Depression: ‘Now the Second biggest cause of disability’ in world

By Helen Briggs BBC News

Depression
Depression is common across the world

 

Depression is the second most common cause of disability worldwide after back pain, according to a review of research.

The disease must be treated as a global public health priority, experts report in the journal PLOS Medicine.

The study compared clinical depression with more than 200 other diseases and injuries as a cause of disability.

Globally, only a small proportion of patients have access to treatment, the World Health Organization says.

“Depression is a big problem and we definitely need to pay more attention to it than we are now”

End Quote Dr Alize Ferrari University of Queensland

Depression was ranked at number two as a global cause of disability, but its impact varied in different countries and regions. For example, rates of major depression were highest in Afghanistan and lowest in Japan. In the UK, depression was ranked at number three in terms of years lived with a disability.

Dr Alize Ferrari from the University of Queensland’s School of Population Health led the study.

“Depression is a big problem and we definitely need to pay more attention to it than we are now,” she told BBC News.

“There’s still more work to be done in terms of awareness of the disease and also in coming up with successful ways of treating it.

“The burden is different between countries, so it tends to be higher in low and middle income countries and lower in high income countries.”

Policy-makers had made an effort to bring depression to the forefront, but there was a lot more work to be done, she added.

“There’s lots of stigma we know associated with mental health,” she explained.

“What one person recognises as disabling might be different to another person and might be different across countries as well, there are lots of cultural implications and interpretations that come in place, which makes it all the more important to raise awareness of the size of the problem and also signs and how to detect it.”

The data – for the year 2010 – follows similar studies in 1990 and 2000 looking at the global burden of depression.

Commenting on the study, Dr Daniel Chisholm, a health economist at the department for mental health and substance abuse at the World Health Organization said depression was a very disabling condition.

“It’s a big public health challenge and a big problem to be reckoned with but not enough is being done.

“Around the world only a tiny proportion of people get any sort of treatment or diagnosis.”

The WHO recently launched a global mental health action plan to raise awareness among policy-makers.

http://www.bbc.co.uk/news/health-24818048

 

Long-term use ( 6+ Months) of prescription-based painkillers increases the risk of depression

Contact: Riya Anandwala ranandwa@slu.edu 314-977-8018 Saint Louis University

ST. LOUIS – Opioid analgesics, or prescription-based narcotic pain killers, have long been known to reduce pain, but reports of adverse effects and addiction continue to surface. Now, a team of investigators led by a Saint Louis University researcher has discovered a link between chronic use of pain-relieving medication and increase in the risk of developing major depression.

The study, which was published in the Journal of General Internal Medicine on October 31 analyzed medical record data of about 50,000 veterans who had no history of opioid use or depression, and were subsequently prescribed opioid pain killers.

According to the findings, patients who started and remained on opioids for 180 days or longer were at a 53 percent increased risk of developing a new episode of depression, and those using opioids for 90-180 days were at a 25 percent increased risk compared to patients who never took opioids for longer than 1-89 days.

“These findings suggest that the longer one is exposed to opioid analgesics, the greater is their risk of developing depression,” said Jeffrey Scherrer, Ph.D. associate professor of family and community medicine at Saint Louis University and principle investigator of the study. “Opioids have long been known to allay pain and suffering, but reports of adverse effects are abundant and continue to emerge.”

Scherrer said even though there is no clear evidence about the mechanisms by which opioids may contribute to the development of depression in a patient, there could be several factors that lead to it.

Some of these include opioid-induced resetting of the brain’s ‘reward pathway’ to a higher level, which means the chronic use of narcotic pain killers can elevate the threshold for a person’s ability to experience pleasure from natural rewards such as a food or sexual activity.

Other factors may include body aches months and years after the use of opioids has stopped, side effects such as adrenal, testosterone and vitamin D deficiencies and glucose dysregulation.

The study also suggests that the higher the dose of opioid analgesics, the greater the risk of depression.

“Preliminary evidence suggests that if you can keep your daily dose low, you may be at lower risk for depression,” he said.

Scherrer notes that even though a minority of patients take these pain killers chronically, they are at risk of developing depression that can affect their quality of life and ability to cope with chronic pain.

He said recent studies indicate that the use of prescription opioid analgesics has quintupled recently and that more than 200 million prescriptions were issued to patients in 2009 in the US.

“Even though the risk is not huge, there is enough exposure that we may have a public health problem,” he said.

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Other authors of the paper include Dragan Svrakic, M.D., Ph.D., Kenneth Freedland, Ph.D., Sumitra Balasubramanian, Kathleen K. Bucholz, Ph.D., and Patrick Lustman, Ph.D., at Washington University in St. Louis, Timothy Chrusciel at St. Louis VA Medical Center, and Elizabeth Lawler of the Veterans Administration at the time when the study was completed.

Established in 1836, Saint Louis University School of Medicine has the distinction of awarding the first medical degree west of the Mississippi River. The school educates physicians and biomedical scientists, conducts medical research, and provides health care on a local, national and international level. Research at the school seeks new cures and treatments in five key areas: cancer, liver disease, heart/lung disease, aging and brain disease, and infectious disease.

