Link Between Insomnia And Depression In Young Adults - New Study In The Journal SLEEP

A study published in the April 1 issue of the journal SLEEP confirms the persistent nature of insomnia and the increased risk of subsequent depression among individuals with insomnia.



The study, conducted by Jules Angst, MD, of Zurich University Psychiatric Hospital in Switzerland, focused on 591 young adults, whose psychiatric, physical, and sleep symptoms were assessed with six interviews spanning 20 years. Four duration-based subtypes of insomnia were distinguished: one-month insomnia associated with significant distress, two-to-three-week insomnia, recurrent brief insomnia, and occasional brief insomnia.



According to the results, the annual prevalence of one-month insomnia increased gradually over time, with a cumulative prevalence rate of 20 percent and a greater than two-fold risk among women. In 40 percent of subjects, insomnia developed into more chronic forms over time. Insomnia either with or without comorbid depression was highly stable over time. Insomnia lasting two weeks or longer predicted major depressive episodes and major depressive disorder at subsequent interviews. Seventeen to 50 percent of subjects with insomnia lasting two weeks or longer developed a major depressive episode in a later interview. "Pure" insomnia and "pure" depression were not longitudinally related to each other, whereas insomnia comorbid with depression was longitudinally related to both.



"We used to think that insomnia was most often just a symptom of depression. However, a growing body of evidence suggests that insomnia is not just a symptom of depression, but that it may actually precede depression. In other words, people who have insomnia but no depression are at increased risk for later developing depression. This study adds to our knowledge by including a much longer follow-up period than most previous studies," said Daniel J. Buysse, MD, of the University of Pittsburgh, lead author of the paper. "We were also able to look separately at insomnia alone, depression alone, and combined insomnia-depression. The results show that insomnia seems to be followed by depression more consistently than the other way around. In addition, we found that insomnia tended to be a chronic problem that gets more persistent over time, whereas depression was a more intermittent problem."



Insomnia is a classification of sleep disorders in which a person has trouble falling asleep, staying asleep or waking up too early. It is the most commonly reported sleep disorder. About 30 percent of adults have symptoms of insomnia. It is more common among elderly people and women.



It is recommended that adults get between seven and eight hours of nightly sleep.



The American Academy of Sleep Medicine (AASM) offers the following tips on how to get a good night's sleep:















- Follow a consistent bedtime routine.

- Establish a relaxing setting at bedtime.

- Get a full night's sleep every night.

- Avoid foods or drinks that contain caffeine, as well as any medicine that has a stimulant, prior to bedtime.

- Do not bring your worries to bed with you.

- Do not go to bed hungry, but don't eat a big meal before bedtime either.

- Avoid any rigorous exercise within six hours of your bedtime.

- Make your bedroom quiet, dark and a little bit cool.

- Get up at the same time every morning.


Those who suspect that they might be suffering from insomnia, or another sleep disorder, are encouraged to consult with their primary care physician or a sleep specialist.



More information about insomnia is available from the AASM at SleepEducation/Disorder.aspx?id=6.


SLEEP is the official journal of the Associated Professional Sleep Societies, LLC, a joint venture of the AASM and the Sleep Research Society.



SleepEducation, a patient education Web site created by the AASM, provides information about various sleep disorders, the forms of treatment available, recent news on the topic of sleep, sleep studies that have been conducted and a listing of sleep facilities.


SLEEP 2008, the 22nd Annual Meeting of the Associated Professional Sleep Societies and the world's largest annual gathering of sleep scientists and sleep medicine professionals, will take place in Baltimore, Maryland, from June 9-12, 2008. SLEEP 2008 will bring together an international body of 5,000 leading researchers and clinicians, who will present and discuss over 1,100 new findings and medical developments related to sleep and sleep disorders. The deadline to register is Friday, May 30, 2008. Contact Jim Arcuri at (708) 492-0930, ext. 9317, or jarcuriaasmnet for more information or to register for a free press pass. More details, including the program schedule and a list of invited lecturers, are available at SleepMeeting.


journalsleep

Less Than 5 Hours Sleep Linked To Higher Mental Illness Risk

Young healthy adults aged between 17 and 24 years who get less than an average of 5 hours' sleep each night have three times the risk of developing a mental illness compared to individuals of the same age who sleep eight to nine hours every night, according to a study carried out by the George Institute on Global Health, published in the medical journal Sleep.


Researchers at the George Institute for Global Health carried out a survey involving 20,822 individuals aged 17-24 years across New South Wales, Australia, identified through the state vehicle licensing authority. The study ran for 18 months and revealed a clear link between lack of sleep and mental ill health, the authors wrote.


Lead author, Professor Nick Glozier, said:


The study has revealed a number of links between mental health problems and lack of sleep among young adults." The study, published in the journal SLEEP, also showed that mental ill health is more likely to develop into a chronic problem if a person is sleeping fewer than average hours.


Professor Glozier said that sleep disturbance is an important symptom in mental health disorders, such as depression, and often an early sign or "prodrome" of the illness.


(A prodrome is an early symptom indicating the onset of an attack or disease)


The researchers added that evidence is compelling and consistent that lack of sleep can also raise the risk of cardiovascular disease, as well as weight gain in young individuals.


Professor Glozier added:


Changes in lifestyle patterns are a contributing factor to these problems but it's evident that disrupted sleep patterns are a major contributor to many types of mental health conditions.


The study was conducted as part of collaborative work undertaken by the University of Sydney's Brain and Mind Institute and the George Institute for Global Health.


