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Fish for Depression? One New Study Says Yes.

August 30, 2010

You already know the omega-3 fatty acids in fish are good for your heart. But a new study adds to the evidence that a high intake of fish (about four 3.5 ounce servings per week) may also help treat depression.

The study, published in Pediatrics, examined the self-reported diets and depression symptoms of 6,500 Japanese students ages 12 to 15. Boys who ate about one ounce of fish for every 1,000 calories were 27 percent less likely to report feelings of worthlessness or hopelessness than boys who ate little fish.

The findings are significant because this is the first study to look at the effects of omega-3s on depression in young teens—a group that may be particularly susceptible to problems that stem from untreated depression, such as poor grades, impaired relationships and suicide. (Studies in adults have yielded mixed results.)

Curiously, the depression-fighting ability of omega-3s was not seen for girls in the study; researchers hypothesized that this might be due to physiological or cultural differences but did not propose a definite answer. Also, one type of omega-3 was shown to be effective: Higher intakes of the omega-3 eicosapentaenoic acid (EPA) in boys were associated with lower prevalence of depressive symptoms, while the omega-3 docosahexaenoic acid (DHA) alone and in combination with EPA was slightly less successful. (Other studies have hypothesized that EPA and DHA have different effects on the brain.)

Fatty cold-water fish—salmon, mackerel, herring, lake trout, sardines and albacore tuna—are the best sources of omega-3 fatty acids. The American Heart Association recommends eating at least two 3.5-ounce servings per week. To reduce mercury exposure, avoid shark, swordfish, king mackerel and tilefish.

Sources: Murakami, K., et. al. Fish and n-3 Polyunsaturated Fatty Acid Intake and Depressive Symptoms: Ryukyus Child Health Study. Pediatrics, published online Aug 16, 2010. DOI:10.1542/peds.;
The American Heart Association; and Food and Drug Administration

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Internet Addiction May Lead to Depression

August 30, 2010

As many as one in eight Americans may suffer from what the Center for Internet Addiction terms "problematic Internet use." A new study published in the Archives of Pediatrics & Adolescent Medicine suggests such addiction is especially dangerous for adolescents, whose Internet overuse may lead to depression, which in turn can lead to increasingly problematic Internet use.

For the study, about 1,000 high school students (ages 13 to 18) from Guandong Providence in Southeast China completed questionnaires that assessed depression, anxiety and Internet behaviors. Teens who were considered free of depression and anxiety were then followed. After nine months, 8.4% of these teens scored in the depressive range.

What's more, teenagers who used the Internet pathologically were 2½ times more likely to be depressed than those with normal usage. No association was found for anxiety.

How Internet addiction might contribute to depression is still unclear. And this study couldn't account for factors such as genetic susceptibility and family history of depression, which are major contributors to depression.

But problematic Internet use may be one sign that a child has or will experience depression. Experts suggest teens in this situation might benefit from therapy, such as antidepressants to treat depression and psychotherapy to address media dependency.

Sources: Lam, LT; Peng, Z. Effect of Pathological Use of the Internet on Adolescent Mental Health. Archives of Pediatrics & Adolescent Medicine. August 2, 2010. DOI:10.1001/archpediatrics.2010.159;
Center for Internet Addiction

The 2 Keys to Making Therapy Work

July 27, 2010

Cognitive therapy helps many people manage depression; but it would be nice to know which elements are the most beneficial. Now two exploratory studies from Ohio State University offer insights that can improve your care:

Choose a Highly Competent Therapist

According to the first study published in the Journal of Consulting and Clinical Psychology, the more competent the therapist, the more likely the patient is to experience symptom relief from one session to the next in the early stages of treatment. People with anxiety, in particular, may benefit from a highly skilled therapist.

While this may seem obvious, you need to know how to gauge competence. It goes beyond having a pleasant manner. In this study, assessors used Young and Beck's cognitive therapy scale, which gives high marks to a therapist who:

  • Shows warmth, concern, confidence, genuineness and professionalism
  • Understands your internal reality, listens and conveys empathy
  • Sets an appropriate agenda to deal with target problems, and establishes priorities for the session
  • Encourages you to take an active role in the session, so you function as a team
  • Incorporates the most appropriate cognitive-behavioral techniques (CBT) and follows a consistent strategy
  • Focuses on key thoughts, assumptions and behaviors that are most relevant to the problem
  • Helps you see new perspectives through gentle guidance, rather than lectures
  • When appropriate, gives you helpful assignments to complete at home, then makes sure they're discussed at the next session
  • Makes productive use of the time by steering away from less important issues and limiting discussions that won't be fruitful
  • Elicits and responds to your feedback. Summarizes the main points at the end of session

Be an Active Participant

The crucial element in cognitive therapy is how well you and your therapist work together to change negative thought patterns, suggests the second study published in Behaviour Research and Therapy. What you believe about yourself and your situation has a powerful influence over your life. By reversing destructive beliefs, you help break the cycle of depression.

Being open is one key. Patients who were, for instance, "able and willing to provide specific examples of events or thoughts" tended to show more symptom relief from one session to the next.

A good therapist teaches you the skills needed to make the transition: "Our results suggest therapist adherence [to cognitive therapy techniques], such as...efforts to encourage patients to evaluate their thoughts and beliefs, appear to be driving symptom change," write the study authors.

The bottom line: Cognitive therapy is one of several forms of psychotherapy available to treat depression. It can be used before or along with medication to reduce symptoms. Talk to your doctor about the best option for you. Then, use the points above to find a good therapist.

Sources: Strunk, DR, et al. Therapist competence in cognitive therapy for depression, Journal of Consulting Clinical Psychology. 2010 Jun;78(3):429-37.
Cognitive Therapy Scale (copyright © 1980, J.E. Young & A. T. Beck); and
Strunk, DR, et al. The Process of Change in Cognitive Therapy for Depression. Behaviour Research and Therapy. 2010 Jul;48(7):599-606.

Generic Version of Effexor XR® Now Available

July 27, 2010

The first generic version of extended release Effexor was recently approved by the U.S. Food and Drug Administration (FDA). Generic venlafaxine hydrochloride ER capsules are now available in 37.5 mg, 75 mg, and 150 mg strengths and in bottle sizes of 30 and 90 capsules, according to the pharmaceutical company Teva, which makes the generic drug.

Like Effexor, generic venlafaxine capsules carry a black box warning: Antidepressants increase the risk of suicidal thinking and behavior in children, teens, and young adults. According to the National Institute of Mental Health, children taking antidepressants should be closely monitored, especially during the initial weeks of treatment, for worsening depression, suicidal thinking or behavior. These include any unusual changes in behavior such as sleeplessness, agitation, or withdrawal from normal social situations.

A generic medicine contains the same active ingredient as the brand name drug. It is the same in dosage, safety, strength, quality, the way it works, the way it is taken and the way it should be used, according to the FDA. But a generic drug may have a different color, shape or flavor. It also may contain different inactive ingredients.

The bottom line: Switching to the generic antidepressant may save you money. On average, the cost of a generic drug is 80 to 85% lower than the brand name medication, according to the FDA. If you're interested in switching to generic venlafaxine, discuss it with your doctor. Check your health insurance carrier's drug formulary to find out how much the new medication will cost.

Sources: FDA;
Teva Pharmaceuticals;
National Institute of Mental Health

Stronger Warnings for Pain Reliever

June 8, 2010

The FDA recently strengthened warnings for Ultram (tramadol hydrochloride) and Ultracet (tramadol hydrochloride and acetaminophen), medications used to treat moderate to severe pain. The updated label urges caution when prescribing opioid medication to people taking antidepressants or suffering from depression, following reports of suicide among some users of the drug.

If you're currently taking tramadol, don't stop taking it without consulting your doctor; if recommended, the medication may need to be tapered off. If you're currently seeking treatment for chronic pain, talk to your doctor about alternative pain medications and therapies.

