The American College of Physicians is publishing a new guideline for the treatment of depression in Annals of Internal Medicine. ACP found no substantial differences in efficacy or quality of life among "second-generation" antidepressants used to treat depressive disorders such as major depressive disorder. ACP recommends that physicians make treatment decisions based on side effects, cost, and patient preferences, and make necessary changes in therapy if the response is not sufficient after six to eight weeks. Doctors should also assess patient status and adverse effects on a regular basis starting within one to two weeks of starting the treatment.
Depression is a serious illness that causes sadness that interferes with daily life. Depressive disorders are more prevalent during the late fall and winter months when a reduced amount of natural sunlight can trigger seasonal affective disorder, or SAD. During these months some people may also experience deep sadness, dread, or loneliness due to the approaching holidays. Symptoms of depression include loss of interest in daily activities, decreased ability to think or concentrate, lack of energy, or fluctuation in weight or sleeping patterns.
Stressful situations, such as a financial or economic crisis, also may trigger a depressive episode. Depression is a medical condition, not a normal reaction to life situations such as the death of a loved one or the loss of a job. Depression will affect about 16 percent of American adults in their lifetime. It can be treated with drug therapy, counseling, or both. Because symptoms can be vague, some people are unaware that they have a treatable medical condition. The economic burden of depressive disorders is estimated to be about $83 billion.
Annals of Internal Medicine is one of the most widely cited peer-reviewed medical journals in the world. The journal has been published for 81 years and accepts only 7 percent of the original research studies submitted for publication. Annals of Internal Medicine is published by the American College of Physicians, the nation's largest medical specialty society.
American College of Physicians
вторник, 31 мая 2011 г.
Preventing Suicide Among College Students
As the second leading cause of death in college students after car accidents, suicide is a serious problem that can affect teenagers and young adults at an age when serious mental illness first manifests itself and often goes undiagnosed. A psychiatrist and an authority on suicide at Columbia University Medical Center and NewYork-Presbyterian Hospital offers parents and students advice on how to spot and address potentially suicidal behavior.
"College can be a difficult transition, with new independence, responsibilities and expectations arriving just as a student's previous support system of family and friends are often not readily available. To add to the problem, the late teen years are often when biologically-based illnesses, such as depression and bipolar disorder, begin to manifest themselves. And students, who are new at asserting and managing their independence, can be especially reluctant to seek out help," says Dr. David Kahn, vice chair for clinical affairs for the Department of Psychiatry at NewYork-Presbyterian Hospital/Columbia University Medical Center. He is also clinical professor of psychiatry at Columbia University College of Physicians and Surgeons and a staff member of the New York State Psychiatric Institute.
"While the warning signs of mental illness can be difficult to spot in the context of college where unusual sleeping patterns, experimental 'phases,' drug taking and binge drinking are common, there are several behaviors that should indicate that intervention is necessary," adds Dr. Kelly Posner, a leading expert in suicide research who helps the FDA and CDC on suicidality issues. She is an assistant professor of clinical psychiatry in the Division of Child and Adolescent Psychiatry at Columbia University College of Physicians and Surgeons and a child psychologist at NewYork-Presbyterian Hospital. She is also on staff at the New York State Psychiatric Institute.
Warning Signs
-- Any signs of depression, such as sad mood, reduced interest and enjoyment in life and a sense of hopelessness.
-- Withdrawing from friends and activities.
-- Talking about suicide. This may be stated directly -- "I'm going to kill myself." Or indirectly -- "You would be better off without me," "I wish I were not alive any more," or "Soon you won't have to worry about me anymore." Eight of 10 suicides verbalize their intention to commit suicide.
-- Giving away possessions.
-- Abrupt change in personality and behavior -- including appearing sad, anxious or hostile most of the time or displaying unusual calmness after a loss or period of depression.
-- Sudden drop in school performance.
-- Dwelling on an academic or relationship setback or other loss of prestige or physical health.
"Virtually all college students who take their own lives had a diagnosable, treatable mental illness. The issues that lead to suicide are usually temporary -- sadly suicide is permanent. If treated, these students will receive the necessary tools to manage their depression and develop coping mechanisms later in adult life," says Dr. Kahn. "When you suspect that someone might be considering suicide, trust your instincts and, as awkward as it might seem, reach out to them and ask them about their intentions. This is an important first step toward getting them the help they need."
What to Do When You Suspect a Student Is Suicidal
-- Develop a relationship with them or strengthen your current relationship by being available to listen and talk. Show and say that you care about them.
-- Ask directly about suicide. You will not be "putting thoughts into the person's head" or causing them distress -- in fact, it's the best thing you can do. Don't act shocked or scared and don't argue about morality of suicide.
Ask the following questions to assess their seriousness:
-- Are you thinking about hurting yourself or committing suicide?
-- When would you do it?
-- What would you do?
-- What method(s) would you use?
-- How available is this method to you?
-- Who can you turn to for help?
-- When are your family members home?
If you've determined that the situation is serious enough that they have a plan and means to execute the plan, do not leave the student alone unless you yourself are physically threatened.
Encourage the student to seek professional guidance. If they refuse help, contact someone in authority immediately -- an angry friend is better than a dead one. Maintain contact with the student until help is secured.
"Almost half of all college students report being depressed at some time, and as many as 10 percent of all college students consider suicide in a given year. It is vitally important that young people, whether in college or not, understand that mental illness, including thoughts of suicide, is not something to be ashamed of and will not be penalized. Confidential treatment is available," says Dr. Posner. "Most people who have mental illness or depression are grossly undertreated and suffering silently. The most helpful thing one can do, which truly can be lifesaving, is to facilitate treatment."
NewYork Presbyterian Hospital
627 West 165th St., SB-621
New York, NY 10032
United States
nyp
"College can be a difficult transition, with new independence, responsibilities and expectations arriving just as a student's previous support system of family and friends are often not readily available. To add to the problem, the late teen years are often when biologically-based illnesses, such as depression and bipolar disorder, begin to manifest themselves. And students, who are new at asserting and managing their independence, can be especially reluctant to seek out help," says Dr. David Kahn, vice chair for clinical affairs for the Department of Psychiatry at NewYork-Presbyterian Hospital/Columbia University Medical Center. He is also clinical professor of psychiatry at Columbia University College of Physicians and Surgeons and a staff member of the New York State Psychiatric Institute.
"While the warning signs of mental illness can be difficult to spot in the context of college where unusual sleeping patterns, experimental 'phases,' drug taking and binge drinking are common, there are several behaviors that should indicate that intervention is necessary," adds Dr. Kelly Posner, a leading expert in suicide research who helps the FDA and CDC on suicidality issues. She is an assistant professor of clinical psychiatry in the Division of Child and Adolescent Psychiatry at Columbia University College of Physicians and Surgeons and a child psychologist at NewYork-Presbyterian Hospital. She is also on staff at the New York State Psychiatric Institute.
Warning Signs
-- Any signs of depression, such as sad mood, reduced interest and enjoyment in life and a sense of hopelessness.
-- Withdrawing from friends and activities.
-- Talking about suicide. This may be stated directly -- "I'm going to kill myself." Or indirectly -- "You would be better off without me," "I wish I were not alive any more," or "Soon you won't have to worry about me anymore." Eight of 10 suicides verbalize their intention to commit suicide.
-- Giving away possessions.
-- Abrupt change in personality and behavior -- including appearing sad, anxious or hostile most of the time or displaying unusual calmness after a loss or period of depression.
-- Sudden drop in school performance.
-- Dwelling on an academic or relationship setback or other loss of prestige or physical health.
"Virtually all college students who take their own lives had a diagnosable, treatable mental illness. The issues that lead to suicide are usually temporary -- sadly suicide is permanent. If treated, these students will receive the necessary tools to manage their depression and develop coping mechanisms later in adult life," says Dr. Kahn. "When you suspect that someone might be considering suicide, trust your instincts and, as awkward as it might seem, reach out to them and ask them about their intentions. This is an important first step toward getting them the help they need."
What to Do When You Suspect a Student Is Suicidal
-- Develop a relationship with them or strengthen your current relationship by being available to listen and talk. Show and say that you care about them.
-- Ask directly about suicide. You will not be "putting thoughts into the person's head" or causing them distress -- in fact, it's the best thing you can do. Don't act shocked or scared and don't argue about morality of suicide.
Ask the following questions to assess their seriousness:
-- Are you thinking about hurting yourself or committing suicide?
-- When would you do it?
-- What would you do?
-- What method(s) would you use?
-- How available is this method to you?
-- Who can you turn to for help?
-- When are your family members home?
If you've determined that the situation is serious enough that they have a plan and means to execute the plan, do not leave the student alone unless you yourself are physically threatened.
Encourage the student to seek professional guidance. If they refuse help, contact someone in authority immediately -- an angry friend is better than a dead one. Maintain contact with the student until help is secured.
"Almost half of all college students report being depressed at some time, and as many as 10 percent of all college students consider suicide in a given year. It is vitally important that young people, whether in college or not, understand that mental illness, including thoughts of suicide, is not something to be ashamed of and will not be penalized. Confidential treatment is available," says Dr. Posner. "Most people who have mental illness or depression are grossly undertreated and suffering silently. The most helpful thing one can do, which truly can be lifesaving, is to facilitate treatment."
NewYork Presbyterian Hospital
627 West 165th St., SB-621
New York, NY 10032
United States
nyp
Antidepressant Medication May Prevent Recurring Depression In Diabetics
The antidepressant sertraline may reduce the risk of recurrent depression and increase the period of time between episodes of depression in patients with diabetes, according to a study in the May issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
One of every four patients with diabetes experiences clinical depression, according to background information in the article. Among those with diabetes, depression can reduce quality of life and the ability to function and increase the risk for high blood sugar levels, diabetes-related complications and death. Treatment with antidepressant medications and psychotherapy has been shown to be effective, but only in the short term. In previous studies, one in seven patients with diabetes developed recurrent depression that did not respond to treatment and their blood sugar levels generally increased, placing them at a higher risk of complications associated with their diabetes.
Patrick J. Lustman, M.D., Washington University School of Medicine, St. Louis, and colleagues studied 152 patients with diabetes (average age 52.8 years) who had recovered from depression during treatment with sertraline. Participants were followed for up to one year or until their depression recurred, during which time 79 were randomly assigned to continue taking sertraline and 73 were randomly assigned to take a placebo. They visited a physician's office every month and received phone calls at the two-week point to screen for symptoms of depression. If such symptoms were detected, they underwent a psychiatric interview. Patients' hemoglobin (Hb A1c) levels, which reflect the individual's control of blood glucose levels over the previous two to three months, were measured every two months.
Participants taking sertraline were significantly less likely to develop an additional episode of depression. After one year, 65.8 percent of the patients taking sertraline remained in remission from their depression, compared with 47.9 percent of those taking placebo. The amount of time that passed before depression recurred in one-third of the patients increased from 57 days among patients receiving placebo to 226 days among those taking sertraline. "Using data available at the one-year point, the number needed to be treated was six patients, i.e., it would be necessary to treat six patients to spare one patient from depression recurrence," the authors write. All participants' Hb A1c levels had decreased when they recovered from depression and remained lower as long as they remained depression-free, with no difference between the two study groups.
Depression is increasingly understood as a recurrent and debilitating disease, especially for those with diabetes, the authors write. Physicians suspect that the more time an individual spends depressed, the greater the risk for diabetic complications and death. "Our study establishes a clear benefit of sertraline for prevention of depression recurrence in patients with diabetes," they conclude. "Sertraline lengthened the depression-free interval of maintenance and did not interfere with glycemic improvement achieved during the recovery phase. Treatment with sertraline is relatively simple, safe and widely available, and although it is not curative, it offers patients with diabetes a potentially viable method for ameliorating the suffering, incapacity and burden associated with recurrent depression."
(Arch Gen Psychiatry. 2006;63:521-529)
This study was supported in part by grants from the National Institutes of Health, Bethesda, Md., and an unrestricted educational grant from Pfizer, Inc., New York.
Contact: Jim Dryden
JAMA and Archives Journals
One of every four patients with diabetes experiences clinical depression, according to background information in the article. Among those with diabetes, depression can reduce quality of life and the ability to function and increase the risk for high blood sugar levels, diabetes-related complications and death. Treatment with antidepressant medications and psychotherapy has been shown to be effective, but only in the short term. In previous studies, one in seven patients with diabetes developed recurrent depression that did not respond to treatment and their blood sugar levels generally increased, placing them at a higher risk of complications associated with their diabetes.
Patrick J. Lustman, M.D., Washington University School of Medicine, St. Louis, and colleagues studied 152 patients with diabetes (average age 52.8 years) who had recovered from depression during treatment with sertraline. Participants were followed for up to one year or until their depression recurred, during which time 79 were randomly assigned to continue taking sertraline and 73 were randomly assigned to take a placebo. They visited a physician's office every month and received phone calls at the two-week point to screen for symptoms of depression. If such symptoms were detected, they underwent a psychiatric interview. Patients' hemoglobin (Hb A1c) levels, which reflect the individual's control of blood glucose levels over the previous two to three months, were measured every two months.
Participants taking sertraline were significantly less likely to develop an additional episode of depression. After one year, 65.8 percent of the patients taking sertraline remained in remission from their depression, compared with 47.9 percent of those taking placebo. The amount of time that passed before depression recurred in one-third of the patients increased from 57 days among patients receiving placebo to 226 days among those taking sertraline. "Using data available at the one-year point, the number needed to be treated was six patients, i.e., it would be necessary to treat six patients to spare one patient from depression recurrence," the authors write. All participants' Hb A1c levels had decreased when they recovered from depression and remained lower as long as they remained depression-free, with no difference between the two study groups.
Depression is increasingly understood as a recurrent and debilitating disease, especially for those with diabetes, the authors write. Physicians suspect that the more time an individual spends depressed, the greater the risk for diabetic complications and death. "Our study establishes a clear benefit of sertraline for prevention of depression recurrence in patients with diabetes," they conclude. "Sertraline lengthened the depression-free interval of maintenance and did not interfere with glycemic improvement achieved during the recovery phase. Treatment with sertraline is relatively simple, safe and widely available, and although it is not curative, it offers patients with diabetes a potentially viable method for ameliorating the suffering, incapacity and burden associated with recurrent depression."
(Arch Gen Psychiatry. 2006;63:521-529)
This study was supported in part by grants from the National Institutes of Health, Bethesda, Md., and an unrestricted educational grant from Pfizer, Inc., New York.
Contact: Jim Dryden
JAMA and Archives Journals
Antidepressant Does Not Appear To Reduce Repetitive Behaviors In Children With Autism Spectrum Disorders
The antidepressant citalopram does not appear to reduce the occurrence of repetitive behaviors in children and teens with autism spectrum disorders, according to a report in the June issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
Although the U.S. Food and Drug Administration has not approved any drugs to treat the core symptoms of autism and related disorders, medications are increasingly being used in this population, according to background information in the article. Citalopram belongs to a class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs), which interfere with the way the brain regulates the neurotransmitter serotonin.
"Because of suggested similarities between repetitive behavior in autism spectrum disorders and obsessive-compulsive disorder and the findings of serotonin system abnormalities in autism, anti-obsessional agents such as SSRIs have long been of interest," the authors write. Repetitive behaviors in children with autism-including inflexible routines and repetitive play-tend to persevere over time and predict the endurance of an early autism diagnosis. "Despite the relative dearth of evidence supporting their use, SSRIs are among the most frequently used medications for children with autism, partially because of their perceived safety."
Bryan H. King, M.D., of Seattle Children's Hospital and the University of Washington, Seattle, and colleagues conducted a randomized controlled trial to determine the safety and efficacy of citalopram in children with autism spectrum disorders who had at least moderate levels of repetitive behavior. Of 149 children age 5 to 17 (average age 9.4) with autism spectrum disorders who participated, 73 were randomly assigned to receive citalopram (at an average maximum dosage of 16.5 milligrams per day) and 76 to receive a placebo for 12 weeks. Most of the participants (82.6 percent) completed the 12-week trial.
At the end of the treatment period, there were no differences between the treatment group and the placebo group in the number of children who demonstrated improvements on scales measuring repetitive behavior (32.9 percent vs. 34.2 percent). "Citalopram use was significantly more likely to be associated with adverse events, particularly increased energy level, impulsiveness, decreased concentration, hyperactivity, stereotypy [mechanical repetition of the same posture or movement], diarrhea, insomnia and dry skin or pruritis," the authors write.
"There is growing recognition that children and adolescents with autism spectrum disorders have serious behavioral problems and psychiatric symptoms that may be appropriate targets for pharmacotherapy," they continue. "To date, there are few large-scale trials to guide clinical practice, so clinicians are left to address these problems with inadequate information. The results of this trial indicate that citalopram is not an effective treatment for children having autism spectrum disorders with moderate or greater repetitive behavior. The results also highlight the urgent need for placebo-controlled trials of medications commonly used for children with autism spectrum disorders to determine whether the risks of specific drugs substantially outweigh their benefits."
Arch Gen Psychiatry. 2009;66[6]:583-590.
Source
Archives of General Psychiatry
Although the U.S. Food and Drug Administration has not approved any drugs to treat the core symptoms of autism and related disorders, medications are increasingly being used in this population, according to background information in the article. Citalopram belongs to a class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs), which interfere with the way the brain regulates the neurotransmitter serotonin.
