Common Antidepressant Sertraline Does Not Improve Depression in Chronic Kidney Disease Patients

MedicalResearch.com Interview with:

Dr. Susan Hedayati MD University of Texas Southwestern Dallas, Texas

Dr. Hedayati

Dr. Susan Hedayati MD
Yin Quan-Yuen Distinguished Professorship in Nephrology
University of Texas Southwestern
Dallas, Texas

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

Response: We previously showed that Major Depression is associated with a significantly higher risk of death, dialysis initiation, and hospitalization among patients with Chronic Kidney Disease (CKD). Now we show that a common antidepressant medication, a selective serotonin reuptake inhibitors (SSRI), sertraline, does not improve depression in this patient population, a chronically ill group that is not only at significantly increased risk for developing depression but also its serious complications.

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Antidepressants in Youth Associated With Increased Risk of Type 2 Diabetes

MedicalResearch.com Interview with:
Mehmet Burcu, PhD, MS
Department of Pharmaceutical Health Services Research
University of Maryland, Baltimore 

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

Response: Antidepressants are one of the most commonly used psychotropic medication classes in U.S. youth, with serotonin reuptake inhibitors representing a large majority of total antidepressant use in youth.

The most interesting finding was that the current use of serotonin reuptake inhibitors in youth was associated with an increased risk of type 2 diabetes mellitus, and this increased risk intensified further with the increasing duration of use and with the increasing dose. A secondary analysis also revealed that the risk of incident type 2 diabetes was most apparent in youth who used serotonin reuptake inhibitors for longer durations AND in greater daily doses.

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Alzheimer’s: Antidepressants Increase Risk of Head and Traumatic Brain Injuries

MedicalResearch.com Interview with:

Heidi Taipale, PhD Pharm Senior Researcher School of Pharmacy, University of Eastern Finland; and Department of Clinical Neuroscience Karolinska Institutet 

Dr. Taipale

Heidi Taipale, PhD Pharm
Senior Researcher
School of Pharmacy, University of Eastern Finland; and
Department of Clinical Neuroscience
Karolinska Institutet 

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

Response: Antidepressant use among older persons has been associated with an increased risk of falling and fall-related events, such as hip fractures, in previous studies. Our previous study identified risk of hip fractures in antidepressant among persons with Alzheimer’s disease. As falling is the main causal factor for head traumas and traumatic brain injuries among older persons, we hypothesized that antidepressant use could also be associated with these injuries.

We utilized a nationwide cohort of 70,718 persons newly diagnosed with Alzheimer’s disease, identified from the Finnish registers. The risk of head injuries and traumatic brain injuries was compared between persons initiating antidepressant use and comparison persons of the same age, gender and time since they received diagnoses of Alzheimer’s disease but not using antidepressants. We found a 40-percent increased risk of head injuries and 30-percent increased risk of traumatic brain injuries associated with antidepressant use. Antidepressant use was associated with a higher risk of head injuries especially at the beginning of use – during the first 30 days – but the risk persisted even longer, up to two years. The association was also confirmed in a study design comparing time periods within the same person, thus eliminating selective factors. Continue reading

Brain Imaging Confirms Boys and Girls Experience Depression Differently

MedicalResearch.com Interview with:

Jie-Yu Chuang PhD Department of Psychiatry University of Cambridge Cambridge, United Kingdom

Dr. Jie-Yu Chuang

Jie-Yu Chuang PhD
Department of Psychiatry
University of Cambridge
Cambridge, United Kingdom 

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

Response: Men and women appear to suffer from depression differently, and this is particularly striking in adolescents. By 15 years of age, girls are twice as likely to suffer from depression as boys. There are various possible reasons for this, including body image issues, hormonal fluctuations and genetic factors, where girls are more at risk of inheriting depression. However, differences between the sexes don’t just involve the risk of experiencing depression. Men are more liable to suffer from persistent depression, whereas in women depression tends to be more episodic. Compared with women, depressed men are also more likely to suffer serious consequences from their depression, such as substance abuse and suicide. Despite this, so far, most researchers have focused on depression in women, likely because it is more common. As a result, we’d like to make people more aware of the sex difference issue in depression.

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Study Helps Explains Why Dopamine Drugs Not Effective For Depression

MedicalResearch.com Interview with:

Robb B. Rutledge, PhD Max Planck University College London Centre for Computational Psychiatry  and Ageing Research University College London London, England

Dr. Rutledge

Robb B. Rutledge, PhD
Max Planck University College London Centre for Computational Psychiatry
and Ageing Research
University College London
London, England

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

Response: Depression is associated with deficits in how the brain responds to rewards, something the neurotransmitter dopamine is strongly implicated in.

Dopamine represents what is called a reward prediction error, the difference between experienced and predicted reward. This error signal is used for learning. For example, if the outcome of a decision is better than expected, you can update your expectations using this error signal and you should expect more next time. Previous research has shown that depression reduces these signals in the brain when people are learning about the world around them. We designed a task where participants did not have to learn anything during the experiment and we found that in this situation reward prediction error signals were not affected by depression. The signals we measured in the ventral striatum, a brain area with a lot of input from the dopamine neurons, looked the same in depressed and non-depressed individuals. We also found that the emotional impacts of reward prediction errors were similar in depressed and non-depressed individuals when we eliminated the need for learning during the task in both the lab and using a smartphone experiment with 1833 participants.

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Brexanolone Shows Promise in PostPartum Depression

MedicalResearch.com Interview with:

Samantha Meltzer-Brody, MD, MPH Associate Professor and Associate Chair for Faculty Development Director, Perinatal Psychiatry Program Director, Taking Care of Our Own Program Department of Psychiatry Chapel Hill, NC 2759

Dr. Meltzer-Brody

Samantha Meltzer-Brody, MD, MPH
Associate Professor and Associate Chair for Faculty Development
Director, Perinatal Psychiatry Program
Director, Taking Care of Our Own Program
Department of Psychiatry
Chapel Hill, NC 2759 

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

Response: The Lancet published results from a randomized, placebo-controlled, phase 2 clinical trial with the investigational medication, brexanolone, for women with severe postpartum depression (PPD). During the study, which was conducted at multiple sites across the country, physician researchers administered brexanolone in 21 women, 10 of whom were administered a 60-hour infusion of brexanolone. The other 11 women were given a placebo. Results from the trial showed that 70 percent of participants who received the drug saw remission of their PPD symptoms within 60 hours of treatment, an effect that was maintained until the 30-day follow up.

