Spirituality Protects Against Depression Better Than Church Attendance

Those who worship a higher power often do so in different ways. Whether they are active in their religious community, or prefer to simply pray or meditate, new research out of Temple University suggests that a person's religiousness - also called religiosity - can offer insight into their risk for depression.



Lead researcher Joanna Maselko, Sc.D., characterized the religiosity of 918 study participants in terms of three domains of religiosity: religious service attendance, which refers to being involved with a church; religious well-being, which refers to the quality of a person's relationship with a higher power; and existential well-being, which refers to a person's sense of meaning and their purpose in life.



In a study published on-line this month in Psychological Medicine, Maselko and fellow researchers compared each domain of religiosity to their risk of depression, and were surprised to find that the group with higher levels of religious well-being were 1.5 times more likely to have had depression than those with lower levels of religious well-being.



Maselko theorizes this is because people with depression tend to use religion as a coping mechanism. As a result, they're more closely relating to God and praying more.



Researchers also found that those who attended religious services were 30 percent less likely to have had depression in their lifetime, and those who had high levels of existential well-being were 70 percent less likely to have had depression than those who had low levels of existential well-being.



Maselko says involvement in the church provides the opportunity for community interaction, which could help forge attachments to others, an important factor in preventing depression. She added that those with higher levels of existential-well being have a strong sense of their place in the world.



"People with high levels of existential well-being tend to have a good base, which makes them very centered emotionally," said Maselko. "People who don't have those things are at greater risk for depression, and those same people might also turn to religion to cope."



Maselko admits that researchers have yet to determine which comes first: depression or being religious, but is currently investigating the time sequence of this over people's lives to figure out the answer.



"For doctors, psychiatrists and counselors, it's hard to disentangle these elements when treating mental illness," she said. "You can't just ask a patient if they go to church to gauge their spirituality or coping behaviors. There are other components to consider when treating patients, and its important information for doctors to have."







Other authors on this study are Stephen Gilman, Sc.D., and Stephen Buka, Sc.D., from the department of Public Health at Harvard University and Brown University Medical School. This research was funded by a grant from the National Institutes of Mental Health and by the Jack Shand Award from the Society for the Scientific Study of Religion.

Corcept Therapeutics Completes Enrollment In Second Phase 3 Study For Treating Psychotic Major Depression

Corcept
Therapeutics Incorporated (Nasdaq: CORT) announced today that it completed
patient enrollment in Corcept 09, the second of three Phase 3 clinical
trials in which CORLUX(R) (mifepristone) is being evaluated for treating
the psychotic features of psychotic major depression (PMD).


"We recently announced that patient enrollment was completed in our
first Phase 3 study, Corcept 07, and that we expect to report the results
of that trial in August," said Corcept's Chief Executive Officer Joseph K.
Belanoff, M.D. "In addition, we now expect to report the results from
Corcept 09 in September 2006. We expect to report the results of our third
Phase 3 trial, Corcept 06, in the fourth quarter."


About Psychotic Major Depression


PMD is a serious psychiatric disorder that affects about three million
people in the United States every year. It is more prevalent than either
schizophrenia or manic depression. The disorder is characterized by severe
depression accompanied by delusions, hallucinations or both. People with
PMD are approximately 70 times more likely to commit suicide than the
general population and often require lengthy and expensive hospital stays.
There is no FDA-approved treatment for PMD.


A Description of Study 09


Study 09 is a randomized, double-blind, placebo-controlled study that
is being conducted in Europe. The primary endpoint is the proportion of
patients with at least a 50 percent improvement in the Brief Psychiatric
Rating Scale Positive Symptom Subscale (BPRS PSS) at both Day 7 and Day 28, a responder analysis. A secondary endpoint is the proportion of patients
with at least a 50 percent improvement in the BPRS PSS at both Day 7 and
Day 56. The BPRS is an 18-item rating instrument used to assess
psychopathology, and the PSS includes the four items in the BPRS that
specifically measure psychosis. Patients must have at least mild psychotic
symptoms (BPRS PSS greater than or equal to 12) to enter the study. Study
enrollees may be either inpatients or outpatients. BPRS PSS assessments are
made at Days 14, 42 and 56.



