- mentalhealthchannel

Obesity and Depression: What's the Connection?

March 15, 2010

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

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

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

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

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

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

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

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Antidepressants and Cataract Risk

March 15, 2010

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

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

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

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

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

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

Antidepressant May Interfere With Breast Cancer Treatment

February 27, 2010

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

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

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

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

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

Can Acupuncture Help Depressed Pregnant Women?

February 27, 2010

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

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

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

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

Excessive Internet Use Linked to Depression

February 15, 2010

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

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

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

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

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

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

Family Therapy Helps Teens With Suicidal Thoughts

February 15, 2010

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

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

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

Depression and Migraine May Share a Genetic Component

January 29, 2010

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

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

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

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

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

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

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

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

SSRIs Affect Breast Milk Production

January 29, 2010

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

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

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

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

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

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

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

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

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

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

Clearing Up the Confusion Over Antidepressants' Effectiveness

January 18, 2010

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

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

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

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

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

Earlier Bedtimes May Help Protect Teens Against Depression and Suicidal Thoughts

January 18, 2010

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

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

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

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

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

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

Antidepressant May Change Personality While Relieving Depression Symptoms

January 4, 2010

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

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

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

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

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

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

January 4, 2010

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

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

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

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

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

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

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

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

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

December 21, 2009

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

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

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

The most common side effects of Seroquel XR were

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

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

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

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

Depressed Women Can Lose Weight

December 21, 2009

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

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

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

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

Antidepressants Linked to Falls

December 4, 2009

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

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

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

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

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

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

FDA Approves Cymbalta® for Maintenance Treatment of Generalized Anxiety Disorder

December 4, 2009

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

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

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

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

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

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

FDA Warns of Potential Drug Interaction

November 23, 2009

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

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

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

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

Phone Program Helps Depressed Heart Patients

November 23, 2009

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

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

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

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

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

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

Whole Foods Diet May Protect Against Depression

November 11, 2009

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

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

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

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

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

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

Treating Adolescent Depression: Results from the TADS study

November 11, 2009

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

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

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

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

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

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

Suicidal Thoughts Appear To Vary by Antidepressant

November 2, 2009

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

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

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

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

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

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

New Antidepressant in the Pipeline

November 2, 2009

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

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

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

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

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

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

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

October 12, 2009

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

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

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

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

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

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

Depression Poses Dilemma for Pregnant Women

October 12, 2009

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

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

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

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

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

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

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

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

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

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