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New Simultaneous Antidepressant and Benzodiazepine Use Relatively Common

MedicalResearch.com Interview with:

Greta A Bushnell, MSPH Doctoral Candidate, Department of Epidemiology UNC, Gillings School of Global Public Health

Greta Bushnell

Greta A Bushnell, MSPH
Doctoral Candidate, Department of Epidemiology
UNC, Gillings School of Global Public Health

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

Response: Patients with depression may be co-prescribed a benzodiazepine at antidepressant initiation for a short period for a variety of reasons. Reasons include reducing concurrent anxiety and insomnia, reducing depression severity more quickly, and improved antidepressant continuation. However, there are concerns with benzodiazepines including dependency. As such, benzodiazepines are usually recommended for only short-term treatment.

Prior to our study, little was known about a) how often new simultaneous antidepressant and benzodiazepine prescribing occurred among patients initiating antidepressant treatment for depression or b) whether new simultaneous users became long-term benzodiazepine users.

In a large commercial insurance database, we identified adults aged 18-64 years with depression who initiated an antidepressant from 2001 to 2014. We found that 11% of adults simultaneously initiated benzodiazepine treatment, which increased from 6% in 2001 to a peak at 12% in 2012. We observed similar antidepressant treatment length at six months in simultaneous new users and among patients initiating antidepressants only. The majority of simultaneous new users had only one benzodiazepine prescription fill before benzodiazepine discontinuation; however, 12% were identified as long-term benzodiazepine users.

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Pain and Depression in ESRD- End Stage Renal Disease

MedicalResearch.com Interview with:
Kathy Aebel-Groesch, MSW,LCSW
Manager, Social Work Services
DaVita Inc.

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

Response: Chronic pain and depression can impact quality of life and adherence to treatment regimen among patients with end-stage renal disease (ESRD). Previous research has demonstrated that patients with ESRD experience pain and depression more frequently than the general population. From 2016, CMS has required that all eligible ESRD patients are evaluated regularly for pain and depressive symptoms.

We assessed pain and depression symptom scores among patients of a large dialysis organization (LDO) over the period Mar-Oct 2016. Pain was assessed monthly by LDO nurses using the Wong-Baker pain scale (0-10). Depression screenings were conducted biannually by LDO social workers using the PHQ-2 (scale 0-6) and excluded patients with existing diagnosis of depression or bipolar disorder, cognitive impairment or language barrier, and those who were hospitalized or refused screening.

A total of 688,346 pain responses from 160,626 individual patients and 223,421 depression screening responses from 158,172 patients were considered. A score of 0 (no pain) was reported for 83.5% of pain responses and 65.7% of patients had a 0 score in all pain assessments. A score of 10 (most severe pain) was reported at least once during the study period by 3.0% of patients. Patients with a pain score of 10 were more frequently female (55%) and patients on peritoneal dialysis were less likely to have a pain score of 10 than those on other modalities. A depression score of 0 (patient answered “Not at all” to both “Little interest or pleasure in doing things” and “Feeling down, depressed, or hopeless”) was reported for 69.1% of all responses and 62.6% of patients had a 0 score in all assessments; 1.8% of patients had at least one score of 6 (patient responded “Nearly every day” to both questions) and 9.7% had at least one score of 3 or more. Patients with a score of 0 were more likely to be male vs. female, HHD vs. PD or ICHD, ≥ age 70 years.

The majority of ESRD patients did not report pain symptoms and, among those not excluded from screening due to an existing diagnosis of depression or other reason, the majority did not report symptoms of depression. However, routine assessment of pain and depression enables the timely identification of new or increased symptoms, thus allowing earlier implementation of interventions that may improve patient experience. The LDO has since revised its depression screening policy to remove diagnosis of depression from exclusion criteria and to administer the PHQ-9 to patients with a PHQ-2 score ≥ 3.

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Acupuncture Therapy and Incidence of Depression After Stroke

MedicalResearch.com Interview with:
Chung-Yen Lu, MD, PhD

Assistant Professor
Department of Sport and Health Management, Da-Yeh University, Changhua, Taiwan; Department of Chinese Medicine, Taipei Hospital, Ministry of Health and Welfare,
New Taipei, Taiwan 

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

Response: Post-stroke depression is a common mood complication of patients with stroke and may deteriorate motor function and cognitive function. Acupuncture therapy is an alternative and supplementary medical care often used worldwide. Previous studies have reported that acupuncture therapy for post-stroke depression may involve multiple therapeuticeffects including treating neurological disorders and physical disabilities following stroke, which are predictors of post-stroke depression. However, population-based evaluations on the association between acupuncture treatment and prevention of post-stroke depression are rare.  Continue reading

Microvascular Disease Linked To Late-Life Depression

MedicalResearch.com Interview with:

Miranda T. Schram PhD Associate professor Department of Medicine Maastrich

Dr. Schram

Miranda T. Schram PhD
Associate professor
Department of Medicine
Maastrich

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

Response: Late-life depression, also called vascular depression, is highly prevalent, recurrent and difficult to treat. Anti-depressants only relieve symptoms in about 50% of the patients. So we urgently need new treatment targets for this disease.

In this study we found that microvascular dysfunction, irrespective if you measure this by biomarkers in the blood or in the brain, is associated with an increased risk for depression. Moreover, we found evidence from longitudinal studies that microvascular dysfunction, at least of the brain, may actually be a cause of depression. To investigate this, we undertook a meta-analyses of data from over 40,000 individuals of whom over 9,000 had a depression.

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LATUDA Phase 3 Study Demonstrates Improvement in Pediatric and Adolescent Bipolar Depression

MedicalResearch.com Interview with:

Antony Loebel, M.D. Executive Vice President and Chief Medical Officer Sunovion, Head of Global Clinical Development Sumitomo Dainippon Pharma Group

Dr. Loebel

Antony Loebel, M.D.
Executive Vice President and Chief Medical Officer
Sunovion, Head of Global Clinical Development
Sumitomo Dainippon Pharma Group

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

In the six-week, randomized, double-blind, placebo-controlled study, 347 children and adolescents (10 to 17 years of age) with bipolar depression received once-daily LATUDA flexibly dosed (20-80 mg/day) or placebo.The Phase 3 clinical study met its primary endpoint, showing statistically significant and clinically meaningful improvement in symptoms compared to placebo. LATUDA was generally well tolerated, with minimal effects on weight and metabolic parameters.