Patients may not take any antidepressant or antipsychotic medication
for at least one week before study randomization. At randomization, they
are placed in a one-to-one distribution into either a treatment group or a
placebo group. Patients in the treatment group receive 600 mg of CORLUX
once daily for a period of seven days. All patients receive antidepressant
therapy starting on Day 1 and through Day 56. Treatment with antipsychotic
medications or electroconvulsive therapy at any time during the study
results in the patient being classified as a non-responder.


Previously Completed Trials


The company has completed four studies of CORLUX for treating the
psychotic features of PMD. In January 2001, a dose-finding clinical trial
evaluated the efficacy, tolerability of and dose response to CORLUX. The
results showed that after one week of treatment, approximately two-thirds
of the patients in the two higher dosage groups (600 mg and 1200 mg)
experienced clinically meaningful reductions in psychosis, as measured by
the BPRS PSS. Based on these encouraging results, Corcept conducted two
double-blind, placebo-controlled safety and efficacy clinical trials (Study
02 and Study 03) in which a total of 429 patients were enrolled.















Study 02 indicated that CORLUX was well tolerated, and there were no
discernible problems with drug interactions between CORLUX and commonly
prescribed antipsychotic and antidepressant medications. Study 03
demonstrated with statistical significance that patients in the CORLUX
group were more likely than patients in the placebo group to achieve a 50
percent reduction in the BPRS PSS at Day 7, sustained to Day 28. At the
request of the FDA, approximately one third of the 221 patients enrolled in
this study had efficacy measures taken at Day 56. Of those patients who
exhibited at least mild psychotic symptoms on Day 0 (BPRS PSS greater than
or equal to 12) Study 03 showed with statistical significance that patients
receiving CORLUX were more likely than patients receiving placebo to
achieve a 50% reduction in the BPRS PSS at day 7 sustained to day 56.


A fourth trial involved an open-label study of the safety of
retreatment in patients with a favorable response to treatment in Studies
02 and 03. The results indicated that patients tolerated their retreatment
well. Twenty-eight patients participated in this study.


About Corcept Therapeutics Incorporated


Corcept Therapeutics Incorporated is a pharmaceutical company focused
on developing drugs for treating severe psychiatric and neurological
diseases. Corcept's lead product, CORLUX, is in Phase 3 clinical trials for
treating the psychotic features of PMD. The drug is administered orally to
PMD patients once per day for seven days. CORLUX, a potent GR-II
antagonist, appears to reduce the effects of the elevated and abnormal
release patterns of cortisol seen in PMD. The company has also initiated a
proof-of-concept study to evaluate the ability of CORLUX to mitigate weight
gain associated with the use of olanzapine. For more information, please
visit corcept.


Forward-looking Statements


Statements made in this news release -- other than statements of
historical fact -- are forward-looking statements. These include
information relating to Corcept's PMD clinical development program, FDA
agreements, and the timing of the completion of pivotal Phase 3 trials.
Forward-looking statements are subject to a number of known and unknown
risks and uncertainties that might cause actual results to differ
materially from those expressed or implied here. For example, there can be
no assurances on the efficacy, safety, completion or success of clinical
trials; the regulatory process or regulatory approvals; or commercial
success; in addition, trial timetables may not be accurate. Risk factors
are explained in the company's SEC filings, all of which are available from
its Web site ( corcept ) or from the SEC's Web site ( sec ).


The company does not have any intention or duty to update forward-looking
statements made in this news release.


Corcept Therapeutics Incorporated

corcept/

Antidepressants may lower risk of recurrent heart attack in depressed heart attack patients

In depressed patients who have experienced a heart attack, use of antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), was associated with a reduced risk of death and recurrent heart attack, according to an article in the July issue of Archives of General Psychiatry, one of the JAMA/Archives journals.