NAC ( N-Acetyl Cysteine ) amino acid offers a potential therapeutic alternative in psychiatric disorders

Contact: Sonja Mak s.mak@update.europe.at 43-140-55734 European College of Neuropsychopharmacology

This press release is in support of a presentation by Professor Michael Berk on Monday Oct. 7 at the 26th ECNP Congress in Barcelona, Spain

BARCELONA, SPAIN (7 October 2013) – Improved understanding of the roles of inflammation and oxidative stress in psychiatric disorders has generated new leads in the search for novel therapies. One such investigative compound currently in clinical trials is an amino acid, N-Acetyl Cysteine (NAC), which appears to reduce the core symptoms of bipolar disorder, schizophrenia, depression, autism and cravings in addictions including cocaine, cannabis abuse and cigarette smoking.

At the start of the decade of the brain, in the early 1990s, there was great hope that a flurry of new treatment discoveries would eventuate. In contrast, today, most pharmaceutical companies have a drying psychiatry and neurology pipeline and many have exited the field entirely. “One of the factors has been an over reliance on typical monoamine pathways as targets for drug discovery,” said Professor Michael Berk, Chair in Psychiatry at Deakin University, Geelong, Australia.

Professor Berk pointed out that the situation regarding new drug development for psychiatric problems was best summarised by former National Institute for Mental Health Director, Steven Hyman: “drug discovery is at a near standstill for treating psychiatric disorders such as schizophrenia, bipolar disorder, depression and common forms of autism.”

Beyond the monoamine-based drugs, neuroscience has elucidated an array of other important pathways that are involved in most major psychiatric disorders, for example schizophrenia and both unipolar and bipolar depression. According to Professor Berk, there is now an incontrovertible evidence base that these disorders share inflammation and oxidative stress as part of their disease physiology. In addition, associated pathways including reduction in proteins that stimulate neuronal growth (neurotrophins), and increased cell death (apoptosis), as well as energy generation in organelles called mitochondria are intimately involved. “This understanding provides an entirely new set of treatment targets.”

The amino acid, NAC, seems to have multiple effects on all these pathways: it boosts glutathione, which is the body’s major antioxidant defence; has anti-inflammatory properties; enhances levels of nerve cell growth proteins and the growth of new neurons; and reduces cell death pathways. It also appears to reduce dysfunction of mitochondria.

These molecular effects of NAC have been investigated in a series of clinical trials, which show that NAC reduces the core symptoms of schizophrenia including negative symptoms such as improved apathy, social interaction and motivation. It also appears to reduce depression in people with bipolar disorder and at this meeting, new data on its role in unipolar major depression was presented. Furthermore, there is intriguing evidence that it reduces cravings in a number of addictions including cocaine, cannabis and cigarette smoking. “Apart from nausea, it appears to be relatively free of problematic side effects,” said Professor Berk.

In addition to NAC, a range of other compounds that target similar pathways, particularly inflammation, seem to have therapeutic potential. These include aspirin, cyclooxygenase (COX) inhibitors, statins, omega-3 fatty acids and even some anti-diabetic agents such as pioglitazone. “Capitalising on our understanding of inflammation and oxidative stress in major psychiatric disorders appears to give us an entirely new range of potential treatments for these common, severe and disabling conditions,” said Professor Berk.

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Contact

Michael Berk Chair in Psychiatry at Deakin University Geelong, Australia  Email: MIKEBE@BarwonHealth.org.au

ECNP Press Office

For all enquiries, please contact:

Sonja Mak  Update Europe GmbH  Tigergasse 3/5  1080 Vienna, Austria  T: +43 1 405 5734  F: +43 1 405 5734-16  E-mail: s.mak@update.europe.at

About ECNP

The European College of Neuropsychopharmacology (ECNP) is an independent scientific association dedicated to translating advances in the understanding of brain function and human behaviour into better treatments and enhanced public health. ECNP organises a wide range of scientific and educational activities, programmes and events across Europe, promoting exchange of high-quality experimental and clinical research and fostering young scientists and clinicians in the field. The annual ECNP Congress attracts around 4,000-7,000 scientists and clinicians from across the world to discuss the latest advances in brain research in Europe’s largest meeting on brain science.

Disclaimer: Information contained in this press release was provided by the abstracts’ authors and reflects the content of the studies. It does not necessarily express ECNP’s point of view.

Anti-depressant link to Clostridium difficile infection

Contact: Hilary Glover hilary.glover@biomedcentral.com 44-020-319-22370 BioMed Central

Certain types of anti-depressants have been linked to an increase in the risk of Clostridium difficile infection (CDI) finds a study in BioMed Central’s open access journal BMC Medicine. Awareness of this link should improve identification and early treatment of CDI.

CDI is one of the most common hospital acquired infections and is responsible for more than 7000 deaths annually in the USA alone. Several types of medications are thought to increase risk of CDI, including anti-depressants, and given that depression is the third most common medical condition worldwide a team from the University of Michigan investigated the exact nature of this risk.

Firstly the team studied Clostridium difficile infection in people with and without depression and found that people with major depression had a much higher chance of CDI (a 36% increase) than people without depression. This association held for a variety of depressive disorders and nervous or psychiatric problems. Age and family support also impacted risk of CDI. Older, widowed Americans were 54% more likely to catch C. difficile than their married peers. Just living alone increased risk by 25%.

Secondly they looked to see if there was an association between antidepressant medication and hospital acquired CDI. They found that use of most types of antidepressants did not affect CDI risk – out of the twelve drugs tested only mirtazapine and fluoxetine increased risk of CDI, in each case the risk was doubled.