"Because of suggested similarities between repetitive behavior in autism spectrum disorders and obsessive-compulsive disorder and the findings of serotonin system abnormalities in autism, anti-obsessional agents such as SSRIs have long been of interest," the authors write. Repetitive behaviors in children with autism-including inflexible routines and repetitive play-tend to persevere over time and predict the endurance of an early autism diagnosis. "Despite the relative dearth of evidence supporting their use, SSRIs are among the most frequently used medications for children with autism, partially because of their perceived safety."
Bryan H. King, M.D., of Seattle Children's Hospital and the University of Washington, Seattle, and colleagues conducted a randomized controlled trial to determine the safety and efficacy of citalopram in children with autism spectrum disorders who had at least moderate levels of repetitive behavior. Of 149 children age 5 to 17 (average age 9.4) with autism spectrum disorders who participated, 73 were randomly assigned to receive citalopram (at an average maximum dosage of 16.5 milligrams per day) and 76 to receive a placebo for 12 weeks. Most of the participants (82.6 percent) completed the 12-week trial.
At the end of the treatment period, there were no differences between the treatment group and the placebo group in the number of children who demonstrated improvements on scales measuring repetitive behavior (32.9 percent vs. 34.2 percent). "Citalopram use was significantly more likely to be associated with adverse events, particularly increased energy level, impulsiveness, decreased concentration, hyperactivity, stereotypy [mechanical repetition of the same posture or movement], diarrhea, insomnia and dry skin or pruritis," the authors write.
"There is growing recognition that children and adolescents with autism spectrum disorders have serious behavioral problems and psychiatric symptoms that may be appropriate targets for pharmacotherapy," they continue. "To date, there are few large-scale trials to guide clinical practice, so clinicians are left to address these problems with inadequate information. The results of this trial indicate that citalopram is not an effective treatment for children having autism spectrum disorders with moderate or greater repetitive behavior. The results also highlight the urgent need for placebo-controlled trials of medications commonly used for children with autism spectrum disorders to determine whether the risks of specific drugs substantially outweigh their benefits."
Arch Gen Psychiatry. 2009;66[6]:583-590.
Source
Archives of General Psychiatry
Depression Appears To Be A Cause Of Dementia
We know that people with Alzheimer's disease and other forms of dementia also suffer from depression. Some studies have shown that people with a history of major depression are twice as likely as others to eventually develop dementia. However, nobody really knows whether depression is a symptom of dementia or a potential cause of it.
Scientists from Rush University Medical Center tracked the symptoms of depression during the transition from no cognitive impairment and discovered that depressive symptoms showed little change during the development and progression of Alzheimer's disease. You can read about this study in the July 6th edition of the peer-reviewed medical journal Neurology, an American Academy of Neurology publication.
Lead author Robert S. Wilson, PhD, senior neuropsychologist, Rush Alzheimer's Disease Center, and a professor in the Department of Behavioral Sciences at Rush, said:
Our study suggests that depression is truly a risk factor for Alzheimer's disease. If depression was an early sign of the disease, we would expect to see it increase prior to diagnosis and as the disease progresses. Our study found very little change. Depression should not be viewed as an inevitable part of Alzheimer's disease. If a patient with Alzheimer's has depression, the depression should be treated.
Study participants included individuals in the Chicago Health and Aging Project, a longitudinal study of risk factors for Alzheimer's disease of older adults on Chicago's south side. They all completed a self-report measure of depressive symptoms every three years; clinical evaluations for Alzheimer's disease were also done.
They initially examined 357 people who had developed Alzheimer's disease during the course of the study. The researchers detected a barely perceptible rise in depressive symptoms, a rate of 0.04 symptoms annually for a period of 6 to 7 years of monitoring before an Alzheimer's disease diagnosis was made - and no change during the 2 to 3 years of observation after diagnosis.
The researchers conducted further analyses of change in depressive symptoms by interviewing family, friends and people who were close to the study participants, to make up for possible inaccuracies in self-reports by people with dementia. During the mean of 3 years of observation they found that neither Alzheimer's disease nor its precursor (mild cognitive impairment) was linked with change in depressive symptoms.
The researchers report that the results were consistent across all demographics. Sex, age, education or race did not influence the trajectory of depressive symptoms before or after Alzheimer's disease diagnosis
Wilson said:
Here is this terrible disease that robs people of who they are and their ability to function and yet it doesn't make them depressed. Alzheimer's may disrupt the ability to have prolonged bouts of negative emotions, in much the same way it disrupts many other activities.
The researchers say there should be further studies to see whether depressive symptoms may eventually decrease as Alzheimer's disease severity worsens. They are currently looking at why depression raises the risk of Alzheimer's disease.
The study was supported by funding from the National Institutes of Health (NIH)/ National Institute on Aging (NIA). Co-authors include G.M. Hoganson, BS; K.B. Rajan, PhD; L.L. Barnes, PhD; C.F. Mendes de Leon, PhD; and D.A. Evans, MD.
neurology/cgi/content/abstract/75/1/21"Temporal course of depressive symptoms during the development of Alzheimer disease"
R.S. Wilson, PhD, G.M. Hoganson, BS, K.B. Rajan, PhD, L.L. Barnes, PhD, C.F. Mendes de Leon, PhD and D.A. Evans, MD
NEUROLOGY 2010;75:21-26
Scientists from Rush University Medical Center tracked the symptoms of depression during the transition from no cognitive impairment and discovered that depressive symptoms showed little change during the development and progression of Alzheimer's disease. You can read about this study in the July 6th edition of the peer-reviewed medical journal Neurology, an American Academy of Neurology publication.
Lead author Robert S. Wilson, PhD, senior neuropsychologist, Rush Alzheimer's Disease Center, and a professor in the Department of Behavioral Sciences at Rush, said:
Our study suggests that depression is truly a risk factor for Alzheimer's disease. If depression was an early sign of the disease, we would expect to see it increase prior to diagnosis and as the disease progresses. Our study found very little change. Depression should not be viewed as an inevitable part of Alzheimer's disease. If a patient with Alzheimer's has depression, the depression should be treated.
Study participants included individuals in the Chicago Health and Aging Project, a longitudinal study of risk factors for Alzheimer's disease of older adults on Chicago's south side. They all completed a self-report measure of depressive symptoms every three years; clinical evaluations for Alzheimer's disease were also done.
They initially examined 357 people who had developed Alzheimer's disease during the course of the study. The researchers detected a barely perceptible rise in depressive symptoms, a rate of 0.04 symptoms annually for a period of 6 to 7 years of monitoring before an Alzheimer's disease diagnosis was made - and no change during the 2 to 3 years of observation after diagnosis.
The researchers conducted further analyses of change in depressive symptoms by interviewing family, friends and people who were close to the study participants, to make up for possible inaccuracies in self-reports by people with dementia. During the mean of 3 years of observation they found that neither Alzheimer's disease nor its precursor (mild cognitive impairment) was linked with change in depressive symptoms.
The researchers report that the results were consistent across all demographics. Sex, age, education or race did not influence the trajectory of depressive symptoms before or after Alzheimer's disease diagnosis
Wilson said:
Here is this terrible disease that robs people of who they are and their ability to function and yet it doesn't make them depressed. Alzheimer's may disrupt the ability to have prolonged bouts of negative emotions, in much the same way it disrupts many other activities.
The researchers say there should be further studies to see whether depressive symptoms may eventually decrease as Alzheimer's disease severity worsens. They are currently looking at why depression raises the risk of Alzheimer's disease.
The study was supported by funding from the National Institutes of Health (NIH)/ National Institute on Aging (NIA). Co-authors include G.M. Hoganson, BS; K.B. Rajan, PhD; L.L. Barnes, PhD; C.F. Mendes de Leon, PhD; and D.A. Evans, MD.
neurology/cgi/content/abstract/75/1/21"Temporal course of depressive symptoms during the development of Alzheimer disease"
R.S. Wilson, PhD, G.M. Hoganson, BS, K.B. Rajan, PhD, L.L. Barnes, PhD, C.F. Mendes de Leon, PhD and D.A. Evans, MD
NEUROLOGY 2010;75:21-26
FDA Approves AstraZeneca's Seroquel(c) For Bipolar Depression Treatment
AstraZeneca today announced that the U.S. Food and Drug Administration (FDA) has approved SEROQUEL(c) (quetiapine fumarate) for the treatment of patients with depressive episodes associated with bipolar disorder. SEROQUEL already is approved for the treatment of acute manic episodes associated with bipolar I disorder and for the treatment of schizophrenia. SEROQUEL is now the first and only single medication approved by the FDA to treat both depressive and manic episodes associated with bipolar disorder.
he FDA approval was based primarily on results from the clinical trial programme known as BOLDER (BipOLar DEpRession), which comprises the BOLDER I and BOLDER II studies. In these studies, patients taking SEROQUEL showed an improvement in depressive symptoms starting at week one compared to those taking placebo, and this improvement continued throughout the eight-week study. The recommended dose is 300 mg once-daily, to be achieved by day four of treatment.
More than seven million American adults are affected by bipolar disorder, a serious psychiatric condition also known as manic depressive illness. Patients with bipolar disorder are symptomatic almost half of their lives, and approximately two-thirds of that time is spent in the depressed phase of the illness. For many people with bipolar disorder, the depressive symptoms are significantly more debilitating than the manic symptoms associated with the illness.
"The new indication for SEROQUEL provides physicians and their patients with a single medication to treat both the depressive and manic episodes associated with bipolar disorder," said John Patterson, Executive Director Development, AstraZeneca. "Treating acute bipolar disorder with a single medication may help patients adhere to their medication regimen."
Both studies in the BOLDER programme were double-blind, placebo-controlled trials of outpatients (N=1,045) with bipolar I or II disorder. Patients were randomized to receive eight weeks of treatment with fixed doses of SEROQUEL(c) (300 mg or 600 mg) or placebo administered once-daily. Efficacy in bipolar depression was demonstrated in the studies at both 300 mg a day and 600 mg a day. No additional benefit was seen in the 600 mg a day dose groups. Therefore, the recommended dose is 300 mg once-daily, to be achieved by day four of treatment.
SEROQUEL was generally well tolerated, with adverse event types similar to those seen in other clinical trials of SEROQUEL in bipolar mania and schizophrenia. The most frequent adverse events seen in the bipolar depression trials were dry mouth, sedation, somnolence, dizziness and constipation.
Because the depressive symptoms associated with bipolar disorder are also seen in major depressive disorder, a proper diagnosis can be difficult to achieve. In fact, studies show that as many as 69 percent of people with bipolar disorder were misdiagnosed, with the most frequent misdiagnosis being major depressive disorder. This misdiagnosis can lead to unfocused treatment that may exacerbate the disease.
Beyond schizophrenia, bipolar mania and bipolar depression, the ongoing clinical development programme includes investigations of the use of SEROQUEL in bipolar maintenance. Regulatory filings for the treatment of schizophrenia with a sustained release formulation of quetiapine fumarate, SEROQUEL SR(c), were submitted this year to regulatory authorities in the US, EU and other markets. Ongoing SEROQUEL SR(c) clinical studies also cover major depressive disorder and generalized anxiety disorder. SEROQUEL is the number 1 prescribed atypical antipsychotic in the United States. With a well-established safety and efficacy profile, SEROQUEL has had more than 19 million patient exposures worldwide since its launch in 1997. In 2005, global sales for SEROQUEL reached $2.8 billion.
astrazeneca
View drug information on Seroquel.
he FDA approval was based primarily on results from the clinical trial programme known as BOLDER (BipOLar DEpRession), which comprises the BOLDER I and BOLDER II studies. In these studies, patients taking SEROQUEL showed an improvement in depressive symptoms starting at week one compared to those taking placebo, and this improvement continued throughout the eight-week study. The recommended dose is 300 mg once-daily, to be achieved by day four of treatment.
More than seven million American adults are affected by bipolar disorder, a serious psychiatric condition also known as manic depressive illness. Patients with bipolar disorder are symptomatic almost half of their lives, and approximately two-thirds of that time is spent in the depressed phase of the illness. For many people with bipolar disorder, the depressive symptoms are significantly more debilitating than the manic symptoms associated with the illness.
"The new indication for SEROQUEL provides physicians and their patients with a single medication to treat both the depressive and manic episodes associated with bipolar disorder," said John Patterson, Executive Director Development, AstraZeneca. "Treating acute bipolar disorder with a single medication may help patients adhere to their medication regimen."
Both studies in the BOLDER programme were double-blind, placebo-controlled trials of outpatients (N=1,045) with bipolar I or II disorder. Patients were randomized to receive eight weeks of treatment with fixed doses of SEROQUEL(c) (300 mg or 600 mg) or placebo administered once-daily. Efficacy in bipolar depression was demonstrated in the studies at both 300 mg a day and 600 mg a day. No additional benefit was seen in the 600 mg a day dose groups. Therefore, the recommended dose is 300 mg once-daily, to be achieved by day four of treatment.
SEROQUEL was generally well tolerated, with adverse event types similar to those seen in other clinical trials of SEROQUEL in bipolar mania and schizophrenia. The most frequent adverse events seen in the bipolar depression trials were dry mouth, sedation, somnolence, dizziness and constipation.
Because the depressive symptoms associated with bipolar disorder are also seen in major depressive disorder, a proper diagnosis can be difficult to achieve. In fact, studies show that as many as 69 percent of people with bipolar disorder were misdiagnosed, with the most frequent misdiagnosis being major depressive disorder. This misdiagnosis can lead to unfocused treatment that may exacerbate the disease.
Beyond schizophrenia, bipolar mania and bipolar depression, the ongoing clinical development programme includes investigations of the use of SEROQUEL in bipolar maintenance. Regulatory filings for the treatment of schizophrenia with a sustained release formulation of quetiapine fumarate, SEROQUEL SR(c), were submitted this year to regulatory authorities in the US, EU and other markets. Ongoing SEROQUEL SR(c) clinical studies also cover major depressive disorder and generalized anxiety disorder. SEROQUEL is the number 1 prescribed atypical antipsychotic in the United States. With a well-established safety and efficacy profile, SEROQUEL has had more than 19 million patient exposures worldwide since its launch in 1997. In 2005, global sales for SEROQUEL reached $2.8 billion.
astrazeneca
View drug information on Seroquel.
New Depression Model Advances Disease Frontiers
A new study released today by the Centre
for Addiction and Mental Heath (CAMH) provides a thorough explanation of
how the "chemical imbalance" occurs in major depression, a disease that
impacts approximately 5 percent of people globally. For over 30 years, scientists
believed that monoamines -- mood-related chemicals such as serotonin,
norepinephrine and dopamine -- are low in the brain during major depressive
episodes. This is commonly referred to as a "chemical imbalance". However,
no one had ever found a convincing explanation for monoamine loss, until
now.
Led by CAMH's Dr. Jeffrey Meyer, this study published in the November
Archives of General Psychiatry investigated whether brain monoamine oxidase
A (MAO-A) -- an enzyme that breaks down chemicals like serotonin,
norepinephrine and dopamine -- was higher in those with untreated
depression. The results showed that in major depression MAO-A was
significantly higher in every brain region that the scientists
investigated. On average, MAO-A was 34% higher.
According to Dr. Meyer, "In major depression, higher levels of MAO-A is
the primary process that lowers monoamine levels. Having more MAO-A leads
to greater breakdown of key chemicals like serotonin."
This study includes a detailed new monoamine model of depression, based
upon this work as well as four previous publications from Dr. Meyer and
collaborators at CAMH.
Said Dr. Meyer, "A key barrier to making advances in treating
depression is a lack of precise disease models. Having disease model is
like having a map. Once you have that map you can really begin to
understand how an illness like depression works, and offer more targeted
and effective treatment."
A second part of this new model is that monoamine transporters have an
important role in removing monoamines away from active sites. Having more
of a monoamine transporter is not helpful as it removes more monoamine --
for example if one has more serotonin transporter, one would additionally
lose more serotonin during depression.
"An important aspect of our advanced monoamine model is that
individuals with depression lose chemicals like serotonin and dopamine at
different rates based upon transporter density. This helps explain why one
person with depression may experience loss of appetite while another may
not. And some people have more severe symptoms than others," said Dr.
Meyer.
This advanced monoamine model of depression is a huge step forward in
the disease frontier. It brings the study of mental illness closer to the
advancements seen in research into physical illness such as cardiac
disease, and offers one of the most comprehensive disease models in mental
illness.
The next step for researchers will be to investigate why MAO-A levels
are raised in the brain and consider prevention strategies. Prevention
strategies are critical -- according to the World Health Organization,
major depression is currently the fourth leading cause of death and
disability and is expected to rise to second by the year 2020.
To view a diagram, visit Monoamine Model of Depression
(camh/Research/Areas_of_research/new_depression_model%20.html).
More information on this field of study is available at Background
Information
(camh/Research/Areas_of_research/background_monoamine_depression.html)
The Centre for Addiction and Mental Health (CAMH) is one of the largest
addiction and mental health organizations in North America and Canada's
leading mental health and addiction teaching hospital. CAMH is a Pan
American Health Organization and World Health Organization Collaborating
Centre, and is fully affiliated with the University of Toronto. CAMH
combines clinical care, research, policy, education and health promotion to
improve the lives of people impacted by mental health and addiction issues.
Centre for Addiction and Mental Health
camh/
for Addiction and Mental Heath (CAMH) provides a thorough explanation of
how the "chemical imbalance" occurs in major depression, a disease that
impacts approximately 5 percent of people globally. For over 30 years, scientists
believed that monoamines -- mood-related chemicals such as serotonin,
norepinephrine and dopamine -- are low in the brain during major depressive
episodes. This is commonly referred to as a "chemical imbalance". However,
no one had ever found a convincing explanation for monoamine loss, until
now.