Cardiovascular disease (CVD) is the leading cause of death, major disease and disability among U.S. men and women, according to background information in the article. Major depression was found in approximately 20 percent of patients with a recent myocardial infarction (MI; heart attack); a similar prevalence was found for minor depression. Depression is a risk factor for recurrent non-fatal heart attack and cardiac death in patients who experience an acute MI (AMI), independent of cardiac disease severity. Despite their effectiveness in treating depression, the use of antidepressants in patients with CVD remains controversial.


C. Barr Taylor, M.D., from Stanford Medical Center, Stanford, Calif., and colleagues conducted a secondary analysis of data from the Enhancing Recovery in Coronary Heart Disease (ENRICHD) clinical trial to determine the effects of antidepressants on post-MI patients. The ENRICHD trial randomized 2,481 depressed and/or socially isolated patients from October 1, 1996 to October 31, 1999. The analysis in this report is based on 1834 patients (985 men and 849 women) who had depression, with or without low social support. Of these, 446 patients took antidepressants during the study, including 301 who were prescribed SSRIs (a class of drugs that increases the levels of serotonin in the body); and 145 patients who were prescribed other types of antidepressants.


During an average follow-up of 29 months, 457 fatal and non-fatal cardiovascular events occurred. Twenty-six percent (361 of 1,388) of the patients who did not receive antidepressants died or had a recurrent MI, compared to 21.5 percent (96 of 446) of the patients who did take antidepressants. After adjusting for baseline depression and cardiac risk, SSRI use was associated with 43 percent lower risk of death or recurrent non-fatal MI, and 43 percent lower risk of death from all causes, compared with patients not receiving SSRIs. Risk of death or recurrent MI, all-cause death, or recurrent MI was 28 percent, 36 percent, and 27 percent lower, respectively, in patients taking non-SSRI antidepressants, compared with nonusers.


"The main finding of this study is that antidepressant use post-AMI by depressed patients in the ENRICHD clinical trial was associated with significantly lower rates of the study primary end points, death and reinfarction [recurrent heart attack]," the authors write.


(Arch Gen Psychiatry. 2005; 62: 792-798. Available pre-embargo to the media at jamamedia.)















Editor's Note: This study was supported by contracts from the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md.


Editorial: Does Treating Post-Myocardial Infarction Depression Reduce Medical Mortality?


In an editorial accompanying this study, Alexander H. Glassman, M.D., of the New York State Psychiatric Institute, writes that in the ENRICHD trial "only the most depressed patients, those known to be at higher risk for cardiac events, were offered antidepressants. In addition, there was no control over when the drug was started or stopped, and even the reported start and stop times were only estimates. However, the sample was large, the number of events reasonable, and the magnitude of the effect is hard to ignore. Had the ENRICHD study observed an uncontrolled 40 percent increase in mortality with antidepressant drug treatment, public advocates would be clamoring for review by the Food and Drug Administration, label changes, or even 'black box' warnings. Yet this observation of a 40 percent decrease in life-threatening outcomes has been in the literature for almost three years with no systematic follow-up and minimal medical or psychiatric awareness."


"There are multiple mechanisms by which depression could increase vascular disease," Dr. Glassman writes. "It increases platelet activation and inflammatory markers, reduces heart variability, and leads to multiple adverse health behaviors; all are associated with increased cardiovascular risk and death. Whatever links depression and heart disease, it is more likely to involve all of the above rather than any single pathway."


"Acknowledging the implications of MDD [major depressive disorder] for cardiac morbidity and mortality would validate depression as a systemic disease with implications for the entire body, and reduce the stigma of this diagnosis for medical professionals, the public, and the patients themselves," Dr. Glassman concludes. "The ENRICHD investigators have made a significant step in that direction."


(Arch Gen Psychiatry. 2005; 62: 711-712. Available pre-embargo to the media at jamamedia.)


For more information, contact JAMA/Archives Media Relations at 312-464-JAMA (5262) or email mediarelationsjama-archives.


JAMA and Archives Journals

jamamedia

Teen Pregnancy May Be Symptom, Not Cause, Of Emotional Distress

It would make sense that teenage mothers have a lot of psychological stress in their lives, but a new study shows that the distress comes before the pregnancy, not because of it.