The authors concluded:


Self-reported shorter sleep duration is linearly associated with prevalent and persistent psychological distress in young adults. In contrast, only the very short sleepers had a raised risk of new onset of distress. Different approaches to sleep duration measurement yield different results and should guide any interventions to improve subjective sleep duration in young adults.


"Short Sleep Duration in Prevalent and Persistent Psychological Distress in Young Adults: The DRIVE Study"

Nicholas Glozier, MBBS, MRCPsych, PhD; Alexandra Martiniuk, MSc, PhD; George Patton, MBBS, PhD; Rebecca Ivers, MIPH, PhD; Qiang Li, MSc; Ian Hickie, MBBS, MD; Teresa Senserrick, PhD; Mark Woodward, PhD; Robyn Norton, PhD; Mark Stevenson, MPH, PhD

SLEEP 2010;33(9):1139-1145.

FDA Approves Lilly's Cymbalta for the Treatment of Depression

Dual-reuptake inhibitor judged safe and effective, giving doctors and patients a new option for treating the emotional and painful physical symptoms of depression


The U.S. Food and Drug Administration has approved Cymbalta® (duloxetine HCl; pronounced SIM-BALL-TA), judging it a safe and effective treatment for major depressive disorder, Eli Lilly and Company announced today.


Cymbalta, a balanced and potent reuptake inhibitor of serotonin and norepinephrine, has been studied in more than 6,000 adults with major depression worldwide. Its approval gives healthcare professionals and patients a long-awaited new option for treating the broad range of emotional and physical symptoms of depression. Today, only 25-35 percent of patients treated for depression in clinical studies experience relief from all of their disease symptoms.1



"Depression is a whole-body illness, but most modern antidepressants treat the emotional symptoms, such as crying and sadness, better than they treat the physical symptoms of depression," said Dr. Stephen Stahl, chairman of the Neuroscience Education Institute and adjunct professor of psychiatry at the University of California at San Diego School of Medicine. "Because of its dual action on serotonin and norepinephrine, Cymbalta offers physicians a new opportunity to help patients with depression, particularly those who experience the common physical symptoms of the disease, such as vague aches and pains."


Neurotransmitters are believed to help regulate a person's emotions and sensitivity to pain. Scientists believe that if these neurotransmitters are out of balance, a person may become depressed and be more likely to feel painful physical symptoms. The combination of emotional and painful physical effects of depression can have a tremendous negative impact on a person's quality of life.2


"Lilly's leadership in neuroscience and dedication to the treatment of depression is well established," said Sidney Taurel, Lilly's chairman, president and chief executive officer. "Lilly is committed to solving the world's most pressing neuroscience problems, through research programs in Alzheimer's and Parkinson's as well as through our established expertise in depression, schizophrenia, bipolar disorder and Attention-Deficit/Hyperactivity Disorder."


Lilly demonstrated Cymbalta's effectiveness in treating major depression with data from four placebo-controlled clinical studies, all in adults. The safety and efficacy of Cymbalta in children have not been studied.


Milt Meyers, a participant in a Cymbalta clinical trial, found it worked for him. "Cymbalta worked for me," Meyers said. "I felt really good for the first time in a long time. I really felt like I was on the right track."















Cymbalta comes in a capsule and can be taken once a day. In clinical trials, Cymbalta was studied in a dose range of 40-120 mg per day. The recommended daily dose is 60 mg.


Duloxetine hydrochloride also is being studied for the treatment of stress urinary incontinence and diabetic neuropathic pain, conditions believed to respond to treatment with both serotonin and norepinephrine.


About Depression


Nearly 19 million Americans suffer from depression each year, making it one of the leading causes of disability according to the World Health Organization. Current medical literature suggests that patients who are successfully treated for all their depressive symptoms, including both the emotional and painful physical ones, may be more likely to achieve remission than those whose physical symptoms are not alleviated.1, 3, 4, 5


Patient Experience


In clinical trials, Cymbalta was safe and effective. Not all patients respond the same. The experience of the patient quoted in this release might not be typical.


Important Safety Information


Depression, as a disease, can be associated with periods when the symptoms can worsen or thoughts of suicide can emerge. Patients and their families should watch for these as well as for anxiety, agitation, panic, difficulty sleeping, irritability, hostility, aggressiveness, impulsivity, restlessness, or overexcitement and hyperactivity. Call the doctor if any of these are severe or occur suddenly. Be especially observant at the initiation of antidepressant drug therapy and whenever there is a change in dose.


Prescription Cymbalta is not for everyone. People who are allergic to duloxetine hydrochloride or the other ingredients in Cymbalta should not take it. If you are taking thioridazine or if you are taking or have recently taken a type of antidepressant called a monoamine oxidase inhibitor (MAOI), you should not take Cymbalta. It also should not be administered to patients with any hepatic insufficiency, end-stage renal disease or uncontrolled, narrow-angle glaucoma. Cymbalta ordinarily should not be prescribed to patients with substantial alcohol use. Women who are pregnant should talk with their doctor before taking Cymbalta. Nursing while taking Cymbalta is not recommended.


In clinical studies, the most common side effects were nausea, dry mouth, constipation, decreased appetite, fatigue, sleepiness and increased sweating. Most people were not bothered enough by side effects to stop taking Cymbalta. Your doctor may periodically check your blood pressure. Don't stop taking Cymbalta without talking to your doctor.


For full patient information, visit Cymbalta.


About Lilly


Lilly, a leading innovation-driven corporation, is developing a growing portfolio of first-in-class and best-in-class pharmaceutical products by applying the latest research from its own worldwide laboratories and from collaborations with eminent scientific organizations. Headquartered in Indianapolis, Ind., Lilly provides answers - through medicines and information - for some of the world's most urgent medical needs. Additional information about Lilly is available at lilly.