People who have been prescribed these types of anti-depressants need to keep taking them unless otherwise advised by their physician. The researchers stress that it is not yet known whether the increase in CDI is due to microbial changes in the gut during depression or to the medications associated with depression.

Dr. Mary Rogers who led this study explained, “Depression is common worldwide. We have long known that depression is associated with changes in the gastrointestinal system.  The interaction between the brain and the gut, called the “brain-gut axis” is fascinating and deserves more study.  Our finding of a link between depression and Clostridium difficile should help us better identify those at risk of infection and perhaps, encourage exploration of the underlying brain-gut mechanisms involved.”

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Media Contact

Dr Hilary Glover Scientific Press Officer, BioMed Central Mob: +44 (0) 778 698 1967

Notes to Editors

1. Depression, antidepressant medications, and risk of Clostridium difficile infection Mary A Rogers, M Todd Greene, Vincent B Young, Sanjay Saint, Kenneth M Langa, John Y Kao and David M Aronoff BMC Medicine (in press)

Please name the journal in any story you write. If you are writing for the web, please link to the article. All articles are available free of charge, according to BioMed Central’s open access policy.

2. BMC Medicine is the flagship medical journal of the BMC series, publishing original research, commentaries and reviews that are either of significant interest to all areas of medicine and clinical practice, or provide key translational or clinical advances in a specific field. @BMCMedicine

3. BioMed Central is an STM (Science, Technology and Medicine) publisher which has pioneered the open access publishing model. All peer-reviewed research articles published by BioMed Central are made immediately and freely accessible online, and are licensed to allow redistribution and reuse. BioMed Central is part of Springer Science+Business Media, a leading global publisher in the STM sector. @BioMedCentral

Over-diagnosis and over-treatment of depression is common in the US

Contact: Natalie Wood-Wright nwoodwri@jhsph.edu 410-614-6029 Johns Hopkins University Bloomberg School of Public Health

Americans are over-diagnosed and over-treated for depression, according to a new study conducted at the Johns Hopkins Bloomberg School of Public Health. The study examines adults with clinician-identified depression and individuals who experienced major depressive episodes within a 12-month period. It found that when assessed for major depressive episodes using a structured interview, only 38.4 percent of adults with clinician-identified depression met the 12-month criteria for depression, despite the majority of participants being prescribed and using psychiatric medications. The results are featured in the April 2013 issue of Psychotherapy and Psychosomatics.

“Depression over-diagnosis and over-treatment is common in the U.S. and frankly the numbers are staggering,” said Ramin J. Mojtabai, PhD, author of the study and an associate professor with the Bloomberg School’s Department of Mental Health. “Among study participants who were 65 years old or older with clinician-identified depression, 6 out of every 7 did not meet the 12-month major-depressive-episodes criteria. While participants who did not meet the criteria used significantly fewer services and treatment contacts, the majority of both groups used prescription psychiatric medication.”

Using a sample of 5,639 participants from the 2009-2010 United States National Survey of Drug Use and Health, Mojtabai assessed clinician-identified depression based on questions about conditions that the participants were told they had by a doctor or other medical professional in the past 12 months. The study indicates that even among participants without a lifetime history of major or minor depression, a majority reported having taken prescription psychiatric medications.

“A number of factors likely contribute to the high false-positive rate of depression diagnosis in community settings, including the relatively low prevalence of depression in these settings, clinicians’ uncertainty about the diagnostic criteria and the ambiguity regarding sub-threshold syndromes,” said Mojtabai. “Previous evidence has highlighted the under-diagnosis and under-treatment of major depression in community settings.  The new data suggest that the under-diagnosis and under-treatment of many who are in need of treatment occurs in conjunction with the over-diagnosis and over-treatment of others who do not need such treatment. There is a need for improved targeting of diagnosis and treatment of depression and other mental disorders in these settings.”

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“Clinician-Identified Depression in Community Settings: Concordance with Structured-Interview Diagnoses,” was written by Ramin J. Mojtabai.

Government Psychologists tell Cypriots to accept their fate

EEV: This is one incredibly disturbing article, geared more towards social engineering and not justice.

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We can’t fight what has happened, so we should use it

By Maria-Christina DoulamiPublished on April 7, 2013
Psychologists expect cases of depression and anxiety to rise rapidly

MEDICAL experts are expecting a rapid increase in cases of depression and anxiety disorders as the extent of the economic crisis begins to register and impact on peoples’ lives.

The economic uncertainty, wage cuts and job losses of the last 18 months will now snowball as the effects of the tough conditions set by international lenders for a bailout are felt indiscriminately across society.

Psychologists all foresee an increase in depression, anxiety disorders, alcohol abuse and psychosomatic disorders – insomnia, fatigue and gastrointestinal illnesses – and even attempted suicides.

Severe, clinical depression is a biological illness and needs to be treated professionally, but those who might be suffering from milder forms are urged not to view what has happened as a tragedy, but rather as an opportunity to reform.

“The constant bombarding of talks about this crisis makes us focus on all this negativity, rendering us more vulnerable to any kind of illness,” said psychologist Dr Antonios Raftis. He likened the crisis and its burst of negativity with a river whose dividing channels have been blocked and the surge of the water downstream is such that it overflows and destroys its surroundings.