The primary efficacy endpoint was change from baseline to week 6 on the Children Depression Rating Scale, Revised (CDRS-R) total score. LATUDA was associated with statistically significant and clinically meaningful improvement in bipolar depression symptoms compared to placebo, based on CDRS-R total score (-21.0 vs. -15.3; effect size = 0.45; p<0.0001) and CGI-BP-S score for depression (-1.49 vs. -1.05; effect size = 0.44; p<0.001).

LATUDA also demonstrated statistically significant improvement on secondary efficacy endpoints.

The most common treatment-emergent adverse events reported for LATUDA compared to placebo were nausea (16% vs. 5.8%), somnolence (9.1% vs. 4.7%), weight gain (6.9% vs. 1.7%), vomiting (6.3% vs. 3.5%), dizziness (5.7% vs. 4.7%) and insomnia (5.1% vs. 2.3%). LATUDA was associated with no increases in fasting glucose or lipids, and minimal increase in mean weight vs. placebo (+0.74 kg vs. +0.44 kg).

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Depressive Symptoms Not Found To Increase Risk of Dementia

MedicalResearch.com Interview with:

Archana Singh-Manoux, PhD Research Professor (Directeur de Recherche) Epidemiology of ageing & age-related diseases INSERM U1018, France Honorary Professor University College London, UK

Dr. Archana Singh-Manoux

Archana Singh-Manoux, PhD
Research Professor (Directeur de Recherche)
Epidemiology of ageing & age-related diseases
INSERM  France
Honorary Professor
University College London, UK 

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

Response: Depressive symptoms are common in dementia patients. Previous studies, based on older adults, show depressive symptoms in late life to be associated with an increased risk of dementia. These studies do not allow conclusions to be drawn on the causal nature of the association between depressive symptoms and dementia.

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Antidepressant May Enhance Drug Delivery to the Brain

MedicalResearch.com Interview with:

Ronald Cannon, Ph.D. Staff scientist at NIH’s National Institute of Environmental Health Sciences

Dr. Cannon

Ronald Cannon, Ph.D.
Staff scientist at NIH’s National Institute of Environmental Health Sciences

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

Response: The protein pump, P-glycoprotein, is a major obstacle to the delivery of therapeutic drugs across the blood-brain barrier and into the central nervous system (CNS). During the last 10 years, our laboratory has studied the regulation of P-glycoprotein with the hope of treating CNS diseases.

MedicalResearch.com: What are the main findings?

Response: Our most recent finding shows that the antidepressant, amitriptyline, suppresses P-glycoprotein pump activity. The discovery is significant because P-glycoprotein restricts most CNS targeted drugs from entering the brain. If fully translatable to human patients, suppression of P-glycoprotein could allow higher levels of CNS therapeutic drugs to reach their intended target.

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Study Finds No Link To Autism, ADHD In Offspring From Antidepressant Use In Pregnancy

MedicalResearch.com Interview with:

Simone Vigod, MD, MSc, FRCPC Psychiatrist and Lead, Reproductive Life Stages Program Women’s Mental Health Program Women’s College Hospital Toronto, ON

Dr. Vigod

Simone Vigod, MD, MSc, FRCPC
Psychiatrist and Lead, Reproductive Life Stages Program
Women’s Mental Health Program
Women’s College Hospital
Toronto, ON

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

Response: Depression is one of the most common problems that can complicate a pregnancy. Untreated, or incompletely treated, it can be associated with significant harm to mother and child. While psychotherapies alone may be effective for women with mild (or even moderate) severity symptoms, sometimes antidepressant medication is required. In these cases, the benefits of treatment must be weighed against potential risks. Previous research suggested that there may be an increased risk for autism in children exposed to antidepressant medication during pregnancy. However, previous studies were limited in their ability to account for other potential causes of autism in their analyses. In our study, we used several different strategies to try to compare children whose pregnancy exposures were very similar, except for exposure to an antidepressant.

The main finding was that after using these strategies, there was no longer a statistically significant association between in-utero antidepressant exposure and autism.

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Review of Risk for Autism Spectrum Disorders According to Period of Prenatal Antidepressant Exposure:

MedicalResearch.com Interview with:
Florence Gressier MD PhD

Insermk Department of psychiatry
CHU de Bicêtrem Le Kremlin Bicêtre
France

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

Response: Results from recent studies have suggested an increased risk for Autism Spectrum Disorders (ASDs) in children exposed to antidepressants in utero.

We performed a systematic review of and a meta-analysis of published studies to assess the association between ASDs and fetal exposure to antidepressants during pregnancy for each trimester of pregnancy and preconception.

Our systematic review and meta-analysis suggests a significant association between increased ASD risk and maternal use of antidepressants during pregnancy; however, it appears to be more consistent during the preconception period than during each trimester. In addition, the association was weaker when controlled for past maternal mental illness. Maternal psychiatric disorders in treatment before pregnancy rather than antenatal exposure to antidepressants could have a major role in the risk for Autism Spectrum Disorders.

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Rare Gene Variant Linked To Depressive Symptoms

MedicalResearch.com Interview with:
Najaf Amin, PhD
Erasmus University Medical Center
Netherlands

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

Response: Identifying genetic risk factors for depression has not been easy. Over a decade of genetic research did not yield a single replicable genetic factor for depression. It was only recently that 15 common genetic variants mostly in the non-coding parts of the genome were identified through a large genome-wide association study performed by 23andMe. All of these variants add a very small risk to depression individually (odds ratio < 1.05). These common variants cannot explain the cases that have a family history of depression.

Our hypothesis is that such familial cases are enriched for variants that are rare, lie in the coding region of the genome and thus have a large effect on depression. Such variants are enriched in families and isolated populations and therefore have a higher chance of being discovered compared to more cosmopolitan populations. Through gene-based analysis of rare coding variants we have identified a novel gene NKPD1 that may be relevant for depression. Further, we have noticed that the more deleterious the effect of the variant is on the protein, the larger the effect is on depressive symptoms.