"Psychological distress does not appear to be caused by teen childbearing, nor does it cause teen childbearing, except apparently among girls from poor households," said Stefanie Mollborn, Ph.D., an assistant professor of sociology at the Institute of Behavioral Science of the University of Colorado at Boulder.


The study, published in the September issue of the Journal of Health and Social Behavior, used data from two large long-term U.S. surveys that followed thousands of teen girls and women. Participants responded to items on symptoms associated with depression, such as how often they found things that did not usually bother them to be bothersome, how easily they could shake off feeling blue or whether they had trouble concentrating. The researchers did not use the term "depression," which is a clinical diagnosis.


Only the combination of poverty and existing distress was a good predictor of teen pregnancy.


Previous studies had shown high levels of depression among teen mothers, but nationally representative studies had not examined if distress was present before the pregnancy and stresses of young motherhood.


"Psychologically distressed girls are at risk for teen childbearing and vice versa, even if the two things usually do not cause each other," Mollborn said. "This could help educators and clinicians identify at-risk adolescents."


Looking for symptoms of depression or distress should be part of normal health screening for all teenagers, said Diane Merritt, M.D., director of Pediatric and Adolescent Gynecology at the Washington University School of Medicine in St. Louis. "Talking to teenagers about their sexuality and responsible behavior is key," she said. Responsible behavior would include the use of birth control if the teenager were sexually active.


One of the best ways to prevent teen pregnancy is for teens to have long-term goals and good self-esteem, Merritt added.


High levels of depression have long-term negative consequences for both mothers and children, Mollborn said. The higher levels of psychological distress in women who had teenage pregnancies continued well into adulthood, she added.


The Journal of Health and Social Behavior is a quarterly journal of the American Sociological Association.

Source
Health Behavior News Service

Sudden Death Of A Parent Raises Risk Of Depression, Post-Traumatic Stress Disorder For Surviving Children, Pitt Researchers Find

The children of parents who die suddenly - whether by suicide, accident or natural causes - are three times more likely to develop depression and are at higher risk for post-traumatic stress disorder (PTSD) than children who don't face such a difficult life event, according to a University of Pittsburgh School of Medicine study published in the current issue of the Archives of Pediatric & Adolescent Medicine, one of the JAMA/Archives journals.


In the first controlled, population-based study of its kind, the team of Pitt and University of Pittsburgh Medical Center (UPMC) researchers also found that parents who died of suicide had higher rates of bipolar disorder, alcohol and substance abuse disorders and personality disorders. Higher rates of these disorders are expected in suicide victims; however, those who died accidentally or from sudden natural death also had higher rates of psychiatric disorders, specifically, alcohol and substance abuse and personality disorders, and showed a trend toward higher rates of bipolar disorder.


While the death of a parent is consistently rated as one of the most stressful events that a child can experience, little has been known about the psychiatric outcomes in bereaved children until now. "Our study shows that when premature parental death occurs, physicians should be alert to the increased risk for depression and post-traumatic stress disorder in bereaved offspring and in their surviving caregivers," said David A. Brent, M.D., academic chief of child and adolescent psychiatry at Western Psychiatric Institute and Clinic and professor of psychiatry, pediatrics and epidemiology at the University of Pittsburgh School of Medicine. "Not surprisingly, we found that bereaved offspring are at increased risk for adverse outcomes in part because of factors that may have contributed to the parent's death."


The study involved 140 families in which one parent had died of either suicide, accidental death - such as drug overdoses and car accidents - or sudden natural death, while a control group consisted of 99 families with two living biological parents who were matched to the deceased parents in the study group based on sex, age and neighborhood. Ages of the children at their parents' deaths ranged from seven to 25 years.


Other factors that affected outcomes included the nature of the last conversation with the deceased. Researchers found that a caregiver's recollection of a supportive conversation led to a higher risk of depression. "Understanding the effects of bereavement is essential to identifying those at highest risk who should be targeted for future prevention and intervention efforts," noted Nadine Melhem, Ph.D., first author and assistant professor of psychiatry at the University of Pittsburgh School of Medicine.