Before you start taking any new medication, the Agency for Healthcare Research and Quality suggests asking your doctor the following questions:

  • What am I taking this medicine for?
  • Does this new prescription mean I should stop taking any other medicines I’m taking now?
  • How do I take the medicine, and how often do I take it?
  • Are there foods, drinks (including alcoholic beverages), other medicines, or activities to avoid while I'm taking this medicine?
  • Do I need to take all of the medication, or should I stop when I feel better?
  • How long will I be taking it? Can I get a refill?
  • Are there any tests I need to take while I'm on this medicine?
  • When should I expect the medicine to start working? How can I tell if it's working?
  • What are the side effects that can happen with this medicine?
  • What should I do if I have a side effect?
  • What happens if I miss a dose?
  • What printed information can you give me about this medicine?

Sources: News release, FDA.
Agency for Healthcare Research and Quality. Your Medicine: Play It Safe.

Helping Dads Beat the Baby Blues

June 8, 2010

Father's Day is a time of joy and pride. But not all new dads will be in the mood to celebrate, suggests a new study. As many as 10 percent of expecting and new fathers experience prenatal or postpartum depression, according to the Journal of the American Medical Association study. That's twice the rate of depression among men than would be expected (5%). And the problem appears to be worse in the United States where depression before or after pregnancy reaches 14%, compared to 8% in other countries.

These estimates are based on a meta-analysis of 43 studies involving a total of 28,000 participants from 16 countries. "Depression" included symptoms ranging from minor depression to major depression and were based mostly on self-report.

The most difficult time for new fathers appeared to be 3 to 6 months after the birth of a child. And paternal depression may be associated with maternal depression.

These findings should be interpreted cautiously, suggest the researchers. But the implications are clear. According to several studies, early paternal depression may have "substantial emotional, behavioral and developmental effects on children."

The study authors suggest more efforts should be made to improve screening of paternal depression and referral of dads to health care professionals. If depression is detected in one parent, the other parent should be evaluated as well. The authors also suggest therapy might focus on the couple and family.

If you are a new dad experiencing unusual sadness, lack of interest or pleasure, sleep problems or fatigue, talk to your health care provider or a mental health professional. Medication, psychotherapy, a postpartum depression support group and other resources may improve your symptoms and ease the often difficult transition to parenthood. Not only could it improve your mental health, it may help protect your child's wellbeing as well.

Source: Paulson, JF; Bazemore, SD. JAMA 2010;303(19):, DOI:10.1001/jama.2010.605.

Antidepressants & Suicide Risk in Tweens and Teens

May 12, 2010

When it comes to prescribing antidepressants to children, is one regimen safer than another? According to a new Pediatrics study, the answer appears to be no; the (relatively low) risk of suicidal acts among children using selective serotonin reuptake inhibitors (SSRIs) and other antidepressant medications is roughly the same.

For the study, researchers examined medical data on nearly 21,000 Canadian children ages 10 to 18 with a depression diagnosis (and, in some cases, co-occurring psychiatric disorders), who started taking an antidepressant between 1997 and 2005. During the first year of use of a single antidepressant, 266 children attempted suicide and three died as a result of suicide.

Using fluoxetine—the most widely prescribed antidepressant—as a benchmark, the researchers found no meaningful differences in the rate of suicide attempts for other SSRIs (including citalopram, fluvoxamine, paroxetine and sertraline). And tricyclics showed similar risks. Too few children used monoamine oxidase inhibitors (MAOIs), so these drugs could not be studied. For various reasons, bupropion, escitalopram and duloxetine were not studied.

The researchers conclude that their analysis "supports the decision of the Food and Drug Administration [FDA] to include all antidepressants in the black box warning regarding suicidality risk for children and adolescents initiating use of antidepressants." The Black Box Warning highlights an increased risk of suicidal thinking and behavior in children and adolescents with major depressive disorder and other psychiatric disorders.

It's important to note that depression itself raises the risk of suicide. In fact, experts point out that untreated depression is the bigger worry. Many believe that antidepressant therapy reduces suicidal attempts.

Suicide Prevention

If your son or daughter is starting an antidepressant, switching antidepressants or changing doses, it's important to monitor your child and to work closely with the health care provider. After starting an antidepressant, the FDA recommends that your child see his or her doctor

  • Once a week for the first 4 weeks
  • Every 2 weeks for the next 4 weeks
  • After taking the antidepressant for 12 weeks
  • After 12 weeks, follow your health care provider's advice about how often to come back

If problems or questions arise, see your child's health care provider more often. Contact the doctor right away, if your child exhibits any of the following signs for the first time, or if they seem worse: thoughts about suicide or dying, suicide attempts, new or worse depression, agitation, irritability or restlessness, panic attacks, insomnia, aggressive behavior, anger, violence or other unusual changes in behavior.

For more information on suicide prevention, check out these helpful resources:

Chocolate and Depression: What's the Connection?

May 12, 2010

Who doesn't love a bit of decadent chocolate every now and again? But could we be overdoing it? Well, the most recent study on the subject has found that people with depression symptoms consume 56% more servings of chocolate candy in a month than those without the symptoms. And people with possible major depression eat twice as many servings of chocolate candy. A serving was one ounce, or two-thirds or less of a regular-size chocolate bar. The findings applied to both men and women. Fat, carbohydrate and energy intake didn't appear to account for the differences in consumption.

The study, published in the Archives of Internal Medicine, involved 931 men and women from California, who were not taking antidepressant medications. Those screening positive for possible depression ate 8.4 servings of chocolate candy per month, compared to 5.4 servings per month for those without depression symptoms. People with possible major depression consumed 11.8 servings a month.

So is there a connection between chocolate and mood? It's hard to say. Previous studies have examined the association, but many have had notable limitations. This study, published in the Archives of Internal Medicine, went a step further but also couldn't determine if people with depression symptoms reach for chocolate as a temporary mood lifter, or whether some other factor is at work.

In fact, the researchers propose at least four other potential explanations: Depression could stimulate chocolate cravings as "self-treatment"—or for unrelated reasons. Chocolate may contribute to a depressed mood. Or inflammation and oxidative stress in the body could lead to both depression and chocolate cravings. There are many other possible explanations.

In this study, depression scores were based on the CES-D scale, which is a screening test, and doesn't necessarily indicate a depression diagnosis.

How Much Chocolate is in a Chocolate Bar?

Then there is the matter of the actual chocolate or cacao content. The food questionnaires used in the study asked about the consumption of chocolate. But chocolate candies vary in the amount of chocolate or cacao they contain; in fact, some contain little to no cacao. And, as any chocoholic can testify, there are distinct differences between milk chocolates and dark chocolates, as well as differences between brands.

So, while this study provides food for thought, it is not the last word on the subject. For general health, it makes sense to limit consumption of chocolate candy, since it contains excess sugar and fat. The researchers also point out that many chocolate candies contain trans fats, which inhibit the production of omega-3 fatty acids and may lead to worse mood.

Doctors Unaware of Many Patient Side Effects

April 23, 2010

Bothersome side effects are one reason people with depression stop taking their depression medications prematurely. Working with your doctor may help reduce these problems. But according to a recent study published in the Journal of Clinical Psychiatry, psychiatrists may not be aware of most side effects experienced by patients.

According to the study, the average number of side effects reported by people with depression was 20 times higher than the number recorded by psychiatrists. After the doctor office visit, patients completed a side effects checklist (an adapted version of the Toronto Side Effects Scale) in the waiting room and reported how often they experienced 31 possible medication side effects, such as nausea and dry mouth, and rated how troublesome these symptoms were.

Even when the list was narrowed to the most troubling side effects, the number of side effects reported by patients was still two to three times higher.

There are several possible explanations for these findings. Some of the symptoms could be attributed to depression rather than to medications, so the doctors didn't record them. It's also possible that some of the side effects might be due to medications for other conditions.

The researchers assert that it's more helpful for doctors to ask about specific side effects than to ask a global, open-ended question, such as, "Are you experiencing any problems related to your medication?" A side effects checklist for patients might also be beneficial.

The study involved 300 people—211 women and 89 men—with major depression being treated in the Rhode Island Hospital Department of Psychiatry, a private, outpatient practice. Most patients had medical insurance.

The majority of patients were taking two or more psychiatric medications; and more than one quarter were taking three or more medications. The most frequently prescribed medications were selective serotonin reuptake inhibitors (SSRIs) (57%), benzodiazepines (30%), serotonin and norepinephrine reuptake inhibitors (SNRIs) (24%), and bupropion (19%). Most patients were in the continuation or maintenance phase of depression treatment.