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Vagus Nerve Stimulation Improved Treatment-Resistant Depression

MedicalResearch.com Interview with:

Scott T. Aaronson, M.D Psychiatrist, The Retreat at Sheppard Pratt Director of Clinical Research Sheppard Pratt Health System Baltimore, MD

Dr. Aaronson

Scott T. Aaronson, M.D
Psychiatrist, The Retreat at Sheppard Pratt
Director of Clinical Research
Sheppard Pratt Health System
Baltimore, MD

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

Response: This study is the largest ever conducted on patients with severe, chronic depression, a group typically ignored by clinical research in psychiatry. We looked at individuals who, on average, had received 8 unsuccessful treatment interventions in the past. These individuals were split into two groups and examined over five years. One group was given proven anti-depressant treatments (medications, psychotherapy, and/or electroconvulsive therapy (ECT)), and one group was given both anti-depressant treatments and VNS Therapy—an implantable, pacemaker-like device that stimulates the vagus nerve, which regulates mood in the brain.
• The study found that 67.9% of the VNS therapy group responded to treatment, compared to 40.9% of patients receiving treatment as usual. Importantly, the VNS therapy group reported responses earlier in treatment, and responses were sustained longer than those receiving treatment as usual.
• VNS therapy improved treatment effect in individuals whether they had unipolar or bipolar disorder, and whether or not they had responded to ECT in the past.

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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.

More Medical Research Interviews on MedicalResearch.com

 

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

Sanna Torvinen-Kiiskinen

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.

More Medical Research Interviews on MedicalResearch.com

Use of Marijuana At Young Age Linked To Functional Brain Abnormalities and Lower IQ

MedicalResearch.com Interview with:

Elizabeth Osuch, M.D. Associate Professor; Rea Chair Department of Psychiatry FEMAP--London Health Sciences Centre London, ON

Dr. Elizabeth Osuch

Elizabeth Osuch, M.D.
Associate Professor; Rea Chair
Department of Psychiatry
FEMAP–London Health Sciences Centre
London, ON   

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

Response: As a researcher and psychiatrist doing clinical work in youth aged 16-25 with mood and anxiety disorders I often see patients who are depressed and believe that using marijuana (MJ) improves their mood.  Yet they remain depressed.  This was the clinical inspiration for this brain imaging study, where we investigated emerging adults with Major Depressive Disorder (MDD).  Subject groups included patients with MDD who did and did not use MJ frequently.  Our results showed that the MDD+MJ group did not have significantly less depression than the MDD alone group, and the brain abnormalities found in MDD were not corrected by MJ use in the MDD+MJ group.  In fact, some of the brain differences were worse with the addition of MJ, while others were just different.

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Efficacy of Lurasidone in treatment of MDD-MF

MedicalResearch.com Interview with:
Antony Loebel, M.D. Executive Vice President and Chief Medical Officer, Sunovion, Head of Global Clinical Development for Sumitomo Dainippon Pharma GroupAntony Loebel, M.D.
Executive Vice President and Chief Medical Officer
Sunovion
Head of Global Clinical Development
Sumitomo Dainippon Pharma Group

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

Response: Early predictors of subsequent clinical response are important in the treatment of depression, since 6-10 weeks of treatment are often required before full antidepressant response may occur. Early identification of patients who are unlikely to eventually achieve a response permits clinicians to intervene early to adjust the dose of medication, or switch to an alternative therapy.

Multiple studies in major depressive disorder (MDD, unipolar) have reported that early improvement at 2 weeks is significantly predictive of treatment response at 6-8 weeks.The most common early improvement criterion is a 20-25% reduction in the Hamilton Depression Rating Scale (HAM-D) or the Montgomery-Asberg Depression Rating Scale (MADRS) scores1-6.

Major depressive disorder with mixed features (MDD-MF) has recently been recognized as a diagnostic subtype in DSM-5. No research we are aware of has examined the predictive value of early improvement in patients diagnosed with MDD-MF.

The aim of the current post-hoc analysis was to evaluate the value of early improvement in the MADRS or the Clinical Global Impressions, Severity (CGI-S) scale as predictors of response to lurasidone in patients with MDD-MF.

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Depression Common in Lung Cancer and Linked To Mortality

MedicalResearch.com Interview with:

Donald R. Sullivan, M.D., M.A. Assistant Professor, Division of Pulmonary & Critical Care Medicine Oregon Health & Science University Investigator, VA Portland Health Care System

Dr. Donald Sullivan

Donald R. Sullivan, M.D., M.A.
Assistant Professor, Division of Pulmonary & Critical Care Medicine
Oregon Health & Science University
Investigator, VA Portland Health Care System

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

Response: There is an inextricably link between physical and mental health, and all too often clinicians focus solely on the physical components of disease. A life-threatening diagnosis such as cancer often evokes significant psychological distress and lung cancer patients are at significantly risk. Up to 44% of lung cancer patients experience depression symptoms and 5-13% major depressive disorder, higher than most other cancers. Previous studies have demonstrated the development of depression or depression symptoms at lung cancer diagnosis can increase patient mortality, but there is a paucity of research exploring how longitudinal changes in depression symptoms impact patient outcomes.
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Nighttime Hot Flashes With Sleep Disruption Linked To Depressive Symptoms During Menopause

MedicalResearch.com Interview with:

Hadine Joffe, MD, MSc Associate Professor of Psychiatry, Harvard Medical School Vice Chair for Psychiatry Research Director of Division of Women's Mental Health / Dept of Psychiatry / Brigham and Women’s Hospital Director of Psycho-Oncology Research / Dept of Psychosocial Oncology and Palliative Care /Dana Farber Cancer Institute www.brighamwharp.org

Dr. Hadine Joffe

Hadine Joffe, MD, MSc
Associate Professor of Psychiatry, Harvard Medical School
Vice Chair for Psychiatry Research
Director of Division of Women’s Mental Health / Dept of Psychiatry / Brigham and Women’s Hospital
Director of Psycho-Oncology Research / Dept of Psychosocial Oncology and Palliative Care /Dana Farber Cancer Institute
www.brighamwharp.org

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

Response: We conducted this study to advance our understanding about causes of mood disturbance in the menopause transition that are specifically related to menopause. We used an experimental model to dissect out the contributions of hot flashes and sleep disturbance from contribution of changing levels of estrogen because hot flashes, sleep problems, and estrogen fluctuations co-occur and are difficult to distinguish from one another. Understanding whether hot flashes and/or sleep disturbance are causally related to mood disturbance will help us identify who is at risk for mood changes during the menopause transition. This is incredibly important now that we are finding effective non-hormonal treatments for hot flashes and sleep disruption.