Led by CAMH's Dr. Jeffrey Meyer, this study published in the November
Archives of General Psychiatry investigated whether brain monoamine oxidase
A (MAO-A) -- an enzyme that breaks down chemicals like serotonin,
norepinephrine and dopamine -- was higher in those with untreated
depression. The results showed that in major depression MAO-A was
significantly higher in every brain region that the scientists
investigated. On average, MAO-A was 34% higher.
According to Dr. Meyer, "In major depression, higher levels of MAO-A is
the primary process that lowers monoamine levels. Having more MAO-A leads
to greater breakdown of key chemicals like serotonin."
This study includes a detailed new monoamine model of depression, based
upon this work as well as four previous publications from Dr. Meyer and
collaborators at CAMH.
Said Dr. Meyer, "A key barrier to making advances in treating
depression is a lack of precise disease models. Having disease model is
like having a map. Once you have that map you can really begin to
understand how an illness like depression works, and offer more targeted
and effective treatment."
A second part of this new model is that monoamine transporters have an
important role in removing monoamines away from active sites. Having more
of a monoamine transporter is not helpful as it removes more monoamine --
for example if one has more serotonin transporter, one would additionally
lose more serotonin during depression.
"An important aspect of our advanced monoamine model is that
individuals with depression lose chemicals like serotonin and dopamine at
different rates based upon transporter density. This helps explain why one
person with depression may experience loss of appetite while another may
not. And some people have more severe symptoms than others," said Dr.
Meyer.
This advanced monoamine model of depression is a huge step forward in
the disease frontier. It brings the study of mental illness closer to the
advancements seen in research into physical illness such as cardiac
disease, and offers one of the most comprehensive disease models in mental
illness.
The next step for researchers will be to investigate why MAO-A levels
are raised in the brain and consider prevention strategies. Prevention
strategies are critical -- according to the World Health Organization,
major depression is currently the fourth leading cause of death and
disability and is expected to rise to second by the year 2020.
To view a diagram, visit Monoamine Model of Depression
(camh/Research/Areas_of_research/new_depression_model%20.html).
More information on this field of study is available at Background
Information
(camh/Research/Areas_of_research/background_monoamine_depression.html)
The Centre for Addiction and Mental Health (CAMH) is one of the largest
addiction and mental health organizations in North America and Canada's
leading mental health and addiction teaching hospital. CAMH is a Pan
American Health Organization and World Health Organization Collaborating
Centre, and is fully affiliated with the University of Toronto. CAMH
combines clinical care, research, policy, education and health promotion to
improve the lives of people impacted by mental health and addiction issues.
Centre for Addiction and Mental Health
camh/
Daughters Caring For A Parent Recovering From Stroke More Prone To Depression Than Sons
Adult daughters caring for a parent recovering from stroke are more prone to depression than sons, Marina Bastawrous today told the Canadian Stroke Congress, co-hosted by the Canadian Stroke Network, the Heart and Stroke Foundation, and the Canadian Stroke Consortium.
Caring for a parent who has experienced a stroke results in a dramatic shift from the usual parent-child relationship. "Stroke can be particularly challenging for families," says Bastawrous, a masters candidate at the University of Toronto. "Taking care of elderly parents can bring out family strengths and family weaknesses."
The adult child-to-parent bond can result in excellent care when a senior has a stroke. But not always, she says.
The study found that close and secure relationships with parents predicted better mental health and greater satisfaction in adult child caregivers.
"But strained relationships before or following the stroke increases depression in daughters," she says. "If the relationship between a parent and adult daughter is already strained, a stroke can make things even worse."
The quality of relationships both before and after the stroke had an equally important influence on wellbeing.
The study found that adult daughters placed greater importance on family relationships than sons and, in turn, were more negatively impacted by poor relationships with their parent.
"When a parent has a stroke, adult children often become their primary caregivers," says Heart and Stroke Foundation spokesperson Dr. Michael Hill. "It's important that as part of the recovery process we examine their experiences because they are obviously vital to the ongoing care of the stroke patient."
Sandwich generation spread too thin
Study co-author Dr. Jill Cameron says adult children providing stroke care for their parents need help and they need it now.
"Adult children are stroke care's forgotten generation," she says. "We can't afford to leave them behind."
Sixty two percent of stroke caregivers are adult children. Yet stroke care interventions are overwhelmingly designed for spouses.
This imbalance must be addressed, says Dr. Cameron. "We need to make better use of financial resources to enhance the support provided to this growing population of caregivers."
She notes that adult children caregivers need to balance the challenges of professional life, family life, and the added responsibility of taking on the care of somebody post-stroke. "Caregivers need more support," she says. "They aren't trained but their role is essential."
To remove some of the strain - financial and emotional - innovative thinking is required.
"Our healthcare system is not sustainable in the face of rising costs," says Dr. Cameron. "We need to plan."
Here's what Dr. Cameron envisions as part of this plan:
Create work environments that support family members caring for stroke survivors (e.g., caregiving leave).
Recognizing that family members perform many caregiving duties after the stroke survivor returns home but receive little if any training; hospitals must train family members for their caregiving role.
To ensure post-hospital care plans incorporate the unique circumstances of the family, caregivers should be recognized as members of the care team. "Family caregivers are critical to stroke recovery and typically assume major care roles that are frequently costly to their financial, social, and emotional well-being," says Dr. Antoine Hakim, spokesperson for the Canadian Stroke Network. "Innovative new ideas to support their balance and quality of life is essential."
Caring for a parent who has experienced a stroke results in a dramatic shift from the usual parent-child relationship. "Stroke can be particularly challenging for families," says Bastawrous, a masters candidate at the University of Toronto. "Taking care of elderly parents can bring out family strengths and family weaknesses."
The adult child-to-parent bond can result in excellent care when a senior has a stroke. But not always, she says.
The study found that close and secure relationships with parents predicted better mental health and greater satisfaction in adult child caregivers.
"But strained relationships before or following the stroke increases depression in daughters," she says. "If the relationship between a parent and adult daughter is already strained, a stroke can make things even worse."
The quality of relationships both before and after the stroke had an equally important influence on wellbeing.
The study found that adult daughters placed greater importance on family relationships than sons and, in turn, were more negatively impacted by poor relationships with their parent.
"When a parent has a stroke, adult children often become their primary caregivers," says Heart and Stroke Foundation spokesperson Dr. Michael Hill. "It's important that as part of the recovery process we examine their experiences because they are obviously vital to the ongoing care of the stroke patient."
Sandwich generation spread too thin
Study co-author Dr. Jill Cameron says adult children providing stroke care for their parents need help and they need it now.
"Adult children are stroke care's forgotten generation," she says. "We can't afford to leave them behind."
Sixty two percent of stroke caregivers are adult children. Yet stroke care interventions are overwhelmingly designed for spouses.
This imbalance must be addressed, says Dr. Cameron. "We need to make better use of financial resources to enhance the support provided to this growing population of caregivers."
She notes that adult children caregivers need to balance the challenges of professional life, family life, and the added responsibility of taking on the care of somebody post-stroke. "Caregivers need more support," she says. "They aren't trained but their role is essential."
To remove some of the strain - financial and emotional - innovative thinking is required.
"Our healthcare system is not sustainable in the face of rising costs," says Dr. Cameron. "We need to plan."
Here's what Dr. Cameron envisions as part of this plan:
Create work environments that support family members caring for stroke survivors (e.g., caregiving leave).
Recognizing that family members perform many caregiving duties after the stroke survivor returns home but receive little if any training; hospitals must train family members for their caregiving role.
To ensure post-hospital care plans incorporate the unique circumstances of the family, caregivers should be recognized as members of the care team. "Family caregivers are critical to stroke recovery and typically assume major care roles that are frequently costly to their financial, social, and emotional well-being," says Dr. Antoine Hakim, spokesperson for the Canadian Stroke Network. "Innovative new ideas to support their balance and quality of life is essential."
Depression, Anxiety Among Overweight Teenagers Varies By Race, Ethnicity, Study Finds
Some overweight teenagers are more likely than normal weight teens to show symptoms of depression or anxiety, though there are differences by race and ethnicity, according to a study published in the February issue of Pediatrics, Reuters Health reports. The study, by Rhonda BeLue of Pennsylvania State University and colleagues, is based on a national survey of 35,184 parents of teens ages 12 to 17.
Researchers found parents of an overweight white or Hispanic teen were more likely than parents of healthy weight children to say their child displayed symptoms of depression or anxiety. According to the study, the finding was not true for parents of black teens.
The reasons for the racial differences were not clear, but researchers said previous studies have shown that black teenagers are not as affected by excess pounds as white teens and appear to be under less pressure from family and friends to be thin. Researchers added it also is possible that black teens deal with a "constellation" of stresses in their lives, making excess weight less significant to their overall mental well-being.
Researchers recommended that childhood obesity programs account for racial differences in risks of mental health problems related to the condition (Reuters Health, 1/27).
An abstract of the study is available online.
Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation.
© 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
Researchers found parents of an overweight white or Hispanic teen were more likely than parents of healthy weight children to say their child displayed symptoms of depression or anxiety. According to the study, the finding was not true for parents of black teens.
The reasons for the racial differences were not clear, but researchers said previous studies have shown that black teenagers are not as affected by excess pounds as white teens and appear to be under less pressure from family and friends to be thin. Researchers added it also is possible that black teens deal with a "constellation" of stresses in their lives, making excess weight less significant to their overall mental well-being.
Researchers recommended that childhood obesity programs account for racial differences in risks of mental health problems related to the condition (Reuters Health, 1/27).
An abstract of the study is available online.
Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation.
© 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
Depression May Increase Exacerbations, Hospitalizations In COPD
It is well known that patients with chronic obstructive pulmonary disease (COPD) frequently suffer from depression and anxiety, but according to new research, depression and anxiety may actually cause increased hospitalizations and exacerbations.
"This is an important and revealing finding, indicating that for COPD patients, depression and anxiety must be treated as potential clinically important risk factors, rather than simple comorbidities that are caused by COPD," said principle investigator of the paper, Jean Bourbeau, M.D., director of the Respiratory Epidemiology and Clinical Research Unit of McGill University, in Montreal.
The research, published in the first issue for November of the American Thoracic Society's clinical research journal, the American Journal of Respiratory and Critical Care Medicine, is the first study to indicate a causal relationship between depression and exacerbations and hospitalizations for COPD.
To determine whether depression and anxiety were independent risk factors for COPD exacerbations and hospitalizations, the researchers prospectively recruited nearly 500 patients with stable COPD from ten hospitals in Beijing. Each patient was assessed at baseline for anxiety and depression as well as disease severity. They were contacted monthly by telephone for one year to determine whether they had experienced any exacerbations or hospitalizations.
"Almost a quarter of the patients we monitored were suspected of having depression at baseline (13.8 percent possible and 9 percent probably cases), and nearly one in ten were suspected of having anxiety (4.5 percent possible and 5.1 percent probable cases)," said Dr. Bourbeau.
Depressed patients had a higher proportion of concurrent anxiety than non-depressed patients. They also had higher mortality, more symptom- and event-based exacerbations and hospitalizations and longer hospital stays than non-depressed patients. They were also more likely to have had past exacerbations and hospitalizations. Hospital stays were nearly two and a half times as long for depressed patients, although the association did not reach statistical significance.
Anxiety was also associated with a greater risk of exacerbations and longer hospital stays. Overall, among patients with anxiety who had at least one exacerbation, the exacerbation lasted nearly twice as long as those without anxiety, but there was no support for previous findings that hospitalizations were affected by anxiety in length or frequency.
Because these effects were evident after adjustments for all known confounding factors using a causal diagram, and because the outcomes were measured after psychological exposures, the researchers assert that not only is depression linked to greater risk of more and lengthier COPD exacerbations and hospitalizations, but that their findings suggest a causal relationship.
"To our knowledge this is the first report of the possible causal association between depressive symptoms and exacerbations and hospitalizations in stable COPD. However, people have to realize that the causal relationship is a complicated issue and will require further evaluation as part of other properly designed longitudinal studies," wrote Dr. Bourbeau.
While they acknowledge that there may have been a differential loss of depressed/non-depressed patients in follow up, because patients who withdrew earlier had more severe COPD and were more depressed than those who completed follow-up, it is likely that the association was underestimated than anything. "Similarly, the association between anxiety and exacerbations may have been underestimated due to the differential attrition," said Dr. Bourbeau.
The researchers proposed a number of possible explanations for their findings-that depression itself may effect changes in the immune system; that depression affects patients' ability to adapt to chronic symptoms, thereby making them more likely to make frequent visits to the doctor and receive pharmacological treatment; or depression may decrease self-confidence and increase feelings of hopelessness, resulting in poorer self-care and poorer medication compliance.
"The results of this study can guide researchers and clinicians to evaluate in COPD patients with depression the effectiveness of antidepressants and psychotherapies on reducing exacerbations and related complications such as hospital admissions," concluded Dr. Bourbeau.
Full text of original article available here.
This news brief is based on an article published in the American Thoracic Society's peer-reviewed journal, the American Journal of Respiratory and Critical Care Medicine.
About the American Thoracic Society
Founded in 1905, the American Thoracic Society is the world's leading medical association dedicated to advancing pulmonary, critical care and sleep medicine. The Society has more than 15,000 members who prevent and fight respiratory disease around the globe, through research, education, patient care and advocacy.
American Thoracic Society
"This is an important and revealing finding, indicating that for COPD patients, depression and anxiety must be treated as potential clinically important risk factors, rather than simple comorbidities that are caused by COPD," said principle investigator of the paper, Jean Bourbeau, M.D., director of the Respiratory Epidemiology and Clinical Research Unit of McGill University, in Montreal.
The research, published in the first issue for November of the American Thoracic Society's clinical research journal, the American Journal of Respiratory and Critical Care Medicine, is the first study to indicate a causal relationship between depression and exacerbations and hospitalizations for COPD.
To determine whether depression and anxiety were independent risk factors for COPD exacerbations and hospitalizations, the researchers prospectively recruited nearly 500 patients with stable COPD from ten hospitals in Beijing. Each patient was assessed at baseline for anxiety and depression as well as disease severity. They were contacted monthly by telephone for one year to determine whether they had experienced any exacerbations or hospitalizations.
"Almost a quarter of the patients we monitored were suspected of having depression at baseline (13.8 percent possible and 9 percent probably cases), and nearly one in ten were suspected of having anxiety (4.5 percent possible and 5.1 percent probable cases)," said Dr. Bourbeau.
Depressed patients had a higher proportion of concurrent anxiety than non-depressed patients. They also had higher mortality, more symptom- and event-based exacerbations and hospitalizations and longer hospital stays than non-depressed patients. They were also more likely to have had past exacerbations and hospitalizations. Hospital stays were nearly two and a half times as long for depressed patients, although the association did not reach statistical significance.
Anxiety was also associated with a greater risk of exacerbations and longer hospital stays. Overall, among patients with anxiety who had at least one exacerbation, the exacerbation lasted nearly twice as long as those without anxiety, but there was no support for previous findings that hospitalizations were affected by anxiety in length or frequency.
Because these effects were evident after adjustments for all known confounding factors using a causal diagram, and because the outcomes were measured after psychological exposures, the researchers assert that not only is depression linked to greater risk of more and lengthier COPD exacerbations and hospitalizations, but that their findings suggest a causal relationship.
"To our knowledge this is the first report of the possible causal association between depressive symptoms and exacerbations and hospitalizations in stable COPD. However, people have to realize that the causal relationship is a complicated issue and will require further evaluation as part of other properly designed longitudinal studies," wrote Dr. Bourbeau.
While they acknowledge that there may have been a differential loss of depressed/non-depressed patients in follow up, because patients who withdrew earlier had more severe COPD and were more depressed than those who completed follow-up, it is likely that the association was underestimated than anything. "Similarly, the association between anxiety and exacerbations may have been underestimated due to the differential attrition," said Dr. Bourbeau.
The researchers proposed a number of possible explanations for their findings-that depression itself may effect changes in the immune system; that depression affects patients' ability to adapt to chronic symptoms, thereby making them more likely to make frequent visits to the doctor and receive pharmacological treatment; or depression may decrease self-confidence and increase feelings of hopelessness, resulting in poorer self-care and poorer medication compliance.
"The results of this study can guide researchers and clinicians to evaluate in COPD patients with depression the effectiveness of antidepressants and psychotherapies on reducing exacerbations and related complications such as hospital admissions," concluded Dr. Bourbeau.
Full text of original article available here.
This news brief is based on an article published in the American Thoracic Society's peer-reviewed journal, the American Journal of Respiratory and Critical Care Medicine.
About the American Thoracic Society
Founded in 1905, the American Thoracic Society is the world's leading medical association dedicated to advancing pulmonary, critical care and sleep medicine. The Society has more than 15,000 members who prevent and fight respiratory disease around the globe, through research, education, patient care and advocacy.
American Thoracic Society
Survey Reveals Hidden Bipolarity In Many Depressed Respondents
Interviews with members of more than 5,000 representative U.S.
households as part of the National Comorbidity Survey Replication found that nearly 40 percent of those with
major depressive disorder may actually have subthreshold hypomania, defined as a discrete period of increased
energy, activity, and euphoria or irritability that is not related to impairment in daily activities.
Hypomania is a less disruptive form of mania that lacks psychotic symptoms. The majority of patients with
bipolar disorder experience hypomania, rather than mania. Recognition of subthreshold hypomania, or hypomanic
symptoms below the threshold for bipolar disorder, would have implications for the diagnosis and treatment of
major depression.