The bottom line: Premature discontinuation of depression medication is associated with poorer outcomes. While you should expect your doctor to ask about medication side effects, it's also your responsibility to tell your doctor about troublesome reactions—particularly if they cause you to take your medication less often or to stop taking it. Often, there are ways to reduce or manage side effects, such as switching to another depression medication within the same drug class. Talk to your doctor about the options.

Smoking Prevalent Among Depressed Individuals

April 23, 2010

A new report from the Centers for Disease Control and Prevention (CDC) highlights the significant—and troubling—association between depression and smoking. The report, based on findings from the National Health and Nutrition Examination Surveys from 2005 to 2008, revealed the following trends.

Compared to adults without depression, people with the mood disorder were

  • more likely to be current smokers. Almost one-half of depressed adults under age 55 smoked.
  • more likely to smoke heavily. In fact, they were more likely to smoke their first cigarette within 5 minutes of awakening and to smoke more than one pack of cigarettes daily.
  • less likely to quit smoking.

What's more, the percentage of adults who were current smokers increased as depression severity increased. But even those with mild depression symptoms—but no depression diagnosis—were more likely to smoke than other adults.

Of course, an association doesn't prove that depression leads to smoking or that smoking triggers depression. But, according to experts, smoking habits may help explain the prevalence of heart disease and diabetes among people with depression. Quitting smoking is one positive step you can take to reduce your risks of these diseases.

The good news is the CDC's report is likely to lead to better smoking cessation services for people with depression.

According to the report, a few studies show that "with intensive treatment, persons with depression can quit smoking and remain abstinent." Intensive smoking cessation programs may include therapies such as cognitive behavioral therapy or antidepressant medications—both very familiar to many people with depression.

In the meantime, if you smoke, talk to your doctor about ways to quit. Even if you tried to kick the habit before, it's worth trying again. The following resources on smoking cessation may help:


  • National Network of Tobacco Cessation Quitlines
    800.QUITNOW ()


Girls at Risk for Depression Respond Less to Reward

April 12, 2010

Girls whose mothers suffer from depression appear to have impairments in the processing of reward and loss, which might predict future depression, suggests a new study published in the Archives of General Psychiatry.Brain images revealed patterns of activation that indicate significant variations in reward functioning among girls with a family history of depression.

One characteristic of major depressive disorder is diminished pleasure or reward. For example, compared with people who are not depressed, individuals with the mood disorder react less to slides depicting pleasant scenes, funny movie clips, appealing drinks, and money prizes, according to background information in the article.

Previous research has found anomalies in reward processing in adolescents and adults with depression. But it wasn't clear whether these problems occurred before or after the onset of depression. This small study showed that anomalies occur in young girls who haven't experienced a depressive episode, but who have a high risk of the disorder.

Approximately 40% of children (both girls and boys) of depressed mothers will develop depression, state the researchers. Of note, investigators have also reported gender differences in the transmission and recurrence of depression.

In this study, thirteen 10 to 14 year-old girls whose mothers had recurrent depression were matched with girls of the same age without a family history of depression. To assess neural functioning, researchers asked the girls to play a game in which they could earn points toward a prize of their choosing. Players could win points, lose points, or keep their point level the same by responding to various cues to hit a target. Functional magnetic resonance imaging (fMRI) was used to take images of the brain.

Areas of the brain involved were the striatum, dorsal anterior cingulate cortex and insula. The dorsal anterior cingulate cortex appears to be involved in reinforcing past experiences to facilitate learning. Compared with low-risk girls, high-risk girls showed an increased activation in this area when receiving punishment. This suggests they may more easily integrate information about loss and punishment than reward and pleasure over time.

"Most important, we also document a prominent role of the insula as an index of normal and disordered reward functioning; this structure may be a promising candidate for a biological marker of risk for the development of a depressive disorder," conclude the authors.

Future research is needed to determine if these characteristics go on to predict the onset of depression. Additional studies might also examine fathers' depression.

In the meantime, a program that focuses on increasing ability to derive pleasure or reward from daily activities might be helpful, suggests one of the study authors in a news report.

Stigma Keeps Some Latinos From Getting Help for Depression

April 12, 2010

What do you think of feeling depressed? It's an important question, according to new research.

A recent study involving a small group of depressed Latinos receiving primary care in one area of Los Angeles found that Latinos with stigma concerns were less likely to take depression medications, less able to manage their depressive symptoms, and more likely to miss scheduled appointments for depression treatment. Stigma may be one of several factors that contribute to these deficiencies in care.

While these results can't be generalized to other populations, including to other groups of Latinos, it does reveal certain troubling attitudes that could be barriers to depression treatment. The authors suggest that some depressed people avoid treatment out of concern they may be judged or discriminated against by others. Others may avoid addressing stigma because of its potential to affect their self-esteem, which already may be compromised by depression. Or, some patients may perceive the health care system as a threat, rather than a source of help.

The main goal of the study, published in General Hospital Psychiatry, was to develop a tool for doctors to reveal and address stigma in this Latino population. If you find that you also hold erroneous beliefs such as "people who take medication for depression have difficulties solving their own problems" or "family and friends would think less of me because of a depression diagnosis," talk to your doctor. If you know what you believe about a depression diagnosis and why, you can take steps to challenge and change beliefs that are detrimental to your care.

Here are a few helpful facts to remember:

  • Depression is a physical illness, not a mental weakness.
  • Depression is no one's fault. It is a disease of the brain that develops for complex reasons.
  • You are a valuable person, not an illness.
  • You can decide whom to tell about the mental illness and what to tell them.
  • Effective therapies to treat depression are available.

If you find you're struggling with personal stigma, cognitive behavioral therapy may help. The Depression is Real Coalition also offers helpful resources on coping with depression; visit The bottom line: Don't let stigma stop you from seeking care for depression for a better quality of life.

A New, Fast-Acting Antidepressant?

March 29, 2010

Conventional antidepressants take at least 3 to 4 weeks to become effective, so scientists have been eager to find treatments with a more rapid onset. Such therapies could potentially bring relief from depression that much sooner. Now results from a preliminary study suggest that scopolamine, an anticholinergic drug, holds promise in producing rapid and effective relief of depression symptoms.

The study, published in Biological Psychiatry, aimed to replicate previous research. In the crossover trial, 22 participants with major depression (mostly in the moderate to severe range) received three sessions of either intravenous scopolamine (4 micrograms per kilogram) or placebo, then were switched to three sessions of the opposite treatment. During the 4-week study, neither the participants nor the researchers knew which treatments were being administered.

The results: the group receiving scopolamine first showed a 32% reduction in depression scores, outperforming placebo. The other group, which received scopolamine later, had similar improvements in mood characterized by a 53% reduction in depression scores. Notably, 11 of the 22 participants (50%) experienced depression remission.

"The antidepressant effects occurred within 3 to 5 days, and treatment responders generally reported improvement in symptoms by the morning following the first infusion," the study authors wrote.

The most common side effects from intravenous scopolamine included drowsiness, blurred vision, dry mouth, lightheadedness, and reduced blood pressure; but in rare cases, the medication may cause mental clouding and/or irregular heartbeat.

Scopolamine is currently used as a sedative and a motion sickness treatment. Its antidepressant effects may stem from temporary blockage of the muscarinic cholinergic receptor in the brain, thought to be overactive in people suffering from depression.

The bottom line: Scopolamine is one of a handful of potential new depression treatments being studied. Although these findings "open the door" to a new approach to treating depression, more research is needed to examine scopolamine's efficacy and usefulness in practice, as well as its administration and dosage. Stay tuned.

Drug Combination May Improve Depression and Problem Drinking

March 29, 2010

Treating depression in people who are also alcohol dependent (who consume 12 or more drinks a week) is fighting only half the battle. Not only does alcohol abuse increase the risk of depression, alcoholism is associated with more severe depression—and vice versa. In addition, alcohol dependence prolongs co-occurring depression, and persistent depression during abstinence from alcohol may lead to a drinking relapse.

A few studies have found that antidepressants alone are not very helpful in reducing excessive drinking among those who abuse alcohol. So researchers asked: Is combination treatment including an antidepressant and a medication FDA-approved to treat alcohol dependence more effective?