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Depressive disorders are the most frequent neuropsychiatric complication of TBI

MedicalResearch.com Interview with:

Ricardo E. Jorge MD Professor of Psychiatry and Behavioral Sciences Director Houston Translational Research Center for TBI and Stress Disorders Senior Scientist Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry Michael E DeBakey VA Medical Center Baylor College of Medicine

Dr. Ricardo Jorge

Ricardo E. Jorge  MD
Professor of Psychiatry and Behavioral Sciences
Director Houston Translational Research Center for TBI and Stress Disorders
Senior Scientist  Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry
Michael E DeBakey VA Medical Center
Baylor College of Medicine

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

Response: Depressive disorders affect between one-third and one-half of patients with traumatic brain injury. Once established, these disorders are difficult to treat and frequently follow a chronic and refractory course.

Depression has a deleterious effect on TBI outcomes, particularly affecting the community reintegration of TBI patients.

In this randomized clinical trial that included 94 adult patients with TBI, the hazards for developing depression for participants receiving placebo were about 4 times the hazards of participants receiving sertraline treatment.

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Sertraline May Prevent Depression Following Traumatic Brain Injury

MedicalResearch.com Interview with:

Ricardo E. Jorge MD Professor of Psychiatry and Behavioral Sciences Director Houston Translational Research Center for TBI and Stress Disorders Senior Scientist Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry Michael E DeBakey VA Medical Center Baylor College of Medicine

Dr. Ricardo Jorge

Ricardo E. Jorge MD
Professor of Psychiatry and Behavioral Sciences
Director Houston Translational Research Center for TBI and Stress Disorders
Senior Scientist Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry
Michael E DeBakey VA Medical Center
Baylor College of Medicine

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

Response: Depressive disorders affect between one-third and one-half of patients with traumatic brain injury (TBI). Once established, these disorders are difficult to treat and frequently follow a chronic and refractory course.

Depression has a deleterious effect on TBI outcomes, particularly affecting the community reintegration of TBI patients. In this randomized clinical trial that included 94 adult patients with TBI, the hazards for developing depression for participants receiving placebo were about 4 times the hazards of participants receiving sertraline treatment.

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Collaborative Care is Effective and Cost-Effective For Adolescent Depression

MedicalResearch.com Interview with:

Laura P. Richardson, MD, MPH Interim Chief | Division of Adolescent Medicine Director | UW Leadership Education in Adolescent Health (LEAH) Program Professor | UW Department of Pediatrics Seattle Children's | University of Washington

Dr. Laura Richardson

Laura P. Richardson, MD, MPH
Interim Chief | Division of Adolescent Medicine
Director | UW Leadership Education in Adolescent Health (LEAH) Program
Professor | UW Department of Pediatrics
Seattle Children’s | University of Washington

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

Response: Adolescent depression is one of the most common mental health conditions during adolescence. Up to one in five adolescents experience an episode of major depression by age 18. Depressed youth are at greater risk of suicide, dropping out of school and poor long-term health. Treatments, including medications and psychotherapy, have been proven to be effective but most depressed teens don’t receive any treatment.

Two years ago, we showed that the Reaching Out to Adolescents in Distress (ROAD) collaborative care model (a.k.a. Reach Out 4 Teens) designed to increase support and the delivery of evidence-based treatments in primary care was effective in treating depression in teens, significantly improving outcomes. We ran a randomized clinical trial at nine of Group Health’s primary care clinics and reported effectiveness results in JAMA.

The current paper represents the next step in this work, examining the cost-effectiveness of collaborative care for adolescent depression in our intervention sample of 101 adolescents with depression, ages 13-17 years.

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Standardized Clinical Interview Evaluates Depression in Diabetes Patients

MedicalResearch.com Interview with:

Dr Cathy E. Lloyd Professor of Health Studies School of Health, Wellbeing and Social Care Faculty of Wellbeing, Education and Language Studies The Open University Milton Keynes

Prof. Cathy Lloyd

Dr Cathy E. Lloyd
Professor of Health Studies
School of Health, Wellbeing and Social Care
Faculty of Wellbeing, Education and Language Studies
The Open University
Milton Keynes UK

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

Response: We know from earlier epidemiological research that people with diabetes have an increased risk of developing depression and other mental health problems compared to those without diabetes. However the impact of this and what treatment and care should be provided is still unclear, in particular in countries other than the US or the UK.
Our study aims to redress that imbalance, collecting data on diabetes and depression in 16 countries across the globe.

Ours is the first study to measure depressive symptoms but also use a standardised clinical interview to diagnose depression according to ICD criteria.

Overall 10.6% received a diagnosis of Major Depressive Disorder (MDD), however prevalence rates differed widely between countries with 1% diagnosed with MDD in Uganda and nearly 30% in Bangladesh. Twenty-five percent reported subthreshold levels (PHQ-9 score 5 -9) of depression. Those with MDD were significantly more likely to be female and living in an urban rather than rural location (p<0.001). Age and duration of diabetes did not significantly differ between those with and without MDD. Multi-variable analyses demonstrated that while controlling for country, a diagnosis of MDD was significantly associated with female sex, lower education, taking insulin, less exercise, higher levels of diabetes-related distress and a previous diagnosis of MDD. A negligible proportion of those with either MDD or subthreshold levels of depression had a diagnosis or any treatment for their depression recorded in their medical records.

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Long-Term Bone Loss Linked to Antidepressants May Be Ameliorated By Beta Blockers

MedicalResearch.com Interview with:

Patricia Ducy, PhD Associate Professor Department of Pathology & Cell Biology Columbia University New York, NY 10032

Dr. Patricia Ducy

Patricia Ducy, PhD
Associate Professor
Department of Pathology & Cell Biology
Columbia University
New York, NY 10032

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

Response: In the past few years, several large clinical studies have reported an association between the use of selective serotonin reuptake inhibitors (SSRIs) and an increased risk of bone fractures. Yet, a few studies conducted on small cohorts using these drugs for a short time showed a decrease in bone resorption parameters and thus minor bone gain.

To understand this paradox and to define how the deleterious effect of SSRIs could be prevented we conducted a series of studies in mice treated with fluoxetine, the active molecule of the widely prescribed SSRI Prozac.