All psychologists agree that worrying constantly is unhelpful. “We cannot control life. What we can do is accept the facts and see how we can best deal with the situation,” said Dr Achilleas Koukkides, likening the crisis to a parent (the government and politicians) who has now betrayed us.

“This spreads fear and instability,” he said.

Cypriots are likely to feel particularly badly hit because social status has played such an important part in people’s lives for so long. According to Dr Jacqueline Widmer Kalochoritis, this will be even more apparent for the younger generation who have grown up believing wealth and luxury is their birth right.

“The older generations are more prepared for this crisis,” she said, “because they have experienced difficult situations in the past and know how to struggle. But the younger generation will potentially be the biggest victims of the crisis because they don’t know what it is like to fight.”

Men too will suffer, according to Widmer Kalochoritis, because in Western cultures men are still socialised to base their worth on their careers, income and wealth, and “losing that means losing their footing”.

But psychologists are eager to urge people to view the crisis as an opening to new possibilities for redefining who you are, without letting society and cultural values tell you what car to drive, what job to do, what house to live in.

Recent research indicates that the difference in the level of happiness between people who have suffered traumatic experiences and people who have, for example, won the lottery is actually statistically zero.

Widmer Kalochorits explained that people nowadays focus such a large part of their lives on their careers that everything else gains less significance. “Once that is pulled away,” she said, “as has happened with this crisis, people are forced to pay more attention to the other facets of their personality, of who they are.”

In this, focusing on relationships, marriage, family and friends are essential to maintaining some semblance of a positive attitude.

“These are the people who will support, boost and soothe you and this is the time more than ever to tend to these relationships,” said Widmer Kalochoritis. “Depression, feelings of helplessness and hopelessness, may provoke a greater tendency for isolation, but we must realise that the biggest protective factor for all this is our social support.”

Psychologists all recommend distractions – going for walks, picnics, social gatherings. But also exercise as this helps reduce stress hormones and increases feel-good levels, enabling you to feel more in control. The routine also gives a structure to your day.

Above all, it is about attitude. “We should see the glass as half-full and not half-empty,” said Raftis, “because the former is easier to refill and hence recover from this crisis.”

People suffering from depression need someone to validate their feelings of despair and fear, but simultaneously, they need someone to force them to change said Widmer Kalochoritis.

“Everybody has unexpected resources, that they have successfully used in past situations, and there is always something that can be done,” she said. “What blocks us is the pervasive hopelessness brought about by depression. We need to change our attitude to force ourselves to pull through and sometimes an absence of choice can be helpful for promoting change.”

The crisis has entered our lives as a shockwave, but that doesn’t necessarily mean it has to bring with it the misery, the doom and gloom many expect. It can also be a chance for people to redefine, rediscover and reinvent themselves.

Government psychological support

THE HEALTH ministry announced on Thursday the launch of a round-the-clock psychological support hotline to help those dealing with anxiety and depression because of the financial crisis.

The ministry is doing away with waiting lists, and has said that people will be referred to a specialist immediately.

From tomorrow, a hotline will be available round-the-clock. Officials will provide immediate psychological support, try to contain stress and depression and refer callers to support centres.

For the hotline call 22-603263 if you are in Nicosia, Larnaca or Famagusta. For Paphos and Limassol call 25-801107/106

http://www.cyprus-mail.com/features/we-can-t-fight-what-has-happened-so-we-should-use-it/20130407

Are antidepressants overused? : 75% of those who write these definitions have links to drug companies.

Contact: Emma Dickinson edickinson@bmjgroup.com 44-020-738-36529 BMJ-British Medical Journal

Head to head: Are antidepressants overprescribed?

Antidepressant prescriptions in the UK have increased by 9.6% in 2011, to 46 million prescriptions. Does this reflect overmedicalisation or appropriate treatment? Two experts debate the issue on bmj.com today.

Glasgow GP, Dr Des Spence, thinks that “we use antidepressants too easily, for too long, and that they are effective for few people (if at all)”

He acknowledges that depression is an important illness, but argues that the current definition of clinical depression (two weeks of low mood – even after bereavement) “is too loose and is causing widespread medicalisation.” He also points out that 75% of those who write these definitions have links to drug companies.

National Institute for Health and Clinical Excellence (NICE) guidelines do not support the use of antidepressant medication in mild depression, nor necessarily as first line treatment of moderate depression. Instead, they promote talking therapies.

“But even if we accept that antidepressants are effective, a Cochrane review suggests that only one in seven people actually benefits. Thus millions of people are enduring at least six months of ineffective treatment,” he writes.

He is unconvinced by research showing that depression is undertreated and that antidepressants are being used appropriately, saying “the only explanation is that we are prescribing more antidepressants to ever more people.”     He also questions the view that depression is a mere chemical imbalance and concludes: “Improving society’s wellbeing is not in the gift of medicine nor mere medication, and overprescribing of antidepressants serves as a distraction from a wider debate about why we are so unhappy as a society. We are doing harm.”

But Ian Reid, Professor of Psychiatry at the University of Aberdeen, says the claim that antidepressants are overprescribed “needs careful consideration.”

He argues that the rise in prescriptions is due to small but appropriate increases in the duration of treatment, rather than more patients being treated, and that increased use of antidepressants in other conditions “has compounded misunderstanding.”