This press release contains forward-looking statements about the potential of Cymbalta for the treatment of major depressive disorder and reflects Lilly's current beliefs. However, as with any pharmaceutical product, there are substantial risks and uncertainties in the process of development and commercialization. There is no guarantee that the product will prove to be commercially successful. For further discussion of these and other risks and uncertainties, see Lilly's filings with the United States Securities and Exchange Commission. Lilly undertakes no duty to update forward-looking statements.


1. Tran PV, Bymaster FP, McNamara RK, et al. Dual Monoamine Modulation for Improved Treatment of Major Depressive Disorder, J Clin Psychopharmacology, 2003; 23: 78-86.


2. The Regents of the University of Michigan. Beyond Sadness. Bridging the gap between emotional and physical symptoms of depression. Ann Arbor, MI, 2002.


3. Nemeroff CB et al. Duloxetine for the Treatment of Major Depressive Disorder. Psychoharmacol Bul. 2002; 36 (4):106-132.


4. Ohayon, M., et al. Using Chronic Pain to Predict Depressive Morbidity in the General Population. Arch Gen Psychiatry 2003; 60: 39-47.


5. Poster presented at American Psychiatric Association annual meeting. May 19, 2003. San Francisco, CA.


View drug information on Cymbalta.

New Mothers' Postpartum Lifestyle And Parenting Stress

Post-pregnancy excess weight is likely caused by the impact of new parenthood stress on physical activity, Georgia Health Sciences University researchers say.



In a study of 60 first-time mothers, researchers linked higher post-pregnancy body mass index - weight in relation to height - to a combination of a high BMI before pregnancy, excessive weight gain during pregnancy, parenting stress and a sedentary lifestyle, according to a study published in Women & Health.



The study gauged parental stress by asking participants to rate statements such as "I feel like I have less time to myself" and "I enjoy being a parent." They were also asked to recall their physical activity over the previous 24 hours, categorizing that activity from light to vigorous.



"Sedentary lifestyle, or a low amount of physical activity, was most influenced by the type of parenting stress the mothers reported," says Dr. Deborah Young-Hyman, behavioral psychologist with the Georgia Prevention Institute. "More parenting stress, especially depression, was associated with less physical activity and a higher postpartum BMI."



Interestingly, social interaction, generally considered a measure of well-being, correlated with a higher body mass index, she noted.



"We think women are socializing with their friends, not isolating themselves, but they are doing sedentary things like talking on the phone, watching television or hanging out at home, instead of taking their babies on a walk together."



New moms with a higher BMI did report more depressive symptoms, but overall felt competent as parents. Those with lower BMIs reported more physical activity (and less depressive symptoms) but more concern about their competence as parents.



"We know that physical activity improves your mood and helps you lose weight, but no one has ever asked how physical activity is related to parenting stress in first-time moms," Young-Hyman said. "The bottom line is that parenting stress does impact the postpartum lifestyles of new moms," she said.



Based on a current study tracking how first-time mothers adjust to parenthood, researchers will develop an intervention to help new moms create healthy lifestyles for both themselves and their babies ??" preventing overweight mothers and children.

Experimental Medication Kicks Depression In Hours Instead Of Weeks

People with treatment-resistant depression experienced symptom relief in as little as two hours with a single intravenous dose of ketamine, a medication usually used in higher doses as an anesthetic in humans and animals, in a preliminary study. Current antidepressants routinely take eight weeks or more to exert their effect in treatment-resistant patients and four to six weeks in more responsive patients - a major drawback of these medications. Some participants in this study, who previously had tried an average of six medications without relief, continued to show benefits over the next seven days after just a single dose of the experimental treatment, according to researchers conducting the study at the National Institutes of Health's National Institute of Mental Health.



This is among the first studies of humans to examine the effects of ketamine on depression, a debilitating illness that affects 14.8 million people in any given year. Used in very low doses, the medication is important for research, but is unlikely to become a widely used clinical treatment for depression because of potential side effects, including hallucinations and euphoria, at higher doses. However, scientists say this research could point the way toward development of a new class of faster- and -longer-acting medications. None of the patients in this study, all of whom received a low dose, had serious side effects. Study results were published in the August issue of the Archives of General Psychiatry.



"The public health implications of being able to treat major depression this quickly would be enormous," said NIH Director Elias A. Zerhouni, M.D. "These new findings demonstrate the importance of developing new classes of antidepressants that are not simply variations of existing medications."



For this study 18 treatment-resistant, depressed patients were randomly assigned to receive either a single intravenous dose of ketamine or a placebo (inactive compound). Depression improved within one day in 71 percent of all those who received ketamine, and 29 percent of these patients became nearly symptom-free within one day. Thirty-five percent of patients who received ketamine still showed benefits seven days later. Participants receiving a placebo infusion showed no improvement. One week later, participants were given the opposite treatment, unless the beneficial effects of the first treatment were still evident. This "crossover" study design strengthens the validity of the results.



"To my knowledge, this is the first report of any medication or other treatment that results in such a pronounced, rapid, prolonged response with a single dose. These were very treatment-resistant patients," said NIMH Director Thomas R. Insel, M.D.



Ketamine blocks a brain protein called the N-methyl-D-aspartic acid (NMDA) receptor. Previous studies have shown that agents that block the NMDA receptor reduce depression-like behaviors in animals.
















NMDA receptors are critical for receiving the signals of glutamate, a brain chemical that enhances the electrical flow among brain cells that is required for normal function. Studies indicate that dysregulation in glutamate could be among the culprits in depression. Using ketamine to block glutamate's actions on the NMDA receptor appears to improve function of another brain receptor - the AMPA receptor - that also helps regulate brain cells' electrical flow.