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HIV Patients With Depression Have Greater Risk of Myocardial Infarction

MedicalResearch.com Interview with:
Matthew S Freiberg, MD, MSc
Cardiovascular Medicine Division, Vanderbilt University School of Medicine
Tennessee Valley Geriatric Research Education and Clinical Center, Nashville  TN
Tasneem Khambaty, PhD
Department of Psychology, University of Miami, Coral Gables, Florida
Jesse C. Stewart, PhD
Department of Psychology, Indiana University–Purdue University , Indianapolis, Indianapolis

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

Response: Due to highly effective antiretroviral therapy, people with HIV are living longer. Unfortunately, these HIV-infected individuals remain at a higher risk for other chronic diseases, with cardiovascular disease (CVD) being one of the leading cause of death in this population. In the general population, depressive disorders, such as major depressive disorder (MDD) and dysthymic disorder, are associated with increased risk of new-onset CVD. Given that roughly 24-40% of HIV-infected individuals have a depressive disorder, we examined whether MDD and dysthymic disorder are also associated with an increased risk of new-onset CVD in people with HIV.
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PET Scan Identifies Low Serotonin Functioning Linked To Suicidal Behavior

Maria A. Oquendo, M.D. Professor of Psychiatry Vice Chair for Education Columbia University Medical Center American Psychiatric Association, President International Academy of Suicide Research, President

Dr. Maria Oquendo

MedicalResearch.com Interview with:
Maria A. Oquendo, M.D.
Professor of Psychiatry
Vice Chair for Education
Columbia University Medical Center
American Psychiatric Association, President
International Academy of Suicide Research, President

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

Response: Our team has worked for years on identifying the biological underpinnings of both risk for suicidal behavior (SB) and for predicting the lethality or medical consequences of suicidal behavior. We have shown that if you compare those who are depressed and have had SB to those who are depressed but do not have suicidal behavior, you can see clear differences in the serotonin system using Positron Emission Tomography and a molecule tagged with radioactivity. We predicted that if you could see these differences cross-sectionally, then their presence might also predict suicidal behavior and its lethality in the future. Our study showed that those with higher serotonin 1a binding in the raphe nuclei, which likely indicates low serotonin functioning, made more medically damaging suicide attempts in the two years that followed. They also suffered from more pronounced suicidal ideation in the subsequent year.

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Behavioural Activation Therapy Offers Lower-Cost, Effective Treatment for Depression

MedicalResearch.com Interview with: David A Richards, PhD Professor of Mental Health Services Research and NIHR Senior Investigator University of Exeter Medical School University of Exeter St Luke's Campus Exeter United Kingdom MedicalResearch.com: What is the background for this study? Response: Depression is a common mental health disorder affecting around 350 million people worldwide. Untreated depression is expected to cost the global economy US$5.36 trillion between 2011 and 2030. Many patients request psychological therapy, but the best-evidenced therapy—cognitive behavioural therapy (CBT)—is complex and costly. A simpler therapy—behavioural activation (BA)—might be as effective and cheaper than is CBT. We aimed to establish the clinical efficacy and cost-effectiveness of BA compared with CBT for adults with depression. MedicalResearch.com: What are the main findings? Response: We found that behavioural activation, a simpler psychological treatment than CBT, can be delivered by junior mental health workers with less intensive and costly training, with no lesser effect than CBT. Effective psychological therapy for depression can be delivered without the need for costly and highly trained professionals MedicalResearch.com: What should readers take away from your report? Response: Our findings have substantial implications given the increasing global pressure for cost containment across health systems in high-income countries and the need to develop accessible, scalable interventions in low-income and middle-income countries. Such countries might choose to investigate the training and employment of junior workers over expensive groups of psychological professionals. Our results, therefore, offer hope to many societies, cultures, and communities worldwide, rich and poor, struggling with the effect of depression on the health of their people and economies. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Response: Research into these and other potential strengths of behavioural activation in the context of implementation science is necessary for the hope and promise offered by the COBRA trial to be fulfilled. Now that we have support for BA as a treatment that is clinically effective and cost-effective, we can shift our efforts to focus on what is necessary to produce sustainable large-scale behavioural activation implementation across diverse geographical and cultural settings. MedicalResearch.com: Is there anything else you would like to add? Response: Although many obstacles exist to successful dissemination in addition to training of Mental Health Workers, our findings suggest that health services globally could reduce the need for costly professional training and infrastructure, reduce waiting times, and increase access to psychological therapies. MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community. Citation: Lancet Cost and Outcome of Behavioural Activation versus Cognitive Behavioural Therapy for Depression (COBRA): a randomised, controlled, non-inferiority trial Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions. More Medical Research Interviews on MedicalResearch.com

Prof. David Richards

MedicalResearch.com Interview with:
Professor David A. Richards, PhD
Professor of Mental Health Services Research and NIHR Senior Investigator
University of Exeter Medical School
University of Exeter
St Luke’s Campus
Exeter United Kingdom

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

Response: Depression is a common mental health disorder affecting around 350 million people worldwide. Untreated depression is expected to cost the global economy US$5.36 trillion between 2011 and 2030.

Many patients request psychological therapy, but the best-evidenced therapy—cognitive behavioural therapy (CBT)—is complex and costly. A simpler therapy—behavioural activation (BA)—might be as effective and cheaper than is CBT. We aimed to establish the clinical efficacy and cost-effectiveness of BA compared with CBT for adults with depression.

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Depression in Parents of Preterm Infants Can Persist With Ongoing Childcare Challenges

MedicalResearch.com Interview with:

Dr Carmen Pace MPsych (Clin Child) PhD AMACPA Clinical Psychologist and Research Fellow Murdoch Childrens Research Institute The Royal Children’s Hospital Flemington Rd Parkville, Victoria AU

Dr. Carmen Pace

Dr Carmen Pace MPsych (Clin Child) PhD AMACPA
Clinical Psychologist and Research Fellow
Murdoch Childrens Research Institute
The Royal Children’s Hospital
Flemington Rd Parkville, Victoria AUS

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

Response: We know that mothers of very preterm infants (born prior to 32 weeks gestation) are at higher risk for psychological distress compared to mothers who have healthy full term infants. However, detailed longitudinal research looking at how symptoms evolve over the first weeks and months is limited, and fathers are largely neglected in the literature. We addressed these gaps by assessing symptoms of depression and anxiety in both mothers and fathers every two weeks for the first twelve weeks after birth, and again at six months.