These findings point out the importance of improving the detection and treatment of bipolar illness, substance and alcohol abuse, and personality disorders, as well as the significance of addressing the lifestyle associations of these illnesses that lead to premature deaths, according to Dr. Brent.


"The caregivers should be monitored for depression and PTSD because restoring their normal mental functioning could lead to more positive outcomes for the children," said Dr. Brent. "However, given the increased risk of depression and PTSD, the bereaved children also should be monitored and, if necessary, referred and treated for their psychiatric disorders."


Co-authors of the study include Monica Walker, M.A., Western Psychiatric Institute and Clinic, and the Department of Psychiatry, University of Pittsburgh School of Medicine; and Grace Moritz, M.S.W., Division of Collaborative Care Medicine, UPMC.


Drs. Brent and Melhem were supported by funding provided by the National Institute of Mental Health and the American Foundation for Suicide Prevention.


The University of Pittsburgh School of Medicine is one of the nation's leading medical schools, renowned for its curriculum that emphasizes both the science and humanity of medicine and its remarkable growth in National Institutes of Health (NIH) grant support, which has more than doubled since 1998. For fiscal year 2006, the University ranked sixth out of more than 3,000 entities receiving NIH support with respect to the research grants awarded to its faculty. The majority of these grants were awarded to the faculty of the medical school. As one of the university's six Schools of the Health Sciences, the School of Medicine is the academic partner to the University of Pittsburgh Medical Center. Their combined mission is to train tomorrow's health care specialists and biomedical scientists, engage in groundbreaking research that will advance understanding of the causes and treatments of disease and participate in the delivery of outstanding patient care.


University of Pittsburgh Medical Center

Depression Returns In About Half Of Treated Teens

Most depressed teens who receive treatment appear to recover, but the condition recurs in almost half of adolescent patients and even more often among females, according to a report posted online today that will appear in the March 2011 print issue of Archives of General Psychiatry, one of the JAMA/Archives journals.



Major depressive disorder affects approximately 5.9 percent of teen females and 4.6 percent of teen males, according to background information in the article. "It is associated with functional impairment, risk of suicide and risk of adult depression," the authors write. "Thus, it is important to investigate not only the efficacy of adolescent major depressive disorder treatments but also whether they reduce the risk of subsequent negative outcomes, especially depression recurrence."



John Curry, Ph.D., of Duke University Medical Center, Durham, N.C., and colleagues studied 196 adolescents (86 males and 110 females) who participated in the Treatment for Adolescents With Depression Study (TADS). The teens were randomly assigned to one of four short-term treatment interventions (medication with fluoxetine hydrochloride, cognitive behavioral therapy, a combination of the two or placebo) and followed up for five years.



Almost all participants (96.4 percent) recovered from their initial episode of depression during the follow-up period, including 88.3 percent who recovered within two years. Those who responded to a 12-week treatment session (short-term responders) were more likely to have recovered by two years (96.2 percent vs. 79.1 percent). However, two-year recovery was not associated with any particular type of treatment.



Of the 189 teens who recovered from depression, 88 (46.6 percent) experienced a recurrence. "Contrary to our hypotheses, neither full response to short-term treatment nor treatment with a combination of fluoxetine and cognitive behavioral therapy reduced the risk of recurrence," the authors write. "However, short-term treatment non-responders were more likely to experience recurrence than full and partial responders. Females were significantly more likely to have a recurrence than males."



Teens who also had an anxiety disorder were more likely to experience recurrence (61.9 percent vs. 42.2 percent of those without anxiety disorders). In addition, participants whose depression returned had higher scores on scales of suicidal thoughts and behaviors.



"Our results reinforce the importance of modifying a short-term treatment that leads to partial response or non-response because these were associated with less likelihood of recovery in two years," the authors write. "The finding that recurrence rates increased significantly from two to three years after baseline suggests that recurrence prevention efforts, such as symptom or medication monitoring or cognitive behavioral therapy booster sessions may be of value beyond the [18-week] maintenance period included in TADS."