Among those with subthreshold hypomania, family history of mania was just as common as it was among people
with threshold mania. In addition, compared to those with depression alone, those who had depression with
subthreshold hypomania tended to have an earlier onset of mood disorder, higher rates of anxiety and substance
abuse, and more depressive episodes. Other research has shown that young people with subthreshold hypomania
are more likely to develop bipolar disorder over time.
The findings provide key information for evaluating diagnostic criteria for mood disorders and have important
implications for promoting appropriate treatment for individuals with bipolar spectrum disorders. Author
Kathleen Merikangas, Ph.D., states, "Recognition of hypomania among people with major depression is important
in determining the future risk for the development of bipolar disorder, and should be considered in treatment
decisions among people with major depression. The increased rate of suicide attempts is of particular concern."
The study will appear on August 16 at AJP in Advance, the online advance edition of The American Journal of
Psychiatry (AJP), the official journal of the American Psychiatric Association. The National Comorbidity Survey
Replication was supported by the National Institute of Mental Health (NIMH), National Institute of Drug Abuse,
Substance Abuse and Mental Health Services Administration, Robert Wood Johnson Foundation, and John W.
Alden Trust. Manuscript preparation was supported by NIMH and the French National Center for Scientific
Research. Other funding received by individual authors is disclosed in the article.
The American Journal of Psychiatry is the oldest continuously published medical specialty journal in the United
States and was recently named one of the "Most Influential Journals in Biology & Medicine of the Last 100
Years."
households as part of the National Comorbidity Survey Replication found that nearly 40 percent of those with
major depressive disorder may actually have subthreshold hypomania, defined as a discrete period of increased
energy, activity, and euphoria or irritability that is not related to impairment in daily activities.
Hypomania is a less disruptive form of mania that lacks psychotic symptoms. The majority of patients with
bipolar disorder experience hypomania, rather than mania. Recognition of subthreshold hypomania, or hypomanic
symptoms below the threshold for bipolar disorder, would have implications for the diagnosis and treatment of
major depression.
Among those with subthreshold hypomania, family history of mania was just as common as it was among people
with threshold mania. In addition, compared to those with depression alone, those who had depression with
subthreshold hypomania tended to have an earlier onset of mood disorder, higher rates of anxiety and substance
abuse, and more depressive episodes. Other research has shown that young people with subthreshold hypomania
are more likely to develop bipolar disorder over time.
The findings provide key information for evaluating diagnostic criteria for mood disorders and have important
implications for promoting appropriate treatment for individuals with bipolar spectrum disorders. Author
Kathleen Merikangas, Ph.D., states, "Recognition of hypomania among people with major depression is important
in determining the future risk for the development of bipolar disorder, and should be considered in treatment
decisions among people with major depression. The increased rate of suicide attempts is of particular concern."
The study will appear on August 16 at AJP in Advance, the online advance edition of The American Journal of
Psychiatry (AJP), the official journal of the American Psychiatric Association. The National Comorbidity Survey
Replication was supported by the National Institute of Mental Health (NIMH), National Institute of Drug Abuse,
Substance Abuse and Mental Health Services Administration, Robert Wood Johnson Foundation, and John W.
Alden Trust. Manuscript preparation was supported by NIMH and the French National Center for Scientific
Research. Other funding received by individual authors is disclosed in the article.
The American Journal of Psychiatry is the oldest continuously published medical specialty journal in the United
States and was recently named one of the "Most Influential Journals in Biology & Medicine of the Last 100
Years."
Barr Receives Tentative Approval For A Generic Version Of ZYPREXA(R) Zydis(R) Tablets, 5mg, 10mg, 15mg And 20mg
Barr
Pharmaceuticals, Inc. (NYSE: BRL) today announced that its subsidiary, Barr
Laboratories, Inc. has received tentative approval from the U.S. Food and
Drug Administration (FDA) for its generic version of Eli Lilly and
Company's ZYPREXA(R) Zydis(R) (Olanzapine) Orally Disintegrating Tablets,
5mg, 10mg, 15mg and 20mg. The Company anticipates receiving final approval
following the expiration of the 30-month stay in April 2007.
The patent listed in the Orange Book for ZYPREXA Zydis expires on April
23, 2011. Barr's Abbreviated New Drug Application (ANDA) alleges that the
Orange Book listed patent is invalid, unenforceable and/or would not be
infringed by Barr's product.
Barr filed its ANDA containing a paragraph IV certification for a
generic ZYPREXA Zydis product with the FDA in August 2004, and received
notification of the application's acceptance for filing in September 2004.
Following receipt of the notice from the FDA, Barr notified Lilly
Industries Limited, the patent owner, and Eli Lilly & Company, the New Drug
Application (NDA) holder. On December 1, 2004, Lilly Industries Limited and
Eli Lilly & Company filed suit in U.S. District Court, Southern District of
Indiana to prevent Barr from proceeding with the commercialization of its
product, formally initiating the patent challenge process under the
Hatch-Waxman Act.
ZYPREXA (olanzapine) is indicated for the treatment of schizophrenia
and for the short-term treatment of acute manic episodes associated with
Bipolar I disorder. The product had annual sales of approximately $246
million for the twelve months ended September 2006, based on IMS sales
data.
A tentative approval reflects FDA's preliminary determination that a
generic product satisfies the substantive requirements for approval,
subject to the expiration of all statutorily imposed non-approval periods.
A tentative approval does not allow the applicant to market the generic
drug product.
About Barr Pharmaceuticals, Inc.
Barr Pharmaceuticals, Inc. is a global specialty pharmaceutical company
that operates in more than 30 countries worldwide and is engaged in the
development, manufacture and marketing of generic and proprietary
pharmaceuticals, biopharmaceuticals and active pharmaceutical ingredients.
A holding company, Barr operates through its principal subsidiaries: Barr
Laboratories, Inc., Duramed Pharmaceuticals, Inc. and PLIVA d.d. and its
subsidiaries. The Company markets more than 120 generic and 25 proprietary
products in the U.S. and more than 550 products globally outside of the
U.S.
Forward-Looking Statements
Except for the historical information contained herein, the statements
made in this press release constitute forward-looking statements within the
meaning of Section 27A of the Securities Act of 1933 and Section 21E of the
Securities Exchange Act of 1934. Forward-looking statements can be
identified by their use of words such as "expects," "plans," "projects,"
"will," "may," "anticipates," "believes," "should," "intends," "estimates"
and other words of similar meaning. Because such statements inherently
involve risks and uncertainties that cannot be predicted or quantified,
actual results may differ materially from those expressed or implied by
such forward-looking statements depending upon a number of factors
affecting the Company's business. These factors include, among others: the
difficulty in predicting the timing and outcome of legal proceedings,
including patent-related matters such as patent challenge settlements and
patent infringement cases; the outcome of litigation arising from
challenging the validity or non- infringement of patents covering our
products; the difficulty of predicting the timing of FDA approvals; court
and FDA decisions on exclusivity periods; the ability of competitors to
extend exclusivity periods for their products; our ability to complete
product development activities in the timeframes and for the costs we
expect; market and customer acceptance and demand for our pharmaceutical
products; our dependence on revenues from significant customers;
reimbursement policies of third party payors; our dependence on revenues
from significant products; the use of estimates in the preparation of our
financial statements; the impact of competitive products and pricing on
products, including the launch of authorized generics; the ability to
launch new products in the timeframes we expect; the availability of raw
materials; the availability of any product we purchase and sell as a
distributor; the regulatory environment; our exposure to product liability
and other lawsuits and contingencies; the increasing cost of insurance and
the availability of product liability insurance coverage; our timely and
successful completion of strategic initiatives, including integrating
companies (including PLIVA d.d.) and products we acquire and implementing
our new enterprise resource planning system; fluctuations in operating
results, including the effects on such results from spending for research
and development, sales and marketing activities and patent challenge
activities; the inherent uncertainty associated with financial projections;
our expansion into international markets through the completion of the
PLIVA acquisition, and the resulting currency, governmental, regulatory and
other risks involved with international operations; our ability to service
our increased debt obligations as a result of the PLIVA acquisition;
changes in generally accepted accounting principles; and other risks
detailed from time-to-time in our filings with the Securities and Exchange
Commission, including in our Annual Report on Form 10-K for the fiscal year
ended June 30, 2006.
The forward-looking statements contained in this press release speak
only as of the date the statement was made. The Company undertakes no
obligation (nor does it intend) to publicly update or revise any
forward-looking statements, whether as a result of new information, future
events or otherwise, except to the extent required under applicable law.
Barr Pharmaceuticals, Inc.
barrlabs
View drug information on Zyprexa.
Pharmaceuticals, Inc. (NYSE: BRL) today announced that its subsidiary, Barr
Laboratories, Inc. has received tentative approval from the U.S. Food and
Drug Administration (FDA) for its generic version of Eli Lilly and
Company's ZYPREXA(R) Zydis(R) (Olanzapine) Orally Disintegrating Tablets,
5mg, 10mg, 15mg and 20mg. The Company anticipates receiving final approval
following the expiration of the 30-month stay in April 2007.
The patent listed in the Orange Book for ZYPREXA Zydis expires on April
23, 2011. Barr's Abbreviated New Drug Application (ANDA) alleges that the
Orange Book listed patent is invalid, unenforceable and/or would not be
infringed by Barr's product.
Barr filed its ANDA containing a paragraph IV certification for a
generic ZYPREXA Zydis product with the FDA in August 2004, and received
notification of the application's acceptance for filing in September 2004.
Following receipt of the notice from the FDA, Barr notified Lilly
Industries Limited, the patent owner, and Eli Lilly & Company, the New Drug
Application (NDA) holder. On December 1, 2004, Lilly Industries Limited and
Eli Lilly & Company filed suit in U.S. District Court, Southern District of
Indiana to prevent Barr from proceeding with the commercialization of its
product, formally initiating the patent challenge process under the
Hatch-Waxman Act.
ZYPREXA (olanzapine) is indicated for the treatment of schizophrenia
and for the short-term treatment of acute manic episodes associated with
Bipolar I disorder. The product had annual sales of approximately $246
million for the twelve months ended September 2006, based on IMS sales
data.
A tentative approval reflects FDA's preliminary determination that a
generic product satisfies the substantive requirements for approval,
subject to the expiration of all statutorily imposed non-approval periods.
A tentative approval does not allow the applicant to market the generic
drug product.
About Barr Pharmaceuticals, Inc.
Barr Pharmaceuticals, Inc. is a global specialty pharmaceutical company
that operates in more than 30 countries worldwide and is engaged in the
development, manufacture and marketing of generic and proprietary
pharmaceuticals, biopharmaceuticals and active pharmaceutical ingredients.
A holding company, Barr operates through its principal subsidiaries: Barr
Laboratories, Inc., Duramed Pharmaceuticals, Inc. and PLIVA d.d. and its
subsidiaries. The Company markets more than 120 generic and 25 proprietary
products in the U.S. and more than 550 products globally outside of the
U.S.
Forward-Looking Statements
Except for the historical information contained herein, the statements
made in this press release constitute forward-looking statements within the
meaning of Section 27A of the Securities Act of 1933 and Section 21E of the
Securities Exchange Act of 1934. Forward-looking statements can be
identified by their use of words such as "expects," "plans," "projects,"
"will," "may," "anticipates," "believes," "should," "intends," "estimates"
and other words of similar meaning. Because such statements inherently
involve risks and uncertainties that cannot be predicted or quantified,
actual results may differ materially from those expressed or implied by
such forward-looking statements depending upon a number of factors
affecting the Company's business. These factors include, among others: the
difficulty in predicting the timing and outcome of legal proceedings,
including patent-related matters such as patent challenge settlements and
patent infringement cases; the outcome of litigation arising from
challenging the validity or non- infringement of patents covering our
products; the difficulty of predicting the timing of FDA approvals; court
and FDA decisions on exclusivity periods; the ability of competitors to
extend exclusivity periods for their products; our ability to complete
product development activities in the timeframes and for the costs we
expect; market and customer acceptance and demand for our pharmaceutical
products; our dependence on revenues from significant customers;
reimbursement policies of third party payors; our dependence on revenues
from significant products; the use of estimates in the preparation of our
financial statements; the impact of competitive products and pricing on
products, including the launch of authorized generics; the ability to
launch new products in the timeframes we expect; the availability of raw
materials; the availability of any product we purchase and sell as a
distributor; the regulatory environment; our exposure to product liability
and other lawsuits and contingencies; the increasing cost of insurance and
the availability of product liability insurance coverage; our timely and
successful completion of strategic initiatives, including integrating
companies (including PLIVA d.d.) and products we acquire and implementing
our new enterprise resource planning system; fluctuations in operating
results, including the effects on such results from spending for research
and development, sales and marketing activities and patent challenge
activities; the inherent uncertainty associated with financial projections;
our expansion into international markets through the completion of the
PLIVA acquisition, and the resulting currency, governmental, regulatory and
other risks involved with international operations; our ability to service
our increased debt obligations as a result of the PLIVA acquisition;
changes in generally accepted accounting principles; and other risks
detailed from time-to-time in our filings with the Securities and Exchange
Commission, including in our Annual Report on Form 10-K for the fiscal year
ended June 30, 2006.
The forward-looking statements contained in this press release speak
only as of the date the statement was made. The Company undertakes no
obligation (nor does it intend) to publicly update or revise any
forward-looking statements, whether as a result of new information, future
events or otherwise, except to the extent required under applicable law.
Barr Pharmaceuticals, Inc.
barrlabs
View drug information on Zyprexa.
Adults Who Have Lost A Loved One Due To Suicide Needed For Complicated Grief Study At Pitt
Researchers from the Late-Life Depression Evaluation and Treatment Program at the University of Pittsburgh are seeking adults ages 18 to 95 who have experienced the loss of a loved one due to suicide and are having emotional difficulties coping with grief.
Suicide survivors may face overwhelming challenges that can lead to what is termed "complicated grief" in which mourning is unusually intense and prolonged and the ability for the mourner to resume usual activities is impaired. The pain of the loss remains intense with symptoms that include a preoccupation with the person who has died, longing that does not substantially abate with time, and difficulty reestablishing a meaningful life. Complicated grief may affect as many as one out of 10 individuals who have lost someone close to them. Untreated, it can last for years.
Complicated grief treatment is a recently developed psychotherapy, or talking therapy approach, that specifically targets the grief. In the study, the Pitt researchers utilize techniques from cognitive behavioral therapy, interpersonal psychotherapy and motivational interviewing, to provide an individualized approach to resolving the areas that hinder the restorative process. Some research data suggest that antidepressant medication may also have a role in relieving symptoms of complicated grief, but the degree to which medications help, either alone or in combination with the therapy, remains to be determined.
The University of Pittsburgh is one of four sites nationally that has been funded by the American Foundation for Suicide Prevention and theNational Institute of Mental Health to study whether antidepressant medications, alone or in combination with complicated grief therapy, help relieve complicated grief and its associated health consequences. The study is being conducted locally by Charles F. Reynolds III, M.D., professor of psychiatry at Pitt's School of Medicine.
Suicide survivors may face overwhelming challenges that can lead to what is termed "complicated grief" in which mourning is unusually intense and prolonged and the ability for the mourner to resume usual activities is impaired. The pain of the loss remains intense with symptoms that include a preoccupation with the person who has died, longing that does not substantially abate with time, and difficulty reestablishing a meaningful life. Complicated grief may affect as many as one out of 10 individuals who have lost someone close to them. Untreated, it can last for years.
Complicated grief treatment is a recently developed psychotherapy, or talking therapy approach, that specifically targets the grief. In the study, the Pitt researchers utilize techniques from cognitive behavioral therapy, interpersonal psychotherapy and motivational interviewing, to provide an individualized approach to resolving the areas that hinder the restorative process. Some research data suggest that antidepressant medication may also have a role in relieving symptoms of complicated grief, but the degree to which medications help, either alone or in combination with the therapy, remains to be determined.
The University of Pittsburgh is one of four sites nationally that has been funded by the American Foundation for Suicide Prevention and theNational Institute of Mental Health to study whether antidepressant medications, alone or in combination with complicated grief therapy, help relieve complicated grief and its associated health consequences. The study is being conducted locally by Charles F. Reynolds III, M.D., professor of psychiatry at Pitt's School of Medicine.
Extending Life By Tackling Depression In Cancer Patients
A study recommended by David Spiegel of Faculty of 1000 Medicine (f1000medicine/), looks at the relationship between depression care management and survival rates in older patients. He identifies it as "an important and well-conducted study of the effects of treatment of depression on survival in a primary care setting"
A leading authority on mind-body interactions and professor of psychiatry and behavioural sciences at Stanford University, Spiegel evaluates the research published in the Annals of Internal Medicine, stressing the finding that "Comorbid depression shortens survival time with cancer, and intervention with medication and psychotherapy can therefore extend survival among cancer patients."
The better survival rates were not seen in patients with depression and cardiovascular disease, only in those with cancer. Spiegel notes that this "is surprising given the well-known link between depression and poor cardiovascular disease outcome".
He concludes, "Vigorous diagnosis and treatment programs for comorbid depression in cancer patients should, based on this study, extend survival time."
