Since the horror of the Thalidomide scandal in the 1960s, pharmaceutical companies and medicines regulators have been acutely aware of the dangers drugs may pose to the unborn child.
Establishing what the effect of a drug may be on a foetus, however, is no simple task. Companies must rely on animal studies in the early stages of research and hope that the drug will behave in humans in the same way. Trials on pregnant women are rarely carried out, for obvious reasons.
Depression and anxiety became big business for the pharmaceutical industry in the 1990s as doctors became better at diagnosing the problems, exposing a population of over-achieving, highly-stressed, worried-well.
Women, always more willing to see a doctor than men, were a large proportion of those diagnosed and put on SSRIs (selective serotonin reuptake inhibitors) such as Prozac and the British drug Seroxat, known as Paxil in the US. For a while, these seemed to be the new miracle drugs. They were safer than older antidepressants because the severely depressed could not overdose on them.
But in court cases about to begin in the US, it will be argued that insufficient attention was paid to the possible dangers for young women who were pregnant or might become pregnant and more particularly, for their babies.
READ MORE @ GUARDIAN
Saturday, August 8, 2009
Friday, August 7, 2009
Psychologists: Gays shouldn't be advised to change
The American Psychological Association declared Wednesday that mental health professionals should not tell gay clients they can become straight through therapy or other treatments.
Instead, the APA urged therapists to consider multiple options — that could range from celibacy to switching churches — for helping clients whose sexual orientation and religious faith conflict.
FAITH & REASON: 'Be straight or go away'
YOUNG ADULTS: 'Don't want to be defined by gender, orientation'
In a resolution adopted on a 125-to-4 vote by the APA's governing council, and in a comprehensive report based on two years of research, the 150,000-member association put itself firmly on record in opposition of so-called "reparative therapy" which seeks to change sexual orientation.
No solid evidence exists that such change is likely, says the report, and some research suggests that efforts to produce change could be harmful, inducing depression and suicidal tendencies.
READ MORE @ USA TODAY
Instead, the APA urged therapists to consider multiple options — that could range from celibacy to switching churches — for helping clients whose sexual orientation and religious faith conflict.
FAITH & REASON: 'Be straight or go away'
YOUNG ADULTS: 'Don't want to be defined by gender, orientation'
In a resolution adopted on a 125-to-4 vote by the APA's governing council, and in a comprehensive report based on two years of research, the 150,000-member association put itself firmly on record in opposition of so-called "reparative therapy" which seeks to change sexual orientation.
No solid evidence exists that such change is likely, says the report, and some research suggests that efforts to produce change could be harmful, inducing depression and suicidal tendencies.
READ MORE @ USA TODAY
Thursday, August 6, 2009
FDA Okays First Monthly Antipsychotic Drug
The FDA has approved the injectable maintenance drug paliperidone palmitate (Invega Sustenna), making it the first once-monthly, atypical antipsychotic for schizophrenia.
The long-acting drug is approved for both acute and maintenance treatment.
The parent drug -- paliperidone in a once-daily tablet -- is an active metabolite of an old pharmaceutical, the atypical antipsychotic risperidone (Risperdal). (See Invega (paliperidone), Son of Risperdal (risperidone), Wins FDA Okay for Schizophrenia)
Researchers see once-monthly dosing as a potential solution for the medication adherence problems common in schizophrenia, noted Henry A. Nasrallah, MD, of the University of Cincinnati, an investigator in the paliperidone palmitate clinical trials.
"Inconsistent compliance with medications is arguably one of the single greatest impediments to managing the symptoms of schizophrenia and delaying the time to relapse," he said in a prepared statement.
READ MORE @ MEDPAGE TODAY
The long-acting drug is approved for both acute and maintenance treatment.
The parent drug -- paliperidone in a once-daily tablet -- is an active metabolite of an old pharmaceutical, the atypical antipsychotic risperidone (Risperdal). (See Invega (paliperidone), Son of Risperdal (risperidone), Wins FDA Okay for Schizophrenia)
Researchers see once-monthly dosing as a potential solution for the medication adherence problems common in schizophrenia, noted Henry A. Nasrallah, MD, of the University of Cincinnati, an investigator in the paliperidone palmitate clinical trials.
"Inconsistent compliance with medications is arguably one of the single greatest impediments to managing the symptoms of schizophrenia and delaying the time to relapse," he said in a prepared statement.
READ MORE @ MEDPAGE TODAY
Wednesday, August 5, 2009
CCHRINT Announces FDA Reported Psychiatric Drug Side Effects Search Engine
Citizens Commission on Human Rights International Announces FDA Reported Psychiatric Drug Side Effects Search Engine: Decrypted FDA reports reveal 4,260 suicides, 2,452 additional deaths, 195 homicides from 2004-2006 alone.