Scientists think the reason current antidepressant medications take weeks to work is that they act on targets close to the beginning of a series of biochemical reactions that regulate mood. The medications' effects then have to trickle down through the rest of the reactions, which takes time. Scientists theorize that ketamine skips much of this route because its target, the NMDA receptor, is closer to the end of the series of reactions in question.



"This may be a key to developing medications that eliminate the weeks or months patients have to wait for antidepressant treatments to kick in," said lead researcher Carlos A. Zarate Jr., of the NIMH Mood and Anxiety Disorders Program.







The researchers who conducted the study now are zeroing in on other areas of the glutamate system. Specifying which components of the system are affected by compounds such as ketamine may help scientists understand how and why depression occurs, reveal biological markers that may one day aid in diagnosis, and point the way to more precise targets for new medications.



Dr. Zarate was joined in this research by Husseini K. Manji, chief of the NIMH Mood and Anxiety Disorders Program, and colleagues Jaskaran B. Singh, Paul J. Carlson, Nancy E. Brutsche, Rezvan Ameli, David A. Luckenbaugh, and Dennis S. Charney.



NIMH is part of the National Institutes of Health (NIH), the Federal Government's primary agency for biomedical and behavioral research. NIH is a component of the U.S. Department of Health and Human Services.



Contact: Susan Cahill

NIH/National Institute of Mental Health

New treatment for fibromyalgia

Fibromyalgia is a chronic, incapacitating musculoskeletal disorder. Nearly six times more common in women than in men, fibromyalgia is marked by widespread body pain and muscle tenderness, often accompanied by headaches, sleep disturbances, and fatigue. While its cause remains a mystery, fibromyalgia has been linked to abnormalities in the brain's neurotransmitters, serotonin and norepinephrine--chemicals key to mood and widely recognized for their role in depression. Not all patients with fibromyalgia, however, have depression or respond to antidepressants. Treatment studies of the other types of antidepressant drugs, including selective serotonin uptake inhibitors and tricyclic agents, have had mixed results.


A new and different antidepressant, duloxetine, works by inhibiting the reuptake of both serotonin and norepinephrine. In a recent clinical trial conducted for the treatment of fibromyalgia--one of the largest ever--duloxetine was shown to reduce pain and improve a range of disease symptoms, significantly and safely. The results, published in the September 2004 issue of Arthritis & Rheumatism, offer the promise of relief for women with fibromyalgia.


"Our results suggest that duloxetine improves pain and tenderness, the hallmark characteristics of fibromyalgia," states Lesley M. Arnold, M.D., who coordinated the research at 18 centers, including the University of Cincinnati College of Medicine, Indiana University Medical School, and Harvard Medical School. "The effect of duloxetine on the reduction of pain," Dr. Arnold further notes, "appears to be independent of its effect on mood."


To test duloxetine's effectiveness on the range of symptoms, researchers recruited 207 patients, all meeting the American College of Rheumatology criteria for fibromyalgia. Like the majority of those with this disease, the majority of the participants--89 percent--were women. 87 percent of the subjects were Caucasian and the mean age was 49. Just over a third of the patients--38 percent--had been diagnosed with depression. On a random basis, the patients were prescribed one of two treatments for a course of 12 weeks. About half, 104 individuals, received 60 milligrams of duloxetine twice a day. The remaining 103 patients were given a placebo. Both groups were evaluated and scored, using the Fibromyalgia Impact Questionnaire and other standard measures, for improvements in their condition.


In various measures of disease--from pervasive pain to tiredness to tenderness--the female fibromyalgia patients treated with duloxetine improved significantly over those treated with a placebo. One of the most dramatic changes was in the reduction of the number of tender points--places on the body where it hurts to touch--and the increase of pressure pain threshold. Women with or without depression receiving duloxetine benefited emotionally and physically, reporting improvements in general mood, ability to function, and overall enjoyment of life.


For the study's 23 men, however, duloxetine did little to change their condition. Although researchers reported some evidence of improvement in tender point measures among duloxetine-treated men over their placebo-treated counterparts, it was not statistically significant. "The reasons for the sex differences in response are unclear," Dr. Arnold observes. "Because the male subgroup was small, reflecting the much higher prevalence of fibromyalgia in women, the results of the study may not be generalizable to all men with fibromyalgia. There may also be sex differences in fibromyalgia that affect treatment response."


As Dr. Arnold notes, further research is needed on larger samples of not only men but also other groups with fibromyalgia to evaluate duloxetine's effectiveness.


Duloxetine (Cymbalta???) is indicated by the FDA for the treatment of major depressive disorder and is not indicated for the treatment of fibromyalgia.


Article: "A Double-Blind, Multicenter Trial Comparing Duloxetine With Placebo in the Treatment of Fibromyalgia Patients With or Without Major Depressive Disorder," Lesley M. Arnold, Yili Lu, Leslie J. Crofford, Madelaine Wohlreich, Michael J. Detke, Smriti Iyengar, and David J. Goldstein, for the Duloxetine Fibromyalgia Trial Group, Arthritis & Rheumatism, September 2004; 50:9; pp. 2974-2984.



Contact: Amy Molnar

amolnarwiley

201-748-8844

John Wiley & Sons, Inc.

'On Track' For Staying Free Of Depression.

Professor David Kavanagh from UQ's Discipline of Psychiatry said the program was ideal for people living in rural areas, where treatment facilities are scarce.