1 Dr. David Spiegel, Faculty Member for F1000 Medicine Psychiatry Specialty, is a global authority on mind-body interactions and professor of psychiatry and behavioural sciences at Stanford University
2 The effect of a primary care practice-based depression intervention on mortality in older adults: a randomized trial.
Gallo JJ, Bogner HR, Morales KH, Post EP, Lin JY, Bruce ML
Ann Intern Med 2007 May 15 146(10):689-98
annals/cgi/reprint/146/10/689.pdf
3 Faculty of 1000 Medicine's evaluation of this article is available at f1000medicine/article/zckntxms4rbt1bm/id/1103568
4 Faculty of 1000 Medicine, f1000medicine/, is a unique online service that helps clinicians and researchers stay informed of high impact articles and access the opinions of global leaders in medicine. A distinguished international faculty select and evaluate key articles across medicine, providing a rapidly updated, authoritative guide to the medical literature that matters.
A leading authority on mind-body interactions and professor of psychiatry and behavioural sciences at Stanford University, Spiegel evaluates the research published in the Annals of Internal Medicine, stressing the finding that "Comorbid depression shortens survival time with cancer, and intervention with medication and psychotherapy can therefore extend survival among cancer patients."
The better survival rates were not seen in patients with depression and cardiovascular disease, only in those with cancer. Spiegel notes that this "is surprising given the well-known link between depression and poor cardiovascular disease outcome".
He concludes, "Vigorous diagnosis and treatment programs for comorbid depression in cancer patients should, based on this study, extend survival time."
1 Dr. David Spiegel, Faculty Member for F1000 Medicine Psychiatry Specialty, is a global authority on mind-body interactions and professor of psychiatry and behavioural sciences at Stanford University
2 The effect of a primary care practice-based depression intervention on mortality in older adults: a randomized trial.
Gallo JJ, Bogner HR, Morales KH, Post EP, Lin JY, Bruce ML
Ann Intern Med 2007 May 15 146(10):689-98
annals/cgi/reprint/146/10/689.pdf
3 Faculty of 1000 Medicine's evaluation of this article is available at f1000medicine/article/zckntxms4rbt1bm/id/1103568
4 Faculty of 1000 Medicine, f1000medicine/, is a unique online service that helps clinicians and researchers stay informed of high impact articles and access the opinions of global leaders in medicine. A distinguished international faculty select and evaluate key articles across medicine, providing a rapidly updated, authoritative guide to the medical literature that matters.
One in 6 chronically ill adults skip prescription drugs due to cost
Skimping most common among those who pay the most out-of-pocket, earn the least, or don't have prescription drug
coverage
A recent nationally representative survey of older adults finds that 18 percent of those with chronic conditions such as
heart disease and depression skip some of their prescription medicines because of out-of-pocket cost pressures, and 14
percent do so at least every month.
Based on the study's findings, the authors estimate that every month, this cost-related medication skimping leads more than a
million Americans with diabetes to use less medication for that illness than was prescribed to them, and causes more than 1.6
million people with asthma to miss some of their doses of medication.
The findings, from a nationally representative survey of 4,055 adults over the age of 50, are published in the October issue
of the American Journal of Public Health by a team from the University of Michigan Health System, the Veterans Affairs Ann
Arbor Healthcare System and Stanford University. The study was funded by the VA.
Not surprisingly, the study finds that seniors whose out-of-pocket prescription costs are more than $100 a month, and those
with low incomes or no prescription drug coverage, are at the greatest risk for skimping on their medications.
Other results of the survey indicate that people with chronic illnesses were more likely to cut back on certain kinds of
medications over others, suggesting that patients are selective about which drugs they go without.
"We found that many patients go without drugs that relieve serious symptomatic conditions such as back pain or ulcers, while
others skipped drugs that are life-sustaining, such as blood pressure and cholesterol drugs, but that might not cause any
noticeable difference in day-to-day functioning," says lead author John D. Piette, a VA Career Scientist and associate
professor of internal medicine at the U-M Medical School.
More patients regularly cut back on costs by forgoing their medicines for depression, asthma, ulcers, arthritis, migraines
and back pain, for example, than went without medicines for high blood pressure, high cholesterol or diabetes. Piette and his
colleagues say their findings suggest that changes in prescription drug benefit policites will affect patients differently
depending on their particular medical problems and possibly their demographic characteristics as well.
The data add to a growing list of findings on cost-related prescription drug skimping that have been published by the same
group of researchers in the last few months.
In September, the group reported in the Archives of Internal Medicine that most chronically ill patients who cut back on
prescription drugs due to cost don't tell their doctors they're doing so. And in June, they released the first long-term
evidence that skimping on medications due to cost can lead to adverse health outcomes for chronically ill patients. In
February, they reported that diabetes patients who forgo medication due to cost pressures have worse blood sugar control,
symptoms and physical functioning.
"We're getting a clearer picture of how chronic illness, out-of-pocket cost, insurance and patient characteristics combine to
create a pattern of non-adherence among older Americans," says Piette. "This is an issue that affects millions of Americans,
and will influence their health for years to come."
No matter which drugs they cut back on, those patients who reported at least some cost-related adherence problems were
describing a relatively frequent problem. In fact, 78 percent of those who reported ever having cut back on any medication
due to cost in the last year also said they were forgoing treatment at least once a month.
Having insurance to cover drug costs didn't always mean patients were always able to stay on their medications, the
researchers found. That's because cash co-payments and deductibles required by some insurance plans can add up to hundreds of
dollars a month, especially for the large number of older adults with multiple chronic illnesses.
When the sample of surveyed adults was weighted to reflect national population characteristics, the researchers found that
half of all respondents had monthly prescription-related costs of $50 or more, and 25 percent had monthly costs of $100 or
more. Eighty-three percent of respondents had some form of prescription drug coverage, but even so, many of these patients
reported that their monthly medication costs topped $100.
Those who didn't have insurance were the least likely to be able to afford out-of-pocket payments for drugs: Respondents who
had incomes under $20,000 a year were more than twice as likely to be without drug coverage than those making more than
$60,000 a year.
In general, there were no notable differences in cost-related medication under-use across groups defined by race, gender or
educational attainment. However, the researchers found that patients over the age of 65 were substantially less likely to cut
back on medications due to cost than those in their 50s. As a result, Piette says, planned Medicare reforms will not address
the problems of medication cost pressures for those chronically ill patients who may need assistance the most: those under
age 65.
In the study, the researchers examined risk factors for cost-related medication under-use separately for patients with the 10
most common chronic health problems. For example, people who had been prescribed drugs to control their blood pressure were
more than four times as likely to skimp on their medicines if they paid more than $100 a month for all their medications than
if they paid less than $100. Overall, about 7 percent of people with high blood pressure said they had cut back on their
blood pressure medication due to cost at least once per month.
Similarly, people who had been prescribed drugs to treat depression were more than four times as likely to say they had cut
back on a medication due to cost if they paid more than $100 a month for all their medications. And 14 percent of those
patients who had prescriptions for antidepressants cut back on those depression medications each month due to cost.
In addition to Piette, the study's authors include Michele Heisler, M.D., M.P.A., also of the VA Ann Arbor Healthcare System
and the U-M Medical School, and Todd H. Wagner, Ph.D., of the VA Health Economics Resource Center and Stanford University.
Reference: AJPH: Oct. 2004, Vol. 94, No. 10, pp 1782-1787.
Contact: Kara Gavin
kegavinumich
734-764-2220
University of Michigan Health System
coverage
A recent nationally representative survey of older adults finds that 18 percent of those with chronic conditions such as
heart disease and depression skip some of their prescription medicines because of out-of-pocket cost pressures, and 14
percent do so at least every month.
Based on the study's findings, the authors estimate that every month, this cost-related medication skimping leads more than a
million Americans with diabetes to use less medication for that illness than was prescribed to them, and causes more than 1.6
million people with asthma to miss some of their doses of medication.
The findings, from a nationally representative survey of 4,055 adults over the age of 50, are published in the October issue
of the American Journal of Public Health by a team from the University of Michigan Health System, the Veterans Affairs Ann
Arbor Healthcare System and Stanford University. The study was funded by the VA.
Not surprisingly, the study finds that seniors whose out-of-pocket prescription costs are more than $100 a month, and those
with low incomes or no prescription drug coverage, are at the greatest risk for skimping on their medications.
Other results of the survey indicate that people with chronic illnesses were more likely to cut back on certain kinds of
medications over others, suggesting that patients are selective about which drugs they go without.
"We found that many patients go without drugs that relieve serious symptomatic conditions such as back pain or ulcers, while
others skipped drugs that are life-sustaining, such as blood pressure and cholesterol drugs, but that might not cause any
noticeable difference in day-to-day functioning," says lead author John D. Piette, a VA Career Scientist and associate
professor of internal medicine at the U-M Medical School.
More patients regularly cut back on costs by forgoing their medicines for depression, asthma, ulcers, arthritis, migraines
and back pain, for example, than went without medicines for high blood pressure, high cholesterol or diabetes. Piette and his
colleagues say their findings suggest that changes in prescription drug benefit policites will affect patients differently
depending on their particular medical problems and possibly their demographic characteristics as well.
The data add to a growing list of findings on cost-related prescription drug skimping that have been published by the same
group of researchers in the last few months.
In September, the group reported in the Archives of Internal Medicine that most chronically ill patients who cut back on
prescription drugs due to cost don't tell their doctors they're doing so. And in June, they released the first long-term
evidence that skimping on medications due to cost can lead to adverse health outcomes for chronically ill patients. In
February, they reported that diabetes patients who forgo medication due to cost pressures have worse blood sugar control,
symptoms and physical functioning.
"We're getting a clearer picture of how chronic illness, out-of-pocket cost, insurance and patient characteristics combine to
create a pattern of non-adherence among older Americans," says Piette. "This is an issue that affects millions of Americans,
and will influence their health for years to come."
No matter which drugs they cut back on, those patients who reported at least some cost-related adherence problems were
describing a relatively frequent problem. In fact, 78 percent of those who reported ever having cut back on any medication
due to cost in the last year also said they were forgoing treatment at least once a month.
Having insurance to cover drug costs didn't always mean patients were always able to stay on their medications, the
researchers found. That's because cash co-payments and deductibles required by some insurance plans can add up to hundreds of
dollars a month, especially for the large number of older adults with multiple chronic illnesses.
When the sample of surveyed adults was weighted to reflect national population characteristics, the researchers found that
half of all respondents had monthly prescription-related costs of $50 or more, and 25 percent had monthly costs of $100 or
more. Eighty-three percent of respondents had some form of prescription drug coverage, but even so, many of these patients
reported that their monthly medication costs topped $100.
Those who didn't have insurance were the least likely to be able to afford out-of-pocket payments for drugs: Respondents who
had incomes under $20,000 a year were more than twice as likely to be without drug coverage than those making more than
$60,000 a year.
In general, there were no notable differences in cost-related medication under-use across groups defined by race, gender or
educational attainment. However, the researchers found that patients over the age of 65 were substantially less likely to cut
back on medications due to cost than those in their 50s. As a result, Piette says, planned Medicare reforms will not address
the problems of medication cost pressures for those chronically ill patients who may need assistance the most: those under
age 65.
In the study, the researchers examined risk factors for cost-related medication under-use separately for patients with the 10
most common chronic health problems. For example, people who had been prescribed drugs to control their blood pressure were
more than four times as likely to skimp on their medicines if they paid more than $100 a month for all their medications than
if they paid less than $100. Overall, about 7 percent of people with high blood pressure said they had cut back on their
blood pressure medication due to cost at least once per month.
Similarly, people who had been prescribed drugs to treat depression were more than four times as likely to say they had cut
back on a medication due to cost if they paid more than $100 a month for all their medications. And 14 percent of those
patients who had prescriptions for antidepressants cut back on those depression medications each month due to cost.
In addition to Piette, the study's authors include Michele Heisler, M.D., M.P.A., also of the VA Ann Arbor Healthcare System
and the U-M Medical School, and Todd H. Wagner, Ph.D., of the VA Health Economics Resource Center and Stanford University.
Reference: AJPH: Oct. 2004, Vol. 94, No. 10, pp 1782-1787.
Contact: Kara Gavin
kegavinumich
734-764-2220
University of Michigan Health System
Depression Treatments Reviewed By NeuroInvestment
NeuroInvestment announced the release of its May issue, which reviews novel treatments being developed for depression. Even though depression can be argued to be the success story of psychopharmacology, the current array of largely similar monoamine-targeting drugs leave 30% of patients without adequate relief, and incur significantly aversive side effects for the majority. With millions of patients going untreated or not complying with treatment due to side effects, depression remains an undertreated disorder of enormous magnitude and societal cost. While major pharmaceutical companies have and continue to devote major resources to the development of drugs which are in fact just minor variations on well-trodden themes, the real promise of genuinely accelerated and impactful antidepressant therapies is more likely to be found in the numerous novel targets that are being explored. None of these have proven to be an easy target: CRF antagonism, as was pioneered by Neurocrine Biosciences has made painfully little progress since its early signs of promise nearly ten years ago.
The same is true for NK-1 antagonism, which in 1998 was cited as the new revolution in depression therapy. These strategies have been joined by other novel approaches, including neurogenesis-enhancement (BrainCells Inc.); melatonin-modulation (Servier and Novartis); mGluR modulation (Addex, JNJ, Merck, Lilly); vasopressin modulation (Schering-Plough, Sanofi-Aventis) and AMPA-modulation (Schering-Plough, Cortex (AMEX: COR), Lilly) as possible new strategies for depression treatment, while CeNeRx is bringing forward a selective MAO-A inhibitor. Other intriguing programs include those from Affectis, Lundbeck, NeuroSearch, Karo AB, and Targacept (NASDAQ: TRGT), amongst several.
The May issue also includes commentary regarding the major partnership between Astellas Pharma and CoMentis; the acquisitions of Sirtis by GSK and CeNeS by Paion; the StemCells Inc. claim that they control all uses of neural stem cells; additional commentary regarding the Catalyst Pharmaceuticals vigabatrin program; prospects for the GSK/Pozen migraine drug; and an overview of Japan's M's Science.
NeuroInvestment is the independent, monthly review of the neurotherapeutics area. A one-year corporate subscription is $1600, email or hardcopy. Add $250 for dual delivery, add $50 for airmail delivery outside North America. A three month trial subscription is US$600. Individual investor information is available upon request.
NI Research is the leading publisher of independent research on the neuropharmaceutical/therapeutic industry. NI Research has published NeuroInvestment since 1995, the Private CNS Company Review since 2003, and CNS Disorders/Therapeutics since 2007. NI Research also provides inlicensing consultation and custom research for large and small pharmaceutical firms. NI Research has developed an unmatched information base regarding both publicly and privately-held neuro-oriented companies.
NeuroInvestment
The same is true for NK-1 antagonism, which in 1998 was cited as the new revolution in depression therapy. These strategies have been joined by other novel approaches, including neurogenesis-enhancement (BrainCells Inc.); melatonin-modulation (Servier and Novartis); mGluR modulation (Addex, JNJ, Merck, Lilly); vasopressin modulation (Schering-Plough, Sanofi-Aventis) and AMPA-modulation (Schering-Plough, Cortex (AMEX: COR), Lilly) as possible new strategies for depression treatment, while CeNeRx is bringing forward a selective MAO-A inhibitor. Other intriguing programs include those from Affectis, Lundbeck, NeuroSearch, Karo AB, and Targacept (NASDAQ: TRGT), amongst several.
The May issue also includes commentary regarding the major partnership between Astellas Pharma and CoMentis; the acquisitions of Sirtis by GSK and CeNeS by Paion; the StemCells Inc. claim that they control all uses of neural stem cells; additional commentary regarding the Catalyst Pharmaceuticals vigabatrin program; prospects for the GSK/Pozen migraine drug; and an overview of Japan's M's Science.
NeuroInvestment is the independent, monthly review of the neurotherapeutics area. A one-year corporate subscription is $1600, email or hardcopy. Add $250 for dual delivery, add $50 for airmail delivery outside North America. A three month trial subscription is US$600. Individual investor information is available upon request.
NI Research is the leading publisher of independent research on the neuropharmaceutical/therapeutic industry. NI Research has published NeuroInvestment since 1995, the Private CNS Company Review since 2003, and CNS Disorders/Therapeutics since 2007. NI Research also provides inlicensing consultation and custom research for large and small pharmaceutical firms. NI Research has developed an unmatched information base regarding both publicly and privately-held neuro-oriented companies.
NeuroInvestment
CeNeRx BioPharma Initiates Phase II Clinical Trial Of Its Novel Antidepressant Agent Tyrima(TM)
CeNeRx BioPharma,
Inc., a clinical stage company developing and commercializing innovative
treatments for diseases of the central nervous system, announced that
it has initiated a Phase II clinical trial for its lead product candidate
Tyrima(TM) for the treatment of major depressive disorder (MDD). Tyrima is
a selective and reversible member of a novel class of drugs known as RIMAs,
or reversible inhibitors of monoamine oxidase A (MAO-A). The primary
objective of this Phase II trial is to evaluate the antidepressant efficacy
of Tyrima in patients with confirmed MDD. The trial design incorporates a
number of features intended to reduce the variability and placebo response
often observed in MDD clinical trials.
The randomized, double-blind, placebo-controlled Phase II trial will
enroll approximately 272 patients with moderate to severe MDD who will
receive either Tyrima or placebo for six weeks. The primary study objective
of antidepressant efficacy will be assessed using the Montgomery-Asberg
Depression Rating Scale (MADRS). Secondary objectives of the study include
evaluation of safety, tolerability, and pharmacokinetics of Tyrima. The
trial design was supported by a Tyrima Phase I safety database of 106
subjects and a PET (positron emission tomography) study that yielded
critical insight into the dose-response relationship of Tyrima. A number of
patients are already randomized in the trial and initial results are
expected by the end of 2009.