For the first time the side effects of psychiatric drugs that have been reported to the U.S. Food and Drug Administration (FDA) by doctors, pharmacists, other health care providers and consumers have been decrypted from the FDA's MedWatch reporting system and been made available to the public in an easy to search psychiatric drug side effects database and search engine. The database is provided as a free public service by the mental health watchdog, Citizens Commission on Human Rights International (CCHR).
The report totals reveal that between 2004-2008 the FDA's MedWatch system received pregnancy-related psychiatric drug adverse reaction reports which included 2,442 babies born with heart disease, 3,372 other birth defects, as well as 1,072 miscarriages, abortions and other deaths.
The database also reveals that, between 2004-2008 there were reports submitted to MedWatch including 4,895 suicides, 3,908 cases of aggression, 309 homicides and 6,945 cases of diabetes from people taking psychiatric drugs. These numbers reflect only a small percentage of the actual side effects occurring in the consumer market, as the FDA has admitted that only 1-10% of side effects are ever reported to the FDA.
The database is searchable by individual reports (for the 2004-2006 period), type of drug, age of patient, the side effect reported (suicide, homicide, heart attack, stroke, mania, etc.), and whether the drug in question carries a black box warning (the agency's strongest warning--short of banning a drug).
It is searchable by drug name and age group and includes who reported the psychiatric drug reaction (doctor, pharmacist, consumer, etc.). It also includes the top 20 reported adverse reactions to all psychiatric drugs to the FDA and combined summaries of all psychiatric drug reactions for the years 2004-2006 and 2004-2008.
READ MORE @ PR WEB
For the first time the side effects of psychiatric drugs that have been reported to the U.S. Food and Drug Administration (FDA) by doctors, pharmacists, other health care providers and consumers have been decrypted from the FDA's MedWatch reporting system and been made available to the public in an easy to search psychiatric drug side effects database and search engine. The database is provided as a free public service by the mental health watchdog, Citizens Commission on Human Rights International (CCHR).
The report totals reveal that between 2004-2008 the FDA's MedWatch system received pregnancy-related psychiatric drug adverse reaction reports which included 2,442 babies born with heart disease, 3,372 other birth defects, as well as 1,072 miscarriages, abortions and other deaths.
The database also reveals that, between 2004-2008 there were reports submitted to MedWatch including 4,895 suicides, 3,908 cases of aggression, 309 homicides and 6,945 cases of diabetes from people taking psychiatric drugs. These numbers reflect only a small percentage of the actual side effects occurring in the consumer market, as the FDA has admitted that only 1-10% of side effects are ever reported to the FDA.
The database is searchable by individual reports (for the 2004-2006 period), type of drug, age of patient, the side effect reported (suicide, homicide, heart attack, stroke, mania, etc.), and whether the drug in question carries a black box warning (the agency's strongest warning--short of banning a drug).
It is searchable by drug name and age group and includes who reported the psychiatric drug reaction (doctor, pharmacist, consumer, etc.). It also includes the top 20 reported adverse reactions to all psychiatric drugs to the FDA and combined summaries of all psychiatric drug reactions for the years 2004-2006 and 2004-2008.
READ MORE @ PR WEB
Tuesday, August 4, 2009
After Combat, Victims of an Inner War
Sgt. Jacob Blaylock flipped on the video camera he had set up in a trailer at the Tallil military base, southeast of Baghdad.
He lit a cigarette, inhaled deeply, blew the smoke upward.
“Hey, it’s Jackie,” he said. “It’s the 20th of April. We go home in six days. I lost two good friends on the 14th. I’m having a hard time dealing with it.”
For almost a year, the soldiers of the 1451st Transportation Company had been escorting trucks full of gasoline, building materials and other supplies along Iraq’s dark, dangerous highways. There had been injuries, but no one had died.
Their luck evaporated less than two weeks before they were to return home, in the spring of 2007. A scout truck driving at the front of a convoy late at night hit a homemade bomb buried in the asphalt. Two soldiers, Sgt. Brandon Wallace and Sgt. Joshua Schmit, were killed.
The deaths stunned the unit, part of the North Carolina National Guard. The two men were popular and respected — “big personalities,” as one soldier put it. Sergeant Blaylock, who was close to both men, seemed especially shaken. Sometime earlier, feeling the strain of riding the gunner position in the exposed front truck, he had switched places with Sergeant Wallace, moving to a Humvee at the rear.
READ MORE @ NY TIMES
He lit a cigarette, inhaled deeply, blew the smoke upward.
“Hey, it’s Jackie,” he said. “It’s the 20th of April. We go home in six days. I lost two good friends on the 14th. I’m having a hard time dealing with it.”
For almost a year, the soldiers of the 1451st Transportation Company had been escorting trucks full of gasoline, building materials and other supplies along Iraq’s dark, dangerous highways. There had been injuries, but no one had died.
Their luck evaporated less than two weeks before they were to return home, in the spring of 2007. A scout truck driving at the front of a convoy late at night hit a homemade bomb buried in the asphalt. Two soldiers, Sgt. Brandon Wallace and Sgt. Joshua Schmit, were killed.