He refutes the idea that GPs are handing out antidepressants “like sweeties” and points to a survey showing “cautious and conservative prescribing” among GPs in Grampian. He also points to “methodological flaws and selective reporting” of data showing that antidepressants are no better than placebo except in severe depression. Instead, he says, practice is supported by evidence.

Finally, he dismisses reports that limited availability of psychological therapy leads to inappropriate antidepressant prescription, saying there is no consistent relation between the availability of psychological therapies and antidepressant use.

“Antidepressants are but one element available in the treatment of depression, not a panacea,” he writes. “Like ‘talking treatments’ (with which antidepressants are entirely compatible), they can have harmful side effects, and they certainly don’t help everyone with the disorder. But they are not overprescribed. Careless reportage has demonised them in the public eye, adding to the stigmatisation of mental illness, and erecting unnecessary barriers to effective care.”

Eating more fish could reduce postpartum depression

Contact: William Raillant-Clark
w.raillant-clark@umontreal.ca
514-343-7593
University of Montreal

Emerging evidence suggests many pregnant women are deficient in omega-3

This release is available in French.

Low levels of omega-3 may be behind postpartum depression, according to a review lead by Gabriel Shapiro of the University of Montreal and the Research Centre at the Sainte-Justine Mother and Child Hospital. Women are at the highest risk of depression during their childbearing years, and the birth of a child may trigger a depressive episode in vulnerable women. Postpartum depression is associated with diminished maternal health as well as developmental and health problems for her child. “The literature shows that there could be a link between pregnancy, omega-3 and the chemical reaction that enables serotonin, a mood regulator, to be released into our brains,” Shapiro said. “Many women could bring their omega-3 intake to recommended levels.” The findings were announced by the Canadian Journal of Psychiatry on November 15, 2012.

Because omega-3 is transferred from the mother to her fetus and later to her breastfeeding infant, maternal omega-3 levels decrease during pregnancy, and remain lowered for at least six-weeks following the birth. Furthermore, in addition to the specific biological circumstances of pregnant women, it has been found in the US that most people do not consume sufficient amounts of omega-3. “These findings suggest that new screening strategies and prevention practices may be useful,” Shapiro said, noting that the study was preliminary and the further research would be needed to clarify the link and identify the reasons for it.

Young adults’ blood lead levels linked to depression, panic disorder

2009 study posted for filing

Contact: Todd Datz tdatz@hsph.harvard.edu 617-432-3952 JAMA and Archives Journals

Young adults with higher blood lead levels appear more likely to have major depression and panic disorders, even if they have exposure to lead levels generally considered safe, according to a report in the December issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

“Lead is a well-known neurotoxicant that is ubiquitous in the environment, found in air, soil, dust and water,” the authors write as background information in the article. Eliminating lead from gasoline has led to a dramatic decline in average blood levels, but remaining sources of exposure include paint, industrial processes, pottery and contaminated water. “Research on the neurotoxic effects of low-level lead exposure has focused on the in utero and early childhood periods. In adult populations, the neurotoxic effects of lead have been studied mainly in the context of occupational exposures, with levels of exposure orders of magnitude greater than that experienced by the general population.”

Maryse F. Bouchard, Ph.D., M.Sc., of the Universite de Montreal, Canada, and Harvard School of Public Health, Boston, and colleagues analyzed data from 1,987 adults age 20 to 39 years who participated in the National Health and Nutrition Examination Survey between 1999 and 2004. Participants underwent medical examinations that included collection of a blood sample, and also completed a diagnostic interview to identify major depressive disorder, panic disorder and generalized anxiety disorder.

The number of young adults who met diagnostic criteria for major depressive disorder was 134 (6.7 percent), 44 (2.2 percent) had panic disorder and 47 (2.4 percent) had generalized anxiety disorder. The average blood lead level was 1.61 micrograms per deciliter. The one-fifth of participants with the highest blood lead levels (2.11 micrograms per deciliter or more) had 2.3 times the odds of having major depressive disorder and nearly five times the odds of panic disorder as the one-fifth with the lowest lead levels (0.7 micrograms per deciliter or less).

Smoking is related to blood lead levels, so the researchers conducted additional analyses excluding the 628 smokers. Among non-smokers, the elevation in risk between the highest and lowest blood lead levels was increased to 2.5-fold for major depressive disorder and 8.2-fold for panic disorder.

Low-level lead exposure may disrupt brain processes, such as those involving the neurotransmitters catecholamine and serotonin, that are associated with depression and panic disorders, the authors note. Exposure to lead in individuals predisposed to these conditions could trigger their development, make them more severe or reduce response to treatment.

“These findings suggest that lead neurotoxicity may contribute to adverse mental health outcomes, even at levels generally considered to pose low or no risk,” they conclude. “These findings, combined with recent reports of adverse behavioral outcomes in children with similarly low blood lead levels, should underscore the need for considering ways to further reduce environmental lead exposures.”

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(Arch Gen Psychiatry. 2009;66[12]:1313-1319. Available pre-embargo to the media at www.jamamedia.org.)