"Tyrima has the potential to be the first triple-action antidepressant
with a safety profile appropriate for the treatment of a broad population
of patients with depression, and we are committed to generating robust
clinical data from this Phase Il trial," said Dr. Daniel Burch, Executive
Vice President of R&D and Chief Medical Officer of CeNeRx. "We worked
closely with experienced MDD clinical trial experts, disease specialists,
and biostatisticians to incorporate a number of features in the study
design intended to manage the issues that can confound antidepressant
clinical trial results."
Depression clinical trial expert Dr. Norman Rosenthal, Medical Director
of Capital Clinical Associates and one of the lead investigators of the
Tyrima Phase II study noted, "The CeNeRx team gets high marks for designing
a first-class clinical trial. Recent efforts to test new antidepressants
have encountered technical difficulties, such as a high placebo effect,
which the current trial works hard to avoid. I am optimistic that the
present trial should enable us to assess the potential of Tyrima as a
potentially valuable new antidepressant agent."
Similar to the mechanism of conventional monoamine oxidase A inhibitors
(MAOI), the triple-action mechanism of Tyrima elevates the levels of three
key neurotransmitters (serotonin, norepinephrine and dopamine) that
positively affect mood and anxiety, compared to the one or two
neurotransmitters addressed by most current antidepressant drugs. This
triple-action mechanism has the potential to provide improved
antidepressant efficacy in some patients, while the selectivity and
reversibility of Tyrima are expected to reduce or eliminate the risk of
food-associated cardiovascular side effects of conventional MAOIs.
"A substantial subset of patients suffering from depression responds
much better to treatment with MAOIs than other therapies, yet the risk of
food-associated cardiovascular side effects of conventional MAOIs have
greatly restricted their use, to the disadvantage of our patients," said
Dr. Alexander Bodkin, a Tyrima Phase II investigator and Director of the
Clinical Psychopharmacology Research Program at McLean Hospital of Harvard
Medical School. "A novel agent such as Tyrima with proven MAOI activity in
the CNS and a good safety and tolerability profile would be a valuable
option for the many patients whose depression is refractory to treatment
with currently prescribed antidepressant drugs."
CeNeRx has worldwide rights to develop and commercialize Tyrima. This
compound, which could be the first RIMA antidepressant available in the
U.S. market, has patent protection beyond 2027.
About CeNeRx BioPharma
CeNeRx is a privately held clinical stage biopharmaceutical company
developing and commercializing innovative treatments for diseases of the
central nervous system. CeNeRx's most advanced compound, a reversible
inhibitor of monoamine oxidase, or RIMA, has entered Phase II development
for the treatment of major depressive disorder. RIMAs may have efficacy
advantages over current agents for depression and are expected to have a
good safety profile. The company is also developing its pipeline of
selective cannabinoid compounds that have recently completed successful
preclinical proof-of-concept studies for the treatment of pain, glaucoma
and spasticity. More information about CeNeRx BioPharma can be found at
cenerx.
CeNeRx BioPharma, Inc.
cenerxw
Inc., a clinical stage company developing and commercializing innovative
treatments for diseases of the central nervous system, announced that
it has initiated a Phase II clinical trial for its lead product candidate
Tyrima(TM) for the treatment of major depressive disorder (MDD). Tyrima is
a selective and reversible member of a novel class of drugs known as RIMAs,
or reversible inhibitors of monoamine oxidase A (MAO-A). The primary
objective of this Phase II trial is to evaluate the antidepressant efficacy
of Tyrima in patients with confirmed MDD. The trial design incorporates a
number of features intended to reduce the variability and placebo response
often observed in MDD clinical trials.
The randomized, double-blind, placebo-controlled Phase II trial will
enroll approximately 272 patients with moderate to severe MDD who will
receive either Tyrima or placebo for six weeks. The primary study objective
of antidepressant efficacy will be assessed using the Montgomery-Asberg
Depression Rating Scale (MADRS). Secondary objectives of the study include
evaluation of safety, tolerability, and pharmacokinetics of Tyrima. The
trial design was supported by a Tyrima Phase I safety database of 106
subjects and a PET (positron emission tomography) study that yielded
critical insight into the dose-response relationship of Tyrima. A number of
patients are already randomized in the trial and initial results are
expected by the end of 2009.
"Tyrima has the potential to be the first triple-action antidepressant
with a safety profile appropriate for the treatment of a broad population
of patients with depression, and we are committed to generating robust
clinical data from this Phase Il trial," said Dr. Daniel Burch, Executive
Vice President of R&D and Chief Medical Officer of CeNeRx. "We worked
closely with experienced MDD clinical trial experts, disease specialists,
and biostatisticians to incorporate a number of features in the study
design intended to manage the issues that can confound antidepressant
clinical trial results."
Depression clinical trial expert Dr. Norman Rosenthal, Medical Director
of Capital Clinical Associates and one of the lead investigators of the
Tyrima Phase II study noted, "The CeNeRx team gets high marks for designing
a first-class clinical trial. Recent efforts to test new antidepressants
have encountered technical difficulties, such as a high placebo effect,
which the current trial works hard to avoid. I am optimistic that the
present trial should enable us to assess the potential of Tyrima as a
potentially valuable new antidepressant agent."
Similar to the mechanism of conventional monoamine oxidase A inhibitors
(MAOI), the triple-action mechanism of Tyrima elevates the levels of three
key neurotransmitters (serotonin, norepinephrine and dopamine) that
positively affect mood and anxiety, compared to the one or two
neurotransmitters addressed by most current antidepressant drugs. This
triple-action mechanism has the potential to provide improved
antidepressant efficacy in some patients, while the selectivity and
reversibility of Tyrima are expected to reduce or eliminate the risk of
food-associated cardiovascular side effects of conventional MAOIs.
"A substantial subset of patients suffering from depression responds
much better to treatment with MAOIs than other therapies, yet the risk of
food-associated cardiovascular side effects of conventional MAOIs have
greatly restricted their use, to the disadvantage of our patients," said
Dr. Alexander Bodkin, a Tyrima Phase II investigator and Director of the
Clinical Psychopharmacology Research Program at McLean Hospital of Harvard
Medical School. "A novel agent such as Tyrima with proven MAOI activity in
the CNS and a good safety and tolerability profile would be a valuable
option for the many patients whose depression is refractory to treatment
with currently prescribed antidepressant drugs."
CeNeRx has worldwide rights to develop and commercialize Tyrima. This
compound, which could be the first RIMA antidepressant available in the
U.S. market, has patent protection beyond 2027.
About CeNeRx BioPharma
CeNeRx is a privately held clinical stage biopharmaceutical company
developing and commercializing innovative treatments for diseases of the
central nervous system. CeNeRx's most advanced compound, a reversible
inhibitor of monoamine oxidase, or RIMA, has entered Phase II development
for the treatment of major depressive disorder. RIMAs may have efficacy
advantages over current agents for depression and are expected to have a
good safety profile. The company is also developing its pipeline of
selective cannabinoid compounds that have recently completed successful
preclinical proof-of-concept studies for the treatment of pain, glaucoma
and spasticity. More information about CeNeRx BioPharma can be found at
cenerx.
CeNeRx BioPharma, Inc.
cenerxw
Depression And Lack Of Concentration Do Not Necessarily Go Together
Many clinicians believe that depression goes hand in hand with cognitive difficulties such as memory problems or difficulties concentrating and paying attention, but a recent review of nearly 20 years of literature conducted by researchers from UT Southwestern Medical Center has found that depression does not always lead to such impairments.
"The relationship between cognition thinking, attention and memory and depression remains poorly understood from a neuroscientific standpoint," said Dr. Munro Cullum, chief of psychology at UT Southwestern and senior author of the review appearing in the January issue of Neuropsychology, a journal published by the American Psychological Association. "This paper represents an important review of the literature that challenges some of the clinical myths about the effects of depression on cognitive functioning."
Part of what contributes to the clinical lore is that difficulties in concentrating can be a symptom of depression, and this may masquerade as other cognitive problems such as variability in memory performance.
"The presentation of depression can vary between people," said Dr. Shawn McClintock, assistant professor of psychiatry at UT Southwestern and lead author of the study. "Many symptoms can be used to diagnose depression, so we tried to dissect and better understand how specific factors in depression might contribute to cognitive difficulties."
Just as a higher fever can indicate more-severe illness, researchers wanted to determine if more-severe depressive episodes led to a greater impairment of cognitive abilities. The reviewers examined 35 studies published between 1991 and 2007 that investigated links between depression severity in patients and specific impairments in their cognition. The areas of cognition included processing speed, attention, memory, language abilities and executive functioning.
"We found a lot of variability between studies that were conducted," Dr. McClintock said. "Some suggested cognitive difficulties; others said there were none."
In the research, processing speed was found to be the cognitive function most often affected by depression. Processing speed refers to an individual's ability to quickly take in information, process and act upon it. The capability slows when some individuals are depressed, the reviewers found. The link wasn't as clear for other types of cognitive abilities, including attention, concentration, memory and executive function.
Researchers found that part of the variability in the literature may be due to inconsistent measurement and diagnosis of depression among studies. Some studies diagnose depression using clinical research criteria, while others use depression severity scales.
"The research has not been the most rigorously controlled," Dr. McClintock said.
The review suggests that researchers need to collect more comprehensive neurocognitive assessment data in patients diagnosed with depression to minimize confounding factors such as age and education. The researchers also recommend that more detailed information be collected about each depressive episode, such as its duration and intensity.
"If we do this, clinicians can help a depressed patient with processing speed deficits by decreasing the amount of information a patient has to process at one time, while researchers could work out nuances to discover if we can target cognitive deficits and improve them," Dr. McClintock said.
"Research for the past few decades has been very beneficial, but it has actually provided more questions than answers. We need to take the heterogeneous, nuanced concept of depression and better characterize it, so we can refine future investigations and guide clinical practice."
Other UT Southwestern researchers involved in the study were Dr. Mustafa Husain, professor of psychiatry and internal medicine, and Dr. Tracy Greer, assistant professor of psychiatry.
"The relationship between cognition thinking, attention and memory and depression remains poorly understood from a neuroscientific standpoint," said Dr. Munro Cullum, chief of psychology at UT Southwestern and senior author of the review appearing in the January issue of Neuropsychology, a journal published by the American Psychological Association. "This paper represents an important review of the literature that challenges some of the clinical myths about the effects of depression on cognitive functioning."
Part of what contributes to the clinical lore is that difficulties in concentrating can be a symptom of depression, and this may masquerade as other cognitive problems such as variability in memory performance.
"The presentation of depression can vary between people," said Dr. Shawn McClintock, assistant professor of psychiatry at UT Southwestern and lead author of the study. "Many symptoms can be used to diagnose depression, so we tried to dissect and better understand how specific factors in depression might contribute to cognitive difficulties."
Just as a higher fever can indicate more-severe illness, researchers wanted to determine if more-severe depressive episodes led to a greater impairment of cognitive abilities. The reviewers examined 35 studies published between 1991 and 2007 that investigated links between depression severity in patients and specific impairments in their cognition. The areas of cognition included processing speed, attention, memory, language abilities and executive functioning.
"We found a lot of variability between studies that were conducted," Dr. McClintock said. "Some suggested cognitive difficulties; others said there were none."
In the research, processing speed was found to be the cognitive function most often affected by depression. Processing speed refers to an individual's ability to quickly take in information, process and act upon it. The capability slows when some individuals are depressed, the reviewers found. The link wasn't as clear for other types of cognitive abilities, including attention, concentration, memory and executive function.
Researchers found that part of the variability in the literature may be due to inconsistent measurement and diagnosis of depression among studies. Some studies diagnose depression using clinical research criteria, while others use depression severity scales.
"The research has not been the most rigorously controlled," Dr. McClintock said.
The review suggests that researchers need to collect more comprehensive neurocognitive assessment data in patients diagnosed with depression to minimize confounding factors such as age and education. The researchers also recommend that more detailed information be collected about each depressive episode, such as its duration and intensity.
"If we do this, clinicians can help a depressed patient with processing speed deficits by decreasing the amount of information a patient has to process at one time, while researchers could work out nuances to discover if we can target cognitive deficits and improve them," Dr. McClintock said.
"Research for the past few decades has been very beneficial, but it has actually provided more questions than answers. We need to take the heterogeneous, nuanced concept of depression and better characterize it, so we can refine future investigations and guide clinical practice."
Other UT Southwestern researchers involved in the study were Dr. Mustafa Husain, professor of psychiatry and internal medicine, and Dr. Tracy Greer, assistant professor of psychiatry.
Postpartum Depression Associated With Impaired Social Engagement And Physiological Stress Reactivity
Postpartum depression has long been known to compromise a mother's capacity to optimally care for her newborn. But just how maternal depression can negatively affect infant development and physiological regulation is the subject of a study to be published in the August 2009 issue of the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP).
Feldman and colleagues at the Bar-Ilan University and Sheba Medical Center in Tel-Hashomer, Israel studied three infant outcomes - social engagement, fear regulation, and physiological stress reactivity, in a cohort of 100 mother-infant dyads at nine months postpartum. These three infant outcomes are considered foundations of social-emotional growth and are associated with the infant's ability to manage physiological stress and regulate negative emotions.
The researchers collected a large community cohort of 971 mothers who reported symptoms of depression and anxiety at 2 days postpartum and again at 6 months. Of these, a cohort of 100 mothers and infants were observed at 9 months and included three groups: Mothers who were depressed across the first nine months and were diagnosed as suffering a Major Depression Disorder at 9 months, mothers who reported high levels of anxiety across the first 9 months and were diagnosed with an Anxiety Disorder at 9 months, and control mothers who reported low anxiety and depressive symptoms across the first 9 months after childbirth. To remove the influence of other known risk factors such as teenage pregnancy or premature birth, which could independently contribute to maternal depression, the researchers only recruited women who were in stable relationships, were physically healthy, educated, and those who delivered a healthy full-term infant.
In the article titled, "Maternal Depression and Anxiety across the Postpartum Year and Infant Social Engagement, Fear Regulation, and Stress Reactivity," the authors reported that infants of depressed mothers scored the poorest on all outcome measures at 9 months: they showed the lowest levels of social engagement during interactions with their mothers, were unable to self-regulate during situations that introduced novelty, fussed and cried more often, and their physiological stress response showed both higher baseline levels and a more pronounced stress reactivity. Children of anxious mothers showed lower social engagement than children of control mothers but higher than children of depressed mothers. However, their physiological stress response was similar to children of depressed mothers.
The mother's sensitive behavior played an important role in shaping infant outcomes. Sensitive mothering was related to the infant's social engagement and protected against the effects of maternal depression on the development of the child's social skills. Maternal sensitivity also had a positive impact on the infant's physiological stress response and reduced the degree of physiological reactivity as measured by cortisol reactivity to stress.
Sensitive mothering is important in an infant's ability to develop social competence and further study of the effects of maternal depression on child development within the first year of life is warranted.
Feldman and colleagues stated, "By recruiting a large community sample, separating maternal depression from typically-occurring conditions, comparing cases of major depressive disorder to those of post-partum anxiety disorders, and assessing the chronicity of the mother's mood from birth, the findings may illuminate specific pathways leading from maternal depression to child outcomes across the first year of life. Furthermore, the unique associations found between maternal depression and each outcome underscore the need to consider maternal depression in the context of the child's global rearing environment and in relation to the attainment of specific developmental goals."
The study findings by Drs. Feldman and colleagues were supported by the Israel Science Foundation (#1318/08), the US-Israel Bi-National Science Foundation (#2005-273), and the NARSAD Foundation (Independent Investigator Award, RF).
The study is published in the Journal of the American Academy of Child and Adolescent Psychiatry and online.
References
"Maternal Depression
and Anxiety across the Postpartum Year and Infant Social Engagement, Fear Regulation, and
Stress Reactivity. "
Feldman R, Granat A, Pariente C, Kanety H, Kuint J, Gilboa-Schechtman E.
Journal of the American Academy of Child and Adolescent Psychiatry.
2009; 48:919-927.
Source
The Journal of the American Academy of Child and Adolescent Psychiatry
Feldman and colleagues at the Bar-Ilan University and Sheba Medical Center in Tel-Hashomer, Israel studied three infant outcomes - social engagement, fear regulation, and physiological stress reactivity, in a cohort of 100 mother-infant dyads at nine months postpartum. These three infant outcomes are considered foundations of social-emotional growth and are associated with the infant's ability to manage physiological stress and regulate negative emotions.
The researchers collected a large community cohort of 971 mothers who reported symptoms of depression and anxiety at 2 days postpartum and again at 6 months. Of these, a cohort of 100 mothers and infants were observed at 9 months and included three groups: Mothers who were depressed across the first nine months and were diagnosed as suffering a Major Depression Disorder at 9 months, mothers who reported high levels of anxiety across the first 9 months and were diagnosed with an Anxiety Disorder at 9 months, and control mothers who reported low anxiety and depressive symptoms across the first 9 months after childbirth. To remove the influence of other known risk factors such as teenage pregnancy or premature birth, which could independently contribute to maternal depression, the researchers only recruited women who were in stable relationships, were physically healthy, educated, and those who delivered a healthy full-term infant.
In the article titled, "Maternal Depression and Anxiety across the Postpartum Year and Infant Social Engagement, Fear Regulation, and Stress Reactivity," the authors reported that infants of depressed mothers scored the poorest on all outcome measures at 9 months: they showed the lowest levels of social engagement during interactions with their mothers, were unable to self-regulate during situations that introduced novelty, fussed and cried more often, and their physiological stress response showed both higher baseline levels and a more pronounced stress reactivity. Children of anxious mothers showed lower social engagement than children of control mothers but higher than children of depressed mothers. However, their physiological stress response was similar to children of depressed mothers.