The deaths stunned the unit, part of the North Carolina National Guard. The two men were popular and respected — “big personalities,” as one soldier put it. Sergeant Blaylock, who was close to both men, seemed especially shaken. Sometime earlier, feeling the strain of riding the gunner position in the exposed front truck, he had switched places with Sergeant Wallace, moving to a Humvee at the rear.
READ MORE @ NY TIMES
Monday, August 3, 2009
Antidepressant Use in U.S. Has Almost Doubled Study also finds increases in use of other psychotropic medications
Antidepressant use among U.S. residents almost doubled between 1996 and 2005, along with a concurrent rise in the use of other psychotropic medications, a new report shows.
The increase seemed to span virtually all demographic groups.
"Over 10 percent of people over the age of 6 were receiving anti-depression medication. That strikes me as significant," said study author Dr. Mark Olfson, a professor of clinical psychiatry at Columbia University/New York State Psychiatric Institute in New York City.
According to background information in the study, antidepressants are now the most widely prescribed class of drugs in the United States. The expansion in use dates back to the 1980s, with the introduction of the antidepressant Prozac (fluoxetine).
The study found that 5.84 percent of U.S. residents aged 6 and over were using antidepressants in 1996, compared with 10.12 percent in 2005. That's 13.3 million people, up to 27 million people.
"This is a 20-year trend and it's very powerful," remarked Dr. Eric Caine, chair of the department of psychiatry and co-director of the Center for the Study of Prevention of Suicide at the University of Rochester Medical Center.
This happened despite a "black box" warning mandated for many antidepressant medications by the U.S. Food and Drug Administration in 2004, the study authors noted.
READ MORE @ U.S. NEWS & WORLD REPORT
The increase seemed to span virtually all demographic groups.
"Over 10 percent of people over the age of 6 were receiving anti-depression medication. That strikes me as significant," said study author Dr. Mark Olfson, a professor of clinical psychiatry at Columbia University/New York State Psychiatric Institute in New York City.
According to background information in the study, antidepressants are now the most widely prescribed class of drugs in the United States. The expansion in use dates back to the 1980s, with the introduction of the antidepressant Prozac (fluoxetine).
The study found that 5.84 percent of U.S. residents aged 6 and over were using antidepressants in 1996, compared with 10.12 percent in 2005. That's 13.3 million people, up to 27 million people.
"This is a 20-year trend and it's very powerful," remarked Dr. Eric Caine, chair of the department of psychiatry and co-director of the Center for the Study of Prevention of Suicide at the University of Rochester Medical Center.
This happened despite a "black box" warning mandated for many antidepressant medications by the U.S. Food and Drug Administration in 2004, the study authors noted.
READ MORE @ U.S. NEWS & WORLD REPORT
Sunday, August 2, 2009
New link between depression and heart disease
Researchers have identified an enzyme that may trigger depressive symptoms in patients with heart disease and may help to explain why general antidepressants are often not as effective for these specific patients.
"Our study confirms that depressive symptoms are associated with inflammation in patients with heart disease and suggests a mechanism by which the brain might be affected," says Walter Swardfager, lead author of a new study and PhD candidate in the Neuropsychopharmacology Research Program at Sunnybrook Health Sciences Centre.
The research focuses on an enzyme that is part of the inflammatory process in patients with coronary artery disease (CAD). The enzyme breaks down the amino acid tryptophan and it is associated with damage to brain cells. Findings show a significant association between activation of this enzyme and the degree of depressive symptoms in these patients. They also identify a trend towards even higher levels in those suffering from clinical depression.
"This enzyme makes 'brain unfriendly' chemicals," says Dr. Krista Lanctôt, principal investigator and head of the Neuropsychopharmacology Research Program at Sunnybrook. "We are trying to chase down a treatment for patients with CAD that will block the enzyme and/or prevent the inflammatory process in the first place."
"Our study confirms that depressive symptoms are associated with inflammation in patients with heart disease and suggests a mechanism by which the brain might be affected," says Walter Swardfager, lead author of a new study and PhD candidate in the Neuropsychopharmacology Research Program at Sunnybrook Health Sciences Centre.
The research focuses on an enzyme that is part of the inflammatory process in patients with coronary artery disease (CAD). The enzyme breaks down the amino acid tryptophan and it is associated with damage to brain cells. Findings show a significant association between activation of this enzyme and the degree of depressive symptoms in these patients. They also identify a trend towards even higher levels in those suffering from clinical depression.
"This enzyme makes 'brain unfriendly' chemicals," says Dr. Krista Lanctôt, principal investigator and head of the Neuropsychopharmacology Research Program at Sunnybrook. "We are trying to chase down a treatment for patients with CAD that will block the enzyme and/or prevent the inflammatory process in the first place."