Editor’s Note: This study was supported by a fellowship from the Canadian Institutes for Health Research and by a career development award from the National Institute of Environmental Health Sciences. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Fluoxetine (Prozac) increases aggressive behavior, affects brain development among adolescent hamsters

October 1, 2012

BOSTON, Mass.—Fluoxetine was the first drug approved by the FDA for major depressive disorder (MDD) in children and adolescents, and to this date, it remains one of only two selective serotonin reuptake inhibitors (SSRIs) registered for treatment of MDD in children and adolescents, despite reports that indicate this class of drugs is associated with side effects, such as agitation, hostility and aggression.

SSRIs have been amongst the most widely prescribed medications in psychiatry for over a decade. While there is a wealth of information regarding their effectiveness and safety in adults, considerably less data exists regarding whether they are safe for children.

A study published in Behavioral Neuroscience by Prof. Richard Melloni of Northeastern University shows that repeated administration of a low dose of fluoxetine to adolescent hamsters dramatically increased offensive aggression and altered the development of brain areas directly associated with controlling the aggressive response. “These data show clearly that repeated exposure to fluoxetine during adolescence directly stimulates aggressive responding and alters the normal development of two important brain systems, i.e., the serotonin and vasopressin neural systems, in a fashion consistent with the expression of the highly aggressive behavioral characteristics.”

For over a decade, Prof. Melloni and his team have researched the neural and behavioral consequences of illicit drugs and prescribed medications on the adolescent brain. Importantly, the data collected during the study indicates that clinically relevant doses of fluoxetine, when administered during adolescent development, can dramatically alter the wiring of brain circuits implicated in aggression control.“These data support the notion that interactions between adolescent fluoxetine and the developing vasopressin neural system might underlie fluoxetine-induced aggressive behavior and hint that serotonin, perhaps by acting on vasopressin neurons, may play a more permissive role in this response.”

For more information on this study, please contact: Lori Lennon, Communications Coordinator/Senior Writer, College of Science, Northeastern University, 617/373.7686, 617/680.5129 (cell), l.lennon@neu.edu

St. John’s wort relieves symptoms of major depression: 29 trials 5,489 patients

2008 study posted for filing

Contact: Jennifer Beal
wbnewseurope@wiley.com
44-012-437-70633
Wiley-Blackwell

New research provides support for the use of St. John’s wort extracts in treating major depression. A Cochrane Systematic Review backs up previous research that showed the plant extract is effective in treating mild to moderate depressive disorders.

“Overall, we found that the St. John’s wort extracts tested in the trials were superior to placebos and as effective as standard antidepressants, with fewer side effects,” says lead researcher, Klaus Linde of the Centre for Complementary Medicine in Munich, Germany.

Extracts of the plant Hypericum perforatum, commonly known as St. John’s wort, have long been used in folk medicine to treat depression and sleep disorders. The plant produces a number of different substances that may have anti-depressive properties, but the whole extract is considered to be more effective.

Cochrane Researchers reviewed 29 trials which together included 5,489 patients with symptoms of major depression. All trials employed the commonly used Hamilton Rating Scale for Depression to assess the severity of depression. In trials comparing St. John’s wort to other remedies, not only were the plant extracts considered to be equally effective, but fewer patients dropped out of trials due to adverse effects. The overall picture is complicated, however, by the fact that the results were more favourable in trials conducted in German speaking countries, where St. John’s extracts have a long tradition and are often prescribed by doctors.

Despite the favourable findings for St. John’s wort, researchers are anxious not to make generalisations about the plant’s use as an anti-depressant and recommend consulting a doctor in the first instance, especially as the extracts can sometimes affect the actions of other beneficial drugs.

“Using a St. Johns wort extract might be justified, but products on the market vary considerably, so these results only apply to the preparations tested,” says Linde

Live Vaccination against ( German Measles ) Rubella caused Signifigant Depression up to 10 weeks – Vaccines/ Bacteria Can Alter Mood and Behavior


Mood Disorders

April 30, 2007

Norman Sussman, MD, DFAPA Editor, Primary Psychiatry and Psychiatry Weekly, Professor of Psychiatry, New York University School of Medicine

There is growing interest in a suspected cause of some cases of depression: infection and inflammatory response. New research findings that add to our understanding of the interrelationship of immunology and depression, and the reasons that some currently used antidepressants work, may fundamentally change the way that mood disorders and drug therapies are conceptualized.

There are several unambiguous examples of psychiatric illness being the result of an inflammatory or immune reaction.  Considerable evidence already exists about the Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS), a disorder in which Streptoccal infection triggers an autoimmune response. The antibodies that form against the invading bacteria mistakenly recognize and “attack” certain parts of the brain, causing psychiatric symptoms.

Another notable example of immune-mediated depression is the response of some patients to treatment with Interferon α, who become profoundly depressed and suicidal. Interestingly, onset of depressive symptoms has been shown to be prevented by treatment with antidepressants that work on the serotonin system.

The involvement of immune activation and depressive-like “sickness behavior” symptoms has been suspected for many years. Evidence specifically suggests that patients with major depression exhibit changes in cytokine activity and inflammation. Immune-mediated psychological and neuroendocrine changes were observed following vaccination with live attenuated rubella virus. A subgroup of vulnerable subjects showed a significant virus-induced increase in depressed mood up to 10 weeks following their vaccination. In a related animal study, the investigators also showed that immune activation with a variety of immune challenges induced a “depressive-like syndrome in rodents: anhedonia, anorexia, body weight loess, and reduced exploratory, and social behavior.” Chronic treatment with TCAs or SSRIs attenuated many of the behavioral effects.

