Effect of SSRIs and Depression On Revisions After Hip or Knee Replacement

MedicalResearch.com Interview with:

Hilal Maradit Kremers, M.D. M.Sc.   Associate Professor of Epidemiology Mayo Clinic College of Medicine

Dr. Hilal Maradit Kremers

Hilal Maradit Kremers, M.D. M.Sc. 
Associate Professor of Epidemiology
Mayo Clinic College of Medicine 

MedicalResearch.com: What is the background for this study?

Response: Depression and mood disorders are common comorbidities in patients undergoing total hip and total knee arthroplasty.  Based on previous research, there is evidence to suggest presence of depression in arthroplasty patients is associated with worse functional and clinical outcomes, such as complications, readmissions and mortality.  Although the mechanisms are poorly understood, it is important to identify strategies to effectively manage perioperative depression in an effort to improve arthroplasty outcomes.  One potential strategy is effective medical treatment of underlying depression which can potentially improve depression symptoms, thereby surgical outcomes.

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Antidepressants Have Variable Effects On Symptom Clusters

MedicalResearch.com Interview with:

Adam Chekroud PhD Candidate Human Neuroscience Lab

Adam Chekroud

Adam Chekroud
PhD Candidate
Human Neuroscience Lab
Department of Psychology
Yale University

MedicalResearch.com: What is the background for this study?

Response: We know that depression includes a wide range of symptoms, from low mood and feeling worthless, to problems sleeping, slowed thinking, and suicidal ideation.

We wanted to know whether antidepressants work well in treating all of these symptoms, or whether they are primarily effective on certain kinds of symptoms.

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Self-Guided Internet Based Cognitive Behavioral Therapy Shows Promise For Depression

MedicalResearch.com Interview with:
Eirini Karyotaki, MSc

Department of Clinical Psychology and EMGO Institute for Health and Care Research
Vrije Universiteit Amsterdam
Amsterdam, the Netherlands

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Depression is broadly acknowledged as a major health issue associated with a great risk of mortality and morbidity. Nevertheless, help-seeking rates are low among individuals with depression. Some of the barriers that impede help seeking are the limited availability of trained clinicians, the fear of stigmatisation and the cost of treatment. Self-guided Internet based Cognitive behavioural therapy (iCBT) has the potential to overcome many of these treatment barriers. However, recent randomised controlled trials (RCTs) have produced mixed evidence regarding the effects of self-guided iCBT in treating adults with depressive symptoms.

To gain more insight in the effectiveness of self-guided iCBT, an Individual Participant Data meta-analysis was performed. 3876 individual participant data across 13 RCTs were collected and analysed.

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Paternal Depression Linked To Not Being in Relationship With Mother

MedicalResearch.com Interview with:
Lisa Underwood, PhD
Research Fellow| Centre for Longitudinal Research
Growing Up in New Zealand | Who are Today’s Dads?
School of Population Health, Faculty of Medical & Health Sciences
University of Auckland  Auckland

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This study is part of the contemporary, longitudinal study Growing Up in New Zealand, which is tracking the development of more than 6000 children born in 2009 and 2010.

In previous reports we investigated antenatal and postnatal depression symptoms among the mothers of our cohort children. In this study we looked at the partners of those mothers to explore whether men and women have different risks for depression in each perinatal period.

Our main findings were that expectant fathers were at risk if they felt stressed or were in poor health. Elevated depression symptoms following their child’s birth, were also linked to social and relationship problems.

The strongest predictor of postnatal paternal depression was no longer being in a relationship with the child’s mother.

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Disorder-Specific vs Nonspecific Psychotherapy for Chronic Depression

MedicalResearch.com Interview with:

Prof. Dr. phil. Elisabeth Schramm Klinik für Psychiatrie und Psychotherapie

Dr. Elisabeth Schramm

Prof. Dr. phil. Elisabeth Schramm
Klinik für Psychiatrie und Psychotherapie

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Chronic depression is a highly prevalent and disabling disorder. As compared to acute episodically depressed patients, chronic depressives benefit less from psychological and pharmaceutical treatment.

Prior investigations suggest that these patients need longer treatment duration for symptom improvement.

In this randomized clinical trial including 268 adults with early onset chronic depression not taking antidepressant medication, patients treated with a disorder-specific psychological treatment (Cognitive Behavioral Analysis System of Psychotherapy; CBASP) reported significantly less severe depressive symptoms after 20 and 48 weeks as compared to a nonspecific supportive therapy. CBASP patients were also more likely to reach remission and showed significant advantages in global functioning and quality of life.

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Physically Active Children May Have Reduced Symptoms of Depression

MedicalResearch.com Interview with:
Lars Wichstrøm, PhD
NTNU Social Reseach, Trondheim, Norway; and
Department of Psychology
Norwegian University of Science and Technology
Trondheim, Norway

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Previous research has linked physical activity, and particularly moderate to vigorous physical activity to less depression in adolescents and adults, but the potential prospective relationship between physical activity and depression in middle childhood has not yet been identified.