The mother's sensitive behavior played an important role in shaping infant outcomes. Sensitive mothering was related to the infant's social engagement and protected against the effects of maternal depression on the development of the child's social skills. Maternal sensitivity also had a positive impact on the infant's physiological stress response and reduced the degree of physiological reactivity as measured by cortisol reactivity to stress.
Sensitive mothering is important in an infant's ability to develop social competence and further study of the effects of maternal depression on child development within the first year of life is warranted.
Feldman and colleagues stated, "By recruiting a large community sample, separating maternal depression from typically-occurring conditions, comparing cases of major depressive disorder to those of post-partum anxiety disorders, and assessing the chronicity of the mother's mood from birth, the findings may illuminate specific pathways leading from maternal depression to child outcomes across the first year of life. Furthermore, the unique associations found between maternal depression and each outcome underscore the need to consider maternal depression in the context of the child's global rearing environment and in relation to the attainment of specific developmental goals."
The study findings by Drs. Feldman and colleagues were supported by the Israel Science Foundation (#1318/08), the US-Israel Bi-National Science Foundation (#2005-273), and the NARSAD Foundation (Independent Investigator Award, RF).
The study is published in the Journal of the American Academy of Child and Adolescent Psychiatry and online.
References
"Maternal Depression
and Anxiety across the Postpartum Year and Infant Social Engagement, Fear Regulation, and
Stress Reactivity. "
Feldman R, Granat A, Pariente C, Kanety H, Kuint J, Gilboa-Schechtman E.
Journal of the American Academy of Child and Adolescent Psychiatry.
2009; 48:919-927.
Source
The Journal of the American Academy of Child and Adolescent Psychiatry
Telemedicine To Improve Geriatric Depression
Studies have shown a high rate of depression among elderly homebound individuals, and few patients receive adequate treatment, if any. To address this issue, researchers at Rhode Island Hospital and other organizations have developed a telemedicine-based depression care protocol in home health care. The early findings from their pilot study were presented at the 29th Annual Meeting and Exposition of the National Association for Home Care and Hospice on October 3.
Thomas Sheeran, PhD, ME, clinical psychologist in the department of psychiatry at Rhode Island Hospital, led the study. Sheeran explains, "Using telemedicine in home care to provide disease management for geriatric depression is timely for several reasons. The home care industry is already using telemedicine to provide chronic disease management for many medical illnesses, such as heart disease. However, guideline-based depression care often is not included in these monitoring programs. Also, research suggests that telemedicine can be successfully used to address mental health needs of the elderly in community settings." Sheeran adds, "Finally, work by the Cornell Homecare Research Partnership and others has shown that community health nurses - who typically are the telehealth disease managers in home care - can identify and successfully provide this service for their elderly home care patients."
Through the pilot study, Sheeran reports that overall, feasibility and patient satisfaction ratings were very high. He notes that a majority of the elderly participants reported they were satisfied or very satisfied with the protocol, that they quickly became comfortable using the telehealth equipment and there were few technical problems. More importantly, they felt it improved their care and that they would be willing to use it again. The researchers also found that telehealth nurses reported that with the majority of their patients, the Depression TeleCare Protocol was easy to implement, there were few technical problems, that it improved care and improved depression outcomes. Both patients and nurses believed that confidentiality was maintained.
Sheeran also comments, "At the start of the study, 19 of these patients met full diagnostic criteria for Major Depression, with a mean depression severity score in the 'Markedly Severe' range. We were very pleased to find that at follow-up, the average depression severity scores were in the 'Mild' range, indicating significant improvement in depression severity through the use of this protocol. While these findings need to be replicated in a more rigorously controlled randomized trial, we believe these results offer great encouragement for reaching this population who can experience a better quality of life from this program."
The project began at the Cornell Homecare Research Project at Weill Cornell Medical College and was completed at Rhode Island Hospital, in collaboration with the University of Vermont's Telemedicine Program. In addition to the three academic centers, the project partnered with three home health agencies in New York, Vermont and Florida to integrate and pilot evidence-based depression care into existing telehealth programs.
In his presentation, Sheeran, who is also an assistant professor at The Warren Alpert Medical School of Brown University, will provide a description of the clinical protocol, implementation challenges and more information on the preliminary findings of the pilot work.
The study was funded by a grant from the National Institute of Mental Health and by the Cornell Clinical and Translational Science Center. Other researchers involved in the study with Sheeran include Martha L. Bruce, Phd, MPH, professor of sociology in psychiatry at the Cornell Homecare Research Partnership, Weill Cornell Medical College, and Terry Rabinowitz, MD, DDS, professor of psychiatry and family medicine at Fletcher Allen Health Care, Telemedicine Program, University of Vermont College of Medicine.
Thomas Sheeran, PhD, ME, clinical psychologist in the department of psychiatry at Rhode Island Hospital, led the study. Sheeran explains, "Using telemedicine in home care to provide disease management for geriatric depression is timely for several reasons. The home care industry is already using telemedicine to provide chronic disease management for many medical illnesses, such as heart disease. However, guideline-based depression care often is not included in these monitoring programs. Also, research suggests that telemedicine can be successfully used to address mental health needs of the elderly in community settings." Sheeran adds, "Finally, work by the Cornell Homecare Research Partnership and others has shown that community health nurses - who typically are the telehealth disease managers in home care - can identify and successfully provide this service for their elderly home care patients."
Through the pilot study, Sheeran reports that overall, feasibility and patient satisfaction ratings were very high. He notes that a majority of the elderly participants reported they were satisfied or very satisfied with the protocol, that they quickly became comfortable using the telehealth equipment and there were few technical problems. More importantly, they felt it improved their care and that they would be willing to use it again. The researchers also found that telehealth nurses reported that with the majority of their patients, the Depression TeleCare Protocol was easy to implement, there were few technical problems, that it improved care and improved depression outcomes. Both patients and nurses believed that confidentiality was maintained.
Sheeran also comments, "At the start of the study, 19 of these patients met full diagnostic criteria for Major Depression, with a mean depression severity score in the 'Markedly Severe' range. We were very pleased to find that at follow-up, the average depression severity scores were in the 'Mild' range, indicating significant improvement in depression severity through the use of this protocol. While these findings need to be replicated in a more rigorously controlled randomized trial, we believe these results offer great encouragement for reaching this population who can experience a better quality of life from this program."
The project began at the Cornell Homecare Research Project at Weill Cornell Medical College and was completed at Rhode Island Hospital, in collaboration with the University of Vermont's Telemedicine Program. In addition to the three academic centers, the project partnered with three home health agencies in New York, Vermont and Florida to integrate and pilot evidence-based depression care into existing telehealth programs.
In his presentation, Sheeran, who is also an assistant professor at The Warren Alpert Medical School of Brown University, will provide a description of the clinical protocol, implementation challenges and more information on the preliminary findings of the pilot work.
The study was funded by a grant from the National Institute of Mental Health and by the Cornell Clinical and Translational Science Center. Other researchers involved in the study with Sheeran include Martha L. Bruce, Phd, MPH, professor of sociology in psychiatry at the Cornell Homecare Research Partnership, Weill Cornell Medical College, and Terry Rabinowitz, MD, DDS, professor of psychiatry and family medicine at Fletcher Allen Health Care, Telemedicine Program, University of Vermont College of Medicine.
U-M Continues Efforts To Prevent Tragedy Among College Students
The devastating shooting near Tucson, Ariz. that left six people dead and U.S. Rep. Gabrielle Giffords critically injured thrust mental health on college campuses back into the national spotlight.
In the tragedy's aftermath, many are questioning whether more could have been done to respond to shooting suspect Jared Loughner's increasingly disturbing behavior in his community college classes.
The annual University of Michigan's Depression on College Campuses conference, held March 28-29, will focus on detection of mental illness during the high stakes college years.
Experts agree that early detection and intervention can help stop the progression of mental illnesses and prevent infrequent but tragic violent attacks, but the broader - though less sensational - public health challenge of addressing mental health issues on college campuses has been largely left out of the national conversation.
For nearly a decade, the U-M's Depression on College Campuses conference has provided a forum for educators and medical professionals to discuss the latest developments in research and practical approaches to depressive illnesses in young adults.
This year's theme of "Early Detection and Intervention" supplies a thread for talks and panel discussions aimed at preventing tragedies large and small - including not only violence aimed at others, but suicide, eating disorders and withdrawal from life.
"For years, participants at the Depression on College Campuses Conference have presented compelling data confirming that depression, bipolar illness and related conditions among college students are a critical public health problem," says John Greden, M.D., executive director of the U-M Depression Center.
"The college years coincide with peak onset of depression, bipolar disorder, and most other mental illnesses, which are most treatable soon after onset. Our conference goals are to identify, articulate and plan ways in which campus leaders can implement earlier detection and intervention strategies. Only then will we help prevent the recurrences, lessen the huge burdens and high costs, and help prevent the terrible tragedies such as have occurred in Tucson," Greden continues. "We can and must do better."
College students face high internal and external pressures. In 2010, only 51.9 percent of college freshmen responding to a national survey reported that their mental health was good or above average - a record low, the Chronicle of Higher Education reported.
The March conference will feature a choice of intensive three-hour workshops in addition to keynote presentations, panel discussions, and concurrent sessions.
Keynote speakers include Gregory Eells, Ph.D., associate director for counseling and psychological services at Cornell University and Drew Westen, Ph.D., professor of psychology and psychiatry at Emory University.
Additional areas of focus will include:
- creatively imagining the role and use of technology in depression treatment
- successful models for campus peer-to-peer support programs
- evidence-based strategies for alcohol screening.
The conference will also feature two sessions aimed primarily at students: a workshop on creating community and strengthening social networks, and a panel discussion on the myriad challenges of managing depression in graduate school.
The audience for the conference, which will be held at U-M's Rackham Graduate School, includes: counselors, nurses, physicians, students, academic advisers, residence hall staff, university leaders and anyone with an interest in mental health among college students.
Registration is free for all students from any campus, but an online registration form is still required. The registration fee for non-students is $130 (before March 1st) or $140 after. (Members of the media covering the event may register at no cost.)
In the tragedy's aftermath, many are questioning whether more could have been done to respond to shooting suspect Jared Loughner's increasingly disturbing behavior in his community college classes.
The annual University of Michigan's Depression on College Campuses conference, held March 28-29, will focus on detection of mental illness during the high stakes college years.
Experts agree that early detection and intervention can help stop the progression of mental illnesses and prevent infrequent but tragic violent attacks, but the broader - though less sensational - public health challenge of addressing mental health issues on college campuses has been largely left out of the national conversation.
For nearly a decade, the U-M's Depression on College Campuses conference has provided a forum for educators and medical professionals to discuss the latest developments in research and practical approaches to depressive illnesses in young adults.
This year's theme of "Early Detection and Intervention" supplies a thread for talks and panel discussions aimed at preventing tragedies large and small - including not only violence aimed at others, but suicide, eating disorders and withdrawal from life.
"For years, participants at the Depression on College Campuses Conference have presented compelling data confirming that depression, bipolar illness and related conditions among college students are a critical public health problem," says John Greden, M.D., executive director of the U-M Depression Center.
"The college years coincide with peak onset of depression, bipolar disorder, and most other mental illnesses, which are most treatable soon after onset. Our conference goals are to identify, articulate and plan ways in which campus leaders can implement earlier detection and intervention strategies. Only then will we help prevent the recurrences, lessen the huge burdens and high costs, and help prevent the terrible tragedies such as have occurred in Tucson," Greden continues. "We can and must do better."
College students face high internal and external pressures. In 2010, only 51.9 percent of college freshmen responding to a national survey reported that their mental health was good or above average - a record low, the Chronicle of Higher Education reported.
The March conference will feature a choice of intensive three-hour workshops in addition to keynote presentations, panel discussions, and concurrent sessions.
Keynote speakers include Gregory Eells, Ph.D., associate director for counseling and psychological services at Cornell University and Drew Westen, Ph.D., professor of psychology and psychiatry at Emory University.
Additional areas of focus will include:
- creatively imagining the role and use of technology in depression treatment
- successful models for campus peer-to-peer support programs
- evidence-based strategies for alcohol screening.
The conference will also feature two sessions aimed primarily at students: a workshop on creating community and strengthening social networks, and a panel discussion on the myriad challenges of managing depression in graduate school.
The audience for the conference, which will be held at U-M's Rackham Graduate School, includes: counselors, nurses, physicians, students, academic advisers, residence hall staff, university leaders and anyone with an interest in mental health among college students.
Registration is free for all students from any campus, but an online registration form is still required. The registration fee for non-students is $130 (before March 1st) or $140 after. (Members of the media covering the event may register at no cost.)
Preventing Teenage Depression By Recognizing Children's Successes In All Areas
Students' successes in the first grade can affect more than their future report cards. In a new study, University of Missouri researchers found links among students' weak academic performance in the first grade, self-perceptions in the sixth grade, and depression symptoms in the seventh grade.
"We found that students in the first grade who struggled academically with core subjects, including reading and math, later displayed negative self-perceptions and symptoms of depression in sixth and seventh grade, respectively," said Keith Herman, associate professor of education, school and counseling psychology in the MU College of Education. "Often, children with poor academic skills believe they have less influence on important outcomes in their life. Poor academic skills can influence how children view themselves as students and as social beings."
In the study, MU researchers examined the behaviors of 474 boys and girls in the first grade and re-examined the students when they entered middle school. Herman found that students who struggled academically with core subjects, such as reading and math, in the first grade later showed risk factors for negative self-beliefs and depressive symptoms as they entered sixth and seventh grade. Herman suggests that because differences in children's learning will continue to exist even if all students are given effective instruction and support, parents and teachers should acknowledge student's skills in other areas.
"One of the main ways children can get others to like them in school is by being good students. Children with poor academic skills may believe that they have one less method for influencing important social outcomes, which could lead to negative consequences later in life. Children's individual differences will always exist in basic academic skills, so it is necessary to explore and emphasize other assets in students, especially those with lower academic skill relative to their peers," Herman said. "Along with reading and math, teachers and parents should honor skills in other areas, such as interpersonal skills, non-core academic areas, athletics and music."
The researchers also found the effect of academic proficiency on self-perceptions was significantly stronger for girls. Girls who did not advance academically believed that they had less control of important outcomes, a risk factor for symptoms of depression.
The study, "Low Academic Competence in First Grade as a Risk Factor for Depressive Cognitions and Symptoms in Middle School," was recently published in the Journal of Counseling Psychology.
"We found that students in the first grade who struggled academically with core subjects, including reading and math, later displayed negative self-perceptions and symptoms of depression in sixth and seventh grade, respectively," said Keith Herman, associate professor of education, school and counseling psychology in the MU College of Education. "Often, children with poor academic skills believe they have less influence on important outcomes in their life. Poor academic skills can influence how children view themselves as students and as social beings."
In the study, MU researchers examined the behaviors of 474 boys and girls in the first grade and re-examined the students when they entered middle school. Herman found that students who struggled academically with core subjects, such as reading and math, in the first grade later showed risk factors for negative self-beliefs and depressive symptoms as they entered sixth and seventh grade. Herman suggests that because differences in children's learning will continue to exist even if all students are given effective instruction and support, parents and teachers should acknowledge student's skills in other areas.
"One of the main ways children can get others to like them in school is by being good students. Children with poor academic skills may believe that they have one less method for influencing important social outcomes, which could lead to negative consequences later in life. Children's individual differences will always exist in basic academic skills, so it is necessary to explore and emphasize other assets in students, especially those with lower academic skill relative to their peers," Herman said. "Along with reading and math, teachers and parents should honor skills in other areas, such as interpersonal skills, non-core academic areas, athletics and music."
The researchers also found the effect of academic proficiency on self-perceptions was significantly stronger for girls. Girls who did not advance academically believed that they had less control of important outcomes, a risk factor for symptoms of depression.
The study, "Low Academic Competence in First Grade as a Risk Factor for Depressive Cognitions and Symptoms in Middle School," was recently published in the Journal of Counseling Psychology.
Searching For A Cognitive Behaviour Therapist? This Is The Place To Go, UK
A NEW on-line register, CBT Register UK will give the public access to all accredited Cognitive Behavioural Therapy
(CBT) practitioners in the UK.
As the leading organisations in the CBT field, the British Association for Behavioural and Cognitive Psychotherapies (BABCP) and the Association for Rational and Emotive Behaviour Therapy (AREBT) have been accrediting CBT therapists since 1994.
In line with government moves to improve access to effective psychological therapies, the two organisations have now come together to form a single CBT Register UK.
It means members of the public who are looking for an accredited CBT therapist will be able to find one within just a few clicks.
More than 1,400 therapists, who are working within the NHS, private practice, or both, are accredited on the new CBT Register UK. This means they have specialist skills and knowledge, having undergone training and supervision to recognised standards.
There has been an increasing demand from the public, health professionals and health care providers for a register which lists fully qualified therapists who have achieved a high level of competence in cognitive and behavioural methods.
BABCP and AREBT say it is vital that members of the public are able to easily and quickly find an accredited Cognitive Behavioural Therapist on-line. The new joint CBT Register UK, with easy to access information, is an essential aid for those seeking CBT for emotional problems or a range of mental health conditions.
CBT, which is supported by extensive clinical research, is recommended as an effective treatment for a range of mental health conditions by NICE (the National Institute for Health and Clinical Excellence).
"This is the first and only definitive and complete register of accredited CBT and AREBT therapists in the country," said BABCP President, Professor John Taylor.
