,000 people in the United States today; another 70,000 people who are alive today will be diagnosed with the disease. FDA has classified tetrabenazine as an "orphan drug," since it's targeted to a disease that directly affects fewer than 200,000 people in the nation.

The pivotal study leading to the drug's approval was done by the Huntington Study Group, based at the University of Rochester Medical Center, and was led by Rochester neurologist Frederick J. Marshall, M.D. That study, published in the journal Neurology in 2006, found that the medication cut down involuntary movements on average by about 25 percent, with many patients experiencing a greater improvement. Overall, patients who received the medication were six times as likely to be considered by their doctors to have improved considerably, compared to participants who received a placebo.

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Dissociative disorder often persists to adulthood

Dissociative disorder that begins in childhood or adolescence frequently persists into adulthood and is often followed by other psychiatric disorders, according to a report published online in the journal Child and Adolescent Psychiatry and Mental Health.

Dr. Thomas Jan from the University of Wuerzburg, Germany and colleagues analyzed the long-term clinical outcomes of 27 former patients with juvenile dissociative disorder (two of whom had committed suicide). The average age at onset of dissociative disorder was 12 years old.

According to the researchers, 89 percent of these patients had "recovered or had markedly reduced symptoms" after treatment during childhood. However, at follow-up an average of 12.4 years after the initial diagnosis, 83 percent of the patients "met the criteria for some form of psychiatric disorder."

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FDA Psychiatry Chief Refuses To Address Questions About Pediatric Bipolar Disorder

Two weeks ago, the FDA announced that pediatric bipolar disorder--aka, child bipolar disorder, juvenile bipolar disorder, etc.--was a valid diagnosis, despite the fact that it doesn't exist in the DSM and child psychiatrists cannot even agree amongst themselves whether the disorder exists, whether it's a proxy term for something else, and what its exact symptomology might be much less its supposed pathology. The announcement occurred in an odd way--one of the inventors of child bipolar disorder, Harvard's Janet Wozniak, asserted in a letter to the editor of the Boston Globe that the FDA considered "pediatric bipolar disorder"--her term--a valid diagnosis. That was news to me, so I queried the FDA and was told that, why yes indeedy, the agency considered the diagnosis real. Despite approving two drugs (Risperdal and Abilify, both atypical antipsychotics) for the treatment of pediatric bipolar disorder in kids aged 10 to 17 in the last year, the agency had not taken any sort of public stance on the existence of the disorder in kids and teens. Now it has.

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Sensitivity to antidepressants linked with TrkB-mediated neural proliferation

Scientists have unveiled a functional link between production of new neurons and the effectiveness of antidepressants (ADs) in an animal model. The study, published by Cell Press in the August 14 issue of the journal Neuron, provides exciting insight into a mechanism that might underlie a poor response to antidepressive medications for anxiety or depression.

Depression is a significant public health problem due to both its high prevalence and its devastating impact on individuals and society," says senior author Dr. Luis F. Parada from the University of Texas Southwestern Medical Center. "Despite much excitement generated by recent advances in the knowledge of brain development and function, the mechanisms underlying the pathogenesis of depression, as well as its amelioration by AD treatment, remain poorly understood."

Animal studies have indicated that chronic treatment with ADs leads to production of new neurons in a part of the brain called the hippocampus. Exercise, such as running, which has a documented positive impact on mental health, also stimulates hippocampal neurogenesis. In both cases, new neurons arise from neural progenitor cells (NPCs) that seem to be required for the behavioral response to ADs.

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Mental Health: Exercise Is Found Not to Affect Depression

Many people are sure that exercise improves their mood, and studies have suggested that exercise is almost as effective as antidepressants in relieving symptoms of depression. But a new study has found that even though people who exercise are less likely to be depressed or anxious, it is probably not because they exercise.

Dutch researchers studied 5,952 twins from the Netherlands Twins Registry, as well as 1,357 additional siblings and 1,249 parents, all 18 to 50 years old. They recorded survey data about the frequency and duration of exercise and used well-validated scales to uncover symptoms of depression and anxiety. The study was published Monday in The Archives of General Psychiatry.

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Astonishing 52 Percent of Newly Diagnosed Bipolar Disorder Patients Receive Antidepressant Drugs in First-Line Treatment

Lamictal is the Leading Single-Agent in First-, Second- and Third-Line Therapy, According to a New Report from Decision Resources

Decision Resources, one of the world's leading research and advisory firms focusing on pharmaceutical and healthcare issues, finds that an astonishing 52.3 percent of newly diagnosed bipolar disorder patients are prescribed antidepressant drugs first line. The new report entitled Treatment Algorithms in Bipolar Disorder finds that this high preponderance of early-line antidepressant use stems from primary care physician prescribing. Surveyed primary care physicians specify selective serotonin reuptake inhibitors (including Forest Laboratories' Lexapro) as a favored first-line treatment choice for patients with bipolar disorder I with acute depression (51 percent of surveyed physicians), bipolar disorder II with acute depression without hypomania (52 percent of surveyed physicians) and bipolar disorder II with acute depression with hypomania (46 percent of surveyed physicians).
"The number of primary care physicians who are diagnosing and treating bipolar patients has been on the rise in the past few years, but surveyed primary care physicians follow a very different treatment pattern than surveyed psychiatrists," said Madhuri Borde, Ph.D., analyst at Decision Resources. "Nearly half of the patients taking selective serotonin reuptake inhibitors first line receive these drugs as a monotherapy, despite guideline recommendations to give bipolar patients presenting with depression an antimanic first line."

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