Saturday, August 1, 2009
Popular Breast Cancer Drug Used with Certain Antidepressants Puts New Jersey Women at Risk
A new analysis finds that women in New Jersey who take the breast cancer drug tamoxifen in conjunction with certain popular antidepressants may be at a higher risk for a breast cancer recurrence.
In May, Medco Health Solutions, Inc. (NYSE: MHS) and Indiana University School of Medicine released a study revealing that women using tamoxifen to prevent a recurrence of breast cancer who also use certain selective serotonin reuptake inhibitors (SSRI), for example Prozac(R) (fluoxetine), Paxil(R) (paroxetine) and Zoloft(R) (sertraline), have up to twice the chance of having a recurrence of the disease.
In a separate New Jersey-specific analysis, Medco found that among nearly 2,000 tamoxifen patients in the state during 2008, 12 percent were also taking SSRIs, including those that could put them in the at-risk population.
READ MORE @ PR NEWSWIRE
In May, Medco Health Solutions, Inc. (NYSE: MHS) and Indiana University School of Medicine released a study revealing that women using tamoxifen to prevent a recurrence of breast cancer who also use certain selective serotonin reuptake inhibitors (SSRI), for example Prozac(R) (fluoxetine), Paxil(R) (paroxetine) and Zoloft(R) (sertraline), have up to twice the chance of having a recurrence of the disease.
In a separate New Jersey-specific analysis, Medco found that among nearly 2,000 tamoxifen patients in the state during 2008, 12 percent were also taking SSRIs, including those that could put them in the at-risk population.
READ MORE @ PR NEWSWIRE
Friday, July 31, 2009
Stopping antidepressants can cause side effects - Recognizing withdrawal symptoms and working with your doctor are key.
Ryan Yorke, now 21, started taking Paxil after an out-of-the-blue panic attack his freshman year of high school. At first it worked great. But he gained weight and had other problems -- he started acting up in school and failing classes, for example. So after a year, he -- along with his mother and his psychologist -- decided it was time to stop.
Every time he reduced his dose, things got out of control, says his mother, Laurie Yorke, a registered nurse and now an administrator of paxilprogress.org, an antidepressant-withdrawal support site.
After the first big dose drop, Ryan slashed his wrists in front of his mother in the living room. "It was a six-hour psychotic episode. He was quoting Shakespeare and saying he wanted to die," she recalls.
A few weeks later, after more gradual dose changes, Ryan was still so sensitive to light and sound that he taped shut the window shades in his bedroom. His memory and concentration were poor. He dropped out of school and got his GED later, after the withdrawal process was over.
Mental health professionals aren't sure how many people have problems when stopping antidepressant medication. It's not even clear how to define the cluster of withdrawal symptoms people report, or even what causes the effects. "It's a difficult corner of the field," says Dr. Kenneth Duckworth, medical director of the National Alliance on Mental Illness and psychiatry professor at Harvard Medical School. "It's hard to know whether the person's depression is worsening or if they're having a variation on a discontinuation syndrome.
READ MORE @ LOS ANGELES TIMES
Every time he reduced his dose, things got out of control, says his mother, Laurie Yorke, a registered nurse and now an administrator of paxilprogress.org, an antidepressant-withdrawal support site.
After the first big dose drop, Ryan slashed his wrists in front of his mother in the living room. "It was a six-hour psychotic episode. He was quoting Shakespeare and saying he wanted to die," she recalls.
A few weeks later, after more gradual dose changes, Ryan was still so sensitive to light and sound that he taped shut the window shades in his bedroom. His memory and concentration were poor. He dropped out of school and got his GED later, after the withdrawal process was over.
Mental health professionals aren't sure how many people have problems when stopping antidepressant medication. It's not even clear how to define the cluster of withdrawal symptoms people report, or even what causes the effects. "It's a difficult corner of the field," says Dr. Kenneth Duckworth, medical director of the National Alliance on Mental Illness and psychiatry professor at Harvard Medical School. "It's hard to know whether the person's depression is worsening or if they're having a variation on a discontinuation syndrome.
READ MORE @ LOS ANGELES TIMES
Thursday, July 30, 2009
UPDATE 1-US FDA staff: Schering's antipsychotic works
Schering-Plough Corp's (SGP.N) experimental antipsychotic drug Saphris appears to be effective and as safe as other similar medications, U.S. Food and Drug Administration staff said in a memo released on Tuesday.
The drugmaker, which is expected to be acquired by Merck & Co Inc (MRK.N) later this year, is seeking FDA approval of the drug to treat adults with acute schizophrenia or bipolar disorder.
It has touted Saphris, or asenapine, as one of its five "star" products with the potential to earn more than $1 billion a year.
Although no final conclusion has been made, "we generally are in agreement that the sponsor has provided adequate support to suggest effectiveness for asenapine for the claimed indications," Dr. Thomas Laughren, director of the FDA's Division of Psychiatry Products, wrote in a June 24 memo.