"We are particularly keen to tell people in rural and regional areas about this program as we know that it is often hard for them to get enough help for this problem," Professor Kavanagh said.



"The great thing about this program is that it is free and uses a series of letters??¦this means that people can get some help, no matter where they live.



"It may feel odd for them to ask for help if they are not actually depressed right now, but it is really important that they do something about it, before the depression comes back."



Professor Kavanagh said that without counselling or support, for many people depression can be like a "roundabout" they feel they cannot get off.



"We know that over half the people who suffer from depression will have another episode in the next five years," he said.



Over time, they are also more likely to get physical illnesses, or use alcohol or other drugs."



Professor Kavanagh said the program, which has been running for over a year, was an ideal way of communicating with people who experience depression, as there was "something personal" about receiving a letter.



"The series of letters that our recruits receive will let them know when depression may happen in the future and help them to pick up early signs," he said.



"The letters also get people to consider how they can look after their physical health.



"Each letter gives ideas to try out and shows them how they are going. There is also a toll free number people can use to talk to someone about how they are going."



Heather*, a participant in "On Track", said the program was particularly helpful because it allowed her to retain a sense of anonymity while giving her the skills to take charge of her life.



"I think in city areas it is easier to be anonymous - if you want to go to a doctor it is easy to go across the city," she said.



"If you are in a rural or country town where you are known, going to the doctor and saying I am experiencing these symptoms is harder to do??¦I think in some areas there is still a stigma associated with depression.



"For me, I'd find it hard to relate to people face to face."



Heather said it was easy for her to forget about her depression when things were going really well, but through her participation in "On Track" she now had the skills to recognize symptoms early.



"The most helpful things for me in the program have been putting pleasant events into my day, finding my early warning signs for depression, challenging my thoughts, and the mindfulness activities.



"With "On Track" I can work at my own pace and there is always a number to call if I get stuck."







The research project behind "On Track" is supported by the Australian Rotary Health Research Fund and Queensland Health.



Information and help for depression can be found at beyondblue.au/, which lists a number of other Australian websites.



*Surname withheld.



Contact: Lucy Manderson

Research Australia

Maine Receives 500,000 Dolars Grant To Support Youth Suicide Prevention Efforts

The Maine Youth Suicide Prevention Program (MYSPP) recently learned that it has been selected to receive a $500,000 grant to enhance its efforts in high schools across the state.


The U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) awarded 18 grants totaling almost $27 million over three years. Awards ranged form $317,000 to $500,000. This is the second Garret Lee Smith SAMHSA youth suicide prevention award received by MSYPP.


"Each year, more children and young adults die from suicide than from cancer, heart disease, AIDS, birth defects, stroke, and chronic lung diseases combined," said SAMHSA Acting Administrator Eric Broderick, D.D.S., M.P.H. "These new grants will help states build on and strengthen established youth suicide prevention and early intervention strategies."


The title for the new project is Caring About Lives in Maine (CAL ME). Ten high schools will be selected to help from the Department of Education, MSYPP through Medical Care Development implement this project. The MYSPP wants to fund one high school in every public health district throughout the state. Awards to high schools will be announced November 10, 2008.


"This is an exciting project and we're thankful that SAMHSA continues to support Maine's work in youth suicide prevention," said Cheryl DiCara, Director of the Maine Injury Prevention Program and Maine Youth Suicide Prevention Program.


The MYSPP is a collaborative initiative among the agencies of the Maine Children's Cabinet, representing Commissioners from the Departments of Health and Human Services; Education; Corrections; Labor; and Public Safety.


More information on the CAL ME Project and suicide prevention information can be found on the MYSPP website at mainesuicideprevention.


Maine Department of Health and Human Services

Standard therapy for depression does not help many people

A new study suggests that there are several people around who do not benefit from standard therapy for depression - their depression is still there two years later. According to the study, which looked at 1,200 patients from 46 American primary care centers, nearly 50% of patients who had 'at least minimally appropriate' depression treatment did not get any better.


What does Minimally Appropriate Care mean?


Minimally appropriate care means the patient has been treated for at least six months. During that time he/she has had four or more therapy sessions and has been on antidepressants for at least two months.


542 patients in this study had minimally appropriate care. 261 of them did not get better after two six month periods.


Dr. Catherine Sherbourne (team leader), RAND Corporation, Santa Monica, California, said to Reuters health "What we need is more research on the most effective way to treat this group."


You can read about this study in the journal General Hospital Psychiatry.


Those with persistent depression did seem to be getting more aggressive treatment, the team said. 15% were on prescriptions plus therapy for every three-six month period of treatment while only 3% did not respond to treatment.


It appears that the more persistent the depression is the harder the health professional will try.


Shebourne suggested that more combination of drugs and therapy, ongoing assessments by their own doctors and better referral to specialists is needed.


If the patient had suicidal thoughts, was unemployed and did not follow the medication instructions properly he/she was most likely not to get better.


Sherbourne reckons that suicidal thoughts are an indication of more severe depression. Unemployment could be because of the patient's inability to function properly in the outside world.

Physical symptoms of depression may be misdiagnosed

A study published in the Journal of General Internal Medicine revealed that physicians sometimes misattribute ill-defined physical symptoms to causes other than what may actually be depression. Patients complaining of physical ailments related to depression may not receive appropriate treatment from their doctors, as compared to patients who present with psychological symptoms.


Palpitations, hot flashes, chest pains, or problems with appetite, can be overlooked as signs of depression, according to a study of 200 adults. The study focused on a secondary analysis of patients beginning a new treatment episode for depression, and evaluated the effects of treatment as a result of physical versus psychological symptoms presented.