To find out, the scientists compared a combination treatment of sertraline, a selective serotonin reuptake inhibitor, and naltrexone, an opioid receptor antagonist well known to treat alcoholism, with each medication alone and with placebo. 170 men and women with depression symptoms (such as a flagging mood or loss of pleasure) and drinking problems were randomly assigned to one of the treatments or placebo for about 14 weeks. All participants also received cognitive behavioral therapy once a week, a type of psychotherapy that aims to disrupt destructive patterns of thinking and acting and to teach better problem solving skills.

The major findings: More depressed alcohol-dependent individuals receiving the combination of sertraline and naltrexone

  • achieved abstinence from alcohol (53.7%) during the study;
  • had delayed relapse to heavy drinking (median delay, 98 days);
  • reported fewer serious adverse effects (11.9%), such as inpatient detoxification and/or rehabilitation; and
  • tended not to be depressed in the final three weeks of the trial.

Notably, the dosages of sertraline (200 mg/day) and naltrexone (100 mg/day) were generally higher than the amounts recommended on the medication labels.

Nonetheless, all participants had significant reductions in depression symptoms, which may be attributable to cognitive behavioral therapy, according to the study authors.

The bottom line: "When depression and alcohol disorders occur together, each disorder often worsens the other, and patients lose hope for recovery," says Helen M. Pettinati, Ph.D., lead author of the study and research professor of psychiatry at the University of Pennsylvania. But "the findings signal an important advance in the treatment of depressed people with alcohol dependence."

Before the treatment could be recommended, these study results need to be replicated and the long-term effectiveness of the medications assessed. In the meantime, if you have a drinking problem in addition to depression, talk to your doctor about addressing both problems, so you can enjoy a better quality of life.

Obesity and Depression: What's the Connection?

March 15, 2010

Depression and obesity are widespread among Americans. Each condition carries its own set of burdens, but together, they present additional challenges. Now a new study finds a reciprocal relationship between them: depression may lead to obesity, and obesity may raise the risk of depression.

The study, published in Archives of General Psychiatry, pooled results from 15 previous studies. According to the data, being obese—defined as having a body mass index (BMI) of 30 or above—increases the risk of diagnosed depression among adults by 55%. Similarly, the mood disorder raises the odds of obesity by 58%.

So how might one condition lead to the other? It's too early to know for sure, but there are numerous theories.

How Obesity Might Lead to Depression
Obesity carries a stigma in our culture. Among the potential psychological consequences, this stigma may lead to a negative body image and lower self-esteem—both risk factors for depression. Eating disorders and pain resulting from obesity may also contribute to depression. Or, one or more biological effects could play a role: inflammation, stress response abnormalities, and/or diabetes-related changes in the brain.

How Depression Might Lead to Obesity
Depression may cause weight gain through hormonal disturbances of nerve activity. If depression leads to unhealthy habits such as eating high-calorie and junk foods and exercising less frequently, it could also promote weight gain. Or, using antidepressants may possibly lead to excess pounds—but the authors believe the effect was minimal in this study.

Future studies could examine the potential roles of specific depression characteristics, medication use, physical activity, and dietary patterns.

The bottom line: Greater awareness is key to preventing and managing these health problems. Along with your health care provider, monitor weight gain and take steps to shed excess pounds. Similarly, overweight and obese individuals shouldn't hesitate to tell their doctors that they're experiencing depression symptoms. There is help.

Antidepressants and Cataract Risk

March 15, 2010

In the United States, 75% of people over age 60 have some sign of cataracts, or clouding of the lens of the eye. Cigarette smoking, certain medications, eye injuries, sunlight, diabetes, and even obesity can increase the risk of cataracts. Now a new Canadian study suggests a possible association between certain antidepressants and development of cataracts.

For the study, published in Ophthalmology, researchers examined medical data on over 187,000 Canadians older than 65 with existing cardiovascular disease. Among the 18,784 users of selective serotonin reuptake inhibitors (SSRIs), the risk of cataracts was elevated by 15%. Risk of the eye disease was highest with fluvoxamine use (39%), followed by venlafaxine (33%), which is technically a serotonin and norepinephrine reuptake inhibitor (SNRI). Paroxetine was also associated with cataracts among those who had cataract surgery.

This study is the first to show a possible association between SSRIs and cataracts. But other factors, such as heavy smoking, can’t be ruled out. Future studies are needed to clarify if certain antidepressants indeed raise risk.

"When you look at the trade-offs of these drugs, the benefits of treating depression—which can be life-threatening—still outweigh the risk of developing cataracts, which are treatable and relatively benign," says Mahyar Etminan, lead author of the article and an assistant professor in the department of Medicine at the University of British Columbia.

In the meantime, take these steps to help prevent or detect cataracts:

  • Quit smoking,
  • wear sunglasses outdoors and
  • see your eye care professional regularly for vision exams.

Antidepressant May Interfere With Breast Cancer Treatment

February 27, 2010

The selective serotonin reuptake inhibitor (SSRI) paroxetine (Paxil®) may decrease the effectiveness of tamoxifen, a drug used to prevent and treat breast cancer, a new study suggests. The longer paroxetine use overlapped with tamoxifen treatment, the higher the chances of untimely death related to breast cancer. To put it in perspective, the researchers estimate that one extra breast cancer death would occur within 5 years of stopping tamoxifen treatment for every 20 women using both drugs 41% of the time during treatment.

What's the danger? Paroxetine may diminish tamoxifen's cancer-fighting effects. It inhibits a key enzyme, CYP2D6, involved in converting tamoxifen to its active form.

These findings, published in BMJ, have major implications, assert the study authors. The prevalence of depression among women with early breast cancer is roughly twice that of the general female population. In addition, SSRIs are prescribed to women taking tamoxifen to reduce hot flashes.

In this particular study, no risks were seen with other antidepressants. But the researchers note that SSRIs inhibit CYP2D6 to varying degrees and may reduce tamoxifen's effectiveness. Fluoxetine (Prozac®), for example, is also a strong inhibitor of CYP2D6.

The bottom line: Tamoxifen is beneficial for breast cancer treatment. In women with early stage estrogen-receptor positive breast cancer, tamoxifen reduces the risk of recurrence by about half and the risk of breast cancer death by about a third. If you're taking tamoxifen and paroxetine or fluoxetine, talk to your doctor about switching to an antidepressant that shows little or no inhibition of CYP2D6.

Can Acupuncture Help Depressed Pregnant Women?

February 27, 2010

Acupuncture that's specific for depression may benefit some pregnant women with the mood disorder, suggests a new study published in Obstetrics & Gynecology. In the 8-week study, depression-specific acupuncture—based on traditional Chinese medicine—outperformed traditional acupuncture and Swedish massage in reducing the severity of depression symptoms. The special acupuncture's response rate was also greater: 63% versus 44% for the other therapies. But notably the groups had similar rates of depression remission, characterized by the absence of sadness and an ability to feel pleasure.

Side effects of acupuncture included temporary discomfort and bleeding at the point of needle insertion.

According to the authors, depression-specific acupuncture may be a viable treatment option for some pregnant women. The response rate from the acupuncture was comparable to standard depression treatments, such as interpersonal psychotherapy.

The bottom line: Although promising, more research needs to be done before depression-specific acupuncture is widely recommended. For example, future studies need to include depressed individuals with co-occurring mental disorders.

Excessive Internet Use Linked to Depression

February 15, 2010

People who spend a lot of time surfing the Internet are more likely to suffer depressive symptoms, according to a British study. These users report more symptoms on the Beck depression inventory, a questionnaire that gauges emotional and physical aspects, such as hopelessness, irritability, feelings of guilt, fatigue and weight loss.

In addition, a small subset of people who surf the Internet compulsively report high levels of depressive symptoms. These users spend more time browsing sexually-gratifying websites, gaming sites and online communities; the Internet appears to replace real-life social interaction.

"Our research indicates that excessive internet use is associated with depression, but what we don't know is which comes first—are depressed people drawn to the internet or does the internet cause depression?," points out lead author Catriona Morrison of the University of Leeds in the UK. "What is clear, is that for a small subset of people, excessive use of the internet could be a warning signal for depressive tendencies."