Additionally, the drug's safety profile was "acceptable" and appears to be "qualitatively similar to that observed for other atypical antipsychotic drugs," he wrote.
READ MORE @ REUTERS
The drugmaker, which is expected to be acquired by Merck & Co Inc (MRK.N) later this year, is seeking FDA approval of the drug to treat adults with acute schizophrenia or bipolar disorder.
It has touted Saphris, or asenapine, as one of its five "star" products with the potential to earn more than $1 billion a year.
Although no final conclusion has been made, "we generally are in agreement that the sponsor has provided adequate support to suggest effectiveness for asenapine for the claimed indications," Dr. Thomas Laughren, director of the FDA's Division of Psychiatry Products, wrote in a June 24 memo.
Additionally, the drug's safety profile was "acceptable" and appears to be "qualitatively similar to that observed for other atypical antipsychotic drugs," he wrote.
READ MORE @ REUTERS
Wednesday, July 29, 2009
Treatment-Resistant Bipolar Disorder - A Review of Psychotherapeutic Approaches
The concept of treatment resistance in bipolar disorder is clinically familiar but lacks a standard definition.1 Whether the term refers to nonresponse to 1 or more standard treatments, at what dosages, and for what phases of bipolar disorder is unclear. Treatment resistance in bipolar disorder should always be based on a specific phase of treatment: mania or depression and acute or maintenance.
Treatment resistance is extremely common. Even under optimal maintenance conditions, almost half of bipolar patients with symptom remission will have a recurrence in 2 years under standard care (including medication combinations).2
Optimizing phase-specific , s is crucial. This may include raising the dosage of an initial treatment according to response unless limited by adverse effects. Acute treatments are often continued into maintenance. Combinations are commonplace, and the number of potential combinations is large. Decisions about which medications to use first or in what combinations, as well as dosing issues, require good clinical judgment on the part of each clinician because there is little evidence to drive such decisions.
READ MORE @ PSYCHIATRIC TIMES
Treatment resistance is extremely common. Even under optimal maintenance conditions, almost half of bipolar patients with symptom remission will have a recurrence in 2 years under standard care (including medication combinations).2
Optimizing phase-specific , s is crucial. This may include raising the dosage of an initial treatment according to response unless limited by adverse effects. Acute treatments are often continued into maintenance. Combinations are commonplace, and the number of potential combinations is large. Decisions about which medications to use first or in what combinations, as well as dosing issues, require good clinical judgment on the part of each clinician because there is little evidence to drive such decisions.
READ MORE @ PSYCHIATRIC TIMES
Tuesday, July 28, 2009
Antipsychotic Drugs Associated With High Blood Sugar in Older Adults With Diabetes
Older patients with diabetes who take antipsychotic medications appear to have an increased risk of hospitalization for hyperglycemia (elevated blood glucose level), especially soon after beginning treatment, according to a report in the July 27 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
An increasing number of older adults are being prescribed antipsychotic drugs for dementia and other conditions, according to background information in the article. However, these medications may be associated with a—including Parkinson’s disease symptoms, stroke and diabetes—in the older population. “The risk of diabetes may be partly related to chronic effects of the weight gain associated with antipsychotic agents,” the authors write. “However, case reports of acute hyperglycemia after the initiation of therapy with these drugs suggest that they may also be associated with acute glycemic [blood glucose level] changes.”
Lorraine L. Lipscombe, M.D., M.Sc., of the Institute for Clinical Evaluative Sciences, University of Toronto and Women’s College Research Institute at Women’s College Hospital, Toronto, Ontario, Canada, and colleagues studied 13,817 individuals age 66 and older (average age 78) with diabetes who began treatment with antipsychotics between April 1, 2002, and March 31, 2006. Each patient who was hospitalized for hyperglycemia during the observation period—through March 31, 2007, an average of two years of follow-up—was considered a case and was matched with up to 10 control patients who were the same age and sex but were not hospitalized over the same time period. The researchers then compared the likelihood of hyperglycemia among those who were currently taking antipsychotic medications to those who had discontinued antipsychotic medications for more than 180 days.
Of the total group of 13,817 patients, 1,515 (11 percent) were hospitalized for hyperglycemia. Those who were currently taking antipsychotic drugs had a higher risk of hospitalization than those who had stopped the medications more than 180 days ago. The risk was highest among those who were just starting antipsychotic drug treatment.
READ MORE @ NEWSWISE
An increasing number of older adults are being prescribed antipsychotic drugs for dementia and other conditions, according to background information in the article. However, these medications may be associated with a—including Parkinson’s disease symptoms, stroke and diabetes—in the older population. “The risk of diabetes may be partly related to chronic effects of the weight gain associated with antipsychotic agents,” the authors write. “However, case reports of acute hyperglycemia after the initiation of therapy with these drugs suggest that they may also be associated with acute glycemic [blood glucose level] changes.”