"While we are aware that current depression treatment is most often ineffective," offers author Dr. Robert D. Keeley, "we attempted to define the patient group that does not receive appropriate treatment, or does not respond to adequate treatment, by returning to the basic medical tenet of listening to the patient." The findings pointed out that physicians sometimes misattribute ill-defined physical symptoms to causes other than depression.


The most effective treatments, regardless of symptoms, were successful because they matched patient preference. Patients who had physical symptoms of depression were less likely to agree with a medical diagnosis of depression and thus tended to be nonaccepting of antidepressants, while 72% of patients with psychological symptoms who were presented with antidepressants as a treatment showed improved outcomes.


The study concludes that physicians need to search for new or modified interventions for depression when treating a patient with physical symptoms to improve the outcome.


Media wishing to receive a pdf of this article please contact medicalnewsbos.blackwellpublishing.



About the Author


Dr. Robert D. Keeley received his M.D. from Stanford University School of Medicine in 1994. He resides in Longmont, Colorado and has received multiple awards in the areas of Neuroscience, Primary Care Research and Family Practice. Dr. Keeley is available for questions and interviews and can be reached at RobKeeleypol or 303-775-0812.


About the Journal of General Internal Medicine


The Journal of General Internal Medicine (JGIM) is the official scientific publication of the Society of General Internal Medicine, whose mission is to promote improved patient care, research, and education in primary care and general internal medicine. JGIM articles focus on topics such as clinical research, curriculum development, epidemiology, prevention, and health care delivery in general internal medicine.



About Blackwell Publishing



Blackwell Publishing is the world's leading, independent society publisher with offices in the US, UK, Japan, Denmark, Australia, and Germany. Blackwell publishes over 700 journals in partnership with more than 550 academic and professional societies.



Contact: Sharon Agsalda

medicalnewsbos.blackwellpublishing

781-388-8507

Blackwell Publishing Ltd.

Brain Atrophy Responsible For Depression In People Battling Multiple Sclerosis

Adding to all that ails people managing their multiple sclerosis is depression for which MS sufferers have a lifetime risk as high as 50 percent.


Yet despite its prevalence, the cause of this depression is not understood. It's not related to how severe one's MS is, and it can occur at any stage of the disease. That suggests it is not simply a psychological reaction that comes from dealing with the burden of a serious neurologic disorder.


Now, in the first such study in living humans, researchers at UCLA suggest a cause, and it's not psychological, but physical: atrophy of a specific region of the hippocampus, a critical part of the brain involved in mood and memory, among other functions.


Reporting in the early online edition of the journal Biological Psychiatry, senior study author Dr. Nancy Sicotte, a UCLA associate professor of neurology, Stefan Gold, lead author and a postdoctoral fellow in the UCLA Multiple Sclerosis Program, and colleagues used high-resolution magnetic resonance imaging to identify three key sub-regions of the hippocampus that were found to be smaller in people with MS when compared with the brains of healthy individuals.


The researchers also found a relationship between this atrophy and hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis, a complex set of interactions among three glands. The HPA axis is part of the neuroendocrine system that controls reactions to stress and regulates many physiological processes. It's thought that this dysregulation may play a role in the atrophy of the hippocampus and the development of depression.


"Depression is one of the most common symptoms in patients with multiple sclerosis," Gold said. "It impacts cognitive function, quality of life, work performance and treatment compliance. Worst of all, it's also one of the strongest predictors of suicide."


The researchers examined three sub-regions of the hippocampus region CA1, CA3 and the dentate gyrus area of the hippocampal region called CA23DG (CA stands for cornu ammonis). They imaged 29 patients with relapsing remitting multiple sclerosis and compared them with 20 healthy control subjects who did not have MS. They also measured participants' cortisol level three times a day; cortisol is a major stress hormone produced by the HPA axis that affects many tissues in the body, including the brain.


In addition to the difference between MS patients and healthy controls, the researchers found that the multiple sclerosis patients diagnosed with depression showed a smaller CA23DG sub-region of the hippocampus, along with excessive release of cortisol from the HPA axis.


"Interestingly, this idea of a link between excessive activity of the HPA axis and reduced brain volume in the hippocampus hasn't received a lot of attention, despite the fact that the most consistently reproduced findings in psychiatric patients with depression (but without MS) include hyperactivity of the HPA axis and smaller volumes of the hippocampus," Sicotte said.


"So the next step is to compare MS patients with depression to psychiatric patients with depression to see how the disease progresses in each," she said.


Other authors of the study included Kyle C. Kern, Mary-Frances O'Connor, Michael J. Montag, Aileen Kim, Ye S. Yoo and Barbara S. Giesser, all of UCLA.


Funding was provided by the National Multiple Sclerosis Society, the National Institutes of Health, the UCLA Cousins Center for Psychoneuroimmunology, and Claire and William Vaughn.


The authors report no conflicts of interest.


The UCLA Department of Neurology encompasses more than a dozen research, clinical and teaching programs that cover brain mapping and neuroimaging, movement disorders, Alzheimer's disease, multiple sclerosis, neurogenetics, nerve and muscle disorders, epilepsy, neuro-oncology, neurotology, neuropsychology, headaches and migraines, neurorehabilitation, and neurovascular disorders. The department ranks first among its peers nationwide in National Institutes of Health funding.

Approval Of Wyeth's Experimental Drug Pristiq As Depression Treatment Will Not Be Delayed By FDA, Company Officials Say

FDA's request for more data on Wyeth's experimental drug Pristiq as a nonhormonal treatment for hot flashes and other menopausal symptoms should not delay its approval as a depression treatment, company officials said Tuesday, the AP/BusinessWeek reports (Johnson, AP/BusinessWeek, 7/31).