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Depression More Common In Women (But Not Men) Who Experience Infertility

MedicalResearch.com Interview with:

Jessica Datta Department of Social & Environmental Health Research London School of Hygiene & Tropical Medicine London

Jessica Datta

Jessica Datta
Department of Social & Environmental Health Research
London School of Hygiene & Tropical Medicine
London

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

Response: The paper presents an analysis of data from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). Natsal-3 is a survey of more than 15,000 women and men aged 16-74 resident in Britain, conducted in 2010-2012, which includes a wide range of questions about sexual relationships and behaviour and reproductive history.

In this paper we analysed responses to the questions: ‘Have you ever had a time, lasting 12 months or longer, when you and a partner were trying for a pregnancy but it didn’t happen?’ and ‘Have you (or a partner) ever sought medical or professional help about infertility?’. As well as calculating the prevalence of experience of infertility and help seeking, we looked at associated factors e.g. education, employment, relationship status.

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Telehealth System Improved Mental Health and Depression in Army Study

MedicalResearch.com Interview with:

Bradley E. Belsher, Ph.D. Chief of Research Translation and Integration, Deployment Health Clinical Center, Defense Center of Excellence for PH and TBI Research Assistant Professor, Department of Psychiatry Uniformed Services University of the Health Sciences

Dr. Bradley Belsher

Bradley E. Belsher, Ph.D.
Chief of Research Translation and Integration,
Deployment Health Clinical Center,
Defense Center of Excellence for PH
and TBI
Research Assistant Professor, Department of Psychiatry
Uniformed Services University of the Health Sciences


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

Response: One out of five U.S. military service members returning from overseas military conflicts meets screening criteria for at least one mental health condition, yet fewer than half of service members will receive help from a mental health professional. The consequences of inadequate mental health treatment are considerable and can lead to significant social and functional problems for service members and their families. In response to these mounting concerns, the Military Health System (MHS) has increased efforts to expand and improve the identification and treatment of mental health disorders. Given that the average service member visits primary care three times each year, the MHS has invested considerable resources into the integration of mental health services into the primary care setting. Collaborative care is an effective model for integrating mental health services into primary care and has demonstrated effectiveness in treating different mental health conditions to include depression and anxiety disorders. However, no previous studies have examined whether the concept can work in the MHS.

Recently, the first large-scale, randomized effectiveness trial evaluating an integrated health care model in primary care for PTSD and depression in the DoD was conducted. This trial randomized 666 military members treated across six large Army bases to a centrally-assisted collaborative telecare (CACT) approach for PTSD and depression or to the existing standard of care (usual collaborative care). This effectiveness trial targeted a large population of service members as they came into primary care and minimized exclusion criteria to improve the generalizability of the findings and broaden the applicable reach of the intervention.

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Antidepressant Did Not Reduce Hospitalizations or Death in Heart Failure Patients

MedicalResearch.com Interview with:

Prof. Dr. med. Christiane E. Angermann, FESC, HFA Deutsches Zentrum für Herzinsuffizienz Würzburg Comprehensive Heart Failure Center (CHFC) Universitätsklinikum Würzburg Würzburg

Prof. Christiane Angermann

Prof. Dr. med. Christiane E. Angermann, FESC, HFA
Deutsches Zentrum für Herzinsuffizienz Würzburg
Comprehensive Heart Failure Center (CHFC)
Universitätsklinikum Würzburg
Würzburg

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

Response: Previous meta-analysis indicates that depression prevalence in patients with heart failure is much higher than in the general population, 10 percent to 40 percent, depending on disease severity. Depression has been shown to be an independent predictor of mortality and rehospitalization in patients with heart failure, with incidence rates increasing in parallel with depression severity. Furthermore, it is associated with poor quality of life and increased healthcare costs.

It would, against this background, seem desirable to treat the depression, and when planning the study we hypothesized that by doing so we might be able to improve depression and thus reduce mortality and morbidity of this population. Long-term efficacy and safety of selective serotonin reuptake inhibitors (SSRIs), which are widely used to treat depression and have proven efficacious in individuals with primary depression, is unknown for patients with heart failure and (comorbid) depression.

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Religious Service Attendance Is Protective Against Suicide

MedicalResearch.com Interview with:

Dr. Tyler J. VanderWeele Tyler J. VanderWeele, PhD, Department of Epidemiology Harvard T. H. Chan School of Public Health, Boston, MA 02115

Dr. Tyler VanderWeele

Dr. Tyler J. VanderWeele
Tyler J. VanderWeele, PhD, Department of Epidemiology
Harvard T. H. Chan School of Public Health,
Boston, MA 02115

MedicalResearch.com: What is the background for this study?
Response
: Suicide is one of the ten leading causes of death in the United States, and in recent years the suicide rate has been increasing. A recent report from the National Center for Health Statistics indicated that the suicide rate per year per 100,000 people had increased from 10.5 in 1999 to 13.0 in 2014.

MedicalResearch.com: What are the main findings?

Response: We examined the association between religious service attendance and suicide, and found that women who attend religious services once or more per week were more than 5 times less likely to subsequently commit suicide. There was also some evidence that this varied by religious affiliation: Protestant women who attended services once or more per week were approximately 3 times less likely to subsequently commit suicide, whereas Catholic women who attended services once or more per week were about 20 times less likely to commit suicide.

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

Response: Other studies have suggested that religious service attendance can have powerful effects on health, including longevity, depression, and cancer survival. This study provides evidence that religious service attendance is protective against suicide as well. Our results do not imply that health care providers should prescribe attendance at religious services. Decisions about religious participation are made on the grounds of personal experience, beliefs, upbringing, evidence, values, relationships and so on. However, for patients who are already religious, service attendance might be encouraged as a form of meaningful social participation. Religion and spirituality may be an underappreciated resource that psychiatrists and clinicians could explore with their patients, as appropriate.

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

Response: We attempted to identify some of the mechanisms that might explain the association between religious service attendance and lower suicide risk. Those who attended religious services tended to subsequently have more social support, were less depressed, and consumed less alcohol. While each of these explained some of the association, we were surprised that they were not more prominent. Our speculation is that an important mechanism relating religious service attendance and lower suicide risk might be the belief that suicide is morally wrong, but this would require other studies that assessed such moral beliefs. Feeling close to God has also been proposed as a mechanism that may prevent suicide but this too would require future research to assess.