According to the Center for Internet Addiction, answering "yes" to any five of the following questions qualifies as an Internet addiction diagnosis:

  1. Do you feel preoccupied with the Internet (think about previous online activity or anticipate next online session)?
  2. Do you feel the need to use the Internet with increasing amounts of time in order to achieve satisfaction?
  3. Have you repeatedly made unsuccessful efforts to control, cut back, or stop Internet use?
  4. Do you feel restless, moody, depressed, or irritable when attempting to cut down or stop Internet use?
  5. Do you stay online longer than originally intended?
  6. Have you jeopardized or risked the loss of significant relationship, job, educational or career opportunity because of the Internet?
  7. Have you lied to family members, therapist, or others to conceal the extent of involvement with the Internet?
  8. Do you use the Internet as a way of escaping from problems or of relieving a dysphoric mood (e.g., feelings of helplessness, guilt, anxiety, depression)?

The study published in the journal Psychopathology involved 1,319 Internet users ages 16 to 51. Eighteen participants—or roughly 1%—displayed behaviors consistent with Internet addiction. The differences in depressive symptoms were significant: The non-addicted group scored firmly in the non-depressed range, and the Internet-addicted group in the moderately-to-severely depressed range. With larger studies, the researchers hope to clarify the relationship between Internet use and depression.

Family Therapy Helps Teens With Suicidal Thoughts

February 15, 2010

Young adults suffering with suicidal thoughts and depression had stronger and faster reduction of their symptoms when treated with attachment-based family therapy than with usual care, according to a new study. Teens with severe suicidal thinking who participated in the family therapy were at least four times more likely to have no suicidal thoughts immediately following and 3 months after treatment.

Family involvement may be one key. "Most treatment models mainly work with the adolescents alone, helping them to learn new coping and problem-solving strategies," says study leader Guy S. Diamond, Ph.D., director of the Center for Family Intervention Science at the Children's Hospital of Philadelphia. "But adolescents are highly influenced by their parents. Family conflict, chaos, and strife can contribute to youth suicide, while at the same time family love, trust, and communication can buffer against it. This therapy aims to resolve family conflicts and promote family strengths so that the appropriate bond of attachment can protect youth from self-harm. Parents are not viewed as the problem, but as the curative medicine."

For the study, researchers studied 66 children ages 12 to 17 who visited a primary care doctor or hospital with severe suicidal thinking and depressive symptoms. The next step is to conduct larger studies to clarify which, if any, aspects of the therapy are protective.

January 29, 2010

It's not surprising that some people with depression experience migraine headaches. In fact, research shows that people with depression are 3 times more likely to experience migraine; and four times more likely to experience migraine with aura, headache preceded by visual disturbances such as flashes of light.

It's also understandable that individuals with troubling migraines—headaches accompanied by nausea, vomiting and/or hypersensitivity to light and sound—tend to feel depressed. These migraineurs are 2 to 6 times more likely to suffer depression symptoms.

Previous research has focused on how one disorder may lead to the other. But some scientists now believe that there is another connection between depression and migraine headache: a strong, underlying genetic component.

In a recent study, published in the journal Neurology, researchers looked at the incidence of depression and migraine in the Erasmus Rucphen Family, the descendents of 22 Dutch couples who lived in one part of the Netherlands from the 1850s to 1900s. Of the over 2,600 family members who were studied, 977 had depression and 360 had migraine. Notably, twenty-five percent of migraineurs also had depression, compared to 13% of people without the headaches. Depression was more often seen in people who experienced migraine with aura.

After adjusting heritability scores—the percentage of a trait that is explained by genetic effects—the researchers found a correlation between depression and migraine—particularly migraine with aura. "This suggests that common genetic pathways may, at least partly, underlie both of these disorders, rather than that one is the consequence of the other," says lead study author Gisela M. Terwindt, M.D., Ph.D., of Leiden University Medical Center in the Netherlands.

While more research is needed, the study adds to the understanding of both disorders. It may lead to preventive strategies. And in an accompanying editorial, Andrew Ahn, M.D., Ph.D., of the University of Florida in Gainesville wrote: "Understanding the genetic factors that contribute to these disabling disorders could one day lead to better strategies to manage the course of these diseases when they occur together."

The bottom line: If you are experiencing headaches along with depression, don't suffer in silence. Talk to your doctor about getting an accurate diagnosis of your type of headache and treating both conditions. Depression may make migraines more frequent.

Lifestyle adjustments—such as getting more good-quality sleep—may help. In terms of drug therapy, sometimes a single medication will treat both conditions. But in other cases, separate medications will offer more relief. Collaborating with your doctor is the best way to find effective treatments.

SSRIs Affect Breast Milk Production

January 29, 2010

Taking selective serotonin reuptake inhibitors (SSRIs) may delay the start of breast milk production, according to a new study. Beyond 72 hours is considered to be delayed lactation in women who have just given birth. And the median onset among new mothers taking SSRIs was very late: 85.8 hours after delivery (compared to 69.1 hours among other women).

But women who breastfeed early are more likely to continue with the practice for the recommended six months, according to the study authors. Compared to using baby formula, breastfeeding for a full six months provides infants with additional nutrients and antibodies that help protect them from illness as well as fosters growth. Currently, only about 11% of all new mothers in the United States breastfeed exclusively for six months.

Many women face early breastfeeding difficulty—especially first-time mothers. So it's a widespread problem.

So how might SSRIs affect breast milk production? The neurotransmitter serotonin appears to help regulate breast milk production, according to the researchers. In an animal experiment, SSRIs disrupted certain processes affecting serotonin that may have caused breast milk production to dwindle.

This study, published online in The Journal of Clinical Endocrinology & Metabolism, is the first to report on SSRIs and breast milk secretion. Other studies have investigated whether SSRI medications pass into breast milk, the associated safety implications, and whether SSRIs cause developmental defects in infants.

That said, these results should be considered preliminary. The study was observational and involved only a small sample of women, so larger, clinical studies are needed to confirm the findings.

The bottom line: As previously reported, a 2009 report by the American Psychiatric Association and the American College of Obstetrics & Gynecology suggests that women with mild to moderate depression who are trying to conceive consider psychotherapy—particularly cognitive behavior therapy or internal psychotherapy—as first-line treatment for depression instead of medications.

Women who have severe depression or who prefer to keep taking antidepressants should talk to their doctors about the relative benefits and risks of various antidepressant medications.

If you are now pregnant, don't stop taking your antidepressant without talking to your doctor. There are risks associated with suddenly stopping depression medications. Uncontrolled depression also carries risks for both mother and child.

In conclusion, there is no universal "best answer" for all women, according to the 2009 report. Instead the decision to continue or change medication should be made by a woman in collaboration with her doctor.

Clearing Up the Confusion Over Antidepressants' Effectiveness

January 18, 2010

A recent study examining how well antidepressants work has stirred debate and raised more than a few questions. It concludes that, whereas antidepressant medications substantially benefit people with severe depression, they appear to have little or no effect over placebo in people with mild or moderate depression.

Those startling findings have left some people with depression wondering whether to continue taking their antidepressant medications. But according to several experts, it's premature to change antidepressant prescribing habits because the study had some notable limitations.

First, the study, published in the Journal of the American Medical Association (JAMA), is a meta-analysis, not a clinical trial. Rather than independently testing antidepressants' effectiveness in a large sample of people with depression, it pooled data from six previous trials.

In addition, experts point out that the JAMA study examined data on just a couple of the antidepressants currently on the market: the tricyclic antidepressant imipramine and the selective serotonin reuptake inhibitor paroxetine. It remains to be seen whether these results can and should be generalized to all antidepressants.

The bottom line: Continue to take your antidepressant medication. If you have concerns about the effectiveness of your depression treatment, talk to your doctor. Remember, you need to allow a reasonable time period to see how well your current antidepressant is working. It's also common for people with depression to try a few antidepressant medications before finding one that works. Consider psychotherapy, too. Research shows that talk and behavioral therapies effectively relieve depression symptoms. Talk to your doctor or a mental health professional.

Earlier Bedtimes May Help Protect Teens Against Depression and Suicidal Thoughts

January 18, 2010

If you have a teenager at home, here's another reason to get him or her to bed at a decent hour. New research published in the journal Sleep has found that teens with set bedtimes of midnight or later are 24% more likely to suffer from depression and 20% more likely to have suicidal thoughts than teens who hit the sack by 10 p.m. or even earlier.