Lorraine L. Lipscombe, M.D., M.Sc., of the Institute for Clinical Evaluative Sciences, University of Toronto and Women’s College Research Institute at Women’s College Hospital, Toronto, Ontario, Canada, and colleagues studied 13,817 individuals age 66 and older (average age 78) with diabetes who began treatment with antipsychotics between April 1, 2002, and March 31, 2006. Each patient who was hospitalized for hyperglycemia during the observation period—through March 31, 2007, an average of two years of follow-up—was considered a case and was matched with up to 10 control patients who were the same age and sex but were not hospitalized over the same time period. The researchers then compared the likelihood of hyperglycemia among those who were currently taking antipsychotic medications to those who had discontinued antipsychotic medications for more than 180 days.
Of the total group of 13,817 patients, 1,515 (11 percent) were hospitalized for hyperglycemia. Those who were currently taking antipsychotic drugs had a higher risk of hospitalization than those who had stopped the medications more than 180 days ago. The risk was highest among those who were just starting antipsychotic drug treatment.
READ MORE @ NEWSWISE
Monday, July 27, 2009
Treatment-Resistant Depression - Management Strategies
Approximately 32 to 35 million adults in the United States have an episode of major depression sometime during their lifetime, and many of them do not respond to initial treatment.1 The results of an analysis undertaken by Fava and Davidson2 suggest that between 29% and 46% of depressed patients fail to respond fully to antidepressant treatment of adequate dose and duration; about 15% of patients fail to respond to multiple treatment trials.3 Fagiolini and Kupfer4 have suggested that patients with treatment-resistant depression (TRD) may represent a biologically unique subtype of depressed patients. Unfortunately, the chances for full recovery diminish the longer a patient remains depressed—a fact that lends a sense of urgency for appropriate therapy.5
Management strategies
Before discussing the effectiveness of individual agents in TRD, it is important to review recent evidence regarding the principles of using these agents to maximize the chance of a response.6-9 Some of the most salient findings from the STAR*D trial on this topic are summarized in Table 1.
The standard strategy for managing patients who are depressed includes an adequate clinical trial; when the response is unsatisfactory, the clinician’s options are:
• Switch to another antidepressant
• Combine a second antidepressant with the first
• Add a second drug that is not approved as an antidepressant
• Start psychotherapy
READ MORE @ PSYCHIATRIC TIMES
Management strategies
Before discussing the effectiveness of individual agents in TRD, it is important to review recent evidence regarding the principles of using these agents to maximize the chance of a response.6-9 Some of the most salient findings from the STAR*D trial on this topic are summarized in Table 1.
The standard strategy for managing patients who are depressed includes an adequate clinical trial; when the response is unsatisfactory, the clinician’s options are:
• Switch to another antidepressant
• Combine a second antidepressant with the first
• Add a second drug that is not approved as an antidepressant
• Start psychotherapy
READ MORE @ PSYCHIATRIC TIMES
Sunday, July 26, 2009
Psychiatric care for dementia could be assisted by blood pressure medication
Angiotensin-converting enzyme (ACE) inhibitors are important for control of blood pressure and have made a profound impact on patients with diabetes and congestive heart failure. The ACE inhibitors, which act outside the brain, have had minimal impact on dementia of any cause. However, there is now evidence indicating that ACE Inhibitors which act inside the brain, may have the ability to reduce cognitive decline.
Recent observational data from the Cardiovascular Health Study revealed that that centrally active ACE inhibitors did diminish cognitive decline by 65% per year of exposure, an effect that is likely related to the drug’s ability to cross the blood-brain barrier.
READ MORE @ EMPOWER
Recent observational data from the Cardiovascular Health Study revealed that that centrally active ACE inhibitors did diminish cognitive decline by 65% per year of exposure, an effect that is likely related to the drug’s ability to cross the blood-brain barrier.
READ MORE @ EMPOWER
Saturday, July 25, 2009
Antidepressants, not sleep drugs, often prescribed for insomnia * Story Highlights * Doctors prescribed more antidepressants for insomnia
Insomnia, the inability to fall or stay asleep, can make the days feel fuzzy and the nights never-ending.
The disorder can increase the risk for depression and suicidal thoughts, lower work productivity and even raise blood pressure, studies have shown.
About 40 million Americans have chronic sleep disorders that prevent them from getting good rest. Singer Michael Jackson struggled with insomnia, a nutritionist who worked for him told CNN. Sources close to Jackson told CNN that during a world tour in the mid-'90s, the pop star traveled with an anesthesiologist who would "take him down" at night, then "bring him back up."
Stress or traumatic events can trigger the sleeping disorder. Insomnia drugs help the patient sleep, but they do not treat the underlying cause, which could be a result of another illness, life changes or shifting work schedules. And patients who seek relief for insomnia may not receive the most effective prescription.