Although our study results were based on rigorous design and analysis, suicide is a relatively rare outcome and so one needs a very large sample to adequately study it. We examined the association among 89,708 women in the Nurses’ Health Study, but it would also be good if the results could be replicated in other large studies, especially those concerning differences across religious affiliation.

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

Response: The National Center for Health Care Statistics indicated an increase in the suicide rate from 10.5 in 1999 to 13.0 in 2014. During this same period, the Gallup Poll indicates a decline in weekly religious service attendance from 43% in 1999 to 36% in 2014. While a calculation like this requires a great deal of extrapolation from the data, if we use our estimates from this study and apply it to the general population, this would suggest that of the increase in the suicide rate between 1999 and 2014, nearly 40% of this could be attributed to the decline in religious service attendance.

Suicide has been considered a major public health issue for some time. It is one of the ten leading causes of death in the United States. Efforts have been and continue to be made to prevent suicide. In light of this, one rather striking feature of the contemporary discussion of suicide in the United States is the proposal, and in some states legislation, to allow physician-assisted suicide. From a public health perspective, suicide is viewed as a cause of great concern, but when placed within a medical context, are we then to consider it acceptable? There seems something morally anomalous when we attempt to prevent suicide in one context but facilitate it in another. I think this is an important issue for the medical and public health communities to work through.

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

Citation:
Association Between Religious Service Attendance and Lower Suicide Rates Among US Women
Tyler J. VanderWeele PhD, Shanshan Li ScD, Alexander C. Tsai MD, Ichiro Kawachi PhD
JAMA Psychiatry. doi:10.1001/jamapsychiatry.2016.1243 Published online June 29, 2016.

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

More Medical Research Interviews on MedicalResearch.com.

DSM-V Classification May Not Capture Depression in African Americans

MedicalResearch.com Interview with:

Sirry Alang PhD Assistant professor of sociology and anthropology Lehigh University

Dr. Sirry Alang

Sirry Alang PhD
Assistant professor of sociology and anthropology
Lehigh University

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

Response: Discrepancies exist between how some Black populations perceive depression and how depression is conceptualized within research and clinical settings. African Americans are exposed to a lot of stress from structural racism, yet, they perceive themselves to be resilient. The context of stress from discrimination and beliefs about depression inform how they express psychological distress. Depression is thought of as a weakness that is inconsistent with notions of strength in the community. Although depression was expressed through classic depressive symptoms such as feeling hopeless, loss of sleep, and losing interests in activities, symptom like anger, agitation, and the frantic need for human interaction were considered to be indicative of depression. Anger, agitation, and the frantic need for human interaction are not consistent with how depression is defined in the latest manual for psychiatric diagnosis- the DSM-V.

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Maternal Antidepressants Have Subtle Effects on Newborn Brain Activity

MedicalResearch.com Interview with:

Mari Videman Senior Consultant in Child Neurology BABA Center Children’s Hospital, Helsinki University Hospital

Dr. Mari Videman

Mari Videman
Senior Consultant in Child Neurology
BABA Center
Children’s Hospital, Helsinki University Hospital

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

Response: Depression and anxiety are common during pregnancy, and up to 5% of all pregnant women are treated with serotonin uptake inhibitors (SRI). It is now known that SRIs do not cause major malformations in humans, however recent animal studies have suggested that fetal early SRI exposure may cause changes in brain microstructure and neuronal signaling. Prior human studies have shown that fetal SRI exposure leads to transient postnatal adaptation syndrome, as well as to an increased risk of developing childhood depression.

We used electroencephalography (EEG) and advanced computational methods to assess both the local and global cortical function of the newborn brain. We found that several aspects of newborn brain activity are affected by exposuse to SRI during pregnancy. Most importantly, the communication between brain hemispheres, and the synchronization between cortical rhythms were weaker in the SRI-exposed newborns. These changes were most likely related to SRI exposure, because they did not correlate with the psychiatric symptoms of the mothers.

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Is Depression Genetic or Environmental?

As of now, little is known about the causes of depression. Whilst some scientists believe that there are genetic links to depression, many people who suffer from this condition do so due to past experiences, upbringing, or trauma. Perhaps you are related to somebody who has suffered or is suffering from depression – watching a loved one battle depression is never easy, but does this mean that you will also suffer from the condition? Studies show that a person with a family member who suffers from depression is five times more likely to suffer from the condition themselves, but is this hereditary, or are other factors involved?

About Depression:

Major depressive disorder or clinical depression is one of the most common forms of depression and also one of the most commonly suffered mental health conditions. The Stanford School of Medicine estimates that around ten percent of U.S.A. citizens will experience major depressive disorder at some point in their lives. Clinical depression is also more likely to be shared by siblings and children, putting those who are related to somebody with the condition at a higher risk of suffering from clinical depression themselves. If you know somebody who is battling depression, Smart Brain and Health offers depression treatment Los Angeles.

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Fluoxetine – Prozac – May Be Best Choice For Pediatric and Adolescent Depression

MedicalResearch.com Interview with:

Andrea Cipriani, MD PhD Associate Professor Department of Psychiatry University of Oxford Warneford Hospital Oxford UK

Dr. Andrea Cipriani

Andrea Cipriani, MD PhD
Associate Professor
Department of Psychiatry
University of Oxford
Warneford Hospital
Oxford UK

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

Dr. Cipriani: Major depressive disorder is common in young people, with a prevalence of about 3% in school-age children (aged 6–12 years) and 6% in adolescents (aged 13–18 years). Compared with adults, children and adolescents with major depressive disorder are still underdiagnosed and undertreated, possibly because they tend to present with rather undifferentiated depressive symptoms—eg, irritability, aggressive behaviours, and school refusal. Consequences of depressive episodes in these patients include serious impairments in social functioning, and suicidal ideation and attempts. Our analysis represents the most comprehensive synthesis of data for currently available pharmacological treatments for children and adolescents with acute major depressive disorder (5620 participants, recruited in 34 trials).

Among all antidepressants, we found that only fluoxetine was significantly better than placebo. According to our results, fluoxetine should be considered the best evidence-based option among antidepressants when a pharmacological treatment is indicated for children and adolescents with moderate to severe depression. Other antidepressants do not seem to be suitable as routine treatment options.

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