The main findings in this study support existing research by showing that physically active children have fewer symptoms of depression two years later compared to less physically active children, but there is no relationship between sedentary behavior and depressive symptoms in middle childhood.

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Oxytocin During Labor Linked to Increased Risk of Postpartum Depression

MedicalResearch.com Interview with:

Kristina M. Deligiannidis, MD Associate Professor, Center for Psychiatric Neuroscience The Feinstein Institute for Medical Research Director, Women’s Behavioral Health, Zucker Hillside Hospital Northwell Health Associate Professor, Psychiatry and Obstetrics & Gynecology Hofstra Northwell School of Medicine

Dr. Kristina Deligiannidis

Kristina M. Deligiannidis, MD
Associate Professor
Center for Psychiatric Neuroscience
The Feinstein Institute for Medical Research
Director, Women’s Behavioral Health
Zucker Hillside Hospital Northwell Health
Associate Professor
Psychiatry and Obstetrics & Gynecology
Hofstra Northwell School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Because of effects on social behavior, including maternal behavior, oxytocin has often been seen as a potential mediator of postpartum depression and anxiety.

The original objective of our study was to examine the relationship between the use of synthetic oxytocin during and after labor and the development of depressive and anxiety disorders within the first year postpartum. We hypothesized that women exposed to synthetic oxytocin before or during labor would have a reduced risk of postpartum depressive and anxiety disorders compared with those without any exposure. Our findings told the opposite story.

We found that peripartum synthetic oxytocin exposure was associated with an increase in risk for the development of postpartum depression and anxiety.

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Link Between Antidepressants During Pregnancy and Birth Defects

MedicalResearch.com Interview with:
Anick Bérard PhD FISPE

Research chair FRQ-S on Medications and Pregnancy and
Director, Réseau Québécois de recherche sur le médicament (RQRM)
and Professor, Research Chair on Medications, Pregnancy and Lactation
Faculty of Pharmacy University of Montreal and
Director, Research Unit on Medications and Pregnancy
Research Center CHU Ste-Justine 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We have over 20 years of research showing that antidepressant use during the first trimester of pregnancy increases the risk of major congenital malformations. However, it still remains that controversies exist because we are not sure which of this increased risk is due to maternal depression. Therefore, we have only studied depressed pregnant women – some of them did not take antidepressant during pregnancy.

We were able to show that among depressed pregnant women, those who took antidepressants were at increased risk of having children with malformations – especially those taking citalopram. We were also able to show that many SSRIs, SNRI and tricyclic antidepressants put women at increased risk of having children with various malformations due to their similar mechanism of action (serotonin inhibition in utero).

MedicalResearch.com: What should readers take away from your report?

Response: Depression is a serious condition that requires medical attention during pregnancy. However, given that up to 85% of depressed pregnant women have mild to moderate depression – other treatment (other than antidepressants) options need to be considered. If a woman finds out she is pregnant and is taking antidepressants however, no abrupt discontinuation is suggested and a discussion with a health care provider is advised.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Very few data on the benefits of antidepressant use during pregnancy is available within depressed pregnant women with mild to moderate depression. Our study results taken together with all the body of literature on this topic should lead to other research on the benefits and risks of other forms of treatment for depression such as psychotherapy.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Anick Bérard, Jinping Zhao and Odile Sheehy. Antidepressant use during pregnancy and the risk of major congenital malformations in a cohort of depressed pregnant women: An updated analysis of the Quebec Pregnancy Cohort. BMJ Open, January 2017 DOI: 10.1136/bmjopen-2016-01337

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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More Hip Fractures in Elderly on Antidepressants

MedicalResearch.com Interview with:
Sanna Torvinen-Kiiskinen

MSc (Pharm.), PhD student,
Kuopio Research Centre of Geriatric Care and School of Pharmacy
University of Eastern Finland

MedicalResearch.com: What is the background for this study?

Response: Antidepressants are widely used among elderly persons, especially persons with Alzheimer’s disease. They are used not only for treatment for major depression, but for treatment of anxiety, insomnia and chronic pain as well as behavioral symptoms caused by dementia.

However, antidepressants, as well as other psychotropic drugs, may cause sedation, confusion, orthostatic hypotension and hyponatremia, which increase the risk of falling and fractures. Because of changes in pharmacodynamics and pharmacokinetics due to aging, older persons are at the higher risk of those adverse events.

The aim of our study was to investigate whether antidepressant use is associated with an increased risk of hip fracture among community-dwelling persons with and without Alzheimer’s disease.