A team of English investigators have, for the first time, shown a possible link between administration of a vaccine, peripheral immune activation, psychological and behavioral changes, and the brain serotonin system. The researchers used antigens derived from the bacterium Mycobacterium vaccae, a generally benign and ubiquitous agent found in dirt. After vaccination, they found that the subsequent immune activation was temporally associated with increases in serotonin metabolism within the ventromedial prefrontal cortex. Treatment with the vaccine seemed to alter behavior in mice similarly as is typically seen with antidepressants. This research was initiated following observations that human cancer patients being treated with the bacteria Mycobacterium vaccae unexpectedly reported increases in their quality of life.

The identification of serotonin neurons in the dorsal raphe nucleus that are uniquely responsive to peripheral immune activation raises the possibility that one day there will be a vaccine designed to modulate the immune response which in turn will the prevent the onset or attenuate the symptoms of major depression and other psychiatric disorders

Repsoted at Request

Yale team discovers how stress and depression can shrink the brain

Public release date: 12-Aug-2012 [

Contact: Bill Hathaway william.hathaway@yale.edu 203-432-1322 Yale University

Yale team discovers how stress and depression can shrink the brain

Major depression or chronic stress can cause the loss of brain volume, a condition that contributes to both emotional and cognitive impairment. Now a team of researchers led by Yale scientists has discovered one reason why this occurs — a single genetic switch that triggers loss of brain connections in humans and depression in animal models.

The findings, reported in the Aug. 12 issue of the journal Nature Medicine, show that the genetic switch known as a transcription factor represses the expression of several genes that are necessary for the formation of synaptic connections between brain cells, which in turn could contribute to loss of brain mass in the prefrontal cortex.

“We wanted to test the idea that stress causes a loss of brain synapses in humans,” said senior author Ronald Duman, the Elizabeth Mears and House Jameson Professor of Psychiatry and professor of neurobiology and of pharmacology. “We show that circuits normally involved in emotion, as well as cognition, are disrupted when this single transcription factor is activated.”

The research team analyzed tissue of depressed and non-depressed patients donated from a brain bank and looked for different patterns of gene activation. The brains of patients who had been depressed exhibited lower levels of expression in genes that are required for the function and structure of brain synapses. Lead author and postdoctoral researcher H.J. Kang discovered that at least five of these genes could be regulated by a single transcription factor called GATA1. When the transcription factor was activated, rodents exhibited depressive-like symptoms, suggesting GATA1 plays a role not only in the loss of connections between neurons but also in symptoms of depression.

Duman theorizes that genetic variations in GATA1 may one day help identify people at high risk for major depression or sensitivity to stress.

“We hope that by enhancing synaptic connections, either with novel medications or behavioral therapy, we can develop more effective antidepressant therapies,” Duman said.

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The study was funded by the National Institutes of Health and the Connecticut Department of Mental Health and Addiction Services.

Other Yale authors of the paper are Bhavya Voleti, Pawel Licznerski, Ashley Lepack, and Mounira Banasr

44% of Former Propecia, Proscar ( finasteride ) users now suffer from Suicidal thoughts and major Depression

GW Researcher finds depressive symptoms and suicidal thoughts in former finasteride users

WASHINGTON — (Aug 7, 2012) New research, to be published in the Journal of Clinical Psychiatry, finds that men who developed persistent sexual side effects while on finasteride (Propecia), a drug commonly used for male pattern hair loss, have a high prevalence of depressive symptoms and suicidal thoughts. The study, titled “Depressive Symptoms and Suicidal Thoughts Among Former Users of Finasteride With Persistent Sexual Side Effects,” was authored by Michael S. Irwig, M.D., an assistant professor of medicine in the Division of Endocrinology at the George Washington University School of Medicine and Health Sciences.

For the study, Dr. Irwig administered standardized interviews to 61 men who were former users of finasteride with persistent sexual side effects for more than three months. The interview gathered demographic information, medical and psychiatric histories, and information on medication use, sexual function, and alcohol consumption. All of the former finasteride users were otherwise healthy men with no baseline sexual dysfunction, medical conditions, psychiatric conditions or use of oral prescription medications. Dr. Irwig also conducted interviews with a control group of 29 men who had male pattern hair loss but who had never used finasteride and who denied any history of psychiatric conditions or use of psychiatric medications. Both groups self-administered the Beck Depression Inventory II (BDI-II), a widely used, validated instrument that measures the severity of depression in adults.

According to the total scores from the BDI-II, most former finasteride users exhibited some degree of depressive symptoms: 11% had mild symptoms; 28% had moderate symptoms; and 36% had severe symptoms. In addition, 44% reported suicidal thoughts. In the control group, 10%had mild depressive symptoms with no cases of moderate or severe symptoms, and 3% reported suicidal thoughts.

“The potential life-threatening side-effects associated with finasteride should prompt clinicians to have serious discussions with their patients. The preliminary findings of this study warrant further research.” said Dr. Irwig

Creatine aids women rapidly with major depression

Muscle-building supplement vastly improves reponse time, quality of recovery

(SALT LAKE CITY)—Women battling stubborn major depression may have a surprising new ally in their fight—the muscle-building dietary supplement creatine.