This study, which involved over 15,000 middle- and high-school students, strengthens the argument that getting too little sleep may contribute to adolescent depression.

"It is a common perception and societal expectation that adolescents do not need as much sleep as pre-adolescents, yet studies suggest that adolescents may actually require more sleep," said James Gangwisch, Ph.D., of the New York State Psychiatric Institute and Columbia University Medical Center and lead author of the study.

What appears to matter is the number of sleep hours: "Adolescents with later parental mandated bedtimes went to bed later, got less sleep, and were less likely to get enough sleep," explains Gangwisch. "Short sleep duration explained the relationship between parental mandated bedtimes and depression, functioning as a risk factor for depression and suicidal ideation."

So what's the right amount of sleep? According to the American Academy of Sleep Medicine, teenagers should be getting a little more than nine hours of shuteye a night.

The bottom line: While it's not uncommon for teens to want to stay up talking on the phone, watching TV, or using the computer, the bedtimes parents and caregivers set do matter. Stick to your rules about an earlier bedtime, and you may be protecting your teen's mental health. Visit the American Academy of Sleep Medicine for more sleep tips for adolescents.

Antidepressant May Change Personality While Relieving Depression Symptoms

January 4, 2010

People taking a selective serotonin reuptake inhibitor (SSRI) to treat depression may experience beneficial changes in their personality that is distinct from relief of depression symptoms, concludes a new study published in the Archives of General Psychiatry.

According to emerging research, two personality traits—high neuroticism and possibly low extroversion—may reflect vulnerability to major depression. Neuroticism and extroversion are two of five primary personality dimensions in the Five-Factor Model of Personality. Neuroticism describes a tendency to experience negative emotions and emotional instability. Extroversion encompasses energy, positive emotions, and the tendency to seek stimulation in the company of others.

Both personality traits have been linked to the brain's serotonin system—a target of SSRIs. That led scientists to wonder if SSRIs affect personality. To find out, researchers in the study randomized 240 adults with moderate-to-severe depression to receive one of three therapies: treatment with the SSRI paroxetine (Paxil), cognitive behavioral therapy, or a placebo (sham therapy).

The results: People in all three groups experienced depression improvement. But people taking the SSRI paroxetine reported 6.8 times more change in neuroticism and 3.5 times more change in extroversion as people taking a placebo when matched for depression improvement.

Researchers conclude that paroxetine (Paxil) appears to have a specific effect on personality that is distinct from its effect on depression. If future studies confirm these results, according to the researchers, it could indicate that "SSRIs' effects on personality go beyond and perhaps contribute to their antidepressant effects."

Do Antidepressants Increase the Risk of Heart Attack, Stroke or Early Death?

January 4, 2010

Antidepressants are one of the most widely prescribed medications, but how they affect the risks of heart disease, stroke, and early death remains unclear. Antidepressant safety is an important issue, particularly for postmenopausal women who due to aging, declining estrogen levels, and/or other factors have greater risks of both depression and cardiovascular diseases.

To get some answers, researchers examined new antidepressant use among more than 136,000 mostly Caucasian women ages 50 to 79 in the Women's Health Initiative. They then compared health outcomes of women taking antidepressants to women not taking depression medication.

Of the group, roughly 5,500 women started taking antidepressants during the study. More than half were taking selective serotonin reuptake inhibitors (SSRIs), about a quarter received tricyclic antidepressants (TCAs), and about 18 percent took another antidepressant or multiple depression medications.

Here are the major findings published in the Archives of Internal Medicine:

  • Early Death: Use of any antidepressants was associated with a greater risk of premature death.
  • Stroke: Taking an SSRI appeared to increase the chances of stroke by 45%—particularly hemorrhagic stroke—although the actual number of women affected was very small. If future research confirms these findings, the researchers note that SSRIs have an anti-clotting effect that could help explain abnormal bleeding.
  • Heart Attack: Taking any antidepressant did not appear to raise the risk of heart attack.

So if you're taking an SSRI or TCA should you worry? According to the researchers, although these results raise concern, they should be interpreted cautiously. Since the study was simply observational, causes and effects couldn't be determined. For example, it's possible that the cardiovascular risks are due partly to depression itself.

The scientists also point out that untreated or inadequately treated depression can lead to substantial disability and impair quality of life. For those reasons, antidepressant treatment is valuable.

The bottom line: If you're taking antidepressants, ask your doctor about other ways to control your risk factors for heart disease and stroke. Your doctor may suggest lifestyle changes—such as a heart-healthy diet, regular physical activity, and appropriate weight loss—and/or medications to control high blood pressure, high cholesterol, and related health conditions.

FDA Approves Seroquel XR® as an Add-on Treatment for Depression

December 21, 2009

For adults with major depressive disorder whose symptoms don't improve significantly with antidepressants alone, the Food and Drug Administration (FDA) has recently approved the drug Seroquel XR (quetiapine fumarate). Seroquel XR is a once-daily, extended-release form of Seroquel, an atypical antipsychotic drug that has been used to treat schizophrenia and bipolar disorder. To help treat major depression, Seroquel XR would be added to antidepressant therapy.

Seroquel XR was shown to be safe and effective in two six-week trials involving over 900 adults who continued to have major depression symptoms despite having used at least one antidepressant for a course of treatment (six weeks). The participants had been taking various antidepressants before the study including SSRIs (paroxetine, fluoxetine, sertraline, escitalopram, or citalopram), SNRIs (duloxetine and venlafaxine), tricyclic antidepressant (amitryptyline), or other depression treatments, such as bupropion. Seroquel XR was administered as 50 mg per day on days 1 and 2, and increased to 150 mg per day on day 3. On day 5, some of the study participants continued with the 150 mg dose while others started taking a higher dose of 300 mg per day.

In one of the two trials, participants taking the 150 mg daily dose experienced improvement compared to a control group taking antidepressants alone. Participants in both trials taking the 300 mg daily dose of Seroquel XR also reported fewer depressive symptoms (such as sadness, tension, lack of sleep, poor appetite, difficulty concentrating, fatigue, lack of feeling, pessimistic thoughts or suicidal thoughts).

The most common side effects of Seroquel XR were

  • sleepiness
  • dry mouth
  • constipation
  • dizziness
  • increased appetite
  • indigestion
  • weight gain
  • fatigue
  • speech impairment
  • nasal congestion

According to the drug label, more serious side effects include high blood glucose levels, diabetes, abnormal lipid levels (increased triglyceride levels and "bad" LDL cholesterol levels; decreased "good" HDL cholesterol), low blood pressure, and low white blood cell count. Seroquel XR may cause tardive dyskinesia, a neurological disorder involving uncontrollable movements of the mouth, tongue, limbs, and other body parts and, in rare cases, a potentially fatal complex called neuroleptic malignant syndrome (symptoms include high fever, stiff muscles, profuse sweating, altered mental state and irregular pulse, heartbeat or blood pressure).

The drug label warns of an increased risk of suicidal thinking and behavior in children, adolescents and young adults taking antidepressants for major depressive disorder and other psychiatric disorders. (Seroquel XR is not approved for children under age 18.)

If you are interested in taking Seroquel XR along with your antidepressant to help treat major depression, talk to your doctor about the potential risks and benefits. Seroquel XR should not be used by seniors with dementia-related thought disorders. According to a news report, the FDA has required that the makers of Seroquel XR, AstraZeneca, implement a Risk Evaluation and Mitigation Strategy (REMS) that includes a medication guide and periodic assessments.

Depressed Women Can Lose Weight

December 21, 2009

If you are overweight, don't let depression stop you from participating in a weight loss program to help you shed pounds. A recent study published in the journal Behavioral Medicine reveals that women with major depression are no less likely than women without the disorder to lose weight.

The study included almost 200 women ages 40 to 65 with a body mass index (BMI) of 30 or higher: 65 women had major depressive disorder and 125 did not. The depressed women, who had not been seeking depression treatment, agreed to enroll in a one year weight loss program that involved group sessions, diet and exercise. After the one year, women with major depressive disorder lost more than 6½ pounds, while women without the disorder lost close to 8 pounds.