Over the last two decades, doctors treating sleep disorders have prescribed more antidepressants than insomnia drugs, according to several published analyses. And there is insufficient evidence that most antidepressants are effective in treating insomnia, concluded a National Institutes of Health panel that convened on the topic in 2005.
Doctors may be factoring in cost considerations and their own familiarity with prescribing antidepressants relative to newer sleep medications, experts said.
READ MORE @ CNN
The disorder can increase the risk for depression and suicidal thoughts, lower work productivity and even raise blood pressure, studies have shown.
About 40 million Americans have chronic sleep disorders that prevent them from getting good rest. Singer Michael Jackson struggled with insomnia, a nutritionist who worked for him told CNN. Sources close to Jackson told CNN that during a world tour in the mid-'90s, the pop star traveled with an anesthesiologist who would "take him down" at night, then "bring him back up."
Stress or traumatic events can trigger the sleeping disorder. Insomnia drugs help the patient sleep, but they do not treat the underlying cause, which could be a result of another illness, life changes or shifting work schedules. And patients who seek relief for insomnia may not receive the most effective prescription.
Over the last two decades, doctors treating sleep disorders have prescribed more antidepressants than insomnia drugs, according to several published analyses. And there is insufficient evidence that most antidepressants are effective in treating insomnia, concluded a National Institutes of Health panel that convened on the topic in 2005.
Doctors may be factoring in cost considerations and their own familiarity with prescribing antidepressants relative to newer sleep medications, experts said.
READ MORE @ CNN
Friday, July 24, 2009
Study shows schools could help in reducing depression
Research by the University of Queensland has shown school intervention programs could help radically reduce the amount ofhttp://www.thetechherald.com/article.php/200930/4122/Study-shows-schools-could-help-in-reducing-depression being prescribed to adolescent boys.
School Counsellor Mark Taylor, who led the research, said that schools could help students deal with depression by teaching more conflict resolution and positive thinking, as well as encouraging more outdoor activities.
Dr Taylor said he was concerned not enough was being done to look at underlying conditions of adolescents' depression.
“Working in a school setting as a counsellor I became concerned about the numbers of students who were being prescribed antidepressants, without what I considered to be enough effort to find out what was going on in the lives of these students,” Dr Taylor said in a University of Queensland (UQ) news release.
“I wanted to substantiate that there are viable alternatives to antidepressants which can significantly reduce depressive symptoms.”
READ MORE @ THE TECH HERALD
School Counsellor Mark Taylor, who led the research, said that schools could help students deal with depression by teaching more conflict resolution and positive thinking, as well as encouraging more outdoor activities.
Dr Taylor said he was concerned not enough was being done to look at underlying conditions of adolescents' depression.
“Working in a school setting as a counsellor I became concerned about the numbers of students who were being prescribed antidepressants, without what I considered to be enough effort to find out what was going on in the lives of these students,” Dr Taylor said in a University of Queensland (UQ) news release.
“I wanted to substantiate that there are viable alternatives to antidepressants which can significantly reduce depressive symptoms.”
READ MORE @ THE TECH HERALD
Thursday, July 23, 2009
New Insights Into Causes Of Anorexia
New imaging technology provides insight into abnormalities in the brain circuitry of patients with anorexia nervosa (commonly known as anorexia) that may contribute to the puzzling symptoms found in people with the eating disorder. In a review paper published online in Nature Reviews Neuroscience, Walter Kaye, MD, professor of psychiatry and director of the Eating Disorders Program at the University of California, San Diego, and colleagues describe dysfunction in certain neural circuits of the brain which may help explain why people develop anorexia in the first place, and behaviors such as the relentless pursuit of dieting and weight loss.
"Currently, we don't have very effective means of treating people with anorexia," said Kaye. "Consequently, many patients with the disorder remain ill for years or eventually die from the disease, which has the highest death rate of any psychiatric disorder."
A better understanding of the underlying neurobiology – how behavior is coded in the brain and contributes to anorexia —is likely to result in more effective treatments, according to the researchers.
READ MORE @ SCIENCE DAILY
"Currently, we don't have very effective means of treating people with anorexia," said Kaye. "Consequently, many patients with the disorder remain ill for years or eventually die from the disease, which has the highest death rate of any psychiatric disorder."
A better understanding of the underlying neurobiology – how behavior is coded in the brain and contributes to anorexia —is likely to result in more effective treatments, according to the researchers.
READ MORE @ SCIENCE DAILY
Wednesday, July 22, 2009
Can the relationship between doctors and drug companies ever be a healthy one?
Should the financial ties between doctors and drug companies be completely cut, or are healthy alliances between the two possible with the common aim of improving human health? A debate in this week's PLoS Medicine discusses whether the influence of drug company money on doctors is always a corrupting one.
READ MORE @ EUREKALERT
READ MORE @ EUREKALERT
Tuesday, July 21, 2009
Number of Uninsured Appears Poised for Dramatic Surge
The researchers acknowledge that their model does not take into account the effect of job losses during the current recession, which could add millions to the ranks of the uninsured.