In a new proof-of-concept study, researchers from three South Korean universities and the University of Utah report that women with major depressive disorder (MDD) who augmented their daily antidepressant with 5 grams of creatine responded twice as fast and experienced remission of the illness at twice the rate of women who took the antidepressant alone. The study, published Aug. 3, 2012, in the American Journal of Psychiatry online, means that taking creatine under a doctor’s supervision could provide a relatively inexpensive way for women who haven’t responded well to SSRI (selective serotonin reuptake inhibitor) antidepressants to improve their treatment outcomes.

“If we can get people to feel better more quickly, they’re more likely to stay with treatment and, ultimately, have better outcomes,” says Perry F. Renshaw, M.D., Ph.D., M.B.A, USTAR professor of psychiatry at the U of U medical school and senior author on the study.

If these initial study results are borne out by further, larger trials, the benefits of taking creatine could directly affect many Utahns. The depression incidence in Utah is estimated to be 25 percent higher than the rest of the nation, meaning the state has an even larger proportion of people with the disease. This also brings a huge economic cost to both the state and individuals.

According to numbers recently compiled at the U of U, the state of Utah paid an estimated $214 million in depression-related Medicaid and disability insurance in 2008. Add the costs of inpatient and outpatient treatment, medication, and lost productivity in the workplace, and the total price of depression in Utah reached $1.3 billion in 2008, according to the U estimate. With those large numbers, any treatment that improves outcomes not only could ease the life of thousands of Utah women but also would save millions of dollars.

“There has been a misunderstanding of how crippling and common this disease is in Utah,” says Renshaw, who’s also medical director of the Mental Illness Research, Education and Clinical Center at the Salt Lake City Veterans Affairs Health Care System. “It begs that we understand it better than we do.”

Creatine is an amino acid made in the human liver, kidneys, and pancreas. It also is found in meat and fish. Inside the body it is converted into phosphocreatine and stored in muscle. During high-intensity exercise, phosphocreatine is converted into ATP, an important energy source for cells. For this reason, creatine has become a popular supplement among bodybuilders and athletes who are trying to add muscle mass or improve athletic ability.

How creatine works against depression is not precisely known, but Renshaw and his colleagues suggest that the pro-energetic effect of creatine supplementation, including the making of more phosphocreatine, may contribute to the earlier and greater response to antidepressants.

The eight-week study included 52 South Korean women, ages 19-65, with major depressive disorder. All the women took the antidepressant Lexapro (escitalopram) during the trial. Twenty-five of the women received creatine with the Lexapro and 27 were given a placebo.  Neither the study participants nor the researchers knew who received creatine or placebo. Eight women in the creatine group and five in the placebo group did not finish the trial, leaving a total of 39 participants.

Participants were interviewed at the start of the trial to establish baselines for their depression, and then were checked at two, four, and eight weeks to see how they’d responded to Lexapro plus creatine or Lexapro and a placebo. The researchers used three measures to check the severity of depression, with the primary outcomes being measured by the Hamilton Depression Rating Scale (HDRS), a widely accepted test.

The group that received creatine showed significantly higher improvement rates on the HDRS at two and four weeks (32 percent and 68 percent) compared to the placebo group (3.7 percent and 29 percent). At the end of eight weeks, half of those in the creatine group showed no signs of depression compared with one-quarter in the placebo group. There were no significant adverse side effects associated with creatine.

Antidepressants typically don’t start to work until four to six weeks. But research shows that the sooner an antidepressant begins to work, the better the treatment outcome, and that’s why Renshaw and his colleagues are excited about the results of this first study. “Getting people to feel better faster is the Holy Grail of treating depression,” he says.

Study co-author Tae-Suk Kim, M.D., Ph.D., associate professor of psychiatry at the Catholic University of Korea College of Medicine and visiting associate professor of psychiatry at the U of U, already is recommending creatine for some of his female depression patients.

In prior studies, creatine had been shown to be effective only in female rats. But that shouldn’t rule out testing the supplement in men as well, according to Renshaw.

U of U researchers expect soon to begin another trial to test creatine in adolescent and college-age females who have not responded to SSRI medications. Principal investigator Douglas G. Kondo, M.D., assistant professor of psychiatry, says he is looking for 40 females between the ages of 13-21. Recruitment of participants will begin as soon as the U of U Institutional Review Board approves the study, which is expected in early July.

After the initial eight weeks of treatment, study participants will be offered a six-month extension of close supervision and monitoring by the research team and board-certified child, adolescent, and adult psychiatrist at no charge.

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Those interested in joining the study can call (801) 587-1549; visit the study Web site www.UtahBrain.org; or email Doug.Kondo@hsc.utah.edu.

The first authors on the study are In Kyoon Loo, M.D., Ph.D., professor of the Seoul National University College of Medicine and College of Natural Sciences, Seoul, South Korea, and USTAR research associate professor of psychiatry at the U of U, and Sujung Yoon, M.D., Ph.D., associate professor of psychiatry at the Catholic University of Korea College of Medicine, Seoul, and visiting associate professor of psychiatry at the U of U.

Other authors include Jaeuk Hwang M.D., Ph.D., of the Soonchunhyang University College of Medicine, Seoul; Wangyoun Won, M.D., Catholic University of Korea College of Medicine, Seoul; Jieun E. Kim, M.D., Ph.D., Ewha Womans University Graduate School, Seoul; Sujin Bae, Ph.D., Seoul National University College of Natural Sciences