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Strong SSRIs Linked To Increase Risk of Intracranial Hemorrhage

MedicalResearch.com Interview with:
Christel Renoux, MD, PhD
Assistant Professor, Dept. of Neurology & Neurosurgery
McGill University
Centre For Clinical Epidemiology
Jewish General Hospital – Lady Davis Research Institute
Montreal  Canada

MedicalResearch.com: What is the background for this study?

Response: Selective serotonin reuptake inhibitors (SSRIs) increase the risk for abnormal bleeding, in particular, gastrointestinal tract bleeding. Previous studies also suggested an increased risk for intracranial hemorrhage (ICH) in patients treated with SSRIs compared to non users. However, even if this risk exists, the comparison with a non-treated group may exaggerate the strength of a potential association and the comparison with a group of patients treated with other antidepressants may help better delineate the risk. The potential bleeding effect of antidepressants is linked to the strength of serotonin inhibition reuptake, and antidepressants that are strong inhibitors of serotonin reuptake have been associated with the risk for gastrointestinal or abnormal bleeding compared with weak inhibitors but the risk of ICH is unclear.

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Is Depression in Mild Cognitive Impairment a Precursor to Dementia?

MedicalResearch.com Interview with:
Zahinoor Ismail MD FRCPC

Clinical Associate Professor,
Hotchkiss Brain Institute
University of Calgary

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Depression and depressive symptoms are common in mild cognitive impairment (MCI). Evidence suggests that depression in MCI increases the likelihood of progression from MCI to dementia, compared to non-depressed people with MCI. In the newer construct of mild behavioural impairment (MBI), which describes the relationship between later life onset of sustained and impactful neuropsychiatric symptoms and the risk of cognitive decline and dementia, depression is an important subdomain (in addition to apathy, impulse control, social cognition and psychotic symptoms). Thus, depression and depressive symptoms are a significant risk factor for cognitive, behavioural and functional outcomes in older adults who have at most mild cognitive impairment. As the importance of neuropsychiatric symptoms in older adults emerges, good prevalence estimates are required to inform clinicians and researchers as well as public health policy and decision makers.

We performed a systematic review and meta-analysis to determine the best estimate of prevalence of depression in  mild cognitive impairment. We included 57 studies, representing 20,892 participants in the analysis. While we determined that the omnibus prevalence estimate was 32%, there was significant heterogeneity in this sample based on setting. In community samples, the rate was 25%, but in clinical samples this was higher at 40%. Additionally, different case ascertainment methods for depression (self report, clinician administered or caregiver report) and different MCI criteria didn’t change the prevalence estimates.

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Hearing Loss Linked To Increased Depression and Dementia Risk

MedicalResearch.com Interview with:

Dr-Frank-Lin.jpg

Dr. Lin

Frank Robert Lin, M.D., Ph.D.
Associate Professor of Geriatric Medicine, Head and Neck Surgery
Johns Hopkins Medicine

MedicalResearch.com Editor’s note: Dr. Lin discussed his research during Cochlear’s Global Research Symposium, which brought together international experts from the audiology community.

MedicalResearch.com: Is there a link between hearing loss and the risk of developing dementia?

Response: In the last few years, we have investigated the link between hearing loss and dementia in large studies of older adults who have been followed for many years. In these studies, we and others have found that those with greater hearing loss have a higher risk of developing dementia even after we account for factors like age, education, medical comorbidities, etc. We think this is because there are some pathways through which hearing loss can directly affect our thinking and memory abilities

MedicalResearch.com: Is there an association between hearing loss and cognitive decline or premature death?

Response: There is a link between hearing loss and accelerated cognitive decline. There is also external research that links hearing loss and premature death (Friburg 2014, Contrera 2015). Hearing loss can also increase a person’s chance of using medical and social services

MedicalResearch.com: How is hearing loss linked to increased social isolation and depression in the elderly?

Response: Older people with hearing loss are at a greater risk of social isolation due to their difficulty communicating with people. These individuals may be less likely to go out, particularly to settings where listening can be difficult (e.g., restaurants), and even if they do go out, they may feel isolated from the conversation and not able to engage with others.

MedicalResearch.com: What should readers take away from your report?

Response: Readers should understand that we’re increasingly understanding that hearing loss can detrimentally impact our thinking and memory abilities, risk of dementia, and our ability to remain engaged with others. Ongoing research is now studying to what extent our current hearing loss therapies can reduce and mitigate these risks and promote healthy aging.

MedicalResearch.com: Is there anything else you would like to add?

Response: Readers should know that hearing loss is a growing public health issue. It has been estimated that by 2050 1.2 billion people will suffer from hearing loss, underscoring the need for us to address it and recognize the burden of hearing loss on wider health. To learn more visit,www.linresearch.org and www.nas.edu/hearing

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Cochlear’s Global Research Symposium October 2016

Disclosure:  Symposium supported by Cochlear Limited (ASX: COH), together with Macquarie University and the Australian Hearing Hub

www.cochlear.com

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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