Pristiq is a new version of Wyeth's depression treatment Effexor, which will lose patent protection in 2010. Wyeth is seeking approval from FDA to market Pristiq as a depression treatment for older women, as well as a treatment for menopausal symptoms. FDA last week issued an approvable letter for Pristiq as a menopausal-symptom treatment, which means that the agency could approve the drug but also usually means the agency needs more information before granting final approval.

According to Wyeth, FDA in its letter said that before the application could be approved, Wyeth must provide additional data on the potential for serious adverse cardiovascular and hepatic effects associated with the use of Pristiq. In addition, FDA said that Wyeth must address certain chemistry, manufacturing and control deficiencies prior to approval. FDA also made additional clinical and chemistry requests, which it said were not approvability issues (Kaiser Daily Women's Health Policy Report, 7/24).

Wyeth officials said they will work with FDA to speed the drug's approval as a nonhormonal treatment for menopausal symptoms. Greg Norden, Wyeth's CFO, said FDA officials have reassured the company that the additional safety data required for approval as a menopausal symptom treatment will not delay approval of the drug as a depression treatment. "We continue to believe [Pristiq] will receive approval in the first quarter of 2008" for depression, Norden said (AP/BusinessWeek, 7/31).

Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation. © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.



View drug information on Effexor.

Neurogenesis In The Adult Brain: The Association With Stress And Depression

The brain is the key organ in the response to stress. Brain reactions determine what in the world is threatening and might be stressful for us, and regulate the stress responses that can be either adaptive or maladaptive. Chronic stress can affect the brain and lead into depression: Environmental stressors related to job or family situation are important triggers of depressive episodes and major life events such as trauma or abuse amongst the most potent factors inducing depression.



The World Health Organization (WHO) predicts that major depression will soon be the world??s greatest public health burden. Thus optimising antidepressive therapy with regard to delayed or insufficient treatment response and unwanted side effects is urgent. Since the development of novel antidepressants is based upon an improved neurobiological understanding of this condition, new information about the cellular changes that take place in the brain is required.



Professor Fuchs from the Clinical Neurobiology Laboratory, German Primate Center in Goettingen, will present the latest findings on how brain cells can be adversely affected by stress and depression. He will explain how the adult brain is generating new cells and which impact these findings will have on the development of novel antidepressant drugs.







SPEAKER: Professor Eberhard Fuchs, Clinical Neurobiology Laboratory, German Primate Center, Goettingen, and Department of Neurology, University Medical Center, Georg-August-University Goettingen, Germany. Press conference on 31 August 2008 in Barcelona, Spain.

Journal Editor Resigns After Failure To Disclose Conflict Of Interest

Charles Nemeroff has decided to resign as editor of the journal Neuropsychopharmacology after he co-authored a favorable article on a chest implant that treats depression and did not disclose his financial ties to Cyberonics, which manufactures the device, the Wall Street Journal reports. The article, published last month in Neuropsychopharmacology, said that the device -- which delivers mild electrical pulses to the vagus nerve in the neck -- is "a promising and well-tolerated intervention that is effective in a subset of patients with treatment-resistant depression." Nemeroff, chair of the Department of Psychiatry and Behavioral Sciences at Emory University, and seven of the eight other authors of the article serve as consultants for Cyberonics, and one of the authors was an employee of the company. In an e-mail, the owner of Neuropsychopharmacology said that Nemeroff decided to resign, "in part, based on the recent adverse publicity to the journal." Neuropsychopharmacology has published a correction that disclosed the financial ties of the authors of the article to Cyberonics (Armstrong, Wall Street Journal, 8/26).


"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Physician-Assisted Suicide Does Not Increase Severity Of Depression, Grief Among Family Members

Unlike other forms of suicide, physician assisted death does not cause substantial regret, or a sense of rejection among surviving family members. In addition, the prevalence and severity of depression and grief among family members whose loved ones received aid in dying is no different than family members whose loved ones did not pursue physician assisted suicide. These findings are the result of a study conducted by researchers at Oregon Health & Science University and published online this week in the Journal of Pain and Symptom Management.



"Grief following the death of a loved one can be persistent, painful and debilitating," said Linda Ganzini, M.D., a professor of psychiatry and medicine in the OHSU School of Medicine and lead author of the research paper. "Prior studies on suicides indicate high levels of shame, guilt, stigma and sense of rejection in surviving family members. However, until now, little was known about mental health outcomes in the family members of a patient who receives physician aid in dying. Based on our research, we know that family members of loved ones who pursue physician assisted suicide do not have different prevalence and severity of depression and prolonged grief compared to the general population."



To conduct the study, researchers surveyed 95 family members whose loved ones requested aid in dying through Oregon's Death with Dignity Act. This group included 59 family members whose loved one received a lethal prescription and 36 whose loved one died by lethal ingestion. The researchers compared this information with responses received from 63 family members whose loved one had died from cancer or amyotrophic lateral sclerosis (Lou Gehrig's disease) and had not requested aid in dying.



In comparing survey results, the researchers found that the rate of grief and depression between these two groups was nearly identical. However, family members of loved ones who requested a lethal prescription indicated they felt more prepared for and more accepting of the death.



Among family members whose loved one requested but did not receive a lethal prescription, there was greater likelihood that the family members had regrets about how their loved one died. This group also was less likely to confirm that the patient's preferences for care were honored, and they gave a lower rating for overall quality of care the last week of life.