"We expected women with major depression to lose less weight, attend fewer sessions, eat more calories, and get less exercise than those without depression," says Evette J. Ludman, Ph.D., the lead author of the study. "We were surprised to find no significant differences between the women who had depression and those who did not have it."

What was the key to successful weight loss? "Just showing up," says Dr. Ludman. Women who attended at least 12 treatment sessions lost more weight than women who attended fewer sessions, regardless of their depression status.

Antidepressants Linked to Falls

December 4, 2009

Falls are a major problem for older adults, causing injury, disability and, in serious cases, death. Poor muscle strength, thinning bones, certain medical conditions, medications, and a variety of other factors may contribute to greater risk. Now a study presenting updated research on medication use and the risk of falls finds that people taking antidepressants are more likely to experience falls. Taking benzodiazepines for mood disorders or sedatives and hypnotics for sleep problems were also associated with greater risk.

The researchers couldn't determine whether the medications themselves, the medical conditions these drugs treat, or some other factor was to blame. But drowsiness and/or dizziness are common side effects of using antidepressants and benzodiazepines.

In the study, published in the Archives of Internal Medicine, researchers looked at fall occurrences among 79,000 participants age 60 and older and the use of medications in nine unique drug classes (including high blood pressure medications, other heart drugs, antipsychotics, narcotics, and nonsteroidal anti-inflammatory drugs).

More research using larger samples of patients needs to be done before firm conclusions can be made. In the meantime, the study authors suggest doctors use caution when prescribing these medications to seniors.

If you're taking medication for depression treatment or for a mood disorder, talk to your doctor about the potential side effects, including the risk of falls. Also follow these general tips from the Centers for Disease Control and Prevention (CDC) on preventing fall injuries.

  • Exercise regularly; exercise programs like Tai Chi that increase strength and improve balance are especially good.
  • Ask your doctor or pharmacist to review all of your medicines—both prescription and over-the counter—to reduce side effects and interactions.
  • Have your eyes checked by an eye doctor at least once a year to manage vision problems.
  • Improve the lighting in your home.
  • Reduce hazards in your home that can lead to falls. Remove loose rugs and items blocking entrances and hallways; fasten electric cords to the wall; and consider mounting grab bars near tubs and showers.

FDA Approves Cymbalta® for Maintenance Treatment of Generalized Anxiety Disorder

December 4, 2009

Cymbalta® (duloxetine HCl), which has been used to treat acute phases of generalized anxiety disorder (GAD) in adults, is now FDA-approved for extended treatment of the disorder, according to a press release from Eli Lilly and Company. This new approval demonstrates the drug's effectiveness in preventing recurrence of anxiety symptoms.

The efficacy and safety of Cymbalta for the maintenance treatment of GAD were established in a double-blind, placebo-controlled trial, according to the press release. Patients with GAD who initially had responded to treatment with Cymbalta 60 to 120 mg/day during a 26-week open-label phase were randomly assigned to receive Cymbalta 60 to 120 mg/day (216 patients) or placebo (213 patients). At the end of the trial, patients taking Cymbalta experienced a statistically significantly longer time to relapse of GAD symptoms than did patients taking placebo. The estimated probability of relapse at 26 weeks of maintenance treatment was 46.4 percent for placebo and 15 percent for Cymbalta.

The most commonly reported side events in patients taking Cymbalta in the trial included nausea, headache, dry mouth, diarrhea, dizziness, constipation, fatigue, and increased sweating.

People with generalized anxiety disorder experience excessive anxiety and worry more days than not for six months or more. The excessive anxiety and worry is difficult to control and causes significant distress or impairment in normal functioning. It is also associated with at least three of the following symptoms: restlessness or feeling keyed up or on edge; being easily fatigued; difficulty concentrating or experiencing the mind going blank; irritability; muscle tension; and/or sleep disturbance.

In addition to treating generalized anxiety disorder, Cymbalta® (duloxetine HCl) is approved for the treatment of major depressive disorder, diabetic nerve pain, and fibromyalgia.

If you have generalized anxiety disorder, and you're interested in Cymbalta for maintenance treatment, talk to your doctor about the potential risks and benefits of the anxiety medication.

FDA Warns of Potential Drug Interaction

November 23, 2009

The Food and Drug Administration (FDA) has issued a public-health warning about a possible interaction between the anti-clotting drug clopidogrel (Plavix®) and the GERD medication omeprazole (Prilosec®). In the same alert, the FDA also suggests that people taking clopidogrel should not use it along with the antidepressants fluoxetine (Prozac®, Sarafem®, Symbyax®) or fluvoxamine (Luvox®).

Why the warnings? New unpublished research suggests that omeprazole reduces the effectiveness of clopidogrel, a popular drug used to prevent heart attack and strokes. The GERD medication inhibits CYP2C19, a drug-metabolizing enzyme that converts clopidogrel into its active form. Using the two drugs together may reduce the anti-clotting effect of clopidogrel by as much as half. Timing the drugs didn't appear to help: Reductions were seen whether the proton pump inhibitor and blood thinner were given at the same time or 12 hours apart. The clopidogrel medication label will be updated accordingly.

How does all of this relate to antidepressant treatment? Fluoxetine and fluvoxamine (as well as other medications) are also potent inhibitors of the CYP2C19 enzyme, which suggests that these selective serotonin reuptake inhibitors (SSRIs) may produce a similar effect.

More research is forthcoming, so stay tuned for updated information from the FDA. In the meantime, if you take clopidogrel for heart disease and fluoxetine or fluvoxamine for depression, don't stop taking the medications until you talk to your doctors and discuss treatment options.

Phone Program Helps Depressed Heart Patients

November 23, 2009

For people suffering with depression symptoms following heart surgery, help may be just a phone call away. A study published in the Journal of the American Medical Association found that people who experienced symptoms of depression after coronary artery bypass graft (CABG) surgery had greater improvements in overall mental health, physical functioning, and mood symptoms if they regularly spoke to a nurse care manager by phone.

CABG surgery is commonly performed to relieve chest pain (angina) and improve quality of life for heart patients. Yet, as many as half of these patients report depression symptoms following surgery, and depression has been linked to poorer outcomes.

In the Bypassing the Blues trial, researchers compared the collaborative care program to usual physician care. For 8 months following surgery, a nurse care manager working with the primary care physician regularly called a patient to discuss current symptoms and address treatment issues, such as:

  • the individual's mental health history and present state of mind
  • depression and its effect on heart disease
  • self-management techniques
  • treatment options
  • real-time adjustments to treatment suggested by the patient's primary care doctor
  • referrals to a mental health specialist, when needed

Each case was also routinely reviewed by the study's psychiatrist and internist, who made further recommendations. The nurse care manager played the instrumental role of communicating the patient's symptoms to the doctors and the doctors' advice to the patient. The nurse care manager also called in prescriptions and located local mental health providers as needed.

The efforts paid off in better mental health for many of the heart patients. The researchers suggest that future studies clarify which elements of the program were the most beneficial and determine how to incorporate them into everyday practice.

Whole Foods Diet May Protect Against Depression

November 11, 2009

Eating a whole foods diet may not only stave off weight gain, it may also help prevent depression. In a study published in the British Journal of Psychiatry, Caucasian, middle-aged adults who consumed a diet rich in fruits, vegetables, and fish reported fewer depression symptoms on a depression test (the Center for Epidemiologic Studies Depression Scale or CES-D) five years later, compared to people who frequently ate processed foods. By comparison, participants whose eating habits revolved around processed meat, high-fat dairy products, and fried, refined, and sugary foods had a more than 50 percent higher chance of depression symptoms. The association between diet and depression held even after controlling for physical activity, smoking, total energy intake, and other factors.

Food & Mood
If poor diet does indeed cause depression symptoms, the researchers note that one or more of the following mechanisms might be at work:

  • The rate of depression may rise with sugar consumption.
  • Processed foods may promote inflammation and heart disease, which may contribute to depression.
  • Insulin resistance and/or other disease processes could be to blame.

The protective effects of a whole foods diet could come from antioxidants, folate or fatty acids, or the combined effects of nutrients in these foods. Although previous research has focused on isolated nutrients and depression, this study is among the first to examine overall dietary patterns and the risk of experiencing symptoms of this mood disorder.