"Female sex was the most robust predictor of recurrence, indicating the importance of understanding and reducing the vulnerabilities of female adolescents to recurrent episodes."


(Arch Gen Psychiatry. Published online November 1, 2010. doi:10.1001/archgenpsychiatry.2010.150.)

Depressed People Have High Rates Of Physical Illness

People with recurrent depression have high rates of many common physical illnesses, such as gastric ulcer, rhinitis/hay fever, osteoarthritis, thyroid disease, hypertension and asthma, a new study has found.



Published in the May 2008 issue of the British Journal of Psychiatry, the study compared 1546 people with recurrent depression with 884 psychiatrically healthy controls in terms of past treatment for 16 different physical disorders.



Since many medical disorders are related to obesity, the researchers also examined body mass index (BMI) in both groups.



It was found that 15 physical disorders were significantly more frequent in people with recurrent depression than in controls. However, when BMI, age and gender were taken into account, depression was found to predict 6 disorders - gastric ulcer, asthma, rhinitis, hypertension, thyroid disease and osteoarthritis.



For the remaining physical health problems - diabetes, epilepsy, hypercholesterolaemia (high blood fats), kidney disease, liver disease, heart attack, osteoporosis, rheumatoid arthritis and stroke - the difference between those with and without each disorder could be accounted for by BMI, age or gender.



Both men and women with recurrent depression had significantly higher BMIs than men and women in the control group.



Although the percentages of the two groups were similar in the overweight range, a greater proportion of people with depression were in the obese range, and substantially fewer were in the normal range, compared with controls.



Thus, around a quarter of the men and women with depression were obese, which increases their susceptibility to physical health problems. In this study, obesity was associated with an increase in self-reported rates of hypercholesterolaemia, type II diabetes and heart attack.



High rates of obesity may be caused by some antidepressant medications, or arise because people who are depressed take less exercise and/or 'comfort' eat. However, it is also possible that genetic factors may be involved.
















Evidence from previous research, and from this study, lends some support to the hypothesis that there are shared causal factors between recurrent depression, obesity and certain physical disorders.



One possible explanation for this is the effect that stress, and stress hormones, have on the brain and body. For instance, high levels of the stress hormone cortisol may link both obesity and gastric ulcers with depression.



The researchers comment that inflammatory processes that activate stress hormones may also link depression with asthma, hay fever, osteoarthritis and hypertension. These are speculations, however, and need confirmation from further studies.



Although long neglected, the physical health of people with schizophrenia is starting to be addressed, particularly in relation to the weight gain caused by antipsychotic drugs. This study suggests that attention needs to be paid to the physical health needs of people with depression.



"Medical disorders in people with recurrent depression."

Farmer A. et al (2008)

British Journal of Psychiatry, 192, 5, pages 351-355.

Click here to view Abstract online



The Royal College of Psychiatrists


The Royal College of Psychiatrists is the professional and educational body for psychiatrists in the United Kingdom and the Republic of Ireland. We promote mental health by:


-- Setting standards and promoting excellence in mental health care

-- Improving understanding through research and education

-- Leading, representing, training and supporting psychiatrists

-- Working with patients, carers and their organisations


As well as running its membership examination (MRCPsych), and visiting and approving hospitals for training purposes, the College organises scientific and clinical conferences and lectures and continuing professional development activities. The College publishes books, reports and educational material for professionals and the general public. It also publishes the British Journal of Psychiatry, Psychiatric Bulletin and Advances in Psychiatric Treatment, all of which are now available on-line.


The Royal College of Psychiatrists has been in existence in some form since 1841. First as the "Association of Medical Officers of Asylums and Hospitals for the Insane" (later changed to the Medico Psychological Association) then, in 1926 receiving its Royal Charter to become the "Royal Medico Psychological Association, and finally, in 1971 receiving a Supplemental Charter to become the "Royal College of Psychiatrists" we know today.


rcpsych.ac.uk