"One of the other interesting findings in this research was the fact that families often had shared views when it came to the acceptability of physician aid in dying," added Ganzini. "When we communicated with the family members of those who received aid in dying, 98 percent said they would consider physician assisted suicide for themselves."



This research was funded by the Greenwall Foundation.

Interactive Autism Network Opens Its Doors To Adults With Autism

The Kennedy Krieger Institute will commemorate the two-year anniversary of the Interactive Autism Network (IAN), IANProject, with the much-anticipated launch of its research initiative for adults and the unveiling of a more user-friendly, easily navigated online community. Launched in April 2007 as the first national autism registry, the IAN Project has become the largest pool of autism data in the world, with registration expected to reach 30,000 individuals during Autism Awareness Month.
Having already uncovered new insights and aided hundreds of research studies about children with autism, the IAN Project is now enrolling adults with autism in hopes of using the same proven research model to address the many unanswered questions about this underserved population. Adults with autism can now have their voices heard through the IAN Project in order to help researchers gain a clearer picture of how they are living today. Adult participation meets a significant unmet need - while the number of adults living with autism grows every day, little is known about them. There hasn't been a comprehensive, national effort to find out what services adults with autism are in need of, or to document the ways they contribute to society. In fact, there is no official estimate of how many adults with autism are living in the U.S. today.
"By expanding the IAN Project beyond children, we will provide much-needed insight that will ultimately enable caregivers, the community, legislators, advocates and researchers to better serve adults with autism," said Dr. Paul Law, Director of the Interactive Autism Network at the Kennedy Krieger Institute in Baltimore, Maryland. "By surveying and registering adults with autism, the IAN Project will be able to gain a clearer picture of how adults with autism are living today, and connect them with researchers who are working to understand the disorder at all stages of life."



The IAN Project is also unveiling a new look for its online community, which with its unique model of information exchange and community interaction has facilitated the most comprehensive collection of evidence-based information on autism available to parents on the Web to date. The new design allows users to more easily navigate through the site, and highlights the depth of resources available to the autism community. From the community homepage, users can quickly see the most recent research articles written by prominent autism experts, the latest autism news and what discussions are currently taking place in the community forums.



"We're proud of the trusted, comprehensive resource we have created for the autism community. Because of the volume of participation in the site it became important to redesign the interface to make the wealth of information available through the IAN Project more accessible. The enhanced site will make it easier for stakeholders in the autism community to locate resources and connect with others affected by autism," said Dr. Law.
















Additionally, the IAN Project continues to generate new insights into autism and shed light on issues of critical importance to the autism community. Research highlights from 2008 include:
Defining the Spectrum: Having meaningful autism spectrum diagnostic categories is essential to treatments and research. On March 18, 2009, the IAN Project published a paper in the Journal of Autism and Developmental Disorders that described the varied pattern of autism diagnosis across the country and over time (1994-2007). This information is being used by scientists to better define the best way to diagnose autism. Better autism diagnoses will lead to better treatments and more finely tuned research.
Parental Depression: More than 44 percent of mothers and 28 percent of fathers of children with autism report they have been professionally diagnosed with either depression or bipolar disorder at some point in their lives, with more than 50 percent reporting diagnosis before the birth of their child(ren) with autism. This statistic is striking when compared to the estimated lifetime prevalence in the U.S. population for major depressive disorder of 16.2 percent and for bipolar disorder of 1 to 2.1 percent.

The IAN Project is funded by Autism Speaks, a non-profit organization dedicated to increasing awareness about the growing autism health crisis and raising funds for critical autism research. To register or learn more, visit IANproject.


Notes:


About Autism



Autism spectrum disorders (ASD) is the nation's fastest growing developmental disorder, with current incidence rates estimated at 1 in 150 children. This year more children will be diagnosed with autism than AIDS, diabetes and cancer combined, yet profound gaps remain in our understanding of both the causes and cures of the disorder. Continued research and education about developmental disruptions in individuals with ASD is crucial, as early detection and intervention can lead to improved outcomes in individuals with ASD.



About the Kennedy Krieger Institute



Internationally recognized for improving the lives of children and adolescents with disorders and injuries of the brain and spinal cord, the Kennedy Krieger Institute in Baltimore, MD serves more than 13,000 individuals each year through inpatient and outpatient clinics, home and community services and school-based programs. Kennedy Krieger provides a wide range of services for children with developmental concerns mild to severe, and is home to a team of investigators who are contributing to the understanding of how disorders develop while pioneering new interventions and earlier diagnosis.



About Autism Speaks



Autism Speaks is the nation's largest autism science and advocacy organization, dedicated to funding research into the causes, prevention, treatments and a cure for autism; increasing awareness of autism spectrum disorders; and advocating for the needs of individuals with autism and their families. Autism Speaks funds more than $30 million each year in new autism research, in addition to supporting the Autism Treatment Network, Autism Genetic Resource Exchange, Autism Clinical Trials Network, Autism Tissue Program and a range of other scientific and medical programs. Notable awareness initiatives include the establishment of the annual United Nations-sanctioned World Autism Awareness Day on April 2 and an award-winning, multi-year national public service advertising campaign with the Ad Council. Autism Speaks' family services efforts include the Autism Video Glossary, a 100 Day Kit for newly-diagnosed families, a School Community Tool Kit and the distribution of community grants to local service providers. Its government relations department, through its Autism Votes initiative, has played a critical role in securing federal legislation to advance the federal government's response to autism, and has successfully advocated for insurance reform to require insurers to cover medically-necessary autism therapies. Each year, Autism Speaks Walk Now for Autism fundraising events are held in more than 70 cities across the country, as well as Canada and the United Kingdom.