Rising health care costs and slow growth in personal income related to the current recession will add at least another 6.9 million nonelderly Americans to the rolls of the uninsured by 2010, according to a study published May 28 on the Web site of the journal Health Affairs.
In the study report, researchers Todd Gilmer, Ph.D., and Richard Kronick, Ph.D., of the University of California, San Diego, predicted that 19.2 percent of all nonelderly Americans will be uninsured by 2010, an increase of 2 percentage points from 2007.
The researchers used a complex method that involves several data sources to calculate an "affordability index," defined as the ratio of per-capita health spending for insured adults to the median income among workers. Those data sources included the National Health Accounts developed by the Office of the Actuary at the Centers for Medicare and Medicaid Services, the 1977 National Medical Care Expenditure Survey, the 1987 National Medical Expenditure Survey, and the 1996 and 1999 Medical Expenditure Panel Surveys. Their analysis also takes into account employment characteristics such as firm size, industry, and self-employment and part-time status, as well as demographic and socioeconomic characteristics such as age, sex, marital status, race and ethnicity, education, and home ownership. After using their index to derive predictions for uninsurance rates among workers, Gilmer and Kronick used the historical relationship between coverage rates for workers and for all nonelderly adults to generate predicted uninsurance rates for all nonelderly adults.
READ MORE @ PSYCHIATRIC NEWS
Rising health care costs and slow growth in personal income related to the current recession will add at least another 6.9 million nonelderly Americans to the rolls of the uninsured by 2010, according to a study published May 28 on the Web site of the journal Health Affairs.
In the study report, researchers Todd Gilmer, Ph.D., and Richard Kronick, Ph.D., of the University of California, San Diego, predicted that 19.2 percent of all nonelderly Americans will be uninsured by 2010, an increase of 2 percentage points from 2007.
The researchers used a complex method that involves several data sources to calculate an "affordability index," defined as the ratio of per-capita health spending for insured adults to the median income among workers. Those data sources included the National Health Accounts developed by the Office of the Actuary at the Centers for Medicare and Medicaid Services, the 1977 National Medical Care Expenditure Survey, the 1987 National Medical Expenditure Survey, and the 1996 and 1999 Medical Expenditure Panel Surveys. Their analysis also takes into account employment characteristics such as firm size, industry, and self-employment and part-time status, as well as demographic and socioeconomic characteristics such as age, sex, marital status, race and ethnicity, education, and home ownership. After using their index to derive predictions for uninsurance rates among workers, Gilmer and Kronick used the historical relationship between coverage rates for workers and for all nonelderly adults to generate predicted uninsurance rates for all nonelderly adults.
READ MORE @ PSYCHIATRIC NEWS
Monday, July 20, 2009
Learning of Risk of Alzheimer’s Seems to Do No Harm
A genetic test that can find an increased risk of Alzheimer’s disease does no psychological harm to people who take it, even if they test positive for a risky gene, a new study finds.
The results challenge views long held by the medical establishment, which has discouraged people from being tested, arguing that the test is not definitive, that it may needlessly frighten people into thinking a terrible disease is hanging over them and that testing is pointless anyway because there is no way to cure or prevent the dementia caused by Alzheimer’s.
“There has been this extraordinary worry that disclosing risk was going to devastate people,” said Dr. Robert C. Green, a professor of neurology, genetics and epidemiology at Boston University, and the lead author of the study, which is being published on Thursday in The New England Journal of Medicine. “This has upended those assumptions.”
The idea behind the study was to treat information like a drug, something with risks and benefits that could be measured, Dr. Green said.
Dr. Green led a large team in the study, called Reveal, in which 162 adults who had a close relative with Alzheimer’s could find out if they had the genes that increased their risk for the disease. All participants had genetic testing, but 51, picked at random, were not told the results. The other 111 were told, and the two groups were compared.
READ MORE @ NY TIMES
The results challenge views long held by the medical establishment, which has discouraged people from being tested, arguing that the test is not definitive, that it may needlessly frighten people into thinking a terrible disease is hanging over them and that testing is pointless anyway because there is no way to cure or prevent the dementia caused by Alzheimer’s.
“There has been this extraordinary worry that disclosing risk was going to devastate people,” said Dr. Robert C. Green, a professor of neurology, genetics and epidemiology at Boston University, and the lead author of the study, which is being published on Thursday in The New England Journal of Medicine. “This has upended those assumptions.”
The idea behind the study was to treat information like a drug, something with risks and benefits that could be measured, Dr. Green said.
Dr. Green led a large team in the study, called Reveal, in which 162 adults who had a close relative with Alzheimer’s could find out if they had the genes that increased their risk for the disease. All participants had genetic testing, but 51, picked at random, were not told the results. The other 111 were told, and the two groups were compared.
READ MORE @ NY TIMES
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