"Members of the public who are looking for a CBT therapist will be able to go straight to the CBT Register UK which is a specially dedicated website. It is a web-based, one-stop shop for talking therapists."
"We believe the register will make CBT much more widely available to more people." said AREBT Chair, Irene Tubbs
"The CBT Register UK gives the public easy access to highly trained and fully qualified therapists, ensuring quality provision."
1. Together the BABCP and AREBT now have over 7,000 members, including
psychologists, psychiatrists, counsellors, social workers, occupational
therapists, and mental health nurses.
2. The Government recently announced a ??173 million Improving Access to
Psychological Therapies (IAPT) programme to improve access on the NHS
to effective talking therapies such as CBT for anxiety and depression
through a series of centres all over the country.
cbtregister.co.uk
BABCP
(CBT) practitioners in the UK.
As the leading organisations in the CBT field, the British Association for Behavioural and Cognitive Psychotherapies (BABCP) and the Association for Rational and Emotive Behaviour Therapy (AREBT) have been accrediting CBT therapists since 1994.
In line with government moves to improve access to effective psychological therapies, the two organisations have now come together to form a single CBT Register UK.
It means members of the public who are looking for an accredited CBT therapist will be able to find one within just a few clicks.
More than 1,400 therapists, who are working within the NHS, private practice, or both, are accredited on the new CBT Register UK. This means they have specialist skills and knowledge, having undergone training and supervision to recognised standards.
There has been an increasing demand from the public, health professionals and health care providers for a register which lists fully qualified therapists who have achieved a high level of competence in cognitive and behavioural methods.
BABCP and AREBT say it is vital that members of the public are able to easily and quickly find an accredited Cognitive Behavioural Therapist on-line. The new joint CBT Register UK, with easy to access information, is an essential aid for those seeking CBT for emotional problems or a range of mental health conditions.
CBT, which is supported by extensive clinical research, is recommended as an effective treatment for a range of mental health conditions by NICE (the National Institute for Health and Clinical Excellence).
"This is the first and only definitive and complete register of accredited CBT and AREBT therapists in the country," said BABCP President, Professor John Taylor.
"Members of the public who are looking for a CBT therapist will be able to go straight to the CBT Register UK which is a specially dedicated website. It is a web-based, one-stop shop for talking therapists."
"We believe the register will make CBT much more widely available to more people." said AREBT Chair, Irene Tubbs
"The CBT Register UK gives the public easy access to highly trained and fully qualified therapists, ensuring quality provision."
1. Together the BABCP and AREBT now have over 7,000 members, including
psychologists, psychiatrists, counsellors, social workers, occupational
therapists, and mental health nurses.
2. The Government recently announced a ??173 million Improving Access to
Psychological Therapies (IAPT) programme to improve access on the NHS
to effective talking therapies such as CBT for anxiety and depression
through a series of centres all over the country.
cbtregister.co.uk
BABCP
Antipsychotic And Antidepressant Medication Is On The Rise In Sydney Nursing Homes
Regular use of antipsychotic and antidepressant medication has increased among residents of
Sydney nursing homes since 2003, an expert says.
In a letter published in the latest Medical Journal of Australia, Clinical Professor John
Snowdon and co-authors also reported that regular use of anxiolytic and hypnotic medication
has decreased since the 1990s. They compared their 2009 study into psychotropic medication
use in Sydney nursing homes with similar studies conducted in 1993, 1998 and 2003.
Prof Snowdon said that the use of antipsychotic agents fell between 1993 and 1998 but by
2009 there had been a progressive change from conventional antipsychotics to a three-to-one
preference for atypical antipsychotic medication. By 2009, the rate of regular use of
antipsychotic medication had risen above the level it had been in 1993.
In 2009, 25.6 per cent of residents were regularly taking an antidepressant compared with
15.6 per cent in 1993, while the proportion of residents prescribed anxiolytic (4.7 per cent) or
hypnotic medication (11.1 per cent) regularly had fallen.
Prof Snowdon said that over time, revision of management guidelines, warnings about
potentially lethal side effects, and introduction of new drugs have contributed to changes in
the pattern of use of psychotropic medication in aged care facilities.
However, Prof Snowdon noted that the findings could not be generalised as recent evidence
from Tasmania showed that 42 per cent of residents were taking benzodiazepines regularly.
"Nevertheless, changes in medication use should provoke discussion," Prof Snowdon said.
Source
The Medical Journal of Australia
Sydney nursing homes since 2003, an expert says.
In a letter published in the latest Medical Journal of Australia, Clinical Professor John
Snowdon and co-authors also reported that regular use of anxiolytic and hypnotic medication
has decreased since the 1990s. They compared their 2009 study into psychotropic medication
use in Sydney nursing homes with similar studies conducted in 1993, 1998 and 2003.
Prof Snowdon said that the use of antipsychotic agents fell between 1993 and 1998 but by
2009 there had been a progressive change from conventional antipsychotics to a three-to-one
preference for atypical antipsychotic medication. By 2009, the rate of regular use of
antipsychotic medication had risen above the level it had been in 1993.
In 2009, 25.6 per cent of residents were regularly taking an antidepressant compared with
15.6 per cent in 1993, while the proportion of residents prescribed anxiolytic (4.7 per cent) or
hypnotic medication (11.1 per cent) regularly had fallen.
Prof Snowdon said that over time, revision of management guidelines, warnings about
potentially lethal side effects, and introduction of new drugs have contributed to changes in
the pattern of use of psychotropic medication in aged care facilities.
However, Prof Snowdon noted that the findings could not be generalised as recent evidence
from Tasmania showed that 42 per cent of residents were taking benzodiazepines regularly.
"Nevertheless, changes in medication use should provoke discussion," Prof Snowdon said.
Source
The Medical Journal of Australia
Family Stress And Child's Temper Extremes Contribute To Anxiety And Depression In Children
Small children who grow up in a family where the mother has psychological distress, the family is exposed to stress or is lacking social support, are at higher risk of developing anxious and depressive symptoms in early adolescence. Girls are more vulnerable than boys, and very timid or short-tempered children are more vulnerable than others to develop emotional problems. This is shown in a new doctorate study from the Norwegian Institute of Public Health (NIPH).
Anxiety and depression are two of the most common mental problems for children and adolescents.
Contributing factors to the development of symptoms of anxiety and depression while growing up is the key focus in the doctorate project by Evalill Karevold at the NIPH.
10-20% of all children and young people will, in the course of growing up, display enough symptoms of anxiety and depression to qualify for a diagnosis.
Environmental factors play an important role
Karevold has followed more than 900 families from when the children were 18 months old through to adolescence (data from the NIPH's TOPP-study). The findings are based on maternal and child report of the child's symptoms of anxiety and depression, plus reports from the mother about risk and protective factors in the family environment.
A main finding highlights the importance of environmental factors for families with children less than 5 years of age. Maternal distress symptoms, family stress and lack of social support in their children's growing-up environment in pre-school age leads to an increase in anxiety and depression symptoms when these children reach 12-13 years old.
In addition, the results show that girls are more likely to develop emotional problems at 12-13 years of age than boys.
"Research indicates that girls tend to churn over problems and events more than boys. In addition, early puberty in girls is thought to make them extra vulnerable to developing depressive symptoms," says Evalill Karevold.
Timid children have a greater risk for anxiety and depression
Another discovery shows that shy children generally have a higher risk of developing anxiety and depression than children who are not shy. If timid boys are also very inactive, the risk of developing emotional difficulties is almost three times as high compared with shy boys with a high level of activity. This does not seem to be the case for girls.
The results indicate that there can be two central developmental paths to emotional problems in early adolescence. One path goes through the child's temperament, especially temperamental emotionality (tendency to react quickly and intensely). A different course goes through the environmental factors that are present when the children are at pre-school age.
"It is important to be aware of families who are struggling with multiple burdens, and who have little support or network around them when the children are young. Having pre-school aged children is believed to be a particularly vulnerable period to be exposed to maternal symptoms, so it is especially important to identify and help mothers who are struggling with anxiety and depression as early as possible. Health clinics can play a central role in spotting families who are struggling, and a lot more emphasis should be made to build up mental health expertise here," says Karevold.
Anxiety and depression are two of the most common mental problems for children and adolescents.
Contributing factors to the development of symptoms of anxiety and depression while growing up is the key focus in the doctorate project by Evalill Karevold at the NIPH.
10-20% of all children and young people will, in the course of growing up, display enough symptoms of anxiety and depression to qualify for a diagnosis.
Environmental factors play an important role
Karevold has followed more than 900 families from when the children were 18 months old through to adolescence (data from the NIPH's TOPP-study). The findings are based on maternal and child report of the child's symptoms of anxiety and depression, plus reports from the mother about risk and protective factors in the family environment.
A main finding highlights the importance of environmental factors for families with children less than 5 years of age. Maternal distress symptoms, family stress and lack of social support in their children's growing-up environment in pre-school age leads to an increase in anxiety and depression symptoms when these children reach 12-13 years old.
In addition, the results show that girls are more likely to develop emotional problems at 12-13 years of age than boys.
"Research indicates that girls tend to churn over problems and events more than boys. In addition, early puberty in girls is thought to make them extra vulnerable to developing depressive symptoms," says Evalill Karevold.
Timid children have a greater risk for anxiety and depression
Another discovery shows that shy children generally have a higher risk of developing anxiety and depression than children who are not shy. If timid boys are also very inactive, the risk of developing emotional difficulties is almost three times as high compared with shy boys with a high level of activity. This does not seem to be the case for girls.
The results indicate that there can be two central developmental paths to emotional problems in early adolescence. One path goes through the child's temperament, especially temperamental emotionality (tendency to react quickly and intensely). A different course goes through the environmental factors that are present when the children are at pre-school age.
"It is important to be aware of families who are struggling with multiple burdens, and who have little support or network around them when the children are young. Having pre-school aged children is believed to be a particularly vulnerable period to be exposed to maternal symptoms, so it is especially important to identify and help mothers who are struggling with anxiety and depression as early as possible. Health clinics can play a central role in spotting families who are struggling, and a lot more emphasis should be made to build up mental health expertise here," says Karevold.
University Of Queensland Research Uncovers How Antidepressants Actually Work
Researchers at UQ's Queensland Brain Institute have uncovered how antidepressants stimulate the brain to improve a person's mood.
They have discovered the class of drugs that increase levels of a neurotransmitter known as 'norepinephrine' triggers neurogenesis - the growth of new neurons - in a brain region called the hippocampus.
"If you block hippocampus neurogenesis, antidepressants no longer work," lead researcher Dr Dhanisha Jhaveri said.
"That suggests antidepressants must up-regulate neurogenesis in order for them to actually have any affect on behaviour."
However, the neuroscientists also found not all antidepressants worked in the same way.
Dr Jhaveri said surprisingly, the class of antidepressants that increase levels of the neurotransmitter called serotonin - Prozac is a common example - fails to stimulate neurogenesis.
"Norepinephrine is basically binding directly onto the precursors which then initiate a signal which leads to the production of more neurons," she said.
"Serotonin just doesn't do that. Prozac doesn't work by regulating the precursor activity - it may work outside that region, but it isn't regulating the hippocampus directly. More research is needed to find out what serotonin actually does."
Using rodent models the research, published today in the Journal of Neuroscience , established that selectively blocking the re-uptake of norepinephrine directly activated hippocampal stem cells thereby discovering a much larger pool of dormant precursors in the hippocampus than previously thought to exist.
The researchers also improved their understanding of the mechanisms by which norepinephrine activated the precursors in the hippocampus and found the expression of beta3 adrenergic receptors is critical in mediating the effect.
Fellow researcher and team leader Professor Perry Bartlett said armed with this information, the team would be able to explore improved treatments for depression as well as dementia.
"Since dementia, especially in the ageing population, appears to be related to a decrease in neurogenesis this discovery opens up exciting new ways to stimulate the production of new neurons to alleviate the devastating effects of dementia in our society," Professor Bartlett said.
Dr Jhaveri said the findings would also allow researchers to develop specific and more effective antidepressants.
"Depression is such a complex disorder, so we are going to test different behavioural outcomes to see whether the compounds that increase norepinephrine levels or stimulate beta3 adrenergic receptors work only for certain aspects of depression. We just don't know yet but it may, for example, improve learning and memory, or reduce anxiety," Dr Jhaveri said.
Source
University of Queensland
View drug information on Prozac Weekly.
They have discovered the class of drugs that increase levels of a neurotransmitter known as 'norepinephrine' triggers neurogenesis - the growth of new neurons - in a brain region called the hippocampus.
"If you block hippocampus neurogenesis, antidepressants no longer work," lead researcher Dr Dhanisha Jhaveri said.
"That suggests antidepressants must up-regulate neurogenesis in order for them to actually have any affect on behaviour."
However, the neuroscientists also found not all antidepressants worked in the same way.
Dr Jhaveri said surprisingly, the class of antidepressants that increase levels of the neurotransmitter called serotonin - Prozac is a common example - fails to stimulate neurogenesis.
"Norepinephrine is basically binding directly onto the precursors which then initiate a signal which leads to the production of more neurons," she said.
"Serotonin just doesn't do that. Prozac doesn't work by regulating the precursor activity - it may work outside that region, but it isn't regulating the hippocampus directly. More research is needed to find out what serotonin actually does."
Using rodent models the research, published today in the Journal of Neuroscience , established that selectively blocking the re-uptake of norepinephrine directly activated hippocampal stem cells thereby discovering a much larger pool of dormant precursors in the hippocampus than previously thought to exist.
The researchers also improved their understanding of the mechanisms by which norepinephrine activated the precursors in the hippocampus and found the expression of beta3 adrenergic receptors is critical in mediating the effect.
Fellow researcher and team leader Professor Perry Bartlett said armed with this information, the team would be able to explore improved treatments for depression as well as dementia.
"Since dementia, especially in the ageing population, appears to be related to a decrease in neurogenesis this discovery opens up exciting new ways to stimulate the production of new neurons to alleviate the devastating effects of dementia in our society," Professor Bartlett said.
Dr Jhaveri said the findings would also allow researchers to develop specific and more effective antidepressants.
"Depression is such a complex disorder, so we are going to test different behavioural outcomes to see whether the compounds that increase norepinephrine levels or stimulate beta3 adrenergic receptors work only for certain aspects of depression. We just don't know yet but it may, for example, improve learning and memory, or reduce anxiety," Dr Jhaveri said.
Source
University of Queensland
View drug information on Prozac Weekly.
Gender Difference In Elderly Suicide Risk After Previous Attempts
In older age groups, repeated suicide attempts constitute an increased risk for completed suicide in depressed women, while severe attempts constitute an increased risk for depressed men. Researchers writing in the open access journal BMC Psychiatry studied suicide attempts in 100 patients who committed suicide and in an age- and sex-matched control group, investigating the effects of age on suicidal behaviour, as a risk factor for accomplished suicide.
Louise Br??dvik and Mats Berglund, from Lund University, Sweden, studied the hospital records of patients admitted between 1956 and 1969 and followed up until 2006. According to Br??dvik, "Men and women showed different patterns of suicide attempts in the older age groups. The risk for an initial suicide attempt reduced with age in all females and in male controls, but not in male victims, repetition and severity then showing a special pattern".
Speaking about the results, Br??dvik said, "Suicide attempt is known to be one of the main predictors for suicide in depression. If attempts are repeated or serious, the risk for suicide is considered to be increased. However, to our knowledge, there has been no investigation into the predictive value of age at repeated and severe suicide attempt for accomplished suicide. In our study it appears that from middle age onwards, repeated attempts are a risk factor for suicide in women and so are severe attempts for men. In other words, though all suicide attempts should be taken seriously, an older woman who makes a repeated attempt is at higher risk for suicide and needs more observation and treatment than a young female repeater. Correspondingly, an older man who makes a severe attempt (or an initial attempt) is in need of more observation".
The study concerns patients with severe depression (with psychotic and melancholic features) only. It is unknown if the findings are applicable for other depressives.
Notes:
Repetition and severity of suicide attempts across the life cycle: a comparison by age group between suicide victims and controls with severe depression
Louise Bradvik and Mats Berglund
BMC Psychiatry (in press)
biomedcentral/bmcpsychiatry/
Louise Br??dvik and Mats Berglund, from Lund University, Sweden, studied the hospital records of patients admitted between 1956 and 1969 and followed up until 2006. According to Br??dvik, "Men and women showed different patterns of suicide attempts in the older age groups. The risk for an initial suicide attempt reduced with age in all females and in male controls, but not in male victims, repetition and severity then showing a special pattern".
Speaking about the results, Br??dvik said, "Suicide attempt is known to be one of the main predictors for suicide in depression. If attempts are repeated or serious, the risk for suicide is considered to be increased. However, to our knowledge, there has been no investigation into the predictive value of age at repeated and severe suicide attempt for accomplished suicide. In our study it appears that from middle age onwards, repeated attempts are a risk factor for suicide in women and so are severe attempts for men. In other words, though all suicide attempts should be taken seriously, an older woman who makes a repeated attempt is at higher risk for suicide and needs more observation and treatment than a young female repeater. Correspondingly, an older man who makes a severe attempt (or an initial attempt) is in need of more observation".
The study concerns patients with severe depression (with psychotic and melancholic features) only. It is unknown if the findings are applicable for other depressives.
Notes:
Repetition and severity of suicide attempts across the life cycle: a comparison by age group between suicide victims and controls with severe depression
Louise Bradvik and Mats Berglund
BMC Psychiatry (in press)
biomedcentral/bmcpsychiatry/
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