The researchers note that more research needs to be done to confirm that diet influences depression and not the reverse.

The bottom line: While the study group was limited, adopting healthy eating habits is generally a good idea for most people. Whole foods are closer to a natural state, receive minimal or no processing, and typically contain no added fats, sugars or salt. Try tasty options such as raw fruits and vegetables, unpolished whole grains, and minimally processed fish, poultry, and meat.

Treating Adolescent Depression: Results from the TADS study

November 11, 2009

Good news for teenagers suffering from major depressive disorder and their families: Researchers examining results from the Treatment for Adolescents With Depression Study (TADS) reached several helpful, evidence-based conclusions.

In the TADS study, which began in 1999, depressed teens received active treatment with either the selective serotonin reuptake inhibitor (SSRI) fluoxetine (Prozac®), cognitive behavioral therapy (CBT), or both medication and CBT (a specific type of psychotherapy) for 9 months; they were followed for a year afterwards.

Among the key findings of the study published in the American Journal of Psychiatry:

  • Receiving longer-term treatment for nine months results in better outcomes than short-term therapy (12 weeks).
  • Longer-term depression treatment (with drug therapy, CBT, or both) may reduce the chances of relapse or recurrence when active treatment is discontinued.
  • Combined treatment with the antidepressant and cognitive behavioral therapy may improve the rate of recovery from depression compared to fluoxetine or CBT alone. During cognitive behavioral therapy, adolescents develop skills to combat negative thinking and change unhealthy behaviors.
  • Adding CBT to medication appears to minimize persistent suicidal thoughts and suicide attempts in teens taking the antidepressant fluoxetine.

To help depression in adolescents, the researchers note that additional clinical trials need to be done to determine optimal treatment. As every teen may respond differently to therapy, it remains important for health care providers and families to make treatment decisions on an individual basis.

For more information about adolescent depression, visit the NIMH Depression in Children and Adolescents web page.

Suicidal Thoughts Appear To Vary by Antidepressant

November 2, 2009

Men who take the antidepressant nortriptyline (Aventyl, Pamelor) are nearly 10 times more likely to have suicidal thoughts than those who take the antidepressant escitalopram (Lexapro), according to a new study published in the journal BMC Medicine.

Previous evidence of suicidal thoughts and behaviors associated with antidepressant treatment—particularly during the first weeks of treatment for depression—has prompted safety warnings by drug regulatory agencies around the world. These warnings are controversial and have reduced prescribing rates, unintentionally increasing the risk of suicide among people suffering from depression who go untreated.

The goal of this study was to investigate whether suicidal thoughts emerged or worsened depending on the type of antidepressant used for treating depression.

The study included 811 people with moderate to severe depression. Though it reported an overall reduction in suicidal thoughts over the 12-week treatment period, men who took nortriptyline were found to have a 9.8-fold increase in emerging suicidal thoughts and a 2.4-fold increase in worsening suicidal thoughts, compared with men who took Lexapro.

This study refutes the idea that the newer antidepressants—the selective serotonin reuptake inhibitors (SSRIs)—are worse than older medications in terms of increasing suicidal thoughts. Lexapro is an SSRI; nortriptyline belongs to the older class of antidepressants known as tricyclics.

Retired or unemployed men and those with a history of past suicide attempts were at particular risk of worsening suicidal thoughts when undergoing antidepressant treatment and should be carefully monitored throughout antidepressant treatment.

New Antidepressant in the Pipeline

November 2, 2009

A potential new medication just passed through another testing phase, showing great promise in the treatment of depression. It's called Serdaxin, and it elevates levels of chemical messengers in the brain (neurotransmitters) believed to be involved in mood regulation, specifically serotonin and dopamine.

The latest phase of testing assessed Serdaxin's safety and preliminary effectiveness. The study was designed to meet the gold standard of research (a randomized, double blind, placebo-controlled and dose-ranging study). It enrolled 77 patients aged 18-65 with major depressive disorder and was conducted at multiple sites across the United States.

The study showed that participants taking Serdaxin experienced substantial improvement in symptoms of depression as measured by a standard scale (the Montgomery-Asberg Depression Rating Scale, or MADRS). What's more, the positive response occurred within two weeks! This is fast relative to other antidepressants on the market.

In addition, there was a considerably lower drop-out rate among participants taking Serdaxin compared with those taking a dummy pill (placebo), meaning participants were able to tolerate any drug side effects.

That's three for three when it comes to factors that define a medication’s success: safety, efficacy, and tolerability.

Stay tuned for results from the next phase of drug testing for Serdaxin. If its promise holds up in future trials, we could soon have another medication to add to our arsenal of antidepressant treatments.

Antismoking Drug Not Linked to Risk of Self-harm or Depression

October 12, 2009

Despite previous reports linking the antismoking drug Chantix® (varenicline) to suicide, suicidal thoughts, and depression, a new study published in the British Medical Journal shows that, if such a risk exists, it is likely to be very small.

Last July, the Food and Drug Administration (FDA) issued labeling requirements for Chantix and another antismoking drug, Zyban® (bupropion), to include its strongest safety message, warning that people taking the drugs should be closely watched for signs of suicidal thoughts, hostility, and depressed mood. According to the FDA, 98 suicides and 188 suicide attempts had been reported among people taking Chantix since the drug was approved for sale in the United States in 2006. (Fourteen suicides and 17 suicide attempts had been reported in users of Zyban.)

Despite the FDA’s warning, few large-scale studies had been conducted to accurately assess the mental health risks. Assessing risk is difficult because of the need to control for factors such as previous smoking habits and the presence of certain diseases. For example, people who smoke already have a two- to-threefold increased risk of suicide, since smoking is common among people with psychiatric illness, according to the researchers.

To clarify the risk, researchers from the University of Bristol and the UK's Medicines and Healthcare products Regulatory Agency (MHRA) compared the risk of self-harm among 80,660 patients, aged 18 to 95, who were prescribed a new course of any smoking-cessation product—Chantix, Zyban, or nicotine replacement products—between September 2006 and May 2008.

The researchers found "no clear evidence" that Chantix was associated with an increased risk of suicide or self-harm.

More studies are needed to further quantify the mental health risks associated with taking Chantix, but any risk should be weighed against the effectiveness of Chantix as an antismoking drug and the risks associated with continuing to smoke.

Depression Poses Dilemma for Pregnant Women

October 12, 2009

Pregnant women suffering from depression face a dilemma: take an antidepressant that might pose a risk to the fetus or battle through the depressive symptoms that could harm the baby in other ways?

To help women in this predicament decide on a course of action, experts from the American Psychiatric Association (APA) and the American College of Obstetricians and Gynecologists (ACOG) teamed up to review existing data and make recommendations for managing depression during pregnancy.

Unfortunately, existing data are limited, given that pregnant women are rarely recruited for clinical trials. There are no data, for example, from the kind of randomized controlled trials considered the gold standard of research. Rather, much of our current information comes from large European observational studies that cannot control for factors other than medication use that may be affecting the pregnancies.

As many as 25% of all pregnant women suffer from depression; about 12.5% use an antidepressant at some point during pregnancy, according to the latest statistics. Although many antidepressants appear to be safe, studies have reported a slight increased risk of some fetal defects. Drug withdrawal and persistent pulmonary hypertension—a condition that can impair blood flow to the lungs—are other potential newborn problems.

Recently, a Danish study in the British Medical Journal reported a link between pregnant women's use of several antidepressants in the selective serotonin reuptake inhibitor (SSRI) class (e.g., Celexa, Zoloft) and an increased risk for a common heart defect in newborns.

A new study in The Archives of Pediatrics & Adolescent Medicine reports that newborns of mothers who use SSRIs were more likely to have low scores on the five-minute Apgar test—an overall measure of newborn health.

On the other hand, studies have linked untreated depression during pregnancy to premature births.

The current report from the APA and ACOG, published in the September-October issue of General Hospital Psychiatry, highlights that no general rules apply; i.e., all treatment decisions should be made case by case.

The report recommends that talk therapy be the first-line treatment for mild to moderate depression. For severe cases of depression, the risks of antidepressants and even electroshock therapy are relatively low. But, again, the overall take-home message from the report is that generalizations are not possible based on existing data; treatment choice remains an individual decision.

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